Naps

11/9/2020

Last week we talked about setting up good sleep foundations. One way to help set up good night sleep is to make sure your child is not overtired. This requires napping during the day for most children under the age of 3 and for some children up to the age of 5. Most adults would love a day-time naps, but babies and toddler, not so much! Babies and toddlers sometimes like to refuse naps or have a hard time napping.

We are going to discuss things you can do to help your child go down easier for a nap and nap longer. We ill also discuss nap transitions.

NAPPING NORMS

Your child’s nap schedule will actually depend on your child’s awake time tolerance. Before 4-6 weeks, babies have short wake times that are mostly spent feeding so nap very frequently. It is important to follow the lead of your newborn. After 4-6 weeks they can extend their wake time. Wake times always includes any time spent feeding your baby. Here are average wake times for babies:

0-4 weeks: 20-60 minutes
4-12 weeks: 60-90 minutes
3-4 months: 75-120 minutes
5-6 months: 2-3hours
7-14 months: 4-6 hours
14-24 months: 5-6 hours

Based on awake times here are average naps for age:

4+ naps; less than 4 months
3 naps: 4-8 months
2 naps: 8-17 months
1 nap: 13-24+ months

If your baby is premature (before 37 weeks) you should use their adjusted age to determine sleep times. That means if your baby Is 12 weeks old but was born 5 weeks early, you would treat your baby like they are 7 weeks old with regards to sleep times.

Sometimes that 3rd nap for 4-8 months old is a “cat nap” that helps get them through bedtime. Dinner can be a nightmare without it but often this is the nap that is hardest to get babies to sleep. Do not worry about using motion such as a walk or a carrier to get this nap in. And remember outdoor light during this time actually HELPS your baby sleep better at night so feel free to get outside! For babies coming home from daycare, a car nap on the commute home can be just enough to allow well-rested wake time so that you can enjoy dinner and a bedtime routine before they go to bed. We’ve all seen babies falling asleep in their highchair. A car nap or a late afternoon nap will help prevent this from occurring and ensuring a calm and easier bedtime.

Babies consolidate night sleep first but around 5-6 months most babies start to consolidate their naps. This is the age naps will become more routine in nature and your baby will be easier to put down. Also, if you have been laying strong sleep foundations (see previous blog post), your baby will more easily be able to self-soothe.

NAP SCHEDULE SUGGESTIONS

5-6 MONTHS

6:30am Wake, Feed, Play

8:30-9:30am Nap 1

9:30am Feed

11:45am Feed

12pm-2pm Nap 2

2:30pm Feed

4:30-5:15pm Nap

5:15pm Feed

7:15pm Feed

7:30pm Bedtime

7-14 MONTHS

6:30am Wake and Feed

9:30-10:30am Nap 1

10:30am Feed

1::15pm Lunch

1:30-3:30pm Nap 2

4pm or 5pm: Feed

7 pm Feed

7:30pm Bedtime

2 to 1 NAP TRANSITION

6:30am: Wake and Feed

9am: Snack

10:30-12pm: NAP because your baby showed tired cues

12:30pm Lunch

3:30pm Snack

3:45pm-4:15pm Short Nap to get to bedtime

5pm: Dinner

8pm: Bedtime (later due to extra afternoon nap)

13-24 MONTHS-ONE NAP

6:30am Wake and Feed

9 am: Snack

11am Lunch

11:30-2:30pm Nap

2:30 pm: Snack

5pm Dinner

7pm Bedtime

Remember these are just suggestions. Use your child’s cues to determine the best routine for them. And remember to be flexible in response to short naps., rough naps, or early waking. This includes moving bedtime earlier, adding a short nap during transitions, or moving the schedule forward if the previous nap was not restorative.

TIPS FOR SUCCESSFUL NAPS

We all know a bad nap can ruin the day. A bad nap will result in a cranky baby or an overtired baby. A cranky baby or an overtired baby often does not sleep as well at night. How can we help our kids have better naps?

Routine

Just like night sleep, a routine is important for nap time too. Babies as young as 8 weeks can recognize the cues of a routine. A shortened version of your night routine or a special nap routine can be helpful. Routines can include changing into “sleeping” or comfortable clothes, potentially using their night swaddle or sleep sack, reading a short book, turning the sound machine on, turning lights off and darkening the room. Babies that sleep in a very dark room for their nap sleep better. Light stimulate their brain and suppresses melatonin, a hormone needed for sleep. Babies that consistently get naps in the dark are actually BETTER at being flexible and when needed can sleep in rooms that are light, for example on vacation or on a day where a home nap is not possible. The room is dark enough if you can’t see your hand in front of you.

