Healthy Sleep
Good quality sleep is important for everyone but especially for children as it directly impacts on their mental and physical development.
Good sleep helps to improve attention, behaviour, learning and memory.
Useful links and resources
Having a baby or child who doesn't sleep well can be difficult. Below are some tips on coping and some resources that have further information and advice that might help you.
Helping parents to cope.
Encourgaing and maintaining good sleep routines and habits for children can be tough for parents who are themselves tored at the end of the day. Things may get worse before they get better, if the child resisits the new approach.
- Planinng is important. If parents are working or if school age siblings may be disturbed, they may have better chance of sucess during annual leave or school holidays.
- Mutual support is important. Agree a strategy that all parents and caregivers can work with.
- Contact your health visitor who can give you advice on sleep that is specific to the needs of your body.
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When should you worry?
Newborn
NEWBORN
Contact your health visitor or GP if your baby is newborn and they…
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm into their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You may also find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy, or have floppy arms or legs when awake
- Move their arms and legs in repetitive jerky movements, or writhing movements
- Don’t have a Grasp Reflex (doesn’t grab your finger or small object when you put it in their hand)
- Are often startling and you cannot understand why
- Move one side of their body more than the other, for example:
- Rarely moves one of their arms compared to the other arm
- Rarely moves one leg compared to the other leg
- When your baby startles, one side moves or looks different from the other
6-8 weeks
6-8 WEEKS
Contact your health visitor or GP if your baby is 6-8 weeks and they…
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm into their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You may also find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy, or have floppy arms or legs when awake
- Move their arms and legs in repetitive jerky movements, or writhing movements
- Have not started to bring both their hands to their face, or do not move their arms much
- Keep their hands fisted, and you find it difficult to open their hands
- Can’t lift their head when lying on their tummy
- Move one side of their body more than the other, for example:
- Mostly moves one arm or mostly brings one hand to their face
- Rarely kicks or moves one leg compared to the other leg
2-3 months
2-3 MONTHS
Contact your health visitor or GP if your baby is 2-3 months and they…
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm into their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You may also find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy, or have floppy arms or legs when awake
- Move their arms and legs in repetitive jerky movements, or writhing movements
- Have not started to bring both their hands to their face, or do not move their arms much
- Keep their hands fisted, and you find it difficult to open their hands
- Can’t lift their head when lying on their tummy
- Move one side of their body more than the other, for example:
- Mostly moves one arm or mostly brings one hand to their face
- Rarely kicks or moves one leg compared to the other leg
3-4 months
3-4 MONTHS
Contact your health visitor or GP if your baby is 3-4 months and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy when awake
- Prefer to keep their arms by their sides. For example, they do not reach for things, or do not bring their hands together over their face or tummy
- Move their arms or legs in repetitive, jerky, or strange ways
- Still need you to support their head, or can’t lift their head when lying on their tummy
- Have very tight fists and it’s hard to open their hand
- Move one side of their body more than the other, for example:
- Rarely use one of their arms to pick up toys
- Rarely kick one leg compared to the other
4-6 months
4-6 MONTHS
Contact your health visitor or GP if your baby is 4-6 months and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy when they are awake
- Move their arms or legs in repetitive, jerky, or strange ways
- Move one side of their body more than the other, for example:
- Rarely use one of their arms to pick up toys
- Rarely kick one leg compared to the other
- Are unable to roll, or can roll in one direction but not the other
- Find it difficult to reach their arms out. For example, they do not reach for toys
- Still have their early reflexes, like the startle reflex and grasp reflex
- Keep their legs flat when lying on their back. For example, they do not bring their feet to their chest
- Still need you to support their head
6-9 months
6-9 MONTHS
Contact your health visitor or GP if your baby is 6-9 months and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy when they are awake
- Move their arms or legs in repetitive, jerky or strange ways
- Move one side of their body more than the other, for example:
- Rarely use one of their arms to pick up toys, or eat and drink
- Rarely kick one leg compared to the other
- Can’t sit without support. For example, they lean on their hand, or, when they sit, their back is very curved
- Still have their early reflexes, like the startle reflex and grasp reflex
- Keep their legs flat when lying on their back, for example, do not bring their feet to their chest
- Still need you to support their head
- Still need you to help turn their head when lying on their back
- Can’t crawl, or find it hard, for example, drags one of their legs behind them
- Find it difficult to stand, for example:
- Can’t stand with support
- Doesn’t try to pull themselves up to stand
- Can’t move a toy from one hand to the other
- Doesn’t use both hands to hold larger things
9-12 months
9-12 MONTHS
Contact your health visitor or GP if your baby is 9-12 months and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy when they are awake
- Move their arms and legs in repetitive, jerky, or strange ways
- Use one side of their body more than the other, for example:
- Lean to the side when they sit
- Use one arm to pull to stand more than the other
- Rarely use one of their arms to pick up toys, or eat and drink.
