Newborns and Sleep – The First Six Weeks
We spent a lot of time thinking about this blog because we have SO MUCH to say about
newborns and sleep, the first being CONGRATULATIONS! We also don’t want to overwhelm you information-overloaded, exhausted, possibly uncertain new parents either. If you remember nothing else about this blog in your sleep-deprived haze, remember these two things:
Read a variety of information and be skeptical of too-good-to-be-true promises and one size fits all approaches.
There are a lot of terrible (yet popular!) sleep books on the market. It’s a good idea to read information from more than one source. If a book is based almost solely in author opinion or experience (no matter how many MDs are singing its praises in a prologue) take that into consideration AND be skeptical of any book that seems overly restrictive or that offers a one-size-fits-all approach for a newborn!
Try not to stress too much about “bad habits”, “magic windows of wakefulness”, or beating yourself up for making the “wrong” decisions. Yes, sleep is important – for health and immune function, for mental and emotional wellbeing, for learning and attention spans, and even for romantic relationships and marriage – but as long as your baby is getting sleep, and you are making sleep safety decisions from an informed point of view (read AAP guidelines here) it’s all good! Okay? We promise! It’s all good! Even if you aren’t getting good sleep right now for any number of reasons (reflux, allergies, illness, breastfeeding issues, anxiety, etc), sleep deprivation can be reversed and you have lots of time to solve any problems. So, BREATHE!
As long as you are loving and bonding with your new little baby, nursing or feeding frequently, and keeping him or her as rested as you can (safely), there are few “rights” and “wrongs” when it comes to sleep. Sure, sure we’ll talk about the science of newborn sleep, reasonable expectations, things to watch for, developing a great foundation for good sleep, things to try, and patterns to try to avoid BUT, the bottom line is – your baby needs sleep! So if the crib or bassinet isn’t working at the moment, strap on the soft carrier, soothe with some recreational nursing or sucking, start bouncing on the yoga ball (or do all three!) and spend a few minutes reading this blog out loud to your newborn – it just might put him or her to sleep!
NOTE: These additional important newborn sleep topics are NOT discussed in this blog, but we highly recommend you read about them in our other blogs here: important sleep basics for all parents, swaddling, pacifiers, age by stage expectations, and night feeding expectations.
Newborns sleep – a lot!
Up to 18-20 hours a day in those first couple of weeks. By the end of the first four months those numbers decrease down to 13.5 -15 hours in 24 hours. For some babies that sleep comes much easier than others and things may not go as smoothly as you expected. We hope this blog will provide you with some useful tools to help improve your new baby’s sleep and provide you with some comfort and reassurance that you are already doing a great thing just by reading this!
First things, first: Adjust for prematurity
Your baby’s sleep typically matures week by week based on your estimated due date. If your baby was born before due date, you’ll want to be sure to adjust for that. For example, if your baby was born 2 weeks before due date, when your baby is 7 weeks old, she is considered only 5 weeks old in terms of sleep development. If your baby was born post due date (ex: two weeks past due date) it’s possible she’ll be a little precocious in her sleep development, but in a situation like that we suggest calculating sleep age from BIRTH date. In other words, when it comes to due dates and birth dates – use the date that came later to figure out your baby’s sleep age.
When your baby reaches approximately 6 months (adjusted) you can stop adjusting.
Allow other caregivers to soothe your baby and offer a variety of soothing if possible.
Newborns: THE FIRST WEEK
As with most things brand new, this is most definitely the honeymoon in many cases, especially if it’s your first baby. Hopefully you have a close family member or friend helping you and if you are choosing to breastfeed be sure to start early and often in those first hours after delivery to promote adequate milk production. In between feedings try to sleep, allow your body to heal from delivery, and bond with your baby.
Although not what all families choose, The American Academy of Pediatricians recommends sharing a room with your newborn baby in the form of a separate crib or approved bassinet close to the parent’s bed, without pillows or blankets (a snug swaddle is a good idea), and placing your baby on his or her back for sleep. Avoid over bundling and overheating your newborn and never fall asleep while propped up in a chair or couch holding your baby.
