Establishing Healthy Sleep Habits in Your 0-3 Month Old

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By Dr. Nicky Cohen

If you are a sleep deprived parent of a newborn or young infant you are in good company! According to the National Sleep Foundation’s 2004 Sleep in America Poll, 75% of parents are up with their young infants during the night, and about 50% feel that their child's sleeping pattern disrupts the family. Furthermore, 76% of parents of young children are dissatisfied with their child’s sleep and would like to change something about it. Be assured, it is normal to feel sleep deprived and exhausted during the first few months.
 
Given how much information – some accurate and some not so accurate – that can be found on the internet and in popular media on infant sleep, it is not surprising that parents are often confused about their child’s sleep (or lack of it) and what they can do.

The following information is intended to help provide you with accurate information on your young infant’s sleep with some guidelines for establishing healthy sleep habits and getting through the first few months. This information is not a substitute for medical or other professional advice and it is recommended that you consult with your child’s physician or other health care professional with training in this area if you have any concerns regarding your child’s sleep.

Normal development of sleep

In the first few months, there is a wide range of what is considered normal in both daytime and nighttime sleep. Some babies sleep a lot, waking for short periods, while others are more wakeful, and will sleep for short durations during both the day and night. Both patterns, and everything in between, are developmentally normal. Follow your baby’s lead and respond to all of his “signals”.

Biologically, there are a lot of changes occurring in relation to your baby’s sleep over the first few months of life. Newborns experience a lot of “active” sleep and during that state are highly vulnerable to frequent arousals. At about 3 months, infants start having more deep sleep, and by 6 months of age, their sleep structure starts to more closely resemble adult sleep. 

Establishing healthy sleep habits

Develop a consistent and soothing bedtime routine
Between 6-12 weeks, you can start developing a bedtime routine and by 3 months of age, a routine should be established. A routine can help cue or signal to your baby that sleep time is approaching. A bedtime routine should be predictable (the same every night) and calming, and can increase in length as your baby gets older. A routine may include having a bath, a massage, putting on pajamas, feeding, and singing a song.

Keep your baby well rested

Most young infants are ready to sleep after 1-2 hours of being awake. It is important to avoid overstimulating your baby as infants often have a more difficult time falling asleep when they are overtired. This is because cortisol, a stress hormone, is released and works to fight fatigue. This can further interfere with falling asleep. Look for your baby’s signs that she is getting tired. These signs may include rubbing her eyes, yawning, and getting fussy.

Find what is soothing for your baby

Some newborn babies are soothed by swaddling, others by white noise or motion including rocking. At this stage, many babies need your help falling asleep. Don’t worry about bad habits at this young age. Feel free to rock, hold, or feed your baby to sleep if she needs your help.

Night/day reversal

Many newborns have their days and nights mixed up, meaning that they sleep more during the day than during the night. At about 2-3 weeks of age, you can start signalling to your baby that nighttime is for sleeping and not for playing. For example, keep the lights dim and noise to a minimum during nighttime feedings and diaper changes. Also, if your baby is more active during the night, try increasing his wakeful time during the day and wake him for feeds. Nighttime sleep starts to consolidate between 6-12 weeks and by 2 months of age many babies naturally start sleeping for longer periods at night.

Encourage napping

Don’t deprive your baby of daytime sleep in hopes of getting her to sleep longer at night. This can actually lead to more difficulties with falling asleep, nighttime wakings, and an earlier than usual awakening time. Naps are also beneficial to your developing baby’s health, and in fact, sleep experts believe that in young children, “sleep begets sleep”. That is, the better rested they are, the more easily sleep comes!

Implement safe sleep hygiene

Always place your baby on a firm, flat surface on his back to sleep. According to Canadian Paediatric Society (CPS) and American Academy of Pediatrics (AAP) guidelines, children under 1 year should be placed on their back to sleep when put into their crib (at bedtime and naptime). This sleeping position is recommended as it has been shown to significantly reduce the risk of SIDS (Sudden Infant Death Syndrome). However, it is okay to let your child find her own comfortable position. According to CPS guidelines, if she can roll on her tummy, for example, it is not necessary to roll her on her back throughout the night and during naps (unless her physician has told you of a medical reason to do so).

