Sleeping Through the Night

What is it?

"Sleeping through the night" is a big milestone for most babies. Actually, it’s a milestone for the parents – the babies are just doing what comes naturally! A baby sleeps through the night when s/he goes to sleep some time before the parents, and does not wake up until morning, soon before or after the parents wake up. Babies are people too, and that means that they vary a lot in how much sleep they need, and what their normal patterns are. There are a few normal trends, of course. Newborns tend to sleep up to 18 hours in every 24 hour period, so they often sleep through the night just because they sleep so much. As babies get older, their total need for sleep drops off, and they begin to try to organize their sleeping into patterns that work best for them. How parents respond to this process can have a big influence on how well and how long babies sleep at night.

Here are a few things we know about normal infant sleeping:

• Right around 6 weeks of age most babies begin to change their sleep patterns significantly. At this age babies tend to cry more during early evening, and they begin cutting back on the total number of hours they sleep in a day. Between 6 and 12 weeks, babies sleep less during the day, and more at night. One study found that babies who were exposed to more light in early afternoon tended to sleep better at night.
• Not only light, but many other things about the environment affect how well babies sleep at night. Babies sleep better at night if they live in families that are well organized and have regular habits such as meal and nap-times. Babies also sleep better at night if they get appropriate stimulation during the day.
• After about three months of age, babies who fall asleep in their own cribs sleep better through the night than babies who fall asleep in their parents’ arms or beds.
• After about six months of age, babies begin to have their longest and deepest sleep at night. They tend to have trouble staying asleep during the day if they are awakened.
• Infants who sleep in the bed with their parents ("co-sleeping") wake up and feed almost twice as often as infants who sleep in their own cribs. There is also good evidence that infants who sleep in cribs have higher quality, less stressful sleep, than infants who co-sleep with their parents.
• Babies need to get enough sleep and on their own patterns. Infants who become sleep-deprived even for short terms (under 2 hours) become harder to awaken, and are more likely to have blocked breathing during sleeping. This is called "obstructive sleep apnea," and some experts believe it is related to sudden infant death syndrome, or SIDS.

There are two big concerns for most families. The first, of course, is to be sure the baby is getting enough sleep at the right times. The other is to be sure the parents are getting enough sleep at the right times! Parents who don’t get enough sleep can become irritable, depressed, and can have more trouble at work and in their other relationships. So please, take your baby’s sleep patterns seriously, but also remember how important your own sleep is. Persistent crying is the leading trigger for child abuse. Every parent has felt anger and frustration with their baby who won’t sleep. That’s normal. It’s also a good sign that it’s time to take a break, have someone else watch the baby for a while, or trade "shifts" with a partner.

Many parents have the opposite concern – that they aren’t being good parents if they let their babies cry too long, or cry themselves to sleep. It may help to remember that crying and sleeping are two things babies do naturally and well. Younger infants especially don’t have many other ways of communicating, and crying does not always mean that the baby is unhappy or in distress. Babies often cry when the first wake up, but for no particular reason. If you pick up and comfort or feed a baby the minute s/he starts to cry, neither you nor the baby get a chance to find out whether s/he would have fallen back asleep again. Then the baby can get so used to having you there the minute s/he wakes up that s/he needs you to fall asleep every time. That will drive you both crazy.

The most important step in handling sleeping issues in babies is to have a reasonable goal. If the goal is simply to get the baby to sleep at a certain time and wake up at a certain other time, we will fail. If, on the other hand, the goal is to provide an environment that makes the baby likeliest to find his or her healthy, normal sleep pattern, we can easily succeed. Once the baby has developed a healthy sleep pattern and is well-rested, s/he will have better days and nights. And of course, so will the rest of the family.

Here are some simple guidelines to follow day and night in helping your baby to establish healthy and regular sleep habits:

