The first two – three weeks

Averages 

Getting to know your baby, curiosity 

Removing roadblocks:

Making sure feeding is going well

Nervous system regulation 

Digestive discomfort 

 

Make sure feeding is going well

Breastfeeding vs bottlefeeding: which babies sleep better?

To be honest, there isn’t much difference. Some evidence suggests breastfed babies sleep a bit better in the first few months because they get sleepy hormones via breastmilk (tryptophan and melatonin), before they start making their own.

Breastfed babies usually feed 8-12 times in 24 hours. If your baby is sleepy during the day, I think it’s perfectly acceptable to wake them, strip them down, or do some skin to skin contact, and encourage them to feed a little bit more often during the day. What you don’t want is your baby sleeping for long stretches during the day and then feeding all night! 

Sometimes breastfed babies struggle to gain weight adequately in the first few weeks – this can mean that babies feed more often, or longer, and feed very frequently at night time to get enough calories. 

Other breastfed babies sometimes struggle with the milk flow a bit, and can struggle with a bit of lactose overload, especially if mum has a very good milk supply. Often these babies will bring milk up frequently, have crampy windy tummies and explosive nappies. 

Bottlefeeding babies can have feeding issues too. If you’re bottlefeeding, it can be helpful to use a paced bottlefeeding technique and feed your baby on cue, rather than to schedule. Remember that babies’ tummies are only the size of their fist, so bottlefed babies benefit from small, frequent feeds too, just like breastfed babies. If you’re tempted to give them a big bottle of milk before bedtime to help them sleep better, probably all that will happen is that their tummies will get overstretched, and they’ll have crampy tummies, wind or reflux.

There is a bit of a myth that babies don’t need night feeds over a certain weight, or after a few months.  The truth is, most babies whether they are breastfed or bottlefed, will need night feeds until around the age of a year.  In fact, if you’re breastfeeding, night feeds are really important for helping to maintain your milk supply and as a lactation consultant I would never advise stopping night feeds completely under the age of a year.  I also want to reassure you that feeding to sleep is the biologically normal way for babies to fall asleep. It is absolutely the easiest way for a baby to fall asleep, and it’s not a bad habit. You only need to change the feeding to sleep habit if it is genuinely not working for you, and I’ll talk about that in more detail in the Sleep Strategies module.

 

 

Hold your baby more

Following on from my last point, I want to emphasize that babies absolutely thrive when in contact with a parent.  If you find that your baby sleeps best on your chest, know that this is completely normal. That position where they curl up on your chest I call their default position.  In this position they can they organise their reflexes better, they’ve got better control over their limbs and they can settle and feel calm and secure. I don’t think you can ever hold your baby enough, and the research would suggest that about 10 hours a day of contact with a parent will help to reduce crying and fussiness. It’s not surefire guarantee that your baby will never be fussy or cry, but the more we hold our babies, the better it is for their brain development, and there is absolutely no doubt that they sleep better on you too. I a firm believer that there are no bad habits when it comes to sleep, and if a baby sleeping on you, or next to you, works for you and your family then then that’s fine.  Obviously, you need to make sure that they are safe, and I cover this in the Safe Sleep module. 

Modulate your response

When we look at modulating our response to babies, I think I need to start off by reassuring you that I’m not advocating a non-response to your baby, merely a response that is is appropriate to their needs.  I work a lot with very responsive parents who really want to meet their babies needs immediately. There is absolutely nothing wrong with that. I always advocate responding to your baby but there are few times, when I would say it’s worth just thinking about what you’re doing, before jumping in straight away.

Sometimes babies can get over-stimulated and if we jump in straight away with a strong response, we may not actually be helping them.  There is a great pathway that I’ve learned for looking at how babies are responding to stimuli. Say you’ve been changing a nappy, or playing with your baby and they are crying and fussing.  If you immediately start jiggling them and walking around the room bouncing them, and they’ve actually had too much stimulation and what they need is a break, then lots of vigorous rocking and talking isn’t going to calm them down, it’s only adding to that overstimulation. In this situation, you want to start off with a minimum level of intervention first, and then gradually build it up until your baby is completely settled. So it’s not a case that you let your baby cry themselves to sleep or you don’t respond, it’s that you work with them and work just how much support they need.

SOOTHING AND SUPPORTING YOUR BABY

If your baby is crying, try each of the following in sequence, taking around 10-15 seconds for each step (adapted from the Brazelton Newborn Behaviour Observations):

  • Stay close to them and look at them
  • In a calm voice, talk to them while looking at them
  • Try putting your hand on your baby’s tummy while continuing to talk to them 
  • Gently bring their arms across their chest while talking calmly to them
  • If your baby is still crying, pick your baby up, without rocking, and talk calmly to them
  • Add rocking while you hold and talk to them
  • Wrap them in a blanket to give them some containment, but leave their hands free and close to their mouth (unwrap before putting down for sleep)
  • If still crying, try giving them something to suck, like their hand, a breast or a dummy.

