Module 6: Infant sleep

This module is designed to cover all the background information and knowledge you will need in order to support parents with baby sleep. It will take you from a scientific basis through an understanding of what is normal for babies. Then we will discuss and analyse all the possible methods that can be used to improve infant sleep, and their benefits and limitations, from mainstream to mindful and gentle. Lastly we will cover safety in relation to sleep.

The Science of infant sleep

Introduction to sleep science

Introduction to sleep science

Baby and child sleep is a hot topic. It is talked about all the time by parents that you meet, by the media and by health care professionals. Everyone who talks about infants and toddlers, talks about sleep. There is also now a wealth of research on infant sleep, particularly in the area of safety and in relation to SIDS, but also in regard to how sleep actually occurs and how it affects health and wellbeing. From these studies we know quite a lot about the psychology of sleep.

Research by Armstrong, Quinn and Dadds studied the sleeping habits of over 3000 children in Australia from birth to 38 months. Their findings included the following information: 

  • almost one-third of all parents of babies and small children consider their child’s sleep ‘problematic’
  • Only 16% of six month olds regularly sleep through the night, meaning that 84% do not
  • Once children reach the age of 18 months, they require more parental help in order to get them to sleep than they previously needed
  • They found that the majority of children do not regularly sleep through the night until they reach their second birthday
  • They established that there is a wide range of normal childhood sleep behaviour 
  • Daytime sleep becomes less regular with increasing age
  • Frequent night waking that disturbs parents is common from 4-12 months (12.7% disturb their parents 3 or more times every night).

Armstrong, K. L., Quinn, R. A., Dadds, M. R., (1994) ‘The sleep patterns of normal children’


Mothers of 118 infants, who took part in a follow-up study of normal babies, completed a sleep questionnaire at 3, 6, 9 and 12 months. Regular night waking was a common characteristic throughout the first year:

Baby's age      % Babies waking at night

3 months          46%

6 months          39%

9 months          58%

12 months        55%

When talking to parents/care givers make sure that you get them thinking about why night time awakenings may increase and how it differs from societal expectation. Some ideas are; 

  • Separation anxiety
  • Developmental spurts, psychological changes (there is a lot going on for toddlers)
  • Child starting nursery/mother returning to work
  • New sibling/imminent arrival of new sibling
  • Teething

Often parents worry about their child needing parental help to get to sleep, but research has shown us that at least 50% of all one-year olds need parental input in order to help them settle to sleep. 

Goodlin-Jones, B. L. et al., ‘Night waking, sleep-wake organisation, and self-soothing in the first year of life’ (2001) 

Worrying research shows us that 31% of 25-38 month old children were disciplined (mostly smacking) to get them to settle. 27% of parents let their children cry themselves to sleep. 

Scher, A., ‘A longitudinal study of night waking in the first year’ (1991) 1

The biology of sleep

The biology of sleep

Sleep is a fairly complex chemically controlled process. It can (and regularly is) influenced by external factors, but when stripped back, the basic building blocks of sleep are chemical ones. The brainstem (reptilian brain) along with a section of the hypothalamus, is responsible for what is known as 'homeostasis' or basic life support function. It is responsible for all the things that keep us alive; breathing, temperature regulation, eating, and you guessed it, sleeping. The hypothalamus contains neurons which help to promote sleep by inhibiting activity in areas of the brainstem that maintain wakefulness. When the alerting areas of the brain are most active, they send arousal signals to the cerebral cortex (the outer layer of the brain that is responsible for learning, thinking, and organising information), while at the same time inhibiting activity in other areas of the brain that are responsible for promoting sleep, resulting in a period of stable wakefulness. When the sleep-promoting areas of the brain are most active they inhibit activity in areas of the brain responsible for promoting wakefulness, resulting in a period of sleep. 

Circadian rhythms

The neurons and chemicals make us feel sleepy or awake and do so over a period of 24 hours. This recurring 24 hour sleep/wake cycle is known as a circadian rhythm. The word 'circadian' derives from the Latin phrase 'circa dies', which translates to mean 'around a day'.The circadian biological clock is controlled by a part of the brain called the Suprachiasmatic Nucleus (SCN), a group of cells in the hypothalamus that respond to light and dark signals. The SCN is situated at the back of the eyes, close to the optic nerve. From the optic nerve of the eye, light travels to the SCN, signaling the internal clock that it is time to be awake. The SCN signals to other parts of the brain, the most significant being the pineal gland, that control hormones, body temperature and other functions that play a role in making us feel sleepy or awake. The pineal gland responds to the presence of light by inhibiting the production of melatonin.

What is Melatonin?

Melatonin is a natural hormone that is produced by pineal (pic-knee-uhl) gland. This is located just above the middle of the brain. During the day the pineal is completely inactive but starts to work when the sun goes down & darkness occurs. It is 'turned on' by the SCN and begins to actively produce melatonin, which is then released into the blood. Once melatonin levels in the blood rise, we begin to feel less alert and sleepy. Melatonin levels usually remain elevated in the blood for about 12 hours - all through the night - and fall in the morning when they are barely detectable.

Sleep Cycles and Circadian Rhythms in Infants

To understand baby sleep it is important to start at the beginning. A newborn baby is not born with circadian rhythms and it takes a while for them to develop these, although while in utero, melatonin does pass into the body via the umbilical cord and the mother's body and babies exhibit similar sleep/wake patterns to their mother (Torres-Farfan etc al, 2006). Further research indicates that circadian rhythms are not well established until babies are around four months of age. This is the age from which you may start to notice a child’s sleep patterns showing some response between night-time and daytime.

Mirmiran, M., Maas, Y. G., Ariagno, R. L., (2003) ’Development of fetal and neonatal sleep and circadian rhythms’

Understanding Sleep Cycles

Stage 1 - a drowsy state or very light sleep - your eyes are usually closed but it's easy to wake you up

Stage 2 - early sleep, muscles relax - You are in light sleep. Your heart rate slows and your body temperature drops. Your body is getting ready for deep sleep

Stage 3 - deep sleep, heart rate slows, body temperature drops - This is the deep sleep stage. It's harder to rouse you during this stage, and if someone woke you up, you would feel disoriented for a few minutes. 

During the deep stages of NREM sleep, the body repairs and regrows tissues, builds bone and muscle, and strengthens the immune system.

REM - body immobile and brain highly active - Your heart rate and breathing quickens. This is the stage of sleep that you can experience intense dreams, since your brain is more active. 

Baby's sleep cycles are also much shorter than an adults and their sleep is much lighter, therefore babies are much more easily awakened than adults - 50% of a newborns sleep is spent in REM  in comparison to 20% of a adult. In evolutionary terms, this is incredibly beneficial for babies. An average adult sleep cycle lasts for approximately 90-120 minutes (starting in phase 1 and ending in REM sleep) at the end of this cycle the adult will either awaken or go back to sleep for another cycle.

A baby's sleep however is very different; their sleep cycles last on average 45-60 minutes. When a newborn first falls asleep they enter a state known as “active sleep” or REM (fluttering eyelids, rapid irregular breathing, body jerks and vocalizations). Babies in active sleep are easily woken and remain in this stage of sleep for about 20 minutes. The final 20 minutes a baby passes into "quiet sleep" or NREM (no eyelid fluttering/movement/noise), this stage of sleep is deeper and babies are less likely to awake in this sleep cycle (including being less likely to wake to a lack of oxygen, Parslow, 2003). At the end of this sleep cycle a baby may wake if something alerts them (this can be anything from a wet nappy, feeling cold or feeling hungry to feeling insecure or lonely when not close to their caregiver) or start a new sleep cycle. This makes perfect sense in evolutionary terms to keep a newborn safe, it would have kept them alert to any potential predators or harm and more recently it is believed to help protect a baby from SIDS. 

REM sleep is said to be especially important to the developing brain in babies and young children, researching hypothesise that the increased neutral stimulation that happens during this is stage is necessary in order to create new neural connections in the developing brain. As a baby grows their sleep cycles become longer and they spend less time in active sleep. 

  • Newborn = 50% REM sleep 
  • 3-6 Months = 40% REM sleep 
  • 6-12 Months = 35% REM sleep 
  • 1-2 Years = 30% REM sleep
  • 2-3 Years = 28% REM sleep 
  • 3-5 Years = 25% REM sleep
  •  5-13 Years = 20% REM sleep 
  • Teenager = 25% REM sleep 
  • Adult = 20% REM Sleep 

A child's sleep cycle does not reach the average length of an adult sleep cycle until they are school age (approx 4-5 years). This is also when most people see an improvement in their child's sleep and "sleeping through the night" (without needing parental input) usually becomes more frequent. Some research has indicated that 50% of pre-school children wake regularly at night.

Blair, P. S., Humphreys, J. S., Gringras, P., Taheri, S., Scott, N., Emond, A., Henderson, J., Fleming, P. J., (2012) ‘Childhood sleep duration and associated demographic characteristics in an english cohort’ 

Now that we understand the biology of sleep a little better, we will look at how research shows that sleep is impacted by external factors.

Sleep and maternal mood and attachment

Sleep and maternal mood

Many parents report that bedtime can be stressful and affect their overall mood, and many professionals have noted that depressed mothers seem to have more difficulty with their infants' sleep. Here we will explore some studies that have been carried out to determine whether infant sleep and maternal mood can affect each other.

Can maternal mood issues impact sleep?

In 2014 research found that life stress in the mothers (in the study) was statistically significant and negatively related to pre-school child’s sleep duration.

Caldwell, B. A., Redeker, N. S., ‘Maternal stress and psychological status and sleep in minority preschool children’ (6 Jan 2014) 

In 2012, the lead researcher. Dr Douglas Teti, commented ‘We found that mothers with high depressive symptom levels are more likely to excessively worry about their infants at night than mothers with low symptom levels, and that such mothers were more likely to seek out their babies at night and spend more time with their infants than mothers with low symptom levels. This in turn was associated with increased night waking in the infants of depressed mothers, compared to the infants of non-depressed mothers. Especially interesting was that when depressed mothers sought out their infants at night, their infants did not appear to be in need of parental help. They were either sound asleep or perhaps awake, but not distressed. 

Teti, D. M., Crosby, B. ‘Maternal depressive symptoms, dysfunctional cognitions and infant night waking: the role of maternal nighttime behaviour’ (2012) 

Research in 2014 highlighted a link that infants may pick up on their mother’s moods and become more distressed as a result. Lead researcher Dr Sarah Waters commented on the findings, saying ‘Our research shows that infants “catch” and embody the physiological residue of their mothers’ stressful experiences… Before infants are verbal and able to express themselves fully, we can overlook how exquisitely attuned they are to the emotional tenor of their caregivers.’ She goes on to say, ‘Your infant may not be able to tell you that you seem stressed or ask you what is wrong, but our work shows that, as soon as she is in your arms, she is picking up on the bodily responses accompanying your emotional state and immediately begins to feel in her own body your own negative emotions.’ This goes part way to demonstrating that our own emotional mood affects the sleep of our babies. 

