Infant Sleeping

Dear Lisa,

My baby is 2 1/2 months old and I was wondering at what age should she be able to just sleep or nap on her own without being rocked?

“Mother of 1”

Dear ”Mother of 1”,

Before a parent considers putting an infant to sleep it is prudent to make sure that she is fed, burped and changed. Hunger, a wet diaper or a gas bubble can irritate a child so much that it doesn’t matter what measures you take, the child will never settle down and fall asleep on their own. This is quite a difficult task because infants require frequent feeding, burping and changing. Breastfed infants need to eat every 2 to 3 hours and are expected to wake at night at these intervals for feeding. Bottle fed infants typically eat every 3 to 4 hours and also wake up at these intervals for a feeding. By the time an infant is 3 months old, most infants will sleep for 4 to 6 hours at night in between feedings.(1)

In addition to these basic measures, a level of maturity is required for an infant to be able to sleep at night. The development of consolidated sleep where the infant sleeps for a longer period of time with fewer awakenings depends on central nervous system maturation.(2) On average it is not expected for a child to be able to sleep through the night until they are about 6 months old. (2). When the phrase “sleep through the night” is used it refers to sleeping after 8 p.m. without waking except for feedings.

Nighttime awakenings once again are expected to emerge between 6 to 12 months of age. At this age infants wake because of teething pain or due to individual child temperaments.(2) Sleeping in the same room as a parent at this age also has been related to night time wakening.(2) By the time a child is between 18 to 36 months she is expected to sleep from 7 ½ to 10 hours per night and receive the rest of the sleep needed during daytime napping. It is not realistic to expect a child younger than this to sleep for long intervals at night.

It is important for parents to understand the expected sleep patterns of infants so that they can be reassured that their baby is normal when it does not sleep through the night. Understanding an infant’s sleep pattern can also prevent the parents from becoming frustrated due to different expectations.

Once an infant’s normal sleep pattern is understood, measures can be taken to ensure that an infant goes to sleep in between feedings as opposed to staying awake all night. Some of these measures are based on the development of an infant’s circadian rhythm. The circadian rhythm is what dictates the body’s sleep wake cycle. This circadian rhythm is not developed in an infant until they are 3 to 6 months old.

The circadian rhythm or sleep cycle determines when a baby sleeps and when it is awake. It is mainly influenced by the timing and intensity of light. (3) The measures that parents can take to help change a child’s circadian rhythm is the use of light. Light has the greatest effect on a person’s circadian rhythm. Therefore parents should put all of the lights on and pull up all of the shades in the home starting early in the morning. When the infant sleeps during the daytime, she should not be put in a dark room with the shades pulled down. Instead she should nap in a common area such as the living room with the lights on.

At night, the opposite should occur. Starting at 9 or 10 p.m. at night all of the lights in the house or child’s bedroom should be turned off and all of the shades should be drawn. You can use a night light for diapering and feeding. Parents should engage in as little activity as possible. Exposing the infant to these two opposite environments on a daily basis the child will learn that night time is for sleeping and daytime is for activity and playing. By following this procedure, at three months old an infant should develop its circadian rhythm, begin to sleep more at night and have an established daytime nap schedule. (3)

The next important step in teaching an infant to go to sleep at night is to develop a sleep routine that is reasonable for both the parents and the child. Elaborate sleep routines that require a lot of time can physically drain a parent and lead to exhaustion. As time goes on, parents will not physically be able to continue this level of attention in order to get their child to go to sleep.

Physical exhaustion can lead to parental stress which ultimately can have a negative effect on the infant’s sleep pattern. Research has shown that infant sleep problems are associated with parental stress and depression. In addition, it has been shown that infants whose mothers reported lower level of stress slept longer at night.(2)

Sleep routines that promote self soothing behaviors and minimal parental intervention are more realistic and healthy for both parent and child. Elaborate routines involving prolonged periods of holding and rocking a child develop into a learned behavior that an infant expects each and every time he or she needs to go to sleep. Therefore, it is best to put a child in the bassinet or crib when they are still partially awake so that they can learn to settle themselves down and fall asleep on their own. If an infant learns to settle themselves early in infancy, they will not require prolonged periods of attention in order to fall asleep when they are older.(4)

In regards to your question about the age your daughter should be expected to sleep on her own without being rocked; this is a good question. A child can be put down without rocking, starting from birth. Once a child as been rocked to sleep, there is not an age that she will automaticaly not need to be rocked anymore. Unfortunately, the bedtime routines that babies learn early in infancy in order to settle down and fall asleep cannot easily be changed. Since your baby has been rocked to sleep for the first 2 ½ months of her life, this is the sleep behavior that she has learned to become accustomed to. Now that a pattern has been established, it will be difficult to break.

