Newborn Sleep Basics

Postpartum
Written By Sophie Smith


For many new parents, the most challenging part of their new lives is the sleep deprivation, which can last a few months or (as was the case with my first baby) up to 2 years! This is a huge topic, so I’ll only cover the basics relating to the first few months - there are plenty of other resources out there for things like sleep training and weaning night feeds that come later. 

First, some key concepts to bear in mind:

  • Every Baby is Different

    • While there are some common patterns across babies (e.g. most sleep better with white noise), there is also huge variation that is all still within the bounds of “normal” 

    • Some babies will naturally start sleeping through the night way sooner than others, and it’s not necessarily anything the parents did or didn’t do

    • Some parents will swear by a certain piece of gear (the SNOO, a particular swaddle), while another parent may find it does nothing for their baby

  • Everything is a Phase

    • This is our mantra throughout parenting, beyond just sleep - your baby may go through gassy, fussy, picky phases that start and end seemingly without explanation!

    • Babies will inevitably go through difficult sleep stages - you may have heard of this concept of “sleep regressions”. You might have heard of "sleep regressions," which often happen around specific milestones—4 months (arguably the toughest one), 12 months, 18 months, and 24 months are common markers. But again there is huge variation - some kids won’t experience any of these, while others will seem to be constantly regressing.

    • Although there are strategies you can try to improve sleep and maintain your sanity, it can also be helpful to practice a little acceptance - remind yourself that these phases are temporary! It will get better (and then worse again, and then better, etc. etc.)

  • Do What Works for Your Family

    • Just like breastfeeding, sleep is an area where people often hold very strong opinions and aren’t shy about sharing them. Some think that sleep training (i.e. “cry-it-out”) is inhumane and will traumatize your child, while others think that co-sleeping/bedsharing is unsafe and weird. 

    • At the end of the day, you should feel free to make the choices that work best for your family, schedule, and sanity. If you are better rested as a parent, it benefits your mental health, ability to drive safely, etc - all things that also impact the safety of your child. 

SIDS & Newborn Sleep

  • SIDS is the unexplained, terrifying, and thankfully quite rare death of an infant. We don’t really understand the mechanism but it seems to be some combination of an intrinsic vulnerability in the baby and something unsafe in their sleep environment.

  • 90% of SIDS death occur in the first 4 months, so this is the period to take the most precautions

  • “Back is Best”

    • In 1992, the AAP updated their guidelines to recommend that babies sleep on their backs, rather than their stomachs (which had been the norm). This has led to a dramatic decline in SIDS - from 130 deaths per 100,000 births in 1990 to 38 deaths per 100,000 births in 2020

    • This is the SIDS prevention strategy with the most evidence and 100% something you should follow for the first 4 months or until your baby learns to roll over on their own 

      • Once they can do that, you can leave them in tummy position because they clearly have enough head control and strength to move their head to breathe better (and honestly tummy is more comfortable for most babies so it may help them sleep better)

    • Because the back sleeping guidance is relatively recent, your parents or other older caregivers may need to be gently reminded of this

    • One side-effect of back sleeping is it can increase the incidence of babies developing flattened heads. There’s nothing dangerous about this, it’s purely an aesthetic concern.

      • Mitigate this by doing plenty of tummy time in the day and putting the baby upright in a bouncer rather than on their back. Also embrace contact naps in the beginning, when babies sleep on their tummies on your chest

      • If the head flattening is particularly pronounced, you can talk to your pediatrician about using a helmet to reshape

  • Room sharing? 

    • The official AAP guidance recommends that babies sleep in the parent’s room at least for 6 months, ideally a year

      • In reality, basically no one I know does that; many people have baby in the room for the first couple months (when SIDS risk is highest) but then transition to their own 

      • Plenty of people put baby in his room even earlier and just use a baby monitor

      • If you’re fortunate to have a night doula, then they are in a separate room from parents but with an awake and monitoring adult nearby; you’ll still need to decide how you’ll handle the nights when the doula is off

    • There is indeed data supporting the claim that room-sharing can reduce SIDS risk, but it’s imperfect and logic isn’t that clear - would a parent even be able to identify an issue and intervene? And is there that big of a difference between being a few feet further away in the next door room?

