Baby not sleeping? That’s actually normal.
Macall Gordon, M.A.
“Hi, I’m calling about getting some help with sleep for our 4-month-old… We’ve been… um…nursing her to sleep and picking her up when she cries. I know…we have all kinds of bad habits and I’m worried we’ve really screwed it up by doing all of that.”
This is pretty typical of calls I receive from parents—even parents of very young babies. My heart bleeds for them. Barely out of the gate and they’re already sure they’re failing at parenting. It’s not their fault. Parenting advice tells parents that if they don’t start early, their baby’s sleep is doomed. Not so.
The notion that you’ve already irrevocably ruined your child’s chances of sleep and, well, life success, by nursing her to sleep at 4-months is just not true. The ability to manage waking and sleeping is dependent on neurological and physical development. At each stage, babies can only do what they are capable of doing. As parents, we can’t rush that process. It’s appropriate for parents to help young infants navigate between awake and sleep, between distress and calm until some of the developmental dust begins to settle (around 6-months of age).
What does “normal” sleep look like?
Nightwaking is very normal throughout the first year . Some parenting advice books tell parents that infants as young as 12-weeks are capable of sleeping 10- or 12-hours without waking or feeding. This notion is not supported by developmental science or research and is not achievable for many infants. Understanding the range of “normal” may help parents worry less about how sleep is going.
Newborn: Sleep is spread out evenly across daytime and nighttime hours. The ability to tell day from night doesn’t come online for another month or so.
Total sleep: 14-16 hours in 24
Naps: About every 60- to 90-minutes (and they may be short)
Bedtime: Relative to naps. It’s okay to have something of a routine but a real “bedtime” won’t happen for a while.
(This pattern will remain in place until the next shift at 6-months.)
4-5 months: The 4-month sleep regression happens because of a large burst of brain growth (the biggest burst an individual has besides adolescence) . A physical growth spurt may also prompt nightwakings for feeding. Even a baby who was a champion sleeper at 3-months, may suddenly start waking a lot.
Four-months is when most parenting advice says to start sleep training , but trying to work on sleep at this age may be difficult and result in less progress (and more crying) than if parents waited until the regression resolves and skills are in place. Babies at this age have a limited bandwidth for distress at the same time their brains and bodies are growing rapidly. Trying to sleep train now may work for some babies. If it’s not working for you, it’s okay to try again later.
If your baby really isn’t sleeping…
If your baby isn’t even close to the sleep ballpark, there are factors besides behavior that can negatively affect sleep.
Silent Reflux (baby may not actually spit up). Acid reflux can cause pain as stomach acid is refluxed up into the esophagus. This makes lying flat painful for infants. Parents of infants with silent reflux report that the infant may arch their back while nursing/feeding, they may feed best when drowsy or “nibble nurse.” These infants may also prefer to sleep slightly upright (on you or in a carrier) or on their side. Silent reflux is often a culprit in infants who appear to have difficulty sleeping any time or anywhere . Check with your pediatrician.
Feeding difficulties. For young infants, consultation with a lactation consultant to rule out feeding issues is a first line of action in sleep difficulty. Food intolerance can also cause a baby to be uncomfortable and unable to sleep.
Intense/Alert/Sensitive Temperament. Studies show that infants who are more alert, sensitive, and/or intense have much more difficulty with sleep . Babies with sensitive/alert temperaments often also have a very low sensory threshhold, making sleep much more difficult . These children resist sleep more strongly and sleep less overall .
Physical discomfort. For babies who seem persistently unhappy and unable to sleep, parents have found success with infant chiropractic or craniosacral therapy. These address physical “misalignments” that may happen as a result of the birth process.
Some easy things parents can do…
Get sleep in any way that works. Try to get good, well-timed naps that are appropriate for the child’s age. Up to 6-months, these can happen (supervised) anywhere that works (swing, carrier, bouncy seat). Before 6-months, naps may be short and frequent. This is normal.
Support. Partners can be really helpful at any stage. Expressed milk or bottle can allow a partner to take on bedtime and/or the first block of nighttime sleep, so Mom can get at least a four-hour chunk of sleep. Support for Mom has also been shown to improve baby’s sleep.
Gently practice. It’s okay to test the waters and see if there are times when the baby can go that last little bit to sleep without nursing or can be soothed through a wakeup without feeding. There should be no “agenda” in terms of progress. Just introduce the idea and if it doesn’t work, that’s okay. You can try again in another week or so.
Take the pressure off. Sleep deprivation is hard enough. It’s not necessary to add the pressure of worrying about how you’re managing sleep and whether you’re doing it “right.” There’s time to learn and improve skills. It’s likely that you’re responding to the baby you have. Give yourself and your baby time to learn. Sleep training can wait.