#5 Babies Can be very Sleepy and Difficult to Awaken to Breast Feed.
"I've tried and tied to feed him, but he only fed a little. Why he is so sleepy?"
This is something I hear nearly every day. I am either requested by a mother, or an RN who has been working with the baby but neither of them can get the baby to actively breastfeed; "My baby fed so well after delivery, but now he won't wake up to feed, or he falls asleep quickly into the feeding."
Now PLEASE remember that I am speaking of healthy full term babies, born with no risk factors. The babies I'm speaking of have brown fat energy stores (formed in the last 1-2 weeks before delivery) that help keep their blood sugars stable while only eating infrequently during their first 24 hours. And this is the fact...full term, healthy babies are very tired and sleepy especially during the first 24 hours. However, a little sleepiness can extend into the first 1-2 weeks and still be considered normal...frustrating, but normal!
The "Golden Hour" of breastfeeding is especially important after delivery for babies who are born with "risk factors" such as restricted fetal growth, being small or large for gestational age gestational diabetes are some risk factors" We as RN's and Lactation Consultants know very well that during the first 24 hours of a newborns life, regardless of risk factors, it can be very difficult to get them to breastfeed, but not impossible.
So what can be done to overcome this breastfeeding hurdle after the golden hour?....a sleepy baby who just won't cooperate? Here are some tips and tricks:
➸ Keep baby close, tummy to tummy, skin to skin, in an upright position between the breasts. Incidentally, rooming in is especially encouraged for breastfeeding mothers at most breastfeeding friendly hospitals. Offer the breast any time baby shows early feeding cues (sucking on hands, rooting to the side, and licking/smacking lips etc) If you offer and baby isn't actually interested, simply return her to the skin to skin position on mother's chest.
➸ One significant observation that I have made while consulting in the hospital is that the baby is already fully dressed in a very cute outfit ~~ and along with the outfit, the baby is tightly swaddled blanket. And if the baby isn't lying away from mother in the bassinet, a visitor or mom or dad is holding the baby. Although mom continues to offer the breast while baby is wrapped tightly and content, he will continues to sleep not responding to her efforts. What is going on? Baby is in a comfortable state! He has no interest in waking up while clothed and tightly wrapped. What should you do? Blankets off, clothing off (except the diaper). Get him uncomfortable and baby will likely decide to "join the party" as I call it, and latch and breastfeed.
➸ "Anchor the baby" By this I mean position the baby in such a way that she will feels secure and ready to feed. If someone offered you a sandwich while you were walking on tight rope, you would decline because you don't feel stable enough to eat. Kind of an exaggerated example, but it helps moms to realize they may need to make changes to how the baby is being brought to the breast.
➸ Hand express a few drops of colostrum and place it on baby's lips or in baby's mouth. It's a way of inviting baby to the "table"...showing her what she is being offered.
➸ Once baby is comfortably latched, "meet him/her half way" by using one of my best tips and tricks...breast compression/massage during entire feeding with colostrum, and at the beginning, middle, and end of mature milk feedings. If a sleepy baby is placed at the breast and left to do all of the work himself, he'll likely go back to sleep! Colostrum is especially difficult to remove.
➸ Is little one still not waking up to feed or staying awake once feeding has started? Now is the time that I teach momma to be assertive (NOT aggressive!!, assertive) Baby sit ups with the head and neck supported, along with moving intermittently side to side. Rub his back and talk to him, "Momma needs you to wake up and feed and I'm not going to take 'no' for an answer!" Tickle or rub his feed. Try the following to stimulate sucking...
Take a cold wet wipe, or washcloth to his back, face, head, arms. Still no active breastfeeding response?
➼ If baby has a wet or messy diaper...Change it!! Use plenty of cold wet wipes to make sure baby is clean...Hopefully, baby will be fully awakened by this.
➸ If this baby is healthy and full term (not large or small for gestational age, & no gestational diabetes) then replace baby back to skin to skin position (upright, between the breasts) Wait for more feeding early feeding cues and start the process all over again.
➸ If six hours has past without a good latch and active breastfeeding, ask the RN to bring in a hospital grade breast pump to help stimulate your breast supply until baby is willing to get on board! In addition to this, mom should Hand Express her colostrum into a spoon. What ever you are able to pump may be supplemented to the baby so as to "spark his appetite, and realize that this suckling thing is actually good! (Please don't worry if you are unable to express and colostrum. This is actually normal!)
