Sleep (birth to 6 years)

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The text for this topic is copyright Parenting SA, Government of South Australia.

Managing sleep for babies and children is one of the most common concerns for parents. Many worry about whether they are doing the right thing if their child doesn’t sleep soundly all through the night. There is no right way or place for parents to put babies and children to sleep, and patterns vary between different cultures and families. What matters is that bedtime is relaxed and comfortable and that babies and children have comfort when they need it and that they are safe. If things aren’t working well for you, some of the following information may help.

Some facts about sleep

How we sleep

There are two main kinds of sleep. light sleep and deep sleep.

• Light sleep is when we dream and when we ‘go over’ the day’s events and wake feeling refreshed. It is also the kind of sleep where we wake more easily. With babies this is 80 per cent of sleep, but by adolescence it is only about 20 per cent of sleep.
• Deep sleep where growing and healing take place. It is much harder to wake people from this kind of sleep.

Each night we all go through sleep cycles from light sleep to deep sleep then light again.

Babies move through these two types of sleep but their cycle is shorter. Toddlers usually take about an hour for each sleep pattern or cycle.

It is between the stages of light and deep sleep that, as adults, we may pull up another blanket or roll over and then fade back into. For babies and toddlers this may be where they cry and need help to resettle back to sleep.

Settle/sleep chart

The best way to work out how much sleep your baby or child needs is to keep a sleep diary or chart.

Mark when your baby or child is asleep and when she is awake.

This way you can get an average of how much sleep she needs each day. Talk to your health professional if you’d like help to do this.

Remember that sleep needs change quickly as babies and children grow and you need to adapt to these changes. (see sleep chart in PDF version of this guide)

Getting ready for sleep

Most of us have some kind of winding down time before we go to sleep. This can also help babies and children to relax and settle into sleep.

Try to make the last hour or so before bed a time for quiet, relaxing activities. Babies generally find comfort and security in a bath, a quiet story, a song and special goodnight kiss. Routines can often help parents too in organising bedtimes and so reduce tension and stress.

Sleep programs

There are a number of programs that are meant to help parents settle babies and children for sleep. Programs that distress babies and children, such as controlled crying, are not recommended. They respond to crying on the basis of time rather than the child’s signals, and so do not help babies and children develop secure attachment with their parents.

Young babies often give very small signals for what they need and parents need to learn their baby’s signals and respond to them. This says to the baby that they have been hears. Babies need to know you will respond to them when they cry in order to feel safe and secure. Learn to know your child’s cry – when it is just a settling ‘grizzle’, and when it is a ‘real’ cry that you need to attend to.

Night waking

For many parents just knowing that night waking is ‘normal’ in the early years helps remove some of the stress. Each family needs to deal with night waking in the way that best suits them.

Often babies and children just need to know someone is near and they will settle back to sleep.

Sometimes night waking can be due to pain such as ear-ache, a cold or teething, so check for this out if it is not their usual pattern. With pain, your child may not settle even if you are there to comfort, or may settle for a short time and then wake again.

It is important to meet your child’s need for comfort in the way that also gives you the best rest. Parents also need sleep and broken sleep can bring added stress to family life.

It is also important to ask for help and support from others, to help you through when your sleep is reduced or broken. Support may be available from your partner, other family members, friends or community agencies.

Safe sleeping

It is important that your baby is safe while he sleeps. Babies may get into dangerous situations while they sleep, such as suffocating under bedding and not be able to move out of the situation.

Evidence shows there are things parents can do to reduce the risk of Sudden Infant Death Syndrome (SIDS) and fatal sleep accidents.

• Babies should always sleep on their backs from birth, never on their tummy or side.

Put baby on his back to sleep. When making up his bed place him half way down the cot with his feet almost touching the end. Make up the bedclothes so that they just come up to baby’s shoulders and his head cannot go under the bedclothes. Use light bedding (not doonas, thick quilts or heavy blankets). Babies who have their heads covered, whose breathing is blocked in some way, or who become too hot, may be more likely to die suddenly.

