Each baby is an unique individual with his own distinct sleep requirements. Newborns generally sleep 16 to 20 hours a day with breaks for meals.

Introduction

An average newborn sleeps much of the day and night, waking only for feeds. A newborn baby cannot distinguish night and day and may sleep as long as 16 hours a day, in 2 to 4 hours stretches, between meals.

Sleep patterns

Each baby is an unique individual with his own distinct sleep requirements.

• Newborns generally sleep for 16-20 hours a day with breaks for meals.
• Their longest sleep period is usually 4-5 hours because this is how long their stomachs can go between meals.
• There is no fixed schedule for newborns because their internal clocks are not well developed yet. This usually lasts till about three months when the baby’s sleep pattern begins to shift towards the night. About 90% of babies this age sleep through the night, meaning 6-8 hours at a stretch.
• Sometimes babies may cry or make soft noises when they are in light sleep. They may also wake up momentarily in the night but go back to sleep again on their own. You need not attend to these minor interruptions; and let your baby learn to get himself to sleep.
• If your baby continues to cry for several minutes then it’s time to respond to his cries. He may be hungry, wet, cold, hot, in pain or may be sick. Attend to his needs as quickly, swiftly and quietly as possible without overstimulating him and put him back to sleep.

Sleep-Related Infant Deaths : Updated AAP 2022 Recommendations for Reducing Infant Deaths in Sleep Environment

The American Academy of Pediatrics (AAP) Task Force recently revised the Safe Sleep Guidelines in 2022 which were made to replaced the previous  2016 Safe Infant Sleeping Environments recommendations. The recommendation were first introduced in 1992 and has decreased the incidence of sudden infant death syndrome (SIDS) by 50%.

Sleep positions

The AAP Task Force recommends that healthy babies be placed on their backs to sleep for every sleep; not on their stomachs or sides.The only exception to this rule would be babies with head deformities or those with relatively large tongues which make them susceptible to develop airway obstruction when lying on their backs.

Sleep surface and location

Recommendations for infant bedding :

• Place the baby on his or her back on a firm, non inclined sleep surface with tight-fitting mattress in a cot that meets current safety standards. Sleep surfaces with inclines or more than 10 degrees are unsafe for infant sleep.
• Remove pillows, quilts, comforters, sheepskins, stuffed toys, and other soft products from the crib.
• If using a blanket, put the baby with his or her feet at the foot of the crib. Tuck a thin blanket around the crib mattress, only as far as the baby’s chest.
• Make sure the baby’s head remains uncovered during sleep.
• Do not place your baby on a waterbed, sofa, soft mattress, pillow or other soft surface to sleep.
• To prevent overheating, the infant should be lightly clothed for sleep and the room temperature kept comfortable for a lightly clothed adult.
• Avoid over bundling and check the baby’s skin to make sure it is not overheat
• While babies should sleep on their backs, other positions can be used during the time babies are awake and supervised for a short period of time. Babies can be placed in tummy time while awake to help develop muscles and eyes and to help prevent flattened areas on the back of the head.

Bed – sharing or co-sleeping may be hazardous for babies in certain conditions. The advises were :

• Place the infant’s crib close to the parent’s bed ideally for at least the first 6 months. It is more convenient for breastfeeding, baby’s comfort and parent contact.
• If you choose to have your baby  sleep in your bed to breastfeed, make sure the baby sleeps in a non-prone position, soft surfaces or loose covers are avoided, and the bed is moved away from the wall and other furniture to avoid the baby becoming entrapped between them. Ensure that you do not fall asleep while breastfeeding as you may accidentally suffocate your baby.
• Adults other than the parents, children or other siblings should not share a bed with an infant.
• Parents who choose to share a bed with their infant should not smoke or use substances such as drugs or alcohol that may impair their ability to care for their babies.

Breastfeeding

Feeding of human milk is recommended as it is associated with reduced risk of SIDS. Unless contraindicated or the parent is unable to do so, exclusive breastfeeding for 6 months is recommended with continuation of breastfeeding for 1 year or longer as mutually desired by parents and infant. The usage of pacifier should be delayed until breastfeeding is firmly established.

Helping baby sleep

You can help your baby sleep by recognizing signs of sleep and providing the right environment for a comfortable and safe sleep.

• Avoid overstimulation during nighttime feeds and diaper changes.
• Try to keep the lights low and the room quiet.
• Allow your  baby to become sleepy in your arms, but place him or her in the bed while still awake. This way the baby can learn how to go to sleep on his own.
• Singing a lullaby or playing soft music while your baby is getting sleepy can help to establish a bedtime routine.

Referrences

1. Sleep-Related Infant Deaths: Updated 2022 Recommendations for Reducing Infant Deaths in the Sleep Environment. The Task Force on Sudden Infant Death Syndrome and The Committee of Fetus and Newborn. Paediatrics (2022) 150 (1) : e2022057990. https://doi.org/10.1542/peds.2022-057990