Sleep Requirements
Newborns
• Should sleep on back in crib with flat surface, no pillows or soft items
• In parents’ room for first 6 months
Older babies
• Maintain regular daytime and bedtime schedule
• Start consistent bedtime routine
• Avoid putting baby to bed with a bottle
Sleep Problems
Night terrors
• Parasomnia that occurs in first third of night
• High to extreme autonomic agitation
• High arousal threshold, agitated if awakened
• No daytime sleepiness or recall of event
Nightmares
• Occur in last third of night during REM sleep
• Mild to high autonomic arousal/agitation
• Low arousal threshold, agitated after event
• Can have daytime sleepiness and frequent, vivid recall of event
• Very common
BEARS Screening Tool for Pediatric Sleep Disorders
Sleep associations
• Infant or toddler child has learned to fall asleep only under certain
conditions or has specific sleep associations that require parental
intervention, such as being rocked or fed, which are usually readily
available at bedtime
• During the night, when the infant or toddler awakens, they are not able
to get back to sleep ("self‐soothe") unless those same conditions are
available
90
o The infant then "signals" the caregiver by crying or coming into the
parents' bedroom if the child is no longer in a crib until the
necessary associations are provided
o Ferber method advocates that at bedtime child is put in bed while
they are drowsy, but still awake, to help them learn how to fall
asleep on their own (self‐soothe)