Infant sleep problems:
A troubleshooting guide
© 2017 Gwen Dewar, Ph.D., all rights reserved
Are you struggling with infant sleep problems? Baby sleep is
different than adult sleep. A lot of the stuff that drives us crazy is
developmentally normal behavior.
For example, newborns need to feed frequently (8-12 times
every 24 hours), and the transition to longer, consolidated bouts of sleep is
In general, we shouldn't expect babies to sleep for more than 4-5
hours at a stretch until they are at least 3 months old.
But that doesn't mean we can't improve things. On the
contrary, there's a lot we can do.
Might your baby's sleep troubles be caused by
a medical condition? That's possible, so you might want to review these common
infant medical problems that interfere with sleep.
But in this article we'll focus on
other culprits -- the everyday stumbling blocks on the path to easier, more restful
Here is a list of ten things that might be going wrong, and what you
can do about them.
At the end, I talk about that controversy that every new parent faces -- the "cry it out" controversy -- and then I sum things up with a checklist of good practices for avoiding infant sleep problems.
1. Not drowsy at bedtime? It might be because your baby's internal clock is out of sync with the 24-hour day.
First things first: Does your baby appreciate that nighttime
is for sleeping? If not, you're fighting an uphill battle.
Most infants don't
develop strong, hormonally-driven circadian rhythms until they are 12 weeks
old, and some babies take considerably longer (Jenni and Carskadon 2005; Jenni
et al 2006).
You might assume that this is one of those developmental things we
just have to wait out. But that's not quite true. The evidence suggests we have
help young babies attune themselves faster. If we lay the right groundwork early on, we may avoid some infant sleep problems later on.
Be sure to try these tactics:
- Support your baby's tendencies to wake up at the same time each morning, and expose your baby to daylight during the morning and
- Include your baby in everyday activities. The hustle and bustle of social life helps set your baby's inner clock.
- Avoid exposure to artificial lights before and during bedtime --
particularly LED lights and other light sources that feature light from the
blue part of the spectrum.
Experiments show that blue light is particularly
effective at blocking the brain's production of melatonin, a hormone that
promotes sleepiness. A little exposure to blue light can delay sleepiness for
an hour or more. And it affects adults as well as children!
You can read more about artificial lighting -- and how to cope with it -- in this article about the effects of light-emitting entertainments and devices. Tackling blue light exposure can improve the sleep of everyone in your family, so it's worth taking seriously.
more tips, see "How to help baby adapt to the 24-hour day" in my article
about newborn sleep.
2. Will your baby sleep when he or she is hungry? Probably not.
This is one reason why newborns sleep in short bouts. They get hungry!
What can we do about it? Not much, not when our babies are very young. They need frequent feedings in order to grow and thrive.
But you can probably improve your own ability to sleep with smart timing.
Dream feeding is a technique in which you provide your baby with a big meal immediately before you attempt to fall asleep for yourself. The idea to help your baby "tank up," so your baby (and you) will sleep longer. For tips on this practice, read more here.
Another tactic is to introduce brief delays before beginning those middle-of-the-night feeds. For example, instead of feeding your baby immediately, you might change your baby's diaper first. As babies get older, this might help them break the association between night wakings -- which all babies experience -- and feeding.
Do these tactics work? One experimental study suggests they do.
Researchers recruited 26 families, and assigned half the parents to offer their babies a big meal between
10pm and midnight. They were also told to avoid feeding babies immediately after they
woke up during the night.
In addition, parents were instructed to expose
their babies to strong cues about the natural, 24 hour day.
The intervention appeared to be very successful. Eight weeks
after training began, 13 out of 13 infants in the treatment group were sleeping
quietly from midnight to 5am (Pinilla and Birch 1993). Only 3 out of 13 control
infants were doing so.
It sounds promising, but keep in mind: This is a small study that needs replication.
Moreover, the study design doesn't permit us to
tell which of the interventions were important, and we don’t know if the effect
was long-lasting. It's also unclear if going 5 hours without feeding is in the
best interest of every 8-week old infant.
But as long as your baby is getting
enough food and fluids -- and your pediatrician approves -- these tactics are
worth trying. For more information about nursing young babies, see this article
about feeding infants on cue.
