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

Healthcare providers, specifically nurse practitioners, can help parents understand what "normal" sleep patterns are for their child, according to researchers.

"Nurse practitioners are at the frontline of healthcare," said Robin Yaure, senior instructor of human development and family studies, Penn State Mont Alto.

"They are in an ideal position to help parents understand infant sleep pattern norms. Thus, nurse practitioners can help parents understand that 'sleeping through the night' is not entirely likely in young infants and that infants' sleep patterns change during the first few years of life."

According to the researchers, 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.

Yaure 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. The researchers suggest how to best integrate parents' preferences for care and best practice information, and include conversation points for nurse practitioners recently online in the Journal of the American Association of Nurse Practitioners.

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.