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1
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
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