MODULE 1

Objectives

Overview

• Goals and Concerns
• Parent/Infant Interactions
• Developmental Surveillance
• Screening

Key Components

• Temperament
• "Goodness of Fit"
• Self-Regulation
  • Feeding
  • Sleep/Waking
  • Emotions
  • Distress
• Family Formation
• Families at Risk
• Attachment
• Cognitive Development
• Communication
• Play
• Mastery
• Stimulating Environments
• Child Care

Developmental Checklist

Office Practices

Community Practices

Sleep/Wake Behaviors

Keeping Baby Safe and Sound while Sleeping

Infant sleep patterns evolve over time. Newborns have irregular sleep cycles and may sleep as much as 16 hours a day, often in stretches of just one to two hours at a time. A more consistent sleep schedule emerges as the baby’s nervous system matures and he is able to go longer between feedings.

Questions to Ask

• How is your baby sleeping? What is her sleep/wake schedule?
  
• Where does your baby sleep? What position does she sleep in?
  
• What is your bedtime routine for your baby?
  
• How long is she sleeping at night?
  
• Does your baby ever wake up during the night?

Provider Tips

• Discussion of concerns around a baby’s sleep is often the provider’s first opportunity to demonstrate nonjudgmental support of parents, which will encourage future openness and honesty.
  
• Ask parents about sleeping arrangements. If they are co-sleeping with their baby, be sensitive to cultural practices and use the guidance below to identify hazards of co-sleeping.
  
• Using the guidance listed below, discuss sleep safety issues and the importance of parents establishing bedtime routines.

Guidance for Parents

Sleep Safety

• To reduce the risk of Sudden Infant Death Syndrome (SIDS), always place your baby on her back for sleeping. Keep pillows, toys, and soft bedding out of her crib.
  
• If you are co-sleeping with your baby, be sure you are aware of the hazards that exist when your baby sleeps in bed with you:
  
  • Overlying – you might accidentally roll on top of your baby
    
  • Entrapment – your baby could get trapped between the mattress and headboard or wall
    
  • Suffocation – your baby could get smothered in a waterbed, bedding, or other overly soft surfaces
  • Smoking in bed – can increase the risk of SIDS
• Your baby will be close to you and safe if you put her to sleep in your bedroom but in her own crib. This is the safest place for your baby to sleep. Never allow your baby to sleep in a water bed, chair, or sofa.
  
• Don’t try to wake your baby up for feedings, especially if she is in a deep, quiet sleep. Waking her may be almost impossible, and she probably will not feed well.

Bedtime Routines

• Your baby needs your help in developing regular times for sleeping and being awake. Consistent bedtime and sleep routines that include cuddling, singing, reading, and talking softly help your baby to feel secure, form regular sleep patterns, and eventually sleep longer at night. Share ’her sleep routines with others who care for her so they can maintain consistent routines.
  
• You can help your baby learn to put herself to sleep by placing her in her crib while she is drowsy but not asleep. If your baby wakes at night, check on her and settle her back to sleep. This will help her begin to put herself back to sleep.
  
• In time your baby can learn to console herself and fall asleep by sucking her finger or a pacifier, and rocking her body.

Provider and Family Resources

For the Provider Sleep in the First Year Birth–3 Months The sleep patterns of rapid eye movement (REM) and non–rapid eye movement (NREM) sleep, also called active and quiet sleep, can be demonstrated to the parent during the office visit. During REM (active) sleep, the infant has considerable body activity, visible eye movements under closed eyelids, irregular respiration, and sucking movements. During NREM (quiet) sleep, the infant has almost no body activity, no eye movement, regular respiration, and no sucking movements. Drowsy behavior is also easy to spot, because it appears similar in infants as in adults and is characterized by eyes opening and closing and random body movements, with occasional yawning. There should be about 5 sleep periods per 24 hours and a total of 10–16 hours of sleep, with an average of 13–14. Out of the daily 13–14 hours of sleep, 8–10 hours should be at night. If the family has irregular schedules, the infant’s sleep patterns will be affected. Work toward a healthy solution for everyone. Remind parents that even adults need 8–9 hours of total sleep per day to keep healthy; help parents figure out how to get enough sleep. 3–6 Months Infants sleep approximately 14 hours per 24-hour period, with more sleep at night and 2–3 naps per day. 6–12 Months Infants sleep an average of 12–14 hours per day. They sleep more at night than during the day Source: Barnard KE. 1999. Beginning Rhythms: The Emerging Process of Sleep Wake Behaviors and Self Regulation. Seattle, WA: University of Washington, National Child Assessment Satellite Training Programs. Area of Concern: Sleep Many new parents express concerns about their infant’s sleep patterns. Parents may worry that their infant sleeps too little or too much, or may be frustrated by difficulties in getting the infant to fall asleep or stay asleep throughout the night. Providers can address sleep issues in several ways: Educate parents about the variations in sleep patterns during infancy Assess details of bedtime routines Help parents develop consistent routines Suggest ways to encourage the infant to use self-soothing techniques Consider referral to a developmental or sleep center, if problems persist For the Family Sleep Challenges American Academy of Pediatrics, Cohen GJ (ed.). 1999. Guide to Your Child's Sleep. New York: Villard Books. Fostering Comfortable Sleep Patterns in Infancy