Naptime Basics (Part Three) - Sleep Challenges and Solutions
BWS - 09
Below are several causes of sleep disturbance, along with an expanded explanation of many of the various sleep challenges noted in the previous blog. This is list two, note in our previous blog.
1. Baby is hungry because he needs more milk calories in a 24-hour period.
Explanation/Recommendation: Whether breast or formula feeding, a baby’s growth necessitates more calories. While this does not always signal the start of solids, it may signal a need for more feedings (if breastfeeding) or more ounces (if offering formula). Hunger can disrupt established nap and nighttime sleep routines. Check with your baby’s pediatrician for literature relating to the number of ounces a baby needs at each week or month of life.
2. Baby is starting a growth spurt.
Explanation/Recommendation: Growth spurts will disrupt Baby’s naptimes for the length of the spurt, which may be one to four days. When a growth spurt occurs, feed as often as your baby needs, but try to maintain the feed-wake-sleep cycles as best you can. The day after the growth spurt ends, your baby will take longer-than-normal naps for a few days. That is because growth spurts are as exhausting for the Baby as for the Mom. A growth spurt is a biological process in which a baby requires additional calories for a specific growth need, most likely to restore depleted energy to the cells. Your primary concern is to provide the extra calories your baby needs. (Please review the Growth Spurt section in Chapter Four.)
3. Baby is ready to start solid foods.
Explanation/Recommendation: For the baby with a well-established nighttime sleep pattern, any abnormal waking between five and six months of age or waking early during naps might also signal that more nutrition is required during the day. Babies are highly individual when it comes to showing a readiness for solid foods. One baby might show signs at four months, while another shows no signs of readiness until six months. Generally, babies usually start between four and six months of age. However, some research suggests that holding off solids to five or six months may decrease the possibility of food allergies. Please note that the research does not suggest that offering solids at four months will create food allergies; rather, some babies have an underdeveloped ability to digest solid foods, which is reflected by food allergies. The AAP leans toward six months before starting solids, but most grandmothers will tell you any time between four and six months is appropriate if your baby shows all the signs. Your baby’s pediatrician or family practitioner will direct you based on your child’s unique nutritional needs and readiness cues.
4. Baby is uncomfortable because he is getting sick, is teething, has a slight fever, starts an ear infection, etc.
Explanation/Recommendation: It is a little scary! Your baby wakes early from his nap and cries as if in pain, but you do not know why. First, you check his forehead for any indication of a fever. The ears and nose are next. No redness is good news, so you examine the baby’s mouth for an emerging new tooth. Nothing there. Examination time is over. You assume it is a sleep issue.
Not so fast! The sudden and unexplainable cry has a reason, and you must figure out why as a parent. If you have not already, get into the habit of checking your baby all over once a day, including fingers and toes. Certainly look for the bug bites, which often appear as a red skin bump. There is also a condition, though relatively under-reported, called “toe-tourniquet” syndrome. A single strand of hair, usually Mom’s, or a fiber from a carpet or blanket where the baby was playing, somehow gets wrapped around a toe or finger. Although hardly noticeable, it eventually begins to tighten and cut off circulation to the appendage, causing swelling, inflammation, and pain. The problem is often missed because the baby wears a sock or sleeper. While this may not explain every sudden and unexplainable cry or why your baby is waking early from his naps, it does alert you to the need for a daily “once over” of your baby’s body.
5. Baby’s tummy is troubling him because he has a mild or delayed case of reflux.
Explanation/Recommendation: While you can read more about reflux in Chapter Eight, it is important to understand that reflux symptoms may not be present at birth and may not show up for several weeks. It is estimated that in the United States, three to five percent of all newborns have mild to severe reflux symptoms for the first few months of life. Reflux results from an immature sphincter valve where the esophagus connects with the stomach. When working correctly, it opens to allow us to swallow, burp or vomit, then closes immediately afterward. Reflux occurs when the sphincter stays relaxed or relaxes periodically, allowing food mixed with stomach acid to back up into the esophagus and throat, causing pain. This condition is called heartburn in the adult world.
If your baby is troubled by reflux, you can count on it showing up throughout the day, not just at naptime. We have a little friend named Micah who provides an example of this. After three weeks, a mild case of reflux began to manifest itself. To counter its effects, his parents did two things: They kept him upright for a short time following each feeding and elevated his crib's head by two inches, allowing gravity to prevent stomach acids from moving back into Micah’s esophagus while he was sleeping. Because this was a mild case of reflux, these solutions worked. For more severe cases, medication may be necessary.
