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How to Get a Baby to Sleep: Tips from Pediatrician Dr. Gurinder Dabhia | San Diego Health

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– Hi, I'm Susan Taylor with Scripps Health in San Diego, California. Please subscribe to our
Scripps Health YouTube channel. We've got great videos
featuring the latest technology, our stellar doctors, and
inspiring patient stories. All right, you've just
welcomed your new little baby into the world, and now that you're home, how do you get your newborn
to sleep through the night? Developing good sleep habits early on is critical to a child's development, and it allows time for tired parents to recharge so they
can have tons of energy to care for that new little bundle of joy. Joining us is Dr. Gurinder
Dabhia, a pediatrician at Scripps Clinic in Rancho
Bernardo, California. Thanks so much for being with us, Doctor. – Thanks for having me. – So how does an infant
learn to fall asleep? How do you train them? – Good question. There are books and books that are written about sleep training. The main thing to keep in mind is to work with your
physician, your pediatrician, to ensure that your baby's
developmentally ready to be able to sleep
longer periods at night and they're growing
appropriately in order to be able to go between feedings
longer periods at night.

– So what is the best age
to start this training? – So usually laying the
foundation and starting to think about longterm
sleep training plan, around four to six weeks of age is an appropriate time to
start thinking about it. Between six to eight weeks of age, they're neurologically
ready to go longer periods of time, so that's around the time we can start laying the foundation. – So before two months, it's
whatever the baby wants. – A lot of feeding and a lot
of sleeping for the baby, but not, unfortunately, for the parents. – Parents, right. (laughs)
– And at that stage, they're growing very rapidly. Their metabolic rate
is extremely increased, which means they're eating
a lot and sleeping a lot. But before that, you do wanna ensure that you are appropriately
feeding the baby and because they are growing very rapidly. – So at what time of night do
infants usually fall asleep? – So usually when they're
starting to be able to go longer periods at night, anywhere between 10 to 11 is a bedtime. And then as they go even longer, between three to four months of age, they can go nine to 10 hours at night.

Typically, the bedtime is
between seven to 8:00 PM. – And how long can you
expect them to stay asleep? – So that also depends on which developmental stage they're in, so between about six
to eight weeks of age, sleeping through the
night is only five hours, which, for parents that are
used to getting up every two to three, that's a treasure until– – It feels like a luxury.
– It feels like a luxury, exactly, and then usually after that, they're able to go longer
periods, about 10 hours. – But you say that they're
really not sleeping straight through the night, so
they're waking up often. Why are they waking up? – So again, they're still
growing very rapidly.

They're doubling their birth
weight in the first six months, so limiting their feedings
to only our daytime hours is not enough for them. So they do still need some
of those nighttime feedings. And as they wake up, they
also have wet diapers and bowel movements
that need to be changed in association with the feedings. – And do they also just wanna be held? – Well, so– – Do they even know? (laughs) – Not necessarily, not necessarily. Babies are able to sleep long stretches if we don't interrupt them too much and if we allow them the
opportunity to learn how to sleep. – So we want you to hold this thought. We're gonna come back and talk about this in a couple of minutes. Psychologists will tell you that, during the first four months of life, the infant is developing trust. And so how do you communicate
that trust with your infant? Do you risk breaking that trust if you rock the baby
until they go to sleep and then you put them in the crib so that you're actually
separating away from them? We'll come back and talk about
that in a couple of minutes.

How much sleep does an
infant need every 24 hours? – Yeah, so initially,
they need quite a bit. So usually within the
first three months or so, it can be even up to 17 hours of sleep in a 24-hour period, so
usually 14 to 17 hours. And then after about four months of age, they can go anywhere between 12 to 14 hours of sleep in a 24-hour cycle. – And should they be in the same room with you in a bassinet or a crib? – Yeah, I think, initially,
that makes parents feel a lot more comfortable to have
their newborn near them. But I think you do have to keep in mind that around two to three months of age, they're a lot more aware
of their surroundings. So any movement or noise
that's made in the room could affect their sleep, and
that includes daytime sleep if they're sleeping in a living room.

