All the sleep advice has us confused!

Now that our baby is three months old, we are hoping to get him to sleep better.  I have a stack of books that seem to have contradictory advice, although I have to say I don’t have the ability to get through most of them--I’m just too tired! Talking to friends gets me into long sessions of what worked for their babies.  I have the feeling that I am making this harder on myself by getting so much information, but I don’t know what information is important!

You aren’t the first new parent to be overwhelmed by the number of sleep advice books out there! Last time I looked there were 358 titles on Amazon--not as many as there are for weight loss, but it’s useful to think: if there were a proven way to get babies to sleepbetter, why would there be so many books?

This is the right time to be thinking about getting your baby to sleep longer during the night and more predictably during the day.  If you are lucky, some of the suggestions I am offering here will make a big difference--and then you will be telling all of your friends what worked for YOUR baby.

Babies learn to sleep better when parents look at sleep as part of the overall daily plan.  Baby sleep isn’t a random event.  Some babies have such a strong internal rhythm that they will schedule themselves, but most babies need a predictable daily flow and a good sleep environment to be able to sleep well.

Here’s what you can do that will benefit any three month old:

• SLEEP ENVIRONMENT

Decrease visual stimulation by using plain sheets. Remove mobiles, mirrors, and toys from your baby’s sleep area. Keep your baby’s room DARK!  A dim nightlight is O.K.

White background noise is helpful, especially if you live in a noisy area.

During feeding and cuddling time place a thin blanket with an edging against your skin and place your baby’s hand on it. Place it next to her in her crib at night as a lovey.

If your baby falls asleep with a pacifier or bottle or anything that she needs help to find during the night, she may wake up and call for you to provide it during the night. This is called a sleep habit and is a common cause of night wakings.

Monitors of any type are only necessary is you are in a part of the house where you can’t hear your baby cry. Staying awake to listen to or watch your baby sleep interferes with everyone’s sleep!

• TIMING and SCHEDULE:

Timing: The first step in planning a schedule involves learning to read your baby’s “sleepy cues”. Sleepy cues are the hints that your baby is ready for sleep: slight fussiness, a glazed look, wanting to nurse when she’s just been fed. If your baby is yawning or rubbing her eyes she’s passed from sleepy into overtired and will have more difficulty falling asleep. It is very helpful to start noticing these cues and writing down when they occur. The initial nap schedule may be different if your baby is always tired!

Bedtime: Choose a bedtime—early is better for all babies!! For most babies, the eventual falling asleep time should be between 6- 7:30 p.m. That means beginning a bedtime routine early.  A bedtime routine (feeding, quiet play, diaper, massage, pjs, cuddling and song or story), plus a brief “and now to sleep” ritual, such as good night kisses and a special song should take about 20 minutes.

Wake-up Time: Wake-up time in the morning should be 6 a.m. or later. Earlier than that is too early for everyone!  Almost all babies need at least 11 hours of nighttime sleep.

Nap Times: Naps should be spaced throughout the day at regular times. For most babies, once good sleep habits are established, the first morning nap is usually within two hours of wake-up time. The second nap is usually two to three hours after waking from first nap. Many babies will need a short half hour nap in the late afternoon. The total nap time will usually be at least 3-4 hours. Of course, all babies are different, and the right schedule is what works best for your baby. Observing her “sleepy cues” will help us to schedule naps. Regulating nap patterns is usually much more challenging than nighttime sleep patterns!

Feeding times: After a baby is three to four months old it is helpful to space daytime feedings so that a baby is hungry enough at each feeding to nurse at both breasts or take a 6-8 oz bottle. This schedule (which doesn’t have to be rigid) helps a baby shift to mostly daytime feeding.

• FALLING ASLEEP:

“Drowsy but awake” sounds easy to figure out, but it is not. After a baby is four months old, what looks like drowsy is often Stage 1 sleep. It is better to put your baby in her crib fully awake soon after she has shown signs of being a little sleepy.

The hardest part of any sleep plan is helping a baby to fall asleep without a parent’s help. You can do this by staying in the room and patting her while she learns, or by leaving the room and returning at regular intervals to let her know she’s O.K. Babies do cry when you leave them, but the process takes less than a week. You don’t have to do this, but please don’t let your baby cry during the night if she hasn’t learned to fall asleep without your help at bedtime--it won’t work.

• FEEDING: 

Hungry babies will cry no matter how well they can fall asleep on their own at bedtime. If you want to eliminate night feedings, your baby will need to eat enough during the day to get through the night without a feeding. Some breast fed babies will need one middle of the night feeding for many months. Your expectations have to be in line with your baby’s need to be well nourished!

It is helpful to keep a record of each feeding: time and quantity (for breast fed babies mom should notice how hungry the baby seems at the start of the feeding, how long she nurses at each breast, and whether her sucking is continuously strong or interspersed with fluttery sucking which indicates nursing for comfort rather than food). That will help you to decide whether she is feeding from hunger or habit.

A breast feeding baby will usually need to nurse at both breasts to get the maximum amount of milk at each feeding. A bottle fed baby should be offered an ounce more than you expect her to take, so that she ends the feeding when she is full, rather than when the bottle is empty. The nipple size should be “Stage 2”.

• REASONABLE EXPECTATIONS:

Most 3-6 month old babies can sleep 11-12 hours at night with one feeding. Some breastfed babies may need two feedings. A good clue that your baby needs less feeding at night is when she’s not hungry for her first morning feed. 

• DON’T BELIEVE THAT ANY SLEEP MANAGEMENT PLAN IS HARMFUL:

Babies need to sleep.  Parents need enough sleep to be responsive during the day. For some reason advocates of almost every sleeping style sometimes get angry at people who take a different approach. The reality is, babies are different, families are different, and sleep is just one of many, many areas where parents have to figure out what feels right to them. 

Meg Zweiback is a pediatric nurse practitioner and an infant sleep consultant in Oakland, California