A Guide To Newborn Sleep

In the Words of Dr. Harvey Karp “Your babies nine months – or three trimesters – inside you is a time of unbelievable complex development. Never less, it takes a baby an additional three months to “wake up” and become active partners in the relationship. This time between birth and the end of your baby’s third month is what I call your baby’s fourth trimester.”

As a sleep consultant and from a mother’s perspective I love looking at newborn sleep as a 4th trimester chunk of time. I feel strongly that our babies have been inside our womb for 9 months and so all they know and recognize is you! As parents, it is our job to gently introduce them to their new way of life outside the womb. This includes helping them learn healthy sleep habits which in turn leads to reaching healthy sleep goals that nourish their rapidly growing bodies!

During the first 4 months of your baby’s life sleep is not always easy! Baby sleep is a windy and bumpy road. There is no straight, easy, logical way about it. You may have heard somebody say “I slept like a baby!” and thought to yourself ‘hopefully not like my baby or you would be exhausted!’ So, what does “sleeping like a baby” really mean??

Newborn sleep is erratic and often doesn’t show any sort of pattern until around the 4 month mark when they go through a major sleep milestone and their sleep cycles begin to fully develop. Read about this change here so you know what to expect. Before this 4 month mark babies tend to sleep often and they may require some help from you to get the sleep they need. You may notice that as the weeks go by they begin staying awake for longer periods of time and you may notice sleep becoming a little more difficult in terms of taking longer to fall asleep, shorter naps, increaed fussiness and more frequent night wakings. This is perfectly normal as the body adjusts to the longer periods of wakefulness and the body develops. Don’t be discouraged! Instead use the tips below to get the next sleep period or next day back on track. You may also begin to see that some of the longer spurts of sleep may be happening at night versus happening sporadically. This often happens in the early part of the night when we adults are still awake but it still is showing that your baby’s body clock is shifting to more sleep at night and less during the day.

** The main goal for the “fourth trimester” is to make sure your baby is getting the sleep that they need doing what works best for you.

How Much Sleep Does My Baby Need?

Babies need A LOT of sleep!! Much more than parents anticipate. Here is a little breakdown:

Newborn – 2 months

Total Sleep: 16-20 hours

Day Sleep: 7-9 hours

Night Sleep: 8-9 hours

2-4 Months

Total Sleep: 14-18

Day Sleep: 5-7 hours

Night Sleep: 8-10 hours

** For the first 4 months babies feed around the clock day and night and so those numbers include night feeds in there. At 4 months you can begin working on sleep but even at this age it is normal for your baby to have feeds! Yes.... plural!

** If your baby does sleep through the night then that is o.k. too. (Don't tell your friends!) I don't want parents to be stressed either way for those early months!

Sleep Tips to Help Reach Baby’s Sleep Recommendations

As mentioned above, we are all our baby knows!! They have been inside our womb for what has been their entire life. This is why I am a big fan of recreating the world that they know and feel safe in…..the womb!! Help them learn healthy habits by using what they already know and gradually introducing new things as well.

Here are some guidelines to follow for your new baby to ensure that they are getting the sleep that they need! If you have a baby on the way this is great to know beforehand but if your bundle of joy is here already then you can begin implementing some of these practices now!!

1. Follow the 5 S’s

The 5 S’s are based on the notion that recreating the womb for our babies allows for a gentle transition to our outside world. Dr. Karp, the doctor who came up with this concept, believes that by following these 5 S’s you can soothe a fussy baby in no time by triggering their internal “calming reflex” which helps lead to more sleep.

A. Shushing – There is a wide belief that inside the womb is quiet. The opposite is actually true. There is blood flow happening all around your baby while they are in the womb and so they hear A LOT of constant noise. By doing loud “Shhhhhhhh” or “Shhh, shhhh, shhhh, shhh” close to your babies ear you are re-creating a calming sound that they are familiar with. (More on this with white noise).

B. Swaddling – Our wombs really do not have that much space in them. It is tight and compact and our little babies get to feel like they are wrapped up tight for the length of time they are inside. When babies are born they do not have control over their limbs and so you may notice their arms and legs moving in jolt like movements. These are reflexes and these reflexes OFTEN wake a sleeping baby. Swaddling your baby mimics that safe, comfortable feeling in the womb and it also prevents these jolty reflexes from waking them up.

C. Swinging – When baby is in the womb there is also constant movement….well during the day. This movement lulls your sweet baby to sleep while they are inside of you. Using motion to help your baby get the sleep they need is a great idea if they like it!!