Waters, S. F., West, T. V., Mendes, W. B., ‘Stress contagion physiological conversation between mothers and infants’ (30 Jan 2014)

Can lack of sleep impact maternal mood?

Research from 2005 linked sleep deprivation with the onset of depression in mothers, with researchers concluding that ‘infant sleep patterns and maternal fatigue are strongly associated with the new onset of depressive symptoms in the postpartum period,’ which indicates that maternal depression can be worsened by the excessive tiredness caused by sleep deprivation. 

Dennis, C. L., Ross, L., ‘Relationships among infant sleep patterns, maternal fatigue, and development of depressive symptomatology’ (2005) 

How does all this affect attachment?

Research by Scher * in 2001 examined the association between a young toddler’s sleep pattern and mother-infant attachment in 94 mother-infant dyads. 

At 12 months each dyad participated in the Strange Situation procedure; 77% of the 94 babies were securely attached. 55% of the secure and 60% of the ambivalent children were described as night wakers. The frequency of the night waking was similar for the secure and insecure infants. The findings confirm that night waking at the end of the first year is a common developmental phenomenon that is not indicative of attachment.

* Scher, “Attachment and sleep: a study of night waking in 12-month-old infants.” Dev Psychobiol2001 May;38(4):274-85.

Environmental factors

Environmental factors

There are lots of things which can encourage or inhibit the brain producing the necessary chemical processes that we talked about earlier. In this section we will explore a variety of those external factors. 

Artificial Light

Electric lighting is everywhere! It is a brilliant invention BUT it plays a huge part in the way we sleep. For thousands of years, our circadian rhythms were controlled by the rising and setting of the sun. Melatonin levels would rise at dusk and cortisol levels would rise at dawn. Now, we are able to trick our bodies that it's daytime during the night, that the sun doesn't set until midnight or that it rises well before it actually does - all because of artificial light! 

The Professor of Sleep Medicine at Harvard Medical School, Charles Czeisler, said ‘There are many reasons why people get insufficient sleep in our 24/7 society. But the participating factor is often unappreciated, technological breakthrough: the electric light…light affects our circadian rhythms more powerfully than any drug.' Professor Czeisler found that between the years 1950 and 2000 the use of artificial light increased fourfold and sleeping problems increased correspondingly. On average children are now getting 1.2 hours less sleep at night than they did 100 years ago. He comments ‘Technology has effectively decoupled us from the natural 24-hour day to which our bodies evolved, driving us to go to bed later. And we use caffeine in the morning to rise as early as we ever did, putting the squeeze on sleep.’ 

Czeisler, C. A. ‘Perspective: casting light on sleep deficiency’ (2013) 

Can you reset your circadian rhythm, I hear you ask! The answer is YES! 

A study carried out at the University of Colorado which explored the effects of camping in nature found that even one week without the interruption of electrical lighting can be enough to improve sleep. The researchers found that seven days of camping, with exposure only to the natural light or the sun and moon, and camp fires in the evening, is enough to reset our circadian rhythms to be more in-line with the natural sunrise and sunset. After studying the melatonin levels of the participants, the researchers found that levels began to rise around two hours earlier when camping, compared to when they were at home surrounded by artificial light. 

Wright, K. P. Jr, McHill, A. W., Birks, B. R., Griffin, B. R., Rusterholz, T., Chinoy, E. D., ‘Entrainment of the human circadian clock to natural light-dark cycle’ (2013) 

Red light, blue light

Some people may argue that we have used artificial light long before the electric light was invented, in the form of fire and candles, but there is one significant difference - the colour and intensity of light. The natural colour of fire and candlelight is always orange-red, in comparison to modern natural lighting which is incredibly bright and, probably more importantly, focussed on the blue and white colour spectrum. 

Research that was carried out to look at the impact of different colours of light has found our body’s natural clock system responds differently to artificial light sources, depending on the colour. 

Holzman, D. C., ‘What is in a colour? The unique human health effects of blue light (2010) 

Debra Skene, a scientist from the University of Surrey, who conducted research into the effect of colour wavelengths of light and their impact on melatonin, says ‘We observed peak light sensitivity at a wavelength of around 460 to 480 nanometres - a nice deep blue.’ She goes on, ‘Red light, by contrast, has only a weak impact on melanopsin receptors and is less prone to stimulate wakefulness. So adjusting the relative levels of blue and red light that people are exposed to throughout the day could preserve normal circadian timing even during prolonged exposure to artificial light.’ 

Warman, V. L., Dijk, D. J., Warman, G. R., Arendt, J., Skene, D. J., ‘Phase advancing human circadian rhythms with short wavelength light’ (2003) 

Screen time

As with artificial light, the increasing popularity of electronic screen time. We are exposed for hours each week to televisions, tablets, computers and smart phones - all which omit artificial light which promote brain activity. Research conducted in New Zealand in 2013 found that in the last hour and half before bedtime almost 50 per cent of children watch as much as 30 minutes of television. Unsurprisingly, those children who watched television in the last hour or two before bedtime went to sleep later than those who watched none. 

Louise Foley, lead researcher, commented that ‘Reducing screen time in this pre-sleep window, could be a good strategy for helping kids go to sleep earlier.' Professor Christakis, a paediatrician at the University of Washington, when talking about this research, said “There is growing evidence that media use around sleep time is bad for sleep initiation: it is not so much having a bedtime for your children. You have to have a bedtime for their devices.’

Foley, L. S., Maddison, R., Jiang, Y., Marsh, S., Olds, T., Ridley, K., ‘Presleep activities and time of sleep onset in children’ (2013) 

Researched carried out in 2013 found that the more children used electronic media the less sleep they got. The lead researcher, Teija Nuutinen, commented that ‘Media viewing habits should be considered for kids who are tired and struggling to concentrate or who have behaviour problems caused by lack of sleep’ 

Nuutinen, T., Ray, C., Roos, E., ‘Do computer use, TV viewing, and the presence of the media in the bedroom predict school-aged children’s sleep habits in the longitudinal study’ (2013) 

Sleep and diet

Diet (Are there differences between formula and breastmilk?)

In short, yes they usually do sleep differently. Biologically breastmilk and formula milk are different and as such they are digested by infants differently. Breast milk takes around 1 1/2 hours for a baby to digest while formula milk takes around 3 1/2 hours - that's a pretty big difference!! 

Why?

Human breast milk provides just the right balance of nutrients for a baby, comprising of more than 200 different ingredients and the composition continually changes. Breast milk is higher in lactose, but is lower in protein than formula milk. Breast milk contains approximately 4% fat, 1% protein and 7% carbohydrates, usually containing around 70 calories per 100ml. In comparison, formula milk contains around 3.5% fat, 3.5% protein and 5% carbohydrate and around 80 calories per 100ml. The natural composition of breast milk and formula (made from cows milk) is different. 

Research from 2012 found that breast milk produced at night contains signifiant levels of melatonin, the sleep hormone. Melatonin isn't the only sleep hormone contained within breastmilk at night - it also contains more tryptophan, another chemical that aids sleep. 

Cohen Engler, A., Hadash, A., Shehadeh, N., Pillar, G., ‘Breastfeeding may improve nocturnal sleep and reduce infantile colic: potential role of breast milk melatonin (2012) 

Ever heard someone saying that eating a banana can help you sleep better? Well here is the theory behind it - bananas contain Tryptophan! Other foods also do - examples of these are; nuts, seeds, tofu, cheese, red meat, chicken, turkey, fish, oats, beans, lentils, and eggs. Tryptophan is an amino-acid and an essential part of the human diet because our bodies are unable to make it, and the only way we can get enough is through our diet (including breastmilk). Tryptophan is an important component in the manufacture of serotonin and melatonin, the hormone of sleep, and for this reason many suggest that foods containing high levels of tryptophan may help us to sleep. Research has found that although increased tryptophan intake augmented feelings of sleepiness it doesn't decrease the amount of night wakings. 

Hartmann, E., ‘Effects of L-tryptophan on sleepiness and on sleep (1982) 

I'm sure it's no surprise to you that E numbers can have a negative impact on sleep. Research conducted at a Children's hospital in Australian in 1994 found that ‘restlessness, and sleep disturbance are associated with the ingestion of tartrazine (E102, a very common food colouring, usually used to colour foods yellow)  in some children’. Although a lot of babies won't be consuming E numbers regularly, if at all, it's important to be aware because certain children's medicines contain E numbers. 

Rowe, K. S., Rowe, K. J., ‘Synthetic food colouring and behaviour: a dose response effect in a double-blind placebo-controlled, repeated-measures study’ (1994) 

Rowe, K. S., Rowe, K. J., ‘Synthetic food colouring and behaviour: a dose response effect in a double-blind placebo-controlled, repeated-measures study’ (1994) echoed the findings in earlier research. It found there was an increase in time taken to go to sleep at night, as well as night awakenings. 

Kaplan, B. J., McNicol, J., Conte, R. A., Moghadam, H. K., ‘Dietry replacement in preschool-aged hyperactive boys’ (1989) 

Daytime naps and napping

Napping

Newborn babies sleep on and off throughout the day and night. Initially they don't have any concept of day and night and actually differentiate between the two less well than when they were in the womb as they don't have the mother's body and hormones to guide them, and they cannot do this on their own yet.

As they grow a little older, their sleeping rhythm becomes more predictable (in most cases but not all). In most 3 month old babies they start to develop a reasonably predictable wakeful period of 90 minutes between sleeps. This is the start of the circadian rhythm emerging, with wakeful periods lengthening before sleep cycles. So at this stage a wakeful period is likely to be 90 minutes and then a sleep cycle is closer to 45 minutes. These will adapt over time as discussed before. In Polly Moore’s book, The 90 Minute Baby Sleep Program, she discusses how parents can use this knowledge to  observe their baby, predicting the timings of likely tiredness, and therefore offering the opportunity to calmly offer them a soothing transition to sleep at the right moment. This equals easier naps.

Moore uses the tool NAPS to assist parents:

Note time of waking

Add 90 minutes

Play / feed/ massage/ whatever

Soothe to sleep just before the 90 min mark

Whilst this is scientifically valid and interesting, Moore heads into the mindset of making 90 minute parenting rigid at times and this does not work for BabyCalm.  We absolutely are not suggesting a 90 minute routine, but we do think this is useful information for observational purposes and useful to give parents who are struggling with daytime sleeping during the 2-6 month period. It can be applied later too but the timings may need adjustment.

