My Doctor Online The Permanente Medical Group

Newborn Sleep Patterns

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Newborns sleep many hours during the day and the night and usually awaken only when they need to be fed, need a diaper change, or want loving interaction with a parent or caregiver. Newborns typically spend 15 to 18 hours per day sleeping. They usually remain awake for 1 to 3-hour intervals throughout the day or night.

Babies show signs of sleepiness in different ways. They may get fussy, cry for no reason, or rub their eyes. During sleep, they might be restless, kick their arms or legs, make sucking noises, or even grimace or smile.

The best time to put your newborn to bed is when they first show signs of sleepiness. Learn your child's unique signs of sleepiness. If your newborn rubs their eyes or gets fussy and has been fed, changed, and cuddled, it is time to place them in their bed. It is better to place your baby in bed when they first get sleepy but before they actually fall asleep somewhere other than their bed. Placing your baby in their crib before they fall asleep trains them to comfortably fall asleep in their bed because it is a familiar routine.

Safe sleeping position. Be sure to place your newborn on their back with their face and head away from blankets, toys, stuffed animals, or other bedding. Learn more about ways to reduce your baby's risk of sudden infant death syndrome (SIDS).

Encourage nighttime sleep. You can train your newborn to sleep more at night than during the day by exposing them to noise and light and interacting with them during the day. At night, lower the lights and noise and refrain from talking or playing when they awaken during the night to be fed and changed. Make middle-of-the-night feedings brief and boring.

Sharing Your Bed

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We recommend that you place your baby on a firm, flat mattress in his or her own crib or bassinet.

Some parents wish to share their bed with their baby. The thought is if your baby wakes up in the night next to you or your partner they will feel secure and fall back to sleep more easily.

However, sharing your bed is considered less safe, as your baby is at greater risk for accidental suffocation. For instance, you may unknowingly roll over on your baby during the night. Also, a soft mattress, pillows, or fluffy blankets pose a risk of suffocation. The American Academy of Pediatrics states there is some evidence that sharing a bed with your baby may increase their risk of SIDS.

If you do choose to co-sleep, the following precautions can help keep your baby safer:

• Avoid drinking alcohol, taking medications, or using other substances that will make you sleepy.
  
• Tie back long hair.
  
• Limit the number of pillows and blankets.

Ultimately, you will help your child learn to sleep in their own bed in the future.

Infants (3 to 12 months)

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Babies this age usually sleep around 9 to 12 hours per night and need several naps during the daytime. By the time an infant is 3 to 5 months of age, most babies no longer need to be fed during the night, but may still wake up periodically. As your baby gets older, he or she needs fewer naps during the daytime.

Common sleep problems
During this developmental stage, your child's sleep may be interrupted by changes in their social settings and from increased mobility. Once they begin crawling and walking, this new independence can also affect sleep patterns. It is common during this stage for some children to experience separation anxiety, which can interrupt their sleep patterns.

Between the ages of 6 months and 1 year, your child may be exposed to more germs and develop colds, influenza, or other illness, which can also interrupt their sleep.

Solutions
Continue to place your infant in their crib when they are drowsy but not yet asleep. This familiar routine helps your infant understand it is time to sleep and encourages them to self-soothe when falling asleep. If you have always rocked, patted, or coaxed your child to sleep or allowed your infant to routinely fall asleep somewhere other than their bed, they may not be able to soothe themselves back to sleep if they awaken during the night. This can result in some long, restless nights for you and your infant as they cry for you to help them fall back to sleep.

Develop consistent sleep schedules so that your infant takes a nap and goes to bed at the same time each day. Create a bedtime routine that your infant can recognize and enjoy, such as reading a book together before you lay them down to sleep. Make sure that your baby's room is dark, quiet, and comfortable so that they can fall asleep without interruption.

Sleeping Through the Night

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It is okay to let your child fuss a little when they try to fall asleep, as long as your baby is safe, fed, and has a dry diaper. This helps them learn to self-soothe so they can fall asleep on their own.