    • This decision can come down to your personal habits:

      • If you and/or your baby are light sleepers, sharing a room could cause you to wake each other up a ton and result in less sleep for everyone (in fact, there is research that shows babies who sleep in their own rooms get more total sleep)

      • On the other hand, some people sleep more soundly knowing their baby is right there, instead of worrying whether they’ll hear them through the monitor

      • Ultimately, there are not right answers with this stuff - it’s a matter of tradeoffs and your own risk assessment

  • Bedsharing/Co-sleeping?

    • This is a somewhat controversial issue - the official AAP stance is that co-sleeping is risky, but many parents feel that it’s the most natural and comfortable setup (and can make breastfeeding much easier)

    • The data suggests that co-sleeping does increase the risk of SIDs in the first few months,  especially if either parent smokes or drinks, but not beyond that point if parents don’t smoke/drink

    • Again, this comes down to a personal cost/benefit analysis: the incidence of SIDS is still very low so even a slight increase in risk is still an extremely unlikely risk; on the other hand, there is probably nothing you can imagine worse than the loss of your baby

      • If you do end up co-sleeping, ensure you’re doing it as safely as possible by using a firm mattress with a tight fitting sheet, and keeping all adult bedding/pillows far away from where baby is sleeping

      • Co-sleeping on a bed is MUCH safer than co-sleeping on a sofa, which is very dangerous and should def be avoided

  • No stuff in the crib

    • No toys/stuffed animals, blankets, bumpers for the first 12 months; instead of blankets, swaddles and sleep sacks will keep your baby cozy 

  • Pacifier use may reduce SIDs risk

    • There is evidence for this, although the effect is small and the studies lack good randomization. But given that pacifiers are also really effective at soothing babies, they are an appealing tool for many parents. 

  • Avoid overheating

    • Some research has found an association between outdoor temperature and SIDS risk, but the impact is small

    • Still, it’s a good idea to try to keep your baby’s room between 68-72 degrees. But this is a somewhat arbitrary range, so don’t freak out if it’s a degree or two off.

      • If it’s over 72, dress your baby in lighter PJs and lower TOG sleep sack (and the reverse if it’s colder)

      • One study has claimed that fan use is associated with lower risk of SIDS, and while there are methodological flaws in this study, there's little downside

Helping your Newborn Sleep

  • The simplest advice I’ve read for how to soothe a newborn and promote better sleep comes from the book Happiest Baby on the Block - which I recommend reading towards the end of pregnancy, though I summarize the main takeaways below

  • The thesis is basically that babies are born a few months too early (because otherwise they wouldn’t fit through our hips!), so the best thing you can do in the “4th trimester” is to recreate the conditions of the womb

  • The author breaks this down into the easy to remember 5 “S”es: Swaddling, Sucking, Shushing, Swinging, Side/Stomach Position

    • Swaddling

        • Helps recreate the coziness of the womb and prevents babies from waking themselves up with the startle reflex (the Moro reflex). Similarly, starting the baby off in the bassinet rather than the much larger crib can help them feel more secure (I’d recommend sticking to the bassinet until they no longer fit!)

        • You can also use swaddling as a calming strategy during wake periods too! Just don’t overdo it, because it’s important for babies to also have time when they can have freedom of movement to exercise their legs and arms

        • There are lots of swaddle options out there, babies (and/or parents) often 

        • They can stay swaddled until they start trying to roll over (between 2-4 months), at which point you’ll want to transition them out of the swaddle. You can do this gradually by first taking one arm out for a week or 2 and then both, starting with just naps, or cold turkey.

        • There are a few great products that are considered “transition swaddles” for this period:

          • Merlin Sleep Suit: still somewhat muffles the Moro reflex and keeps them pretty immobilized, so not rolling over. Also, they look like an adorable marshmallow.

