Dear Doctor,

My new-born doesn’t seem to sleep at all during the night or day. The slightest noise and she is awake. We are now in our second week and I could really use some sleep. She doesn’t cry much, just doesn’t sleep the way new-borns are supposed to. What’s happening?

Sheila

It is a pleasure to have a new baby in the house. But it is stressful also at times, because babies can cry and refuse to sleep for reasons difficult to fathom.

A baby does not sleep soundly for some hours continuously. Firstly, the sleep/wake cycle of a new born is not set, as it is for an adult. They can sleep and wake at any time, whether day or night. Usually, on average, a new-born may sleep for half an hour to one hour and then wake up, thus having small frequent naps throughout the day and even night. But if an infant sleeps for a short while only and cries more or seems restless, it becomes a reason for anxiety for the parents.

The most common cause for a new-born’s limited sleep is hunger. Babies have a small tummy which is filled very fast and is emptied shortly by passing motion or urine. A baby may not be able to feed adequately due to several reasons. Therefore, when put to sleep, she may get up within a few minutes or at the most, 20 to 30 minutes.

A new-born may get too tired to sleep well. Parents should be able to identify signs of tiredness in a very small baby. Yawning, rubbing her eyes, looking away from your face, not responding readily to a tickle or any other action readily, are signs that the new-born is getting fatigued. On observing any such sign, the baby should be put to sleep immediately.

It is good to engage the baby in some play to stimulate her during the waking stage. However, over stimulation can stress the baby. Babies do not feel comfortable and may not respond very well to bright sounds and loud noise. If the baby starts looking away, starts becoming cranky, take her to a quiet place and help her sleep.

At times, babies wake up suddenly with a startle.  Some new-borns simply need cuddling before going to sleep. If possible, swaddling is beneficial in such situations. In this, the baby is wrapped in a soft cloth, such that limb movement is restricted and the baby feels safe.

Physical discomfort is yet another cause for a new-born to fail to sleep well. Excess warmth (when babies are dressed with more clothing than necessary), flatulence, abdominal pain, itchiness and or painful ears, are some conditions which make a baby feel sick, making it difficult to sleep.

Try to feed the baby more frequently, make her sleep in a quiet room, ensure the bed clothes and clothes worn are soft and comfortable, preferably made of cotton. Nylon clothes look attractive but are uncomfortable.

If the new-born does not sleep after adopting above measures, is irritable, has fever, ear discharge or pain on touching, and similar symptoms, it is advisable to consult a paediatrician.

 Dr. Rachna  Pande is a specialist in internal medicine.