SLEEP AND ROUTINE FOR NEW BABIES, by Alison Scott-Wright
Sleep, or the lack of it, is probably the most widely written about and discussed topic within the entire range of baby care issues.
“How do I get my baby to sleep through the night?” is the most commonly asked question and sought after solution amongst all those who are preparing for or have reached parenthood.
It is essential for a baby’s cognitive and physical development to get enough rest and without the right amount of sleep a baby may easily become irritable, fretful, and fractious and be difficult to feed.
During adult sleep restorative functions occur as the mind and body are given the chance to rest. The same applies to babies, but they also actually grow and develop whilst they are asleep and it is during this restful period that the majority of actual brain development takes place. In fact much research indicates that early brain development, learning, and memory are all supported by good sleep nutrition, while sleep deprivation has been linked to behavioural and emotional problems as babies grow up.
It is vitally important to encourage babies to develop positive associations to bedtime and sleep. This can easily be achieved within the first few weeks by following the flexible but structured, daytime feeding / sleeping plan that establishes a good bedtime routine as described in detail in my book The Sensational Baby Sleep Plan.
The amount of sleep an adult needs is variable and changes from one developmental stage to another. Research shows the average amount of sleep an adult needs each night is around 7.5 to 8 hours of unbroken, good quality sleep. When a new baby arrives, the parents’ sleep is inevitably disrupted and it is estimated that 200 hours of sleep can be lost during their child’s first year. Long-term sleep deprivation can have far reaching effects on both our physical, mental and emotional well-being and some of the symptoms are listed below.
- An increase in digestive disorders.
- An increase in cardiovascular problems.
- Slower reactions and physical reflexes, loss of concentration.
- Difficulty with sight and problems focusing.
- Heightened sensitivity to pain.
- Mood swings and emotional upsets.
- Increased irritability and lack of patience.
- Inability to stay alert and vigilant.
- Headaches and migraines.
- Increased risk of suffering from depression and anxiety disorders
Looking at that list it is a wonder that anyone who suffers from any of the symptoms of sleep deprivation can ever manage to look after themselves – let alone a new baby!!
Very few people realise that babies can actually suffer from sleep deprivation too and it is estimated that half of all infants are getting less sleep than they should – usually falling short by at least two hours per 24-hour period. According to the ‘Sleep in America Poll’ annually carried out by the National Sleep Foundation task force, the rate of childhood sleep deprivation has increased in recent years and is on the increase.
This comes as no surprise to me as I have encountered first-hand the increasing numbers of parents who are seeking my help to get their babies sleeping through the night. They often contact me at the point of sheer exhaustion and complete desperation after months or even years of little or no sleep, as their babies continually wake throughout the night.
There is not much individual variation in the daily amount of sleep that a baby needs and generally, this will be 17 to 18 hours per 24 at one-week old, around 16 at week 8 then very gradually lessening over the months as the baby develops until at 12 months most will need14 to 15 hours in every 24.
A full-term, average weight baby at four weeks should be able to sleep for an unbroken 6 to 8 hour period and by eight weeks is actually capable of achieving a full 12 hours!
Establishing a simple feeding and sleeping structure within the first few weeks of life is key to encouraging good sleep patterns. All babies learn by association, therefore, it is very important that from day one they learn the right sleep associations, and to quickly differentiate between night and day.
When a baby is first born they are usually ‘nocturnal’. In the womb the motion of the mother’s movements throughout the day tend to ‘rock’ baby to sleep, whereas when she goes to bed and stretches out, the baby has more room to be active and no motion to sleep to.
It is therefore vital that in the early weeks after birth, the baby’s sleep patterns are re-educated to coincide with our normal day / night routines.
This can be done by following these simple rules;
- Ensure the nursery is as dark as possible throughout the night
- When giving night feeds, keep the lights as low as possible, try not to over-stimulate the baby and settle him back down with the minimum of fuss.
- Open the curtains to let in the morning light at the start of each day.
- In the morning wash and dress the baby, changing him into ‘day clothes’.
- Put a good bath and bedtime routine in place and stick to it most evenings.
- Ensure that the baby has a good daytime routine with a balanced amount of daytime sleeps, play, love, stimulation and inter-action.
- Ensure baby follows a structured but flexible feeding pattern to ensure enough milk is taken during the day.
- Never wake a sleeping baby at night unless there is a medical reason to do so.
Small babies spend a great deal of their waking time feeding and in order to avoid excessive night feeding it is important to structure and establish a good day time feeding pattern.
– Generally a newborn should only stay awake for about an hour at a time and then need to sleep for two.
– A baby’s system, takes 2 to 3 hours for digestion and gastric emptying after a full feed.
Based on these two facts, establishing a 3-hourly daily feeding routine in the early weeks, meets all their essential feeding requirements whilst also supporting the baby’s naturally developing sleep patterns.
It helps to mentally split each 24 hour period into 12 hours of daytime and 12 hours of night. For simplicity, use the timing of 7am to 7pm, although it is not necessarily about ‘clock-watching’ but just trying to split day and night and make sure to fit in the 5 daytime feeds. These feeds can be guided by the times of 7am, 10am, 1pm, 4pm and 7pm with feeds after that being classed as night-time feeds.
Up to three months of age, babies should be fed on this three-hourly routine at which point they should be sleeping the unbroken 12 hour night and can then sustain dropping to four-hourly feeds during the day.
