Developing Good Sleeping Patterns for Young Babies

Problems That Parents Experience
* Your 6-week-old baby falls asleep quietly in your arms. You put him down, but immediately (or just after a few minutes), he wakes up and starts crying. You pick him up again and hold him until he is asleep again. In the meantime, you can’t take a shower or get anything done in the house. And at 6 o’clock in the evening, he starts crying a lot. Is he hungry? Does he want attention? You can no longer eat dinner!
* You have a 3-month-old baby, and it seems the pattern of sleeping and feeding is becoming increasingly chaotic. She sleeps only briefly and drinks often.

Parents of babies are often very tired. They are unable to maintain their good mood and their sharp memory. They may start feeling dizzy, or become mentally foggy. This is especially hard on mothers returning to a demanding job in which they need to focus. It is not only sleep deprivation that can cause drowsiness. The hormones that circulate in nursing moms help moms to relax and contribute to a feeling of fatigue.

Below are some facts that present-day parents need to know and understand before they act on advice.

Development of sleep
In the uterus, the baby is very protected and sleeps a lot. Suddenly, after birth, there are many stimuli from the outside world. The world is overwhelming, and everything touches the child deeply. Because the nervous system is not sufficiently developed, the baby is very vulnerable. In the first two weeks, it seems as if the newborn is still in a different world. She sleeps fine everywhere, even in a busy living room. In the first weeks after birth, the child sleeps about 16-20 hours per day. Sleeping develops in a rhythm and has two different states. One of these is the REM (Rapid Eye Movement) state. REM is the lightest sleep state. During this state, the child dreams, organs are working, the eyes are moving (hence the name) and breathing is irregular. In this state, the child processes information and learns. (Research has shown that new synapses between neurons are formed during REM sleep.) Most newborns make uncontrolled movements which can easily wake them. In the first weeks, the child can open her eyes but she is still asleep. What is the second stage of sleep? Maybe you should define it; maybe you don’t want to define it. It is deep sleep.

The sleep of newborns is about 50% REM sleep. During deep sleep, the heartbeat and breathing are slow and regular because the body is resting. Deep sleep strengthens the immune system. Each sleep cycle consists of a deep sleep phase followed by a light sleep phase lasting a total of about one hour. After a cycle of three to four hours, newborns wake up because they are hungry.

A mother enters her REM sleep, in which she also dreams and moves, every 90 minutes. After every cycle, the REM sleep is a little longer in proportion to the non-REM sleep. When a mother sleeps with a baby in her arms next to her body, the baby follows the REM sleep cycle of the mother and therefore awakens more quickly and more often. Research shows that the baby sleeping with the mother nurses about every one and one-half hours. When you sleep separately (for example, the baby in a little bassinet next to your bed or co-sleeping under a different blanket), the breast feeding interval is at least twice as long because the baby is able to follow her own rhythm.

After six to eight weeks, babies have a day and night rhythm. However, it is not a 24-hour rhythm, but a 25-hour rhythm! Therefore, the baby first wakes up at five and the day after, at six and yet another day later, at seven. It takes the baby until he is three to four months old before he has a 24-hour rhythm. (Interestingly, if adults are deprived of light, they go back in this 25-hour rhythm.)

The First Weeks
For a newborn, it is healthy when life after birth is similar to what it was in the uterus. It is especially important to protect him against too many stimuli in his surroundings and to keep him warm enough.

Body contact and being held is also important for a newborn. By holding him close to your chest, he feels the rhythm of your heart. Holding stimulates the breast milk and your bonding.

The first two weeks after the baby’s birth, you can put the baby down on her side, alternating each time you lie her down between the left and right side.

If the baby cries a lot in the first two weeks, or if he only wants to look in one direction (and not in the other), go to a good Doctor of Osteopathy (most insurance plans provide coverage). In many cases, the crying can be solved.

Immediately following the baby’s birth, you can initiate a predictable rhythm. The normal order is the following:
* Sleep
* Nurse immediately after she awakens (for a maximum of half-an-hour) and concentrate on the baby while nursing
* Spend time together, including letting her burp and changing her diaper. Defecation is a reflex after nursing.
* Then, as soon as the baby is tired, give her a pacifier or help her find her thumb and put her in her bassinet. Most babies have a great need to suck before they fall asleep. Do not interpret this as hunger! Some practitioners recommend not using a pacifier for the first three weeks because of the risk that parents will use it when the baby is in fact hungry. If a pacifier is used under these conditions, the baby may not have enough energy left to empty the breast. However, if you have followed the order described here, the baby will already have had enough to drink before she is put down, eliminating this risk. If you nurse a newborn to sleep, she often awakens soon because she needs to burp.

The time between feedings normally is two to four hours. (Count from the start of one feeding to the start of the next.) Do not feed the baby before two hours have passed because the digestive system needs to rest. Awaken the baby during the day after four hours. In the first ten days you often need to awaken her after three hours. You often do not have to awaken her at night.

With clear boundaries, the baby feels secure and can more easily relax. When you swaddle him from shoulder to toe, he is limited and feels where he ends. It is then easier for him to let go and fall asleep. When swaddled, he will not awaken as easily as a result of the startle reflex or other uncontrolled movements of his arms.