There are a number of "sleep training" methods and a host of books on the topic. You may want to learn more about each and talk with friends and family to help you decide how you want to approach helping your baby sleep through the night.

Remember, there is no single approach that works for everyone. You know your baby and yourself. Ultimately, the "best" method is the one that allows everyone in your family to get the most sleep.

One technique to consider: If your baby starts to cry when placed in their crib, let them cry for 5 minutes before you go back into their room. Briefly comfort your baby but try not to pick up your child. Leave the room and if they begin to cry again, wait 10 minutes before returning to their room to comfort them without picking them up. Next time, wait 15 minutes before going into their room, and then repeat this step by adding 5 minutes in between each time before returning into your baby's room. Your baby will eventually fall asleep.

Within 3 to 7 days, your baby will associate their crib with sleep. It can be difficult to let your baby cry, but this sleep-training method is not harmful to your baby. Your commitment to this method will help gently train your baby to understand it is time to sleep when placed in the crib.

Scheduled Awakenings

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This method trains your baby to sleep through the night by waking them up at specific times. For this method to be effective, your baby must already be waking up on their own around the same time each night.

Keep track of what time your baby awakens during the night for 1 week. During the following week, wake your baby up 15 minutes earlier than when they were waking up on their own the previous week. For instance, if your baby wakes up at midnight and 4:00 a.m., wake them up at 11:45 p.m. and 3:45 a.m.

Each day during the second week, wake your baby 15 minutes later than the previous night. So if you woke your baby at 11:45 p.m. and 3:45 a.m. the first night, wake your child at midnight and 4:00 a.m. the second night, and so on. Eventually, your child will stop waking up on their own and learn to sleep through the night.

This method trains your baby to wake on their own without having to endure their crying. However, it can be difficult to make yourself wake up your sleeping infant. It might also take up to 3 or 4 weeks to train your child to sleep through the night using this method.

Reinforcing Sleep Rhythms

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The goal with this approach is to prevent your 4 to 12-month-old from becoming overly tired. You can do so by placing your baby in their crib every 1 to 2 hours during the day or placing your older infant down for a nap 2 to 3 times per day. You can use a soothing bedtime ritual but try not let your baby nap in the car or stroller. In the evening, put your baby to bed early at night, sometime between 6:00 p.m. and 8:00 p.m.

For this method, you must be able to predict when your baby will be sleepy and try not to wake them after they fall asleep. The thought is that if your baby sleeps well during their naps, they will sleep better during the night, no matter how long they sleep during the day. The challenge is to not let your baby become overtired, which can be difficult. Also, this method works only over a long period of time and is not a quick fix to sleep problems.

Toddlers (1 to 3 years)

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During the ages of 1 to 3 years, your toddler requires around 12 to 14 hours of sleep in a 24-hour period. They usually only need 1 nap per day that lasts from 1 to 3 hours.

It is also during this developmental stage that your toddler usually begins displaying independence, including when to get to sleep. In addition, at this age, your toddler may be able to crawl out of their crib or bed during the middle of the night or when they are supposed to be taking a nap. You may have to place your child back into their beds repeatedly, usually with your child crying or insisting they want to sleep with you or stay awake. Remember to remain consistent in your method of training your child to sleep in their bed during regular sleeping hours.

It is important that you maintain regular nap and bedtime sleep schedules during this stage. Continue the bedtime ritual, such as reading a book together, so they understand it is bedtime. Set limits and be consistent with enforcing those limits.

Common sleep problems
During this developmental stage, your child may develop fears, nightmares, or night terrors. They may awaken during the night and resist going back to their bed. 

Children this age may also wander out of their rooms, looking for you or other family members who are still awake.

Solutions
A security blanket, stuffed animal, or another object can encourage your child to self-soothe if they awaken during the night. Make sure their bedroom is comfortable and quiet so that they feel safe. 

If your toddler gets up in the night, gently guide him or her back to bed, without a lot of talking. Repeat this as many times as you need to, until your child gets bored and falls back to sleep. 