The best way for your child to learn to go to sleep on her own is to put her to sleep partially awake. This way she will learn self soothing behavior that will settle her and help her fall asleep without the need to be rocked. Since she is used to being rocked, this approach most likely will not be well received.

There are some measures that you can take to help the transition to the new routine. First, start by limiting the rocking time and instead put her down, pat her and talk to her with a soothing voice.(2) Replicating the in utero environment is an approach that also can be utilized.

The fetal position and the warmth experienced in the womb can be duplicated with the use of swaddling. Swaddling during early infancy is said to promote restful sleep in the “back to sleep position”, is easily accepted by most babies, reduces the frequency and intensity of brainstem arousals during deep nocturnal sleep and diminishes frequency, intensity and duration of crying episodes.(5)

Swaddling can be done with a common commercially available 42 inch by 42 inch cotton flannelette infant receiving blanket.(5) The technique is usually taught to parents in the newborn nursery. You can get instructions on how to swaddle your baby correctly from the staff in your child’s Doctor’s office or from a Pediatric Nurse. There are also some swaddling blankets that are available that have Velcro and flaps that perform the same task. These blankets include; Swaddle Me by Kiddopotamus and Company, the Miracle Blanket, Loving Baby Swaddle Blanket, the Cuddle Bug Cloverleaf Swaddling Blankets and the Slumber Bug Swaddling Blanket. The choice of a swaddling blanket or technique is a personal opinion that varies from parent to parent.

The problem with swaddling is, once a child reaches 3 to 4 months old, their size and movement usually precludes them from staying in a swaddled position. Typically the arms and legs of an infant this age pop out of the blanket and the infant does not maintain a swaddled position. In cases where a child is too large or breaks out of the blanket, a helpful technique is to leave one or both arms free outside of the blanket.(5) I swaddled my own daughter this way once she became too large to stay in a traditional swaddle.

When swaddling an infant it is important to make sure that the child does not overheat. The ambient temperature in the infant’s room should not be too high because this can present a danger to the child. Overheating can occur if an infant is tightly swaddled in several layers of clothes and blankets and the temperature of the room is warm.(5)


Another self soothing method that can be utilized in helping an infant go to sleep is the use of music. Tapes or CD’s of a heart beat or rushing, swishing water can also replicate the comfortable, familiar in utero environment. Many of these CD’s play a soothing lullaby with the sound of a beating heart in the background. Other tapes have humming or swishing sounds that replicate the sounds of the mother’s circulatory system. These familiar sounds can be very soothing to an infant.

I have seen these tapes work first hand on infants that I took care of in the hospital after they had surgery. The infants who listened to these tapes settled down and fell asleep easily, some of them did not even require pain medication. The music alone was all that they needed to feel comfortable and fall asleep.

Getting an infant to fall asleep requires a lot of mental strength, patience and persistence. The task can become very tiresome. It is a good idea to recruit the help of family members or friends in order to accomplish the task. It also helps to take naps during the day when your baby naps so that you can regain the strength that you need to take care of your baby. If your infant continues to resist sleeping without being rocked I suggest discussing the topic with your Doctor or Nurse Practitioner who can give you further guidance.


If you are interested in reading additional Pediatric Advice stories about sleep issues:

Infant Sleeping

Sleeping Through the Night

Infant Pillow and Blanket Use

Crying at Night

Problem Waking in the Morning

References:
(1)Chow M, Durand B, Feldman M, Mills M. Handbook of Pediatric Primary Care. Albany, New York:Delmar Publishers Inc. 1984:341-342.
(2)Betz C, Hunsberger M, Wright S. Family-Centered Nursing Care of Children. 2nd ed. Philadelphia, PA:W.B.Saunders Company. 1994:171-176.
(3)Rosen G. General Overview of Neuroanatomy and Neurophysiology of Sleep. Presented at: Pediatric Sleep Disorders Conference;May 31, 2002:Edison.
(4)Rosen G.Conditioned Insomnia inChildren. Presented at: Pediatric Sleep Disorders Conference; May 31, 2002:Edison.
(5) Schwartz R, Guthrie K. Musings on infant swaddling. Infectious Diseases in Children. 2006. June:14.

Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

Pediatric Advice About Infant Care