Last week, the CDC and the American Academy of Pediatrics, (AAP) revised developmental milestones for children age 2 months to 5 years. The purpose of the updates is to help parents identify autism and developmental delays in their children, so that helpful interventions may occur earlier. Early intervention is a key factor in allowing children to reach their full potential. Baby Milestones: Updated details how milestone evaluation has changed since 2004.
Parents can use the milestone checklists to keep track of their infant, toddler and child’s development.
Baby Milestones: Updated – What’s Different?
Clearer Language and Narrower Age Ranges
According to the AAP, the revised developmental milestones “identify the behaviors that 75% or more of children can be expected to exhibit at a certain age…”. In the past, milestones contained vague language such as, “At this age baby may…” or “this behavior begins between 12 -17 months…” The updated guidance now includes specific checklists for ages 15 and 30 months to bridge any gaps between the previously longer ranges.
Development as a Continuing Discussion Between Families and Primary Care Providers
The new guidance is clear to say that parents know their children best and should not wait to contact a doctor with concerns. Further, that early childhood development should be an ongoing conversation between parents and doctors. To facilitate this conversation, the new guidelines contain a specific checklist for each well-child visit ( 2 months, 4 months, 6 months etc.) rather than checklists by age range.
Doctors and clinicians will also ask open-ended questions such as Is there anything your child does that concerns you? This will also encourage child development as a discussion.
Baby Milestones: Updated – Ongoing Resources and Tips for Parents to Use at Each Age
Expanded, appropriate tips parents can incorporate into developmental learning are now available. For example: Use “back and forth” play with your baby. When your baby smiles, you smile; when he makes sounds, you copy them. This helps them learn to be social.
The Milestone Moments checklist (below) details developmental milestones from ages 2 months to 5 years. The CDC’s free App, Milestone Tracker is also available. This may be especially helpful to parents of twins or children of different ages.
Baby Milestones: Updated, ages 2 months to 5 years
Many parents are looking for a routine to help their baby have a consistent daytime routine and eventually sleep through the night. Baby Sleep Schedule for a 10-11 Month Old provides a sample to get started.
Baby Sleep Schedule for a 10-11 Month Old
This is the latest in our social sleep consult series and is taken directly from one of our sleep consultations. If we can ever help with your baby’s sleep just give us a call or use #AskLMS on social media and we’ll help as best we can. Before we begin, make sure Pediatrician:
Rules out any physical or medical conditions that are affecting sleep habits.
Gives the okay to begin sleep training, meaning about 8-10 hours of uninterrupted sleep.
10 Month Old
Once you get the pediatrician’s approval and you are sure baby is not waking overnight due to hunger because s/he’s taking in all of his calories between 6:30am and 10pm, you can begin sleep training using whatever sleep training method makes you most comfortable. The method we defer to is called Slingshot which is basically staying close to baby but not intervening as they find their way to “get” to sleep. You can find step-by-step instructions on how to do Slingshot and get baby to sleep through the night here.
Things to remember:
THIS IS JUST AN EXAMPLE. It is FINE if your schedule differs, but the goal is to have defined eating times to set the stage for long sleep overnight.
We are just using 6:30am as a starting point. If baby wakes earlier or later, simply adjust the schedule accordingly. For example, if he wakes at 7:00a, adjust this schedule forward 1/2 hour.
You are aiming for about 28 oz of milk per day as well as 3 meals of solids (which you already do).
We are teaching baby to have a start and an end to the day rather than have a 24 hour schedule.
If you have a question on helping your twins or single baby sleep through the night, contact us on Facebook or Twitter using #AskLMS.
Updates, Aug 1, 2023 – Few infant sleep issues are as frustrating as naps. We break down baby’s awake and sleep cycles week by week here in Baby Sleep: Naps Decoded to help you understand when baby is ready for a rest. This allows for more sleep and fewer meltdowns.
Newborns and infants sleep differently than adults. There are several reasons for this and once we understand them we can work with their natural rhythms to help them sleep longer and without fuss.
