Clique aqui para transferir o artigo no português – Thank you to Gabriela O. da Silva for the translation!

As my daughter gets older I’ve become more aware of the expectations that we place on babies these days.  From the reasonable expectation that they will walk (someday) to the more perplexing expectation that your infant should sleep through the night (and the thousands in between), it seems as if we’re putting a lot on babies’ shoulders these days.  And I’m not convinced it’s for their own good.  Here I’d like to talk about these expectations—what they are, why we have them, and whether or not they do any harm—with the hopes that some parents will be able to let go of some of these expectations and simply enjoy the ride that your baby is bringing you on.  Or at least decide which ones are reasonable and which ones may be causing the family more stress and heartache than is necessary.  After all, parenting is demanding enough for parents without having to place irrational expectations on their child, ones the child can’t possibly live up to without pain and suffering for everyone.

Physical Expectations

These are probably the absolute first expectations to emerge because we can include here the number of times your newborn should pee, poo, how many hours they should sleep, etc.  I’m going to leave sleep for a category unto its own (which I’ll get to next), but let’s take a look at the first physical expectations of the, shall we say, sticky kind because I’m not sure I’ve met a parent who didn’t start counting the number of times their baby peed or pooped that very first day.  Starting in your prenatal classes, you’re told that your newborn should pee 5-6 times a day and poop at least once a day.  So that’s what we expect our newborns to do.  Heaven help the parents whose baby only pees 4 times a day or goes a day without pooping.  Our expectations that there is a set right number is so strong that there are forums for these parents – they can get online, panic while they type their question, then get loads of answers about how it’s PROBABLY normal, but maybe they want to call their doctor just in case.  They may lose sleep over it, wake their babies up more frequently to get them to feed more out of fear that it’s because they aren’t getting enough, or just remain stressed enough all the time until their babies start following the ‘expected’ pattern.

As our babies get older, we start adding to this list.  Are they crawling? Clapping? Cruising? Walking? Picking up small objects with a pointed grip?  We act as though these milestones have to met by a certain stage or the world will end.  If you admit that your child hasn’t met one, you’re bound to get that look – you know the one – that says, “You may want to consider that your child is a bit slow”.  And so the stressing continues and the online forums flourish with more half-assed words of comfort that always have in them couched that sinister advice that, just maybe, you’ll want to see your doctor about this.  Might I inquire what a doctor is going to do about this?  I’ve yet to meet a doctor who could get a baby to suddenly crawl, clap, cruise, walk, or pick up tiny objects.  Of course they can check for any physical problems, but let’s face it, if there is a physical problem, it’s probably manifesting itself in various ways, not just because your baby isn’t crawling at 7 months.  These expectations have gotten to be so bad that I’ve actually met parents whose 13-14 month olds weren’t walking yet (no biggie) who actually apologized because of this.  They prefaced their statement with, “I’m sorry, but…”  Should I start apologizing to other parents because my daughter only has 6 teeth?  Is that not enough?

I think we need parents to relax a bit more.  Let’s start with crawling because it’s one of the first expectations that parents start to truly worry about.  All the books tell us that around six months of age (or a bit after), your baby should start crawling.  But this ignores some very real changes that have occurred in recent times that aren’t being taken into account.  Recent research has shown that we’re now off the average age by a few months[1].  Why the change?  In the effort to cut the SIDS rates down (a highly laudable effort, fyi), we’ve been putting babies to sleep on their backs, thus they aren’t getting used to the motions of pushing themselves up and rolling front-to-back.  None of the standard literature out there has even bothered to update this leading to paranoid parents worldwide.  But there’s more, it used to be that only 5% of babies just never crawl and go straight to pulling themselves up and walking, but that number too seems to be rising as a result of the Back-to-Sleep campaign (and even more find other ways of getting around, like pulling themselves on their bums and use that instead of crawling).  Furthermore, some people have suggested that the age at which a baby starts crawling and walking is inversely related to how heavy they are.  While there are no studies on the topic (that I can find), it makes sense.  Heavier babies have to bear more weight in order to crawl, and so will take a bit longer to develop this skill than lighter babies.  Now what about walking?  Dr. Sears has a great summary of early-versus-late walking which suggests that there are personality types associated with each too[2].  While early walkers may be the impulsive, on-the-go babies, late walkers may be more cautious and be waiting until they’ve mastered the skill before trying it (meaning late walkers are also less accident-prone).  Additionally, the weight issue is brought up by Dr. Sears here as well—leaner kids tend to be earlier walkers for the exact same reason.