For older babies the below information may be relevant:

The impact of daycare on naps

Current figures suggest that around 21 per cent of children under 2 attend a day care setting (this figure doesn't include those cared for by childminders, grandparents and nannies). It is becoming more and more apparent that the government are keen to increase this figure. Many nurseries and childcare settings can be busy, stimulating, noisy environments and not one that babies may have been exposed to much before, historically speaking. Understandably this can affect some babies naps, particularly afternoon naps. 

Kurdziel, L., Duclos, K., Spencer, R., ‘Sleep spindles in midday naps enhance learning in preschool children’ (2013) 

Siestas (aka naps) and later bedtimes

Research carried out in 2006 suggested that the practice of taking a afternoon siesta might be due, in part, to the glucose contained within our lunch, which inhibits neurons in the brain that are responsible for keeping us alert and active. The researchers said: ‘It has been known for a while that people and animals can become sleepy and less active after a meal, but brain signals responsible for this are poorly understood.  We have pin-pointed how glucose - the sugar in food - can stop the brain cells from producing signals that keep us awake… This may well provide an explanation for after-meal tiredness and why it is difficult to sleep when hungry… This research perhaps sheds light on why our European friends are so fond of their siestas.’ 

Burdakov, D., Jensen. L. T., Alexopoulos, H., Williams, R. H., Fearon, I. M., O’Kelly, I., Gerasimenko, O., Fugger, L., Verkhratsky, A., ‘Tandem-pore K+ channels mediate inhibition of orexin neurons by glucose’, (2006) 

Dr Michael Twery, Director of the National Heart Lung and Blood Institute’s National Centre on Sleep Disorders Research, said: ‘Napping may help deal with the stress of daily living. Another possibility is that it is part of the normal biological rhythms of daily living. The biological clock that drives sleep and wakefulness has two cycles each day. and one of them dips usually in the early afternoon. It’s possible that not engaging in napping for some people might disrupt these processes.' 

Naska, A., Oikonomou, E., Trichopoulou, A., Psaltopoulou, T., Trichpopoulos, D., ‘Siesta in healthy adults and coronary mortality in the general population’ (2007) 

Research conducted in 2013 found that pre-school aged children from Asian countries tend to have a much later bedtime than those in Europe, the USA and Australia. The earliest bedtimes were found in Australia and NZ, with an average bedtime of 7.43pm. On the other side of the globe bedtimes in India averaged at 10.26pm, almost 3 hours later! Daytime naps, however, were more common in the Asian countries studied, but the total time asleep per 24 hours was roughly the same for all children, no matter where in the world they lived. It was apparent that children from Asian countries were spreading their sleeps throughout the day and night whereas predominately Caucasian countries daytime naps were significantly rarer and more sleep was being taken at night.

Mindell, J. A., Sadeh, A., Kwon, R., Goh, D. Y., ‘Cross cultural differences in the sleep of pre-school children’ (2013) 

Later bedtimes are prevalent in many other cultures around the world. Anthropologists Carol Worthman and Melissa Melby described different bedtime habits of two tribes, the !Kung and the Efe. In a article produced in 2002 it states ‘neither Kung nor Efe have bedtimes, so time of falling asleep varies widely with individuals. People stay up as long as something interesting - a conversation, music, dance - is happening and participate; then they go to sleep when they feel like it….Additionally no-one, including children, is told to go to bed, and individuals of any age may nod off amid ongoing social intercourse and fade in and out of sleep during night-time social activities.' 

Worthman, C. M., Melby, M. K., ‘Toward a comparative developmental ecology of human sleep’ (2002) 

What this can tell us is that our ideas (or others' ideas) in society about sleep, napping and routine aren't always those that work for us a species biologically. There are many other ways of living that may work just as well, if not better. Understanding this concept can empower parents to follow their babies' leads and refrain from trying to force them into our society's ideals of sleep.

Sleep 'regressions'

Sleep 'regressions'

We can see from the research that infant sleep does not progress from regular night wakings to "sleeping through the night" using a linear curve of improvement. Babies' sleep can improve and then "regress". This term is here in quotations because the term means "to go backwards" and that is misleading.

Classically at around 4, 9, 12 and 18 months, infant night waking increases. There are many reasons for this, which will be briefly discussed below but something important to remember and essential for parents to understand is that their baby's development is not "going backwards" or "regressing". In fact, most of the time it is quite the opposite.

Development

A major factor in increased night waking seems to be that babies need increased reassurance during developmental "leaps". These are stages in which babies make a significant step forward in their development in some area (learning to smile, laugh, sit, crawl, speak, walk). These developments are able to happen due to developments in the brain and can therefore change a baby's perspective on the world which can be disconcerting.

Teething

Some babies are born with their first teeth. Others start teething before they are 4 months old, and some after 12 months. But most babies start teething at around 6 months. 

Baby teeth sometimes emerge with no pain or discomfort at all. At other times, you may notice that:

  • your baby's gum is sore and red where the tooth is coming through 
  • one cheek is flushed 
  • your baby is dribbling more than usual 
  • they are gnawing and chewing on things a lot 
  • they are more fretful than usual 

Most babies cut their first tooth between six and ten months old. Whilst most parents tend to report that their babies suffer from pain and sleep disturbance during teething, this is not actually backed by research. 

Wake, M., Hesketh, K., Lucas, J., ‘Teething and tooth-eruption in infants: A cohort study’ (2000) Owais, A. I., Zawaideh, F., Bataineh, O., ‘Challenging parents’ myths regarding their children’s teething.’ (2010)

Childcare

As we have just seen, childcare features heavily in the lives of children today and can impact on their naps due to the busy environment. This can, in turn, have a impact on sleep when at home, be that during the night or for daytime sleep. If a baby hasn't had enough sleep for them during the day (and indeed during the length of their naps) then they may become overtired and we know this has a impact on the rest of a baby's sleep. It is also important to keep in mind that the childcare setting may get your baby to sleep in a different way than you do and while some children will adapt, others will struggle with the transitions. It is worth keeping the communication in regards to sleep open with whoever looks after your baby. 

Separation anxiety

Babies can show signs of separation anxiety as early as 6 or 7 months but for most babies it peaks between 10 to 18 months and eases up by 2 years, and they will experience it in varying degrees. 

In the second half of the first year babies begin to develop the motor skills of crawling and walking, which enable them to move farther away from their caregivers. But separation anxiety keeps them safely connected so they don't move too far; it's as if their body says "go" but their mind says "stay." Also, a young baby doesn't have what's called "person permanence," which, in plain language means "out of sight, out of mind." So when your infant can't see you, to her you don't exist. Between 1 and 2 years of age, an infant develops the ability to carry a mental picture of you in her mind even when you are out of her sight - this in turn helps her separate with less anxiety. Don't misinterpret separation anxiety as your child being overly attached or dependent, or spoiled. In fact, it's just the opposite. The most securely connected infants during the first year often become the most independent toddlers.

Obviously, going to sleep means 'leaving' the safety of their caregiver and as a result increased wakings can occur. 

Sleep and carrying

Sleep and carrying

Carrying babies (and children) has many benefits and one of those is 'better' and 'easier' sleep. When a baby is carried they are close to their caregiver, they feel safe and therefore are more relaxed to be able to fall asleep more easily. Thinking back to when they were in utero, they would be cocooned with warmth with a constant sound and movement, and to all intents and purposes a carrier/sling mimics this for the baby and they can happily doze in and out of sleep as they feel like, in the most natural way. Research carried out by Urs Hunziker and Ronald Barr found that babies who were carried during the daytime for one hour more than those in the control group cried 43 per cent less. Between the hours of 4pm to midnight the babies who were carried more cried 51 per cent less, compared to a control group. 

Hunziker, U. A., Barr, R. G., ‘Increased carrying reduces infant crying: a randomised controlled trial’ (1986) 

Research into rituals and rhythms

Bedtime Rituals

Research into the sleep behaviour of 199 toddlers between the ages of 18 and 36 months has shown that the use of a consistent bedtime ritual can improvement multiple aspects of toddler sleep, bedtime behaviour and maternal mood. Bedtime rituals were shown to:

  • Produce improvements in sleep onset and the number and duration of night wakings.

  • Toddlers were less likely to call out to their parents or get out of their crib/bed during the night.

  • Sleep continuity increased.

  • A significant decrease in the number of mothers who rated their child's sleep as problematic.

  • Maternal mood also significantly improved.

Dr Jodi Mindell, professor of psychology at Saint Joseph's University in Philadelphia stated:

”There is no question that maternal mood and children's sleep impact one another. The better a child sleeps and the easier bedtime is, the better a mother's mood is going to be. In addition, a mom who is not feeling tense, depressed, and fatigued is going to be calmer at bedtime, which will help a child settle down to sleep."

Families were randomly assigned to a routine or control group. The first week of the study served as a baseline, during which the mothers followed their child's usual bedtime weeks. During the following two weeks mothers were instructed to conduct a specific bedtime routine, while the control group continued with their child's normal bedtime procedure. All children included in the study had a small to severe sleep problem, as identified by the mother. Problems included more than three nightly wakings, awakening for longer than 60 minutes per night, or having total daily sleep duration of less than nine hours.

Parents in the intervention group were given a three-step bedtime procedure to follow that included a bath, an application of moisturising lotion and quiet activities (such as cuddling and singing); lights were to be turned out within 30 minutes of the end of the bath. Mothers then proceeded to put the child to sleep as they normally did, by either putting the child to bed while awake or rocking them to sleep. Thus, the only instituted change was the routine.

Source: Mindell JA, Telofski LS, Wiegand B, Kurtz ES. “A nightly bedtime routine: impact on sleep in young children and maternal mood.” Sleep. 2009 May;32(5):599-606.

According to Armstrong, Quinn and Dadds, what percentage of six months old regularly sleep through the night?

