Making sense of the latest sleep advice and research
Here's the latest in sleep research this past year and safety tips to help keep your baby safe at night.
You have a 3 month old and you're feeling sleep deprived. You are falling asleep at your desk in the middle of the morning. Aunt Minnie says let little Noa cry herself to sleep. Your best friend says get Noa her own room so won't hear unimportant brief awakenings, but the American Academy of Pediatrics has recently recommended keeping her crib in your room for at least 6 months for safety. Meanwhile, your college roommate says have the baby sleep in the "family bed." But what do you when you have no alone time with your husband and the AAP tells you that you can be increasing the risk of sudden death syndrome?
First you should know that babies can have different sleep patterns. Three of my four children sleep through the night—doctors define this as five and a half hours of straight sleep between 8 p.m. and 8 a.m.—by eight weeks. My now 34-year-old still does not sleep straight through the night. One of my children would sleep until 10 a.m. or later if allowed, the others were always up by 7 a.m. A combination of studies done in 2011 showed that the average time an infant sleeps is 12.8 hours, but some sleep less than 10 hours and some more than 15 hours each night. Babies up to 2 months old normally wake up four times a night, but by 2 years almost all awaken less than two times and most do not awaken at all.
You are in luck about infant sleep because 2016 was a good year for well controlled studies on how infants sleep. An Australian study showed that "graduated extinction," letting babies cry themselves to sleep, worked if you had a reasonable limit (10 minutes or less) and were able to be consistant about letting the babies cry. My wife and I did this many years ago, it is very effective and very hard to do. Try not picking up a crying baby especially if the child is in the same room.
A study from the Children's Hospital of Philadelphia collected data via a phone app on 841 preschool nightly for 19 months in a row. For the first three months of life, very few children slept through the night and most took naps of three and a half hour several times during a 24 hour period. Between 3 and 7 months, most took shorter naps up to 90 minutes, and slept at night averaging 10.5 hours with wide variation. Interestingly, this study showed that children put to bed earlier in the evening slept for a longer time. This may not be causal, the infants that fall asleep earlier may simply need more sleep.
A Penn State study where families with infants were video recorded showed what happened at night in home with co-sleeping. In this case, the infant was in the same room with parents, and may or may have not been in the same bed versus not co-sleeping in 139 families. Co-sleeping past 6 months was associated with poor sleep for the mother, but not the baby. These mothers did perceive that their babies woke more frequently than children in their own rooms, but they did not. Persistent co-sleeping was strongly associated with heightened family stress and marital discord, but it was not clear which side was causal.
What is the take away from this research and advice?
1. Babies are different, but most do sleep through the night (five and a half to six hours nightly) by 6 months.
2. Co-sleeping in separate beds until 12 months is strongly recommended by AAP, but it is associated with perceived increased awakening and perhaps marital strife.
3. Babies should sleep on their backs without pillows and blankets. Stomach or side sleeping is sounder, but is strongly associated with SIDS.
4. Do not use older cribs, they may not be up to current safety standards.
5. There should be no cords, tie-backs or ribbons anywhere near the crib.
6. Consistency of routine, bedtime stories and holding, rocking or singing is great if they work for you. You can spoil a baby under 6 months!
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