Infant Sleep

What are a baby's sleep needs?

Sleep needs for babies vary depending on their age. Newborns do sleep much of the time. But their sleep is in very short segments. As a baby grows, the total amount of sleep slowly decreases. But the length of nighttime sleep increases.

Generally, babies don't have regular sleep cycles until they are about 6 months old. Newborns sleep about 16 to 17 hours per day. But they may not sleep more than 1 to 2 hours at a time. Most babies don't start sleeping through the night (6 to 8 hours) without waking until they are about 3 months old.

Babies also have different sleep cycles than adults. Babies spend much less time in rapid eye movement (REM) sleep (which is dreamtime sleep). And the cycles are shorter. The following are the usual sleep needs per 24 hours for newborns through 2 years old:

• Newborns to first few months: 16 to 17 hours

• 4 to 12 months: 12 to 16 hours

• 1 to 2 years: 11 to 14 hours

What are the symptoms of sleep problems in a baby?

Once a baby begins to regularly sleep through the night, parents are often unhappy when the baby starts to wake up at night again. This often happens at about 6 months old. This is often a normal part of development called separation anxiety. This is when a baby does not understand that separations are short-term (temporary). Babies may also start to have trouble going to sleep because of separation anxiety. Or because they are overstimulated or overtired.

Common responses of babies having these night awakenings or trouble going to sleep may include the following:

• Waking and crying one or more times in the night after sleeping through the night

• Crying when you leave the room

• Refusing to go to sleep without a parent nearby

• Clinging to the parent at separation

Sleep problems may also happen with illness. Talk with your baby's healthcare provider if your baby begins having trouble going to sleep or staying asleep, especially if this is a new pattern.

Signs of sleep readiness

You can help your baby sleep by recognizing signs of sleep readiness, teaching them to fall asleep on their own, and comforting them when they wake up. Your baby may show signs of being ready for sleep by:

• Rubbing eyes

• Yawning

• Looking away

• Fussing

Helping your baby fall asleep

Babies may not be able to create their own sleeping and waking patterns. Surprisingly, not all babies know how to put themselves to sleep. And not all babies can go back to sleep if they wake up in the night. When it's time for bed, many parents want to rock or breastfeed a baby to help them fall asleep. Creating a bedtime routine is a good idea. But don't let your baby fall asleep in your arms. This may become a pattern. And your baby may begin to expect to be in your arms to fall asleep. When your baby briefly wakes up during a sleep cycle, they may not be able to go back to sleep on their own.

Babies who feel secure are better able to handle separations, especially at night. Cuddling and comforting your baby during the day can help them feel more secure. Other ways to help your baby learn to sleep include:

• Allowing time for naps each day as needed for your baby's age.

• Not having any stimulation or activity close to bedtime.

• Creating a bedtime routine, such as bath, reading books, and rocking.

• Swaddling your baby. This can be soothing and bring comfort. But stop swaddling your baby when they show signs of trying to roll over.

• Playing soft music while your baby is getting sleepy.

• Tucking your baby into bed when they are drowsy, but before going to sleep.

• Comforting and reassuring your baby when they are afraid.

• For night awakenings, comfort and reassure your baby by patting and soothing. Don't take your baby out of bed.

• If your baby cries, wait a few minutes, then return and reassure with patting and soothing. Then say goodnight and leave. Repeat as needed.

• Being consistent with the routine and your responses.

Reducing the risk for SIDS and other sleep-related infant deaths

Here are recommendations from the American Academy of Pediatrics (AAP) on how to reduce the risk for SIDS (sudden infant death syndrome) and sleep-related deaths from birth to 1 year old:

• Know the ABCs of safe baby sleep:

  • A is for alone. Put baby to sleep alone in their crib. Keep soft items like toys, crib bumpers, and blankets out of the crib.

  • B is for back. Place your baby on their back to sleep. Do this both during naps and at night. Studies show this is the best way to reduce the risk for SIDS or other sleep-related causes of infant death. Don't put a baby on their side or stomach to sleep.

  • C is for crib. Use a safe sleep surface. Babies should sleep on a firm, flat surface. Don't use one that is at an angle or inclined. Safe examples are a crib, bassinet, portable crib, or play yard that follows the safety standards of the CPSC. Check the CPSC website at www.cpsc.gov to make sure the product is not recalled. This is especially important for used cribs. Don't use broken cribs or cribs with missing instructions or missing parts. Many babies have died in cribs that were broken or had missing parts. The space between crib bars must be no more than 2-3/8 inches apart. This way, the baby can’t get their head stuck between the bars.