They’re tiny! – Newborns have small stomachs so they need to eat frequently. Their tummies can only hold small amounts of breast milk or formula and this nutrition gets digested quickly. As a result, they wake up frequently to feed, typically every 2 to 3 hours.
Hunger, need for comfort or growth spurts – Babies usually wake up if they’re hungry, have a wet or dirty diaper, or are experiencing discomfort due to issues like teething or gas. Additionally periods of growth mean their bodies and brains are developing rapidly, leading to more frequent waking during the night.
Immature sleep patterns: Newborns have an immature sleep-wake cycle, and it takes time for their circadian and ultradian rhythms to develop. This means that their sleep is not yet regulated by day and night patterns, and they have shorter sleep cycles compared to adults.
Melatonin isn’t Present Yet!: Just like #3 above, your newborn is still developing. Newborns receive melatonin, widely known as the sleep hormone from the placenta but don’t start developing their own until they’re about 8-9 weeks old.
Is my infant sleeping enough
Baby Sleep: Naps Decoded – Circadian Rhythm
Circadian rhythm is nature’s mechanism to regulate our awake and sleep times over the course of 24 hours. Within this daily cycle are ultradian rhythms, which are 30- 90 minute wakeful/sleepy patterns. This 30-90 minute pattern repeats over the course of 24 hours. There are a lot books written about baby sleep and getting baby on a schedule and they’re all based on this cycle. This can be confusing , so let’s break down how this pattern works:
Ultradian Rhythm
Circadian rhythm and sleep cycles are controlled by serotonin and melatonin.
Serotonin produces alertness during the day and is triggered by daylight.
Melatonin produces sleepiness during the night and is triggered by darkness.
If we visualize the cycle using a 6 month old for example, baby is wakeful at the top of the curve (45 minutes after waking up) and then sleepy at the bottom of the cycle (90 minutes after waking). So, about 5-10 minutes before the 90 minute mark is when they should be in their crib, prepared to sleep.
Like this:
Infant Sleep Cycles visual
Here’s the tricky part though! In full-term newborns, melatonin isn’t fully produced until weeks 9-12 so they don’t start out on a 90 minute cycle, they build up to it. Getting baby down to rest before their internal “clock dings” at the end of their time awake. This is key to ensuring baby doesn’t enter into another wakeful period. This is one thing that makes them fussy and can lead to being overtired.
Remember: Baby doesn’t start to go down for a nap at the end of their 30, 45, 60 or 90 minutes awake. They should already be in their crib at the 30, 45, 60 or 90 minute mark.
Here’s a breakdown of newborns’ basic awake and sleep times:
Newborn Sleep Expectations
Baby Sleep: Naps Decoded
Weeks 0-2: Baby is awake for a maximum of 30 minutes. Most of this time is spent feeding and baby will appear sleepy even during wakeful periods, often falling back asleep with no help at all.
Weeks 3-8: Baby is awake for a maximum of 45 minutes. You’ll notice baby is more wakeful around week 8; s/he won’t just go right back to sleep like s/he used to and may need your help to stay asleep. Baby wearing, white noise, giving a pacifier to help sleep are all fine to do because at this age baby needs your help to get and stay sleep.
Weeks 8-12: Baby is working on and eventually awake for 60 minutes. Napping will become longer during these weeks as well but it’s perfectly fine and even recommended to help baby with napping when s/he pops up after 10-15 minutes or so by giving a pacifier, using white noise etc. You’re not creating bad habits, baby simply needs a little help to not fully awaken because the systems that make seratonin and melatonin are not quite mature yet.
Weeks 12 – 18: Baby is working on and eventually is awake for 90 minutes. Baby is even more alert and still may need help getting and staying asleep. If your goal is to have baby eventually sleep through the night independently, try not to pick baby up if she wakes before a 90 minute nap is done. Instead, stay near to comfort with patting on the back or giving pacifier while baby is still asleep, but exhibiting signs of waking up like twitching or moving her head back and forth.
Weeks 18 -24:Baby is awake for 90+ minutes and consolidates naps now. There may be fewer naps that vary in length but a nap of at least 90 minutes will provide adequate rest. S/he will usually be awake for some increment of 90 minutes (11⁄2 hours, 3 hours, 4 1⁄2 hours).
