Baby Life Topic

From the restless final weeks of your pregnancy and then the birthing experience (which can be a stay-awake-a-thon) it's common to start your parenting duties with a sleep debt. The best outcome for parents and babies is for everyone to be getting what they need. What newborn babies need is to be with their mother to feel safe, warm, comfortable, and fed. When those needs are met, the sleep pressure ensures that sleep comes. If your baby is sleeping, then your sleep follows.

There are a few things to know about newborn sleep that can help set realistic expectations, help you go with the flow, and troubleshoot when you feel something is not right. Read on to find out more about what can affect newborn sleep and how to support them.

Average Sleep Times for 0-3-month-olds

A rough guide for how long your baby may sleep includes the following averages:

Day sleep: 6-7 hours (45 mins - 105 mins awake time between naps)

Night sleep: 8 hours average (maximum 4 hours between feeds)

Total: half of babies will average 13-16 hours (but between 10 and 19 hours is the range)

It is important to take these numbers as a guide, not a rule. Knowing the averages helps to give you an idea of where your baby fits on the sleep spectrum and also an idea of what awake/sleep rhythms to expect at this age.

In the first months, babies sleep often, with around 50% of their sleep in REM sleep. REM is an important light sleep state where their brains build, develop, and consolidate. We recommend reading our related articles: Where to go for gentle sleep advice & Want more sleep? 10 questions to ask yourself to learn more about how infant sleep is different to adult sleep. Knowing about REM sleep can help you to support your baby to get the right sort of sleep rather than worrying about the total sleep hours.

The Startle Reflex

An interesting newborn reflex that can affect sleep in the first 2 to 4 months, is the startle (or Moro) reflex. This reflex can be activated by sudden loud noises or when your baby senses they are falling such as when being lowered or put down on their back. Your baby will look startled as they involuntarily throw their arms and legs out, move their head back and then flex their body in again. When they first experience this sensation, it can be unsettling, frightening and cause them to cry. Whilst you want to protect them from upset, it is believed that primitive reflexes serve a naturally protective purpose and are important developmental milestones your baby needs to pass through. Each time the reflex is activated, the brain and body are working towards integrating or resolving the reflex. Until the reflex can be integrated, it is known as a retained reflex that can inhibit motor development. It is interesting to learn about infant reflexes, how to activate them, and when to expect them to integrate as a way of working with your baby and supporting their development. To learn more about newborn primitive reflexes and why they are important, check out the first half of this YouTube video by OT MIRI.

To Swaddle or Not to Swaddle

Wrapping or swaddling babies from birth is a common practice in many traditional cultures. For many babies, the pressure on the skin provided by the fabric helps to calm and settle them. Swaddling also prevents the startle reflex from being activated during sleep and potentially waking them. Choosing to swaddle your baby will be based on your own and your baby's personal preference - a good rule is to be guided by their cues. Try a few things, but listen to your baby to decide if it's worth persisting with swaddling. 

There are two types of babies:

1. Babies who enjoy the pressure and security provided by the fabric to relax into the swaddle. These babies will love being swaddled so much that they need to be gradually weaned out of the swaddle one arm at a time when they are starting to roll independently at around 3-4 months.

2. Babies who respond to the swaddle's pressure with tension, upset and end up wasting a lot of energy trying to free themselves. If your baby only wants free movement and unrestricted access to their hands, then follow their lead. Alternatives to swaddling include sleeping in a gown, looser wrapping with arms out, or using a sleeping bag such as those available from Ergobaby or The Stork Nest or Amazon Au. They may respond to other ways of applying gentle pressure to their chest to help calm the body and breathing, such as:

• putting your hand on their chest,
• settling them on their tummy or side before putting them on their back to sleep,
• skin to skin
• being wrapped in a carrier or held in arms

Things to keep in mind:

1. Babies enjoy having their hands to their mouth and benefit from being able to suck on their hands for comfort. Most swaddles can be fitted to allow hands to the mouth and the best-fitted ones give you the option to have hands in or out which helps when you need to transition your baby's hands out. Examples include the Woombie Convertible Swaddle, Love To Dream Transition Bag, Halo Sleepsack Swaddle, Tommee Tippee The Original Grobag Snuggle or the Ergopouch Butterfly Cardi (cardigan style option to fit over a regular sleeping bag).

