Infant Sleep

With the arrival of a new infant into a home, the sleep patterns of the entire family are affected. Every time the baby wakes overnight, the parents and other siblings are roused from sleep as well. On top of fragmented sleep, parents worry about Sudden Infant Death Syndrome (SIDS) and the safety of their baby overnight.

So how can you encourage your baby to sleep safely and to sleep well?

Sleep Safety

Sudden Infant Death Syndrome (SIDS) – the unexplained death of an infant in the first year of life – is a frightening phenomenon for parents. Pediatricians are constantly looking for ways to reduce the number of infants affected by SIDS. Many of the methods that have been found are related to how babies are put to sleep.

In what position should a baby be put to sleep?

Since 1992, the American Academy of Pediatrics has recommended putting your baby “back to sleep” – meaning that infants should always be put to sleep on their backs; this applies to both night time and nap time. Since the recommendation was made, the number of infants dying from SIDS has greatly decreased, and it has become clear that sleeping on the back significantly reduces the risk of infants dying of SIDS.

Many years ago, it was believed that putting babies to sleep on their stomachs was safer than on their backs in order to avoid choking; however, there has not been an increase in choking among babies who have been put to sleep on their backs. When the recommendation to put babies on their backs to sleep was initially made, it was thought that putting babies to sleep on their sides was also acceptable. Since then, studies have proven otherwise. At this time, it is recommended that parents always (unless told otherwise by a doctor) put their babies to sleep on their back.

Where should a baby sleep?

While it is clear that babies should be put on their backs to sleep, where they should sleep is more controversial. Some individuals feel that bringing a baby to bed with the parents strengthens the bond with the parents and encourages breastfeeding. However, many studies have shown an increase in the risk of SIDS among infants who share a bed with their parents. Some factors making SIDS more likely do so by increasing the chance of suffocation or of an infant being rolled over in bed. The risk of SIDS is greatest when the mother smokes, the infant is young, there are multiple people sharing the bed, someone in bed has consumed alcohol, or a bed-sharer is overtired. The risk of SIDS also increases with longer periods of time in bed together, as well as when someone sleeps with a baby on a couch. Babies should never sleep on a couch, chair, pillow or other soft surface because of a greater danger of SIDS.

Recent studies have shown a decrease in the risk of SIDS among infants who sleep in the same room as their parents, but in their own crib or basinet. It has also been found that infants who are put to sleep with a pacifier are less likely to die from SIDS. For mothers who are breastfeeding, it is suggested that the pacifier not be introduced until after breastfeeding has been well established, usually at about one month of life.

The safest place for a baby to sleep is in his or her own crib or bassinette, in the same room as the parents for the first six months of life.

            What should be in a baby’s crib?

When choosing bedding for cribs, parents often think of the appearance and style. Unfortunately, even some of the most attractive bedding can pose a dangerous threat to a young infant.

SIDS risks are greater with softer mattresses, and infants can become trapped between a mattress and the side of the crib if it doesn’t fit properly. So a crib mattress should be the firmest you can find, and fit snugly in the crib. Only a fitted crib sheet should be used, which should fit around the mattress tightly. Cribs should never be placed near a window, blinds, cords, or wall hangings. Windows can pose a risk of falling, cords and blinds can be strangulation risks, and wall hangings can be pulled down or fall on a young child.

Infants should not have any pillows, blankets, stuffed animals, or other soft bedding or toys in their crib because of the risk of suffocation. When babies are five months old or are able to push up on their hands and knees, remove any mobiles so the child cannot get caught in them. Traditionally, bumper pads have been considered safe until babies pull to stand; at that point, the bumper pads could be used to step on in order to get out of the crib. However, a recent study[1] found an increased risk of crib deaths when bumper pads were used, causing experts to question their safety. 

Bedtime Routines

Family members, friends, and even strangers will have suggestions on ways to get infants to sleep. No matter who you choose to listen to, the most important thing you can do in getting your baby to sleep is to establish a bedtime routine.

Babies do well with regular schedules and patterns to their days. Some routines work better for some babies than others, and a routine that works well for you at one point may not at another. The bedtime routine will change and adapt over time as your baby develops his or her own patterns, but there should always be a set of behaviors that you go through prior to bedtime each night.

You need to find a bedtime routine that fits in to the members of your family’s lives and schedules. While a bath may be a great way to settle down a baby in one family, it may disrupt an older sibling’s bathing schedule in another family. Some activities that can get infants ready for sleep include:

• taking a bath

• feeding

• reading a book with a low voice

• singing a lullaby

• listening to calming music

By going through the same set of activities nightly prior to bedtime, the baby begins to associate these behaviors with sleep.

In addition to the bedtime routine, infants benefit from a schedule throughout the entire day. By waking up at approximately the same time each morning, napping at set times during the day, and going to bed at the same time each night, babies begin to sleep soundly at those times rather than dozing on and off throughout the day. Newborn babies often have erratic sleep patterns, but they usually settle down within a few months of life.

Sleep Methods

While babies need large amounts of sleep, it is initially obtained in fragmented portions, rather than a long stretch overnight. Newborns need to eat at least every three to four hours, and should not be allowed to sleep for longer until they have shown reliable weight gain. However, even when they are feeding frequently, it is important to emphasize the difference between night feedings and day feedings. Right from the start, daytime feedings should be in a light room, with talking and stimulation. After the feeding is done, try to keep the baby awake for a period of time. Even just by speaking and showing the baby things around the house, you are introducing the idea that daytime is for activity. At night, feedings should be all business. Try to change the diaper and do the feeding with minimal light and noise, and without talking or playing with the baby. This will help infants understand that nighttime is for sleeping, and daytime is for playing.

As infants get older, they can be encouraged to sleep for longer stretches overnight. There are many different schools of thought when it comes to ways of “training” babies to sleep well overnight. Some experts believe in teaching the infant early on to calm himself down, while others promote parental soothing.

The American Academy of Pediatrics recommends putting your baby in the crib while awake, but sleepy, in order for him to learn to fall asleep on his own. If the baby is fussy, you can rock him, gently sing to him, and cuddle with him in order to calm him down. It’s best if you don’t let him fall asleep in your arms, or he will learn to expect you to hold him whenever he wakes up. Instead, put the baby in the crib calm, but awake. When you put him down, don’t be surprised if he fusses and cries a bit. Give him a few minutes to settle down. If he is still crying after several minutes, try putting a hand on him, massaging him, speaking to him gently, or turning on a mobile, rather than immediately picking him up. Babies often make noises, squirm, and fuss a bit while sleeping. Rather than going to the baby right away when you hear movement or fussing, wait a couple of minutes to see if he calms down on his own.

The widely discussed Ferber method of sleep training involves putting the baby in the crib awake, and progressively allowing the baby to cry for longer and longer periods of time. There are several variations on this method, some of which are considered “gentler” than others.

Some people feel that the Ferber method and others like it are too hard on infants, and create long lasting feelings of mistrust and isolation. They encourage parents to rock, nurse, and soothe their babies to sleep, and feel that when infants see sleep as a pleasant state, they will learn to sleep through the night.

Many parents try several methods of getting their baby to sleep before finding the way that works best for them. Almost all schools of thought agree on one thing – the importance of establishing a bedtime routine.

Tips to Improve Your Infant’s Sleep

•  Naps 
• In addition to having a bedtime routine, try to have consistent nap times and routines
• It’s best to not let naps go too long in order to avoid disrupting the night time sleep routine

• Feeds
• Make sure that the baby is getting enough to eat during the day – a baby who is not satisfied with daytime feeds will be hungrier overnight  
• Consider waking the baby sometime between 10 pm and 12 am for a last feed of the night to avoid waking up hungry in the middle of the night

• Activities 
• Stimulate and engage infants during the day, while keeping nighttime stimulation to a minimum
• Pay attention to the activities that went on the day before a bad night of sleep – sometimes an overly hectic day can lead to a less restful night of sleep
• A recent study[2] found that babies who were taken outside in the early afternoon slept better at night

• Patterns 
• Avoid becoming dependant on driving in the car or walking in the stroller to fall asleep. While these tricks can be invaluable on a cranky day, you don’t want the baby to need to go for a car ride in order to fall asleep

• Basic needs
• Make sure the baby has a clean diaper, is well fed, and is in comfortable clothing before putting him to sleep

• Sleep environment 
• Keep the room the baby is sleeping in at a comfortable temperature. Usually 65 – 70 degrees Fahrenheit is comfortable for infants. 
• Humidifiers can help maintain an environment conducive to sleep, especially in dry climates and cold weather. By helping to clear nasal congestion, humidifiers can also help infants who have upper respiratory infections sleep. It is important to frequently clean humidifiers according to their instructions in order to avoid growth of bacteria and mold.

Getting an infant to sleep through the night can be a trying and exhausting experience. By setting up a low risk sleep environment, and establishing a bedtime routine, you can encourage your baby to sleep soundly and safely.

Additional Information

KidsHealth.org

Consumer Reports

Mayo Clinic

References

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