Baby Sleep: Are They Sleeping Enough
What’s Next?
If your goal is to have baby sleep long stretches overnight without feeding, the 4 month well check is a great time to start talking with your pediatrician. These longer stretches of sleep are really just one big nap consolidation! They can help you to know whether baby is developmentally ready to sleep for at least 6 hours uninterrupted.
If you’re ready for your baby to sleep through the night, start with an appropriate routine. While the cry-it-out method gets a lot of press, sleeping through the night can be a gradual process where baby’s body adjusts to less milk overnight, making sleep a natural next step to waking from hunger. This is detailed here.
Baby Sleep: Naps Decoded – Important Notes
Sometimes even though we’re doing everything right, babies cry. A LOT.
They might cry because of colic, could be overstimulation, reflux or any other reason only known to your baby. Even if you follow this blog or any sleep advice exactly as it’s written, babies are not robots. You’re doing a great job, but if you’re concerned about baby’s crying or health, please contact your pediatrician.
These guidelines are for full-term babies without any health issues. Preemies and twins are often born early and therefore smaller than full-term newborns. Many singletons also arrive sooner than expected or bring health issues so these guidelines might need to be modified. Some babies need to be woken up to feed to gain weight for example. You can never go wrong with patience, following doctors’ orders and responding to your baby’s needs.
“What should my baby’s schedule look like?” is one of those questions for which there are a lot of right answers. Being “on a schedule” is usually just a matter of following baby’s natural cycle; it shouldn’t feel forced or like a stand-off between parent and baby, and there are as many versions of a good schedule as there are families and caregivers. And for some parents the schedule is their first step to helping baby sleep through the night. Below is one example of a 4-6 month’s old schedule which can be used as a Sample Schedule for a 5-6 Month Old Baby.
5-6 Month Old Baby
Sample Schedule for a 5-6 Month Old Baby
7:00am wake up, change
7:15 or 7:30 milk/formula given when baby is showing signs of hunger
8:30 solids: grain, or grain + fruit when solids are introduced as directed by your pediatrician. Milk/formula can also be given here.
9:30 wind down to get ready for nap
10:00 down for a nap
– 4 hour cycle repeats upon waking up –
11:30 milk/formula
12:30 solids: grain or grain + veg (when lunch is introduced as directed by pediatrician) Milk/formula can also be given here.
12:00 – 1:00 activity
1:00 – 1:30pm wind down for nap
1:30 – 3:30 nap
– 4 hour cycle repeats again upon waking from nap, but with a third short nap-
3:30 milk/formula
3:30 – 4:30 quiet play, try to stay around home and stick to calm activities
4:30 – 5ish nap
5:30 dinner of solids (this is appropriate whenever you want to begin the addition of an evening meal—we are only including it to show what it looks like to have a 3 meal per day schedule)
6:15 – 7:00 milk/formula, getting into PJ’s, books and quite time and then into bed
10pm Dreamfeed if you wish. Baby does not have to be fully awake for this. It is just a small 2-3 ounce feed to be sure baby has gotten all of the ounces in for the night. You do not have to wake baby, simply hold the bottle or breast to baby’s lips and baby will instinctually take in what is needed. When you’re done there’s no need to burp since baby ois so relaxed but a quick diaper change should be done.
Conclusion and Sleeping through the Night
There will be 3 “blocks” of 4 hours. The last block will only include a short nap since it is close to bedtime.
Each block begins with milk and the last block ends with milk, so feeding times are at: 7am, 11:00am, 3pm and 6:30pm. There may be milk “snacks” in between and at mealtimes, especially for our breastfed babies who do not take in 6 ounces per feed but the 4 main feeding times are the anchor to this schedule.
Once again, the schedule above is just an example. Please share what works for you on Facebook!
