As a Fort Collins pediatric sleep consultant, I would consider myself a pretty solid expert on infant and child sleep and the steps behind shaping a good sleeper. I’ve helped 100s of parents gain back their sleep with some simple changes to their child’s routine and habits.
In August 2021 my view on infant sleep, specifically newborn sleep, totally flipped upside down. Due to severe pregnancy complications, my son was born at only 34 weeks and was whisked away to the NICU. At the time I hadn’t thought through many details such as what would feeding or sleep would be like for my little preemie. My worries were centered on his safe arrival and survival in the NICU.
After 3 weeks in the NICU, we finally brought him home and it was unbelievable bliss for our entire family. Within a few days to week, I started noticing some big differences between my preemie and my term baby (born in 2017). To help other parents of preemies, I’d love to share the differences I spotted and how I’ve helped my preemie, now 22 months old earthside, become an excellent sleeper with very few tears and very little training.
Preemies sleep a LOT
Newborn babies can spend upwards of 18 hours a day sleeping, with very little stamina in-between periods of sleep and wakefulness. Preemie babies take this to the next level. I remember bringing home my son and being shocked by how quickly he would fall asleep, with absolutely no intervention. He would sleep anywhere, any time, and for hours and hours a day. At times we woke him from a 4-hour nap. It was amazing yet something that wouldn’t last.
When you think of your premature baby, think of those first weeks as your baby is in “the negative”, meaning they should still be inside, not born yet. ALL your baby is going to be doing is eating and sleeping. This phase will last until your baby approaches their actual age closer to term (37-40 weeks).
Base your awake windows off of adjusted age
Parents of preterm babies often are navigating two ages: their babies actual age (based on the date they were born), and their adjusted age, which takes into consideration how many weeks they were born prematurely. When evaluating your baby’s sleep and when it’s time to make transitions, always go by your baby’s adjusted age. For example, my son was born at 34 weeks old, making him about 6 weeks early. When my son is 8 weeks old (actual age), he is just 2 weeks old (adjusted age). In his case I treat his sleep expectations as if he was 2 weeks old, as well as feeding, nap length, and awake windows. When my son reaches 12 months old, he will likely still behave or sleep like a 10-month-old.
Going off your baby’s adjusted age will be super important, especially when evaluating development and milestones. In fact, pediatricians will adjust your baby’s age until they are 2 years old. This allows parents and physicians to have realistic expectations for a child based upon where they are developmentally.
Do not let your baby get overtired – this is vital!
As a pediatric sleep consultant, if I had only one single piece of advice for preemie and term parents, it would be to never let your baby get overtired. The nice thing about the first weeks of sleepiness is your baby will likely sleep anywhere and nearly all the time. Whether it’s in your arms, the car, or in a stroller, brand new babies are very drowsy and likely will sleep wherever they are. Remember, there are no “rules” for newborn or preemie sleep. The only guidelines you should follow are safe sleep, feeding your baby enough during awake windows, and making sure they are only awake for 45 minutes at a time during those early days. You will feel exhausted from such a repetitive cycle, but I promise you that getting your baby enough sleep will not only help them thrive but will also help you as parents survive the early days. Keep in mind that a premature baby is starting off VERY sleepy and in the “negative” age wise, so they will spend much more time in the very sleep phase. This is normal and will decrease as they grow.
Feeding and Sleeping
Premature babies have special feeding needs and likely will start out with a feeding tube and IV to gain enough fluids and meet caloric needs. Often feeding struggles keep babies in the NICU longer than anticipated, which was the case with my son. Feeding enough and following your pediatricians’ instructions on the type of formula or breastmilk required will help your baby sleep well and for several hours at a time. Your preemie will likely go home eating every 2-3 hours around the clock, until they are gaining weight well and stable in their health. Always follow your physician’s guidelines for feeding your baby.
If your baby is not feeding enough or efficiently, they will also not sleep well. Hunger is a human feeling that is nearly impossible to sleep through. Making sure you are meeting your baby’s caloric needs will also positively impact their sleep and the length of their naps. If your baby is struggling to gain weight or meet feeding needs, make sure you immediately address this with your care team.
Premature babies often will need to eat at night for longer than a full-term baby. My daughter stopped eating at night at 4 months old. My son, however, needed to be fed overnight until he was closer to 7 months old. Keep your expectations in-line with what is healthy for your child and their adjusted age.
Self-Soothing
Premature babies are born with immature nervous systems. They are sensitive to touch and sound and often need a quiet environment, light touch on their skin and bodies, and support to keep their body temperature normal. Your preemie may also be experiencing medical trauma early in life, with painful IVs, labs, feeding tubes, and procedures. You may find that your preemie needs more help calming down or soothing, which is normal! Hold your baby, rock them, swaddle them, use a pacifier, and have a lot of patience going forward.
My son is 22 months old and often needs a pacifier to soothe him after medical procedures. Would I allow a term, healthy baby to use a pacifier all night? Likely not. However, a premature baby has different needs and needs to be treated with care and flexibility. There will be a time to remove the pacifier or stop holding to sleep. This is just a phase.
Sleep Training
Your baby will be ready to sleep train when they are 4 months adjusted age. You may find that they are not ready for several months after that due to their feeding needs or inability to self soothe. As your baby becomes more stable and is developing well, you can start gently sleep training.
How to avoid needing heavy amounts of sleep training? Do not let your baby get overtired! As a pediatric sleep consultant, if I could ask parents to do one thing, I would say to never let your baby get overtired. This will truly transform your baby’s sleep, feeding, and overall mood.
When does your baby catch up?
Your pediatrician and other providers will think of your baby’s adjusted age until they reach 2 years old. Most children are developmentally caught up by this age and are at the same level as other typical children. If your child is not there yet, don’t worry! Many preemies require extra support and time to catch up developmentally.
When it comes to sleep, I would continue treating your baby as if they were a little younger than they are until they are 2-3 years old. You may find that their long-term endurance for awake windows is shorter than other babies. Meeting their needs is much more important than following black and white sleep schedules and rules.
Your Pediatric Sleep Consultant
As a Fort Collins pediatric sleep consultant, I encourage you to allow your baby space to grow and develop at their pace. There are many times that you will feel grief or guilt about how your baby’s life started. This is valid and you deserve the same loving support that every other mother deserves. If you’re looking for a compassionate baby sleep coach that understands preemie sleep, reach out!