Establishing Healthy Sleep Habits in Your 0-3 Month Old

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 sleeping habits.

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 dreaming 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 stages start resembling those of adults.

Establishing healthy sleep habits

Develop a consistent and soothing bedtime routine

Between 6-12 weeks, you can start developing a bedtime routine. Having 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 can include having a bath, putting on pajamas, feeding, and singing a song.

Keep your baby well rested

Most younger 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, bounce, or feed your baby to sleep.



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 3-5 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 (or off) and noise to a minimum during nighttime feedings and diaper changes. Also, if your baby is more active during the night, try increasing his activity during the day and waking him for feeds. Most babies by 2 months of age 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 his back to sleep. This sleeping position is recommended by the Canadian Paediatric Society (CPS) and the American Academy of Pediatrics as it greatly reduces the risk of SIDS (Sudden Infant Death Syndrome). Also, due to safety concerns the CPS recommends avoiding the use of loose blankets, bumper pads, toys, and stuffed animals in the crib, which can prevent the circulation of fresh air around your baby’s face. 

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. 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 Canadian Paediatric Society handout for parents (www.caringforkids.cps.ca – see Pregnancy & Babies - “Safe sleep for babies”).

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 there has been some research showing a relationship between pacifier use and reduced SIDS risk, the CPS does not advocate strongly for their use as a protective method against SIDS. The CPS recommendation is that the use of a pacifier should not be generally discouraged. If you do decide to offer your infant a pacifier at sleep times, you should consider discontinuing it after about 8 months of age when the risk of SIDS is very low, if it is causing sleep problems. The Canadian Federation for the Study of Infant Deaths in 2005 concluded that "parents who did not want to use a pacifier should be free to do so".

Encourage self-soothing

At around the 2-3 month mark, you can start experimenting with putting your baby to bed, drowsy but awake. 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 night, when the drive for sleep is particularly strong is suggested. If you have some success with this at sleep onset at nighttime, 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 when they are a bit older.

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!