This guest post was written by Jessica Brodey, a trained and certified Gentle Sleep CoachSM. Through her company Eat-Sleep-Love, Jessica provides private consultations with parents to help them develop healthy sleep habits for their children by creating and implementing sleep plans that are tailored to each child’s needs and respect parental philosophies; seminars and workshops on sleep strategies for parents of infants and young children; Happiest Baby courses; breastfeeding education and support; and guidance, advocacy and support for parents seeking early interventions, assessments, Individualized Education Programs, or Section 504 Plans for their children. Please see Jessica’s contact information at the end of the post.
The first six months of parenting a new baby are a challenging time, especially for first-time parents. New parents struggle with a changing family dynamic, the responsibility of getting to know their new baby, and balancing feeding, sleeping, and other care needs. Parents welcoming a subsequent baby into the family share these same challenges, but must also balance the needs of their newborn against the needs of their older children. Sleep (or the lack thereof) is a critical factor for parents as they embark on parenting their new baby.
Sleep is a Learned Skill
It may be stating the obvious, but sleep is a learned skill. While newborns instinctively know how to sleep from the moment they are born, sleep patterns (differentiating between day and night sleep, napping, putting one’s self to sleep) are all skills that develop over time. Part of the skill is neurological – over the course of infancy, our brains change and develop, and sleep begins to organize: first night sleep, then the morning nap, and then finally the afternoon nap. By the time a newborn is six months old, his/her pattern of sleep cycles is largely the same as an adult’s. Part of the skill of sleeping is also behavioral, and incorporates the ability to self-soothe. Ultimately, as a parent it is our responsibility to teach our children the behavioral components to sleep as they become neurologically ready to master those tasks. Every child should learn to put him/herself to sleep without a “sleep crutch” – a negative sleep association that requires something to be done either to or for them to fall asleep. Luckily, this is not a skill we expect our children to master overnight.
The first step to developing good sleep habits is to have a sleep plan. Before baby arrives, talk to your spouse/significant other about your sleep goals – do you want your baby co-sleeping in your bedroom, sharing your bed, or sleeping in is/her own room? How long and what is your timeline for achieving your goals? Any option can work for a family, but if you become an “unintentional” bed-sharer, you (or your spouse/significant other) may grow to resent your baby’s presence in the bed.
The Fourth Trimester
The first night or two of life, newborns often seem “perfect” – they sleep all night, and just wake to feed. The third or fourth nights can be a different story, which often coincides with coming home from the hospital! This may create a sense of panic in many new parents, because parents do not want to see their baby in distress. Try not to worry…it is likely just a short-lived case of the baby fussies, and as parents and baby get to know each other better (and baby’s natural clock kicks in), nighttime should become easier again.
Many baby experts, including Dr. Harvey Karp, Assistant Professor of Pediatrics at USC School of Medicine, consider the first three months of newborn life the “fourth trimester.” This is the time that babies need to transition from life in the womb where every need is met and they are in an optimal environment to life outside the womb where they need to develop a new set of skills. What can parents do to help soothe their babies during the “fourth trimester?” One tip is to practice Dr. Harvey Karp’s 5 S’s to help soothe your baby when upset: swaddling, stomach/side hold, shushing, swinging, and sucking. Ultimately, the notion of the fourth trimester boils down to one simple fact…you cannot spoil a newborn! Those first weeks and months are all about responding to a newborn’s needs and making them feel loved and secure. But how do we do this and still help our newborns develop healthy sleep habits?
Building Healthy Sleep Habits
The key to helping new babies sleep well is to be mindful of their sleep requirements. An over-tired baby is a cranky baby, and it is difficult to soothe a cranky, over-tired baby to sleep. Instead, the best approach is to avoid letting a baby become over-tired. With babies, consistency matters…work on developing flexible but predictable routines around eat and sleep for your baby over the early weeks and months.
