Infant Sleep

Introduction

Sleep is an essential requirement for human beings. When we don't sleep, our ability to concentrate declines, we experience mood swings, and we may view things more negatively.

Sleep benefits children, as the reducing level of cortisol and the stimulated production of growth hormones enables the child to grow while they are asleep.¹

In some cases, sleep deprivation in children leads to irritability, crying and stress.

It also gives rise to one of the greatest challenges facing new mothers, namely acclimatising to the rhythm of their new-born. Adapting to the rhythm of their child means becoming mutually acquainted, understanding each other and redefining one’s own habits.

In the early days, when the new-born’s sleep-wake cycle has yet to be established, this lack of rhythm is a significant risk factor for the development of postpartum depression, as it entails a great deal of stress for the new mother.

There is a strong correlation between postpartum depression and the irregular sleep cycle of the new-born, as the stress caused by this results in hormonal imbalances and changes in hypothalamus pituitary adrenal (HPA) axis activity.²

Infant sleep: Reasons for waking up

Parents often ask themselves why their child does not sleep through the night.

Up to the age of 3 - and for many children up to 5 years of age - sleep is very fragmented and differs from the sleep of an adult.

The waking phases that occur every 30 or 60 minutes are known as control waking. They are physiologically and naturally intended, so that the parents know that the child is alright.

It is therefore important to learn about sleep physiology in babies to avoid having any unrealistic expectations.

In view of this, there can be many reasons for sleep disturbance, it may be physiological, organic, emotional, behaviour-related, or due to environmental factors.³

A paediatrician can rule out physiological disturbances. These can include heartburn or urinary tract diseases, for example, that may cause pain and discomfort when the child urinates in the night. Nappy rash and atopic dermatitis can cause a child to wake up if they are itching badly.

Paediatric osteopaths also have an important role when it comes to the well-being of a new-born: They can exclude organic causes, such as neck tension caused as a result of birth or the baby’s position in the womb (when the baby adopts the “half-moon” position in the crib, i.e., with their neck drawn up). These experts can also help with colic, vomiting, plagiocephaly and sleep disturbances in general.

Other reasons may be emotional in nature. Perhaps the mother is suffering from postpartum depression or she is pregnant again with another child. Or perhaps it is a question of getting used to nursery or weaning. The mother’s return to work, a family bereavement and many other circumstances can also play a part.

Mechanisms and methods for normalising sleep in childhood

There are various mechanisms for promoting the normalisation of sleep in childhood. Some are biological and depend on the nightly production of melatonin and brain development, others depend on the influence of the external environment and upbringing.

Sleep can be learned from parents. They can support their children in this learning process to gradually achieve a balance.

Having excluded all the above-mentioned causes of sleep disturbance, the child’s behaviour can be analysed: very often, the cause of sleep disturbance lies in the difficulty of being able to go back to sleep and return to the phase of deep sleep.

Children seek the conditions that helped them to get to sleep to begin with, and if these conditions are not present, they may not be able to fall asleep again by themselves.

What does it mean for a child to sleep through the night? It does not mean that the child does not wake up until the next morning. Waking up is physiological, but the child becomes increasingly capable of falling back to sleep by themselves and thus quickly falling into the deep sleep phase.

How can a child be trained to fall asleep and when can training start? Over the years, a number of methods have been tried, some of which have since become outdated or old-fashioned, such as the famous “crying method”⁴, the “controlled crying,” method⁵ or the “organised routines” method.⁶ In reality, there is no one method that suits all. It is more a case of considering all the aforementioned variables and working with the parents to develop a strategy that suits their parenting style and respects the child’s nature. Even if there is a sound empirical reason that verifies that various methods can contribute to improving a child's sleep, they remain a point of discussion, in spite of studies on their effectiveness and reliability.⁷

Advice to parents in the early months:

1. In the first few months following the birth, physical contact⁸ is important, so that the baby feels calm and protected: cradle the baby in your arms or in a baby sling. Lay the baby in a crib next to the parents’ bed or in an alongside crib that can be secured directly to your bed. This means your child is always in contact with you and sleeps more soundly.⁹
2. Transmit calmness to your baby: if you are anxious or stressed and put your baby to bed while you are in that state, this negative energy often results in your baby crying and taking some time to go to sleep.
3. Feeding in the night is necessary in the first few months of life, as the infant’s stomach is still very small, so the baby needs to feed frequently. Regardless of how you feed your baby, it is therefore important to satisfy your baby’s needs after feeding them, so that they can sleep for longer and more peacefully. Switch off or dim the lights. Speak quietly and only if it is necessary. Ensure your movements are slow and calm, so that your baby does not fully wake up. Sucking relaxes the baby and milk satisfies them, enabling them to sleep for a few more hours.
4. After the fourth month, you can introduce daytime and night-time bedtime routines. Routines are important for your child; they learn from you exactly what happens at night-time. This makes them feel calm, enabling them to sleep more peacefully and for longer periods.