Studies have shown that swaddled babies, in the first seven weeks of their lives awaken less frequently and fall asleep much sooner after arousal. The duration of REM sleep is nearly doubled if the child is swaddled. In combination with rhythm and predictability, swaddling also has a positive effect on crying and restlessness in babies. (For more information, see the 2007 article in the scientific journal Pediatrics.)

Swaddling is a very old technique that was applied universally before the 18th Century. Currently, only a small percentage of children in the Western world are swaddled. Many mothers nowadays feel uncomfortable with swaddling. Perhaps this is because it seems to run contrary to the current cultural bias in favour of personal freedom over limitations.

As you swaddle a baby, look at him. The baby usually becomes totally quiet and peaceful. A few times in my practice when I showed mothers how to swaddle, the baby fell asleep within two minutes. The child should only be swaddled when he is brought to bed and needs to sleep. If you swaddle, do it correctly and safely! For instructions on how to swaddle your baby properly, consult your physician or another trusted childcare expert. In any case, however, do not swaddle under the following conditions:
* in the first 24 hours after a vaccination is administered to the child
* when the child has a fever
* when a child has a serious infection of the respiratory system
* after a child has started rolling over from back to belly

Tucking in Tightly
An alternative to swaddling is to tuck the baby’s blankets firmly around her, thereby also confining her arms. The blanket needs to be big enough and tucked far enough under the mattress. The mattress needs to fit properly. This, in combination with the baby’s weight, prevents the blanket from coming loose. The blanket should reach the child’s chin. Use woollen blankets (or silk or cotton) and use them lengthwise across the baby. Tuck the baby every time she goes to sleep, with her feet touching the bottom of the crib or bassinet. With her feet touching the bottom of the crib or bassinet, the baby cannot move down any further. This way, the baby’s head cannot end up under the blankets.

Belly Sleeping
Most babies sleep deeper and longer when they sleep on their bellies. However, research has shown that the chance of sudden infant death syndrome (SIDS) is ten times greater when babies sleep on their belly than on their back.

A baby who is equally warm all over (including his feet) feels comfortable and is able to relax. Cover the shoulders and, if necessary, put socks on and two layers of long-sleeved shirts. However, make sure the baby is not too warm. Overheating when a baby is sleeping can be dangerous! Do not use a down comforter or synthetic blanket. Be aware of the room temperature! If it is very warm, put the baby in just a diaper and use thin sheets to swaddle or tuck him in. This way, he still feels the boundaries but does not become too warm. A baby will sleep best when he has and maintains proper body temperature.

The Bassinet
A small bassinet next to the bed of the parents is a good follow-up to the small house the baby lived in before: the mother’s uterus. A small bassinet helps with the feeling of security. A soft pink curtain makes the space even more intimate. Pinks works calming and it prevent the baby from being distracted by the environment. The mattress needs to be flat and firm, but not cold. (A sheepskin on the mattress is often too warm.)

Co-Sleeping at Night
For some babies the transition of being separated from the mother after birth is difficult. You can co-sleep with them closely and even let the newborn sleep on you. During the day you can carry her in a sling. However for most babies, during the night, I recommend that if you choose to co-sleep, you keep the baby at arm’s length under a separate blanket. This will prevent the baby from following your REM cycle. If you do not do this and the baby does follow your REM cycle, she will likely awaken every one and a-half hours. Further, feed only when the baby is awake and starts crying, and not if she is a little fussy. Keep feedings short and to the point-- no noise, little light, and if possible, no change of diaper. The night is from around 8 p.m. until around 7 a.m.

Five Weeks to Three Months
Week after week, you can see that the child is more aware of the environment. He starts looking around, and with the first smile at around 6 weeks, you really can see that your baby is a totally different person than you. Rhythm and predictability are very important. This is the normal order:
* Sleep
* Nurse immediately after he awakens. Normally babies awaken and start crying because they are hungry.
* Spend time together
* After some quality time together, you can leave the baby for a short period of time alone in a quiet spot on a flat surface. Instead of the old-fashioned playpen, you can put a simple crib in the living room near the place where you spend most of your time. There the baby can see you. And you can see when he gets tired. If he does, he will become fussy and/or start yawning. If you play too long with him, sometimes you cannot see when he gets tired, and you miss the right moment. If a baby gets tired, he breaks eye contact and looks away. Another way to know if your baby is tired is that if you put him down in his quiet spot, and he immediately starts to fuss, he is tired. Often this behaviour is interpreted as the baby not wanting to be in that location, and more attention is a common but inappropriate reaction. This causes stress, and stress releases a hormone that awakens him.
* If you swaddle, swaddle the child when he is tired and give him a pacifier. The sucking need before falling asleep continues until he is about 3 months old. However, after 3 months, sucking helps many children fall asleep.
* Your baby soon recognizes this ritual of swaddling. He also recognizes his bassinet, and the song you always sing before he falls asleep. It is important to put your baby to bed awake and to tell him that it is time for him to go to sleep. He needs to learn to fall asleep by himself. You can stay with your baby until he is asleep. You can put your hand on his head or caress his back, or you can leave the room. Do not take the baby out of his bed again if he starts crying; 95 percent of babies cry because they are tired. Often babies need to cry before falling asleep. It is their way of relaxing fully. So allow him to cry. You have already made sure that he is not hungry, does not have to burp, does not have a dirty diaper, etc. Picking him up can lead to confusion and more crying. (Sometimes, especially when your baby is not used to this routine, he can cry longer because habits are difficult to change. If a child cries continually for more than ten minutes, you can make an exception, hold him and offer him your most empty breast. Nursing him for one or two minutes—perhaps while swaddled—can help him relax. You can put him back to bed immediately afterwards.) The time between feedings remains two to four hours. The time awake is normally 45-75 minutes and the time asleep is 75-180 minutes. If you want your baby to sleep through the night as soon as possible after six weeks, you can try to extend the periods between night feedings by offering a pacifier. However, only do this if the baby is gaining enough weight.

