Tiny Snoozers: The Journey of Newborn Sleep
Why is sleep so important?
Sleep is vital for developing brains in children. It affects learning, language, attention, and impulse control. For young children, sleep helps their bodies recharge and retain information, supports growth and repair, and releases important brain development hormones. Numerous studies show that sleep affects mood and can prevent mood disorders in children of all ages.
Brace yourselves, new parents! Research reveals that sleep disruptions can haunt you up to six years after your first little one’s arrival.
How much sleep does my child need?
Age Group Age Range Recommended hours of sleep per 24 hours
Newborns 0-3 months 14-17 hours including naps
Infants 4-12 months 12-16 hours including naps
Toddler 1-2 years 11-14 hours including naps
Newborn and Infants
There are apps, podcasts, and books galore to help your little one catch some Z’s. But beware! The flood of advice can sometimes turn into a tidal wave of confusion, leaving you feeling like you’re drowning in information overload. Ready to embark on the ultimate sleep quest? Here are the essentials to kick-start your journey:
First things first…
Create a safe sleeping environment
• A firm, flat sleep surface
• No loose bedding or soft objects
• A “neutral thermal” environment-not too hot, not too cold
• Room sharing without bed sharing
• Smoke-free environment
Recommendations for success
• Swaddle your baby. Wearable blankets (which often have a swaddle wrap feature) are preferred to conventional blankets for providing warmth while decreasing risk for covering the baby’s face
• Establish a bedtime routine and sleep schedule. Easier said than done, but soooo worth it.
• Don’t ignore your baby’s sleep cues. Seriously, don’t…
• Create a sleep zone: your baby should have a familiar sleep zone where they sleep at night and take the majority of their naps. Preferably in a bassinet or a crib.
• Don’t make sleep decisions in the middle of night! Sleep deprivation is real! When you get to the point where you feel you're not making good sleep decisions for your child, ask for help.
• Partners need to be on the same page! Research shows that families do better when the adults are intentional and in agreement about their choices. Teamwork makes the dream work!
Bedsharing vs Room Sharing
Bedsharing aka co-sleeping: The ultimate bonding experience or a wild ride of sleepless nights and potential hazards?
For centuries, children worldwide have shared a bed with their parents. And while co-sleeping with infants is a common practice across cultures, studies show that pediatricians struggle to have patient-centered conversations about sleep practices. This is especially true with non-native English- speaking families.
In 2015, a US CDC survey found 61% of American babies bedshare at least occasionally. The American Academy of Pediatrics advise in 2016 that parents and babies should sleep in the same room for at least 6 months to a year but didn’t endorse bedsharing. This means there is a clash between everyday cultural habits and official guidelines. Parents may be afraid to talk to their pediatrician for fear of being criticized or fear of being reported to child protective services.
It has been reported that caregivers and babies tend to sleep longer when bedsharing, likely because the caregivers can feed without getting up and babies don’t need to call out and wait for help. This extra sleep can lead to better daytime parent-child interactions. Studies suggest well-rested parents make better decisions and regulate their emotions more effectively. Sleep deprivation, on the other hand, increased the risk of postpartum depression.
Breastfeeding at night is usually the main reason for co-sleeping. However, when it comes to supporting breastfeeding, studies show there is no difference found between bedsharing and room sharing. Meeting a baby’s needs works the same way. Studies show that physical contact and room sharing align the child’s circadian rhythm with the parent’s, which helps the baby sleep. This allows parents to be more responsive to the baby’s signal, enhancing communication and quick response to baby’s needs.
The risk of SIDS is highest at 2-4 months of age. Room sharing is associated with a lower risk of SIDS and is recommended for the first six months of life. The risk decreases between 6-12 months, allowing parents to feel more at ease as the baby grows older. After the first six months, when baby’s body becomes more settled, other factors can affect sleeping arrangements, like cultural beliefs, family well-being, and baby’s personality or medical needs. For example, a child might benefit from staying close to parents longer, while a parent might need separate sleeping arrangements for better sleep.
A well-rested parent is a happier and healthier parent!
Back to sleep vs tummy sleeping
Back-sleeping lowers the risk of SIDS by providing better access to fresh air and preventing overheating. Some caregivers believe their baby will sleep better on their stomach, but this increases the risk of SIDS. Babies used to sleeping on their back are 18 times more likely to die of SIDS if placed on their stomach. Studies also show that side-sleeping is riskier because babies can easily roll onto their stomachs from their side by may struggle to roll back. Once baby can roll over by themselves, typically around 6 months of age, they have the motor skills to rescue themselves
But What About…
My baby has really bad reflux
The American Academy of Pediatrics, the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology and Nutrition are all in agreement that positional therapy should NOT be used to treat symptoms of reflux in sleeping infants.
What is positional therapy?
Elevating the baby’s head, elevating the head of the crib, lateral positioning (placing baby on its side), and/or prone positioning (placing baby on its tummy).
But wait, my pediatrician and/or GI specialist told me to prop up my crib (or position my baby a certain way)
Unfortunately, there is no evidence to support that positional therapy actually works. Your doctor should provide you with a documented reason for going against safe sleep recommendations. Also, you may want to consider getting a new doctor…
But how the heck is my baby supposed to sleep???
