What is Normal Infant Sleep? (Part III)

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By: Tracy G. Cassels
Wendy Middlemiss
Darcia Narvaez
Sarah Ockwell-Smith
John Hoffman
Kathleen Kendall-Tackett
Helen Stevens

Infant sleep problems are some of the most common concerns reported by parents of young children.  Ask any new parent and most will complain about lack of sleep. Many will also be worried that what they are experiencing isn’t “normal” and that they believe that their child has a problem that needs fixing.  So they search books, ask friends and family or even their doctor about what to do about their child’s problematic sleep patterns.  And to top it off, they feel immense anxiety and worry about it.  Part of this epidemic of parental angst about children’s sleep is that we live in a culture in which parents are repeated told that they need to worry about their child’s sleep, that there will be dire consequences if their child doesn’t get enough sleep. Another problem is that most new parents, having had little experience with children prior to having their own, have little awareness about what truly is “normal” when it comes to infant sleep.

Simply being made aware of normal sleep patterns can help alleviate the stress and anxiety parents feel, leading to happier times for the entire family.

So what is normal?

In this series of posts, we’ll tackle some of the more common sleep concerns parents have with the hope that they can see them as normal, developmental stages for their child.

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PART 1: THE CRITICAL ROLES OF FEEDING METHOD AND CHANGES IN DEVELOPMENT

PART 2:  THE IMPORTANCE OF UNDERSTANDING INDIVIDUAL PATTERNS IN SLEEP

PART 3: NORMAL PARENT BEHAVIOURS AND WHY THEY WON’T HURT YOUR CHILD

“My child is still sleeping in our bed.”

Many parents who sleep with their child get comments along the lines of, “Your child will never leave if you don’t move them” or “What about your sex life?”.  Parents end up questioning if they are doing the right thing for their child or if they will end up with a 16-year-old who still wants to crawl into bed with mom and dad every night.  First, let’s address the question of when a child leaves the bed.  Rest assured that your child will not be dragging you off to college so they can still sleep with you even if you don’t force them out of the bed.

The age at which a child is ready to move into their own room varies widely and bedsharing is quite common worldwide.  Notably, bedsharing rates in Scandinavian countries and Asian countries are much higher than those in the US or Canada (Mindell, Sadeh, Wiegand, How, & Goh, 2010; Nelson & Taylor, 2001; Welles-Nystrom, 2005; for a review, see Cassels, 2013).  Parents polled by one the authors about the age at which their child initiated the move to another room report ages as young as 18 months and as old as 10 years.

Some factors that influence the transition age include: having a sibling in the other room (thus being able to room-share with another child), the presence of a new baby in the bed (and needed attention to safety for the new baby and disrupted sleep for the older child), and the child’s own developmental needs. Each family will need to consider the factors that are relevant for their particular child.  No one should tell a family that they must stop the family bed if it is working for them.  Importantly, the research on extended bedsharing has not found any social, emotional, or cognitive detriment for bedsharing children relative to children who were placed in their own room in infancy (e.g., Abel, Park, Tipene-Leach, Finau, & Lennan, 2001; Barajas, Martin, Brooks-Gunn, & Hale, 2011; Keller & Goldberg, 2004; Okami, Weisner, & Olmstead, 2002).

The second issue that is often brought up is to do with the marital relationship when the family bed is utilized.  New research looking at bedsharing and marital satisfaction has reported no influence of bedsharing on the marital relationship when bedsharing is intentional (Messmer, Miller, & Yu, 2012).  When bedsharing is in reaction to child sleep problems, parents may report greater stress on their relationship, but it is likely that this is due to the problems associated with infant sleep problems.  As to intimacy, parents of co-sleepers and bedsharers often find creative ways to make sure their needs are met as well.  There are excellent (and humorous) blogs on the topic if you’re in need of some extra assistance.

 

“My child only goes to sleep nursing.”

Most parents in the early months know how quickly an infant can go to sleep while nursing.  In fact, nursing often is what sends our little ones to sleep.  Although many people do not think twice about these behaviours when their infants are still quite tiny, they start to worry about it as the child ages.  It doesn’t help that falling to sleep while breastfeeding is listed as one of the sleep disorders by sleep researchers (Melzer & Mindell, 2006) and that often family and friends will tell you that you’re doing your child harm and that he or she will never learn to fall asleep on his or her own.  Many “sleep experts” will recommend not letting your infant fall asleep on your breast for fear of creating this “bad habit” (Meltzer & Mindell, 2006), instead recommending that you rouse your little one before putting him or her down.

