Infant Sleep Red Flags You Need to Know About

Most babies are sleeping quite normally and appropriately- even when they wake and feed throughout the night, or need support to get to fall asleep. However, sometimes infant and child sleep isn’t quite normal. Download this free guide to learn what normal infant sleep looks like in the first year of life. In some situations, a child’s sleep is excessively disrupted for a variety of underlying reasons. In this post, I’m going to share some of the most common infant sleep red flags that I see when a child has an underlying health or medical issue that is disturbing their sleep.

Quality is more important than quantity

Often, when a parent describes their child’s sleep, they tell me how often they wake up at night. This can be useful information, but we really need more context to accurately assess whether sleep is normal or whether there are infant sleep red flags present. Think of it this way: quality is more important than just quantity when describing infant sleep.

We need to focus on the quality of a child’s sleep (especially an infant’s sleep), not just how often they are waking. Why? Because it is very normal for infants and toddlers to wake throughout the night. In the case of a breastfeeding dyad (a breastfeeding mother bedsharing with her infant), it can be very normal for a baby to stir hourly or every couple of hours to latch, nurse for a few minutes, and go right back to sleep without fully waking up or crying out.

Some questions I usually ask parents to help gauge quality of sleep:

• How does your baby sleep in between feeds?
• Is it relatively easy to support your baby back to sleep after they wake?
• Does your baby/child seem uncomfortable or distressed when they wake?
• What does your child do when they wake at night (loudly crying or screaming, kicking, arching the back, calm, a bit fussy, but then easily consolable)?
• Does your child seem calmer and more consolable when they are sleeping near you?
• Can your child sleep well when laying flat?

These are examples of questions you may want to ask yourself to better assess your child’s sleep and whether it is “normal”, or whether infant sleep red flags are present. Before I dive into red flags, I want to share a quick example of why quality of sleep is so important.

Suppose you have two mother-baby dyads who both say the same thing: “My baby wakes up hourly at night!”

All we know from this statement is that both babies wake approximately once per hour. When we ask for more details and context about the child’s sleep, what we find is that one baby is bedsharing and breastfeeding, and she stirs about once an hour, latches and nurses for a few minutes before going right back to sleep. She never cries much because mom is right next to her and is able to catch her early cues. She actually doesn’t fully wake at all most of the time. She just nurses frequently, which can be very normal for a breastsleeping baby. I would say that this is likely very normal infant behavior, and I would not be concerned or call this a red flag.

The other baby who wakes hourly is also a breastfeeding, bedsharing baby, but this baby wakes screaming about once an hour. He is very difficult to console even with nursing. He arches his back, seems uncomfortable and distressed, and it often takes mom up to an hour of bouncing/rocking him to console him back to sleep, only for him to wake again shortly after. This is a situation in which infant sleep red flags are present.

I hope this helps illustrate why quality of sleep is even more important than knowing how often a baby is waking. Now, let’s get into some of the most common red flags I see as well as some of the most common causes of these red flags. You will see that many of the red flags overlap with each other and often share possible causes.

Hourly waking in the context of other red flags

As we just discussed, hourly waking by itself is not always a red flag because this can be normal within the context of a breastsleeping relationship. I actually don’t count a baby stirring and nursing for a few minutes before going right back to sleep as a full wake. Oftentimes, baby is just doing this as they transition between sleep cycles, and they don’t fully wake at all.

Waking hourly with the presence of other sleep red flags is a sign that there could be an underlying issue that negatively impacts sleep.

Discomfort/Inconsolability

Most parents can tell when their baby seems uncomfortable or in pain. These babies are often very difficult to console. They may cry, or even scream excessively when they wake. Oftentimes, this discomfort is associated with gastrointestinal symptoms like gassiness. Parents may experience similar signs of discomfort during the day. It’s likely that these babies have been labeled as “colicky” babies from a healthcare provider. Note: Colic is not actually a diagnosis, but a symptom of an underlying issue.

Possible causes of discomfort in infants include: reflux, gut health issues, food sensitivities, and tension/strain. Developmentally normal, temporary discomfort can also come from teething and illness, but if it only happens occasionally during these periods, it is not considered a red flag.

Restlessness

A common infant sleep red flag I see in infants and children is restlessness- tossing and turning throughout the night. Parents of these children tell me they often find their child upside down or at the foot of their bed.

Possible causes of restlessness include: mouth breathing, airway obstruction, low iron

Sleeping with the mouth open, snoring, and noisy breathing

Humans are designed to breathe through their nose, so at rest the tongue should ideally be suctioned to the roof of the mouth, and the lips should be sealed closed. When an infant or child routinely sleeps with their mouth open, this indicates some sort of oral motor dysfunction. Sleeping with the mouth open limits the amount of oxygen that the brain receives, can contribute to poor dental health and jaw development, and can cause a whole host of other issues. Snoring and noisy breathing are other signs that there may be breathing issues.