• Try your best to keep to fairly regular schedules for everyone in the household. You don’t have to be rigid about this, of course, but if in general mealtimes are regular, naptimes and bath times are regular, older siblings homework and play-times are regular, your baby will start to fall into a pattern of his or her own that fits with yours. Of course, it’s important to stay flexible enough that your baby can change over time, especially as his or her daytime sleep requirements go down.
• Try to provide a healthy and stimulating environment for your baby while s/he is awake. Babies can get bored just like older children or adults, and that makes them fussy. Bored babies also may sleep more during the day, and then be wakeful at night. Please remember that even a newborn baby enjoys having a story read to him or her, or hearing a song from a parent. You can let your baby listen to music too – just remember that babies have sensitive hearing, and don’t make it too loud. Put a mobile over your baby’s crib so that s/he can see colors and movement. And of course, most important of all, play with and talk to your baby – that’s what s/he loves the most!
• It’s best not to let the baby fall asleep for the night on your lap or in your bed, even though most parents love the cuddling. Babies (and older children) sleep much better at night if they get into bed awake, and fall asleep in bed. If nothing else, this reduces the chances that they’ll wake up when being put into bed. This will also help you to establish a regular bedtime for the baby. As an extra bonus you’ll have a few more hours to spend with each other and the family.
• Try to limit the amount of disruption and disturbances in your home during the night. If your baby shares a room with another child, please remind that child to be careful and quiet while the baby sleeps. This is good for the older child as well, because it helps settle him or her for sleep.
• Virtually all experts today agree that co-sleeping (letting the baby or child sleep in the bed with parents) is not a good idea. It’s best not to start this habit, because it is a very hard one to break, and gets harder the older the child gets and the more s/he protests. If you can establish that the baby’s crib is his or her own special place, s/he will rapidly associate it as the place to fall asleep.
• When babies wake in the night, they often cry. This does not by any means mean that they are unhappy or hungry. Sometimes they are just making noise, and sometimes they are not fully awake and just need to comfort themselves back to sleep. If a parent comes in and tries to comfort a baby who is not in distress, or who isn’t fully awake, the baby will become more alert, and this can mean an unwanted interruption in the sleep cycle. It can also make the baby dependent on having a parent present to fall asleep. As hard as it is, it’s best to give your crying baby a chance to fall back to sleep on his or her own, before you go in to comfort. Of course, you’ll want to sneak to the door to be sure the baby is safe and not in real discomfort, but then try to set a time limit. Agree with yourself to stay out of the room for 5 minutes before going in. Often the baby will be asleep at the end of that time. If not, go in and give comfort. Over a few days to weeks, try to increase the amount of time you can stay out of the baby’s room. You’ll eventually find that you can stay out of the baby’s room until s/he naturally falls back to sleep. This approach is well tested and the vast majority of doctors and other experts agree that it is effective and safe, and will have long-term bad effects on the baby.
• Bottom Line Summary: Here’s a simple routine to follow to get your baby to sleep and stay asleep:
  • Have a regular evening schedule that can flex a bit as your baby changes and grows.
  • Try to keep things in the same order, so the baby learns to associate certain things with upcoming time to sleep. For example: dinner, play, bath, song/story, bed.
  • Put the baby to sleep in his or her own crib (and on his or her back or side), not in your bed
  • Put the baby to bed before s/he falls asleep, and avoid having the baby fall asleep in your arms or on your lap.
  • When the baby wakes during the night, give him or her a chance to self-comfort and get back to sleep on his or her own.
  • Give yourself a set amount of time you’re willing to wait before going in to your crying baby. Start small, say 5 minutes, and work your way up.

Naturally every time your baby cries in the night you’ll first want to be sure that s/he is safe and not in any trouble. Once you’ve done that, you can be pretty sure that there’s nothing to worry about from a physical standpoint. Sometimes babies do cry unusually hard or unusually long when there’s something the matter with them. Here are a few things to watch for that might suggest that your baby isn’t just fussing:

• Fever
• An unusual pitch or tone to the baby’s cry, such as high-pitched or shrieking
• A crying spell that lasts for more than twice as long as the baby typically cries
• Signs of pain, like pulling the knees up to the chest, or grunting with breathing
• Vomiting
• Not moving an arm or a leg
• More severe crying when picked up, rather than comforting
• Any unexplained bruising or mark on the baby
• A bulging fontanel (soft spot)

Crying babies are frustrating for parents and others who care for them – no matter how much they really love the baby. When a person has other stresses in their life, like financial or marital problems, the frustrations all add up. Sometimes people take out their frustration on the baby – not even always on purpose. It’s easy to be so desperate for a moment’s peace and quiet that you try to calm the baby too vigorously. Babies love to be rocked to sleep – frustrated parents can rock too hard, or even shake a baby without really meaning to. NEVER, EVER, SHAKE A BABY. If you feel yourself getting overwhelmed, get out, even for a minute or two. There are times when a baby is safer in a crib while the parent is standing in the yard cooling off for just a few minutes.

Also, please remember the "Back to Sleep" campaign. The number of babies who die from sudden infant death syndrome (SIDS) each year has dropped dramatically. This is the result of parents learning to put their babies on their back or side for sleeping – never on their stomach. Remember: BACK TO SLEEP!

Most babies who wake and cry in the night are just doing what comes naturally. In rare cases there’s something else going on. Young infants, and very rarely older children can have a rare condition in which their intestines get twisted. These infants look very sick and are often vomiting, usually with greenish material. This is an emergency - please go directly to an emergency room if this happens. Older babies and toddlers can also get a temporary blockage of their intestines (intussusception) that causes bouts of pain mixed with periods of seeming normal. These babies may vomit or have blood in their stool. Again, please call your doctor right away if that happens.

Less serious things that can make a baby cry or fuss a lot can include a scratch on the eye (corneal abrasion), or a bit of hair or thread wrapped around a small part like finger or toe. Bad constipation can also cause a baby to cry for long periods. Finally, a broken bone can be a cause of pain that the baby can’t tell you about. Sadly, this kind of injury is often the result of someone hurting the baby. It’s best to get medical care right away, no matter what, if you think that might have happened to your baby.

Caring for an infant who isn’t sleeping through the night is tiring and frustrating. As badly as you feel for your baby, you yourself may feel out of control, inadequate, or even angry – these are normal feelings. It is easy for parents to feel stressed to the breaking point, especially when there are other children or adults to take care of. One of the best things you can do for your child is to be sure you take care of yourself. If possible, try to have other adults take care of your child for an hour or two each day so you can get some rest or just some quiet time. If you get so stressed that you are worried about your baby’s safety, call your local Parents’ Anonymous Hotline or visit the Parents Anonymous website to find a group near you.