- Rarely kick one leg compared to the other
- Find it difficult to sit, for example:
- Only sit with support
- Lean on their hand when sitting
- When they sit their back is very curved
- Can’t move a toy from one hand to the other
- Don’t use both hands to hold larger things
- Don’t point to objects
- Can’t crawl, or find it hard, for example, drags one leg behind them
- Find it difficult to stand, for example:
- Can’t pull themselves up to stand
- Find it hard to pull themselves up. For example, they only use their arms and don’t push with their legs
- Can’t stand with support
2 months
Your Baby By Two Months
Social/Emotional Milestones
- Calms down when spoken to or picked up
- Looks at your face
- Seems happy to see you when you walk up to her
- Smiles when you talk to or smile at her
Language/Communication Milestones
- Makes sounds other than crying
- Reacts to loud sounds
Cognitive Milestones (learning, thinking, problem-solving)
- Watches you as you move
- Looks at a toy for several seconds
Movement/Physical Development Milestones
- Holds head up when on tummy
- Moves both arms and both legs
- Opens hands briefly
4 months
Your Baby By Four Months
Social/Emotional Milestones
- Smiles on his own to get your attention
- Chuckles (not yet a full laugh) when you try to make him laugh
- Looks at you, moves, or makes sounds to get or keep your attention
Language/Communication Milestones
- Makes sounds like “oooo”, “aahh” (cooing)
- Makes sounds back when you talk to him
- Turns head towards the sound of your voice
Cognitive Milestones (learning, thinking, problem-solving
- If hungry, opens mouth when he sees breast or bottle
- Looks at her hands with interest
Movement/Physical Development Milestones
- Holds head steady without support when you are holding him
- Holds a toy when you put it in his hand
- Uses his arm to swing at toys
- Brings hands to mouth
- Pushes up onto elbows/forearms when on tummy
6 months
Your Baby By Six Months
Social/Emotional Milestones
- Knows familiar people
- Likes to look at self in a mirror
- Laughs
Language/Communication Milestones
- Takes turns making sounds with you
- Blows “raspberries” (sticks tongue out and blows)
- Makes squealing noises
Cognitive Milestones (learning, thinking, problem-solving)
- Puts things in her mouth to explore them
- Reaches to grab a toy she wants
- Closes lips to show she doesn’t want more food
Movement/Physical Development Milestones
- Rolls from tummy to back
- Pushes up with straight arms when on tummy
- Leans on hands to support herself when sitting
9 months
Your Baby By Nine Months
Social/Emotional Milestones
- Is shy, clingy, or fearful around strangers
- Shows several facial expressions, like happy, sad, angry, and surprised
- Looks when you call her name
- Reacts when you leave (looks, reaches for you, or cries)
- Smiles or laughs when you play peek-a-boo
Language/Communication Milestones
- Makes a lot of different sounds like “mamamama” and “bababababa”
- Lifts arms up to be picked up
Cognitive Milestones (learning, thinking, problem-solving)
- Looks for objects when dropped out of sight (like his spoon or toy)
- Bangs two things together
Movement/Physical Development Milestones
- Gets to a sitting position by herself
- Moves things from one hand to her other hand
- Uses fingers to “rake” food towards himself
- Sits without support
1 year
Your Baby By One Year
Social/Emotional Milestones
- Plays games with you, like pat-a-cake
Language/Communication Milestones
- Waves “bye-bye”
- Calls a parent “mama” or “dada” or another special name
- Understands “no” (pauses briefly or stops when you say it)
Cognitive Milestones (learning, thinking, problem-solving)
- Puts something in a container, like a block in a cup
- Looks for things he sees you hide, like a toy under a blanket
Movement/Physical Development Milestones
- Pulls up to stand
- Walks, holding on to furniture
- Drinks from a cup without a lid, as you hold it