Once the baby has been put to bed after the 7 p.m. feed he does not need to be woken for any night-time feeds. The baby should be left to sleep which will allow his own sleep patterns to develop and he will then wake for a feed as necessary. In the very early weeks this can often be twice or even three times a night, but by weeks four to six baby should be naturally sleeping for longer unbroken periods and be down to just one or perhaps two night feeds, which by 8 to 12 weeks should have disappeared and the baby will naturally be sleeping through the night.
One problem that I believe to be the cause of many sleep problems in infants, is the so called ‘dream-feed’ advocated by many other sleep advisors. This is designed to meet the needs of the parents and NOT the baby as the idea is to wake a baby at ten or eleven in the evening and give a feed in the hope that the baby will then sleep through for a number of hours to coincide with the parents sleeping habits. However, the deepest and most rejuvenating sleep any of us have is the long, unbroken sleep soon after going to bed through to the early hours of the morning. We are in deeper sleep during the first half of our night than the second and this is true of babies too. Therefore, by waking them up after they went to sleep at say 7.30pm or 8pm and giving their body food it didn’t actually need, disturbs their developing sleep rhythms and wakes them from their deepest part of sleep. In the early weeks some babies accept being woken for this feed and do settle afterwards, through till morning, but all too often if that feed continues to be given past three months of age the sleep patterns can regress and the baby may start to wake every 2 to3 hours after the dream feed and expecting another. This is because waking the sleeping baby to give a feed teaches the baby’s system to rely on food during the night time hours when the body should be actually be at rest.
There are essentially two types of sleep, rapid eye movement sleep [REM or Active] and non-rapid eye movement sleep [Non REM or quiet].
Features of active sleep;
- Flickering eyelids
- Eyes partly or fully open
- Jerky, twitching limb movements
- Rapid, irregular breathing
- Changing facial expressions, frowning or smiling
Features of quiet sleep;
- No eye movement
- Eyelids remain closed
- Little or no movement of limbs
- Slower and regular breathing
- Generally relaxed and calm appearance
Active and quiet sleep is broken down into what are known as sleep cycles. In newborns the first sleep cycle is active sleep and will last for approximately 30 to 40 minutes at which point the baby may appear to wake and / or cry out and it may take a few minutes for him to settle himself back into his quiet sleep cycle. Lack of understanding of these sleep cycles often leads parents into unintentionally creating sleep problems, because as soon as they hear baby stir they will go to pick him up without first seeing if the baby was actually just in the middle of a sleep cycle and would have re-settled back to sleep if left for a little while.
Encouraging a baby to sleep through the night also relies on establishing a good daytime nap structure. An over-tired baby will take longer to settle at night and not sleep particularly well during the night – SLEEP BREEDS SLEEP! In fact, I have witnessed many babies who display ‘colicky’ symptoms in the evening, are in fact just completely exhausted and over-tired which creates a disinterest in feeding and an inability ‘switch off’ and fall asleep. Some babies described to me as ‘wired’, ‘just needs less sleep’, ‘hyper-active’ or ‘really alert’ are often suffering from sleep deprivation and as I then explain how to teach the baby to sleep, parents are utterly amazed not only at the transformation in their baby, but at how much their baby does then actually sleep!
Of course, the biggest problem that prevents some babies being able to settle into calm and restful sleep is Silent Reflux. Most people link Gastro-Oesophageal Reflux Disease to vomiting, weight loss and ‘failure to thrive’ but very few people understand Silent Reflux and do not realise that a baby can have reflux but not vomit. Where silent reflux is present, when a baby is lying down, refluxate material from the gut along with gastric acid refluxes up into the oesophagus causing extreme pain and ‘heartburn’ like symptoms. Undoubtedly this causes the baby to cry or scream, and also prevents him from being able to sleep. Even if they are able to settle the acid can fluctuate at any time during sleep and the pain will cause him to wake frequently throughout the night.
SLEEP FACT SHEET:
- It is essential for a baby’s cognitive and physical development to get enough rest and without the right amount of sleep a baby may easily become irritable, fretful, and fractious and be difficult to feed.
- Many babies actually suffer from sleep deprivation and it is estimated that half of all infants are getting less sleep than they should – usually falling short by at least two hours per 24-hour period.
- Sleep deprivation in babies has a negative impact on their emotional and physical development and, if not resolved, sleep disturbances that started in infancy can often continue into late childhood.
- Long-term sleep deprivation from infancy through to childhood is proven as a major contributing factor in many cases of ADHD.
- Full-term, healthy weight babies are capable of sleeping 12 hours through the night by 8 to 12 weeks of age without the need for night time feeds.
- Sleep breeds sleep and it is imperative to instigate a regular feeding and sleeping pattern during the day which will help promote better sleep at night.
- Never wake a sleeping baby at night unless there is a medical reason to do so.
- Refrain from using so called ‘sleep-aids’ such as dummies, music, mobiles, constant rocking, etc – these are not conducive to promoting independent sleep, in fact hinder sleep in the long-term.
- Whatever a baby associates with falling asleep such as a dummy or in being rocked, they will crave this ‘assistance’ when briefly waking throughout sleep cycles and be unable to self-settle back into sleep.
- Sleep deprivation is an internationally recognised form of torture and teaching a baby the art of independent sleep within the first few weeks is, in my opinion, one of the most important and necessary skills with which to equip them.
Alison Scott-Wright © The Magic Sleep Fairy ™