Sweet Dreams (are made of these)

Sleep. Everyone needs it. We don't get enough of it. Most people wish they got more of it. Whether it’s tired parents of newborns who are up every few hours in the middle of the night to feed their baby, frustrated parents of toddlers who won't stay in their beds, or exasperated parents of teenagers whose children won’t get out of bed because he or she stayed up until midnight binge-watching Netflix, parents are concerned about their child’s sleeping habits and with good reason. No matter the age, sleep is extremely important to our overall health and well-being. A well-rested body and mind is a well-functioning body and mind. While I can't make your child sleep, I can try to give you suggestions to foster a positive environment for sleeping and prevent bad habits from taking root, no matter what stage of life your child is in. Because sleep is such a broad topic, I've broken it up into 2 parts. This month, I'll discuss sleep in infancy, that is, newborn to 1 year of age, and next month I'll tackle some sleep issues for toddler years and beyond. I've organized this month's post in a question/answer format. These are similar questions to those I have received at clinic regarding infant sleep.

1) How much sleep should my baby be getting everyday?
Answer: It depends on how old your baby is. Newborn sleep patterns differ greatly from the sleep patterns of older children and adults for they will not develop a regular sleep pattern until about 6 months of age. Newborns up until 6 months of age need a total of about 16 to 18 hours of sleep daily. In the newborn period, this sleep is broken up into increments and babies will wake every 2 to 3 hours to eat and then fall back asleep again sleeping only 1 to 2 hours at a time, with some periods of wakefulness. At about 2 months of age, infants will start stretching out their sleep with a preference for sleeping at night, about 5 to 6 hours at a time, and then are awake for longer periods during the day. By 6 months of age, many babies are sleeping at least 10 hours at night with 2 to 3 naps during the day. This longer stretch of sleep at night is again mirroring the sleep patterns of older children and adults. By one year of age, most babies are sleeping 11-12 hours at night and have 1 to 2 naps during the day.

2) When can I expect that my baby will be sleeping through the night?
Answer: Sleeping through the night during the first few months of life means a baby is sleeping about 5 to 6 hours at night without needing to eat. This usually happens around 2 months of age, although some babies begin earlier. Most parents of newborns will agree, that first time your baby gives you a 5 to 6 hour stretch of sleep, you feel like a new person, especially if it continues. As your infant grows, that stretch of sleep will increase, and your baby will baby able to go for longer stretches of time without eating.

3) Why isn't my son a good sleeper like his cousin? My son is 2 months old and his cousin who is the same age sleeps 10 hours a night without waking up. What am I doing wrong?
Answer: First, let me describe what a good sleeper is at 2 months of age. A good sleeper is a baby that sleeps at least 5 to 6 hours at night and during those long stretches may wake up every so often, but can put himself back to sleep. I would be concerned if the parents of a 2 month old told me that their baby slept 10 hours a night without waking. It is developmentally appropriate for a child to wake often, as this shows the infant can wake in situations where they're not getting enough oxygen or if they are having trouble breathing. Because infants wake often in their sleep, this is another reason why it's important to not always rush and get them out of bed at each little cry. I call this the “declaration period”. Let your baby “declare” himself awake. In France, they call this “Le pause”. Many times babies cry out as they are transitioning from one sleep cycle to the next. Give it a few minutes and see if he can soothe himself on his own and fall back to sleep before taking action. If he is still crying after 2 to 3 minutes, go check on him.

4) My daughter is 3 months old and needs me to rock her to sleep. How can I get her to fall asleep on her own?
Answer: The trick to getting her to sleep on her own is putting her to bed when she’s drowsy, but not asleep. For example: if she needs you to rock her to sleep to put her down at night, then anytime she gets up in the middle of the night she will likely need you to rock her to put her back to sleep. This then creates a vicious cycle. Pay attention to signs that she’s getting sleepy, this might include her yawning or rubbing her eyes, but be sure to not wait too long until she’s over-tired, as that makes getting her to sleep on her own even more difficult. Don’t worry, as time goes by, you’ll get to know your baby’s tired cues and by putting her down as the first signs of sleepiness and she will learn to settle herself to sleep.

