When to Feed Your Baby

Newborns and young infants have a small stomach and must wake every few hours to eat. In most cases, your baby will awaken and be ready to eat about every three to four hours.

It is not necessary to wake a baby for feedings unless you have been advised to do so by your baby's physician.

However, do not let a newborn sleep longer than five hours at a time in the first five to six weeks.

Some premature babies need more frequent feedings and must be awakened to eat.

Never put a baby to bed with a bottle propped for feeding. This is a dangerous practice that can lead to ear infections and choking.

Sleep States of a Newborn

Babies, like adults, have various stages and depths of sleep. Depending on the stage, the baby may actively move or lie very still. Infant sleep patterns begin forming during the last months of pregnancy -- active sleep first, then quiet sleep by about the eighth month.

There are two types of sleep:

• REM (rapid eye movement sleep): This is a light sleep when dreams occur and the eyes move rapidly back and forth. Although babies spend about 16 hours each day sleeping, about half of this is in REM sleep. Older children and adults sleep fewer hours and spend much less time in REM sleep.
• Non-REM, which has four stages:
• Stage 1: Drowsiness -- eyes droop, may open and close, dozing
• Stage 2: Light sleep -- the baby moves and may startle or jump with sounds
• Stage 3: Deep sleep -- the baby is quiet and does not move
• Stage 4: Very deep sleep -- the baby is quiet and does not move

A baby enters stage 1 at the beginning of the sleep cycle, then moves into stage 2, then 3, then 4, then back to 3, then 2, then to REM. These cycles may occur several times during sleep. Babies may awaken as they pass from deep sleep to light sleep and may have difficulty going back to sleep in the first few months.

Alert Phases of a Newborn

Babies also have differences in how alert they are during the time they are awake. When a newborn awakens at the end of the sleep cycles, there is typically a quiet alert phase. This is a time when the baby is very still but awake and taking in the environment.

During the quiet alert time, babies may look or stare at objects, and respond to sounds and motion. This phase usually progresses to the active alert phase in which the baby is attentive to sounds and sights but moves actively. After this phase is a crying phase. The baby's body moves erratically, and they may cry loudly. Babies can easily be overstimulated during the crying phase. It is usually best to find a way of calming the baby and the environment. Holding a baby close or swaddling (wrapping snugly in a blanket) may help calm a crying baby.

It is usually best to feed babies before they reach the crying phase. During the crying phase, they can be so upset that they may refuse the breast or bottle. In newborns, crying is a late sign of hunger.

Helping Your Newborn Sleep

Babies may not be able to establish their own sleeping and waking patterns, especially in going to sleep. You can help your baby sleep by recognizing signs of sleep readiness, teaching them to fall asleep on their own, and providing the right environment for comfortable and safe sleep.

Although it is surprising, not all babies know how to put themselves to sleep. When it is time for bed, many parents want to rock or breastfeed a baby to help them fall asleep. Establishing a routine like this at bedtime is a good idea. However, be sure that the baby does not fall asleep in your arms. This may become a pattern and the baby may begin to expect to be in your arms in order to fall asleep. When the baby briefly awakens during a sleep cycle, they may not be able to go back to sleep on their own.

Most experts recommend allowing a baby to become sleepy in your arms, then placing them in the bed while still awake. This way the baby learns how to go to sleep on their own. Playing soft music while your baby is getting sleepy is also a good way to help establish a bedtime routine.

Signs of Sleepiness

• Rubbing eyes
• Yawning
• Looking away
• Fussing

Sleeping Positions for a Newborn

Babies should sleep on their backs. Research has found a link between sudden infant death syndrome (SIDS) and babies who sleep on their stomachs (in the prone position). It is reported that the risk of SIDS from prone sleeping is from 1.7 to nearly 13 times higher. Experts now agree that putting a baby to sleep on their back is the safest position.

Other reports have found soft surfaces, loose bedding, and overheating with too many blankets also increase the risk for SIDS. Smoking by the mother is also a major risk for SIDS, as are poor prenatal care and prematurity. Since the American Academy of Pediatrics (AAP) made the "back-to-sleep" recommendation in 1992, the SIDS rate has dropped more than 40 percent. Back sleeping also appears to be safer for other reasons. There is no evidence that babies are more likely to vomit or spit up while sleeping on their back. In fact, choking may be more likely when infants are on their stomach. A task force of the US Consumer Product Safety Commission (CPSC), the American Academy of Pediatrics (AAP) and the National Institute of Child Health and Human Development (NICHD) offer the following recommendations for infant bedding:

• Place your baby on their back on a firm, tight-fitting mattress in a crib that meets current safety standards.
• Remove pillows, quilts, comforters, sheepskins, stuffed toys, and other soft products from the crib.
• Use a sleeper as an alternative to blankets with no other covering.
• Make sure your baby's head remains uncovered during sleep.
• Do not place your baby on a waterbed, sofa, soft mattress, pillow, or other soft surface to sleep.
• Parents should consider placing the infant's crib near their bed for more convenient breastfeeding and parent contact.
• If a mother chooses to have her infant in her bed to breastfeed, the baby must be returned to the crib or basinet to sleep. A baby should never sleep in an adult bed, on a couch, or on a chair alone, with a parent, or with anyone else.
• While babies should never share a bed, room sharing is encouraged. Keeping the baby’s sleep area in the same room where the parents sleep reduces the risk of SIDS.

To prevent overheating, the report recommends that the infant should be lightly clothed for sleep and the room temperature kept comfortable for a lightly clothed adult. Avoid over bundling and check the baby's skin to make sure it is not hot to the touch.

While babies should sleep on their backs, other positions can be used during the time babies are awake. Babies can be placed on their stomachs while awake to help develop muscles and eyes and to help prevent flattened areas on the back of the head.