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How to Get a Baby to Sleep: Tips from Pediatrician Dr. Gurinder Dabhia | San Diego Health



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- Hi, I'm Susan Taylor with Scripps Health

in San Diego, California.

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All right, you've just welcomed your new little baby

into the world, and now that you're home,

how do you get your newborn to sleep through the night?

Developing good sleep habits early on

is critical to a child's development,

and it allows time for tired parents

to recharge so they can have tons of energy

to care for that new little bundle of joy.

Joining us is Dr. Gurinder Dabhia, a pediatrician

at Scripps Clinic in Rancho Bernardo, California.

Thanks so much for being with us, Doctor.

- Thanks for having me.

- So how does an infant learn to fall asleep?

How do you train them?

- Good question.

There are books and books that

are written about sleep training.

The main thing to keep in mind

is to work with your physician, your pediatrician,

to ensure that your baby's developmentally ready

to be able to sleep longer periods at night

and they're growing appropriately in order to be able

to go between feedings longer periods at night.

- So what is the best age to start this training?

- So usually laying the foundation and starting

to think about longterm sleep training plan,

around four to six weeks of age

is an appropriate time to start thinking about it.

Between six to eight weeks of age,

they're neurologically ready to go longer periods

of time, so that's around the time we

can start laying the foundation.

- So before two months, it's whatever the baby wants.

- A lot of feeding and a lot of sleeping for the baby,

but not, unfortunately, for the parents.

- Parents, right. (laughs) - And at that stage,

they're growing very rapidly.

Their metabolic rate is extremely increased,

which means they're eating a lot and sleeping a lot.

But before that, you do wanna ensure

that you are appropriately feeding the baby

and because they are growing very rapidly.

- So at what time of night do infants usually fall asleep?

- So usually when they're starting to be able

to go longer periods at night,

anywhere between 10 to 11 is a bedtime.

And then as they go even longer,

between three to four months of age,

they can go nine to 10 hours at night.

Typically, the bedtime is between seven to 8:00 PM.

- And how long can you expect them to stay asleep?

- So that also depends

on which developmental stage they're in,

so between about six to eight weeks of age,

sleeping through the night is only five hours,

which, for parents that are used to getting up every two

to three, that's a treasure until--

- It feels like a luxury. - It feels like a luxury,

exactly, and then usually after that,

they're able to go longer periods, about 10 hours.

- But you say that they're really not sleeping straight

through the night, so they're waking up often.

Why are they waking up?

- So again, they're still growing very rapidly.

They're doubling their birth weight in the first six months,

so limiting their feedings to only our daytime hours

is not enough for them.

So they do still need some of those nighttime feedings.

And as they wake up, they also have wet diapers

and bowel movements that need to be changed

in association with the feedings.

- And do they also just wanna be held?

- Well, so--

- Do they even know? (laughs)

- Not necessarily, not necessarily.

Babies are able to sleep long stretches

if we don't interrupt them too much

and if we allow them the opportunity to learn how to sleep.

- So we want you to hold this thought.

We're gonna come back and talk

about this in a couple of minutes.

Psychologists will tell you that,

during the first four months of life,

the infant is developing trust.

And so how do you communicate that trust with your infant?

Do you risk breaking that trust

if you rock the baby until they go to sleep

and then you put them in the crib

so that you're actually separating away from them?

We'll come back and talk about that in a couple of minutes.

How much sleep does an infant need every 24 hours?

- Yeah, so initially, they need quite a bit.

So usually within the first three months or so,

it can be even up to 17 hours of sleep

in a 24-hour period, so usually 14 to 17 hours.

And then after about four months of age,

they can go anywhere between 12

to 14 hours of sleep in a 24-hour cycle.

- And should they be in the same room

with you in a bassinet or a crib?

- Yeah, I think, initially, that makes parents feel a lot

more comfortable to have their newborn near them.

But I think you do have to keep in mind

that around two to three months of age,

they're a lot more aware of their surroundings.

So any movement or noise that's made in the room

could affect their sleep, and that includes daytime sleep

if they're sleeping in a living room.

They're a lot more attuned to their environment,

so that's up to the parents to decide

when the appropriate time is to move the baby.

But they're definitely more stimulated, so.

- So if they hear the sound of your voice,

is that soothing to the baby

or does it actually keep them awake

or does that interrupt their sleep?

- It could potentially interrupt their sleep.