If your baby is in daycare, following a routine of your choice may not be an option. Your daycare may have their own routine. Speak with your daycare provider about what nap times will be like for your child and what of your routine they feel comfortable or are allowed to incorporate. Most children in daycare have an adjustment period where they resist napping but almost all of these babies are sleeping well at daycare within a few weeks and end up great and flexible nappers!

One of the most important parts of a routine is consistency. It is also important to have a consistent location for naps. By 4 months 80% of naps should take place in your baby’s crib or a certain spot at daycare. Before 4 months you want to practice naps in cribs but may need to have naps outside of the crib to work on soothing skills. And because life needs to be flexible some naps outside of a crib are totally fine. Car naps are often not as restful as crib naps. We’ve all slept in a car or plane an know that that sleep is never as restorative as being in your bed. If your baby sleeps in the car or on the move, just know their next awake time may be shorter and their next nap may need to be longer.

Awake Time

Awake time is the time you spend feeding, playing, and interacting with your baby. This is important time for your baby to practice and learn new skills. We want our babies to be active during awake time because we need our babies o be tired enough to need to nap. Activity choices are age dependent but can include talking, singing, taking a walk, working on tummy time, outdoor play, swimming, playing with toys, reading, or attending infant or toddler classes. Active awake time is important because a bored baby looks very much like a tired baby and can make it harder for you to read your baby’s sleep cues.

Because there is a range of awake time a baby can tolerate, their awake time tolerance will determine how often your baby naps. Your baby needs the right amount of sleep for YOUR baby. Don’t worry if your baby needs more or less sleep than other babies their age. If your baby is sleeping well, well rested, growing and thriving, then you do not need to change anything.

Not only is awake time different for different children, awake time can be variable throughout the day for your child. Sometimes your baby will have a short awake time first thing in the morning. This seems counterintuitive after a long night of sleep. The amounts of awake time after the 3rd nap can also be shorter than normal awake times. A baby;s awake time will also be based on activity level, previous nap quality or night sleep quality. Do not worry about the pattern of awake times. Aim for the age appropriate awake times but follow your baby’s sleep cues!

Sleep Cues

Because awakes times are variable for different babies and because your baby may have different length awake times on different days or even within the same day, it is important to get to know your baby’s sleep cues. When babies start to show sleep cues at the end of their awake window, you want to move toward a nap. If they pass that point or they have very subtle awake cues, you can move into that “second wind” where your baby is overtired and is harder to get to sleep.

Sleep Cues can include:

• TIRED:

o staring off into space
o pink eyebrows
o starts looking away from you more than engaging with you

• READY FOR NAP:

o Fussy
o big yawns
o rubs eyes

• OVERTIRED:

o Screaming
o rigid/stiff body
o pushes away from you when you are holding them

Learning about your baby takes time and everyone misses that window at some point. If your baby is overtired and unable to fall asleep, your goal should be to get that baby to sleep! Remember, a well-rested baby will sleep better at night or have better future naps that day. Your baby may need more or less soothing when overtimes based on their age, with younger babies needing more help soothing than older babies or toddlers. Some children even do better being allowed some “fussy” time in the crib. This is different than letting them cry. This cry won’t have “heart” behind it and will sound more like an engine and be more rhythmic in nature. Often during this winddown, they will fall asleep and often, trying to hold them or help them during this time actually makes it harder for them to sleep. If you do need to soothe your baby, you may need to provide extra snuggles, rock or walk your baby a bit longer, or you may need to have that nap outside of the crib in a carrier or a stroller.

SOOTHING

Just like with night sleep, a baby needs to be taught self-soothing. By working on soothing our babies and practicing self-soothing, they will be able to use those skills to fall asleep on their own. When practicing naptime self-soothing skills, start with the first nap of the day. This nap is the nap where your baby will be easier to get to sleep and more likely to be able to self sooth. The 3rd nap is the hardest and shortest nap. It will also be the one that may need the most soothing from you for your baby to fall asleep.

Soothing may also be needed if your baby has a short nap. A short nap is anything less than 45-50 minutes in a baby 5 months or older. It is developmentally appropriate for a baby to have naps that range from 20 min to 2 hours before 5 months of age. A short nap is the result of your baby coming out of the sleep cycle (nap cycles are shorter than night cycles) and not getting into the next nap cycle. Our goal is for good long restorative naps. Therefore, work on soothing your baby back to sleep. This may include rocking, holding, or replacing a pacifier. This will also be easiest to work on during the first nap because like above they are the easiest to get to sleep at that time and that is the nap that naturally lengthens first. Remember that 3rd nap is a short nap of only 30-45 minutes so there is no need to extend this nap.

