Establishing Healthy Sleep Habits in Your 3-12 month old

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By Dr. Nicky Cohen

Your baby is no longer a newborn and many parents are ready to start sleeping for longer stretches at night. Although most older infants are biologically ready to sleep for longer durations at night, many continue to waken throughout the night for feeds or have learned to need other parental assistance (e.g., rocking, holding) to return to sleep. In fact, research has shown that sleep problems are one of the most common parental complaints to paediatric practitioners.

 

There is a general consensus among paediatricians that full-term healthy babies no longer need to be fed during the night after 6 months of age, once they are established on solid food. This means that most infants 6 months of age and older are physiologically able to sleep through the night without being fed. However, according to the National Sleep Foundation’s 2005 Infant Sleep Poll, 70% of parents reported that their 6-11 month old child wakes at least once a night and needs their help or attention to return to sleep. A third of these parents (33%) reported that their infant wakes twice a night, while 10% reported that their baby needs their help to return to sleep three or more times a night. Also, over 50% of these parents reported that they feed their child during the night at least several times a week.

 

Although there is a lot of information available to parents on infant sleep (e.g., self-help books, the internet), parents often are confused about what advice to follow. This is because some of the techniques conflict with one another, or what is recommended may not fit with their style of parenting. The following information is intended to help provide you with accurate information on your infant's sleep, with some guidelines for establishing healthy sleep habits with your older infant. 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 professional with training in this area if you have any concerns regarding your child’s sleeping habits.


Normal development of sleep

By 6 months of age, infant sleep starts to resemble adult sleep. There is a decrease in active sleep and an increase in quiet (deep) sleep. Due to this increase in amount of deep sleep, older infants are less vulnerable to frequent arousals in their sleep. By 6 months all the stages of non-dreaming sleep are present (Stages 1-4): dreaming (REM) sleep accounts for 30% of time sleeping and non-REM sleep for 70% of total sleep time (more like adult sleep). Most infants in the 6-11 month age range need about 13-14 hours of sleep in a 24 hour period. Usually this consists of 11-12 hours at night and 2-4 hours during the day. 

Establishing healthy sleep habits

Develop a consistent and soothing bedtime routine

At this age, a bedtime routine is important to cue your child that bed time is approaching. A bedtime routine should be consistent and calming. Typically, bedtime routines at this age are about 30 minutes in length. A routine may include having a bath, putting on pajamas, feeding, and singing a song. Having a shorter nap-time routine can also be helpful. A nap-time routine can be 5-10 minutes long and may include a feed, diaper change, and song.

Transitioning to a crib

In the first few weeks to months, many babies are in a bassinet in the parents’ bedroom. However, if parents plan to move the baby to a crib, it is suggested that they make the transition by 3 months of age. Waiting much longer than 3 months will be more difficult for the baby. This is because after 3 months of age, babies are more aware of their surroundings, and the change in sleeping location will feel new and different. When parents decide to switch to a crib, they can make the move all at once or gradually. For a gradual change, parents can start with nap-time or nighttime. 

Sleeping environment

As your older infant is increasingly aware of his surroundings and therefore more easily distracted, it often is a good idea to remove things from the crib that do not contribute to sleep, such as toys and mobiles. Maintaining a comfortable sleeping environment is also important. This includes a temperature on the cool side of comfortable, minimal light, and little to no noise. A white noise machine can be helpful to soothe young children and minimize external or household noise.

Encourage napping

Continue to encourage napping. Naps are not only important to your baby’s physical and emotional development; they often are the only time that caregivers have a break during the day. Many infants continue to need 3 naps a day until 6-8 months of age. Usually by 8 months of age the late afternoon nap is dropped and most infants have 2 naps a day until approximately 14-16 months of age. Anecdotal evidence suggests that depriving your child of her nap is not effective in helping her sleep longer at night. Young children who do not nap enough may have more difficulty falling asleep, may wake more frequently during the night, and may have an earlier than usual awakening time. The motto “sleep begets sleep” still applies to this age group. 

Implement safe sleep hygiene

Continue to place your baby on his back to sleep. This is the sleeping position recommended by the Canadian Paediatric Society (CPS) and the American Academy of Pediatrics, as it is associated with a significantly decreased risk of Sudden Infant Death Syndrome (SIDS). It is okay to let your child find her own comfortable position, however. 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. It is recommended that objects that can prevent the circulation of fresh air around the baby’s face be removed from the crib. Avoid overdressing your infant and continue to give your baby ‘tummy time’ during the day to prevent a flattened area from developing on the back of her head from sleeping on her 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”).

