Kim Arrington Johnson in BabyParenthood

Sleep Guide: Newborn to Age Three Years

Where will my baby sleep?

This issue has become slightly contentious as attachment parenting has become a mainstream method of caring for baby. Let’s first define some confusing terms.

Bed sharing is physically sleeping next to baby in an adult bed.
Room sharing, or co-sleeping, is keeping baby nearby in a bassinet, portable crib, or his own sleeping space for the first months of life.
The AAP recommends room sharing or co-sleeping. However, many attachment parent advocates steadfastly disagree and maintain that safe bed sharing occurs around the world. So what is a parent to do?

The AAP recommends that infants sleep in the same room as their parents, close to their parents’ bed, but in a separate bed or crib appropriate for infants. This sleeping arrangement is recommended ideally for the baby’s first year, but should at least be maintained for the first 6 months.

Only you can determine what is best for your family. However, here is an example of what worked in our home. After researching various sleep arrangements, we chose room sharing or co-sleeping for our own children. During the day, we followed attachment parenting techniques. Yet at night, we wanted to know that our newborns were safe. We both sleep soundly, and our memory foam mattress makes a large indentation around a sleeping adult, a relative sinkhole for a seven-pound baby. Our bedding is also plush and thick, which is not the case for many non-western cultures. Bottom line: If we slept on a firm floor mat or solid wood platform, as many parents do around the world, I might be more inclined to support family bed sharing. However, since we do not, we chose to keep our newborns next to us in a bassinet for the first several months of life.

American Academy of Pediatrics (AAP) recommendations on creating a safe sleep environment include:

Place the baby on his or her back on a firm sleep surface such as a crib or bassinet with a tight-fitting sheet.
Avoid use of soft bedding, including crib bumpers, blankets, pillows and soft toys. The crib should be bare.
Share a bedroom with parents, but not the same sleeping surface, preferably until the baby turns 1 but at least for the first six months. Room-sharing decreases the risk of SIDS by as much as 50 percent.
Avoid baby’s exposure to smoke, alcohol and illicit drugs.

While infants are at heightened risk for SIDS between the ages 1 and 4 months, new evidence shows that soft bedding continues to pose hazards to babies who are 4 months and older.

Other AAP recommendations include:

Offer a pacifier at nap time and bedtime.
Do not use home monitors or commercial devices, including wedges or positioners, marketed to reduce the risk of SIDS.
Infants should receive all recommended vaccinations.
Supervised, awake tummy time is recommended daily to facilitate development.

How much sleep does your child need? ¹⁹

Age	Nighttime Sleep	Daytime Sleep	Total Sleep
1 month	8 1/2	7 (3 naps)	15 ½
3 months	10	5 (3 naps)	15
6 months	11	3 ¼ (2 naps)	14 ¼
9 months	11	3 (2 naps)	14
12 months	11 ¼	2 ½ (2 naps)	13 ¾
18 months	11 ¼	2 ¼ (1 nap)	13 ½
2 years	11	2 (1 nap)	13
3 years	10 ½	1 ½ (1 nap)	12

Newborns

Newborn babies typically sleep sixteen to eighteen hours a day, but may sleep as little as fourteen hours. A tight swaddle helps babies feel warm and secure, but avoid overheating. Dress your newborn in a single layer cotton pajama and swaddle with a thin blanket (a thicker swaddle or sleep-sack may be used in winter). In general, dress baby with no more than one more layer than an adult might wear to be comfortable. A full-term healthy infant should not need a hat, unless your home is particularly drafty. Place your newborn to sleep on a firm, flat surface. The AAP states that infants should be placed on their backs until age one. The supine sleep position (on the back) does not increase the risk for choking or aspirating, even for babies with gastro-esophageal reflux, since they have protective mechanisms for the airway.²⁰ Elevating the head is also not recommended, even for reflux, because baby might slide to the foot of the crib or sleeper, which can affect their breathing.²⁰ A crib nap is always better than a nap in a car seat, bouncer seat, or swing for maximum oxygen flow. The AAP does not recommend any type of bed-sharing as safe. If you do choose to bed-share, place baby next to Mom—not between Mom and Dad—because mothers have an innate protective awareness for baby. Do not bed share with anyone who smokes, drinks alcohol before bedtime, or is taking medications.²¹

Sudden Unexpected Infant Death (SUID)

In 2017, there were about 1,400 deaths due to SIDS, about 1,300 deaths due to unknown causes, and about 900 deaths due to accidental suffocation and strangulation in bed, according to the CDC.

SIDS is the leading cause of death for babies one to twelve months old in the U.S. The peak age for SIDS is two to four months, and 90% of cases occur between one and six months old. SIDS is more likely to occur in the winter months.²²
Cut SIDS risk in half by putting baby to sleep on her back on a firm mattress and removing all blankets, sleep positioners, bumper pads, and pillows in the crib. Unaccustomed stomach sleeping increases SIDS risk 18-20 times.²³

One month

Most infants this age will awaken every two to four hours during the night for feedings. To attempt to lengthen sleep periods at night, feed baby every two to three hours during the day. Establish a routine of daily tummy time and avoid excessive time in car seats to prevent positional plagiocephaly, or a flat head.²⁰ If your baby sleeps more during the day than night, help her know the difference. Let her sleep in a partially lit room for daytime naps and in a darker room at night.

Two months

Most infants are still waking every three to four hours. Sleep patterns are highly variable, and the duration of sleep is not always related to the amount or type of feeding. Fight the urge to talk or play during nighttime feedings or diaper changes. If your baby is still sleeping when you want her awake, encourage more playtime during the day. To establish a better family schedule, wake baby for a late-night feeding at a time that suits your schedule. For example, if baby goes to sleep at 7:00 p.m. and sleeps until 2:00 a.m., wake baby up to feed at 11:00 p.m. and then put her down to sleep for a 5:00 or 6:00 a.m. wakeup. It may take a few nights or weeks to establish this routine; however, it can be accomplished with consistency.

