Supporting Your Baby's Sleep in the First Year - Sleeping, Crying and Being Awake

by Virginia Spielmann

Supporting Your Baby's Sleep in the First Year - Sleeping, Crying and Being Awake

New Baby Clinic: Sleeping, Crying and Being Awake 

Every baby’s first job is to get used to life outside the womb, starting with the first breaths (1) baby must develop stable body function, the ability to maintain homeostasis, appropriate muscle tone and motor control, eating skills, self-soothing capacity, and functional sleep-wake cycles (2).

Whether your child was born at term, and is having difficulty organising their behaviour; preterm, including late preterm; with special needs; or is considered high-risk they will benefit from proactive strategies to support development of functional sleep-state-cycling. (3)

When do you wake a sleeping baby?

It is a good idea to protect baby’s sleep and wait for baby to be awake before changing their diaper or providing other forms of care (13). Babies in deep sleep are experiencing a very restorative stage of rest and rejuvenation and should be left alone; REM sleep or active sleep also serves important benefits (3).

New babies need to eat roughly every 4 hours and most babies wake up to eat at a regular time, however some babies do need to be woken up to eat and this should be done gently and with respect to the baby’s response time and state of arousal. Ask your health visitor / midwife for advice if you are concerned (13,22). When you need to help baby wake gently pick them up, talk to them, provide them with something to look at or something to listen to (3,13).

It takes practice to learn how to read your baby’s state – are they asleep or awake, drowsy, quiet or overstimulated? We will be writing our next blog with more information on how to wake baby and when, and strategies for reading baby’s sleep states. 

Parents are encouraged to decide on whether or not an ‘infant-led’, or ‘limit setting’ approach best suits their family. This is very personal and many factors including culture, time off work, number of available adult carers, and personal values need to be taken into consideration (22).

For families who choose to prioritise their infant sleeping through the night a strategic plan of care that differentiates night and day type activities and has a calming night time routine - including ‘night clothes’, limiting movement and play and nominal soft soothing interactions – has been found to be helpful.  Only start to lengthen the time between night-time feeds once your infant is about 6 weeks old, thriving and your Doctor / Midwife have no concerns regarding well-being (22).

Babies have short periods of sleep and waking in the first weeks of life. They wake every few hours for feeding with not much difference between day and night (22).

The total amount of time spent sleeping decreases with age and the distribution of sleep across the 24-hour cycle also shifts with age (4).

Sleep Distribution During the First Year (4):

  • 1st month – 12-18 hours in 6 segments

  • 2-5 months – 12-16 hours in 5 segments

  • 6-12 months – 10-14 hours in 4 segments

(The term sleep segments refers to the number of times an infant shifts from asleep to awake to back asleep again.)

Sleeping through the night develops late in the first year of life (4,5).

Sleep Safety

The most important support you can offer your baby is your focused presence. Some call this kind of focus ‘attunement’, this simply means being ‘in tune’.
Attuned care is individualised to your unique baby, and involves taking extra time learning how to adjust to the signals from your baby. 

Practicing the art of ‘tuning-in’ helps you determine the best timing for interactions with your baby. See our next blog post for more information. Premature babies are not as well developed as term born babies and still need some time to get ready for the world (3). Therefore if your baby is, at all, preterm, special needs, or medically fragile, it may be difficult to ascertain what state they are in. As they mature the differences in state will become easier to discern. 

Getting to Know Your Baby is a great resource for learning how to ‘speak’ the language of your new infant.

Strategies that may help your baby to develop a sleep-wake cycle:

Kangaroo Care or Skin-to-Skin contact can increase the amount of quiet sleep a new baby achieves, as well as general organisation and sustained exploration (7,8,9).

Day-Night lighting, where day lighting is low and night lighting is dim (5, 10, 11). Lighting should always be low enough that baby remains comfortable enough to open their eyes during social interactions (5).

Swaddling – even swaddling of the arms only – is associated with increased quiet sleep in infants (12). You can swaddle your baby with their hands near their face so that they can reach their mouth to self soothe (13).

Rest Periods – scheduled daytime rest periods, or nap times, are likely to promote longer uninterrupted sleep in preterm infants (14, 15).

Sucking that is not for feeding is a normal neonatal reflex. Growing evidence supports the understanding that sucking a thumb, finger, or pacifier contributes to infant organisation and therefore the development of the new born. Sucking has a self-soothing and even analgesic function (16, 17, 18, 19). 

For the most beneficial long-term outcomes, whenever possible, care and the environment should be restful, nurturing and non-invasive (5, 20).

Make sure you get enough sleep. Look after yourself. (21)

Always ask a health professional for more information if you are in doubt. Stay engaged with your midwife, health visitor, social worker, counsellor or therapist. Ask for their expert advice, be honest and allow your family, friends and support team to help you enjoy your baby and support these first important months of life.

As well as the Getting to Know Your Baby guide other great web based resources include:

A Family Guidebook: Supporting Development of Newborns and Infants

Understanding Your Premature Infant – March of Dimes

WONDERbabies – Ways of Nurturing Development through Enhancing Relationships

This information sheet was compiled by Virginia Spielmann, Occupational Therapist, as part of the Infant and Early Childhood Development PhD program at Fielding Graduate University.

