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Infant Sleep "Red Flags"

As parents we want the best from our children and many times we are up late at night asking google "Is it normal my baby ____?" What we find is an overwhelming amount of information - the truth is there is a wide spectrum of what "normal" is and it is mostly dependent on your babies personality. There are somethings though that are considered "red flags" that usually require some medical assistance for mostly non-serious conditions. I always recommend parents to follow their gut and get a second opinion if needed.


It wouldn't be the first time I would of heard that you had to fight for something in regards to infant sleep. It might be a test or procedure that you have to find the right person for. Know you are not alone and you are capable of figuring it out.


You might be thinking about hourly waking and while exhausting to us this is not always a sign of something being wrong. Most often, hourly waking's are paired with something else like growth spurts or teething, cognitive development or separation anxiety. They can be alarming to us when we have to help them back to sleep regularly or they are so upset it takes so long to resettle. It is important to ask yourself has this persisted for longer than 2 weeks - if so then hourly waking could be signaling something more.


What is a normal infant sleep cycle?

Infants have shorter sleep cycle than adults. Infants only have two sleep states (active sleep and deep sleep), while adults have 4. Theirs range from 50 to 60 minutes. Many infants who are breastfed wake every 2-3 hours to be fed (which is normal and expected). The circadian rhythm, meaning the sleep-wake cycle is not established until 6 months of age and then most still need assistance in falling back to sleep. As adults, we wake occasionally through the night as well, we just do not usually remember because we have developed sleep maturity.


What about personality?

Your infants personality is a big piece to the sleep puzzle. If you have an easy going baby they might not cry out as often. Other parents might have a more sensitive baby who requires more assistance with things. It is normal for either kind of baby and the spectrum of easy going to sensitive is large. Sensitive babies might cry out more often than an easy going baby.


So what are some red flags?

There are some symptoms to look for that could indicate concern, especially when there are frequent AND persistent waking's.

  • Mouth breathing or snoring

  • Gasping or pauses in breath

  • Screams when waking

  • Very restless sleep

  • Taking long time to settle back down

  • Feeding issues or tongue ties

  • Obvious discomfort or pain

  • Rashes or eczema

  • Frequent congestion

So while we do expect babies to connect a couple sleep cycles, hourly waking is not always a concern unless paired with something else. If any "red flags" were checked take a look at these 6 steps.


Step 1 Rule Out

  • Teething

  • Sleep progression/developmental bursts

  • Illness

  • Feeding issue

  • Separation/big change in the family

  • Environmental or sensory factors

  • Allergies (food or airborne)


Step 2 Check with an IBCLC

If you have an exclusively breastfed baby it is not uncommon that they go through many sleep wake cycles during the day and night. When checking with an IBCLC they will assess your latch, ensure you baby is transferring milk and educate on normal infant behavior. If there is a feeding issue they can make a feeding plan that meets your needs.


Step 3 Consider oral ties or airway restriction

Tongue ties, enlarged tonsils/adenoids, sleep apnea, and other disordered breathing conditions can cause disrupted sleep. If you have any concerns on your babies anatomy talk with a pediatric dentist or ENT.


Step 4 Check ferritin - iron store

Consult your pediatrician to check your babies blood for ferritin (blood protein that stores iron). Ferritin levels under 50 can disrupt sleep. Iron deficiency/anemia are linked to poor nighttime sleep, restless leg syndrome, and insomnia. There is a higher chance of you baby being low in iron if you were anemic during pregnancy or if they were born prematurely. This is most commonly an issue after six months, as most babies will have a sufficient iron store until then, especially if breastfed.


Step 5 Get another opinion

It would not be the first time I've heard that pediatricians brush off the sleep concerns. Most are told to sleep train or to stop nursing to sleep. The truth is studies show that a sleep trained baby wakes up just as often as a non sleep trained baby. They just wont cry out for their care giver. Here is an NPR article on cry-it-out.

Nursing to sleep is a normal biological phenomena that has happened since the beginning of time. Nursing to sleep is NOT the reason for hourly waking. The way feeding would be the issue is if there was a food allergy or reflex. If someone is telling you to just sleep train your baby or stop nursing to sleep or during the night - take a step back and maybe get a second opinion. ITS OKAY TO TALK TO A NEW DR.


Step 6 Self Care

When we are navigating this new terrain of parenthood sometimes we take a backseat to our own self care, especially when our child is having night time sleep disturbances. Take a moment and think of what could help - is it more sleep in general? Could naps help? Can someone help in the night to get the baby to bring them to you or comfort them? Can someone watch the baby while you take rest during the day? Do your best to take care of yourself. Drink more water. Take a shower. Watch your favorite show.


As always, this is not medical advise. Please reach out to your pediatrician if you have any concerns about your baby.

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