Parenting Series 5 – The Lullaby I – Developing Regular Sleep Patterns

New parents have so many queries about baby’s sleep like ‘Is it normal for my baby waking several times at night? How come he can’t sleep on his own? When will he sleep through the night?’ If parents can learn more about baby’s sleep characteristics, and with other support, their babies can gradually learn to build up good sleep habit and soothe themselves to sleep. Both you and your child can enjoy a nice sleep.

Baby’s Sleep States

• There are different states in sleep – drowsy, light sleep / dreaming, deep sleep, awake.
• A sleep cycle goes from light sleep to deep sleep and then light sleep(see next page baby sleep diagram). Each cycle lasts about dozens of minutes in infancy. As your baby grows, the duration of the cycle gradually extends and at age 3 to 6, each cycle lasts about 90 minutes like the adults’.
• In light sleep, your baby’s breathing is quick and less regular. Her body and limbs may tremble lightly. Eye movement underneath eyelids may be observed (maybe in the dreaming state). She may be easily woken up by sounds or lights in the surroundings. Throughout her sleep, she may wake up briefly several times which is normal and expected. You may let her sleep by gently patting her or talking softly to her instead of picking her up or feeding her.
• During deep sleep, your baby is less affected by the surroundings. Her breathing becomes regular with few body movements.

Baby Sleep Patterns

After birth, baby relies on herself to breathe and to adjust and accommodate to the environment outside mommy’s tummy – including temperature, light/darkness, sound as well as your care. Newborn has not yet had any day-night living pattern. They eat when awake and sleep when full. The sleep-wake pattern repeats throughout day and night though newborn spends most of the time in sleeping.

After caring your baby for some time, you may begin to grasp your baby’s tired cues. Let her sleep when drowsy to avoid her being overly tired to be asleep. Your baby may need your soothing to fall asleep. She rely on your responsive care to help her adjust to the day-night rhythm and to regulate sleep accordingly. Upon your responsive care and as your baby grows, her sleeping pattern would change.

When your baby reaches 3 to 6 months old (figure 1), you baby may have a longer time on night sleep and daytime wakefulness. This is the time she starts to have day-night rhythm.

She still needs day naps but the frequency of naps decrease as she grows. In the meantime, her ability to self soothe to sleep* is ready to be developed if you allow her to fall asleep in her cot when she is drowsy but awake. She can soothe herself back to sleep even she wakes in the middle of the night. In general, about 60-70% of the 8-month old babies can self soothe to sleep.

Sleeping hours

The sleeping hours will change as our baby grows:

*References : WHO guidelines on physical activity, sedentary behaviour and sleep for children under 5 years of age. Geneva: World Health Organization; 2019. Licence: CC BY-NC-SA 3.0 IGO.

The above is for reference only. Each baby is unique and there can be individual differences. Some babies sleep more while some sleep less. Some have longer night sleep when 2 months old but some need more time to develop on her own pace. Parents try not to compare your baby with others’ and she is fine as long as she is healthy and growing.

How To Help Your Baby Sleep Well?

Providing a Comfortable

• Comfortable room temperature
• Good ventilation
• Right amount of clothing or blanket. You may check whether he is too warm or too cold by feeling the nape of his neck. Warm without sweating will be just right.
• Use cotton blankets to avoid allergy
• Comfortable swaddling

Your baby will feel more secure if you swaddle him in a soft blanket. Avoid wrapping him up too tightly which makes him too hot or limits the movement of his legs. Make sure his head and face are exposed without obstructing his airway.

If a baby’s lower limbs are pulled and wrapped too tight when swaddled, the hip joints may not develop normally.

More details can be obtained from ‘Developmental Dysplasia of Hip (DDH)‘

Please also refer to ‘Sleep Safety’ for infant’s safety on sleep.

Emphasizing The Difference Between Day And Night

• Difference in the room light
  • The room should be well-lit in the daytime. Dim the light before sleep to tell the baby that it is bedtime.
  • Some babies may wake up during the night crying because the room is too dark. A night-light can reassure her that she is in familiar surroundings.
• Difference in activities
  • When your baby is awake in the daytime, actively play and talk with her. When you are spending quality time together, you are giving her adequate attention as well as keeping her alert and interested. This will prevent her from sleeping too much during the day.
  • When she gets tired as shown by her having drooping eyelids, rubbing her face against you or yawning, let her have a rest.
  • Avoid taking a nap for more than 4 hours.
  • At night, engage in quiet activities to prevent her from getting too excited before bedtime.

Sleep Safety

• We care about whether our baby sleeps sufficiently and most important of all, sleep safely and lower the chance of occurring the Sudden Infant Death Syndrome (SIDs). Studies showed that sleeping on the back is the safest and correct sleep posture for babies. It is far better than sleeping on tummy or side position in reducing the likelihood of occurring SIDs.
• To know more about SIDs and sleep safety,
  • Refer to the leaflet on ‘Safe Sleep Sweet Dreams‘ co-authored by the Department of Health, HKSAR and the Department of Paediatrics, The Chinese University of Hong Kong.
  • Fill in ‘Is Your Newborn Baby Safe?‘ and check whether the safety measures taken for your baby is enough or not
  • Watch the video ‘Home Safety‘ to know more about safety at home and sleep environment

Establishing Bedtime Routine helps your baby to Sleep at Regular Time and to Develop Self-Soothing Ability

• Begin to establish a good bedtime routine after your baby has shown day-night rhythm.
• 20 – 45 minutes before bedtime, turn off the TV and any other screen devices. Arrange bedtime activities which are relax and calming. For example, bathing, story-telling, gentle play, singing lullabies, listening to soft music, etc. These activities should be enjoyable without exciting him. Sleep follows after completion of the bedtime activities.
• Activities chosen should be subject to your baby’s characteristics and habits. Most importantly, your baby must be fed, burped and on clean diapers.
• Put your baby in the cot when she is drowsy but awake. Let her self soothe to sleep*. Leave her in the cot after saying goodnight
• Baby may be soothed to sleep when she is physically unwell. Let her self soothe to sleep when her physical condition is stable.
• You may refer to our video ‘Developing regular sleep routine‘ (Video in Cantonese dialect with English subtitles) for more information.

*Self-soothing refers to the ability of baby to fall asleep on her own when drowsy without any parental intervention. The most common sleep habits are those which may impede babies’ learning and development of their self-soothing ability. These poor habits include suckling or nursing to sleep, rocking, stroking or walking to help babies fall asleep. Once these patterns have become established routines, your baby will totally depend on your attention and company to fall asleep. These sleep habits will take up, quite unnecessarily, much of your time and energy.

What about if my baby falls asleep while feeding? You may stop feeding and put him to bed without waking him. You can feed him a little earlier next time so as to minimize the chance of falling asleep during feeding.