How sleep changes during infancy and beyond
As babies emerge from the newborn stage, they may be sleeping for one longer chunk at some point of the night and parents often find they can place their sleeping baby down with relative ease. Unless advised to do so by a medical professional, there is no need to wake a baby for additional night feeds. Parents should be wary of strategies designed to proactively lengthen chunks of sleep in the first six months, however, given that periodic waking is protective against SIDS.
Waking and resettling
At some point, typically in the 3-6 month window, babies shift to sleeping in a more organised and complex way,[1] and parents may find themselves helping their child to resettle back to sleep during the night more frequently than previously. On average, at 6 months old, babies wake between two and three times overnight.[2] Some wake more[3] and some will appear to wake less, although a more accurate description is that when some babies wake in the night, they are naturally more inclined than others to resettle without parental intervention.[4] For a child who does require parental support to settle back to sleep, this is only a problem if it is something a parent wants to change – all children will eventually grow out of requiring this help, even without intervention.[5] If things are working as they are, there is no need to change anything.
‘Sleeping through’
For many families there does come a time when they start to think about whether their child is able to ‘sleep-through’. This typically involves encouraging a child to resettle in a different way to the one(s) they have been used to. From the 1980s onwards, ‘controlled crying’ gained traction, with babies being left alone to cry for varying periods of time, in order that they learn to ‘self-soothe’. Studies have reported that this practice does not cause long-term harm to children,[6] although both the methodology and findings of such studies have been subject to critique in recent years.[7] Concerns tend to focus on increasing knowledge around how early-life experiences impact the developing brain[8] and a purported misunderstanding of the immature brain to self-soothe.[9]
In any event, many parents find it hugely distressing to hear their child cry[10] and alternative approaches have increased in popularity. These strategies typically involve the supportive presence of a caregiver, something that research shows has a buffering effect, helping a child to cope with any stress they may experience.[11] Debate continues to rage regarding how much stress is ‘too much’ for a developing brain, and this is likely to vary from child-to-child depending on a number of biological and environmental factors, such as their age, temperament and life-experience to-date.
Informed choice
At what stage a family chooses to review the habits and practices around their child’s sleep is a matter entirely for them. Many babies at 6 months will still be taking night feeds,[12] which may be beneficial for them and manageable for the parent(s). A toddler may be drinking so much milk at night that it is having an adverse impact on their daytime appetite and dental health. Some families are happy bedsharing with a toddler who helps themself to breastfeeds through the night, whereas another parent may be returning to work feeling unable to function due to sleep deprivation.
Of any sleep scenario, the two questions for parents to ask are:
If the answers to those questions are yes, then it doesn’t matter whether the sleep arrangements would work for someone else. But if the answer to either question is no, families are entitled to make informed decisions as to how they can make changes in a way that feels right for them.
References:
[1] Galland B. C, Taylor B. J, Elder D. E & Herbison P (2012) Normal sleep patterns in infants and children: a systematic review of observational studies, Sleep Medicine Review, 16(3) p. 213-222.
[2] Paavonen E. J, Saarenpää-Heikkilä O, Morales-Munoz I, Virta M, Häkälä N, Pölkki P, Kylliäinen A, Karlsson H, Paunio T, & Karlsson L (2020) Normal sleep development in infants: findings from two large birth cohorts. Sleep Medicine Review, 69 p.145-154.
[3] Hysing M (2014) Trajectories and Predictors of Nocturnal Awakenings and Sleep Duration in Infants, Journal of developmental and behavioral pediatrics, 35 p. 309-316.
[4] Anders T. F (1979) Night-waking in Infants During the First Year of Life, Pediatrics, 63(3) p. 860-864.
[5] Price A. M, Wake M, Ukoumunne O. C & Hiscock H (2012) Five-year follow-up of harms and benefits of behavioral infant sleep intervention: randomized trial. Pediatrics, 130(4) p. 643-651.
[6] Gradisar M, Jackson K, Spurrier N. J, Gibson J, Whitham J, Williams A. S, Dolby R & Kennaway D. J (2016) Behavioral Interventions for Infant Sleep Problems: A Randomized Controlled Trial. Pediatrics. 137(6).
[7] Hookway L (2019) Holistic Sleep Coaching. Texas. Praeclarus Press.
[8] Baram T. Z, Davis E. P, Obenaus A, Sandman C. A, Small S. L, Solodkin A & Stern H (2012) Fragmentation and unpredictability of early-life experience in mental disorders. American Journal of Psychiatry, 169 p. 907–915.
[9] Eisenberg N, Spinrad T. L, & Eggum N. D (2010) Emotion-related self-regulation and its relation to children's maladjustment. Annual Review of Clinical Psychology, 6 p. 495-525.
[10] Hostinar C. E, Sullivan R. M & Gunnar M. R (2014) Psychobiological Mechanisms Underlying the Social Buffering of the Hypothalamic-Pituitary-Adrenocortical Axis: A Review of Animal Models and Human Studies Across Development. Psychological Bulletin, 140 p. 256-282.
[11] Rutter M (2016) Implications of resilience concepts for scientific understanding. Annals of the New York Academy of Science, 1094 p. 1-12.
[12] Brown, A & Harries, V (2015) Infant Sleep and Night Feeding Patterns During Later Infancy: Association with Breastfeeding Frequency, Daytime Complementary Food Intake, and Infant Weight. Breastfeeding Medicine, 10(5) p. 246-252.