Newborns: Weeks 0-6: Overview
Manage Your Expectations: When your baby is born, his or her sleep is immature and constant. A healthy newborn (free of colic, reflux or other medical concerns) will sleep until one of three things happen 1) hunger, 2) another need (wet/dirty diaper/discomfort), 3) sleep is no longer needed. This pattern is difficult at first, but for most families sleep unfolds as you expect it to – your baby begins life with fragmented sleep and frequent feedings. Parents whose babies are sleeping for long 4-6+ hour stretches at night at this age are simply… lucky! Sleep cycles aren’t mature at this point and there is no biologically driven schedule. Despite what you’ll read, there is no magic bullet, no secret sleep training method, or promise filled book that will teach your baby to master this skill at such a tiny age. Some babies do and some babies don’t.
Avoiding Over-tiredness: What you do want to do is start to watch your baby and see if you can detect any signs he or she is becoming tired before he starts to get fussy from being awake too long. This may simply appear as some quiet, mellow moments, nestling or snuggling, or yawning. Some parents find it very difficult to notice sleepy signs in their baby finding their baby goes from happy to overtired and crying very quickly. This is all perfectly normal.
Learn To Soothe: Try to figure out what soothes and calms your baby now and soothe your baby before he or she fusses from overtiredness. This may include, “shhh”ing, walking, rocking, sucking, bouncing on an exercise ball, riding in a stroller, gently rocking the carseat, swinging, baby wearing, nursing, or massage. Some extra fussy babies may need a combination of soothing factors with pretty high intensity and more mellow babies may simply be content with a gentle rock in a swing or vibrate in an infant seat. If possible, allow other caregivers to practice soothing your baby and try offering a variety of soothing techniques if you can. If, after some soothing, you are able to place your baby on his or her back on a flat surface such as a crib or bassinet it’s an awesome time to start getting your baby used to that experience.
Weeks 0-6: DAY SLEEP: Many parents wonder how long their newborn should stay awake between daytime sleep episodes. Keep in mind that capacity to stay awake does not equal recommended time to stay awake. Because homeostatic or sleep pressure (a measure of your child’s sleepiness) is the driving force behind your child’s need to sleep, there will be no predictable schedule for sleep! Your baby simply needs to sleep as often as he appears tired. For newborns this will be approximately every 45 – 120 minutes – just enough time for some smiles and cuddles, a diaper change (or three) and a feeding and burp! The order in which you eat/sleep/play is insignificant. There is no right or wrong order to feed your baby and it will be hard to notice a pattern at this age anyway. The LENGTH of your baby’s naps will determine in some ways how long he can subsequently stay awake. A newborn who takes a nice long nap may tolerate staying awake for 75-90 minutes, where the same baby who took a short 20 minute snooze may only stay awake for 45 minutes. Irregularity is normal! We always like to reassure parents at this age that sleep tends to deteriorate as the day goes on. You may have some success with a long nap or two in the early or late morning but find by the early evening – especially if you are trying to fix dinner for an older toddler – things are going downhill fast! Please don’t be afraid to soothe your baby by wearing in a soft carrier, using a swing, vibrating chair, bouncing on an exercise ball, etc. This is NOT a parenting failure, though many popular sleep books would have you believe it is.
Your baby may have periods of sleep during the day OR night that last up to 4 hours during the first 6 weeks, and then the very next day do something entirely different. That is normal for now. The most important rule of day sleep at this young age is to allow your baby to sleep as often as she needs to and keep her stretches of awake time brief. It will probably be helpful if you learn to watch for your baby’s signs of tiredness. If your baby is yawning or seems sleepy, she may need shorter awake intervals between naps, so offer sleep more frequently. Offering sleep just means that you want to provide an environment that is conducive to getting your baby to sleep. This may be by moving to a quieter room, closing shades, turning on a white noise machine, swaddling, rocking, bouncing, swinging, riding in a stroller or soft carrier or sucking. Try not to be watching for schedules or patterns just yet – focus on keeping your baby rested.
