Based on an evaluation of current sudden infant death syndrome (SIDS) data, the American Academy of Pediatrics recommends that healthy infants always be placed for sleep on their backs—whether for nap time or nighttime.
Despite common beliefs, there is no evidence that choking is more frequent among infants lying on their backs (the supine position) when compared to other positions, nor is there evidence that sleeping on the back is harmful to healthy babies. Babies with gastroesophageal reflux (excessive spitting up) should still be placed on their backs. In some very rare circumstances (for instance, if your baby has just had back surgery), your infant may need to be on the stomach for sleep. Discuss your individual circumstances with your pediatrician.
Since 1992, when the American Academy of Pediatrics began recommending this sleep position, the annual SIDS rate has declined more than 50 percent. However, there has also been an increase in accidental suffocation deaths. A safe sleep environment (baby on his back in a crib close to the parents’ bed without any bedding or soft objects) is important to protect your baby from SIDS or an accidental suffocation death.
You may have heard the age-old adage “never wake a sleeping baby.” Many expectant parents take this advice to heart and prepare themselves and their homes accordingly.
In anticipation, they begin by turning the ringer off switches on their phones and making signs to tape over their doorbells that read, “Please knock quietly—baby sleeping.”
After bringing home a newborn of your own, however, you’re far more likely to discover that most young babies (older babies are a different story) can sleep through just about anything—vacuums, doorbells, and a whole host of ringtones included. Instead of figuring out ways to ensure peaceful slumber, many new parents find themselves wondering if, in fact, their babies would awaken to the sound of a freight train going by or the house being hit by a tornado.
You’ll find that as your baby gets older, they will probably become a lighter sleeper. For the time being, however, feel free to relax a little on the noise control unless, of course, you need it so you can sleep.
How to Wake a Sleeping Baby
As we mentioned at the outset, newborns have an impressive ability to ignore the world around them when they see fit to sleep. If you find yourself in the position of needing to wake up your baby, here are some simple techniques that sometimes (notice we said “sometimes”) work.
The kinder, gentler approach. You might as well start out with the kinder, gentler approach to baby waking and see what kind of response you get. This can include such basic measures as talking, singing, and gentle stimulation. Pick your baby up, talk to them, move their arms and legs around, even tickle the bottom of their feet or rub their cheek—whatever works to rouse them.
Dressing down. Whether it’s the physical stimulation or the increased exposure to cool air that does it, many newborns absolutely hate to be undressed. Your newborn may find it well worth the time and effort it takes to awaken and voice their opinion.
Double-duty diapering. Even if your baby doesn’t technically require one, going through the motions (even reusing the same diaper, assuming it’s still clean) may help if undressing alone doesn’t do the trick. This works especially well for those babies who have a tendency to fall asleep before finishing their meals. We think of it as dual-purpose diapering because diaper changes not only tend to wake up sleeping babies but are more likely to be needed around feeding times.
Cleanliness is next to wakefulness. Giving sleepy babies a bath certainly takes things a step beyond undressing and changing diapers, but has been known to work when all else fails. While we certainly don’t approve of cruel and unusual punishment in any way, shape, or form, there may be times when some of you simply have no other choice than to resort to a bath to get your baby to wake up. This more “drastic” measure is most appropriately used sparingly, such as in the event that a newborn is long overdue to eat, and can be modified to accommodate your baby’s umbilical cord as needed.
The approaches we have described to you are obviously based on the assumption that your newborn is healthy. While it is true that newborns are known to be challenging to wake up at times, you should also be aware that babies who are not easily aroused or responsive despite their parents’ best efforts need medical attention. Do not wait to discuss any questions or concerns you might have about your baby’s sleepiness with their doctor: Seek medical help immediately if your newborn seems increasingly sleepy, unresponsive, or hard to arouse.
If your baby doesn’t tolerate tummy time—and even if she does, you are encouraged to try the following activities:
Activity #1: Tummy to Tummy
It’s a good idea to begin exposing your baby to tummy time while you’re both still in the hospital. The earlier you start, the more likely your baby will accept the stomach as a natural position. In fact, before the umbilical cord has fallen off, you can position your newborn on your stomach or chest while you are awake and in a reclined position on a chair, bed, or floor (with a pillow to support your head), tummy to tummy with baby.
