Prevention of Sleep Problems

from Shine Newsletter, Fall 2006

By Barton D. Schmitt, MD

If you want a good sleeper, start early. Teach your baby that nighttime is a special time for sleeping, that her crib is where she stays at night and that she can put herself back to sleep following normal awakenings that don’t relate to hunger. It is far easier to prevent sleep problems than it is to treat them later.

Newborns

Help your baby fall asleep using any technique that works

If your baby falls asleep at the breast or bottle, so be it. But if your baby is on the brink of falling asleep and calm, try to put him in his crib to introduce self-initiation of sleep into his repertoire. (Note: The safe sleep position for healthy babies is on their backs.)

Keep daytime feeding intervals to at least two hours for newborns

More frequent daytime feedings (such as hourly) lead to frequent awakenings for small feedings at night. (Exception: the first week when breast milk is still coming in.) Crying does not always mean your baby is hungry. He may be tired, bored, lonely or too hot. Hold your baby at these times or put him down to sleep. Don’t let feeding become a pacifier (called comfort nursing).

One-Month-Old Babies

Place your baby in the crib when he is drowsy but partially awake

Your baby’s last waking memory should be of the crib, not of being held or fed. He must learn to put himself to sleep without you. Don’t expect him to go to sleep as soon as you lay him down. It often takes 10 to 20 minutes of restlessness and fussiness for a baby to go to sleep.

Make middle-of-the-night feedings brief and boring

When he awakens at night for feedings, don’t turn on the lights, talk to him or rock him. Feed him quickly and quietly in the dark. Provide extra rocking and playtime during the day.  By contrast, during the day don’t try to make his bedroom too quiet or dark.

Two-Month-Old Babies

Move your baby’s crib to a separate room

By 3 months of age, your baby should be sleeping in a separate room. This will help parents who are light sleepers sleep better. Also, your baby may forget that her parents are available if she can’t see them when she awakens.

Four-Month-Old Babies

Try to discontinue the last middle-of-the-night feeding before it becomes a habit

By 4 months of age, your bottle-fed baby does not need to be fed formula more than four times a day. Breast-fed babies do not need more than five or six nursing sessions a day. Remember to give the last feeding at 10 or 11 p.m. Include extra baby food with this feeding.

Don’t allow your baby to hold his bottle or take it to bed with him

Babies should think that the bottle belongs to the parents. A bottle in bed leads to middle-of-the-night crying for refills because your baby will inevitably reach for the bottle and find it empty or on the floor.

Six-Month-Old Babies

Provide a soft security object for your child to hold in her crib

At the age of 6 months, children start to be aware and sometimes fearful of separation from their parents. A stuffed animal, doll or blanket can be a security object that will give comfort to your child when she wakes up during the night. Exception: If your baby can’t easily roll over both ways, don’t place any soft objects in the crib.

One-Year-Old Children

Establish a pleasant and predictable bedtime ritual

Bedtime rituals become very important to a child by 1 year of age. Both parents can be involved, taking turns with reading or making up stories. Both parents should kiss and hug the child “goodnight.” Finish the bedtime ritual before your child falls asleep.

Don’t worry about the amount of sleep your child is getting

Different children need different amounts of sleep at different ages. The best way you can know your child is getting adequate sleep is that he is not tired upon awakening or during the day.