Possible causes of sleeping with the mouth open/snoring: airway obstruction, congestion (chronic congestion can be linked to allergies/sensitivities), oral ties, oral musculature weakness, and misaligned teeth

Some other infant and child sleep red flags to know:

Being unable to sleep restfully while flat/on their back

When a baby will not sleep flat next to a parent, or needs to sleep being held in an upright position, that is a red flag. Often, babies need their position to change while sleeping in order to open up their airway. Potential causes: reflux, airway obstruction

Sleeping prone with the butt in the air

This is another sign that the airway may be obstructed, and the infant/child moves to this position to open the airway a bit. For more about tummy sleeping, you may find this podcast episode interesting!

Thumb sucking

I know this one might be surprising to learn, but thumb sucking to soothe can be a red flag! As explained earlier, when we are sleeping, our tongue should be suctioned to the roof of our mouth and our lips should be sealed. This stimulates the vagus nerve, and activates the parasympathetic nervous system, which allows our body to “rest and digest”, or in other words, enter into relaxation mode, as we should be when we are sleeping. Low tongue posture results in low vagus nerve stimulation, which can lead to being stuck in the sympathetic nervous system, or our “fight or flight” mode. Here’s the thing about thumb sucking: it’s a compensatory mechanism for when the tongue can’t rest in it’s ideal location at the top of the mouth. Instead, the child’s thumb rests where the tongue should be, and stimulates the vagus nerve. If this compensatory mechanism is present, it’s very likely that the child has low tongue posture for a variety of possible reasons, and I would recommend a functional oral and airway assessment.

Teeth grinding

Grinding the teeth is a sign that the airway is blocked. When asleep, the brain signals to the jaw to move forward to open the airway.

Staying latched all night

This is a tricky one because although it can be totally normal for a baby to nurse throughout the night, the need to have a nipple in the mouth all night can be a red flag just like thumb sucking. It’s not that baby wants to nurse frequently that is itself a red flag, but it’s the potential of the nipple being used as a compensatory mechanism for the tongue, which isn’t doing it’s job, to stimulate the vagus nerve and put the body in relaxation mode that is the red flag here.

Feeding issues/reflux/tongue ties

I’m adding this one in here because it’s important for parents to know that if their baby has feeding issues, reflux, or oral ties, these issues could be impacting their sleep. It’s all related!

Excessive night sweats

Excessive sweatiness at night, especially when combined with restlessness, snoring or noisy breathing, and/or mouth breathing could be related to sleep apnea or sleep disordered breathing.

So your baby has one or more red flags: what do you do?

This is such a hard question to answer because, unfortunately, most of these areas are areas in which healthcare providers need skilled training beyond what they receive in their basic educational program. Most pediatricians are not even aware of these red flags, and will often dismiss parents’ concerns.

Many of these infant sleep red flags are related to oral motor function, so if your baby is demonstrating any of these signs, I would recommend starting with a healthcare provider who specializes in oral motor dysfunction and oral ties. There is not just one type of provider who will help you. What’s most important is finding a provider who has the appropriate knowledge set. Providers you may want to look for include holistic dentists, myofunctional therapists, occupational therapists, speech language pathologists, or physical therapists. Here is a directory for tongue tie professionals.

If you suspect your child has an airway obstruction, here is a directory for airway focused providers.

If you suspect your child has food sensitivities/allergies, or gut health issues, I would highly recommend Tiny Health for sequencing their gut microbiome. Tiny Health tells you exactly what bacteria (both beneficial and problematic) are in the gut so you can specifically target gut issues and improve the gut microbiome rather than guessing. They give you tailored suggestions to improve gut health. The gut microbiome is so malleable in the first three years of life, so the sooner you can address gut issues, the better. The test is only $179 with my code TAYLOR. You may also want to work with a functional/integrative healthcare practitioner to address any food sensitivities or intolerances, but knowing exactly what is going on in the gut is so important, and can save you so much time.

If you suspect your baby is uncomfortable due to tension/strain patterns, and if your child has oral ties, bodywork is a helpful step. Bodywork comes in many forms so it is again important to make sure you are working with a practitioner who specializes in infants/children. Some forms of bodywork you may want to look into: craniosacral fascial therapy, craniosacral therapy, chiropractic, PT/OT/SLP, and myofunctional therapy.

If you’ve ruled out infant sleep red flags, and you are wanting support shift sleep patterns that no longer work for your family, grab one of my comprehensive eCourses, such as The Infant Sleep Foundations eCourse or the Toddler Sleep Foundations eCourse. If you’d prefer 1:1 support, you can book a call or support package.