- 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)
- 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.
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