Preventing sleep concerns (7) – babies 0 to 6 months

Getting to know your baby

Bonding, or attachment, with your baby is important. It will help your baby develop and help you to understand your baby and their cues.

Babies feel safe and loved when you respond to their needs.

You can help your baby develop by:

• touching
• cuddling
• talking
• singing
• smiling
• looking into their eyes.

You may feel an overwhelming sense of love for your baby and develop an instant strong connection.

What if I can't bond with my baby?

For some parents it may take time to bond with your baby, this is normal. A newborn can significantly change your relationships with others and many find this a challenging time.

Being a parent doesn’t come naturally for most people and adjusting to parenthood can look very different for new dads and mums. For instance, in the early days, some new dads and partners may feel left out because they are not feeding or nursing their newborn, but there are other ways to bond with your baby, such as bathing, reading a story, changing nappies or taking your baby for a stroll while your partner is catching up on sleep.

Remember, no one is expected to be an expert and bonding with your baby is really a matter of trial and error.

Try to approach parenthood as a team effort. Single parents can call on family and friends to share the responsibilities, so your child builds important connections with others around them.

If you are concerned that you are not connecting with your baby, speak to your maternal and child health nurse or doctor. If you are experiencing relationship difficulties, consider seeking the help of a counsellor. With the right support, things can often improve.

Settling your baby

Newborns aged 0 to 3 months have not yet learned to settle by themselves. With your help they will learn to self-settle.

It’s common for them to be unsettled.

They wake often overnight between sleep cycles and when they need to be fed or changed.

They usually need your help to settle and go back to sleep. We call this responsive settling.

Each baby is different. Your baby’s ability to settle comes down to their individual temperament.

Some babies are very difficult to settle. This can be stressful and upsetting. Your self-care is important, if you need a break, place your baby in their cot and walk away for a few minutes.

Things you can do to help settle your baby include:

• Gently touching your baby, such as patting or stroking your baby in their cot.
• Using gentle shushing noises, settling music or white noise.
• Check they do not need a nappy change.
• Check they are not too hot or too cold.
• Check it hasn’t been longer than 2 to 3 hours since their last feed.

If one approach doesn’t work after 5 minutes, move on to a different approach.

Continue with the approach until the baby is quiet, but not asleep.

Put your baby in their cot when they are tired, but still awake.

This helps your baby learn to settle by themselves and stops them from relying on these approaches to get to sleep.

Recognising your baby’s tired signs

When your baby is tired, they show signs or cues that they are tired. If you learn to recognise these signs, you can encourage your baby to go to sleep at the right time.

Babies from 0 to 3 months might start showing tired signs after 30 minutes of being awake.

From 3 to 6 months, they might be tired after 1.5 to 3 hours of being awake.

Tired signs for these age groups can include:

• jerky movement
• frowning
• clenching of fists
• yawning
• staring
• poor eye contact
• fluttering of eyelids
• rubbing eyes
• sucking on fingers
• back arching, grizzling and crying, which are late signs.

Some of these signs may mean your baby is bored and they settle with a change of environment.

However, if your baby has been awake for longer than 30 minutes (newborn) or longer than 90 minutes (3 to 6 months), they are likely to be tired.

Creating a sleep routine and environment for your baby

Routines and environments play a big part in helping babies get to sleep.

Babies need a cue to tell them it is time to go to sleep. This is usually something in their external environment.

It could be a dark room, being swaddled or wrapped (if they cannot yet roll over).

Some things like cuddling or holding your baby until they fall asleep might be difficult to keep doing for the long term, as it may create a negative sleep association for your baby. They may then only be able to fall asleep if you cuddle or hold them. It’s up to you to decide whether you can maintain these types of routines.

Your baby's sleep environment

Some things you can do to create a good sleep environment for your baby include:

• reducing stimulation around your baby – for example, sit in a quiet room with dim lighting.
• swaddling or wrapping your baby (if they cannot yet roll over).
• giving your baby a bath at night.
• giving your baby a gentle massage.
• creating a pre-sleeping routine, like singing lullabies.

Bedtime routines for your baby

Bedtime routines help your baby develop positive sleep patterns and behaviour and can prevent sleep problems.

Regular daytime and bedtime routines can help your baby to fall asleep and stay asleep. They let your baby know that sleep is coming.

Bedtime routines are predictable and calming for your baby.

Some things you can do include:

• keeping the routine short – no more than 15 to 30 minutes
• using the same relaxing activities before bed every day (such as a warm bath, a massage, reading stories or singing lullabies)
• creating a calm, quiet, dark and warm environment, with no television.

Use regular bed times, nap times and wake times to help your baby develop a good sleep-wake rhythm.

Feed, play, sleep and your baby

It’s good to keep using the same sleep routine as your baby grows and develops.

Feed, play, sleep is a daytime routine you can use for babies, toddlers and pre-schoolers to encourage positive sleep patterns and behaviour early on.

Feed your child as appropriate for their age.

