111 - Sleep

Dr. Carole Keim MD talks you through everything about sleep in this episode. Your baby’s sleep and yours as well. She addresses sleep patterns, helping your baby fall asleep and stay asleep, crying, safe sleep and reducing SIDS risk, and how to consider nighttime work division with a partner so both of you can get your own sleep.

Sleep is vital for both you and your baby. For the first months of your baby’s life, they will sleep a lot in two or three hour increments, and wake to feed often, while you don’t really sleep at all. Dr. Carole offers suggestions on how to help your baby learn the difference between night and day so you can teach that nighttime is for sleep. Develop a nighttime routine for your baby that will help them be ready to fall asleep faster in their crib. Dr. Carole also explains why she’s pro-pacifier and swaddling and cautions about other ideas that may not be safe for your baby. Learn all about your baby’s sleep health so you can get back to your own night rest.

This episode will cover:

• Baby sleep patterns
• How to help baby fall asleep and transfer to the bed
• How much crying is ok
• Safe sleep / SIDS
• Co-sleeping
• Division of night work
• Tips to help you sleep better
• Sleep training

Baby sleep patterns: 00:44

• Newborns: about 18h per day, in 2-3h increments, and MUST be woken up to feed if they have slept 4 hours. NB are only awake to feed/pee/poop/cry.
• Around a month they learn the night-day difference, and will start to sleep longer stretches at night and shorter ones during the day. They still wake at least 1-3x per night and nap throughout the day.
  • You can help by interacting more during the day, and keeping the lights dim and a quiet voice at night
• Around 2 months they are allowed to sleep more than 4h at a time; check with your doctor to make sure they are gaining weight consistently
• By 6 months some babies may sleep through the night, but most will still wake up at least once. They are also typically taking 3 naps per day at this age, then 2/day at 9 mos, and 1/day at 1 year.
• It is normal even for the first few years of life to wake 1-2x per night. Can make it less appealing by adding water to the bottle after 1y of age.
• The 4-6mo sleep regression - not a medical thing, may be due to teething. Many babies actually start to sleep better at this age - this is not due to starting solid foods, but more likely due to their ability to consume larger amounts of breastmilk/formula at a time.
• Total hours of sleep: 18h per 24h for newborn scattered throughout the day, 14-18h per 24h for 6 mos old (12-14 at night, then 2-3 naps 1-2h each), 12-14h per 24h for 1 year (11-12 at night, 1 nap for 1-2h)

Help baby fall/stay asleep: 05:43

• Signs baby is tired: drooping eyelids, rubbing eyes, yawning, fussing
• Swaddle baby for the first month or until they bust out of it; can go longer if baby loves it, but MUST stop when baby can roll over
• Have a wind down routine
  • Last nighttime feed in arms / high chair
  • Brush teeth or gums
  • Bath (optional; they don’t need it daily, but it can be relaxing)
  • Sway/rock with baby in arms
  • Speak in a quiet, soothing voice
  • Read a book / sing a lullaby
• Place baby down “awake but drowsy” - they will get used to falling asleep in their bed
• All babies hate their bed!
• If baby falls asleep in arms, transfer quickly to bed, place a hand over them for 10-20 seconds or until they seem settled in, then walk away
• For babies who seem to want more, can sit in a chair near the crib and move the chair progressively farther away each night, eventually stand in doorway while they fall asleep, then you should be able to walk away
• Can try adding in blackout blinds, white noise machine, lotion, etc - keep in mind that baby will get used to this and it can make sleep harder later
• Tylenol/ibuprofen at bedtime for teething infants can help them sleep better
• DO NOT put rice cereal in the bottle for sleep, or start solids early; these actually contain less calories per ounce than breastmilk/formula and will make them get hungry sooner
• DO NOT use melatonin in babies less than a year, or for more than 2 nights in a row after 1 year of age
• DO NOT give your infant or child sedating antihistamines or other sleep medicines, they are not safe

How much crying is reasonable? 12:07

• Most babies will wake up a little as you set them down, and many will cry
• It’s ok to put a hand on them, rock them gently in their bed, pat them gently, talk to them, sing, etc. but try not to pick them up for a few mins
• Generally 5-20 mins of crying is ok, but if it is hard for you to wa...