• Sleep baby with his face and head uncovered (no doonas, pillows, lambswool, bumpers or soft toys).

Babies do not need a pillow to sleep comfortably. A safe sleeping bag can be helpful instead of blankets. Remember babies cannot get themselves into a safe position, for example, if the bedclothes cover their head or large toys or pets smother them. For this reason it is important not to leave your baby asleep alone in the room with a pet.

• Avoid exposing babies to tobacco smoke before birth and after.
• Provide a safe sleeping environment night and day (safe cot, safe mattress, safe bedding)

Choose cots, beds and bedding that meet Australian Standards (see SIDS and Kids website). Avoid clothing that has long strings, ribbons or cords (less than 10cm long if a dummy is attached to clothing).

• Sleep baby in their own cot or bassinet next to the parent’s bed for the first six to 12 months of life.

Evidence shows that when babies sleep in a bed with a parent there is an increased risk of SIDS and fatal sleeping accidents. The SIDS and Kids Safe Sleep program therefore recommends that babies sleep in a cot next to their parent’s bed for the first six to 12 months of life.

If you are feeding, cuddling or playing with your baby in bed, remember to place baby into his cot before you go to sleep. This is particularly important if you are extremely tired, a heavy sleeper, very overweight, taking medicines that make you sleep more deeply, or drinking alcohol.

It is also very dangerous to sleep on a sofa with your baby, as his head can easily become caught between the seat and back of the sofa. 

Wrapping

Some babies settle better if they are wrapped in a light sheet, while others do not. It can help young babies develop a more settled sleep pattern and older unsettled babies may sleep better. Wrapping helps to prevent arm movements that can disturb sleep. (With older babies it is usually better to leave their arms out). Make sure that the wrapping is firm but not too tight so babies can bend their knees. 

Wrap in a muslin or light cotton sheet. Do not wrap in a bunny rug or blanket, or over-dress your baby as these are not safe and can cause over-heating. The wrap should not cover your baby’s face (see diagram)

Sleep at birth to three months

How much sleep?

In the first few weeks, many babies sleep much of the day and night.They have little idea of day or night and most wake regularly around the clock every two or three hours needing a feed and attention. As a guide, many babies sleep 14–20 hours a day in the first.

• By three months, many babies will have settled into a pattern of longer times awake during the day, and longer sleep times (perhaps four to five hours) at night.
• Most babies of this age still require one or two night feeds.
• By three months many are settled into a pattern of longer sleep times.
• When a baby sleeps five hours straight this is considered sleeping through the night. 

Getting ready for sleep

• Watch your baby’s signals for when he is alert and wanting to play and when he is sleepy. It might take you some time to learn the signs that your baby is tired. Signs can include yawning, random jerky movements, crying or rubbing her eyes. After a feed, babies are often relaxed and sleepy. Some babies are awake for a short time before showing signs that they are tired and ready for sleep.
• Even with young babies you can start a bedtime pattern. You may sing a little song, kiss goodnight, feed and bath your baby and then give a gentle kiss with some special soft words of love when you put him down.
• Some young babies tend to be more wakeful in the evening or night rather than during the day. It helps your baby 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.

Settling ideas

Put your baby on his back for sleep. Often a tired newborn will accept being put into his cot while awake and fall asleep on his own. Some new babies settle best in a quiet, dark place, others settle more easily in noisier, lighter places. Some babies are harder to settle than others and many need help to relax into sleep.

Very young babies do not always settle well in a large space—many parents use bassinets for the early weeks.

Some tips for settling your baby:

• have some constant noise such as humming, singing a little song, relaxing music or household noise—many babies love the vibration noise of the washing machine or dryer
• wrap him in a thin cotton sheet or use a safe sleeping bag that has no hood or arms
• settle him in the cot and then pat him with a cupped hand. Start patting quickly and then slow down as he calms, usually at about the pace of your heartbeat
• rock her in a pram, crib or your arms for a short period and then settle into bed (you must stay with your baby at all times if she is in a pram)
• push him in a pram back and forth over a bumpy surface such as the edge between your carpet and tiles or over footpath bumps
• check that he is not too hot or cold, and that clothing is not too tight
• a warm bath
• a massage if your baby likes it
• offer another feed, (often called a ‘top-up’ feed)
• allow him to suck on a dummy or thumb (do not give a dummy until breastfeeding is working well, around four to six weeks)
• use a baby sling so your baby is close and can hear your heartbeat. This may help him settle and allow you to do a few household tasks.

Sleep at three to six months

How much sleep?

At this age some babies have two or three longish sleeps during the day, while others just have short naps. A few may sleep 12 hours without interruption; some manage eight hours, while many others wake fairly regularly for feeds. Most have learnt to sleep more at night than they do during the day.

By six months of age about 50 per cent of babies are sleeping through the night—that is sleeping about five hours or more.

Getting ready for sleep

Now your baby is awake more and has some longer play times during the day. This will help your baby to learn that day is for playing and night is for sleeping. Playtime may be a walk, reading a book together, a bath or massage, tummy time on the floor (always supervised) or talking with you. Watch your baby for sings that she is tired or does not want to play any more and try to respond to them.

Continue the bedtime pattern you may have started from birth but be flexible and change your bedtime pattern to meet the changing needs of your baby.

Settling ideas

It is important to use the same settling pattern each time you put your baby to sleep, day or night, as this helps her to learn about sleep more quickly.

Many of the suggestions made for settling babies birth to three months can be tried as well as:

• reading a book with a soothing voice
• talking calmly to your baby—tell her what is happening
• darkening the room to make a difference between wake time and sleep time
• making a tape of household sounds and play it in your baby’s room.

Night waking

Many babies still wake at night for feeds. Some sleep through although they may wake again for a few nights when their appetite increases. They usually settle again when their feeds increase during the day.

• To help reduce night feeds at this age, try giving your baby a sleepy feed before you go to bed and before your baby wakes for her next feed. Disturb your baby as little as possible; lift her without fully waking her and breastfeed. If bottle feeding, you could give a feed without picking her up from the cot, but you still must hold the bottle and watch the feed to keep her safe. The next time your baby wakes at night, try to resettle without a feed using some of the settling ideas already mentioned.
• If resettling does not work in about 15 minutes or so, offer another feed so that you can get some sleep, and try again the next night. Over time your baby will gradually get the idea.

Sleep at six months to three years

How much sleep?

• Some babies and toddlers can sleep through the night.
• Some toddlers are ‘sleepy owls’ who need more sleep, while others are the ‘larks’ and get by with much less sleep and this is okay.
• Many still wake once or twice, or several times at night.
• Between the ages of two to three years, 41 per cent of young children wake once or twice a night, with a few still waking more often.
• During sleep they may, as most adults do, turn over and go back to sleep, or they may cry because they are uncomfortable, or afraid or want to know you are there.

Getting ready for sleep

• During the day try a regular mealtimes with some snacks and one or two sleeps.
• Encourage plenty of activity when your child is awake. Visit the park or playground, have some outside activity or go for a walk if the weather is fine.
• As before, make the last hour or so before sleep a relaxing, not exciting time.

Settling ideas

• Keep to the regular settling pattern that you have established, such as a bath, quiet play, story, cuddles and/or a song.
• You can put your child into the cot awake (this will help him go to sleep there).
• You might sing a little song or put on some relaxing music.
• Patting and rocking may still work at this age—a chair by the side of the cot or bed may be most restful for you. Some babies and toddlers may get used to this and cry as soon as you stop, so change the timing of the patting, slow it down and become softer, finally resting your hand on his body.
• Some will still feel more secure if they are wrapped in a thin cotton sheet, others may not like it.