Encourage play time during the day. Examples of play time for babies include:

• singing
• gently talking to your baby
• reading
• floor time
• sitting in a pram outside.

Watch for the first tired signs and then put your baby to bed.

Feed, play, sleep is most effective if done throughout the day. You should reduce play at night and provide a quiet and dim environment so that your baby understands the difference between day and night.

Feeding is a very important part of the routine. With a healthy and adequate diet, your baby will have energy for play, which in turn encourages positive sleep behaviours.

Self-settling and your baby

Self-settling is when your baby learns to settle and fall asleep by themselves.

You can help your baby learn how to self-settle from 3 months of age with positive sleep routines and environments.

When your baby learns to self-settle, they don’t need to rely on you to settle them.

They can get back to sleep by themselves if they wake overnight (except when they need to feed).

Self-settling may help your baby to sleep for longer periods at night.

To help your baby learn to self-settle you can:

• make sure the room is dark and quiet
• swaddle or wrap your baby (if they cannot yet roll over)
• put your baby into their cot when they are awake. This helps them learn to associate being in bed with settling and falling asleep.

If your baby still does not settle, you can:

• try going for a walk in the pram
• give your baby a bath or massage
• cuddle or hold your baby in your arms until they are tired or drowsy, placing them in their cot whilst they are still awake.

Some things like cuddling or holding your baby until they fall asleep might be difficult to keep doing for the long term, as it may create a negative sleep association for your baby. They may then only be able to fall asleep if you cuddle or hold them. It’s up to you to decide whether you can maintain these types of routines.

Helping your baby to sleep safely

Many parents worry about their baby’s risk of sudden unexpected death in infancy (SUDI), This is when a baby dies suddenly and unexpectedly. Although it can happen at any time, SUDI often occurs during sleep.

To help your baby sleep safely follow these simple rules from Red Nose:

• sleep baby on their back
• keep their head and face uncovered
• ensure baby’s environment is smoke free
• have a safe sleep environment
• sleep baby in a safe cot in your room
• breastfeed.

Although the rates of SUDI are declining in Australia, it is the major cause of unexpected death in babies aged between 4 weeks and 12 months.

Sharing a sleep surface

A considerable proportion of SUDI occurs when parents or caregivers share a sleep surface with a baby. This is also called co-sleeping or bed-sharing.

It is recommended by Red Nose that the safest place for your baby to sleep is in their own cot next to your bed for the first 6 to 12 months of life.

Sleep and settling concerns for newborns and babies

Waking and settling issues are very normal for newborns and babies less than 6 months of age.

Your newborn may wake frequently during the night to feed and they may need assistance to settle back to sleep.

It is not uncommon for newborns and babies to not sleep through the night until around 1 year of age.

If you are concerned about your newborn’s sleep and settling, speak to your maternal and child health nurse, call the Maternal and Child Health Line on Tel. 13 22 29 or talk to your doctor.

Information in community languages

This fact sheet is available for download in the following community languages:

Maternal and child health nurse visits are important

Victorian parents have free access to the Maternal and Child Health Service, which is a great support after your baby is born.

Specially trained maternal and child health will work with your family to help you care for your child until they are ready to start school.

As part of this service, you will visit a maternal and child health nurse in your local area at 10 key ages and stages in your child’s development. These visits are important because they you an opportunity to identify and address any issues and concerns early in your child’s development.

Visits take place:

• following discharge from hospital (home visit)
• 2 weeks
• 4 weeks
• 8 weeks
• 4 months
• 8 months
• 1 year
• 18 months
• 2 years
• 3 and a half years.

Families can access the service at other times by telephone or through a centre visit.

Where to get help

• Your local maternal and child health service
• Your GP (doctor)
• Maternal and Child Health Line Tel. 13 22 29 – available 24 hours a day for the cost of a local call throughout Victoria
• Mercy Health O’Connell Family Centre, Canterbury Tel. (03) 8416 7600
• Mercy Health Woi-wurrung-yagila-wulumperi Whittlesea Early Parenting Centre, South Morang Tel. (03) 9407 6820
• Queen Elizabeth Centre (QEC) Tel. (03) 9549 2777
• Tweddle Child and Family Health Service, Footscray and Werribee Tel. (03) 9689 1577
• Aboriginal Health Service (VAHS) Tel. 03 9419 3000
• Translating and Interpreting Service (TIS National) Tel. 131 450 – available (24 hours, 7 days) for callers who speak other languages
• National Relay Service (24 hours, 7 days) – Speak and listen Tel. 1300 555 727, TTY Tel. 133 677, SMS relay Tel. 0423 677 767. Captioned, internet and video relay calls are also available through this service.
• Nurse-On-Call Tel. 1300 60 60 24 – for expert health advice 24 hours a day, 7 days a week
• Kidsafe Victoria Tel. (03) 9036 2306
• Red Nose (formerly SIDS and Kids) Tel. 1300 998 698 – for safe sleeping information, education, and all other enquiries