Another good habit to develop is a bedtime routine. You can even begin this when your baby is still on the every 2 to 3 hour feeding schedule. Early on, this is teaching your little one that nighttime is for sleeping and daytime is for playing. Also, a bedtime routine creates consistency and consistency is key in parenting. By performing the same ritual each night, babies will come to know it’s bedtime and, therefore, will have an easier time falling asleep. This bedtime routine could be as simple as making sure lights are turned down low about an hour before bed, giving a bath, doing the final feeding of the night, reading a book and putting your child to bed while drowsy, but not asleep. Finally, always be sure you’re putting your infant on his or her back to sleep. The best sleep is safe sleep, so remember Back to Sleep!

5) Help! My 6 month old son still wakes up every 2-3 hours in the middle of the night to nurse? He acts so hungry and then immediately goes back to sleep when he’s done. I’m so tired though, I can’t go on like this.
Answer: One common phrase I often hear from parents of older infants who aren’t sleeping through the night is “He must wake up because he’s hungry because once he eats he goes right back to sleep”. And, while this seems logical, this is one of those instances where he’s likely gotten in the habit of snacking in the middle of the night and this is not a necessary feeding. A healthy, thriving 6 month old does not need to eat in the middle of the night. I will often say to parents “Well, if you offered me chocolate chip cookie, I’d eat it too”. So, what to do now? Well, we have to rid him of this bad habit. The best way to do this is still quite the debate and many people feel strongly that some ways are better than others. There are a plethora of different methods (extinction i.e. “cry it out”, graduated extinction, bedtime fading, scheduled awakenings) and the good news is, no matter what method you choose they work. A recent New York Times article highlighted a systematic study that was published in 2006 in the journal of Sleep on the efficacy on these interventions. After reviewing fifty-two studies, 94 percent of those reviewed reported improved sleep with implementation of any studied intervention. Hooray, there is hope!

What I would recommend in the case of this 6 month old that is nursing every 2 to 3 hours is the extinction method with some slight modifications. The extinction method has parents let their infants “cry it out”. After performing a nightly bedtime routine, parents do not go in the room until morning. Now the traditionalists of this method would say to not go in the room, under any circumstances. That may be quite harsh for some parents (It was for me!). What I have parents do is set a timer, usually 10 minutes. If after 10 minutes, he is still crying (which he likely will be) it is okay to go in his room and make sure he’s okay. If all is well, and he’s just upset that he’s not getting his 1 am snack, you tell him you love him, that he’s safe and he needs his sleep just like mommy and daddy do. This is another French parenting tip – talk to your babies. The French believe babies understand what you’re saying (as do I) and it makes you feel better too. The first night of this method will be brutal, but it will get better. If he cries on and off the first night for 3 hours, by night two it may only be 45 minutes, and by night three it may be only 30 minutes, and most often, by 1 week, they are sleeping through the night. I’m not going to lie, there is nothing easy about listening to your baby cry, but you have to keep the end goal in mind and that is, a night of good sleep, for your child and for you.

You will sleep again, I promise. I won’t ever forget that one of the most helpful words of encouragement I received in the first few weeks after becoming a parent myself was “I know you are tired right now, try not to worry, you will sleep again”. During that time, with sleep deprivation weighing heavy, to hear that sleep deprivation was only temporary was a tremendous relief. It is my hope that whatever sleep struggles you are experiencing at the moment you'll find some guidance and comfort in reading this post today. As always, if you have a more specific sleep concern or any other questions, please don’t hesitate to contact at ABC Pediatrics. We are here for you!

​Information presented adapted from:
American Academy of Pediatrics, Sleep: What Every Parent Needs to Know.
http://shop.aap.org/Sleep-What-Every-Parent-Needs-to-Know-Paperback/
American Academy of Pediatrics, Sleep Problems in Children.
http://www.pediatricspec.com/resources/SleepProblems.pdf
Carroll, Aaron, Putting Your Baby to Sleep: Some Advice and Good News
http://www.nytimes.com/2016/08/02/upshot/putting-your-baby-to-sleep-some-advice-and-good-news.html?smprod=nytcore-iphone&smid=nytcore-iphone-share&_r=0
​Druckerman, Pamela, Bringing Up Bebe
https://www.amazon.com/Bringing-Up-B%C3%A9b%C3%A9-Discovers-Parenting/dp/0143122967