Healthy Sleep in Babies with Heart Defects

All babies sleep a lot. All babies take a while to learn a regular sleep/way cycle. Babies are often awake at night, and asleep during the day. This is normal and expected.

Babies with heart defects often need more sleep than healthy babies. They may:

• Sleep for most of every day

• Sleep through the night earlier than most babies

• Be hard to wake

• Fall asleep while eating before they are full

Sometimes, babies with heart defects have more trouble falling or staying asleep than other babies. Even though they seem tired, they might often fuss or cry instead of sleeping.

Babies with heart defects often take longer than other babies to settle into a sleep/wake pattern. They may:

• Nap at different times and for different lengths each day

• Fall asleep for the night at different times

• Wake in the morning at different times

• Wake at different times through the night

• Seem sleepy and alert randomly, not on a schedule

Babies with heart defects may have trouble with sleep if they:

• Spend a long time in the hospital

• Are in a room that is not dark at night and light during the day

• Are in a room that is not quiet at night and louder during the day

• Take medicine that makes them extra sleepy (sedation)

• Are usually hungry, or never hungry

• Have to be woken up to eat or for procedures

• Are often uncomfortable

• Get very tired from their illness

• Have a brain injury

• Have a genetic diagnosis

Caregivers can use many strategies to help babies sleep better, and on a schedule. Some strategies work better at home than in the hospital. However, caregivers can work with doctors and nurses to improve a baby’s sleep in the hospital as well.

Most babies have a better sleep schedule when:

• Their room is lighter during the day, and dark at night

• Their room is quiet at night and during naps

• They go outside or near windows during the day

• They move around and explore during the day

• Caregivers use a consistent bedtime routine (example: pajamas, brush teeth, story, song)

• Caregivers use a consistent wakeup routine (example: song, get dressed, breakfast)

• Caregivers start bedtime at the same time every evening

• Caregivers get them up at the same time every morning

• They go down for naps at the same time every day

Most babies sleep more soundly when they:

• Are wrapped snugly in a blanket to prevent their arms from flailing (until they are able to roll over independently)

• Feel contained

• Have a pacifier

• Have white noise (example: a fan or white noise machine)

• Are being rocked or gently vibrated

Many babies prefer to sleep in someone’s arms. Caregivers should always stay awake if they are holding a sleeping baby. Caregivers should be aware that if they usually hold their sleeping baby, the baby may have trouble learning to sleep in a bed.

When babies are in the hospital, they are being monitored all the time. Hospital staff work hard to keep babies comfortable and safe. Hospital staff do not always use the same Safe Sleep practices caregivers should use at home. Instead, they make sure babes are safe by measuring their oxygen, heart rate, and breathing. Family should ask if they have concerns or questions about how a baby is sleeping in the hospital.

When a baby is sleeping in the hospital, they usually:

• Have their legs and arms bent and facing forward

• Have their hands near their mouth

• Have a pacifier

• Have supports (pillows or rolled-up blankets) to keep them contained

When a baby is sleeping in the hospital, they might:

• Be positioned on their back, side, or tummy

• Be sleeping on a slanted surface

• Be covered with a loose blanket from the waist down

• Be swaddled firmly in a blanket

Family can ask if they can hold their sleeping baby in the hospital. Most babies can be safely held. Holding a baby helps build connection and self-regulation.

After a baby with a heart defect is home, families should use Safe Sleep practices. These practices lower the risk of Sudden Infant Death Syndrome (SIDS).

Babies usually are at risk of SIDS from birth until age 18 months. Families should talk with their doctor about their baby’s risk of SIDS.

Unless a doctor advises otherwise, most babies should sleep:

• On their back

• In their own bed

• On a flat, firm mattress

• With no loose blankets or pillows

• With no soft toys or crib bumpers

Wearable blankets can help a baby stay warm and are safe. Pacifiers can soothe many babies, and sucking might reduce the risk of SIDS.

Families can talk with their doctors about whether a baby with a heart defect needs a monitor while they sleep.

During the first year, most babies gradually:

• Stay awake longer during the day

• Sleep more at night

• Have more regular nap times

During normal development, sleep patterns change over the first year. Babies may sleep better for awhile, and then have more trouble.

Babies will often have more trouble sleeping when they have a major disruption, such as a surgery, or when they are learning a new skill, such as crawling. These variations in sleep are normal and healthy.

Families can seek help from their doctor or neurodevelopmental team if they are concerned about their baby's sleep. Help is always available.

This content was reviewed by a psychologist at Boston Children's Hospital.

Developmental care is best when it is local. Families local to Boston can receive care from the Cardiac Neurodevelopmental Program (CNP). Families from other regions can use the link below to find their local care team.