Since the Back to Sleep campaign began in 1994, it has become widely known that babies sleeping on their backs instead of their bellies helps reduce the risk of Sudden Infant Death Syndrome (SIDS). ABC’s of Safe Sleep is an easy way to remember how to help newborns and infants sleep safely.
An example of what a safe sleep environment looks like can be seen here on the National Institute of Health’s website. A good summary however is to also remember the ABC’s of Safe Sleep: Alone, Back, Crib. Let’s break down each of the ABC’s:
Alone
It’s recommended that baby share a room but not a bed with parents for the first year of life.
No toys, pillows, blankets, crib bumpers or other loose items should be in baby’s crib.
Once baby is rolling over or taking off their swaddle blanket, it’s time to remove the swaddle blanket, or exchange it for a sleep suit that will keep baby warm.
Back
Put baby to sleep on their back, also called the supine position, for sleep.
If baby falls asleep in a carseat or stroller, it’s okay to stay there for short stretches. Place the carseat in an area where you can observe, or ideally put baby in the crib.
Crib
The terms “crib” and “bassinet” are regulated terms meaning that in order for a product to use those terms they must meet strict safety standards. Baby should not sleep in products called infant swings, beds, sleepers, napper or couch.
A crib with a flat, firm mattress should be used
Use a properly fitted sheet on the mattress.
And one last tip -as NationwideChildrens.org reminds us the “S” in ABC’S can stand for smoking…newborns “exposed to smoking, either while in the womb or after birth, have a higher risk of SIDS than infants who have not been exposed.”
Getting Baby on a Schedule and Sleeping Through the Night is a step by step plan to allow your baby or twins to sleep through the night. This can be used once your pediatrician agrees it’s appropriate. This is the exact sleep plan our newborn care providers and night nurses (RN/LPN) use to help all the parents who ask, How can I get my baby on a schedule? and How do we start to sleep train?
We understand there are many ways to care for your infant and don’t advocate for any parenting style. But we do want to provide concrete sleep training answers. Our infant sleep plans were written by Registered Nurses and Night Nannies using the guidance of our Medical Advisory Board.
The 4 month well-check at the pediatrician’s office is a great time to discuss your baby’s readiness to sleep through the night, because:
this time is when full-term babies are typically taking 4-6 ounces of milk/formula per feed, so their tummies are getting big enough to allow them to take larger feeds, fewer times through the day (meaning longer stretches of sleep between feeds at night)
Getting Baby on a Schedule and Sleeping Through the Night: 4 Steps
Get pediatrician’s okay that baby is able to sleep 8 or more hours without needing to feed
Give consistent daytime feeding of 4 larger feeding sessions during the day of 6-7 oz per feed, plus a dreamfeed of 2-3 oz = 28oz. This is usually enough to fill baby’s belly to sleep through the night. But again, the decision really depends on your own baby.
Wean overnight feeds while increasing daytime feeds.
implement formal sleep training using the Slingshot Method (below)
Once the pediatrician’s blessing is given that baby is able to sleep long stretches without feeds, you can use this plan.
Consolidating Feeds During the Day to Help Baby Sleep Through the Night
The most crucial first step to getting on schedule and getting babies sleeping restfully through the night is ensuring they’re taking larger, consistent feeds during the day. This means giving 4 consistent feeding sessions (milk every 4 hours) with one last “dreamfeed” around 10:00p.
With 4 feeding sessions of 6-7 ounces plus a final dreamfeed, we’re giving enough calories to get through the night. In other words, if baby is getting 28 ounces in a day up to and including a 10p feed, we can expect this is enough calories to sleep long stretches at night. (Getting baby to actually sleep without waking takes some teaching which we will discuss below). We’re not taking away ounces at night, we are simply “repositioning” them to be taken in during the day. Eating larger meals at predictable times means baby will also anticipate rest at predictable times. This is the natural transition to night and day instead of the 24 hour schedule of eating a bit, sleeping a bit, eating a bit, sleeping a bit.
So how exactly do we consolidate feeds and transition baby to a 4 hour feeding schedule?
Upon waking in the morning, give as much milk as he wants at feeding time.
