Why Do Some Babies Hate Being Drowsy?

We've had several readers ask us questions about drowsy babies. Specifically, they want to know why their drowsy babies become fussy and irritable while others become quiet, relaxed, and easily drift to sleep. We'd like to use this post to focus on this challenging infant state.

The Drowsy State
Babies move in and out of 6 different "states" or moods: crying, irritable, quiet alert, drowsy, active sleep, and quiet sleep. You can tell what "state" a baby is in by the way she moves, breathes, and the noises she makes. I'm sure you all know that babies become drowsy when they are tired. Tiny babies tire very quickly, especially when they've had to deal with a lot of stimulation. Drowsy babies will stop paying attention to things around them, open and close their eyes, yawn, breathe faster then slower, and rub their faces with their hands. Some babies, especially younger babies, also get cranky, fussy, and increasingly frustrated.

Why Some Drowsy Babies Get so Irritable
Babies are hardwired to learn and socialize with the adults who care for them. They stare at their parents' faces, watch their mouths, try to copy their movements, and often calm down when they hear mommy's or daddy's voice. As babies get older, they become fascinated by every new object they see and try to touch, taste, drop, and explore everything in their reach. Babies work hard as little scientists, experimenting day and night to determine cause and effect. They love to play repetitive games and will giggle with excitement when they "discover" how to make their daddies' tickle their tummies or to elicit their mommies' smiles. Anything that gets in the way of that work may irritate babies. Unfortunately, babies can't maintain that learning state forever. They'll start to get sleepy, even though their brains and bodies will push them to learn more and more. For some very social and determined babies, sleepiness is so annoying, they'll start to cry.

Why Some Babies Fight Sleep
Some babies have a much harder time than others in changing their states, particularly calming themselves and getting to sleep. Fortunately, as babies get older, they get better at these important skills. However, all babies (even babies who regularly fall asleep easily), may struggle with sleep when they have been overstimulated or exposed to a stimulant like caffeine. Babies who are overstimulated (by vigorous play near nap or bed time, big changes in routine, or spending time in a crowd) have a hard time dealing with all the excitement. Their bodies react by releasing chemicals that stimulate their brains. Some babies will process these chemicals quickly, but others will not. Adults may have the same experience after watching a scary movie or attending a large party. In those circumstances, we can't fall asleep either. Some babies (and I had one) want the social time to last forever and fuss and cry and fight sleep with all their might.


5 Quick Tips for Dealing with Babies Who Hate Being Drowsy

1. Prevent over stimulation or any prolonged stimulation, particularly at bed time and nap time.

2. Avoid exposing your baby to stimulants like caffeine.

3. To calm your drowsy baby, maintain social play but slow the pace, gradually narrowing the type and duration of stimulation your baby receives. Limit what your baby sees, hears, and touches. Try slowly narrowing your interaction to include only one sense. Let her look quietly at your face OR hear your voice as she nestles into your shoulder.

4. Start a bedtime routine with a slow steady reduction in stimulation. Many experts suggest 45 minutes may be needed for a baby who struggles with getting to sleep. Don't worry, this won't last forever!

5. Try sustained stimulation, like white noise and steady motion, to help soothe babies who are fighting their need to sleep.

Next time: A Preview of Upcoming New Series!

The Science of Infant Sleep Part III. Relationships that Influence Babies' Sleep

In this series, we've been sharing information about how and why infants' sleep patterns change as they grow. In this post, we'll focus on the how characteristics of babies, parents, and sleep environments interact to influence how infants sleep.

In other posts, we've talked about why a "one size fits all" sleep intervention is not likely to work for all babies. That's because there is no one reason why babies sleep the way they do. Their own bodies and abilities, how and when they are cared for, and where they sleep, all work together to help or hinder babies' sleep. Parents need to keep this bigger picture in mind.

Baby Characteristics

While parents can and do shape many of their babies' behaviors, babies come into the world as unique human beings with combinations of traits all their own. Your baby's sleep patterns will be affected by her age, health, physiology (like her ability to make and respond to hormones), exposure to medications or stimulants (like caffeine), her development, stomach capacity, day time activity level, feeding pattern, intake, temperament, and sensitivity to the environment. Each of these factors can influence her sleep patterns differently.

Family Characteristics

Parents and other caregivers are, of course, as unique as their babies. Some important characteristics that may influence infant sleep include parents' own physical and emotional health, cultural and family experiences, sensitivities to baby behaviors, and infant feeding practices. Most of these factors affect babies' sleep because they have powerful influences on parents' day and night time infant care behaviors.