They're a lot more attuned
to their environment, so that's up to the parents to decide when the appropriate
time is to move the baby. But they're definitely
more stimulated, so. – So if they hear the sound of your voice, is that soothing to the baby or does it actually keep them awake or does that interrupt their sleep? – It could potentially
interrupt their sleep. It depends on what they're getting up for. Usually, they're in deep sleep, and if we don't interrupt
them during the time that they're in those
different sleep cycles and changing between sleep cycles, they're able to get to the other side without us interfering.

Unfortunately, we do
tend to interfere more, and so sometimes our voice could be more, too much stimulation for them when they really just need to sleep. – And what's your thoughts
on holding the baby, rocking the baby to sleep
and then putting the baby in the crib versus having
the baby in the crib and just maybe gently touching them and singing to them or
soothing them to sleep? – Sure, sure. So initially, that's a good way to start the foundation of sleep training. We're holding our baby,
we're feeding our baby but at some point detaching those things that are allowing that, that are crutches to them going to sleep on their own.

So I usually recommend holding the baby or holding and feeding and then detaching once they're starting to
get a little bit sleepy and then laying the baby down. So that you can start even at
four, six, eight weeks of age. So I think it's appropriate
at certain ages and stages of sleep training, but
eventually, that can be negative towards your effort to
sleep train your baby. – What are your thoughts about having the baby
sleep in bed with you? – So the American Academy of Pediatrics does not recommend co-sleeping. So usually, if there's any co-sleeping, there is a risk with pillows and blankets, alcohol use, extremely sleepy parents, which is basically every
parent of a newborn. So the risk is greater than
the benefit of co-sleeping. – And how long should you
feed or nurse your baby before you expect them to fall asleep? Is it five, 10, 15 minutes, hour? – So initially, the babies
are probably falling asleep as they're feeding, and the goal would be to try to detach them
either from the bottle or the breast before
they fall fully asleep, so just as they're getting sleepy.

As they get older,
ideally feeding them well before it's sleep time and
ideally in a different space than where they're normally
going to fall asleep. So in a living room, you
have a six-month-old baby, feed them in the living room and then get them the
last little bit of sleep, calming down before sleep in their room. So you've completely
detached the feeding aspect with soothing to go to sleep. – And then what if you rock
the baby to sleep in your arms and then you put them in the
crib and they start crying? Do you get back to them right away, or do you let them cry for awhile? – I think that's been debated (both women laugh) for centuries. – Since the dawn of man. (laughs) – Since the dawn of men, exactly. It really depends on which
sleep training technique that you feel you and your
partner can proceed with. Most sleep training techniques
do require some sort of crying to allow your
baby to learn how to sleep.

There's the cry it out, the Ferber method, the modified Ferber, there's– – What's the Ferber method? – So that's when you go into the room when the baby is crying and you start off with, say, 10 minutes of
them seeing that you're there but trying not to pick up the baby. And then eventually, then the next time, it's a shorter period of time that you're in there when the baby is crying. Most of the sleep training
methods really focus on not picking up the baby
when the baby is crying. And again, there are different
sleep training methods that will work for the
baby but not the parents and vice versa, so you
have to pick the one that you're going to be
able to sustain longterm because sleep training is
not one time and that's it.

It's really something
that you have to revisit. – It's a learned behavior. – It's learned, and
then also they get sick, there's a time change, you travel, then you always have to
come back to a method, shorter, hopefully, not as long a duration as the initial sleep training. But you always have to be
able to come back to it to get them back on a routine. – At what age do you start to
let the baby cry for a bit? – Yeah, so initially, when
they're ready to be able to go longer periods at
night between feedings, about six to eight weeks of age, trying to lay them down without
having them being eating to go to sleep, that's
a good place to start. And then usually about two to three months is a good time to work
with your pediatrician to make sure that your baby
is ready to be sleep trained, and that's when the discussion
about how long to cry and if to cry and if that method
is gonna work for your family. – If they're crying, how
long should you let them cry? – That's a good question.

So unfortunately, there's
not really a great answer in terms of specific timing. Usually, we try to work
with parents to find out what is the sleep training
technique that they are going to be able to maintain
and be consistent with. Sometimes, many parents are only able to handle five minutes of baby crying. Sometimes, there are some parents that can last an hour of a baby crying, and sometimes that is what it takes.

