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 gradual.
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 nights. Here is a list of ten things that might be going wrong, and what you can do about them.
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.
So support your baby's tendency to awaken at roughly the same time each morning, and expose him or her to daylight during the morning and afternoon. In addition, include your baby in everyday activities. The hustle and bustle of social life helps set your baby's inner clock.
And 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.
For more tips, see "How to help baby adapt to the 24-hour day" in my article about newborn sleep.
If your baby is very young, there may be little you can do about the timing of feedings. Newborns need to feed frequently. However, if you feed your baby shortly before your own bedtime, you might give yourself more uninterrupted sleep time, and encourage your baby to sleep longer at night (Pinilla and Birch 1993).
The evidence comes from an experimental study of 26 breastfed newborns. Half the parents were instructed to offer babies a big meal between 10pm and midnight. They were also told to avoid feeding babies immediately after they woke up during the night. For instance, instead of feeding first, a parent might change the baby's diapers. 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.
Some infant sleep problems are caused by adults who make life a little too exciting before bedtime. Rambunctious play? Animated verbal interactions? These can rev up your baby's sympathetic nervous system—the system in charge of keeping him or her alert. 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. They also had shorter nocturnal sleep times. Every additional hour that a baby used touch screens was associated with about 26 minutes less sleep during the night (Cheung et al 2017).
The 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.
This is crucial to know: Babies sometimes make noises--and may even cry out--when they are still asleep or only partially aroused. Babies are "sleep talkers."
Furthermore, video studies 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). Sometimes the babies in this study 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). 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
This is the flip side of being too interesting before 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 possible.
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).
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 might be fooled by babies that seem active and energetic. If they won't settle down, isn't that proof that they don't need to sleep yet? Possibly, but they could also be hyper-reactive -- strung out or "overtired." Their stress response systems may be stuck on "high," overriding the physiological responses that would ordinarily allow them to become drowsy.
What to do? If you're uncertain, review these signs of infant tiredness, and read about range of sleep times observed in normal, healthy babies. If you suspect your baby's bedtime is too early, try the gentle infant sleep training programs described below. If overtiredness is the problem, pick an earlier bedtime, and help your baby wind down by introducing some soothing, low-key bedtime rituals. For more tips, see this article about solving bedtime problems.
You've heard the advice that children should go to bed at the same time each night. You've also heard that it's important to observe a bedtime routine, a habitual sequence of activities that comfort children and wind them down for bed.
Are these things really necessary to avoid infant sleep problems? Evidently not, because in many parts of the world bedtimes are fluid or irregular, and babies go to bed without fanfare (e.g., Morelli et al 1992; Ottaviano et al 1996). Indeed, it's 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 appears you can lead a healthy life without observing regular bedtimes or reading bedtime stories.
But we should keep a couple of things in mind.
First, while hunter-gathers tend to vary their bedtimes over the course of a week, they are very consistent about when they wake up in the morning (Yetish et al 2015). This is important, because waking up at roughly the same time each day helps keep the body's circadian rhythms attuned.
Second, people in these societies can make up for a shortened night's sleep by napping (Worthman and Melby 2002; Samson et al 2017).
So if your baby's irregular bedtimes are leading to
irregular mornings -- waking up at different times each day --
this could cause
infant sleep problems (see #1). And if your baby isn't getting the
chance to catch up on lost sleep, irregular bedtimes could cause
behavior problems (Kelly et al 2013).
What about bedtime routines? If they aren't necessary, are they at least helpful? Experimental studies suggest they can be. Parents have improved infant sleep problems by leading babies through the same sequence of calming activities each night (Mindell et al 2009). And a large international survey has reported links between bedtime routines and nighttime behavior: According to parents, babies who experienced consistent routines fell asleep faster. They also spent less time awake in the middle of the night (Mindell et al 2015).
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 bedtime. 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. When 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).
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 disruptive. 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 fallen asleep.
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 2001). 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 these concerns.
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 room.
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 largely ignored. 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 securely attached.
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. For
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. In places 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 parental presence.
So if you want to encourage your baby to self-soothe, it's worth taking a look at these sleep training alternatives to graduated extinction. 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). Regardless of whatever else you might do, and whatever sleep arrangements you adopt, maintaining emotional availability at bedtime can help your baby settle down.
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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