👶 Please remember that the tactics I have listed above are not to be routinely used with a Late preterm newborn. These babies are also sleepy at the breast, but for many different reasons. If given easy food for 1-2 weeks, these babies rapidly build their stamina and strength. As mentioned before in another post, we cannot expect babies born 3 weeks or more earlier than their due date to perform at the breast in the same way a full term healthy newborn.
👶 Give these babies "easy feedings," So he doesn't burn more calories than he is getting while feeding. Some methods of easy feeding include; expressed colostrum or mother's milk in tube with syringe at the breast (also called SNS or Supplemental Nursing System) Mom may need to use a nipple shield with SNS. Mom might Use "Paced bottle feeding" to teach baby the flow rhythms of the breast, while also giving baby easy calories.
😌 I often tell the story of being up at 2:00am, just me and baby...and when I glanced at the clock I remember tears filling my eyes when I realized I had been awake for 45 min, and my baby hadn't even latched well or breastfed. I tell this story because I want New mothers, and experienced mothers to know that even an RN/Lactation Consultant/mother of now 5 breastfed children may take a while before the latch is appropriate. Patience is the name of the game!
❗When to worry:
❗If you feel that your baby is lethargic, and difficult to arouse, despite all of the above suggestions please call your pediatrician, or seek emergency help.
❗If baby has less than 4 wet/messy diapers by day 4 of life, with baby's poop still not transitioned from black, sticky, meconium, to mustard yellow, runny "seedy" looking...call your pediatrician.
❗If baby's skin is looking more and more yellow (even the "whites" of his/her eyes) in addition to excessive sleepiness...call your pediatrician.
❗If baby won't even suck on bottle nipple of pumped breast milk, call pediatrician.
Of course these recommendations correlate with "sleepy baby issues," but remember that the above warning signs are not the only reasons to call your pediatrician. You should have been well educated about these reasons before you are discharged to home with baby.
🙋 One last thought...you are this baby's mother, and you know what is "normal" and "not normal" for your baby. A good pediatrician welcomes your concerns, and takes them seriously. This are what I call "Mother's Intuition" and should be respected and responded to!
Now PLEASE remember that I am speaking of healthy full term babies, born with no risk factors. The babies I'm speaking of have brown fat energy stores (formed in the last 1-2 weeks before delivery) that help keep their blood sugars stable while only eating infrequently during their first 24 hours. And this is the fact...full term, healthy babies are very tired and sleepy especially during the first 24 hours. However, a little sleepiness can extend into the first 1-2 weeks and still be considered normal...frustrating, but normal!
The "Golden Hour" of breastfeeding is especially important after delivery for babies who are born with "risk factors" such as restricted fetal growth, being small or large for gestational age gestational diabetes are some risk factors" We as RN's and Lactation Consultants know very well that during the first 24 hours of a newborns life, regardless of risk factors, it can be very difficult to get them to breastfeed, but not impossible.
So what can be done to overcome this breastfeeding hurdle after the golden hour?....a sleepy baby who just won't cooperate? Here are some tips and tricks:
➸ Keep baby close, tummy to tummy, skin to skin, in an upright position between the breasts. Incidentally, rooming in is especially encouraged for breastfeeding mothers at most breastfeeding friendly hospitals. Offer the breast any time baby shows early feeding cues (sucking on hands, rooting to the side, and licking/smacking lips etc) If you offer and baby isn't actually interested, simply return her to the skin to skin position on mother's chest.
➸ One significant observation that I have made while consulting in the hospital is that the baby is already fully dressed in a very cute outfit ~~ and along with the outfit, the baby is tightly swaddled blanket. And if the baby isn't lying away from mother in the bassinet, a visitor or mom or dad is holding the baby. Although mom continues to offer the breast while baby is wrapped tightly and content, he will continues to sleep not responding to her efforts. What is going on? Baby is in a comfortable state! He has no interest in waking up while clothed and tightly wrapped. What should you do? Blankets off, clothing off (except the diaper). Get him uncomfortable and baby will likely decide to "join the party" as I call it, and latch and breastfeed.
