Because the nervous system of newborns is immature, newborns sleep a great deal, but only for 1 or 2 hours at a time, regardless of whether it is day or night. By 4 to 6 weeks of age, many infants are on a cycle of waking for about 4 hours and sleeping for about 4 hours. By 4 to 6 months of age, infants usually are capable of adopting a day-night sleep schedule. By 1 year of age, most infants sleep 8 to 9 hours continuously through the night. However, disturbances in sleep are common and occur at different times during the first few years (see Sleep Problems in Children).
Factors that influence sleep patterns vary by age. Disturbances in sleep become common after 9 months of age because
Separation anxiety develops.
Children can move independently and control their environment.
They may take long late-afternoon naps.
They may become overstimulated while playing before bedtime.
Nightmares tend to become more common.
Parents can help infants sleep at night by handling and stimulating the child less in the late evening and keeping the child's room dark at night, which is important in the development of normal vision. Infants should be encouraged at an early age to fall asleep on their own and not in a parent's arms. In this way, they will be able to quiet themselves when they wake in the middle of the night.
To minimize the risk of sudden unexpected infant death (SUID) and sudden infant death syndrome (SIDS), infants should always sleep on their back, rather than on their stomach or in a side sleep position. This recommendation has helped reduce the incidence of SIDS in recent years. Also, infants should not sleep with soft pillows, toys, or heavy blankets, which may block their breathing. Putting an infant to bed with a pacifier may also help prevent SIDS (breastfed infants should be at least 1 month old or accustomed to breastfeeding before they are given a pacifier). (See also Prevention of SUID and SIDS.)
Co-sleeping
Co-sleeping is when a parent and infant sleep close to one another so as to be able to see, hear, and/or touch one another. Co-sleeping arrangements can include
Bed-sharing (the infant sleeps in the same bed as the parent)
Room-sharing (the infant sleeps in a different bed but in the same room as the parent)
Bed-sharing between parents and infants is common but controversial. There are often cultural and personal reasons why parents choose to bed-share, including convenience for feeding, bonding, believing their own watchfulness is the only way to keep their infant safe, and believing that bed-sharing allows them to continue watchfulness even while sleeping. However, bed-sharing has been associated with an increased risk of SIDS and may result in injury or death because infants may become suffocated, strangled, or trapped. Bed-sharing should be avoided through at least 12 months of age.
Room-sharing without bed-sharing still allows parents to be physically close to their infant for ease of feeding and monitoring, is safer than bed-sharing or solitary sleeping (the infant sleeps in a separate room), and is associated with a decreased risk of SUID and SIDS. For these reasons, doctors recommend room-sharing without bed-sharing as the preferred sleeping arrangement for parents and infants in the first 6 months of life.
Learning to sleep (sleep training)
Learning to fall asleep is an important developmental task.
All children awaken during the night, but children who have been taught to fall asleep by themselves usually settle themselves back to sleep. Infants are often comforted by swaddling, soothing background noise, and movement. However, infants who are always rocked to sleep do not learn how to fall asleep on their own, which is an important developmental task.
Strategies that are effective for helping infants learn to fall asleep or self-soothe include the following:
Extinction ("cry it out"): Putting the child to bed and ignoring them (except for safety concerns), leading to the elimination of behaviors such as crying and screaming prior to falling asleep.
Graduated extinction: Ignoring the child for a set period of time before responding; gradually lengthening the period of time before caregivers respond.
Bedtime fading: Starting with a bedtime that is when the child naturally falls asleep; gradually moving it earlier to the desired bedtime.
Scheduled awakenings: Waking the child prior to them waking up on their own, and comforting them as if they had woken up on their own.
None of these approaches is right or wrong. All techniques involve creating a positive bedtime routine.
As a substitute for rocking, the parent can sit quietly by the crib until the infant falls asleep; the infant eventually learns to be comforted and to fall asleep without being held.
In older children, a period of winding down with quiet activities, such as reading at bedtime, facilitates sleep. A consistent bedtime routine is helpful for all children. Asking fully verbal children to talk through events of the day often eliminates nightmares and waking in the middle of the night. Encouraging exercise in the daytime, avoiding scary television programs and movies, and refusing to allow bedtime to become an element of manipulation can also help prevent sleep problems. Finally, minimizing or avoiding screen time, digital media use, and exposure to blue light before bedtime help with sleep.
If stressful events are the cause, reassurance and encouragement can be helpful. Allowing children to sleep in their parents’ bed often prolongs rather than resolves the problem.