As long as breastfeeding your child ‘til they are sleeping and placing them down while sleeping is not a problem for you as a parent, you need not worry about it for your child.  How can we say this?  First, a child who is tired enough will fall asleep with or without breastfeeding.  Although falling asleep at the breast may remain a preferred way to fall asleep for a child (full of the closeness and intimacy that is so necessary for bonding), it will not be a necessary step. As children age, they will fall asleep in various places and positions.  Young infants should not be forced to fall asleep without comfort; they may need to nurse to feel relaxed and safe enough to enter sleep.  Another factor to remember is that all children eventually wean.  Nursing and cuddling to sleep offers comfort for your child, a closeness that is associated with positive developmental outcomes. Children  will seek this closeness as a natural part of development.   This is not a bad thing, it is simply offering your child the closeness that is a natural part of growth and parenting.

If still uncertain, be assured that breastfeeding is a natural way to help children sleep and provide important support for their growth. Parents should know that breastmilk in the evening contains more tryptophan (a sleep-inducing amino acid). Tryptophan is a precursor to serotonin, a vital hormone for brain function and development. In early life, tryptophan ingestion leads to more serotonin receptor development (Hibberd, Brooke, Carter, Haug, & Harzer, 1981). Nighttime breastmilk also has amino acids that promote serotonin synthesis (Delgado, 2006; Goldman, 1983; Lien, 2003). Serotonin makes the brain work better, keeps one in a good mood, and helps with sleep-wake cycles (Somer, 2009). So because of tryptophan and its wider effects, it may be especially important for children to have evening or night breastmilk for reasons beyond getting them to sleep.

The other concern that is brought up is that infants and children who fall asleep at the breast (or even in-arms) often wake looking for the same environment in which they first feel asleep (Anders, Halpern, & Hua, 1992).  This can lead to crying upon waking when they find themselves in a different environment, such as a crib.  [For parents who bedshare and breastfeed, parents have reported decreased signaling as infants learn to seek mother’s breast and  latch themselves on to breastfeed when waking at night. Though arousals continue to be greater in bedsharing dyads (Mosko, Richard, & McKenna, 1997), this natural interaction provides a soothing and simple way to care for infants as they wake.]  In these cases, when the children are developmentally ready, putting them down nearly asleep and letting them finish the process on their own may help reduce wakings that result in signaling for the parent.  However, one should not expect an infant (or toddler) to sleep through the night as they have myriad needs that require parental responses, even during the night.

 

“My child only naps when I’m outside/walking/on me.”

Wouldn’t it be nice if infants and children wanted to sleep exactly where we wanted to put them on a given day?  No joke here – it would be wonderful, but unfortunately it’s not how most babies sleep.  We’ve heard of moms complaining about having to be outside walking for a nap to happen while living in cities with blizzards and 30 below weather, or needing to be walking constantly (inside or out) meaning naps are not only not a time of respite for mom, but can be downright unpleasant.

Interestingly, the most common situations involve touch, sound, or movement, three things that are abundant for the infant while in the womb.  Recall that human babies are born at least 9 months early compared to other animals because of head size (if they got any bigger they could not get through the birth canal; see Trevathan, 2011), so for at least 9 months their bodies expect an “external womb.” So is it much surprise that outside the womb they expect the same things to lull them to sleep?  With respect to touch, we know that oxytocin plays a huge role in feelings of contentment, security, and love, all of which affect the quality of our sleep (Uvnäs-Moberg, 2003).  So it is not difficult to imagine that infants who are physically close to their caregivers, experiencing a release of oxytocin, are much more likely to fall asleep and remain asleep.

A second factor is sound – most notably the caregiver’s heartbeat, a sound that is highly familiar to infants from their time in the womb.  When it is the mother holding the infant, her heartbeat, voice, and breathing can all offer a form of white noise which helps an infant feel safe and remain asleep, though the same effects can happen when another caregiver holds the infant as well.  When this is not possible, the use of a white noise machine to block out some of the more abrasive sounds of our environment while still providing background noise can help with infant sleep.  These white noise machines have been successful in inducing infant sleep (Spencer, Moran, Lee, & Talbert, 1990), and at assisting some parents achieve better sleep (Lee & Gay, 2011).

The third factor, movement, was also abundant in the womb, with baby in a soft, liquid pouch being swayed regularly.  Remember how your baby was always awake in utero when you were resting?  It’s because he or she was sleeping while you moved.  Modern parents in Western cultures often focus on the car ride to get their infants to sleep.  The lull of the car coupled with the snugness of the car seat can send many infants into a drowsy state, allowing them to nap contently while parents drive aimlessly around.  However, the same movement-induced sleep can be gained from the use of a stroller, providing mom or dad with the ability to run errands or go for a walk or run.  Possibly best of all, babywearing promotes movement, touch, and sound, all while allowing the caregiver to run errands and generally go about one’s life. Babywearing may provide the best form of an “external womb” for developing the baby’s brain and body in optimal ways (Narvaez et al., 2013).