For the next feed, hold off for as close to the 4 hour mark as possible. THIS WILL BE A GRADUAL PROCESS and may take 1-2 weeks. We of course do not want baby to get to a state of frenzied hunger so it is absolutely okay if you can only hold off feeds for 3 hours and 15 minutes on these first tries. You will not see a perfect 4 hour schedule emerge on the first day. It will take 5-7 days of consistently working toward 4 hour feedings, before you see a 4 hour feeding schedule. You’ll see he’s able to go longer and longer stretches with each feed until after several days, he’ll be doing the larger 6/7 ounce feeds every 4 hours.
While you are transitioning to feed only during the day, baby will still wake up during the night. This is because the full transition time will take several days and we have not yet addressed formal sleep training. During this time you are still doing your normal overnight feeds but gradually giving less and less overnight. Don’t worry though, these ounces are being taken in during the day.
To wean overnight simply give ½ ounce less in his bottle over the course of 2-3 nights. It’s okay to use a pacifier to help baby go to sleep during this time.
Once we know baby does not physically need milk overnight, we can address…
Sleeping Through the Night
One of the key components of a child sleeping through the night is learning to fall asleep for the night at their bedtime of 7:00/8p on their own. Putting baby down awake but drowsy at bedtime means that he already has the tools to put himself back to sleep if he has a middle of the night waking.
A key component to helping baby get ready for bed and in the “drowsy but awake” state is to instill an average of a 30 minute wind-down routine. It doesn’t matter what the wind down is; just that it is the same 2-3 quiet things before bed every night so he can switch gears and can physically and mentally wind down for sleep. Baby cannot fall asleep using anything outside of his control; he must control how *he* gets himself to sleep. In other words, no pacifier, no falling asleep while feeding and no rocking to sleep. These 3 things are controlled by parent and not baby so baby can’t find out how he gets himself to sleep.
When baby wakes for a bottle during the first wake up window, we find the more formal sleep training technique of the Slingshot Method is helpful. Slingshot -where a parent stays in the room while baby learns to go back to sleep- can be the least jarring method of sleep training. You may choose another method though and that’s fine!
How to do the Slingshot Method of Sleep Training
During the first few nights, stay next to the crib and reassure with your voice and touch. You can try patting or singing, but try not to pick baby up when he fusses. You are showing that you are there to comfort and support, but baby is the only person who truly knows how to get to sleep. It is okay to sleep in the room during the first nights.
During the next few nights, sit (sleep) a little further across the room and just soothe with your voice. If he continues to fuss, you can get up and reassure with touch but try to wait a bit longer in between each time. During the next few nights, sit even further away from the crib near the doorway and soothe with your voice. The next few nights you should be in the doorway or even into the hall. The object is to slowly and gradually do this so that it is a gradual change for your baby.
Employ Slingshot for night waking as well. We define a night waking as any wake time between 10p – 5:30a.m Once he is able to fall asleep independently at 7:00, he will also be able to soothe back to sleep during the night wakings. If baby wakes for the day rested and happy at 6:00a, then you know that that is his natural wake up time.
Consistency is Key
The most important thing to remember in helping a baby sleep through the night is consistency. If you are sure, and the pediatrician agrees, that baby is able to sleep through the night without waking to feed, the only way sleep training works is to see it through. For example, if baby cries for 10 minutes and you give a bottle, they learned that crying for 10 minutes = bottle.
Getting Baby on a Schedule and Sleeping Through the Night: Twins and Schedules for Older Babies
Twins sharing the same room should be kept together for sleep training since they will need to learn to sleep through each other’s wake ups.
To help with this transition from dependent to independent sleep, you can make the atmosphere as comfortable as possible by incorporating dark blinds and shades and a small nightlight in the room. Calm activities during the afternoon will also help pave the way for a calm bedtime. Below is a sample schedule for a 4-6 month old, based on an average 7:00 awake-for-the-day time. If baby wakes at 6, simply adjust back 1 hour.
There will be 3 “blocks” of 4 hours. The last block includes only a short nap since it is close to bedtime.
