Sleep Problems: Prevention (Birth to 6 Months)

Parents want their children to sleep through the night, giving the parent 7 or 8 hours of uninterrupted sleep. Newborns, however, are not able to sleep through the night. They usually cannot go without a nighttime feeding for more than 4 or 5 hours. By 2 months of age, about 50% of bottle-fed infants can sleep through the night. By 4 months, most bottle-fed infants have this ability. Most breast-fed babies can sleep through the night by 5 or 6 months of age. Good sleep habits may not develop, however, unless you have a plan.

It is far easier to prevent sleep problems before 6 months of age than it is to treat them later. These guidelines will help you teach your baby that:

• Nighttime is a special time for sleeping.
• Her crib is where she stays at night.
• She can put herself back to sleep after normal awakenings that don't relate to hunger.

Newborns

• Help your baby fall asleep using any technique that works.

  Some babies fall asleep at the breast or bottle. They may need skin-to-skin contact to fall asleep. This is okay at this age, but if your baby is on the brink of falling asleep and calm, try to put him in his crib. This helps the baby learn how to fall asleep by himself. (Note: The safe sleep position for healthy babies is on the back.)

• Swaddle your baby in a blanket.

  Snug swaddling reduces awakenings caused by the startle reflex and increases the length of sleep. Swaddling also helps babies fall asleep. Swaddling should be done before your baby is put down in the crib. To swaddle your baby use the 3-step "burrito-wrap" technique. Start with your baby lying on the blanket with the arms at the sides. Then (1) pull the left side of the blanket over the body and tuck it in, (2) pull the bottom up, and (3) pull the right side over and tuck. It is a useful technique from birth to 4 or 6 months of age. For more details, see Dr. Harvey Karp's book: The Happiest Baby on the Block.

• Try different techniques to calm your baby.

  If your baby is tired but irritable, try holding and gentle rocking to calm her. If that does not work, try swaddling her. For babies, swaddling is the next best thing to being hugged. Try humming, singing lullabies, or using white noise. Try massage or patting. Different babies respond to different calming techniques.

• Do not use a pacifier to help your baby fall asleep.

  While it is OK to use a pacifier to calm a crying infant if holding does not work, do not use a pacifier when your child is drowsy. Your infant will not be able to find and reinsert the pacifier until at least 10 months of age. If the baby cannot find the pacifier, he will cry and you will need to be there to help him find the pacifier again.

• Do not feed newborns more often than every 2 hours during the day.

  More frequent daytime feedings (such as hourly) lead to frequent awakenings for small feedings at night (exception: the first week when breast milk is still coming in). Feeding when your baby cries is okay, but only if your baby is hungry. Crying is the only way that newborns have to communicate. Crying does not always mean your baby is hungry. He may be tired, bored, lonely, or too hot. Hold your baby at these times or put him down to sleep. Don't let feeding become comfort nursing. For every time you nurse your baby, there should be 4 or 5 times that you snuggle your baby without nursing. Don't let him get into the bad habit of nursing every time you hold him (called grazing).

• Give the last feeding at your bedtime (10 or 11 PM).

  Try to keep your baby awake for the 2 hours before this last feeding. Going to bed at the same time every night helps your baby develop good sleeping habits. Look after your sleep needs by sleeping when your baby sleeps.

• Do not let your baby sleep for more than 3 hours in a row during the day.

  Try to awaken her gently and entertain her during the day. Doing this helps your infant sleep longer during the night. (Note: Many newborns can sleep 5 hours in a row every 24 hours. You can teach your newborn to sleep for this longer period at night.)

• Don't let your baby sleep in your bed.

  Once your baby is used to sleeping in your bed, a move to her own bed will be very difficult. Teach your child to prefer her crib. The risk of sudden infant death during the first 8 months is higher for babies who sleep in an adult bed than for babies who sleep in a crib. For the first 2 or 3 months, you can keep your baby in a crib or bassinet next to your bed.

1 Month-Old Babies

• Learn to recognize the signs of drowsiness.