          • Zipadee: allows baby to roll, but still calms startle reflex and provides some resistance 

          • Dreamland Transition Weighted Swaddle: similarly, allows for movement but still provides weighted feeling and dampens reflex

        • Eventually, you will transition them to a sleep sack which is like a wearable blanket; even though technically you can switch to normal blankets at 1 year, sleep sacks can be great through toddlerhood because they can’t lose them in the crib like a blanket; some companies make them up to size 5 years old!

    • Sucking

        • Sucking is a primitive reflex that babies develop in-utero; in addition to sucking for food through feeding, babies also suck for comfort. A pacifier is an amazing tool for providing this “non-nutritive sucking” that can help calm a baby and promote better sleep

        • Despite what you might hear, there is no risk of pacifiers interfering with breastfeeding (so called “nipple confusion”)

        • The bummer about pacifiers is most babies develop a habit of spitting them out and you may find yourself having to go into their room and replace it many times a night

          • By 8 months or so, they should be able to find and replace it themselves (at this point, parents often scatter many pacifiers across the crib!). So it’s a question of whether you can make it through the in-between period before they have this skill.

          • Eventually, you’ll need to wean them off the pacifier, so you basically need to decide when to make that transition. On the one hand, the pacifier can be a useful soothing tool through toddler years; it has not been found to impair language development, but it can increase dental issues (same with thumbsucking). 

          • On the other hand, it might make sense to ditch the paci as part of sleep training - if it’s going to be a rough period anyway, might as well kill a few birds with one stone (this is what I did with my daughter!)

        • Like swaddles and bottles, babies tend to have preferences for certain brands of pacifiers; I’d recommend starting out with a sampler box to experiment and then you can buy more of the ones that work best; make sure to get the right size as they often come in 0-6 vs. 6-18. My personal favorite which isn’t in the sampler box is Philips Avent Ultra Light - I like that it has a ring so you can hang it on your finger while carrying baby or other stuff more easily

    • Shushing

      • The womb is actually a very noisy environment with all the blood flowing - supposedly as loud as a vacuum cleaner. So babies sleep best when there is white noise.

      • On top of the baseline white noise, they may also respond well to the “shushing” sound specifically. You can do it yourself, but if you get tired there is a special shushing device or play this youtube video that’s 8 hours of a woman going “shhhh” (the comments section is hilarious)

      • In the first month or two, your baby will probably be able to sleep through anything - they can nap while you’re out at busy restaurants, watching a loud movie, etc. Enjoy this period, because they will eventually become more sensitive

    • Swinging

      • Again, it all goes back to the womb - they were in pretty constant motion while in there as you moved around, so motion continues to soothe them on the outside

      • You’ll probably master the baby bounce pretty quickly; during the night, it can be really nice to have a bouncy ball to sit on to make this even easier

      • If you have the SNOO or Halo Bassinest, there’s built-in swinging or vibrating settings. But even if you have a more traditional bassinet, giving a few rocks by hand can help resettle your baby back to sleep.

    • Side/Stomach Position

      • This one is less relevant for sleep since babies need to sleep on their backs; but if you are picking them up to soothe them back to sleep, try holding them on their side or stomach, like in the pic below

Other key strategies:

  • Exposing to natural light

    • In the beginning, newborns don’t distinguish between day and night. You can help their circadian rhythms develop by exposing them to sunlight in the day.

    • Ideally, at least 10 minutes in the morning and 10 minutes in the afternoon - this will also be nice for the parents’ mental health!

  • Refraining from responding immediately

    • Babies are notoriously noisy and active sleepers, especially in the beginning. You may be tempted to jump in to soothe as soon as you hear your baby stirring or whimpering, or assume the nap is over is they briefly open their eyes.

    • But if you wait just a minute or so, you might see them self-settle and fall back asleep. This skill is important for laying the foundation of sleep training that can happen later.

    • Of course, if they don’t settle back down and the whimpering gets more intense, you should definitely jump in and help. I’m definitely not suggesting any real “cry-it-out” at this age, just a minute or two of a “pause” to observe before responding.

  • Establishing a bedtime routine

    • Around 6-8 weeks in, it can be helpful to start having a bedtime routine, as babies thrive on consistency, especially as they get older

    • This can be super simple/short - I liked to think of the B’s: bath, boob/bottle, book, bed! You can also add in a lullaby.

