A newborn infant’s sleep pattern is very irregular.  Fortunately, infants will always get enough sleep over a day’s time, regardless of the pattern.  So the goal is to maximize the parents’ sleep.  It is better for children if their parents are well-rested!

During the first couple of weeks, newborns sleep a lot during the day.  Parents might nap when the infant does!  But if the infant sleeps longer during the day than at night, and the infant wants to feed frequently at night, then we say that “the days and nights are mixed up.”  In this case, the best solution is to wake the baby frequently during the day for feeds.  There is no value to “teach” a baby to last longer between feeds; in fact, babies who feed frequently during the day sleep better at night.  I suggest that parents let their newborn sleep only 2 or 2½ hours before waking him for a feeding during the day.  If the infant sleeps longer than 3 hours at a time during the day, he is likely to be up hungry at night.  (But I would not wake a sleeping baby for feeding at night.)

In the first couple of months, I don’t think it matters much where the baby sleeps.  Whether in a crib or bassinet, whether in the nursery or the parents’ bedroom, the decision may be made mostly for the parents’ convenience.  (There is some controversy about the safety of infants co-sleeping in the parents’ bed.  The American Academy of Pediatrics website www.aap.org has details.)

But an infant’s sleep habits begin to be well established by 3 to 4 months of age.  So, by that age, parents will want to establish a sleep routine that they themselves are comfortable with; those routines are harder to change after 6 months.

Many parents feel quite relaxed about their infant’s sleep habits.  Some parents don’t mind being up at night with their baby, and in fact they may value the “quiet time” in the middle of the night.  I encourage such parents to follow sleep routines that they feel comfortable with, remembering that the infant will get enough sleep no matter what.

However, if parents want to make sure that they get a good night’s sleep, there are two routines to establish by age 4 months:

1. Regular sleep habits are easier to establish if the infant falls asleep at night in the crib.  If he falls asleep in the parents’ arms, or on their bed, or during a feeding, then when he wakes up he will scream for that situation to be recreated.  When the baby is put down, awake, in his crib, he may cry for a while the first couple of nights.  But once he learns that he can put himself to sleep, the crying lessens.

2. Healthy infants over 4 months do not need to be fed at night.  By this age, their liver is able to maintain their blood sugar level without food overnight.  But if the infant learns to expect night feedings, he may not eat enough during the day to avoid feeling hungry at night.  I recommend that water may be given, but no calories, after the baby’s bedtime.

Establishing these two routines will have nine out of ten infants sleeping through the night within a week or two.  But if this doesn’t work, I recommend that parents may consult a book by Marc Weissbluth MD, Healthy Sleep Habits, Happy Child.

It should be remembered that establishing healthy sleep routines benefit the parents, so that they can get a restful night’s sleep.  Some parents feel little advantage to enforcing a sleep routine; these families will do well by following their instincts without guilt.  But if getting a night’s sleep is important, these simple habits will usually have your infant sleeping reliably all night.