Infant Sleep

What are an infant's sleep needs?

Sleep needs for babies vary depending on their age. Newborns do sleep much of the time. But their sleep is in very short segments. As a baby grows, the total amount of sleep slowly 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 they may not sleep more than 1 to 2 hours at a time. Most babies don't start sleeping through the night (6 to 8 hours) without waking until they are about 3 months old, 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 age 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 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 unhappy when the baby starts to wake up at night again. This often happens at about 6 months old. This is often a normal part of development called separation anxiety. This is when a baby does not understand that separations are short-term (temporary). Babies may also start to have trouble going to sleep because of separation anxiety. Or because they are overstimulated or overtired.

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

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

• Crying when you leave the room

• Refusing to go to sleep without a parent nearby

• Clinging to the parent at separation

Sleep problems may also happen with illness. Talk with your baby's healthcare provider if your baby begins having trouble 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 by:

• Rubbing eyes

• Yawning

• Looking away

• Fussing

Helping your baby fall asleep

Babies may not be able to create their own sleeping and waking patterns. Surprisingly, not all babies know how to put themselves to sleep. And not all babies can 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. Creating a bedtime routine is a good idea. But don't let your baby 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 wakes up during a sleep cycle, they may not be able to go back to sleep on their 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:

• Allowing time for naps each day as needed for your baby's age.

• Not having any stimulation or activity close to bedtime.

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

• Playing soft music while your baby is getting sleepy.

• Offering a transitional object that your baby can take to bed. This may be a small blanket or a soft toy. But don't do this before your baby is old enough. Your baby should be able to roll and sit. This will prevent the risk of suffocation.

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

• Comforting and reassuring your baby when he or she is afraid.

• For night awakenings, comfort and reassure your baby by patting and soothing. Don't take 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.

• Being 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 1 year old:

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

• Breastfeed your baby. The AAP recommends breastmilk only for at least 6 months.

• Place your baby on their back for all sleep and naps until they are 1 year old. This can reduce the risk for SIDS, breathing in food or a foreign object (aspiration), and choking. Never place your baby on their side or stomach for sleep or naps. If your baby is awake, give your child time on their tummy as long as you are watching. This can reduce the chance that your child will develop a flat head.

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

• Offer your baby a pacifier for sleeping or naps. If your baby is breastfeeding, don't use a pacifier until breastfeeding has been fully established.

• Use a firm mattress that is covered by a tightly fitted sheet. This can prevent gaps between the mattress and the sides of a crib, a play yard, or a bassinet. That can reduce the risk of the baby getting stuck between the mattress and the sides (entrapment). It can also reduce the risk of 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 babies should be in a separate bed or crib appropriate for infants. This sleeping arrangement is recommended ideally for the baby's first year. But it should at least be maintained for the first 6 months.

• Don't use infant seats, car seats, strollers, infant carriers, and infant swings for routine sleep and daily naps. These may lead to blockage of an infant's airway or suffocation.

• Don't put infants on a couch or armchair for sleep. Sleeping on a couch or armchair puts the baby at a much higher risk of death, including SIDS.

• Don't use illegal drugs and alcohol, and don't smoke during pregnancy or after birth. Keep your baby away from others who are smoking and places where others smoke.

• Don't overbundle, overdress, or cover your baby's face or head. This will prevent them from getting overheated, reducing the risk for SIDS.

• Don't use loose bedding or soft objects (bumper pads, pillows, comforters, blankets) in your baby's crib or bassinet. This can help prevent suffocation, strangulation, entrapment, or SIDS.

• Don't use home cardiorespiratory monitors and commercial devices (wedges, positioners, and special mattresses) to help reduce 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 places with no dangling cords, wires, or window coverings. This can reduce the risk for strangulation.