When wakefulness is beyond normal
There are babies that sleep through the night, there are babies that wake every 1-2 hours, there are babies that do both at different stages of their lives, and there is everything in between. Infant sleep can be so multifactorial that it can be hard for any parent to know what is normal and what isn’t.
While it is often true that western society's expectations of infant sleep do not match the reality of normal infant sleep. The sleep training industry would also have us believe that waking nightly is abnormal and that every 12-week-old should be capable of 12 solid hours of sleep per night. There is an area of greyness that sits between waiting it out and crying it out. There is a proportion of infants who fall into this grey area in which their sleep can be considered “abnormal.” Parents of these wakeful infants are often told the solution is to simply leave them alone to figure it out themselves through tears. Or perhaps these parents follow their instincts and desire for connection with their children and are hanging on with exhaustion through 30-minute wake-ups all night long for months or sometimes years.
Before delving into what is abnormal, it is important for us to understand what is in fact normal. We have an incredible post on what normal infant sleep looks like – you can read more HERE. We need to start differentiating between what society is telling us isn’t right (hello sleep trainers making us believe night waking of any sort is abnormal) vs what our intuition is telling us isn’t right. Our babies all the way up to toddlerhood and beyond can wake through the night for comfort or feeds and this is completely to be expected behaviour. But if you’ve delved into all things sleep and your mama alarm bells are still concerned something is off then perhaps it is time to listen to that voice inside.
There is a subset of families and infants who can experience highly wakeful children, who will wake, often crying after less than an hour, every night, all night long and the whole family is exhausted beyond comprehension. There are also babies who can take a long time to settle and go to sleep beyond the variations of what is considered normal and these parents are at their wit's end. There will be also those who struggle with both of these things and it can make day-to-day life so very hard. If you have an infant who sounds similar to what I have just described several things could be going on for them and maybe the answer isn’t as simple as sleep training. While infant sleep is nuanced and complex and it is usually difficult to put down to one thing some of these very wakeful infants' issues can be pinpointed to certain medical or biological imbalances.
It is not an uncommon story that the medical or infant sleep industry jumps upon sleep training as the answer for all that ails these wakeful children before even considering other thighs going on. They first want to check that the child is not just being “difficult” before assessing things medically. The nuances of our children's biological systems are so often overlooked as too are the changes that happen internally as they grow.
If we can step back and look holistically at our children, particularly those who struggle to sleep consistently, there are a number of things that can be going on for them. The frequent and persistent struggle to find sleep and restlessness that lasts beyond a few weeks or months is certainly a red flag that something more might be going on inside. Below is a list of some of the common things, that can impact sleep, to be on the lookout for when our intuition is raising the alarm.
MINERAL DEFICIENCIES
Vitamin and mineral deficiency such as low iron, magnesium or zinc in children can cause restless sleep and exhaustion in both mothers and infants. The dyad or just the infant can be significantly low in vital vitamins and minerals. When both are in these elements the loop can be exacerbated during the breastfeeding relationship. The mother can be low on the same vitamins as the child, passing over what she does have left to the infant in her breastmilk – which isn’t enough to sustain their baby's stores. If your baby is restless and waking frequently, usually every 30-40 minutes or less per night or takes a significant amount of time to settle into sleep then this may be what is going on for them.
It is not uncommon for mothers who discover these deficiencies to have passed through many medical professionals who have overlooked this as a possible cause and instead pushed sleep school or training as the solution. While a blood test might not be something you want to subject your baby to, consulting a qualified paediatric naturopath and getting their advice on trialling iron supplements for a few weeks might be beneficial. It is strongly recommended not to self-diagnose or commence iron or other supplements as they can be toxic for children if taken incorrectly or at a dose too high for their systems.