We must ask ourselves, though, what are the effects of these expectations?  To start, we have parents forcing their children into things like tummy-time, buying toys to ‘help’ their child crawl (or walk or clap), and eager parents trying to force these physical milestones onto their babies.  Many babies hate tummy-time so this is an activity that causes distress.  The same could be said for many of the ways in which parents try to force their children to perform these skills.  As for the toys, they may be fun for babies, but not always in the ways that will get them to crawl or walk and if parents don’t let their baby simply enjoy the toy, it’s another example of causing our babies distress.  At a deeper level though, we have parents who are perpetually stressed about their infants instead of simply enjoying the time they have with them.  While it hasn’t been studied experimentally, I would imagine that a caregiver who is always worried (though within what we have decided is the ‘normal’ range of worry) and thinking that her child isn’t up to snuff will pass some of that stress onto her child and that just can’t be healthy.  Babies pick up on emotional cues quite well[3] and we’d be wise to remember that—our emotional state affects them just as it affects us.

Despite the plethora of worries out there about the physical expectations, they sadly tend to be the least of our concerns when it comes to our baby expectations.  While there are the obvious exceptions (and I think I’m met many of them), most people seem to be able to calm themselves down enough around the physical milestones, knowing that they too will come, even if just in time.

Sleep Expectations

I will start by saying there is no way to fully cover this topic in such a brief forum, but I hope to his to key points here.  Somewhere along the line, parents in Western societies decided that babies should sleep according to the parents’ schedule.  I don’t know how or why this came about, but that is the new expectation for babies when it comes to sleep.  Five-month-olds are expected to sleep through the night and if they aren’t, well, you need to do something about it.  This expectation has led to a flourish of sleep training books for babies — as babies won’t naturally do this so it’s up to us to train them to do it.  After all, we need to treat our children like dogs, monkeys, or circus animals, didn’t you know?

In all seriousness, I can’t help but wonder what people think about babies to make them think that they should be sleeping through the night.  First off, a baby’s stomach is TINY (the size of a pea at birth) and so it only makes sense that they would need to wake regularly in order to feed themselves.  On top of the size of their stomach, human breastmilk has some of the lowest fat and protein contents of all mammalian breastmilk and thus babies are expected to feed regularly in order to grow and thrive.  Secondly, a human’s natural circadian rhythm can take up to nine months to develop(for a review on the literature, see [4]), meaning that messing with it ahead of that time may be detrimental to the development of a child’s sleep patterns later on.

Outside of these very real, physical reasons for waking, there are reasons to believe it is also highly adaptive for young infants to wake throughout the night.  For example, James McKenna has hypothesized (and is researching) the utility of infant arousals as a protective mechanism against SIDS[5][6].  The hypothesis is based upon the assumption that one possible manifestation of SIDS is that infants fall into states which they cannot arouse from and the body shuts down.  Infant arousals, therefore, serve to keep the brain awake (so to speak) to keep baby alive (according to this hypothesis).  In addition to McKenna’s arousal hypothesis, it is known that newborns do not share the same physiological sleep-wake cycle that adults do[7], and thus attempting to force that sleep pattern on them can have detrimental effects to their stress-reactivity.  How is that?  Well, turns out that the development of our sleep-wake cycle, or circadian rhythm, is intricately linked to the development of our cortisol cycles[4][8] and changing one seem to affect the other.

What are we doing by imposing these expectations?  Well, this is a huge topic that depends on how we deal with these expectations.  The fact that there is a plethora of Sleep Training books out there suggests we’re not doing our infants a favour when it comes to what we want them to do sleep-wise as methods such as Cry-It-Out have been linked with increases in cortisol to the brain which affects neural development, leading infants to develop a stress-reactive neurological profile (for a review, see[9]).  As a less benign response, children who are left to sleep alone (one of the main tenants of these Sleep Training books) are more likely to develop attachments to ‘security objects’ like stuffed animals or blankets and use them as sleep aids[10].  In and of itself this isn’t a bad thing, but the implication is that our children are not having some important psychological needs being met and are therefore finding that comfort in other ways.  As a parent, I can say that I would hope that I am able to provide the comfort and psychological security my daughter needs as an infant (because we all know they’ll need to cope as they get older, but infancy is not the time to start pushing that, but we’ll get to that later).  In line with the idea that a parent isn’t meeting his or her child’s psychological needs, these sleep methods can also contribute to insecure attachments as they recommend that, in order to get your baby to sleep, you ignore his or her calls of distress and consistent failures to respond to distress negatively affect the parent-infant attachment relationship[11].   Interestingly, there is evidence of a vicious cycle in this regard as these methods promote practices that can damage the attachment relationship and insecure attachment has been found to be a strong predictor of sleep disorders in early childhood[12].  Go figure.  And for breastfeeding moms, the effects can be particularly deleterious.  Keeping up a mother’s supply of breastmilk requires mom to breastfeed regularly, even through the night, and in fact breastfeeding at night is one predictor of a mother breastfeeding later and breastfeeding exclusively[13].  Given the innumerable benefits of breastfeeding, a mother having her supply decrease because she’s forcing her baby to sleep longer at night can have more global health effects.

