Sleep & Your Baby

Sleep problems are common in the second half of a baby’s first year. Some babies may call out or cry in the middle of the night, then calm down when mom or dad enters the room. This is due to separation anxiety, a normal stage of development that happens during this time.

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.

How Long Will My Baby Sleep?

Most babies this age should sleep 12 to 15 hours per day, including a stretch of 9 to 12 hours at night, says the National Sleep Foundation. Your baby is probably still taking two naps per day. Some babies will nap for 30 minutes, while others will nap for up to 2 hours.

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.

How Can I Make Bedtime Easier?

You may have started a bedtime routine that you’re sticking to. If you haven’t yet, now’s 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.

If your child keeps on crying and calling for you, a few loving words from the bedroom door (“Mommy’s right here, but it’s time for you to go to sleep now”) and another quick exit may do the trick. Try to lengthen the time between these personal appearances until — at long last — your baby is asleep.

What If My Baby Wakes 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 seeing that everything is OK, leave your baby alone to fall back to sleep.

When your baby wakes up in the night and cries for you, reassure your baby quietly that you’re there. Then send the message that he or she needs to go back to sleep. Your best bet might be a soothing pat on the back and a quick exit. If you are firm and consistent about teaching your baby to go back to sleep without you, this stage should pass pretty quickly.

Remember: Any cuddling, feeding, or talking you do may prompt your baby to wake each night for this attention.

When to Call the Doctor

It can be difficult to respond to your baby’s needs with the right balance of concern and consistency, but remember: This is the time to set the stage for future restful nights for the whole family.

If you have questions about your baby’s sleep, talk with your doctor.

Reducing the Risk

A lack of answers is part of what makes sudden infant death syndrome (SIDS) so frightening. SIDS is the leading cause of death among infants 1 month to 1 year old, and claims the lives of about 2,500 each year in the United States. It remains unpredictable despite years of research.

Even so, the risk of SIDS can be greatly reduced. First and foremost, infants younger than 1 year old should be placed on their backs to sleep — never face-down on their stomachs or on their sides.

Searching for Answers

As the name implies, SIDS is the sudden and unexplained death of an infant who is younger than 1 year old. It’s a frightening prospect because it can strike without warning, usually in seemingly healthy babies. Most SIDS deaths are associated with sleep (hence the common reference to “crib death”) and infants who die of SIDS show no signs of suffering.

While most conditions or diseases usually are diagnosed by the presence of specific symptoms, most SIDS diagnoses come only after all other possible causes of death have been ruled out through a review of the infant’s medical history, sleeping environment, and autopsy. This review helps distinguish true SIDS deaths from those resulting from accidents, abuse, and previously undiagnosed conditions, such as cardiac or metabolic disorders.

When considering which babies could be most at risk, no single risk factor is likely to be sufficient to cause a SIDS death. Rather, several risk factors combined may contribute to cause an at-risk infant to die of SIDS.

Most deaths due to SIDS occur between 2 and 4 months of age, and incidence increases during cold weather. African-American infants are twice as likely and Native American infants are about three times more likely to die of SIDS than caucasian infants. More boys than girls fall victim to SIDS.

Other potential risk factors include:

• smoking, drinking, or drug use during pregnancy
• poor prenatal care
• prematurity or low birth weight
• mothers younger than 20
• tobacco smoke exposure following birth
• overheating from excessive sleepwear and bedding
• stomach sleeping

Stomach Sleeping

Foremost among these risk factors is stomach sleeping. Numerous studies have found a higher incidence of SIDS among babies placed on their stomachs to sleep than among those sleeping on their backs or sides. Some researchers have hypothesized that stomach sleeping puts pressure on a child’s jaw, therefore narrowing the airway and hampering breathing.

Another theory is that stomach sleeping can increase an infant’s risk of “rebreathing” his or her own exhaled air, particularly if the infant is sleeping on a soft mattress or with bedding, stuffed toys, or a pillow near the face. In that scenario, the soft surface could create a small enclosure around the baby’s mouth and trap exhaled air. As the baby breathes exhaled air, the oxygen level in the body drops and carbon dioxide accumulates. Eventually, this lack of oxygen could contribute to SIDS.