• For sleep put your baby in the swing and let the swing motion put your baby to sleep. It often works best to turn the swing on its highest speed as this is most similar to the womb (I know it seems fast but it really isn’t). I always recommend using the swing for sleep during the first few months. When your baby is swaddled nicely and placed in the swing they are brought back to their womb days. Place the swing in a dark room with white noise to help further recreate that womb environment.

• If you are trying to calm your baby in your arms do a more jiggly type of motion. As you are holding them swaddled and belly to belly, begin to jiggle your arms quickly up and down. It is the fast, jolty motion that mimics the womb when you are trying to calm them. This works!!

• Once your baby enters the 4 month sleep shift then motion sleep is no longer as restorative but during those early months I say to milk that swing for your sanity!

D. Side Lying – When your baby is sleeping it is always safest to put them on their backs to sleep as recommended by your family doctor and the National Sleep Foundation!! When you are trying to calm your baby in order for them to fall asleep holding them in a side lying position so their belly is against your belly is a great holding position to help trigger that calming reflex.

E. Sucking – New babies often do a lot of sucking reflexes as newborns. This is when they are hungry and it also triggers that calming reflex. Pacifiers can help greatly with this. When you are trying to soothe a fussy baby using a pacifier with the above tactics can help your baby settle so that they can fall asleep. If they fall asleep with the pacifier try not to replace it if it falls out but instead use other soothing techniques. This can avoid the pacifier association that often occurs in older infants.

** The key to the 5 S’s is combining them! One by itself may not work but by using a combination this is a very successful method to calming your baby down which will make it easier for them to fall asleep.

** These methods can be used perfectly when cuddled up in your arms!

2. Don't Keep Your Baby Awake Too Long

You may be wondering how on earth you’re going to get your baby to sleep the amount of sleep hours that I recommended above! 16-20 hours for a newborn and 14-18 for 2-4 month old seems crazy! As adults we go day to day not even realizing all of the stimulation that our bodies get. Babies on the other hand have never had this stimulation and so it is a MAJOR factor in their development and sleep.

**Keep in mind that a lot of brain development occurs during sleep**

By limiting the time your baby is awake in between sleep sessions allows you to control the amount of stimulation their little body receives and prevents them from becoming overtired! Overtired babies DO NOT SLEEP WELL!!

Follow these suggestions for your little one:

0-1 Month – Babies here will be sleeping all of the time. Rule of thumb is to have them awake the duration of their last sleep period or up until a max of 45-60 minutes (closer to 45 minutes is even better!). For example, if your baby only slept for 30 minutes then we would want them sleeping again in 30 minutes but if they had a 2 hour nap then the max we would keep them awake for is 45-60 minutes and so we would want them ASLEEP by the 60 minute mark. At this age most babies fall asleep at feeds which is totally normal!

1-2 Months – Your baby may be beginning to stay awake for slightly longer periods of time. The awake time here is duration of their last sleep period or up until a max of 1-1.25 hours (closer to 1 hour is better!) For example, if your baby slept for 45 minutes you would want them asleep again by 45 minutes but if they had a 2 hour nap then their new max time is 1.25 hours and so we would want them ASLEEP by at least this time.

** 1.25 hours would be 1 hour and 15 minutes.

2-3 Months – Every month they are becoming more alert! Awake time is duration of their last sleep period or up until a max of 1.5 hours.

3-4 Months – Your little baby is becoming quite the character!! At this point I like to start having more consistency and using awake times no matter what the nap was before. Usually between this age we are seeing 4 naps emerge and so 1.75 hours would be the max. Closer to 3 months I would maybe have 1.5 hours but extend it throughout the month to get closer to 1.74 hours. If they short nap then shorten the next awake time a little to help prevent them from becoming overtired!

** With all ages the first awake time of the day is usually the shortest. The first nap is an extension of night sleep which is why they are ready to go down again shortly after waking. The awake times in the afternoon stretch a little more.

** Having your baby asleep following the above suggestions can make a huge difference in sleep quality for your little one!

3. Identify Your Baby’s Sleepy Cues

For infants there is a lot of clock watching to prevent them from becoming overtired but we should also be watching their individual cues! If you notice sleepy signals before your goal wake time (listed above) then this is a sign that your baby is ready to go to sleep earlier. This is O.K.! Remember, they need A LOT of sleep!

Signs to watch for include: becoming still, staring into space, getting fussy, rubbing eyes, eyes/eyebrows becoming red, or when your baby is being quiet but lets out a single whine/cry.

