Myths and Facts About Night Wakings

When you hear of most people talk of night-wakings in infancy, there seems to be a fear that somehow if they aren’t stopped (usually by a parent), one will be looking at long-term problems that will follow your infant into childhood and beyond.  It’s really rather dramatic, especially for something that is so biologically normal for infants.  After all, they biologically expect to breastfeed and the fat content of our human milk is much lower than in other mammals, meaning our babies need to feed frequently to simply stay alive and grow.  (This is why scheduled feeds with hours between are linked with a ‘failure to thrive’ condition in the short-term[1] and lower intelligence in the long-term[2].)

But what is the situation with respect to night wakings across infancy, toddlerhood, and childhood?  At what point do frequent night wakings pose a problem that will follow a child long-term?  Or is it simply a state like any other state?

Myth: Your baby should be sleeping through by 3 months of age.

Fact: Night waking is normal for babies and toddlers.

I think we first need to be clear that night waking itself isn’t really the “problem”.  The “problem” is that when younger children wake, they often require parental help to fall back asleep, and so parents view night wakings as a problem[3] despite them being biologically normal and not contrary to healthy development.  We must also be clear that when people believe their baby or child “sleeps through the night”, they can only refer to the fact that they do not wake when or if their child wakes.  Babies and children can wake and fall asleep on their own again (though not all will) and so parents simply have no idea how often (if at all) these babies are rousing during the night.

How normal is night waking?  Well, in a longitudinal study looking at night wakings between birth and 3 years of age, the percentage of infants/children who did not signal their parents at night from 6 months to 3 years only rose from 29.58% to 37.94%[4].  At 3 years of age, 25.6% of toddlers were waking and signalling their parents 3 or more nights per week.  And notably, none of these children suffered any clinical problems or sleep disorders.

Myth: If your baby wakes regularly into the night, they will continue to wake in the night until you stop it.

Fact:  Early night waking does not predict later night wakings.

What do I mean?  Well, I mean that night waking in infancy does not predict night waking at later ages, at least based on a very comprehensive, longitudinal study out of Switzerland[5] and there are no studies I have found that counter this finding.  In this particular study, which examined 493 children and their families, night wakings from 3 months of age onward actually rose consistently until age 4, when over half of the children were waking at least once per week and 22% were waking every night.  These numbers then declined slightly until age 10, but even at age 10, over 20% of children were waking at least once per week and around 4% were waking nightly.  Notably, night waking in infancy (< 1-2 years) was not predictive of night waking later, but later (> 1-2 years) night waking was associated with further night wakings.  Now, what the authors do not measure, and acknowledge as a limitation, is how long the child wakes, the reason for waking, does the child require parental help, breastfeeding, etc.

 

Notably, night wakings were not associated with other sleep disturbances, such as bedtime resistance and sleep-onset problems (i.e., the ability to fall asleep relatively efficiently).  This implies that they are distinct from other sleep behaviours that parents find problematic.  Though only my opinion, my take is that these other behaviours reflect social or emotional issues (e.g., anxiety around sleep, stress) while night wakings are more physiological or biological in nature.

[Somewhat off topic but fascinatingly, they found that increases in bedsharing in the toddler years was associated with less bedtime resistance or sleep-onset problems, suggesting that children are yearning for contact and experiencing separation anxiety which bedsharing provides a “fix” to.  The authors propose this as well as cohort effects found that children raised in an earlier time did not have the bedsharing rates later groups did and had much greater reported problems associated with bedtime resistance and sleep-onset problems.]

Myth: Night waking is a sign that something is wrong and you have to do something to fix it.

Fact: Night waking often reflects developmentally appropriate behaviour across all ages.

One of the highlights of the Swiss research mentioned above was the acknowledgement that night wakings may not be negative at all, but rather reflect the individual developmental stage of any child.  As they so wonderfully put it,

[N]ight wakings must be understood in the context of cognitive, emotional, and physical changes that occur at different developmental stages.  Some children may need parental proximity during the night as during the day depending on their developmental level, individual characteristics, and attachment behavior.[5]

In the toddler years, night wakings are often associated with children coming into bed with the parents as many toddlers are first put to sleep in their own room or bed.  The degree of separation anxiety that toddlers feel can be great and they require the proximity to parents to help feel safe again[6], leading to night wakings and moving sleep locations.  This same feeling of anxiety or security can come at all ages throughout childhood, though, and a child that still demonstrates this at 8 or 9 years of age is still in the developmentally normal range.  There is also the issue of nighttime fears and nightmares which increase with age through childhood until a peak (often early childhood) then start to decrease again; these fears are considered cognitively, socially, and emotionally normal[7], but do result in night wakings that often require parental involvement.  Then of course there are the reasons we all tend to wake at night (adults included): Going to the bathroom, too much on our mind, stress, etc.  These things can affect children as well, especially school-age children who have to cope with school, evolving relationships with friends, possible stress in the household, and more.

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Lots of people today worry that night wakings reflect a “problem” and that they need to deal with it or else they will face long-term sleep problems.  Well, first let’s be clear that night wakings in infancy have no predictive power over later night wakings.  So you can put that little myth to rest.  Second, you can be sure that night wakings are entirely normal through toddlerhood and are not associated with any ill effects for your child.  Not all children will experience them, but those that do are not experiencing anything problematic.  And finally, many of the children who continue to wake do so for very normal, developmentally appropriate reasons; just as adults often wake at night too.  There may be times when parents need to seek help about their child’s sleep, but these will often be due to more than just night wakings.  Clusters of problems are what parents should be concerned with, not night wakings alone.

So the next time someone – anyone – tells you that you need to stop your child from waking in the night, you can – at the very least – smile, nod, and go ahead and do absolutely nothing.  Without worry.