Due to safety concerns, CPS and AAP guidelines recommend avoiding the use of soft materials in the crib, including loose blankets, bumper pads, quilts, comforters, stuffed animals, pillows, and other pillow-like items, which can prevent the circulation of air around your baby’s face.

Bed-sharing (co-sleeping) is not recommended due to evidence linking bed-sharing with accidental smothering and suffocation. Due to the same safety concerns, waterbeds, air mattresses, couches, rocking chairs, car seats and infant swings or carriers should also not replace the crib for sleep. However, room-sharing (e.g., having your child sleep in a crib next to the parental bed) until 6 months of age is associated with a reduced risk of SIDS. Make sure that your child’s crib meets Health Canada’s current safety standards.
   
To avoid overheating your infant, keep the room temperature on the cool side of comfortable and do not overdress your baby. A good rule of thumb is that if a temperature is comfortable for a lightly clothed adult, it is usually comfortable for a baby. Give your baby plenty of ‘tummy time’ when awake to avoid a flat head from developing. It is important to let your baby play on his tummy during the daytime. This will help to keep his head rounded, rather than developing a flattened area on the back of his head from sleeping on his back.

For more information on safe sleep practices for infants, see the following handouts for parents:

• Safe Sleep for Babies (Canadian Paediatric Society) – see Pregnancy & Babies
• Safe Sleep for Your Baby (Health Canada)

A word about pacifier use

Some parents find pacifiers to be helpful for soothing their infant; others find them to be a hindrance as some babies wake repeatedly when they fall out. Parents are often the best judge as to whether pacifiers interfere with their infant's sleep or are helpful.

In the scientific literature, the use of pacifiers has been a hot topic of debate over the last several years. While the CPS acknowledges that “using a pacifier may reduce the risk of SIDS”, they do not advocate strongly for their use as a protective method against SIDS. Their “position statement” on this topic states that “no recommendation to use pacifiers to reduce the risk of SIDS can be made at this time” but that “paediatricians and other care professionals should be cautious before routinely advising against their use”.

In a press release (on October 18, 2005), the Canadian Foundation for the Study of Infant Deaths concluded that “more research is needed before a definitive statement can be made about using pacifiers with every infant to decrease the risk of SIDS”. However, it stated that the consensus reached at the most recent SIDS International conference (prior to the press release) was that “health professionals should not in general discourage pacifier use. But, if parents wanted to use a pacifier, they should do so all the time, for naps and at night, everyday, because of the increase risk of SIDS for infants not having a pacifier if they are used to having one. It was also felt that parents who did not want to use a pacifier should be free to do so”.

For more information on the advantages and disadvantages of pacifier use and guidelines for safe pacifier use see:

• Pacifiers (soothers): A User’s Guide for Parents (Canadian Paediatric Society) – see Pregnancy & Babies
• Recommendations for the Use of Pacifiers (Canadian Paediatric Society Position Statement)

Encourage self-soothing

Between 8-12 weeks, you can start experimenting with putting your baby to bed, drowsy but awake (if you haven’t already started). However, at this age, babies should not be left to cry for more than 5 minutes or so, and possibly less depending on the intensity of their cry.

Starting this process at nighttime sleep-onset (bedtime), when the drive for sleep is particularly strong, is suggested. If you have some success with this at bedtime, you can try the same technique following night wakings, when your child is not due to be fed, and at naptime. For some babies this will work and they will naturally start sleeping for longer periods of time. For others it may not; for these babies, continue to nurture them and try again for their next sleep period or, if you prefer, when they are closer to 3 months of age.

Take care of yourself

Often parents are in need of physical and emotional support during the first few months of bringing home a new baby. Enlist the help of willing family and friends, or hire a trusted babysitter. Spend your “free time” catching up on much needed sleep or doing something relaxing such as taking a walk or having a bath.

Pleasant dreams!

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