I’m Exhausted! My Baby Won’t Sleep!
By Dr. Todd Wolynn
What is “Normal” Sleep for an Infant?
While the total amount can vary, 14-16 hours per 24 hours is reasonable. The tough part is how those hours are assembled.
The norm for the first couple months are sleep spans of 2-3 hours, with lots of feedings and diaper changes during the waking periods. Infants need these frequent feeds, as they are growing incredibly fast. (Think an old-fashioned steam engine locomotive with two engineers rapidly shoveling coal into the engine; all those feeds shovel calories into the baby’s engine to be metabolized and create brain, bone, and muscle tissue.) Of course, all this feeding results in lots of pees and poops too.
Most babies don’t consistently start consolidating 6+ hours of sleep until about 4 months of age. (If you have a healthy, normally developing infant who can string 6+ hours together regularly in the evening earlier than that, consider yourself blessed, and don’t brag — you’ll be hated by a lot of jealous parents with typical infant sleepers!) By 6 months, the majority of healthy infants can start stretching spans of 10+ hours of sleep, and they typically do not require night feedings anymore. Most of the healthy kids who continue to have several night feeds beyond 6 months of age don’t “need” the feedings; they either want them — which is a big difference — or they’re offered them and don’t refuse.
Naps in the first few months can be chaotic for many babies, but they too become longer and more predictable by 4-6 months, usually occurring in the early morning and early afternoon. By 12-15 months, most infants are down to one midday nap of 1-2 hours per day.
Our Biologic Clocks
I’m frequently asked about how and when a baby establishes longer, more mature, sleep patterns (basically: “is there any chance of a return to ‘normal’ sleep for everyone in the home?). It’s completely reasonable that within 6 months, a baby will achieve long stretches of sleep. To help ensure that these stretches occur at a time that fits with a family’s schedule and routine, we need to be mindful of everyone’s internal “biologic clock.”
Our own biologic clock, which helps us orient to our day’s activity and night’s sleep, is influenced by things like light (especially bright daylight), sound, and events like feedings, playtime, cuddle-time, and so on. Assuming a family wants their baby be awake in the daytime and sleep at night, they need to understand that this pattern is also shaped and influenced by the baby’s surroundings. The more stimulated into wakefulness the baby is during the day, the less sleep will occur at that time. As a result, the body builds a “sleep debt” and tries to make up for the displaced sleep, so more sleep is shifted to the night. This is a gradual process for infants, because their sleep patterns are just developing. The idea here is that if you want your baby to “get their days and nights straight,” you should:
- Stimulate your baby at least every 2-3 hours in the day, with feedings, playtime, and reasonable light exposure.
- Keep things mellow at night, with limited and low light exposure.
So, what to do with this information? Just understand that…
INFANTS (1 Day – 6 Months)
- Sleep in short spurts of 2-3 hrs (sometimes even shorter)
- Awaken multiple times and require feeding and diaper changes
- Sleep may appear very active at times
- Naps can be all over the place: short cat naps to longer 1-3 hour naps
- At 4-6 months, many babies have condensed naps to about twice per day — usually morning and early afternoon.
OLDER BABIES (6-12 Months)
- Sleep can start to extend to 10+ hours overnight and does not necessarily require awakenings for feeding sessions.
- Awakenings may still occur but do not physiologically require help for the baby to return to sleep. Thus, your parental sleep philosophy, and your actions/decisions, have a significant impact on the baby’s sleep pattern.
- Naps by 12-15 months typically condense to one mid-day nap.
THE BOTTOM LINE
There are multiple ways to approach sleep from a parenting approach.
We encourage you to discuss your questions with us at your baby’s office visits, check out our Facebook page and Doctor’s Notes, and read our Kids Plus Sleep Handout, which addresses sleep in children 6 months to 2+ years.
You can also learn a lot more about infant sleep by attending our next Kids Plus Quiet Night Sleep Class.
Dr. Todd Wolynn, the CEO of Kids Plus Pediatrics, is a clinically trained, nationally renowned pediatric sleep expert.