- Picks things up between thumb and pointer finger, like small bits of food
RED
RED
AMBER
AMBER
AMBER
AMBER
Green
Green
Advice and Guidance
Baby Sleep Info Source (Basis)
Adapted from Galland et al (2012) “Normal Sleep Patterns in Infants and Children: A Systematic review of Observational Studies”. Sleep Medicine Reviews 16(3):213–22
Newborn babies may sleep anywhere between 12 and 20 hours a day. Younger infants up to 6 months tend to sleep on and off around the clock, waking every 1–3 hours to feed.
The older they become, the more they may have a day/night cycle, but this is not guarante
Is it normal for babies to wake at night?
- Yes. It is normal for babies to wake during the night. Some babies sleep much more than others. Some sleep for long periods, others in short bursts. Some sleep through the night, some don't for a long time. Your baby will have their own pattern of waking and sleeping, and it's unlikely to be the same as other babies you know.
- All babies over 5 months of age will stir 4–6 times during the night as they come to the end of each sleep cycle. This is normal, it's the falling back to sleep that can be difficult.
Daytime naps advice:
- Daytime naps provide much needed downtime that aids the important physical and mental development that happens in early childhood.
- They help keep babies and young children from becoming overtired, which can affect their mood and make it harder for them to fall asleep at night.
There’s no single rule about how much daytime sleep infants need.
If your child is napping ‘on the go’ (for example in the car) try to ensure that this is balanced by daytime sleep in their own bed at home so that they get good quality daytime sleep over the course of a week.
Do babies and young children automatically fall into a good sleeping pattern?
- No. All babies and children need to be supported to develop a good sleep routine and good sleeping habits. It is a process that will take time and can’t be achieved in a few days. This can be a struggle, especially when you are sleep deprived and feel constantly tired yourself.
- All babies are different and will start sleeping through at different times. There also needs to be a degree of flexibility around sleep routines.
- You may find that if babies early on appear to sleep through the night, this will change over time and many will start night waking again as they get older.
What routines and habits promote good sleep?
There are many practical ways to develop and help improve your child’s sleeping routine and habits.
- Sleep during the early months occurs around the clock and the sleep-wake cycle is driven by the need to be fed, changed and given attention.
- During sleep, they are often active, twitching their arms and legs, smiling, sucking and generally appearing restless. Some babies may sleep with their eyes partially open.
- Infants express their need to sleep in different ways. Some fuss, cry or rub their eyes.
- Children benefit from being allowed to settle to sleep on their own while awake but drowsy. If children learn to settle independently, they will be more likely to self soothe back to sleep after natural night awakenings.
Bedtime routine:
- Develop regular daytime and bedtime schedules; maintain consistent sleep and wake times
- Create a consistent and enjoyable bedtime routine
- Establish a regular ‘sleep friendly’ environment (see advice below)
Sleep tips:
- Observe sleep patterns and identify signs of sleepiness.
- Put newborn in a cot or Moses basket (even during the day) when they are drowsy, and not asleep, to encourage self-settling.
- Encourage night time sleep; as evening approaches try to make the environment quieter and lighting dimmer with less stimulation.
Safer sleep tips:
Simple steps can be taken to ensure that your baby sleeps in a safe environment, which will reduce the risk of sudden infant death syndrome (SIDS), commonly known as cot death.
