Sleep & Your Baby

The practice of bed-sharing — parents sharing a bed with their infant — is a hot topic. Supporters of bed-sharing believe that a parent’s bed is just where a baby belongs. But others worry that bed-sharing is unsafe.

Co-Sleeping, Room-Sharing, and Bed-Sharing

Many people use the terms “bed-sharing” and “co-sleeping” to describe the same thing, but there are differences:

• Co-sleeping: This is when a parent and child sleep in close social or physical contact of each other, meaning that each can tell that the other is nearby.

  Room-sharing and bed-sharing are types of co-sleeping:

  • Room-sharing: This is when parents have a crib in the room with them; a bassinet, portable crib, or play yard near the bed; or a bedside sleeper attached to the side of the parental bed.
  • Bed-sharing: This is when parents and infants sleep together in a bed. This has raised concerns because bed-sharing with an infant increases the risk sleep-related deaths, including sudden infant death syndrome (SIDS).

Why Some People Bed-Share

Bed-sharing supporters believe — and some studies support their beliefs — that bed-sharing:

• encourages breastfeeding by making nighttime breastfeeding more convenient
• makes it easier for a nursing mother to get her sleep cycle in sync with her baby’s
• helps babies fall asleep more easily, especially during their first few months and when they wake up in the middle of the night
• helps babies get more nighttime sleep (because they awaken more often with shorter feeding time, which can add up to a greater amount of sleep throughout the night)
• helps parents regain closeness with their infant after being separated from their babies during the workday

But do the risks of bed-sharing outweigh the benefits?

Is Bed-Sharing Safe?

In some non-Western cultures, bed-sharing is common and the number of infant deaths related to it is lower than in the West. Differences in mattresses, bedding, and other cultural practices may account for the lower risk in these countries.

Despite the possible pros, various U.S. medical groups warn parents not to place their infants to sleep in adult beds due to serious safety risks. Bed-sharing puts babies at risk of suffocation, strangulation, and SIDS. Studies have found that bed-sharing is the most common cause of deaths in babies, especially those 3 months and younger.

An adult bed has many safety risks for a baby, including:

• suffocation from a soft mattress, memory foam, waterbed, or loose or soft bedding such as pillows, blankets, or quilts
• entrapment and suffocation when an infant gets trapped or wedged between a mattress and headboard, wall, or other object
• strangulation in a bed frame that allows part of an infant’s body to pass through an area while trapping the baby’s head, or from dangling cords

Among older infants (4 to 12 months old) who died due to bed-sharing, having an additional item (like a pillow or a blanket) on the bed increased the risk of death. Babies should always be placed to sleep on their backs on a firm mattress without any pillows, blankets, toys, stuffed animals, or other items.

Because of the risks involved, both the American Academy of Pediatrics (AAP) and the U.S. Consumer Product Safety Commission (CPSC) advise against bed-sharing. The AAP does recommend the practice of room-sharing without bed-sharing. Sleeping in the parents’ room but on a separate surface lowers a baby’s risk of SIDS.

Besides the potential safety risks, sharing a bed with a baby sometimes prevent parents from getting a good night’s sleep. And infants who sleep with their parents learn to associate sleep with being close to a parent in the parent’s bed, which can become a problem at naptime or when the baby needs to go to sleep before the parent is ready.

Bed-Sharing & SIDS

Bed-sharing increases the risk of SIDS, especially in preterm infants (preemies), babies with low birth weight, and healthy full-term infants younger than 4 months old.

Other things that further increase this risk of death while bed-sharing include:

• a baby sleeping on a couch alone or with a parent
• a baby sleeping between two parents
• a mother who smokes
• parents who are extremely tired
• a parent who has recently used alcohol or drugs
• bed-sharing with pillows or bedcovers
• bed-sharing with other children

How to Room-Share Safely

To avoid the risks of bed sharing while enjoying the benefits of room-sharing, parents have lots of options. To keep your little one close by, but not in your bed, you could:

• Put a bassinet, play yard, or crib next to your bed. This lets you keep that desired closeness, which can be especially important if you’re breastfeeding. Having an infant sleep in a separate space in the same room as the mother reduces the risk of SIDS.
• Consider using a bedside sleeper, which attaches to your bed to allow you and your baby to be next to each other but on a separate surface. The CPSC has recommended safety standards for bedside sleepers, but no studies have looked at whether these devices prevent SIDS and other sleep-related deaths or injuries.

