Pediatric Sleep Disorders
(Also Called 'Sleep Disorders in Children')
Over the first year of life, your baby will sleep and nap a lot—from 12 up to 18 hours a day. The amount of sleep an infant gets at any one stretch of time is mostly ruled by hunger. Newborns will wake up and want to be fed about every 3-4 hours at first. Do not let your newborn sleep longer than 5 hours at a time in the first 5-6 weeks. Thereafter, you can keep the following general milestones in mind:
- By 4 months, most babies begin to show some preferences for longer sleep at night.
- By 6 months, many babies can go for 5-6 hours or more without the need to feed and will begin to "sleep through the night."
- Daytime naps reduce in number as the baby grows. A 2-month-old may nap up to 4 times a day, whereas an older infant may nap only 1-2 times a day.
Where should our newborn sleep?
Your newborn can sleep in a bassinet or a crib in a parent's or sibling's bedroom, or in the newborn's own bedroom. The American Academy of Pediatrics (AAP) 2005 Task Force on Sudden Infant Death Syndrome (updated 2011) and the U.S. Consumer Product Safety Commission recommend against having your infant sleep with you in your bed due to the risk of suffocation, strangulation, and sudden infant death syndrome (SIDS). The baby may be brought to the parental bed for feeding but should be returned to the crib after this is done. The AAP recommends room-sharing without bed-sharing for infants. Important: your newborn should sleep on his or her back to reduce the risk of SIDS (read more about SIDS in the related article).
Sleep and nighttime awakening during the first 12 months.
During the first 12 months, babies develop quickly, and their sleep patterns change rapidly as well. It is also important to understand that all babies briefly awaken several times (up to 6) a night. Some babies are able to soothe themselves back to sleep after they wake up. Other babies learn to signal their parents for help (ie, rocking, holding, cuddling) to settle them back to sleep if they wake up in the middle of the night. However, it is best to let the newborn comfort himself or herself back to sleep rather than develop a need or association with a parent or guardian.
What are some ways to help my newborn sleep well?
There are a number of ways you can help your baby become a better sleeper. These include:
- Work on shifting your baby's sleep cycle more toward nighttime by 2-3 months of age. Newborns frequently have their days and nights reversed and often the awake/sleep cycle is governed by the need to feed. When there is a need to feed during the night, keep lights dim and reserve stimulating interaction for the daytime hours. Eventually, this will help develop a more consistent sleep/wake schedule. Also, try not to cut back on nap time, as this will result in overtiredness and lack of a good night's sleep.
- Learn to understand signals that your baby is getting tired. Signs of being tired differ among babies but can include things like becoming fussy, crying, tugging on body parts, yawning, and rubbing eyes. Putting your baby to bed when he or she is showing these signs usually allows them to fall asleep more quickly and begins to establish a bedtime routine. Most experts recommend putting your baby to bed while he or she is still awake but drowsy. This way the baby will learn how to go to sleep on his/her own and learn not to associate your presence with sleep onset.
- Establish a bedtime ritual. Your baby can respond well to such near bedtime rituals as bathing, rocking, reading, quiet talking, singing, playing soft music, cuddling, and gentle massage. Even though your baby may not understand these signals yet, setting up these bedtime drills now can help establish a regular bedtime routine that will lead to good sleeping habits in the future. Avoid making bedtime feedings part of the bedtime routine after about 6 months of age. Try to introduce a security object (eg, a stuffed animal or blanket or a knotted T-shirt with your body odor on it) around the age of 1 year. This object, if accepted by the baby, may help the baby soothe itself at night. Make sure the bedroom environment is quiet, cool, dark, and comfortable for sleeping. A nightlight or area light on the very lowest dimmer setting is fine.
- Do not be surprised to see a lot of body movement as your baby sleeps. Your child may sound like he or she is awake, but actually is not. You'll see smiling, sucking, twitching, jerking, and all kinds of motions—these are all normal aspects of sleep. However, if he or she continues to cry for several minutes, it is time to check on him or her. Your baby may be cold, wet, hungry, or even sick and require your care and attention.
When should I seek a doctor's help?
Contact a doctor, if:
- Your baby seems to be extremely fussy/irritable or cannot be soothed – he or she may have a medical problem such as colic or reflux (backward flow of content from the stomach into the food-pipe).
- Your baby appears to have a breathing problem.
- Your baby has a difficult time being awakened from sleep.
- Your baby is uninterested in feeding or persistently shies away from activity.
Guidelines to Prevent Sudden Infant Death Syndrome (SIDS)
- “Back to sleep”: Place your baby on his or her back to sleep at night and during naptime.
- Place your baby on a firm mattress in a safety-approved crib with slats that are no greater than 2 & 3/8 inches apart.
- Do not place your baby on a waterbed, sofa, soft mattress, pillow, or other soft surface to sleep.
- Your baby's head and face must remain free and clear of blankets or any other coverings inside the crib. If a blanket is used, it must be tucked in around the mattress, and must be no higher than chest high against your baby.
- Clutter-free environment: Remove pillows, quilts/comforters, plush toys, and any other objects from the crib—these could interfere with your baby's breathing. Make sure there are no objects with cords or ties or anything with sharp corners or edges.
- Smoke-free environment: Smokers should smoke outside of the home and especially, do not allow smoking in and around the crib area.
- The room temperature for your baby should be the same as it is for an average adult.
- Remove all hanging toys from the crib at about 5 months of age, an age when your baby begins being able to pull himself/herself up in the crib.
- Your baby can be placed on his/her stomach while awake during the daytime (not in the crib) to help develop muscles and eyes and to help prevent flattened areas on the back of the head.
- Consider pacifier use, which has been linked to reduced SIDS rates.
Source: Tips summarized from the American Academy of Pediatrics
Additional Sleep Information and Suggested Readings
- Mindell, JA and Owens, JA. A Clinical Guide to Pediatric Sleep: Diagnosis and Management of Sleep Problems. Philadelphia, PA: Lippincott Williams and Wilkins, 2003.
- www.sleepeducation.com and other educational links on the American Academy of Sleep Medicine website www.aasmnet.org.
- The National Sleep Foundation at www.sleepfoundation.org.
© Copyright 1995-2013 The Cleveland Clinic Foundation. All rights reserved
Can't find the health information you’re looking for?
This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 5/30/2013…#14300