Infant Sleep

What are the sleep needs of an infant?

Sleep needs for babies vary depending on their age. While newborns do sleep much of the time, their sleep is in very short segments. As a baby grows, the total amount of sleep gradually decreases, but the length of nighttime sleep increases.

Generally, newborns sleep about eight to nine hours in the daytime and about eight hours at night, but may not sleep more than one to two hours at a stretch. Most babies do not begin sleeping through the night (six to eight hours) without waking until about 3 months of age, or until they weigh 12 to 13 pounds. About two-thirds of babies are able to sleep through the night on a regular basis by the age of 6 months.

Babies also have different sleep cycles than adults. Babies spend much less time in rapid eye movement (REM) sleep (which is dream time sleep) and the cycles are shorter. The following are the usual nighttime and daytime sleep requirements for newborns through age 2 years old:

What are the signs of infant sleep problems?

Once a baby begins to regularly sleep through the night, parents are often dismayed when he or she begins to awaken in the night again. This typically happens at about 6 months of age. This is often a normal part of development called separation anxiety, when a baby does not understand that separations are temporary. Babies may also begin to have difficulty going to sleep because of separation anxiety, overstimulation, or overtiredness.

Common responses of babies experiencing these night awakenings or difficulty going to sleep may include the following:

• Awakening and crying one or more times in the night after previously sleeping through the night

• Crying when you leave the room

• Refusal to go to sleep without a parent nearby

• Clinging to the parent at separation

Because sleep problems may also occur with illness, consult your baby's primary care provider if your baby begins having difficulty going to sleep or staying asleep, especially if this is a new pattern.

Signs of sleep readiness

You can help your baby sleep by recognizing signs of sleep readiness, teaching them to fall asleep on their own, and comforting them with awakenings. Your baby may show signs of being ready for sleep with the following:

• Rubbing eyes

• Yawning

• Looking away

• Fussing

Helping your baby fall asleep

Babies may not be able to establish their own sleeping and waking patterns. Surprisingly, not all babies know how to put themselves to sleep, or are able to go back to sleep if they are awakened in the night. When it is time for bed, many parents want to rock or breastfeed a baby to help them fall asleep. Establishing a routine at bedtime is a good idea. However, be sure that your baby does not fall asleep in your arms. This may become a pattern and your baby may begin to expect to be in your arms in order to fall asleep. When your baby briefly awakens during a sleep cycle, he or she may not be able to go back to sleep on their own.

Babies who feel secure are better able to handle separations, especially at night. Cuddling and comforting your baby during the day can help them feel more secure. Other ways to help your baby learn to sleep include the following:

• Allow time for naps each day as needed for the age of the baby.

• Avoid stimulation and activity close to bedtime.

• Establish a bedtime routine, such as bath, reading books, and rocking.

• Play soft music while your baby is getting sleepy.

• Introduce a transitional object such as a small blanket or soft toy that your baby can take to bed, but not before your baby is old enough (able to roll and sit) to avoid the risk of suffocation.

• Tuck your baby into bed when he and she is drowsy, but before going to sleep.

• Comfort and reassure your baby when he or she is afraid.

• For night awakenings, comfort and reassure your baby by patting and soothing, but avoid taking your baby out of bed.

• If your baby cries, wait a few minutes, then return and reassure with patting and soothing. Then, say goodnight and leave (repeat as needed).

• Be consistent with the routine and your responses.

Reducing the risk for sudden infant death syndrome (SIDS) and other sleep-related infant deaths

Here are recommendations from the American Academy of Pediatrics (AAP) on how to reduce the risk for SIDS and sleep-related deaths from birth to age 1:

• Make sure your baby is immunized. An infant who is fully immunized can reduce their risk for SIDS by 50 percent.

• Breastfeed your infant. The AAP recommends breastfeeding for at least six months.

• Place your infant on their back for sleep or naps. This can decrease the risk for SIDS, aspiration, and choking. Never place your baby on their side or stomach for sleep or naps.

• Supervised, awake tummy time is recommended to facilitate development and to minimize the risk that your child will develop a flat head. Place your infant in tummy time while awake and supervised for short periods of time beginning soon after hospital discharge, increasing incrementally to at least 15 to 30 minutes total daily by age 7 weeks.

• Offer your baby a pacifier for sleeping or naps, if he or she isn't breastfed. If breastfeeding, delay introducing a pacifier until breastfeeding has been firmly established.

• Use a firm mattress (covered by a tightly fitted sheet) to prevent gaps between the mattress and the sides of a crib, a play yard, or a bassinet. This can decrease the risk for entrapment, suffocation, and SIDS.

• Room-sharing, but not bed-sharing, is recommended for the first 6 months. Your infant should sleep in your room, close to your bed, but on a separate surface designed for infants. Putting your baby in bed with you raises the risk for strangulation, suffocation, entrapment, and SIDS. Bed sharing is not recommended for twins or other higher multiples.

• Avoid using infant seats, car seats, strollers, infant carriers, infant swings, hammocks, cardboard boxes, in-bed sleepers, baby nests and pods for routine sleep and daily naps. These may lead to obstruction of an infant's airway or suffocation.

• Avoid using illicit drugs and alcohol, and don't smoke during pregnancy or after birth.

• Avoid over bundling, overdressing, or covering an infant's face or head. This will prevent them from getting overheated, reducing the risk for SIDS.

• Avoid using loose bedding or soft objects (bumper pads, pillows, comforters, blankets) in an infant's crib or bassinet to help prevent suffocation, strangulation, entrapment, or SIDS.

• Avoid using home cardiorespiratory monitors and commercial devices (wedges, positioners, and special mattresses) to help decrease the risk for SIDS and sleep-related infant deaths. These devices have never been shown to reduce the risk of SIDS. In rare cases, they have caused infant deaths.

• Always place cribs, bassinets, and play yards in hazard-free areas (those with no dangling cords or wires) to reduce the risk for strangulation.