Home Page Office Sick Child Well Child Newborn Topics Other Issues ADHD Community Resources Links FAQ Email

Copyright 2010,
Sonja Brownlee, MD.
All rights reserved.
Site created by
Joanne Asch.
Questions about this site? Email Webmaster

Last Updated 1/2010

The information contained on this web site is not a substitute for direct examination and treatment by a physician. If any of this material is unclear or confusing, or if you have additional questions or concerns, please call the office at 778-6762. 

Disclaimer:Sonja Brownlee,M.D. cannot endorse all links presented on the website as they may link to unrelated third-party websites.

Sleeping

1. SIDS
2. Where Will Baby Sleep?
3. Sleep Position
4. Co-Sleeping
5. Sleeping Patterns
6. Establishing Basic Sleep Habits
7. Newborn
8. 1-3 Months
9. 4-5 Months
10. 6-7 Months
11. 8-12 Months
12. 1 Year Old Toddlers
13. 2 Year Old Children
14. 3 Year Old Children
15. 4 Year Old Children
16. 5 & 6 Year Old Children
17. 7-12 Year Old Children
18. Teens (13 - 18 year olds)
19. Sleep Disturbances
20. Resources
21. Sleeping Safety (0-11 months)
22. Sleeping Safety (1-5 years old)

Some parents prefer their baby to be in his/her own room from the very start. Others keep their baby in a bassinet next to parent's bed. And others prefer baby to sleep in bed with parents. Some families do a combination of these and change sleep places as baby grows.

Where your baby sleeps depends on your personality, your sleep needs, your comfort level, and what meets your needs for feeling fulfilled and bonded to your baby. When deciding on what "Your" needs and desires are, you must remember that "Your" includes mom, dad, baby, siblings, and whoever else may live in your home. As baby grows, you may find the need to rethink your needs and desires and adjust sleeping patterns and places accordingly.

Put your baby to sleep on his/her back for naps and at night. Tummy time is okay when your baby is awake. Sleeping baby on his/her tummy increases the risk of SIDS 10- to 15-fold over back sleeping. Side sleeping is safer than tummy, but still increases the risk 2-fold over back sleeping. (See SIDS for more details)

Car seats, swings, or carrier seats are not safe places for a baby to sleep, especially newborns (under 2 months old). See Can I let him sleep in his car seat in his crib?

Co-sleeping may promote breast feeding, minimize tummy infant sleeping, and increase parent and infant arousal, but it may also result in overheating and excessive exposure to passive smoke. Baby may also be sleeping on a soft mattress with pillows and quilts and may be at risk of entrapment between the bed and wall or headboard.

The American Academy of Pediatrics states that co-sleeping does not protect against SIDS and may increase the risk of accidental suffocation. However, many pediatricians and parents strongly advocate co-sleeping. If parents choose to share their bed with their baby, they should follow these guidelines:

1. Place your baby on his/her back to sleep.
2. Be aware of the risk of entrapment - adult beds are not designed to meet child safety standards.Be aware of suffocation risks. Avoid soft sleep surfaces, quilts, and pillows, for example.
3. Refrain from smoking or using substances that may impair arousal (drugs, alcohol).

(Go back to top)

The sleep-wake cycle and patterns of sleep undergo developmental changes from infancy to adulthood. 

Newborns spend about 70% of their time sleeping; adults, only 25-30%. 

Age	Sleep Time per Day
Infants	14-16 hours
2 years	13 hours
5 years	11 hours
10 years	10 hours
adolescence	8-9 hours

Age	Nighttime Sleep
Term Newborn	4-6 evenly distributed sleep-wake periods daily
6 weeks	starts consolidating sleep time into the nighttime period
4-6 months	many infants start to sleep through the night
6 months to adults	partial awakenings or light/deep sleep cycles.  The sleeper may open eyes, but resumes a deeper sleep once s/he recognizes a familiar environment.

Age	Daytime Sleep
by 6 months	to 3 naps per day
from 6 to 12 months	to 2 naps per day
from 12 to 24 months	to 1 nap per day
from 3 to 5 years	to no naps per day

Sleep States:

 NREM (non-rapid eye movement):

• brain activity slows, muscle movement and thermoregulation are preserved
•  predominate during the first third to half of nighttime sleep
• progresses through 4 stages:

In stage 1, a person is drowsy and yet still somewhat responsive. 

By stage 4 (slow-wave or delta-wave sleep or deep sleep), a person is very difficult to arouse and is quite confused if awakened.

