Tag Archives: baby won’t sleep

Normal Baby Sleep – Do we have realistic expectations? (PART 2).

NOTE: This is a collaborative post – for an author listing please see the end of the post.

This is Part 2 of a 2 part post, to see part 1 click HERE.

 

“My child wakes up at 2am and is up for 1-2 hours!”

One of us remembers very clearly the first time her daughter ended up doing this.  At around 14 months, she woke up in the middle of the night and simply wasn’t ready to fall back asleep.  We nursed, we read, but nothing worked.  She insisted upon getting up and going to play, which she did for 2 hours before being ready to get back to sleep.  This continued regularly for a couple months.  And then as quickly as it started, it stopped and hasn’t happened again in over The “why” of this is relatively unknown—although researchers are continuing to explore the physiological underpinnings of sleep—but we do know that extended night wakings like these are experienced by many children until around 3 years of age (Weinraub, Bender, Friedman, Susman, Knoke, Bradley, et al., 2012).

Many times the wakings are brief and the child settles quickly. Other times settling takes longer. In either case, these wakings do not readily suggest your child has a sleep “problem”.  Increased night wakings, call-outs, and crying are common around 6 months of age or so, and again as infants near 2 years of age. These wakings may simply be one (of many) manifestations of separation anxiety experienced by the child—a normal change resulting from infants learning that they exist separately from their caregivers (for a review, see Middlemiss, 2004).Some argue that night wakings in toddlerhood are reflective of sleep problems, but these opinions are based on criteria that do not necessarily reflect the realities of infant sleep.  Several studies found that night waking is relatively common between age 12 and 24 months (Richman, 1981; Goodlin-Jones, Burnham, Gaylor, & Anders 2005; Scher, 2000; Weinraub et al., 2013).

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Thus, a parent’s perceptions about what constitutes a sleep problem may be triggered by either a disconnect between expectations of uninterrupted sleep and a toddler sleep pattern that arguably falls within the range of normal, or by the impact that night waking has on the parent’s quality of sleep and daily functioning (Loutzenhiser,  Ahlquist, & Hoffman 2012).  However, although changes in sleep patterns may be inconvenient and frustrating, they are normal occurrences in the context of a healthy parent-child relationship. When viewed as indicating problematic, rather than normal, sleep patterns that will come and go, oarents can experience greater stress and worry (Middlemiss, 2004). As we have learned from many parents, understanding that these night wakings are normal can go a long way to making them more bearable.

 

 “My child won’t go to sleep before 10 pm.”

It is not uncommon in our society to assume that infants and young children must be tired by 7 pm and asleep shortly thereafter.  In a posted lecture on infant sleep, Dr. Wendy Hall, a researcher at the University of British Columbia, suggested that no child should be put to sleep later than 9 pm.  Unfortunately, that’s just not the reality for many families and it’s not because parents are negligent in getting their infants to bed, but because some children simply have a different circadian rhythm or a later schedule may work for the family.  Some children will continue this pattern into their toddler years and beyond.

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Cross-cultural data on bedtimes for infants and toddlers shows that later bedtimes are actually quite frequent in predominantly Asian countries (Mindell, Sadeh, Wiegand, How, & Goh, 2010).  Whereas the mean bedtime for children in predominantly Caucasian countries was found to be 8:42 pm, it was a full hour later for predominantly Asian countries (with a mean at 9:44 pm), with the latest mean bedtime being 10:17 pm in Hong Kong.  Notably, the rising time was also significantly later in these countries.  A concurrent finding was that the vast majority of children in predominantly Asian countries sleep either in the parent’s bed or room. Thus children who sleep with their parents may naturally have a sleep schedule closer to their parents owing to the sleeping arrangements.

What is important to remember is that a late bedtime in and of itself is not a problem.  If it poses a problem for the family as a whole, then parents may want to adjust the bedtime routine (Mindell, Telofski, Weigand, & Kurtz, 2009) or start the routine earlier in small increments in order to gradually move to an earlier bedtime (Richman, 1981).

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 “My child sleeps less (or more) than the recommended amount no matter what I do!”

Most people have seen the “sleep guidelines” about how much sleep our children need at various stages.  Parents are told that newborns should sleep around 16-18 hours, that at two years of age, children require a total of 13 hours sleep, and so on.  When researchers explore questions of how long infants and children should sleep and what are healthy recommendations, the answers are not particularly clear and are often based on examining how much children are sleepingat different times in history (Matricciani, Olds, Blunden, Rigney, & Williams, 2012).

As parents it is important to remember that they arerecommendations. 

