What is normal bedtime for a baby?
With newborns, the saying “sleeping like a baby” may seem more ironic than realistic. Newborn babies typically have a very different sleep cycle from their new parents. Newborns may initially seem to have day and night reversed. Newborns will eat, play, soak a diaper, and then sleep on a 1-3 hr. cycle, which will gradually change to 3-4 hrs. By age 9-12 weeks, parents and newborns may be able to get 5-6 golden hours (with the help of a 12 hr. overnight diaper) and eventually they will sleep through the night by age 9 months (12 hrs., i.e. 7 pm to 7 am). Their sleep time may then decrease during their childhood years (i.e., age 6-10) but will again lengthen during adolescence and return to approximately 10-12 hours during the teenage years.
As far as naps go, newborns will usually nap frequently and briefly. By age one year, babies will have one to two naps that last one to two hours a day. By age two years, this may decrease to one nap a day and then disappear. Longer sleeps in the daytime should be avoided after age one, because this may lead to more difficulty in achieving nighttime sleep.
The first routine time to establish is the morning wake time. The saying “never wake a sleeping baby” is not necessarily true. Keeping a consistent wake time in the morning will help to establish a consistent bedtime. This wake time should be for both weekdays and weekends. Initially, the baby will have erratic bedtimes with frequent awakenings for feedings or diapers. However, with a consistent wake time, a consistent bedtime will soon emerge. Sleepy babies tend to cry and fuss more in noisy active environments. If your baby is not soothed by eating, diaper changes and rocking; then consider moving to a dark and quiet room, especially in the evening. It is not recommended to have a baby fall asleep with a bottle in their mouth, both due to the risk of choking and because as they get older it promotes tooth decay and cavities. The more routine feedings, diaper changes and naps are, the easier your baby’s needs can be anticipated and the less crying and frustration for you both.
How do I help my baby to fall asleep?
Sleep habits form early and there are things parents can do from day one to encourage good sleep. In general, daytime naps and nighttime sleep should be treated differently. Nighttime sleep should occur in the baby’s own room with placement in their own crib. Musical toys and mobiles should be used for play and stimulation in the daytime and should be avoided for the nighttime sleep period. The room should be kept dark, with minimal light. The baby should only be placed in the crib for sleep, and the crib should not be used as a playpen in the daytime. It is preferable to use a portable crib (pack-and-play) in another location for daytime naps. However, the crib can be used if no safe alternative is available. Baby monitors can be used to help alert parents and caregivers to the status of the baby (i.e., sleep or wake).
First, be sure that the baby is well-fed and had a diaper change before putting to bed. Routine is very important. However, whatever routine you start now will be expected to be continued. For example, if you rock the baby for twenty minutes prior to sleep, the baby will come to expect twenty minutes of rocking prior to every sleep time and may eventually refuse to sleep without being rocked. It is also better to put the baby to bed when drowsy but not asleep. This allows the baby to fall asleep on their own, and if they awaken, they will be more easily able to return to sleep on their own. It is generally not recommended that babies be given bottles in the crib with them. Children usually establish bedtime rituals or expectations as young as 6 months.
Just like adults trying to sleep, the temperature of the room is important as well. Too hot or too cold of an environment will make it more difficult to fall asleep. The optimal temperature is likely between 68-72 degrees Fahrenheit with approximately 50% humidity, which can easily be checked with a digital thermometer and hygrometer. If the weather is cool and you are planning to use a blanket, it is sometimes helpful to warm one blanket against your (or the baby’s) skin and place it under the baby and a second blanket warmed to use as a cover. Otherwise, lowering your warm sleepy baby onto cold crib sheets, may awaken them from sleep. Do not “over bundle” your baby with clothing or blankets for sleep. Cold hands do not mean that your baby is cold, place your hand on their chest or abdomen to see if they are warm or cold. If your baby is sweating, then you have put too many layers on. It is better to err on the too cool side, as over bundling (too warm) is associated with SIDS or sudden infant death syndrome.
Babies should be placed on their backs to sleep, and never on their sides or bellies. It is generally recommended that you place your baby in opposite directions each night (head turned to the right, head turned to the left) to avoid flattening their head due to them repeatedly facing the same side. Nothing should be placed in the crib with the baby apart from a light blanket. Newborns are incapable of moving their head or moving objects away from their face which could cause suffocation (i.e., bed bumpers, pillows, plush toys, et cetera). Infant wedges are sometimes used to elevate the baby’s head if they have severe reflux, but this should only be used under the supervision of a Pediatrician. Some babies preferred to be swaddled to sleep, others do not. Safe swaddling can be learned from your Pediatrician as well.
What if my baby is a good sleeper and suddenly becomes a bad sleeper?
