NOTES AND QUOTES FROM...
Healthy Sleep Habits, Happy Child, by Dr Marc Weissbluth
(Vermillion, London: 2005)
Age 5-12 Months
Increased sociability, infants enjoy their parents company. The more you amuse your baby, the more s/he expects this to be the natural way of things, so when you dress baby or leave him/her alone to get dressed yourself, you can expect her to protest at the fun stopping.
Cue ? more crying when it?s time to sleep. This is normal, but difficult for parents to deal with. Several options from Extinguishing to Gradual Withdrawal
After 4 months, infant sleep becomes more adult-like, the sleep cycles from deep to light non-REM sleep with interruptions of REM sleep.
There should be brief periods of wakefulness during the day, to avoid an overtired state
This is an outline of a reasonable, healthy sleep pattern. Not a set of rigid rules. Times are described by clock time but best to watch your baby than to watch the clock.
Cycle is:
Start the day: around 7am
1st nap: 9am
2nd nap: 1pm
3rd nap: varies
Bedtime: 6-8pm
1st awakening:
2nd awakening:
Wake-up time:
Some babies wake up early, 5 or 6 am, and return to sleep after feeding or nappy change. This is continuation of night sleep and not a nap.
It is not a good idea to go to your child before 6, because he will start to force himself awake earlier and earlier to enjoy your company.
You can?t change the wake-up time by keeping baby up later, feeding solids before bedtime or awakening baby for a feeding before you go to sleep. It?s an independent neurological alarm clock that appears to be independent of the part of the brain that keeps infants asleep.
Morning wakefulness:
Lasts about 2 hours for 4-5 month-old babies or about 3 hours for 8 months. Some babies may only be able to stay up for 1 hour.
Plan a wind-down or nap time ritual of up to 30 minutes ? you decide what it is, but limit it because hours of holding your baby produces only a light sleep state, which is poor quality sleep. Begin the wind-down ritual about 30 mins before the end of your baby?s wakeful period. At the end of the wind-down ritual, whether your baby is asleep or awake lie down with her on the bed or put her in the cot. She may now cry a little, a lot, or not at all.
Nap 1: Midmorning, around 9am, for about an hour or two.
This nap develops first, usually established at about 12-16 weeks. A sleep period is considered ?restorative sleep? if it is about an hour or longer. Forty to forty-five minutes is sometimes enough. Naps of less than 30 mins should not count as naps.
- try starting the morning nap earlier ? after just one hour of wakefulness ? if difficulty establishing it.
- try brief but intense stimulation outdoors during wakefulness periods, especially exposing the baby to outdoor light in the morning or make the room as bright as possible when he wakes. Darken when it?s time for soothing.
- try a longer soothing to sleep routine
Midday Wakeful Time
Expect your baby to be ready for another nap after 2-3 hours of wakefulness.
If your child did not take a morning nap, don?t allow him to snooze in the car or pushchair at a time when he should be awake, it throws the remaining sleep/wake pattern off kilter.
- During a wakeful period, it is difficult to fall asleep or stay asleep and if you do fall asleep it?s less restful during this time.
Usually if a nap doesn?t occur, let baby stay awake and go on to the next sleep period. Probably it will take place a little earlier.
Nap 2: Early Afternoon
Usually occurs between noon and 2pm, most commonly around 1pm, try to make sure it starts before 3pm. The nap should last about an hour or two.
Most common problem is that the Midday wakeful time goes on too long which causes your baby to be overtired and makes going to sleep falling or staying asleep difficult.
Nap 3: Late Afternoon: 16% of babies have 3 naps
If this nap occurs, the time it starts may vary between 3pm and 5pm. Duration also varies but it is usually quite brief, around 30-45 mins.
This nap usually disappears by 9 months.
Persisting with this nap when it isn?t needed can make the bedtime difficult, cutting it out usually then requires an earlier bedtime.
Bedtime:
Establish a regular bedtime routine in terms of WHAT you do: bathing, massage, story, lullaby, rocking or other soothing efforts. Approximately the same sequence each night helps signal to the child that it is the time for night-sleep at approximately the same time. But don?t be rigidly regular in terms of WHEN you do it: there is enough normal irregularity in napping to produce variability in bedtime.
Different parts of the brain are responsible for day and night sleep, so you don?t need to do the same soothing for day sleep as for night ? just be consistent in whatever you do for nightsleep, and how you soothe for day time naps, even if the two routines are different.
Night wakings for feeding:
Your baby may wake to be fed 4-6 hours after his last feeding. Some babies don?t, others are actually hungry at this time and you should respond to them promptly.
In a child under 4 months, the bedtime may have been later and the last feeding at night later. Now your baby is going to sleep earlier, is fed earlier in the evening and may need a night feeding; this is normal.
This night feeding, and a second night feeding, may be needed until your baby is about 9 months of age.
Partial awakenings, or light sleep stages (?arousals?) occur every one or two hours when your child is asleep. Sometimes your child will call out or cry during these arousals. If your child is not in your bed, going in to him at the time of these partial awakenings will eventually lead to a night-waking or night-feeding habit. This is because picking up, holding and feeding your baby will eventually cause him to force himself to a more alert state during these arousals for the pleasure of your company. He will learn to expect to be fed or played with at every arousal.
If your baby wakes at night and appears hungry, feed her. If your baby appears to want to play at night, stop going to her. At night, the question is ?Does my baby need me or want me?.
