Manaaki Tamariki: Kia au tō moe sleep toolkit - NPA272

Reviewed: May 2022

Child health

Sleep toolkit to support whānau and pēpē. The toolkit is for health professionals, including Plunket and Well Child Tamariki Ora nurses, to use with parents of young pēpē and tamariki aged 0 to 2 years. It focuses on information to support a variety of parenting styles and approaches to sleep for pēpē, and signposts people to other useful resources.

Health New Zealand - Te Whatu Ora gratefully acknowledges the support and advice of the Tokelau peoples and communities who champion Tokelau wellbeing, in developing the Te Vaka Atafaga resource.

Tokelau! Tapui tau gagana ma tau aganuku, i te manaola ma te lautupuola.
(Tokelau! Preserve your language and culture, to enhance spiritual and physical wellbeing.)

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Details

Reviewed: May 2022
Updated: May 2022
Format: Booklet A5
HE code: NPA272
Language: English

The full resource:

Sleep toolkit to support whānau and pēpē

Welcome to the Te Hiringa Hauora sleep toolkit.

This toolkit is for health professionals to use with parents and caregivers of young pēpē and tamariki aged 0-2 years. It focuses on information to support a variety of parenting styles and approaches to sleep for pēpē.

Health professionals may choose to share the information as part of conversations they have with parents and caregivers, or use it for their own learning and development.

The development of good sleep patterns begins in childhood and can lay the foundation for good sleep through later childhood and into adulthood.

Adopting safe sleep practices reduces the risk of sudden unexpected death of an infant (SUDI).

More information on safe sleep can be found at Keeping pēpi safe in their own bed - Health Information and Services and National SUDI Prevention Coordination Service | Hāpai te Hauora (hapai.co.nz)

Key facts for parents and caregivers
Safe sleep for pēpē
Pēpē sleep patterns
Getting ready for sleep
Influences on sleep
Harakeke model showing influences on sleep
Te Vaka Atafaga model showing influences on sleep
Sleep lullaby
More information
Other helpful resources

Key facts for parents and caregivers

All whānau and all pēpē are different and there is no one size fits all approach to sleep. It is important to do what’s best for the individual whānau, rather than making comparisons to others.
There can be a wide variation in infant sleep patterns, especially in the early months of life. Sleep patterns vary from from pēpē to pēpē and change is common within one pēpē including from day to day, or week to week. Sleep patterns can also change over time.
Remind parents to hold off from picking up a restless baby straight away. The baby may just be in ‘active’ sleep, or may just be resettling themselves.
Parents and caregivers know their pēpē better than anyone else, and can be supported to develop the confidence to support pēpē to sleep well.

Newborn infants (aged 0-3 months) might sleep anywhere from 11 to 19 hours in 24 hours.

On average, most babies this age will sleep between 14-17 hours per day. Total sleep duration at either end of these ranges is normal and usually of no cause for concern.

For those unsure about how to support sleep development for pēpē or young tamariki, there is an overwhelming availability of advice. Anyone with concerns about any aspect of sleep should always talk to a registered health professional, such as a midwife, Plunket nurse, Well Child Tamariki Ora provider, or GP, to get accurate information. For sources of trusted online information, see other helpful resources
By six months of age, about half of babies can sleep for a prolonged period at night (9-11 hours) and can re-settle themselves when they experience normal wakings during their sleep. Some babies can’t sleep for prolonged periods at this stage, which is part of the normal range of sleep, and these babies may need comfort if unsettled.
The early days with a new baby can be exhausting for parents and caregivers. Managing parental tiredness is the key to coping with the demands of a new baby. If whānau are struggling, the advice and information in this toolkit may be helpful.

Safe sleep for pēpē

Safe sleep is vitally important for pēpē and will reduce the risk of sudden infant death syndrome. The following actions will help parents to support pēpē to sleep safely.

Ensure baby sleeps alone in their own bed for every sleep, preferably in the same room as their parent or caregiver. This is especially important if your baby was premature, born small or if there is a smoker in the household.
For parents who choose to bring baby into their bed, provide a separate safe sleep space such as a sturdy plastic Pēpi-Pod or flax wahakura (woven bassinet for infants).
Ensure baby lies flat on their back with their face up. Baby’s breathing works best in this position.
Ensure baby’s face is clear of obstructions to avoid suffocation. Don’t have pillows, toys, loose bedding, bumper pads or necklaces in baby’s bed. Don’t put baby down on soft surfaces such as a beanbag or couch where they can roll into a gap and suffocate.
Ensure there are no gaps between the mattress and pēpē to ensure pēpē does not get wedged in the gap.
Remove any ribbons, strings, cords from bedding and clothing. Make sure baby’s bed (cot, bassinette, wahakura or Pēpi-Pod) is away from windows, curtains and blind cords to avoid strangulation.
Eliminate smoking in pregnancy and protect baby with a smokefree whānau, whare and waka. The wider whānau can also provide support to mum by also becoming smokefree.
Encourage and support māmā to breastfeed – breastmilk is the best food for baby.