Right around 4 weeks of age, babies start to “wake-up” during the day – this is when it becomes important that they do not become over-tired. According to Dr. Marc Weissbluth, author of Healthy Sleep Habits, Happy Child, most newborns should not be awake longer than 60-90 minutes at a time for the first few months. It is a good idea to watch the clock and start putting a newborn down to sleep (in a crib, in a swing, in a parent’s arms, in a car seat, in a stroller…whatever works!) within 90 minutes after each waking all day. This process will help lay the foundation for excellent sleep habits by helping babies recognize when they need to sleep (and helping parents begin to recognize their baby’s sometimes subtle sleepy cues).
Nursing moms should look for other ways to soothe their baby in addition to nursing, especially after the first 6 weeks. By 6 weeks, parents should start working on putting baby to sleep drowsy but awake – falling asleep without a bottle or breast in their mouth. This can be a gentle process over time, and a calming and predictable bedtime routine is a key component to help a baby recognize it is time for bed.
Initially, newborns prefer a later bedtime (around 10-11 pm), but once baby starts to get older and sleep at least 8 hours at night (usually by 4-5 months of age), bedtime should move earlier (8:00 – 8:30). Parents should not expect to see a regular nap routine during the newborn phase – many babies do not consolidate into three regular naps a day until they are 6-8 months old! Until then, parents should watch those awake windows and sleepy cues (slowed activity, increased fussiness, rubbing eyes or face, needing to be held) to make sure their babies are getting sufficient daytime sleep.
Parents may also explore a variety of tools to help calm and soothe a baby to sleep during the early weeks…a bouncy seat, using strange voices, a quiet song, a swing, even the car. Many parents find babywearing an invaluable tool – it allows for closeness and bonding with baby, but it also leaves hands free to engage in other activities. Sometimes, a baby will hate a tool the first time or two, but could grow to love it later. The lesson is to try, try again…we never know when s/he may start to love something new!
Creating a Healthy Environment for Sleep
Most experts recommend that babies sleep in a clean, quiet, dark room that is temperature controlled (ideally between 65-70 degrees). A baby’s crib should be free from any hazards such as loose blankets or bedding and pillows, and monitor wires, strings from window coverings, and toys/stuffed animals that could constitute choke or strangulation hazards should be kept out of reach. Back sleeping is best for prevention against Sudden Infant Death Syndrome (SIDS). Because babies do not sleep as deeply on their backs due to the startle reflex, swaddling babies calms the startle reflex and helps promote good sleep habits. White noise (such as a ceiling fan or from a noise machine) can help drown out household noises and limit sleep disruptions.
Parents should also take steps to help baby differentiate between night and day. During daytime hours, expose baby to natural light and room lights. At nighttime, prepare a quiet, dark environment for your baby. Parents should limit infants’ exposure to television at nighttime, and consider getting room darkening shades to help keep the light out in the early morning and during nap time. Parents should treat nighttime feedings/wakings in a “business-like” manner – keep it quiet, dark, and about the feeding, not playtime. Additionally, babies need morning rituals to help differentiate between nighttime and daytime (a good morning song, opening the blinds, etc.)
Medical Issues and Infant Sleep
Sometimes, despite a parent’s best efforts, a baby just will not sleep. Before you throw in the towel and think “my baby just does not need as much sleep as other babies” or “perhaps if I quit breast feeding and just gave him/her formula,” consider whether there are medical causes for your baby’s sleep challenges. There are many medical reasons that may cause a baby to be awake and unhappy. Reflux is one key culprit. In the past, many doctors diagnosed unhappy babies who cried inconsolably for long periods of time with “colic.” Newer information is actually showing that these babies may be suffering from reflux. Reflux can present in many different ways. Some babies spit up all the time, and some babies will scream inconsolably for hours and hours at a time, particularly at nighttime or after prolonged periods of laying flat. Some babies simply refuse to lay flat on their backs. Other symptoms may include: excessive hiccupping, choking/gasping/gagging sounds, frequent night wakings, constant congestion, gassiness, refusal to eat, or desire to continuously nurse or eat (the milk is soothing and neutralizes the stomach acid). If a parent suspects reflux, talk to a pediatrician! Simple tips such as feeding baby in an upright position, keeping baby upright for 15-30 minutes following a feed, feed smaller amounts more often, burp frequently, and elevate baby’s head when sleeping (like on a bouncy seat or a newborn napper) may provide relief. A pediatrician may suggest trying an over the counter or a prescription medication. Other common medical causes for sleep disturbances during the first six months may include food sensitivities, poor latch, gassiness due to bottle, low breastmilk supply, and sickness.
