Part 1 – Newborns
What’s Sleep for Anyway?
All animals require sleep. Some sleep during the day, others, like humans, sleep when it’s dark. When we get a good night of sleep, we feel refreshed and energized and ready to face the day. When we don’t, all bets are off. We get crabby, make poor food choices, compromise our immune system, have trouble concentrating, get in more car accidents, compromise muscular and skeletal growth, and, in general, make everyone around us miserable. This is true whether we are 1 month old or 80 years old. Adequate sleep is as necessary for proper brain and body functioning as food and oxygen.
Sleep requirements depend on age and, to a certain extent, individual needs. Not surprisingly, children need more sleep than adults. Unfortunately, many children don’t seem to realize this and fight going to bed like they’re being shipped off to ‘Nam. Others will sleep forever if they’re plastered to your side in your bed but their presence can greatly interfere with plans the adults may have had for the night (I’m talking about sleeping!). Teenagers, of course, won’t go to sleep until the wee hours of the morning and then reenact scenes from “The Walking Dead” at school.
“How do I make my child sleep?” is one of the most frequent questions I hear at well-visits (and sick visits, come to think of it). Like many things with kids, it’s much easier to set good habits from the beginning than try to change the bad habits once they’ve been set. Having said that, it’s never too late to try! So, to that end, this is the first of a series on sleep that will start with newborns and end with those darned night owls, the teenagers.
Newborns and Sleep
So, you’ve just brought your new little bundle home from the hospital. You’re completely in love and all you want to do is just look at him. But, you didn’t sleep well for the last couple of months of the pregnancy and you certainly didn’t get any sleep in the hospital, so maybe you’ll just take a little … WAAAAHHHH!!!! And the precious bundle is up! Okay, change the diaper, nurse, change diaper, burp, nurse, change the diaper (where is all this poop coming from?), burp, rock to sleep, and ahh… time for that nap. But, the laundry needs to be done, the house is a mess, someone needs to run to the store for more diapers (seriously, where did all that poop come from?) and WAAAAHHHH!!! And it starts all over again…
Newborns sleep 14-18 hours a day, but it never seems to be at the right time or in long enough stretches to get anything like mommy sleep done. Newborn babies have immature sleep cycles and frequent nutritional needs which means that the best you can hope for is 2-3 hours of continuous sleep in the first weeks to months. One of the most chilling things for a pediatrician to hear is that the one week old is such a good baby and sleeps through the night. Your baby should be eating every 2-4 hours until they are gaining weight well and their feeding (especially if you are nursing) is well established. This will generally take 3-4 weeks, so sleep when the baby sleeps, let the house go, and let grandma do the laundry!
How and Where Should Babies Sleep?
All babies should sleep on their back. Let me repeat that. All babies should sleep on their back. Since the advent of the Back to Sleep Campaign in the early 1990’s, the incidence of Sudden Infant Death Syndrome (SIDS) has dropped by half. By putting them on their back. If only everything in pediatrics was that easy. They also should not sleep on any kind of a soft surface or have any soft items around them like blankets, bumper pads, or pillows. They should not sleep in any kind of a sleep positioner – these have been found to increase the risk of SIDS. Really, it should be like a scene from Dickens – the baby on a bare mattress without any embellishments. You can put her in cute footie pajamas if you want. I’m partial to ones with monkeys on them.
Now that that’s settled, let’s talk about where. The American Academy of Pediatrics recommends that infants should sleep in a crib, bassinet, or a play yard that is certified by the Consumer Safety Protection Commission (CPSC) in the parents’ room. However, the AAP does not recommend that babies sleep in the bed with their parents and I completely agree. Yes, it’s the way humans evolved. Moms didn’t put their babies to sleep in the Cave Nursery while she slept in the Cave Master Bedroom. However, I don’t think Cave Mama slept on a pillow top queen with sheets, a down duvet, and enough pillows to suffocate an elephant. Modern beds are just not safe for infants. If you want to sleep on the floor on a grass mat so you can bed share with your infant, we can talk. Here are the risks of modern bed sharing – suffocation, asphyxia, entrapment, falls, overlying, strangulation, and death. Not what the doctor ordered.
And on that topic, babies should not routinely sleep in car seats, swings, bouncy seats, or dresser drawers. They’re just not safe enough for unsupervised sleep with young infants.
So put Precious Bundle safely in her bassinet right next to your bed. That way you can see and hear her and can easily bring her into your bed for feeding. Then, before you crash, put her back in her bassinet ON HER BACK. And admire the cute footie pajamas.
So What About Sleep Training?
Yeah, you’re too tired for that conversation. Getting through the first couple of months is all about sleeping when you can. Stay tuned for the next segment. However, if you’re feeling ambitious you can start on some early steps:
- Start trying to put the baby down to sleep while he’s drowsy but still awake or at least discourage him from falling asleep with the breast or bottle in his mouth
- Don’t let her lengthen the interval between her daytime feeds; try to keep them every 2-3 hours so she can go longer at night
- Start putting him down for naps in another room where it’s darker and quiet rather than in the family room with you; he should start to get the message that dark means sleep, bright and noisy means awake
- Continue to observe your baby and learn what her sleep cues are
- Go ahead and put that crib in the nursery together!
And congratulations on your newborn!