  • 95%
  • 16%
  • 84%
  • 71%

Briefly describe the difference between Adult and Baby Sleep

Please ensure that you refer to the biology of sleep

Sleep Cycles

  • Stage Two
    early sleep, muscles relax - You are in light sleep. Your heart rate slows and your body temperature drops. Your body is getting ready for deep sleep
  • Stage One
    a drowsy state or very light sleep - your eyes are usually closed but it's easy to wake you up
  • Stage Three
    deep sleep, heart rate slows, body temperature drops - This is the deep sleep stage. It's harder to rouse you during this stage, and if someone woke you up, you would feel disoriented for a few minutes.
  • REM (Rapid Eye Movement)
    body immobile and brain highly active - Your heart rate and breathing quickens. This is the stage of sleep that you can experience intense dreams, since your brain is more active.
  • NREM (Non Rapid Eye Movement)
    the body repairs and regrows tissues, builds bone and muscle, and strengthens the immune system

Name three things that affect the way we sleep and discuss why they affect our sleep

Normal infant sleep

Research into normal baby sleep

Normal infant-sleep research

In the first month, babies spend at least 80 per cent of their day asleep. At the age of one month, babies take an average of three to four naps per day. totalling around 7 hours. At one month, most babies wake between three and four times through the night. 

Gallanad, B. C., Taylor, B. J., Elder, D. E., Herbison, P., ‘Normal sleep patterns in infants and children: a systematic review of observational studies’ (2012) 

At the age of one month, in a total 24 hour period sleep is around fifteen to sixteen hours, which is divided between 45 per cent in the daytime and 55 percent at night. At two months, total sleep per twenty four hour period averages around fifteen hours. 

Michelsson, K., Rinne, A., Paajanen, S., ‘Crying, feeding and sleeping patterns in 1 to 12-month-old infants’ (1990)

At two months old, daytime sleep is around five hours, with around nine - ten hours taken at night, meaning that daytime sleep has now reduced to 35 per cent of the total sleep taken in a 24 hour period and 65 per cent of sleep happening at night. At three months old, average sleep taken per 24 hour period is around fourteen hours, with around 75 per cent happening during the night - this indicates the development of circadian rhythms. 

Iglowstein, I., Jenni, O. G., Molinari, L., Largo, R. H., ‘Sleep duration from infancy to adolescence: reference values and generational trends’ (2003) 

Research indicates that by the age of three months, 58 per cent of babies are capable of sleeping for stretches of up to five hours. However, this means that 42 per cent are still not sleeping for longer than four hours straight. 

Henderson, J. Et al. ‘Sleeping through the night: the consolidation of self-regulated sleep across the first year of life’ (2010) 

Research indicates that 46 per cent of all three month olds still wake regularly every night.  

Scher, A., ‘A longitudinal study of night waking in the first year’ (1994) 15

An average 3 month old wakes 2.7 times each night, and this increases slightly to waking on average 3.1 times each night by the time they are 6 months old. 

Burnham, M. M., Goodlin-Jones, B. L., Gaylor, E. E. and Anders, T. F., ‘Nighttime sleep-wake patterns and self-soothing from birth to one year of age: a longitudinal intervention study’ (2002) 

The average 4-6 month old goes to bed at 8pm and has 3 hours of daytime naps. 

Price, A. M., Brown, J. E., Pittman, M., Wake, M., Quach, J., Hiscock, H., ‘Children’s sleep patterns from 0 to 9 years: Australian population longitudinal study’ (2014) 

Research looking at the sleep of six month olds found that only 16 per cent regularly sleep through the night, meaning that 84 per cent do not! Further research found that by three months old, although 71 per cent have slept through the night at least once, many relapse into frequent waking after they turn 4 months old. 

Armstrong, L., Quinn, R. A. And Dadds, M. R., ‘The sleep patterns of normal children’ (1994) 

16 percent of all six-month-olds have no regular sleeping pattern at all.  

Sadler, S., ‘Sleep: what is normal at six months (1994)

16 percent of six to nine month olds are reliably sleeping through the night, every night. 

Sadler, S., ‘Sleep: what is normal at six months (1994) 1

Around 60% of six to night month olds are sleeping for periods of five hours or more with some regularity and 13 percent still wake at least three times every night. At six months babies are sleeping on average around 10 & half hours at night and 3 hours during the daytime. Research indicates that between 9 and 12 months only 40 per cent of babies are sleeping for stretches of 5 hours or more at night and that the majority are still waking at least once at night, usually needing parental-input to get back to sleep. 

Armstrong, L., Quinn, R. A. And Dadds, M. R., ‘The sleep patterns of normal children’ (1994) 2 3

Around the world

Traditional baby sleep patterns

  • From Africa to the Arctic to the Americas, modern-day hunter-gatherers keep their babies in close, physical contact throughout the day, and mothers typically sleep with them at night. Babies frequently fall asleep while breastfeeding and experiencing skin-to-skin contact (Konner 2005).
  • In Bali, babies sleep with their mothers until age 3. During the day, they are carried in slings as their mothers go about their daily work. Babies may fall asleep in the sling, and, if mothers must put their babies down, they are encouraged to give them to someone else to hold (Diener 2000).
  • Among the Beng, village farmers living in the Cote D’Ivoire, babies spend their days on someone’s back; either the mother or a designated baby carrier. Carrying a baby in this way is considered a good way to get babies to fall asleep (Gottlieb 2000).
  • In Japan, family members have traditionally slept in the same room, and many babies sleep in their parents’ beds (Fukumizu et al 2005). Where babies sleep in their own beds, parents often lie with babies until they fall asleep (Moore et al 1957).
  • Mayan babies share their mothers’ beds and may breastfeed during the night until they are 2-3 years old (Morelli et al 1992).
  • Among the Ifaluk of the Deep Pacific, babies sleep alongside their parents each night. This continues until they are about three years old. During the day, babies may be rocked to sleep (Le 2000).

The history of sleep

History of sleep

Night-waking

From an anthropological and evolutionary perspective, human infants (including babies) would have been kept very close to parents at night. It is normal and necessary for them to be within touching distance and to need the reassurance of seeing and touching their parent when they wake during the night. Checking on their own safety at several points during the night is a natural survival instinct which humans cannot simply override.

Two sleeps

Babies often wake during the night. Sometimes parents report that their baby will wake in the early hours expecting to get up and play, have some food/drink/milk and not return to sleep for a couple of hours. This, of course, isn't normal to us but it may be how we 'should' sleep! 

Research by Roger Ekirch, professor of History at Virginia Tech found that adults haven't always slept in one eight hour chunk. The existence of our sleeping twice per night was first uncovered by Roger Ekirch. He described this range was about 12 hours long, and began with a sleep of three to four hours, wakefulness of two to three hours, then sleep again until morning.

References are scattered throughout literature, court documents, personal papers, and the ephemera of the past. What is surprising is not that people slept in two sessions, but that the concept was so incredibly common. Two-piece sleeping was the standard, accepted way to sleep. Ekirch says “It’s not just the number of references – it is the way they refer to it, as if it was common knowledge,” 

But just what did people do with these extra twilight hours? Pretty much what you might expect.

Most stayed in their beds and bedrooms, sometimes reading, and often they would use the time to pray. Religious manuals included special prayers to be said in the mid-sleep hours. Others might smoke, talk with co-sleepers, or have sex. Some were more active and would leave to visit with neighbours.

As we know, this practice eventually died out. Ekirch attributes the change to the advent of street lighting and eventually electric indoor light, as well as the popularity of coffee houses. Author Craig Koslofsky offers a further theory in his book Evening’s Empire. With the rise of more street lighting, night stopped being the domain of criminals and sub-classes and became a time for work or socialising. Two sleeps were eventually considered a wasteful way to spend these hours.

No matter why the change happened, shortly after the turn of the 20th century the concept of two sleeps had vanished from common knowledge and it has more recently turned into a sleep problem for young children.

What does the evidence tell us?

So what can we take away from all that scientific understanding and research?

We have given a wide range of evidence in regard to infant sleep both in the form of biological understanding and in terms of research studies across a range of disciplines affecting sleep. Below we take a brief look at what useful, tangible knowledge we can gain from all of that evidence.

Sleep cycles and circadian rhythms

The fact that we sleep in cycles of lighter and deeper sleep helps us to understand that there are times in the night when humans are more rousable than others. The fact that babies' sleep cycles are still much shorter than adults' tells us that there is a greater frequency in which babies are more likely to wake at night.

By understanding that we don't always wake each time we enter a lighter state of sleep we can can extrapolate that sometimes adults and babies are able to move from one sleep cycle to the next with little or no difficulty. We can also realise that even as adults we don't always transition from one sleep cycle to another. Sometimes an external (light change in the room, noises) or internal stimulus (full bladder, thirst, discomfort) can cause even adults to wake during the night. 

Adults are usually quite accustomed to dealing with whatever woke them (if they know) and then settling themselves back to sleep. Babies are both not yet, and not consistently, competent in understanding what woke them, nor do they have the maturity of emotional control and neocortex development necessary to calm the reptilian brain that is necessary for "self-settling". Sometimes they may be naturally calm enough to settle back to sleep but if awake at night, babies are likely to need reassurance from a parent to feel safe and calm enough to sleep.

From history and anthropology we can understand that children are programmed to take their safety cues from their parents and to be extra vigilant at night. If a child can see their parent is calm, they are more likely to be able to calm themselves and sleep.

Melatonin production and environment

Environmental factors such as artificial light and the colour and intensity of light have a huge impact on  melatonin production. If melatonin production is restricted by the things that are all around us then there is no wonder that we have problems falling and/or staying asleep. Parents may not have considered that a very bright bedtime routine is negatively impacting their babies' bedtimes or that the blue night light that they leave on all through the night is causing their baby to startle when they move from one sleep cycle to the next. If we can share this information with parents then it will help them to consider it when thinking about their babies' sleep. 

Attachment and mood

The studies that we explored in Sleep and Maternal Mood showed us that maternal mood and child sleep tend to go hand-in-hand. Low maternal mood often resulted in difficult infant sleep and difficult infant sleep often resulted in low maternal mood. This can lead to parents using sleep training under the feeling that they cannot continue to due to the potential impact on the mother's mental health. At BabyCalm we like to talk about balancing the needs and long term mental health of all parties and therefore suggest other things before sleep training is attempted. Of course, there are times when sleep training is preferable to the alternative - in extreme circumstances.

Diet

We know that the composition of breastmilk and formula milk is different and therefore can cause a baby to sleep very differently. We know that breastmilk is more easily digested than formula milk and thus it will digest more quickly. However we also know that a baby who is waking more frequently and easy to rouse is safer in terms of SIDS. Formula makes babies sleep in an unnaturally deep state for their development.

When we looked at how diet can impact an infant's sleep we discussed foods which can encourage the chemical processes in the brain which get us to sleep and also the foods which can inhibit that process. Often foods (and medicines) that contain these ingredients inhibit that process are marketed to children. As an example we looked a E102 which is very common and used to colour foods yellow) which was found to cause restlessness and sleep disturbance. 

