Infant sleep

Type of psychology: Biological bases of human behavior; Child; Clinical; Counseling; Cross-cultural; Developmental; Family; Social

According to Merriam-Webster, sleep is the natural, periodic suspension of consciousness during which the powers of the body are restored. Sleep plays a critical role in brain development in infants and young children. During sleep, the body works to support healthy brain function and maintain physical health.

Introduction

One of the major concerns of parents of newborns is their infant's sleeping routines. From the first few months to a year of the newborn's life, sleeping patterns may not be well established and parents often find this a troublesome period for the baby's comfort level and the parents' personal adjustment to sleep deprivation. Sleep is not only a critical feature for the baby's brain growth and physical development, but the newborn also becomes familiar with his or her bodily functions and rhythms, thus leading to an improved sleep/wake cycle. Because parents and the newborn are unfamiliar with each other, they are often learning about each other seemingly “on the fly.” Newborns are learning to adjust to the “outside” world of getting their breathing, sucking, and swallowing pattern organized in order to nurse or be fed. They are unaware that there is a difference between night and day (i.e., sleep/wake cycle), and their circadian rhythms have not yet matured. (Adults' activity cycle lasts twenty-four hours; many living things, including humans, follow a circadian rhythm that is generated by an internal clock that is synchronized to light-dark cycles.) Additionally, the newborn's physiological system is becoming synchronized. During the first or second month, babies may sleep from forty-five to seventy-five minutes at one time, which does not provide the parents the long and sound sleep to which they were accustomed prior to the newborn's arrival. All newborns and infants are different so though a newborn may sleep through the night at three months, most babies do not sleep through the night after six months.

Importance of Sleep

“[A] mother's ability to attune, regulate, and appropriately respond to an infant has significant relational and developmental implications” (Snyder, Shapiro, & Treleaven, 2012, 709).

Signs that a baby may be sleepy are often present; however, parents are new to picking up on the subtle clues that their baby may be giving. If a parent notices the baby rubbing his or her eyes, tugging on his or her ears, crying, or becoming fussy, these may be signs of needing to settle quietly for a nap or bedtime. Sometimes babies may become overtired and have great difficulty in quieting due to elevated levels of cortisol, so it is important to become attuned to the baby's communicative attempts.

Typically babies sleep anywhere from ten to sixteen hours a day; however, a sleep/wake cycle may take months to develop into a routine. During the first few months, however, they may only sleep for two to four hours at any given time. This is due to their need to be fed every three hours or so. All babies are different, and parents should not become concerned if their baby does not exactly “match” what experts or other parents may say. Around six months, the periods of sustained sleep may begin to lengthen as the baby has formed the sleep/wake cycle. Parents should take cues from the baby to get some rest when the baby is down for a nap during the day or asleep for the night. In the first few months, attention should be paid to a newborn's needs and the clues indicated by movements, facial signs, and feel of the body (relaxed or tense), which are all ways a newborn communicates needs. As the baby's brain matures over the first few months, a more stable sleep pattern should start to emerge.

Feeding

Tiny babies mean tiny stomachs, causing babies to feel hungrier more often. Infants who are nursed are able to digest and use breast milk more efficiently and therefore are hungrier within shorter periods of time. Formula is often more difficult to digest and takes longer to be metabolized so babies may sleep or nap for longer periods of time. The medical field does, however, recommend exclusive breastfeeding for the first six months of life and then supplemental breastfeeding for up to one year for maximum health benefits of breast milk. Infants at three months are sleeping typically for a total of fifteen hours throughout the day and are awake to nurse/be fed and be changed. As little bodies continue to develop, the sleep-wake patterns will change. Infants will not require the same amount of sleep as when a newborn, and they will be able to sleep for longer periods of time between physiologically needing to wake to be fed or changed. Feeding is a cultural practice influenced by family traditions and values and lifestyle choices.

If the infant pulls away from the bottle it may indicate lack of hunger or the need to take a break. Breastfed infants may need more frequent, shorter feedings than formula fed infants because the body breaks down and uses breast milk more easily. Breastfeeding infants receive antibodies from their mothers through breast milk, which support a stronger immune system, resulting in fewer ear infections, allergies, and respiratory and intestinal illnesses. Most important is the fact that the feeding experience provides a wonderful opportunity to get to know the infant. It is a caregiving situation that allows development of a loving, secure relationship with the infant and a supportive environment for the infant's developing brain.

Crying

A baby's developing brain is significantly influenced by interactions with the world around him or her and especially by relationships with the adults who care for him or her. Crying may be nature's way of helping ensure that babies receive enough interaction—holding, snuggling, talking, and singing— and nutrition to help the brain develop. Perhaps we do not know what the brain is learning from this wonderful attention, but we do know that children grow up more secure and competent when their parents respond to their cries with loving attention.