    • As part of the routine, some moms who are primarily breastfeeding choose to have the last feed before bed come from a bottle, to ensure more precisely that baby is going to bed with a full tummy

    • Avoid putting them down too early when they might be under tired, or too late when they can be overtired (and counterintuitively can be just as difficult for them to fall asleep). It’s a tricky balance to strike and may take some trial and error to learn their cues. 

  • Blacking out the room

    • In the first few months, blackout curtains aren’t necessary; in fact, it can be good for baby to be exposed to daylight for naps, to help their circadian rhythms figure out the difference between day and night

    • Around 4-6 months, they might start struggling to nap, or waking up early in the morning (depending on when sun rises). At this point, installing blackout curtains or shades can really help - darkness is a powerful signal and can cause the release of melatonin.

    • The logistics depend on the size and type of windows in the nursery - I have spent an embarrassing amount of time troubleshooting blackout solutions in various rooms, so I am happy to consult on this!

      • Drapes/curtains seem to be more effective at blocking out light than shades, which tend to still let some through the sides; but shades fit more windows well, and you can add Light Blocking Tracks to alleviate the side issue

      • If possible, it’s nice to install ones where it’ll be easy to open when you do want light (so avoiding the more temporary solutions with suction cups/clips; those are great for travel though - Sleepout is my fave)

      • If lots of light is getting in under the door, install this

Schedules & Wake Windows

  • In the beginning, many newborns will wake up on their own to feed during the night, but others will need to be actively woken for feedings every 2-3 hours

    • As unnatural as that may seem, it’s important for ensuring sufficient weight gain

    • Once your baby regains their birthweight (typically after 1-2 weeks), your pediatrician may give you the green-light to allow them go for longer stretches before waking to feed

  • For the first 1-2 months, it’s not feasible to put your baby on a schedule and you should instead focus on just reading your baby’s hunger and sleep cues rather than the clock, making sure to feed your baby every 2-3 hours during the day

  • After that point, some parents notice a natural pattern emerging and prefer to have more predictability in their days by establishing a loose schedule

    • If you are into tracking sleep/feeds, consider trying the Huckleberry App which also provides predictions and suggestions

  • Other parents prefer to “go with the flow” for many more months before landing on a schedule; there’s not right or wrong here, it’s what works best for the baby and parent team

  • Another area where people take different approaches is the order of baby’s cycle: 

    • Babies are biologically wired to get sleepy from feeding, so the most “natural” cycle is “eat, sleep, play”  

    • Some families shift towards a “eat, play, sleep” cycle instead, in order to help baby learn to fall asleep without milk, rather than form a “sleep association” with feeding. This can lay the foundation for later independent sleep training

      • This starts to wade into an area where people have very strong opinions that you’ll need to learn to tune out, and trust your own intuition of what works best for your family

    • In the beginning, lots of the awake time between naps will be occupied with feeding, so “play” may be only 10-20 minutes; it can consist of tummy time, hearing you talk, looking at black & white images/books, being outdoors

  • The concept of “wake windows” can be helpful in determining when to put your baby down - you’ll see these are fairly wide ranges, but they give you a sense of what’s “normal” for each age

 
 

Travel & tradeoffs

  • One area where you’ll have to find your own philosophy is how much you want to be homebound in the first months vs. be out and about (and even going on overnight trips)

    • The people I know who are more in the “get out, travel!” camp call it “making your baby a barnacle, rather than an anchor”

    • As someone who practiced the “barnacle baby” approach, I can say it led to some amazing trips and experiences I don’t regret, but with a major downside: it can take a lot longer for baby to advance in their sleep progress and can disrupt attempts to get into a routine because you are changing sleep environments (and potentially even time zones)

  • The question of naps-on-the-go is a little less extreme than the overnight travel decision: having your baby take some naps in the stroller, carrier or car can allow you to do many more excursions and bring more balance and socializing to your life

    • Some people practice the 80/20 rule, aiming for 80% of naps at home/in crib and 20% on the go - find what proportion works for you!

Sophie Smith
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