We found that foods containing tryptophan (an amino-acid) was a important component in the manufacture of the hormone of sleep and that including such foods in our infants diet (by breastmilk or food if they are at weaning age) can help to promote the chemical process that results in sleep. 

Parental expectations vs reality

In the introduction to the science of sleep we described some basic statistics on infant sleep. One of the most interesting and significant points within those statistics is understanding the combination of the percentage of parents who consider their child to have a "sleep problem" versus the percentage of reported children who wake. What this basically tells us is that wakefulness in babies is very common and therefore is "normal" sleep behaviour, and it is the parents that struggle with their child's normal behaviour. 

At BabyCalm one of the key elements of sleep work with parents lies in normalising infant sleep behaviour.

Normal baby sleep quiz

Please select which of these statements are true or false.

  • Other cultures think about baby sleep differently from us
  • It is normal across the world for parents to struggle with their baby's sleep
  • Co-sleeping and bed sharing is a western fad from Attachment Parenting
  • Most mammals sleep in two distinct periods during the night with a period of wakefulness
  • From an evolutionary perspective, baby's are designed to be wakeful at night for survival
  • It is parents, and not babies, that have a sleep problem in most cases

Key element of sleep work at BabyCalm

At BabyCalm one of the key elements of sleep work with parents lies in infant sleep behaviour.

Increased night waking for 9 to 12 month olds

Select all the things that might cause night waking to increase at 9 and 12 months

  • Seperation anxiety
  • Teething
  • Baby is not eating enough
  • Milk supply decreases at this time
  • Growth spurts are common at these ages
  • Key developmental milestones happen at around this stage
  • If mum returns to work, babies need to reconnect when mum is there (at night)
  • Baby is over-attached
  • Baby has got into a and habit of having milk and cuddles at night
  • Baby knows you need more sleep and is messing you around on purpose

Sleep training

Introduction to sleep training

Sleep Training 

Sleep training describes any approach you may take to help your baby learn to settle herself to sleep. When we are talking to parents we need to be fully aware of the different information that is readily available to them; methods they may have used or may be thinking about using. There are lots of sleep training methods around, some are marketed as 'gentle' while others aren't. 

In one of your modules you will explore the 'experts' in baby sleep and parenting and many have a specific approach that they advocate or reinvent. Be aware that, although you may not agree with these methods, some parents may have already used these on their children and it may be very emotive when discussing the various methods. 

It's important to be aware that, although we do discuss different sleep training techniques along with the pros and cons of each during our classes, we never advocate any sleep training method. We want to allow parents to make an informed choice and without all the information they are unable to do that. Equally we do not judge any parent for having used sleep training methods or for an intention to use them.

If a parent attends your workshop or consultation and then goes on to use a method of sleep training that does not mean you have failed or done something incorrectly. It indicates you have provided all the relevant information for that family to make their own informed choice. 

Controlled Crying

Controlled crying vs Crying it out

We have purposefully not included "Cry it out" (also known as extinction), which involves leaving a baby or toddler to cry completely alone without parental input, in this section as it is NOT a valid form of sleep training. Leaving a human being to cry indefinitely is abuse and should not be condoned. Although we do not advocate leaving children to cry at all, it must be recognised that controlled crying does differ from cry it out by the nature of some parental input.

What is controlled crying?

Controlled crying is a form of sleep training, where you allow your baby to cry for short, specified periods of time before going in to offer comfort. In some cases the interval time increases between each parental response.

This approach involves putting your baby to bed awake, and you leaving the room for a short period, returning if the baby is crying, but leaving again for progressively longer periods until the baby falls asleep. 

The use of controlled crying can be traced back over 100 years, and was a method first popularised in the mid 1980s by an American Dr Richard Ferber (American mums refer to Ferberizing their babies when they do controlled crying).

What do we know about Controlled Crying? 

The Australian Association of Infant Mental Health (AAIMHI) states "Controlled crying is not consistent with what infants need for their optimal emotional and psychological health, and may have unintended negative consequences. There have been no studies, such as sleep laboratory studies, to our knowledge, that assess the physiological stress levels of infants who undergo controlled crying, or its emotional or psychological impact on the developing child."

What are the disadvantages of controlled crying? 

  • Babies miss out on stimulating touch
  • Babies may not receive as much nutrition 
  • Increased cortisol levels (see research below) and possible neurological damage
  • Increased pulse, blood pressure and temperature
  • Vomiting
  • Potential for an increased SIDS risk - this is yet unproven because it is unresearched** 
  • Learned helplessness phenomenon
  • Negative impact on breastfeeding (breastmilk production)
  • Negative impact on secure attachment 
  • CC & CIO as a young baby = more fussy & harder to settle by 10mths of age (1)

(1) Stifter and Spinrad, The Effect of Excessive Crying on the Development of Emotion Regulation, Infancy, 2002.

The stress of crying it out during the process is high in both parent and child, shown by increases in cortisol levels. When the crying stops (usually night 3 or 4) the stress levels in the parent drop rapidly. However, the research shows that the stress levels in babies does not decrease; they are producing similar levels of cortisol to when they were crying long after the crying has stopped. (2)

(2) Middlemiss, W. Granger, D.A. Goldberg, W.A. Nathans, L. (2012) ‘Asynchrony of Mother-Infant Hypothalamic-Pituitary-Adrenal-Axis Activity Following Extinction of Infant Crying Responses Induced During the Transition to Sleep’. Early Human Development, 88 (4), 227-232

It is very important that you are able to explain this study to parents. On Days 1-3 the cortisol levels in both mother and child were raised. On day 3-4 the baby stopped crying, resulting in the mother's cortisol levels returning to normal whilst the child's cortisol levels remain elevated. From this we can see that although the crying behaviour has been extinguished, the cause of the crying (distress) remains unchanged. The baby is not soothing themselves to sleep.

Some research shows that when a baby continuously secretes cortisol as an infant it can have an effect on their stress response in later life. It may cause them to either over or under produce cortisol  in adulthood. Either of these is undesirable. Too much cortisol can lead to anxiety and depression whilst too little can lead to ambivalence and emotional detachment.

To elaborate a little regarding the impact of sleep training on secure attachment, we must understand that our babies do not understand any concept of why you, as their loving parent, would respond differently to them during daytime hours and during night time hours. Why does mummy come when I cry in the day and not in the night? This will affect how secure your baby feels (how much they trust you to respond) about your love and nurturing of them.

** Encouraging babies to sleep for periods longer than is biologically normal and creating unusually deep sleep means it is harder for a baby to arouse which is thought to be linked to SIDS. Research also shows babies who sleep in their own room are at higher risk of SIDS - most sleep training takes place in the nursery.

Why is this information not more commonly known?

We’re sure you’ve noticed today how emotive this topic is. It is highly uncomfortable to learn that you may have damaged your child in some way by following sleep advice in the quest to "do the right thing" for your baby. In short, it is too uncomfortable for society to bring these feelings up. Sleep training is so common in our society and there are too many people with too many uncomfortable feelings.

Michel Odent calls this ‘cul-de-sac epidemiology’ I.e. research that is buried away because it is too uncomfortable for society to deal with.

Why else? Because baby sleep is big business. Think about how many baby sleep books you have seen? How many baby trainers and ‘experts’ make their living from ‘naughty non sleeping babies’? How many products are designed to encourage babies to sleep through the night? Nobody makes money from normal baby sleep.

Other forms of sleep training

Other forms of sleep training

In this section we will look briefly at some of the other methods often used by sleep trainers or in mainstream sleep texts to get babies to sleep longer. Each of these have their own pros and cons which are worth investigating.

Gradual retreat

This is usually marketed as a more 'gentle' approach to sleep training. Gradual retreat involves the caregiver doing their bedtime routine as normal; including any cuddling, rocking or feeding. Then just as the child becomes drowsy, put them down into their cot to fall asleep by themselves. The parent/care giver must then sit down next to the cot and wait for the baby to fall asleep. If the baby protests, cries or tries to engage then the parent/care giver must 'remain boring' reminding baby it is time to go to sleep, using 'key words' that are repeated (e.g. its bedtime, time to sleep). Each night the parent will do this from a progressively further distance from their baby, eventually being outside there room.

Pick up/Put down 

This particular sleep training method was made popular by Tracey Hogg (The Baby Whisperer). It has been marketed as the more gentle of sleep training techniques and it is suggested that this should only be carried out with a baby older than 3 months. 

If baby cries when he/she is first put him/her down,  hand a on his/her chest gently and reassure baby with a 'Shhhh' or key phrase like ‘It's sleepy time'. 

If this doesn't soothe baby, pick them up and repeat the key phrase.

When baby stops crying, but is still awake, put them back down in their cot. If they start crying on the way down, put them in anyway.

If baby is still crying, pick them up again. This process is to be repeated until signs that baby is settling are clear (for example, his/her cries are getting weaker).

When this settling behaviour if clear, don’t pick baby up anymore. Leave him/her in their cot, place a hand on them and say the phrase.

Then the care giver is to leave the room.

If the baby starts crying again, the process is to be repeated as many times as needed until baby falls asleep.

The hope is that the baby will eventually associate the key phrase or 'shhhh' with going to sleep.


A letter from a sleep trained baby

Please note that this "poem" is emotive. this is not something that we give or read out in classes.  

Dear Mummy,

I am confused…

I am used to falling asleep in your soft, warm arms.

Each night I lay snuggled close to you; close enough to hear your heartbeat, close enough to smell your sweet fragrance. I gaze at your beautiful face as I gently drift off to sleep, safe and secure in your loving embrace. When I awaken with a growling stomach, cold feet or because I need a cuddle, you attend to me quickly and before long I am sound asleep once again.

But this last week has been different.

Each night this week has gone like this.

You tucked me up into my cot and kissed me goodnight, turned out the light and left.

At first I was confused, wondering where you’d gone.

Soon I became scared, and called for you.

I called and called for you mummy, but you wouldn’t come!

I was so sad, mummy. I wanted you so badly. I’ve never felt feelings that strong before.

Where did you go?

Eventually you came back!

Oh, how happy and relieved I was that you came back! I thought you had left me forever!

I reached up to you but you wouldn’t pick me up.

You wouldn’t even look me in the eye.

 You lay me back down with those soft warm arms, said “shhh, its night time now” and left again.

This happened again, over and over.

 I screamed for you & after a while, longer each time, you would return but you wouldn’t hold me.

After I had screamed a while, I had to stop. My throat hurt so badly. My head was pounding and my tiny tummy was growling. My heart hurt the most, though. I just couldn’t understand why you wouldn’t come.

After what felt like a lifetime of nights like this, I gave up.

You don’t come when I scream, and when you do finally come you won’t even look me in the eye, let alone hold my shaking, sobbing little body.