These are all signs that it is time for your baby to be sleeping, even if it is earlier than your expected wake time. Stimulation levels are always different which means they may need some earlier sleep times and some later ones.

4. The E.A.S.Y Routine

E – Eat

A – Activity

S – Sleep

Y – You time!

The not so easy…easy routine! During the first month your baby will be waking up to eat, be changed, and then will be going back to sleep. Often times your baby will drift off back to sleep during the feeding and this is normal!

As the days go by you may notice that your baby is staying awake longer and so the E.A.S.Y routine might work for family! What this does is help prevent a milk to sleep association where your baby only knows how to fall asleep while feeding. When an older baby has a milk to sleep association they often wake frequently during the night for a quick snack and then go back to sleep. This can be very tiring for both baby and the parents!

You would follow this routine throughout the day after each waking. When they wake you would feed them milk, then do some light stimulation via a diaper change and some talking/playing, then before your wake time is up you can swaddle them up and do a quick routine to help them fall back asleep for their next sleep time.

** Please note that if you really enjoy having your baby fall asleep while cuddling them with a bottle or nursing them then please continue to do this. This is just one suggestion that I have to help in the upcoming months but every family and baby is different.

** For nursing mommas, keep in mind that comfort nursing is totally normal. If you feel that your baby wants to nurse then follow that instinct! The goal of E.A.S.Y is to just not have feeding to sleep happening at every sleep period forming an association in the later months.

** If you feel your baby is hungry then FEED THEM! Once babies can stay awake longer it sometimes helps fill up their belly to have another feed after some activity time about 15-20 minutes before going to sleep.

5. Establish a Healthy Room Environment

Sleep environments are so important to sleep. As adults we like to have our bed, our pillow, and our blankets because it gives our body consistency. Our babies like this consistent nature as well. It does not matter if you are room sharing, bed sharing, or they have their own room but it is helpful to include some things in the room that can help your baby feel safe and therefore sleep better.

White Noise – White noise is a very similar concept to the shushing outlined above! It mimics the sounds of the womb which help your baby to relax. If we think about it from our baby’s point of view they came from a noisy environment to a place where everyone is trying to keep things quiet. Having white noise on in their sleep environment can help re-create their safe place! Don’t forget that this sound can help to block out disturbing noises from inside and outside your home!

Create a Sleep Cave! – Days & Nights are influenced by light levels. As outlined above darkness signals our body to sleep and light signals our body to be awake. Although newborns don’t have the sleep hormones to regulate their sleep cycles until around the 4th month (between 12-15 weeks usually) the light can still act as stimulation.

Have an optimal room temperature - We don't want the room to be too hot or too cold but generally sleep resources agree that between 19-22 celcius is a great room temperature for your baby. Keep in mind that your baby's hands and feet may feel cold even though they are comfortable. For more accurate body temperature assessment feel between their shoulder blades on their back.

Try a consistent space when at home - I always have done this just to get into the habit. When at home I try and have all the sleep happening in the same room environment where we have sleep cues like white noise and darkness established. Co-sleeping, the swing, bassinet, ect all in the same room.

6. Help Your Baby Learn Days & Nights

This is one of the biggest complaints with newborn sleep. We as parents are all ready to get tucked in but your baby is WIDE awake and ready to party in those late evening hours or sometimes even in the middle of the night! I know it is so frustrating and remember very clearly these long nights.

When baby is in your womb they first learn days/nights via the stimulation they receive. During the day you are rocking them to sleep with your movements and then at night there is less movements and therefore they are awake more. This then carries over into those first couple of months after birth.

Between 12-15 weeks adjusted age (on average) your baby's body will begin to produce their own hormones and their sleep cycle will be starting to mature which will help their body create a sleep/wake cycle. This is a big process in the maturation of sleep!

For tips on how to help your baby learn to differentiate between days and nights check out my blog here.

7. Be Patient

Your baby is new! They are learning about their new world and most importantly you are learning about them. Although you have known them for a long time there is still a lot of learning to do! Respect the changes and try not to stress about sleep. I know that many resources stress to work on sleep right from the beginning but give yourself a break. You have a new baby, you smell like baby puke, your hair is in a side pony and all you want is a shower. Embrace these special months because before you know it they will be older and you can work on sleep. It won't be too late!

The first few months are tough and I say in full confidence that months 3 through 5 are always the hardest for me. My baby is 6 months and so it is still fresh in mind. If you can be patient until that 4-5 month mark when sleep balances out a bit more on a hormonal level you can then work on sleep and get on the right track. As for the first 3 months.... enjoying your baby, keeping your sanity and relaxing are the goals!