How to Bed-Share as Safely as Possible

Despite the risks of bed-sharing, some parents decide this sleeping arrangement is best for their family. If you do choose to share your bed with your baby, follow these precautions:

• Don’t share a bed with an infant under 4 months of age — a bassinet or crib next to the bed is a better choice.
• Always place your baby on his or her back to sleep to reduce the risk of SIDS.
• Dress your baby in minimal clothing to avoid overheating.
• Don’t place a baby to sleep alone in an adult bed.
• Don’t place a baby on a soft surface to sleep, such as a soft mattress, sofa, or waterbed.
• Make sure your bed’s headboard and footboard don’t have openings or cutouts that could trap your baby’s head.
• Make sure your mattress fits snugly in the bed frame so that your baby won’t become trapped between the frame and the mattress.
• Don’t cover your child’s head while sleeping.
• Don’t use pillows, comforters, quilts, and other soft or plush items on the bed. You can dress your baby in a sleeper instead of using blankets.
• Don’t drink alcohol or use medicines or drugs that could keep you from waking or might cause you to roll over onto, and therefore suffocate, your baby.
• Don’t place your bed near draperies or blinds where your child could be get caught in and strangled by cords.
• Don’t fall asleep with a baby on your chest.
• Don’t sleep on couches, recliners, or rockers with a baby.

Moving Out of the Parents’ Room

Experts recommend that infants sleep in their parents’ room until their first birthday. If parents prefer to move the baby to another bedroom, it’s best to wait until their child is at least 6 months of age.

Whether you’re a new mom or a seasoned parenting pro, breastfeeding often comes with its fair share of questions. Here are some answers to common queries that mothers — new and veteran — may have.

Where should my baby sleep?

There are many options for where your baby can sleep, but in your bed is not one of them. Putting your baby in bed with you, or bed-sharing, is hazardous and increases the risk of sudden infant death syndrome (SIDS).

Never let your baby sleep on a soft surface or in the same room with people who are smoking. Babies should always be put on their backs to sleep to help reduce the risk of SIDS.

To make nursing in bed more comfortable for yourself, it may help to keep a donut-type nursing pillow on or near your bed or to use a “husband” back pillow with arms on each side.

Keep the room dimly lit for nighttime feedings and also keep stimulation (talking, singing, etc.) to a minimum. This will help your baby to realize that nighttime is for sleeping — not playing — and will encourage your little one to return to sleep sooner.

My baby falls asleep while nursing. What can I do?

Newborns often fall asleep at the breast, especially after feeling satisfied from a good feeding. (You’ll know if your baby isn’t nursing if you don’t hear swallowing sounds, like little clicks, or see the jawbones moving.)

If you think your baby is asleep and hasn’t finished nursing, here are some tips to try:

• undress your baby and rub the back
• tickle the feet
• burp your baby
• try changing your baby’s diaper or switching to the other breast

Babies who latch on incorrectly may fall asleep at the breast. If this happens, break the suction and reposition your baby onto your breast to include both your nipple and areola. You can break the suction by slipping your finger in the side of your baby’s mouth (between the gums) and then turning your finger a quarter turn to break the suction. (If you just pull your baby off your breast, it will likely startle your little one and hurt your breasts as well.)

After you’ve broken the suction, try to burp your baby and switch your little one to the other breast. A lactation consultant can show you the right latch method and help you with any questions or concerns you might have.

Is it OK to nurse my baby to sleep?

In the first few months of life, it’s practically impossible to keep a nursing baby awake who is satisfied with a full belly. Once babies get older, however, most doctors advise against nursing a baby solely for the purpose of getting him or her to sleep. Doing this regularly may prevent your baby from learning how to fall asleep on his or her own.

At nap times and bedtime, try to put your baby down slightly awake so that he or she will get used to falling asleep without having to nurse. Make breastfeeding sessions more about nourishment and less about pacifying.

If your baby is sick or has been separated from you, you may want to nurse for comfort, but try not to make it a habit.

If your baby has trouble falling asleep, consider giving him or her a pacifier. Experts recommend giving babies under 1 year old pacifiers at nap time and bedtime to reduce the risk of SIDS — but only after breastfeeding has become established, so no sooner than 3 weeks of age. But if your little one doesn’t want a pacifier, don’t push it.

Try to encourage your baby’s sleep by establishing a bedtime routine that will be familiar and relaxing. Bathing, reading, and singing can soothe babies and signal an end to the day. Be consistent and your baby will soon associate these steps with sleeping.

When will my baby sleep through the night?

Newborns should be woken up every 3 to 4 hours until their weight gain is established, which typically happens within the first couple of weeks. After that, it’s OK if a baby sleeps for longer periods of time.

But don’t get your slumber hopes up just yet — most breastfed infants won’t snooze for extended periods of time because they get hungry. Remember, breast milk is much more easily digested than formula, so it passes through babies’ systems faster and, therefore, makes them hungry more often.

Newborns’ longest sleep periods are generally 4 or 5 hours — this is about how long their small bellies can go between feedings. If newborns do sleep for a while, they’ll probably be extra-hungry during the day and may want to nurse more frequently.

And just when parents think that sleeping through the night seems like a far-off dream, things start to get a little easier. At 3 months, a baby averages a total of 5 hours of sleep during daytime naps and 10 hours at night, usually with an interruption or two. Most babies this age sleep “through the night,” meaning 6 to 8 hours in a row.

