Understanding Newborn Sleep
Updated: Mar 6
Let’s be honest: having a baby is incredibly exciting and joyous. At the same time, most of us are met with a new sense of overload and fear of the unknown. The endless choices can send even the most rational person into a tailspin – crib mattresses, breastfeeding, swaddles, pacifiers and the list goes on! Perhaps the most daunting of all…is sleep. With the plethora of approaches to pediatric sleep, and the fussy nature of many babies, it’s no wonder families just wing it and opt for the path of least resistance.
The simple keys to sleep, for you and your infant are:
1) Setting realistic expectations
2) Practicing with some simple tools
These efforts will help to decrease your very natural new parent anxiety.
A University of Warwick meta-analysis of 8,700 babies showed that, “on average, babies around the world cry for around 2 hours per day in the first two weeks." The peak comes at six weeks: 2 hours 15 mins per day. By week 12, crying scales back to 1 hour 10 minutes.” Quite simply, babies cry. When learning your baby’s cues, try not to panic that your little one fusses.
Our first role as parents is to nurture and love them: always. We are also their primary guides as each child’s natural, biological abilities emerge. In the first few months of life, there are safe and gentle strategies that can be used to build your baby’s healthy sleep skills.
Some families have “unicorn babies” who just sleep well (lucky them). But for the majority, independent sleep is a learned skill that I define as:
…a human’s ability to fall asleep and return to sleep during naturally occurring sleep cycles, without the assistance of another human being.
Like riding a bike, learning to read or doing math, someone needs to gently and lovingly guide us. As much as we want to assist our children, there are many things they will need to do for themselves. Between 4 and 6 months, independent sleep is possible, and it is amongst the most important for overall well-being and growth.
A Roadmap to Newborn Sleep:
Remember that your baby is very new, and everything is fluid. Early on, forget the schedule. Your focus is to keep your baby safe, fed, loved and rested. Like many things in life, these early weeks are simple but not easy. The less you schedule and the more you can spend time together, honoring your baby’s emerging rhythm, the better.
As your baby’s circadian rhythm develops over the first few months, he cannot tell the difference between day and night. For the first 2 weeks or so, let your baby’s daytime sleep occur in a lighter environment. If the daytime sleep lasts beyond 2-3 hours, feed your baby and keep him up for an hour or so. We want to cap these daytime sleep periods in order to save the longer sleep stretches for nighttime.
If you are breastfeeding, starting a feed during REM sleep (you can see their eyes moving under the eyelids) or during the Quiet Alert phase are optimal because of your baby’s calm state. Once a baby starts to cry, they are more agitated which causes the latch process to be more difficult.
While there is a wide range of normal around the timing, every child has the innate biological ability to sleep well. As their guides, if we provide developmentally appropriate opportunities to practice independent sleep, we are ultimately helping them meet these intrinsic needs.
Lay your newborn (0-12 weeks) down 45-60 minutes after she last woke up. Developmentally, this is the average amount of time awake that they can sustain. Young babies cannot easily show us when they are tired – the clock is your most reliable cue for sleep needs at this stage. Keep track of the time with a simple chart.
If you are breastfeeding, expect your baby to eat 10-12 times in a 24 hour period for the first weeks. This regular feeding not only keeps your baby optimally nourished, but it stimulates the production of prolactin and oxytocin, the two hormones that encourage healthy milk supply and release.
The National Sleep Foundation recommends that newborns, from birth to 12 weeks sleep 14-17 hours in every 24-hour period. Put it on repeat: Eat – Play – Sleep.
Each time your baby wakes up, notice the “quiet alert” phase. This is a good time to begin a feeding – while your baby is relaxed and not upset. Our goal is to eventually separate food (and rocking, bouncing, holding) from sleep. The simple and gentle efforts that you make early on will eventually build your baby’s independent sleep skills.
Do your best (without stress) to provide a full feed. Try to keep your baby awake in order to really eat. Babies are very drowsy in the beginning and it is hard to keep them alert. But this will shift over time. After eating, play. A little assisted tummy time, some fresh air and natural sunlight and then 45-60 minutes later, provide another opportunity for a snooze.
Think of a walnut – in the first days, that’s the size of your baby’s stomach. This, plus the fact that they digest their food quickly and efficiently, is why they eat so often. Healthy, breastfed babies gain an average of an ounce of weight every day. Expect rapid change for your new baby.