Nap #3 in the late afternoon will disappear in month 7. You will see the nap become shorter and less reliable for about 3-4 weeks until the lap nap eventually drops altogether.
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 will obviously be some adjustment time where the schedule is not perfect. This transition time it will likely last 5-7 days.
Sample Schedule for a 4-6 Month Old
7:00 wake up, change
7:15 or 7:30 5/6 oz. milk
8:30 solids: grain or grain + fruit
9:30 wind down
10:00 nap
– 4 hour cycle repeats upon waking up –
11:30 5/6 oz. milk
12:30 solids: grain or grain + veg (when lunch is introduced)
12:00 – 1:00 activity
1:00 – 1:30 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 5/6 oz. milk
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’re only including it so you can see what it looks like to have a 3 meal per day schedule)
6:15 – 7:00 5/6 oz. milk, bed
Last thing… the Dreamfeed
10pm Dreamfeed as the last feed of the night and baby does not have to be fully awake for this. It is just a small 2-3 ounce feed to “top baby off” for the night. You don’t have to wake baby, simply hold the bottle to their lips and they’ll instinctually take in what is needed. When finished, there’s no need to burp but you may opt to do a quick diaper change at this time.
The above is only a sample schedule. It might not work for you and that’s okay!
Did you read all this and feel like you want someone to help talk it through? You can schedule a sleep consult here!
Vaccine notifications pouring in from our Night Nurses & Nannies, January 2021
As the pandemic emergency is officially over on May 11, 2023, this post is no longer being updated. We are keeping it up as an archived post for those interested in how the company handled COVID19.
COVID19 and Newborn Care Best Practices for our Night Nurses and Postpartum Caregivers working in the family home have been updated as the coronavirus pandemic evolves. Vaccinations are now widely available and covid19 testing easily accessible, so we’re able to service more families while still remaining vigilant with safety. Below is a breakdown of our COVID19 safety and ongoing best practices:
Updated, Nov 20 2021 – Yes, we are all vaccinated including the booster. We understand some folks have big feelings about the vaccine however, as an evidence-based newborn and postpartum care company we’re following the advice of the CDC, The American College of Obstetricians and Gynecologists (ACOG), the Society for Maternal-Fetal Medicine (SMFM) and the AAP.
Updated, Jan 11 2021 – Our Nurses and Newborn Care Providers are now receiving the 2nd round of the Pfizer and Moderna vaccines. We still wear masks because it’s possible for a vaccinated individual to transmit the virus. We also want to protect those in the household too young to receive immunization or those who are immune-compromised.
Update – Dec 1, 2020 We’ve prided ourselves on using the highest vetting and safety practices possible since we began in 2010. As a company dedicated to evidence-based care, we lean on the recommendations of the CDC, the American Academy of Pediatrics (AAP) and other primary sources. Specifically we follow the AAP statement that vaccines are “ethical, necessary and just” to protect vulnerable populations. Too young to receive vaccines themselves, newborns and infants are considered vulnerable.
COVID19 and Newborn Care Best Practices
Coronavirus has caused us to examine and refine our practices even further. Here is an overview of current Let Mommy Sleep practices:
What we always do:
Wash Hands – Caregivers wash hands upon arrival into the family home and continue handwashing and sanitizing through the night and before and after all contact with baby.
Remove Shoes – upon arrival into your home.
Masking – Masks are required unless the family and caregiver mutually agree that they are comfortable without masks.
Vaccinate – We follow evidence-based science. We remain updated on all vaccinations to minimize the risk of illnesses to which newborns are vulnerable. These include influenza, pertussis (MMR), TDaP and COVID.
Continuing Ed – Provide free continuing education to all staff. This ensures we’re following the most recent safety, health and care guidelines.
Err on the side of caution – Staff is kept home at any sign of illness, even if symptoms might be “just allergies.”
What can we do together to minimize exposure?
Please leave sanitizing wipes or other household cleaners out for our team to use periodically through the night. While we can’t always practice social distancing when caring for babies, we can wear masks, handwash and clean, clean, clean!
We can’t wait to see you again and remain thankful and privileged to be in your homes. If you’d like to learn more about us and our practices, please visit this page.
