Plunket Well Child Tamariki Ora – sleep: newborn to three months
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Baby sleep is often a controversial topic. New parents, whether breastfeeding or bottle-feeding, are usually sleep deprived due to numerous and expected baby waking up periods during the night. It’s important to talk about concerns with your midwife or well child nurse as parents may feel there is something ‘wrong’ with a wakeful baby, particularly if they have come across misleading information about sleep training or articles containing unrealistic expectations about baby behaviour. It is also important for exhausted parents to have support about how to manage during this time of sleep deprivation and broken sleep.
It is recommended that babies sleep in the same room as their parents until at least the age of six months as a protection against sudden unexpected death in infancy (SUDI). Some parents settle babies in their own bassinet or cot and others make a decision to share their bed with their baby. There are safe sleeping tools available for parents – pepi pods or wahakura.
Avoid having a baby in bed if the baby:
Face-up + face clear + smokefree. Face-up position protects arousal in babies during a critical stage of development, Face clear protects from asphyxia in the sleeping environment, Smokefree reduces vulnerability.
Health Navigator has useful information about how to share a bed safely with a baby and how to reduce the risks of SUDI, and this includes advice to create a smoke-free environment and to breastfeed.
It is important that every baby sleep is a safe sleep whether during the day or night, at home or out of the home. One of the most dangerous places for a baby to sleep, either alone or with someone, is a sofa, so it is better for a tired mother, who thinks she may easily fall asleep, to breastfeed her baby in bed rather than getting up to breastfeed on a sofa.
Here is information from ‘The Baby Sleep Info Source’ (BASIS) about the dangers of sofa-sharing.
Access to information about what is biologically normal sleep for babies can help parents understand how to navigate the mass of different information out there on the internet and from families and friends, and how to separate evidence from opinions. The Baby Sleep Info Source (BASIS) is a good resource for evidence about normal sleep development and how babies operate in tune with their own internal biological rhythms
Crying is a normal part of baby development and communication. It’s a way for the baby to tell parents and carers that they need some attention because of hunger, the need for reassurance, love and contact, being tired, feeling uncomfortable, needing a nappy change, or being too hot or too cold. Parents get to know what their baby’s needs are after a while but initially reasons for crying can be confusing for new parents and sometimes there doesn’t seem to be an obvious reason for the baby distress. Responsive parenting means attending to the baby’s cry, trying to work out what is going on for the baby, and finding ways to help the baby soothe and settle regardless of the reason for crying. Parents develop a range of strategies to help settle babies and sometimes it takes a lot of calming and soothing approaches by parents to help calm and comfort a distressed baby. Some babies cry more than others and there seems to be ‘peak’ crying times between two weeks of age and two months of age. Comforting the baby before they become too distressed often works better than leaving them to cry. Comforting the baby, breastfeeding the baby and picking the baby up for cuddles does not ‘spoil the baby’, and in fact evidence shows that responsive attention from parents and carers helps a baby feel more secure.
Colic is a term that parents will be aware of and it is described as crying that lasts for several hours without any obvious reason. Colic seems to disappear after 16 weeks of age but coping with this degree of baby distress is very hard for parents. Support for parents is very important. Constantly crying babies can cause distress and anxiety in parents who may wonder if they are doing anything wrong, or if there is something seriously wrong with the baby. Talking to the midwife or well child nurse if you are worried about baby crying or your response to the baby’s crying is concerning you.
‘What’s in a nappy’ – it’s important to know what to expect. The contents of the baby’s nappy change day by day initially. From the early meconium poo – (which is already in the baby’s bowel at the time of birth), which is thick, sticky and black/dark green in colour, to poos in various shades of mustardy yellow (yellow poos sometimes look seedy too and this is normal). The number of, and amount of, wees will increase daily after day one. There will be a variation in the consistencies of poo depending on how the baby is being fed, but the number of wees and poos initially should settle into similar amounts. The formula-fed baby may have more wet nappies initially than the breastfed baby and the poos of the formula-fed baby may be less frequent and not as soft.
Sometimes there are other contents in the nappy in the first few days – urates which are urine salts, look orange/pinkish on the nappy and they are generally harmless and disappear very quickly in babies who are feeding well – they may only have urates in one nappy. If urates persist it can be a sign that a baby may need some help with breastfeeding more effectively, or may need encouragement to breastfeed more often. Tell the LMC midwife about the nappy – you can save it to show them too – and the midwife will check how breastfeeding is going.
There may be a little blood stain in a baby girl’s nappy in the first few days. This is a very light blood loss from the vagina and it happens in response to the mother’s hormones that are still affecting the baby. This is harmless and does not last long.