And if you are interested in trying out dream feeding, check out this evidence-based guide.
3. Do you know how to calm your baby before bedtime?
Research suggests that some parents make the hour leading up to bedtime too exciting, and this could make it harder for babies to nod off.
Rambunctious play and energetic talk can rev up your baby's sympathetic nervous system—the system
in charge of keeping him or her alert.
In addition, research suggests that screen time could cause trouble. In a recent survey of 715 British parents, researchers found that babies who spent time playing with touch screens (on phones and other devices) took longer to fall asleep at night.
These babies also had shorter nocturnal sleep times. For every additional hour that an infant used touch screens, the infant was likely to sleep 26 minutes less at night (Cheung et al 2017).
So researchers recommend that parents make the last 2-3 hours
before bedtime quiet and calm (e.g., Glaze 2004).
But exciting interpersonal activities aren't the only sources of trouble. In a recent survey of
715 British parents, researchers found that babies who spent time playing with
touch screens (on phones and other devices) took longer to fall asleep at night.
These babies also had shorter nocturnal
sleep times. For every additional hour that an infant used touch screens, the infant was likely to sleep 26 minutes less at night (Cheung et al 2017).
researchers didn't collect information about when babies used touch screens, and can't say for sure if touch
screen use contributes to infant sleep problems.
But the blue light emitted by
tablets and other electronic devices is known to delay drowsiness. So it's
plausible that this blue light, and the stimulating nature of media content, are to blame.
What should we do?
It makes sense to be cautious about screen time. It's also a good idea to avoid excitement in the evening (e.g., Glaze 2004), and to consider introducing a soothing bedtime routine (see below).
4. Is irregular timing -- or a lack of routine -- is making it harder for your baby to settle down?
Young children may sleep longer at night when they observe regular bedtimes (Staples et al 2015).
Research also suggests that children fall asleep faster, and spend less time awake at night, when their parents implement a consistent bedtime routine at night -- like bathing, quietly dressing for bed, and reading a bedtime story (Mindell et al 2015).
So if you're struggling with infant sleep problems, it's worth introducing a bedtime routine. Indeed, in one experimental study, parents improved infant sleep problems after introducing bedtime routines (Mindell et al 2009).
But are regular bedtimes really necessary to avoid sleep trouble?
Cross-cultural studies suggest otherwise. In many parts of the world bedtimes are fluid
or irregular, and babies go to sleep without fanfare (e.g., Morelli et al 1992; Ottaviano et al 1996).
the norm among hunter-gatherer societies -- the peoples whose life-ways most
closely resemble those of our ancestors. And hunter-gatherers are remarkable for their
lack of sleep complaints (Yetish et al 2015; Samson et al 2017).
It's evident, then, that there is more than one way to achieve healthy sleep patterns. But before you conclude that anything goes, keep in mind these crucial points.
First, irregular bedtimes can cause trouble if they lead to irregular morning wake-up times.
If you wake up at different times each morning, it can disrupt your circadian rhythms. Maybe that's why anthropologists have observed morning regularity among hunter-gatherers: They tend to get up at the same time each morning regardless of when they fell asleep the night before (Yetish et al 2015).
Second, babies might get less sleep at night -- a deficit they'll need to make up during the day.
This isn't perceived as a problem in many traditional societies, where babies are expected to take short daytime naps while being carried in a sling. Parents, too, may sometimes take naps to compensate for a short night's sleep (Worthman and Melby 2002; Samson et al 2017).
But you? If your schedule doesn't permit this flexibility, irregular bedtimes could leave you short-changed.
So it really isn't anything goes. Babies and adults alike benefit from waking up at the same time each morning, so that's something to aim for. And when irregular bedtimes lead to shorter nighttime sleep bouts, be prepared to make up for lost sleep during the day.
5. Is your baby's bedtime is too early? Or too late?
When should babies go to bed? It can be hard to figure out.
Some parents overestimate infant sleep requirements, or try to force bedtime on
an infant that isn't sleepy.
