Sleep in Infants

American Thoracic Society
PATIENT EDUCATION | INFORMATION SERIES
Sleep in Infants
Sleep is important for the body to grow, develop, and
restore itself. This is especially true for newborn babies
and infants in their first year of life when development
is happening very quickly. You may notice that your Supine
baby is sleeping often and has different sleep patterns
compared to older children, teenagers, and adults. Infants
Alone
spend more hours asleep and more time in rapid eye Firm mattress
movement (REM) sleep which is thought to nurture brain Empty Crib
development, knowledge, and behavior. This fact sheet
will talk about sleep in infants 24 months and younger.
What is normal sleep for my baby? Infant Death Syndrome (SIDS). Always place your baby on his
Infant sleep patterns vary with age. Before 6 months of age, it can or her back to sleep. However, once your baby can roll back
be normal for infants to have irregular sleep patterns. Below is a to front and front to back, then he or she can stay in the sleep
general guideline for sleep time, although individual infants may position they choose. Supervised tummy time while awake is
have different sleep needs. recommended to help motor development and decrease the
chance of a flat spot on the head.
Recommended hours of sleep
Age
CLIP AND COPY
per 24 hours ■■ Babies should sleep alone in a crib or bassinette in their

◆◆ 16 to 20 hours parents’ room.
◆◆ Sleep for 1 to 4 hour periods ■■ Babies should sleep on a firm surface. Do not allow babies to
followed by 1 to 2 hours of time sleep on sofas or armchairs.
Newborn – 1 month
awake. ■■ Babies should sleep in an empty crib. Do not put toys,
◆◆ The amount of daytime sleep
blankets, or pillows in the crib. Bumper pads in the crib are not
equals night time sleep.
recommended.
◆◆ 15 to 17 hours
■■ For sleep, dress your baby in infant sleepwear or a wearable
◆◆ Sleep for 3 to 4 hour periods.
1 – 4 months blanket. Avoid loose blankets in the crib.
◆◆ Knowing day versus night starts
■■ Avoid head coverings such as hats to prevent overheating.
between 6 weeks to 3 months
■■ Do not use sitting devices such as car seats or strollers for
routine sleep. If your baby falls asleep in one of these, move
4 – 12 months ◆◆ (including daytime naps: typically
30 minutes to 3 hours) him or her to a firm sleep surface as soon as possible.
■■ Pacifiers may be used at nap time and bedtime.
12 – 24 months ◆◆ (including daytime naps: typically ■■ Avoid secondhand tobacco smoke or nicotine vapor exposure.
30 minutes to 2 hours) Is sleeping with my baby in the same bed okay?
Sleeping with your baby on the same surface is called bed-
When should my baby be sleeping through the night?
sharing. Bed sharing puts your baby at risk for physical injury and
Infants are able to start sleeping through the night by 4 to 6 suffocation. Bed sharing is not recommended for infants, especially
months of age because they are able to sleep for 4-6 hour periods. if your baby is younger than 4 months of age. Bed sharing is
Before 4 months of age, babies feed every 3 to 4 hours and wake especially unsafe if your baby was premature, if the bed surface
up to eat in the middle of the night. Up to 80% of babies will sleep is soft (such as a sofa or armchair), if there are many pillows or
through the night by 9 months of age. blankets in the bed, or if anyone in the bed smokes, drinks alcohol,
How should my baby be sleeping? or takes medications that make it hard to wake up.
■■ Think S.A.F.E! (Supine–Alone–Firm Mattress–Empty Crib) My baby has trouble falling asleep. What can I do to help
■■ It is recommended that all infants younger than 12 months of him or her sleep?
age sleep on their back (supine) to decrease the risk of Sudden ■■ Keep a simple bedtime routine every night. Choose quiet and
Am J Respir Crit Care Med Vol. 198, P15-P16, 2018