6. Your baby is having an ongoing allergic reaction to a new baby food.
Explanation/Recommendation: One basic rule of introducing solids is to begin with one item at a time, waiting three to five days before introducing another new food type to see if your baby develops an allergic reaction. Sequential introduction of food items allows you to monitor your baby’s reaction so proper nutritional adjustments can be made if needed. For example, your baby might do fine with yellow squash but have a reaction to peas. Tummy discomfort, diarrhea, and even rashes are common symptoms of food allergies and can also affect naps and nighttime sleep. Vomiting, while rare, is a more serious indicator that the baby is having a reaction. The bottom line? Never introduce multiple food types simultaneously so you will not have to guess which food caused the reaction, should one occur.
When introducing cereal into your baby’s diet, begin with the morning meal. If, by any chance, your baby does have an intestinal reaction, it will be noticed and should be over by the end of the day. Starting a new food at noon or at dinner risks pushing the reaction to the middle of the night when sleep disturbances are more difficult to discern.
Finally, before starting solids, check with immediate and extended family members to find out if there is a history of food allergies. Knowing whether allergies run in the family gives you a big advantage. If there is a history on either side, a higher probability exists that your little one will be challenged by food allergies. This is good information to have. If it happens, at least you are not caught off guard.
7. Baby is starting a sleep/nap transition because he is extending his nighttime sleep, affecting daytime naps.
Explanation/Recommendation: When a baby begins to extend his sleep at night, such as going from 10 to 12 hours, this naturally reduces the time the baby sleeps during the day. This reduction usually shows up at naptime (on rare occasions, it can show up at 3:00 a.m., when the baby wakes and wants to play). In this case, the baby is not adding or subtracting hours of sleep; he is rearranging when his sleep occurs. However, as Baby grows, he will begin to subtract hours because his body will not allow him to over-sleep.
8. Baby is getting too much sleep and needs to subtract sleep hours.
Explanation/Recommendation: While sleep is very important to a baby’s development and overall behavioral performance, there are limits to the amount of sleep a baby needs at each stage of growth. The “sleep center” in a baby’s brain will automatically send an “awake signal” if too much sleep occurs in a 24-hour period. When he reaches this level of growth, he will begin to subtract hours of sleep. Normally, babies do not subtract hours from nighttime sleep but from daytime sleep. Correspondingly, this means waketimes are extending, and the number of naps decreases during the day.
9. Baby is hungry because Mom’s milk supply has gradually decreased.
Explanation/Recommendation: When it comes to a drop in Mom’s milk supply, the decrease is usually gradual, and correspondingly her baby gradually shifts nap duration. Baby might start waking just 15 to 30 minutes early and then 30 to 45 minutes or 60 minutes early. Most Moms can add a feeding or two and increase their milk supply.
However, there is a very small percentage of breastfeeding moms who are not able to sustain their milk supply during the day, even after trying every reasonable lactation suggestion offered. Sometimes, during the long stretch of nighttime sleep, Mom can produce a sufficient quantity of milk for the morning feed, but she cannot sustain the necessary production throughout the day. The end result shows up at various sleep times. Possible causes for lower milk production include:
Mom is not offering enough feedings in a 24-hour period.
Mom is fatigued because she offers too many feedings (or is cluster-feeding).
Mom’s schedule is too busy (i.e. she is not getting sufficient rest).
Mom is not eating properly or not taking in sufficient calories or liquids.
Mom is on a lactation-suppressing medication.
Mom is not able to keep up with the baby’s nutritional needs.
Once Mom discovers the probable cause for the decrease in her milk supply, she should take corrective action on any cause that she can control or influence. If she determines that she is not able to provide her baby adequate nutrition through exclusive breastfeeding, even after making all the proper nursing adjustments, then she has two choices. Continue to nurse and supplement with formula, or completely switch over to formula. Either way, the most important aspect is whether the baby is receiving adequate nutrition for healthy growth, and that is what Mom’s decision should be based on.
10. Baby has a reaction to a new medication Mom is taking.
Explanation/Recommendation: Most medications prescribed to breastfeeding mothers are safe for the nursing infant. However, certain medications can potentially become a source of discomfort, impacting a baby’s sleep. If Mom suspects a link between her medication and her baby’s irritability, there are several factors to consider.
First, a mother should not assume that a medication safely taken during pregnancy will always be safe for a nursing baby. Second, Mom should check the prescription dosage with her doctor or pharmacist. Is it possible to reduce the dosage or substitute another drug that has fewer side effects for the baby? Third, what time of day is Mom taking her medication? Is it possible to take it right after the baby’s last feeding of the night so her body can metabolize most of the medication during her nighttime sleep, which hopefully will be 8 to 10 hours before her baby’s next meal? In the end, Mom must weigh the benefits of taking her medication in light of the possibility that the medication is having a negative impact on her baby. Getting advice from a medical expert should be considered.