First, talk to your pediatrician about your baby’s symptoms. There may need to be some changes to their diet or maybe there is an underlying condition. Discuss if your baby needs to be referred to a GI specialist. Reflux can be common in infants who are premature or have a medical condition. Try feeding your baby in an upright position. After feeding, hold your baby upright for 30 minutes. This can be incredibly difficult in the middle of the night! If you are struggling, reach out and ask for help! This might need getting additional support from a co-parent or family member, or talking to your pediatrician or specialist about what else can by done to manage your baby’s symptoms.
My baby has a flat head
Pediatric occupational and physical therapists often use a variety of positioning devices to correct head shape. These devices are especially used if a baby has torticollis. In the hospital setting these products are commonly used while the baby is sleeping because the baby is being monitored. However, they should be removed before the baby is discharged to model safe sleep recommendations at home. Positioners are great to use when baby is awake. Also giving your baby opportunities to be in a variety of positions throughout the day for example: tummy time (while awake), being held in different positions to keep them off the back of their heads.
My baby has a congenital airway abnormality
Congenital airway abnormalities can result in baby having difficulty breathing. Depending on the condition, some babies may benefit from positioning on their tummy. If this applies to your baby, your doctor must provide documentation on why this sleep position is safe.
My baby is on a ventilator
In the hospital setting, your baby might be positioned with the head of the crib elevated. That is typically because the hospital is trying to prevent pneumonia. You should talk to your pulmonologist about safe sleep recommendations. If your baby is not safe to sleep on their back, your doctor should provide you with a documented reason. You may qualify for nursing services which might be helpful so that you can get some sleep.
My baby has a medical condition or genetic disorder
Babies with medical conditions or genetic disorders that do not allow for safe sleep recommendations, a documented reason is required prior to your baby leaving the hospital. Most babies with medical conditions or genetic disorders are totally safe to sleep on their backs. If you have concerns, do not hesitate to reach out to your pediatrician or any of your child’s specialists.
Sudden Unexpected Infant Death
Sudden unexpected infant death (SUID), including sudden infant death syndrome (SIDS), is the leading cause of infant death in the United States. In up to 95% of these cases, there were risk factors involved due to an unsafe sleeping environment.
What is the difference between SUID and SIDS?
Sudden Unexpected Infant Death (SUID) is the death of an infant younger than 1 year of age that occurs suddenly and unexpectedly. Following an investigation, these deaths may be classified as:
• Suffocation: When a baby’s lungs don’t receive air due to a blockage in the airway.
• Entrapment: When a baby gets trapped between two objects and can’t breathe. For example, getting stuck between a mattress and a wall.
• Infection: When a baby has difficulty breathing due to a cold or other infection caused by a virus or bacteria.
• Ingestion: When a baby puts something in their mouth that blocks their airway or makes them choke.
• Metabolic diseases: Medical conditions that can affect how the body functions and can lead to problems with breathing.
• Cardiac arrhythmias: When a baby’s heart beats too fast or too slow and affects breathing.
• Trauma (accidental or non-accidental): When a baby experiences an injury.
Sudden Infant Death Syndrome (SIDS) is a type of SUID, that refers to the sudden, unexplained death of an infant under 1 year, even after thorough investigations including autopsy, death scene examination, and clinical history review. Sometimes, due to insufficient evidence, the cause remains undetermined.
Bottom line
The infant sleep struggle is real and so is sleep deprivation. Parents and caregivers need to be united so that everyone can get some sleep. Create a safe sleep environment. Babies need to sleep on their back until they are old enough to roll over on their own. Co-sleeping remains controversial. Room sharing is helpful for breastfeeding and can help everyone sleep better. Dealing with a baby with reflux in the middle of the night is challenging. If you are concerned that your baby is not safe to sleep on their back, reach out to your pediatrician for help. By the time babies turn one, less than half sleep through the night! Ultimately, it is the quality of the parent-child relationship that truly impacts a child’s development. You can’t be your best when you’re exhausted.
A good night’s sleep = happy and healthy family!
References
https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/a-parents-guide-to-safe-sleep.aspx
https://safetosleep.nichd.nih.gov
https://www.aap.org/en/news-room/news-releases/aap/2022/american-academy-of-pediatrics-updates-safe-sleep-recommendations-back-is-best
Bartick M, Young M, Louis-Jacques A, McKenna JJ and Ball HL (2022) Bedsharing may partially explain the reduced risk of sleep related death in breastfed infants. Front. Pediatr. 10:1081028. doi: 10.3389/fped.2022.1081028
Moore C, Hecht S M, Sui H, et al. (December 31, 2021) Integrating Cultural Humility Into Infant Safe Sleep Counseling: A Pediatric Resident Simulation. Cureus 13(12): e20847. DOI 10.7759/cureus.20847
Ouattara, B.S., Tibbits, M.K., Toure, D.M. et al. Sudden unexpected infant death rates and risk factors for unsafe sleep practices. World J Pediatr 18, 225–229 (2022). https://doi.org/10.1007/s12519-021-00500-6
Rachel Y. Moon, Jodi A. Mindell, Sarah Honaker, Sarah Keim, Kristin J. Roberts, Rebecca J. McAdams, Lara B. McKenzie; The Tension Between AAP Safe Sleep Guidelines and Infant Sleep. Pediatrics April 2024; 153 (4): e2023064675. 10.1542/peds.2023-064675