For more information on the National SUDI Prevention Coordination Service, see National SUDI Prevention Coordination Service | Hāpai te Hauora (hapai.co.nz)

Pēpē sleep patterns

Humans are naturally programmed to be awake and active during the day and asleep at night. However, during the first few months of life, babies' internal biological clock systems are developing. They need to feed frequently and they tire quickly. This means they need to sleep at intervals across night and day. Their ability to stay awake longer during the day and sleep more at night develops gradually over the first year of life.

Every pēpē is unique. Sleep patterns will be influenced by a whole range of factors, including age, temperament, health, family rhythms (such as mealtimes) and environment. Influences on sleep patterns are shown on pages 8 and 11.

Some pēpē may only need short 30 to 40 minute naps in the day, others will need longer. Nap lengths can vary from day to day. The best indication of whether pēpē has had enough sleep is whether they are happy and engaged, or tired and grizzly.

Sleep habits can also change as infants develop and learn new skills such as rolling over, crawling and sitting up.

Sleep cycles in babies are shorter than in adults, and consist of quiet sleep, active sleep, and sleep that transitions between these two states. In active sleep, pēpē may be restless and noisy, in quiet sleep pēpē can be very still and quiet.

Expect pēpē to wake frequently through the night. They will often need support to settle back to sleep.

Getting ready to sleep

It can be helpful to develop consistent but flexible bedtime routines, especially at night. A bedtime routine may include a warm bath, a massage, dressing in bed clothes, singing oriori or waiata, saying a karakia or telling a story. This provides clear signals that it’s time for sleep and can support pēpē and tamariki to settle and be ready for sleep to occur.

Some pēpē can settle themselves to sleep, others need cuddles, rocking to sleep, or sleep while attached to their caregiver. There is no right or wrong way to settle pēpē for sleep and what works today may change from sleep to sleep and day to day. Encourage whānau to do what’s best for their different and unique circumstances and situations.

Newborns often fall asleep while feeding or being held. After the first 6 to 12 weeks it can be helpful for pēpē to fall asleep in the same place where they will wake up. Encourage whānau to watch for tired signs, and ideally put pēpē to sleep in their safe sleep space when ready to sleep but still awake.

Babies can give a variety of cues to show if he/she is ready to play and be active, or ready to sleep and be restful. Being able to spot the cues can help avoid baby becoming over tired and unable to fall into sleep. Counties Manukau DHB has Look at You - Aroha Atu, Aroha Mai | Te Whatu Ora Counties Manukau to support parents, whānau and health professionals in understanding and responding to the social and emotional needs in the early month of life. See also Other helpful resources

Hāpai te Hauora has some video resources on The value of the oriori, and Te mana o te wahakura, as well as some stories from Safe Sleep Day 2019.

During the early months, babies will likely sleep in any environment (but do need to be in a safe space). However, as babies get older, an environment with less distractions may be helpful. Some pēpē may like an darkened room for day sleeps, but this is not essential.

Exposing babies and young children to electronic screens may interfere with sleep. Exposure to blue light on digital devices can reduce how long pēpē and tamariki sleep. Keep electronic devices away from pēpē at bedtime.

Influences on sleep

Sleep/wake patterns for pēpē are driven by a complex range of factors, including age, developmental stage, health, environment, culture and social factors. The following two info-graphics are available at Manaaki Tamariki: Kia au tō moe resources | Te Whatu Ora | Health Promotion (hpa.org.nz) and show visually the many influences on sleep from Māori and Pasifika world views.

Pā Harakeke

A pā harakeke, or thicket of flax bushes, is sometimes used as a metaphor for a community - with each bush representing generations in a whānau.

Te Vaka Atafaga

Te Vaka Atafaga shows a canoe traversing both calm and stormy seas, which provides a useful analogy to navigating the early weeks and months with pēpē in relation to sleep.

Sleep lullaby

Whānau might like to sing pēpē a lullaby or ori ori. 'Just When the Sun Goes Down' is a lullaby that can be used to calm both mama and pēpē.

The video version shows how to support pēpē to sleep.

Available on Spotify and Manaaki Tamariki: Kia au tō moe resources | Te Whatu Ora | Health Promotion (hpa.org.nz)

Video tips from whānau on sleep for pēpē

Families come together to share the realities of sleep for pēpē and the wider whānau, and the importance of sleep on wellbeing. Available on Spotify and Manaaki Tamariki: Kia au tō moe resources | Te Whatu Ora | Health Promotion (hpa.org.nz)