Newborns Who Confuse Night and Day
St. Kilda, Dunedin, New Zealand
From: NEW BEGINNINGS, Vol. 12 No. 1, January-February 1995, pp. 14-15
We provide articles from our publications from previous years for reference for our Leaders and members. Readers are cautioned to remember that research and medical information change over time.
Few things are as challenging to new parents as being awakened every half hour or so all night long by a baby who finally settles in at 5:00 or 6:00 AM, then sleeps solidly (or at least with minimal interruption) until noon. My daughter, Rachel, began this pattern the second day after her birth and stuck to it persistently. We were still in the hospital, and the hospital routine imposed on us meant it was virtually impossible for me to sleep with Rachel during the morning. I had greater flexibility once at home, but my mother was visiting from the US, and my husband was taking parental leave from his job. I really wanted to be awake during the day to spend time with them. The result was incredible exhaustion! I searched through books on nighttime parenting, but found little help. Now after years of experience and further reading, I have a few thoughts to offer parents who might find themselves in a similar situation.
The first question that must be asked is whether there is really a problem. First-time parents who hear stories told by friends and family or consult popular "how to" child-rearing books often believe that their baby will sleep round-the-clock in the early weeks, waking after 8:00 PM for feeds only. Babies, though, have not read the same books or heard the same stories. Midnight is often their preferred bedtime—not the 7:00 PM many a parent might prefer.
There is also great variability in babies. At one month of age, some normal babies sleep as much as nineteen hours total, while others sleep as few as twelve. If the problem is one of unrealistic expectations, the simple answer is to revise them. Good-natured acceptance of this situation goes a long way.
A problem exists only if the baby needs continual attention during the mother's usual sleep period (continual attention being more than frequent breastfeeds, an occasional nappy change, and some quiet cuddling. A baby needing these things at night is normal and not confusing night and day). An awake baby may not require much attention if placed in a secure and interesting place (e.g., in bed between sleeping parents with a low light on and a few soft toys or an interesting ceiling). So long as the baby is safe and happy, there is no reason for the parents to remain awake.
Even when the baby needs continual attention during the mother's usual sleep period, it may be easier for the mother to adjust her sleeping habits than to attempt to change the baby's. If the baby is an only child, the mother might be able to take the phone off the hook, put a sign on the front door, and sleep blissfully until noon or whenever the baby decides to wake. But sometimes a change in the mother's schedule isn't possible. For example, an older sibling who wakes at 6:30 AM each morning will make a long lie-in for the mother difficult. A working mother whose maternity leave expires before baby is sleeping more soundly may find it impossible to nap.
The next step then, is to consider whether any reason for the baby's schedule can be identified. Is the mother drinking too much coffee, tea, cola, or other substances containing caffeine? Caffeine is a stimulant which passes into breast milk. The easiest way to test the possibility that caffeine is affecting the baby is for the mother to cut down on (or better yet, totally avoid) caffeine for several days and see if any changes occur. If caffeine seems to be the cause of the problem, it may not be necessary to abstain totally. Experiment--avoiding caffeine after about 4 PM may be enough to do the trick.
Food allergies also may be involved. Rachel had "colicky" crying fits for seven months. These were ultimately attributed to her sensitivity to foods that I was eating and passing through my breast milk. Evening is the most painful time and morning the most comfortable for many infants with colic. Perhaps this is because the mother does not eat during the night. Our second child, Helen, also suffered from severe food allergies, but we were much better informed after her arrival and were able to control her colic a few weeks after it appeared. Both children had the tendency to prefer sleeping during the morning. If food allergies are suspected, talk to your La Leche League Leader about eliminating some of the most likely allergens from your diet. Supplements such as vitamins or fluoride may also interfere with a baby's ability to sleep.
Another possible cause of a troublesome sleeping pattern may be the parents' schedule. Children quickly learn to adjust their schedules to maximize time with their loved ones. If the mother is absent during part of the day, or present but preoccupied with other concerns (such as getting older children off to school), the baby may decide that this is an excellent time for a nap. More focused attention on the baby during the day may help to change the pattern. Overstimulation is another possible cause to consider. Some sensitive babies may shut out a loud and boisterous daytime atmosphere by sleeping through it. If this is the case, create a predictable, low-stress environment for the infant during the day. A parent or day care provider who allows an infant to sleep the day away can expect a baby who hasn't much interest in sleeping at night.
If no cause for the pattern can be found and remedied, try easing the baby into a new schedule. The basic approach is to clearly distinguish between night and day; make day as interesting as possible and night as peaceful and relaxing as possible. To clearly distinguish between night and day, parents may need to exaggerate their normal behavior. Clothing, sleeping place, lighting, and noise level can be altered. At nighttime, for example, baby may always be dressed in a nightgown and nursed lying down in a dark or dimly lit room (use towels over the windows if necessary when days are longer). Be sure that baby is not overdressed or the environment too warm. One study indicated that babies that disturbed their parents in the middle of the night were significantly more heavily wrapped in significantly warmer rooms. This suggests that an above-normal body temperature may lead to wakefulness. During the day, the baby might wear a one-piece stretch suit and be nursed in a chair in a brightly lit and noisy living room.
Even more important than these physical factors is the parents' behavior. During the day, the parents might talk directly to the baby and play with him or her. At night, there could be lullaby singing and quiet cuddling rather than direct eye contact, chatting, or vigorous play. (This might be difficult to manage: Helen smiled for the first time in the middle of the night, and my determination to be low-key disappeared.) Nighttime parenting books give advice which may be helpful in making a baby sleepy, such as a consistent bedtime routine.
The goal during the day is to stimulate the baby so that he or she doesn't want to sleep, rather than trying to force the baby to stay awake. In addition to play, cool air on the face (as in a walk outside) may discourage sleep, as may frequent nursing or a bath. Tine Thevenin, author of The Family Bed, suggests that carrying the baby around a lot during the day may stimulate and keep him or her awake. This approach may work for some babies, but others may be lulled to sleep by being carried. (If so, it might be a strategy to try at night.) Babies are very different, and an approach must be tailor-made to the individual baby.
If the baby is upset by attempts to change his or her sleeping schedule, re-evaluate your desire to do so. Most children will settle down dramatically by the age of three months regardless of what parents do or don't do. The most important thing is to accept babies as they are. It may help to remember that a significant number of adults love to stay up at night and sleep in late the next morning. Why should babies be any different?
Sears, William MD. NIGHTTIME PARENTING. La Leche League International. Franklin Park, IL USA. 1983.
Thevenin, Tine. The Family Bed: An Age-old Concept in Child Rearing (2nd ed.). Avery Publishing Group. Wayne, NJ. 1977.
Wailoo, M.P. et al. Disturbed nights and 3-4 month old infants: the effects of feeding and thermal environment. Arch Dis Child 1990; 65:499-501.