Understanding Infant Sleep - A Guide for Supporting Parents
By Dr Hannah Guzinska, Clinical Psychologist and Cattanach Associate

Sleep deprivation is hard. Most parents will experience it, to varying degrees. Disrupted sleep can have a very real impact on parental coping and mental health, particularly in a society where there is frequently a systemic lack of support, not enough value placed on the parental role, and pressure to return to work.

At the same time, babies are born with an intense need to be near their parents, who provide them with physiological and psychological regulation and meet all their needs in a way that babies are completely unable to do for themselves. And we know that parents who are responsive to their baby’s needs promote optimal brain development and help their babies to develop self-regulation, the capacity to form close relationships, and the capacity to explore and learn.

This blog (and the second part) aims to share some ideas about how you can work with this central dilemma of parenting in a way that honours everyone’s needs. I’d like to support more parents to understand their child’s sleep, normalise that babies’ sleep is not meant to look the same as adult sleep, and know that there are things that can help everyone get more sleep, without resorting to leaving babies to cry and parents having to go against their instincts.

Here are some ideas for working with parents who are struggling with their baby’s sleep:

 Offer empathy first 

Often people really just need to be heard and understood without judgement or jumping in to solve problems. Parents are allowed to find sleep deprivation hard, without any pressure to change anything at all, and you don't have to have answers. If parents do want solutions, generate ideas together and encourage parents to try things out. There are many different options and what works for one family won’t necessarily be the best solution for another. Try to work out a realistic and helpful goal with parents. If the goal is more sleep for parents, there are a few ideas at the end of this blog.

 Don’t “Compare and Despair”

Try not to compare to others’ experiences (including your own) unless you are very clear it will be helpful to the parent and not experienced as a judgement or a source of worry. Every baby is different, and every family circumstance is different. For example, some babies tend to signal to their parents each and every time they wake, while others can wake and return to sleep by themselves if there is nothing that needs parental attention. There is also a wide variety in sleep needs, with some babies needing many hours more than other babies. That’s not to mention differences in temperament (of baby and parents), preferences (of baby and parents), and family circumstances.

Normalise infant sleep

It is absolutely normal, and developmentally appropriate, for babies to spend long periods in light sleep, to wake frequently, and to need comfort and support to go (back) to sleep and to need frequent feeds through the night. There is no set age when children will start to sleep independently through the night. Babies are not able to self-regulate; if they are distressed they need adult support to come back to a state of calm. We cannot make babies (or ourselves) fall asleep, only create the right conditions. They will only fall asleep if they are tired enough, and relaxed enough.

It is normal for babies to want to be close to parents - it’s part of our evolution; their need for closeness is almost as crucial to babies as their need for food. Being in contact with a caregiver regulates a baby’s vital bodily functions such as heart rate, breathing, and temperature, as well as helping them to feel safe and secure. Theory and research suggests that meeting a child’s need for dependence in the early years fosters greater independence later on, because it helps their brain to build the connections associated with comfort, helps them to develop beliefs that they are loveable and worthy, and teaches self-regulation through the repeated experience of co-regulation. In addition, “parents' emotional availability to children in sleep contexts promotes feelings of safety and security and, as a result, better-regulated child sleep” (Teti et al.,2010).

Sleep development is not linear - sleeping through the night last night is no guarantee a baby will sleep through again tonight. Babies may also go through phases where their sleep gets noticeably worse - this often coincides with a developmental “leap” (when their brain is going through in intense growth spurt and they are developing new skills) and although often called a sleep “regression” is actually a sign of development.

It is normal for babies to need feeding during the night, and it is not recommended to wean early or add things such as baby rice to milk in an effort to get them sleeping longer. Artificially deepening sleep may be a risk for SIDS, and babies’ digestive systems are not ready for solids before they are showing certain outward signs of readiness. Babies wake for more than hunger, so it may not help anyway. Emphasise that parents haven’t done anything wrong, and babies will naturally start to sleep in longer stretches in their own time.

If you do have concerns that sleep is outside normal and something else is going on - for example, an allergy, reflux, or other medical condition, support parents to access professional medical advice.

Support parents to optimise their own sleep and rest 

If a parent is very tired, creative solutions to get them more sleep might make all the difference, even if their baby continues to sleep like a...well, like a baby. Can baby be closer to their parent for sleep so that responding to them is less disruptive, and so that baby is easier to settle quickly? Is there anyone who can provide support to allow parents to take a nap? Can parents take a “reverse lie in” (go to bed early, with baby) to get a couple of extra hours, even one or two times a week? Can sleep hygiene help parents to get more restorative productive sleep (big hint here: blue light from phones and other screens, as well as the stimulating nature of social media, is really disruptive to sleep onset and sleep quality)? How about some restorative self-care that allows rest, and allows the parent to be in a state of calm rather than constantly stressed? Allow parents to generate their own solutions, and encourage them to experiment to find what works for them.

 Share trusted information sources on infant sleep:

The infant sleep industry is large and unregulated - it is worth checking out the credentials of anyone working with families around infant sleep. Here are a few sources I would trust:

https://www.basisonline.org.uk
https://www.lullabytrust.org.uk
https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/sleep-and-night-time-resources/
https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2016/07/Co-sleeping-and-SIDS-A-Guide-for-Health-Professionals.pdf