Preschoolers (3 to 5 years)

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Children aged 3 to 5 years generally need around 11 to 13 hours of sleep per night. By the age of 5 years, a child usually no longer needs a nap during the day, although some children still require quiet time. 

Common sleep problems
Nightmares, night terrors, and waking up in the middle of the night can be problems for this age group. Some children begin sleepwalking during this developmental stage.

Solutions
Make sure your child gets 11 to 13 hours of sleep each night and that they go to bed around the same time each night. Continue a relaxing bedtime routine, such as reading a book or having bath time. Try not to stimulate your child with TV, games, or other activities right before bedtime. Make sure your preschooler falls asleep in their bed each night to establish the routine.

School-Age Children (5 to 12 years)

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As children reach school age, they begin to have more outside demands, such as homework, sports and school activities, hobbies, and growing friendships. Children in this developmental stage typically need 10 to 11 hours of sleep each night. Older children may begin spending more time on activities that stimulate their mind right before bedtime, such as computers or TV.

Common sleep problems
Your child may struggle to fall asleep and stay asleep during this age range. Younger children may continue to experience nightmares or night terrors. Some children begin to feel anxious about going to sleep. Too little sleep can cause mood swings, problems learning in school, and even behavioral problems (including hyperactivity).

Solutions
Set a schedule for bedtime and try to stick to it. You may want to schedule their bedtime a little later as your child ages. Make sure they are not overextended in activities during the day. To keep your child from staying awake too long, keep televisions, computers, and other electronics out of your child's room. Avoid letting your child drink caffeinated drinks, which can interfere with sleep.

Teenagers (12 to 18 years)

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Teenagers need around 9 hours of sleep per night. However, they typically do not get enough sleep, since they often stay up late watching TV, socializing on their phones or computers, or doing homework. But the brain needs sleep to properly function each day.

Teenagers often have irregular sleep patterns that include staying up late and sleeping in on the weekends and then getting up early for school during the week. This pattern can interfere with their biological clocks and affect the quality of their sleep.

Sleep helps your teenager manage stress and be successful in their daily activities. A natural part of getting older is that sleep patterns shift to getting sleepy later at night and sleeping in a little later. Your teenager may find it difficult to fall sleep before 11:00 p.m.

Common sleep problems
A lack of sleep can cause your teenager to have difficulty concentrating, become moody, perform poorly in school or other activities, and exhibit behavioral problems. It can also cause acne, unhealthy eating, and weight gain and possibly increase the use of caffeine, alcohol, or nicotine.

Solutions
Getting regular exercise or taking a short nap during the day can help your teenager sleep better at night. You can also help ensure that their room is comfortable for sleeping (quiet, dark, and cool). Remind them not to drink caffeine, exercise, or eat late at night.

To fight the natural tendency to fall asleep later and wake up later, your child can establish a routine that lets them relax before bedtime. This might include listening to soft or gentle music, writing in a journal, or reading. They should avoid video games, TV, computer, phone, or any activity that will stimulate their mind. Help your teenager stick to a regular sleep schedule as much as possible, even on the weekends.

Encourage your child to finish their homework early instead of saving it for later in the evening. It may help if they keep a "to-do" list so they don't suddenly remember an assignment late in the evening or to prevent them from worrying during sleep about things they need to do.

When to Contact Us

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Young children may experience nightmares, night terrors, or episodes of sleepwalking when they begin active dreaming. Most of these issues go away on their own, but if they continue, or they are very frightening to you or your child, please call the Appointment and Advice Line or send a secure e-mail. 

If your child at any age is consistently having a difficult time falling or staying asleep, let us know. A lack of sleep can affect their health in many ways.

We can make an appointment specifically to discuss your concerns.

Your Child's Care with Me

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If you are concerned about your child’s symptoms, and your concerns are urgent, please contact our Appointment and Advice line, which is available 24 hours a day, 7 days a week.

Our advice nurses can give you immediate advice, and our telephone staff can send me a message or schedule an appointment for your child.

