Sleep

For many parents sleep becomes their favourite activity and the one that’s most frequently denied them. While some babies get the hang of sleeping from an indecently early age, others continue waking up until they’re school age. Parents are not hopeless bystanders in their children’s sleep patterns, however, and most of us could at least encourage our babies to sleep better.

But sleep is an emotive issue, often causing rows between couples who are already frazzled by not getting enough sleep. Some parents fear that letting their child sleep away from them may increase the risk of cot death. And for the single parent it may be too exhausting to try to train your toddler into acquiring good habits when you can’t keep your own eyes open long enough to find her cot.

Expert advice on babies and sleeping is as subject to fashion as anything else. While our grandparents left our parents to cry for hours at the bottom of the garden ‘to exercise their lungs’, our generation is more inclined to be directed by our babies and to feed and cuddle on demand.

Lately there has been a move towards returning to establishing routines, with Gina Ford’s (a maternity nurse’s) book The Contented Little Baby Book (Vermillion £7.99). This is a prescriptive book that tells you what routine is suitable for what age. Some mothers find it brilliant - never taking their baby out at night and gearing every early evening towards getting their child to bed. Most who followed it to the letter seem to boast good sleepers as a result. This passion for routine won't suit everyone, however. Many parents find the regimes too inflexible to be realistic but if you're looking for someone to tell you what to do when with your newborn then there's no doubt Gina Ford does that. And plenty of parents have found her a life-saver.

Probably the sensible thing is to go for a middle course and see how things go - start off at least with doing what feels most natural to you. If nothing feels natural then use whichever baby book suits you best.

The trouble with sleep is that not getting enough of it makes you miserable and takes the joy out of parenthood. Childcare books will tell you that baby’s sleep problems are really only a problem for parents - babies tend to get themselves enough sleep somehow. They can fall asleep in the car after all or while you’re out shopping. This doesn’t solve the problem but should reassure you that babies are resilient and that if you can endure a little hard-heartedness you may provide your baby with a happier parent.

Newborn babies

Contrary to mythology your newborn baby may not sleep all day and all night but instead be awake from three to eight hours a day over the first few weeks. Because they need to feed frequently, they will also only sleep for short periods at a time, some for only an hour.

Do not assume that you will be able to do any activity uninterrupted because your baby is likely to be asleep. Babies have built in antennae for precisely those moments. Some babies seem to be relentlessly wakeful and some will indicate they aren’t keen on sleeping early on by howling when they feel themselves dropping off. Sleep experts suggest that between 5 and 10 percent of babies may have ‘regulatory’ trouble with sleep. These babies have difficulty making the transition between being awake and asleep and may struggle for ages to fall asleep.

You will be lucky if your baby can get into any routine before three months - it’s probably not appropriate to really try before then anyway - but there are some things worth knowing to help with those first hard weeks:

The first weeks

Initially your baby will not be able to sort day out from night and will usually sleep when she wants, often dropping off, blissfully and soundly, while feeding. Many new mothers and fathers hold their babies while they sleep because it can seem brutal to put them into their seat, cot or Moses basket. There is not a great deal of evidence that holding a newborn makes her less likely to be able to sleep on her own but it seems sensible to get her used to somewhere that’s a place especially for sleep (that isn’t you).

Put your baby down just before she has nodded off, in order to establish her ability to drop off on her own. Otherwise later on when she wakes up she may not know how to get herself off to sleep and may immediately call for a grown-up to help. While your tired little baby may cry a little before she falls asleep, your tired little toddler will most certainly cry longer and louder. Be flexible, though. If your child is unwell or unhappy you don’t have to enforce sleep training rigidly at this age.

In these first few weeks consider a few manipulations to try to encourage good sleep patterns (by good I mean good for the baby and parents).

• When your baby is asleep do not tip toe round the house. You may want to turn your garage music down but not entirely, or your baby will get used to being able to sleep only in silent conditions.
• Try to differentiate day from night by taking your baby out in the day to the park, to see shadows and trees, and by stimulating her with songs, chat and lifting her up. Babies respond to toys much earlier than many parents expect them to.
• When you put her to bed think about a routine of bath (with or without massage afterwards), feed and bed with a little musical box or mobile. Talk softly to her.
• Darken the room that your baby will sleep in, maybe leaving a nightlight so that you can feed at night without either falling on top of her in the dark or waking her by turning on a main light.

