Whenever I talk to new or expectant parents about sleep, the most important message I convey is what normal infant sleep actually looks like. Mainstay questions which plague new parents, including the perennial, “Is he a good baby? Is he sleeping?” perpetuate a belief that babies, from a very young age, should be sleeping in a similar way to adults. Yet, babies are very different indeed to adults - in many ways. And sleep is no different…
Human babies are born with a brain that is just 25% of the size it will eventually reach. This is largely due to our evolution to walk upright and, by association, the narrowing of the human pelvis through which a baby is expected to pass at birth. Unable to gestate until the brain is fully-developed, babies arrive early and continue their rapid development out in the big wide world.
New-born babies sleep a lot. After all, all that development and processing of new stimulation is tiring! However, unlike typical adult sleep, newborns take their rest in smaller chunks. This is, in part, due to their tiny tummies and the need to feed frequently. One of the most damaging myths I hear around child sleep is that formula helps babies to sleep longer. For desperately tired parents, this can sound very appealing indeed. However, there is absolutely zero evidence to support this claim. In fact, the evidence that is available finds that it is exclusively breast-feeding mums who get the most sleep overall.
A full tummy
Where I suspect the confusion arises is that bottle-fed babies often do, initially at least, sleep for longer chunks of time. However, this is largely due to how a baby feeds rather than what they are drinking. Traditional bottle-feeding, where babies often drink more and/or finish the bottle more quickly, typically leads to guzzling, where baby overfills before their stomach has communicated its fullness to the brain. This applies no matter whether baby is guzzling formula or expressed breast milk.
With an over-full tummy, babies may well “conk out” and sleep for longer stretches, which is often construed as a positive. However, over time, the over-filling will systematically stretch a tiny tummy. It can also lead to a strong association between over-satiety and sleep. Neither of these outcomes are positive in the longer-term.
When babies are pace-bottle-fed, a strategy which mimics breastfeeding, they tend to take smaller, more frequent feeds in line with their hunger. Whilst this can mean more wake-ups, the feeding pattern is a biologically more normal one. It also helps to keep a baby safe…
As babies move through their early weeks and months, with a little help from their parents, they begin to figure out night from day. Alongside this, they also begin to take at least one longer stretch of sleep in a 24-hour period, which, as long as their body-clock has correctly established, will be at some point during the night. As this period lengthens, babies become more vulnerable to SIDS, with the risk peaking between two and four months of age. This is because babies don’t sleep like adults – at least not in the beginning. Rather than cycling through periods of lighter sleep every hour or so, very young babies are either awake or fairly deeply asleep. It is during periods of lighter sleep that our body checks whether it needs anything – are we thirsty, wet, too hot or too cold? Without these frequent self-checks, babies are vulnerable.
Unless advised by a medical professional, I generally don’t advocate waking babies for feeds. However, proactively encouraging a longer chunk of sleep through methods such as “tanking up” a baby are not recommended either – being led by your baby is the safest and most biologically normal option.
When sleep is elusive
For anyone thinking, “My child doesn’t/has never taken one longer chunk of sleep”, there is likely to be a sleep-blocker. For young babies who do not sleep restfully and/or are very unsettled when awake, I encourage parents to consider possibilities such as tongue-tie, reflux/silent reflux, birth trauma, Cows Milk Protein allergy or other food allergies/sensitivities.
It is also imperative that a baby sleeps enough during the day. As unbelievable as it sounds, a newborn is typically only comfortable awake for 45-60 minutes at a time. This “wakeful window” will have edged out to nearer two-hours as a baby approaches four-months. Babies are unlikely to take themselves off to sleep at these intervals without the conditions being conducive to sleep. The world is new and exciting, with sensory input abounding and most babies will continue to engage with their environment into the realms of overtiredness. Keeping to age-appropriate wakeful windows and ensuring baby is physically comfortable are the best routes to settled sleep.
Somewhere in the first six-months, most commonly around month four, everything changes. Literally overnight, babies switch from a solid chunk of sleep that may last six, seven or even eight hours, to waking, on average, three to five times. This is often referred to as the “four-month sleep regression”. It is, in fact, a huge progression! Rather than sleeping like a newborn, baby has now transitioned to sleeping in a more organised way, periodically cycling through lighter sleep and performing those essential checks to ensure they remain safe whilst asleep.
The reason it feels like a regression, however, is because a baby who requires parental help to return to sleep (as most babies do) will need that help much more frequently than before. This support is usually in the same or similar form to what was needed for them to settle at sleep onset and commonly includes feeding and/or rocking. A baby who is settled in this way at bedtime and wakes three or more times through the night requiring help to resettle is not broken – far from it. They are simply sleeping on a biologically normal pattern and being consistent about the support they need.
For some families at some times, the help their child needs is completely manageable. For others, a time may come when they choose to help their little one learn to fall asleep in a different way – something which can be achieved using gentle, supportive methods which do not feel like an ordeal for parent or child.