Many families come to QEII seeking support with sleep and settling issues. We know that sleep is important for babies to grow and develop just as it is important too for those parenting them! There is a lot of information on sleep and settling available and sometimes it can be overwhelming knowing which way to turn or who to trust.
What can families expect at QEII
We understand parenting is complex and there are a lot of factors influencing the ability to make and sustain change. To guide this process the staff at QEII use the C-Frame, a strengths based, solution focused approach for working with families that promotes connection, collaboration and change. This means we explore: what goals the family is hoping to achieve; what changes are made along the way; how much progress is being made towards meeting the goals; how carers are adjusting to parenting; how to manage some self-care; what supports are available to help at what is often a challenging time; how the primary carer is coping emotionally; and what barriers there may be to achieving goals.
The nurses and midwives work in partnership with the families discussing different settling options and providing support with strategies to help them and their baby. They work to identify responsive settling strategies that best meet each child’s physical, developmental and emotional needs as well as matching the family’s goals and capacity. It is important that these strategies complement the family’s values and will continue to work at home. It takes time and patience for a baby to learn new ways to settle and this work continues after the stay at QEII.
What the literature says
All babies cry and have periods of being unsettled. This crying is best viewed as a sign that they are upset and in need of physical and emotional closeness from their caregiver. Babies become distressed if left to cry alone, and this can lead to negative long term psychological consequences if done repeatedly.
Caregivers are encouraged to do whatever they can to help soothe their babies (for example holding, stroking, rocking, singing, or talking to the baby). When caregivers help babies to manage their difficult feelings, their babies learn how to do this for themselves as they grow older. Many healthy babies have long periods of being unsettled, where the cause of the crying is not immediately evident. A caregiver’s kind presence helps babies feel less alone with their feelings, making these feelings less overwhelming and easier to tolerate. It is reassuring to know that babies are resilient enough to cope with incidental or accidental lapses in responsiveness (for example, when a parent is caught in traffic while the baby is crying) and that this resilience increases with age.
What helps a baby sleep?
- Ensuring that the baby’s nutritional needs are being met.
- Spending quality time with the baby when they are awake.
- Responding to the baby’s cues. An example of this is looking for tired signs and responding to them – an overtired baby is more challenging to settle.
- Wrapping the baby if they are not yet rolling, as strong startle reflexes can disturb their sleep.
- Having a calm relaxed household prior to and during sleep times, for example, keeping the baby away from the TV or other electronic devices, having soft background music and dimmed lights.
- Establishing a bedtime routine as babies respond to predictable rhythms. A bed time routine will help associate certain actions with sleep time. The key is that similar activities are done in roughly the same way before, starting around 20 minutes before the child’s bedtime.
- Most night time bedtime routines include pre-bed tasks like having a bath and brushing teeth, as well as quiet, enjoyable activities like reading a book or listening to a story. In the daytime it may be closing the blinds, a short story and a cuddle. The aim is to keep the atmosphere calm and positive.
How much sleep do babies need?
Just like grown-ups, babies all sleep for different amounts of time. But a baby’s mood and wellbeing is often a good guide to whether they are getting enough sleep. If a baby is:
- wakeful and grizzly, they probably need more sleep
- wakeful and contented, they are probably getting enough sleep!
The first three months
Newborns generally sleep between 15 to 18 hours in a 24-hour period. Baby’s sleep cycles largely depend on feeding cycles. During this period babies will feed 6-12 times in a 24-hour period. Most babies will not have a consistent or reliable sleep pattern for at least the first three months. Tired signs at this age can include: grimacing, yawning, grizzling, frowning, sucking, staring, turning head away, jerky movements, becoming over active, clenching fists, squirming, fussiness or crying.
Three to six months
Babies at this age will have between 10 to 18 hours sleep in a 24-hour period. On average they sleep around 14 hours. Night and day rhythms may mean longer night sleeps. They will still require a minimum of six feeds per 24 hours but for some babies night feeds may become less frequent. Sleeping patterns vary a lot, but babies generally nap three times during the day and most babies need help to settle to sleep. At this age a tired baby may: grimace; avoid eye contact; have jerky movements; yawn; frown; clench fists; grizzle; have a tense body; and cry.
Six to twelve months
Babies still sleep for around 14 hours in a 24-hour period. Sleeping patterns vary a lot, but babies generally nap three times during the day for 1 to 2 hours however, a quarter of babies nap for less than an hour. Some babies need 1 to 2 night feeds, however this normally decreases by 12 months. More than a third of parents say they have problems with their baby’s sleep at this age. Tired signs include a baby: being less co-ordinated and clumsier; not interested in food; having a shorter concentration span; in need of constant attention; grizzling; requiring more physical contact; and rubbing eyes, nose, ears or pulling hair.
Settling strategies
At QEII we recommend using evidenced based settling strategies that are responsive to a baby’s cues. These strategies may vary depending on how the caregivers and the baby are coping.
Place the baby on their back in the cot when they are calm and drowsy and give them an opportunity to self-settle. Some babies might grizzle before finding a comfortable position and drifting off to sleep. Many babies will call out and need assistance to calm. The carer may need to shush, sing or pat them to calm them in the cot. If they are not calming they may need to be picked up and cuddled until calm. Once calm return them to the cot. This process is repeated until the baby falls asleep. If it is not working and either the carer or the baby are getting distressed it is OK to settle them another way or get them up and try again at the next sleep time.
How much “hands on” settling each baby needs will vary from settle to settle. The nurses and midwives working with each family provide guidance and support until they feel confident to do it alone.
Initial settling sessions may not immediately be successful as the baby is learning a new way to settle. Being persistent and consistent with the settling strategies will enable a baby to adjust to the new settling regime. It is important carers look after themselves too and the midwives and nurses will discuss strategies to help remain calm and cope when settling is a challenge.
References
Australian Association for Infant Mental Health Inc., 2016, Responding to Baby’s Cues, viewed 6 September 2018, available at https://www.aaimhi.org/key-issues/position-statements-and-guidelines/AAIMHI-Position-paper-2-(2016)-Responding-to-infant-cues-(1).pdf
Raising Children Network, 2017, Sleep Needs for Babies, viewed 6 September 2018, available at http://raisingchildren.net.au/articles/concerned_about_your_babys_sleep.html/context/730