11. An over-abundant milk supply is providing too much lactose for baby.
Explanation/Recommendation: Most breastfeeding concerns are associated with mothers who are not producing enough breastmilk. However, in rare cases, some mothers produce too much milk, which sets in motion a ripple effect that shows up at naptime. When a mother’s milk-producing glands make and store more milk than her baby needs, the foremilk/hindmilk volumes change correspondingly. While the foremilk/hindmilk nutrient ratios remain the same, the total quantities in each breast are higher. When more foremilk is available to a hungry baby, more lactose (milk sugar) is ingested, and that is when the problem starts.
Healthy babies do not have a problem with processing normal levels of lactose, but ingesting a large volume will overpower their digestive tracks because they do not have enough lactase (digestive enzyme) to break down all the lactose. Excessive lactose causes significant discomfort from gas build-up. Green watery stools are a common symptom of this condition.
Let’s do the math on this. We will assume that Baby is at an age when he should be taking a total of 5 ounces of milk at each feeding (2½ ounces from each breast). However, Mom produces 6 to 8 ounces of milk at each feeding, which proportionally increases lactose availability during nursing. Baby starts on one side, takes 3-4 ounces, switches breasts, but then becomes satiated with 2 ounces of mostly foremilk from the second side. Since foremilk is high in lactose but lower in fat than hindmilk, the result is too much lactose entering the baby’s digestive system causing stomach pain, watery stools, and ultimately leading to disruptions at Baby’s naptimes.
A downward cycle follows: naps become shorter, Baby begins to feed less vigorously, and the lactose cycle repeats itself. Possible solution? Pumping some milk from both breasts just prior to feeding might help remedy the problem. That will remove some of the foremilk so when Baby feeds, he will receive a closer to normal foremilk/hindmilk ratio. Unfortunately, trial and error is the only way to discover the right amount to pump.
12. Baby’s waketime is too short.
Explanation/Recommendation: There will always be days when a baby’s routine will have some variance impacting the length of waketimes. However, if a baby’s waketime is routinely too short for his age, then naptimes will be disrupted.
13. Baby’s waketimes are over-stimulating or too long.
Explanation/Recommendation: When searching for the solution to naptime challenges, parents often overlook the quality of the waketime that preceded the nap. Remember, everything is connected. Waketimes affect naps just like naps affect waketimes. Over-tired and over-stimulated babies become hyper-alert, fighting off sleep through crying. If this is a regular problem, shortening your baby’s waketime by 15-minute increments might help.
Also, be aware of the types of activities you and your baby are involved in. Are you having too many visitors drop by who have an irresistible urge to entertain your baby? Was your baby being exposed to Dad’s loud friends as they sat watching a sporting event? Might Mom be on the go too much? When Baby is along for the ride, the coming and going, the new sights and sounds, and the absence of predictability all work against good nap behavior. That is because catnaps in a car seat are no substitute for a full nap in the crib. An occasional nap in the car seat will not cause trouble, but it should not be the norm, especially during the first six months of your baby’s life.
14. First feeding of the day has too much flexibility.
Explanation/Recommendation: As previously noted, it is important that the first feeding of the day stays fairly consistent (within 20 to 30 minutes.) Otherwise, each day will be a different rhythm, which works against stabilizing the baby’s hunger metabolism. This will eventually affect the length of baby’s naptime.
15. Baby is not being exposed to adequate amounts of daylight.
Explanation/Recommendation: Natural light is important to help babies regulate their circadian clock. This is the inner clock, the biological time-keeping system that regulates daily activities, such as sleep and wake cycles. We recommend that, as soon as your baby awakens in the morning, you take him to a room filled with daylight (although he does not need to be in direct sunlight). Natural light, along with the first feeding of the day, will help establish his circadian rhythm and keep them consistent. Routine helps facilitate this amazing function possessed by all humans.
16. Baby’s room is not dark enough.
Explanation/Recommendation: This is one of the most overlooked reasons for the sudden occurrence of a baby waking early and one of the easiest to fix. While newborns can sleep just about anywhere and under any conditions, the “light sensitivity” changes after three months of age. The morning sun is on one side of the house, but the afternoon sun is on the other. Depending on the baby’s room's direction, the sun’s light can impact a baby’s naps. Like most adults, babies tend to sleep better and longer if the room is darkened. Shades or curtains are the simple solution.
17. Baby is over-stimulated in the crib because a wind-up toy/ mobile was turned on when he was put down for a nap.
Explanation/Recommendation: All those fun baby gifts Mom and Dad want to use right away can be a problem. Why? Newborns are not ready to appreciate crib gear yet because of their eyesight. We recommend keeping the crib mobiles in their boxes before four months of age. Put them over the playpen rather than the crib when they come out. Mobiles are entertaining, but they can become a source of over-stimulation when set up too early and activated just before naptime. Some babies cannot neurologically handle particular types of stimulation created by movement and sound. Even the flickering of light from a television can over-stimulate a baby.