Sleep Environment Characteristics

Babies' sleep patterns may also be influenced by their physical environment. Sounds, sights (like lights from a TV), movement, comfort, and temperature of the places where babies sleep all make a difference for sensitive babies. These factors affect babies differently depending on whether they are in a lighter (active) or deeper (quiet) state of sleep and babies' bodies influence how long they stay in each type of sleep.

Interactions and Babies' Sleep

All this means that babies' sleep patterns emerge when all of these factors come together, like puzzle pieces. We can't always predict what babies will do. For example, older babies with bigger stomachs may wake when they are sick, teething, or sleeping in a room that is too hot or cold even after they have slept for longer stretches for awhile. City-dwelling younger babies may stay asleep despite loud noises and lights because their bodies have adapted to what goes on around them. Parents' interactions can make a difference too. Parents checking on babies in active sleep might inadvertently wake their babies or babies might sleep longer at night for parents who make sure that their babies have lots of daytime activity. But parent interactions can only go so far if babies bodies are not ready to sleep longer or they are sleeping in an unfamiliar environment (like grandma's house).

Next time, we'll wrap up this series and talk about what all this means for tired parents, how sleep patterns change in older babies, and the research we found about putting babies down partially awake.


Next time: The Science of Infant Sleep Part IV: Older Babies, Falling Asleep versus Staying Asleep

Tips for Successful Breastfeeding After a C-Section

Here are a few tips that can help you achieve a positive breastfeeding experience, even if your birth "plan" doesn't include a c-section.

Communicate with the hospital staff about your decision to breastfeed.
Plan ahead by letting hospital staff know that you plan to breastfeed before your baby is born. Ask that no bottles, supplements, or pacifiers be given to your baby unless medically necessary, and ask for your baby to be brought to you as soon as possible after delivery. Inquire if the hospital has a rooming-in policy, meaning they let the baby stay in your room for your entire hospital stay. This will give you time to get to know your baby's cues and let you practice breastfeeding. In case you are not able to be with your baby immediately post partum, be sure that your partner (or other support person) is aware of your feeding choices and ready to talk to hospital staff about them.

As soon as you can, put your baby skin-to-skin.
In most cases, you can start skin-to-skin contact with your baby in the delivery room, while the doctor is completing your procedure. Your partner or a nurse can hold your baby against your bare chest until you are ready to be transported to the recovery room. Keep your baby skin-to-skin as much as possible during the first few days postpartum. Skin-to-skin contact enhances bonding and ensures that your breast is readily available when baby needs to feed. It also helps regulate your baby's temperature and heart rate. If your baby is taken to the nursery, encourage your partner to stay with your baby and practice skin-to-skin contact with him until you are reunited.

Be patient, your milk will come in.
There may be a bit of a delay in your milk "coming in" after a c-section, but that does not mean that you can't breastfeed. Put your baby to the breast soon after delivery and as often as possible to stimulate your milk production. Your newborn needs 8-12 feedings in a 24-hour period. Before you start to produce larger volumes of milk, your body will produce colostrum. Colostrum is produced in very small amounts because your baby's tummy is also small. Colostrum is all that your baby needs in his first days of life. You will notice that things change quickly by day 3-5 after delivery. Your milk will change in consistency and color and the volume will increase. If for some reason you do have to supplement temporarily with formula, you can go back to exclusive breastfeeding. Be sure to talk to your doctor, nurse, or lactation consultant about the steps you'll need to take to reduce the amount of supplementation when your baby is ready.

Get some help. Your incision will make it challenging to position your baby to breastfeed comfortably.
Get help with positioning your baby at the breast to feed. A lactation consultant or nurse can show you the most comfortable positions to breastfeed that won't irritate your incision. Usually the side lying position or football hold puts less pressure on your abdomen. It can also be painful to get out of bed and pick up your baby the first few days postpartum. For the first week or so after delivery, have someone bring your baby to you and help you get into a position that is the most comfortable for you and your baby to breastfeed. Use pillows to protect your incision and keep you comfortable while breastfeeding. Also, you may have received a lot of fluid during and after your surgery. This extra fluid may make it harder in the first few days for your baby to latch onto your breast.

Tell your doctor that you plan to breastfeed, many medications are safe to take while breastfeeding.
After your surgery, your doctor will prescribe medications to control your pain. These days, many pain medications are safe to take while breastfeeding. Ask your doctor about the safety and compatibility of all medications you take while breastfeeding.