REM (rapid eye movement):

• active sleep, dreams are common
• predominate in the latter half to third of nighttime sleep
• extremities are motionless (except muscle twitches are occasionally observed), thermoregulation is lost.
• sleeper has episodic bursts of rapid eye movement, irregular pulse, rapid breathing
• the amount of REM sleep decreases with age: infancy (50-85% REM Sleep) vs. adults (20% REM Sleep)

Children younger than 3 months of age experience mostly REM sleep.  At this age, sucking movements, facial twitches or grimaces, vocalizations, and stretching during REM sleep are common.  Minimal body movement is noted during this stage. 

Establishing Basic Sleep Habits

A good night's sleep can make a big difference in your child's day (and yours).  Sleep is thought to be important for learning, growth, healing, and proper function of the immune system.  Children who don't sleep well may be irritable, less successful in school, and more likely to have an accident.  And if one person in the family isn't sleeping, the rest of the family may be kept awake by the problem.  Fortunately, certain simple things you can do are the keys to good sleep.

 General

• Follow a consistent schedule for bedtime and wakening.
• Never use bed as a place of punishment

Daytime

• Discourage daytime play in the bed.
• Limit caffeine (tea, soda, chocolate), especially after lunchtime.
• Schedule naps, if needed, early in the day (before 2:00 pm)

 Nighttime

• Turn the television off at least 30 minutes before bedtime.
• Avoid meals, exercise, or stimulating TV shows near bedtime.
• Have your child empty his/her bladder just before going to bed.
• Establish a calming bedtime routine.
• Make the sleeping environment quiet, dark, and not too hot or cold.
• Put your child in bed while s/he is still awake, so s/he gets used to falling asleep there.
• Put infants to sleep on their backs.
• Don't reward your child for leaving bed - TV, play, and long conversations with you should not be allowed.
• If your child gets out of bed, calmly and immediately lead him/her back to bed.
• Stickers or other rewards given for staying in bed may be useful if your child keeps getting out of bed.

 Common Problems

Click here for information on a variety of Sleep Disturbances.

Newborn

States of consciousness: At first, your baby seems to do nothing but eat, sleep, cry, and fill diapers. By the end of the 1^st month, baby will be more alert and responsive. There are six states your baby will cycle through several times a day:

Deep sleep: quiet and relatively unresponsive to noise.

Light sleep: moves and startles to noises. Baby may "retreat" into sleep states when over stimulated.

Drowsiness: starting to wake or sleep.

Quiet alert: eyes open, face is bright, body is quiet.

Active alert: face and body move actively. Baby is most responsive to you during the alert states.

Crying: cries, even screams, body moves in very disorganized way. Best way to comfort at this age is to pick baby up and hold him/her.

The awake states may occur during your night-time and this "day-night reversal" may take 1-4 weeks to start to coincide with your daily schedule.

(Go back to top)

1-3 Month Old Baby

By 2 months, most babies have either dropped one nighttime feeding or stretched to feeding every 4-5 hours at night. By 3 months, most babies will sleep 6-8 hours without waking (usually a baby must weight about 12 pounds before s/he can sleep a 6-8 hour stretch). Some babies (especially if premature, or under 6 pounds at birth, or breast fed) will continue to nurse or feed every 2-4 hours at night.

Put your baby to sleep on his/her back for naps and at night. Tummy time is OK when your baby is awake. (See SIDS).

Encourage good night time sleeping habits by minimizing your interaction at night. Feed and change your baby with as little disruption as possible. If you want baby to sleep in his/her own room, always go there to nurse or feed at night. If you bring baby to your bed at night, baby will want to sleep there and it can be very difficult to move baby out of your bed when s/he is older. (see co-sleeping above)

Babies cycle between light and deep slumber. They often squirm, startle, fuss, or even cry during light slumber. You'll soon learn to tell the difference between when baby may just be fussing in light sleep and when s/he's truly hungry. Give baby a chance to settle into deep slumber on his/her own without picking him/her up too soon to nurse or feed. Some babies need to let off energy by crying in order to settle into sleep or rouse themselves out of sleep. As much as 15 minutes of fussing won't harm your baby. Just be sure s/he's not crying out of hunger or pain, or wet or messy diapers. If you're becoming exhausted with your baby's schedule, call the office for advice for your specific situation.

(Go back to top)

4-5 Month Old Baby

If your baby has slept in a bassinet, s/he will most likely outgrow it by 4 months of age and be ready to sleep in his/her crib.

Most 4-5 month old babies need two 1-3 hour naps each day, but some babies take more frequent shorter naps (catnaps) each day.

