New Born Sleep
I advocate for removing the term ‘trying not to create bad habits’ from the modern parent’s vocabulary, as they already face significant pressure. Even for an experienced individual like myself, sleep training a newborn can be challenging and, in many cases, unachievable. Moreover, it’s generally unnecessary during the first sixteen weeks of a newborn’s life. My advice to parents is to refrain from pursuing sleep training until their child reaches at least sixteen weeks old, counting from their estimated due date. However, there are numerous strategies parents can employ to promote healthy sleep habits for their newborns, which may lead to longer periods of sleep for both the baby and the parents.
In 1992, the American Academy of Pediatrics issued a recommendation stipulating that infants, from birth to twelve months old, should exclusively sleep on their backs. This directive significantly reduced the incidence of Sudden Infant Death Syndrome (SIDS). However, this commendable and life-saving guideline inadvertently led to a new challenge: infants now required assistance to fall asleep. Previously, parents were often advised to place their babies on their stomachs for sleep, as this position, facilitated by the Moro reflex, typically resulted in newborns waking less frequently, enjoying longer periods of uninterrupted sleep, and returning to sleep without assistance. It is crucial to emphasize that while newborns may find it easier to sleep on their stomachs, all babies must always be placed to sleep on their backs until they reach twelve months of age. No amount of sleep is worth the very real risk of suffocation associated with stomach sleeping.
As nearly all babies are now placed on their backs to sleep, parents quickly realize the need to assist them in falling asleep for naps and bedtime, as well as throughout the night and sometimes during naps. Various techniques, such as swaddling tightly, utilizing specially designed sleep rockers, and co-sleeping, are commonly employed and will be elaborated upon in this chapter. It is entirely developmentally appropriate for newborn babies to develop a reliance on some form of assistance to fall asleep, akin to young children using training wheels on their bicycles. Therefore, parents should not concern themselves with avoiding potential ‘bad habits.’ In the vast majority of cases, it is practically impossible for newborns to refrain from forming a dependence on the assistance they require to fall asleep. Subsequently, nearly all babies will eventually need to break this dependence, which is when the process of sleep training begins
It’s important to recognize that some newborns can sleep for what might seem like an exceptionally long duration—up to eighteen to twenty hours per day. The majority of newborn sleep consists of REM sleep, during which dreaming occurs, and as they mature, their sleep patterns become more consistent. Around the age of four months, as a child’s sleep cycles resemble those of adults more closely, parents often observe an increase in nighttime awakenings and a greater challenge in getting them back to sleep. Additionally, as babies grow older and become more aware, they may resist falling asleep and require more assistance, such as rocking or feeding, to facilitate sleep
What actions can you take to not only assist your newborn in obtaining the necessary sleep but also establish a strong basis for future sleep patterns?
1. Discover how your newborn prefers to sleep. Swaddling is generally considered safe as long as they are not yet able to flip over, but it’s essential to consult your pediatrician for personalized advice. While learning how to soothe your newborn (whether it’s through bouncing on a yoga ball, providing a quiet, dark room with loud white noise to counteract any disturbances, or using a gently moving swing or bouncer), it’s advisable to minimize reliance on feeding for soothing. Although keeping a newborn awake during feeding may be challenging in the early weeks, as time progresses, it becomes easier to facilitate sleep through other means. Breaking the habit of feeding-to-sleep can be challenging, so it’s often best to avoid it from the outset. It’s important to note that if your child is sleeping anywhere other than an empty crib, they should remain within your direct line of sight at all times. Never allow a baby of any age to sleep unsupervised in anything other than an empty crib.
- Ensure that as your newborn progresses beyond the sixth week of life, during which they may begin to awaken more frequently from sleep and display a reduced propensity to fall asleep in various environments, you establish a consistent sleep routine. This entails placing them for both naps and nighttime sleep in a dimly lit room with loud white noise. The white noise machine should emit a constant whirring sound, avoiding variations like ocean waves, rain, or lullabies. When adjusting the volume, keep in mind that babies in the womb are accustomed to constant sound, reaching levels as loud as a lawnmower. As long as your white noise machine is not excessively loud, it is generally considered safe for your baby’s ears.”
- “The American Academy of Pediatrics suggests that parents cohabitate with their newborn (without co-sleeping) from birth until at least the sixth month, preferably extending to the twelfth month. If you are thinking about transitioning your newborn to their own room, it is advivsable to seek advice from your medical practitioner beforehand..”
- Prioritize safety wherever your baby sleeps. Cribs should have a completely flat surface, devoid of bumpers, pillows, blankets, or any other objects. While small lovies measuring less than twelve inches square are technically safe, they are unnecessary for newborns. Similarly, although mesh bumpers are considered safe, they are not essential during the initial weeks of life. Sleep-sack-style wearable blankets are an excellent option if a parent is concerned about their child feeling cold at bedtime.
- “If a baby naps or sleeps at night away from their parent or caregiver, it is imperative to use a video monitor to continuously monitor them. Additionally, they should only be placed to sleep in a room other than their parents’ bedroom with direct approval from a pediatrician.”
