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When a baby’s not sleeping, life is rough. Every mother wants to know if it’s a sleep issue or a health issue, this post will help by explaining 12 common medical reasons (or health conditions) that stop baby sleeping well.
Two of my first cousins had their first baby a couple of months ago. Brand new moms.
One had an easy newborn. Some day night confusion, but other than that he was chill.
My other cousin? She had a hard time. She’s over in Germany so we were texting day and night, trying to troubleshoot his issues. Baby was taking super short naps, seemed very uncomfortable, had a hard time settling, wouldn’t sleep at night unless he was lying on her.
A lot of issues for such a small baby.
Eventually I said… “Honestly, stop eating dairy and see what happens.”
In a few days his face had cleared up, he had less tummy pain, and was far more settled. She said it was night and day difference.
Because she was doing all the things moms do to help newborns be settled… but a baby in pain won’t sleep well.
Let’s dive in… 12 medical considerations if baby won’t sleep
Of course, you’ll want to dive in with your own doctor, but here are some good symptoms and explanations to get you started.
Full disclosure: many parents think there’s a medical issue when the issue is baby doesn’t know how to sleep independently.
Before launching a full scale sleep intervention, however, most moms want to rule out some medical explanation, which is what I hope to do here.
Food sensitivities and allergies
Duration: short term, when food is eliminated
If you remove the common culprits (dairy, egg, peanut butter, etc.) then symptons will typically subside within 2 weeks, max. Sometimes as soon as a few days.
Babies who are in chronic pain or discomfort will have a very hard time getting to sleep and staying asleep. They’ll often take short naps and essentially refuse to get to sleep anyway but in mother’s arms.
Because we all want to be cuddled and loved when we’re uncomfortable or in pain.
Typical symptoms for food sensitivities or allergies are eczema, rashes, bumps or pimple like spots on the face, upset tummy, constipation, irritability, lots of witching hours, and general discomfort.
If your baby is otherwise healthy and just has sleep issues, it’s unlikely to be food related.
If you suspect food sensitivities or allergies are the culprit you can do a few things:
- Eliminate foods from your diet (if you’re nursing) and from your baby’s diet if they’re eating.
- See an allergist who can perform an allergy test. We did this and found my son had a peanut butter allergy.
Fast, simple, and free strategies to implement if baby can’t get to sleep, won’t *stay* asleep, or is unsettled in general.
Duration: short term when supplemented by diet and with iron
As a certified sleep consultant, I’ve heard it all. What I’ve found is that when you are doing all the right stuff, great routine, no overtiredness, enough solids, good bedtime routine, and they know how to sleep independently… and sleep is still a mess.
It can often be attributed to something medical. Iron is one of these things. Iron can, in fact, lead to restless leg and insomnia in adults. There are a lot of symptoms of iron deficiency in little ones.
If you suspect your little one could have low iron, consult your pediatrician. They can run a panel and tell you if this is the case, and offer solutions that make sense based on your child’s age, weight, and other dietary factors.
Viruses, colds, or ear aches
Duration: short term
Once the illness passes, sleep should go back to normal.
If your little one has previously slept well and then, all of a sudden, has a regression, it could be infection related. Whether a virus, cold, sore throat, or ear ache.
When a child has an ear infection they’ll often tug on it, put their hands over it, and will often run a fever as well. This can result in short naps, early morning wakings, and night wakings where baby’s cry is clearly one of pain, not protest.
If your baby has symptoms of a sickness or illness, go see your doctor or nurse. Treating the root cause (in this case the illness) will fix the sleeping issue when it’s resolved.
When children are smaller their ear canals are narrower and more likely to get blocked. They also tend to get more bacteria build up in their ears and can have chronic ear aches because of this. When this is severe many parents opt for tubes.
Your doctor will help you navigate this. Easing the symptoms of baby’s illness with some natural pain relief (or OTC pain relief when necessary) will help this pass.
Learn how to space naps, how many a day per age, best times, etc. and get your nap game ON!
Duration: medium to long term, requires treatment
A dear friend of mine had a baby in and out of the hospital for his early years. She knew he had some type of sleep issue because he had a stridor, which was a loud noise when he breathed in and out. She could hear him breathe loudly then stop… and she’d sit up and race in there.