➸ "Anchor the baby" By this I mean position the baby in such a way that she will feels secure and ready to feed. If someone offered you a sandwich while you were walking on tight rope, you would decline because you don't feel stable enough to eat. Kind of an exaggerated example, but it helps moms to realize they may need to make changes to how the baby is being brought to the breast.
➸ Hand express a few drops of colostrum and place it on baby's lips or in baby's mouth. It's a way of inviting baby to the "table"...showing her what she is being offered.
➸ Once baby is comfortably latched, "meet him/her half way" by using one of my best tips and tricks...breast compression/massage during entire feeding with colostrum, and at the beginning, middle, and end of mature milk feedings. If a sleepy baby is placed at the breast and left to do all of the work himself, he'll likely go back to sleep! Colostrum is especially difficult to remove.
➸ Is little one still not waking up to feed or staying awake once feeding has started? Now is the time that I teach momma to be assertive (NOT aggressive!!, assertive) Baby sit ups with the head and neck supported, along with moving intermittently side to side. Rub his back and talk to him, "Momma needs you to wake up and feed and I'm not going to take 'no' for an answer!" Tickle or rub his feed. Try the following to stimulate sucking...
Take a cold wet wipe, or washcloth to his back, face, head, arms. Still no active breastfeeding response?
➼ If baby has a wet or messy diaper...Change it!! Use plenty of cold wet wipes to make sure baby is clean...Hopefully, baby will be fully awakened by this.
➸ If this baby is healthy and full term (not large or small for gestational age, & no gestational diabetes) then replace baby back to skin to skin position (upright, between the breasts) Wait for more feeding early feeding cues and start the process all over again.
➸ If six hours has past without a good latch and active breastfeeding, ask the RN to bring in a hospital grade breast pump to help stimulate your breast supply until baby is willing to get on board! In addition to this, mom should Hand Express her colostrum into a spoon. What ever you are able to pump may be supplemented to the baby so as to "spark his appetite, and realize that this suckling thing is actually good! (Please don't worry if you are unable to express and colostrum. This is actually normal!)
👶 Please remember that the tactics I have listed above are not to be routinely used with a Late preterm newborn. These babies are also sleepy at the breast, but for many different reasons. If given easy food for 1-2 weeks, these babies rapidly build their stamina and strength. As mentioned before in another post, we cannot expect babies born 3 weeks or more earlier than their due date to perform at the breast in the same way a full term healthy newborn.
👶 Give these babies "easy feedings," So he doesn't burn more calories than he is getting while feeding. Some methods of easy feeding include; expressed colostrum or mother's milk in tube with syringe at the breast (also called SNS or Supplemental Nursing System) Mom may need to use a nipple shield with SNS. Mom might Use "Paced bottle feeding" to teach baby the flow rhythms of the breast, while also giving baby easy calories.
😌 I often tell the story of being up at 2:00am, just me and baby...and when I glanced at the clock I remember tears filling my eyes when I realized I had been awake for 45 min, and my baby hadn't even latched well or breastfed. I tell this story because I want New mothers, and experienced mothers to know that even an RN/Lactation Consultant/mother of now 5 breastfed children may take a while before the latch is appropriate. Patience is the name of the game!
❗When to worry:
❗If you feel that your baby is lethargic, and difficult to arouse, despite all of the above suggestions please call your pediatrician, or seek emergency help.
❗If baby has less than 4 wet/messy diapers by day 4 of life, with baby's poop still not transitioned from black, sticky, meconium, to mustard yellow, runny "seedy" looking...call your pediatrician.
❗If baby's skin is looking more and more yellow (even the "whites" of his/her eyes) in addition to excessive sleepiness...call your pediatrician.
❗If baby won't even suck on bottle nipple of pumped breast milk, call pediatrician.
Of course these recommendations correlate with "sleepy baby issues," but remember that the above warning signs are not the only reasons to call your pediatrician. You should have been well educated about these reasons before you are discharged to home with baby.
🙋 One last thought...you are this baby's mother, and you know what is "normal" and "not normal" for your baby. A good pediatrician welcomes your concerns, and takes them seriously. This are what I call "Mother's Intuition" and should be respected and responded to!
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