When sleep isn't normal
Image Credit: Vida Images
In our article on normal infant sleep, we give you an overview of what we can consider biologically normal for your baby. Because of the warped expectations and portrayals of infant sleep in society, it is essential to understand that many times, a “sleep problem”, is not inherently a problem from your baby’s side. It is more likely the unrealistic expectations being placed on you and your family as you try to raise your little one.
To help improve sleep for your entire family, it is important to focus on understanding what is going on for your baby, why they behave the way they do and your own sleep hygiene and lifestyle practices.
For most families, this is the key to surviving and thriving when your baby needs you at night just as much as they do in the day. However, for some, there is more to the story.
Waking and needing help to fall back to sleep are normal behaviours for your baby, but sometimes these behaviours stray to abnormal territory. In these situations, it is important to understand what makes it difficult for your baby to settle and find restful sleep.
It isn't always easy to figure out what is going on, but if you have concerns that something isn’t right for your baby, investigate this. In the meantime, keep responding to your baby. Nurturing, responsive care helps to buffer your baby through their discomfort as you work to find the cause.
How do I know if my baby’s sleep is normal or not?
As mentioned above, this can be challenging because society doesn’t always allow families an accurate grasp of what is normal. If you haven’t already, please read our article on normal infant sleep and consider this information.
Here are four signs that may flag that your baby’s sleep falls out of the range of normal.
This list is not exhaustive, but may help you to decide if you need to investigate your baby’s difficulties with sleep.
1. Your baby takes a long time to go to sleep and wakes frequently.
Sometimes, your baby may take longer to go to sleep because they are not yet tired. Adjusting their nap and bedtimes may be all it takes to get them to fall asleep quickly (around 15-25 minutes). Some babies are also naturally frequent wakers (under 1.5 hours) or go through periods of time where they wake more frequently and then go back to sleeping for longer stretches. If your baby often takes a long time to go to sleep, or they wake frequently every night, there may be more to your story. Feeding problems (especially in the first 6 months) can be one issue to consider [1-2]. Please consult your healthcare provider about this.
2. Your baby wakes frequently and is screaming and/ or is awake for long periods of time.
A baby waking frequently can be normal. A baby waking screaming can also be normal if they are quickly and easily soothed back to sleep. If your baby is waking frequently and screaming or crying and is hard to soothe back to sleep, this may indicate a problem. If this is a new pattern, it may be something causing temporary discomfort. Similarly, there may be times when your baby is going through periods of rapid growth and development where they may be more wakeful. This is usually a brief phase. If this is a continuing pattern it is important to seek advice. Food allergies or intolerances, reflux and feeding problems are just a few things to consider [3-4]. Please consult your healthcare provider about this.
3. Your baby breathes through their mouth (sleeping with an open mouth posture, but still nose breathing, is normal), snores, has noisy breathing, gasps for air, or your baby sweats a lot as they sleep.
All of these signs need to be investigated by an Ear, Nose Throat (ENT) specialist who is skilled in airways. There are a number of conditions that may fit with this and an ENT can help you work through what is going on for your baby. [5-7]
4. Your baby requires an extremely rigid sleep environment and methods of soothing.
Most people, including babies, have preferred ways to go to sleep. This is normal. However, if you find that your baby needs a very controlled sleep environment and intense input to soothe (eg. must be held extremely tight, bounced in just the right rhythm, in a completely blacked out room) your baby might be extremely sensitive. This is not necessarily a problem and many sensitive babies grow into sensitive but typically developing children but it can be an early indicator that your baby may have additional sensory needs and it is one to monitor and discuss with your healthcare provider. [8-9]
“Remember, you know your baby best. If something doesn’t seem right to you, it is always worth discussing it with a trusted professional. As your child’s advocate, you have the right and responsibility to speak for them. If you feel your concerns are dismissed or misunderstood, seeking another option for support is an avenue to consider.”
Contributed by: Georgina Dowden, IBCLC, Registered Nurse, Registered Midwife, Little Sparklers Director
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REFERENCES:
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[2] Levkovich, R., Sidebotham, M., Vaughan, K., & Dietsch, E. (2017). Ankyloglossia (Tongue-Tie)—To Snip or Not to Snip: An Integrative Literature Review. International Journal of Childbirth, 7, 126 - 138.
[3]Kahn A, Rebuffat E, Blum D, Casimir G, Duchateau J, et al. Difficulty initiating and maintaining sleep associated with cow’s milk allergy in infants. Sleep 1987; 10: 116-21.
[4] Kahn A, Mozin MJ, Casimir G, Montauk L, Blum D. Insomnia and cow’s milk allergy in infants. Pediatrics 1985; 76: 880-4.
[5] Bandyopadhyay A, Daftary AS. Obstructive Sleep Apnea in Infants During the First Year of Life: What the Pediatrician Needs to Know. Clinical Pediatrics. 2020;59(8):752-759. doi:10.1177/0009922820915733
[6] https://www.rch.org.au/kidsinfo/fact_sheets/Childhood_obstructive_sleep_apnoea_OSA/ Accessed 1/10/2020.
[7] https://rednose.org.au/article/room-temperature Accessed 1/10/2020
[8] Kamara, D., & Beauchaine, T. (2019). A Review of Sleep Disturbances among Infants and Children with Neurodevelopmental Disorders. Review Journal of Autism and Developmental Disorders, 7, 278-294.
[9] Mark Vasak, James Williamson, Jennifer Garden, Jill G. Zwicker; Sensory Processing and Sleep in Typically Developing Infants and Toddlers. Am J Occup Ther 2015;69(4):6904220040. https://doi.org/10.5014/ajot.2015.015891
