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Sleeping Difficulties in Infants

Adapted verbatim from:
Am Fam Physician. 2009Jul15;80(2):139-142.

Guidance for Parents

Newborns usually wake up every two to three hours. Each baby will have different sleep habits. Babies will sleep longer as they get older. Most babies sleep through the night by one year of age, but some babies start sleeping through the night by four to six months of age.

If your baby is not sleeping through the night by the end of the first year, you can try some things to help him or her sleep longer. Responding less often to your baby’s cries may help. For example, at first go to your baby within five minutes of crying, then wait for 10 minutes the next time, and then a little longer each time. After awhile, your baby will learn to calm down and go back to sleep.

Having your baby wake up at the same time each morning and go to sleep at the same time each night can help. Waking up your baby before expected middle-of-the-night awakening times also might help. For example, if your baby usually wakes up at 1:00 a.m., 4:00 a.m., and 7:00 a.m., wake him or her 15 minutes earlier each time. Your baby may eventually sleep through his or her predicted times.

More Info: Development of Normal Sleep Pattern

An important part of the childhood development process is gaining independence, and one way in which an infant works toward this goal is by sleeping through the night. Approximately 80 percent of children sleep through the night by six months of age, and 90 percent by one year of age. The definition of “sleeping through the night” is variable, because sleep schedules for each family and person are unique. Some children sleep through the night at an early age, but temporarily revert to nighttime awakenings. These awakenings are usual in the nine- to 18-month age group, when separation anxiety is common.

American Academy of Sleep Medicine 2006 Recommended Methods for Prolonging Sleep in Infants (5 years and younger):

The Parental Guidance above is from on these recommendations. These recommendations were based on a review of 52 articles on sleep in children. There is insufficient evidence to favor one method of sleep intervention over another. There is also insufficient evidence to support a combination of methods as more favorable than one sleep intervention alone.

Unmodified extinction

Lay the infant down to sleep at a designated time and do not respond to any crying until morning

Graduated extinction

Gradually respond less frequently to the infant’s cries (e.g., initially respond within five minutes of crying, then space out the response to every 10 minutes, then longer)

Bedtime routines

Maintain the same sleep and wake schedule daily

Scheduled awakenings before expected awakening time

If the predicted awakening times for the infant are, for example, 1:00 a.m., 4:00 a.m., and 7:00 a.m., awaken the infant 15 minutes earlier than the predicted time; the infant will eventually sleep through the predicted times

Note: Some methods listed may not be feasible for some families; for example, a family that lives in a thin-walled apartment complex may have complaints from neighbors if they attempt to let their infant cry through the night. Parents can try a method that fits with their values, culture, and living arrangement.

Avoid Medications

Trial of Infant Response to Diphenhydramine (TIRED)
The TIRED study showed that diphenhydramine (Benadryl) was no more effective than placebo in reducing nighttime awakenings in infants. Medication should not be used to treat this normal developmental stage. Parents can be reassured that regardless of the method used, there is no difference in family functioning between children who have and do not have sleep issues.

Resources

Childhood Sleep Information from UM Pediatrics

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