That's bad for a couple of reasons. In the
short-term, the baby resists bedtime, and everyone is unhappy. In the
long-term, your child is learning to associate bedtime with the failure to fall
asleep. It could be a recipe for developing bedtime resistance and insomnia
(LeBourgeois et al 2013).
Other parents keep their babies awake too long, making their babies irritable.
It can be an easy mistake to make, especially if your baby seems very active and energetic. Isn't that proof that your baby isn't yet ready for sleep?
Maybe, but there is another possibility: Your baby might be hyper-reactive or "overtired." If so, you're baby's behavior is deceptive: He's not alert because he's well-rested. He's alert because his stress response system is stuck on high gear.
What to do? If you're uncertain, review these signs of
infant tiredness, and consult this article about the range of sleep times observed in normal,
healthy babies. It will help you home in on your baby's needs.
Then, if you suspect your baby's bedtime is too early, try these gentle
infant sleep training solutions. They are safe to use, and don't involve any "cry it out" tactics.
If overtiredness is the
problem, pick an earlier bedtime, and help your baby wind down by introducing
some soothing, low-key bedtime rituals. For tips, see this article about
solving bedtime problems.
6. Are you too quick to intervene when you think your baby has awakened?
Babies sometimes make noises--and
may even cry out--when they are still asleep or only partially aroused. In other words, babies are "sleep talkers."
So it's easy for newbies to make a crucial mistake -- assuming that a baby is awake and signalling for attention when she's really just sleeping in a fitful, noisy way.
If you intervene under these conditions -- touch and talk to your baby -- you may be doing the very thing you most want to avoid: Waking up a sleeping infant!
That's one reason to be cautious before interacting with your baby. And here's another:
Video recordings of sleeping infants reveal that
babies as young as 5 weeks can spontaneously resettle themselves after waking up
in the middle of the night (St. James Roberts et al 2015).
During the study in question, babies sometimes went back to sleep quietly. In other cases, the infants cried or
fussed briefly (for about one minute) before going back to sleep on their own
(St. James Roberts et al 2015).
But either way, these babies fell back to sleep on
their own, without coaching or marked distress. That's the sort of thing you
want to promote.
So intervening too soon can backfire. You think you are being
proactive, responding quickly so your baby will be able to go back to sleep
quickly. But instead you are awakening a sleeping baby, or interfering with a
drowsy baby who was about to nod off. Ouch.
To avoid becoming the cause of infant sleep problems, don't jump in at the first signs of movement
7. Are you making those middle-of-the-night care sessions too interesting?
We've seen how too much stimulation can cause trouble at bedtime. Parents can also cause infant sleep problems by creating too much excitement after a baby has awakened during the night.
Babies are social creatures, and are easily stimulated by talk
and other forms of communication.
So if you want your baby to go back to sleep
quickly, avoid engaging him or her in conversation or play. As you tend to
your baby's nighttime needs, keep things comforting, but dull and quiet. And
don't forget to avoid those artificial lights. Keep things as dark as
8. Are you being inconsistent in the way you respond to your baby?
It's easy to get off-track when you are frustrated or tired.
Sometimes you might use overly-stimulating soothing techniques. Other times --
when it seems that nothing works -- you might withdraw from your baby altogether
(France and Blampied 1999). It's human nature, but it's confusing for the baby,
and it can make infant sleep problems worse.
To help avoid this scenario, take the time to create a
single, consistent approach to your infant sleep problems.
Research the science of infant sleep patterns, and
decide what approach is best for you and your baby.
Thinking things through
ahead of time will help you stick to the plan, and may have additional
psychological benefits for you.
Parenting studies suggest that getting informed
can boost your sense of competence and confidence, and protect you from
feelings of frustration and despair (Heerman et al 2017).
9. Is your baby is napping too late in the afternoon?
Sleep pressure (the physiological urge to sleep) builds up
the longer we've been awake. So it shouldn't surprise us if a baby -- having awakened
from a long nap only a couple of hours earlier -- has trouble falling asleep at
If this seems to be the trouble, try extending the last waking period
of your baby's day.
That may seem hard to do if you've got a drowsy baby at
5pm; but remember, you don't have to arrive at the perfect schedule all at once.