• Don't smoke or use nicotine around your baby. Keep smoke of any kind away from your baby. No cigarettes, marijuana, or vaping in your home. Babies exposed to smoke have more colds and other diseases. Smoke of any kind increases a baby’s risk of dying while sleeping, especially babies who are sick.

• Don't share a bed with your baby. This is extra important if your baby is very young or small or was born prematurely. This is also extra important if you have been drinking alcohol, used marijuana, or taken any medicines or illegal drugs. Don't put your baby to sleep in a bed with other children or adults. You can bring your baby to your bed for feedings and comforting. But return your baby to the crib or bassinet for sleep. Don't fall asleep with your baby. Bed sharing is also not advised for twins or other multiples.

• Share your room instead of your bed with your baby. The American Academy of Pediatrics recommends that babies sleep in the same room as their parents, close to their parents' bed. But babies should be in a separate bed or crib appropriate for babies. This sleeping arrangement is recommended for at least the first 6 months.

• Use correct bedding. Your baby should sleep on a firm, flat mattress or firm surface with no slant. The mattress should fit tightly and be designed just for the crib. Cover the mattress with a fitted sheet. Don’t use fluffy blankets or comforters. Don’t let your baby sleep on an adult bed, waterbed, air mattress, sofa, sheepskin, pillow, or other soft material. Don’t put soft toys, pillows, or bumper pads in the crib. Don't use weighted blankets, sleepers, swaddles, or other weighted items. Make sure nothing is covering your baby's head. These increase a baby's risk of suffocating.

• Put your baby in other positions while they are awake. This helps your baby grow stronger. It also helps prevent your baby from having a misshaped head. When your baby is awake, hold your baby. Give your baby time on their tummy while awake and supervised for short periods of time beginning soon after coming home from the hospital. Slowly increase tummy time to at least 15 to 30 minutes each day by 7 weeks old. Try not to let your baby sit in a seat or swing for long periods of time.

• Don't use sitting devices for routine sleep. Infant seats, car seats, strollers, infant carriers, and infant swings are not advised for routine sleep. These may lead to blockage of a baby's airway or suffocation. If your baby is in a sitting device, remove them from the device and put them in the crib or other appropriate surface as soon as is safe and practical.

• Make sure your baby doesn't get overheated when sleeping. Keep the room at a temperature that is comfortable for you and your baby. Dress your baby lightly. Instead of using blankets, keep your baby warm by dressing them in a sleep sack, or a wearable blanket. Don't use a hat on your baby indoors.

• Use caution when swaddling your baby. Swaddling doesn't reduce the risk for SIDS. If you choose to swaddle your baby, make sure they are on their back and the swaddle is not too tight. Stop swaddling your baby when they look like they're trying to roll over. Some babies start working on rolling as early as 2 months. The risk of suffocation is higher if your baby rolls to their stomach while they are swaddled.

• Offer a pacifier (not attached to a string or a clip) to your baby at naptime and bedtime. This helps reduce the risk for SIDS. If your baby is breastfeeding, don't give the baby a pacifier until your baby is breastfeeding well.

• Don't use products that claim to decrease the risk for SIDS. This includes wedges, positioners, special mattresses, special sleep surfaces, or other products. These devices have not been shown to prevent SIDS. In rare cases, they have resulted in infant death. Cardiorespiratory monitors sold for home use are also not helpful in preventing SIDS.

• Always place cribs, bassinets, and play yards in hazard-free areas. Make sure there are no dangling cords, wires, or window coverings. This is to reduce the risk for strangulation. Place the crib away from windows.

• Breastfeed your baby. This can reduce the risk for SIDS. Give your baby only human milk for at least 6 months, unless your healthcare provider tells you otherwise. Experts advise continuing to use human milk for 1 year or longer. This depends on if both you and your baby want to do this. Using human milk for a year or longer reduces the risk for SIDS and many other health problems.

• Take your baby for checkups and vaccines. If your baby seems sick, call your baby’s healthcare provider. Take your baby in for regular well-baby checkups and routine shots. Some studies show that fully vaccinating your child lowers the risk for SIDS.

• Don't use alcohol, marijuana, opioids, or illegal drugs. There is an increased risk for SIDS with exposure to substance use. Using these substances affects your ability to care for your baby.

Safe sleep when your baby is sick

Babies with a recent or current illness, such as a respiratory infection, are at a higher risk for SIDS. Following safe sleep guidelines is even more important when your baby is sick. Do this even if they have symptoms like congestion, runny nose, coughing, or poor appetite. If you are concerned about your baby’s health, contact your baby’s healthcare provider right away.