Struggling to fall asleep and waking up many times through the night is very common in babies and toddlers. It can be very distressing and exhausting for their parents and caregivers. There are many strategies that can help improve baby and toddler sleep, and families will need to choose which one(s) suit their child and family best. Caring for babies and toddlers with sleep challenges can be exhausting and it is important to seek support for yourself through family, friends and your community. Please talk to your GP if you have concerns about how you are coping with the situation.

For sleep problems in older children, see our fact sheet Bedtime problems – children.

Normal sleep

Sleep is made up of sleep cycles, which consist of periods of light and deep sleep. When we go to sleep at the start of the night, it takes around 20 minutes to pass from light into deep sleep. We then spend some time in deep sleep, coming up into light sleep again. This is called a sleep cycle. In adults, a sleep cycle lasts about 90 min. In children aged six months to 18 months, sleep cycles last about an hour.  In newborns, sleep cycles are even shorter. It is normal for children to wake when a sleep cycle comes to an end, when they are in light sleep. Many children can easily resettle themselves, while others will call out or cry at this time.

Like adults, different children need different amounts of sleep to feel rested and happy during the day. More information on how much sleep to expect in babies and toddlers can be found at: https://raisingchildren.net.au/babies/sleep/understanding-sleep/sleep-2-12-months and https://raisingchildren.net.au/toddlers/sleep/understanding-sleep/toddler-sleep

Sleep in babies younger than 6 months

Babies less than 6 months usually wake regularly during the night. They need regular feeds overnight, and they need time for their body clocks to adapt to the differences between daytime and nighttime (circadian rhythm). During the first 6 months, parents learn about their baby’s cues of tiredness, hunger and overstimulation – although for many babies, it may be hard to work these out. Behavioural sleep interventions in babies younger than 6 months old are not recommended. There is no evidence  behavioural sleep interventions are beneficial for these babies in these early months, so it is important to respond to your baby’s cues when they wake.

More information on settling and sleep for newborns and babies less than 6 months old can be found at: https://raisingchildren.net.au/babies/sleep and https://www.rch.org.au/kidsinfo/fact_sheets/Crying_and_unsettled_babies/

Sleep in babies and toddlers aged older than 6 months

Sleep associations

Every family and every child are different. Some children naturally settle and fall asleep more easily than others, who may need help to fall asleep. It is common for parents and caregivers to soothe or settle their child to sleep using techniques such as feeding, patting, rocking or holding the child until they fall asleep in their arms. If a child is used to getting help from their parents to fall asleep, this can become a habit, called a sleep association. Specific preference to one parent or caregiver can also be a sleep association.

Sleep associations are usually not a problem in the first few months of life. However, at around 4-5 months of age, babies start to realize that their parents are still around even if they cannot see them. This normal developmental milestone is called ‘object permanence’. During this time, babies may start to cry out for their parent at the end of each sleep cycle. Babies who do not need help to fall asleep at the start of a night or nap may be able to soothe themselves back to sleep. However, babies who have sleep associations are likely to need help from their parents to fall back to sleep.

Sleep associations are not a problem for all children and families. Children who don't settle easily are more likely to become dependent on sleep associations to fall asleep, and may wake up frequently. This may be a cause of distress to some parents and caregivers. For parents and caregivers who need more support with their child’s sleep,  below are some strategies to promote good sleep habits. 

Strategies to promote good sleep habits

The Sleep with Kip https://sleepwithkip.com/strategies is an evidence based resource for sleep strategies:

• Sleep associations
• Checking method
• Camping out
• Bedtime fading
• Rewards

The Raising Children Network is an evidence based parenting resource: https://raisingchildren.net.au/babies/sleep/solving-sleep-problems/changing-sleep-patterns

These strategies promote good sleep habits, which can help babies to fall asleep more easily and wake less frequently overnight. Every family and their baby are different, and some strategies may work for one family/baby but not for the other. Talk to a health professional, for example a maternal and child health nurse, to ask for help. When working to support a baby over 6 months of age to sleep separately from their caregivers, it is important that it is done gently. Sometimes, plans may need to be put on hold if your baby is unwell or needs extra support for another reason.

