My child will not sleep!

Dr C. Michie, Paediatrician, Associate Academic Dean, American University of the Caribbean Medical School, St Martin; and Dr N. Humphrey, Assistant Professor, Behavioural Sciences, American University of the Caribbean Medical School, St Martin.

The first month of your new baby’s life, you watched her sleep and marvelled as her little chest moved up and down. Like most new moms, you checked frequently to see if she was breathing OK.

At some point, you realized that you were exhausted and needed a nap yourself. They always say, “New moms must sleep when the baby sleeps!” But there are always a few things you must do first! You rush to do the laundry, prepare something to eat and that assignment from work that is a little past due. Just as your head hits the pillow, the baby wakes up crying. You have had less than three hours of sleep in the last 24. You just hope she will settle soon.

To your surprise, she does not sleep. She has been fussing all morning; crying, drawing her legs up, screaming, then dozing for five minutes. Then doing it all over again. Nothing seems to help! She did it all last night and most of yesterday too.

Your partner is back to work – the baby is a month old, after all – and you feel alone. You must be letting your baby down somehow. Everything was so wonderful for that first week...

Babies have several behaviours that can challenge their parents. This is because they find our world strange, having been held snug in a womb which was warm, very noisy and bouncy as you moved! Adapting will take most babies several months. Parents often worry about their baby’s feeding, sleeping or crying. What should you expect? At what point should you get concerned?

Fussy Babies

Crying is your baby’s first language! It is the only way for her to tell you that she has needs. She does not know how to make sense of being uncomfortable, hungry or tired. It will take time for both of you to figure out how to soothe these discomforts. Be patient with yourself - crying is natural for babies. As your baby grows, you will find that you have developed a strong connection with your baby that will last a lifetime. 

This language of crying also helps you to provide the nourishment your baby needs! When lactating, you might notice a tightening of your chest when you hear any baby cry. This is because you produce milk in response to the sound of those cries. Interestingly, most babies become fussier and noisier until 6 weeks of age, when they need your milk the most.

Some new babies who cry or fuss a lot may collect gas in their stomach – this is sometimes called colic. You may need to help with this gas by gently moving their legs like they are riding a bicycle or touching their toes to their heads.

This is an engaging activity that creates a bond and shows your baby you are there to ease her discomfort. Medications for colic are notoriously ineffective. Crying settles in most infants by three months of age. Video studies show that infants can settle themselves should they wake, with their own self-soothing behaviours at this stage.

For the first three months, you cannot spoil your baby. Responding when she cries is the right thing to do. A number of ‘tricks’ can help you settle her, by copying her womb experience. Using cuddling and tight swaddling, white noise, holding the infant on one side and bouncing or swinging her carefully is usually effective.

Some parents resort to hair dryers or washing machines to make noise; loud “shhh” noises, or, for some, music, can be just as effective. Carrying your baby on your back or close to your skin may work for some. Crying babies are regarded as particularly healthy in Japan, where nakizumo competitions are held annually to find out which infant cries loudest! 

Sleeping Babes

Babies sleep for long periods after birth, usually between 16 and 20 hours a day. Those hours will not happen all at once. Babies begin to sleep more at night after several weeks. You might give her cues about when it is bedtime and when it is time to play.  Many mothers establish a routine for bedtime with relaxing, bonding activities such as a bath, reading stories, singing songs and nursing.

Lighting should be dim at bedtime to teach her it is time to sleep. Remember, safe sleeping involves placing the baby on her back! When she wakes during the night, be patient, continue to show her that it is night-time, with dim lighting and less playful interactions. Soothing and nursing will be really helpful during those night hours.

Napping during the day is normal and babies should be allowed to rest. When awake,  playing, talking and activity will help her brain develop all the bits and pieces that she will need to regulate her sleep at night.

During the first few months, this could include placing her on her stomach to practice lifting her head (“tummy” time), talking to her about anything that comes to mind and touching her as much as possible. No baby can be spoiled by too many cuddles!

When Mom Should Be Concerned?

A practical time to look at how your baby behaves is when he or she is 3-6 months old. If there are problems with the baby’s sleep, crying and feeding, it may be worth seeking advice. About a quarter of babies have problems with one of these three behaviours at this point.

A much smaller group have problems with all three. You should be concerned if your baby is not growing or developing. Babies usually double their birth weight in the first 3-6 months.  Before this, breast milk will provide sufficient calories.

Strategies of feeding are important, as the hindmilk in the breast, accessed after longer feeds, contains a higher fat content. Frequent short feeds may therefore not be effective as fewer longer ones.  

Moms – do you take care of yourself? If you had hypertension or high blood sugar levels during pregnancy, you can have ongoing health challenges if you are not seeing your own doctor on a regular basis. Although it seems impossible, it is still important for a mother to get enough sleep to regulate her health. The postpartum period is called the fourth trimester by some because mothers and infants are equally vulnerable.

There is often considerable wisdom about caring for infants hidden within your extended family. Grandparents or parents of large families are invaluable! There are many programmes available on smartphones to help you learn more about behaviour in infants.

Infants need to mature and to self-regulate; parents need to be patient with themselves. Rushing to soothe, feed or stimulate will not break the bonds you have made with your baby! Let your infant adapt as she becomes older - be sure to give her time. It will teach her how to cope.

 

Dudu darling, go to sleep now, be good:

Your eyes shut? You dreaming?

That’s right, sugarcake, my skin, my own blood

Just a little kiss, till morning.

 

Albert Helman (Suriname)