It can help to stimulate your baby during the day, keep things calm at night, and have a regular bedtime routine. But every baby is different, so don’t be surprised if your baby sleeps more or less than others.

Will it hurt my milk supply to let my baby sleep?

Letting your baby sleep through the night (usually at around 3 months of age) isn’t going to hurt your breastfeeding efforts. Your body readjusts your milk supply based on when you nurse and how much your baby needs. Some babies will sleep through the night early but will make up for it during the day, so your breasts will accommodate that.

As your baby matures and starts taking solid foods, the need for breast milk will decrease and your body will adjust for that too.

Babies are born with soft heads to allow for the amazing brain growth that occurs in the first year of life. As a result, their heads are easily “molded.”

Passage through the birth canal during childbirth can cause a newborn’s head to look pointy or too long. So it’s normal for a baby’s skull, which is made up of several bones that eventually fuse together, to be a bit oddly shaped during the few days or weeks after birth.

But if a baby develops a lasting flat spot, either on one side or the back of the head, it could be flat head syndrome, also called positional plagiocephaly (pu-ZI-shu-nul play-jee-oh-SEF-uh-lee). Flat head syndrome usually happens when a baby sleeps in the same position most of the time or because of problems with the neck muscles.

This problem does not harm brain development or cause any lasting appearance problems. And, fortunately, it does not require surgery. Simple practices like changing a baby’s sleep position, holding your baby, and providing lots of “tummy time” can help.

Causes

The most common cause of a flattened head is a baby’s sleep position. Because infants sleep for so many hours on their backs, the head sometimes flattens in one spot. Placing babies in devices where they lie down often during the day (infant car seats, carriers, strollers, swings, and bouncy seats) also adds to this problem.

Premature babies are more likely to have a flattened head. Their skulls are softer than those of full-term babies. They also spend a lot of time on their backs without being moved or picked up because of their medical needs and extreme fragility after birth, which usually requires a stay in the neonatal intensive care unit (NICU).

A baby might even start to develop flat head syndrome before birth, if pressure is placed on the baby’s skull by the mother’s pelvis or a twin. In fact, many babies from multiple births are born with heads that have some flat spots.

Being cramped in the womb can also cause torticollis, which can lead to a flattened head. Babies with torticollis have a hard time turning their heads because of tight neck muscles on one side of the neck. Since it’s hard to turn the head, they tend to keep their heads in the same position when lying down. This can cause flattening.

Likewise, many babies who started out with flat head syndrome develop torticollis. Because it takes a lot of energy for them to turn their heads, babies with severe flattening on one side tend to stay on that side, so their necks become stiff from lack of use.

Signs and Symptoms

Flattened head syndrome is usually easy for parents to notice. Typically, the back of the child’s head, called the occiput (AHK-suh-puht), is flattened on one side. There is usually less hair on that part of the baby’s head. If a person is looking down at the baby’s head, the ear on the flattened side may be pushed forward.

In severe cases, the head might bulge on the side opposite from the flattening, and the forehead may be uneven. If torticollis is the cause, the neck, jaw, and face may be uneven as well.

Diagnosis

Doctors usually diagnose flat head syndrome simply by looking a child’s head. To check for torticollis, the doctor may watch how a baby moves the head and neck. Lab tests, X-rays, and computed tomography (CT scans) usually are not needed.

The doctor may monitor a child over a few visits to see how the shape of the head changes. If repositioning the child’s head during sleep helps to improve the skull over time, the problem is likely due to flat head syndrome. If it doesn’t, the cause could be due to another condition, such as craniosynostosis (kray-nee-oh-sin-os-TOE-sis).

Craniosynostosis happens when a child’s skull bones fuse together before they’re supposed to (normally, around age 4). This fusion restricts brain growth and causes skull deformities. Children with craniosynostosis need treatment to correct the problem.

If the doctor suspects craniosynostosis or another condition, the child will be referred to a pediatric neurosurgeon or a craniofacial plastic surgeon who may order other tests, like X-rays or a CT scan.

