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Baby Sleep - the elixir of blissful family life - here's how

Dr Sharryn Gardner clinical adviser for the paediatric health app Juno, is on hand with five tips to help re-establish a healthy sleeping routine for little ones…

This was published in the Sun & Scottish Sun newspapers, though being from near Liverpool I found that very difficult.

Just a bit more sleep for your baby would change the lives of your whole family

If they sleep 17 hours a day at first, how on earth can we be so tired?

It’s only 1-2 hours at a time at the very start - disturbed sleep makes anyone exhausted and often hangry and cranky.

Let me share some of hacks and secrets….

Before we even dive in let’s start with the most important 'rules’. This is your baby, living in your family environment and you their mum know them better than anyone - you had an extra 9 months with them remember! No book or article can prescribe exactly what you both should be doing, only suggest ways which may help.

First of all, be kind to you. It’s hard to overstate the benefit that a mom gets from having a shower or bath in peace, from having a hot cup of coffee or a hot undisturbed meal. Being kind to you involves eating and drinking well, and most of all ensuring you feel no guilt whatever others or ‘experts’ say you should be doing.

Experts say you need a routine and consistency is key. It’s easy to write about it and honestly, it can come across as a bit patronising! There is truth in it - the more of a routine and consistency you can manage, the more your baby settles and knows what to expect, and when. There will be days where the routine is disturbed or your baby isn’t well. The more embedded the routines are the less likely these will derail you.

Especially in those first days and weeks, your early routines and sanity trump any need to exhibit your baby to well-wishers. Do not feel guilty - even those who have recently had tiny ones don’t fully remember just how tired they were, and good habits early really pay off.

Saying that, it’s never too late. The sleep routine can be nudged to be better even as adults!

Remember that everything you do should be safe. Cot deaths are much rarer than they were and increasingly they only ever occur when there are significant risk factors present (smoking, drugs, alcohol or co-sleeping mainly).

Your baby, your life, your rules.

There is some science to help understand the way baby’s sleep develops too.

Falling asleep happens so frequently to us that it seems easy to do - the hormones and brain activity to make it happen are actually fiendishly complex - like the back-end of a computer that the user finds intuitive (Apple products for example).

Babies come out from a world of constant darkness blinking into the light and take time to develop a circadian rhythm - usually around 3 months. Remember how our sleep changed from toddlers to teens to adulthood? Babies are also used to a constant stream of nutrients rather than intermittent feeds. In fact the stomach is not even involved swallowing only amniotic fluid in utero.

They also come out with tiny tummies. Much smaller than most of us would guess. This means that they need to feed little and often, around every 1-2 hours at first then up to 3-4 hours. Breastfed babies feed a bit more frequently than bottle-fed babies. If they overfeed they become unsettled and nap and sleep shorter and more poorly. Interestingly many babies we see in Emergency Departments can actually be overfed rather than underfed.

We go through stages of sleep. In cycles lighter, deeper, REM (rapid eye movement), sleep where we thrash around more. In one stage we dream, in 1 the brain rests and recuperates and the body repairs, in another the body is still and the brain organises new memories, and works hard.

Our cycle is around 90 mins compared to less than 40 minutes for babies. When they finish a cycle before the new one starts their sleep is light and they can easily wake.

Our circadian rhythms are determined mainly by light and hormones. Melatonin (jet lag medication and our natural hormone) levels rise from the early afternoon until the light falls and we go to sleep and then fall before the new dawn light arrives. Another chemical called adenosine rises as we stay awake, driving us to feel sleepier and sleepier the longer the day goes on. Caffeine blocks adenosine’s receptors and that’s how it buys us some time even while we still feel tired.

The holy grail of a full night’s sleep is actually a bit less than a normal night’s sleep - around 6 hours. You’d still be very tired!

