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Other survival
tip areas:
• Breastfeeding
• Biting
• When your Baby (under 4 months)
cries
• Toddler
Behaviour
• Toddler Nutrition
• Tips
for Introducing Solids (PDF)
•
Toilet Training
• Postnatal
Depression
• Wrapping
your Baby
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Sleep and
Settling Strategies: |
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Sleep and Settling Strategies:
For ease of reading the female gender has been used throughout this article.
The following information provides a brief guide to sleep and settling strategies and gives you some suggestions for solving problems you might be experiencing. For further information and support please consult your Early Childhood Nurse, Lactation Consultant, General Practitioner or Karitane Careline on (02) 9794 1852 or 1800 677 961 outside the Sydney metropolitan area.
All babies are different but it is important to know a little about sleep cycles, sleep needs, routines and signs of tiredness when settling babies.
SLEEP CYCLES: We all have sleep cycles, adults cycles last approximately 90 minutes and babies usually 40 minutes. During each sleep cycle we have REM or Rapid Eye Movement Sleep which is our active or light sleep and NON-REM which is our deep sleep. Some babies may progress to NON-REM sleep quite quickly while others may take longer, up to twenty minutes. We all wake briefly after our deep sleep and if everything is how we expect it to be we then go back into our light sleep phase. We don't even remember waking.
- Basic prepration for settling infants
- Settling strategies for babies
Birth – 4 months
4 – 7 months
6 – 11 months
over 9 months and sleeping in a cot
toddlers and older children sleeping in a bed
You will notice that some of these age brackets overlap – this may give you further ideas for settling your baby. Whatever strategies you choose it is important to use them for a while before moving on to another. This avoids confusing your baby.
SLEEP NEEDS: As babies get older they require
less sleep and are able to stay awake for longer periods before tiring
e.g. at 6 weeks they can happily be awake for approximately
1 hour and sleep for 2-3 hours, from 12 weeks waking
time may be 1 1/2- 2 hours and sleep time
2-2 1/2hours. By 20 - 22 weeks awake time may be 2 -
2 1/2hours with sleeps being 2-2 1/2hours and by 6-8 months
awake time will average 2 1/2 hours with 2-3 sleeps each day of approximately
2 hours. Older children may continue to require one day sleep until 3-4
years of age.
At Karitane we suggest you follow a routine of sleep , feed and play
for your baby.
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The chart below
is a guide for sleep needs for infants up to the age of approximately
6 months. It can be used in conjunction with the above routine to help
you to look after your baby.
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SLEEP NEEDS GUIDE FOR INFANTS 0 TO 6 MONTHS |
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FEEDING SCHEDULE:
Time your baby's feeding schedule so feeds are given after a sleep. If
infants are fed immediately before a sleep, they will associate feeding
with sleep time and when they wake out of a light sleep cycle they may
wake expecting to be fed.
The chart below is a flexible guide for your baby's daily routine for
the ages from 6 – 12 months. Activities during 'up time' include
eating, drinking and playing.
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FLEXIBLE
PLAN FOR BABIES 6 MONTHS-ONWARDS
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TIRED
SIGNS: Babies show when they are ready for sleep through tired signs.
One minute they may be playing happily and the next they may grizzle or
cry, clench their fists, grimace and have jerky movements of their hands
and feet. Children may become upset, start to loose their concentration
and co-ordination, rub their eyes or yawn.
SETTLING STRATEGIES: There are a number of settling strategies
used to settle infants and young children. Each is designed to meet the
cognitive development of the child. No matter which strategy you use each
is designed to teach the infant/child to self-settle and learn to get
themselves to sleep.
BASIC PREPARATION FOR SETTLING INFANTS:
- Ensure that your infant is comfortable, not hungry, has a clean nappy and is not too hot or cold.
- In preparation for day or night sleeps, allow a wind down period. This may involve cuddles, a story, a gentle massage or a bath.
- Put your baby to bed while she is awake. Don't be tempted to rock or feed your baby to sleep before putting her to bed, because when she progresses through the light sleep cycle she will expect to still be in your arms and will then need your help to go back to sleep.
- Wrap your baby in a light cotton, muslin (available from Karitane by telephoning (02) 9794 1800), or cheese cloth fabric. The fabric will need to be at least one meter squared. Your baby should be wrapped with her hands up near her face, as she may like to suck on her hands or use her hands to self-soothe. When your baby starts to move and roll over she may not want or like to be wrapped. Ordinary cot sheets may be used to tuck her in.
