How long should my baby sleep?

In this world of conflicting parent advice, and instinct verses messages shared, it can sometimes be hard to know how long a baby should ideally be sleeping for? We all yearn for a our babies to sleep well, to feel rested and content. Yet for many, this is sadly not the case as they experience unnecessary digestive discomfort that can leave them unsettled, crying, screaming, bloated, wakeful and exhausted, which in turn can push parents to the point of despair as they search desperately for something to help. It sounds awful, right? How can this happen? There must be something that can be done to improve this situation. But on exploring the options, parents often here the resounding but unhelpful reply that all of this is "normal." It will soon pass. It's just how a baby is. You just have to wait a while. Wait!? Normal!? Normal for a baby to cry or scream for hours. Normal for them to have 45 minute sleep cycles or often wake after five minutes of being snuggled into bed. Really? Really? If you cried for as long as some of these babies, or didn't sleep well on a consistent basis would we just say it's normal? I often, often ask myself, and I am fighting back tears as I write this, how did we arrive at this place where this obvious distress is labelled as 'normal?'

Within my BabyCues Clinic I commonly hear parents say, ‘she doesn’t sleep well during the day. Maybe she'll have two or three 45 minute naps on a good day, but she sleeps really well at night. I get two blocks of good sleep. She is a really hungry baby, feeding from 8-15 times a day. But sometimes she is only on for a few minutes, other times she has a good feed of 30-40 minutes.’ Or I hear, ‘she sleeps really well during the day. I can get 2-3 hours out of her, sometimes twice a day. But at night, she is restless and just won’t sleep for long, so I end up feeding her and she tends to go back off for another 45 minutes or so, if I’m lucky.’

Both of these scenarios have two things in common. Both predominantly have baby sleeping for a longer time somewhere within 24-48 hours, but this is often out of exhaustion, rather than comfortability. These scenarios also have the sleep deprived, sometimes desperate mother feeding baby often, which I define as 8 or more times in a 24 hour period, with this largely being taught and accepted as "normal." However, when we examine the digestive biology of a newborn we can begin to see why short sleep cycles are becoming more prevalent for our young.

The common causes of short sleep cycles

• Over feeding – frequent feeding
• Feeding a newborn to sleep
• An overabundance of trapped air in the digestive tract
• Reactions to diet 

So let’s first focus on why frequent feeding cause short sleep cycles. 

Frequent feeding

Frequent feeding is defined as feeding baby before 3 ½ to four hours on a consistent daily basis – also known as ‘demand feeding’.  In the Western world we are largely taught to ‘demand feed’ our babies – also known as cue feeding, or baby led feeding. In my practice and teachings I totally advocate and teach these forms of feeding. Being cue lead is so important. However, the widely accepted Western form of ‘demand feeding’, which may see baby latched on to the breast for a few minutes or for two hours in some cases, has been missing some vital information about some of the newborn cues and how these relate to hunger. Parents are also largely taught that when a baby is rooting to suck they are hungry. However a baby also roots to suck when they feel discomfort in the body, whether it be digestive or otherwise. This may have them looking ravenous at times and really gulping back food when in reality they actually only wanted to suck without food so they could feel better for sucking is their innate soothing mechanism. 

By and large, this lack of knowledge has resulted in parents being taught to feed their baby frequently, which commonly results in over-feeding – whether breast or bottle fed. Parents are also taught that if baby is crying, unsettled or won’t sleep, then put bubs to the breast. “Feed them more” you will get told by health professionals, or family. “They are just hungry. They are going through a growth spurt and because of this it’s normal that your baby may ask for more in the evening hours”. Thus projecting cluster feeding as normal.

One mother that recently wrote a letter of thanks to me (you can read her full letter here) summed the teaching of ‘demand feeding’ up as 'if in doubt, give them boob'. She said, “With our first baby (now 3) as new parents we were told by our midwife (whom we loved and trusted dearly) that newborns didn't need much burping and to feed whenever she needed it. Now I understand that our daughter was an 'unpredictable' baby who actually was struggling with a very full and overloaded stomach.  Second time around, things started to go downhill again and I found myself asking the same questions you asked in your book: if my baby is tired, why is she not sleeping? Why is she giving me tired cues but not going to sleep. Why is she giving me hunger cues but not feeding well.   After reading your book for two days with our second child I am relieved. I am confident my baby doesn't have 'reflux' but indeed was suffering from a massive amount of digestive overload due to me frantically feeding to soothe her.  Your book has saved me! I'm day two into your recommended feeding and sleep guide with my three month old baby girl. Today her feeding was incredible!”