In your room

Many parents choose to have their newborn in the same room as them in the first few months. The evidence of whether this reduces the risk of cot death (the theory being your baby hears you and is stimulated to breathe) is not completely convincing but you may feel it's more ‘natural’ to keep your baby close by at night.

In your bed

Many parents also take their baby into their bed, the typical scenario being that everyone falls asleep while the baby is being breast-fed. Again, the studies on whether this increases the risk of cot death (through raising the child’s temperature or through smothering) are not conclusive but it is a myth to think that mother nature will prevent you rolling over onto your baby, especially if you are very tired or have had a few drinks.

Night feeds

When your baby wakes in the night, whether you get out of bed and feed her in a chair or take her into bed, keep the feed shortish. Since you may need to change her in the first few months at night, keep everything you need close by so you don’t have to traipse around the house for a nappy.

If you are a couple then take it in turns to catch up on sleep, try to nap when the baby does and let the house get into a state because it’s really not important to keep up appearances when you have a baby to look after. Now is not the time to be an over achiever.

Beg members of your family to take the baby out for a walk so that you can sleep a little during the day. If it is hard to separate from your baby, realise that most parents feel that way and try to make yourself, you will feel much more up for parenting after a rest.

Waking your child up to feed

You may want to wake your child up for a 10.30/11.30pm (depending on your bedtime) feed in the hope that the next wake up will be when your baby is hungry again in about four hours time. This may work but some babies will wake up again anyway when they would have done if you hadn’t woken them - so this may not work for you.

Six months to a year

Expert opinion varies but by 6 months babies can sleep most of their sleep at night and you can certainly hope for ten hours (although not from any of my children). You may have already started sleep training your child but if not, now is a good time, as your baby is most likely on solids and if she is eating well you can feel happy that she doesn’t really need that middle of the night feed anymore.

• Try to avoid letting your baby sleep a lot in the day as she gets older as this may make it less likely she’ll sleep well at night. Do not expect unbroken nights, however, as at least one in six babies between 6 months and one year wake more than once a night.

You may want to keep your baby in bed with you and you may be happy to have her stay there when she gets to be a big toddler with kicking legs and a tendency to stand up in bed at 3 in the morning (personal experience) but you should consider whether this is in everyone’s best interests. It is hard to get a toddler out of your bed because it is generally nicer for her than her cot on her own.

The bedtime routine (some suggestions)

Whatever you decide, babies do appreciate a bedtime routine and, conducted cheerfully, it works better for everyone than having an overtired emotional baby still up at 10pm, making sure no one’s having a good time.

• Don’t take your baby abruptly from having a noisy time in a brightly-lit room to her cot.
• Gradually wind your baby down with a bath and a story book that she learns to associate with bed time.
• As you take her up to bed say softly and firmly that you are going to bed because it is time to sleep and that you will see her in the morning (you can use your own words!)
• Give her a breast feed or bottle, brush her teeth as soon as she has it, get kisses from everyone and then tuck her into her cot (on her back without a pillow until age one). You can have a musical box or musical mobile playing and some parents apparently still sing to their children.
• You may want to use a baby monitor but your baby should be able to hear you for a little bit so she doesn’t go from a noisy environment to a silent (as in "oh no I have been deserted") one. As she gets older she may wake up more easily and you may need to keep her room quieter.

If your baby cries and won’t go to sleep you can either pick her up and try to get her off by rocking, feeding or bringing her into your bed; or you can try sleep training. If she is closer to six months beware that she might be in pain from a sore bottom or teeth coming through and that she could have a cold. These things all keep babies awake and you have to realise that some sleepless nights are inevitable - it’s the part of being a parent that allows you to tell your children at a later date how much you sacrificed for them.

Sleep training

There isn’t a written-in-stone method for sleep training. It can be done either by letting your baby cry herself to sleep or letting her cry for repeatedly longer intervals before going in and reassuring her that you are there and love her but that it is time for her to sleep. The interaction can involve patting or not but experts all agree it should not involve a prolonged interaction (few words) and you should never, ever (unless there’s a house fire) take her out of the cot.

A research paper in the British Medical Journal (22^nd January 2000 -go to www.bmj.com and search for the author - Ramchandani - in the archives section) found that the reassuringly-named "extinction programme" worked better than drugs for sleep problems (the baby gets the drug - not the parent). With extinction therapy the parents ignore tantrums or protests in the cot and at the end of a pre-determined time, go into the room and resettle the child in bed, tell them it’s time to sleep and then leave the room again for another 15 minutes. (Some of the therapies did involve checking on the baby and not speaking and then not going back for the rest of that crying episode.)