 

References

1) van Vonderen, J., Roest, A., Siew, M., Walther, F., Hooper, S., & te Pas, A. (2014). Measuring Physiological Changes during the Transition to Life after Birth. Neonatology, 105(3), 230-242. http://dx.doi.org/10.1159/000356704

2) Browne, J. (2014). BABIES and PreSTEPS Manual. WONDERBabies.

3) VandenBerg, K., Browne, J., Perez, L., & Newstetter, A. (2009). Getting to Know Your Baby (1st ed.). San Francisco: Special Start Training Program. Retrieved from http://www.wonderbabiesco.org/UserFiles/File/GTKYB%20from%20kathy%20vandenberg%201-8-09.pdf

4) Lillas, C., & Turnbull, J. (2009). Infant/child mental health, early intervention, and relationship-based therapies. New York: W.W. Norton & Co.

5) Graven, S., & Browne, J. (2008). Sleep and Brain Development: The Critical Role of Sleep in Fetal and Early Neonatal Brain Development. Newborn & Infant Nursing Review, 8(4).

6) Blackburn, S., & Blakewell-Sachs, S. (2010). Understanding Your Premature Infant. Marchofdimes.org. Retrieved 21 October 2015, from http://www.marchofdimes.org/flash/modpreemie/preemie.html

7) Feldman, R., Weller, A., Sirota, L., & Eidelman, A. (2002). Skin-to-skin contact (kangaroo care) promotes self-regulation in premature infants: Sleep-wake cyclicity, arousal modulation, and sustained exploration. Developmental Psychology, 38(2), 194-207. http://dx.doi.org/10.1037//0012-1649.38.2.194

8) Jefferies, A.L., (2012) Kangaroo care for the preterm infant and family. Paediatr Child Health 17(3):141-143. Canadian Paediatric Society, Fetus and Newborn Committee.

9) Eckman, E., & Rausch, H. (2014). Kangaroo Care as a Possible Intervention to Increase Length of Quiet Sleep in Neonates Diagnosed with Neonatal Abstinence Syndrome (Master of Science in Occupational Therapy). The College of Saint Scholastica Duluth, MN

10) Mirmiran, M., & Ariagno, R. (2000). Influence of light in the NICU on the development of circadian rhythms in preterm infants. Seminars In Perinatology, 24(4), 247-257. http://dx.doi.org/10.1053/sper.2000.8593

11) Rivkees, S. (2003). Developing Circadian Rhythmicity in Infants. PEDIATRICS, 112(2), 373-381. http://dx.doi.org/10.1542/peds.112.2.373

12) Dodwell, E. (2013). Swaddling. Pediatrics For Parents, 29(7 & 8). Retrieved from http://search.proquest.com/docview/1544411299?accountid=10868

13) Browne, J., Tamli, A., & Immele, A. (2015). A Family Guidebook: Supporting Development of Newborns and Infants (1st ed.). Early Intervention Colorado. Retrieved from http://www.wonderbabiesco.org/UserFiles/File/EI%20Colorado_Supporting%20Development%20of%20Newborns%20and%20Infants_FINAL.pdf

14) Holditch-Davis, D., Barham, L. N., O'Hale, A. & Tucker, B. (1995), Effect of Standard Rest Periods on Convalescent Preterm Infants. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 24: 424–433. doi: 10.1111/j.1552-6909.1995.tb02499.x

15) Schwichtenberg, A., & Poehlmann, J. (2008). A Transactional Model of Sleep-Wake Regulation in Infants Born Preterm or Low Birthweight. Journal Of Pediatric Psychology, 34(8), 837-849. http://dx.doi.org/10.1093/jpepsy/jsn132

16) Prevention and Management of Pain and Stress in the Neonate. (2000). PEDIATRICS, 105(2), 454-461. http://dx.doi.org/10.1542/peds.105.2.454

17) Carbajal, R., Chauvet, X., Couderc, S., Olivier-Martin, M., (1999) Randomised trial of analgesic effects of sucrose, glucose, and pacifiers in term neonates. BMJ. 319:1393–7.

18) Papile, L. (2012). The effects of giving pacifiers to premature infants and making them listen to lullabies on their transition period for total oral feeding and sucking success. Yearbook Of Neonatal And Perinatal Medicine, 2012, 318-319. http://dx.doi.org/10.1016/j.ynpm.2012.06.016

19) Recommendations for the use of pacifiers. (2003). Paediatrics & Child Health, 8(8), 515–519.

20) Brandon, D., Holditch-Davis, D., & Beylea, M. (1999). Nursing care and the development of sleeping and waking behaviors in preterm infants. Res. Nurs. Health, 22(3), 217-229. http://dx.doi.org/10.1002/(sici)1098-240x(199906)22:3<217::aid-nur4>3.0.co;2-u

21) Gallagher, S., Phillips, A., & Carroll, D. (2009). Parental stress is associated with poor sleep quality in parents caring for children with developmental disabilities. Journal Of Pediatric Psychology, 35(7), 728-737. http://dx.doi.org/10.1093/jpepsy/jsp093

22) St. James-Roberts, I. (2012). The origins, prevention and treatment of infant crying and sleeping problems. Hove, East Sussex: Routledge.

23) Safe Sleep for Your Baby. Bethesda. [Online Pamphlet] http://safetosleep.nichd.nih.gov 

 

Comments

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