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Improving sleep with mom (and baby) in mind: Strategies for clinicians



This poster provides information for clinicians about normative sleep development and easy strategies that they can offer to mothers with postpartum mood challenges. Information is developmentally-focused and considers the whole family system.
Strategies for
“Easy” sleep skills for
babies under 6-months.
Get sleep in any way that
works. “Habits” can be easily
shifted when the baby has the cognitive and regulatory ability to
manage sleep transitions more independently—after 6-months.
Room-share or use a cosleeper to make nursing and getting back to
sleep quick and easy.
Gently experiment with drowsy-but-awake without crying at
bedtime. See if the parent can put the baby down still a tiny bit
awake. If not, parents shouldn’t worry. They can try again later.
Awake # of Daytime Nighttime
Age Window Naps Sleep Sleep
0-5 mos 60-90min 4-5 Varies 8-1/2-11 hrs
6-8 mos 90-min-2+hrs 3 3-1/2 hrs 11 hrs
9-10 mos 2-3 hrs 2 3-1/2 hrs 11 hrs
11-12 mos 3-4 hrs 2 2-1/2 hrs 11 hrs
Sleep develops as the brain develops...
Windows of “awake time” starts small and grows slowly
across the first three years.
Exceeding the child’s awake window can result in a
“second wind” which can make ALL sleep more difficult.
Frequent “regression periods” are normal sleep disruptors as
new skills emerge and brain development surges (Chugani,
1998; Sadurni, Pérez Burriel, & Plooij, 2010; Schore, 2003).
The 4-month sleep regression can cause even previously
good sleepers to wake frequently at night.
Self-soothing skills and sleep regulation also develop
as the brain develops...
The ability to self-soothe once upset depends on a toolbox of
cognitive and motor skills that are limited at young ages.
The amount of distress an infant can manage without help is
highly dependent on age and temperament (Kopp, 1989).
Improving Sleep with Mom (and Baby) in Mind:
Strategies for Clinicians
Macall Gordon, M.A. (Antioch University, Seattle; Certified Pediatric Sleep Consultant)
Jen Varela (Certified Pediatric Sleep Consultant, San Diego, CA)
Kim West, LCSW-C (Sleep Lady Solutions)
Related strongly to
depressive symptoms via
fatigue, but also due to
the violation of expectations
and challenges to self-
efficacy and self-concept.
Sleep is more than just behavior
Infant Variables
Silent reflux
Can cause pain that keeps babies
awake and uncomfortable with-
out visible “spitting up.”
Persistent fussiness/crying
Intense crying on being laid
flat (especially after feeding)
Back arching during nursing
Sleeps best on an incline
Nurses best when drowsy
Doesn’t sleep well anywhere
(in arms, carrier, seat) For more information:
Jen Varela
Macall Gordon, MA
Research has shown
that just providing
support improves
sleep ...
by reducing
and increasing
Normative sleep development
Expectations vs. Reality
Information from books,
websites, etc. can raise
expectations, as well as worry
that they are not “doing it right”
or “have blown it already.”
Advice on expectable sleep for infants is not consistent
with developmental science.
A majority of sleep books recommend starting sleep
training by 4-months or earlier.
Advice promoting crying-based sleep training techniques
on infants under 6-months is not evidence-based.
Parental Variables
Obstructed breathing/Apnea
Symptoms (rare in infants):
Snoring, mouth breathing (not
associated with cold)
Sweaty head upon awakening
Very restless sleep
Feeding issues
Check with Lactation Consult-
ants to rule out:
• Tongue/lip-tie
• Feeding problem
• Dietary intolerance or allergy
Low ferritin stores
Also uncommon, but can cause
disrupted sleep architecture and
later symptoms of Restless Legs
Syndrome (Peirano et al., 2010).
Sleep Targets in the First Year
Low sensory threshold -
Can’t buffer out sound/activity.
Easily overstimulated.
Intensity/Reactivity - Cries
vigorously; difficult to soothe.
Alertness - Very aware, often has
subtle or no sleepy signals.
Persistence - Does not easily
give up. Doesn’t respond to
Known mental health
contributor to infant sleep
• Depression
• Anxiety
Traumatic birth
Low self-efficacy
Childhood trauma/
“ghosts in the nursery”
Lack of social support
Level of partner support
Marital conflict
Maternal sleep issues
Mental Health and the Transition to Parenthood
What to do when it’s a “sleep crisis”...
(infants under 6-months)
Dad/Partner to the rescue: Have a partner
take a block of nighttime.
Marshal social support: Anyone who can help
and/or give mom some extra sleep.
Night nurse/doula: Get some professional
support to get a night or two of solid sleep.
How can sleep consultants help?
As a point of entry. Parents come to sleep consultants with
problems that may actually be psychologically or physiologi-
cally rooted.
As “boots on the ground”. Trained consultants can work in
concert with mental health clinicians. Consultants provide
ongoing support and modifications as they track progress.
Not all coaches are the same. Check training,
credentials, and philosophy/approach.
Sleep strategies for over 6-months
1. Fill up the nap bank. Make sure naps are adequate and bed-
time is early.
2. Rule out physiological difficulties and assess temperament.
3. Suggest a very gradual approach to scaffold sleep skills.
Parents can stay with the child and pick up if too upset.
In a stepwise way, reduce the amount of input, or physical
4. If parents are exhausted, work only on bedtime.
Then add middle of the night. Tackle naps last.
Adapted from “Good Night, Sleep Tight” by Kim West, LCSW-C
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