Realistic expectations for infant and toddler sleep
Image Credit: Vida Images
Many parents find infant and toddler sleep challenging and it’s common to wonder whether they need to do more to support healthy sleeping patterns.
Unfortunately, most sleep advice is provided by people without qualifications in normal infant sleep and behaviour. Therefore, while well-intentioned, this advice may not reflect current scientific evidence, or consider how brain development influences sleep, leading to unrealistic expectations.
When a child does not meet these expectations, it is easy to believe they have a sleep problem which can cause unnecessary family stress. Understanding normal infant sleep can reduce stress and overwhelm, and support close, loving relationships.
What is normal baby sleep?
A ‘one-size-fits-all’ approach is rarely helpful with sleep in the 0–3-year age group, partly because of the wide variation in normal sleep patterns. While infants and toddlers need more total sleep than older children and adults, this sleep is not consolidated and is spread across 24 hours. It is normal for babies and toddlers to take daytime naps, wake in the night, and need support to fall back to sleep at night.
Napping patterns also vary: some babies take regular catnaps of 20-30 minutes, while others nap for longer periods. Toddlers may nap into the preschool years or drop all naps much earlier. Night waking gradually reduces with age, and sleep consolidation may start sometime in the first year, though many children continue to have fragmented sleep until age 3 and beyond. [1] This normal fragmented sleep does not cause sleep deprivation in the same way that it does for older children and adults.
Benefits of waking up
Protects against SUDI (including SIDS)
Frequent arousal has been proposed to have a protective effect against sudden unexpected death in infancy (infants: 0-12 months).[2]
Promotes regular feeding
While frequent waking can be exhausting, it promotes regular feeding which is important to establish milk supply if you are breastfeeding and optimises growth and development. Babies have small stomach capacities and both breast and formula milk are rapidly digested, which means that your baby will wake for feeds in the night, though how frequently they feed depends on their unique needs. [3]
Myths about feeding and sleep
Unfortunately, while night feeds are normal in children up to the age of 18 months and beyond, there are many myths [4] which can cause parental anxiety, including:
Babies over a certain age or weight don’t need night feeds
Babies only need 1-2 feeds a night
Babies should sleep through the night by three to six months
Babies should have scheduled feeds
Babies need long naps in the dark
Babies all need to go to sleep at 6 or 7pm
Infant brains won’t develop if they have broken sleep.
None of these are based in fact.
How to soothe your baby
One common parental issue when children wake up is getting them back to sleep. It may be helpful to remember it is normal for children to need help falling back to sleep, though at times it may be frustrating or tiring. Children gradually require less sleep support as they mature, but this process takes a variable amount of time. Until your child is ready to fall asleep independently, active soothing strategies can help. Babies prefer to be close to their family at night - especially their birth mother or primary caregiver, as their smell, taste and heartbeat are familiar.
Feeding to sleep
Many babies fall asleep feeding, partly due to hormones such as the gut hormone cholecystokinin (CCK). This is released during suckling at the breast or bottle. CCK helps your baby feel full and sleepy. CCK triggers oxytocin (known as the ‘love hormone’).[5] Oxytocin is also released during skin-to-skin contact and during feeding. Meanwhile, brain derived neurotrophic factor released during feeding induces deep sleep. The bottom line is that feeding and holding leads to sleep.
Rocking and bouncing
Many babies like to be rocked or gently bounced to sleep. Research shows that rocking can reduce crying, help babies get to sleep quicker and improve their overall sleep quality. [6] It’s thought that rocking or bouncing has a synchronising effect on the brain that triggers natural sleep rhythms. [7] Most babies need either holding, rocking, feeding, or bouncing to fall asleep - these are not “bad habits!”
Carrying
Carrying your baby in arms helps them to regulate their stress and take in the world while feeling calm, safe, and secure in your care.[8]
Slings and carriers may help meet your child’s carrying needs
While not all children like them, using a sling or carrier may help soothe your baby or toddler. Gentle movement and being close to people they trust can help babies feel safe and calm. Children who are carried this way often stop wriggling and crying, and experience physiological calmness and stability.[9] Note, that if you use a sling or carrier, be sure to follow the TICKS safety principles.
The power of touch
Baby massage may help your baby feel calm and sleep soundly. Research has shown that babies who were massaged had a better quality of sleep than those who didn’t.[10] Similarly, snuggling, shushing and patting your baby may also calm them.
Bathing
Giving your baby a bath may help them sleep better. Not only does water mimic the in-utero environment helping your baby feel calm and relaxed, but research shows that a warm bath can help children sleep better. [11]
Tips for better baby sleep
While it’s normal for babies and toddlers to wake through the night, the following can help improve your infant’s sleep.
Keep your baby in your room until at least 6 months old or ideally 12 months. Room-sharing has been shown to be protective, as it is associated with a reduced risk of SUDI.[12] [13] [14]
Set up for safer bedsharing in case you need it. This can include using a sidecar cot, a cot by your bed or a floor bed. This can also mean creating a clear space around a baby if they are sharing the same bed or sleep surface. Although some government authorities advise against ever bedsharing, others recognise that most parents will bedshare at some stage, whether they intend to or not, [15]and knowing how to do this more safely is key. [16][17]
Understand and accept that your child is likely to wake frequently and need physical contact throughout the night for a while, as this is normal.[18]
Avoid clock-watching with night wakes – this just causes anxiety and greater feelings of tiredness.
