Sleeping

By Daniel Feiten MD

 

References

http://pediatrics.aappublications.org/content/early/2011/10/12/peds.2011-2284

Newborns sleep a lot during the first month of life. Your child may sleep anywhere from 12 to 20 hours per day with an average of 16 hours per day. The duration of this sleep is variable, from 15 minutes to 5 or 6 hours.

Most newborns awaken 1 to 3 times during the night in the first 3 months of life and the majority of infants can be expected to sleep through the night by 4 to 6 months of age. Many parents (and grandparents!) assume that these nighttime awakenings are related to their infant's need to eat. This may be part of the problem in the first 2 months, but there is much more to it.

Infants awaken several times during the night because they have an immature sleeping pattern. Two general patterns exist:

• REM Sleep: This is an "active sleep" pattern in which babies display a lot of movement, restlessness, twitching, irregular breathing and brief awakenings. Infants may go through this pattern 2 - 4 times a night, resulting in a nighttime awakening at the end of each REM sleep pattern. Newborns have this pattern during 50% of their sleeping time (adults have 25%). No wonder babies wake up so much at night! Fortunately, this pattern decreases by age 3 - 4 months, allowing most children (and parents) to sleep through the night.
• NON-REM Sleep: A "Quiet Sleep" pattern in which infants display less movement, a regular breathing pattern, and a deeper sleep in which it seems to be very difficult to awaken your baby.

Although most children learn to sleep through the night on their own, here are a few tips to follow to try to avoid future sleep problems:

Before 4 Months:

1. Keep 'em Cozy. Your newborn has been used to 9 months of close quarters while she was growing inside you. Keep her comfortable by swaddling her, using a small bassinet or crib, and keeping the room at about 68° to 72°F. Caution: don't over bundle, and don't use sheepskins, waterbeds or down comforters because of the risk of suffocation.
2. Put your baby in the crib while awake. Let your baby learn to fall asleep without you. Crying for 15 to 20 minutes is not unusual. If necessary, rock her, but put her in the crib before she falls asleep. Background noise may also help to signal nap times or bed time. Try a radio, air conditioner, a musical toy, tapes of uterine sounds, or the white noise that comes from an unoccupied TV channel or radio frequency. Try to wean the use of noises by 4 months of age.
3. Establish a routine. A consistent daytime and nighttime ritual for naps and bedtime is extremely important. If your hectic schedule does not permit this, try to always be home for the same nap time every day.
4. Hold your baby for fussy crying. Children under 4 months need to be soothed. Respond to your baby. You will not spoil her.
5. Be brief during nighttime feedings. Save the fun stuff (singing, playing etc.) for the daytime.
6. Don't awaken your child during the night to change diapers. Wet diapers can be left until the morning, unless your child has a severe diaper rash.

Preventing Sudden Infant Death Syndrome (SIDS):  

The American Academy of Pediatrics has reviewed the factors that prevent (or lead to) Sudden Infant Death Syndrome. Please be mindful of the following recommendations:

1.   Put your infant to sleep on her back.
2.   Share your room with her....but do not share your bed. This can reduce the risk of SIDS by up to 50%.
3.   Keep toys, stuffed animals, bumper pads and loose bedding out of the crib.
4.   Use a firm mattress that conforms to the safety standards of the Consumer Product Safety Commission
5.   Consider offering a pacifier to your infant under 4 months at naps and bedtime. You do not need to re-insert the pacifier if it falls out and your chlld is sleeping well. 
6.   Avoid smoke exposure, alcohol and illicit drug use during your pregnancy and after birth.
7.   Avoid overheating your baby. Keep the room temperature between 68 - 72 degrees.
8.   Breastfeeding is recommended.
9.   Avoid the use of commercial products that are marketed as a product to reduce SIDS. Bed Co-sleepers should be avoided.
10.   Supervise all tummy time while your baby is awake.