Settling for older toddlers

• Try leaving a soft light on, giving a cuddly toy, giving him something of yours to cuddle, for example, an old T-shirt that has ‘your smell’ on it. Many still like their dummy at bedtime. If they lose it in the night, try putting several in the cot and, if the child wakes, move his hand to a dummy so he gets the idea of finding it.
• Some children need you to stay near while they go to sleep. If you decide to do this, don’t sneak out without telling your child. This may keep him tense and on edge in case you do it again. You can whisper that you are going to another room and will be back soon. Make sure you do return soon. If your child copes with this you can start taking a bit longer before coming back, but make sure you always return before he gets upset as this builds trust. Even if he has fallen asleep give him a goodnight kiss and whisper ’I came back’.
• When your child settles to bed but needs you nearby, this could become your relaxation time. Take a book to read or a CD and sit in a comfortable chair near your child (you are present but not doing anything that might disturb your child). Over a few nights you could gradually move your chair nearer to the door. Eventually you will be able to put it outside the door so your child can hear you but not see you. This way your child gradually learns to settle when you are not there.

Night waking

Many children of this age wake at night and will grow out of it in time. If you and your child are happy with the way things are, do not feel pressured to change.

Your child may wake at night and cry due to:

• being in a light phase of sleep so that something like a noise causes him to wake fully
• separation anxiety—this is a very common reason for children under three years to cry at night. You can tell if your child is waking due to separation anxiety because if you are nearby to reassure him, he will settle back to sleep. By eight or nine months of age, babies have learned that their parents exist even if they can’t see them and they often get frightened when they wake and their parents aren’t there.
• not knowing how to settle back to sleep. Sometimes young children need to be fed, rocked or nursed to sleep and find it hard to settle back to sleep when they are in their own beds
• pain, such as ear-ache, a cold, or teething.

What parents can do

• Put a day bed or mattress in your child’s room and lie down near her so you both get to sleep.
• Put his bed in your room near you, or take him into your bed.
• Make sure he gets plenty to eat during the day.

Sleep at three to six years

How much sleep?

Many children of this age need about 10–12 hours sleep at night. Bedtime may vary a lot. Some may go to bed at 6.30pm, while many go to bed later. Wake-up time may be early or late and those who go to bed later tend to wake later.

Young children may still need a daytime sleep as well. By kindergarten age only a few still have a daytime nap.

Getting ready for sleep

• To help three to six-year-olds prepare for the idea of going to bed familiar routines will help.
• Work out a routine around what is special for you and your child. A typical routine may include a bath, drink, teeth cleaning, cuddle, story, prayer or song and kiss ‘goodnight’. It might be a quiet time to sit on the bed and talk about the events of the day.
• It is helpful to let children know in advance that bedtime is coming, for example, ‘just one more game and then it’s time to get ready for bed’—and mean what you say. This can prevent the pestering for more time to stay up.
• The half-hour before bed is not a good time for tickles, wrestles, quarrels, TV or other excitement.

Settling ideas

• If you have a night time pattern it will help to settle your child but stressful events of the day can sometimes mean that extra time and quiet attention is needed, for example, starting school, being unwell, family disruptions.
• Reassuring words, a longer cuddle or relaxing music can help.
• It is at these moments that older children may talk about things that are bothering them.

Night waking

Night waking is common in these years and there is no ‘right way’ to solve night waking. Sometimes doing whatever works for you as a family is good enough. Some children can resettle themselves—others may need comforting.

• The inner confidence to feel secure when parents are not present is still developing by three to four years of age.
• If night waking is being caused by separation anxiety, it usually improves after four years of age.
• At times when children are sick, lonely, sad or frightened they need help to go back to sleep.
• The changes in your child’s life, for example, moving house, separations and family tensions or starting preschool can be a factor.