Four months

Typically, by age three to four months babies have started to develop more of a regular sleep and wake pattern and have dropped most of their nighttime feedings. Somewhere between four and six months most babies are ready for some type of sleep training and are capable of sleeping through the night, a stretch of five to six hours.

Six months

If your baby sleeps nine to ten hours at night, it means he’s figured out how to settle back to sleep. If your baby isn’t sleeping five to six hours straight, you’re not alone. As adults, we all wake up several times each night for brief periods of time, yet we put ourselves back to sleep so quickly that we don’t remember it in the morning. If your baby hasn’t mastered this skill, he will wake up and cry during the night, even if he’s not hungry. Nighttime feedings are usually no longer necessary after six months, though a sick or fussy baby will appreciate a soothing feeding when needed.

Nine months

Infants may resist going to sleep due to separation anxiety, and it is not unusual for a child this age to awaken at night, due to teething or achievement of developmental milestones. By nine months, most babies’ sleep patterns are fairly established.²⁴ After the first one to two hours of deep sleep, your baby will move into a stage of lighter snoozing. This pattern of deep and light may occur up to four to six times per night. During the lighter phases of sleep your baby may open his eyes, look around, and cry for you. If his crying includes whimpers, wait and see if baby can soothe himself back to sleep. If the crying warrants attention, go to baby. Use your preferred sleep training method for deciding whether to pick him up or not. Some parents choose to hold, feed, and rock baby back to sleep, while other parents prefer to reassure baby of their presence without picking him up. If handled properly, this exasperating period of nighttime awakenings should last no more than a few weeks.^{21, 25}

Twelve months

Naptime and nighttime may be more of a struggle due to separation anxiety. If this occurs, a favorite soft toy or lovey may help. It is also not unusual for a child this age to awaken at night. At some point between twelve and eighteen months, consolidate daytime sleep to one nap. This can often result in more quality sleep for a one-and-a-half-year-old and can be easier to work into family schedules. Never use television in place of a parent for the bedtime routine and expect that if a child, regardless of age, receives an iPad in Mom and Dad’s bed upon waking, he will gleefully wake earlier and earlier for this mesmerizing treat. Television viewing at either end of the nighttime sleep cycle can interfere with good sleep. Poor sleep habits affect a child’s mood, behavior, and learning.²⁶

Eighteen months to thirty-six months (one and a half to three years)

Your child will be ready to move from a crib to a big bed between eighteen and thirty-six months, depending on your circumstances. If your toddler is climbing out of his crib, you’ll need to move to a toddler bed or big bed. With two children closely spaced, don’t feel too rushed to move the elder sibling into a big bed, especially if there is concern that he is not ready. You can keep an older sibling in a crib (better sleep for everyone), since the newborn may sleep in a bassinet for several months. If your children are very closely spaced, you may want to borrow another crib. A two-year-old can still be potty trained during the day and wear a diaper at night in his crib.

What is a floor bed or Montessori-style bed?

Some parents choose to skip cribs altogether by putting a Montessori-style bed on the floor. The idea behind a Montessori floor bed is similar to the underlying principles of the Montessori Method—a child should have freedom of movement within a safe environment. With a floor bed, a child exerts his own independence as he moves freely about the room once mobile.

Pros: The floor bed can be a firm mattress that you already own, eliminating the expense of a bassinet, crib, and toddler bed. Many parents cite difficulties with bending over a too tall, fixed-side crib as a reason for a floor bed.

Cons: Your nursery must be meticulously childproofed and getting your child to stay in his bed may require time and patience.

What is Sleep Training?

For more information on baby sleep training, read my next post BABY SLEEP TRAINING: PUTTING BABY ON A SLEEP SCHEDULE (SUMMARY OF ALL THE BOOKS). Learn about Babywise, Ferber Method, Weissbluth Method, Pantley Method, The Happiest Baby/5’s, Dr. Sear’s Attachment Parenting Sleep Methods, and more.

For more high-quality baby content from UPKiQ, try the following:

Sources

19. Mindell, J.A., Sleeping through the night : how infants, toddlers, and their parents can get a good night’s sleep. Rev. ed. 2005, New York: HarperResource. vi, 360 p.

20. Moon, R.Y. and Task Force on Sudden Infant Death Syndrome, SIDS and other sleep-related infant deaths: expansion of recommendations for a safe infant sleeping environment. Pediatrics, 2011. 128(5): p. 1030-9.

21. Sears, W., The baby book: everything you need to know about your baby–from birth to age two. 2nd ed. 2003, Boston: Little, Brown and Company.

22. Centers for Disease Control and Prevention. Sudden Unexpected Infant Death and Sudden Infant Death Syndrome. 2014; Available from: http://www.cdc.gov/sids/aboutsuidandsids.htm.

23. Palfrey, J., Safe Sleep: Tips for Avoiding Sudden Infant Death Syndrome, in Health Issues. 2013, Boston Children’s Hospital.

24. Halpin, D., Nine Months – Sleeping. 2012, Northern Virginia Pediatrics: Falls Church, VA.

25. Ferber, R., Solve your child’s sleep problems. New, revised, and expanded ed. 2006, New York: Fireside Book. xxi, 440 p.

26. Ferber, R., Important Tips to Help Your Child Sleep Well, in Boston Children’s Hospital. 2013.

Next Read: Baby Sleep Training: Putting Baby on a Sleep Schedule (Summary of all the Books) »

Kim Arrington Johnson: