Baby Sleep Questions, Answered
Published on in Health Tip of the Week
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Published on in Health Tip of the Week
Having a new baby can wreak havoc on a caregiver’s sleep, and trying to predict infant sleep, well … it can be like trying to predict the weather. Most caregivers of newborns don’t have time to read much on sleep. So here, Melisa Moore, PhD, DBSM, Licensed Clinical Psychologist in CHOP’s Sleep Center, shares quick answers to some of the most common questions parents have about baby sleep.
The circadian clock and sleep hormone melatonin are not primed for sleeping long periods at night until about 3 months of age. Not surprisingly, “through the night” means different things to different people, but it typically involves several hours of consolidated sleep. For a 5-year-old, this might be 10 to 12 hours. For a 3-month-old infant born prematurely, this might mean three to four hours because they need to eat during the night.
There are many ways to approach helping a baby learn to sleep through the night, and the specific techniques we recommend depend on the age of the child and parent preferences. There are many options that are based on the same behavioral approach. Moore usually suggests starting with behavioral changes only at bedtime. During night wakings (which are likely), she recommends just doing whatever it takes for everyone to get as much sleep as possible. If your baby can’t fall asleep independently (from wide awake) at bedtime, it’s highly likely they will keep signaling you that they are awake throughout the night.
There are no hard and fast rules regarding sleep training. Many experts say at 4 to 6 months of age, but again, it depends on your definition of sleep training. You can absolutely have a bedtime routine and put your baby down without feeding as early as 4 months old. Most sleep experts would not recommend letting a baby fuss for more than 10 or 15 minutes at that age.
There isn’t really a “should” for hours of sleep for a newborn, because there is such a wide range of normal. For any age, Moore recommends viewing specific numbers as general guidelines. Better indicators are that your child is happy and healthy and waking on their own in the morning when given the opportunity.
Any changes will be easiest before about 4 months of age. They are still doable at later ages, but because the brain has the ability to develop stronger associations, it may be slightly more difficult. Another important question is when to transition to a toddler or “big kid” bed. Moore recommends waiting as long as is safely possible. If the child is not climbing out of the crib, keeping them in it is the way to keep their sleep consistent.
Sleep and feeding are inextricably linked, especially the younger an infant is. It is up to you and your pediatrician to decide when a baby no longer needs to be awoken to eat. If a child is not having problems gaining weight and has their longest bout of sleep at night, it is likely the pediatrician’s advice will be to not wake the baby.
Babies can sleep with a blanket after they turn one. Baby sleep sacks are a great way to ensure that your baby is warm enough without worrying about the risk of using blankets. A side benefit of sleep sacks is they can delay the inevitable: climbing out of the crib.
The “sleep regression” that people talk about is really a developmental progression. Babies start to be able to develop stronger associations with a wider variety of objects and situations at about 4 months of age (this is why it is easiest to move them to a crib before about four months). It is important to have the sleep environment consistent throughout the whole night and not to develop habits related to falling asleep that can’t be maintained all night long.
Of course, there are a wide range of timelines regarding toddlers and napping, but in general, around 12 to 18 months of age, toddlers generally go down to one nap a day. Between ages three and five, they will give up that nap altogether.
Babies can sleep on their stomach after they can safely roll from their stomach to their back. Many parents have the experience of putting their little one down on their back and finding them on their tummy. Though this can be scary, it’s completely normal, and once babies are able to roll, they should be safe. That said, it’s safest to ALWAYS put a baby to sleep on their back, regardless of their age. If they roll to their tummy, so be it.
A baby can absolutely sleep with a pacifier! Sleep professionals love pacifiers because they can help prevent sudden infant death syndrome (SIDS), but if you ask other kinds of doctors (such as ear, nose and throat specialists or dentists), they likely have different recommendations. Babies aren’t able to replace their pacifier if it falls out until about 7 months of age, though. If you’re willing to pop it back in throughout the night, the paci can be a great sleep tool throughout infancy and toddlerhood.
Contributed by: Melisa E. Moore, PhD