As individuals, we all have our own sleep patterns and body rhythms, but when it comes to our ability to fall asleep easily and to stay asleep, our relationships can play a key role.
- Infancy: what's normal?
Babies and young children need sleep for healthy development. Although they need more sleep per day than adults and can sleep for longer period, they are light sleepers and have shorter sleep cycles.
- From birth to 3 months, babies sleep on average between 14-17 hours a day, including naps and these hours will increase.
- From about 6 months, they can sleep for longer stretches.
- It can take a while for babies to build an uninterrupted 8-12 hours sleep, with no crying or wakefulness whatsoever.
Learning to go to sleep, and getting back to sleep if you wake up is closely linked to emotion regulation (understanding and managing your strong feelings). Parents and carers learn these skills through seeing their parents do it.
However parents and carers, because of their own sleep shortage, can feel desperate for their baby to sleep through the night. They may also have mixed feelings about putting baby down for the night: guilty for wanting time to themselves; enjoying having them depend on them to be rocked to sleep; anxious that something will happen when they are away from them; or even frightened that their baby will not wake up.
But if parents and carers are confident about sleep-time (for themselves and their baby), most infants will learn to soothe themselves back to sleep, and eventually sleep through the night.
- Strategies for working with babies and their families
- Reassure parents and carers that babies can learn to soothe themselves. Putting baby down drowsy but not yet fully asleep allows baby the opportunity to fall asleep on their own, and therefore start to learn what is involved in calming themselves down. These skills will then start to be translated when they wake up in the night.
- Babies may cry when they are left to settle themselves to sleep at first, but they don't have to be - nor should they be - left crying for longer than a few minutes.
- When a baby wakes up in the night, the tendency can be to very quickly go and pick them up and resettle them; both to prevent them waking up fully and as a parent it can feel unbearable to hear your baby crying and your instinct is to want to soothe them as soon as possible. However, it can be so helpful for the baby to practice their self-soothing by giving them a few brief moments to try and get themselves back to sleep – as practice makes perfect. Instead, they can be sat next to, spoken with, stroked or held if they cannot calm or fall asleep.
- Even though babies often move or murmur during lighter phases of sleep, parents should not anxiously rush in the moment they think their baby has woken. If baby doesn’t receive stimulation during these moments, they may go back to sleep on their own.
- Over time, most babies will then start to be able to put themselves back to sleep, rather than waking themselves up fully, to get their parents or carers in to comfort them back to sleep.
- Nights where there are setbacks might cause parents to feel discouraged. Reassuring them that baby’s skill of settling themselves takes time and might come and go when baby is unwell or going through periods of change, will benefit parents and carers.
- Advise parents and carers that if baby has trouble settling themselves, they may be too young to self-soothe, and it may be best to wait for a few weeks before trying again.
- Recommend a consistent bedtime routine which can help ease the separation between parent or carer and baby.
- Because a baby’s memory is still forming and unstable, night times can be scary: baby might not be able to consistently remember that when their parent or carer goes away, it is only temporary. Reassure parents that repeated experiences during the day of them going and returning (i.e. to get a cup of tea, or to go to work) will help build baby’s confidence that their parent will return.
- If a parent or carers' level of exhaustion is so great that it is affecting their mood or ability to carry out their daily activities, they should discuss this with a health professional. A lack of sleep may actually increase chances of postnatal mental health difficulties, such as depression, which in turn, can make it more challenging for a new parent to get enough sleep.
- Toddlerhood: what’s normal?
As babies grow into toddlers, they are able to explore much more and have greater control over where they go and what they do. Yet they are still so dependent on their caregivers. The fear and excitement they feel as a result of being both dependent and separated can impact their sleep. The average developing toddler may start fighting sleep-time routines because the world they must leave behind for the night is exciting, and their parents will continue in this world without them.
Nightmares are common between the ages of 2 and 3, even in loved and well cared for children. The child may wake from a ‘bad dream’ or remember it in the morning. Dreams are an important way for children, like adults, to work out confusing or difficult feelings and experiences.
At age two, children do not really understand the difference between fantasy and reality, or between their own feelings and those of others. So, for example, when a child feels angry with their parent or carer, they may assume that the parent is also angry with them. This can lead to an increase in fears, which sometimes get expressed through nightmares, such as monsters under the bed.
- Strategies for working with toddlers and their families
- Acknowledge with parents and carers that it can be really challenging, especially at the end of the day, to look after a toddler who doesn’t want to sleep. It is important they are sympathetic but remain firm with the child.
- Encourage parents and carers to keep to a routine, because this can help their child wind-down, entering a calmer state, and be more ready for sleep.
- Remind parents and carers that a toddler calling out to them to return at night may be out of not wanting to be alone rather than a specific or more concerning anxiety.
- If a child is consistently waking from nightmares, consider what might be specifically causing stress or anxiety in their life, for example the arrival of a new sibling, starting nursery or parental separation.
- Tips for parents and carers
- If your child wakes in the night having a bad dream, tell him/her that it's 'gone' now. Try not to dress it up with long explanations or distractions.
- Try to avoid telling a child that their dream wasn't real or fear doesn't exist because it denies the emotional experience that may be going for the child that is causing the dream.
- The best thing you can do for your child and bedtime is to soothe and reassure them to bring their arousal down, and as soon as the child relaxes, say good night.
- When does a baby or toddler have a ‘sleep problem’?
Sleep problems affect about half of all babies and toddlers at least at one point across their early years. A number of possible factors may be associated with sleep difficulties including:
- traumatic delivery
- feeding difficulties
- infant temperament
- parental mental health
- physical health
- housing / space problems
Supporting a parent or carer to help their baby with sleeping better can be complicated. Families are likely to feel overwhelmed by exhaustion and unable to think about which steps to take next to improve the situation. Understandably, families often want to fix things as quickly as possible, coming to seek professional support when they are feeling desperate, and in need of support and compassion.
Navigating all the different sleep advice available can be exhausting for parents and carers and they may ignore even excellent advice, if it does not chime with their beliefs regarding sleep. They may discard advice that is uncomfortable to them, or react by telling the professional they were unhelpful, and the negative spiral may worsen.
As professionals, our own beliefs, histories and parenting experiences about the cruelty or benefits of how to support babies to sleep also colours our advice and non-verbal communication with parents. Therefore when advising parents around sleep problems, it is important to be as impartial as possible and led by each family and what they are comfortable with (i.e. how little sleep, how much crying).
- Be genuinely curious about the details of sleeping arrangements and what the parent or carer feels the difficulty is, in order to better understand what can be adjusted and what cannot, or may seem intolerable to the parent.
- Encourage parents and carers to think about going to sleep as a “life skill” because it is about learning to regulate body and emotional states: from active to quiet, from busy to restful. Like talking, it begins with just a few signals or recognisable cues or sounds/clues that need to be built on gradually.
- If the parent or carer is anxious, guilty, has mixed feelings about leaving the child to sleep alone when the child begs them to stay with him or her, the child will undoubtably pick this up and not settle.
- Exploring a parent or carers' feelings, fears and fantasies generally about sleeping difficulties and the relationship with baby is key. spending time talking and listening to how parents experience parenting – with all the elements of helplessness, separation, confusing rage and even hostility towards a wakeful baby - can be explored by asking them about their own history, difficulties with sleep, and losses or separations.
- Supporting parents and carers with their fears- what does the crying make them feel etc. is very helpful. This feeling of being perhaps neglectful, "a bad parent" or even cruel, may be worth exploring and discussing further as it may support the parent to differentiate their own history and their own beliefs from the reality that baby is experiencing.