Newborn infants sleep an average of 20 hours per day, and that amount of sleep usually decreases over the first year to 16 hours per day, equivalent to 12 hours at night and two hour naps twice a day. Any mother will tell you, however, that this average varies widely depending on the child. Some toddlers take a 45 minute nap in the morning and a three hour nap in the afternoon. Some children hardly seem to sleep at all. Your child is likely to get all the sleep that she needs, and most children self-regulate their sleep patterns quite well. Babies do wake from sleep to nurse. Many infants will sleep for five hours at a stretch in the night. Others wake every hour or two to nurse. Some four-month-old babies sleep for long stretches, but by nine months are waking every hour. All of these patterns are normal. A problem that parents sometimes encounter is babies who trade night for day, who think that nighttime is a great time for playing. These babies may need some encouragement to sleep less during the day and more at night. Babies who sleep with their parents usually become attuned to parental sleep patterns and learn by example that nighttime is for sleep. I do not recommend that parents allow their babies to cry themselves to sleep or put babies in a separate room to learn how to fall asleep alone. Babies thrive when their needs are met promptly and they have intimate contact with a parent most of the time.
Most babies will fall asleep while nursing, and mothers are able to put them down after a feeding. In the postpartum period for a few weeks mothers should get plenty of rest. Napping with your baby will rejuvenate you and speed your own recovery from the rigors of labor and birthing. Even with older infants, a quick nap with your baby can be invigorating. Unfortunately, this luxury is often only possible with the first baby. A toddler in the house is not likely to allow mom to take a nap unless he is also sleeping. None of these sleep patterns are much in a parent's control, and babies will usually guide the program.
Many mothers choose to keep their infants close to their own bodies during the day in a sling, when the baby is awake and asleep. Babies naturally sleep best next to a parent's body. Wearing your baby in a sling for most activities is optimal, but parents may also want to put their babies down in a bassinet or cradle (or for an older baby a crib) for extended naptimes. You may choose to nurse your baby while lying in bed before a nap, which is perfectly fine, but then you should place your baby in a safe sleeping space when you get up, either the bassinet or crib. An infant is not safe alone in the parents' bed. Babies can become entangled in covers while sleeping unattended or become trapped in the space between the mattress and the bed frame, or between the bed and a wall. Babies can also simply fall out of bed. Use a bed rail (also called a guardrail) in a bed with a mattress and box springs only for babies over one year of age. Again, infants can become trapped in the space between the mattress and the bed rail. Even for older children it is safer to roll up a bath or beach towel and stuff it into the space between the bed rail and mattress.
The question that parents must decide is where their baby will sleep at night. There are four options: bassinets, cribs, sidecars, and in the parents' bed. A sidecar is a three-sided bed that attaches to the side of the parents' bed at the same level as your mattress. This arrangement keeps baby within arm's reach, but outside of the parents' space in the bed. It is especially useful for babies who tend to be restless during the night, disturbing parents. On the other hand, most parents are happy to cuddle up with their baby and suffer a few elbows or kicks in the middle of the night.
The most appropriate and natural place for babies during the night is in the parents' bed. If babies are close, then parents will be able to respond quickly to crying or hunger. Why get out of bed to care for a crying baby if you can just turn to them and provide comfort and food? Sharing a bed is the arrangement of choice and custom in most of the world. A great deal of evidence shows that bedsharing, or cosleeping, is beneficial to establish natural biorhythms in infants, to reduce the incidence of Sudden Infant Death Syndrome (SIDS), and to establish strong emotional bonds between parents and babies. The father-infant bond especially benefits from a cosleeping arrangement. Mothers establish an intimate bond with their babies in the breastfeeding relationship. Nighttime can provide the same kind of closeness for fathers and babies. Most attachment parenting experts feel that bedsharing leads to confident and self-reliant children. The benefits of bedsharing are plentiful, rewarding, and comforting. Breastfeeding is easier. Everyone tends to sleep better, and children feel safe. Of course parents can also closely monitor their baby during the night if their baby is lying right next to them.