Treatment

If your child has flat head syndrome that’s caused by a sleeping or lying position, there is a lot you can do at home to help treat it:

• Change the head position while your baby sleeps. Reposition your baby’s head (from left to right, right to left) when your baby is sleeping on the back. Even though your baby will probably move around throughout the night, it’s still a good idea to place your child with the rounded side of the head touching the mattress and the flattened side facing up. The American Academy of Pediatrics (AAP) does not recommend using any wedge pillows or other devices to keep your baby in one position.
• Alternate positions in the crib. Consider how you lay your baby down in the crib. Most right-handed parents carry small infants cradled in their left arms and lay them down with the heads to their left. In this position, the infant must turn to the right to look out into the room — and, indeed, torticollis to the right with flattening of the right side of the head is far more common than the left. Whichever side of your infant’s head is flattened, you will want to position your baby in the crib to encourage active turning of the head to the other side.
• Hold your baby more often. Reduce the amount of time your child spends lying on the back or often being in a position where the head is resting against a flat surface (such as in car seats, strollers, swings, bouncy seats, and play yards). For instance, if your baby has fallen asleep in a car seat during travel, take your baby out of the seat when you get home rather than leaving your little one snoozing in the seat. Pick up and hold your baby often, which will take pressure off the head overall.
• Practice tummy time. Provide plenty of supervised time for your baby to lie on the stomach while awake during the day. Not only does “tummy time” promote normal shaping of the back the head, it also helps in other ways. Looking around from a new perspective encourages your baby’s learning and discovery of the world. Plus, it helps babies strengthen their neck muscles and learn to push up on their arms, which helps develop the muscles needed for crawling and sitting up.

As most infants with plagiocephaly have some degree of torticollis, physical therapy and a home exercise program will usually be part of the recommended treatment. A physical therapist can teach you exercises to do with your baby involving stretching techniques that are gradual and progressive. Most moves will involve stretching your child’s neck to the side opposite the tilt. In time, the neck muscles will get longer and the neck will straighten itself out. Although they’re very simple, the exercises must be done correctly.

For kids with severe flat head syndrome in which repositioning for 2-3 months doesn’t help, doctors may prescribe a custom-molded helmet or head band. While helmets might not work for all children, some kids with severe torticollis can benefit from them.

The helmets work best if used between the ages of 4 and 12 months, when a child grows the fastest and the bones are most moldable. They work by applying gentle but constant pressure on a baby’s growing skull in an effort to redirect the growth.

Never purchase or use any devices like these without first having your child seen by a doctor. Only a small percentage of babies wear helmets. The decision to use helmet therapy is made on a case-by-case basis (for example, if the condition is so severe that a baby’s face is becoming misshapen).

Outlook

The outlook for babies with flat head syndrome is excellent. As babies grow, they begin to reposition themselves naturally during sleep much more often than they did as newborns, which allows their heads to be in different positions throughout the night.

After babies are able to roll over, the AAP still recommends that parents put them to sleep on their backs, but then allow them to move into the position that most suits them without repositioning them onto their backs.

As a general rule, once an infant can sit independently, a flat spot will not get any worse. Then, over months and years, as the skull grows, even in severe cases the flattening will improve. The head may never be perfectly symmetrical, but for a variety of reasons the asymmetry becomes less apparent as well. For example, in later childhood the face becomes more prominent in relation to the skull, hair thickens, and children are always on the go. Experience and clinical research have shown that by school age, a flattened head is no longer a social or cosmetic problem.

It’s important to remember that having a flattened head does not affect a child’s brain growth or cause developmental delays or brain damage.

Prevention

Babies should be put down to sleep on their backs to help prevent sudden infant death syndrome (SIDS), despite the possibility of developing an area of flattening on the back of the head.

However, alternating their head position every night when you put them down to sleep and providing lots of tummy time and stimulation during the day while they’re awake can reduce the risk of flat head syndrome.

I know I’m supposed to put my baby on her back when she goes to sleep, but what if she rolls over in the night or spits up?
– Arianne

By having your baby sleep on her back, you decrease her chances of sudden infant death syndrome (SIDS). SIDS, the leading cause of death in babies younger than 1 year old, has been linked to infants sleeping on their stomachs.

Although your concerns about rolling over and spitting up are legitimate, there’s good news — by the time your baby can roll over by herself, her chances of SIDS are greatly reduced. Plus, by putting your baby to sleep on her back, she’ll get used to this position and probably prefer it.

As for spitting up, there is no increased risk of choking for healthy infants who sleep on their backs. If your baby has chronic gastroesophageal reflux (GERD) or an airway problem, your doctor may suggest another sleep position.

The Importance of Naps

Nap. It’s a small word, but for most parents a hugely important one. Why? Sleep is a major requirement for good health, and for young kids to get enough of it, some daytime sleep is usually needed. Crucial physical and mental development occurs in early childhood, and naps provide much-needed downtime for growth and rejuvenation.

Naps also help keep kids from becoming overtired, which not only takes a toll on their moods but may also make it harder for them to fall asleep at night. And naptime gives parents a brief oasis during the day and time to tackle household chores or just unwind.

Sleep Needs by Age

There’s no one-size-fits-all answer regarding how much daytime sleep kids need. It all depends on the age, the child, and the sleep total during a 24-hour period. For example, one toddler may sleep 13 hours at night with only some daytime catnapping, while another gets 9 hours at night but takes a solid 2-hour nap each afternoon.

