4. Feb, 2021
Why is my baby screaming in her sleep?
The first time I encountered a high pitch scream in the night, I jumped out of bed to check on my daughter, only to see that her eyes were shut, she looked asleep yet, as I picked her up to console her, her screams only got louder and louder. No matter how much shushing and cuddling I tried, she was inconsolable.
The following night, the same thing occurred, and the night after that.
As a young mum with no experience of babies sleep, I assumed she had nightmares and left it at that. It continued for a few weeks and, just as it had started, the night screams ended and my daughter was able to sleep peacefully from then on.
Ten years later, with more professional experience, sleep education and meeting more babies displaying similar behaviour, I started understanding what was happening: she had experienced infant parasomnia.
While in older children and adult parasomnia is a medical condition, infant parasomnia is seen as a normal physiological phenomenon due to a change in the baby' sleep cycle.
Usually occurring between 4 and 6 months (but sometimes as early as two months old), parasomnia is characterised by a high pitched scream, inconsolable crying and distress at night.
"The most common non-rapid eye movement (NREM) parasomnias in children are the disorders of arousal (e.g., sleepwalking, night terrors, and confusional arousals), which occur most commonly in the first half of the night.
Rapid eye movement (REM) parasomnias occur later during the night and consist of experiences such as nightmares, recurrent isolated sleep paralysis, and rapid eye movement sleep behaviour disorder (RBD). The latter is extremely rare in children."
"They are ubiquitous among children and more frequent than in adults. Most paediatric parasomnias are benign, self-limited, and generally do not persist into adulthood." British Medical Journal- https://bestpractice.bmj.com/topics/en-gb/1177
Infant sleep initially consists of 2 sleep stages: Rapid eye movement (REM) and Non- Rapid Eye Movement (NREM). During the first phase of sleep, the baby is in alight sleep, often smiling, rolling her eyes, crying or moaning. As she slips into NREM sleep, her breathing slows down, and her sleep deepens. This cycle is repeated throughout the night with occasional waking to feed.
As the baby's sleep evolves and matures, a change occurs in sleep pattern. From the two stages of sleep, we move onto four stages, also knowns as sleep cycles that will constitute mature sleep. However, it does not consolidate until your child is five years old.
Why the screaming and crying?
You settled your baby to sleep, she is calmly sleeping, but she starts screaming shortly after. You run to her only to notice that her eyes are shut (but sometimes they are open), she sounds in pain, and as you pick her up, she is fighting you, kicking, trembling and the screaming continues. It is infant parasomnia. And it is distressing to witness!
Imagine your baby's brain at this point is like a computer. You are now installing new software (new sleep stages). This software has four phases, but instead of downloading smoothly throughout the four stages, it resets your computer every time you move from one stage to another.
It is what happens to your baby's brain. Each new sleep cycle, rather than linking smoothly to the next one, "resets" and your baby is aroused (sometimes awake, sometimes not).
This phenomenon is normal and may occur more predominantly in some babies than others, but does not last. Some babies are even oblivious to it.
What can I do to help my baby?
Parasomnias, even though most of the time, a normal part of infant sleep maturation, can be helped by the following:
- Reassurance: from 6 months of age, babies start showing signs of separation anxiety, this is also the time most parents move their baby into a separate room (NHS/ Lullaby Trust advise on babies sharing the room with parents until at least six months of age). The six months milestone does not mean that your baby must be moved to a different room. If your baby was happy and is now showing signs of separation anxiety, increasing your time apart (new space, darkness, alone) may increase this feeling of anxiety and lead to more night waking!
- Solid food introduction: The six-month milestone also corresponds with the introduction of solid food in babies. Often an exciting time for parents (and babies!), it can also coincide with a baby not sleeping well due to eating a little too much solid food. Solid food at this stage is about play, colour and discovering new flavours. Milk should still be their first source of nutrition, always offered first. If you got a little too excited and started making tons of purees, maybe it is time to step back a little and reduce the amount offered. Contrary to popular opinion, introducing solid does not make a baby sleep longer or better! A great read on introducing solid by Professor Amy Brown "Why solids matter" https://professoramybrown.co.uk/
- Favourable sleep environment: anyone who understands the brain development of a baby and what physiological sleep entitles will agree that while cannot change the nature of your baby, we can modify the environment to promote sleep (see https://www.holisticbabiesouthlondon.com/444329267)
- Reducing stimuli before bed: I get it, dad/ same-sex partner who works out of the home often arrives late, missing out on the last few hours with their baby. Dads/ partners are significant to a baby, and that infant-father/ infant-mother relationship should not be sacrificed but if your little one is fighting sleep in the evening to hang around with daddy/mummy yet is then struggling to sleep, it may be time to review how this can be tackled. Instead of bedtime playtime, your partner can do the bedtime routine in a soothing environment, read the last story before bed and cuddle their baby to sleep. If their work schedule means those are not possible, babies are by nature early risers and having breakfast/ playtime together is a great alternative.
- Put away the gadgets, toys, cuddly toys that may be too distracting: nothing is more damaging to baby's sleep than those baby projectors offering a light show (I nickname those the baby disco!). Would you be able to sleep in a club? In particular, blue light is an enemy of sleep as it inhibits the production of the sleep hormone melatonin. Those toys are great when baby wakes up in the morning but never a good idea at bedtime (or nap time)
- Work with your baby on developing a healthy circadian rhythm: this is simple, 12h of daylight followed by 12h of night-time. Naps in a room with curtains open (or semi-open but not dark), night sleep in a dark room.
- Be patient: like everything in parenting, this is a phase! I know society puts a lot of pressure on new parents when it comes to sleep. We compare our babies with each other (and their siblings), look for something to "fix" them. Their sleep is not broken, it takes time, and we have to work holistically with their nature. While we cannot change their personality, we can do plenty on the nurturing and environmental aspects.
- Be aware of the sleep trainers: while many sleep consultants have a wealth of experience and knowledge, please be aware of those who promise you to get your baby to sleep through the night! No one no matter how good they think they are can offer this! Ask for their background, credentials, methods. Question and ask to see the scientific evidence on which their advice is based. Do they recommend the crying out method, ask them to talk to you about cortisol levels in babies left to cry unattended and dissociative disorders. If they stare at you blankly, shrug, dismiss your query or just reassure you they have always got babies to sleep through, run! Those are all red flags. If your gut tells you it doesn't feel right, that person is probably not the right person for you and your baby!
- Sleep together: even if you disagree with the idea of babies/ children in bed with you, unless you have been advised not to sleep with your baby by an informed healthcare professional (guidelines available on https://www.lullabytrust.org.uk/wp-content/uploads/4-bed-sharing-factsheet-2018.pdf) sleeping together may help all of you! Research by Dr Nils Bergman in 2017 demonstrated that babies who share the bed with their mother have better stress regulation (compared to babies sleeping alone in their cot), breathing and better cardiac function.
- Educate yourself from sources with scientific evidence, or seek someone who only works with current, evidence based advice and trust that you and only you, know what is best for your baby!
Disclaimer: This article is for education purpose only and is not aimed at giving a diagnosis. If you are concerned about your baby's health, always consult your GP or paediatrician.
If you need further information on infant sleep, you can contact us at firstname.lastname@example.org
Stephanie is a Gentle Sleep Coach who has worked with new parents for the past 12 years in promoting good sleep habits in babies and children while protecting breastfeeding. Her approach is always respectful of the baby/ child, enabling a secure attachment between child and parents. She is currently studying for her Masters in Psychology and Neuroscience with a specific interest in baby's neurodevelopment and the impact on parenting on the developing brain.