This of course is music to my ears and something that can happen for all our newborns when we learn how to read their full array of cues correctly, while nurturing them within the firm foundation of knowledge about their early developing digestive system. For example, it is known that:

• a newborns stomach does not stretch
• the stomach can only hold certain capacities at certain ages
• it takes 4-5 five hours for food to be broken down in the stomach in a health manner
• stomach emptying and transit times are naturally delayed for neonates¹
• initial digestion within the stomach is especially important for milk fat because milk fat droplets are not a good substance for pancreatic lipase – the primary enzyme that breaks down fat molecule. Consequently stomach contents naturally delays gastric emptying for neonates.² If mum is breastfeeding baby frequently then it’s highly likely baby will get high levels of fat. Combine this with the fact below and we can begin to see that frequent feeding clearly compromises digestive health for newborns.
• when a baby is overloaded in the stomach they will reflux the excess milk upward (learnt from my clinical research but also pretty logical – if there isn’t any space…) and the excess will also be pushed out of the stomach and onward in the digestive tract whether it has had time to be absorbed by their body in a healthy manner or not. This then creates discomfort as the large quantities of undigested waste travel through the duodenum, intestines and bowel.

When we overfeed, or feed frequently, lactose ferments in the duodenum, fat globules abnormally move through the intestines and an overabundance of intestinal air gets pushed onward through the digestive tract. All of this commonly results in bowel motions that may show one or all of these things – have curdled pieces, be explosive, frothy, green, very frequent (one after every 1-2 feeds) and they may have baby upset before passing them. It also commonly results in baby arching backwards, pedalling legs, crying, perhaps screaming, not wanting to be put down and you guessed it, sleeping for short sleep cycles.

So instead of frequent feeding, feed baby every 3 ½ to four hours so they have time to break down the nutrients of their milk in a healthy manner. Now I know, this may sound like ‘routine feeding’ and most parents have been taught over the years that this is now an awful, outdated form of care that is ‘led by the clock and not baby' and in my opinion being led by the baby is by far best practice, which is what I teach.

However, when we do this - respond knowingly to their full array of cues inclusive of hunger and wind cues - it just so happens that they actually naturally fall into 3 ½ (for low birth weight babies) to four hourly feeding pattern, which also helps to establish healthy, long, consistent sleep. I call this kind of care Bio-logical Care, which has been birthed from a completely different perspective to ‘routine care’, and is highly responsive to a newborns cues and their natural digestive capabilities and capacities.

Professor Ian St James-Roberts, a well-known newborn sleep researcher of the UCL Institute of Education, says, ‘If parents wish to prevent their infant from waking and signalling in the night after 12 weeks, there is strong evidence that using ‘structured’ parenting is effective.³ This aligns well with the natural flow of Bio-logical Care whereby following the full array of cues of a newborn naturally and innately forms a day that is more ‘structured’. 

Feeding baby to sleep

When we feed a baby they automatically swallow air into the stomach, even if baby’s latch is good and they feed well. Therefore, when we feed them to sleep, which often works well in regards to getting them off to sleep, they nod off holding a lot of retained air in their stomach from the feed. This often copious amount of trapped air is then left travel through the intestines and onto the bowel, which for an older child would be largely fine and handled. But for a new, developing baby and some infants, this is not fine. This is a recipe for discomfort and wakeful sleep. It is also one of the contributors, like all that are mentioned here, of colic and reflux, or what I call Digestive Overload – the cause of these behaviours.

Professor Ian St James-Robert, along with three other researchers, also spent some time videoing parenting methods that develop long night-time sleep periods by three months of age. Within this body of work he mentions that “consistently introducing a short interval before feeding was associated with development of longer infant night-time feed intervals… and longer night-time periods of sleep at three months of age.”

