Baby Sleep Problems: Causes and Explanations (Part 1)

In a prior article, Isolating the Source of Your Baby's Sleep Problem, we looked at nap disturbances from a variety of sources.

We provided an extensive list outlining the potential baby sleep problems divided into four categories, some with obvious solutions and other causes that needed further investigation.

The list below contains the promised explanations of the top ten baby sleep challenges noted in the first article. A subsequent article will cover the second half of the most common baby sleep problems. 


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 Baby Sleep Problems: Causes and Explanations (1-10)

  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 number of ounces a baby needs at each week or month of life.

  1. 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 takes place, 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 Baby as for Mom. 

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  1. Baby is ready to start solid foods.

Explanation/Recommendation: For the baby who has a well- established nighttime sleep pattern, any abnormal waking at night 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. As a general rule, babies usually start between four and six months of age, although some research suggests that holding off solids to five or six months may decrease the possibility of food allergies. Please note, the research is not suggesting that by offering solids at four months you will create food allergies, but rather that 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.

  1. Baby is uncomfortable because he is getting sick, is teething, has a slight fever, start of an ear infection, etc.

Explanation/Recommendation: It is a little scary! Your baby wakes early from his nap, cries as if in pain, but you do not know why. First, you check his forehead for any indication of a fever. 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 reason, and as a parent you must figure out why. If you have not already, get into the habit of checking your baby all over once a day, including fingers and toes.  

  1. Baby’s tummy is troubling him because he has a mild or delayed case of reflux.

Explanation/Recommendation: 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 is the result of an immature sphincter valve where the esophagus connects with the stomach. If your baby is troubled by reflux, you can count on it showing up throughout the day, not just at naptime.

  1. Your baby is having an on-going 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. Tummy discomfort, diarrhea, 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 baby is having a reaction. The bottom line? Never introduce multiple food types at the same time 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. 

  1. 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 brings about a reduction in 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 baby wakes and wants to play). In this case, the baby is not adding or subtract- ing 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.

  1. Baby is getting too much sleep and needs to subtract sleep

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 begin to send an “awake signal” if there is too much sleep occurring 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 decrease during the day.

  1. 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 corre- spondingly 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 her 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 reason- able lactation suggestion offered. Sometimes, during the long stretch of nighttime sleep, Mom is able to produce a sufficient quantity of milk for the morning feed, but she is not able to sustain the necessary production throughout the day. The end result shows up at the 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 is offering 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 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.

  1. 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, there are certain medications that can potentially become a source of discomfort, thereby 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 less side effects for the baby? Third, what time of day is Mom taking her medication? Is it possible to take it right after 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.

Stay tuned for a future article expanding upon baby sleep problems 11-19 in further detail.

For more help getting your Baby on a Babywise sleep schedule, you can read more articles on Baby Sleep here.

Excerpted with permission from On Becoming Babywise by Gary Ezzo, M.A. and Robert Bucknam, M.D., copyright Parent-Wise Solutions, Inc. You can learn more and purchase the book here.

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