Healthy Sleep Habits in Children

What is normal sleep?

The total amount of sleep your child needs varies depending on their age.

Helpful tips for healthy sleep habits

Here are some helpful tips for creating good sleep habits for your child:

• Newborns don't have a set night or day schedule for the first few weeks of life. It's best for a newborn not to sleep longer than 3 to 4 hours at a time, as their small bodies need frequent feedings. Follow the instructions from your baby's doctor for sleeping and feeding schedules.

• Older babies and children should have a consistent nap time and bedtime schedule.

• Start a quiet time, such as listening to soft music or reading a book, 20 to 30 minutes before bedtime. Put away any screens during quiet time. This means no TV, smartphones, tablets, or computers.

• After quiet time, follow a bedtime routine, such as a diaper change, going to the bathroom, and brushing teeth.

• Set a time limit for quiet time and the routine so it doesn't drag on and your child knows what to expect before bedtime.

• Say goodnight, turn off the light, and leave the room.

• It's important for children to be put to bed awake so they learn to fall asleep themselves.

• Don't put your child to bed with a bottle. It causes problems with tooth decay and ear infections.

Helpful tips for children with poor sleep habits

Children can easily fall into bedtime habits that are not always healthy habits. The following suggestions can help when a child doesn't want to go to bed or is having trouble staying in bed:

• If your child cries, speak calmly and reassure them. You can say something like, "You are okay. It's time to go to sleep." Then leave the room.

• Don't give your child a bottle or pick up your child.

• Stretch out the time between trips to the room if your child continues to cry. Don't do anything but talk calmly and leave.

• Your child will calm down and go to sleep if you stick to this routine. It may take several nights for your child to get used to the new plan.

• If your child is used to getting a large amount of milk right at bedtime, start to cut down the amount of milk in the bottle by 1/2 to 1 ounce each night until the bottle is empty. Then take it away completely.

• Sometimes children get out of their routine of night sleeping because of an illness or travel. Quickly return to good sleep habits when things are back to normal.

Sometimes older children go through a stage when they revert back to bad sleep habits or develop new problems in going to sleep. Here are some tips to help parents with older children who have problems going to bed:

• If your child gets out of bed, take them back to bed with a warning that the door will be shut (not locked) for 1 or 2 minutes if they get out of bed.

• If your child stays in bed, the door stays open. If your child gets out of bed, the door is closed for 2 minutes. Your child can understand that they have control of keeping the door open by staying in bed.

• If your child gets out again, shut the door for 3 to 5 minutes (no more than 5 minutes).

• Be consistent. Put your child back in bed each time they get out of bed.

• When your child stays in bed, open the door and give them praise (for example, "You are doing a great job of staying in bed. Goodnight."

• Your child can be rewarded by earning a star on a calendar for staying in bed all night. You can give a special prize for a certain number of stars earned.

Reducing the risk for SIDS and other sleep-related deaths

Here are recommendations from the American Academy of Pediatrics (AAP) on how to reduce the risk for SIDS (sudden infant death syndrome) and other sleep-related deaths from birth to age 1:

• Know the ABCs of safe baby sleep:

  • A is for alone. Put your baby to sleep alone in their crib. Keep soft items like toys, crib bumpers, and blankets out of the crib.

  • B is for back. Place your baby on their back to sleep. Do this both during naps and at night. Studies show this is the best way to reduce the risk for SIDS and other sleep-related causes of infant death. Don't put a baby on their side or stomach to sleep.

  • C is for crib. Use a safe sleep surface. Babies should sleep on a firm, flat surface. Don't use one that is at an angle or inclined. Safe examples are a crib, bassinet, portable crib, or play yard that follows the safety standards of the CPSC. Check the CPSC website at www.cpsc.gov to make sure the product is not recalled. This is especially important for used cribs. Don't use broken cribs or cribs with missing instructions or missing parts. Many babies have died in cribs that were broken or had missing parts. The space between crib bars must be no more than 2-3/8 inches apart. This way, the baby can’t get their head stuck between the bars.

• Don't smoke or use nicotine around your baby. Keep smoke of any kind away from your baby. Do not allow cigarettes, marijuana, or vaping in your home. Babies exposed to smoke have more colds and other diseases. Smoke raises a baby’s risk of dying while sleeping, especially babies who are sick.