Take this perfect opportunity to socialize with your newborn and encourage lots of eye contact. Talk in animated tones and use exaggerated expressions to get her to look at you. It’s a special time to bond tummy to tummy.
Activity #2: Lap Time
You can also position your baby tummy down across your lap lengthwise while providing head support. Remember to keep her head aligned with her body. If she falls asleep in that position, just transfer her to the bed (but place her down to sleep on her back). For more stimulation, slowly raise and lower your legs at the same time, then move them slowly from side to side. This motion will likely calm your little one.
Babies need to be exposed to a variety of textures throughout the day, and tummy time is the perfect opportunity to accomplish this. When your baby is on her tummy, the skin on her stomach, legs, arms, and face touches the surface on which she is lying. The most natural place to play is on a clean floor, a nap mat, or blankets of different textures. (Note: Blankets should be secured so they don’t slide around when baby moves her arms or legs.) As she moves her body, arms, and legs against the surface, the friction that is created lets her know where her body is located in space.
Additionally, your baby will gain strength and flexibility during tummy time. Dressing your little one in an infant body suit (eg, Onesie) for tummy time allows her to feel the various textures on her arms and legs.
Tummy time also allows your baby to visually explore the environment in a new way. When positioned on her back, she can see only the ceiling and whatever is directly around her. But on her stomach, she uses her muscles to lift her head and see the world at eye level, giving her a completely different view of the world—a new perspective!
An Important Reminder
Once your baby starts participating in tummy time, be sure to provide supervision. In this world of distractions, your phone will ring or you’ll get called to another room, but stay with your baby because the AAP recommends that tummy time be supervised.
Babies with Special Health Care Needs
If your baby was born premature or has reflux disease or special needs, speak with your child’s pediatrician about tummy time. Some babies need special consideration.
Activity #3: Side Lying With Support
Side lying is a great alternative to tummy time if your baby doesn’t tolerate being on her stomach. Place your baby on a blanket on her side; if needed, prop her back against a rolled-up towel for support. If her head needs support, place a small, folded washcloth under her head. Both of baby’s arms should be in front of her, and you should bring her legs forward at the hips and bend her knees to make her comfortable.
Don’t forget to distract your baby with a fun toy or read her an entertaining book while she’s in this position. It is best to set up a regular time for tummy time and side lying, such as after naps, baths, or diaper changes. Just be sure to have a plan in place and take care to vary your baby’s position every 10 to 15 minutes during playtime
Strive to expose your baby to a variety of positions throughout the day, including time spent in your arms and on your lap. Remember, babies crave emotional interaction and connection with their parents.
SIDS stands for sudden infant death syndrome. It is the sudden, unexplained death of an infant under one year old.
SIDS is rare, but parents worry a lot about it. It is more common in babies that were premature. There’s also more risk if you had another baby who died of SIDS.
Home apnea monitors track the breathing and heart rate of sleeping babies. An alarm goes off if a baby’s breathing stops briefly (apnea) or if the heart rate is unusually slow. This monitor might sound like a good idea to concerned parents. But most newborns do not need a monitor. Here’s why:
Home apnea monitors give little or no protection from SIDS.
Research has not shown a clear link between apnea and SIDS. Even full-term newborns in the first few weeks of life may have brief periods of apnea. But this is not linked to SIDS.
Monitors cause unnecessary worry.
Home apnea monitors cause many false alarms. The noise can make parents worry too much and lose sleep.
Parents may actually feel more fear and anxiety if they often use medical equipment to check on their healthy baby. One study found that parents of monitored infants said they felt more depressed, compared to parents of infants that weren’t monitored.
There are better ways to protect babies against SIDS.
There has been a lot of research on SIDS. Since the start of the “Back to Sleep” campaign in 1994, there are half as many SIDS deaths in the U.S. This campaign encourages two important steps to reduce the risk of SIDS:
You should always put your baby to sleep on his or her back—not on the stomach.
You should also use a firm crib mattress and keep pillows, blankets, and stuffed animals out of the crib.
These steps help prevent “re-breathing.” Re-breathing can happen when a baby is sleeping face down or trapped in soft bedding. As a result, the baby breathes more carbon dioxide instead of taking in oxygen-rich fresh air. This may be related to raising a baby’s risk of getting SIDS.
When is a home apnea monitor a good idea?
In rare cases, your doctor may recommend a home apnea monitor for your baby. The device may be needed if:
Your baby needs home oxygen.
