Definition

• Good sleep habits don’t just happen. You need to have a plan.
• It’s far easier to prevent sleep problems than it is to treat them later.
• You need to start this program by 2 months of age.
• You need to be finished by 6 months of age.
• Your Goal: Teach your baby to put himself to sleep if he is not hungry.

Health Information

Normal Feedings During the Night

• Understanding fasting is important for creating a good sleeper.
• Newborns can’t sleep through the night because they can only fast for 2-3 hours. As babies become older, they can normally sleep longer without a feed.
• By 4 months of age, most bottle-fed babies can sleep 7 hours without a feeding.
• By 6 months, most breast-fed babies can sleep 7 hours without a feeding.
• Normal children of this age do not need calories during the night to stay healthy.
• They are able to sleep through the night unless they develop some bad sleep habits.

Normal Wake-ups During the Night

• Understanding normal wake-ups also is important for creating good sleepers.
• All children partially wake up at the end of each sleep cycle. It normally happens about every 90 minutes
• The good sleepers know how to self-soothe and put themselves back to sleep. Poor sleepers have not learned that skill. They cry for a parent to come help them return to sleep.
• Here are some tips to help your baby become a really good sleeper.

Care Advice

1. Newborns - Help Your Baby Fall Asleep Using any Technique that Works:
   • During the first month of life, survival is the main agenda.
   • Gently rock your baby to sleep. Try humming, singing lullabies, or using white noise. Different babies respond to different calming techniques. Even if your baby falls asleep at the breast or bottle, you can fix that later.
   • Do not feed newborns more often than every 2 hours during the day. (Exception: the first week when breast milk is still coming in).
   • Crying does not always mean your baby is hungry. If your baby is tired but fussing, try gentle rocking to calm him. If that does not work, try swaddling him. For babies, swaddling is the next best thing to being hugged.
   • Do not let your baby sleep for more than 2 hours in a row during the day. Awaken him and feed him. Doing this helps your infant meet his calorie needs and sleep longer during the night.
   • Look after your sleep needs by sleeping when your baby sleeps.
   • Caution: The safe sleep position for healthy babies is on the back in a crib.
2. Place Your Baby in the Crib When He is Drowsy but Awake (starting at 2 months old):
   • Then leave the room. Let your baby put himself to sleep.
   • It often takes 10–20 minutes of restlessness and fussiness for a baby to fall asleep. That’s normal.
   • Common question: What to do if my baby starts cryingƒ
   • Answer: Always respond to a crying baby.
   • First, try a soft voice and a few pats.
   • If that doesn’t work, hold him until he calms down. Return him to the crib before he falls asleep.
   • Again, hold your baby for crying, not for normal fussiness.
   • Remember, all sleep training starts at sleep transitions.
3. Encourage Self-soothing Skills for Entering Sleep:
   • Don’t become part of your baby’s falling asleep transition. The sleep transition is the 10 minutes or so between acting sleepy (but the eyes are still open) and the moment the eyes close.
   • Don’t hold or rock until asleep.
   • Don’t feed until asleep.
   • Don’t let your baby sleep in your bed.
   • Learning to fall asleep without you is very important. He needs that self-soothing skill to put himself back to sleep after normal wake-ups during the night.
4. Separate Feeding from Falling Asleep:
   • Make feeding the first step in the bedtime ritual, not the last step.
   • Feed in a separate room, not the crib room.
   • Interrupt the feeding if your baby starts to fall asleep.
   • Dozing on the breast is a common way that babies become poor sleepers.
   • Your baby’s last waking memory needs to be of the crib and mattress, not of the breast or bottle.
   • The best sequence is feed, read, bedtime ritual, then put in crib.
5. Establish a Last Feeding Time at Your Bedtime:
   • The longest a newborn can sleep is 4 or 5 hours.
   • And that only happens once during each day.
   • Awaken your baby at 10 or 11 PM for a last feed of the day.
   • Continue this last feeding time until your baby can sleep at least 7 straight hours. Reason: To give yourself one good block of sleep each day.
6. Don’t Let Your Baby Become a Grazer:
   • A grazer is a baby who is allowed to feed for any crying.
   • This is also called comfort nursing.
   • Grazers are never good sleepers at night.
   • Keep daytime feeding intervals to at least 2 hours.
7. Phase Out the Last Middle-of-the-night Feeding By 6 Months of Age:
   • Have 7–8 hours of consecutive sleep as a goal. Many formula fed babies reach it by 4 months.
   • By 2 months old, try to stretch daytime feedings to 3 hours apart.
   • By 4 months old, your baby should be down to 1 night-time feeding. And it should be at least 5 hours since he fell asleep at bedtime. If not, try to delay it.
   • By 5 months old, start trying to phase out the last night-time feeding. Gradually reduce the amount.
8. Don’t Have Your Baby Sleep in Your Bed:
   • There are several reasons for having your baby sleep in a crib.
   • In the first 12 months, it can be harmful for your baby to sleep in an adult bed. The SIDS rate is more than 10 times higher.
   • Your baby does not need bed-sharing to be secure and happy.
   • It will become a bad habit that is hard to undo.
   • You probably won’t get a good night’s sleep.
9. Prevent Baby Bottle Tooth Decay:
   • Severe tooth decay is the most serious side effect of poor sleep training.
   • Never give your baby a bottle of milk or juice in the crib. Same goes for sippy cups.
   • The key is to separate feeding your baby from falling asleep. The best sequence is feed, read, bedtime ritual, then put in crib.
10. Keep Your Child in a Crib as Long as Possible:
    • Most toddlers like their crib and associate it with sleep.
    • If possible, keep them there until age 3. Reason: More self-control by then and less likely to try to leave their bedroom.
    • Cure any sleep problem long before your child leaves the crib.
    • Caution: If your child can climb out of the crib, put the mattress on the floor. Safety comes first.

Call Your Doctor If

• You have other questions or concerns

Author: Barton Schmitt MD, FAAP

Copyright 2000-2020 Schmitt Pediatric Guidelines LLC

Disclaimer: This health information is for educational purposes only. You the reader assume full responsibility for how you choose to use it. The information contained in this handout should not be used as a substitute for the medical care and advice of your pediatrician. Listing of any resources does not imply an endorsement.

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