Our goal in the early days is to preserve naps so that we have a well-rested baby. Remember an overtired baby wakes up more at night, then has poor naps the next day, and this creates an ongoing cycle. Working with your baby to help soothe them and teach self-soothing skills before 6 months will result in a baby who will have longer consolidated restful naps AND better nap time sleep. Also, a well-rested baby who can self-soothe is more like to be able to easily put themselves to sleep in their own crib. Soothing and practicing self-soothing can be a lot of work in the beginning but the rewards of a well-rested baby and well rested parents are worth it!

WAKING A BABY

Should you every wake a baby! Yes!!! A baby that sleeps TOO much during the day won’t sleep well at night. And remember our goal is to maximize daytime calories so feeds every 3-4 hours are necessary. Most babies should not nap longer than 2 hours at a time during the day until they go down to 1 nap. A rare baby that takes 2 naps will do a very short morning nap and a longer afternoon nap (2-3 hours) as they get closer to going down to 1 nap a day. If your baby is well rested and sleeping well at night, this is okay to continue.

Too much nap time can result in less night sleep. Restorative sleep at night is so important this should be the priority. But how much daytime sleep is too much:

• over 4 and ½ hours for a baby 4 to 5 months old

• over 3 and ½ hours for a baby 5 to 8 months old

• over 3 hours for a baby 7 to 24 months old

NAP CHANGES

We frequently are asked about infants and toddlers dropping naps either from 3 to 2 or from 2 to 1. First off, your child needs the amount of sleep that is best for them. Do not rush this change. Look for signs your baby is ready to drop a nap. Signs your baby is ready to drop a nap include:

• Bedtime is pushed back from their normal (this means the last nap is TOO restorative)

• Putting your child down for a nap or bedtime is taking a lot longer than usual

• They do not seem tired at their normal nap times or bedtime

• They are waking up earlier than usual in the morning

• They are waking frequently at night

• They are taking shorter naps than usual

• Your child is resisting their 2nd nap for 3-4 days per week for 2 weeks

But how can you help your child make the transition to a new nap schedule?

• Gradually increase your baby’s awake time in 10-15 minute increments

• When they show tired cues change the activity they are doing

o Get outside even for a short while
o Take a walk
o Try a new toy

• Try to keep your ROUTINE consistent and SCHEDULE flexible

• During the transition avoid an accidental car or stroller nap! Even 10 minutes may mess up their nap schedule

• Know that an earlier bedtime may need to occur for a few weeks to help with this change

• When they show tired cues change their activity to help lengthen their awake time

o Try getting outside
o Take a walk
o Try a new toy
o Change their position: tummy time, floor, mat, seat, bouncer

Daycares sometimes shift kids to 1 nap a day once they are 12 months or move into a toddler room. This might not happen at the ideal time for your child. Many children learn to adapt but we find a few need to add a short car nap on the way home or need an earlier bedtime during this transition. We also sometimes see that a baby who takes 1 nap at daycare needs 2 naps when they are home on weekends or home days.

Good day time sleep helps your baby rest better at night. Good night sleep helps your baby nap better during the day. And a well-rested baby means well rested parents! With good rest, we make sure our baby has the foundation set for growth and development. We also reduce the risk of chronic illness and mental health issues in both our child and ourself. But knowing the important of sleep doesn’t mean your baby is on board with that plan. Next week we will troubleshoot sleeping issues and possible solutions.

Children’s Health Care of Newburyport, Massachusetts and Haverhill, Massachusetts is a pediatric healthcare practice providing care for families across the North Shore, Merrimack Valley, southern New Hampshire, and the Seacoast regions. The Children’s Health Care team includes pediatricians and pediatric nurse practitioners who provide comprehensive pediatric health care for children, including newborns, toddlers, school aged children, adolescents, and young adults. Our child-centered and family-focused approach covers preventative and urgent care, immunizations, and specialist referrals. Our services include an on-site pediatric nutritionist, special needs care coordinator, and social workers. We also have walk-in appointments available at all of our locations for acute sick visits. Please visit chcmass.com where you will find information about our pediatric doctors, nurse practitioners, as well as our hours and services.