One thing is for certain, both young children and grown ups need their sleep. As adults we know what it’s like to function with little or no sleep and how it affects our mood, performance, thinking and even health. We might be able to pull an “all-nighter” here and there and we’ve all done it, but imagine how this would affect a young child. A young child’s brain and body needs adequate sleep to develop properly. Yet, concerns related to sleep affect as many as 20-30% of infants and toddlers (Mindell, Meltzer, Carskadon, & Chervin, 2009). Questions related to sleep problems are frequently fielded by pediatricians and early intervention therapists alike.
The most common questions parents ask relate to how to get their child to sleep and then later how to get their child to stay asleep. Babies who don’t sleep mean parents who don’t sleep and this just becomes a vicious cycle for all involved.
What Should Parents Know?
Awareness of Realistic Sleep Expectations According to Developmental Age
Newborns – Newborns from 0-2 months of age spend the majority of their time sleeping. This varies from baby to baby, but anywhere from 10-18 hours is typical at this age. Mindell & Owens in 2009 reported that a newborn baby’s brain is actually more active during sleep than when awake. No wonder they need so much sleep! They also found that newborns spend a greater part of their time in REM sleep than at any other time in life and that this is highly related to their development of their brain & sensory system (vision, hearing, touch, smell, etc). Actual sleep disorders are not as common in newborns as in older children, although we often hear of babies having their days and nights mixed up. It is recommended that babies who have a problem with day & night simply be exposed to more and more natural daylight each day, especially in the morning until their nighttime sleep improves.
Infants – In early infancy, after age 2 months babies typically need 8-12 hours of sleep per night with an additional 3-4 hours of napping during the day. It is reported that about 50% of infant are able to sleep through the night, 8 or more hours, by age 5 months (Henderson, France, Owens, & Blampied, 2012). Keep in mind that night awakenings are common and to be expected. Babies commonly develop the ability to self calm and self soothe in the first 3 months of life, but it is in infancy that many parents first report sleep problems with children who they say need their intervention in order to fall back to sleep. Some parents dislike when a child sucks his thumb or uses a pacifier as an infant, but in early infancy we see this as a important step toward self-soothing.
Toddlers – Toddlers should be getting about 9-12 hours of sleep with another 2-3 hours of daytime naps. By the time a child is 18-20 months old they are usually down from taking two naps to taking only one nap per day. During the toddler years there is a bigger percentage of parent’s reporting problems related to sleep. These include stalling at bedtime, night awakenings, crying, and night terrors. We also hear about toddlers climbing out of their cribs.
One thing you will notice is that the amount of sleep doesn’t necessarily decrease as children get older. You’ll note your teenagers sleeping sometimes as much as your newborn!
How Can We Support Parents in Helping their Children to Sleep?
Setting a Bedtime Routine & Schedule as Early as 3 Months of Age
It’s never too early to develop a bedtime routine and helping your baby develop this sense of routine can begin as early as the second or third month. This is fairly simple, it might mean getting a bath, a diaper change, changing into pajamas, turning down the lights, singing a song, reading a story, etc. If parents do this same routine nightly from an early age it will indeed become just that “routine” for their baby. By age 3 months parents should also have set an established bed time, which is suggested to be before 9:00pm. Studies have reported that children who go to bed before 9:00pm, including kids up to age 10, will fall asleep faster, have less night awakenings and get more overall sleep than their peers with later bedtimes (Mindell, Meltzer, et al., 2009). Toddlers need to “wind down” before bed so no rough & tumble play right before bed, no surgery snacks or caffeinated beverages and parents need to be able to set limits (such as ONE book at bedtime, not six).
Nursing/nighttime feedings/Night awakening
The most important point here is that feeding and sleep should be thought of as two distinct things. While many families breast or bottle feed their babies to sleep or simply rock their babies to sleep in their arms in a rocking chair before putting them into bed sound asleep, this non-separation of feeding to bed transition often leads to sleep problems. By age 3 months parents should be putting their baby into bed when he is tried and drowsy, not sound asleep! For babies to learn to go to sleep and stay asleep on their own they need to be able to handle falling asleep in their cribs and beds without the comfort of a parent or a feeding. Nighttime routines that include feedings should go in the order of bottle, bath, story and then bed, not the other way around. Remember it is normal for babies to awaken during the night often several times, but if they have learned to put themselves to sleep initially, they will have also learned to get themselves back to sleep on their own as well. If you nurse, rock, sing to, play with your baby when it is time to go to sleep or at night awakenings this is what they will learn and it will become habit and make it more difficulty for them to fall asleep and stay asleep on their own without you intervening. Falling asleep is a learned skill and can be taught from this early age of 3 months. One thing you don’t often hear is families with multiples or with 3 or more young kids having sleep problems with their children. Why? They don’t have the time to rock, feed and soothe all the kids at once and so the kids learn to fall asleep on their own because they are left to do so.