ATS Patient Education Series © 2018 American Thoracic Society
www.thoracic.org
American Thoracic Society
PATIENT EDUCATION | INFORMATION SERIES
calm activities to get your baby ready for sleep. Stick to a What are signs that my baby’s sleep is not normal?
consistent bedtime. Signs of abnormal sleep include frequent awakenings,
■■ Put your baby to bed when drowsy but still awake. This will restlessness, mouth breathing, snoring, noisy breathing, long
help teach your baby to learn to fall asleep on their own in their pauses in breathing, and sleeping with the neck extremely
crib. Do not nurse or rock your baby to sleep. extended. These may be signs of sleep apnea. In the first month of
■■ Make daytime playtime. Read and play with your baby during life it can be normal to see short pauses in breathing followed by
the day to increase the amount of time he or she is awake. This rapid breathing during sleep but this should not be seen with color
will make your baby more tired and ready for sleep at night. changes or loud, noisy breathing.
Should I use a white noise machine? Where can I go to learn more about healthy sleep?
Infant sleep machines are being sold to provide ambient noise. For further information on healthy sleep in children, teens, and
However, they are being sold with limited or no instructions on adults read the American Thoracic Society Patient Information
safe use. It can be difficult to control the level of noise and can handouts at www.thoracic.org/patients or visit the American
be harmful to your baby’s ears and lead to hearing loss. If you do Academy of Pediatrics’ website www.healthychildren.org. If you
choose to use an infant sleep machine, place it as far away from or your child continues to have sleep problems such as restless
your baby as possible. Never put it in the crib or on the crib rail. Play sleep or difficulty going to sleep, talk with your healthcare
the noise at a low volume and use only for a short period of time. provider or a sleep specialist.
My baby wakes up all night. What can I do to help him or Authors: Hanna Hong, MD; Melissa A. Maloney, MD; Thomas G.
her sleep through the night? Keens, MD; and Iris A Perez, MD
■■ Nighttime awakenings are a normal part of your baby’s sleep Reviewers: Marinana Sockrider MD, DrPH
cycle, but they become problematic when your baby is unable
■■
to fall back asleep quickly on his or her own.
There are a few different methods to help your baby fall asleep R Action Steps
easily and stay asleep. You can decide what works best for you
and your baby. Discuss your baby’s nighttime awakenings with ✔✔ Infants sleep more than older children, teenagers, or
your healthcare provider to rule out medical causes before adults. The younger the baby, the more he or she will sleep
in the daytime. At around 4 to 6 months of age, infants
trying these methods.
can start sleeping through the night without feeding. It is
Dream Feeding normal for babies to take naps.
❍❍ Thegoal of dream feeding is to reduce nighttime
✔✔ Create a safe sleep environment by always putting your
awakenings by feeding your baby at a single planned time baby “back to sleep” on a firm surface with no blankets,
during the night. This method can be used with babies who pillows, or toys. It is especially important to protect your
are over 2 months of age. It may be useful in infants older infant from secondhand smoke and overheating.
than 6 months of age, when nighttime feedings are more ✔✔ There are different methods of sleep training and simple
likely for comfort than nutrition. bedtime routines. Try what works best for you and your
❍❍ After your baby has been sleeping 2 to 3 hours, gently family. Create good habits early and stick to them.
wake him or her up and offer a feed. After your baby feeds, ✔✔ If there you have any concerns about your baby’s sleep or
place your baby back in the crib. If he or she wakes up again breathing, discuss them with your healthcare provider or
during the night, you may soothe your baby but do not feed sleep specialist.
him or her again.
Healthcare Provider’s Contact Number:
❍❍ When your baby wakes up in the morning, change his or her
clothes and move to another room before feeding.
Graduated extinction method:
❍❍ The goal of graduated extinction is to help your baby learn to fall
Resources
asleep independently by slowing increasing the amount of time
that you let your baby cry until he or she learn to “self-soothe.” American Thoracic Society
www.thoracic.org/patients
❍❍ At the beginning of training, let your baby cry only a few
minutes before soothing him or her. Slowly increase the Healthy Children.org from the American Academy of
amount of time you let your baby to cry before returning to Pediatrics (AAP)
soothe him or her. Over time, your baby will learn to calm www.healthychildren.org
his or herself and fall back to sleep on his or her own. Sleep Education—American Academy of Sleep Medicine
❍❍ When you return to soothe your baby, try not to stay with www.sleepeducation.org
him or her longer than 1-2 minutes. Leave the light off and
keep your voice quiet and calm. Try not to pick up your baby This information is a public service of the American Thoracic Society.
The content is for educational purposes only. It should not be used as a
to comfort him or her. substitute for the medical advice of one’s health care provider.
www.thoracic.org

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American Thoracic Society

PATIENT EDUCATION | INFORMATION SERIES

per 24 hours ■■ Babies should sleep alone in a crib or bassinette in their

Am J Respir Crit Care Med Vol. 198, P15-P16, 2018

PATIENT EDUCATION | INFORMATION SERIES

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