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
Common questions our doctors are asked
I've tried the suggestions for good sleep routines but
nothing seems to help. Should we go to sleep school?
Speak to your Maternal and Child Health Nurse. They may be able to provide you with some other useful advice for getting your baby to sleep better. If nothing seems to help, they will be able to recommend a sleep school (otherwise known as an early parenting centre). Sleep schools have
expert staff who can teach you how to help your baby self-settle. They may have day-stay programs or residential programs where you stay overnight. A sleep consultant may also be able to perform a home-visit and provide a tailored plan for settling your child.
I've been told to try controlled crying to teach
my baby to self-settle, but I am not comfortable with this technique. What are
some other effective options?
There are a number of different techniques for settling children. These include controlled crying, pat-and-shush and camping-out. You should discuss these with your Maternal and Child Health Nurse, sleep specialist or doctor to determine which is suited best to your family.
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.