Parents Corner
Babies and Sleep
Sleep, or the lack there of, is a universal difficulty for parents.
There is a myriad of research, books and articles in popular magazines
telling you how to get your baby to sleep. Different things work with
different children, for the simple reason that all children and families
have different needs, styles and priorities. The following information
from Zero to Three and Parenting magazine should provide you with
some ideas to try yourself. Hopefully, some of them will work for
you and you will begin to get a good nights sleep.
Don’t let the bed bugs bite!
Julie
"Parent Guidelines: Helping teach young infants to sleep
through the night," Zero to Three, October/November
1998
Athleen B. Godfrey, RN, MS, FAAN
University of Utah College of Nursing Salt Lake City, Utah
Anne Kilgore, M.Ed Park City, Utah
Guidelines for parents: Helping very young infants sleep through
the night
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Sleep routines are habit routines.
Sleep habits, even in young infants, can be changed by altering
the environment and introducing routines that support the formation
of new habits. The longer an undesirable sleep routine has existed,
the more difficult it will be to induce change, but it can be
done! |
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The three requisites for promoting
sleep- quiet, dark and warmth- need to be promoted from the beginning.
Many parents find it helpful during summer months to artificially
darken the sleeping room by covering windows with cardboard, foil,
etc. to maintain a dark environment for sleep. |
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From the first day home from the hospital
the infant needs to learn to sleep on his back or side as recommended
by the American Academy of Pediatrics' "Back To Sleep program",
in his own bed, and, preferably, in his own room away from the
parents. These are the first important environmental supports
that lead to good sleep habits. Safety considerations include
choosing a safety-approved crib and a firm mattress that fits
snugly against all sides of the crib. Many parents find comfort
in using an electronic baby-monitor so they can hear when their
infant wakens or cries. |
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Newborns need to learn to comfort
themselves to sleep. Allowing the baby to go to sleep in his parent's
arms or with the breast, bottle or a pacifier in his mouth, is
simply patterning the need for this association and environmental
support into the infant's sleep habits. |
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By about 3-4 weeks of age, the newborn
begins to sustain longer periods of awake time, and his sleep
cycle is changing so that he spends longer time in quiet, deep
sleep and stays awake longer between feedings. By late afternoon,
the four week old infant is often on stimulus-overload, and overstimulation
causes him to become irritable, inconsolable, fussy, and even
promotes gastrointestinal distress commonly associated with "colic." |
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With the young infant already on stimulus
overload, the additional chaos in many families during the early
evening hours, created by a change in caregivers, parents coming
home from work, siblings coming in from school and/or play, supper
time, and a build-up of fatigue and stress in all, makes the early
evening time extremely difficult for the very young infant. This
is the least appropriate time for parents to plan "quality
time" or rough-and-tumble play with infants and young children. |
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Keeping an infant (or any young child)
up late for any reason does not result in the infant or
child sleeping later the next morning. Instead, keeping the infant
or child up late means only that valuable sleep time is lost,
and both the child and family "pay the price" the following
day when the infant is fussy, irritable, cranky, and/or whiny.
Irritable, sleep-deprived parents are not going to be able to
provide true "quality time" that will be satisfying
to themselves or their infant. |
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Moving the bath to early evening will
help the infant calm and prepare for his last "bedtime"
feeding. Quiet talk, smooth movements and a rub-down or gentle
massage after the bath are approaches that can comfort and calm
both the infant and his caregiver at the end of a busy day. |
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Infants who go to bed earlier at night
gradually develop longer initial periods of uninterrupted sleep
in a short time, usually within 3 to 7 days. It is helpful to
move the bath and bedtime forward 20 to 30 minutes per night for
infants who are used to being put to bed much later until the
infant is finally going to bed between 6 and 7 PM. |
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Allowing the very young infant long
periods of uninterrupted night sleep does not lessen the total
food taken in over 24 hours, nor does it lower the rate of weight
gain. Infants make up for loss of night feedings by eating more
during daytime feedings. Production of breast milk will naturally
alter to meet the infant's needs as the infant gradually lengthens
out the first uninterrupted night sleep period. In the early weeks,
mothers are advised to pump as needed for comfort if their breasts
fill before the infant wakens to feed. |
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Parents are encouraged to avoid waking
the sleeping infant if at all possible. This advice is
contrary to that found in several parent-directed publications
including a popular book by Cuthbertson & Schevill (1985)
and the common practice of waking the young infant for a II PM-midnight
focal feed. With proper environmental support, most infants will
gradually lengthen out both day and night sleep times to obtain
sleep adequate for their health and well-being. Interrupting sleep
to feed or for any reason is frustrating for both infant and parent
and often non-productive as well. |
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Crying when put down early or after
a middle-of-the-night feeding should be ignored as much as possible.