Though sleep needs are highly individual, these age-by-age guidelines give an idea of average daily sleep requirements:

Birth to 6 months: Infants require about 14 to 18 total hours of sleep per day. Younger infants tend to sleep on and off around the clock, waking every 1 to 3 hours to eat. As they approach 4 months of age, sleep rhythms become more established. Most babies sleep 9 to 12 hours at night, usually with an interruption for feeding, and have 2 to 3 daytime naps lasting about 30 minutes to 2 hours each.

6 to 12 months: Babies this age usually sleep about 14 hours total for the day. This usually includes two naps a day, which may last 20 minutes for some babies, for others a few hours. At this age, infants may not need to wake at night to feed, but may begin to experience separation anxiety, which can contribute to sleep disturbances.

Toddlers (1 to 3 years): Toddlers generally require 12 to 14 hours of sleep, including an afternoon nap of 1 to 3 hours. Young toddlers might still be taking two naps, but naps should not occur too close to bedtime, as they may make it harder for toddlers to fall asleep at night.

Preschoolers (3 to 5 years): Preschoolers average about 11 to 12 hours at night, plus an afternoon nap. Most give up this nap by 5 years of age.

School-age (5 to 12 years): School-age kids need about 10 to 11 hours at night. Some 5-year-olds might still need a nap, and if a regular nap isn’t possible, they might need an earlier bedtime.

Signs of Insufficient Sleep

Most parents underestimate the amount of sleep kids need, so be sure to watch your child’s behavior for signs of sleep deprivation, which can range from the obvious — like fatigue — to more subtle problems with behavior and schoolwork.

Ask yourself:

• Does my child act sleepy during the day?
• Does my child get cranky and irritable in the late afternoon?
• Is it a battle to get my child out of bed in the morning?
• Is my child inattentive, impatient, hyperactive, or aggressive?
• Does my child have trouble focusing on schoolwork and other tasks?

If you answered yes to any of these questions, consider adjusting your child’s sleep or nap schedule. It may take several weeks to find a routine that works. Talk to your doctor if you have concerns about your child’s sleep.

Naptime Routines and Other Concerns

The key to good napping can be as simple as setting up a good nap routine early on and sticking to it. With infants, watch for cues like fussing and rubbing eyes, then put your baby to bed while sleepy but not yet asleep. This teaches kids how to fall asleep themselves — a skill that only becomes more important as they get older. Soft music, dim lights, or a quiet story or rhyme at bedtime can help ease the transition to sleep and become a source of comfort for your child.

For toddlers and preschoolers, sticking to a naptime schedule can be more challenging. Though many do still love their nap, others don’t want to miss out on a minute of the action and will fight sleep even as their eyes are closing. In this case, don’t let naptime become a battle — you can’t force your child to sleep, but you can insist on some quiet time. Let your child read books or play quietly in his or her room. Parents are often surprised by how quickly quiet time can lead to sleep time — but even if it doesn’t, at least your child is getting some much-needed rest. If your child has given up daytime naps, consider adjusting to an earlier bedtime.

Many parents worry that naptime will interfere with kids’ bedtime, especially on days when a child takes a late-afternoon nap. But before you end naps entirely in an effort to wear out your child by bedtime, consider this: Well-rested kids are quicker to settle down at night than overtired ones. Overtired kids are often “wired” and restless, unable to self-soothe at bedtime, and more likely to wake through the night.

If you feel your child’s late naptime is the cause of bedtime problems, try making the nap a little bit earlier, which may mean waking your child a little earlier in the morning so the nap can begin sooner.

You might also try waking your child from a nap earlier than usual so he or she has a longer active period before bedtime. In other words, try to make some adjustments before abandoning the nap — both you and your child will feel much better if there is one!

Newborns don’t yet have a sense of day and night. They sleep around the clock, and because their tiny stomachs don’t hold hold enough breast milk or formula to keep them satisfied for long, they wake often to eat — no matter what time of day or night it is.

How Long Will My Newborn Sleep?

Newborns should get 14 to 17 hours of sleep over a 24-hour period, says the National Sleep Foundation. Some newborns may sleep up to 18 to 19 hours a day.

Newborns wake every couple of hours to eat. Breastfed babies feed often, about 8 to 12 times a day. Bottle-fed babies tend to feed less often, about every 3 to 4 hours.

Newborns who sleep for longer stretches should be awakened to feed. Wake your baby every 3 to 4 hours to eat until he or she shows good weight gain, which usually happens within the first couple of weeks. After that, it’s OK to let your baby sleep for longer periods of time at night.

The first months of a baby’s life can be the hardest for parents, who might get up many times at night to tend to the baby. Each baby has a different sleep pattern. Some start to sleep “through the night” (for 5-6 hours at a time) by 2 to 3 months of age, but some don’t.

How Should Babies Sleep?

