- Safe Sleeping
- Baby Sleep Patterns
- Tired signs
- Getting your baby to sleep
- Mimic the womb environment
- Night Waking
- Flattened Head Shape
There’s nothing more beautiful and calming than to watch your baby sleep. During the early weeks your baby devotes much of the day and night to sleep. But your baby could be at risk while in the land of nod.
Sudden Infant Death Syndrome (SIDS)
“SIDS and Kids Safe Sleeping is an evidence based health promotion campaign developed for health professionals, childcare workers, new and expectant mothers, parents and anyone who cares for babies and infants. Since its inception in the early 1990’s, the campaign has reduced the incidence of SIDS by 80% saving over 7500 babies lives”. http://www.sidsandkids.org/safe-sleeping/
According to the above SIDS website, your baby is at risk of getting into dangerous situations while sleeping. These include:
- Suffocating under bedding
- Choking or inhaling vomit
- Choking on toys or other small objects
- Getting caught between the cot-side and mattress
- Getting entangled in curtain cords, clothing, dummy ties and ribbon.
Your baby may get in these situations because they:
- Are unable to control the sleeping situation and environment
- Are unable to escape from dangers
- Unknowingly place things in their mouth or around their neck.
SIDS advice for safe sleeping strategies for your baby include:
- Their own cot is best. Putting your baby to sleep in a cot next to your bed is safest option.
- Meet Australian Standards. The cot or bassinette needs to meet the Australian Standard for Cots (AS/NZS 2172) and carry a safety standard approval sign. Be wary when buying a cot or bassinette second hand;
- Sleep your baby on their back from birth, with feet positioned at the end of the cot. As soon as your baby learns to roll from tummy to back you will feel more relaxed;
- The cot should remain flat and not propped. Make sure the mattress your little one sleeps on is firm enough to facilitate maximum circulation of air. Make sure there is no more than 20mm gap between the mattress and the cot sides and ends to prevent your baby becoming wedged in gaps between the mattress and the cot sides. A pillow, cushion or beanbag is not a safe mattress.
- Keep the cot free from all unsafe toys, pillows and loose sheeting and position near parents bed for the first six to twelve months;
- If you wrap or swaddle your baby, do not cover baby’s head or face. You can stop using a wrap when baby can roll from back to tummy and to back again.
- Baby sleeping bag. When baby is over four months old, you may decide to use a safe baby sleeping bag. The bag should be one with a fitted neck and arm holes with no hood. Additional blankets are then not necessary to use
- Ensure head and face remains uncovered during sleep and avoid the use of hoods, beanies, hats or bonnets;
- Only use enough bedding required for warmth; do not overheat Using a sleeping bag will prevent your baby’s face being covered. If you do use blankets it is best to use layers of lightweight blankets that can be easily added or removed according to room temperature. They should also be tucked underneath the mattress. Don’t leave any extra sheets in the cot for your little one to get entangled in. Loose blankets and sheets can restrict airflow and cause suffocation;
- Dummies should not be attached to your baby with ribbon and if the dummy falls out of the mouth during sleep, parents are advised not to reinsert it.
- Avoid exposing your baby to cigarette smoke before and after birth (this includes marijuana as well) and do not co-sleep with your baby if you smoke.
- Avoid Co-Sleeping ;if you smoke, are under the influence of drugs and /or alcohol; if you are overly tired, if there is adult bedding that may cover the baby; if there are other children and pets who are sharing the bed; if you are placing baby to sleep on a sofa, beanbag, waterbed or sagging mattress. If the baby could become trapped between the wall and the bed or fall out or be rolled on it is also advisable to not co-sleep. If your baby is premature, or less than 3 months of age or small when born then co-sleeping should also be avoided.
- Place cot away from hazardous materials. Ensure the cot is not under a window with blind cords within reach. Hanging toy mobiles must be well attached and out of reach. Do not have the cot near peeling paint.
- Height of the cot is same as your bed. When your baby’s cot and your bed are at the same height, it is more convenient;
- Pull up cot sides: Make sure the sides of the cot are pulled all the way up, so it prevents your baby from climbing up and out. It is time to change to a bed if your baby has worked out how to climb out.
Baby Sleep Patterns
Sleep occurs in cycles containing active (light sleep) and passive (deep sleep) phases. In the early days your baby may need encouragement to help them get to sleep and stay asleep. When your baby doesn’t get enough sleep, life can be challenging. Without enough sleep your baby may be:
- Throwing more tantrums with greater intensity;
- Less able to concentrate.
You can use our sample baby sleep routine as a guide for expected day and night sleep patterns. However, sleep is individual and is dependent on physical activity, general health and wellbeing and environmental factors. Therefore the required amount of sleep may vary from baby to baby and sleep to sleep. Be guided by your baby’s tired signs and behaviour.
