Pediatricians never worry about whether babies get enough sleep, only whether parents are getting enough sleep. “Today” contributor, Dr. Mark Widome, answers some of viewer’s most frequent questions about new babies, sleep, and how to survive the first few months.
HOW MUCH SLEEP DO BABIES NEED?
Our new baby doesn’t seem to sleep very much. How much sleep do babies need?
Sleep requirements for babies vary greatly — as they do for adults. But, on average, a newborn baby needs about twice as much sleep as an adult. Newborns sleep for about 17 hours out of 24. Of course, infant sleep is broken up into very small chunks: a baby who nurses every 2 to 3 hours is likely to take at least a short nap between most of those feeds.
By the time an infant reaches her first birthday, she will be sleeping only 13 or 14 hours a day. And, over the course of that year, the short sleep periods will have become consolidated. Bottle-fed infants will, on average, “sleep through the night” (six or seven hours) by the time they are eight weeks old, while breast-fed infants tend to wake for night-time feeds through most of the first six months.
By nine months of age, your infant has likely divided her sleep into a morning nap, an afternoon nap, and a full night of sleep. The morning nap will persist into the second year, but by two years old, most toddlers take only an afternoon nap.
Infant sleep is not only quantitatively different from adult sleep, it is also qualitatively different. Sleep is divided into “REM sleep” and “non-REM sleep.” REM sleep (or rapid eye movement sleep) makes up a relatively small portion of the adult sleep cycle-about 25 percent-and most of it occurs toward the end of the night. Although REM sleep is considered “active” sleep, with eye movements under closed eyelids, dreaming, facial expressions, and lots of body movement, this is actually very restful sleep, and it is the kind of sleep that allows one to feel fully rested the next morning.
Babies have much more REM sleep than older kids or adults. Up to 50% of newborn sleep is REM sleep. And, unlike adults, young infants go directly into REM sleep when they first fall asleep and return to periods of REM sleep frequently throughout the night. The preponderance of REM sleep in young infants is one of the reasons that they seem to be such noisy sleepers. Researchers suspect that REM sleep is essential for normal brain development in infants and in all young mammals.
ADJUSTING TO BABY’S SLEEP PATTERNS
We’re exhausted. It seems like parenthood is a twenty-four hour job without any rest periods. How are we ever going to catch up on our sleep?
It is a strange paradox that this newborn infant who needs twice as much sleep as his parents, is often leaving his parents exhausted and sleep deprived. As they say, timing is everything. Adult habits and schedules are built around a busy day and good night’s sleep. Infant biology is built around an entirely different schedule.
To survive, it is the parents who must make the first adjustment. Mothers who are nursing should do their best to take short naps when their infants are sleeping. Parents need to find ways to share responsibilities whenever both are present. This includes taking care of necessary household chores, providing for the needs of older children, and-of course-taking care of the baby. Until a newborn infant is ready to start consolidating his or her sleep into “chunks” of four hours or more, parents will do best if they can adapted by dividing their sleep into smaller, more frequent “power naps.” Yet, if there is to be light at the end of the tunnel, parents need to start giving their infant early signals about the difference between day and night...
DAYS AND NIGHTS
We have a 3-week-old who still has his days and nights mixed up. What can we do?
There is probably no one thing you can do, but it is all the little things that you probably are already doing that will help your baby eventually adjust to your day-night schedule. Babies learn the difference between day and night because of the repeated cues they get from their parents. Parents keep the home quieter and darker at night than during the day. Babies learn that they have to fuss a little more before their parents come to them at night than during the day. And, at night, parents act tired-not playful! Over the first month, your infant’s seemingly random 24-hour schedule will develop into a pattern of sleeping longer at night and spending increasing hours awake during the day. Because each infant has her own “inborn” temperament, some babies adapt to a regular day/night schedule more readily than others.
THE RIGHT TEMPERATURE FOR SLEEP
How warmly should we dress our newborn for sleep?
