HEALTH INSIGHTS

Infant Sleep

November 27, 2018

Infant Sleep

What are the sleep needs of an infant?

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

Generally, newborns sleep about 8 to 9 hours in the daytime and about 8 hours at night, but may not sleep more than 1 to 2 hours at a stretch. Most babies do not begin sleeping through the night (6 to 8 hours) without waking until about 3 months of age, or until they weigh 12 to 13 pounds. About two-thirds of babies are able to sleep through the night on a regular basis by the age of 6 months.

 

Babies also have different sleep cycles than adults. Babies spend much less time in rapid eye movement (REM) sleep (which is dream time sleep) and the cycles are shorter. The following are the usual nighttime and daytime sleep needs for newborns through age 2 years old:

Age

Total sleep hours

Total hours of nighttime sleep

Total hours of daytime sleep

Newborn

16 hours

8 to 9

8

1 month

15.5 hours

8 to 9

7

3 months

15 hours

9 to 10

4 to 5

6 months

14 hours

10

4

9 months

14 hours

11

3

1 year

14 hours

11

3

1.5 years

13.5 hours

11

2.5

2 years

13 hours

11

2

What are the signs of infant sleep problems?

Once a baby begins to regularly sleep through the night, parents are often dismayed when he or she begins to awaken in the night again. This typically happens at about 6 months of age. This is often a normal part of development called separation anxiety. This is when a baby does not understand that separations are temporary. Babies may also begin to have difficulty going to sleep because of separation anxiety, overstimulation, or overtiredness.

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

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

  • Crying when you leave the room

  • Refusal to go to sleep without a parent nearby

  • Clinging to the parent at separation

Because sleep problems may also happen with illness, talk with your baby's healthcare provider if your baby begins having difficulty 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 him or her to fall asleep on his own, and comforting him or her with awakenings. Your baby may show signs of being ready for sleep with the following:

  • Rubbing eyes

  • Yawning

  • Looking away

  • Fussing

Helping your baby fall asleep

Babies may not be able to establish their own sleeping and waking patterns. Surprisingly, not all babies know how to put themselves to sleep, or are able to go back to sleep if they are awakened in the night. When it is time for bed, many parents want to rock or breastfeed a baby to help him or her fall asleep. Establishing a routine at bedtime is a good idea. However, be sure that your baby does not fall asleep in your arms. This may become a pattern and your baby may begin to expect to be in your arms in order to fall asleep. When your baby briefly awakens during a sleep cycle, he or she may not be able to go back to sleep on his or her own.

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

  • Allow time for naps each day as needed for the age of the baby.

  • Avoid stimulation and activity close to bedtime.

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

  • Play soft music while your baby is getting sleepy.

  • Introduce a transitional object such as a small blanket or soft toy that your baby can take to bed. Do not do this before your baby is old enough (able to roll and sit) to avoid the risk of suffocation.

  • Tuck your baby into bed when he or she is drowsy, but before going to sleep.

  • Comfort and reassure your baby when he or she is afraid.

  • For night awakenings, comfort and reassure your baby by patting and soothing. Avoid taking 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).

  • Be consistent with the routine and your responses.

Reducing the risk for sudden infant death syndrome (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 and sleep-related deaths from birth to age 1:

  • Make sure your baby is immunized. An infant who is fully immunized may reduce his or her risk for SIDS.

  • Breastfeed your infant. The AAP recommends breast milk only for at least 6 months.

  • Place your infant on his or her back for all sleep and naps until he or she is 1-year-old. This can decrease the risk for SIDS, aspiration, and choking. Never place your baby on his or her side or stomach for sleep or naps. If your baby is awake, allow your child time on his or her tummy as long as you are supervising. This is done to decrease the chances that your child will develop a flat head.

  • Always talk with your baby's healthcare provider before raising the head of their crib if he or she has been diagnosed with gastroesophageal reflux.

  • Offer your baby a pacifier for sleeping or naps. If the child is breastfeeding, do not give the baby a pacifier until breastfeeding has been fully established.

  • Use a firm mattress (covered by a tightly fitted sheet) to prevent gaps between the mattress and the sides of a crib, a play yard, or a bassinet. This can decrease the risk for entrapment, suffocation, and SIDS.

  • Share your room instead of your bed with your baby. Putting your baby in bed with you raises the risk for strangulation, suffocation, entrapment, and SIDS. Bed sharing is not recommended for twins or other multiples. The AAP recommends that infants sleep in the same room as their parents, close to their parents' bed, but in a separate bed or crib appropriate for infants. This sleeping arrangement is recommended ideally for the baby's first year, but should at least be maintained for the first 6 months.

  • Avoid using infant seats, car seats, strollers, infant carriers, and infant swings for routine sleep and daily naps. These may lead to obstruction of an infant's airway or suffocation.

  • Avoid placing infants on a couch or armchair for sleep. Sleeping on a couch or armchair puts the infant at a much higher risk of death, including SIDS.

  • Avoid using illicit drugs and alcohol, and don't smoke during pregnancy or after birth and keep your baby away from others who are smoking and areas where others smoke.

  • Avoid over bundling, overdressing, or covering an infant's face or head. This will prevent him or her from getting overheated, reducing the risk for SIDS.

  • Avoid using loose bedding or soft objects—bumper pads, pillows, comforters, blankets—in an infant's crib or bassinet to help prevent suffocation, strangulation, entrapment, or SIDS.

  • Avoid using home cardiorespiratory monitors and commercial devices—wedges, positioners, and special mattresses—to help decrease the risk for SIDS and sleep-related infant deaths. These devices have never been shown to reduce the risk of SIDS. In rare cases, they have caused infant deaths.

  • Always place cribs, bassinets, and play yards in hazard-free areas—those with no dangling cords, wires, or window coverings—to reduce the risk for strangulation.

Updated:  

November 27, 2018

Sources:  

SIDs and Other Sleep Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment, American Academy of Pediatrics, SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment. Task Force on Sudden Infant Death Syndrome. Pediatrics. 2011;128(5):e1341-67., Sudden infant death syndrome: Risk factors and risk reduction strategies. UpToDate

Reviewed By:  

Adler, Liora C., MD,Dozier, Tennille, RN, BSN, RDMS,Turley, Ray, BSN, MSN