Q & A: Your Baby's Sleep

Even before their babies are born, parents-to-be worry about how they're going to get the rest they need. Here are expert answers to the most common questions.

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Q: How much sleep does a newborn need? A: The average newborn sleeps a total of 14 to 18 hours a day, older infants from 13 to 14 hours, says Jodi Mindell, Ph.D., associate director of the Sleep Disorders Center, Children's Hospital in Philadelphia and author of Sleeping Through the Night: How Infants, Toddlers and Their Parents Can Get a Good Night's Sleep, revised edition (HarperCollins, 2005). "The best way to judge whether or not your baby is getting enough sleep is to look at his behavior throughout the day," Mindell says. "If he sleeps 11 hours and is perky and happy, that's enough." Q: My baby seems to have his days and nights confused. Should I do anything? A: "Encourage him to switch," Mindell says. "At night, keep the lights low, and move slowly when you feed him. Be boring. Make sure he gets bright light in the morning and keep him as busy as you can during the day. Make noise. Play with him." In other words, during the day, be interesting. Q: Are bedtime rituals important? A: Yes. "Sleep time should be consistent," Mindell says. "Each family has to develop its own routine, but doing the same activities in the same order every day helps the baby anticipate what will come next." Mindell suggests doing three or four winding-down activities for a total of 20 to 30 minutes; these can include massages, baths, lullabies, prayers, rocking, nursing, reading and telling stories. Q: If I rock my baby to sleep, won't he become dependent on it? A: "If you are doing this and your baby is sleeping all night, don't worry," says Jennifer Waldburger, M.S.W., co-owner of the Los Angeles-based consultation service ChildSleep. "After about four months, if he is waking up, you probably need to let him do the last little bit of falling asleep on his own. You can still rock him as part of the wind-down process, but put him down drowsy, not asleep. When a baby is put to sleep a certain way and wakes up, he checks to see if everything is the same as it was when he went to sleep," Waldburger explains. "So if you nursed him to sleep, he will look for the breast. Same with rocking him or playing music."

Q: Should my baby nap on a schedule? A: Look to your baby for his evolving schedule after about 3 months—before that, anything goes. "You don't have to be rigid," Mindell says, "but some structure helps both parents and baby. By 9 months, most babies naturally move to napping at around 9 a.m. and 2 p.m." But don't try to force a schedule on your baby for your convenience.

Q: My baby has been sleeping in our bed. When and how do I transition him to his crib? A: Mindell says you should anticipate the future. "If you want the baby in his crib by a year, the best time to start making the change is at 3 months—before habits are firmly established," she says. That said, small steps are best. "Take a week—or several—and do the baby's bedtime ritual in his room," Mindell says. "Put him to sleep in his crib. When he wakes up at night, bring him into your bed. Go slowly; it's a big transition."

Q: Could my constant worry about getting my baby to sleep be affecting him? A: "Definitely," Waldburger says. "Babies are sensitive to a mother's cues. If you're not sleeping, you're more tired and stressed and your baby picks up on those vibes." Q: When can I put my baby down to sleep and go have a glass of wine? A: Waldburger and other experts suggest that when he's about 5 months old, you can experiment with letting your baby cry a bit at night. (That does not mean letting him cry it out for hours.) Try starting with five minutes, Waldburger suggests; if that's too hard to take, pick him up after three minutes. "It sounds cruel not to pick up a crying baby," she says, "but we find that teaching babies how to calm themselves is really kinder in the long run. We suggest a long wind-down period with lots of cuddles and laughs, comforting with your voice and finally letting the baby soothe himself to sleep."

SIDS Update: What We Know Now

Despite the progress of the Back to Sleep campaign, launched in 1994, sudden infant death syndrome (SIDS) remains the No. 1 cause of death in babies from 1 month to 1 year of age, according to First Candle/SIDS Alliance, a nonprofit organization in Baltimore.

Many factors have been linked to SIDS: smoking in the home; overdressing the baby; and pillows, blankets and bumpers in the crib. However, says First Candle/SIDS Alliance public affairs director Laura Reno, "new research shows that babies who die from SIDS have a brainstem abnormality that makes them susceptible to challenges in their sleep environment." They don't cough like they should when they rebreathe carbon dioxide (exhaled air). The best precautions: Always place your baby on his back on a firm mattress with everything else removed from the crib (dress him in a sleep sack), and duplicate this environment anywhere the baby sleeps, such as day care.

Coping with Sleep Deprivation

"New moms need to make themselves and their rest priorities," Richard Frieder, M.D., says. "The mother is the linchpin in the family; if she doesn't take care of herself, home life goes downhill." Here are some suggestions for getting the rest you need with a new baby in the house, especially if you go back to work.

1. Take "power naps." Difficult and frustrating as it sounds, the best—and only—remedy for lack of sleep is sleep. "Power napping needs to become a way of life for pregnant women and new moms," says Yan-Go. "Taking a 20- to 30-minute nap once or twice a day can help a lot."

2. Sleep when the baby sleeps. Fight the urge to use this precious time to pay bills or do laundry. Make rest your priority.

3. Enlist help. Hire a postpartum doula or another competent child-care provider to watch your baby while you sleep. Or alternate sleeping shifts with your husband. Don't be afraid to ask for coverage, says psychiatrist Leslie Lundt, M.D., who has a sign in her office that says "Sleep Rocks." "It's unhealthy to skimp on your sleep," she says. Before, you needed it for yourself. Now you need it for your baby, too.

4. Sleep with your baby. If you breastfeed, you won't have to get out of bed and become fully awake, so you'll get more hours of uninterrupted sleep. Even if you don't nurse, you'll sleep more soundly, as you won't wake up worrying about the baby.

5. Be creative at work. If you have an office, close the door, turn off the lights and stretch out on a mat during your breaks and lunch hour. If you work in a cubicle, curl up under your desk. If you have to, catch a nap in your car. Try to work a shorter day, and schedule meetings in the morning, when you're more alert. Take miniexercise breaks, go outside for some fresh air, eat frequent, small snacks instead of a heavy lunch.

Pillow Fight: How The Baby Sleep Experts Disagree

Luckily for new parents, there is a sleep philosophy to suit everyone's temperament. The tricky part is finding the perfect fit. If you can't stand to hear your baby cry, then Richard Ferber, M.D., (see chart below) is definitely not for you. If you feel uncomfortable with the idea of sleeping with a tiny infant in your bed, then steer clear of William Sears, M.D. Let our guide to four of the most prominent ways of thinking about babies' sleep help you pick an approach that feels right for your family.

Expert/book Sleep philosophy Best suited for William Sears, M.D., and Elizabeth Pantley, The No-Cry Sleep Solution: Gentle Ways to Help Your Baby Sleep Through the Night (McGraw-Hill, 2002) From the father of attachment parenting, techniques for developing a "night time parenting style" that encourages bonding, such as baby "wearing" in a sling or carrier and co-sleeping. Attachment-parenting aficionados or other parents who want to be close to their babies at night. Marc Weissbluth, M.D., Healthy Sleep Habits, Happy Child, 3rd Edition (Ballantine Books, 2003) Advocates consistent naps and early bedtimes. Urges parents to look for their baby's drowsy state as a cue to tiredness. For the 27 percent of babies who Weissbluth says have sleep problems by 4 months, he offers "no cry," "maybe cry" and "let cry" solutions. Baby-centered parents who nonetheless want some control over their child's sleep. American Academy of Pediatrics/ George J. Cohen, M.D., American Academy of Pediatrics Guide to Your Child's Sleep: Birth Through Adolescence (Villard, 1999) By the time a baby is 6 to 12 weeks old, he should be able to begin to sleep for six hours a night but may need help with self-soothing. Put baby in crib awake but drowsy. When he cries, wait, then speak softly and pat him. Middle-of-the-road types who don't believe in stringent "sleep training." Richard Ferber, M.D., Solve Your Child's Sleep Problems (Fireside, 1986) Structured sleep plan for babies 6 months and older. "Ferberizing" calls for 5-, 10- and 15-minute intervals of crying interspersed with comforting by your voice and patting. More controlling parents who really want or need their baby to sleep alone and when they do.

The Last Resort: Getting Baby To Sleep

When feeding, rocking, patting, singing and reading fail, here are some other ways people get their babies to sleep, from most to least drastic. Just be forewarned that these are short-term solutions: Do them every night, and your baby will get so used to the association, he'll never go to sleep otherwise.

  • Carry the baby around the house in your arms. Upside: You'll burn a few calories and firm up your biceps.
  • Put him in his car seat or asturdy carrier on top of a running clothes dryer. Just don't leave him unattended; the vibration can cause the seat to move and fall off. Upside: You'll get some laundry done.
  • Put him on the floor in his car seat and run the vacuum cleaner or dishwasher. Upside: The dishes or floor will get clean.
  • Take him for a stroller ride around the neighborhood. Upside: You'll get some exercise. Downside: It can be cold and dark out there.
  • Strap him securely into his car seat and go for a drive. Downside: Gasoline is expensive.

Making the Family Bed Work, Safely

The most important aspect of sleeping with your baby is making it safe. "First and foremost, make sure that no one is a smoker, that there are no other children in the bed and that neither parent has used drugs or alcohol or is excessively tired," says James McKenna, Ph.D., director of the Mother/Baby Sleep Lab at Notre Dame University in Indiana.

Other dangers include: gaps between the bed and the wall or a piece of furniture where the baby can become lodged; gaps between the mattress and headboard or footboard; blankets, pillows and comforters near the baby; and sleeping on other surfaces, such as a couch or waterbed. "The safest way to sleep with your baby is to take the mattress off its frame and put it in the middle of the floor," McKenna says.

An option for parents who want the baby in the bed with them but are afraid of rolling over onto him when they're asleep is to use the Deluxe Snuggle Nest, an "island" with raised edges that goes in the middle of the bed. A co-sleeper that attaches to your bed is another good option. If you opt for a bassinet, keep it as close to your bed as possible, McKenna advises, as being close to his mother regulates the baby's heart rate, immune system and stress levels and makes breastfeeding easier.

"Proximity to his mother also keeps the baby in lighter phases of sleep so he can practice arousing and going back to sleep, which is good in case of any problems such as sleep apnea," McKenna says. Some experts believe it also might help prevent SIDS.

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