Shaken Baby Syndrome

A large number of child deaths are reported in South Africa each year. A lot of deaths relate to neglect, abuse or murder. Despite this, there's a knowledge gap in relation to understanding the issue....

Amniotic fluid problems

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Choosing a pre-school

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Newborn reflexes

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Mastitis

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Pelvic floor exercises

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Colic

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Antenatal Classes

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Strap-in-the-Future

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  • Shaken Baby Syndrome

    Tuesday, 21 July 2015 16:28
  • Amniotic fluid problems

    Thursday, 14 May 2015 12:54
  • Choosing a pre-school

    Friday, 10 April 2015 17:50
  • Newborn reflexes

    Tuesday, 03 March 2015 15:49
  • Mastitis

    Tuesday, 03 March 2015 15:41
  • Pelvic floor exercises

    Wednesday, 11 February 2015 17:20
  • Colic

    Wednesday, 11 February 2015 17:11
  • Antenatal Classes

    Monday, 03 June 2013 09:34
  • Strap-in-the-Future

    Thursday, 30 June 2011 13:52

Sleep Basics

At Tum2Mom we believe that it is important for parents to understand the expected sleep needs of an infant and child and to be able to meet the individual needs of their child and family. We do not have one particular method of ‘sleep training’; we prefer a customised approach, in line with our Responsive Parenting Philosophy (Read more: Responsive Parenting) for each individual family. This will take into account the child’s age, living situation, parents’ work schedules, child’s medical history, as well as recent events that may affect our plan of how to proceed, such as the birth of a sibling or a recent move. We then set up a step-by-step plan of how to implement appropriate routines and structures that will ensure that the child will get the right amount of sleep and develop the ability to fall asleep with a sense of security and comfort. Parents can then be in touch by phone or by email as they proceed, to get support, report progress and make any necessary changes in the plan.

 

Sleep basics  

In the sections on the various developmental stages of your infant there is a brief description of the average sleep patterns for that age. Here is a more in-depth look at establishing some good sleep habits.

 

It is very important to remember that:

·         Sleep is one of a child’s most basic needs. Parents should consider it primary fuel, as important as milk.

·         It is a parent’s responsibility, not an infant or child’s, to ensure that a child gets the correct amount of sleep.

·         All children of a similar age require approximately the same amount of sleep.

·         Children vary significantly in how easy or difficult it is to get the sleep they need.

·         There may be a problem with infant crying and irritability in at least 20% of infants.

·         Without the right amount of sleep, infants and children are compromised in obvious and subtle ways that can be detrimental to their overall growth and development.

 

About sleep – sleep cycles

There are 2 main stages of sleep. We first go into a brief light sleep, then into deep sleep, then into dreaming sleep, then back to light sleep for a few minutes, and then into another cycle of deep sleep, dreaming sleep and light sleep.

 

Babies move through these sleep cycles in about 30 to 40 minutes. Toddlers tend to have a cycle that lasts longer – about 60 minutes, and adults may have a cycle that lasts about 90 minutes.

 

During deep sleep growing and healing take place. It is harder to wake people from this kind of sleep. During dreaming sleep (‘rapid eye movement’ sleep) we dream and ‘go over’ the day’s events. With infants this is 80% of sleep, but by adolescence it is only about 20% of sleep.

 

Many people, including babies, wake during the light sleep phase of a sleep cycle. Usually we settle back to sleep without being aware that we have been briefly awake. During the night babies and young children also usually settle back to sleep after their first cycle of sleep but some may wake, cry and need help to get back to sleep. Babies may need a feed at some of the times when they wake up before they settle back to sleep.

 

In daytime sleeps, if you notice that your baby is starting to stir after about 30-40 minutes you might be able to just rock her a little and help her settle back to sleep. However, sometimes babies may not need more sleep. If they do not respond to resettling in a few minutes they are probably ready to wake up.

 

Daily sleep needs

The average newborn spends at least 16 hours a day sleeping, but there may be big differences from one newborn to the next. The total amount of sleep babies need in any given 24-hour day gradually decreases over time, but still totals just over 14 hours at 6 months of age and just under 14 hours at 1 year.

 

Newborn needs

Young babies need feeding and attention 24 hours of the day. They have no control over when they sleep and when they wake and often appear to be unable to differentiate between day and night. Sleep patterns in the newborn are due partly to circumstance, birth weight, birth experience etc, and partly to luck. These patterns vary between babies as much as the patterns vary between adults. A baby’s sleeplessness is not the parents’ fault. The early weeks are a period of time where a parent gets to know the baby and gradually develops an understanding of how best their baby likes to be soothed and settled.

 

With each passing week, the newborn’s sleep pattern gradually shifts towards more night sleeping with a longer period of sleep between times she is awake. The newborn also starts to spend a longer time awake during the day as she is able to experience more of her surroundings.

 

By providing comfort, soothing cuddles and reassuring responsiveness, your baby will feel increasingly secure and settled which results in a calm, relaxed and restful sleep. A stressed, pressurised environment can cause both parent and baby to feel very anxious about sleep, resulting in a poor quality and inadequate sleep.

