Expert: Dr Kondekar Santosh Venketraman Pediatrician MD, Mumbai India, Online Pediatrician - 7/11/2009

Question
QUESTION: hi, i don't feel our baby is getting enough sleep. she goes to sleep good at night without fussing to much. in bed around 10pm usually wakes anywhere from 4-8am for nursing two times. usually awake by 8-9 sometimes as late as 10am. she seems tired when she wakes but i can't always get her to go back to sleep. she'll eat breakfast and get sleepy and cranky as soon as an hour after waking on occasion, but usually will play for another hour before getting tired. i take her to work with me, so she usually falls asleep in her carseat on the way, which is about 20-30 minutes. i try so hard to get her inside and keep her asleep, but she wakes and i try for another 20 minutes to rock the carseat, but she won't go back to sleep and i give up. at this point i take her out thinking she'll play, but she's just not 100% no matter what. i nurse her some and give her snacks and when she seems sleepy according to "signs" i put her down and she just stands up and cries. i tell her i'm not taking her out and i lay her down and tell her she's tired and needs to sleep. this seems to go on all day and i don 't want to take her out because i feel i'll be teaching her that if she cries like a maniac for an hour i'll take her out. i check on her about every 10 -15 minutes and lay her down give her a bear/blanket, rub her back. eventually it's the patting that puts her to sleep. i fear that spending all day getting her to nap is running into when she should be eating at mealtime, so i don't know what to do because she will not eat when she is that tired and if i take her out then she has not learned to nap..(note: she stays home with daddy two days a week and he gives in and takes her out, or her nana rocks her to sleep for naps- i feel i'm being undermined) i have tried all i read about putting her down as soon as she rubs her eyes or yawns, but all she's ever done at that time is cry hysterically when she is put in her crib or pack n play. i feel like the short nap in the car seat is messing everything up. when the baby's at home, when she does nap they are longer naps. and when she naps she is so much happier and playful. i feel like the napping problem is making her miserable all day and i feel like i spend all day trying to get her to sleep and she spends so much of her day sad when she should be playing and learning. here at work there are so many distractions, like the phone and customers coming in. lately i have put up a room divider for her and play classical music at naptime. any help would be greatly appreciated, i feel so bad for the baby. i have mentioned to her dr's but they don't seem to care about anything other than her healthy weight gain.. thank you kindly for your valuable time, brandi

ANSWER: you havent mentioned her weight but i guess its between 5-9 months, as this is the common compliants of mothers of this age babies.

believe me she is normal, dont try to insist on your sleep beliefs on baby.
even if total sleep is around 8 hrs, its not bad at all.

theer are many reasons why a child may get disturbed, and commonest being constipation & nose block. other ones are physical attachment, tight clothings or nappy or buttons . At times it was even creases on bedsheet.

many such babies love to get rocked on shoulders or in a swing ro car seat. nothing like habituating or pampering her but just giving her enough humane attention she is demanding. she may need someone continuously trying to  talk to her too.


is she constipated? i feel like asking again.


good weight gain and normal milestones rule out 99%b major problems in infants. any worriable thing definitely affects her growth, thats why your docs ask about weight.


---------- FOLLOW-UP ----------

QUESTION: thank you for your answer, i hadn't considered constipation. she is 10 months old, i don't think she is constipated? she is breastfed and she eats mosty veggies and fruits. in a day she eats 2 servings of cereal, 3-4 servings of fruit including juice, 2-3 servings of veggies, half a yougurt, one egg yolk, one serving of meat, along with snacks of puffed wheat or cheerios, and she gets breastmilk for snacks and before meals, with her dinner she usually gets either whole grain bread, whole grain pasta, or sweet potato (she eats alot and loves to eat).... does this look like she could be constipated with this diet, to much starch?? i asked the dr's about how many ounces of everything she should be eating since i am making her baby food at home and not able to use the serving size of the premade baby food... she weighs 18 lbs at her 9 month visit. they said she is in 50% for weight and height combined, so when i ask them questions they just refer back to that.  she almost always goes to sleep without crying at night so i am hoping there is a way to get her to nap without fussing. she gets so overtired and cranky, but when she naps she is refreshed and happy. i had been going by the advice that babies that can get themselves to sleep without rocking will sleep one hour longer on average and be able to sooth themselves back to sleep upon waking in the night... i thought i'm supposed to put her down sleepy but still awake and she is to learn to sleep on her own... i think this is based on the american academy of pediatrics??? i'm not sure, but i read it in alot of different places. to me it seems like a myth. yesterday her dad and i were home together and i realized he doesn't beleive she is tired when she rubs her eyes or yawns, he waits about an hour later and plays with her until she can't play any more and then puts her for a nap and shakes her mattress until she sleeps. so as soon as she rubbed her eyes i put her for a nap and she cried a bit, but with some rubbing her back she went to sleep. then for her next nap her dad did not give in a take her out. for bed she tried to get me to pick her up, i didn't and she laid down and slept. today her dad and i dissagreed on if she was tired or not, i took her in for a nap and she cried at first then laid down and played for a few minutes and fell asleep on her own (for the first time without much fussing). it seems like he waits till she is overtired and entertains her until that point and i try to put her for sleep as soon as she yawns or rubs her eyes or stares. i had not been thinking about a health problem like constipation. she goes usually 2 times a day, but when she does her face turns red and she pushes and grunts, so now i am wondering if this is actually constipation. can you tell from her diet or what can i do to prevent it??? thank you, brandi

Answer
you may add calcum supplements and reduce the milk based feeds over next few months. encourage free water.

considering her age 10 months.. this sleep issue shoudl settle on her own in a month.

dont go too much into theory issues of say tiredness etc. sleep is decided by the need of it. at 8 hrs is too good .