Many 4-5 month old babies can sleep a 6-8 hour stretch at night, however, if co-sleeping with parents and breast fed, they may still nurse every 2-4 hours. (See co-sleeping above).

Put your baby to sleep on his/her back for naps and at night. Tummy time is OK when your baby is awake (See SIDS).

If you want baby to sleep in his/her own room, always go there to nurse or feed at night. If you bring baby to your bed, it may be quite difficult to move baby out of your bed when s/he is older.

Babies cycle between light and deep slumber. They often squirm, startle, fuss, or even cry during light slumber. Give baby a chance to settle into deep slumber on his/her own without picking him/her up too soon to nurse or feed. If you're becoming exhausted with your baby's schedule, call the office for advice for your specific situation.

(Go back to top)

6-7 Month Old Baby

Most 6-7 month old infants need two 1-3 hour naps each day, though some prefer to catnap (more frequent shorter naps).

Most 6-7 month old infants will sleep 8-12 hours at night, though some still wake 1-2 times for nursing or a bottle. If co-sleeping and breast fed, they may still nurse every 2-4 hours at night.

Try to start a consistent bedtime ritual (bath, rocking, music, etc), but try not to let baby fall asleep during this. Try to put baby to bed while s/he's still awake so s/he learns to fall asleep alone. Fussing or crying for 10-15 minutes is OK.

Night waking problems: By 5-6 months of age, most babies have developed their own patterns of sleep. If your baby changes his/her sleep habits by waking more often during the night (and s/he is not teething or developing a cold), s/he may develop night waking habits. Babies cycle between light and deep slumber. They often squirm, startle, fuss, or even cry during light slumber. Try to let baby fall back to deep slumber on his/her own. If your baby doesn't settle down , you must check on him/her. If baby is not ill, don't pick him/her up to rock back to sleep, don't feed, and don't bring baby back to your bed: You don't want baby to need you to be part of his/her "nesting" routine. Baby may need to be started on some solid food feedings during the day, or it may be time to move baby to his/her own room, or maybe you need to turn off the night light, or turn one on, etc. Please call the office, 778-6762, for advice for your specific situation.

(Go back to top)

8-12 Month Old Baby

Most 8-12 months old babies still take 2 naps a day and sleep 8-12 hours each night.

Night-time waking can become a problem. Babies have 4-6 sleep cycles each night, so baby may rouse during light slumber, murmur or cry briefly, and fall back to sleep.  If baby wakes more fully or cries more vigorously, s/he may need reassurance that you are there. Go to baby to be sure s/he's not sick or messy. If baby is OK don't feed, don't pick baby up, and don't bring baby to your bed! Say a quick "good-night, I love you, see you in the morning" and leave and let baby put him/herself back to sleep.

As separation anxieties intensify, baby may resist going to bed and may wake up more at night. Keep a regular bedtime ritual and say goodnight while baby is still awake. Baby may fuss and cry, but stay calm and consistent! Baby will learn to fall asleep and may start sucking a thumb or attach to a special blanket or toy. Continued use of a pacifier at bedtime at this age is also OK.

This information applies to parents that desire their babies to sleep in their own cribs in their own rooms. Bringing your baby to sleep in your bed is OK, if that's what works best for both parents. (See co-sleeping) Training your child to sleep in his/her own crib or bed as s/he gets older can become more difficult and more traumatic for both child and parents. Call our office, 778-6762, for advice for your specific situation.

(Go back to top)

1 Year Old Toddlers

This advice is for toddlers that already sleep in their own rooms. It's OK for your toddler to sleep in your bed, if that's what works best for both parents. (See co-sleeping) Training your toddler to sleep in his/her own bed when s/he's used to co-sleeping with parents can be quite difficult and traumatic for both toddler and parents. Call our office, 778-6762, for advice for your specific situation.

No toddler looks forward to sleep: it means missing out on the action and separating from you. Toddlers will party till they drop! Set a regular bedtime and have a quiet bedtime routine: whether it includes a bath, story, etc, the routine should end with toddler quiet, but awake, in his/her crib, ready for your goodnight kiss before you leave the room.

Night waking is also a reality of life with toddlers. Causes include: a change in routine, changing rooms or beds, losing a favorite toy or blanket, travel, cutting a tooth, and dreams. These are all valid reasons for waking, but not for you to pick him/her up, bring him/her to your bed, or feed him/her. Do respond by voice, or a quick check for illness, then a reassuring pat, "goodnight", and leave the room and let your toddler settle back to sleep alone.

