Sleep & Nap Issues: The ABCs of Baby Sleep

During the first six months of a baby’s life, when the child’s sleep schedule is virtually non-existent, parents are forced to test the limits of their own stamina. How long can you live without sleep? Do you have what it takes to survive? Fortunately, there are some simple steps you can remember and rely on to get you through the rough times. In fact, they’re as easy as to remember as your ABCs. A IS FOR AGE Expectations for your baby’s sleep depend in part on his age. A two-day-old will sleep very differently from a two-month-old, and again from a 10-month old or even two-year-old. Your strategies should vary accordingly (if you can keep your own eyes open long enough to think, which is no guarantee). As your baby goes through developmental shifts and changes, his sleep will likely be disrupted for a short while. Babies working hard on mastering grasping, vocalizing, sitting, or any other skill will likely have this “drive to succeed” break into their nighttime sleep. Reassure them that they can practice in the morning, and that it’s time for sleep. Keep these things in mind: (Baby Size “Small”, 16-20 weeks): Don’t count on much sleep, at least during the night. Baby’s rapidly developing brain needs a ton of rest, but this will occur in cycles throughout the day and night, and babies will often need to be fed every two hours or so. As she approaches 12 weeks, her sleep may consolidate considerably, and stretch for longer periods of time. But her memory has not developed to the point that she “counts on” a regular sleep routine as much as she will when she is older. Try to stick to the routine you had before baby was born, but make your bedtime earlier. For your own sanity, take “shifts” during the night with some caring and selfless person (who may or may not be the baby’s Dad, or your mother, or mother-in-law), or at least enough to let Mom get a four-hour stretch of sleep in (which has been shown to make you feel more rested than smaller chunks of rest). Moms, when it is your turn to sleep, really sleep! Use earplugs and an eyeshade, and trust the person you’ve left in charge of the baby. Otherwise, you’ll sleep with “one ear open” and not rest as soundly. Mom…you just need to get through this tough time…it WILL pass! Baby Size “Medium”, 5-9 months: Baby has developed enough cognitive abilities and trust in you that she can be taught how to fall asleep – and stay asleep through the night – in her own crib. Start with having baby play when awake and happy in her crib. Or, try placing her in her crib when she’s already asleep, so she can awaken there and get used to sleeping there. Experiment with the use of music, noise, or light machines; some babies love those. Talk to her about sleep, and what you need from her. She may not understand all your words, but she’ll start to get the message. Try this script, using a quiet, serious, but enthusiastic tone: “Baby, we’re all tired around here. Tonight is a great night for you to sleep for a long time in your crib. I’m going to nurse you, turn off the lights, sing a song, and then put you in your crib. I will be here to pat you on your side until you fall asleep. If you wake up, you are safe; you can look around for a while and then go back to sleep. And then in the morning, mommy and baby will feel SO GOOD!” It may take several (hundred?) times to repeat this each night, but you (both) will eventually get in the habit, and it will help. Don’t “push” too firmly until you feel that she has the emotional ability to withstand whatever degree of upset that being left alone to sleep will cause. Some babies will only put up a token protest; others will scream loud and long, but not really “mean it”; others will truly be terrified and need to be supported a bit longer before they can sleep for that long alone. You need to know your own baby, and start to trust your Mommy instincts.

Baby Size "Large", 9-12 Months: Now you really have an able little learner on your hands. You can feel assured that most babies will certainly be capable of “going along with the program” by this age. Just make sure YOU know “what the program” is, and be consistent about it. Fussing and crying, at this age, is usually normal and fine; talk with your pediatrician if you have concerns. B IS FOR BELLY Tummy troubles can spell sleep disaster for even the most prepared family. Babies have all sorts of tummy issues throughout their first years. When newborn, they are still adjusting to digestion, and they feel their digestive actions quite acutely. For breastfed newborns, moms can try adjusting their diets. Common causes of tummy troubles in infants include chocolate, dairy, and caffeine in mom’s diet. Check with your pediatrician, then try eliminating these foods from your diet, one at a time, for several days. Formula-fed babies can have trouble with dairy proteins, lactose, or soy. Ask your doctor about trying a new formula. For older babies on solids, think back to see if her sleep problems worsened after introducing a new food. By process of elimination, experiment to see if removing a particular food helps her digestion and sleep.

C IS FOR CONSTITUTION Constitutional factors are ingrained, probably genetically inherited characteristics, and they have a major impact on the way your baby sleeps. Some of these tendencies affect our personalities, emotions, and behaviors – even from day one. Your baby was born with a whole constellation of these tendencies, and your strategies for dealing with her will depend on those tendencies. For instance, we know that overall activity level is mostly inherited. Highly active babies tend to sleep less and need more interaction. They can’t yet move their bodies around much to burn off their energy, so they crave the mental stimulation of being awake. These babies don’t want to miss anything, and will probably end up being social and outgoing. But the price you pay is less sleep now, and maybe more fussiness. It’s difficult to tell if your baby is fussy because of constitutional personality factors, or if her tummy, or something else is bothering her. Careful observation of her daily reactions and behavior will help you decide what’s what. An active baby needs to have lots of interaction and “play” during the day. Give as much “tummy time” as she will tolerate, to work her little muscles. Engage her attention and go for the laughs; play “peek-a-boo” games, make funny noises, do silly things; whatever brings the laughs. This will both excite her and tire her out for better sleep later. DON’T play with an active baby at night, though; she is never too young to learn that nighttime is for sleep.