Updated Feb 1, 2022- One of the great joys we have here at Let Mommy Sleep is transitioning first time parents home from the hospital with their newborns. This blog, Your First Night Home with Baby: Newborn Sleep, is the first of our three part series, “Your First Night Home with Baby,” and answers our most commonly asked newborn sleep questions. As humans we’re programmed to be, well, terrified that first night because we’re fiercely protective, so it’s completely normal to feel anxiety. Knowing what’s typical and what’s not can help parents’ confidence so
Newborn Sleep
Getting Ready for Bed
What should my baby wear?
The rule of thumb is that baby should wear what you would be comfortable in, plus 1 layer. For example, a recommended outfit for baby to sleep in would be a onesie, footed pajamas and swaddle blanket.
How about a hat?
As Rachelle Bernard, RN says in Mom.com, remember to keep baby’s hat on if you’re awake and off if you’re asleep. Those little hats can move and become a safety hazard so when don’t have eyes on baby, practice the ABC’s of safe sleep by removing baby’s hat.
How do I swaddle? Swaddling mimics the feel of the womb which is a comfort to baby. That is why the “baby burrito” is universally recommended. Here are two easy swaddling techniques you can do with a simple baby blanket.
But my baby is busting out of the swaddle, what do I do?
For newborns, give baby a snug swaddle. At this age baby’s movements are not always purposeful and the reflexive movements they have can keep them awake. A snug swaddle will help.
Where should my baby sleep?
The American Academy of Pediatrics (AAP) recommends room-sharing but not bed-sharing. This means that your baby is sleeping in the same room as you, but not in the same bed. A flat bassinet next to the bed is an ideal set-up; baby should be alone (no blankets or stuffed animals), on a flat, firm mattress and flat on their back to adhere to safe sleep recommendations.
Your First Night Home: Newborn Sleep – What’s Typical?
How often can I expect my baby to wake up overnight?
Babies don’t develop regular sleep cycles until about 6 months of age. Their stomachs are also tiny which means they need to eat and have diaper changes through the night. All of these things mean that unpredictable and staggered sleep are normal. Waking every 2-3 hours to eat can also be normal, particularly for babies coming home from the NICU where they got used to scheduled feedings but don’t be surprised if your baby’s sleep is all over the place.
***Bonus Question – What are Baby Sleep Guidelines?*** – Check out the American Academy of Pediatrics Childhood Sleep Guidelines below. Notice anything?! That’s right, ages 0-4 months aren’t even included! So, chances are, whatever your baby is doing is normal! Of course check with your pediatrician if you’re unsure, but even the AAP is like Oh you have an infant that sleeps sometimes? And sometimes doesn’t? Yup, sounds right to us! 🙂
We’re just going to start at 4 months because 0-3 months is wild.
All of this said, while it’s expected that the first nights/weeks home with baby will include overnight waking, the awake times are generally short and peaceful. The “sleepy newborn” stage is real as your baby gets used to the world. Being ready with milk or formula when baby wakes will usually keep their time awake shorter, with less crying rom hunger as well.
My baby is super sleepy, should I wake-to-feed?
It makes sense that babies are pretty sleepy after being born- birth was really exciting for them too! Babies of healthy weight don’t usually need to be woken up to feed but it’s a great question to ask your team before leaving the hospital or birthing center. Babies that have jaundice may need to be woken to feed as milk/formula allows bilirubins (the cause of the yellow color) to pass through baby and if that’s a concern, your pediatrician will direct waking baby to feed. Also if babies are underweight when born, or have lost more weight than expected since birth they may need to eat more often.
It’s important to note that both of these instances are not uncommon and often very easily corrected and that early feeding decisions should be made with the child’s primary care physician.
So how do I wake baby to feed?
To wake baby, first loosen swaddle and clothes. If this does not work then undress baby down to a onesie. Changing babies diaper can also help waken them to feed. Turning on the light does not work. In fact, light will encourage newborns to close their eyes!
Anything Else I need to Know About Sleep?
Help! My baby seems to stop breathing for a long time! Is this normal?