Your baby has serious breathing problems.
Editor’s Note: The American Academy of Pediatrics (AAP) released a list of specific tests or treatments that are commonly given to children, but are not always necessary, as part of the Choosing Wisely® campaign, an initiative of the ABIM Foundation. Infant home apnea monitors were identified; the full list gives more detail as to the reasons for taking a closer look at each item, and cites evidence related to each recommendation.
Before you lay your baby down to sleep at night or for a nap, consider these safety tips and practical considerations.
Sleeping solo or filling the family bed
Probably since the beginning of time, babies and parents around the world have slept together in what has come to be commonly referred to as “the family bed.” But in recent years, particularly in industrialized nations such as the United States, the trend has been to have children sleep separately starting from birth. Given that this trend is in keeping with what we now know to be safest for babies, we suggest you let common sense and a strong commitment to safety prevail.
The family bed.Whether because of space limitations, cultural norms, or a strong belief that bed-sharing is an integral part of parenting, parents have slept with their babies for thousands of years. In many parts of the world and in a good 60% of US households, many babies still sleep in bed with their parents, at least on occasion, despite increasing concerns about the associated risks. Followers of attachment parenting seem to feel quite strongly that parents and babies benefit most from bonding whenever possible, including during sleep. Proponents also feel that bed-sharing makes breastfeeding easier. We encourage you to read on for some important things to consider before you opt for the family bed.
Sleeping solo.By sleeping solo, we don’t mean to imply in a different room, just not in the same bed. In the United States, there has been a definite shift toward placing babies down for sleep independently, whether in a crib, cradle, or bassinet. Our country’s movement toward independent sleep may well be, in part, attributable to recent and well-founded concerns that bed-sharing in the first year increases the risk of sleep-related infant deaths. Other practical reasons why parents opt for solo sleeping: they find it to be safer, sounder (for their baby and themselves), and less intrusive on their “adult” time.
Bed-sharing safety concerns
Many new parents are tempted to take their newborn into bed with them—often out of fatigue and convenience, as well as for cultural and philosophical reasons. Whether bed-sharing is safe, however, has been the subject of much debate. Recent studies suggest that bed-sharing may significantly increase the risk of infant suffocation, so you’ll find that many experts (including those responsible for writing AAP policy) now strongly advise against it and instead suggest the very practical and safer alternative of sharing the same room but not the same bed during your baby’s first year. If you choose to sleep with your baby in your bed, even if only infrequently, here are some extremely important safety considerations.
Make your bed like a crib. The heavy blankets, comforters, pillows, and other accessories typically found on adult beds can suffocate or smother a baby and therefore have no place being in the same location where newborns sleep. (While we’re on the subject of simple yet potentially lifesaving measures, we also strongly recommend removing any and all such items that may have already found their way into your baby’s crib.)
Bed-sharing babies are at risk from falls or the possibility of being trapped between the mattress and the wall, headboard, or other furniture.
Bed-sharing and the use of tobacco, alcohol, or drugs don’t mix. These substances, including over-the-counter or prescription medications, all have the distinct potential to cause excessive drowsiness or impaired judgment, making those who choose to indulge at risk of being less aware of a baby in the bed.
Crib safety considerations
Whether you decide to set up a crib for your baby as soon as your pregnancy test turns positive or months after your newborn’s much-anticipated arrival, there are a few general safety principles that you’ll want to follow to ensure your baby’s safety. Some may not seem particularly relevant during your baby’s first few months, but given that cribs tend to be big-ticket items and the one you invest in is going to be put to the test for years to come as your baby learns to roll, sit, stand and climb in it, it’s well worth considering present and future safety concerns.
Crib slats. The slats should be no more than 2-3/8 inches apart. All new cribs must meet this standard, but older cribs may not. Avoid using any crib that does not meet this 2011 standard.
Posts & cutouts. Steer clear of bedposts taller than 1/16th of an inch (we realize that’s almost nothing, but that’s the point) and/or cutouts in the headboard or any other parts of the crib, where a baby’s or toddler’s body parts could get stuck.
Bumpers and pillows. Yes, they’re soft and cute. But soft and cute should not be your deciding factor. For safety’s sake, keep crib bumpers and pillows out of your baby’s crib.