Other constitutional factors can interfere with sleep: Babies who are overly sensitive, perhaps to noise, light, skin sensations or body movements can have problems sleeping. Don’t assume your baby needs total quiet to sleep well. Some babies need “white noise” to sleep well; ask your doctor just how loud you can play “white noise”; babies are used to a great deal of noise in the womb and often sleep better with constant noise playing. Babies who are sensitive to the motion of their body often need to be swaddled, even late into their first year. There are new, larger-sized swaddling blankets that make this easy to do. Check out Dr. Harvey Karp’s “Happiest Baby on the Block” for great tips on swaddling and calming babies. (I really do suggest you look at the video rather than the book; it’s quite amazing!) Don’t feel bad about using a baby swing, if it works, at least for the first few months. Neurobiologists think that a swinging motion may actually be helpful in brain development. Although illness isn’t exactly constitutional, it’s worth mentioning. Even a little case of the sniffles can throw off a baby’s sleep. Just support him through his cold, make him as comfortable as possible, and get back with the program when he’s feeling better.

D IS FOR DAYTIME What does your baby do during the day? Until three months of age, there isn’t much you can do to influence this; babies will sleep where and when they want to. Until this age, they are more influenced by their internal needs and feelings, and less influenced by external stimulation. But after three months, you can try to limit naps and keep her awake more during the day. Keeping her active, interested, and engaged is the best way to wear her out for better sleep at night. Experiment with her nap times and overall amount of daytime sleep. If she naps three times a day, try two longer naps. Don’t let naps run too late into the afternoon. Or awaken her a few minutes early from her naps, to see if she “consolidates” her sleep better at night. But DON’T make the opposite mistake and eliminate naps; this creates an overtired baby, and an overtired baby will sleep LESS at night.

E IS FOR ENVIRONMENT The environment you provide for your sleeping baby can have a big impact on how well he sleeps. A very young baby (3-4 months) might do better in a swing or a bouncy seat. At that age, my babies tended to sleep better in a bouncy seat, not their cribs; I think the seat provided more cozy support, and having an elevated head helped to clear any possible nasal congestion, as well as being good for reflux or other tummy distress. I moved them from the bouncy into the crib anywhere from 3-5 months.

The right clothing for the right temperature is important too. Don’t make the common mistake of dressing the baby too warmly. It’s easy to assume babies get cold, but often they are too warm. Don’t judgetheir temperature by feeling their hands or legs, but rather their chest. This will give you a better sense of how to dress them for sleep. Dressing them lightly, but fully, for sleep is a good rule of thumb. Babies sleep better if the room is a little on the cool side; they sort of “hibernate” and get cozy for a nice rest. Some babies LOVE little sleep “bags”; my babies hated having their feet and legs restricted. Experiment, experiment, experiment.

Your baby’s sleep can be impacted by other environmental changes you may not have imagined:

~~sleeping in a different room than usual ~~seasonal daylight changes ~~different noise patterns in the house or neighborhood (when I was truly sleep-deprived, I actually thought it would be a reasonable thing to ask the neighbors to eliminate lawn-mowing during nap times!)

If you need to make a major change for a short while (say, a vacation), fall back on what works and plan to get back on track when you get back home. Nothing is permanent, and you can all get back to a good routine with a few nights of getting back in the habit. F IS FOR FUSSING I am not a believer in the “cry it out” method that many experts, and one of our own pediatricians, recommend. I cannot stomach the notion of plopping a baby down in bed and closing the door. That being said, however,a little fussing or crying is certainly fine for a baby to tolerate. Some babies “let off steam” from their days in this way. After all, they can’t exactly go for a brisk run to blow off their extra energy; crying is the only way to let it out sometimes, for some babies more than others.

So how do you decide how much crying is enough? First of all, it should be YOU who decides, not some “expert” who says five, or 15 minutes is OK. Some babies can be fine with crying up to an hour at a time; others fall apart after five minutes. You need to know and interpret your baby’s needs. And each of your babies may be different from its siblings. One of mine was a “fusser”. She fussed off and on, much of the day (and night), until she started talking. And she started talking early. This baby just needed to TALK! Once she could start jabbering, she had no need to fuss any longer. HER crying was not really “distress crying” (usually), but rather “talk crying”.

Once you sort out Baby’s sleep needs and habits through the first year, you have new sleep challenges awaiting you in the Toddler years. So pace yourselves, and go grab a nap!