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Go the %$&# to Sleep, Part 1

Nick DeBlasio, MD and Solomon Behar, MD
00:00
18:20

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Sol chats with Nick Deblasio to discuss the do's and don’ts of sleep habits and sleep training for newborns and infants.

Highlights

  • Normal newborns can sleep anywhere from 16-21 hours a day and will often have irregular sleep patterns for the first few weeks. During this time it is good for parents to establish the difference between daytime and nighttime with environmental cues.  

  • There are many methods to sleep train a baby any of which can be effective if implemented with consistency.

 

What is a normal newborn sleeping pattern?

  • Your typical newborn sleeps anywhere from 16 to 21 hours a day.

  • In the first few weeks timing of naps can be random. Typically after 2 to 4 weeks they develop more of a pattern. This is why DeBlasio starts talking about developing good sleep habits in the newborn period

 

What do you recommend for good sleep habits in the newborn period?

  • The guidance is directed at a common concern: “The baby has her days and nights mixed up." During the day the family should keep things bright in the house with lights on, have a reasonable amount of noise, and there should be things going on. At night everything should be soft, quiet and dark. If the family is up with the baby they should not be talking, passing around the baby or otherwise engaging with the baby.

 

What is the longest you can let an infant sleep before you worry about hypoglycemia?

  • Until the baby regains it’s birth weight they should be feeding every three hours around the clock.

  • Once the baby gets back to birth weight (typically around 10-14 days of age) they can stretch things out a bit longer to 5 hours. Most kids will not go longer than this and if they do the family should be checking in. In the younger kids the worry is that the baby is not actually sleeping that long, but that the family is sleeping through the baby waking up and crying.

 

When can you effectively start to sleep train an infant?

  • Many people say 6 months. DeBlasio often recommends starting closer to 4 months of age in a healthy term baby but will push it back later if there are other factors including prematurity, poor weight gain or medical issues

 

How do you recommend that parents implement sleep training?

  • There are many approaches and as long as they are done consistently they all work. The selection of an approach depends on personality of the parents more than efficacy of the method. Methods range in style with the most extreme being the extinction or “cry it out” method. In this method the parents shut the door at a certain time and do not go in to comfort the baby until a pre-determined time in the morning no matter how much the baby cries.

  • Gradual extinction (often also referred to as “graduated extinction”) is the method that DeBlasio recommends. This involves leaving the baby alone for longer and longer stretches. The goal is for the baby to be able to put themselves to sleep with little or no help.  

    • The first night put the baby down after the typical bedtime routine. The baby should be put down drowsy but awake. Once the baby starts to cry do not go back in immediately. Wait 3 minutes before returning to the room. When returning to the room do not pick the baby up just give a gentle pat and reassurance then leave the room again for 5 minutes. Continue this pattern with progressively longer stretches of time between visits (8,10... minutes).

    • Some books say this can take 2 weeks but with consistent application 4-5 days may be all that is needed.

 

How do you address the situation where one parent wants to sleep train and the other is “coming to the rescue” and going back into the room too early?

  • Focus on the long term goals. "I would rather have you be uncomfortable and upset for 5 days as opposed to being miserable for 6 years as you're dealing with these chronic issues."

  • Sometimes it helps to have one parent who cannot handle it simply stay in another part of the house while the other does the training.

 

What can we say about the thought that “crying it out” does long term damage to the baby?

  • There is not evidence either way though anecdotally DeBlasio has not seen a detrimental effect. Evidence for sleep training is contained in an article in the journal Sleep in 2006.

 

* Editors note: The review referenced in this segment reports that the best evidence for efficacy is for the unmodified extinction (“crying it out”) method as well as preventive parental education. There is evidence for many behavioral modalities including the graduated extinction method he describes above. In this review no study reported detrimental effects of the behavior methods. With 3 of the 34 extinction studies following patients beyond one year there may not be evidence of any long term effect.

 

Mindell et al. Behavioral treatment of bedtime problems and night wakings in infants and young children. Sleep. 2006 Oct;29(10):1263-76. (PMID: 17068979)

 

What do you recommend for trained night time criers?

  • Trained night time criers are kids who wake up in the middle of the night and they never are able to put themselves back to sleep because they haven't really had to sooth themselves before. The best way to deal with those kids is graduated extinction. This method will take longer in these older children than it does in the four to six month old group, but will still work.

 

What do you recommend for eliminating nighttime feeding? Should we be cutting down the volume, or slowly diluting the formula?

  • DeBlasio recommends the cold turkey method for eliminating nighttime feeds and to not slowly dilute or otherwise gradually modify the feeds.  

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