Each child is different and the recommendations may not fit every child.  Some will require much more sleep and some will require less.  If a child is truly sleep deprived, there will be noticeable signs.  Signs of sleep deprivation include rubbing eyes, looking dazed and not focusing on people or toys, becoming overly active late at night, and having a hard time waking up in the morning.  By paying attention to your child and his or her cues and behaviours, you will be able to tell if your child is getting enough sleep, regardless of the exact number of hours your child sleeps.  Sleep is important, but there are many ways to get it apart from one long, uninterrupted stretch.

*Interestingly, researchers are now telling us that waking in the middle of the night is common in adulthood and was viewed as normal in past eras—the “first sleep” lasted about 4 hours with an awake period in between followed by a “second sleep” of another four hours (for more details, see here and the book: At Day’s Close: Night in Times Past by Roger Ekirch (Norton 2005).

 

Co-Authors

Tracy Cassels, University of British Columbia,www.evolutionaryparenting.com

Sarah Ockwell-Smith, babycalming.com

Wendy Middlemiss, University of North Texas

John Hoffman, uncommonjohn.wordpress.com

Kathleen Kendall-Tackett, Texas Tech University,http://www.uppitysciencechick.com/sleep.html

Helen Stevens, Safe Sleep Space

James McKenna, Mother-Baby Behavioral Sleep Laboratory, University of Notre Dame, www.cosleeping.nd.edu

References:

Goodlin-Jones, B. L., Burnham, M. M., Gaylor, E. E., & Anders, T. F. (2001). Night waking, sleep-wake organization, and self-soothing in the first year of life. Journal of developmental and behavioral pediatrics: JDBP22(4), 226.

Loutzenhiser, L., Ahlquist, A., & Hoffman, J. (2011). Infant and maternal factors associated with maternal perceptions of infant sleep problems.Journal of Reproductive and Infant Psychology29(5), 460-471.

Matricciani, L. A., Olds, T. S., Blunden, S., Rigney, G., & Williams, M. T. (2012).  Never enough sleep: a brief history of sleep recommendations for children.  Pediatrics, 129, 548-556.

Middlemiss, W.  (2004). Infant sleep: a review of normative and problematic sleep and interventions.  Early Child Development and Care, 174, 99-122.

Mindell, J. A., Sadeh, A., Wiegand, B., How, T. H., & Goh, D. Y. T. (2010). Cross-cultural differences in infant and toddler sleep.  Sleep Medicine, 11, 274-280.

Normal Baby Sleep – What to Expect (feeding and development) PART 1.

NOTE. This is a collaborative post, for a list of authors please see the end of the post.

 

Infant sleep problems represent some of the most common concerns reported by parents of young children.  Ask any new parent and most will complain about lack of sleep. Many will also be worried that what they are experiencing isn’t “normal” and believe that their child has a problem that needs fixing.  So they search books, ask friends and family or even their doctors about what to do about a child’s problematic sleep patterns.  And to top it off, they feel immense anxiety and worry about them.

Part of the epidemic of parental angst about children’s sleep is that we live in a culture in which parents are repeatedly told that they need to worry about their child’s sleep, that there will be dire consequences if their child doesn’t get enough sleep. Another problem is that most new parents, having had little experience with children prior to having their own, have little awareness about what truly is “normal” when it comes to infant sleep

Simply being made aware of normal sleep patterns can help alleviate the stress and anxiety parents feel, leading to happier times for the entire family.

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So what is normal?

In this series of posts, we’ll tackle some of the more common sleep concerns parents have with the hope that they can see them as normal, developmental stages for their child.

 

“My child wakes every hour, all day and night, to feed”

Whether it’s every hour, or every two hours, or even three, parents are often concerned when their young infant is waking regularly for feedings.  This concern is not surprising given the focus on “sleeping through the night” that our culture pushes. But sleeping through the night is not biologically normal, especially for a breastfeeding baby.

At the time of birth, a baby’s stomach can only hold a teaspoon’s worth of milk, meaning that he or she will need to feed frequently to meet the many demands for energy that accompany this period of growth.   Although the stomach grows relatively quickly, the fat and protein content in human breastmilk is much lower than in the milk of other mammals and thus infants are required to feed often, resulting in greater night wakings (Ball, 2003; Ball, 2009).

Human breastmilk, being designed for infants who need to feed on cue day and night, is easily and quickly digested.  Formula, however, is typically made from the breastmilk of another species – cows – and is higher in fat while also containing myriad additives which make it more difficult, and thus slower, to digest.  This can affect infant sleep, resulting in unnaturally deeper infant sleep (more time spent in stage 3-4) (Butte, Jensen, Moon, Glaze, & Frost Jr., 1992), a stage of sleep from which it is most difficult to arouse to terminate breathing pauses (especially for arousal deficient infants), thereby potentially diminishing the infant’s capacity to maintain sufficient oxygen.  Even so, formula use does not necessarily provide parents with more sleep overall (Doan, Gardiner, Gay, & Lee, 2007).