Fears at night are very common and often not a reason to be concerned. Many young children develop nighttime fears related to their increasing cognitive development and imagination skills. This is when kids don’t like the dark or see monsters and may refuse to be left alone. Remember allowing them to come into your bed or your room each time this happens only creates a habit that you may have difficulty breaking later on. So instead, make modifications, such as playing soft music, buying a nightlight or leaving the door open. Make them a bottle of “monster spray” (water in a travel size spray bottle) to squirt their enemies or give them an arsenal of Nerf balls to toss at the monsters and rid them of their imaginary guests. Sometimes a transitional object like a blanket, stuffed animal, soft photo album of family members or talking picture frame (record your voices and reassurances into it) can also be helpful for toddlers.
The challenge of tears, screaming, parental guilt
When babies are very young, 0-3 months they need picked up when they cry and you won’t be spoiling them by doing so. Older babies and toddlers can be left to cry for longer periods. Remember if your baby is not sleeping through the night or used to you intervening during night awakenings there will be tears. Making any change in behavior is hard and it is no different with sleep. However, it will be easier to remedy the sleep situation when your baby is 9 months old then when they are 2.5 years old. So, be prepared to suffer through several nights of tears…and the suffering may be harder on the parent than the child. If your baby or toddler has never gone to sleep on his own, start with bed time first, not naps, contrary to what some people may say. Bedtime is not a choice, nap time is. If you start with naps you may fail because nap time is typically not more than 1-2 hours for a toddler and if they cry for an hour, nap time is over and they have won. Put the child down AWAKE at bed time into his crib. Be prepared for a full two week or longer transition to better sleep. Also be prepared for at least 45 minutes of tears on night one and for night two to be even worse! But don’t stop on day 3 and say “this isn’t working, he cries too much” because your consistency is the key and giving in will put you back to square one. So have the resolve to deal with the tears unless you want to try this again at age 6. Now, during those crying periods, DO feel free to go in every 10-15 min and briefly reassure your baby everything is fine, but do NOT pick him up. Say “It’s bedtime, go to sleep, you are ok, mommy is here” etc. If you can’t stand not picking the baby up, then pick them up very briefly and put them right back down. If you can’t stay out of the room, then sit in a rocker near the bed, but read a book or pretend you are reading and do not give constant eye contact.
Think of the end result, that in a few weeks your child WILL sleep on his own. Think of this as training and not as punishment, because it is not punishment. Regardless of your feelings at the moment, you are not hurting your child. By not training them to sleep on their own you are hurting your child and yourself. Think of it more as if your child falls down when learning to walk & they cry and you just brush them off and tell them to try again.
We’re not saying it’s easy, but is does work.
Special Needs, Medical & Developmental issues
Certainly children with developmental delays and medical complications can have issues that affect sleep and may need extra intervention based on their needs. A child’s cognitive abilities or issues with attachment and bonding can affect sleep. Also problems such as reflux, constipation, gas, sleep apnea, etc. can also all have an impact on sleep. Addressing these special concerns would take an entire separate article so we will conclude here. These separate issues should be addressed with your child’s doctor and/or therapists.
If your child has sleep problems that you feel are out of the range of typical and you have discussed these concerns with your child’s pediatrician, your child’s therapist or have consistently tried the methods mentioned above without success, you can contact The Sleep Center at Children’s Hospital of Philadelphia where they specialize in the Diagnosis and Treatment of Sleep Disorders in Young Children
Families can access past podcasts on common questions related to sleep by visiting at www.zerotothree.org/parentingpodcasts
Henderson, France, Owens & Blampied (2010) Sleeping Through the Night: the consolidation of self-regulated sleep across the first year of life, Pediatrics, 126 (5).
Du Mond, Mindell (2011) Sleep and Sleep Problems, Zero to Three, November 2011.
Mindell (2012) Talking About Babies, Toddlers, and Sleep, Zero to Three, January 2012.
Mindell, Meltzer, Carskadon, & Chervin (2009), Developmental aspects of Sleep Hygiene: findings from the 2004 National Sleep Foundation Sleep in America Poll.