Identifying and Managing Infant Sleep Issues

Does your baby have ‘sleep issues’ … or is your baby simple doing what we’d expect from a newborn?

Ultimately, it doesn’t matter.

Sleep issues, real or perceived, have a significant impact on the mental health of parents and their ability to function well cognitively. If you, as a parent, are struggling with how your baby is sleeping (or not sleeping), then it’s an issue that needs to be addressed.

A couple of quick things that are good to know about babies and sleep

Extremely frequent waking (consistently sleeping in only 30-minute to 60-minute blocks or so during the night) usually has an underlying problem, commonly a feeding problem, or a physical health problem, which requires a medical review.

No two babies or parents are the same, so it is impossible to discuss averages or ‘normal’. To complicate things further, sleep architecture is not rigid, but shifting and dynamic. This makes the concept of routine very difficult to achieve.

The One for Women policy on infant sleep

When it comes to infant sleep, it is One for Women policy to:

  • Educate parents about the range of normal infant settling patterns.
  • Promote realistic expectations regarding sleep for both parents and infants during the child’s first year.
  • Undertake individualised assessment and provide individualised management strategies

When it comes to babies who are crying, One for Women:

  • encourages parents to pay close attention to their babies and think about what the baby is trying to communicate, including joy, delight, and curiosity, as well as distress and discomfort.
  • encourages parents to view crying as a sign that their baby is upset or has needs that aren’t being met. For a baby to feel soothed, he/she requires a sense of connection via the availability of parent or caregiver. The baby needs his/her parents/caregivers to ensure a sense of warm and caring connection in order to feel soothed enough to move to a more comfortable physiological state. Over time, with repeated contact and experience, parents and caregivers will develop many more ways to signal connection and availability.
  • will undertake to help parents to develop prompt and sensitive responsive strategies to help soothe their babies (for example holding, rocking, carrying or singing).
  • will encourage reflective parenting, and in turn, provide kind and empathic care to parents and assist them in accessing support and respite from their parenting role when required.
  • will adopt a supportive approach which recognises the needs of both the mother and infant in the assessment of unsettled or high needs infants.

When considering sleep issues, an initial assessment should:

  1. Identify, what exactly the issue is. While it might seem the issue is, ‘My baby isn’t sleeping,’ the real issue might be that the primary caregiver feels unsupported and exhausted. This is something that could be managed quite successfully via respite for the primary caregiver.
  2. Aim to understand the parenting philosophy/approach of the primary caregivers. As an example, a parent that needs structure and certainty may struggle with the concept of ‘being responsive to their baby’s cues’. They may benefit from something more structured like ‘eat, play, sleep’ or ‘eat, play, eat, sleep’.
  3. Assess for possible depression (either existing or emerging). This assessment would also establish the level of support available to the person experiencing, or at risk of depression.
  4. Aim to exclude an underlying medical cause. The most common cause of poor sleep/irritability is hunger brought on by feeding difficulties.

Creating an action plan

Once an individualised assessment has been undertaken, a plan for management of the sleep issues at hand should be created in discussion with the infant’s parents.

‘Sleep’ should not be ‘the goal’ – it should be part of the overall goal. (If you link success to sleep, you are putting too much pressure on sleep and setting the parent and child up for failure.) If the parents need a goal, 3 hours of unbroken sleep each night is something that could reasonably be aimed for.

Other items that would feature in most action plans include:

  1. Understanding the existing support network and figuring out how that support network can be expanded (if necessary)
  2. Daily physical exercise as it plays a large role in releasing tension, helping with mental health and meets the need for the baby to have sensation and stimuli
  3. Being aware of negative thoughts and associations. If sleep disturbance is accompanied by unhealthy thoughts such as ‘I am going to be exhausted tomorrow’, this not only makes it difficult to get to sleep but also makes it more challenging to cope/deal with sleep deprivation
  4. Daily relaxation with the goal being to turn down the sympathetic nervous system’s level of arousal. It is important to recognise that it is normal to feel stressed, anxious and agitated in the postnatal period. The key is trying to relax the body down to a calmer state
  5. Aligning circadian clocks (see here for more).

The final word on sleep issues in infants

Over the course of three articles I hope I’ve helped you understand:

  • We need to change the language we use around infant sleep as the language we use currently sets parents up to feel deprived, incompetent, or both.
  • There are practical things we can do to set our babies up to best meet their highly individual sleep needs.
  • There is no one-size-fits-all approach to sleep issues.

Every parent is an individual. Every baby is an individual. Every presentation of sleep issues, (whether they appear to be ‘real’ or ‘perceived’) should therefore be assessed individually, and a management strategy created that helps the parents to feel both supported, and empowered to work with their baby as a team to the benefit of the whole family unit.

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