What’s the big deal about sleep? Matthew Walker, director of The Center for Human Sleep Science writes, “Sleep is the single most effective thing we can do to reset our brain and body health each day.” The list of benefits, including building the immune system, brain development, cell repair and behavior regulation is too long to recount here. Trust me: sleep does the body good!
Safety is paramount. Familiarize yourself with the American Academy of Pediatrics Safe Sleep Guidelines. Even if you “can’t get your baby to sleep”, don’t take the chance on an unsafe sleep surface like a couch or recliner. It’s just not worth the risk!
You may be holding or wearing your baby for daytime sleep. It is natural and if it works for you, it can be helpful for your baby’s regulation. Within a week or two I suggest giving your baby a chance to practice sleeping in an independent, consistent, safe-sleep space. Try to put her down for naps in her safe sleep space when you feel ready. If there is protest, pick your baby up and settle a little and try again. There is no pressure to “get this right” and this is only meant to be a time to practice.
Safe Sleeping Tips
Use a firm mattress or sleep surface.
Place nothing in the crib or bassinet (bumpers, stuffed animals, blankets, toys).
Put your baby down on his or her back in a swaddle.
Room temperature should ideally be 70-72 degrees Fahrenheit. Remember Goldilocks – Not too hot or cold, but just right.
After the first couple of weeks, naps and nighttime sleep should be in a dark room as often as possible (room darkening shades are very helpful).
Use a white noise sound soother.
Baby monitors are also advised – however, don’t feel the need to run to your baby at every little peep. Babies are noisy sleepers. Learn to recognize their cries and their cues. Be patient, as this takes time.
Swaddle your baby for the first few months – or until your baby can roll over on his or her own. Swaddling will help your baby feel snug and decreases the flailing while the Moro Reflex is still at play. Provide enough room for your baby to move his legs so the hip joints can develop normally. Also, remember to keep your baby at the right temperature and don’t overdress.
Establish a simple but repeatable bedtime routine. Do the same exact routine every night as a cue to your child that it is time for sleep. During the first 3 months we like to set a bedtime of 8 PM. As often as possible, stick to it as you are helping your baby regulate the circadian rhythm.
Sleep begets sleep. Don’t fall prey to the myth that if you put your baby to bed later, he or she will sleep later in the morning. It’s just not true. Overtired babies have a harder time falling asleep, getting settled and sleeping later. Late to bed almost guarantees early to rise. Remember that by 4-6 months of age, most babies can (and need to) sleep for 10-12 hours. Some babies still need a middle of the night feed but are stretching out the consolidated sleep period to 6 or 8 hours.
Don’t panic if your baby is awake for hours at night in the first few weeks. This is her natural body clock regulation while she sorts out her circadian rhythm. It usually does not mean that something is wrong. If your baby is awake during these hours, do your best to avoid blue light exposure (cell phones, TVs) because it will encourage cortisol production – the waking hormone.
Eat. Play. Sleep. Repeat. The more you can do full feeds after waking and then get your baby back down within an hour after some playtime, the better. Usually there is no need to feed again before sleep. Separating the feeding out from the going to sleep process will be one of your biggest keys to success when it is time for baby to sleep through the night on his own.
Be kind to yourself. In the beginning this might seem challenging because your baby is so sleepy and fussy. Take it easy. Try a couple of times a day to put your baby down awake. If you are assisting your baby to sleep a few times per day in the beginning – it’s okay. Attempt the independent sleep strategies, some of the time, and you will be building towards the foundation for independent sleep. The last thing we want to do is add stress or worry to an already exhausting process.
Assisting your baby to sleep by rocking, holding, picking up/putting down are only recommended for the first 3-4 months of life. Once you are to that point, if you are not able to figure it out, don’t hesitate to ask for help. Even with the BEST intentions from the beginning, every child is unique, and many families need support in helping their children become great sleepers.
First 3 Months
Remember that in the first 3 months, these suggestions are merely a guide to follow. Ultimately, in the first few months your priorities are:
Provide regular feedings throughout the 24 hour period.
Consistently set your baby up for safe sleep.
Love! Lots of it – skin to skin contact, facial reflection, fresh air and play.
If you are building a foundation using many of these tips, it is realistic to expect that by 6 months of age (or sooner for the unicorns), your baby will be sleeping through the night without interruption. By this point many babies don’t need food during the night and are capable, if guided properly, of independent sleep. After about 4 months of age, if you are curious if your baby is ready to sleep through and go without food during the night, please consult your pediatrician or schedule a free call with me