During the first weeks of a baby’s life, some parents choose to room-share. Room-sharing is when you place your baby’s crib, portable crib, play yard, or bassinet in your own bedroom instead of in a separate nursery. This keeps baby nearby and helps with feeding, comforting, and monitoring at night. The American Academy of Pediatrics (AAP) recommends room-sharing without bed-sharing.

While room-sharing is safe, putting your infant to sleep in bed with you is not. Bed-sharing increases the risk of SIDS (sudden infant death syndrome) and other sleep-related deaths.

Follow these recommendations for a safe sleep environment for your little one:

• Always place your baby on his or her back to sleep, not on the stomach or side. The rate of SIDS has gone way down since the AAP introduced this recommendation in 1992.
• Use a firm sleep surface. Cover the mattress with a sheet that fits snugly. Make sure your crib, bassinet, or play yard meets current safety standards.
• Do not put anything else in the crib or bassinet. Keep plush toys, pillows, blankets, unfitted sheets, quilts, comforters, sheepskins, and bumper pads out of your baby’s sleep area.
• Avoid overheating. Dress your infant for the room temperature, and don’t overbundle. Watch for signs of overheating, such as sweating or feeling hot to the touch.
• Keep your baby away from smokers. Secondhand smoke increases the risk of SIDS.
• Put your baby to sleep with a pacifier. But if your baby rejects the pacifier, don’t force it. If the pacifier falls out during sleep, you don’t have to replace it. If you’re breastfeeding, wait until breastfeeding is firmly established.

Helping Your Newborn Sleep

Newborns follow their own schedule. Over the next couple of weeks to months, you and your baby will begin to settle into a routine.

It may take a few weeks for your baby’s brain to know the difference between night and day. Unfortunately, there are no tricks to speed this up, but it helps to keep things quiet and calm during middle-of-the-night feedings and diaper changes. Try to keep the lights low and resist the urge to play with or talk to your baby. This will send the message that nighttime is for sleeping. If possible, let your baby fall asleep in the crib at night so your little one learns that it’s the place for sleep.

Don’t try to keep your baby up during the day in the hopes that he or she will sleep better at night. Overly tired infants often have more trouble sleeping at night than those who’ve had enough sleep during the day.

If your newborn is fussy it’s OK to rock, cuddle, and sing as your baby settles down. For the first months of your baby’s life, “spoiling” is definitely not a problem. (In fact, newborns who are held or carried during the day tend to have less colic and fussiness.)

When to Call the Doctor

While most parents can expect their newborn to sleep or catnap a lot during the day, the range of what is normal is quite wide. If you have questions about your baby’s sleep, talk with your doctor.

Toddlers are more and more aware of their surroundings, so distractions might disrupt them at bedtime. Their growing imaginations can start to interrupt sleep, too.

Now more than ever, a simple and consistent bedtime routine is a parent’s best bet for getting a sleepy toddler snugly into bed.

How Much Sleep Does My Toddler Need?

Between the ages of 1 and 2, most kids need about 12-14 hours of sleep a day, including one or two daytime naps.

At around 18 months, or sometimes sooner, most toddlers condense their two naps into one afternoon nap. If you find that your toddler fights the morning nap, he or she is probably ready for just an afternoon nap.

Where Should My Toddler Sleep?

Your 1- to 2-year-old should still sleep in a safe, secure crib. Before a child’s first birthday, blankets are not recommended because of the possible risk of sudden infant death (SIDS) syndrome. But at this age, it’s OK to put a light blanket in your child’s crib. Also, security items like “lovies” are fine and can provide a lot of comfort.

But do not put any extra-large soft toys or stuffed animals in the crib, and look out for items with ties or strings that could wind up around your toddler’s neck. Also, be on constant lookout for nearby objects your child might be able to reach from a standing position in the crib: curtains, window blind pulls, pictures, or wall hangings are all possibilities.

Your curious toddler may be looking for ways to climb over the crib railing in an effort to “break out” of the crib. Don’t leave a lot of toys that your child could pile up and climb onto. And remember: No bumper pads — a child might use those as a step at this age.

If you have an active climber who is getting out of the crib, make sure that the crib mattress is on the lowest possible setting. If it is, and your toddler is still trying to scale the crib, consider moving him or her into a toddler bed or “big kid” bed with a side rail. It will be difficult at first to keep your toddler in it, but at least you’ll know your child won’t be hurt climbing out of a crib. For added safety, install a gate in the doorway of the room so that your child cannot wander around the house unattended. Be sure your child’s room is childproofed.

Why Does My Toddler Wake at Night?

Your toddler also may begin waking up at night, for several reasons. Sometimes it’s discomfort, such as teething pain or illness. Sometimes it’s mild separation anxiety: “Where’s Mommy? Where’s Daddy?” Dreams and nightmares can begin to affect toddlers, who have a difficult time distinguishing these from reality. Be mindful of any screen time or books your toddler is exposed to just before bedtime, and keep the content mild. If your child doesn’t have a comfort item like a lovie or blankey, consider getting one to help provide reassurance.