So the hacks & secrets:

1. Don’t put a sleeping baby down to sleep

What?? I used to put my toddler nephew to bed in the big bed and then move him when asleep to a folding bed and he thought it was magic. Tiny babies go first into light sleep and are easily jolted awake. You put them down they wake, you tiptoe out of the room and the tiniest sound wakes them, or they sleep a while and wake scared that they have moved and you aren’t there.

Babies can’t even hide that they’re getting tired, though we might miss the signs (yawning, rubbing their eyes ,jumping or startling, going quiet or stopping playing, crying or clenching their fists).

This is the time to put them down, quietly and reassure and settle them, then leave the room.

2. Do make the room sleep friendly (for you too)

Cribs often have mobiles and all sorts of lovely baby things on them. Actually it’s good to have them quite boring - somewhere to sleep rather than play. Babies can’t tell us they’re hot or cold, and ideally the temperature should be around 18-20 degrees.

Up to 6 months the American Paediatric Association suggests babies stay in the room with their mum - in a separate crib or bassinet. Co-sleeping is a real risk for cot death, and besides tiny movements from you in bed can be enough to stir you baby out of their light sleep. Place the crib or bassinet somewhere where you won’t trip over it (you’d be surprised!) And out of any direct sun, heat vents or cold draughts (a spot great in the summer may be draughty in the winter).. Use light blankets not duvets and only put them up to your baby’s under arms with their feet at the bottom of the bed, or better yet use a baby sleep bag. There shouldn’t be any stuffed toys or pillows either which can cause suffocation.

When your baby is tiny you may not think about things above their heads and yet when they begin to stand they’ll bang their heads on that shelf above them!

3. Daytime routines

To encourage nighttime sleep we need also focus on daytime routines. Babies get tired and show the signs above. If these are missed, they become overtired and cortisol levels rise. As these rise it becomes harder and harder for the baby to settle to sleep. They become more alert and stressed.The boat has been missed.

So actually the baby needs good solid naps in the day to be able to sleep at night. An overtired baby is difficult to settle.

Developing, growing and healing happens in these naps so they are essential. While they are essential, naps longer than 2.5 hours are generally too long.

They also need to be fed well during the day. If your baby is still short of their daily feed requirement by bedtime, they are likely to wake up hungry during the night.

Daylight, in the morning and afternoon and playing also help to show that this is daytime.

4. Nap and bedtime routines

Try as much as possible to keep these routines consistent. This signals to your baby what should be happening. Try and block out daylight (use amber rather than bright white lights and blackout curtains|), turn down sound as much as possible, change the nappy, give a feed (this way around or the nappy change wakes them). Speak softly and give cuddles, and maybe have a short story (using the same one helps keep the routine).

Babies don’t all need baths before bed ( they may have one earlier due to childcare, or have a skin condition so can’t have daily baths) - that’s fine. Even if they do have one it should be slightly warm to help sleep and kept short with no playing. The idea is to calm things down - make them comfy and boring. Just like the warm bathwater acts to help sleep, so does a warmed pre-bed feed.

5. Adjuncts or helpful extras

Some of these may be magical, some may do nothing. See how they work for your baby.

A white noise machine (you can even get apps for travelling) harks back to the constant noises your baby heard in the womb and reduces sounds from outside that can intrude and wake them up. There are concerns that some of these machines / apps have sounds too loud for small babies - please research the one you want to use first. Remember too that it might be better to just let them get used to sounds going on around d them which is far more natural and normal.

Swaddling you baby when very small and not able to roll yet can really settle them. Not all babies like it at least initially. You can always try again another time. Try watching videos on how to do this safely as too tight or too late can be risky.

What if these don’t work straight away?

Often changes can take a while to embed - the suggested period for review is 3-5 nights. If things haven’t improved at all perhaps look at other options. If there is any improvement think about pushing on a bit longer.

Good luck - it’s tough, your baby gets older everyday and heads closer and close to that normal circadian rhythm and bigger feeds before bed.

I can't recommend enough the SleepMum's podcast

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