Most newborns go through the light and deep sleep cycles and may also wake up for a short duration. During this time your baby may be grizzly or may also fidget as they go between the sleep cycles. These are not baby sleep problems – they are normal.
Baby sleep occurs in cycles of two phases – light or REM phase (the rapid eye movement phase) and the and deep phase.
The light phase is when your baby first falls asleep, and it can last a period of 10 to 20 minutes. During this time you may notice body movements, muscle twitches, and dreaming. This is not a sleep problem – it is normal active sleep.
The deep phase is quiet, deep and restful. It’s believed that this deep sleep is when we heal and grow. The depth of this sleep is important and may impact on whether your baby continues to sleep well and how they react when they’re awake – happy or crying. Newborn sleep is different to adult sleep as your baby’s brain is still developing.
Sleep cycles are significant and do change continually for each age group. These changes and sleep patterns are important to be aware of, especially during the first year of life. Newborns tend to sleep for about 2-4 hours at a time and then wake for short periods, often for a feed. It is during the early hours of the morning that your baby tends to wake more easily as they move through the sleep cycles. Most babies may need to be soothed to help them go back to sleep but as they get older they become better at getting back to sleep on their own. It is normal for your baby to wake – the issue that causes most baby sleep problems, is how to go back off to sleep.
Sleep cycles are age dependant and do vary between babies. In babies sleep cycles last about 30-50 minutes and gradually increase in length across childhood. Your baby may stir initially before getting into the deep sleep; this is a normal part of healthy sleeping.
Baby sleep problems can arise when your baby wakes and is unable to or not encouraged to go back to sleep. If your baby develops sleeping patterns of only sleeping for one cycle at a time, it is commonly described as cat napping or power napping. At 3-6 months of age your baby tends to move to a sleep cycle of 20 to 50 minutes long, compared with 90 minutes for adults. This means that babies are light sleepers and have more brief awakenings than adults. With age, the amount of active sleep decreases and by 3 years 33% of sleep is active.
Much like adults, babies may also find it difficult to go back to sleep after an active REM phase if they are stressed or have poorly established sleep patterns.
It can take roughly 15-20 minutes for a baby to fall asleep and may take longer if they are overtired. Before your baby falls asleep, there are often four stages they may pass through:
- The first stage of your newborn’s sleep pattern is crying or showing tired signs. This is one of the most important stages to identify and act on to promote the ease at which sleep occurs.
- The second stage of newborn sleep is the vacant stare. This can easily be identified but is often misread and regarded as your baby being wide eyed and awake. At this stage your baby is almost asleep.
- The third stage of newborn sleep is the drooping eyelids. Your baby often lets out a protest cry but will then stop. Your baby may need holding and comforting at this point or just a gentle rock in the cot.
- The fourth stage is a sleeping baby – your baby shuts their eyes and they stay shut.
There are many factors that contribute to your baby not developing good sleeping patterns. Be patient and calm and seek professional help if your baby won’t sleep – there can be a valid reason.
Recognising and acting on your baby’s tired cues can help them settle earlier and easier. When your baby won’t settle and becomes overtired, getting them to settle and fall asleep is often more difficult and may take longer than usual.
Learn to identify tired signs in your young baby:
- Facial grimacing
- Hiccoughs – not the only cause
- Wandering or cross-eyed – worse when tired
- Breaking eye contact
- Jerky limb movements
- Clenched fists
Learn to identify tired signs in your older baby:
- Rubbing eyes
- Whinges and whines
- Refuses to feed or eat
- Fussing at the breast
- Won’t play on their own
Once you have identified your baby’s tired signs and cues, help him settle and fall sleep. There are several things you can do to help your baby settle and sleep but it is important to understand that every baby may need different strategies and support – depends on personality, environment and comfort to name a few.
Getting Your Baby to Sleep
As a rough guide, for the first four months, most babies sleep for 2-4 hours at a time, waking up for a feed and then usually going back to sleep. When your baby is about 3 months the sleep pattern changes to a pattern of 2-3 daytime sleeps for up to two hours each and may still wake at night at least once. From 6 months your baby will usually sleep for a period of six hours or more at night and will wake less. Most babies are also still having daytime naps which may last for 1-2 hours. Your baby needs about 16 hours sleep a day as a newborn and by 12 months old they require 12 hours at night and may have a nap during the day.
You can help your baby to sleep well during the first few weeks by mimicking the womb environment and re-settling them back to sleep after one sleep cycle rather than getting them up.