This is usually due to discomfort. This may be due to your baby being too warm or too cold at night. Teething is also a common cause of new onset disrupted sleep and can be treated with acetaminophen or oral numbing agents as discussed with your Pediatrician. Ear infections are also a common cause of discomfort. Untreated, ear infections in infants can lead to a buildup of fluid causing decreased hearing and poor speech development. Both the Pediatrician and an Ear, Nose and Throat Physician (ENT) are beneficial in treating these children, with some children requiring frequent antibiotics and others benefitting from the placement of ear tubes to drain the fluid (myringotomy).
What about my one year old?
The same issues and concerns for the newborn also apply to the one year old, with some minor additions. Room and bedding temperature is still important. At this age, most babies are ready to take whole milk and food in the place of formula. It is expected that a third of the diet consists of fats, and less than that may result in increased hunger and decreased satisfaction at bedtime. A poor diet can lead to increased formula intake with increased diarrhea, frequent awakenings, and poor growth. Unlike adults, who benefit from a less than a full stomach at bedtime, babies like to eat and sleep almost seamlessly. They are very content with a full stomach.
As mentioned above, wet diapers can awaken this age group. Babies of this age still have a small bladder and frequent voiding and will still have wet diapers throughout the night. Use of a twelve-hour diaper (overnight diapers) can lead to increased comfort and decreased awakenings.
One other chronic disrupter of sleep is nocturnal cough. If the cough is also present in the daytime, it may be easier to distinguish the cause. One of the most common causes is reflux, when a baby’s not yet mature digestive system allows liquids to come backwards up the throat and then down into the lungs. This can be addressed with the Pediatrician and may benefit from upright feedings, dietary changes, medications, and in severe cases sleeping only upright in car seats or with surgery. Another serious cause of nocturnal cough is upper respiratory infections or asthma. This is usually treated by a pediatrician with inhaled medications (or nebulizers). Finally, one of the more common causes of nocturnal cough is nasal congestion and post-nasal drip. This should again be discussed with the Pediatrician. This is usually managed with sterile saltwater sprays and sometimes with medications (i.e., inhaled or oral, such as diphenhydramine).
Should I share my bed with my baby?
In some cultures, babies traditionally share a bed with their parents. In general, I do not recommend bed sharing for the following reasons. First, it does not allow the infant to achieve sleep on their own and makes it more difficult to later move the child into their own bed. Second, it disrupts the intimacy and sleep of the parents. Third, it puts the baby or child at risk of injury either from smothering, falls or even the inadvertent weight of the parent. As far as achieving trust and feeling loved, as long as a parent or caregiver responds to their baby in a timely fashion overnight and meets their needs (i.e., food, diaper, comfort) both overnight and in the daytime, the baby will feel love and trust or bond to the parent or caregiver.
How can I best prevent SIDS (sudden infant death syndrome)?
SIDS or sudden infant death syndrome occurs in infants younger than 12 months (usually less than 6 months) when the parents or caregivers go to check on a sleeping infant, and instead find them limp and not breathing. It is very rare, and not completely preventable. However, there are some babies at higher risk, and some things parents can do to decrease the risk.
Babies at the highest risk are baby boys, aged ten to twelve weeks. The risk increases if a parent is a smoker and if the baby was born prematurely. It can be associated with multiple respiratory infections, increased reflux and or seizures. It is also associated with babies sleeping on their bellies or sides. It is associated with sleeping in soft bedding or too much clothing or blankets leading to overheating.
To decrease the risk, all babies (even those at low risk), should be placed on their backs to sleep. Loose objects, clothing, and plush materials (toys) should be kept out of the crib. Parents and caregivers should avoid smoking. Breastfeeding and pacifiers may be somewhat protective. It may be beneficial to have the baby’s crib kept in the parents’ room until age 6 months if they are at high risk. All babies, from newborns to infants), also benefit from “tummy time.” Tummy time is when babies are placed on their bellies and allowed to try to lift their heads on their own. Strengthening these muscles will allow babies to better move their heads and mouths into a better position to breathe if they inadvertently turn onto their stomachs from their backs. Tummy time is done under the supervision of a parent or caregiver when the baby is awake and between feedings. Even though tummy time can be started with newborns who will have limited success at simply lifting their heads, good head control should not be expected before ten to twelve weeks.
It is not known exactly what causes SIDS and there are very few abnormalities found at autopsy, which frequently leaves the cause of death as unknown. However, there are some theories as to why this happens. The first theory is that the baby’s brain or respiratory system is immature, leading to long apneas (periods of not breathing or breath-holding) that cause unstable heart rhythms (on a cardiac or heart system which is also not mature) and lead to death. This may be an exaggeration of a premature protective reflex which is usually later outgrown. For example, babies need to suck all of their food. Normally, this food goes from the mouth down into the stomach. However, as the baby sucks, some of the food may trickle into their lungs. When material hits the lung, it usually triggers a brief stopping of breathing or apnea (because if the baby continued to breathe in, they would pull more food into their lungs) and this is followed by a strong cough to expel the material, and then the baby starts to breathe and suck again. Similarly, when baby’s suck food into the stomach, they can also suck air into the stomach. When too much air enters the stomach, it can cause burping or belching and air and food can travel back up into the throat and then either exit out of the mouth, or travel down into the lung (again triggering apnea and cough). In either case, it is the prolonged apnea that can lead to low oxygen and trigger fatal heart rhythms and death. This being said, apnea alarms (which notify parents when baby’s have irregular breathing) have not been shown to be able to prevent deaths from SIDS. This is likely due to the fact that once the apnea triggers the heart to stop, these babies are usually not easily resuscitated. However, the research into this horrible syndrome is continuing. It is generally recommended, however, that all new parents and caregivers learn basic pediatric (child or infant) CPR. It is also recommended that if a baby shows signs of reflux or apnea during sleep, they be evaluated by a Pediatrician and Sleep Physician.