So I put it to you that this short interval, albeit before a feed as opposed to after a feed, which is what I teach, helps to regulate the digestive system. It gives the child more time to process their milk feeds and for you to expel their trapped air before they go to sleep, which as the Professors study outlines, naturally extends their time between feeds. Also, when we move this interval to after a feed, you the parent have time to both enjoy your baby when they are full and content.⁴

If you would like to read more on feeding to sleep, I have previously written another short but concise blog on this, which I do urge you to read.  

Overabundance of trapped air

Most parents are taught to burp baby directly after a feed, expel a few good burps and that this is sufficient. Some may also be told that you don’t have to burp a breastfed baby, or that all newborns do not have to burp. However, this is not the case at all. All newborns need burping, and in order to create developmental sleep levels for each age and stage (guidelines listed below) the more burping after each feed the better. During my twenties I lived in with families as a Maternity Nurse, largely working with families of multiples, working 24 hours a day, 6 days a week from the day baby was born, if not prior to help Mum, to around 3 months of age. Over the six years of doing this, one of the most important, life changing things the hundreds of babies taught me was that burping is paramount to sleep and comfortability. They also taught me that there is a natural sequence of cues that trapped wind causes for all babies and when we nurture alongside these, we can release more trapped air, thus enabling the necessary developmental sleep. This is particularly the case from newborn to six months of age. 

You can read more about these cues here.

Diet

If breastfeeding, what you eat naturally goes through to your baby, effecting their digestive system and therefore there sleep. Some babies are more sensitive to this than others, so keeping a food diary can be helpful as can a ‘Let’s Chat Consultation’ with me if you’d like more information on what you are eating and the changes you could make.

If formula feeding then goats formula is much healthier on the digestive tract than diary formula, and it also has a healthy ingredients list for most of the available brands. Some use maltodextrin – avoid these brands.

Guidelines for development sleep at different ages

Newborn to two weeks: 16-18 hours in 24 hour period
Two to four weeks: 14-15 hours in a 24 hour period
Four weeks to 4-4 months: 13-14 hours in a 24 hour period

You can read more in depth information about these guidelines here.

General tips on how to create longer sleep cycles

• Feed baby in accordance to their innate digestive function. You can read more about their basic innate function in this blog, and you can read about the size of your baby’s stomach at different ages here
• Burp baby after each feed. The less air travelling through the digestive tract, the better. I teach a method called Nature’s Wind Sequence (NWS), which has you working alongside a natural flow of communication that coincides with the movement of trapped air and food in the stomach. This method is available in my BabyCues book as are Bio-logical Daily Patterns that will have you nurturing your baby alongside their natural digestive function.
• Do not feed baby to sleep. Instead burp them well after every feed – read this guide to see many burps are appropriate at each age and stage. At around 3-4 months babies release burps a little easier after feeds and by 6-7 months they don’t require you to be as proactive with burping as their movement aids them with this.
• If breastfeeding restrict the amount of windy foods you are eating. You need your greens but having two windy vegetables a day is generally enough for newborns. It will also help to take dairy out of your diet.
• Have your baby checked for tongue or lip tie by an experienced practitioner. These two things can have your baby swallowing more air when feeding, contributing to shortened sleep cycles.
• Have your baby and infant weighed often. I advise from 0-2 months, this is done every week. From 2-4 months every second week and from 4-8 months at least once a month. I recommend this because obviously hunger can bring short sleep cycles too.

1. The Anatomical Basis of Clinical Practice, Gray's Anatomy 39th Edition
2. Hamosh, M., Scanlon, JW., Ganot, D., Likel, M., Scanlon, K., and Hamosh, P. Fat Digestion in the Newborn — Characterisation of lipase in gastric aspirates of premature and term infants.  www.ncbi.nlm.nih.gov/pubmed/7204558
3. James Roberts I; Thomas Coram Research Unit Institute of Education University of London: Preventing and Managing Infant Sleeping Problems; 2009
4. James-Roberts I; Roberts M, Owen C;: Video evidence that parenting methods parenting methods predict which infants develop long night-time sleep periods by three months of age; 2016