Crib toys. They may seem harmless, entertaining, cute and cuddly, but keep all stuffed animals (and most toys) out of your newborn’s crib because they can pose a small but nevertheless real safety risk. The exceptions are the types of toys that strap securely to the side of the crib. Some babies like mirrors or toys with parts they can play with (such as spinners, rattles, and music), but your newborn probably won’t be terribly interested in them for at least a few weeks.
Mobiles. Mobiles are special hanging toys designed to entertain your baby and can be attached to the crib, ceiling or wall. Some are even adorned with lights or play music. They are fun but definitely optional. If you do choose to use mobiles, make sure they do not hang low enough to entangle your baby, especially once they begin to roll. In fact, once your baby is able to sit up, it will definitely be time for their mobile to come down.
Crib placement. Unless you don’t mind a bit of redecorating and rearranging when your baby starts to get around, we suggest you place your crib well away from any windows and no less than an arm’s reach away from any nearby dressers or tabletops. Knowing that it won’t be long before anything and everything within reach will be fair game, we also recommend limiting your over-the-crib wall decorations to painted walls and wallpaper. Picture frames and mirrors over cribs may be cute, but they are also injuries waiting to happen. Be forewarned that while they may be safe, even paper borders placed within reach of the crib don’t often stand up well to prying fingers.
Firm-fitting mattress/fitted sheet. While they seem to be mostly standardized, cribs and mattresses can and do come in more than one size. So be sure to double-check measurements and read labels to make sure you end up with a mattress that fits snugly into your chosen crib. Any extra space between the mattress and crib frame has the potential to trap a baby’s arm, leg or head. Also make sure your fitted sheets are tight enough that they don’t slip off easily, thus posing a serious safety hazard.
Tooth-resistant rails. Some railings are covered by a special plastic to prevent teething babies from gnawing on the paint or wood.
Adjustable mattress height. Many cribs have adjustable heights so you can lower the mattress as your baby gets taller, making it more difficult for them to climb out. You will likely want to keep it at the highest level while your newborn is relatively immobile and you are coming and going frequently because it will allow you to save a good deal of strain on your back. Remember that by the time your baby is able to sit or stand up, you’ll want to lower the level of the crib mattress accordingly.
Bare is best when it comes to cribs
If you come to find that the excitement you feel about having a new baby is wrapped up in the buying of a fancy baby bedding set complete with bumper and quilted blanket, we suggest you work on changing your mindset rather than your nursery décor. Simply remember that the AAP recommends that nothing but a snugly fitted sheet be placed with your baby in the crib during the first year.
Why drop-side cribs are a thing of the past
In years past, crib railings were almost always adjustable—meaning you could raise and lower one or both side railings. While this feature had long been appealing to parents as a convenience, it became a safety concern. Numerous injuries from crib side-rails resulted in the largest crib recall in history (2.1 million cribs!) in 2009. As a result, the Consumer Product Safety Commission (CPSC), which sets voluntary industry safety standards, required that going forward, all full-sized cribs be manufactured with 4 immovable sides. The take-home message for all parents: Always check out the latest safety information on the CPSC website before dropping your guard.
Sleep patterns in newborns are different from those in older children and adults.
For newborns, sleep is about equally divided between rapid eye movement (REM) and non-REM sleep and follows these stages:
Stage 1: Drowsiness, in which the baby starts to fall asleep. Stage 2: REM sleep (also referred to as active sleep), in which the baby may twitch or jerk her arms or legs, and her eyes move under her closed eyelids. Breathing is often irregular and may stop for 5 to 10 seconds—a condition called normal periodic breathing of infancy—then start again with a burst of rapid breathing at the rate of 50 to 60 breaths a minute for 10 to 15 seconds, followed by regular breathing until the cycle repeats itself. The baby’s skin color does not change with the pauses in breathing and there is no cause for concern (in contrast with apnea). Babies generally outgrow periodic breathing by about the middle of the first year. Stage 3: Light sleep, in which breathing becomes more regular and sleep becomes less active. Stages 4 and 5: Deep non-REM sleep (also referred to as quiet sleep). Twitching and other movements cease, and the baby falls into sleep that becomes progressively deeper. During these stages, the baby may be more difficult to awake.
Healthy, growing babies usually do not need to be awakened to breastfeed or take a bottle.
Check with your pediatrician about nighttime awakening if your baby is not doing the following:
Growing and gaining weight steadily.