You can work towards the goal in steps, trying to make the last nap of the day
end at an increasingly earlier time over the course of a week or so.
parents have managed to lengthen waking time before bedtime, their babies have
required less help settling down and experienced fewer infant sleep problems (Skuladottir et al 2005).
10. Does your baby know how to self-soothe?
Sleep science has proven the point: Everybody wakes up
during the night, and we do it quite frequently, even if we don't remember
these wakings the next day.
So eliminating night wakings isn't a realistic goal. Rather,
we should focus on making night wakings less
As mentioned above, research shows that babies sometimes
resettle themselves without becoming stressed or waking up other people. What
can we do to promote this behavior?
One crucial tactic, noted in #4, is to stop undermining
these spontaneous acts of re-settling. Don't jump in prematurely. Your baby
might actually be asleep, or on the verge of falling back to sleep on his or
her own. By intervening too soon, you can create infant sleep problems.
But can we go further?
In some Western countries parents are advised to
avoid soothing their babies to sleep.
For instance, Richard Ferber argues that
parental soothing trains babies to associate sleep with parental intervention
(Ferber 2006). As a result, children don't develop their own, self-soothing
abilities. When babies wake up during the night (and all babies do), they cry
until their parents come to their aid.
The remedy, according to this argument is to follow certain
rules. Don't let the baby fall asleep in
your arms. Instead, at bedtime, put your baby to bed before he or she has
What does the research tell us? When babies fall asleep at
the breast--or are put to bed after they have fallen asleep--babies are less
likely to soothe themselves back to sleep when they awaken again during the
night (e.g., Anders 1979; Anders et al 1992; Ferber 1986; Goodlin-Jones et al
In addition, researchers have found that parents who feed, hold, or rock
their babies to sleep tend to report more night wakings (Anuntaseree et al
2008; Mindell et al 2010).
That sounds like evidence in support of reduced parental
soothing at bedtime. But there's an obvious complication:
Babies often cry or protest when caregivers withdraw.
It's a natural
behavior. Throughout human history, babies have stayed in close proximity to
their caregivers. Being left alone meant something was wrong. A baby was at
risk for neglect, abandonment, or predation (Hrdy 1999).
So it's little wonder
that our ancestors evolved emotional and behavioral responses to separation --
responses that would help ensure that babies stayed close (Panksepp 1998).
What, then, should we do when babies cry?
Ferber has proposed his own solution, which is to leave the
baby alone for increasingly lengthy intervals, ignoring cries, until the infant
learns to give up (Ferber 2006).
It's not intended for very young babies.
Researchers warn that such sleep training should not be attempted until infants are at
least 6 months old (Owens et al 1999; France and Blampied 1999).
Moreover, the American
Academy of Pediatrics recommends that parents share a bedroom with their babies
for at least six months after birth because it may lower the risk of SIDS and "facilitate…comfort
and monitoring of the infant" (Moon et al 2016).
But when it comes to making nighttime less disruptive, this
method -- called "graduated extinction" -- has a successful track
record. Babies become less likely to cry in the middle of the night when they
awaken. Parents report fewer infant sleep problems.
This can be a relief to desperate parents. But
many people reject the approach. It's stressful to implement, and critics worry
about the possible effects of enforcing its central features -- (1) babies left
alone, unable to perceive the immediate presence of caregivers, and (2) parents
acting as if they are insensitive to the baby's distress.
Major media headlines
to the contrary, studies haven't yet supplied us with strong evidence about
Do "cry it out" tactics cause problems?
One highly-publicized study tested the
long-term effects of sleep training on more than 170 babies, but did so by lumping together several
different training strategies, including a program that didn't involve leaving infants alone (Price et al 2012).
Thus, we can't know if families who used
graduated extinction experienced different outcomes than families who used
other methods -- like those that kept babies and parents together in the same
In addition, this study failed to determine if parents in the control
group attempted sleep training. This, too, is crucial, because it means we
can't draw conclusions about a failure to detect differences between groups.
Maybe outcomes were similar because treatments were similar: Babies in both
groups were exposed to a mixed bag of sleep training techniques.
A more recent study presents similar interpretative
problems (Grandisar et al 2016). The researchers took the helpful step of distinguishing between graduated extinction and other types of sleep training.