(Go back to top)

2 Year Old Children

Your child may need 9-13 of sleep hours a day. Most 2 year olds take a 2-3 hour nap in the afternoon, some take 2 shorter naps, and others give up napping entirely. Unless s/he routinely becomes irritable and overtired from lack of sleep, there's no reason to force a nap schedule. However, most 2 year olds will benefit from a "quiet time" where he/she must stay on his/her bed looking at books or playing with quiet toys. Your 2 year old may often fall asleep during this quiet time.

Many 2 year olds resist bedtime. Have a set bed time (which is the parent's choice, not the child's) and ritual (Turn the TV off, calm the household down, play soothing music, have a light snack, brush teeth, change clothes, read a story, say prayers, and say "Goodnight") Do let your child make as many choices as possible (and reasonable): what PJ's, what story, what stuffed animal to sleep with, and leave a night light on if s/he wants one (there is no danger to the eyes).

(Go back to top)

3 Year Old Children

Your 3 year old needs 10-12 hours of sleep each day.  Most 3 year olds need a 1-2 hour nap in the afternoon.  If your child refuses to nap, but seems to be irritable, over-tired, or hyper without a nap, you might call it a “quiet time” when your child does not have to sleep, but must stay on his/her bed reading or playing quietly for a set time each day.  S/he may occasionally sleep during this time.

Most 3 year olds sleep through the night, but often rouse several times to check their surroundings before falling back to sleep.  Your child may have occasional nightmares that awaken him.  S/he needs to be reassured that dreams are not real:  hold, comfort and stay with him until s/he’s calmed down.  If dreams cause night waking too frequently, consult your pediatrician.  Click here for information on Night Terrors. 

(Go back to top)

4 Year Old Children

Your 4 year old needs 10-12 hours of sleep each day. 

• Most 4 year olds have stopped napping, but many still need a “quiet time” to rest and read or listen to music or books on tape.
• Bedtime is a parent’s choice, not a child’s; but your 4 years old should not be “sent to bed.”  S/he still needs supervision with bathing, putting on PJs, and brushing teeth.
• Reading aloud to your child at bedtime is a great way to help your active 4 year old settle down; and studies show it improves school success later.
• If your child is “scared” at night, include a “monster wand or spray” as part of your final goodnight.  Magical thinking works at the age of 4!
• Night waking is uncommon at this age.  However, nightmares do happen and most 4 year olds do need brief reassurance and comforting.  Keep this short and calm. Don't give your child food or bring him/her to your room.  Click here for information on Night Terrors.

Bed-wetting: About 30% of 4 year olds still wet at night.  If your child has never been consistently dry at night, it’s not abnormal.  Do not punish or ridicule, s/he is not wetting on purpose.  Do not limit fluid intake or wake your child at night to use the bathroom.  Bed-wetting will stop as your child grows older.  If your child had been dry at night for 6 months or more, and then begins to wet again, there may be an underlying physical or emotional cause.  Please call for an appointment.

(Go back to top)

5 & 6 Year Old Children

Your 5 or 6 year old needs 10-12 hours of sleep each day. Most 5&6 year olds do not nap, but some may need a "quiet time" to rest and read or listen to music, etc.

Most 5 & 6 year olds sleep through the night. Nightmares are still fairly common and your child will need reassuring. Keep this short and calm.

(Go back to top)

7-12 Year Old Children

Your elementary aged child will need 9-11 hours of sleep each day.  Children's sleep habits vary considerably and some children need significantly more or less sleep than others.

Sleep problems at this age are relatively uncommon, although most youngsters will have nightmares from time to time.  Insomnia (difficulty falling asleep or staying asleep) may be caused by stress or anxiety.

(Go back to top)

Teens (13-18 year olds)

Your teen will need 8-10 hours of sleep each day. Teen's sleep habits can vary considerably and some teens need significantly more or less sleep than others.

 The main sleep problem in teens is not getting enough.  In our hectic modern lives, it is rather common that children and teens do not get enough sleep.  Studies show that as children progress through middle school (6^th -8^th grade), the amount of nightly sleep declines, along with self-esteem and grades, while symptoms of depression increase.   Studies have also tested the opposite: did depression, falling grades, and lowered self-esteem cause decreased sleep?  The result was, No.   So, once again, Mom is right:  A good night's sleep is a key to success!

Sleep problems at this age are often a sign that something else is going wrong in your teen's life.  Changes in your teen's sleep pattern -- sleeping excessively, excessive or recurrent nightmares, insomnia (difficulty falling asleep or staying asleep) -- is one of the "red flags" for undue stress, anxiety, depression, suicide, drug or alcohol use, sexual activity, delinquent activity, and/or a new medical or psychiatric problem.