Where your newborn sleeps is just as important as how they fall asleep. The safest option is a flat, unoccupied crib or a portable crib like a Pack-n-Play, placed in your bedroom. Side-car-style baby sleepers, designed to attach securely to the parents’ bed, are also considered safe when used according to instructions. While some parents observe that their babies sleep comfortably in co-sleepers, swings, bed “nests,” bassinets, and rockers, it’s generally agreed that these options are unsafe without direct supervision. However, in certain cases, parents may receive approval for their use from their pediatrician.”
Parents may believe that elevating the crib mattress to alleviate reflux symptoms is safe, but it is not, nor are any types of sleep positioners or wedges in a crib. Additionally, despite the safety of the crib, it’s common for babies to sleep in various other places. If your infant falls asleep in a stroller, car seat, swing, or bouncer, whether swaddled or not, ensure they are always within your sight and hearing range. Each year, some babies suffocate when their chin presses too closely to their chest while seated in a car seat. This risk applies to any type of wrap or carrier—remain vigilant to ensure your baby can breathe easily. Lastly, avoid sleeping with your infant on a couch or chair, no matter how convenient it may seem. Especially when experiencing sleep deprivation, it’s crucial to take every precaution to ensure your baby is never in an unsafe position, particularly during moments when you may fall into a deep sleep and not notice potential risks.”
Co-Seelping
The American Academy of Pediatrics (AAP) confirms that “bed sharing remains the most significant risk factor for sleep-related infant deaths” and recommends room sharing as a safer alternative. However, considering that many parents may eventually find themselves sharing a bed with their infant, it is crucial to adhere to safe sleeping practices. Although the AAP has recently provided general guidelines, several straightforward and sensible measures can be followed to ensure the safety of co-sleeping arrangements.
Newborn sleep practices should also be followed to ensure that you and your newborn are co-sleeping safely
- Parents should verify that the baby is lying on their back and that the mattress is extremely firm, refraining from using memory foam-style mattresses
- The mattress needs to be correctly fitted within the bed frame, preventing any large gaps where the baby could accidentally fall through (this unfortunate event has occurred in two families I’m acquainted with).
- Ensure that all bedding is securely attached to the mattress, and keep loose blankets or pillows away from the baby
- Moreover, it’s essential for the adult(s) sharing the bed with the baby to steer clear of drugs, alcohol, or any other substances that could cause them to experience unnaturally deep sleep.
- It is not advisable for siblings to share a bed with a baby under the age of one.
It is not advisable to swaddle infants when bed-sharing.
- It’s important to secure very long hair, as it can pose a risk of wrapping around a baby’s neck.
During the initial days and weeks of a baby’s life, many families will notice that their infant sleeps extensively. There might be extended periods of wakefulness or confusion regarding day and night, where the baby is awake during the night and sleeps during the day. It can be beneficial to view the newborn period as comprised of distinct stages, each with its own unique characteristics. When tallying weeks throughout the newborn phases, parents should begin counting week one from the baby’s estimated due date rather than their actual birth date, especially if the birth occurred prior to the fortieth week of pregnancy.
Early Newborn Stage: Birth through Week Six
During this phase, caregivers will typically observe that their infants are capable of sleeping in various environments, particularly while traveling or being cradled. Occasionally, in rare instances, very young newborns may exhibit intermittent crying, which is usually indicative of either digestive discomfort or feeding challenges, such as inadequate breast milk intake. Any instances of significant crying during this period should be promptly reported to your pediatrician for further evaluation and guidance.
During the initial six weeks, parents should prioritize establishing the feeding routine, whether through breastfeeding or bottle/formula feeding. It is important for the mother to concentrate on her recovery and cherishing the time with her new baby. Any feeding difficulties, particularly for breastfeeding mothers, should be promptly addressed with the assistance of a lactation consultant. While some widely recognized sleep guides suggest initiating some form of sleep training within the first twelve weeks of a baby’s life, the outcomes vary, and the potential stress for both parents and the child outweighs the uncertain results
If parents are interested, they can begin implementing practices such as swaddling, using white noise, and introducing a pacifier to help calm their unsettled baby. It’s advisable for parents to ensure that their baby doesn’t sleep for longer than two hours continuously between approximately 7:00 a.m. and 9:00 p.m., as any sleep beyond that timeframe can be considered nighttime rest. When rousing the baby from a lengthy nap, aim to keep them awake for thirty to fifty minutes (including feeding time), before allowing them to nap again. Restricting the duration of naps to no more than two hours in the early days and weeks is the most effective approach for swiftly resolving any confusion between day and night, and for encouraging longer stretches of overnight sleep for the baby.
Late Newborn Stage: Week Six through Week 16
This period can be notably challenging. Around the sixth week, babies usually become significantly more alert, and reflux problems may arise. A previously tranquil and composed baby may now exhibit fussiness, and may even become inconsolable, particularly during the evening hours, often referred to as the newborn witching hour.