FEEDING DIFFICULTIES
A baby who fusses at the boob takes small frequent feeds, and has excessive gassiness might have feeding issues affecting sleep. These infants may be missing out on enough milk to help them feel satiated or to provide the right nutrition and therefore wake more frequently to fill up more. If you notice or feel like your infant is struggling with feeds or taking small but frequent feeds this can be a cause for getting a lactation consultant to review asap.
ORAL TIES
Linked to difficulties feeding, oral ties can also affect sleep as well as speech. If your baby is having to work super hard at every feed or milk spills out of the side of their mouth it could be that they are affected by a tongue tie. Any feeding difficulties can impact sleep as your baby may not be satiated, or may be uncomfortable. Oral ties may also lead to open mouth breathing which isn’t ideal. A consult with a professional lactation consultant or paediatric dentist is recommended to come up with a personalised solution for your child.
FOOD ALLERGIES AND SENSITIVITIES
Sleep issues and restlessness can be a sign of nutritional deficiencies as mentioned above but another common cause can be food allergies and sensitivities. These can show up as itchy skin such as eczema, or gut discomfort which can all interfere with restful sleep. These problems are often most noticeable when your child starts experimenting more with foods and again is something I would recommend consulting a professional such as a naturopath, nutritionist or GP for.
DISORDERED BREATHING
It isn’t just adults that can have problems with noisy or dysregulated breathing at night. Sleeping with the mouth open, noisy breathing or snoring are definite red flags for parents. These signs can be associated with enlarged tonsils or adenoids, allergies or tongue ties. If you notice consistent mouth breathing or snoring in your babe, or sleeping in funny positions with their bum up in the air and their necks extended, see your GP for a referral to an Ear, Nose and Throat Specialist. You can also read about my daughter’s experience with sleep apnea and enlarged tonsils and adenoids HERE.
ILLNESS & TEETHING
As an adult, it can be hard to sleep when we have a toothache or we just aren't feeling right the same goes for our babies. Teeth often start coming in around 4-6 months old and it can be really painful as the tooth erupts through the gums causing disruption to sleep and a cranky tired baby through the day. If you have ruled out teething and you still notice things such as fever or lethargy during the daytime or just have an inkling something is going on perhaps some other underlying medical issue could also be causing pain and discomfort leading to wakefulness in your baby. In this case, I would recommend finding an aligned GP or paediatrician to rule out anything of concern.
DEVELOPMENTAL SPURTS
Often when our children are wakeful, days and weeks can feel like months and years. If your child has suddenly switched from gracing you with decent periods of sleep to partying the night away it could be a temporary disturbance linked to rapid spurts in mental and physical development. Usually, these temporary changes are just that and aren’t a cause for concern. Our babies often go through short periods where they are not growing or developing much then all of sudden there will often be a massive leap in their speech, coordination or communication. As our babies transition through these developmental leaps, their sleep can be really affected as their brains do a lot of their learning at night. In the middle of the night hours, their minds and bodies can start practising their newfound skills leading to some exhausting days for both baby and mum. This is where understanding the fluctuations of normal infant sleep and that these fussier times are transient can help us get through these tricky times of less sleep with more compassion and understanding. In the same breath, it can also be useful to understand that something might be going on for our babies when these transient times have not disappeared again.
If you are deep into months or years of waking frequently and consistently then perhaps it is time to seek out some further advice about what might be going on for your child. We are the experts on our own children. We are attuned and aware of their subtle shifts and changes, we see them every day and we come to know them intimately. Our intuition comes online so strongly when we transition to motherhood. If you think there is something more going on with your child beyond the normal variations in infant sleep then I recommend seeking out help and guidance be it through a holistic GP/paediatrician, a naturopath that specialising in babies and kids or a children's osteopath or dentist.
If you are unsure about anything infant sleep or whether what you are experiencing is normal or not I offer 1:1 Honest Sleep Support sessions (BOOK IN HERE) where we can discuss what your gut is telling you. We can delve into what sleep looks like in your family and we can assess whether a referral to other professionals is necessary for your situation.