  These include droopy eyelids, tired eyes not interested in the surroundings, yawning, decreased body movement, decreased facial expression, and quietness. When you see these signs, put your baby in the crib. If you miss these signs and your baby gets overtired, he may become irritable and harder to put down. If your child has been awake longer than 2 hours, assume he needs some sleep.

• Place your baby in the crib when he is drowsy but partially awake.

  This step is very important. Your baby's last waking memory should be of the crib, not of being held or of being fed. He must learn to go to sleep without you. Don't expect him to go to sleep as soon as you lay him down. It often takes 10 to 20 minutes of restlessness and fussiness for a baby to go to sleep. If he is crying, hold him and try to calm him. But when he settles down, try to place him in the crib before he falls asleep. Handle naps in the same way. This is how your child will learn to put himself back to sleep after normal awakenings during the night.

• Comfort your baby for all crying, but not for normal fussiness.

  All new babies cry some during the day and night. Always respond to a crying baby. Babies can't be spoiled during the first 6 months of life. But by 1 month of age, hold your baby just for crying, not for normal fussiness. Soothe him until he's calm, not until he's asleep. (Note: Even colicky babies have a few times each day when they are drowsy and not crying. On these occasions, place your child in the crib and let him learn to comfort himself and put himself to sleep).

• Make middle-of-the-night feedings brief and boring.

  You want your baby to think of nighttime as a special time for sleeping. When he wakes up at night for feedings, don't turn on the lights, talk to him, or rock him. Feed him quickly and quietly in the dark. Provide extra rocking and playtime during the day. This approach will lead to longer periods of sleep at night. Normal levels of background noise may keep him from oversleeping during the day. During the day don't make the baby's bedroom too quiet or dark.

2-Month-Old Babies

• Move your baby's crib to a separate room.

  Between 2 and 3 months of age, your baby should be sleeping in a separate room. This will help parents who are light sleepers sleep better. Also, your baby may forget that her parents are available if she can't see them when she awakens. Also close the bedroom door so your child gets used to sleeping that way. If separate rooms are impractical, at least put up a screen or cover the crib railing with a blanket so that your baby cannot see your bed.

• Try to stretch daytime feedings to 3 hours apart.

  Over the next 2 months gradually lengthen the time between daytime feedings. Going without feeding for 3 hours at a time during the day increases the chances that your infant will sleep through the night. Going more than 3 hours between feedings during the day may leave your child more hungry during the night. During the day offer a feeding if 4 hours pass and your infant has not given any signals of being hungry.

• Try to delay middle-of-the-night feedings.

  By now, your baby should be down to 1 feeding during the night (2 for some breast-fed babies). Before preparing a bottle, try holding your baby briefly to see if that will satisfy her. Never awaken your baby at night for a feeding except at your bedtime.

4- to 6-Month-Old Babies

• Try to discontinue the last middle-of-the-night feeding before it becomes a habit.

  By 4 months of age, your bottle-fed baby does not need to be fed formula more than 4 times a day. Breast-fed babies do not need more than 5 or 6 nursing sessions a day. If you do not eliminate the night feedings by 6 months of age, they will become more difficult to stop as your child gets older. Remember to give the last feeding at 10 or 11 PM. If your child cries during the night, try to comfort him with a back rub and some soothing words instead of with a feeding.

• Do not let your baby hold his bottle or take it to bed with him.

  Babies should think that the bottle belongs to the parents. A bottle in bed leads to middle-of-the-night crying for refills when your baby reaches for the bottle and finds it empty or on the floor.

• Make any middle-of-the-night contacts brief and boring.

  All children wake up 4 or 5 times each night. They need to learn how to go back to sleep on their own at these times. If your baby cries for more than a few minutes, visit her but don't turn on the light, play with her, or take her out of his crib. Comfort her with a few soothing words and stay for less than 1 minute. If the crying continues for more than 10 minutes, calm her and stay in the room until she goes to sleep. (Exceptions: You feel your baby is sick, hungry, or afraid.)