Feeding well 8 to 12 times a day for a breastfeeding baby or 5 to 8 times a day for a bottle-fed baby or older infant.
Urinating normally with at least 4 wet diapers a day.
Having at least 3 normal bowel movements per day. Most breastfeeding babies have more frequent bowel movements that are soft and seedy.
Concrete Ways to Help Newborns Learn How to Sleep
Help him fall asleep with a soothing sensation, such as rocking, sucking a thumb or hand, or nonnutritive suckling at the breast. However, never place your baby in the crib with a bottle for comfort. The natural sugar in many liquids promotes growth of the bacteria that cause tooth decay, and the effect is especially severe when the sugary residue stays in the mouth all night long. This can result in serious dental decay, known as nursing bottle caries, in developing primary teeth. Liquid, even water, pooling in the mouth can also back up through the eustachian tubes, the tiny passages that run between the throat and ear. This can set up conditions that foster the development of ear infections.
Give him lots of attention while he is awake. Especially early on, babies need help to feel calm and secure. Holding your baby and being sensitive to his signals and needs will not spoil him or reinforce a behavior.
Pay attention to signs of being sleepy or overtired. By noticing your baby’s cues early on you’ll also have an opportunity to help him fall asleep before he is overtired. These signs will become easier to identify as you get to know your baby, and in turn, it will become easier for you to settle him for sleep.
The bottom line is to meet your baby’s needs early on so that he will be better able to regulate his sleep cycles and emotions.
What It Really Means to be a Good Sleeper
It’s important for parents, caregivers, families, and friends to understand that at this age, a good sleeper is a child who wakes up frequently but can get himself back to sleep. It is not a child who sleeps without waking for 10 hours at night. Frequent waking is developmentally appropriate and allows the baby to wake up when he is in a situation in which he is not getting enough oxygen or is having problems breathing. Sleeping undisturbed for prolonged periods at this age is not healthy.
Sleep apnea is a common problem that affects an estimated 2% of all children, including many who are undiagnosed.
If not treated, sleep apnea can lead to a variety of problems. These include heart, behavior, learning, and growth problems.
Symptoms of sleep apnea include:
Problems breathing during the night
Sleepiness during the day
Difficulty paying attention
If you notice any of these symptoms, let your pediatrician know as soon as possible. Your pediatrician may recommend an overnight sleep study called a polysomnogram. Overnight polysomnograms are conducted at hospitals and major medical centers. During the study, medical staff will watch your child sleep. Several sensors will be attached to your child to monitor breathing, oxygenation, and brain waves (electroencephalogram; EEG).
The results of the study will show whether your child suffers from sleep apnea. Other specialists, such as pediatric pulmonologists, otolaryngologists, neurologists, and pediatricians with specialty training in sleep disorders, may help your pediatrician make the diagnosis.
Many children with sleep apnea have larger tonsils and adenoids. The most common way to treat sleep apnea is to remove your child’s tonsils and adenoid. This surgery is called a tonsillectomy and adenoidectomy. It is highly effective in treating sleep apnea.
Another effective treatment is nasal continuous positive airway pressure (CPAP), which requires the child to wear a mask while he sleeps. The mask delivers steady air pressure through the child’s nose, allowing him to breathe comfortably. Continuous positive airway pressure is usually used in children who do not improve after tonsillectomy and adenoidectomy, or who are not candidates for tonsillectomy and adenoidectomy.
Children born with other medical conditions, such as Down syndrome, cerebral palsy, or craniofacial (skull and face) abnormalities, are at higher risk for sleep apnea. Children with these conditions may need additional treatments. Overweight children are also more likely to suffer from sleep apnea. Most overweight children will improve if they lose weight, but may need to use CPAP until the weight is lost.
A good night’s sleep is important to good health. If your child suffers from the symptoms of sleep apnea, talk with your pediatrician. A proper diagnosis and treatment can mean restful nights and restful days for your child and your family.
Charlie was our first-born son. My wife Maura and I welcomed him into the world on April 6, 2010. We were filled with the most incredible joy – he was healthy and beautiful – absolutely perfect. We felt so blessed and we were so in love with this precious baby boy.
Like most parents, we wished for a long, joyful, and happy life for our baby. We imagined his future, and we made plans. We found joy in the everyday – we read books with him, gave him baths, introduced him to family and friends.