Look around for an environmental cause for your toddler’s nighttime awakenings. Toddlers are notorious for pushing off the covers at night, so in the colder months you might want to dress your child in heavy pajamas for warmth.

Is there too much noise coming from another room? Toddlers will learn to sleep with some noise, but a loud TV or too much conversation close by can be disrupting. Check out your child’s room from a noise perspective. Make it someplace you would sleep soundly and chances are you’ll make it more comfortable for your toddler.

Helping Your Toddler Sleep

By now you’ve probably found the right combination — like a warm bath and a bedtime story — to help your child relax. Stay with it and don’t let it get too long. The backrub that seems like a treat now may not be so fun when it’s demanded night after night for longer and longer periods. Decide how many drinks of water you’ll allow and how many times you’ll retrieve the toy that’s thrown out of the crib in defiance of bedtime.

Get used to setting the rules and sticking to them. This not only helps your child get more sleep now, but also helps you later if other, more serious discipline problems arise.

If your toddler awakens in the middle of the night, you’ll still want to quietly and quickly provide reassurance that everything is OK and you are close by. But too much interaction can backfire, so keep your nighttime “visits” brief and boring for your toddler.

If you have an early riser, help keep sunlight from waking your toddler by keeping curtains or blinds closed. Also try putting a few safe toys in the crib — they may keep your child busy in the morning.

When to Call the Doctor

Sleep problems that seem severe to you, such as recurring nightmares, should be discussed with your doctor.

Just when you think that getting more shut-eye is a far-off dream, your baby will begin to sleep longer stretches at night. Baby’s sleep cycle is getting closer to yours, and he or she may be feeding less often at night.

But don’t assume you’ll be hitting the snooze button just yet. At this stage, “sleeping through the night” is considered to be a stretch of only 5 or 6 hours.

How Long Will My Baby Sleep?

Since babies this age are more awake, alert, and aware of their surroundings during daylight hours, they’re more likely to be tired at night and sleep. But the range of normal is still very wide.

Infants up to 3 months old should get 14 to 17 hours of sleep over a 24-hour period, says the National Sleep Foundation. Many will have settled into a daily sleep routine of two or three naps during the day, followed by a longer “sleeping through the night” stretch after a late-night feeding.

How Should Babies Sleep?

The American of Academy of Pediatrics (AAP) recommends room-sharing without bed-sharing for or at least the first 6 months or, ideally, until a baby’s first birthday. This is when the risk of SIDS (sudden infant death syndrome) is highest.

Room-sharing is when you place your baby’s crib, portable crib, play yard, or bassinet in your own bedroom instead of in a separate nursery. This keeps baby nearby and helps with feeding, comforting, and monitoring baby at night.

While room-sharing is safe, putting your baby to sleep in bed with you is not. Bed-sharing increases the risk of SIDS and other sleep-related deaths.

Follow these recommendations for a safe sleep environment for your little one:

• Always place your baby on his or her back to sleep, not on the stomach or side. The rate of SIDS has gone way down since the AAP introduced this recommendation in 1992.
• Use a firm sleep surface. Cover the mattress with a sheet that fits snugly. Make sure your crib, bassinet, or play yard meets current safety standards.
• Do not put anything else in the crib or bassinet. Keep plush toys, pillows, blankets, unfitted sheets, quilts, comforters, sheepskins, and bumper pads out of your baby’s sleep area.
• Avoid overheating. Dress your baby for the room temperature, and don’t overbundle. Watch for signs of overheating, such as sweating or feeling hot to the touch.
• Keep your baby away from smokers. Secondhand smoke increases the risk of SIDS.
• Put your baby to sleep with a pacifier. But if your baby rejects the pacifier, don’t force it. If the pacifier falls out during sleep you do not have to replace it. If you’re breastfeeding, wait until breastfeeding is firmly established.
• Watch out for other hazards. Avoid items with cords, ties, or ribbons that can wrap around a baby’s neck, and objects with any kind of sharp edge or corner. Look around for things that your baby can touch from a seated or standing position in the crib. Hanging mobiles, wall hangings, pictures, draperies, and window blind cords could be harmful if they are within a baby’s reach.

Helping Your Baby Sleep

If you haven’t already, start a bedtime routine that will be familiar and relaxing for your baby. Bathing, reading, and singing can soothe babies and signal an end to the day. Be consistent and your baby will soon associate these steps with sleeping.

If you rock your baby to sleep before bedtime, your little one may expect to be rocked to sleep after nighttime awakenings. Instead, try putting your baby into a crib or bassinet while drowsy but still awake. This way your baby will learn to fall asleep on his or her own.

Some babies squirm, whine, and even cry a little before falling back to sleep on their own. Unless you think that your baby is hungry or ill, see what happens if you leave your baby alone for a few minutes — he or she might settle down.

