Sleep—What is Sleep? Life after the birth (part 1)

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Why do babies cry?

All babies cry—even entirely healthy newborns will cry for somewhere between one and three hours each day—since crying is a baby's only way of communicating its needs. As a new parent, it can be difficult to work out what your baby is telling you: is she hungry, cold, hot, thirsty, wet, bored, looking for cuddling, tired, or overstimulated? However, you will gradually begin to recognize your baby's different crying patterns and anticipate her needs. As babies grow, they learn other ways to communicate, such as making eye contact, noises, and even smiling, all of which reduce the need to cry.

My baby is two weeks old and cries all the time. I'm feeling so tired. Will things get better?

You will almost certainly find that things improve with time—babies grow and change and you will also grow in confidence as a parent. However, you need to know how to cope with, and hopefully enjoy, life at the moment and you may need some additional help and support to manage this.

Your midwife can still serve as a good resource for you after you leave the hospital. Babies usually are seen at two weeks by your pediatric care provider so this is a good time to bring this issue up. They can examine the baby to make sure all is physically well and may be able to provide you with community support groups, play groups, or doulas. This can be a difficult time in the adjustment to your new role and the responsibilities of parenthood. Perhaps your partner, close friend, or relative can give you assistance with household chores while you take some time for yourself or with your baby. Take a daily walk outdoor to get some light on your skin. Remember to eat and drink. You are very important to your baby so take care of yourself.

What will happen at my baby's well-baby checkup?

First, the nurse will ask about feeding, elimination, crying, adjustment, and take the baby's temperature, pulse, and respiratory rate. Your doctor will ask about sleep patterns, temperament, feeding issues, developmental milestones, if any vaccinations were given at the hospital, and if the baby was jaundiced. Assessment of growth in length, weight, and head and abdominal circumference will be made as will a full physical exam including assessment of your baby's reflexes and neurological development. Your baby will probably receive a second Hepatitis B vaccination or begin the series of three if it was not done after the birth.

The screaming is getting on my nerves—what should I do?

Most of the time, a baby who cries a lot will not do herself any harm, but may cause stress and worry for you. If your baby seems to resist every effort you make to calm her down, it can be hard not to feel rejected as well as frustrated. Parents sometimes blame themselves, feeling they are doing something wrong. If you know that your baby's needs are met, she is not ill, and you've tried everything you can think of to calm her but nothing has worked, it's good to have a coping strategy in place for how to deal with situations when you feel overwhelmed. Here are a few suggestions:

Take deep breaths.
Put your baby down somewhere safe, in the crib or Moses basket, leave the room, and let her cry for five minutes out of your hearing until you feel calmer.
Play your favorite music and let yourself relax for 10 minutes.
Call a friend or relative to take over while you take a break.
Talk to your doctor, midwife, or hospital nurse about local support groups or mother-and-baby groups where you can share your feelings and experiences and discuss ways of coping with your baby's crying with other new parents.
Sometimes taking your baby out for a walk in the fresh air may help to calm her and give you a clearer head.

Should I pick my baby up every time she cries?

Although this is a matter of personal choice, you should never feel you are “spoiling” your baby by attending to her cries, or by giving her plenty of cuddling and carrying her around with you if this comforts her. Crying is initially a baby's only method of communication. It is meant to get your attention and is designed to affect you so that you will quickly find out what is needed. However, as long as you have met her basic needs and you are sure that she isn't hungry, thirsty, too hot or cold, bored, wet, or ill, there is no harm in leaving your baby to cry for a few minutes. Some babies learn to comfort themselves, while some parents find any cry too distressing and quickly go to their baby. You have to trust your own judgment and decide what is right for you. However, try to make sure that you and your partner are consistent in how you respond to your baby's cries.

My baby cries for hours every evening. Could this be colic and is this serious?

Colic is fairly common in newborn babies, affecting around 10–15 percent of infants, and usually appears in the first few weeks after the birth . Babies suffering with colic may lift their head, become red in the face, draw their legs up in pain, and pass gas. There are many theories as to what causes colic, such as swallowing air when feeding or crying, or gas in a baby's tummy, but none of these is proven. The condition usually lasts for three to four months. Colic is not a serious condition, and research shows that babies with colic continue to eat and gain weight normally, despite the crying, but it can have a big impact on the family since the crying is very exhausting. There are plenty of remedies that may ease the symptoms.

If you are bottle-feeding your baby, you could try switching to a different brand of formula to see if another type is less irritating to her.
If you are breast-feeding, you could try not drinking cow's milk for a few days, since some believe this can cause colic. Also, some mothers swear that their baby is calmer when they abstain from spicy foods, caffeine, or alcohol, and you could try omitting these from your diet one at a time to see if this helps your baby to settle down.
Trying different nipples or bottles may help.
Burping your baby regularly during and after feedings may help to relieve pressure in her tummy if she swallows air.
Colic drops containing a substance called simethicone may help break down bubbles in milk feeds in the stomach, allowing swallowed air to be brought up more easily by the baby.
A warm bath with your baby may serve to relax both parent and baby.
A pacifier may satisfy your baby's need to suck and reduce the level of crying.
Gentle massaging over your baby's tummy, in a clockwise direction with a little almond oil, can be comforting for your baby and may relax the parents a little, too!
A warm, relaxed environment in the evenings may help to induce calm in your baby, whether you are bottle-feeding or breast-feeding.
White noise, such as the rhythmic sound of the washing machine, vacuum, and gentle movement, such as pushing the carriage or stroller around the room or around the block or taking a drive in the car, can also help calm your baby.
Arranging for some extra help in the evening when you are tired and stressed will offer you some relief.