The screaming hurt too much to carry on for very long.

I just don’t understand, mummy. In the daytime when I fall and bump my head, you pick me up and kiss it better.

If I am hungry, you feed me. If I crawl over to you for a cuddle, you read my mind and scoop me up, covering my tiny face with kisses and telling me how special I am and how much you love me. If I need you, you respond to me straight away.

 But at night time, when it’s dark and quiet and my night-light casts strange shadows on my wall, you disappear.

I can see that you’re tired; mummy, but I love you so much. I just want to be near to you, that’s all.

Now, at night time, I am quiet. But I still miss you.

All my love,

Your Darling Baby xxx

 

Use and printing with kind permission from Imogen O’Reilly

Sleep training quiz

Please select whether the following statements are true or false

  • Controlled crying raises the level of cortisol in babies, leading to potential issues in later life
  • Controlled crying causes mental health issues
  • Some sleep training methods are gentle and harmless
  • Crying it out is a valid method of sleep training
  • Crying it out is irresponsible and dangerous
  • There are pros and cons to all forms of sleep training
  • Parents need to be informed of the pros and cons of sleep training so they can make a proper choice
  • Parents may still choose to use sleep training methods after attending a BabyCalm class
  • We should discourage sleep training wherever possible
  • Parents who sleep train clearly don't value their child's needs

BabyCalm Sleep strategies

Introduction to BabyCalm sleep

BabyCalm sleep solutions

At BabyCalm we look to work with parents to help them find their own strategies to manage their baby's sleep. We inform and they choose, so we do not condemn sleep training methods or advise on "gentle" sleep tools. We don't advise at all. This may seem like we have nothing to offer parents to help them solve the very thing they came to us to solve. This isn't the case either.

What we do next is we help parents to take the information with which they have been presented by us, both in regard to sleep science and in regard to general baby development, and we walk them through applying it in a way that becomes a strategy to manage life with their baby.

There are two "strategies" we can give to parents for them to use to do this, which we will look at in more detail. They are:

  • Helping your baby CALM for sleep
  • The BabyCalm SNORE ritual

Helping your baby CALM for sleep

Helping your baby CALM for sleep

Using these tools can calm a baby's brain and body in preparation for better sleep.

Containment

In the fourth trimester, a useful tool to help calm babies is containment. The two main forms of containment include using slings and swaddling. Using slings is a fantastic way to induce and maintain sleep in young babies but many parents find it difficult to transfer babies from sling to bed/cot. Furthermore, it is not safe to sleep yourself if you have a baby in a sling and therefore often slings are most useful for creating good opportunities for naps.

Swaddling, if done safely, can be helpful for inducing and maintaining sleep in young babies. This tool can be used in a cot, crib, cosleeper, pram or in your bed (as long as they are in a safe space).

Connection

After the initial period of development, from about 4 months, babies benefit less from this feeling of containment and benefit more from a feeling of connection. Making sure that baby feels connected and secure will help them settle into sleep. 

Parents can ensure that they nurture connection with their baby throughout the day or after work but a few ways to reconnect at bedtime are: sharing stories together and sharing familiar songs together (in this case maybe having a few lullabies that are "family" ones).

As above, whilst carrying or using slings is a fantastic way of connecting with your baby and of calming to sleep, some parents find it difficult to transfer their baby from carrier to bed and therefore do not find it a useful tool for bedtime. This is not always the case so shouldn't be ruled out. This can be a good tool for naps. 

Atmosphere (aka sleep environment)

The atmosphere in which we expect a baby to go to, and stay asleep is essential to its success. This element of CALM is so important for sleep that it is also covered within SNORE. Consider where your baby is sleeping and how you can make their environment cue them to feel more sleepy.

Loving touch

Cuddles and back rubbing

Using loving touch to calm babies is a natural part of parenting. This doesn't change at bedtime or at night. Giving baby cuddles before they go to sleep, or rubbing their backs or cuddling them to sleep has been demonised by some people who call themselves sleep experts under the assumption that parents would be "making a rod for their back". Cuddling our baby is a completely natural way to help our baby soothe to sleep. They will not always need us to do this for them but whilst they do parents can feel confident that they are not doing any harm by meeting their baby's needs.

Furthermore it is anthropologically normal for young children to want to continuously touch their caregiver during the night. This is the least safe time of any 24-hour period for babies and toddlers (in the wild) and so being very close ensures their safety.

Breastfeeding

For mums that are breastfeeding it is important for them to understand that the breastfeeding relationship provides their baby with so much more than optimum nutrition, and this is a good thing. I hear of many mothers being told that their baby should not be feeding at night or feeding as regularly at night because "they don't need as much milk". Babies' under 12 months main source of nutrition comes from milk and thus should not be refused. The nutrition (that is cleverly tailored to their every need), is highly beneficial to the baby and breastfeeding journey. 

Many "parenting experts" and parents themselves can be often heard to say "oh they are just feeding for comfort" in a manner that suggests that this is pointless and something that should be discouraged. Parents need to understand that comforting a baby through loving touch is as nurturing and as necessary as nutrition, and breastfeeding is the most natural way to do this (and what we were designed to do).

Massage

Adding massage into your bedtime ritual could be helpful in inducing restful sleep. Please read the previous section on massage and complete the massage module when it is available for more information.

Movement

Rocking to sleep

Parents often use movement to soothe babies and then this becomes something they are used to, whether in a chair or in our arms. This is another classic example of something that "people" will tell parents is a bad habit to form with their baby. At BabyCalm we disagree. If this is a method that works to calm your baby to sleep and you are happy to do it, then carry on doing it until it no longer works for one of you. At some point in the future your baby will no longer need you to do this but for now, meeting that need will assist in their development and their ability to become independent.

Yoga

Parent and baby yoga can be helpful in making both parent and child more relaxed in general. This can aid restful sleep for all.

Introduction to BabyCalm's SNORE™ ritual

BabyCalm's SNORE ritual

The idea of the SNORE ritual is to take parents through realistic things they can do to improve their baby's ability to initiate and maintain sleep. We have established in the science section that having a bedtime ritual can be beneficial to baby sleep and so have considered the evidence in relation to sleep to create the basis for a ritual that optimises the benefit to sleep. We have come up with this:

S ensory cues

N ight-time expectations

O bjects (transitional)

R esponsive night-time parenting

E xternal factors affecting sleep

Sensory cues

Sensory cues

Cues are essentially a stimulus that parents condition (behaviourism) to induce the response of relaxation or sleepiness. By introducing a stimulus to situations when the baby is getting ready for sleep/relaxing, and by repeating this over a sustained period of time, the stimulus itself will eventually be enough to induce relaxation (conditioned response). Adding cues to a bedtime ritual can be powerful sleep triggers. When we understand that babies' brains are more sensory than ours, we can see that making our sleep cues sensory will be most effective. These are listed in order of usefulness for creating relaxation cues.

Smell

Creating an association between sleep and a certain smell can be highly effective. Babies essentially want to smell their mother. Using something such as a comforter that smells like their mother (or primary caregiver), will help a baby to sleep. Alternatively, using a smell such as lavender or chamomile (known for their relaxing properties) can be helpful in a number of ways: using an aromafan, diffuser, balm, bath additive or essential oils on a muslin all work well. Using a smell such as lavender may also be useful in replacing a baby's need to smell their mother in order to sleep. At BabyCalm we used to demonstrate a battery operated fan that used essential oils, but the ones we used became unavailable and there isn't a similar alternative. There are many oil diffusers on the market though so we feel that leaving it up to parents to discover the right way to add smell into bedtime is probably the way forward.

Sound

Using sound as a cue is also particularly helpful. This is because there are a number of sounds that are inherently helpful in relaxation. 

Alpha music

Studies have shown that music is an effective natural aid to sleep. Alpha music is music that is set to 60 beats per minute (resting heart rate) and is specifically designed to regulate the alpha waves in the brain, relaxing the mind and body into a state that is referred to as the ‘alpha state’. If played during the whole bedtime ritual, babies will become calmer and more ready for sleep. They will also be more likely to transition from one sleep cycle to another during the night, without waking or needing assistance. If maintaining sleep remains a problem, the music can easily be played quietly throughout the night.

There are a number of places parents can find Alpha music but the most obvious one to recommend is that on the ToddlerCalm CD. We are considering getting this updated and improved but that won't happen for a little while. We are also looking at providing the music as a download and developing an app that offers the music as well as information.

Lullabies

Calming songs that your baby is familiar with are a wonderful sleep cue - "We sing this song at bedtime". This doesn't have to be a specific lullaby (I often hear people say "but I don't know any lullabies"). It can be any gentle song that you know, enjoy. Making a few songs that you know and love familiar to your baby will set you up to be able to use these as a cue for a long time to come.                                                                                                                                                                            

White noise (and other similar sounds)

In simple terms, white noise is a special type of sound signal which is used to mask background sounds. When used to promote healthy sleep, white noise helps to drown out sounds which might otherwise prevent you from either falling asleep or waking up whilst asleep. It is also useful for babies particularly in mimicking the more constant background noise that they would be used to from the womb.

In technical terms white noise can be described as noise whose amplitude is constant throughout the audible frequency range. Genuine white noise can only be generated electronically and sounds similar to TV or radio ‘static’. It is not very pleasant on the ears as it contains a lot of high frequency energy.

Sometimes, and in our case, “white noise” is used as a general description for any type of constant, unchanging background noise. It’s become a colloquial term for a diverse range of sounds including:

  • nature sounds – rain, sea/waves, crickets chirping, jungle etc
  • machinery noises – air conditioning units, washing machine
  • ambient soundscapes – aircraft interior, crackling campfire, crowd noise

Some people prefer to listen to these types of sounds when they’re trying to get to sleep in preference to the harsh tone of pure white noise. Here are some of the ways that a constant calming background noise is helpful as a cue for baby sleep:

  1. It can be used as part of a bedtime ritual. "I hear this noise and I am ready to sleep"
  2. It buffers disturbing unexpected sounds that may wake a baby in lighter sleep
  3. It helps to quiet busy thoughts or worries - hence it being used for meditation
  4. Many of the rhythmic versions of background noise promote a calmer body and potentially induce an alpha state in the brain
  5. It acts as a cue to return to sleep if your baby does wake at night
  6. You can bring white noise anywhere, especially if you can have it on your phone.


BabyCalm currently offers a CD of white noise. As with the ToddlerCalm CD, we are looking to update this to offer a range of background sounds for parents to choose from. Ideally this will be available on CD, on download and via an app. This is all in the early stages of development.

