Rebekah Thomson, Certified Sleep Coach
Congratulations on the birth of your little ones! Most of my sleep advice is directed toward children six months and up. By that age, babies are decreasingly reliant on nighttime feedings (though some may still need a few) and more prepared for behavior modification. That said there are some basic, developmentally appropriate ways in which we can begin to lay a solid sleep foundation with babies under six months. And in the case of parents returning to work, coping with postpartum depression or blues, or simply burnt out from sleep deprivation, some early interventions may be necessary.
First, a word about sleep advice from well-intentioned family and friends…
Like parenting in general, how we approach sleep is very personal. Parents must decide for themselves what they feel comfortable with, what meshes with their values and philosophy, and what works for their child’s unique temperament and needs. Lots of friends and family like to opine about sleep, but it is essential that parents listen to their gut and understand that while an approach worked for one family, it does not necessarily mean it’s a good (or healthy) fit for theirs.
There are significant individual differences between all children (and adults!), particularly in babies under six months. This is why one size does NOT fit all and what worked for a friend and her baby, may not work for you. This is especially true for feeding. For example, some infants with large stomach capacity may be able to consume large amounts of breast milk or formula, enabling the baby to go 3.5 hours without another feeding. Another baby with a smaller capacity may truly need to eat every 2 hours. Both are healthy and normal for this variable age group, but clearly the babies have very different feeding needs. Alternatively, one baby’s mother might have an abundant milk supply, while the other’s mother’s supply might be perfectly adequate, though not sufficient to stretch out feedings. Attempting to do so would actually put their otherwise healthy baby at great risk. Then there are babies with reflux, who have a totally different set of feeding needs. For this reason, any recommendation from a book, friend, or family member for scheduled feedings – or stretching out feedings – should be taken with a BIG grain of salt.
Establish a healthy feeding pattern as soon as baby is born.
With young babies, almost everything revolves around feeding, including sleep. Making sure their feeding needs are being met is essential to their health and growth, as well as any sleep success. Most infants need approximately 6-7 full feedings between 6am–10pm, plus more at night depending on their growth and individual needs. “Full” is the operative word here. If breastfeeding, this usually means emptying both sides. The goal is to avoid snacking throughout the day, though shorter cluster feedings in the late afternoon as well as extra comfort feeds are perfectly fine.
If there is any concern or doubt about whether the baby is getting sufficient calories during each feeding – or if breast or bottle-feeding become challenging – consult your pediatrician and/or one of our island’s great lactation consultants promptly. If their answer doesn’t sit right with you, seek a second opinion.
Note: Babies usually have growth spurts around 3 and 6 weeks, and 3 and 6 months. It is essential that they receive additional calories at these times and if breastfeeding, that they go to the breast more to up their mother’s milk production so that she can meet their need.
Create a flexible feeding and sleeping routine
A flexible routine does not mean a minute-by-minute schedule, but rather a sensible framework so that full feedings and sleeping are prioritized. Almost every sleep book on the market agrees that in general, an “eat – active time – sleep” cycle (in that order) is beneficial. In other words, feed your baby “up.” When she wakes, give her a full feeding (and burping). Then encourage her to stay awake for a short period. This is the time to engage with your baby, give her some tummy time, take her outside, etc. How long this active time should last is dictated by her age (wakeful windows get increasingly longer) and your baby’s cues. When she starts to show her sleepy cues – yawning, rubbing her eyes, zoning out, mild fussiness, etc. – you’ll know it’s time for her to rest. This cycle can be continued throughout the day, at least until the afternoon when her central nervous system is more taxed.
The beauty of this routine is that it makes parenting easier. Infants don’t differentiate their cries right away, so it can be hard figuring out why she’s not happy. However, if you know she has had a full feeding, she’s been appropriately stimulated, and now she’s fussy, she’s probably ready to sleep. On the other hand, if she’s had a partial feeding because she fell asleep during the feeding, it’s hard to read her cues. Is she hungry again? Did she not rest enough? Is something else wrong?
The “eat – active time – sleep” cycle brings other advantages too. It helps to disassociate falling asleep and eating (though it’s fine for infants to fall asleep at the breast/bottle sometimes). And for babies dealing with reflux, having upright time after feedings is crucial.
Look for natural day/night cycle to emerge, usually 6am-6pm or 7am-7pm.
Most babies fall into a 6am-6pm or 7am-7pm (or thereabouts) schedule. During the day, we want to focus on full feedings every few hours, outside time, lots of floor time to practice new skills, and napping at appropriate intervals. When you notice your little ones starting to get tired around 6pm or 7pm, she’s probably ready to call it a day.
Many parents mistake this fussiness as a need for one more nap. But after a 12-hr day, her central nervous system is taxed, and it is time to get her into a less stimulating, more sleep friendly environment. Bring her to the bedroom, give her one last feeding, change her diaper, dim the lights, turn on some white noise (especially if the rest of the house is still up and at ‘em), sing her a song, swaddle her up (if she’s into that), and put her to bed.
Manage day and night feedings so that caregivers can get some rest too.
Even though she’s ready to hit the sack around 6 or 7pm, a later evening feeding works well for babies and parents. Rouse her for full, boring feeding 2-3 hours later (around 9-10pm), then put her straight back to bed. Then YOU go to bed too!
Babies can naturally take one long stretch per 24-hour period. At first the long stretch may just be 4 hours, but it will lengthen over the upcoming months to 5-6-7 hours and will eventually become her night sleep. We want to encourage the long stretch to be at night after that last 9-10pm-ish feeding. If she takes it during the day in the form of an epic nap, she will legitimately be up all night making up for calories didn’t receive during the day. (Yes, that means wake a sleeping baby from a nap so that she doesn’t sleep through a daytime feeding.) And if she does her long stretch from 6-10pm, then you haven’t benefited from it. So encourage her little body to take its long stretch after that last evening feed.
Note: If mom really needs some more sleep, see if another caregiver can do the next feeding (probably around 1-3am) so that mom can get a solid stretch herself. If breastfeeding, this can be a bottle of expressed breast milk. As the saying goes, “If mama isn’t happy, ain’t nobody happy.” Knowing how intense as the first few months can be, we need to do what we can to support ourselves. An uninterrupted 6+ hour stretch of sleep can do wonders for a mom coping with baby blues, postpartum depression, or simply trying to regroup after a challenging postpartum time.
I could go on (and on, and on), but will stop there for now – more infant sleep suggestions to come. In the meantime, wishing everyone a very happy holiday season with your little ones.
Rebekah Thomson is a Gentle Sleep Coach, trained and certified by Kim West (AKA The Sleep Lady), author of Good Night Sleep Tight. She works individually with families struggling with sleep challenges and offers workshops regularly. Rebekah and her husband live in West Tisbury with their three children, who offer her ongoing professional development opportunities. She can be reached at www.countingsheepmv.com.