The Need for Sleep As a Child and a Parent

Any parent of a newborn knows that sleep deprivation comes with the territory. But when is it time to sleep train? How can parents make that transition in a way that is successful for their particular family unit? Also, what is considered "normal" for older children and adolescents when it comes to sleep? In this lesson, we will answer all of these questions. We will also discuss how to troubleshoot sleep regressions and roadblocks when they arise, as well as when to see a doctor about possible underlying issues related to sleep.

Need for Sleep

All children need sleep for daily functioning, as well as critical developmental milestones but necessary sleep varies in amount, length, and time of day. Newborns can sleep up to 19 hours a day, typically needing an average of 14 to 17 hours. (Note: In this section, "day" refers to a 24 hour period.) This sleep ideally occurs in longer stretches during the nighttime, around three to four hours, and in shorter stretches during the daytime, anywhere from 30 minutes to two hours. However, this can vary a lot during the newborn phase due to the intense nutritional needs of the newborn's body, as well as other potential factors like reverse cycling that causes the newborn to sleep longer stretches during the day and shorter bursts with longer periods of wakefulness at night.

For infants four through 12 months of age, this number will decrease just a bit to an average of 12 to 15 hours a day. This includes at least two naps per day in addition to nighttime sleep. Toddlers 12 months through 36 months of age may be able to drop about an hour but they still need an average of 11 to 14 hours a day. At some point in this age range, most children will drop from two naps per day to one nap per day. Preschoolers three through five years of age need ten to 13 hours per day. At some point in this age range, most children will drop their daytime nap altogether as they transition to getting all of their sleep needs met during one long nighttime stretch.

School-aged children 6 through 13 years old need 9 to 11 hours of sleep per day. At this point, they are getting all of their sleep needs met at nighttime, but additional factors like the start time of the school day, after school activities and sports, homework, and other evening commitments with their family can make it more difficult to ensure they are getting the necessary amount of sleep between bedtime and the morning alarm. Teenagers 14 through 17 years old can drop this number down a bit to 8 to 10 hours per day. But as they are often starting school even earlier in the day than elementary and middle school students and are also likely to have even more afternoon and evening activities and commitments, parents must be very intentional in supporting their teenage children to prioritize sleep.

Sleep Training and Routines

Contrary to popular belief, sleep training can begin from day one of infancy even during the newborn stage. The most important thing for parents and caregivers to remember with newborns is that they need to eat every 3 to 4 hours and in fact, the baby must be woken to eat if they have reached the 4-hour mark of consecutive sleep. This also means that parents will not be sleeping more than 4 hours at a time. However, parents can still set the stage for healthy sleep routines when the baby is older by embedding the following simple practices at this early stage.

1. Practice laying the baby down when they are starting to doze off but are not yet fully asleep. This will help the baby learn to fall asleep independently later on. Often in the newborn stage, parents and other family members like grandparents will want to hold the baby while they fall asleep. This is okay as long as the adult is awake and holding the baby safely since it is a special and sometimes very short period of time when the baby will drift off to sleep in the arms of a loving adult. You can still practice letting them fully drift off in their bassinet occasionally whenever it feels natural during the newborn phase.

2. Distinguish between day and night but don't force it. Let natural light and noise be part of the environment during the day but don't force your newborn to stay awake. At night, minimize ambient noise and use nightlights or soft lamps rather than fully lit rooms. Try to create a calm and relaxing sleeping environment for the whole family. This can help encourage the newborn to learn the difference between day and night, and will help with successful sleep routines later. Newborns will often "reverse cycle" before they understand the difference between day and night, meaning they will be more wakeful at night and sleep longer stretches during the day. This is normal and usually passes quickly.

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3. Lay the newborn down to sleep on their back in their own safe sleeping space, usually a bassinet or co-sleeper, with nighttime sleep happening in the parents' room but not in the parents' bed. Sleeping on their backs and room-sharing without bed-sharing are critical to decrease the risk of SIDS (Sudden Infant Death Syndrome), but this also helps the newborn learn healthy sleep habits that will support independent sleep later.

Sometime between six and 12 months old, the baby will be ready to transition away from nighttime feeding and toward sleeping through the night. The best way to determine when your baby is ready for this step is to talk to your child's pediatrician. This is because the decision will be partly made according to the baby's weight. The doctor can cue you when it is safe and healthy to decrease and eliminate nighttime feeds. When it is time to sleep train, follow these steps. (Note: the American Academy of Pediatrics recommends that babies continue to room-share in the parents' room until they are 12 months old since this is when the risk of SIDS drops dramatically.