It depends on what they're getting up for.

Usually, they're in deep sleep,

and if we don't interrupt them during the time

that they're in those different sleep cycles

and changing between sleep cycles,

they're able to get to the other side

without us interfering.

Unfortunately, we do tend to interfere more,

and so sometimes our voice could be more,

too much stimulation for them

when they really just need to sleep.

- And what's your thoughts on holding the baby,

rocking the baby to sleep and then putting the baby

in the crib versus having the baby in the crib

and just maybe gently touching them

and singing to them or soothing them to sleep?

- Sure, sure.

So initially, that's a good way

to start the foundation of sleep training.

We're holding our baby, we're feeding our baby

but at some point detaching those things

that are allowing that, that are crutches

to them going to sleep on their own.

So I usually recommend holding the baby

or holding and feeding and then detaching

once they're starting to get a little bit sleepy

and then laying the baby down.

So that you can start even at four, six, eight weeks of age.

So I think it's appropriate at certain ages and stages

of sleep training, but eventually, that can be negative

towards your effort to sleep train your baby.

- What are your thoughts

about having the baby sleep in bed with you?

- So the American Academy of Pediatrics

does not recommend co-sleeping.

So usually, if there's any co-sleeping,

there is a risk with pillows and blankets,

alcohol use, extremely sleepy parents,

which is basically every parent of a newborn.

So the risk is greater than the benefit of co-sleeping.

- And how long should you feed or nurse your baby

before you expect them to fall asleep?

Is it five, 10, 15 minutes, hour?

- So initially, the babies are probably falling asleep

as they're feeding, and the goal would be

to try to detach them either from the bottle

or the breast before they fall fully asleep,

so just as they're getting sleepy.

As they get older, ideally feeding them well

before it's sleep time and ideally in a different space

than where they're normally going to fall asleep.

So in a living room, you have a six-month-old baby,

feed them in the living room

and then get them the last little bit of sleep,

calming down before sleep in their room.

So you've completely detached the feeding aspect

with soothing to go to sleep.

- And then what if you rock the baby to sleep in your arms

and then you put them in the crib and they start crying?

Do you get back to them right away,

or do you let them cry for awhile?

- I think that's been debated

(both women laugh)

for centuries.

- Since the dawn of man. (laughs)

- Since the dawn of men, exactly.

It really depends on which sleep training technique

that you feel you and your partner can proceed with.

Most sleep training techniques do require some sort

of crying to allow your baby to learn how to sleep.

There's the cry it out, the Ferber method,

the modified Ferber, there's--

- What's the Ferber method?

- So that's when you go into the room

when the baby is crying and you start off

with, say, 10 minutes of them seeing that you're there

but trying not to pick up the baby.

And then eventually, then the next time,

it's a shorter period of time that you're

in there when the baby is crying.

Most of the sleep training methods really focus

on not picking up the baby when the baby is crying.

And again, there are different sleep training methods

that will work for the baby but not the parents

and vice versa, so you have to pick the one

that you're going to be able to sustain longterm

because sleep training is not one time and that's it.

It's really something that you have to revisit.

- It's a learned behavior.

- It's learned, and then also they get sick,

there's a time change, you travel,

then you always have to come back to a method,

shorter, hopefully, not as long a duration

as the initial sleep training.

But you always have to be able to come back to it

to get them back on a routine.

- At what age do you start to let the baby cry for a bit?

- Yeah, so initially, when they're ready to be able

to go longer periods at night between feedings,

about six to eight weeks of age,

trying to lay them down without having them being eating

to go to sleep, that's a good place to start.

And then usually about two to three months

is a good time to work with your pediatrician

to make sure that your baby is ready to be sleep trained,

and that's when the discussion about how long to cry and

if to cry and if that method is gonna work for your family.

- If they're crying, how long should you let them cry?

- That's a good question.

So unfortunately, there's not really a great answer

in terms of specific timing.

Usually, we try to work with parents to find out

what is the sleep training technique that they are going

to be able to maintain and be consistent with.

Sometimes, many parents are only able

to handle five minutes of baby crying.

Sometimes, there are some parents

that can last an hour of a baby crying,

and sometimes that is what it takes.

But you have to work with the family

to see what they're able to do as a partnership

but then also to be consistent

and to revisit that sleep training technique later on.

- And consistency is key, isn't it?

