by Kim Brooks
September 15, 2011

Your older baby or toddler resists going to sleep or wakes up during the night and needs help getting back to sleep. Sound familiar? Nighttime awakenings prompted by hunger or thirst are easily satisfied, especially when babies are breastfed. Sometimes all it takes is the soothing sound of a parent’s voice to help a toddler go back to sleep. Although nighttime nursing, rocking, and cuddling are moments parents cherish, bedtime rituals and routines can help ensure that mom, dad, baby, and siblings get the sleep they need.

Sleep matters
Experts agree that sleep is essential for cognitive and physical development. Researchers recently discovered that infants sleep more prior to a growth spurt. There’s much we don’t know about babies’ sleep behavior, but Lampl’s and Johnson’s findings suggest that sleep patterns are related to the timing and control of human growth.

Perhaps it’s not surprising, then, that a baby’s circadian rhythm (the internal clock that regulates sleep and programs the body for periods of wakefulness and rest) usually takes time to adjust to the day and night patterns parents prefer. After all, parents’ rhythms have developed over years, and are no longer influenced by physical growth. In contrast, babies grow rapidly during the first weeks, months, and years.

Setting realistic expectations
Research suggests there’s more to sleep than differentiating day and night, and that not sleeping through the night is biologically normal the first year. Experts such as Dr. James McKenna, anthropology professor, director of the Mother-Baby Behavioral Sleep Laboratory at the University of Notre Dame and author of Sleeping with Your Baby: A Parent’s Guide to Cosleeping, believe that as frustrating as a baby’s awakenings may be for parents, these sleep patterns serve a purpose—safety. Newborns that arouse frequently, says McKenna, are more likely to awaken during a physiological crisis, such as an irregular heartbeat or a lapse in breathing. Waking up during the night may serve to protect babies against sudden infant death syndrome (SIDS).

Babies also awaken more often than adults because they need to feed frequently. A baby’s stomach is about the size of his or her fist. In order to get the calories they need to grow, babies need to feed frequently. This is true whether they’re breastfed or formula-fed. Nighttime feedings provide up to one-third of a baby’s daily intake and ensure that mothers establish and maintain a good milk supply.

According to pediatrician Bill Sears, babies 0–3 months of age typically sleep 14 to 18 hours per day in 1- to 4-hour stretches, waking instinctively for feedings, diaper changes, or to interact with their parents. From 3–6 months, babies will continue to awaken once or twice at night, even though the stretches of awake time during the day will lengthen.

“Babies,” he explains, “still wake up,” for a variety of developmental and health reasons. From 6 to 9 months, such awakenings may be driven by rapid advances in motor skills or cognitive development. After all, who wants to sleep when there is sitting, crawling, or standing to do?

Parents should understand that nighttime awakenings are natural for babies even 1 and 2 years of age. Dr. Jodi Mindell of the Sleep Disorders Center at the Children’s Hospital of Philadelphia and author of Sleeping Through the Night How Infants, Toddlers and Their Parents Can Get a Good Night’s Sleep estimates that as many as 15 to 20 percent of babies wake during the night well into their second year.

Typically, older babies don’t awaken as often at night as newborns. Still, parents need to have realistic expectations about nighttime behavior, so they don’t feel disappointed or frustrated when their babies awaken.

Sleep training
Experts such as Dr. Jodi Mindell and Dr. Richard Ferber, author of Solve Your Child’s Sleep Problems and director of the Center for Pediatric Sleep Disorders at Children’s Hospital Boston, encourage parents to engage in a process known as “sleep training.” They argue that babies who are nursed, fed from a bottle, or rocked to sleep may become too reliant on their parents and may not learn to fall asleep on their own. Some sleep training experts believe that the most beneficial sleep habit a baby can learn is to soothe herself to sleep. Proponents of sleep training insist that if children don’t learn how to fall asleep on their own, they could require the help of a parent to settle back to sleep each time they awaken at night.

Ferber’s method of sleep training (often referred to as “ferbering” or “ferberizing”) is a process of progressive waiting in which parents create a sleep environment for their baby, put him in his crib, then leave him—even if he cries—to fall asleep on his own. Parents are encouraged to check in on their baby and comfort their baby after each preset period of time, but should not pick up, rock, or feed their baby to sleep. Waiting times are determined by such factors as parent comfort with the method, how many days it’s been applied, and how many times the baby has been checked on that night.

