States of alertness in infants

It is important to know the several states of alertness of an infant. In order to understand and to get to know your child better, be aware of how the baby communicates with you from day one, bearing in mind the basics of normal infant behaviour.

All babies experience six different states of alertness in 24 hours, alternating from one to the other, some times evenly, some times quiet abruptly in the beginning.

1. Deep sleep or Non-REM sleep.

The baby’s arms, legs, and eyes do not move at all. Duration is brief compared to that of adults. Parents are often surprised to discover that their baby of just a few weeks doesn’t sleep very much. Actually, it is normal for sleep to be brief in babies, 5-10 minutes in 4-hour cycles.

2. Light sleep or REM-Sleep.

The baby sleeps restlessly, and jitters, moves his eyes under the eyelids, and makes sounds. Newborns spend most of their time in this state. This means that normal babies spend more than 10 hours a day dreaming! Waking from this state is very easy. Light sleep is very important for your little one’s growth and brain development.

3. Drowsy state.

The baby is awake but sluggish, and doesn’t actively respond to environmental stimuli. He stares into space, and is not yet ready to communicate with you.

4. Quiet alert state.  

The baby is quiet and receptive to the outside world. It is time to play and chat with parents! During this phase the child opens his receptors to the outside world, and learns from his environment. A nice timing for getting to nurse as well!

5. Active alert state.

The baby moves his arms and legs actively, makes sounds of protest, and cries intermittently. He appears hungry, bored, or, on the other hand, tired from over stimulation.

6. Crying state.

The baby cries loudly and continuously. He requires immediate and appropriate satisfaction of his needs. His mother should respond by holding him, with food, and with a soft voice.

The newborn will accept the breast more easily and will breastfeed more effectively if he is in the second, third, or fourth state, i.e. if he is in light sleep, has just woken, or is in a quiet alert state. He will not accept the breast during the first state of deep sleep, and will breastfeed dysfunctionally and restlessly during the fifth and the sixth states, i.e. the active alert and crying states. Therefore, don’t feed newborns when they are crying, but long before they reach this state, in order to prevent poor positioning and latching onto the nipple, sore nipples, and inadequate transfer of milk.

Research has shown that breastfeeding babies demonstrate more neurological maturity already in the first few weeks of life, and are able to better adjust to states of alertness from the first days of life. A typical premature baby, seems to be sleeping deeply one moment, and the next moment cries loudly, before immediately going back to sleep. These abrupt transitions are signs of immaturity. The older the baby gets, the more he learns to transition from deep sleep to light sleep to the quiet alert state mildly, gradually and peacefully. A mature, breastfeeding baby spends little time in the drowsy state, breastfeeds, sleeps lightly, breastfeeds a little more, and sleeps quietly and deeply.

Understanding of the states of alertness is not only necessary for the success of breastfeeding, but in general for parental care, better sleep, and richer interaction with the child. It helps parents decode their baby’s messages, understand when they should feed him, when they should play with him, and when, on the other hand, it is better to withdraw stimulation and put the baby to sleep. Parents who respond appropriately and directly to their baby’s indications of need enjoy their role more, and become more deeply attached to their child. Babies who grow up with such parents manifest maximum psychomotor development and physical growth, social skills, and less anxious behaviour. Health professionals should teach parents how to interpret and respond to their baby’s special ways of communication from the first days of life.

Stelios Papaventsis MRCPCH DCH IBCLC 2010

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