- SIDS & Kids recommend that babies are placed on their backs to sleep with their feet positioned at the foot of the cot. It is important to provide a smoke free environment for your baby and not to share your bed with your baby if you smoke. Further information about sleeping precautions may be obtained from the following web site www.sidsaustralia.org.au/safesleep/faq.htm. Avoid placing bumpers, pillows or quilts in the cot and remember to remove all toys prior to settling, as these items could restrict air flow or cover her face and lead to suffocation.
HANDS ON SETTLING
For Infants
from birth to 4 months
Hands on settling is
a technique which involves actively comforting your infant in the cot
until she is settled. This method is the beginning of teaching your infant
to put herself to sleep.
- Observe for tired signs.
- Follow basic preparation for settling.
- Place your baby on her back at the lower end of the cot and tuck in firmly
- If your baby is calm and relaxed leave the room and allow her to go to sleep on her own.
- If she needs help to settle gently pat, body rock, rock her cot, or stroke her face and head. Gradually slow down and reduce these techniques as she calms and relaxes. Once she is settled and before she is asleep, leave the room and allow her to go to sleep on her own.
- If you are unable to stop your baby crying, try comforting her in your arms briefly until she is calm, then place her back in the cot awake.
- You may need to continue these techniques for approximately half an hour ( 30 minutes). If your baby does not settle you may choose to take her for a walk in the pram or pouch, give her a massage or a relaxation bath. Then try to re-settle.
COMFORT
SETTLING
For infants 4 – 7 months
Comfort Settling is a technique which involves actively comforting your
baby in the cot for short periods at a time. This strategy will give your
baby the opportunity to actually fall asleep by herself.
1 Observe for tired signs.
2 Follow basic preparation for settling, remembering
that a baby of this age may prefer to be tucked in firmly rather than
wrapped
3 Place your baby on her back at the lower end of the cot and tuck
in firmly.
4 Spend a brief time giving a few gentle pats and a reassuring
word. Leave the room.
5 Encourage
your baby to attempt to self settle for up to 3 minutes
6 If your baby has not settled return and commence settling strategies
for up to 3 minutes eg. pat, body rock , rock the cot or stroke her face
and head for approximately three minutes. Speak in a quiet reassuring
voice will often help her to settle. Do not pick her up.
7 Leave the room again for three minutes. If you find this too
long at first, try just one minute, then two minutes and then three minutes.
8 Repeat step 6.
9 Repeat step 7 – the time that you leave the room can be
extended a little depending on the age of the child and how you and your
partner feel about her crying. At this age it is recommended that babies
should not be left for any longer than five minutes. Listen to the nature
of your baby's cry when deciding how long to wait before you move onto
the next step.
10 You may continue these techniques for up to 45 minutes. If your
baby does not settle you may choose to take her for a walk in the pram
or pouch, give her a massage or a deep relaxation bath. Then try to re-settle.
PROGRESSIVE SETTLING
For infants 6-11 months
Progressive Settling
is a combination of actively comforting your baby in the cot for short
periods at a time whilst giving your baby the opportunity to fall asleep
by herself with her knowing that you are close .
1 Observe for tired signs.
2 Follow
basic preparation for settling remembering that a baby
of this age may prefer to be tucked in firmly rather than wrapped
3 Place your
baby on her back at the lower end of the cot and tuck in firmly.
4 Spend a
brief time giving a few gentle pats and a reassuring word. Leave the room.
5 Allow your
baby to attempt to self settle for up to 3 minutes
6 If your
baby has not settled return and reassure her - if she will allow you lie
her down and comfort her using your settling strategy for approximately
1 minute eg. back rub, pat or a soothing sshhh, but keep stimulation to
a minimum
7 Repeat
step 5
8 Repeat
step 6
9 Leave the
infant to attempt to self-settle for 5 minutes
10 If your
baby has not settled return and reassure her - if she will allow you lie
her down and comfort her using your settling strategy for approximately
1 minute eg. back rub, pat or a soothing sshhh, but keep stimulation to
a minimum
11 Repeat
step 9.
12 Repeat
step 10
13 Continue
alternating 5 minutes of self settling with approximately 1 minute of
predetermined settling strategy until your baby settles but not exceeding
45 minutes during the day. During the day after 45 minutes it may be necessary
to try an alternative strategy such as a cuddle, a deep bath, a massage,
a walk with the infant in a pouch or the in the pram. At night continue
settling until the infant is asleep.
PROGRESSIVE WAITING
For infants from 7 months
Progressive Waiting is a technique which is used to teach infants to go
to sleep in their cot without your help, while letting them know that
you are not far away.