2. Swaddling around the hip area is associated with hip dysplasia. Make sure you look up hip safe swaddling methods such as on the Healthy Hips Australia website, which has resources for parents to safely swaddle and identify hip issues early. Then, when ready to buy, only consider products designed to keep the hips free to move, such as the Ergobaby Swaddler.

3. Choose a swaddle fabric weight and design appropriate for the room temperature and season. Also, consider the materials of the fabric - natural fabrics will breathe and provide better temperature regulation. Babies have naturally faster metabolisms than adults, so they will need to be dressed similar or even one layer less than yourself. Monitor your baby for overheating signs such as red cheeks and fast/heavy breathing, and check they aren't cold by feeling their feet and hand temperature. It can also help to have a room thermometer to monitor indoor temperatures.

4. Babies need lots of touch and movement to help them develop body awareness which includes their sensory-motor, vestibular and proprioceptive systems. Even if they love swaddling, consider offering a variety of napping arrangements, including doing some naps in a carrier or contact napping. Make sure you create plenty of free movement time with opportunities for them to activate their primitive reflexes.

Positioning

When you are putting your baby down to sleep, it is considered the safest to position them on their back on a flat surface with no gaps or obstructions near their face. In this position, they can move their limbs and/or head to clear their airways of posseted milk or other obstructions and are less likely to be able to move into positions where their airways can be obstructed. Sleeping your baby on an incline or moulded surface is not recommended by rednose.org.au and reflux.org.au since they don't have the freedom of movement they need for their breathing and to clear their airways, and if not secured in place, they can wriggle into positions where their airways become obstructed. Several products were recalled, warnings issued, and deaths have occurred to babies who have slept on an inclined surface and suffocated due to reduced oxygen levels. This is why using a pram bassinet or carrier with your newborn is the safer option than letting them sleep in a baby capsule.

Side positioning is not considered safe since newborns can't independently hold a side position until they are much more mobile and rolling over at around 3-4 months. Tummy sleeping positions are also no longer considered safe since it was found to be a risk factor for SIDS due to reduced oxygen levels and increased suffocation risk. 

Newborn baby's skulls need to be soft enough to fit through the birth canal and also be able to accommodate rapid growth. The downside to this softness, particularly in the first 3 months, is that any pressure on the head's sides and back, if repeated over long periods, can cause flattening, known as positional plagiocephaly or flat head syndrome. It is common for the modern baby to frequently spend time in containers such as car seats, swings, bouncers, stroller seats, as well as flat on their backs to sleep. These products and positions serve their purposes in moderation; however, that time needs to be balanced with time where there is no pressure on the head and where your baby is exposed to a variety of sensory experiences, including touch and movement.

Flattening requires treatment only in severe cases; however, prevention is always better than cure, so acting as soon as you notice any head position preferences and/or head flattening is recommended. Neck pain and tightness known as torticollis is related to head flattening and can be caused by and related to the birth, positioning in the womb or frequent posturing to relieve reflux symptoms. If you are concerned at all and wondering what plagiocephaly looks like, cranialtech.com has a good assessment guide, including images. Another resource for more information is The Flat Head Syndrome Fix book by Rachel Coley (Amazon Australia).

Some things to consider include:

• You can look out for the early signs and alternate your baby's head position each time you lie them down or if they stare at any mobiles or toys when lying down, move it to the other side, so they turn their head.
• Avoid laying your baby on surfaces with a curved head or pillow support, as these can worsen flat head syndrome. 
• If your baby prefers to turn their head to one side and doesn't respond to gentle neck stretches to the opposite side, consider whether to have a practitioner assess their neck or consider if it could be related to reflux.
• It is quite normal for babies to lose their baby hair after birth as new hair replaces it. You can often see hair loss along the head areas that rub on their sleeping surface (as seen in the above right positioned image). When this happens, look for asymmetric (uneven) hair loss patterns and notice the start of any flattened areas to the back or side of the head. The bald patches don't usually last long as the new hair grows through.

When on their back, reflux or silent reflux, babies will typically try to relieve their pain by arching their back, squirming, and turning their head to the side and upwards. In extreme cases where the posturing is accompanied by seizure-like movement, Sandifer's Syndrome might be diagnosed. Their pain is typically worsened if laid horizontal during and within 30 minutes after a feed, so symptoms can be relieved by being held upright.