A positive routine was also found to help with sleep problems. This involved a 20 minute wind down period and replacing the baby in their sleeping position if they got up.

Scheduled wakes were also found to work, with the baby being woken up to an hour before she normally would do at night and then being resettled. Obviously, you need to be fairly sure when she normally wakes in the night, for this to work.

The best advice is to do what you feel most comfortable with, but if you are tired and your relationship is suffering because your baby is in your bed and constantly waking, then you should at least consider sleep training. If you’re lucky, it can take as little as a couple of nights.

Extinction therapy (leaving babies for fixed periods before reassuring them) with checks (I have seen babies who have screamed so much they’ve made themselves sick) seems to be a good compromise. You do need a firm resolve to ignore your child’s outstretched arms and cries of mamma but most parents who have done it say it's worth it.

When your baby wakes up in the night, as long as she doesn’t need feeding - which most don’t after six months if they’ve had enough in the day - apply the same patting and reassuring but not lifting out of cot techniques. You may have to listen to your baby cry a bit but if you reassure her by going in and saying it's sleep time then you may feel less anxious about it. If your baby is really shrieking then you’ll want to stay with her a little longer to get her settled.

Dummies

Many babies find it easier to fall asleep with a comforter as they get older. Dummies can be a pain if they fall out of the cot and the baby cries because she can’t find it (one tip from a mumsnet member is to position a number around the cot at night so there’s always one accessible). But equally if your baby does wake up and can find a dummy it may well be that she settles by herself. Some parents are a bit squeamish about dummies but if they can help you get a good night’s kip there’s a lot to be said for them. Think of dummies as comforters (which is what they are) and you won’t feel so bad about trying one.

Giving your baby a bottle of any sort to get off to sleep with is not a good idea, for dental reasons.

Toddlers

Much of what is said for babies applies to toddlers except toddlers are bigger and better at not sleeping. They also may have nightmares and need comforting. It’s tough being a toddler, learning how to talk and walk properly, learning what it feels like to be happy, sad and scared sometimes. No wonder they’re not always keen to sleep.

Toddlers are good at keeping themselves awake even though it is obvious to everyone that they are exhausted and miserable and would be far better off having a nap. They can sleep for 12 hours a night (though not in my own experience) and still need a daily nap or two. The daytime tiredness can be fearful and if your toddler won’t nap then you should introduce some rest time where they lie on the sofa with you and you try to be as boring as possible.

Toddler time is also the time where your ex-baby starts flexing her muscles of independence. "Did you say bed? Well I don’t think so". She will also be unhappy at being separated from you.

If you do get a routine for your toddler this will generally have to be stuck to or something terrible will happen. The toddler who is used to going up the wooden hill to bed at 8pm will not be the life and soul of your friend’s dinner party when you can’t get a baby sitter. She will be fractious and unhappy. Holiday in Italy and you will see lots of cherubic babies cheerily up in the late evening. Babies lead adult lives from early on in some countries and the idea of sleep training and a set bedtime is viewed as anal to say the least. In my view some adult time, free of the baby, has to be better for a relationship. But the choice is yours.

• Watch out and snatch your toddler from the jaws of overtiredness. Even if it is not the right time for junior to be tired, launch into the bedtime routine (whatever you do she should have some clue you’re building up to something), missing out a few steps if she seems completely exhausted.
• Try to avoid nursing or rocking her to sleep or soon as you try to dislodge her she will wake up instantly and grab you. As with babies, try to get your toddler to learn to fall asleep for herself. If you haven’t done this up till now then it will get worse before it gets better. You can wait for your child to become articulate enough to reason with but if you do you can expect a nightly negotiation (some parents spend an hour a night doing this). If you have waited until now to consider sleep training then the crying will be considerable but you may be less anxious about something untoward happening to your toddler and some toddlers ‘get it’ quite fast.
• Have a wind down period, which is preparation for being separated from you whom they love with a passion unequalled by any pair of lovers. Let your toddler know that it is getting to be bed time. Bath, drink, book and teeth brushing are quite good steps. Don’t rush them. Let your toddler take a favourite thing upstairs if they want and get them to kiss people goodnight.
• You could play a musical or story tape in your toddler room or use a night-light. Cuddle her a lot and be warm and reassuring. Present sleep as a lovely thing to do (knowledge that only comes once you’re a grown up and it’s denied you) and be confident in your handling of her.
• If she cries and won’t sleep you can ignore her, come in at regular intervals and reassure her (with or without patting but repeat after me, never taking her out of her cot), or reassure her once and then just check without interacting. Parents sometimes find ignoring too tough and not parental enough - what if their toddler is ill or scared? A brief but kindly interaction seems nicer.
• Lots of toddlers wake up in the night and instead of going back to sleep on their own, cry because they feel scared. Again, kind reassurance and a kiss without taking her out of her cot are probably a reasonable way to deal with this. It’s a phase that will pass. You could also try the scheduled waking mentioned under 6 months to a year.
• Realise that events disrupt toddlers; such as holidays away (when they may not settle in a cot that they don’t recognise). Then you may have to go back to sleep training and be structured in how you deal with it.
• By the age of two many toddlers can climb out of their cots and wander at will, so make things safe. It may be better to make it clear that if she comes into your room you will kiss her but put her back to bed rather than insist she doesn’t get out in the first place, as the former is more realistic.

