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Predictable Newborn Patterns

Birth & Beyond California:

Breastfeeding Training & QI

Project

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Objectives

• Identify three infant states of consciousness

• Identify nursing responses and interventions

– Infant is sleepy, difficult to awaken– Infant is crying, difficult to soothe

• Describe the normal infant feeding pattern• Identify three infant feeding cues• Describe practices that maximize infant

behaviors in the first hours and days of an infant’s life

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Infant States of Consciousness

Thoman, Early development of sleeping behavior in infants, 1975

Two Sleep States

Transition

State

Three Awake States

QuietSleep

ActiveSleep

DrowsyQuiet Alert

ActiveAlert

Crying

Latch 1,2,3Troubleshooting Breastfeeding

in the Early Weeks

The Healthy Children Project

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The Interactive Baby State

Infants breastfeed and families bond during the Quiet Alert State

De Chateau, Develop Med Child Neurol, 1977

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Predictable Infant Responses

To wake a sleeping baby

To calm a crying baby

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Predictable Infant Responses

Variety to awaken

Repetition to soothe

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Predictable Infant Responses

• Variety to awaken– Skin to skin– Rubbing– Patting– Humming– Singing– Talking– Diaper off– Cool cloth– Eye to eye– Visitors removed – Others?

• Repetition to soothe– Skin to skin– Humming– Singing– Swaddling– Rocking– Walking– Visitors removed– Others?

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Why Do Some Moms Not Know How to Quiet or

Wake Their Baby?

“The Lost Art”

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Societal Shift: From Villages to Nuclear

Families

WiseWomen

Teens & kids

Childbearing Women

Vertical System

Wise Women in Retirement Centers

Childbearing Women at

Work

Teens in School

Kids in Daycare/School

Compartmentalized System

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Activity:Newborn Infant Feeding

Pattern

Sleep/Wake Cycling Effect on Infant Feeding Pattern

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Baby A

Q4H

Q2H

Q1/2H

X X

XX

X

2

X X X X X X X

2

8

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The Normal Infant Feeding Pattern is Cluster Feeding

• Feeding pattern characterized by closely bunched feedings

• May be followed by extended periods of sleep

• Normal newborn feeding behavior• Usually starts on second night • Often interpreted as sign of insufficient

milk

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Baby’s Second Night• Baby misses the habitat of the womb• Mother’s chest is the new “habitat”• Baby’s second night pattern:

Feed – Snuggle – Sleep

• Newborn sleep cycle: Drowsy – Active Sleep – Quiet Sleep

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Feeding Cues

• Soft sounds: grunts

• Wiggling• Hand to mouth• Lip smacking• Sucking motions• Rooting

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Feeding Cues

CRYING is a LATE feeding cue!

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How Often Should I Feed My Baby?

• If she opens her mouth, bring her to the breast to latch on

• She needs all the colostrum she can get

• Your breasts need as much stimulation as possible to establish a good milk supply

• Take every opportunity – no matter how short

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Recommended NewbornFeeding Frequency

“During the early weeks of breastfeeding, mothers should be encouraged to have (at least) 8 to 12 feedings at the breast every 24 hours, offering the breast whenever the infant shows early signs of hunger…”

AAP Breastfeeding Policy Statement, Pediatrics, 2005

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Definition of a Feeding

• Baby actively initiates suckle • Baby has a wide gaping mouth

– Baby’s jaw glides– Baby’s swallow is audible– Baby ends the feeding– Baby is satisfied

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When Left Skin-to-Skin in the First Hours After Birth

• Lifts head and lunges to breast • Searching behaviors• Ability to self attach

Klaus, Your Amazing Newborn, 1998

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Breastfeeding: Baby’s Choice

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Maximizing Infant Behaviors: Immediately Following Birth

• Skin-to-skin• Allow familiarization time• Do not rush breastfeeding• Delay bath and procedures

AAP Breastfeeding Policy Statement, Pediatrics,

2005

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Maximizing Infant Behaviors: The First Few Days

• Skin-to-skin• Allow babies to “re-boot” if needed• Encourage and explain cluster

feeding• Refer babies who “refuse” the breast

to the lactation consultant

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Amazing Talents of the Newborn:

A Video Guide for Health Care Professionals and Parents

Video provided by Marshall Klaus, MD

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Babies Need Their Hands

• Hands help to initiate feeding and to soothe

• Take off the blanket• Take off the mittens

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Let the Baby Do ItThe breast is home

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Summary

• Newborns have predictable sleep-wake cycles and feeding patterns

• Parents may need to be taught: – What feeding cues are and when to

feed the baby– The normal pattern of cluster feeding– Interventions to wake a sleepy baby– Interventions to calm a crying baby

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Photo Credits

• Slide 1 – Die Gattin des Kunstlers by Josef Danhauser circa 1839

• Slide 5 – courtesy Marshall Klaus• Slide 6 – by Microsoft Clipart• Slide 7 – by Microsoft Clipart• Slide 9 – Mothers and Children c. 1912

– http://commons.wikimedia.org/wiki/Image:Mothers_and_children_I.jpg

• Slide 16 – Skin to skin, hand to mouth, courtesy Miller Children’s Hospital