We hear them at playgroups and baby showers, see them on message boards and read them on medicine bottles. Parental Urban Legends add more confusion to new parents’ already overloaded brains and with no basis in fact, they persist like Mikey and Pop Rocks. Here are our Top 3 Infant Sleep Myths and solutions that work better:
Parental Urban Legends
Myth #1. Putting rice cereal in baby’s bottle will help baby sleep longer
There is absolutely no evidence that shows that thickening milk or formula with cereal will make baby sleep longer at night. In fact, the most cited study on this topic, heartily disproves this parental urban legend.
In our desperation to “tank baby up” and buy an extra hour of rest, it’s often thought that a fuller stomach = more sleep. This is true when we give baby milk before bed to ensure that s/he doesn’t wake unnecessarily from hunger, but the addition of rice cereal to thicken a feed does not help baby sleep longer.
There is also a very real, evidence based movement to completely remove rice cereal from babies’ diet but that is for another post.
Why it’s become a parental urban legend: When parents introduce rice cereal in baby’s bottle, it is typically at the 8-12 week mark, when parents are at their wits end with getting up 3-4 times overnight. The fact is, baby is naturally sleeping longer stretches at this time anyway. Thickening formula receives the credit for what baby is doing naturally.
What to Do to Help Baby Sleep Longer: Time is the real answer to allowing babies to sleep longer stretches at night as the more baby grows, the more food their tummies can hold, keeping hunger from naturally waking them. But there are a few things that actually help newborns and infants sleep more soundly:
White Noise – drown out the noises that can wake baby up and simulate the womb
Slow feeding with lots of opportunities to burp – hold baby upright for at least 20 minutes (longer if your baby experiences reflux) after feeding to be sure no gas is trapped and there’s plenty of time to digest.
Myth #2. Mylicon will Eliminate Gas and Soothe your Baby
This myth is near and dear to my heart because like so many, I desperately believed it myself with my own 3 kids. Study after study definitively demonstrate that Simethicone (the generic name for gas drops) is no more or less effective than a placebo. What does this mean? Gas drops don’t work. Period.
Why it’s become a parental urban legend: EVERYONE recommends Simethicone drops. Everyone! They even have their own little section in the pharmacy department. Once again well-meaning parents just want to help baby find some relief. Please try to contain your shock when I tell you this, but marketing companies love to capitalize on “soothing baby” so they sell, sell, sell a harmless but useless product.
And once again it’s you and your baby who should receive the credit for getting that uncomfortable gas out of baby’s tummy. Slow patient feeds, lots of burping and gently switching position or massaging baby to get gas out after feeding are tried and true ways to reduce gas.
What to Do to Help Eliminate Gas – While drops certainly can’t hurt there are several other options to help baby work out the gas that’s causing troubling:
Once again, slow feeds with lots of opportunity to burp during feeding. If bottle feeding, use the slowest nipple flow.
Probiotics – Probiotics to promote good gut health in baby may be recommended by your pediatrician.
When starting solids, give new foods for breakfast, this way baby’s system has all day to work out any issues that the new food might be causing…and by issues we mean gas! 🙂
Myth #3. Putting babies to sleep later at night means they’ll sleep later in the morning
We’ve all done this one. According to pediatric sleep specialist, Dr. Lisa Meltzer, “the internal clock is a powerful force that typically wakes young children up around the same time every morning, no matter what time they go to sleep at night.” This means that putting baby to sleep later robs them of sleep they should be getting. Even worse, poor night sleep adds to the overtired cycle the next day, making it more difficult for baby to settle and rest again.
Why it’s become a parental urban legend: Because staying up late and then sleeping late seems so logical! And we are desperate for sleep AND logic at this point! Sure there are times babies have a big day and sleep for long stretches out of sheer exhaustion, but this gives us a false positive. Keeping baby awake longer than their bodies need may work for one night or one nap, but fighting against baby’s natural rhythms leads to true exhaustion and meltdown.
What You Can Do Instead– Unfortunately, we can’t fight a baby human’s natural body clock; this one goes in the “this too shall pass” category. Taking turns with your partner or a loving caregiver to handle early wake ups won’t cause baby to sleep later but it will help YOU to sleep later!
What Parental Urban legends can you add? Let us know on Insta!
