What strategies can improve sleep in a 2-month-old infant?

From the Guidelines

To improve sleep in a 2-month-old baby, it is crucial to prioritize a safe sleep environment, as recommended by the American Academy of Pediatrics, which includes supine positioning, use of a firm sleep surface, room-sharing without bed-sharing, and avoidance of soft bedding and overheating 1.

Key Strategies for Improving Sleep

• Establish a consistent bedtime routine that includes activities like bathing, gentle massage, feeding, and quiet time to signal to the baby that it's time for sleep.
• Create an optimal sleep environment that's dark, quiet, and maintained at a comfortable temperature between 68-72°F, which can help improve the quality of sleep.
• Feed the baby adequately during the day to reduce nighttime hunger, and consider dream feeds before going to bed to ensure the baby's nutritional needs are met without disrupting sleep patterns.
• Swaddling can help babies feel secure and reduce startle reflexes that wake them, though it's essential to always place swaddled babies on their backs to minimize the risk of SIDS, as emphasized in the updated 2016 recommendations for a safe infant sleeping environment 1.
• Pay attention to sleep cues like eye rubbing or fussiness to avoid overtiredness, which can make it harder for the baby to fall asleep and stay asleep.

Safety Precautions

• Infants should be placed on a firm sleep surface, such as a mattress in a safety-approved crib, covered by a fitted sheet with no other bedding or soft objects to reduce the risk of SIDS and suffocation, as highlighted in the evidence base for 2016 updated recommendations 1.
• Avoid using soft mattresses, including those made from memory foam, as they could create a pocket or indentation and increase the chance of rebreathing or suffocation if the infant is placed in or rolls over to the prone position.
• Room-sharing without bed-sharing is recommended, as it allows for close monitoring of the infant while reducing the risk of SIDS and other sleep-related infant deaths, in line with the recommendations from the American Academy of Pediatrics 1.

Additional Recommendations

• Breastfeeding is recommended, as it has been associated with a reduced risk of SIDS, and routine immunization should be followed as per AAP and CDC recommendations to ensure the baby's overall health and well-being 1.
• Avoid exposure to smoke, alcohol, and illicit drugs, as these can significantly increase the risk of SIDS and other sleep-related infant deaths, emphasizing the importance of a safe environment for sleep 1.
• The use of a pacifier at naptime and bedtime can be considered, as it has been shown to reduce the risk of SIDS, though it's crucial to follow proper guidelines for pacifier introduction and use 1.

From the Research

Strategies to Improve Sleep in Infants

To improve sleep in a 2-month-old infant, several strategies can be employed:

• Establishment of a consistent bedtime routine, which has been shown to improve multiple aspects of infant sleep, including wakefulness after sleep onset and sleep continuity, as well as maternal mood 2.
• Implementation of a massage-based bedtime routine, which can result in improvements in child and mother night wakings, maternal perceptions of child sleep and mood, and improvements in maternal sleep quality 3.
• Institution of a nightly bedtime routine that includes a bath, massage, and quiet activities, which can lead to rapid improvements in sleep onset latency, frequency and duration of nighttime awakenings, sleep consolidation, and maternal perceptions of bedtime ease, sleep quality, and infant mood 4.

Safe Sleep Practices

In addition to bedtime routines, safe sleep practices are crucial for infant sleep:

• Placing the infant in a safe position in a flat bassinet and in a safe environment, which can be promoted through visual cues and nursing education 5.
• Avoiding objects in the crib, which can be a major barrier to maintaining a safe sleep environment 6.

Implementation and Improvement

It is essential to note that improvements in infant sleep can occur quickly, within just a few nights after implementation of a consistent bedtime routine 4. Additionally, quality improvement initiatives can be effective in improving infant sleep practices in newborn nurseries, even in low-volume birth hospitals 5.