• Don't share a bed with your baby. This is extra important if your baby is very young or small or was born prematurely. This is also extra important if you have been drinking alcohol, used marijuana, or taken any medicines or illegal drugs. Don't put your baby to sleep in a bed with other children or adults. You can bring your baby to your bed for feedings and comforting. But return your baby to the crib or bassinet for sleep. Don't fall asleep with your baby. Bed sharing is also not advised for twins or other multiples.

• Share your room instead of your bed with your baby. The AAP recommends that infants sleep in the same room as their parents, close to their parents' bed. But babies should be in a separate bed or crib appropriate for babies. This sleeping arrangement is recommended for at least the first 6 months.

• Use correct bedding. Your baby should sleep on a firm, flat mattress or firm surface with no slant. The mattress should fit tightly and be designed just for the crib. Cover the mattress with a fitted sheet. Don’t use fluffy blankets or comforters. Don’t let your baby sleep on an adult bed, waterbed, air mattress, sofa, sheepskin, pillow, or other soft material. Don’t put soft toys, pillows, or bumper pads in the crib. Don't use weighted blankets, sleepers, swaddles, or other weighted items. Make sure nothing is covering your baby's head. These increase a baby's risk of suffocating.

• Put your baby in other positions while they are awake. This helps your baby grow stronger. It also helps prevent your baby from having a misshaped head. When your baby is awake, hold your baby. Give your baby time on their tummy while awake and supervised for short periods of time beginning soon after coming home from the hospital. Slowly increase tummy time to at least 15 to 30 minutes each day by 7 weeks old. Try not to let your baby sit in a seat or swing for long periods of time.

• Don't use sitting devices for routine sleep. Infant seats, car seats, strollers, infant carriers, and infant swings are not advised for routine sleep. These may lead to blockage of a baby's airway or suffocation. If your baby is in a sitting device, remove them from the device and put them in the crib or other appropriate surface as soon as is safe and practical.

• Make sure your baby doesn't get overheated when sleeping. Keep the room at a temperature that is comfortable for you and your baby. Dress your baby lightly. Instead of using blankets, keep your baby warm by dressing them in a sleep sack, or a wearable blanket. Don't use a hat on your baby indoors.

• Use caution when swaddling your baby. Swaddling doesn't reduce the risk for SIDS. If you choose to swaddle your baby, make sure they are on their back and the swaddle is not too tight. Stop swaddling your baby when they look like they're trying to roll over. Some babies start working on rolling as early as 2 months. The risk of suffocation is higher if your baby rolls to their stomach while they are swaddled.

• Offer a pacifier (not attached to a string or a clip) to your baby at naptime and bedtime. This helps reduce the risk for SIDS. If your baby is breastfeeding, don't give the baby a pacifier until your baby is breastfeeding well.

• Don't use products that claim to decrease the risk for SIDS. This includes wedges, positioners, special mattresses, special sleep surfaces, and other products. These devices have not been shown to prevent SIDS. In rare cases, they have resulted in infant death. Cardiorespiratory monitors sold for home use are also not helpful in preventing SIDS.

• Always place cribs, bassinets, and play yards in hazard-free areas. Make sure there are no dangling cords, wires, or window coverings. This is to reduce the risk for strangulation. Place the crib away from windows.

• Breastfeed your baby. This can reduce the risk for SIDS. Give your baby only breast milk for at least 6 months, unless the doctor tells you otherwise. Experts advise continuing to use breast milk for 1 year or longer. This depends on if both you and your baby want to do this. Using breast milk for a year or longer reduces the risk for SIDS and many other health problems.

• Take your baby for checkups and vaccines. If your baby seems sick, call your baby’s doctor. Take your baby in for regular well-baby checkups and routine shots. Some studies show that fully vaccinating your baby lowers the risk for SIDS.

• Don't use alcohol, marijuana, opioids, or other drugs. There is an increased risk for SIDS with exposure to substance use. Using these substances affects your ability to care for your baby.

Safe sleep when your baby is sick

Babies with a recent or current illness, such as a respiratory infection, are at a higher risk for SIDS. Following safe sleep guidelines is even more important when your baby is sick. Do this even if they have symptoms like congestion, runny nose, coughing, or poor appetite. If you are concerned about your baby’s health, contact your baby’s doctor right away.