How can I tell if my child is sleepy?
Sleepy adults will yawn, close their eyes, and decrease their activity when tired. Unlike adults, babies and children become more active and more agitated prior to sleep. Babies may cry and be difficult to soothe, and when moved into a quiet and dark room and gently rocked, quickly fall asleep. Children may become cranky, irritable, and even aggressive when sleepy. During the daytime, sleepy kids will have a low attention span and hyperactivity. If chronically sleepy, they may develop aggressive behavior and have poor academic performance with low grades. They may develop abnormal growth with either being underweight or overweight.
What if my child refuses to go to bed at bedtime?
It is important that children have an opportunity to sleep enough hours to promote their growth and learning. It is important that they have both enough quantity of sleep and that the quality of their sleep is also good (ie, without sleep apnea or other disorder). One of the first sleep disorders that can develop is sleep onset association disorder. This occurs when a baby or child requires a certain set of circumstances to fall asleep. When they have these circumstances (i.e., toy, rocking, light off, parent at bedside) they are usually quickly and easily asleep. However, when any one of their expected elements are missing (i.e., toy or parent) they refuse to sleep. This commonly occurs when a parent spends excessive time with the child at the beginning of bedtime, then finds that the child expects this time to be spent repeatedly for brief awakenings during the night. Another version of this is what I like to refer to as “curtain calls,” in which a child who is placed in bed frequently emerges and asks for something from the parent (i.e., another story, another glass of water, et cetera). There are two ways to deal with this. One method is to gradually decrease the time of the intervention (i.e., parent at bedside or amount of water given). The second is “cold turkey” in which the child is simply returned to bed with minimal discussion and allowed to cry. While there may be multiple days of sleepless nights for both the parent and the child, if consistently applied, this habit can be changed and good sleep re-established.
Similarly, at age two to three years, children may begin to challenge their bedtime and refuse to enter the bedroom or go to sleep. Unlike sleep onset association disorder, this is more a matter of discipline and testing of authority. It is usually associated with refusal of other parent or caregiver instructions during the daytime as well. The treatment of this usually involves an increase in routine. In general, positive reinforcement is used for good behaviors (i.e., stickers when going to bed on time, with a toy or reward at the end of the week or month if enough stickers are achieved). Alternatively, the “time out” system is used for undesirable behaviors. With the time out system, children are given a brief time that they must refrain from activities (usually by sitting in a chair) for a brief duration for misbehaving (i.e., not stopping when told “no” or not going to bed or brushing teeth immediately when instructed). The time out usually lasts for one minute for every year of a child’s age (i.e., 5 min for a 5-year-old). If the child does not obey the time out, it is repeated until “time served.” For this system to work it must be applied every time that a child misbehaves. Inconsistent application will lead to inconsistent results.
I recommend that nighttime hygiene and preparation for bed occur prior to any fun or relaxing activities immediately prior to bedtime. For example, instead of “brush your teeth, put on your pajamas and get into bed” instead try “brush your teeth, put on your pajamas and then you can play for another hour before bedtime.” When it is time for bed, the child is either escorted to bed and given limited additional attention (prayers, bedtime stories, et cetera), or climbs into the bed on their own and starts to sleep. If the child does not sleep and leaves the bedroom, they are escorted back, and the ritual is repeated. This is repeated until the bedtime ritual begins. This continues every day – weekdays and weekends without exception – until there is no more refusal of the desired bedtime. Your child should fall asleep within 20-30 minutes of being placed into bed with the lights off. Most children will fall asleep within 10-15 minutes. If your bedtime is too early, you may find that your child stays awake longer in the bed and has a more difficult time falling asleep. In addition, if your bedtime is too late, your child may become severely cranky and irritable when being placed into the bed, but again will eventually fall asleep. You may need to adjust the time that they go to bed accordingly.
Should I give my child sleeping medications for travel?
It is generally not recommended that children be given any sleep-inducing medications for travel. However, there may be circumstances in which parents feel that medicating the child is better than having them upset and cranky for prolonged air travel or car travel. This should be discussed with a Pediatrician prior to administering any medication. Preferred medications include diphenhydramine and clonidine. Melatonin is not recommended.