It’s the middle of the night. The baby wakes and cries. Do you rush in, or let him cry? What is causing the baby to wake? Are you spoiling him if you go in every time he cries? On the other hand, he may have an earache and be sick, and really need you. How do parents decide?
If this is the first cry of the night, and if this is a baby who usually sleeps through the night, then you would want to go in and see about the baby. Maybe he needs his diaper changed or is unhappy about something else. He may be teething and even be running a low-grade fever. A lot would depend on the age and circumstances. It’s not likely that you are spoiling your child unless it develops into a habit where he is continuously demanding your attention all during the night, and no one is getting any sleep.
Problems with sleep change with different ages even in the first two years. Although I make some generalizations, each child is unique and has his own special sleep needs. In general, a baby’s pattern of sleep depends on his activity level when he is awake, his satisfaction with feedings and his parents’ response to periods of awakening.
A newborn baby will sleep most of the time except for feeding. In the first few months after birth, most babies sleep about 70 percent of the time. Except for awakenings for feeding, some babies seem to be asleep most of the other time! As long as a baby awakens, is alert and feeds vigorously, you don’t have to worry about too much sleep. At six weeks of age, normal sleep periods vary from three to eleven hours—a good example of the tremendous variation among healthy babies.
Many parents ask about Sudden Infant Death Syndrome (SIDS) and wonder whether to put a baby on her stomach or her back. SIDS refers to an unexplained death of an infant in the first year of life (mostly in the first six months) during sleep. Not long ago, most babies were sleeping on their stomach and about one to two out of every one thousand infants died from SIDS. To put this another way, 998 out of 1000 infants were not at risk.
In 1992, the American Academy of Pediatrics recommended that babies should be placed on their backs to sleep. The recommendation was based on studies showing SIDS cases were reduced by 50 percent when babies who slept on their back were compared to those who slept on their stomach. At first doctors and parents were concerned that the babies might choke if they were on their backs, but this is not the case. Healthy babies will have a sufficient response and will be able to manage any spitting up.
I recommend the “back to sleep” position during the first year of life. In terms of preventing SIDS, this position is even better for a baby than sleeping on her side. A firm bed (not a water mattress or a supersoft mattress), breast-feeding, and an avoidance of smoking will also reduce a baby’s risk for SIDS.
A baby can be in a room by herself, or you may want to put her in your own room for the first few months, when she needs more care. If you can easily hear her, then a separate room is fine. After about two to three months, you may want to move the baby out of your room and into her own. If she is sleeping through the night and needs less care, then she can easily be moved at two to three months. After six months, the baby gets used to the idea of sleeping in her parent’s room and it gets harder to move her the older she is.
Some babies develop a resistance to going to sleep unless they are walked. They may have started out as a colicky baby in the first three months, then gradually got over the colic, but have become used to being walked and carried around until late at night. If you put the baby down, she instantly wakes and demands to be walked. The guilty parent gives in and continues to carry the baby, worried that she may still be in pain. It’s best not to become a slave to your baby’s demands to be carried for hours before going to bed. You should put her in her own bed. Make sure she is comfortable then turn out the light and leave. The first night she will scream for thirty minutes, the second night ten to twelve minutes, then by the third night she will get used to the idea and go to sleep without crying. It’s hard for parents to do, but it will work most of the time if the parents are firm.
Most babies will want a nap in the midmorning and another in the afternoon. Each child is different. By the time they cut out one nap (usually the morning one), they will need a longer afternoon nap. This may happen when the baby is nine months, but for some babies who crave to sleep, both naps are important and they will continue to take two naps up to the age of two years. If the baby acts tired, you can put her in her crib and see if she will go to sleep. If she cuts out one nap, you may want to feed her earlier and put her to bed earlier at night so she makes up for the loss of a nap.
I have long advised not having children sleep with the parents. However, I realize now that 50 percent of some cultures in the United States practice co-sleeping; in fact, it is the preferred pattern of sleeping in most families throughout the world. There are advantages and disadvantages. I think that children are disturbed if they watch their parents during a sexual act. Child psychologists and psychiatrists agree that this can be disturbing and misunderstood by even the youngest child. Parents who choose to co-sleep with their children tell me that they find it easy to place the baby in another room during sexual activities. Another potential disadvantage to co-sleeping is that it may be more difficult to move a child to a separate bed or room when the child is older.
However, there are advantages to keeping the baby close so you don’t have to get up to feed her. To the surprise of many doctors and parents, the amount of sleep time for baby and mother is increased among those who share a bed. Mothers actually report feeling as though they had a better night’s sleep compared to awakening and going to another room to feed the baby. Not surprisingly, the frequency and amount of time breast-feeding is increased. And parents who prefer to sleep with their children say there is a closeness and bonding as they become aware of each others movements and sounds during brief periods of arousal from deeper sleep.
In families who choose to co-sleep, it is important that the parents do not smoke (at any time) and do not take medicines, other drugs, or alcohol that may cause heavy sedation. The bed should be firm (no water beds or couch) with a headboard that prevents the baby’s head from slipping between the bed and wall. Avoid a heavy, bulky blanket and soft pillows.
I find it helpful to have a certain bedtime ritual when putting the baby or older child to sleep. You should be consistent about the bedtime, and make it early enough so that you have time for the going-to-bed ritual. You can start them with a bath, then dress them for bed, then read them a book. Some parents include a prayer, others teach their child a meditation at about age four years. The main thing is to keep this time as quiet and peaceful as possible. No TV or phone calls to interrupt. Your “manner” is also very important. A child going to bed may have fears of the dark, or of separation, and a calm reassuring tone of voice will give him trust and confidence that he is safe and can go to sleep with no fear.
You should avoid putting the baby to bed with a bottle for several reasons. First, the milk in the mouth can cause tooth decay. Also, the milk can run down the throat and into the ear canal, setting up a breeding ground for bacteria and causing an ear infection.
A third reason not to give the bottle at bedtime is because the baby will get used to it and later when you want her to give up the bottle, she will refuse to go to sleep without it. It’s best to give the bottle while you are holding her, then put her to bed and avoid these problems.
I think something should be mentioned here about a child’s separation anxiety with relation to sleep. If a child is fearful of separation, or has other stresses going on in her life, such as a newborn baby in the family, an illness or death of a family member, a move, or a divorce of the parents, then you can certainly expect these anxieties to disturb her sleep. She may wake more often, begin wetting the bed after being dry for some time, or begin having nightmares. If these are disturbing enough, then you may want to consult your child’s doctor, a developmental-behavioral pediatrician, or a child psychologist in order to understand the situation and best help you as your child goes through this stressful period.