What parents can do

• Try settling your child where he will be sleeping the night, so you don’t have to move him.
• During the night when he wakes, go to him and quietly reassure him that everything is all right, say something like ‘Sleep time now—Mummy and Daddy love you’, then walk out of the room. If your child remains unsettled you may need to try some of the ideas below.
• If your child comes into your room when he wakes, you could try to lead him back to his bed, and resettle him there.
• Sometimes putting a spare bed in your child’s room so that you can be comfortable and can rest while your child needs you close is an option.
• Some parents find that everyone gets a better night’s sleep if they allow the child to come into their own bed during the early hours of the morning—or they have a small mattress and sleeping bag next to their bed that their child can get into if he wakes.
• Night-time waking is for comforting and resettling, not for getting out of bed for play or anything else exciting. Be comforting but boring. Don’t respond to any games.
• Ask your child what would help her go to sleep. Some children can tell you, others may not be able to.
• Think about the changes happening in your child’s life that can cause stress. They may seem minor ones to an adult, but major in the eyes of a child.

As children grow older and become more secure they will not need to be so close to you. Most children no longer need to share their parents’ bed or bedroom by the time they are four or five years old, unless something stressful is happening in their lives. Many children still love to come into their parents’ bed for a snuggle early in the mornings.

Going to bed problems

Sometimes parents find it is hard to get young children to go to bed or their waking early causes problems—and there are many different reasons for this. In some cultures children sleep in or near the action, and can nap whenever they feel tired—this is not a problem. However, parents are often tired at the end of the day and need time to themselves, or need extra sleep in the morning—more than their child does.

Some of the reasons a child may not want to go to bed may be:

• having to go off on his own and leaving people or interesting things that are happening in the house
• being frightened of being left alone (no matter what time you put your child to bed with fear or worry he will still be unhappy)
• not being tired yet (probably will go to bed happily but later)
• a very busy or exciting day, or too much excitement just before bed
• being affected by daylight saving
• lack of a night-time routine to help him wind down.

Note: children usually wake when they have had enough sleep so early waking may be because of early bedtime.

Looking after yourself

Caring for babies and young children is tiring and demands a great deal of tolerance, understanding and patience.

When parents are feeling on top of things it can still be taxing—it becomes much more difficult when parents have adult worries or poor health. Little or broken sleep makes people exhausted.

When you are tired you are at your lowest ebb and most parents will say that their need for sleep in the early years is one of their greatest needs.

• Don’t be ashamed to ask for help from family and friends.
• Get some rest during the day while your child is asleep or with someone else.
• Take a short break for yourself now and then.
• Try to get some regular exercise.
• If you feel desperate get help—from your partner, family, neighbours, ring a friend, or a parenting helpline.
• If you feel that you might hurt your child make sure she is in a safe place and then leave until you feel you have calmed down. Contact someone immediately if you feel unable to manage.
• Talking it over with a child health professional may benefit both you and your baby. It can take courage to ask for help but it is important for yourself, your baby and your family.

Reminders

• Remember that sleep needs change quickly as babies and children grow and parents need to adapt to these changes.
• Babies should always sleep on their backs.
• Babies should sleep in their cot or bassinet in your room for the first six to 12 months to protect against SIDS and sleep accidents.
• Have a relaxing, regular bedtime pattern for your baby or child.  
• Often being near you is all a child needs for relaxed sleep.
• Children usually grow out of night waking by the time they are three or four (when they feel more secure being by themselves).

Contacts

• ACT Child and Family Centres (parenting information and support) 9am to 5pm Monday to Friday. Telephone: Gungahlin 6207 0120; Tuggeranong 6207 8228; West Belconnen 6205 2904
• healthdirect Australia (free health advice line, staffed by registered nurses) 24-hr 1800 022 222
• Maternal and Child Health 8am to 5pm Monday to Friday 6207 9977
• Parentline ACT 9am to 9pm Monday to Friday, except public holidays 6287 3833 

Websites

• Child, Youth Health (parenting and child health information) www.cyh.com
• Raising Children Network (the complete Australian resource for parenting newborns to teens, covering a broad range of up-to-date parenting topics) www.raising.children.net.au

ACT Govt Publication No 11/0808 July 2011