You should not be surprised by the irregularity of a newborn infant's sleep patterns but by the age of six months, if the baby is not sleeping through the night, many parents wonder if something is wrong with their baby or their sleeping arrangements.

It helps parents to understand that "normal" sleep patterns for a child are somewhat broad, according to a new paper.

According to the authors, there are four common areas of concern for both parents and practitioners: what constitutes "normal" infant sleep and waking patterns, whether nightwakings are a problem or not, is a parent's presence disruptive when an infant is falling asleep, and whether sleep training is safe and healthy for infants. Sleep training is one way to establish a sleep routine for a child, although the methods used may not be appealing to parents or in the best interests of the child, the researchers said.

Infants' sleep patterns vary for at least the first three years of life. Image: © iStock Photo Alex Motrenko. Source: Penn State

Robin Yaure, senior instructor of human development and family studies at Penn State Mont Alto and colleagues reviewed current research on infant sleep, focusing on the above four areas of concern, and specifically infant safety and the well being of both infant and mother during nighttime care.

Infants' sleep patterns vary for at least the first three years of life. There are many reasons for this, including changes in infant health and mobility and the development of separation anxiety.

"Sharing this basic information with parents is one way of assuring parents that infants' waking does not necessarily mean that the parents are doing something wrong," the researchers wrote.

Parent presence at bedtime, sleep training and infant self-settling are frequently debated topics about which parents might look to healthcare professionals for advice. Yaure and colleagues again point to sharing information with parents -- for example, recent research suggests that the presence of parents at bedtime, specifically during the transition to sleep, may not trigger nightwakings as previously thought.

The researchers also point out that recent research on the nonresponsiveness of mothers during nighttime care can raise stress for both mom and baby. Elevated stress increases cortisol in the body, which may hurt the baby in the long run. Increased cortisol levels are associated with depression, aggression and attention problems, among other issues, in children and adults.

"I worry about parents who feel like they can't trust their own instincts," said Yaure. "Different parents have different goals and ideas for parenting, and we want parents to figure out how to incorporate best practices into their belief system. We have to be culturally aware and sensitive to different families and beliefs."

By encouraging nurse practitioners to talk about current knowledge on infant nightwakings and parental presence, among other things, Yaure hopes that parents will become more comfortable and confident with their nighttime care choices.

Further research will include how doctors can also help translate research-based knowledge of infant sleep into practice.