I recommend that parents sleep with their infant for at least the first three months of life. During this adjustment period babies are learning to physically adapt to the world around them. Evidence suggests that infants actually learn to breathe by sleeping next to their mothers. A fascinating study showed that even placing a mechanical breathing teddy bear next to newborns with breathing interruption during sleep reduces these episodes by 60 percent (Thoman, 1986). This may explain the reduced incidence of SIDS among babies that sleep with their parents. A study in South Africa showed that bedsharing babies have higher survival rates than solitary-sleeping babies (Kibel, 2000). Asian countries where cosleeping is the norm have some of the lowest SIDS rates in the world. This is true for Japan, China, Vietnam, Cambodia, Thailand, and Hong Kong (Davies, 1985; Lee, 1999; Fukai, 2000; Yelland, 1996; Nelson, 2001).
Researchers investigating the nighttime behavior of breastfeeding and bedsharing mothers and infants recorded and evaluated videotapes of the families through the night. They discovered that mothers adopted a position with her knees drawn up under the baby's feet and her upper arm positioned above her baby's head. This allows the mother constant control over the baby's movements in the bed, and keeps her close to the baby's body to monitor the baby's temperature and breathing. Mothers of formula-fed babies took a less protective position, sometimes facing away from their babies and did not sleep curled up around their infants. All babies tended to sleep between the parents. Breastfed babies also spent some time on the outside of the mother to facilitate access to the other breast. Breastfed babies slept on their sides, formula-fed babies slept supine (Richard, 1996).
If you choose to share your bed with your baby, then you will need to consider how long to maintain this arrangement. It is perfectly fine for children to remain in their parents' bed until they want to leave. Sometimes this occurs at two years of age, sometimes as late as six years. You may want to read some of the books devoted to the subject of bedsharing listed in the appendix while making this decision. Those books by pediatricians Jay Gordon (Good Nights) and William Sears (Nighttime Parenting) are especially useful.
The two most common concerns about sharing a bed with your children are fear of rolling onto your baby, and interference with parental intimacy. Neither of these fears is warranted. Mothers do not accidentally smother their babies. An attentive, breastfeeding mother is extraordinarily sensitive to her baby's location and needs. As for sex, infants will sleep through anything. Older children can be moved to an alternate sleeping location while parents steal a few moments alone together, or parents can slip away to another location themselves, or a baby can be temporarily moved off to the other side of the bed with pillows guarding the edge. Be creative and you can continue a happy bedsharing relationship with your baby and still maintain the intimacy of your marriage.
If you choose to use a crib, it can be placed in the parents' bedroom. I do not consider it safe, however, to leave an infant in a separate room during the night. If your baby becomes accustomed to sleeping in a crib, then at some later point you can move the crib to the baby's room if you like. Babies can get trapped between the mattress and bars of a crib, so you must use bumpers on a crib. Each bumper should have at least six ties, and each tie should be no longer than six inches to avoid strangulation.
Other factors besides sleeping alone can contribute to an increased risk of SIDS. These include some other aspects of sleeping arrangements and a variety of different drugs. SIDS has been associated with sleeping on soft mattresses and allowing babies to sleep on couches or other soft surfaces (beanbag chairs, overstuffed chairs, waterbeds). Sleeping next to an older sibling is not safe for infants. Parents attuned to their baby will wake if a problem occurs. Older siblings could potentially lie on a baby or injure a baby during the night. Parents should sleep with their bodies in between siblings and an infant. Infants who sleep in the face down position have an increased risk of SIDS.
Several drugs contribute to a higher risk of SIDS. Maternal smoking has been implicated in the occurrence of SIDS in many studies (Chong, 2004). Alcohol and recreational drug use, sleeping pills and other sedatives have all been associated with SIDS (Carroll-Pankhurst, 2001). And vaccination results in an increased risk of SIDS (Neustaedter, 2002).