If your baby wakes during the period that you want him or her to sleep, keep activity to a minimum. Try to keep the lights low and resist the urge to play with or talk to your baby. Change or feed your baby and return him or her to the crib or bassinet.

If your baby is waking early for a morning feeding, some small changes may allow a slight shift in schedule. You might try waking your baby for the late-night feeding at a time that suits your sleep schedule. For instance, if your baby sleeps after a 7 p.m. feeding and wakes up at 2 a.m. to eat, try waking the baby to feed at 11 p.m. and then put him or her down to sleep until an early-morning feeding at 5 a.m. or 6 a.m. It may take a few nights to establish this routine, but being consistent will improve your chances of success.

When to Call the Doctor

Some infants at this age will start sleeping through the night, but there is a wide range of normal. If you have questions about your baby’s sleep, talk with your doctor.

By this age, your baby should be well on the way toward having a regular sleep pattern. Some infants, particularly those who are breastfed, may still wake at night. But most no longer need a middle-of-the-night feeding.

How Long Will My Baby Sleep?

Most babies this age should sleep 12 to 15 hours a day, which includes a longer stretch at night and at least two naps during the day, says the National Sleep Foundation. The average amount of daytime sleep is now about 3 to 4 hours.

By 6 months, most babies are sleeping at night for 9 hours or longer, with brief awakenings.

How Should Babies Sleep?

The American of Academy of Pediatrics (AAP) recommends room-sharing without bed-sharing until the first birthday or for at least 6 months, when the risk of SIDs (sudden infant death syndrome) is highest.

Room-sharing is when you place your baby’s crib, portable crib, play yard, or bassinet in your own bedroom instead of in a separate nursery. This keeps your baby nearby and helps with feeding, comforting, and monitoring your baby at night.

While room-sharing is safe, putting your baby to sleep in bed with you is not. Bed-sharing increases the risk of SIDS and other sleep-related deaths.

Follow these recommendations for a safe sleep environment for your little one:

• Always place your baby on his or her back to sleep, not on the stomach or side. The rate of SIDS has gone way down since the AAP introduced this recommendation in 1992. Once babies consistently roll over from front to back and back to front, it’s fine for them to remain in the sleep position they choose.
• Use a firm sleep surface. Cover the mattress with a sheet that fits snugly. Make sure your crib, bassinet, or play yard meets current safety standards.
• Do not put anything else in the crib or bassinet. Keep plush toys, pillows, blankets, unfitted sheets, quilts, comforters, sheepskins, and bumper pads out of your baby’s sleep area.
• Avoid overheating. Dress your baby for the room temperature, and don’t overbundle. Watch for signs of overheating, such as sweating or feeling hot to the touch.
• Keep your baby away from smokers. Secondhand smoke increases the risk of SIDS.
• Put your baby to sleep with a pacifier. But if your baby rejects the pacifier, don’t force it. If the pacifier falls out during sleep you do not have to replace it.
• Watch out for other hazards. Avoid items with cords, ties, or ribbons that can wrap around a baby’s neck and objects with any kind of sharp edge or corner. Look around for things that your baby can touch from a seated or standing position in the crib. Hanging mobiles, wall hangings, pictures, draperies, and window blind cords could be harmful if they are within a baby’s reach.

Helping Your Baby Sleep

You may have started a bedtime routine that you’re sticking to. If you haven’t yet, now is a good time to start. Soothing activities that lead up to “night-night” time can help relax your baby. A warm bath followed by stories or singing will signal an end to the day, and these same activities can be used at bedtime for years to come.

You’ll want your baby to fall asleep on his or her own. This may mean doing your nighttime routine and putting the baby into the crib while he or she is drowsy but still awake. If the baby cries, stay away for a few minutes. Your baby may settle down and go to sleep.

If the crying continues, go back in and soothe your baby for a moment without picking him or her up. This may go on a few times until your baby figures out that the crying is not getting results. This can be tough for parents, since it’s upsetting to hear your baby cry. If you know your baby is safe, it’s OK to give him or her time to settle down.

Why Does My Baby Wake at Night?

Even a baby who has been sleeping through the night will sometimes wake in the wee hours. Allow some time to let your baby get back to sleep on his or her own. Give your baby a few fussy minutes before you respond. Then, after checking to see that everything is OK, leave your baby alone to fall back to sleep. Remember: Any cuddling, feeding, or talking you do may prompt your baby to wake each night for this attention.

Separation anxiety, a normal stage of development, can cause some babies between 6 months and 1 year old to call out or cry in the middle of the night. If this happens, as with other awakenings, give your baby some time to settle down. If needed, give brief reassurance to your little one without taking your baby out of the crib.

When to Call the Doctor

Most infants at this age will have a regular sleep routine and are able to sleep through the night. But there is a wide range of normal. If you have any questions about your baby’s sleep, talk with your doctor.