(Go back to top)

Sleep Disturbances 

If sleep struggles like these persist, please call the office, 778-6762, for advice for your specific situation.

Bedtime Difficulties

• General problems with negative and oppositional behavior, in which s/he has difficulty following and adhering to rules and routines.
• Separation anxiety.  Many children who have little contact with their parents will have difficulty separating from them at bedtime.
• Wanting private time with parents when siblings are not around.
• Too early of a bedtime.  Are you expecting your child to sleep more than s/he needs?  Is your child an "owl" with a body clock set for staying up late and sleeping in? 
• Habits and learned behavior.  Some children simply get used to being up late.  Allowing your child to stay up late and sleep in on weekend days can make it hard to re-establish a "school day" bedtime and wake up time.  Most 7-12 year olds do better on a consistent sleep schedule 7 days a week.
• ADHD (Attention Deficit Hyperactivity Disorder).  Many ADHD children need less sleep than their peers.  They may also have great difficulty settling down to sleep at bedtime.

Sleepwalking

About 15% of all children between ages 5-12 have at least one sleepwalking episode.  It tends to happen more in boys than girls, and it tends to run in families.  It usually disappears on its own, usually by 10-13 years of age.

Sleepwalking usually occurs during the 2^nd or 3^rd hour of nighttime sleep.  Your child will walk around without being totally awake.  Make sure your sleepwalker cannot hurt him/herself.  Lock doors so that s/he cannot leave the house, block stairways, and put hazardous objects away.  When you find your child walking in his/her sleep, gently lead him/her back to bed.

Sleep Talking

This occurs more often than sleepwalking.  Most episodes occur during nondreaming sleep and last less than 30 seconds.

Nightmares

Common in 5-12 year olds, usually occurring in the early morning hours, and  remembered the next day.  Nightmares often wake your child up and leave him/her feeling scared.  S/he may need your reassurance in order to fall back asleep.

Nightmares seem to happen more often during times of stress.  If your child has frequent nightmares or if the same scary dream recurs repeatedly, evaluate the stress in your child's life.  Stress does not mean some big event like a death, divorce, or serious illness in the family, etc.  Talk with, and listen to, your child about school, friends, grades, teachers, your home life, siblings, etc.

Night Terrors

Night Terrors are different from nightmares.  They occur about ½ -3 hours after falling asleep.  Your child will sit up in bed and scream or cry for help, gasp, moan, mumble, thrash about, and seem to be in a confused, agitated state.  S/he will not respond to your efforts to comfort, and may even push you away.  It can last for 30-60 minutes, and then can end rather quickly with your child returning to peaceful sleep.  S/he will not remember anything about it the next day. 

Night Terrors occur in only 1-5% of children.  They do not indicate an underlying psychological disturbance.  Children outgrow night terrors without treatment.

How They Differ...	Nightmare	Night Terror
What is it?	A scary dream followed by complete awakening.	A partial arousal from very deep sleep.
When do you realize it?	Afterwards, when your child wakes up and tells you.	During the terror, as child screams and thrashes
Time of occurrence:	In the second half of the night.	Usually 1-4 hours after falling asleep.
Appearance and behavior:	Crying and fearful after waking.	Sitting up, thrashing, bizarre movements. Crying, screaming, moaning, talking, bulging eyes, racing heart, sweating.
Responsiveness	After waking, child is aware of and reassured by your presence.	Child is not very aware of you, and may physically push you away, screaming and thrashing more if you try to restrain her.
Return to sleep	May have trouble falling back to sleep because of fear	Returns to sleep rapidly without fully awakening
Memory of experience?	Often remembers dream and may talk about it.	No memory of a dream or of yelling or thrashing.

 

Sleep Apnea

Children with sleep apnea briefly stop breathing many times during the night due to an obstruction in the respiratory tract, such as enlarged tonsils and adenoids or obesity.  During these episodes, your child will instinctively gasp for breath and awaken momentarily, and then fall asleep.  Most children don't remember any of these the next morning.  Some children with sleep apnea snore.  Children with sleep apnea are sleep deprived.  They may be sleepy during the day, or irritable, or depressed, or inattentive at school.

(Go back to top)

Resources

If you want to know more about sleep in children, here are a few books:

• Solve Your Child's Sleep Problems, by Richard Ferber
• Sleeping Through the Nigh: How Infants, Toddlers, and Their Parents Can Get a Good Night's Sleep, by Jodi A. Mindell
• American Academy of Pediatrics Guide to Your Child's Sleep: Birth Through Adolescence, edited by George J. Cohen