Q & A with Dr. Sofia Axelrod•
You asked—and Dr. Axelrod answered!
We crowd-sourced some top questions from Instagram on baby and toddler sleep. Here are the most frequently asked questions—and Dr. Axelrod's answers.
My newborn is waking every 1.5 to 2 hours to eat, can I stretch that?
Newborns generally eat every 2 hours in the beginning. If baby is full-term and there are no weight gain or health problems, nursing or feeding every 4 hours during the night is acceptable. However, before 3 months of age, you’re often told to feed on demand. But how “on-demand” are we talking?
While I don’t recommend imposing a strict schedule on a newborn, it can be helpful to create a loose schedule around feeding times, so baby comes to learn what to expect, when. What you want to try and avoid is too much cluster-feeding. This is where you’re constantly offering the breast or bottle to the baby, usually to calm them down. They snack a bit, then fall asleep, then wake again half an hour later wanting more, because they only snacked.
Trying to establish longer, more regular feeding times will ensure they get adequate nutrition in larger doses, leaving you and baby more time between feedings to rest or do other activities. Nursing every 2 hours during the day and every 4 hours during the night is what we recommend for the first 3 months of age. (If your baby is premature or has other health problems, talk to your pediatrician first.)
If you’re breastfeeding, try pumping early on so your partner, night nurse, or a helper can take one of those nighttime feedings, leaving you with a longer stretch of uninterrupted sleep. More sleep for parents means a more alert and healthy caregiver for baby.
How do you introduce a sleep routine?
As I said, establishing a loose routine for a baby right away will help them learn what to anticipate, and help entrain their circadian rhythm. In other words, having a routine will help baby start to learn when it’s time to sleep, when it’s time to eat, and when it’s time to be awake.
How do you do this?
As a chronobiologist, I can tell you with absolute certainty that light is a big factor. Keep baby’s sleep environment dark at night—use blackout curtains throughout their entire bedtime, only turning on a red light lamp when you need to for night feedings and diaper changes. Why? Red light is the only light that promotes melatonin, the sleep hormone. All other kinds of light—daylight, lamplight, screens, even candlelight—contain blue light, which suppress melatonin, making your baby (and you) more wide awake during the hours you’re supposed to be sleeping.
Then there’s the routine itself. Try and do the same things at the same times every day—from wakeups to feedings to naps. During the newborn phase this can be challenging, and many parents find their routines don’t fully solidify until closer to 6 or 7 weeks, but having at least a loose routine for the important parts of baby’s day will help immensely in creating a more formal routine later on. Consistency is key!
Should a baby always sleep in their crib?
A hotly contested topic, to be sure.
From a sleep science perspective—as well as a safety perspective—I recommend putting baby in their own safe sleep space from day one. This could be a bassinet, crib, portable crib—anything that is designed for a baby, where baby is sleeping alone (no blankets, stuffed animals, or pillows), and on a firm surface.
Many parents resort to cosleeping because they’re just so tired in those early days. But besides cosleeping being unsafe, as per the AAP, it will likely not help your baby learn to sleep well as time goes on.
Studies have shown parents who cosleep tend to respond to their babies immediately overnight, waking more often to feed and soothe when baby stirs. Whereas when babies are in their own sleep spaces, parents wake less often and take a little longer to soothe and feed them. In one study, this equated to the crib-sleeping babies sleeping 5-hour stretches or longer at a rate of nearly 3 times higher than the cosleeping babies by 3 months of age.
Is swaddling a newborn a must?
It’s definitely not a must—but swaddling is a great way to make a newborn feel safe and secure in their own sleep space. And studies have shown swaddling reduces startles and arousals in newborns by 90 percent in those early months as compared with unswaddled babies.
We recommend using swaddling only at night, to promote better sleep then, so baby doesn’t sleep too much during the day and is then up all night. And remember to stop swaddling as soon as baby shows signs of rolling over, because then it becomes unsafe.
Does milk pumped at night have melatonin/help promote good sleep?
Yes! Melatonin reaches peak concentration in breastmilk at night. Whereas cortisol—the stress hormone that promotes alertness—is typically at its highest in the morning.
Is it normal for an infant to wake at night to eat?