There may be issues preventing your baby from sleeping well during the early weeks, the challenge is to find out what it is. If you have real concerns that your baby’s health may be affecting their sleep patterns you should talk to your doctor. If there has been something hindering your baby’s sleep patterns, it could be several months after you resolve the issue before your baby sleeps for long stretches. Don’t panic as your baby’s sleep will eventually improve, even if you have to help them a little when they are older.
Short sleeps are referred to as power naps or cat naps. Newborns usually doze off constantly in short bursts throughout the day and night. As your baby gets older, and until about 12 months, your baby may sleep from 2-4.5 hours during the day. Daytime sleeping decreases with age and naps during this time can vary from 1-4 per day lasting anywhere between 30 minutes and 2 hours.
At around six months your baby will develop new abilities that may affect their sleep. They are more stimulated by their surroundings and may find it difficult to shut off and go to sleep. Establishing a pre sleep routine where your baby can wind down will help – encourage calmer quieter play and looking at books just before bed.
Dark induces calmer sleep so avoid light in the bedroom and make sure you pull the blinds or cover the stroller during day time sleeps. Creating a dark room can help reduce the stimulation around your baby and may help with settling your baby for sleep. From about 3 months onwards props to help him settle to sleep such as rocking and stroller rides may now hinder settling and disrupt sleep. This is because if you constantly use these techniques to put your baby to sleep they will not learn to put themselves to sleep on their own. From around 8 months if your baby is using a dummy at night they can learn to manage it on their own. It can take 3-4 nights for babies to learn how to replace the dummy on their own but they will learn. The other option is giving up the dummy altogether and you can do this by slowly phasing out how often it is used.
Separation anxiety can also be extreme for some babies during this time, making it difficult for them to feel settled and be able to sleep.
As your baby increases their movements and activity, be aware their energy needs will increase. Consider increasing their milk and solid intake during the day and weigh your baby to ensure they are gaining weight still and to rule out hunger preventing him from getting to sleep.
Swaddling your baby to aid settled sleep, is appropriate until about six months old but if your baby enjoys being wrapped and is sleeping well after this age, don’t worry, keep them wrapped for sleep time until they want out. You can help your baby sleep without the wrap by leaving one arm out then if they cope, take both arms out. Continue to wrap them from under their arms until you are ready to change them into a sleeping bag. Leaving an arm or two out allows your baby to suck on their fist or fingers to soothe themself to slee
Mimic the womb environment
Mimic the Womb Environment Your newborn will need time and support to make a smooth transition from being warm and secure inside the womb to feeling comfortable and secure in the outside world. By mimicking the womb environment for a period of time your baby may find this transition a lot easier. When your baby is born prematurely the extra comfort and security of sleeping in a sling next to your body for extended periods of time may be just what your baby needs to help soothe and settle. The womb can be mimicked in the following ways:
- Warm and snug in the womb becomes swaddling and cuddling up close out of the womb
- Rhythmical movements from activity felt while inside the womb become rocking and swaying outside the womb
- Internal womb noises of the placenta, heartbeat and bowel sounds become humming, ‘white noise’, shhhing, singing, and your heart beat outside the womb
In the early days it is important to keep your baby secure and snug as they settle to sleep. Swaddling is an age-old practice of wrapping babies snugly in natural breathable material, blankets or similar cloth so that movement of the limbs is restricted. Your baby is born with a startle reflex which may cause them to wake during the lighter phases of sleep. The idea behind swaddling is that it prevents this reflex occurring allowing longer periods of sleep
With what we currently know of Sudden Infant Death Syndrome (SIDS), it is considered safer for your baby to sleep on their back rather than on their tummy. Sleeping on the back can make some babies feel exposed and insecure, making it difficult for them to settle and sleep for long periods. During the first few months, an effective way to help your baby feel secure whilst sleeping on their back can be by wrapping them firmly (an ancient technique known as swaddling). Wrapping is a useful technique that can help you settle your baby and sleep them on their back. A comfortable swaddling technique places your baby’s hands in a natural position over the chest, preventing fidgeting and jerking as they settle to sleep. Swaddling also ensures the startle reflex does not jerk them awake between sleep cycles. This assists your baby to have a longer, more settled sleep. If your baby is over three months you may leave their arms free and wrap the lower body instead. This allows your baby to use their hands and fingers which can be a way of self soothing. The following is a step by step guide of how to swaddle your baby:
- Place wrap on a flat surface with the longest edge folded over 10-15 cm
- Place your baby on the wrap with their shoulders lying level with the top of the wrap.