- Consistency is key, support,

and partnership is also very important,

and then also knowing that

this is one of the most important things

that you're going to be teaching your child.

And allowing them to learn how to self soothe

and to get an appropriate nighttime sleep

is really important for their future in so many ways.

- And when they awaken in the middle of the night,

should you let them cry?

For how long?

Do you try and let them cry themselves back to sleep?

- Yeah, so ideally, it depends on how far along you are

in the sleep training method.

So initially, there's a lot more crying,

and then that duration of crying should be less and less.

But there is some crying that is involved

when, as you're getting them to sleep initially

and then also every subsequent time that they wake up.

What you wanna make sure is

that there's not some other reason

why your baby is crying, so if they have a fever,

if they're teething, if they've gotten sick.

So sometimes you do wanna ensure

that the reason that they're crying overnight

is not related to that but is just

that they're still learning how to sleep at night.

- And what about having music or white noise,

like the sound of waves in the room

to help them fall asleep?

- Yeah, so I think for a lot of babies,

that can be very soothing.

Like with anything that can become a habit,

you wanna make sure you have an exit strategy,

so when you're going to wean it.

So, for instance, American Academy of Pediatrics actually

has found a decreased risk of SIDS when using the pacifier,

less than-- - And SIDS is?

- Is Sudden Infant Death Syndrome,

in less than six month of age.

But again, at what point do we want to wean that pacifier,

because that could be a longterm habit

that's hard to eliminate as easily.

- And sleep training is not uniform.

It could be very different from one child to the next.

- Exactly, and I think that's what parents have

to keep in mind, and that's why there

are so many books that are written

is because it's not one size fits all.

So what worked for your first child

may not work for your second child.

I think the most important thing

is to understand that personalities

of children are different, but consistency,

once you do choose a certain sleep training technique,

is the most important factor to success.

- All right, so we referenced this a couple of minutes ago.

Let's come back to this.

Psychologists say that during the first four months of life,

the infant is developing trust.

So how do you communicate that trust to your infant?

Do you risk breaking that trust if you rock the baby

to sleep and then put the baby in the crib

because now you're separating from the baby?

- So when the baby is ready to be sleep trained,

that trust is ideally being built at other times of the day.

So cuddling and snuggling and rocking

and interacting with your baby should be occurring

during the daytime as well.

But I think the very important thing

that you're teaching your baby by allowing them

to self soothe is that nighttime is for sleep

and daytime is for all of the other activities

that really do continue to build trust

and solidify that bond between parent and child.

- What are the signs that your baby has sleep issues

and you now really need to consult a doctor?

- So I think you wanna make sure that,

first and foremost, your baby is ready developmentally

to start the sleep training process,

so they've shown appropriate weight gain

and growing well, they're feeding well.

And if there are any signs of fever, vomiting,

not feeding as well during the daytime or even teething,

then you wanna make sure you involve your pediatrician

in the conversation as you proceed with sleep training.

- And the one piece of advice when your baby sleeps,

you should sleep? (laughs) - Yes.

We tell that to patients, and they roll their eyes

as yes, that's right, I'm not gonna do that.

But I think it's really important initially

when your baby's on that 24-hour cycle

that you do get a little bit of sleep in the daytime

because that is going to impact, a month later,

your mood, supply of milk; it impacts so many things.

So I think if the baby's on the 24-hour cycle,

that means that you're on the 24-hour cycle, too,

and then just to be respectful of yourself

and allow yourself that space and know that it's not forever

even though it feels like that on many days.

It will come to an end soon.

- Any final thoughts, Doctor, to sum it up?

- Yeah, so I think the most important thing

is to work with your pediatrician to ensure

that your baby is ready developmentally to sleep train

and start to allow your baby to self soothe

by detaching the feeding and allow them just

to be laying down when they're just a little bit sleepy.

And then eventually, three to four months,

think about what sort of sleep training techniques

are going to work for your family and for your baby,

partner with whoever you have around you for support,

and then also consistency, just to be as consistent

as you can going forward knowing there will be days you

wanna throw in the towel and you can't do this anymore.

But tomorrow's another day,

and you just keep moving forward with it.

- Doctor, thank you so much. - Thank you.

- We really appreciate it.

- Thanks for having me.

- If you want more information on babies and sleep,

please click on the link or go to Scripps.org/videos.

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I'm Susan Taylor.

Thanks so much for joining us.

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