By the age of around 6 months, children can anticipate and respond to positive routines. It is beneficial to have a positive routine to ‘wind’ down in the evening. This will help your child to expect and anticipate that bedtime is approaching.

You can tailor the routine to suit your family, here are some suggestions:

• Try to keep a consistent and predictable routine each evening so your child learns what to expect and when.
• Screen time or high-energy play in the hour or two before bedtime may make it harder for your child to fall asleep. Instead, try to have some quiet time before your child is put to bed (e.g. having a bath and bedtime story).
• Feeding your child immediately before bedtime can become a sleep association. Instead, try to time the last feed for at least half an hour before bed. Consider giving this feed outside the bedroom if your child associates feeding with going to sleep.
• If dummies have become a sleep association, there may be ways to help your child replace the dummy. More information can be found here: https://raisingchildren.net.au/babies/sleep/solving-sleep-problems/dummy-independence
• Letting your child hold a comforter (e.g. a soft toy or small blanket) can be helpful, but this should not be done for babies under seven months of age as it can be a choking or suffocation hazard.  
• Actions such as patting or rocking your child to sleep are OK for newborns, but older children can form a sleep association with these actions. Try to cut down on these actions if this is the case.
• If it works for you and your child, begin to put your child into the cot awake at bedtime as this can help them to learn to settle themselves to sleep.
• Try to leave the room and go back for brief but regular checks until your child is asleep. If this is too distressing, sit quietly on a chair in the bedroom until they fall asleep. You can gradually move your chair out of the room over time.
• Be consistent in your behaviour, and set your own limits. Each family is different.
• If co-parenting, try to share your child’s bedtime routine and strategies with your partner so there is consistency for your child.

More tips to promote healthy sleep routines can be found here https://raisingchildren.net.au/babies/sleep/settling-routines/bedtime-routines

Follow-up

Once your child has learnt to fall asleep and stay asleep throughout the night, be wary of times of change. Illness or unexpected changes for the child or household can upset your child's routine and may lead to a recurrence of night waking. If your child is sick, it is OK to give yourself a break from the usual sleep strategies and go back to them when things have settled. When you return to the sleep routine, it is common to feel things seem worse than before. Things are likely to get better again with time. 

Key points to remember

• Good sleep routines and consistency can help resolve night wakings.
• It is important to be responsive to your child so your child will trust you'll be there when they really need you .
• Night waking can be distressing and exhausting for parents. However, night waking is usually transient and a majority of children will learn to sleep on their own by the time they approach school age.
• Sleep associations may result in night waking or difficulty settling to sleep on their own.
• Some parents may choose to trial a sleeping intervention to reduce sleep associations in their children.
• If you are concerned about a possible medical problem (e.g. snoring), please see your GP to exclude any underlying medical conditions causing frequent night-waking before trialling a sleeping intervention.
• Ask for help from your friends and family during this tricky time and please talk to your GP if there are concerns about your mental health.
  

For more information

• Raising Children's Network: Sleep and settling help for babies and toddlers
• Sleep with kip: fun books for kids based on sleep strategies from two decades of research by the Murdoch Children’s Research Institute, with audiobooks and sleep podcasts 
• Baby Business booklets: - a guide to managing common sleep and crying problems in the first 12-months of life.
• Dr Margie: How can you help your toddler or school-aged child go to sleep?
• Dr Margie: Tips on when and how to get rid of your baby's dummy
• Kids Health Info fact sheet: Night terrors (night-time wakings)
• Kids Health Info fact sheet: Bedtime problems – children
• Kids Health Info fact sheet: Sleepwalking
  
  

Developed by The Royal Children's Hospital Centre for Community Child Health (CCCH). We acknowledge the input of RCH consumers and carers. We acknowledge the input of RCH consumers and carers.

Reviewed May 2023.

This information is awaiting routine review. Please always seek the most recent advice from a registered and practising clinician.

Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit www.rchfoundation.org.au.