At this stage, parents can make genuine efforts to instill healthy sleep patterns. Whenever the baby is asleep at home, it’s advisable to ensure that the room is very dark and that there’s loud white noise. Unless co-sleeping is strongly preferred, parents can prioritize having the baby sleep in a crib, Pack ‘n Play, or side-car co-sleeper. It’s important to swaddle the baby snugly (until they can roll over; at which point swaddling should be discontinued immediately).
Parents can commence establishing a consistent wake-up time for the baby each day. Ideally, this time would remain relatively consistent each morning, but may vary by approximately thirty to sixty minutes. Irrespective of when the baby wakes up, parents should initiate a routine of feeding, wakefulness, and sleep. While this routine may be initiated during the Early Newborn Stage, it becomes more manageable once the baby becomes slightly more alert and aware after around six weeks.
Once a start time for each day has been established and it’s ensured that the baby doesn’t nap for longer than two hours at a stretch, the primary focus for parents should be ensuring that the baby remains as awake as possible during feeding sessions. Initially, for a baby accustomed to eating and sleeping simultaneously, attempt one feeding each day immediately upon the baby waking up. Parents can aid in keeping the baby awake by removing their clothing, gently rubbing a cool washcloth on their forehead, or changing their diaper midway through the feeding. Even if the baby falls asleep or nods off, they should be roused immediately after the feeding is completed and kept awake until they display signs of sleepiness. This period of wakefulness can range from thirty to ninety minutes, depending on the baby and the time of day. Subsequently, the baby should be assisted in falling asleep using methods that do not involve feeding, if feasible.
In general, newborns exhibit shorter periods of wakefulness earlier in the day, followed by gradually longer periods of alertness towards the evening. While it’s important to note that a small percentage of babies may not display obvious sleep cues, parents can begin to observe their baby closely about thirty to forty minutes after they wake up to recognize signs that indicate readiness for sleep. Common indicators that a baby is ready to nap include rubbing their eyes, displaying fussiness, abruptly losing interest in activities, yawning, or appearing drowsy. Although sleep cues can vary among babies, most parents can learn to recognize them through careful observation.
Once a sleep cue is observed, parents should promptly swaddle the baby and, if feasible, relocate them to a darkened room with loud white noise. At this point, any method except feeding should be employed to aid the baby in falling asleep. Techniques such as rocking, swaying, shushing, bouncing on a yoga ball, or offering a pacifier can all be effective. With direct supervision and approval from a pediatrician, the baby can also be allowed to sleep in a swing or rocker.
After the baby falls asleep and subsequently wakes up, they should be fed, regardless of whether their previous feeding occurred less than two hours earlier. The notion that newborns should be fed only every three to four hours during the day in order to prolong nighttime sleep typically does not result in longer periods of nighttime rest. Rather, adhering to a regular cycle of eating, wakefulness, sleeping, and then eating again promotes longer stretches of sleep at night. Establishing this pattern guarantees that infants have regular chances to feed during the day and diminishes the probability of frequent nocturnal awakenings.
Formula-fed babies may not be ready to feed immediately after waking, especially following a short nap. In such cases, parents can wait and attempt feeding again after about fifteen to thirty minutes, ensuring that the baby remains awake throughout the feeding session.
What is Dreamfeeding?
Dreamfeeding can potentially provide parents with an additional hour or two of nighttime sleep, or at least ensure that the baby receives more calories within a twenty-four-hour period. Generally, dreamfeeding is best suited for babies who are swaddled and younger than sixteen weeks old. To execute a dreamfeed properly, a parent or caregiver should enter the room between 9:30 and 11:30 p.m., gently pick up the swaddled baby, and either initiate feeding immediately or pass the baby to the nursing parent. It’s important that the baby’s eyes remain closed throughout the entire feeding to avoid disrupting their nighttime sleep. If the baby awakens during the feeding, it’s acceptable, but if the parent suspects that the dreamfeed is disturbing the baby’s sleep, it should be discontinued. If the baby refuses to open their mouth due to fatigue, that’s perfectly fine! Some babies may need several attempts at dreamfeeding before they become accustomed to it. Parents should attempt to burp the baby after the dreamfeed, but it’s not necessarily concerning if the baby doesn’t burp. Melatonin, the hormone responsible for inducing drowsiness and relaxing the body’s smooth muscles (particularly in the arms, legs, and abdomen), is naturally present in the body at bedtime and for several hours thereafter. Relaxed abdominal muscles often lead to reduced or absent spitting up since there’s minimal pressure on the stomach. Following a dreamfeed, feedings should continue throughout the night as needed.
When the baby wakes up feeling hungry, it is permissible, with the approval of a pediatrician, to wait three to five minutes after the baby awakens to determine whether they are genuinely hungry or simply transitioning between sleep cycles and making sounds. While I have outlined some methods to begin fostering healthy sleep habits, there is no need to initiate formal sleep training within the first four months of your baby’s life. Newborns encounter various challenges, such as digestive issues and learning to regulate their breathing and temperature. The paramount consideration is that regardless of the actions taken by parents, as long as they provide love and care to their child and themselves, they are fulfilling their responsibilities correctly. The newborn phase can be both exhilarating and demanding, and parents should concentrate on doing their utmost to support their child’s development.