As a result of misinformation or a lack of knowledge about healthy infant sleep, many parents and their babies suffer needlessly—and no one gets enough sleep. A baby’s sleepwake cycles are likely to appear unpredictable to new parents. This, coupled with conflicting advice about infant sleep, can lead to parents simply letting the baby sleep “whenever.” In such a situation, the baby often ends up with chronically insufficient sleep, which, if left unchecked, can spiral into persistent night awakenings and bedtime resistance.
A good understanding of the unique nature of infant sleep-wake cycles can help pediatricians prevent such problems by providing parents with more effective advice regarding their baby’s sleep. Here I provide a brief overview of infant sleep, with a special emphasis on the importance of sufficient sleep. I then present specific information you can draw on when advising your patients’ parents about common sleep-related concerns.
WHY SUFFICIENT SLEEP IN INFANCY IS SO IMPORTANT
Sufficient sleep is vital for humans of all ages. Sleep loss in adults has been shown to lead to, among other things, apathy, attention problems, irritability, increased errors, increased illness, increased aggressive behavior, impulse control problems, difficulty with problem solving,1 and even difficulty in making moral decisions.2 Parents of newborns are likely to have experienced several of these sequelae firsthand and are acutely aware of the short-term consequences of inadequate sleep. However, adults are not unique in being adversely affected by a lack of sleep.
Most, if not all, of the above consequences have a parallel in pediatric populations. In children, there are established associations between short (or irregular) sleep and poor school performance, school absences, weight gain and obesity, mood changes, alterations in ability to manage emotions or deal with failure, impulsivity, and attention difficulties.1 Prospective studies show that sleep problems in infancy or early childhood increase the risk of later development of depression and anxiety,3 alcohol(Drug information on alcohol) and substance abuse,4 behavior problems,5 attention disorders,6 sleep disorders,1 and obesity.7
Sleep’s role in the development of infants’ brains. The developing brain may be particularly vulnerable to sleep loss. In altricial species such as humans, in which the young are born with visual and other systems not fully developed, sleep plays a unique and crucial role in learning and development. For example, there is evidence that sleep enhances plasticity in the developing visual cortex.8 Consequently, the young of such species have a far greater sleep need than do the adults. Moreover, the brain of an adult human can make up for lost sleep to a certain extent via known neural mechanisms. However, these neural mechanisms only emerge after the early years of life and are not functional in babies.9 Thus, infants cannot compensate for a loss of the sleep they need for optimal neurodevelopment.
Yet babies are sleeping less than ever. A 2004 National Sleep Foundation Sleep in America poll showed that, on average, infants are sleeping 12.7 hours per 24-hour period. This is substantially less than the 14 to 15 hours per day sleep experts recommend for 3- to 11-month-olds. Epidemiological data show similar trends, with babies and toddlers in particular sleeping less than they did 4 or 5 decades ago.10 In part, this is a consequence of bedtimes being moved later in the evening hours, while morning awakening times have remained largely unchanged.
Thus, it is important that pediatricians empower parents to protect their baby’s sleep time much as they would any health-promoting strategy and to identify and respond to their baby’s signs of sleepiness with opportunities for sleep and rest.