Although “sleep training” has been around for decades, it remains controversial. Advocates suggest it leads to better lifelong sleep habits and all of the benefits of good sleep (less stress, better memory, better school performance, lower risk of obesity). Many physicians, psychologists, and parents disagree. There is little or no evidence that sleep training is necessary to achieve the benefits of good sleep; in fact, a National Sleep Foundation survey of adults (a population that would have been largely “sleep trained” during childhood) found that 62 percent reported difficulty in falling or staying asleep.

In addition, because sleep training is often associated with excessive crying, opponents conclude it is harsh and potentially damaging to babies. Some, such as Dr. Sears, argue that it may desensitize parents to their babies’ cries, which are an infant’s only form of communicating danger or signaling their needs. According to those who share Sears’ position, there is no age at which a baby’s nighttime needs should be ignored or compromised; responding to the needs of one’s child, day and night, is simply, parenting.

Nighttime parenting
The very behaviors Dr. Ferber and his peers cite as problematic (nursing, bottle-feeding, or rocking a baby to sleep) are dubbed by Dr. Sears as methods of “parenting to sleep.”

“Babies,” he writes, “need to be parented to sleep, not just put to sleep.” While some babies can be set down when drowsy-awake and drift to sleep, others need parental help. This is simply a natural difference, he argues. It may seem unusual to adults because they can usually enter directly into the state of deep sleep, but infants tend to enter sleep through an initial period of light sleep. Only after about 20 minutes or so, do young infants gradually enter into deep sleep. Rather than trying to train babies, Dr. Sears suggests that parents should learn to recognize their baby’s sleep stages and parent accordingly.

Attachment Parenting International (API) supports Sears’ approach. In order to be able to respond to baby’s needs at night, API suggests parents develop nighttime routines and consider co-sleeping or bed-sharing rather than solitary sleep. API advises parents that nighttime awakenings for nourishment and contact are developmentally appropriate for babies who are not neurologically or developmentally capable of self-soothing.

Even the American Academy of Pediatrics (AAP) agrees that babies should sleep in a crib in their parents’ room for at least the first six months of life to reduce the risk of SIDS and make it easier for parents to respond to their babies’ needs.

Bedtime routines
If there is one thing both sides can agree on, it is the beneficial role of healthy habits in reducing nighttime stress and promoting good sleep. Creating bedtime routines may involve any or all of the following elements:

• Establish a schedule. As much as possible, naptimes and bedtimes should occur at the same time each day. This will encourage the child to feel drowsy and fall asleep more easily. While some parents may be tempted to reduce naptimes or push bedtimes later so that their very tired child accepts bedtime or sleeps longer, this approach generally backfires. Children who nap well tend to sleep better at night; those who sleep well at night tend to nap better during the day. Naps actually improve the quality and duration of nighttime sleep.
• Establish a routine. Bedtime routines (bath, infant massage, tooth brushing, bedtime stories, sleepy-time songs, special phrases, good-night rituals) help signal to your child that it’s time to sleep. The routine should be practical for your family, and doable on a regular basis. On nights the routine must be adjusted, rather than skip steps, shorten them. Each activity is a step along the path leading to sleep. Repeating the steps in the same order each night helps draw your child to the final, predictable step: sleep.
• Create a peaceful space. Wherever you put your child to sleep, wrap up your bedtime routine in that space. This is the space where you share a final bedtime story or song. Consider whether your child would benefit from a nightlight, white noise machine, or soft music—but if you make these part of the sleep environment, know that your child will rely on them. Only incorporate into the sleeping environment those elements you can keep available through the entire night every night.
• Expect awakenings. Disruptions in sleep behavior are inevitable. A baby’s biological needs should be a parent’s top priority, for at least the first six months. Rapid growth requires rapid feeding. After 6 months of age, babies still need comfort, attention, and soothing—day and night. Attending to your baby’s needs at night gives you the opportunity to learn more about your child and gives your child a chance to develop a sense of trust that his needs will be met. Eventually, one of those needs will be a good night’s sleep.

How you help your child to sleep is a personal decision for your family. Eventually, you’ll be able to wish your child a “good night” knowing that’s exactly what it will be.

Click here for info on safe sleep tips, here for details on the benefits of co-sleeping, including tips on how to bedshare safely, and here for baby bedding basics.

Kim Brooks is a Phoenix, Arizona-based writer who loves to cook and create. She recently pressed the pause button on her career in interior design to spend more time with her daughters. She is mom to Natalie and Audrey.