 

6 weeks to 3 months

Now the sleep patterns are beginning to emerge and this is an ideal time to start establishing some form of routine and ritual that baby will respond to for a good sleep.

 

At this age babies are often relaxed and sleepy after a feed. Some develop a pattern of waking often and needing a feed to settle. Some babies are helped by a daytime pattern of feed and then settling after a small play, cuddle, talk and touch. Watch your baby’s signals for when she is alert and wanting to play and when she is sleepy.

 

Some young babies tend to be more wakeful in the evening or night rather than during the day. It helps babies learn about day and night if you settle them at night in a quiet, dark place and don’t play with them or do anything that makes them more wakeful.

 

Some babies need to be held until they are in a deep sleep; some prefer to be put down to fall asleep, as constant body contact overstimulates them. Some feel soothed by just a hand placed on their tummy until they drift off. Once they learn to drift off on their own by being placed in their cot when comfortably drowsy, they are more able to comfort and settle themselves when they wake during the night.

 

Tired signs: sleep cues

As you get to know your baby, you will start to learn when she is sleepy and needs to be put down for sleep. Long before they can talk babies have tired signs or sleep cues in their behaviour that show you what they need. Your baby will have her own special sleep cues but here are some that most babies have that will start you off in watching for your baby’s cues.

·         Yawning

·         Jerky movements

·         Becoming quiet, not wanting to play

·         ‘Grizzling’ or fussing

·         Rubbing their eyes

·         Making a sleepy sound

·         Crying

·         Facial grimaces, i.e. pulling faces

·         Clenched fists

·         Waving arms and legs about

If you miss the tired signs and don’t help your baby to settle your baby may get more alert and overtired and be very hard to get to relax and sleep. Signs that the baby has become overtired included being very overactive and being very quick to cry.

 

3 to 6 months

Babies vary a lot in the amount of sleep they need. Between 3 to 6 months some babies have 2 or 3 longish sleeps during the day, while others just have short naps. A few sleep 12 hours at night without interruption, some manage 8 hours while many others wake fairly regularly for feeds. Most have learned to sleep more at night than they do during the day. If you are happy with your baby’s sleep pattern, there is no need to change it. There are many ways to be ‘normal’.

Daytime and night time patterns

By this age your baby will have established a different pattern for day and night sleeps. She is awake for longer periods during the day and these periods are now quite active. During the day, your baby will usually have 2 or 3 sleeps. It is a good idea not to let her sleep for too long (perhaps no more than 2 hours) especially late in the day, as she may not sleep as long during the night. You may want to wake her gently when you see her stirring.

 

An evening bedtime routine should be well established and baby will be responding to these cues. If baby wakes, respond with what she might need, be it a reassuring cuddle or a feed; however avoid overstimulating her as you want to get her to settle back to sleep as quickly as possible.

 

6 to 12 months

By 6 months of age, babies are having most of their sleep at night, but they still need day sleeps. Expect 2 sleeps a day until 12 to 15 months – then 1 is usually enough.

 

Some babies and toddlers sleep through because they can last longer between feeds and hunger does not wake them. Many still wake once or twice, or several times at night. Many wake in the lighter time of sleep, just as we wake (or almost wake). They may, as most adults do, turn over and go back to sleep, or they may cry because they are uncomfortable, afraid or unsettled in some other way, or in the habit of waking up. By 6 months about 50% of babies are ‘sleeping through the night’ (i.e. sleeping about 5 hours or more). Between the ages of 2-3 years 41% of young children wake once or twice a night, with a few still waking more often. 

 

Each family needs to respond to night waking in the way that best suits them. Some parents like to have their baby sleep in a cot next to them; others prefer their baby to sleep in a separate room. Sleeping in their own safe sleeping environment near to the parent’s bed for the first 6 to 12 months is safer for babies because it reduces the risk of SIDS. Many babies will sleep better if they know that someone is close by.

 

If you are happy with the way things are at the moment, do not feel pressured to change. Babies may cry at night because they:

  • Don’t know how to settle themselves back to sleep without a feed, a cuddle or a dummy
  • Are anxious about being separated from their parents
  • Are hungry, unwell or uncomfortable, teething, or have a cold or earache, are overexcited or stressed

If you feel that there could be a better sleep pattern, now is the time to start changing how you have previously responded to your baby waking at night. One common desire is wanting the baby to fall asleep without you. Once your baby seems secure and confident in your care (from about 3 months), try and put her to sleep in her cot in a calm and drowsy state so she can fall asleep without your physical contact. Soft singing, swaddling or a gentle hand holding can help soothe her into a deep sleep. By trial and error and watching your baby’s responses, you’ll develop an understanding of what settles her.

 

All babies and children move, wriggle and wake at night. If your baby has learned to calm herself and doesn’t depend on you for her sleep cues, she may fall back to sleep again on her own and cry for you only if she is hungry or really need attention or comfort.