Another scenario is perhaps the one where we bounce or rock our newborns to sleep.  Most babies don’t need that level of support to fall asleep if they are genuinely tired.  Usually, they’ll fall asleep really easily if they are feeding to sleep and have a comfortably full tummy.  Often, we end up rocking them to sleep because they aren’t actually that tired to begin with, but we think they need to sleep. Then we spend half an hour rocking, by which point they ARE ready to fall asleep.  If you rock them to sleep every time, they get used to the rocking. Then at some point down the line, you’re going to end up with a baby that is very dependent on being rocked to sleep and that isn’t so much fun when they are 10 months old and weigh 15 pounds! By learning to read your baby’s cues for sleep, and also identify when they are cueing for something else, we facilitate sleep more easily.  The following list, adopted from Holistic Sleep Coaching (Hookway, 2019) may be helpful for working out when your baby is tired. If your baby is exhibiting late sleepy cues, you may want to shorten any routine and move quickly into getting your baby to sleep eg if you were planning a bath, best to leave it till later and just feed to sleep now!

EARLY SLEEPY CUES

Yawning

Fussing

Losing interest in toys or people

Turning face away

Glazed expression

Waving arms and legs (becoming more active)

Looking pale

Going quiet

LATE SLEEPY CUES

Grimacing

Back arching

Needing to be comforted more than usual (lots of feeds or cuddles)

Rubbing eyes

Pulling up knees and vigorous wriggling

Crying or being  inconsolable

Pulling ears 

Rubbing face on parent’s chest or shoulder

Should I wind my baby?

Picture the scene: your baby has fed to sleep. You then sit him/her up on your knee for burping. Perhaps a big burp comes out, and in the process a little bit of milk, which you wipe away. Now your baby is fussy and you need to move in to rocking/shushing to settle them back down to sleep. Or, perhaps you don’t get any wind up, so you spend twenty minutes patting or rocking to try to get some wind up. This results in your baby not sleeping a full sleep cycle and they wake fussy and cranky twenty minutes later. You then feed back to sleep but now your baby is unsettled and has a crampy tummy because they’ve had a bit too much milk. You feel frustrated because now you think your baby has trapped wind.

Does this sound familiar? I’m going to suggest that you reduce the vigorous winding after feeding. When your baby feeds to sleep, this dials down their nervous system. You’re providing a calming, soothing experience. After your baby has fallen asleep, perhaps try letting them lie up on your right shoulder for a few minutes until they are in a deep sleep. Or perhaps put them in a sling and let them nap there. Often, patting, rocking and rubbing once a baby has fallen asleep actually dials up their nervous system again, which actually increases movement in the gut. We want their nervous system to stay nice and calm once their asleep. Below is a video of easy ways to get wind up. The first two techniques I suggest are perfect for a sleeping baby. The third technique (tiger in the tree) isn’t suitable for a sleeping baby, but is great for a fussy, colicky baby, which often happens in the evening:

Respond lazily at night time

The other time it’s worth modulating your response is at night.  Often at night time, babies are noisy and wriggle around a lot, they make grunting noises in their sleep. This is really normal! Sometimes parents are so attuned to their babies that every time the baby makes a little movement or they rustle or squirm, mum or dad is putting a hand on them, trying to settle them back down.  There is nothing wrong with just letting them make those little noises.  We will cover this in more detail in the sleep science module, but young babies spend a lot of time in light sleep, and it’s completely normal for them to move and make noises at night time. Some babies do settle and sleep much better next to a parent so it might be worth considering co-sleeping safely.

Remember to keep everything low key. If your baby cries and wakes up, then feed but keep winding to a minimum. Keep the lights low, try not to talk too much, perhaps just soothing hums and shushes, and try not to stimulate your baby too much. Definitely avoid changing nappies unless baby has done a poo.

IS IT REFLUX?

Reflux is a big concern of parents. A lot of babies do bring up a bit of milk, but this usually isn’t problematic. Often normal newborn behaviour is interpreted as pain or reflux. It’s normal for babies to be more settled when in contact with a parent, it’s normal for babies to fidget and grunt in their sleep at night. It’s normal for newborns not to sleep for long periods. The NICE Guidance on reflux in children recommends a feeding assessment as the first line of action, and medication should really only be considered when there is a medical problem, such as refusal to feed, poor weight gain, or pneumonia. If you are worried that reflux is affecting your baby’s sleep you can get in touch with me!

To sum up…

Establishing healthy sleeping patterns in the early days is about providing the right environment for sleep, and providing a soothing experience as babies fall asleep. Most babies do need some help from parents to soothe and regulate their emotional state. Getting to know your baby and what works to keep them calm and relaxed, will in turn help them sleep better.

Swaddling

Published by Rebecca Scott-Pillai

Rebecca Scott-Pillai is a paediatric sleep consultant and lactaction consultant (IBCLC) based in Lisburn, Northern Ireland. She lives there with her two kids, two cats and dog! With over 20 years experience working with families, Rebecca uses her knowledge and experience to provide collaborative flexible plans for gentle, responsive families.