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IS MY BABY SLEEPING WELL AND SAFE? Day-to-Day Care Part 2, Basic Infant Care Series

Bringing your baby home is a big transition. In the beginning, day-to-day tasks might fill you with anxiety. That is completely normal—especially if you have not spent a lot of time around babies in the past. It will not take long until you master how your baby sleeps. In the meantime, a great way to ease the first days’ uncertainty is to have at hand helpful sources of information. You are not alone: your pediatrician can provide the instructions and support you need to take the best possible care of your baby. Nevertheless, always remember that the most valuable cues will come from your baby. Babies let you know when they want to be fed, how they want to be held, how they like to be comforted—and this will gradually reinforce your parental instincts.

This second part of the Day-to-Day article series will share advice on helping your baby sleep and positioning your baby for sleep.

Helping Your Baby Sleep

Initially, your baby is not able to distinguish day from night. During the first few months, newborns sleep approximately 16 hours a day, divided into naps. These naps will be evenly spaced between feedings. They will wake up and ask to be fed every three to four hours because their stomachs can only hold enough to keep them satisfied for that long. However, even at their earliest days, you can start teaching them that the night is for sleeping and the day is for playing. How?

Keep the night feedings as quiet and dim as possible: do not turn on the lights or prolong diaper changes. Once you feed and change your baby, put him or her back down instead of playing or holding them for much longer.
In the afternoon, particularly in late hours, if your baby is napping for longer than three to four hours, wake him or her up and play. This way, your baby saves sleeping for the nighttime.
Follow a bedtime routine. For example: a bath, followed by relaxing time (applying baby lotion, reading, or softly singing), and then a final feed. With time, this might signal to your baby that it is almost time for the long sleep of the day.

As your baby grows, his or her stomach will also develop and hold much more food to keep him or her satisfied for longer. Therefore, they will not wake up as much during the nights asking for food. For instance, the average most prolonged sleep period for infants from birth to five months is about 5.7 hours, and by 6 to 24 months, this increases to a little more than 8 hours. While this is indeed promising, it is also normal for a baby that has slept wonderfully in the past couple of weeks to abruptly start waking up at late hours of the night. The increased awakenings might be caused by growth spurts or any other developmental process, meaning that the baby requires more food. This is all completely normal.

Positioning Your Baby for Sleep

The American Academy of Pediatrics recommends that all infants be placed to sleep on their backs, as it is the safest position for healthy babies. This decreases the chances of sudden infant death syndrome (SIDS), one of the most common causes of death in the United States during the first year. Research has found that babies who sleep on their stomachs sleep more deeply, and it is harder for them to wake up when facing challenging situations. It is also known that sleeping on the side is as dangerous as stomach sleeping. This is because it is very easy for babies sleeping on their sides to roll onto their stomachs.

Just putting your baby on his or her back is enough. We do not recommend using a positioning device, such as blanked rolls, to keep your baby on his or her back because it can cause suffocation. Once your baby is capable of rolling back to front and front to back, you can let him or her stay in the sleeping position of his or her choice.

Even babies with gastroesophageal reflux (excessive spitting up) should sleep on their backs. Your pediatrician might recommend you place your baby in a different position if he or she has a medical condition, such a back surgery, but this is very rare. In case you have any doubts, it is always best to call your pediatrician before making a decision. A safe sleep environment is essential to prevent SIDS and other accidents.

While your baby should be put on his or her back for sleep, it is essential to have “tummy time” when she or he is awake. This helps strengthen neck muscles, increases head control, and avoids flat spots on the head.

The do’s and don’ts of safe sleeping

DO put your baby to sleep on a flat, firm (hard) crib mattress.
DON’T place your baby to sleep on soft surfaces, such as pillows, comforters, bean bags, or quilts. Other unsafe environments include couches, armchairs, and adult beds.

DO cover your baby’s mattress with a fitted sheet.
DON’T have blankets, pillows, toys, stuffed animals, or bumper pads on the crib nor between the mattress and the fitted sheet.

DO put your baby’s crib in the same room where you sleep, within your arm’s reach.
DON’T keep your baby in bed with you.

DO use layers of clothing, wearable blankets, or sleep sacks to keep your baby warm and keep the room at a pleasant temperature.
DON’T use blankets or let your baby overheat.

DO offer a pacifier once breastfeeding is going well (if formula-fed, offer at any moment) and if your baby likes it.
DON’T use pacifiers attached to ties, strings, or stuffed toys.

DO put your baby in a crib to sleep for naptime and nighttime.
DON’T use car safety seats, swings, strollers, or infant carriers for routine sleep.

DO find a way to stay awake while feeding your baby.
DON’T fall asleep holding or feeding your baby.

DO ask your pediatrician how to safely swaddle your baby.
DON’T swaddle your baby too tight (puts too much pressure on baby’s limbs and harms development) or too loose (may result in suffocation or strangulation).

Estefanía Henríquez Luthje, MD

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