Babies Sleeping Through the Night: Is it Clinically Significant?
Pediatric healthcare providers - have you ever asked the parents or caregivers of your patients:
“are they sleeping through the night?”
What if I told you that if you are practicing evidence-based medicine, this question should be omitted from well visits.
“Sleeping through the night” has various definitions:
5 hour stretch (Anders 1979)
8 hour stretch (Henderson et al. 2010)
Yet, many providers & patients believe that it means ~10 hrs of uninterrupted night sleep. The thing is, many healthy infants are not achieving this clinically irrelevant “standard” by 12 months old.
In a recent study, it was found that 37.6% of 6 month old infants were not sleeping six uninterrupted hours & 57.0% were not sleeping eight uninterrupted hours. At 12 months old, 27.9% of babies were not sleeping for six uninterrupted hours & 43.4% were not sleeping eight uninterrupted hours (Pennestri et al. 2018).
Pennestri et al. (2018) found no associations between psychomotor or mental development and sleeping through the night or not. Only a single study noted an association between higher mental development scores in the group with the longest consecutive sleep duration, which is not generalizable to the general population due to the small sample size & focus on preterm infants (Anders, Keener, & Kraemer 1985).
Further, Pennestri et al. (2018) noted an important consideration for clinical care providers: routine questions about infant sleep consolidation may lead to caregivers believing this is the norm.
Beliefs drive behaviors - parents may seek behavioral sleep interventions to “fix” their child’s sleep “problems” that interrupt or cease breastfeeding or even cause undue anxiety (Douglas & Hill 2013). This seemingly mild question may also miss true health issues surrounding sleep.
So, what are some infant sleep questions that have clinical significance?
Is your child getting an appropriate amount of sleep in 24 hours for their age?
Do you have any concerns about your child’s sleep?
Do you can any clinical concerns that may affect sleep? (provide specific symptoms for patients)
Do you feel you are getting the support (professional or personal) you need?
I hope this serves to inform your clinical practice with evidence & compassion - which every patient deserves!
References:
Anders, T. F. (1979). Night-waking in infants during the first year of life. Pediatrics, 63(6), 860–864.
Anders TF, Keener MA, Kraemer H. Sleep-wake state organization, neonatal assessment and development in premature infants during the first year of life. II. Sleep. 1985;8(3):193–206.
Douglas PS, Hill PS. Behavioral sleep interventions in the first six months of life do not improve outcomes for mothers or infants: a systematic review. J Dev Behav Pediatr. 2013;34(7):497–507.
Henderson, J. M. T., France, K. G., Owens, J. L., & Blampied, N. M. (2010). Sleeping through the night: the consolidation of self-regulated sleep across the first year of life. Pediatrics, 126(5), e1081-7.
Pennestri, Marie-Hélène, Christine Laganière, Andrée-Anne Bouvette-Turcot, Irina Pokhvisneva, Meir Steiner, Michael J. Meaney, Hélène Gaudreau, and Mavan Research Team. “Uninterrupted Infant Sleep, Development, and Maternal Mood.” Pediatrics 142, no. 6 (December 2018): e20174330.
Image attribution: Kelly Sikkema
Remember: this post is for informational purposes only and may not be the best fit for you and your personal situation. It shall not be construed as medical advice. The information and education provided here is not intended or implied to supplement or replace professional medical treatment, advice, and/or diagnosis. Always check with your own physician or medical professional before trying or implementing any information read here.
