A sleepy baby who will not wake to feed

"She is so good, she just sleeps." I hear this in the first week all the time, and it is often said with relief. Sometimes it is nothing at all, and some babies genuinely are settled and feeding well between long sleeps. But a very sleepy newborn in the first week or two is one of the things I take most seriously, because sleepiness can be the first sign that a baby is not getting enough, and it sets up a loop. A baby who is not feeding well gets sleepy, and a sleepy baby feeds less well.

Some sleepiness is normal

Newborns sleep a great deal, and there are some predictable reasons for extra sleepiness in the first days:

• The second day. Many babies are very alert for a couple of hours after birth, then sleep heavily. This is normal and usually passes.
• After a long or difficult birth, or after certain pain relief in labour.
• Being too warm, or being swaddled and cosy in your arms.
• Jaundice, which is common and often mild, but makes babies sleepy and less interested in feeding. There is more in What is jaundice.

When sleepiness needs acting on

The pattern matters more than any single long sleep. Take it seriously if:

• Your baby is going longer than four hours between the start of feeds, in the first few weeks.
• They are having fewer than eight feeds in twenty four hours.
• They fall asleep within a couple of minutes of latching, every time.
• They are getting sleepier as the days go on rather than more alert.
• Nappies are dropping off, either fewer wet ones or stools that have not changed colour as expected.
• They are not back to birth weight by around two weeks, or are still losing.

How to wake a sleepy baby

Gentle does not work with a properly sleepy newborn. Be more direct than feels polite.

• Undress them down to the nappy. Cool air on the skin is the single most effective thing.
• Skin to skin on your chest. Your smell and the closeness of the breast set off feeding behaviour that a swaddled baby in a cot will not show.
• Change their nappy before the feed rather than after.
• Hand express a few drops onto their lips. The taste often wakes them enough to start.
• Stroke firmly down their back, along the soles of their feet, or run a hand over their head. Light stroking soothes. Firm contact rouses.
• Switch sides when they stall, and use breast compressions to keep milk moving while they are still sucking. Flow keeps a sleepy baby going.
• Try a cool flannel on their face or feet if nothing else is working.

If they still will not feed

Do not spend an hour on it. Feed your baby with expressed milk by cup, syringe or bottle, and express to protect your supply. A baby who is too sleepy to feed still needs the milk, and your body still needs the message. There is more in Ways to express milk.

Then get them checked. A baby who will not wake for a feed is a baby who needs someone to look at them, not a baby to keep trying with until morning.

The warning signs

How a consultation helps with a sleepy baby

The question I am really answering is whether this is a baby who is sleepy because they are not getting enough, or a baby who is not getting enough because they are sleepy. They look identical from the outside and the plans are different. I weigh your baby, watch a full feed and see how much they actually transfer, and check their mouth and their latch. If the answer is that feeds are not effective, we fix the feed. If the answer is that they need more milk into them first before they will have the energy to feed well, we do that, and then step it back down as they wake up. Either way you stop guessing, which is the exhausting part.