Reflux.org.au have further information about reflux and sleep, and rednose.org.au has a comprehensive article on reflux: sleeping position for babies with gastro-oesophageal reflux (GOR).

Alternatives to laying your baby down or in a container include:

• Increasing the time carrying your baby during the day 
• Contact napping
• Gradually increase tummy time during their active-alert times.
• Chest to chest holding 

Nose Breathing

Babies are natural nose breathers (known as obligatory nasal breathers), and even if their mouth drops open, they will continue to nose breathe. They are also natural diaphragmatic breathers where their tummies will move in and out on each breath.

If you notice your baby’s mouth has fallen open, gently close it and watch and listen for any signs of obstruction. If you notice their nose is blocked, you can help by trying any or a combination of the following:

• Increasing breastfeeding 
• Using baby saline drops to loosen mucus.
• Try a nose/snot sucking device to clear the nose.

Being Guided by Tired Cues

All babies display some degree of tired cues that can tell you when they are getting tired and ready to sleep. Early cues can include staring, turning away from eye gaze, jerky movement, yawning, & eye rubbing. This can escalate into late-tired signs, including fussing, fast jerky arm and leg movements and crying. The following video shows the range of babies displaying typical tired signs. It is helpful to learn the tired signs so you can respond to and even anticipate your baby's needs.  

Baby cues tired from Raising Children Network on Vimeo.

After you have gotten to know your baby and have an idea of what to look for, you will start to see patterns with their sleep/wake cycles and attune to the cues they display when getting tired. Having this awareness will give you all the information you need to respond to your baby's needs. Also, seeing their behaviour as a reflection of need can be reassuring and helps you keep an empathetic mindset.

Routines & Winding down

Your own preferences relating to routines, predictability and expectations can mean you either love or hate the idea of prescriptive time-based routines around when your baby will feed, play and sleep. A lot of stress and anxiety can be born out of a mismatch between your own expectations and your baby's preferences and temperament. Occasionally babies will be very easy-going, sleepy, and go along with whatever routine their caregivers choose. For these babies, the commonly suggested feed-play-sleep routine can work well where they will fall asleep after a short play, then feed on waking. With anything, however, it's not a one-size-fits-all rule. Some babies are very alert and have a longer stretch between sleeps; in this case, the feed-play-feed-sleep routine might be what your baby needs. For sensitive babies who have trouble winding down, a play-feed-sleep routine might be what works for them since breastfeeding, and the warm cuddle that goes with it is very calming. It can be useful to notice what your baby responds to and why, then use this information to respond to their needs and, when you need to, gradually make changes to their routines.

There are many ways to help your baby to wind down to sleep if they need help. Parents instinctively work out that babies calm down with ‘shhh’ing (reminds them of the sounds in utero), your voice, white noise, rocking, movement, familiar music and skin to skin contact. Pinky McKay has come up with 100 of them in her book, 100 Ways to Calm the Crying, which can give you lots of ideas to keep up your sleeve. There is a huge variety of sleep aids on the market to take the pressure off sleep-deprived parents. Some are worth the investment and others exist to appeal to desperate parents. Some popular products include the Baby Shusher, nursery mobiles, white noise machines (consider avoiding any that use Wifi or Bluetooth), & soothing music such as Music For Dreaming by the Ensemble Melbourne Symphony Orchestra.

Introducing a gentle bedtime ritual even from this age allows you to work with your baby’s body to induce sleep (stick with it, though and be consistent as it takes time to work). Try to hold space for your baby with calming energy; then, your baby can tune into a calm state through this connection. This takes practice, being able to go with the flow, accept that your baby needs you now and knowing the assuring fact that it won't last forever.

Don't forget to soak up that newborn smell, enjoy the feeling of their soft squishy skin and the healing power of your baby's cuddles (especially when skin to skin). Spend your time getting to know your baby, and understand their sleep in relation to the big picture of their day/week/month, including what's going on in their body and developmental stage. 
 

Please note: Above all, any information on this website aims to provide general ideas for informational and educational purposes only. We encourage users to investigate several information sources, including, where necessary, independent individualised medical advice before making any decisions that could affect you or your child’s health or wellbeing.

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