What about fussiness? Expect daytime – especially evening – fussiness to increase and peak around 6 weeks from due date. That’s right. Expect your baby to become more and more fussy and harder to soothe, especially in the evening, as you move closer to six weeks from due date. This is what many parents mistakenly refer to as “colic” when in fact it’s just normal newborn behavior. This is not an easy time, but from a biological standpoint it’s a great sign of normal development. It means the circadian rhythm is starting to align with the day and will begin to organize predictable sleep in the first third of the night! Your baby has internal signals at the end of the day keeping him awake, yet his sleep pressure (sleepiness) is high. This is a new experience for him and can cause an increase in fussiness. He will get used to it, but there are a few rough nights or weeks during the adjustment period. The great news is, once this fussy time starts (also usually around the time you start to see social smiling occur) it is a sign that your baby is ready to start having a more regular bedtime and longer stretch of sleep in the first part of the night!
Of course, the first six weeks are also the time when common newborn medical problems such as reflux and allergies or sensitivities and common feeding concerns like over production, rapid letdown, nipple pain or poor latch are appearing too! If you see any symptoms of these common medical or breastfeeding issues such as gobs of mucus or tiny blood streaks in your newborn’s stool (don’t get upset, it’s probably a food sensitivity!), pain with spit up, trouble nursing, inadequate wet or poopy diapers, or not gaining weight please be sure to follow closely with your pediatrician and lactation consultant. Almost all of these common problems can be solved or at least remedied enough to allow for good sleep with a little investigation and sometimes efforts on the part of parents. Our blog on Illness and Reflux may provide some helpful information, though is written for mostly for babies with more mature sleep patterns (approx 3 months and older).
Earliest Work on Independence: If you’ve done any amount of reading about sleep and newborns you are probably familiar with the practice of putting your baby down “sleepy but awake” or “drowsy but awake”. We prefer the term “Awake and Aware” which is a better description of the goal of this practice. Although we chose to introduce it here in the first six weeks, this technique can be practiced any time in the first few months!
Teaching your baby to fall asleep on his own might be low on your priority list and can feel difficult and time consuming. It’s a task some families won’t even think about for many months if at all! If this is more your speed, you will probably rock, hold, nurse, and otherwise assist your baby to sleep for naps and nighttime. As long as it’s working, and your baby is getting enough sleep – we support you! Other families are anxious for their babies to learn how to fall asleep independently as soon as possible and we support that too – IF done with reasonable expectations and using age appropriate techniques. If you are eager to get started teaching your baby how to fall asleep on his or her own, plan to use the first four months to practice putting your baby down awake as much as possible. This means helping your baby reach a point where he is calm, relaxed and ready for sleep by using a soothing technique such as bouncing, rocking, or sucking, but placing him into his place of sleep while he’s still awake and aware he is leaving your arms. By “aware”, we mean your baby knows he’s leaving your arms and going into a new location. It takes a healthy sleeper 5-20 minutes to fall asleep. So, in most cases, if your baby falls asleep in less than 5 minutes of being put down into a crib or bassinet, you rocked your baby into light sleep (ie: you put your baby down asleep.) The first state of sleep can appear like wakefulness so this can be tricky, especially at bedtime! If your baby fusses when you put him down, it’s ok, just pick him right back up and soothe and settle him, before trying again. Keep offering this experience to your baby when you feel up for it and sometimes you may find your baby is able to fall asleep on his own.
Weeks 0-6 Night Sleep
Newborn nights are notorious for being erratic at first and you never know what might be coming. Two feedings, three? Six? A diaper change or two, or maybe a diaper explosion? Pacing, bouncing, rocking. For a newborn, “bedtime” simply means the time you can get your baby to go down for a long, late, “nap” and for most babies this bedtime is very late – probably as late as 10 or 11pm, maybe midnight!