For example, Mom checks her social media feeds in a darkened room while nursing and notices her baby drifting off to sleep. She thinks he must be tired; however, in this case, the baby is shutting down neurologically, a mechanism by which a baby’s body protects itself. Thirty minutes later, the baby wakes, and Mom interprets this as a sleep problem when it is actually a problem brought on by over-stimulation. The problem here is the “blue light” emitting from her phone screen disrupts the production of melatonin, which is necessary for establishing and maintaining natural sleep-wake cycles. The “blue light” is not only affecting Baby, but Mom’s ability to sleep well.
18. Your four to six-month-old baby is waking in response to sounds associated with pleasure.
Explanation/Recommendation: This condition is created when two-time elements cross. The baby’s circadian clock has him moving out of deep sleep into active sleep close to the time a familiar sound occurs each day. He can associate sounds with activities and people as he approaches four months. Once he makes the association, he becomes more alert, and the sound can trigger an awakening mode. While many babies will fall back to sleep, others are ready to fight off sleep in exchange for the next big adventure.
It could be the familiar sound of school bus brakes or a garage door opening. Both signal the arrival of someone, perhaps an entertaining sibling or a fun-loving Dad. You can do very little about the school bus brakes except to substitute some white noise during the naptime affected. Dad can park the car in the driveway and find a less disturbing way to enter the house. Every home has its own peculiar sounds that become part of a baby’s subconscious, especially if the sound precedes pleasure. It is as if a bell goes off in Baby’s head, and suddenly he is ready to party!
19. Unknown: What does this mean? Simply a reason exists, but it is so unique to your baby’s situation that it is not easily duplicated by other babies.
Explanation/Recommendation: It is both amazing and helpful to realize that the simplest things can get overlooked when searching for a sleep/nap solution. One mother reported her search ended when she entered her baby’s room after he fell asleep and started sitting through his nap. She was unsure what she was looking for but discovered something she never expected. Just about 35 minutes into his nap, a beam of sunlight shining down onto her baby’s face began to appear. In this case, the unknown factor was tied to the earth’s rotation, continually changing the sun's angle. In tracing the sunbeam back to its source, Mom discovered the sun’s rays reflected off a piece of metal flashing on her neighbor’s roof. While the sun’s impact at that location lasted only ten minutes, it was enough to wake the baby. Mom hung a towel in the corner of the window during naptime, solving the problem.
If the cause of your baby’s naptime disturbance falls into the category of “unknown,” Keep looking for clues, ask questions, or invite an experienced PDF mom over for part of the day to observe you and your baby. A fresh set of eyes can never hurt if stumped with a nap challenge.
Summary of Waking Early
If your baby wakes early out of a sound sleep with a strong cry, consider whether the cause relates to Baby, Mom, waketime, or the sleep environment. This phenomenon has become known as the 45-Minute Intruder and can visit your baby at any time, but it usually shows up after eight weeks of age and peaks around six months of age. It might stick around a day or two or decide to take up residence for a week.
If you have ruled out the simple explanations, we suggest you begin by treating the sleep intruder as a hunger problem. Try feeding your baby first. If he shows no interest in feeding or does not feed well, you have just ruled out hunger as the cause. But if he does take a full feeding, you have narrowed the problem to a feeding issue. This could indicate that he is starting a growth spurt, or there is a decrease in your milk supply or the quality of your milk.
If this is not a feeding issue, then go through the rest of the items in List two. The key to fixing the problem is to identify the source of the problem and then work toward a solution. Even if you cannot identify the source, the problem tends to be temporary and usually fixes itself.
Finally, be aware that some sleep advocates advise moms to keep their babies on fixed schedules, even if their babies wake early from their naps. Their advice is to allow the baby to “cry it out” until the next feeding, but this ignores the potential needs of the baby. A hungry baby should constantly be fed! Withholding food is never a way to fix a sleep problem.
Summary: Waketime and Naps
Waketime will become an increasingly important part of your baby’s day because it is a learning time. There is a balance, however, that parents must stay mindful of. Over-stimulating a baby during waketime impacts the next set of feedings and naptimes. Remember, everything is connected.
Everyone in the house wins when parents help their babies by establishing healthy feed-wake-sleep patterns. When there are several disruptions in your baby’s feeding or waketime routine, there will be corresponding changes in his sleep patterns. Stay on top of this by being as consistent as possible with mealtime and age-appropriate waketimes.