Touch

Touch is the first sense that babies develop in the womb and therefore babies are very tactile; they respond strongly to touch. This explains why sometimes the only way your baby seems to want to sleep is when they are physically touching you. It makes them feel safe. For some families this means bed sharing is a good option (we will talk about this later) but for other families this isn't an option.  There are a number of other ways touch can be used as a sleep cue:

Massage and stroking

Adding massage into your bedtime ritual can be a fantastic way to incorporate touch as a sensory cue for sleep, which is why it is mentioned in more depth in the CALM section. Many parents incorporate touch into their ritual without even considering it. The stroking of hair, the side of the face or hands is often something that parents of babies do whilst they wait for them to drift off. This can be very useful but is something that requires the parent to be present so will not assist with night-wakings without parental input. That doesn't make it a bad thing though.

Soft objects

We will talk about comforters later in the section but for now it is important to say that having something soft to touch (a toy, blanket or muslin) can be an excellent sleep cue for babies. It also acts as a "mother substitute" but even without that, comforters offer a tangible cue to baby's senses that can be maintained through the night and are completely portable.

Sight

The most effective visual cue for babies is to be able to see their primary caregiver. From an evolutionary perspective, being able to see them means that protection is close and provides the ability for them to sense whether their parent is calm or stressed (from their facial expression), which indicates to the child whether there is danger at an instinctive level. For this reason both bed-sharing and co-sleeping are ideal sleep environments for babies. However, they are not an option for all families. 

Some babies find it useful to have a nightlight in their room to enable them to see at least a little if they wake. This can help them to feel safe. Turning on the night light can also be a cue for them that it is now bedtime. With nightlights it is important to choose carefully as some light can be more detrimental to sleep than others (see below in external factors). Red light is ideal as it is the only colour of light that does not inhibit the production of melatonin. It also mimics the red glow that babies are used to in the womb.

Taste

Milk is a taste that infants have already associated with calming and sleeping from when they were newborns. The conditioning is done already. Furthermore milk contains amino acids that are naturally sleep inducing. Offering milk at bedtime is an excellent way of helping a baby initiate sleep.

For parents who are still able to breastfeed, this is an ideal way to use taste (and many other senses at the same time) to help induce sleep. Breastmilk also contains sleep-inducing hormones, amino acids, and nucleotides, whose concentrations are higher during the night and may actually help babies establish their own circadian rhythms  (Sánchez et al, 2009Cohen et al, 2012). It is completely biologically normal for babies to continue breastfeeding to sleep through their second year and beyond. Remember children will not need this forever and will naturally wean or can be gently weaned when parents find it isn't working for them any more.

For parents who cannot, or choose not, to breastfeed, milk is still a good addition to the bedtime ritual. Formula milk provides at least some of the sleep inducing qualities and is still a pre-conditioned cue for relaxation. In addition, sucking releases the hormone cholecystokinin (CCK), which results in a sleepy feeling (Uvnäs-Moberg et al, 1993).

Lastly, and importantly...

Remember all cues must always be conditioned first. Parents need to understand that they cannot expect alpha music or lavender to work magic on its own. You have to build a strong association between the cue and sleepiness. The idea is that the baby's brain responds as "I hear this, I smell this, I touch this and I sleep". This will not only make bedtime easier but will also assist with night-wakings. When the baby wakes in the night, it may be possible for them to help themselves into another sleep cycle by only using those cues, instead of needing parental input.

Night-time expectations

Night-time expectations

There are two elements to this section:

Expectations of sleep

When parents come to us their expectations are often wildly different from the realities of normal baby sleep, but hopefully once you have taken them through the content, they will understand and have more realistic expectations of their baby at night. It is worth emphasising at this point in the workshop that parents need to keep reminding themselves of what is normal and natural for their baby as it is easy when tired to feel like they are "doing it on purpose".

Baby's expectations during the night

The second element of expectations is both to understand what a baby expects from their parents during the night (due to how they are treated in the day), and for parents to mould their baby's expectations of what happens in their night-time family culture, and as part of that, that parents have a deliberate night-time family culture.

Do parents want children to expect no response from them at night? If so, how does that fit with their parenting goals and how they parent during the day? Are children allowed to come into the parents room/bed? What happens when they wake at night? In the morning?

This is entirely individual to each family - it may be good to facilitate a discussion amongst the group here by using some open questions around the topic. This will empower them to find their own solutions and prevent the "expertise trap" where your own personal practice as a consultant can be held up as the high standard.

Objects (transitional)

Objects (transitional)

Donald Winnicott's transitional objects (as discussed in the psychology section) are also known as comforters. Many parents use them without understanding the full meaning behind them or why and how they work to help baby feel more calm and settled. The truth is that your baby's special toy or blanket is not just their favourite because they think it's soft and cute, it is important to them because it is their link to their primary caregiver. Don't get me wrong, Harlow's experiment with monkeys shows us that touch (softness) is highly important to infants, but this is not the whole story.

A transitional object acts as a "mother substitute" offering comfort, connection and attachment when the parent cannot be there. This may be in their childcare setting but is most commonly during the night.

In fact one of the most important factors in a transitional object being effective is how it smells, and particularly that it smells like the "mother". Have you ever washed your baby's blanket? - I bet they weren't happy.

If parents are looking to introduce a transitional object they need to realise that conditioning is key. The infant needs to relate the object to their parent and to feeling calm. Keeping the comforter close by at all times and holding it between you and your baby during close contact will be effective in creating a strong association and in making the comforter smell right.

At BabyCalm we demonstrate an excellent example of a comforter called a Cuski-boo. We demonstrate this particular product because we think it is the best one on the market for various reasons:

  • It is officially approved by the National Health Service - the only comforter in the UK with its own protocol for use in SCBUs and NICUs.
  • It is made entirely from a special bamboo yarn, organically, sustainably and ethically grown.
  • It is ultra absorbent (retaining scent), antibacterial, eco-friendly and biodegradable.
  • Cuski's unique shape stimulates your child’s imagination - a round shape is the first shape a baby recognises as it mimics the shape of faces
  • The growing of bamboo actually helps our planet
  • It is incredibly soft.

Cuski is the anglicised Welsh term, meaning "to sleep".The company was created to bring comfort to babies and toddlers all over the world. There are a number of other very suitable products that Cuski offer such as their muslin squares (bamboo), their giant muslin square (Giant Swandoodle) which are highly popular with children (and adults) of all ages, their bamboo blankets, and Cuski comforters made from bamboo muslin material.

It is important to remember though that babies will often choose their own transitional object if one is not conditioned for them. If they have already done this, changing objects is probably not advisable unless the chosen object is really unsuitable. In addition there are many many products out there and different comforters will suit different babies. We are not prescriptive and simply show the Cuski-boo as an example for parents. The reason we sell the products we demonstrate on our website is so that parents do not need to search round for them and so that we can offer clients a discount on retail prices. We are not trying to make lots of money from selling people things.

Responsive night-time parenting

Responsive night-time parenting

Although many parents know that parenting is a 24 hours job, they are programmed by society to believe that after the first few months, their baby/toddler does not need them at all during the night-time hours. Many are repeatedly told by the media and friends and family that doing any kind of active parenting at night will in some way harm their child. This is nonsense. All the psychological research is utterly clear. Babies and children whose parents respond to their needs, whenever and wherever possible, develop better independence, are more emotionally resilient and have more optimum brain development. Night-time parenting is as important as daytime parenting (even if it is difficult for parents who are used to being asleep during these hours). So how do we make responding and reassuring at night easier for parents? One way is to keep our baby closer at night so that they wake less and that when they do wake, we need to wake less to respond.

Co-sleeping

Co-sleeping means sleeping in the same room as your baby, but not necessarily on the same sleep surface. This is very normal in many cultures and there are a number of ways this can be done:

Having your baby in the same room as you may mean that they sleep better without the parent doing anything extra. This is likely because they will be able to see  you, hear you, smell you and when they wake in the night may be reassured simply by your presence. Also, research suggests that when parents share rooms with their babies, their heart rates and brain waves are more settled as they regulate each other. The NHS recommends a baby shares a room with their parents for at least their first six months of life. 

Bed-sharing

Bed-sharing means sleeping with your baby (and possibly other children) in your bed. The "family bed" is a common concept in other cultures and actually makes a lot of sense. This set-up allows you to be even more highly responsive to your baby's needs during the night and provides a greater sense of security to your baby. 

It is essential to give parents the information that will keep their baby safe whist bed-sharing (see section below). Whilst some parents choose to bedshare, many others end up bedsharing unintentionally.

It is likely that you will get more sleep in this way. However, many parents in our culture find this to be strange and have some common concerns. We can address these concerns but we must remember that this doesn't work for everyone and it is just one of the possible tools we can offer parents to help them sleep more.

Common bed-sharing concerns

Will they ever be independent?

Many parents have concerns that if they start this they will be unable to, or find it very difficult to, move their child into their own room when they want to - essentially that their baby will never grow to be independent.

Research reliably shows that independence is a developmental milestone that is reached at a certain age and children that have a safe and trusted emotional base (secure attachment derived from responsive parenting) from which to venture become more independent more quickly.

Parents can be reassured that children will naturally want to separate themselves, a process which usually starts around 3-4 years of age.

What about adult space?

Another concern of parents when thinking about sharing their sleeping space is that they will no longer have space for their adult relationship. This is something that is perpetuated by media coverage of co-sleeping and bed-sharing with a common misconception that "co-sleeping kills relationships".

In truth there is a huge list of things about being a parent that are seriously tough on both parents' sex lives and their relationship as a whole. Between changing roles, changing hormones, changing energy levels and changing bodies (just to cover the main ones), parents often feel that things have fundamentally changed. This can be very difficult but the main thing that parents can do to counter all of it is to keep communicating. Communication is fundamental to strong relationships. Being able to have honest and open conversations about all of the above is essential. So for the good of your baby, find time for your relationship - to nurture it and be responsive to that too.

As for sex! If parents are both willing, regardless of all the changes and struggles, then it's time to get a bit more creative and take it out of the bedroom. What a great way to re-kindle the fun.

External factors affecting sleep

External factors affecting sleep

This last item in our SNORE ritual is being cautious about external factors that may inhibit sleep for our babies. From the research we can see that there are a number of things that could do this and, if they are a problem for your baby, there are some relatively simple ways to prevent them affecting sleep negatively.

Diet

The things we eat can have an positive or negative impact on sleep and usually more so our babies. Remember that some babies may be still completely breastfed, formula fed and some will have started to be weaned onto food. 