If parents are anxious about the infant, they can sneak into the
room to observe him every 5-10 minutes but should not turn
on a light or speak to or touch him. If the infant becomes very
upset, quietly pick him up and comfort him for a few minutes,
then gently place him back down to sleep. These approaches might
need to be repeated for several nights until the infant learns
that this is not a play time and to help himself go to sleep by
himself. Be patient! |
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Some parents worry about losing "quality
time" if they put their infant to bed early in the evening.
Parents and infants alike will benefit by having true quality
time in the morning or earlier in the day and can enjoy soothing
interactions during the bedtime routine (which will soon become
anticipated eagerly by all!). |
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Most infants started on this routine
will be sleeping for 8-10 hours after being put down for bed before
8 PM within 2-4 weeks. A middle-of-the-night feed will still be
required for a time, but this need usually changes after several
weeks. |
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Night waking for feedings can be discouraged
by making this a "boring "time for the infant—no
overhead lights, no talking, no changing the diaper unless absolutely
necessary, and gradual reduction of the amount of formula fed
or the amount of time at the breast. |
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Periods of illness or changes in the
family routine will cause temporary disruptions in the infant's
sleep patterns. After these events, parents might have to start
the routine all over again to eliminate night wakings that have
become habit during periods of change or illness. Parents are
encouraged to maintain the late-afternoon quieting routines, the
bath, and early bedtime routine as much as possible during illness
or change. After the infant recovers from illness or change, parents
must be prepared to let the baby fuss or "cry it out"
for a few nights in order to reestablish the former sleep routine
and to let the infant know that he is expected to stay in bed
and go back to sleep. Often no more than three to five consecutive
nights are needed for infants to get back into a regular bedtime
routine if parents are consistent and don't attend to or reinforce
the crying. |
While beginning this routine, parents may find it reassuring to keep
a written record that shows how long the infant cries and/or fusses
when first put to bed, or when put back to bed after a middle-of-the-night
feeding. Writing down how long the infant sleeps after his bedtime
feeding and how long he sleeps after the middle-of-the-night feeding
can help parents see the progress being made toward developing a good
sleep pattern. For many families, a convenient place to keep this
record is on a calendar.
Exceptions to use of this approach
There are always circumstances that will necessitate altering or
delaying use of this routine for some very young infants. Very young
infants with extreme underweight or inadequate weight gain; acute
or chronic illness; or disabilities in the infant which make it difficult
to maintain adequate caloric and fluid intake are conditions that
require special consideration when establishing sleep routines, in
these situations, parents are encouraged to establish an early bath
and bedtime routine and to observe and support the infant's emerging
abilities to lengthen the first sleep period of the night in any way
possible.
A few additional suggestions: Excerpts from Parenting.
May 1994, Laura Flynn McCarthy
Honey, the Baby’s Crying
OR HOW TO GET AN INFANT TO SLEEP
"Good sleepers are made, not born," says Dr. Donald Shifrin,
a clinical associate professor of pediatrics at the University of
Washington in Seattle. The trick, Shifrin says, is to teach your baby
to calm herself to sleep, instead of allowing her to rely on
you to help. "Unless sleep problems are dealt with as soon as
they arise, you'll have a little problem at six months, a bigger problem
at 18 months, and a huge problem at 30 months," Shifrin says.
So how do you get the baby to bed? No problem:
Avoid "crutches" certain ways of getting a baby
to sleep seem wise at first, but in the long run they may do more
harm than good. Many babies like to fall asleep feeding, for instance,
but letting them do so can cause them to associate sleeping with being
fed. And once that link is established, a child is more likely to
cry for you when she wakes later. (If your baby starts to look sleepy
when you're nursing or giving her a bottle, stop feeding her, then
gently put her down to sleep.) Similarly, babies love to be rocked,
and the technique can help them settle down. But a child who falls
asleep while you're rocking her may not learn to get to sleep on her
own, either. The same goes for giving a baby a pacifier at bedtime:
It may help quiet her, but she'll only cry later when the pacifier
falls out of her mouth and she can't get back to sleep by herself.
Bank on blankies Blankets, stuffed animals, and other favorite
objects can all help a child feel secure as she goes to sleep on her
own. From early infancy, most babies clutch and fondle something soft
like a blanket. It is likely to become a token of security for her.
Dr Church feels that baby can be deprived of the blanket long enough
to wash it, but otherwise favors letting her have it. At bedtime the
best choice may be the blanket or burping pad that you use during
feedings. Because such items (which experts call transitional objects)
contain the scent of both parent and child, they can help a baby feel
at ease without Morn or Dad around. Baby can manage to hug a doll,
squeeze a blanket, suck a thumb and finger his ear all while drifting
off to sleep.
Settle the co-sleeping question Decide with your spouse early
on whether you want your child to sleep by herself or in your bed.
Some parents swear by co-sleeping. "We know our two-year-old
Jillian feels more secure in bed with us, and it gives us a sense
of closeness with her that is unmatched during the day," says
Karen Levine, a Germantown, Maryland, mother. Other parents regard
their bed as a refuge from the world of parenting, they sleep better
without a child next to them, and they feel that it's more appropriate
for a baby to sleep alone.
According to a recent University of Massachusetts study, about 55
percent of parents of two- to three-year-olds allow a child to sleep
in their bed for at least part of the night. And the percentage is
likely to be higher for parents of younger children. Whatever you
and your partner decide to do, be consistent, so that a child can
develop a dependable routine.
Factor in Ferber
Dr. Richard Ferber's controversial method for getting children to
sleep has become so well-known that parents have coined a term for
it: Ferberizing. The technique, as described in the doctor's popular
book Solve Your Child's Sleep Problems, involves putting a
baby as young as five months old in the crib while she's still awake,
comforting her for a few minutes, then leaving the room. If she cries,
wait roughly five minutes and then go in and soothe her, but try not
to pick her up, don't stay very long, and be sure to leave while she's
still awake. Continue to soothe her after gradually longer intervals
of crying until she begins to settle herself down. After four nights
of this routine—sometimes less, Ferber says—even children
with a history of difficulty dozing off can usually get themselves
to sleep. And Ferberized kids don't cry for their parents as often
during the night, Ferber says. (The technique shouldn't be used on
children with severe fears or anxieties, he cautions.) Critics claim
that letting a baby cry without acknowledging him is insensitive to
the baby and interferes with the bonding process between parent and
child.
Repeatedly, from all the "experts", suggest that you rely
on routines.
Performing the same simple tasks before bed each night helps signal
a baby that all is well, that she's safe, and that it's time to go
to sleep. Bathing a baby, brushing her teeth (or, for a younger child,
wiping her gums with a clean, wet cloth), getting her into her pajamas,
and reading a book together all establish a comforting, familiar pattern
that your baby can come to depend on at bedtime.
Books available on the subject.
Click on Amazon.com
to find out more.
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On becoming a family: The growth
of attachment (2nd ed.). Brazelton, T.B. (1992a) Dell Publishing
Company. |
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Solve your child's sleep problems
Ferber, R. (1985) Simon & Schuster, Inc. |
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The Sleep Book for Tired Parents |
Articles available on the subject for more information
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American Academy of Pediatrics Committee
on Nutrition (1993). Pediatric nutrition handbook. Elk
Grove, IL: American Academy of Pediatrics. |
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Anders, T.F., Halpern, L.F., &:
Hua, J. (1992). Sleeping through the night: A developmental perspective.
Pediatrics, 90 (4), 554-560. |
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Pinella, T, & Birch, L.L. (1993).
Help me make it through the night: Behavioral entrainment of breast-fed
infant's sleep patterns. Pediatrics, 91 (2), 436-444. |
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Schmitt, B.D., (1992a). The "two-step"
approach to infant sleep problems. Contemporary Pediatrics,
9 (II), 37-38. |
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