Use a sling or carrier appropriate to your infant’s development to help your infant sleep or nap during the day. (Remember the TICKS principles of sling safety)
Limit screen time and avoid it before bedtime, as this can make it hard for you to sleep.
Ensure you and your child are exposed to sunlight during the day as this helps regulate the circadian rhythm (sleep/wake cycle).
Develop a bedtime routine that will help your child relax and prepare for sleep.
Use dim lighting for night-time care to minimise interference with the circadian rhythm.
Ensure your child’s sleepwear, bedding and room are not too hot or too cold.
Teamwork makes the dream work
There’s no doubt having a baby or toddler in the house can disrupt everyone’s sleep. However, this phase won’t last forever. Instead of wishing the time away, or counting how many hours you’re not sleeping, try to have a positive outlook. Remember that day or night, this is an important opportunity to bond with your child and night-time nurturing and feeding promotes brain growth.
Realistic expectations of what can be achieved with a young child in the house are important. A lot of time will be taken up with the essentials of feeding, caring for them and supporting their sleep. That’s why it’s important to work as a team and ask for support when you need it. This may include:
asking key people in your life who want to help (i.e., partner, family friends) to take on more responsibility so you can sleep when you can
asking extended family to help with household chores, shopping, meals and looking after older children
asking friends to take older children to day-care or school, or to have them over for a play date
outsourcing tasks (e.g., online grocery shopping, hiring a cleaner, ordering pre-prepared meals, etc.)
Be guided by your child
While there are recommendations for optimal sleep for infants and children, there is a huge variation on how much sleep an infant needs which is why this advice is intended as a guide only.[19] [20]. All infants have different temperaments and will have their own sleep needs. Once you rule out health issues, optimise sleep environments, and follow your baby’s cues, you’ll learn how much sleep they need.
Of course, if you are concerned their sleep may be related to a health issue, speak to your healthcare provider. You might also like to read our article “When sleep isn’t normal”.
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Acknowledgements
The development of this resource was made possible by the generous support of the Mary Jane Foundation as part of their Her Health Hero program.
Little Sparklers gratefully acknowledge the contribution of our working party members who participated throughout the development of this resource, particularly:
Dr Shireen Durrani, Project Lead, MBChB (Hons) MPP MSc FAFPHM
Carly Grubb, Little Sparklers Managing Director, BEd (Primary)
Lyndsey Hookway, RNC SCPHN IBCLC
Greer Kirshenbaum PhD Neuroscience, CD
Tracy Cassels PhD Developmental Psychology
Professor Jeanine Young AM, FACN, PhD, BSc (Hons) Nursing, Adv. Dip Nursing Care, RGN, Reg. Midwife, Neonatal Nurse
Aloka Kumarage, lived experience consumer
Danielle Brown, lived experience consumer and Little Sparklers volunteer peer supporter
Keren Toynton, lived experience consumer and Little Sparklers volunteer peer supporter
We also thank all our The Beyond Sleep Training Project community members who helped provide the original feedback that this resource was built off.
A special thank you also to the generous contributions of the University of the Sunshine Coast who supported Professor Jeanine Young to attend our regional photoshoot to provide safe sleep expertise and advice.
Extra acknowledgement to the talented photographer, Renee Johnstone of Vida Images and her beautiful family models who have made it possible to bring imagery to this resource.
We also acknowledge the professional skill, patience of our wonderful health communication writer, Nerissa Bentley.
Supplementary safety information included in the downloadable pilot parent resource:
Further information available in the full Queensland Clinical Guidelines document for Safer Infant Sleep
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REFERENCES:
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[2] Ramirez JM, Ramirez SC, Anderson TM. Sudden Infant Death Syndrome, Sleep, and the Physiology and Pathophysiology of the Respiratory Network. In: Duncan JR, Byard RW, editors. SIDS Sudden Infant and Early Childhood Death: The Past, the Present and the Future. Adelaide (AU): University of Adelaide Press; 2018 May. Chapter 27. PMID: 30035952. https://pubmed.ncbi.nlm.nih.gov/30035952/
[3] Peter S. Blair, Helen L. Ball, James J. McKenna, Lori Feldman-Winter, Kathleen A. Marinelli, Melissa C. Bartick, the Academy of Breastfeeding Medicine, Michal Young, Larry Noble, Sarah Calhoun, Megan Elliott-Rudder, Laura Rachael Kair, Susan Lappin, Ilse Larson, Ruth A. Lawrence, Yvonne Lefort, Nicole Marshall, Katrina Mitchell, Catherine Murak, Eliza Myers, Sarah Reece-Stremtan, Casey Rosen-Carole, Susan Rothenberg, Tricia Schmidt, Tomoko Seo, Natasha Sriraman, Elizabeth K. Stehel, Nancy Wight, and Adora Wonodi.Bedsharing and Breastfeeding: The Academy of Breastfeeding Medicine Protocol #6, Revision 2019.Breastfeeding Medicine.Jan 2020.5-6.http://doi.org/10.1089/bfm.2019.29144.psb
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