Post Partum Depression
Another key issue for new moms is post partum depression (PPD). Nearly all moms suffer from a bit of the baby blues, but if it is overwhelming or continuing for longer than two weeks, mom may be suffering from PPD. If a mom is emotionally unavailable, her baby can sense that – it can be harder to soothe a baby and meet his/her needs when mom is overwhelmed and struggling. That, in turn, plays a part in whether a baby is sleeping well. New moms should familiarize themselves (and their partners) with the signs and symptoms of PPD, and should not be afraid to ask for help! There are many remedies, both natural and medical, that can quickly help you feel like yourself again. For more information about PPD, check out Dr. Shosh.
Balancing and meeting parental needs, both sleep and otherwise, are critical in the early weeks of parenthood. Parents need to make sure to take care of themselves…sleep when baby sleeps, eat, and make time for just YOU – even if it is just to escape for a brief period here and there. Stay at home parents should remember that even though they have taken on the job of raising their child, that does not mean they are not entitled to some personal time!
It is a myth that formula-fed babies will sleep better than breastfed babies, and giving baby rice cereal at an early age has not been shown to increase the length or quality of sleep. Newborns will wake to eat every 2-3 hours. For some parents, feeding is quick and easy, but other parents find feedings take a very long time. It is not just the length of a feeding (although some babies are very slow nursers and can nurse 30-45 minutes or more each feeding) – some breastfeeding moms struggle with getting their baby to latch and stay latched, and the overnight feedings can be particularly frustrating. Most feedings involve a diaper change, and for moms who have to pump, the process of getting up, preparing the pump, pumping milk, and feeding a baby can also take a long time. In fact, it can seem like all you do is feed your baby. Parents who formula feed often find it easy to share responsibility for nighttime feedings, but it can be tougher for the breastfeeding mom to figure out how to share that load. It takes at least 2-4 weeks to establish a healthy milk supply, and nursing moms really should try and nurse or pump every 3 hours around the clock until supply is established. Nevertheless, your spouse/significant other can still help by waking up/fetching the baby, changing baby’s diaper after feeding, re-swaddling and soothing baby back to sleep. For moms who pump, your partner can feed baby the breast milk when you are finished. But remember, if mom is just exhausted and needs a break, it really is okay to take it.
So, for all of the new and expectant parents out there, know that good sleep habits do not happen immediately, but they are slowly shaped and developed over time. You will sleep again! Newborns generally wake every 2-3 hours around the clock to eat the first few weeks of life, but many newborns begin to give 3-4 hour stretches between weeks 2-4. By week 8, most babies can go at least 1 4-6 hour stretch without feeding at night (and many will go longer). By week 12, most babies can do at least a 6-8 hour stretch at night without eating. By 4 months, most babies can sleep 8 hours or more without eating, and 10-11 hours by 5 months. Remember – these are guidelines for healthy, full-term babies, so always check with a pediatrician about a specific baby’s needs.
Many expectant parents wonder how they will function with so little sleep. The truth is, you just do it. You try to sleep when baby is sleeping, you forgive yourself when you fail to keep a clean house, and you remember to eat and take care of you. Having strong family support and a good partner throughout the process makes it easier and better.
-Posted by Jessica Brodey
Jessica can be reached at: firstname.lastname@example.org, or (202) 276-7308