by Dr Louise Santhanam, General Practitioner
Normal Infant Sleep
An understanding of normal infant sleep patterns may help parents to cope in the early months, and parents may need to be encouraged to seek support to enable rest when possible1.
Infant Sleep Information Service (ISISOnline) Site with evidence-based information for parents and healthcare professionals. Developed by Professor Helen Ball and the Durham University Parent-Infant Sleep Lab with senior representatives from La Leche League, NCT, The Breastfeeding Network and the Unicef UK Baby Friendly Initiative.
ISISOnline: Normal Infant Sleep Factsheet summarising research on normal infant sleep.
This animation from Professor Amy Brown of Swansea University summarises normal infant sleep and night waking.
Despite the common perception that supplementing an infant’s diet with formula milk or solid food will promote sleep, a recent study1 found that there was no difference in the frequency of night waking between breastfeeding and formula feeding infants aged 6-12 months old. Infants who received more milk or solid feeds during the day were less likely to feed at night but not less likely to wake.
In another study breastfeeding mothers reported significantly more hours of sleep, better physical health, more energy and lower rates of depression than mixed or formula feeding mothers2. Healthcare professionals should therefore be cautious of recommending that supplementation with formula or increasing solids will lead to improvements in maternal wellbeing by reducing infant night waking or improving maternal sleep quality.
Infant night waking is common, and research has found that parent bed-sharing with infants is common, particularly among breastfeeding mothers. In one English study on any given night over one fifth of parents bed-shared with their infant3. Bed-Sharing increases the risk of SIDS, particularly when either parent is a smoker (even if not smoking in the bedroom), or where the parent bed-shares after having consumed alcohol or drugs, or is overtired. However, sleeping in the same bedroom as the parents/carers reduces the risk of SIDS, and breastfeeding has been shown to reduce the risk of SIDS by approximately 50% throughout infancy4. The message regarding co-sleeping and SIDS is therefore a complex one which health care professionals and parents may find confusing.
The following resources highlight modifiable risk factors and how to discuss with parents the safest way to co-sleep if there is a risk that they may otherwise fall asleep in an unsafe position with their infant.
Co-Sleeping and SIDS: A Guide for Health Professionals Infographic and guidance for health professionals on co-sleeping developed in collaboration by the Unicef UK Baby Friendly Initiative, the Lullaby Trust and the Infant Sleep Information Source.
Infant Sleep Information Source (ISISOnline): Where Babies Sleep- Health Professional Section Details the evidence on issues relating to the location of babies’ sleep. The site also contains a number of images of safer co-sleeping positions.
The Lullaby Trust: Safer Sleep Charity which supports families bereaved by SIDS and provides information on safe infant sleep and reduction of SIDS risk. This link includes ‘Quick Tips for Safer Sleep’ listed below:
Associated with a Decreased Risk of SIDS
- Placing the infant on its back to sleep
- Avoiding smoking in pregnancy and smoke exposure to the infant after birth
- Placing the infant to sleep in a separate cot or Moses basket in the same room as the caregiver for the first 6 months
- Breastfeeding the infant
- Use of a firm, flat, waterproof mattress in good condition
Associated with an Increased Risk of SIDS
- Sleeping on a sofa or in an armchair with the infant
- Sleeping in the same bed with the infant if smoking, drinking alcohol or taking drugs, if extremely tired, or if the infant was born preterm or low birth-weight
- Allowing the infant to become overheated
- Covering the infant’s face or head while sleeping or the use of loose bedding
Unicef Baby Friendly Initiative: Caring for your Baby at Night Information booklet for parents on safe infant sleep, coping with waking in the night and night feeding.
Unicef Baby Friendly Initiative: The Health Professional’s Guide to Caring for Your Baby At Night Provides Healthcare Professionals with information on the booklet to support parents to cope at night and to facilitate parents to make informed decisions.
- Brown A, Harries V. Infant Sleep and Night Feeding Patterns During Later Infancy: Association with Breastfeeding Frequency, Daytime Complementary Food Intake, and Infant Weight. Breastfeeding Medicine. 2015;10(5):246-252.
- Kendall-Tackett K, Cong Z, Hale T. The Effect of Feeding Method on Sleep Duration, Maternal Well-being, and Postpartum Depression. Clinical Lactation. 2011;2(2):22-26.
- Blair P. The prevalence and characteristics associated with parent-infant bed-sharing in England. Archives of Disease in Childhood. 2004;89(12):1106-1110.
- Vennemann M, Bajanowski T, Brinkmann B, Jorch G, Yucesan K, Sauerland C et al. Does Breastfeeding Reduce the Risk of Sudden Infant Death Syndrome?. Pediatrics. 2009;123(3):e406-e410.