“Cat Naps” (waking up after a short nap)
After you put her down, sometimes a baby wakes up out of her first REM sleep and cries within 40 minutes. It is not yet time for her next feeding. You can leave her for a few minutes, and see if she falls back to sleep, give the pacifier, or just look to see if everything is all right. You can see if her eyes are open or closed while crying, etc. Check her without her seeing you. If she awakens prematurely, do not take her out of her bed immediately. Wait a few minutes! When she is swaddled or tucked in tightly, she will often fall asleep again.

Noise is stressful for most babies because they do not recognize most noises and cannot filter them. A music box and background music may seem calming to a parent, but are disturbing to a baby. Constant entertainment of the baby can also lead to too much stimuli. When you have a small baby, receive visitors at home rather than going to their place. Wait with a baby gym until the baby is at least 3 months old.

Colic and Crying in the Evening
Some very sensitive babies cry at the end of the day. Often it is a stress-releasing cry, and the baby is exhausted.
* Do not distract him to try to stop the crying
* Relax, be quiet and let him cry in your arms until he falls asleep
* Walk with him in a sling until he falls asleep. Moving with the rhythm of your walk can be calming.
* Sucking may help
* Put him down in his own bassinet.
The crying often will stop within 10-20 minutes. When you hear a deep sigh, he is deeply asleep. Common reasons for “colic” are:
* Stress and over-stimulation
* Not dressed warmly enough
* Breastfeeding at intervals of less than two hours because in that case the baby doesn’t empty the breasts and drinks more front milk than back milk. The front milk contains more sugar and the back milk contains more fat. Sugar can cause yeast in the stomach, whereas fat gives the baby a full feeling. (The baby needs to empty at least one breast)
* The baby is swallowing air while nursing. Make sure the baby doesn’t turn her head while nursing and do not feed him too often. When the breasts are too full, sometimes the milk comes out too fast. (when the baby starts to drink while moving a lot they often need to burp.
* Sensitivities to the food the mother is eating. Avoid eating spices, garlic and onion, and try not eating cow-milk products (milk, cheese, butter) for a few days to see if this helps.

Research in the Netherlands among 400 babies, younger than 12 weeks of age, who cried more than 150 minutes a day has shown the following after the predictable order described above, crying was 40 percent less after a few days. After two weeks, there was 50 percent less crying. The babies who also were swaddled cried 40 percent less on day one.

Three Months to Six Months
After three months, you can feed at set times. You can start with two set times a day and allow the other feedings to occur when she naturally wants to drink. In the morning, you might feed her every four hours, and in the afternoon, every three hours, or the other way around. This will help your baby develop a 24-hour rhythm. Set times are not necessary!

Babies this age are easily distracted. Therefore, you need to focus when you feed the baby and make sure she empties the breast. (Do not watch television while nursing.) Provide her with a horizontal surface on which to play. Here she first discovers her own hands, and next she starts grabbing things next to her from a prone position. Later she grabs and discovers her feet, and after that she rolls over. You need to stop swaddling before she starts to roll over. Most people stop swaddling when their baby is between 3 and 4 months. You can exchange the swaddling blanket for a woolen or cotton sleeping sack. I advise a sleeping sack when babies get stronger legs and are able to kick off blankets. When a child rolls, it also is time for her to sleep in her own crib. This is secure and safe. Learning how to fall asleep by herself as part of a predictable routine and maintaining a ritual around sleep times becomes more important.

Some parents begin to give cereal to help babies sleep through the night. I do not recommend this until the baby is 7 months because there is a chance that she will become constipated.

Sleep problems start when babies’ senses are over-stimulated and babies are fed at unpredictable times. When a baby does not sleep enough, the levels of hormones, such as cortisone and epinephrine, rise. This causes the baby to be more alert and camouflages the baby’s mental fatigue. This can undermine a baby’s ability to maintain optimal health.

Rhythm and uniformity result in predictability. The baby knows what to expect and feels secure. It allows her to relax. One thing is always followed by the next. However, most important is that you need to look closely to your baby. Every baby is different and needs a different approach.

© 2009-2011 Ester Delhoofen. All rights reserved.