Newborn Sleep Pattern, Posture and State of Alertness

Newborn Sleep Related Dilemmas Explained

Newborn sleep pattern lays the biggest hurdle for parenting newborns, the demand on mothers’ waking hours. Though most newborns sleep 16 to 20 hours of the 24 hours cycle, the mothers are usually severely deprived of sleep. This is because -

Almost 60 percent of the sleeping hours, newborns are in the stage of light sleep, known as REM, the rapid eye movements stage of sleep.
Each stretch of sleep is short: 2 to 4 hours, when they get up for feeds.
Day and night cycle is not set in neonates, so they get up after short stretches of sleep for feeds even at night.
Neonates take longer to fall a sleep.
Newborn’s sleep is not associated with usual connotations associated with going to sleep like relaxing, lying quietly in bed or reading a book.
Neonates are very active and demanding during their short intervals of wakefulness.

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Newborn sleeping posture

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On the back

Neonates should be placed on their backs when asleep.
This is recommended by American Academy of Pediatrics (1992) to avoid sudden infant deaths, SIDS, which was frequently observed in the babies who slept in prone position (on the stomach).

SIDS usually occurs during newborn sleep and upto 1 year of age. Therefore, it is important to focus on infant’s sleeping posture during the first 6 months of life, because it is during this early phase, an infants’ preference for the sleeping posture gets established

On the side

The preferred position is on the back.
Side position also has a much lower risk of SIDS as compared to sleeping on stomach.
If you chose to place the baby on her side while asleep, take care to bring the dependent arm forward: It lessens the likelihood of the baby rolling onto her stomach, the prone position.

Prone position (sleeping on the stomach)

Beneficial for neonates with certain disorders:

a.) Symptomatic gastro-esophageal reflux, where the reflux is usually less in the prone position.

b.) Certain upper airway birth defects; such as Robin syndrome have fewer episodes of airway obstruction in the prone position.
Points to note:

a) Healthy babies should never be put in prone position when asleep. Not to be misinterpreted that babies should never be placed prone.

b.) A certain amount of "tummy time," when the baby is awake and observed, is good for shoulder girdle motor development and should be encouraged.

If decided to allow a newborn to sleep on tummy, take special care. Avoid the factors particularly hazardous for an infant sleeping in prone position:

a.) Overheating

b.) Use of soft bedding

c.) Passive smoking

Newborn sleeping position related points of usual concern

Very soft bed for a baby?
No, not advisable.
It further aggravates the chances of SIDS.
Should sleeping position of a baby in her early infancy be checked frequently?
Not necessary.
Repeated checks on sleeping position of an infant once asleep on the back are not required, because during early infancy, children cannot roll into a prone position from the supine position (on back).
Incidence of aspiration
Reported to be negligible in the babies who sleep in supine position.
Aspiration is more likely in babies who sleep in prone position.
What is the flat spot on back of the head often seen in early infancy?
It is caused by the supine positioning of infants while asleep.
This is a harmless side effect of safe positioning of the child.
It disappears over some months after the infants begins to sit up.
Wish to know more on asymmetry of head in infancy? Click here.

Chances of postural flat spots on the back of the head can be minimized:

Turn the head to one side for a few days and then change to the other.
This can also be achieved by reversing the head-to-toe axis in the crib, and changing the orientation of the baby to outside activity.
Abnormal shape of head and overriding of sutures need medical evaluation.

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Newborn’s state of alertness

Newborn sleep alternates with newborn’s state of alertness.
Gestational age and the drugs administered to the mother during delivery influence the state of alertness of a newborn during the initial days of life.

Long sleeping hours of neonatal period, which are interrupted by crying episodes for one or the other reason, makes evaluation of newborn alertness somewhat difficult. Therefore, level of alertness in neonatal period is best evaluated when the baby wakes up on her own after a feed.

Stages of alertness seen in normal infants

Stage I
Deep state of newborn sleep, regular breathing, no movements.

Stage II
Light sleep, irregular respiration, rapid eye movements with eyes closed.
Stage III
Drowsy, eyes may be open or closed, some activity may be possible.
Stage IV
Alert, minimal motor activity
Stage V
Eyes open, alert with considerable motor activity.
Stage VI
Crying