If your baby's crying is becoming very scary and stressful for you, contact your pediatrician for advice.

My friend fed her newborn every three hours to establish a routine. What do you think of this?

Although this is your baby and you must decide how you want to care for her, the recommended way to feed your baby is to feed on demand, whether you choose to breast- or bottle-feed.

A baby needs to take in sufficient calories over a 24-hour period to grow and develop. If you restrict your baby's feedings during the day to every three hours or so, then she will need to wake more often during the night to take in the calories she has not taken in during the day. It's often best to accept that life with a newborn baby is very tiring. At this early stage, if you concentrate on feeding your baby when she wants to be fed, you will probably find that she will develop a routine naturally over the next few weeks and she will eventually sleep through the night. If you do decide to regulate your baby's feedings at an early stage, you will also need to think about how you will deal with a crying baby who wants to feed earlier than she should according to the regimen you have established. You could try discussing this with your friends as well as asking your midwife and pediatrician for their advice.

I want to feed my baby on demand. My mom says I'm making life harder—is she right?

Demand feeding is the recommended way to feed your baby. This method of feeding simply means that you feed your baby whenever she signals that she is hungry and wants food—usually by rooting, crying, or sucking on her hands—rather than according to a schedule set by you. Over time, parents start to recognize the signals more rapidly and know when their baby wants to be fed.

In the early weeks of breast-feeding, you may feel as though your baby feeds constantly. However, bear in mind that newborns have tiny stomachs—about the size of their fist—and so can only hold a certain amount of food. Easily digested breast milk quickly fills a baby's stomach and is easily absorbed, so she will need to eat again relatively soon. For the first six weeks, breast-feeding is being established and it is important to totally demand feed during this time. This means that your baby regulates the amount of milk you produce by feeding more to produce more. When she has let your body know how much she needs, she will sleep better between feedings and only demand more when she needs more. If your baby seems hungry soon after eating—for example, she may be fussy, sucking on her fist, or rooting at your breast—go ahead and feed her again since this will boost your supply. Bear in mind, too, that babies are just hungrier on some days. It's also important to make sure that your baby empties each breast, since the hindmilk at the end of a feeding contains more fat and nourishment and so babies feel fuller and satisfied longer.

If you feed her on demand, she will also begin to sleep longer at night. This way, you don't need a feeding program; you can just give your baby whatever she asks for and continue to do this until she starts taking solid foods.

How long should our new baby sleep for?

Although young babies sleep for an average of 16 hours each day, usually taken in short stretches, all babies are different, so it is impossible to say exactly how long a newborn baby should sleep. Initially, many babies are extremely sleepy and it can feel like they sleep for much of the time. However, as long as they are woken regularly for feedings, this isn't a problem. Other babies seem to be more unsettled from the beginning, sleeping only in short bursts. Ideally, a new baby will sleep whenever and wherever she needs as long as she isn't feeling hungry, too cold, too warm, or uncomfortable.

You will probably find that once your baby is a few weeks old, she will be spending more time awake and alert and will start to take more of an interest in what is going on in the world around her. You may also begin to notice a pattern forming in your baby's sleep habits by about six weeks, which will continue to evolve, and by around four months your baby will probably be sleeping for twice as long during the night as she does during the day. If your baby seems generally relaxed and contented, and is feeding and growing and developing well, then she is most likely getting enough sleep.

Our baby only settles if lying on my partner or me. We allow it since we want a rest. Is this wrong?

Although this is not wrong—getting a rest is important—there is a safety aspect to consider. Bed sharing, or even sleeping on the sofa together, is not advisable unless the adult is awake, so never fall asleep with your baby on a sofa or armchair.

If you have met her basic needs and she isn't ill, you could try other methods to calm your baby, such as putting her in a sling, going out in the car or with the carriage, or singing to your baby. When she is sound asleep try to move her to her sleeping place.

Is it OK for our baby to share our bed? I'm confused about the advice.

Bed sharing while feeding or relaxing when the adult is always awake is enjoyable and can also benefit breast-feeding. However, there are dangers in bed sharing if you are asleep, including accidents involving suffocation and falls. The clear message from health professionals is that the safest place for your baby to sleep, night and day, is in a crib or bassinet in a room with you for the first six months of her life. The American Academy of Pediatrics and the Centers for Disease Control (CDC) outline steps to reduce the risk of crib death, which include not sharing a bed with your baby under certain circumstances (see Safe sleeping and SIDS ). If you want to keep your baby close by, there are cribs available that butt up close to the side of the bed.