Also, infants who succumb to SIDS may have an abnormality in the arcuate nucleus, a part of the brain that may help control breathing and awakening during sleep. If a baby is breathing stale air and not getting enough oxygen, the brain usually triggers the baby to wake up and cry. That movement changes the breathing and heart rate, making up for the lack of oxygen. But a problem with the arcuate nucleus could deprive the baby of this involuntary reaction and put him or her at greater risk for SIDS.

Going “Back to Sleep”

The striking evidence that stomach sleeping might contribute to the incidence of SIDS led the American Academy of Pediatrics (AAP) to recommend in its 1992 Back to Sleep campaign that all healthy infants younger than 1 year of age be put to sleep on their backs (also known as the supine position).

Since the AAP’s recommendation, the rate of SIDS has dropped by more than 50%. Still, SIDS remains the leading cause of death in young infants, so it’s important to keep reminding parents about the necessity of back sleeping.

Many parents fear that babies put to sleep on their backs could choke on spit-up or vomit. According to the AAP, however, there is no increased risk of choking for healthy infants who sleep on their backs. (For infants with chronic gastroesophageal reflux (GER) or certain upper airway malformations, sleeping on the stomach may be the better option. The AAP urges parents to consult with their child’s doctor in these cases to determine the best sleeping position for the baby.)

Placing infants on their sides to sleep is not a good idea, either, as there’s a risk that infants will roll over onto their bellies while they sleep.

Some parents also may be concerned about positional plagiocephaly, a condition in which babies develop a flat spot on the back of their heads from spending too much time lying on their backs. Since the Back to Sleep campaign, this condition has become quite common — but it is usually easily treatable by changing your baby’s position frequently and allowing for more “tummy time” while he or she is awake.

Of course, once babies can roll over consistently — usually around 4 to 7 months — they may choose not to stay on their backs all night long. At this point, it’s fine to let babies pick a sleep position on their own.

Tips for Reducing the Risk of SIDS

In addition to placing healthy infants on their backs to sleep, the AAP suggests these measures to help reduce the risk of SIDS:

• Place your baby on a firm mattress to sleep, never on a pillow, waterbed, sheepskin, couch, chair, or other soft surface. To prevent rebreathing, do not put blankets, comforters, stuffed toys, or pillows near the baby.
• Do not use bumper pads in cribs. Bumper pads can be a potential risk of suffocation or strangulation.
• Make sure your baby receives all recommended immunizations. Studies have shown that babies who have received their immunizations have a 50% lower risk of SIDS.
• Make sure your baby does not get too warm while sleeping. Keep the room at a temperature that feels comfortable for an adult in a short-sleeve shirt. Some researchers suggest that a baby who gets too warm could go into a deeper sleep, making it more difficult to awaken.
• Do not smoke, drink, or use drugs while pregnant and do not expose your baby to secondhand smoke. Infants of mothers who smoked during pregnancy are three times more likely to die of SIDS than those whose mothers were smoke-free; exposure to secondhand smoke doubles a baby’s risk of SIDS. Researchers speculate that smoking might affect the central nervous system, starting prenatally and continuing after birth, which could place the baby at increased risk.
• Receive early and regular prenatal care.
• Make sure your baby has regular well-baby checkups.
• Breastfeed, if possible. There is some evidence that breastfeeding may help decrease the incidence of SIDS. The reason for this is not clear, though researchers think that breast milk may help protect babies from infections that increase the risk of SIDS.
• If your baby has GERD, be sure to follow your doctor’s guidelines on feeding and sleep positions.
• Put your baby to sleep with a pacifier during the first year of life. If your baby rejects the pacifier, don’t force it. Pacifiers have been linked with lower risk of SIDS. If you’re breastfeeding, try to wait until after the baby is 1 month old so that breastfeeding can be established.
• While infants can be brought into a parent’s bed for nursing or comforting, parents should return them to their cribs or bassinets when they’re ready to sleep. It’s a good idea to keep the cribs and bassinets in the room where parents’ sleep. This has been linked with a lower risk of SIDS.

For parents and families who have experienced a SIDS death, many groups, including the Sudden Infant Death Syndrome Alliance, can provide grief counseling, support, and referrals.

And growing public awareness of SIDS and precautions to prevent it should leave fewer parents searching for answers in the future.