But they didn't measure what parents assigned to
the control condition did with their babies. Nor did they keep track of where
babies slept with respect to their parents -- alone or in a shared room.
Moreover, this was a much smaller study, and one marked by substantial amounts of missing data, as well as some discrepancies in the published numbers.
For example, at one time point during the study, almost half the families failed to participate. Researchers filled in the missing data with their own estimates (Grandisar, personal communication).
And it's interesting to reflect on results that the popular press
The researchers tested for attachment security at the
end of the study, and found that only 7 out of 13 (54%) of "graduated
extinction" babies were scored as
securely attached to their parents. By contrast, babies in the control
group fared a bit better: 5 out of 8 babies (62%) were scored as
We can't draw any conclusions from this difference.
The sample sizes are too small, and six families chose not to
participate in this final test, which may have biased the results.
instance, what if having a securely-attached baby made parents more
inclined to participate? Or less inclined? But it underscores the
difficulty in making inferences from small studies with missing data.
So as I write this in May 2017, we're still a long way from
settling questions about the effects of graduated extinction, especially
for parents concerned about leaving babies alone and unable to perceive
presence of caregivers.
And that's important because there are other approaches
of sleep training that don't involve leaving babies alone, and these approaches
have similarly successful track records.
Furthermore, scientific surveys indicate that babies don't
have to sleep in their own rooms to develop quieter sleep habits.
like Hong Kong, babies and children often share a room with others. In many cases, they share a bed with a
parent. But researchers have found no links between sleep location and night
wakings (Yu et al 2017).
It appears to be the use of active soothing measures
-- like feeding or rocking a baby to sleep -- that is linked with trouble. Not necessarily
So if you want to encourage your baby to self-soothe, it's
worth taking a look at these sleep training alternatives to graduated
And keep in mind the work of Douglas Teti, who has found that one
of the most important predictors of infant sleep problems is whether or not parents
are emotionally available at bedtime -- responding with sensitivity to a baby's
needs, and projecting a calm, reassuring mood (Teti et al 2010).
whatever else you might do, and whatever sleep arrangements you adopt,
maintaining emotional availability at bedtime can help your baby settle down.
Putting it all together: A checklist for coping with infant sleep problems
- Establish regular day-time cues. Make sure your baby is
exposed to natural daylight and daytime activity. Include baby in the daily
hustle and bustle.
- Establish regular night-time cues. As bedtime approaches,
shift down from stimulating activities to more passive, sleepy, sedate
activities. Dim the lights. And consider introducing special bedtime rituals, like
reading bedtime stories or singing lullabies.
- Tank up before bedtime. As noted above, babies may sleep for
longer stretches at night if you feed them shortly before bedtime.
- Keep your nighttime interactions calm and low-key. Be responsive, but boring. Avoid making noise, avoid moving your baby around, and avoid eye contact. Some infant sleep problems are caused by parents making too much of a fuss.
- Watch out for intervening too quickly when you think your baby has awakened. You might end up awakening a sleeping baby, or preventing your baby from falling back to sleep spontaneously.
If your baby is over 6 months old, consider these gentle sleep training programs. Because they
don’t require babies to fall asleep alone, they minimize distress for both
parents and infants.
If you're worried about a possible medical problem, or
something just doesn't seem right, talk to your doctor. Most infant sleep
problems aren't caused by medical conditions, but some are. Read more about it
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World J Pediatr. 2017 Mar 22. (epub ahead of print)
this text are derived from an earlier (2008) Parenting Science
article with the same title, "Infant sleep problems: an evidence-based guide."
Image credits for infant sleep problems
The following images are protected by this creative commons license, and should be attributed to the creators listed:
Image of sunset by fdecomite / flickr
Image of baby with tablet by Humbolthead / flickr
Image of baby staring at viewer by Jim Champion / flickr
Image of baby gazing out window by Nana B. Agyel / flickr
Image of baby sleeping in the sunlight by shawn / flickr
Montage of baby-wearing - historical images and Hadza photograph by Idobi
Father soothing infant by Andres Nieto Porras / wikimedia