Is it something your baby needs to do, once they’re eleven pounds and have no weight-gain or health problems? No.
Always check with your pediatrician before dropping night feeds, in case they’re still necessary for your baby. But a healthy baby older than 3 months who is gaining weight normally does not typically need to eat at night. They can get all the calories they need during the day. So if you desire, once your baby reaches that milestone, you can work on night weaning.
What is the earliest age to sleep train?
Studies have shown that babies are ready to learn how to sleep through the night when they are at least eleven pounds, and have shown you they can do a 5-hour stretch of sleep at least once. This milestone is met by most full-term healthy babies around 3 months of age.
How do I sleep train?
The Kulala method is a gentle sleep training method, because it allows for frequent check-ins, making it easier on both the parents and the baby. It’s also very effective when done at the right age. Just follow these steps:
- Start a consistent nighttime routine to let baby know it's time for bed. An example: feed 30 mins before bed, then bathe, dress, read a story, cuddle.
- Put baby into their bed and leave the room.
- Set yourself a no-feed period at least one hour less than baby's longest ever sleep stretch.
- If baby cries during the no-feed period, wait 90 seconds before entering their room.
- During that 90 seconds, distract yourself. Say something like "Everything is okay, my baby is fine. I'm waiting 90 seconds before going in."
- If baby stops crying, great! They're learning to self-soothe.
- If not, that's normal! It usually takes a few rounds.
- Enter baby's room after 90 seconds and placate them (shushing and patting them gently). Leave after one or two minutes.
- If baby is still crying, or cries again during the no-feed period, wait another 90 seconds and repeat.
- This may take a few nights. But eventually, your baby will get used to soothing himself back to sleep.
How do I sleep train if my baby is used to cosleeping?
As we said before, we recommend putting baby in their own sleep space from day one. But if you’re already cosleeping, all is not lost.
First, get baby used to sleeping in their own sleep space. This may take some time (and some tears!) but the key is consistency and discipline. If you give in every time your baby calls out, you’ll be starting at square one all over again, making the entire process much more difficult for both you and your baby. Once baby can sleep in their own space, follow the gentle sleep training methods outlined above.
If you hate hearing your child cry—that’s normal! But the good news is that in every scientific study on sleep training, results have shown that sleep training causes absolutely no harm to babies or children in terms of stress levels, or how close they feel to their parents, in the short or long term. In fact, getting a better night’s sleep can improve the temperament and health—of both children and their parents.
How do I know if my baby is ready to drop a nap?
Daytime sleep controls nighttime sleep. What this means is, babies have a total daily sleep need—and it doesn’t matter much to them if they get that sleep during the day or night. But if that does matter to you, ensuring your baby doesn’t sleep too much during the day is vital to ensuring they’re sleeping well overnight.
If you notice your previously good sleeper fighting bedtime, waking at night, or waking too early in the morning, that means it could be time to drop a nap.
How do I know what kind of schedule my baby should be on as they get older?
Refer to our child sleep schedule to know how much day and nighttime sleep your baby needs by age. You can also download the Kulala app to have a personalized sleep schedule made specifically for your child.
Older Baby and Toddler Sleep
What should I do if my child is waking too early?
As with younger babies, it may be your child is ready to shorten or drop a nap. You could also be putting them to bed too early. Refer to the sleep schedule and make sure you’re not trying to make them sleep more than their daily sleep need according to their age.
It could also do with the light in their room. As days lengthen and we get closer to summer, the sun rises earlier. Unless you have blackout curtains in your baby’s room, that sunlight is leaking in, potentially disturbing their early morning sleep. That’s why it’s so important to create the right light environment for baby and child sleep, using blackout curtains and red light only when you want your child to remain asleep.
Why is my toddler skipping naps?
Again, check our sleep schedule to make sure they’re getting an appropriate amount of sleep for their age. You could try pushing bedtime back or pushing waketime earlier, if you wish to keep your toddler’s nap.
They could also be outgrowing it. Most children drop naps between 3 and 4 years of age, though some do so even earlier.
That’s all your questions! If you have more, you can get more info by downloading Dr. Axelrod’s app, following the Kulala Instagram, or joining her Facebook group.