3-6 years old

Your three to six year old will want to chat rather than sleep and will try to detain you by her bed with questions about the innermost workings of the universe.

• Work towards bedtime by playing family board games or winding down in other ways. Children often have fears of going to bed, or of monsters, bad strangers or ghosts so keep them close to you for the 30 minutes before bedtime so they feel safe.
• Don’t minimise their fear or ever say "Don’t be silly". You should sympathise, reassure them that monsters do not exist except in books, films and imaginative games and ask what will make them feel better. Look under beds while explaining that you yourself know there isn’t a monster there and this is for her benefit.
• Have a time limit that is spelt out for rituals such as saying goodnight to family, toys and furniture or asking why the moon is round.
• Read a book together that she has chosen, while she lies in her bed. You may want to play a story tape for a while. If she doesn’t like the dark, leave a nightlight on.
• You may want to say goodnight with the proviso that you will check she’s asleep and okay shortly afterwards so she doesn’t feel abandoned.

Nightmares and waking up

These are common occurences, with children waking up sometimes frantically in the dark. This isn’t naughtiness and needs tactful reassurance and cuddles. Night terrors are usually more dramatic, with children waking up sobbing fearfully and not sure for a while where they are or who you are. They may not recall why they are scared, not be fully awake and may need reassurance for a long time before they calm down. It is frightening to see your child distressed but try to be calm and normalise the event if possible.

Children can just complain of nasty thoughts that may vary from an early fear of death to fear of bad things happening to their family. (Bear in mind that children may need shielding from some aspects of the news until they are a little older.)

Some children wake up quite early and find it hard to be the only one awake. Pets are sometimes useful, as are books left out and a drink. You may want to give her a sign for when she gets up - such as your alarm clock going off at a certain time.

In general, make her room as pleasant and child friendly as possible so that bed is a good place to be and it feels like it’s hers.

School age

The good news is that regardless of how grown up they think they are, they still need about 10 hours sleep.

• Do not make them lose face by ever saying to your child’s friends what time she goes to bed. Her friends are probably exaggerating the lateness of their bedtimes but since they haven’t been found out will tease your child.
• Be firm about bedtime, it is important for growth and renewal and studies show poorer academic achievement and depression in kids who don’t get enough sleep. Explain why they need sleep even if they feel old enough to stay up after you have gone to bed. You may allow later nights at weekends but do not believe what other parents are said to allow their children to do and insist it is vital for health and beauty that she gets a good night’s sleep.
• School children often announce they are starving or have homework just before bed so start working through a checklist half an hour or an hour before. Avoid letting them watch television just before bed to eliminate arguments about staying up to see the end of the programme.
• Talk to your child quietly in the half an hour run up to bed, about what they need tomorrow for school, how today went. Check they have clothes for the next day set out.
• Let her read for a while, read with her or go up to talk to her for a little while before turning the light out. Kiss and cuddle her - she might let you in her room where no one can see. Children can need lots of reassurance at this age: they may lie in bed worrying about school, things they have seen on television, or the colour of their hair. Try to avoid being called back by a child who can’t sleep by bringing issues like this out before the lights’ out.

Sweet dreams!

Further reading
Gina Ford The Contented Little Baby Book Vermillion £7.99
Penelope Leach Your baby and child Penguin £15.99
The Great Ormond Street New Baby and Childcare Book Vermillion £14.99


The author, Luisa Dilner, is a qualified doctor, mother of three and former health editor of The Guardian. She is currently assistant editor at the BMJ.