Is it OK to rock our baby to sleep, or are we making life more difficult for ourselves?

If this is acceptable to you and your partner then it isn't a problem. However, you should be aware that babies tend to be creatures of habit, so if you use a certain technique to get your baby to sleep in the daytime, she probably won't settle down at night without the same technique. So avoid rocking her, walking her up and down, or taking her for a drive in the car unless you're fine to repeat these things in the early hours of the morning!

If you find that sleep problems are beginning to dominate your life, there are techniques to encourage your baby to sleep (see sleep training your baby ). However, these are not really recommended until your baby is a few months old, although if you are desperate for your baby to sleep in the evening, you may want to try one a bit earlier. All sleep solutions rely on consistency, as well as being sure that your baby can cope on her own. Before you start a routine, make sure that you and your partner agree it is the right thing to do and will support each other during the first few difficult nights.

Is it a bad idea to carry my baby around in a sling or carrier at home? it really calms her.

You are not spoiling your baby at all if she enjoys being carried close to you. An US study observed that the young of animals fell into two categories—cache or carry. Either they were meant to be left for long periods of time in the nest while their parents were out hunting for food (cache), or they were meant to be carried all the time while the parents hunted (carry). The study concluded that humans fell into the carry category. The researchers based their conclusion on the fact that human breast milk is low in protein, so human babies need to be fed fairly frequently, around every two to three hours, and that a human baby has reflexes that represent clinging and attachment.

My mom says babies sleep better on their tummies. Is she right?

Your mother is mistaken on this and nowadays it would not be advised by any health professionals. A key piece of advice from The American Academy of Pediatrics (AAP) is to place babies on their backs to sleep. In 1994, a large campaign was launched in the US to help parents to remember the importance of putting their sleeping babies on their backs to avoid the risk of suffocation, but allowing them time on their front or sitting up safely when they are awake to help their head control and for healthy development.

Depending on your mother's age, the advice may have been to put babies on their tummies when you were young. Also, many grandparents state concerns about babies vomiting while on their backs, but in reality babies turn their head if they are sick. If you are still concerned about this issue, discuss it further with your pediatrician.

My friend sleep-trained her baby within three weeks. How early can you start?

All children have different sleep patterns and differ in the amount of sleep they need. Problems begin when the baby prevents either parent from getting the sort of rest they need. It is important to establish what your sleep expectations are for your baby, bearing in mind that one in three children wake regularly in the night at 12 months. You could talk to your friend about her technique and when she started it. However, generally sleep-training techniques aren't started until a baby is several months old. If you try a sleep-training technique, you must continue it faithfully for at least a week, although after two or three nights you should see an improvement.

A popular method is “controlled crying.” With this method, you leave your baby to fall asleep alone but visit her briefly after 5 minutes, then after 10 minutes, and again after 15 minutes, if she is still crying. Pat her back, say a few words, and tuck her in; don't cuddle her or pick her up. The first few times she may cry for a while. If she wakes at night, follow the same routine. Another technique is to move away gradually from her crib. First sit by her crib and hold her hand for a few nights until she falls asleep. Then move farther away each night until you sit just outside her door where she can still see you until she falls asleep.

Can you use a baby sleeping bag for a newborn?

Also called sleep sacks, these are safe for a newborn if you are using the correct size, although some manufacturers suggest waiting a few months before using one. They are suitable for babies from approximately 7–10 lbs (3–4.5 kg) and have different insulation values for different times of year. They are worn over a sleep suit and it is important you follow the instructions on sizing and insulation values. The ideal room temperature for your baby is around 65–75° F (18–24° C). If the room is warmer or colder, adjust the level of clothing. Sleep sacks prevent overheating by using too much bedding and reduce the risk of loose bedding going over a baby's head; there is also less chance for a baby to become tangled in covers or kick them off in the night. If you use a sleep sack it needs to be hoodless with the right size opening at the neck so your baby won't slip down. Sleeping bags must never be used with a comforter, heavy blanket, or quilt. They can be used in a Moses basket, car seat, or stroller.

My partner never wakes when I'm pacing the floor with the baby. How can I get him involved?

You need to find time when your baby is settled to discuss this issue calmly with your partner. It is possible he is unaware of how you are feeling, or he may be a particularly heavy sleeper. Sometimes partners feel inferior since they think that the mother is better tuned in to their baby's needs. Also bear in mind that your partner may need to function at a different level if he is working during the day and may therefore need a fairly full night's sleep. Perhaps you could suggest that he takes over one night on the weekend to try and let you get a better night's rest. Or you could organize a “sleep-in” morning at the weekend, so one day you get up and let him have extra sleep and then swap the next morning. You could encourage your partner to help out in other ways too, with diaper changes or feeding, or taking the baby for a walk, so you have time to do something for yourself. The more you encourage baby and father interaction, the more inclined to help out he may become. Try and remain calm and hopefully you can resolve this issue together.