Lots of food aimed at children contains E numbers which has been found to cause restlessness and sleep disturbance, so if your baby is having trouble with sleep then it is worth considering if they are being exposed to any E numbers (there are some foods which you may not consider have E numbers but, for example, Infant Paracetamol can have several E numbers contained). 

There also foods which can contribute to more, well rested sleep. You may have heard some people suggesting feeding their baby a banana each day and it will make them sleep. This is because bananas contain Tryptophan. Tryptophan is an amino-acid and an essential part of the human diet because our bodies are unable to make it, and the only way we can get enough is through our diet (including breastmilk). Tryptophan is an important component in the manufacture of serotonin and melatonin, the hormone of sleep, and for this reason many suggest that foods containing high levels of tryptophan may help us to sleep, although it has not been proven to reduce the amount of night wakings.

Breastmilk is a useful tool to promote sleep. Breast milk produced at night contains signifiant levels of melatonin, the sleep hormone. 

Screens

Screen-time can have a negative impact on sleep initiation. Some children can happily fall asleep whilst watching a DVD. However others struggle with having screen-time in the two hours prior to bedtime. Research has shown us that those children who watched television in the last hour or two before bedtime went to sleep later than those who watched none so if parents are struggling with bedtime, limiting their toddlers' exposure to screens in the 2 hours before bedtime might be hugely beneficial. 

Light

Artificial light plays havoc with our circadian rhythms, making our bodies think that the day ends much later than what the sun sets and the day starts much earlier than the sun rises.

Night lights can also contribute to disturbed sleep and problematic bedtimes. Research that was carried out to look at the impact of different colours of light has found our body’s natural clock system responds differently to artificial light sources, depending on the colour. More natural, low intensity light (reds, oranges - colours than mimic firelight) aren't inhibiting of melatonin (the sleep hormone) but blue and white lights have been shown to trick our brains to thinking it's daytime. These are usually the colours that screens use.

Remember, if your baby does not have a sleep problem, there is no need to take these measures. If it ain't broke, don't fix it.

CALM quiz

  • Bedtime stories are a great way of connecting with a baby at bedtime
  • Parents should control which stories and how many stories happen at bedtime to ensure it is not too stimulating
  • It is important to learn proper lullabies as they are know to be calming
  • It is important that a baby likes and feels calm being in the room in which they sleep
  • Massage is too stimulating at bedtime
  • Loving touch that helps induce sleep can be as simple as touching your baby's hand
  • Rocking a baby to sleep is not a habit you want to form

SNORE quiz

  • You must use all the senses in order to provide a proper environment for sleep
  • Parents should use whichever sleep cues suit their family
  • Parents need to work out what they are comfortable with at night (their culture) and build their strategy around that
  • Transitional objects are a mother substitute
  • It is important to ensure your baby's comfort object is a proper one
  • We have a deal with Cuski and must promote their products where possible
  • Responsive parenting is just as important at night as it is during the day
  • At BabyCalm we very much want to promote bed-sharing and co-sleeping as parenting tools
  • It is important to be cautious about the light we have in baby's bedrooms at night, avoiding blue and white light sources where possible.
  • Screentime and TV watching will always cause more difficult sleep

Please identify the difference between co-sleeping and bed-sharing

Looking at BabyCalm's sleep toolkit as a whole, please identify the three key factors in promoting better baby sleep

  • Having a bespoke bedtime ritual that delivers the conditioned response of sleepiness
  • Having a fixed bedtime routine
  • Parents having realistic expectations of their baby's sleep
  • Parents understand that responding to their baby will make strong positive brain connections and promote independence
  • Parents learn that bed-sharing and co-sleeping are the ideal night time set-ups
  • Parents must use a combination of sensory stimulus to induce sleep
  • Ensuring that parents eradicate all possible inhibitors of sleep

Infant sleep safety

Creating a safe place to sleep

Safe baby sleep

All new parents should receive information about SIDS (cot death) before or just after their baby is born from their midwife or health visitor. The NHS and The Lullaby Trust provide detailed information on how to reduce the risk of SIDS. The following points are emphasised: 

  • Place your baby on its back to sleep, in a cot in a room with you
  • Do not smoke in pregnancy or let anyone smoke in the same room as your baby
  • Do not share a bed with your baby if you have been drinking alcohol, if you take drugs or if you are a smoker
  • Never sleep with your baby on a sofa or armchair
  • Do not let your baby get too hot or too cold, keep your baby's head uncovered, and place your baby in the "feet to foot" position
  • Breastfeed your baby

Cot Safety

All new cots sold in the UK must meet European Safety Standards and should carry the British Standards Institution (BSI) number BS EN 716:2008, which indicates that they comply with the required safety standards. However hand-me-down or second-hand products may be defective, or produced before current safety standards were implemented. The Consumer's Association provides guidelines regarding safety of new and second-hand cots. In the US drop-sided cots have been banned since June 2011 due to infant deaths and product recalls; no such ban has been proposed for Europe.*

Research has not found any link between mattresses and SIDS. FSID recommend cot mattresses should be clean and dry with no tears, cracks or holes, and if possible purchase a new mattress for each baby. The mattress should fit the cot without gaps. Consumer's Association provides guidance on these products. Think about where you place your baby's cot and ensure it is away from radiators, curtains, and hanging cords.*

*information taken from Infant Sleep Information Source Online

Bed-sharing Safety 

On any given night a fifth of all UK babies spend at least part of the night sleeping with one or both of their parents. 

The prevalence and characteristics associated with parent-infant bed-sharing in England. Blair & Ball, 2004

Parents should be armed with information on how to safely bed-share even if they never plan on sharing a bed with their baby, as research shows that most parents do, even if it is unintentional. 

It is very important to remember these points: 

  • It is not safe to bed-share in the early months if your baby was born very small or pre-term

  • Do not sleep with your baby when you have been drinking any alcohol or taking drugs that may cause drowsiness (legal or illegal)

  • Do not sleep with your baby if you or anyone else is a smoker.

  • Do not put yourself in a position where you could doze off with your baby on a sofa or armchair.


There are also some guidelines to follow:

  • Keep your baby away from the pillows

  • Make sure your baby cannot fall out of bed or become trapped 

    between the mattress and wall

  • Make sure the bed clothes cannot cover your baby’s face or head

  • Don’t leave your baby alone in the bed, as even very young babies can wriggle into a dangerous position.

Sleeping in their own bedroom

Sleeping in their own bedroom

A baby younger than 6 months must NEVER be put to sleep in a room where there is no care giver present - either during the day or at night. 

1. Windows

Ensure that window blind cords are affixed appropriately. They can become a dangerous addition to a baby's bedroom should they get stuck in one. Most blinds now come with a safety feature which will allow parent/caregiver a bracket to keep the cord out of the way. 

2. Choking Hazards

Make sure the room and sleeping space doesn't have  any choking hazards. As a good rule of thumb,  anything that fits into an empty toilet paper roll could be considered as a potential choking hazard.

3. Electricity and wiring

If there are a lot of wires in baby’s room from the lamp, CD player, humidifier, etc. it may be worth considering concealing the wires using a wire guard.

4. Stairs

If your baby’s room is upstairs, it is important to consider if you need to make the stairs safe or whether you need to prevent the baby from roaming freely on other floors. If either of these are necessary, it might be a  good idea to have a stair gate on the top of the stairs. Even if a baby is able to navigate the stairs with confidence and competence, if they wake in the night and are still half asleep, they may crawl out on to the landing and not know they are near the staircase. They may sleep walk. This is more of a parental choice and will be different for each family.

5. Monitoring 

Some parents find it comforting to have a monitor (either audio or video) and others find it induces paranoia. Listen to your instincts but understand that unless you really couldn't hear your baby without it (even this depends on their age) a monitor isn't necessary. As always, if it helps parents feel calmer then great - it can give some parents peace of mind without disturbing their baby unnecessarily. 

6. Cot Bumpers

Cot bumpers must NOT be used in a baby's cot. The only cot wraps that would be safe are something similar to the Airwrap 4 Sided Mesh Cot Bumper or individual wraps.

Sleeping in parents bedroom

In a parents' room

As with the previous section "sleeping in their own bedroom", it is important that if a baby is left in any room alone, those safety guidelines are followed. 

There are usually two sleep surface options when a child shares a caregivers bedroom:

  1. In their own bed/cot, separate to the master bed 
  2. In the master bed with parents/care givers. 
  3. In a side-car cot, attached to the master bed

If they are in their own bed (be that a floor bed, toddler bed, single bed, cot etc), it is important to still follow safety guidelines. 

Important things to remember for bed sharing... 

There are certain reasons why it would be deemed significantly less safe for parents to room share/bed share with their baby:

  1. Both parents (and anyone who sleeps in the bed) must be non-smokers. Mum should not have smoked during pregnancy either.
  2. Neither parent has been drinking alcohol excessively and is unable to appropriately care for their infant. 
  3. Parents must not have taken any medication which may make them additionally sleepy

  4. Parents must not be ‘excessively tired’ (some says this means less then 5hrs sleep in last 24hrs – others say this should be left to the parent to decide based on their instinct).

  5. Mum must always sleep between dad/older sibling and baby. Baby must not be in middle of bed.

  6. Ensure the sleeping surface is firm. No sofa, bean bag or waterbed sleeping. Memory foam mattresses are to be avoided.

  7. Keep pillows well away from baby. 

  8. Baby must sleep at same level as mum's breasts, not head

  9. Keep duvets and blankets away from baby

  10. Consider a separate sleeping surface if baby was small for dates or premature

  11. Consider a separate sleeping surface if the mother is significantly overweight.

  12. Ensure baby does not overheat

  13. Mum must be breastfeeding: if baby is formula fed then they should have their own sleep surface (be that a side-car cot or stand alone cot)

  14. Tie long hair back and do not wear nightclothes with loose ties

  15. All sleep surfaces should be at the same level. If a cot or crib is next to/attached to the bed (either by design or by modification) great care must be taken to ensure that there is no ridge or lip between sleep surfaces.

  16. Do not have stuffed animals, cot bumpers or any unnecessary items in the sleeping space

  17. Remember that the safest position is for mum to lay on her side and form a protective frame around baby. 
  18. All measures should be taken to prevent baby from rolling onto the floor - e.g: humanity co sleeper protector, arms reach co sleeper or mattress on floor

It is safe for a baby to sleep in its own bedroom, during the day, from 3 months old

  • No, this statement is incorrect. A baby must be at least 6 months old before sleeping in any room without a caregiver present
  • That's right! A baby must be at least 6 months old before sleeping in any room without a caregiver present

Please detail 4 situations when it would be unsafe for a caregiver to bed-share

How do you think we could raise awareness of the safety of bed-sharing?