Introduce a transitional object

This is a good age to introduce a transitional object, sometimes referred to as a “lovey”, to your child. “Blankies” are often a good choice, because if your child rolls onto it at night, it will not disturb him. Transitional objects can help with separation at night, and can make travelling easier. However, be sure to have more than one, in case you ever lose it! At this age, blankies should be no bigger than 8” by 8” and should be breathable (with holes). Giving him several may be helpful to ensure that he is always able to find one (if he wants) during the night.
 

Encourage self-soothing

It is important for your baby to learn the important life-long skill of falling asleep independently. While it is up to parents as to when they want to encourage this development, parents should be aware that it is easier for an infant to learn this skill than it is for a toddler or preschooler. 

Developing a sleep training program

When your child is at least 3-4 months of age, a sleep training program can be developed based on your own reading (see recommended reading below), or with the help of a professional with training in this area. Common pitfalls to sleep training success include inconsistent responding (e.g., sometimes feeding on demand, sometimes not) and continuing feeds when they are no longer necessary. If nighttime feeds are no longer necessary, it often is helpful to wean the feeds gradually over a period of a few nights. Eliminating feeds gradually will give the baby a chance to transfer her food intake from the night to the daytime. Sleep training should not be implemented when your child is ill or in pain (including acute teething).

While the effectiveness of behavioural interventions for bedtime sleep problems and night wakings are well documented, some parents are more ready than others to start a sleep training program. However, many parents report that the anticipation of sleep training their child was worse than the actual carrying out of the plan. While it is best to wait until you have a plan in place that you feel you can carry out consistently, it is advisable to start sooner than later to prevent sleep problems from becoming chronic and more difficult to resolve. 

Pleasant dreams! 

Recommended reading:

The Sleepeasy Solution: The Exhausted Parent’s Guide to Getting Your Child to Sleep – from Birth to Age 5. (Jennifer Waldburger & Jill Spivak, 2007)

Sleeping Through the Night: How Infants, Toddlers, and Their Parents Can Get a Good Night's Sleep (Revised Edition) (Jodi A. Mindell, 2005)

• lisa | February 8, 2008 at 12:22 am - §

  My baby is going on 7mths old.She wakes 3 times for a feed in the night.I am currently nursinh her.She getsaround 8 table spoons of cereal a day.Which consist of rice,barley and oatmeal.I nurse her 4-5 times a day then 3 times at night.IAm I feeding her enough.I will be starting on other foods next week but how much should i give her .What should I do about these nightly feeds?Habit or hungry?

• Tanisha | February 20, 2008 at 10:04 am - §

  They eat at night at that age through habit and comfort.My daughter was similar but we weaned her off the night time feeding a little earlier. We cut out the middle feeding first, she cried at first but it didn't last long. Then we reduced how much she got at the first and last night feedings.Now we wake her up to feed her when we are ready to go to sleep between 10

• Leah | March 3, 2008 at 1:59 pm - §

  My son is 7 1/2 months and still wakes for feeding on average 6 times a night. I really need more sleep and I feel he's ready if not overdue for a change. I've been meeting more and more mothers who let their babies cry it out and they seem so confident in the technique. My husband and I have been in a dilemma about letting our son cry it out and this is partly why we've delayed fixing our sleep issues. I've been trying to find a more gently approch...I like the suggestions above, thank you. We are open to any other suggestions you may have, also some on self soothing techniques.

• Naureen | March 31, 2008 at 10:25 am - §

  Hello, i have a 10 1/2 months daughter. Her sleep has been less at night from the day she was born, but when she was 7 months it got better. i just had to lay her on her crib and she would sleep through out the night. I had to travel to my country when she was nine months and her schedule got messed up. over there is used to sleep with us and now that we are back she does not sleep by herself. I need to put her close to my body to put her back to sleep. I feed her with porridge in the afternoon and at night around 9:30, then i give her a yogurt at 10:30 and around 11:30 i give her 9 ounces of formula milk. then also she doesnt sleep throughout the night, she wakes up and stands in her crib. My baby is also taking pacifier, she drops her pacifier if we dont show up. i have also tried putting her in bed early around 11:00 but then she wakes up at 4:00 in the morning and plays to 2 hours and then go bak to sleep. please advise me what should i do to put her in a schedule. Also she takes around 5 to 6 hours nap in day.