1. Establish a bedtime routine. Typical bedtime routine activities include bath time, brushing teeth, and story time with snuggling. The bedtime routine does not need to be deeply complex or lengthy. Choose short books with some excellent choices being Goodnight Moon, the Leslie Patricelli series, or the Llama Llama series, and pick a limited number of stories per bedtime. Between one and three stories is enough without making story time drag on for too long. Snuggle and cuddle your baby while rocking them but if they start to doze off, lay them down in their crib to help teach them how to fall asleep independently. If your baby has a comfort object, be sure to have it in the in the crib with them.

2. Say goodnight. It is important to use language to communicate what is happening in the routine with your baby. Even though they are not talking yet, their receptive language abilities develop more quickly than their expressive language abilities meaning that they are learning from your narration of their day and activities. Develop the habit of saying "Goodnight, I love you, I will see you in the morning," early on in the sleep training routine.

3. Cry It Out (CIO) and/or gentle sleep training - Sleep training is not normally a perfectly linear process in which the baby immediately starts sleeping through the night independently in their own crib. Most families will need to support their baby to learn how to self-calm and go back to sleep if they wake up during the night before it is time to get up in the morning. This can be a gradual process. For some babies and families, the "Cry It Out" (CIO) system works best. After saying goodnight, the parents leave the room and lets the child learn to fall asleep on their own even if this involves extended periods of crying before the baby learns to self-soothe. For other babies and families, a modified system and "gentle sleep training" is preferable. This involves the parent taking a more active role in teaching their baby how to fall asleep after laying them down in the crib by using strategies like staying in the room for a while and rubbing their back or singing to them. The parent can also utilize an interval time based system by saying goodnight, leaving the room, and letting the baby cry for a short period of time, such as five to ten minutes. After that time has elapsed, the parent returns to the room and repeats the same strategies but does not pick the child all the way up out of the crib. This helps the child learn that the crib is a safe and secure sleep environment. The parent then repeats this process with the same interval of time each time until the baby falls asleep. In subsequent nights as the child begins falling asleep successfully with this support, the interval can gradually increase until the child has learned to fall asleep independently. This method also works well for middle-of-the-night wake-ups. If the child wakes up at night before it is time to get up in the morning, the parent can wait the same interval of time before picking the child up if they are still in the parent's room or going into the child's room. Eventually, the child will learn to fall back to sleep independently. Sometimes when interval training is used at bedtime, the transition to independently falling back asleep after middle-of-the-night wake-ups happens quickly.

Once the child is successfully and independently sleep trained both for bedtime and for sleeping through the night, maintain the established bedtime routine as they get older to continue supporting healthy sleep. When the baby drops the second nap sometime in the second year and when they stop napping altogether sometime before school age, they may naturally gravitate toward an earlier bedtime at least for a time. This is normal and should be supported by the parents.

For school-aged children, additional factors will need to be accounted for when planning for bedtime like time arriving home from school, homework, and extracurricular activities. Allow for an adjustment period during transition times like the start of a new school year, a new sport, or Daylight Savings Time. It can be hard to continue to maintain a consistent bedtime routine as the family dynamic becomes busier, but ensuring the bedtime routine stays constant helps provide a cornerstone for the whole family's health and wellness, as well as the individual child's. This will also help set the children up to be successful when they are managing their sleep routines independently as teenagers and young adults. Finally, as much as possible, try to match weekend sleep schedules with weekday sleep schedules.

Troubleshooting

Sleep regressions are also a normal part of otherwise healthy sleep habits in children. For newborns, this typically happens in the form of cluster feeding when a newborn is going through a growth spurt and needs to eat much more often than every 3 to 4 hours. The parent should facilitate this feeding during increased wake times knowing that the baby will soon go back to sleeping longer periods, since sleep is also a critical component of growth spurts. For older babies and toddlers, sleep regressions can be more frustrating for the parents as their children have already passed through the newborn time when nighttime wake-ups are considered "normal." However, older babies and toddlers will often have periods when their independent sleep skills decrease for no apparent reason. This can be due to many factors, such as teething, other physical discomfort of some kind, or a growth spurt. To cope with sleep regressions, parents should first recognize that this is not abnormal and then apply the same strategies that they used during initial sleep training to reteach sleep habits and skills.

When Should I See a Doctor?

It's always best to see a doctor if you have concerns about your child's sleep. Common indicators that there is an underlying issue impacting your child's sleep include other symptoms of illness or physical discomfort, frequent night terrors or intense nightmares, extended periods of wakefulness in the middle of the night, extreme drowsiness or excessive napping during the day, and repeated disinterest in activities that are normally preferred due to tiredness. Always call or email your doctor's office with any concerns and schedule an appointment if necessary.