- Bend arm up under the flap and bring the wrapped arm across the chest and tuck the wrap firmly under the back
- Do the same with the other arm
- Span out the bottom of the wrap and bring it up to the chest, spread it out and wrap firmly around and under the back
Swaddling your baby to aid settled sleep, is appropriate until about six months old but if your baby enjoys being wrapped and is sleeping well after this age, don’t worry, keep them wrapped for sleep time until they want out. You can help your baby sleep without the wrap by leaving one arm out then if they cope, take both arms out. Continue to wrap them from under their arms until you are ready to change them into a sleeping bag. Leaving an arm or two out allows your baby to suck on their fist or fingers to soothe themself to sleep.
Your baby can wake at night for many reasons and the cause is often age related and very individual. From birth to six months your baby will sleep for around 2-4 hours and then wake for short periods and this occurs throughout the night. As your baby gets older (from about 6 months on) they will sleep for longer time periods that can be up to 6 or more hours and most of these longer periods will be at night. Your baby is also better able to self soothe at this age when they do wake.
Newborns wake during the night primarily for a feed or discomfort. Some will sleep four to six hour stretches from six weeks while many will not do this until six months or beyond.
Night – day rhythms are not established until your baby is about three months old. This means your baby may sleep long stretches during the day and then want to catch up on feeds overnight. You can encourage the development of this inner circadian rhythm by waking your baby for feeds every three to four hours during the day and leave them to wake themselves overnight. Allow your baby to sleep in the daylight during the early weeks and keep the light dim when you are attending to them at night. Other factors that may result in night waking include:
- Temperature Control
Newborns are unable to effectively regulate their body temperature making it important to not overdress and overheat your baby; and conversely under-dress and chill your baby. Avoid using sleep wear and bed linen made from synthetic fibres as these tend to trap heat. Dress your baby in warm clothes so that your baby is warm without needing to use a blanket. Use what you would wear to bed as a guide. Keep an eye on the room temperature, it should be comfortably warm and not to hot or cold.
- Startle reflex
During the first few months, the startle reflex can cause your baby to wake. Swaddling helps by preventing arms from flapping and waking your baby and therefore encouraging longer sleep.
- Digestive discomfort
Digestive discomfort makes it difficult for your baby to settle and sleep. Discomfort such as oesophageal pain, abdominal bloating or wind trapped in the lower bowel can all make it difficult for your baby to relax and sleep. If this persists or you are worried about your babies comfort you should talk to your health care professional.
With increased activity and movement your baby has a need for increased nutrition. Consider increasing their milk and solid intake during the day to rule out hunger being the cause of night waking.
- Teething discomfort can make it difficult for your baby to settle back to sleep if they wake.
Illness such as an ear infection or cold may be the cause of your baby not settling. If they are not miserable during the day and have no fever, an ear infection is rarely the cause of not settling at bedtime. Seek professional health advice to make sure your baby is in good health.
As your baby develops and begins to put their world in sequences – routines become an important way of helping them feel secure. Your baby will benefit from cues that indicate sleep time, and set routines will help prevent your baby being hungry and tired at the same time.
Disrupted sleep can often be triggered by new milestones approaching and once the new skill is mastered, sleep improves until the next stage of development.
Flattened Head Shape
Your baby’s head can quickly develop flattened areas from constant pressure to one part of the head. Your newborn’s skull is thin and flexible making it easy to mould. It can be common for newborns to have an unusual shaped head and this usually goes back to a normal shape about six weeks after birth. Sometimes a baby’s head may not return to a normal shape and may develop a flattened head shape. If you have any concerns about your baby’s head shape talk to your doctor or child health nurse.
Three reasons why a flattened head area may occur in your baby:
- Laying in one position or looking in one direction repeatedly or for long periods of time
- Sitting in a propped up position for long periods. This can happen if your baby suffers from painful symptoms associated with Gastro Oesophageal Reflux Disease (GORD)
- Pain associated from abnormal neck muscle development or tight neck muscles. This pain can cause your baby to favour lying in a pain-free position. This reduction in head movement to both sides can create muscle weakness and the resistance to turn increases.
Below are eight important steps to facilitate balanced muscle development and reduce the risk of a flattened head area developing:
- Alternate the head position when laying your baby down
- Lay your baby at alternate ends of the cot at sleep time
- Allow for several periods of tummy time at every wake time
- Change the position of toys when your baby is on the floor to encourage head movement to different angles
- Vary the way you hold and carry your baby
- Change the side that you wear a baby carry sling on if your baby spends a lot of time in it
- When picking up your baby, approach them from different sides of the body
- Visit a baby accredited Osteopath, Chiropractor or Physiotherapist to assess spinal alignment if you had a long or difficult birth, forceps assisted birth or birth by caesarean section. A visit could also be beneficial if your baby does not feed well from a particular side, hates tummy time, is a poor sleeper or has wind discomfort. Seek professional help EARLY if your baby’s head is becoming flattened; it has a definite tilt to one side or favours facing a certain direction.