A normal, healthy infant demonstrates six sleep-wake cycles. The first two are sleep states. In the first, “deep sleep”, the infant cannot be easily aroused even when stimulated. While in the second state, “quiet sleep”, the infant exhibits some bodily movements and facial expressions. In this state, the infant is more easily aroused by stimuli, either internal or external. The newborn infant may spend as much as 18 hours per day in a combination of these sleep states. The infant will not easily latch on to the breast when in one of these two sleepy states.

The third state, “drowsy”, is a transitional state. In this state, the infant is relaxed; he exhibits irregular breathing and his eyes are either open or closed. The infant is more reactive to stimuli and may either return to a sleep state or progress to one of the three awake states.

In the fourth state, “quiet alert”, the infant is attentive to external stimuli but exhibits little bodily movement. Because the infant in calm in this state, this is an excellent time for breastfeeding. If a stimulus is presented at this point, such as the stroking of the cheek or the lips, the infant will become more and more alert and search for the stimulus.

As the infant moves to the “active alert” state, he will become more sensitive to external stimuli, such as increased handling, diaper changing, or bathing or internal stimuli such as hunger.

The last state, “crying”, is a state of much activity with crying and color change (pink to red). The infant is highly sensitive to external and internal stimuli and may need to be calmed and comforted before he will latch on to the breast. Comforting interventions such as swaddling, rocking and softly singing or talking may help the infant return to the quiet alert or active alert state.

It is important to watch for early and late feeding cues. If you baby is crying, shows exhaustion or falls asleep, he is showing late feeding cues. Some early feeding cues moms can watch out for are hand and foot clasping, bringing hands to mouth or face, rooting behaviour, body flexion and turning head to side.

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