Infant sleep

Infant sleep is often an area parents want to understand more about. Most adults will sleep between 6-8 hours per night having 90-120minute sleep cycles in mainly (75%) NON- REM sleep, which is deep sleep. When you become parents this is radically affected as babies have completely different cycles and physiological needs. Babies have sleep cycles of around 45 minutes long and for 50-75% of that time, in REM sleep, which means active sleep- they can appear restless, moving, grunting or crying (Sleep Foundation, 2020). Newborns begin their sleep cycle in light sleep which means they are easily awoken. This is why it is advisable for babies to be placed down when they are drowsy rather than asleep. Due to adults spending a greater proportion in deep sleep, parents often worry that their baby is not getting any sleep at all. Parents will often tend to their babies noises and movements but should remain mindful that this could cause stimulation, waking their baby between sleep cycles (Grigg-Damberger, 2016) However, having this higher proportion of lighter sleep is actually protective for babies from Sudden Infant Death Syndrome (Brown, 2018). Babies will therefore show frequent arousals between sleep cycles and it is important to observe your baby to decide if they are intending to self settle and go back to sleep, or if they are indeed waking. Babies will wake up frequently to be fed, have a cuddle and/or a nappy change throughout the day and night. Many internal or external triggers cause day and night-time waking and research suggests night-time waking can remain unstable for the first few years of a child’s life (Scher, Epstein, & Tirosh, 2004). This is because sleep is a developmental process that changes with age and even the best, most established routines are at risk of relapse due to new situations such as developmental changes, teething, illness or weaning.

So where did we hear that babies should sleep through the night? The research that has founded this perspective and formed a lot of the guidelines around sleep, is from the 1950’s looking at formula fed infants (Moore & Ucko, 1957 as cited in BASIS, N.D). More recent studies state that it is physiologically normal for many babies to wake throughout the night for the first year of life - with about half of babies still waking at six months old and 27% of babies at one year (Henderson et al, 2010). Current research also reiterates that feeding frequency overnight may be determined by how much a baby feeds during the day, whether it be breast, formula or solids, however it will not influence how many times a baby will wake throughout the night. Therefore introducing formula or solids is not the answer to reducing night-time waking and not a reason to stop breastfeeding (Brown and Harries, 2015). In fact in 2011 researchers and a lactation consultant, Kendall-Tackett et al found that breastfeeding mothers may feed more frequently during the night (due to the quickly digested properties of breastmilk) but report greater sleep durations than formula fed mothers who are awake longer preparing feeds and settling the baby again afterwards. Also, breastmilk contains melatonin overnight, therefore babies who are breastfed have been shown to sleep better and have less colic/irritability due to the soothing effects melatonin has on the stomach.

What is essential to note prior to beginning any sleep training or routines is that night-time feeds should not be restricted in a baby that is under six months. This is because the World Health Organization state that responsive feeding (where you feed when your baby asks for it or your breasts are full/engorged etc) is necessary and important to maintain a supply of milk and ensure a secure, loving attachment between mother and baby. This also stands for bottle fed infants. Additionally, babies take in about one third of their intake during the night, so reducing night-feeds is likely to cause weight loss and early formula and/or weaning introduction (Brown, 2018). Any routines or training to reduce night-feeds is shown to reduce breastfeeding rates so parents awareness of this is important prior to starting.

Conclusively, before worrying that there is something wrong with your baby because they wake often, or do not sleep for 16 hours a day (the stipulated ‘average’ newborn sleep duration, although nine hours is also considered normal and 22 hours!) consider the differences between adults and how not all babies will sleep/wake in the same pattern and for the same duration - hence the word ‘average’. Look at the graph below to see the variations. No baby is the same, like no adult, and having awareness of how our expectations influence what we are feeling can help in having a realistic judgment. Emerging evidence and observations on infant sleep is showing us that there is huge variation in sleep, and ethnicity can also play a part with asian children sleeping for shorter periods; suggesting socio-cultural influences (Galland et al, 2012). Even when your baby starts to sleep for longer periods, this is likely to relapse again at a different developmental stage. Routines can help from three months, however the changes that your baby’s body and brain has to go through in the first two years of life is far greater than at any other time. Therefore responsive and flexible parenting is really the answer, albeit not the magical solution to an understandably exhausting problem. However we need society to support parents to manage these physiological norms of infant behaviour and for partners, friends, professionals and, if lucky- family to all chip in to create an environment that enable parents to manage these challenges. This shift in focus to ‘how can we support these parents to get through this ?’ compared to ‘what is wrong with my baby’ will help support a change regarding what constitutes ‘normal’ infant sleep and boost parental confidence.

By Abigail Marie Laurie

Midwifery degree in 2010. Three-year programme. Midwives work independently in the UK to provide all antenatal, intrapartum and postnatal care until day 28. We work with obstetricians for complex medical cases.

Specialist Public Health Nursing Course 2015. Provide child health and development care for all children 0-5 years. Also provide sexual health, mental health and maternal health advice.

Master's degree in Public Health 2018.

Research project on sexual health and childbirth.

Summary: since 2010, worked in NHS hospitals (public hospital in the United Kingdom) delivering maternity and public health care to children and families both clinically and as a researcher.

Resources:

APP to download: https://www.basisonline.org.uk/infant-sleep-info-app/

Safe sleep: https://www.lullabytrust.org.uk/safer-sleep-advice/