Unlike the physical expectations, sleep expectations don’t just go away.  The pressure on parents and in turn babies to have infants fit this unrealistic pattern is unbelievably intense and only increases as infants’ age.  As a classic example of this, I was reading a scholarly paper on sleep disturbances across development and there was a tiny chart on one of the pages outlining what the sleep disorders are by age[14].  The author, one Dr. Carolyn Thiedke, stated that night waking was considered a “disorder” between 0-4 months of age and that between 4-8 months of age, any night waking should be treated with “systematic ignoring” and in turn doesn’t even suggest that any infant should be waking after 8 months of age.  When family, friends, and then the family physicians are giving this type of information to parents, what are parents supposed to do but heap that burden onto their tiny, beautiful little baby, setting themselves and their infant up for heartbreak and pain?

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[1] Markel H. Who says you have to crawl before you walk? Sudden infant death syndrome, crawling, and medical history. In J. Duffin (Ed.) Clio in the Clinic: History in Medical Practice (pp. 146-159). New York: Oxford University Press (2005).

[3] Schwartz GM, Izard CE, & Ansul SE. The 5-month-old’s ability to discriminate facial expressions of emotion. Infant Behav Dev (1985);  8:65-77.

[4] de Weerth C, Zijl RH, & Buitelaar JK. Development of cortisol circadian rhythm in infancy. Early Human Development (2003);7:39-52.

[5] Mosko S, Richard C, & McKenna J. Infant arousals during mother-infant bed sharing: Implications for infant sleep and sudden infant death syndrome research. Pediatrics (1997); 100:841-849.

[6] McKenna J, Thoman EB, Anders TF, Sadeh A, Schechtman VL, & Glotzbach SF. Infant-parent co-sleeping in an evolutionary perspective: Implications for understanding infant sleep development and the sudden infant death syndrome. Sleep (1993); 16:263-282.

[7] Carskadon MA & Dement WC. Normal human sleep: An overview. In MH Kryger, T Roth, WC Dement, & T Roehrs (Eds.), Principles and Practice of Sleep Medicine (4th Ed., pp. 13-23). St. Louis: Saunders (2005).

[8] Spangler G. The emergence of adrenocortical circadian function in newborns and infants and its relationship to sleep, feeding and maternal adrenocortical activity. Early Human Development (1991); 25:197-208.

[9] Gunnar MR. Social regulation of stress in early childhood. In K McCartney & D Phillips (Eds.), Blackwell Handbook of Early Childhood Development (pp. 106-125). Malden: Blackwell Publishing (2006).

[10] Hayes MJ, Roberts SM, & Stowe R. Early childhood co-sleeping: Parent-child and parent-infant nighttime interactions. Infant Mental Health Journal (1996); 17: 348-357.

[11] Ainsworth MDS. The development of infant-mother attachment. In BM Caldwell & HN Ricciutti (Eds.), Review of child development research (Volume 3, pp 1-94); Chicago: University of Chicago Press (1973).

[12] Benoit D, Zeanah CH, Boucher C, & Minde KK. Sleep disorders in early childhood: Association with insecure maternal attachment. Journal of the American Academy of Child & Adolescent Psychiatry (1992); 31:86-93.

[13] Ball HL, Klingaman KP. Breastfeeding and mother-infant sleep proximity: implications for infant care. In W Trevathan, EO Smith, JJ McKenna (Eds.), Evolutionary medicine, 2nd ed (pp. 226-241). New York: Oxford University Press (2007).

[14] Thiedke CC. Sleep disorders and sleep problems in childhood.  American Family Physician (2001); 63:277-284.