Shortly after birth they diagnosed him with both obstructive apnea (something obstructing breathing pathways) and central apnea (brain isn’t sending the right signals to the muscles that control your breathing). He required a C-PAP for a few years and some subsequent surgeries.
The inability to get to sleep on their own, stay asleep, or frequent wakings in and of themselves are not related to sleep apnea.
Here are some things that are:
- pauses in breathing while sleeping
- snorting, coughing, choking
- mouth breathing
- night sweats, bedwetting
- night terrors
Seeing the doctor, getting a proper diagnosis, and beginning treatment. If you suspect apnea, don’t begin any formal sleep training interventions before visiting your doctor.
Duration: short term, until around 4 months old
Colic is typically diagnosed by a doctor when a baby cries for more than 3 hours a day, more than 3 days a week, lasting for 3 weeks or more. It typically goes away by 3 to 4 months of age.
One day, baby will just stop.
But not so fast….
I have a pet peeve about moms thinking their babies have colic when really their babies are:
- on a whack routine that doesn’t respect their sleep windows
- are overstimulated by too much noise, activity, etc.
- have a too late bedtime
- have witching hours that can be solved by fixing all of the above
If you dial in the routine, make sure bedtime is early enough, and help teach baby how to settle into sleep well and there is still crying you cannot stop… it’s likely colic.
And the cure to colic is letting it pass. Try as many settling techniques as you can, get support, and possibly some ear phones.
Learn how to space naps, how many a day per age, best times, etc. and get your nap game ON!
Duration: short to medium term
This typically disappears (except very serious cases like GERD) by the time baby can sit up. And can be treated with medication to alleviate most symptoms.
The long and short of it is this. Reflux happens when the lower esophageal sphincter muscle isn’t fully formed and lets stomach acids back up into the esophagus. This results in spitting up and discomfort for baby.
I list a host of solutions here in this post, but here are some tidbits below.
- Hold upright after feeding
- Make sure it isn’t hyper-lactation as opposed to reflux (see post linked above)
- Go to pediatrician for medicine, if desired
- Burp well
More strategies here.
Create sustainable sleep habits for your little lamb so the whole family can sleep peacefully without the stress, drama, and tears.Learn More
Duration: short term, if addressed
When I refer to nutrition issues here, I’m talking about feeding and eating.
To get to the point quickly, if babies snack here and there all day they don’t sleep well. They’re getting the foremilk that isn’t as nutrient dense, and they’re simply not filling up.
Babies need full feeds at regular intervals for optimal disposition and sleep. Full stop. 5 minutes here and there and 20 minutes later and then 30 minutes later is a recipe for total chaos. Both for you and baby. It makes for super whiny and also super angry babies.
Now let’s talk solids.
By 6 months of age if your baby isn’t on solids and is having sleep issues, focus on introducing solids. Babies at this age, and on to 7 months, are hungry. If you’re only nursing the same amount of times as before, they’re likely starving. They will nap worse, wake up more at night, and seem fussy.
They are developmentally ready for more nutrient dense, tummy filling foods.
- Offer substantial feedings. If you’re feeding more often than every 2 hours (or even every 3 hours after a few months) then baby is snacking.
- At the 6 month mark, in alignment with your pediatrician’s suggestions, introduce food. If sleep struggles have started around this time it’s likely hunger related.
Use my simple 4 step routine to help your little ones start sleeping better LIKE TODAY.
It doesn’t take weeks, mama.
Dirty diapers that wake baby up
Duration: short term
One thing mothers seem to fixate on is their little one’s diapers at night. We already struggle with baby’s fighting diaper changes during the day, but what about the nighttime?
An obvious rule of thumb is this: if a diaper is leaking then of course change it.
Another obvious truism: the more you feed baby at night, the more they will have dirty and wet diapers at night.
Now, do you need to make sure baby is completely dry all night? No. In fact, if this was your strategy you would up all night checking making sure it’s dry.
Here are some situations that may come up, and how to address them.
- Toddler always wanting to poop right after bedtime | Move this up into the bedtime routine. Allow a relaxing time before putting your little one to bed for them to sit on the toilet. Often, they lay down, relax, and the urge to go comes to them.
- If baby hasn’t woken up, don’t wake them up to change them | When they’re little, they live in a constant state of having a wet/dirty diaper on. If they go to the bathroom while asleep and it hasn’t woken them up, certainly don’t wake them up to do something about it.