A second waking for feeding may occur around 4-5 am. Some children don?t wake at this time, but those who do are usually wet, soiled or hungry and a prompt response is appropriate. While you attend to his needs, maintain silence and darkness so your child will return to sleep, and hopefully wake up around 7.
Many children don?t need to be fed twice at night, but some get up at 2 or 3 am and then not again. A common mistake is to feed at midnight, 2am and again around 4 or 5 am. If you?ve fed 4-6hrs after the last feed, try not to feed again until another 4 hrs have passed.
Drowsy signs:
As your baby shows signs of becoming drowsy you should begin a soothing to sleep routine.
Drowsy signs, sleepy cues, sleep signals:
-
moving into the sleep zone
Decreased activity
Slower motions
Less vocal
Sucking is weaker or slower
Quieter
Calmer
Appears disinterested in surroundings
Eyes are less focussed
Eyelids drooping
Yawning
Fatigue signs:
Fussing
Rubbing eyes
Irritable
Grumpy
Food and sleep:
The brain controls the sleep/wake pattern, not the stomach ? we know this because infants who are continuously fed through gastric tubes develop similar sleep/wake patterns to other infants. That said, it?s unlikely that your baby will relax and feel sleepy if they?re hungry. Also, sucking is soothing to a baby so if you suspect your baby is hungry, feed her, if you?re not sure, try offering the breast and you may soothe your baby to sleep through sucking.
Nap Deprivation:
The fatigue from nap deprivation leads to increased levels of arousal and alertness, and this causes difficulties in falling asleep, staying asleep or both.
- Shorten the interval of wakefulness before the first nap & re-establish the early afternoon nap by focussing on the midday interval.
- Make sure the afternoon nap doesn?t start too late, protect a reasonable evening bedtime
- Consistency in the nap time ritual
If the afternoon nap is needed but the child fights sleep the most then, try shortening the midday period of wakefulness. Start the afternoon nap earlier.
Brief Sleep Durations
If the normal bedtime was around 8/9pm before the onset of nightwaking, try moving the bedtime to an earlier time.
Gradually shift it forward in 20 minute increments until the night wakings stop. (sounds simple?)
Early Awakenings
Most children should go to bed between 6-8pm, and wake between 6-7am. 6AM is a normal wake-up time and shouldn?t be ignored, even if it feels early to the parent.
If going in BEFORE 6am seems to be stimulating the child more than soothing him/her, try waiting until 6. The reason is that children can start to fight sleep and get up earlier and earlier to enjoy their parent?s company, which then has the effect of throwing the entire day?s sleep patterns off.
If this pattern is already established and the baby is waking at 4 and ready to play, try putting the child to bed earlier ? if they get more sleep at the front end of they are better rested and are thus able to sleep better (sleep begets sleep), and a more likely to sleep later in the morning.
Night wakings:
Approx 20% of infants between 4 and 8 months of age who seem especially prone to waking at night had colic when they were younger. Parents of these children found that not much they did helped with the colic, so pretty much gave up regular routine. However after four months of age, regular and consistent attention to bedtimes and nap times really does help the older infant sleep better.
About 10% of infants snore or breathe through their mouths during sleep, possibly due to allergies. These infants awaken as frequently as those who had colic but for some reason parents don?t tend to think of it as a problem.
A 3rd frequent cause of night waking is associated with abnormal sleep schedules.
Other things that cause night waking:
- Fever
- Painful ear infections
- Atopic dermatitis, eczema
Solutions to Help Your Child Sleep Better:
Choose the solution (there are many) that works best for you and your child. For the 20% of babies that suffered from colic in the early months and who persist at the age of 4 months+ in having severe sleep problems, extinction or ignoring all crying, works best. But is also the hardest sleep solution for parents and you should always consider trying other solutions that involve less crying, especially if you child does not/did not have colic.
?No Cry? sleep solutions
- Start early to avoid the overtired state by trying to soothe your baby to sleep within 1 to 2 hours of wakefulness.
- Always hold your baby, always respond and soothe you baby as long as s/he needs to induce sleep; sleep with your baby
- Always respect ?drowsy signs? so your baby never becomes overtired
- Always try to put your child to sleep drowsy but awake
- Motionless sleep (i.e. not in buggy or car)
- Establish and consistently practice bedtime routines
- Practice scheduled awakening
- Get fresh air between naps, go for a walk
- Control the wake-up time
- Slowly and gradually give your child less attention around falling asleep or during the night
- White noise
- Room-darkening window shades
- Relaxation
- Stimulus control
?Maybe Cry? Sleep Solutions
- Father puts baby to sleep
- Make bedtime earlier
- Focus on the morning nap
- Sleep rules
- Silent return to sleep
- Day correction of bedtime problems
?Let Cry? Sleep Solutions
- Ignoring all crying, or extinction
- Ignoring some crying
- Check and console
- Cot tent
Fading = gradual withdrawal
Over a period of time, you gradually reduce your efforts at night, so that your child takes over for himself and falls asleep or returns to sleep by himself.
Here is an example of a fade sequence to eliminate night wakings:
- Respond promptly, spend as much time as needed.
- Respond promptly, father gives bottle or mother doesn?t nurse
- Change from milk to water
- No bottle
- No picking up
- No verbal communication
- Minimal contact, patting or hand-holding
- No eye contact; sober, unresponsive face
- No physical contact; sit next to child
10. Move chair away from cot towards door, slowly over several days
11. Reduce time with child
12. Delay response.