Here is an old rule of thumb: Count the numbers of layers of clothing that you are wearing to stay comfortable and add one more layer for your baby’s comfort. And here is another little trick; it’s called the “Tummy-Toe Test.” When your baby is in bed at night, compare the temperature of her tummy and her toes. If the room temperature and clothing are about right, then your baby’s tummy should feel warm, and her toes, a bit cooler. If both tummy and toes are cool to the touch, your baby is cold. If both feel warm, your baby may be over-heated. When the temperature is right, babies’ bodies make fine adjustments by constricting or relaxing the blood vessels in the skin of their extremities (hands and feet) to release or conserve heat.
Being too warm is as undesirable as being too cold. In fact, overheating, or overdressing at night, may well be a risk factor for SIDS.
It is a great convenience for us nursing moms to keep the baby in bed with us. Are there safe ways to share a bed with a newborn baby?
The safety of bed sharing is controversial. Arguments in its favor are that it is the sleeping arrangement for most babies in the world and has been the sleeping arrangement for most of human history. For many parents, sharing a bed with their baby at night seems like the most natural thing to do, and provides an environment where a parent can respond promptly to their young infants’ needs.
The arguments against bed-sharing rely, in part, on a number of studies showing that the risks of Sudden Infant Death Syndrome (SIDS) is increased with bed-sharing. The evidence is not perfect, in part, because they are complicated by the high rates of cigarette smoking (a known risk factor for SIDS) in some of the studies. Also, it is sometimes hard to distinguish suffocation deaths from true SIDS deaths, and many suffocations occur when infants are sleeping on unsafe surfaces and in unsafe environments shared with adults.
While few would argue with the assertion that an infant crib in good repair that meets all current regulations is the “gold standard” for a safe place for baby to sleep, one can still make recommendations for making bed-sharing as safe as possible for those who still decide upon bed-sharing with their infants. Among those recommendations, I would include:
There should be no tobacco smoke in the home.
There should be no use of alcohol, or any sedative medication by either parent.
Infants should sleep only face-up on a firm surface, never on a sofa, upholstered chair, soft mattress, water bed, or near any pillows, bulky covers or comforters.
Infants should not sleep between a parent and the wall. (The infant could fall into the space between the bed and the wall and suffocate.)
Infants should sleep only on their backs, not on their sides or bellies.
There should be nothing covering an infant’s face.
Parents should avoid excessively warm sleeping environments, or overheating of the infant. (This is believed to be a risk factor or SIDS.)
These are not official recommendations, only suggestions. In my view-a view widely shared by experts and professional organizations in this country-properly positioning a baby in a safe crib is the best way to avoid suffocation, falls, and entrapment, while reducing the risk of SIDS.
When is it safe to no longer put our baby to sleep on her back?
The “Back to Sleep” campaign, started by the American Academy of Pediatrics, National Institutes of Health and other organizations a decade ago has had a major positive impact on reducing SIDS. In the 1980s, there were over 5000 annual SIDS deaths in the U.S. Now that number is cut in half.
It is unknown at exactly what age it become okay to stop back-sleeping. However, the peak incidence of SIDS is at 2 to 3 months old, and very few cases occur after six months. Back-sleeping infants become able to roll themselves over sometime between 4 and 6 months of age. Therefore, it is reasonable to continue to put infants to sleep on their backs, but when they are old enough to roll over by themselves, they need not be monitored or returned to the back position. (A reason for back-sleeping and not side-sleeping is that it is easier for an infant to roll onto the belly from a side-sleeping position.)
CEREAL FOR SLEEP
Does adding cereal to a baby’s formula help them sleep through the night?
I do not recommend adding cereal to the formula. Sleeping though the night is not just a matter of filling up. Little stomachs can only hold so much. Adding cereal to formula makes each feeding less nutritious in terms of calcium, other minerals, fats, and protein. Feed your formula-fed infant all the formula she needs to satisfy her. She will sleep through the night when she is ready. (About half the bottle-fed infants are sleeping through the night at 8 weeks; half are not. Breast-fed infants normally wake for middle-of-the-night feedings for quite a while longer.) After the 4-month check-up (or as recommended by your child’s pediatrician) introduce small amounts of cereal and other baby foods on a spoon, not in the bottle.
Adapted from “Ask Dr. Mark: Answers for Parents.” Copyright © 2003 by The National Safety Council, and available from www.nsc.org. Used by permission of NSC Press. Mark Widome is professor of pediatrics at the Penn State Children’s Hospital and a regular contributor on Today.