If your baby seems to be sleeping for long stretches in the late afternoon and evening and then wants to be awake for long stretches (sometimes up to 1-2am) in the middle of the night he might have a little Day/Night confusion. This behavior is common and very frustrating to exhausted parents who just want to sleep! If your newborn has his days and nights a bit reversed try the following steps:
Limit the length of her afternoon/evening naps if they are very long. Yes, this means wake a sleeping baby! This is one of the few times in the life of a newborn when we would ever recommend doing this! When you wake your baby from a long, late nap you want to be sure to put her back down for another nap OR for her night sleep within your typical awake time of no more than two hours. Be very wary of people (including medical professionals!) who encourage you to force your baby to stay awake for long periods in the late afternoon or evening to “make your baby sleep better at night”. A recent study has shown this to actually be dangerous to your baby. Instead of improving sleep, this practice of extended awake periods actually raises your baby’s threshhold for self-arousal. In otherwords, if your baby needed to wake herself in the night as a safety mechanism or SIDS prevention, it would now be harder for your baby to do it. So, when trying to solve day/night confusion you may limit long naps in the evening by waking your baby, but continue to stick to a short wakeful interval between naps.
Begin to handle night wakings consistently– Turn on your “night parent” behavior at night from the very beginning! This is a very important psychological cue that your baby will recognize more and more as she gets older. At night, be sure to stay very calm and loving with your baby but quite neutral and quiet. This does not mean you need to give your baby the silent treatment by any stretch, but just coming up with a simply whispered murmur like “shhhhh, night time, Mama’s here” should suffice for your verbal interactions with your baby. It’s okay to have eye contact with your baby in the night, but avoid playful singing, playing, turning on music or TV, showing your baby toys, etc. Keep your nighttime interactions as brief as possible, change diapers only when absolutely necessary, and as long as he or she isn’t crying, put your baby back into her crib or bassinet as soon as you can after nursing, feeding or burping.
An additional word about nighttime diapering. As your baby moves to the six week mark and beyond she will start to have fewer BM diapers overnight. When this happens there is no need to change your baby’s diapers for every little wet! Unless your baby suffers from diaper rash, a good absorbant diaper or reusable insert and a generous layer of diaper cream should get you through much of the night! That said, please DO change your baby’s diaper for a BM or if the diaper is going to leak imminently. Stimulating as a diaper change can be in the middle of the night, changing your baby head to toe for a leak can be even more so!
3. Avoid caffeine if nursing: Caffeine does cross the breast milk and while it’s widely considered safe to drink a small amount each day while nursing it is a stimulant and can have such an effect on your new baby. Babies have different tolerances to caffeine (as do adults!) so if you feel like you’ve been doing everything “right” and you’re still having wakeful spells in the night, take stock of your caffeine and chocolate intake. Also consider your pumped milk if you are giving breast milk bottles. If you pump in the morning after a cup of coffee or in the afternoon after a nice chocolate treat, label that milk as “day” milk so your baby doesn’t get that boost of caffeine in the middle of the night!
Night Sleep Expectations: Other than beginning to remedy day night confusion you’ll want to plan to provide your baby feedings, love and attention “on demand” overnight. If your baby is fussing or seems uncomfortable you’ll want to do whatever you can to make her happy again which may include a feeding, adjusting a swaddle, using a pacifier, rocking, or other soothing. Expect 2-4 night wakings for various reasons, some being harder than others to get your baby resettled. Do your best with calm, quiet interactions, a nice snug swaddle, brief diapering only when essential but expect the unexpected and for a lot of interrupted sleep. If your baby seems exceptionally distressed or gassy in the night check with your child’s pediatrician to rule out any medical causes for the sleep disruption.
Who knew there was so much to say about the first six weeks alone! More information on Newborns weeks 6-16 coming soon including the developing circadian rhythm, bedtime drifting earlier, starting a bedtime routine, and 2nd and 3rd month expectations.