Baby Sleep During the Fourth Trimester: The Mysteries of Newborn Sleep

In my family sleep consulting practice, I often get calls from new parents asking about how to help their newborn sleep better. If I had the magical answer to that, I’d be a very rich person indeed! While newborns should dictate their own schedule, there are definitely ways in which you can begin to see your baby’s sleep mature during those early months, and you can start to take steps during that “fourth trimester” that will put your baby on a path to good sleep for the ensuing months.

Here’s a brief overview of what to expect at different stages and how to get your baby primed to sleep well going forward.

Birth to 8 Weeks
My advice here is simple: do whatever works to get the baby to sleep – wear, rock, bounce, walk her. Keep in mind that at this young age they are too biologically immature to have sleep rhythms. As a result, your baby (and you, unfortunately) may experience some day/night confusion. The best cure for that is to get her out in the sunlight! This will help begin to set her natural circadian rhythms. And it will give you a much-needed boost as well.

Points to remember:

• Day and night confusion goes away around 6 weeks.
• Newborns have very short wakeful periods, usually 45—60 minutes, sometimes even shorter. They have disorganized sleep with no patterns, as biological rhythms do not exist. They often sleep 15-18 hours per day, with possible nightly stretches of 2-4 hours in the first month, and 4-6 hours in the second month.
• Do what works to promote sleep in your child. Swaddle, rock, nurse feed etc., and use white noise (a constant, consistent sound).
• Always practice safe sleep habits. Keep bassinet/crib/co-sleeper free of extra blankets, bumpers, toys, etc.

Remember, babies under 4 months of age should not be expected to fall asleep or sleep throughout the night without some parental support.

Weeks 8-16
At this point, your baby will start engaging more with you, making eye contact more, maybe even dropping you a purposeful smile every now and then (hooray for parental gratification!). And, best of all, you might start to see a longer stretch of sleep develop at night, usually 4-6 hours.

At this age, their ever-changing brains are doing their part to get their sleep center set up correctly. And this is when you can start to do your part to keep that sleep center chugging along healthily. As you see that sleep is starting – slowly but surely – to come together at night AND you see that the baby is starting to socialize with you and the world around her more, you can also infer that the baby is ready to follow cues and to make behavioral connections. In short, she is able to begin to understand correlations between things. So let the healthy sleep practice begin!

Here are a few ways to start:

1. Offer a consistent place to sleep. If you haven’t already done so, now is a good time to introduce the crib and/or personal sleeping space and to begin to move away from any dependence on other sleeping spaces, such as swings, car seats, strollers, you, etc. Going down in a consistent, motion-free spot for sleep as much as possible sends a cue to a baby’s brain that sleep is to come.
2. Watch sleepy cues and watch the clock. Make sure her wake time stretches aren’t too long. This means begin watching the baby for sleepy cues or her own personal “tells.” At this age, these sleepy cues typically come within 45 minutes to an hour after being awake. All babies are different in how they show they are tired, but some common signs are spacing out, shaking their heads vigorously, or batting at their faces. Whatever the sign, when you see it, it is a signal to you to begin your soothing routine (see #4) and get the baby down to sleep.
3. Shift schedule earlier. Back that bedtime up! This is what their bodies are looking for.
4. Introduce a soothing routine. This can include some rocking or swaying, a song or two, having a bottle or nursing, and possibly being wrapped in a swaddle blanket. The overall goal of this routine is to relax the baby to a point where she is ready to accept sleep. There are no hard and fast rules here. You know your baby best and will learn the best way to satisfy her needs.
5. Experiment with self-soothing. Use pick up/put down at nap times and bedtimes to soothe a fussy baby and try to put baby down sleepy-but-awake. At around 12 weeks a nap time pattern often develops. But remember, nighttime sleep evolves before day sleep does. Be patient.

Weeks 16 and beyond
I work with families beginning at 18.5 weeks (adjusted age), helping them get their little ones on a good age-appropriate schedule. What’s wonderful about setting up good habits early is that for many parents who do, they often get over that four-month sleep hump very well. They work with their child’s biological sleep needs AND his or her innate capabilities to fall asleep independently early on so that as they get older there is less work to do.

Through all of this, don’t forget to trust yourself! Trust your instincts. Be confident in your choices. Babies are incredibly perceptive and they easily pick up on our moods and changes in behavior. If you show your baby that you are confident in your care of her, she will feel calm and comforted. And delicious sleep will follow.

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Kristina Amerikaner is the (mostly) rested mom of two and a certified pediatric sleep consultant with Good Night Sleep Site New Jersey. You can also connect with her on Facebook or over on that newfangled contraption known as Twitter. When not thinking about sleep (yours and hers), she loves reading, baking, and tackling The New York Times crossword puzzle. She lives with her family in Northern New Jersey, her native state.

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