The take-home point, though, is that it is normal for infants to prefer to sleep in contact with others rather than away from what many people would consider the “ideal” sleep space.  Even though adults may prefer it, a bed in a quiet room is not necessarily ideal for infant naps.  For a summary of napping behaviour and safe napping behaviour when wearing a baby, please click here for a great handout from ISIS (Infant Sleep Information Source).

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A Final Summary

Over these three posts, we hope we have made it clear that often what parents perceive to be problematic infant sleep patterns that require “fixing” are actually quite normal and developmentally appropriate.  We are cognizant of the fact that many families still find infant and toddler sleep to be a problem, which is why we are also focusing on writing about how to gently help with infant and toddler sleep.  What we hope parents take home from this series is (a) a better understanding of the broad array of behaviours that constitute “normal” when it comes to our children’s sleep, and (b) that if the behaviour is not posing a problem for the family, you can rest assured the child is not suffering from these very normal sleep behaviours.  Instead of following a particular expert’s advice, understand what is needed to keep babies safe when they sleep and build the sleep environment around these safe behaviors… then do what works best for your child. Let your child be your guide.

 [Image Credit: Bebo Mia]

References

Anders, T.F., Halpern, L.F., & Hua, J. (1992).  Sleeping through the night: a developmental perspective.  Pediatrics, 90, 554-560.

Barajas, R.G., Martin, A., Brooks-Gunn, J., & Hale, L. (2011).  Mother-child bed-sharing in toddlerhood and cognitive and behavioral outcomes.  Pediatrics, 128, e339-e347.

Cassels, T.G.  (2013).  ADHD, sleep problems, and bed sharing: future considerations.  The American Journal of Family Therapy, 41, 13-25.

Delgado, P.L. (2006). Monoamine depletion studies: Implications for antidepressant discontinuation syndrome. Journal of Clinical Psychiatry, 67(4), 22-26.

Goldman, A. S. (1993). The immune system of human milk: Antimicrobial anti-inflammatory and immunomodulating properties. Pediatric Infectious Disease Journal, 12(8), 664-671.

Hibberd, C.M.; Brooke, O.G.; Carter, N.D.; Haug, M; Harzer, G. (1981). Variation in the composition of breast milk during the first 5 weeks of lactation: implications for the feeding of preterm infants. Arch. Dis. Child., 57:658-62.

Lee, K.A. & Gay, C.L. (2011). Can modifications to the bedroom environment improve the sleep of new parents?  Two randomized control trials.  Research in Nursing and Health, 34, 7-19.

Lien, E.L. (2003). Infant formulas with increased concentrations of α-lactalbumin. American Journal of Clinical Nutrition, 77(6), 1555S-1558S.

Meltzer, L.J. & Mindell, J.A. (2006).  Sleep and sleep disorders in children and adolescents.  Psychiatric Clinics of North America, 29, 1059-1076.

Messmer R, Miller LD, Yu CM.  The relationship between parent-infant bed sharing and marital satisfaction for mothers of infants.  Family Relations 2012; 61: 798-810.

Mindell, J. A., Sadeh, A., Wiegand, B., How, T. H., & Goh, D. Y. T. (2010). Cross-cultural differences in infant and toddler sleep.  Sleep Medicine, 11, 274-280.

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

Narvaez, D., Panksepp, J., Schore, A., & Gleason, T. (Eds.) (2013). Evolution, Early Experience and Human Development: From Research to Practice and Policy. New York: Oxford University Press.

Nelson, E.A.S. & Taylor, B.J.  (2001).  International child care practices study: infant sleeping environment.  Early Human Development, 62, 43-55.

Somer, E. (2009) Eat your way to happiness. New York: Harlequin.

Spencer, J.A., Moran, D.J., Lee, A., & Talbert, D. (1990).  White noise and sleep induction.  Archives of Diseases in Childhood, 65, 135-137.

Trevathan, W.R. (2011). Human birth: An evolutionary perspective. New York: Aldine de Gruyter.

Uvnäs-Moberg, K. (2003).  The oxytocin factor: tapping the hormone of calm, love and healing. Cambridge, MA: Da Capo Press.

Welles-Nystrom, B. (2005).  Co-sleeping as a window into Swedish culture: considerations of gender and health care. Scandinavian Journal of Caring Science, 19, 354-360.

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Comments

  1. stephanie says

    Thankyou for these posts. They have been the final nail in the coffin of any thoughts of sleep training (gentle methods included), as i know now that any short term benefits would likely be undone by baby’s own change in sleep patterns.

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