1 Observe for tired signs.
2 Follow basic basic preparation for settling,
remembering that a baby of this age may prefer to be tucked in firmly
rather than wrapped
3 Settle your baby in her cot.
4 Leave the room for 3 minutes. If you find this too long at first,
try just one minute, then two minutes and then three minutes.
5 If baby does not settle during this time, return to her, calm
her and reassure her to resettle. It is helpful to have minimal eye contact
and do not talk very much during this time, as you do not want to stimulate
her. You can lean into the cot and resettle her there but do not pick
her up as this will confuse her about what you want her to do. Try not
to stay in the room much longer than 30 seconds.
6 Leave the room again for 5 minutes.
7 Repeat step 5.
8 Leave the room again for 7 minutes.
9 If necessary repeat step 5.
10 Continue alternating 7 minutes of self-settling with brief settling
interventions until your baby settles or for up to 45 minutes during the
day and continuously through the night. During the day after 45 minutes
it may be necessary to try an alternative strategy such as a cuddle, a
massage or a walk in the pram.
Listen to the nature
of your baby's cry when deciding how long to wait before you move onto
the next step, but do not leave your baby any longer than ten minutes
before going in to comfort her. At the next sleep time follow the same
routine. Remember being consistent is what will teach your baby to sleep.
Using progressive waiting to teach your baby better sleep habits may be stressful. You may need to seek assistance from your partner or support person before you commence. We suggest you start to use this method at some time when you can support each other. You may like to take turns in implementing the strategy. Do not try it when you and your partner are experiencing a period of high stress, such as when relatives are visiting or one of you is going for a job interview.
Your baby may find this routine strange at first but with persistence and your gentle reassurance she will slowly develop a better sleep pattern.
GRADUAL
WITHDRAWAL
This is a technique which is used to teach older children (such as a toddler)
to sleep in their own bed, and encourage them to settle themselves independently,
while letting them know that you are not far away
1 It is important to establish a bedtime routine or ritual. An example of this may be bath time, clean teeth, story time, and some cuddles with parent. This allows a wind down period in preparation for sleep.
2 Your child may have one particular object that gives her comfort such as a soft toy. Settle her in bed with her comfort object. Say goodnight and leave the room.
3 There is no definite strategy that will be effective with every child. If your child repeatedly leaves the bed, these are some of the options you may wish to select - a parent may sit at the:
- end of the bed
- beside the bed
- in the middle
of the room
- by the doorway
- outside the room
You may be positioned
with your back to your child. Avoid becoming engaged with any of your
child's requests eg. I need a drink, I want something to eat. With this
strategy the parent remains in close proximity to the child until the
child falls asleep. Gradually the distance between the parent and child
is increased as the child gains confidence and the ability to fall asleep
unaided.
4 The time
frame for each parental position would be anticipated to be 24 hours however
this may vary from family to family. Should your child leave the bed,
walk her back to bed and resettle her and verbally reinforce that she
remains in bed. Avoid entering into negotiations with the child.
5 during the day if your child is not asleep after 1 hour defer the settling strategy and continue with the days routine. Start the settling strategies again at the next sleep time. At night continue the settling strategies until your child is asleep.
Using Gradual Withdrawal
to teach your child better sleep habits may be stressful. You may need
to seek assistance from your partner or support person before you commence.
We suggest you start to use this method at some time when you can support
each other. You may like to take turns in implementing the strategy. Do
not try it when you and your partner or support person are experiencing
a period of high stress, such as when relatives are visiting or one of
you is going for a job interview.
Your child may find this routine strange at first but with persistence and your gentle reassurance she will slowly develop a better sleep pattern.
References,
further reading and viewing
Armstrong, K. L. et. al. (1994). The Sleep Patterns of Normal Children,
The Medical Journal of Australia, Vol 161, August.
Child & Youth
Health. (1996). Practical Parenting 1- 5 years, Child & Youth
Health, South Australia.
Ferber, R., (1985),
Solve Your Child's Sleep Problems, Penguin Books, Victoria.
Quine, L. (1997).
Solving Children’s Sleep Problems, Beckett Karlson Ltd., Huntingdon.
St James-Roberts,
I. et. al. (2001). Use of a Behavioural Programme in the First 3 Months
to Prevent Infant Crying and Sleep Problems, Journal of Paediatric
and Child Health, Vol 37.
Tweddle Child and
Family Health Service. (1998). Sleep Right Sleep Tight – a practical
guide to help parents resolve young children’s sleeping difficulties,
Snap Printing, Notting Hill.
Zeanah, C. (2000). Handbook of Infant Mental Health, The Guildford Press, New York.
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Last modified:
Tuesday, 17 June 2003