Depending on your child’s symptoms and medical history and your preferences, the nurse may:

• Provide advice about how to care for your child at home.
• Send me a message so I can follow up with you directly.
• Offer you a telephone appointment with me or a trusted colleague.
• Make an appointment for your child to be seen in person.

Whether by phone or in person, we will discuss your child’s symptoms and medical history, and address your concerns. Together we will create a treatment plan to help your child feel better.

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You can connect with me in a variety of ways, depending on the situation and what is most convenient for you at the time. I am available online, by telephone, or in person.

• For nonurgent questions or concerns, you can e-mail me using this site, once you have registered to use the Act for a Family Member feature. You can also schedule an appointment online to see me in person.
• If your concerns are immediate, or you simply prefer to use the telephone, please call our Appointment and Advice line, which is available 24 hours a day, 7 days a week. Our advice nurses can give you immediate advice, and our telephone staff can send me a message or schedule an appointment for your child.
• Depending on your child’s symptoms, you may also have the option to schedule a telephone appointment – with me or another pediatrician, if I am unavailable. Please let the telephone staff know what you prefer and what is convenient for you.

Coordinating Your Child's Care

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Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting care for your child easier.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your child’s care to stay current on your child’s health status and to collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your child’s condition, care is safer and more effective.

If you come to an office visit

• At the beginning of your child’s visit, you will receive information about when he or she is next due for a well child visit (checkup) and immunizations. We can discuss and schedule any preventive tests that may be needed. 
• At the end of your child’s visit, you may receive a document called the “After Visit Summary” that will summarize the issues we talked about during the visit. You can refer to it if you forget what we discussed, or if you just want to recheck your child’s height, weight, or vital signs. (If your child is under age 12, you can also view these summaries online, under Past Visits.)

If you schedule a telephone appointment

• In addition to in-person visits, we now offer the option of telephone appointments for certain common pediatric concerns. Depending on your child’s symptoms, you may have the option to schedule a telephone appointment with me or another pediatrician, if I am unavailable. We will call you at an agreed-upon time, at whichever phone number is most convenient for you.
• Many parents like this new option, but if you prefer to be seen in person, it’s always your choice. Just let the telephone staff know what type of visit you prefer.
• Telephone appointments are not appropriate for all health concerns. The advice nurse can help you decide what type of care is best for you and your child.

If I prescribe medications

We will work together to monitor and assess how your child’s medications are working and make adjustments as needed. 

Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically, in advance.

• Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
• Have them delivered to you by mail at no extra cost. Or you can pick up your child’s medications at the pharmacy.
• If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.

If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, such as X-rays, we will schedule an appointment with the Radiology Department. 

When the results are ready, I will contact you with the results by letter, secure e-mail message, or phone. In addition, you can view most of your child’s laboratory results online, along with any comments that I have attached to explain them.

If I refer your child to a specialist

My specialty colleagues are readily available to assist me if I need additional advice about your child’s condition. In some cases, I may contact them during your visit, so we can discuss your child’s care together. If we decide your child needs a specialty appointment after that discussion, we can often schedule it the same day or soon thereafter.

Convenient Resources for You

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My goal is to provide high-quality care and to offer you choices that make your child’s health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available to help you manage your child’s care at any time that is most convenient for you. From my home page you can:

Manage your child’s care securely

You can begin to manage your child’s care online by requesting access through our Act for a Family Member feature. Once you have added your child to your account, you can:

• View and compose secure e-mail messages.
• Manage your child’s prescriptions and refills.
• Schedule well visit and nonurgent appointments.
• View your child’s Preventive Services to see whether your child is due for any immunizations or well visits.
• If your child is under 12, you can also view most lab test results and review information about past visits.

Learn more about your child’s condition

• Read about causes, symptoms, treatments, and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your child’s condition.
• View programs to help you decide on or prepare for a surgery or procedure.

Help your child stay healthy

• Sign up for our online newsletters for parents, customized to your child’s age.
• Locate health education classes and support groups offered at our medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you keep your child healthy.
• Check to see when your child is next due for immunizations and a well visit (checkup).