Make sure your baby is awake enough to feed. Your baby will be drowsy.
Because of the pain medications given during labor and delivery, your baby will be drowsy. It could take several days for the medication to completely leave your baby's system. A drowsy baby may fall asleep early in a feeding and thus, not feed effectively. See the next section for the best way to wake a sleepy baby to feed. Call your doctor or lactation consultant if your baby is sleeping all of the time and feeding less than 8-12 times per day.

Use a variety of ways to wake your sleepy baby.
In our last post, we told you the best way to wake a sleepy baby is to use a VARIETY of stimulation. Use different positions, touch, or words. Removing your baby's clothing is another way to change his environment (temperature or touch) to help wake him. Keep in mind that sometimes it can take up to 10-15 minutes for sleepy newborns or premature infants to fully awaken enough to feed effectively. Be patient!

With a little extra support and patience, you can successfully breastfeed your baby after a c-section. I did it, along with thousands of other mothers. That's not to say it was easy, but knowing what to expect will give you the confidence you need to achieve your happy (breastfeeding) ending.

Next time: Just when you thought the worst was over, waking up again with an older infant.

Yes, You Can Breastfeed After a C-Section!

PART 1: My Story

My beautiful baby girl entered this world after 36-hours of labor and an emergency c-section. There were complications from the surgery that led to my being sedated towards the end of the procedure. I vaguely remember the relief I felt hearing my daughter’s first cry before she was quickly taken to a nearby table where a team of respiratory therapists worked to get her breathing. Then the lights went out. (Note: this is not standard protocol for a c-section! Most c-sections are done with either a spinal block or epidural, during both of which you remain awake the entire time). My husband's instincts drove him to follow our daughter wherever she went that morning so that she would not be alone. He watched her get her first bath and have different tests done while I was still heavily sedated. I really wanted to breastfeed. So it was also important that he stay with her to ensure that she was not given any unnecessary supplements.

I awoke in a daze several hours later in a recovery room before being wheeled into the nursery to meet my daughter for the first time. My first impression was not quite love at first sight. I remember thinking: “That’s my baby? But she’s blonde!” I assumed she would have inherited my own dark hair and eyes. I felt disconnected, as many women do after delivering via c-section, and I felt disappointed that I had missed out on bonding with my daughter the moment after she was born. She wasn’t put on my chest to nuzzle and nurse and I was not the first person to hold her. Not to mention the fact that she didn’t look anything like me!

After I had settled into a postpartum room, my daughter was brought to me from the nursery. She was ravenous and a little fussy by the time she got to me. I had planned to breastfeed from the start, but I hadn’t planned on having a c-section and having to wait several hours after her birth to feed her for the first time. Luckily, I had filled out pre-registration papers at the hospital stating that I was planning to breastfeed and that I didn’t want her given any supplements or pacifiers unless medically necessary. I was so excited to breastfeed, hoping that, even though everything else about my labor and delivery had not gone according to plan, I would get a second chance to bond with my daughter by providing her with the milk that my body had made especially for her.

As my daughter attempted to latch onto my breast for the first time, she seemed almost in a panic to find the nipple. She was bobbing her head (rooting) and making little whimpering sounds. Her whole little body was tense. When my hungry child finally latched onto my breast, she sucked for a minute or two and then fell asleep. I became worried immediately. She needed to eat, and I felt it was solely my responsibility to nourish this helpless human being! No pressure at all. I now know that my expectation for this "perfect" first feeding was unrealistic. Newborns don't follow any rules! My daughter and I had to learn to breastfeed together, and that took a lot of practice.

I had taken a breastfeeding class prenatally where I learned several techniques to help wake a sleepy baby to feed. I undressed her, flicked her feet, rubbed her cheek, talked to her, etc. Luckily I was able to arouse her enough to ensure that she fed frequently. From our research with moms and babies, we've found that the BEST way to wake a sleepy baby is to use a variety of positions, touch, and words. Later, as the effects of the medications from the c-section wore off in her little body, as well as in mine, she became more effective with sucking and fed for longer periods of time.

While it was great that my daughter was more awake and alert to feed, my own pain level peaked as the medications from the delivery wore off. I remember feeling a searing, sharp pain in my abdomen (from the incision) every time I tried to sit up in bed to breastfeed my daughter. I was lucky to have great nurses who kept my pain under control with medication so that I could be comfortable enough to nurse. Still, I needed help getting her out of her bassinet and positioning her for every feeding for the first few days.

There is no doubt that breastfeeding after a c-section is challenging, but with a little help, you can have a positive breastfeeding experience!

Next time: Part 2: Tips for Successfully Breastfeeding After a C-Section