Help with Infant sleep

 

Background

Sleep in infants is one of the most common concerns amongst parents. Getting them to fall asleep, stay asleep, can become a battle that lasts months to years. There are numerous techniques, books, opinions and advice that can be confusing to parents. The description below is the technique that is generally accepted by paediatricians, psychologists and infant sleep specialists. It is termed controlled comforting and takes several nights to work.

If you are struggling as a parent to cope with the lack of sleep, the infant will probably be feeling the same. Many parents report a much happier settled infant, once an effective sleep routine is put into place.

Infants sometimes require a feed during the night. Sleep settling techniques like those outlined below will not work if the infant is hungry. Some parents will feed just prior to sleep which makes sense, but they do not allow the infant to fall asleep whilst feeding.

What are sleep associations?

Sleep occurs in stages during the night. There are times when people are in light sleep and almost awake and there are times when people are in a deep sleep. For infants and children to remain asleep and not wake their sleep environment needs to be constant. So if an infant falls asleep with patting, dummies, cuddles and then is placed in the cot, when he reaches a period of light sleep he will wake and cry until the patting, etc is returned. These sleep associations are the main reason for infants and children having problems falling or staying asleep. About the age of 2 – 4 months infants will start responding to sleep associations.

So to get your infant to fall asleep their needs to be a routine and associations that remain constant. This means at the point of falling asleep the infant is in a comfortable cot without any settling stimulations – such as feeding, patting, music, rocking, being in the lounge room, pram etc.

None of the advice has led to later problems in life – either emotional or behavioural – in fact the opposite is true. Evidence shows that the ability to self settle becomes a lifelong habit. If you are unable to handle the crying of an infant then this technique is not for you. If done properly this technique is highly successful.

What age can this start ?

Infants should be allowed to settle fairly early – about 2 – 3 months by themselves. But the following advice tends to apply to infants who are older than 4 months. They should be healthy, thriving, and developing appropriately.  Ensure they start spending some time without someone holding or carrying them, such as placed down in a pram or bassinet where they can see and hear but do not require direct contact. This is so they get used to this feeling of not always being held. Kind of early independence training.

Sleep hygiene guide for infants. 

To be successful the following needs to be in place. Both parents need to be in agreement.

1. Some independence training. Ensure your infant copes with being in a pram or bassinet without direct contact. To do this place them nearby so they can see and hear but do not require direct contact. This is so they get used to this feeling of not always being held.
2. A place to sleep.  Pick a room to place the cot in. Preferably his or her own room with blinds/curtains to ensure adequate darkness. Turn the monitor off during this period. If you want turn it back on when the infant is asleep.
3. Timing – start this during the morning when your infant usually needs a sleep.  Pick a few days where there are not too many interruptions, so a regular routine can be set in place. Ensure he or she is well fed and clean and has had a ‘good play’.
4. Here goes. Place the infant in the cot whilst still awake. A mobile above him or her is useful so there is something to look at. Pat gently for a minute, then stop patting and leave. Fuss around the room for a minute or so, slowly moving out view, but still making some soothing noises, then leave the room. If he or she is crying at this point, still leave the room for a few minutes.
5. Persist. When the crying becomes significant, return and come into the infant’s view, pat a for a minute and then leave. Repeat this process. It is important not to pat to sleep. You do not need to pat to stop the crying.  If the infant is vigorously crying and the patting is not soothing then pat briefly, to let them know you are still ‘around’ but leave the room. This is more of a check for you to ensure the infant is ‘ok’, i.e. no full nappy, or a leg stuck in the rails of the cot etc. Try and extend the staying away time if possible.  Do not stand outside the room whilst doing this.
6. If the infant has not slept after an hour or so of this daytime attempt and you need to do something, then get him or her up, and ‘pretend’ there was a sleep. Do not allow him or her to fall asleep in pram or car if possible. If it is clear that sleep has to happen, place in the cot as before. Repeat 4 and 5.
7. At the next sleep repeat. And so on.  This should take about 24 to 48 hours if done properly to start seeing a lessening of the crying, but up to 2 weeks before settling becomes easy.

Frequently Asked Questions

1. I do not like doing this and I get very upset. What else can I try?
   1. Try an infant sleep consultant. These are usually nurses who have worked in sleep clinics and can help you at home. Obviously there is a cost involved but it can be an excellent investment.
   2. Throughout Australia there are a number of local infant sleep clinics which offer a live in program. Their popularity means sometimes the waiting list is lengthy.
   3. Give up, and try again later, perhaps in a few weeks.
2. Should I feed during the night ?  Certainly. A hungry infant will wake and demand a feed. No amount of settling will work until they have been fed. If breast feeding, quick feed, then place back in the cot. No fuss. Same with formula feeding or giving expressed breast milk via a bottle.
3. Does this cause psychological problems ?  No. This has been studied extensively and as long as there is a good parent infant relationship there has never been any future behaviourial or psychological problems associated with this form of sleep training.
4. What can I do to prevent this from happening ?  Some infants from a young age appear to be happy to be placed in a cot whilst awake. They quickly get into a routine and realise that is what they have to do…. Lucky parents. However some infants are more difficult. Particularly if they have had difficult temperaments in the first month or so and have labels such as colic applied to them. These infants will require some gentle sleep retraining as suggested, but wait until they are coping being independent and awake first as mentioned in step one.
5. What about dummies? In some infants these are invaluable. The oral stimulation allows sleep and for the first 12 months or so there are definitely now problems to using dummies. However in toddlers, they should cease by about 18months at the latest.

Remember

Your infant must have sleep to survive. S/he will eventually fall asleep if done properly. If your infant is rewarded for crying by being picked up and reassured or patted then as soon as this association stops s/he will wake again at the light sleep phase.

• Allow your child to fall asleep without any association
• Both parents need to support each other in this.
• A routine is essential for a good sleep pattern
• Sleep is essential for growth, health and development
• Allowing your child to cry does not lead to later problems such as insecurities, emotional or behavioural.
• If done properly sleep management takes 2-4 nights
• Be consistent. Make sure your partner knows what is going on and will help and support you . If one of you do not think they can do it then organise for them to go away for those evenings.