Infants whose primary source of energy is breastmilk will often wake frequently to nurse, something that is essential for the breastfeeding relationship to continue (Ball, 2009). However, regardless of feeding status, many infants wake regularly during the night (Weinraub, Bender, Friedman, Susman, Knoke, Bradley, et al., 2012).  Waking through the night is normal and biologically adaptive.  In fact, though it is often reported that sleep patterns consolidate in the second year, the pattern differs in breastfed children.

Breastfeeding moms may wake more often, but report greater total sleep.  For example in a study following breastfed children for 2 years, it was found that these children continued to wake frequently throughout the second year of life, a pattern more in line with cultures in which co-sleeping and full-term (aka “extended”)  breastfeeding are more common (Elias, Nicolson, Bora, & Johnston, 1986).

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Night wakings serve to protect the infant.

Night wakings have been reported as being more common in infants who bedshare with a parent, yet the wakings and bedsharing (when done safely) may actually protect the infant from SIDS (Mosko, Richard, & McKenna, 1997; Mosko, Richard, McKenna, & Drummond, 1996).  The critical period for SIDS is up to 8 months of age (with the peak at 2-3 months) and night wakings may serve as a protective mechanism.  In fact, if we look at parenting historically and cross-culturally, frequent night-wakings coupled with co-sleeping and breastfeeding are the norm for which we should be comparing other infant sleep behaviours.

 

“My child was sleeping through the night and suddenly it’s stopped.”

Imagine you’ve been waking regularly with night feeds and arousals, but as time passes they are decreasing.  Then you realize you’re now sleeping in nice, long chunks.  Hours of sleep all at once!  And it’s wonderful.  Then suddenly, as quickly as it came, it’s gone.  Your wonderful, sleeping-through-the-night child is suddenly waking again.  This experience, which is a reality for many, can cause frustration and despair accompanied by the feeling that you’ve done something wrong, or that you must do something get their uninterrupted sleep back again.

But here’s the thing: You didn’t do anything.  A return to night waking after periods of sleeping through the night is entirely normal.  Many children’s sleep will cycle like this for a while.  In fact, researchers looking at sleep patterns have found that often between 6 and 12 months, infants who had previously been sleeping long stretches suddenly start to wake more frequently at night (Scher, 1991; Scher, 2001).  In fact, in one long-term study looking at child sleep between 3 and 42 months found that there was no stability in night wakings or even sleep duration during this time (Scher, Epstein, & Tirosh, 2004).

What causes the change in sleeping pattern?

There are likely a variety of reasons, unique to each child.  For some, it may be a growth spurt or teething.  For others, it may be a cognitive leap that has them buzzing more so than usual or the appearance of separation anxiety.  Just recently a study reported that babies tend to wake more often when they are learning to crawl.   And for some, we may never know the actual reason.  But as children age and each develops a circadian rhythm, they will go through cycles of sleep – some more convenient for parents than others.  Parents need to be aware that these changes are entirely normal, even though they can be frustrating. Hopefully once you know that changes are to be expected, you can be better prepared or at least not add anxiety to the sleep disruptions you are forced to deal with once again.

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For Part 2 of this post please CLICK HERE.

Co-Authors

Tracy Cassels, University of British Columbia,www.evolutionaryparenting.com

Sarah Ockwell-Smith, babycalming.com

Wendy Middlemiss, University of North Texas

John Hoffman, uncommonjohn.wordpress.com

Kathleen Kendall-Tackett, Texas Tech University,http://www.uppitysciencechick.com/sleep.html

Helen Stevens, Safe Sleep Space

James McKenna, Mother-Baby Behavioral Sleep Laboratory, University of Notre Dame, www.cosleeping.nd.edu

References

Ball, H. L. (2003).  Breastfeeding, bed-sharing, and infant sleep.  Birth, 30, 181-188.

Ball, H. L. (2009).  Bed-sharing and co-sleeping: research overview.  NCT New Digest, 48, 22-27.

Ball, H.L, & Volpe, L.W. (2013).  Sudden Infant Death Syndrome (SIDS) risk reduction and infant sleep location –Moving the discussion forward. Social Science & Medicine 79, 84-91

Butte, N. F., Jensen, C. L., Moon, J. K., Glaze, D. G., & Frost Jr., J. D. (1992).  Sleep organization and energy expenditure of breast-fed and formula-fed infants.  Pediatric Research, 32, 514-519.