- ❌ Never co-sleep on a sofa/armchair
- ❌ Never co-sleep if you have smoked or have used alcohol, medication or drugs
- ✅ The safest place for babies to sleep is in their parents’ room, but in their own bed for at least the first six months
- ✅ Place babies on their back for every sleep
- ✅ Babies should sleep on a firm and flat mattress, and the sleeping area should be clear of toys, cot bumpers and duvets; at home and when staying with family and friends
- ✅ When transitioned into own room, the safest place is in a cot or cot bed with all sides up
- ✅ Babies need to be a comfortable temperature. A room temperature of 16–20°C – with light bedding or a lightweight, well-fitting baby sleep bag – is comfortable and safe for sleeping babies
- ✅ Ideally lights off, or at least dimmed. LEDs emit much more blue light than white bulbs and therefore have a greater impact on quality sleep, so ensure these are switched off
- ✅ There does not need to be silence, and it can be helpful for your baby to get used to some noise, though noise needs to be at a level that it does not disrupt sleep
- ✅ A smoke free environment is safest for babies and children
My child is tired, so why won’t they sleep?
If a child is happy, comfortable, and tired, problems falling asleep are likely to be behavioural (such as bedtime resistance) or environmental (such as noise).
I’ve tried all of the above and my baby is still waking frequently!
Some babies take longer than others to respond to a routine and settle into good sleep habits. Look after yourself. Almost all adults find interrupted sleep makes them feel tired and irritable, and relationships can suffer.
Sleep Apnoea
Snoring itself is a very common. It occurs in around 10% of children and not at all children who snore have OSA. Things that can be causing snoring including be overweight, full floppy muscles and some medical conditions.
What is obstructive sleep apnoea?
Obstructive sleep appenoia or OSA is a typical type of sleep problem. It affects breathing during sleep.
All muscles relax through sleep. This includes the muscles around the throat and upper breathing tube (Airways). When this happens there is less air moving in and out of the Airways. This can cause pauses in breathing. These are causes that are called Apnoeas.
What causes OSA?
OSA affects around 3% of children. Most common causes of OSA are big tonsils in the back of the throat or adenoids in the back of the nose.
Some problem make OSA more likely. These include conditions that increase floppiness of the throat and airway muscles. Examples of this are Downs syndrome or being overweight. Hayfever or long-term allergies can increase obstruction inside the nose. Facial problems and muscle weakness diseases, such as cerebral palsy can also cause OSA
How do I know if my child has OSA?
OSA can be noticed if a child's snores. Importantly snoring occurs together with pauses in breathing in OSA.
Children with OSA sleep poorly at night. They may be tired or irritable during the day. They can also have learning or behaviour problems.
Key signs and symptoms of OSA are
During sleep at night:
- Louds snoring with poses in breathing,
- gasping or difficulty breathing,
- Restlessness and unsattered,
- Mouth breathing (instead of through their nose),
- Sleeping in unusual position,
- Excessive sweating,
- Bedwetting
During the daytime
- Difficulty waking up and feeling tired in the mornings
- Complaining of morning headache
- Tiredness and irritability
- Difficulty concentrating in school
- Behaviour and learning problems
- Blocked nose.
When should I see my GP?
You should ask to your GP if you think your child might have OSA. The GB memory for your child to a specialist if they think there is a problem.
Any videos you have a child during sleep can be very helpful.
What tests help to diagnose OSA?
An overnight oxygen statue reaction study (oximetry) may be done at home. This can help you see if a sleep study is needed. A sleep study can help diagnose OSA. This is usually than overnight in the hospital and the parent and stay too. The sleep study measures carbon dioxide and oxygen levels heart rate and muscle activity.
What is the treatment for OSA?
Treatment for OSA depends on the cause, children may need: weight and dietary management, treat hey fever or allergies operation on tonsils and or adenoids
- Weight and dietary management,
- Treat hayfever or allergies
- Operation on tonsils and/or adenoids
Self care and Prevention
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