But you have to work with the family to see what they're able
to do as a partnership but then also to be consistent and to revisit that sleep
training technique later on. – And consistency is key, isn't it? – Consistency is key, support, and partnership is also very important, and then also knowing that this is one of the most important things that you're going to
be teaching your child. And allowing them to
learn how to self soothe and to get an appropriate nighttime sleep is really important for
their future in so many ways. – And when they awaken in
the middle of the night, should you let them cry? For how long? Do you try and let them cry
themselves back to sleep? – Yeah, so ideally, it depends
on how far along you are in the sleep training method. So initially, there's a lot more crying, and then that duration of
crying should be less and less. But there is some crying that is involved when, as you're getting
them to sleep initially and then also every subsequent
time that they wake up.

What you wanna make sure is that there's not some other reason why your baby is crying,
so if they have a fever, if they're teething,
if they've gotten sick. So sometimes you do wanna ensure that the reason that
they're crying overnight is not related to that but is just that they're still learning
how to sleep at night. – And what about having
music or white noise, like the sound of waves in the room to help them fall asleep? – Yeah, so I think for a lot of babies, that can be very soothing. Like with anything that
can become a habit, you wanna make sure you
have an exit strategy, so when you're going to wean it.

So, for instance, American
Academy of Pediatrics actually has found a decreased risk of
SIDS when using the pacifier, less than–
– And SIDS is? – Is Sudden Infant Death Syndrome, in less than six month of age. But again, at what point do
we want to wean that pacifier, because that could be a longterm habit that's hard to eliminate as easily. – And sleep training is not uniform. It could be very different
from one child to the next. – Exactly, and I think
that's what parents have to keep in mind, and that's why there are so many books that are written is because it's not one size fits all. So what worked for your first child may not work for your second child. I think the most important thing is to understand that personalities of children are different,
but consistency, once you do choose a certain
sleep training technique, is the most important factor to success.

– All right, so we referenced
this a couple of minutes ago. Let's come back to this. Psychologists say that during
the first four months of life, the infant is developing trust. So how do you communicate
that trust to your infant? Do you risk breaking that
trust if you rock the baby to sleep and then put the baby in the crib because now you're
separating from the baby? – So when the baby is
ready to be sleep trained, that trust is ideally being
built at other times of the day. So cuddling and snuggling and rocking and interacting with your
baby should be occurring during the daytime as well. But I think the very important thing that you're teaching your
baby by allowing them to self soothe is that
nighttime is for sleep and daytime is for all
of the other activities that really do continue to build trust and solidify that bond
between parent and child.

– What are the signs that
your baby has sleep issues and you now really need
to consult a doctor? – So I think you wanna make sure that, first and foremost, your
baby is ready developmentally to start the sleep training process, so they've shown appropriate weight gain and growing well, they're feeding well. And if there are any
signs of fever, vomiting, not feeding as well during
the daytime or even teething, then you wanna make sure you
involve your pediatrician in the conversation as you
proceed with sleep training. – And the one piece of
advice when your baby sleeps, you should sleep? (laughs)
– Yes. We tell that to patients,
and they roll their eyes as yes, that's right,
I'm not gonna do that. But I think it's really
important initially when your baby's on that 24-hour cycle that you do get a little
bit of sleep in the daytime because that is going to
impact, a month later, your mood, supply of milk;
it impacts so many things.

So I think if the baby's
on the 24-hour cycle, that means that you're on
the 24-hour cycle, too, and then just to be respectful of yourself and allow yourself that space
and know that it's not forever even though it feels
like that on many days. It will come to an end soon. – Any final thoughts,
Doctor, to sum it up? – Yeah, so I think the
most important thing is to work with your
pediatrician to ensure that your baby is ready
developmentally to sleep train and start to allow your
baby to self soothe by detaching the feeding
and allow them just to be laying down when they're
just a little bit sleepy.

And then eventually, three to four months, think about what sort of
sleep training techniques are going to work for your
family and for your baby, partner with whoever you
have around you for support, and then also consistency,
just to be as consistent as you can going forward
knowing there will be days you wanna throw in the towel and
you can't do this anymore. But tomorrow's another day, and you just keep moving forward with it. – Doctor, thank you so much.
– Thank you. – We really appreciate it. – Thanks for having me. – If you want more information
on babies and sleep, please click on the link or
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