But, our lives changed completely on the morning of April 28, 2010. Charlie died, a victim of an unsafe sleep environment. That night, I sat down on the couch with Charlie, to try and soothe him back to sleep. Imagine the perfect picture of sleep-deprived father and son. It wasn’t unusual; we often see this photo on Instagram – baby asleep on dad’s chest, dad sound asleep too. But when I woke up – Charlie didn’t.
Safe sleep saves livesDid you know in the United States more infants die from sleep-related infant death than all children, ages 0-18, die in car crashes every single year? Since the mid-1990s nearly 4,000 otherwise healthy babies have died every single year in their sleep, amounting to one death every two hours. Most of those deaths, nearly 99%, were found to have at least one thing in their sleep environment that was unsafe.
Following safe sleep practices, as outlined by the American Academy of Pediatrics, is vital to preventing sleep-related infant deaths. We know that, when practiced, the advice – placing an infant on their back, in their own crib, next to an adult bed – saves lives.
But preventing the tragedy of sleep-related infant death takes more than education, promoting the ABCs of safe sleep, and breastfeeding. Parents need to be motivated and supported by their community.
Ok, so what can I do?
Be vigilant. We know safe sleep is hard. We have walked in those new parent shoes, exhausted, tank on empty. And, we also know parents want to do what is best for their baby. But, I’m here to tell you it takes just one sleep-deprived moment of fatigue to pull a baby into bed, couch, or armchair, and put that infant at risk. So, we need to talk more openly about parental exhaustion, what to do to stay awake, and how those in our community can help.
Creating a safe sleep plan
Mapping out a safe sleep plan is one place to start. Your plan should include:
Where you will feed your baby.
What activities you can do to stay awake.
Who you can call for encouragement and relief.
Safe sleep is everyone’s business
We all have a role to play in helping new parents be successful by recognizing the challenges that come with practicing safe sleep. From the pediatrician offering real practical tips on getting newborns to sleep, to the friend that can hold the baby so mom and dad can get a break, to the firefighter recognizing an unsafe sleep environment when on an ambulance run, to the child care provider making sure every crib in their facility is blanket and pillow free.
Providing solutions and support can empower parents to follow-through with their safe sleep plan. So parents, don’t be afraid to ask for help. Friends, be encouraging and tell new parents they are doing a great job. Grandparents, be supportive and lend a hand when possible. And finally, all of us can lead with empathy and share real stories from those that have been impacted by sleep-related deaths.
Some babies, however, settle into the newborn sleep routine dreaded by many expectant parents—the so-called day-night reversal. As the description implies, newborns are known on occasion to mix up their days and nights. These temporarily backward-sleeping babies often begin to increase the amount of sleep they get each time they go to sleep according to plan, but simply do so more during the day while demanding to be fed, changed, and entertained throughout the night. As painfully exhausting as this upside-down approach to sleep may be for those of us accustomed to getting most if not all of our sleep at night, the assurance that this too shall pass once again comes to mind. We can all but guarantee you that hope is not far away. In most instances, the fact that your newborn is learning to replace lots of short little catnaps with longer stretches of sleep—whether they happen to fall during the day or at night—bodes well for a more “civilized” sleep routine in your not too distant future.
Lights On, Lights Off
If your baby seems determined to “play” during the night and sleep during the day there’s really no quick fix, but there are some easy things you can do early on to set the stage for more acceptable sleep habits in the future. During your first few weeks at home with your baby, try to establish an atmosphere that clearly differentiates night from day. A good night’s rest may not result overnight, but this approach can help get you there sooner.
Allow for active sleep. During the day, don’t worry if your baby falls asleep in more “active” areas of the house – in rooms with light or music on, for example. Similarly, don’t be afraid to run an occasional daytime errand, even if this means your newborn may not quite make it all the way home before falling asleep.
Consistent contrast. Don’t spend much time worrying about background noises such as talking, telephones, or music during daylight hours. In contrast, try to make your nighttime interactions calm and quiet.
Maintain focus. Whenever possible, take a more focused approach to your nighttime interactions—limiting them to feeding, burping, changing, and gentle soothing when necessary.
Soft-spoken approach. Get in the habit of taking the aforementioned measures in a dark room using a soft voice whenever you want to signal to your newborn that it would be a fine time to sleep.