• Jenny | June 26, 2008 at 7:51 pm - §

  Hello, my daughter is 8 months old, and I have a nighttime routine for her which works out well I feed her, I bathe her, put her pjs on and lay her in the crib and she falls asleep within 5 minutes in between 6and 6:30. Also her naps go very well, I lay her down in the crib and she falls asleep no problems. Now the problem is she will wake up at 11pm and then again at 3, and she cannot fall asleep on her own. My question is why can she fall asleep on her own for her naps and for the evening but not in the middle of the night and why is she waking up. I tried for a week not giving her a bottle at 11pm , but it was taking an hour to get her to fall asleep, so I gave in. I'm at a loss.....any advise?

• Isabelle Menard | September 2, 2008 at 11:08 pm - §

  Hello.... My 4 month old goes to bed at 9pm and wakes up once at 4am for a feeding which I think is pretty good... the problem that I am having is with my milk baby who is 22 months old.. She still sometimes wakes up twice a night for a bottle.. I know I should take her off the bottle but seems like I get too tired of the crying that I give in. I also have a 4 year old who has bearly ever slept through the night only to come and sleep with mommy. Being a single mom of 3 I find it difficult enough without worrying about only sleeping 2hrs a night. Anyone have any tips? I'm exhaused.

• madeline menard | September 23, 2008 at 8:39 pm - §

  Sometimes you just have to do what's right for your baby...that seems to be the first lesson of parenthood - it's not always about keeping them happy in the moment. Sleep is as important as any other life skill. YOu have to bite the bullet and do the hard stuff, no matter how tired you are...because in the end (usually 3-5 days)...you and your babe are sleeping better than ever and you have more energy to be teh parent you want to be for your kids...mom of 3...all cried it out for a day or two..it gets easier...I promise.

• lolita angeles | September 29, 2008 at 3:09 am - §

  I have a 7-8mos baby girl and the problem i am having is her feeding schedule is very poor she takes 20 onces for 24hrs. Please advice to what will i do seriously i feel bad and worry. thanks and GOD bless1

• JC | November 9, 2008 at 3:10 pm - §

  HI there, I have a 6 month old baby boy, who weighed 10.lb 10 oz at birth, and now weighs 23lb. 8oz. I breastfeed exclusively, and feed rice and barley cereal morning and night. He falls asleep after nursing for his morning nap, as well as for his afternoon nap. In the evening he eats cereal, has a bath and then nurses, immediately after finishing nursing he takes his soother and goes to sleep. However, he still wakes every 2-5 hours in the night to nurse. Occasionally he will accept his soother and fall back to sleep, but more often than not, he prefers to breastfeed. Is he hungry during the night? We have co-slept with him since he was born because he has fed so often throughout the night...this way both of us slept better. Any suggestions???? Please

• TB | November 25, 2008 at 6:22 am - §

  Hi. I have twin boys that are 9 months old. They were born healthy weights, and continue to have healthy weights (one has already tripled his weight). They EACH wake up 3-4 times per night, sometimes worse, to breastfeed. I have gotten them to only wake up once a night...for a short period of time, a couple of times since they have been born. I try to give them their soothers in the middle of the night and they both reject it and scream until I nurse them. I even give them a bottle at bedtime after I nurse them to try to get them to sleep threw. I don't know what to do...I am SO VERY TIRED! PLEASE HELP!

• help | December 23, 2008 at 4:18 pm - §

  Hi,My baby is 6 months old and just doesn't want to sleep. She takes three 30 minute naps during the day and is in bed for about 11 hours at night, however she is up every 3 hours during the night. It takes about 20 minutes to get her to sleep for naps and bedtime. We have a specific routine that we do for naps and bedtime which consits of a book, song and some rocking-however she won't sleep unless we pretty much have her asleep in our arms. We have bought many books and have tried many methods. We even went to the extreme of letting her cry it out- but did just seems to make her scared of her crib. Last ngiht she cried for over and hour and didn't fall asleep. We are both exhausted and don't know what to do. We know we need her to start learning to sooth herself back to sleep-but we don't know how to teach her this. Should we just let her cry it out for a couple of nights? We tried the baby whisperer method and the gentle sleep solution methods and they just don't seem to work. We really really need help.

• OSSAI | January 22, 2009 at 7:07 pm - §

  Hi, i have 9 months old baby girl who doesn't sleep well during the night after she turned to 6 months old. she wakes up every 1 to 2 hours at night and she wont go back to sleep till i breastfeed her and some times she won't sleep for tow hours or more till i give her bottle on top. mostly she sleeps 2 times during the day for 1 or 2 hours each time.i don't know what to do and i am really tired of this also i am going to start my work soon if she continue to that it well be very hard... please help me give me any suggestion you have............ thanks

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