A baby’s breathing patterns are not like an adults and they may experience periods of apnea, which means they are temporarily not breathing for several seconds. Check out our previous article, Newborn Breathing Patterns-What’s Normal, to find a good breakdown of normal newborn breathing patterns. However, as always, if you feel something is just not right, please notify your child’s pediatrician.
I know sleep deprivation is normal, but is there any way my partner and I can get more sleep?
Yes! You all can decide on a sleep schedule for yourselves by each taking a block of hours where you are “off.” For example, 2 parent is off from 9pm – 2am and the other is off from 2am – 7am. Better yet, give each other 2 or 3 entire 8 hour nights off. Resist the urge to watch Netflix during your off time, keep sleep as the priority for now.
But I’m breastfeeding and still have to get up, how can *I* get a block of sleep?
In the early weeks before pumped milk is an option, yes, the breastfeeding parent will need to nurse. And even when overnight bottles are available your body will still wake you because your breasts will be full. You can make this as easy as possible by having your partner bring baby to you, do all the diaper changing and soothing back to sleep. Your partner can also be on pump duty if you need to express milk; making sure the pump is within your reach and then bringing milk to the fridge. Ideally you will never have to get out of bed on your nights off. It’s not perfect but you’ll definitely get more sleep.
“Your First Night Home with Baby: Questions About Newborn Sleep” is the first in our three part “Your First Night Home with Baby” series. Here are part 2, “Your First Night Home: FEEDING“. And Part 3, “Your First Night Home: DIAPERING & BATHING.”
Maternal Health Advocacy If We Can Do it You Can Do It!
Updated October 28, 2022: Maternal Health Advocacy: If We Can Do it, You Can Do It! details ways that any of us can stand up for sensible postpartum care. Below is the latest on national legislation, as well as groups you can support if you wish!
What’s Going on with Legislating Paid Leave?
Four weeks of paid family and medical leave is now part of the Build Back Better legislation currently in front of law makers. Maternal health advocacy has been a cause championed by many that is now becoming a reality. In addition to helping postpartum mothers heal and adjust to their new role, paid leave allows all family members to have better mental health, economic outcomes and long term benefits.
Paid leave can also be used for individuals to recover from a serious illness or provide care for another family member. The caregiver’s job will still be there after leave. This is an unfolding situation so we recommend following @paidleaveus on Instagram for the latest.
***
Maternal Health Advocacy in the Postpartum Phase
November 2020 – My team and I visited Capitol Hill to lobby about the importance of postpartum care, specifically in support of H.R. 34 – the 21st Century Cures Act, “Bringing Postpartum Depression Out of the Shadows.” This Resolution is all about the need to continue to recognize postpartum issues. Going hand in hand with this is having qualified professionals helping those struggling in the postpartum phase.
Like everyone who works in mother/baby care, we’ve known for years here at Let Mommy Sleep that early support and intervention just home from baby’s birth are the key to keeping mothers healthy, parents confident and babies safe. The data in support of even one 2 hour postpartum visit also shows cost effective benefits across the board.
These early days home with baby are when everyone is at their most vulnerable. By visiting parents just home from the hospital, Registered Nurses, Lactation Consultants and other trained providers head off issues before they become problems. Troubleshooting breastfeeding challenges before they snowball into an issue that makes a parent quit nursing is one example. Identifying postpartum depression versus baby blues before these emotions spiral into darkness is another. Lastly, we share evidence based safety and newborn care education to build confidence and support for new parents. Postpartum visits help parents see that not only are they “good enough” for their baby…they are amazing!
In a political climate that has become extreme, we remain a nonpartisan company that supports all families trying to do their best just as we did in 2014 with President Obama’s Summit for Working Families, as we will do on the Hill and as our night nurses continue to do in homes every night.
How You, yes YOU! Can Support Postpartum Health
If you would like to support maternal health, learn about active legislation in your state and speak up for families, here are 3 ways to get started:
March for Moms. They work every day educating about maternal death, and how it can be prevented.
Did you know diapers are NOT covered under state or federal child safety-net programs? Donate diapers or funds for diapers via the National Diaper Bank.