- Drop night feedings, when able | If your little one is past 2 or 3 months, there is no need to feed them more than 2x a night. Of course, you’ll keep a dream feed but after that, they’ll likely need only 1 more feed until morning. If they are waking up multiple times at night to feed then you can work on consolidating some of those night feeds so there aren’t so many. If baby feeds 4x a night they will have a lot of dirty and wet diapers, you simply can’t avoid that.
Separation anxieties and fears
Duration: short to medium term, if addressed
Separation anxiety is a normal part of child development.
From around 9 months to around 18 months it can be normal for your little one to want to be near you and only you.
If difficult things are happening around the home (move, divorce, separation, death, etc.) then this will be even worse.
Typically, if your little one has been a good sleeper and all of a sudden, at this age, is super clingy around bedtime you may decide it’s separation anxiety, not a sleep issue.
First off, DON’T SNEAK OUT.
Abandoning routine and making “reactive” sleep decisions will backfire in the long term.
Autism / ADHD
Duration: Long term
If sleep is an issue related because of a neurological condition, it will be persistent and typical behavioral measures or routine changes won’t work.
I want to be clear here: lack of sleep is typically something a mother looks back on, after diagnosis, and says… aahhh… yes they’ve never slept well, no matter what we did.
Just because your baby is having trouble sleeping (as the only presenting symptom) DOES NOT MEAN they have some type of pending neurological diagnosis. In my baby sleep certification networking group, we have, however, found a link between sleep difficulties with little ones who already have a diagnosis.
If you are noticing a lot of symptoms, and sleep is just one of them, it may be worth bringing up to your doctor. I hesitated to put this here since it could cause alarm, but there is a clear link between sleep difficulties and some neurological diagnoses.
However, sleep issues in isolation are not likely linked to this. And, if you go to your doctor and say, “My baby doesn’t sleep well” and has no other symptoms, they will tell you to cry it out or something.
Note: My son is in diagnostic process for ADHD and has never had any sleep issues so this isn’t a hard and fast rule.
Doctors will often suggest melatonin. This can help settle your child into sleep, but wears off and typically does not help them sleep continually through the night if that’s their issue (causing frequent night wakings). Long term effects are also unknown.
Glue ear or swollen adenoids / tonsils
Duration: short, medium to long term, resolved by intervention
Sometimes mechanical issues can cause sleep difficulty.
If your baby has swollen adenoids or tonsils they’ll be having runny noses a lot, breathing through their mouth, snoring, their speech will sound nasal, and will likely have recurring ear infections.
Your doctor will be able to diagnose this.
Glue ear is different than an ear infection in that fluid builds up in the ear canal and can stay there for months. This can cause some hearing loss, auditory processing symptoms, pressure or pain in the ear, and some problems sleeping.
It’s very hard to sleep if your ears hurt when you lay down.
If your baby has any of the symptoms of swollen adenoids or tonsils, of course go to your doctor. They should also be able to look into your ear or use some handy dandy ear fluid testing device to see whether there’s a fluid build up.
These lovely cards and checklists will help you create and keep healthy wind down and sleep routines for your little ones.Learn More
Teething… but maybe not.
Duration: Tooth eruption, a few days.
Babies and toddlers are chronically teething. The period when the tooth is erupting into the surface typically only lasts a few days typically.
If your little one has never slept well and continues to sleep badly, it is not from teething. Sleep disruptions involving teething typically man that a child’s normal sleeping habits are interrupted out of the blue.
It’s more of an “all of a sudden” she won’t sleep than a “she’s never slept well” type thing.
It should be pretty easy to see whether a tooth is about to erupt. If there’s no evidence of this, it’s unlikely to be teething.
A way to test if your little one is in pain is to provide them pain relief for a day or two and see if it improves their sleep.
If pain relief allows them to sleep, pain is occurring. If not, it’s likely not.
Baby still won’t sleep? Try routine!
First, make sure they’re on a good routine. Here are some sample routines below.
Oh, my newborn sleep schedule will really go a long way as well, if babe is under 3 months. Below, I’ve linked some of my most popular routines.
Routine spot on? Maybe it’s a sleep association.
Here are some of my most popular posts relating to general sleep issues.