Crying is one important way babies communicate their feelings and needs. Learning what a baby's cries mean may take time. Thinking about the situation when the crying occurs may help parents identify the specific need the baby is trying to share. Parents might ask themselves, When was the last time I changed the diaper? Is this room too noisy? When was the last feeding? Sometimes crying follows a pattern or routine of the baby. For instance, the baby may cry during the mid-morning or mid-afternoon. This might indicate that the baby is tired and ready to be placed in the crib for a nap. It is often normal for a newborn to cry frequently during the first three months of life. In fact, some may cry up to two hours a day. One-fifth of babies experience colic, which is marked by a regular period of crying each day; there is no known cause of colic and it is thought to be caused by a baby's sensitive temperament and inability to regulate his or her nervous system. Colic typically resolves itself by three to four months of age, although it can last until six months. However, colicky behaviors can also be a sign of a medical problem, such as a sensitivity to a food in their mother's diet if breastfeeding or in their formula. Digestive upset may also be caused by gas, air, overstimulation, or an immature digestive system. Talk to your doctor or pediatrician if you are concerned about your baby's crying.

Be patient. Learn a baby's cues and how to soothe a baby takes time and some trial and error. Parents are often torn between letting their baby cry when going to bed or comforting their baby. There certainly are a lot of opinions from well-meaning family members and friends, but this decision is ultimately the parents. Even if successful, many parents find it difficult and too stressful to demand a baby fall asleep while crying. Some parents use a method known as “progressive watching” or “graduated extinction,” in which the parent leaves the baby alone in their crib for progressively longer amounts of time (although no longer than ten to fifteen minutes) in an effort to have the baby learn to fall asleep on their own. This method is called the Ferber method, named after Richard Ferber, a physician at the Children's Hospital in Boston. Although controversial, Dr. Ferber does not recommend trying this method with babies under six months old. Children younger than six months do not have the ability to self-soothe, and the stress from being left to cry—even for short periods—can negatively affect a child's development.

Crib Environment

A baby should always be placed on the back when being put down to sleep. This has been found to significantly reduce the risk of sudden infant death syndrome (SIDS). It is also crucial to follow safety standards for the crib environment. Use a firm mattress covered with a well-fitting sheet and that fits into the crib without gaps. Do not include soft objects such as toys, crib bumpers, loose blankets, pillows, or sheepskin in the crib as these can pose a suffocation hazard. Dress the baby lightly, do not use a blanket, and keep the room at a comfortable temperature.

Sleeping Routines

People who say they sleep like a baby usually don't have one. – Leo J. Burke

Parents should not wait until their baby is fully asleep to put him or her down in the crib. If the baby seems to be drowsy, place him or her on the back in the crib so that the baby may learn to fall asleep on his or her own. This will support the baby in learning how to fall asleep on their own and form good sleep associations. In this way, babies may not need to be rocked to sleep or nursed if they wake up during the night. Parents should begin talking more softly to the baby when preparing for a night of sleep or a nap. Ensure that the lighting in the bedroom is soft or subdued to support the transition from a light to dark environment.

Swaddling newborns may help them transition from the womb to the outside world more easily. When not swaddled, babies' twitches or jerky movements may unfortunately startle them from sound sleep. Learn the right techniques of swaddling to ensure that the baby is safe and secure. Once a baby has learned to roll over, however, discontinue swaddling immediately.

Cosleeping

Some cultures and parenting philosophies include infants sleeping in the parental bed. While this certainly may be considered to provide a close, secure, and warm environment for sleeping, a note of extreme caution would be advised when considering this type of sleeping arrangement. The American Academy of Pediatrics (AAP) warns against bed-sharing due to safety hazards, but the AAP does promote room-sharing, in which the infant sleeps in his or her own crib or bassinet inside the parents' bedroom. Room-sharing has been found to reduce the risk of SIDS.

Bed-sharing is controversial as it has both proponents and those who are in strong opposition to the practice for safety reasons. Proponents of bed-sharing argue that the practice promotes successful breastfeeding and improves parent-infant bonding; these supporters assert that bed-sharing can be done safely when the baby and parent sleep on a large, firm mattress with no blankets, pillows, or duvets that could pose suffocation hazards. Additional bed-sharing hazards are posed when older children also share a bed with an infant and by parents who drink alcohol, smoke cigarettes, take sleep-inducing drugs or medications, are difficult to wake, or are obese.

Bibliography

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Snyder, Rosa, Shauna Shapiro, and David Treleaven. “Attachment Theory and Mindfulness.” Journal of Child and Family Studies 21.5 (2012): 709–17. Print.

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