Sleep Problems
sleeping is helpful
Sleep problems develop in early infancy
because of colic or
because an otherwise healthy infant takes
longer than usual
to adjust to sleeping through the night.
Breastfed babies tend
to wake more often than those who are
formula fed because
breast milk is more easily digested, so
infants become hungry
sooner. In late infancy, the problem of
waking at night and
remaining awake for an hour or more
becomes common.
Although an infant may be content and
not cry during this
time, parents are reluctant to sleep while
the child is awake,
so they may become extremely fatigued.
This is an increasing
concern because more and more families
today consist of two
wage-earning parents; there is no time for
parents to nap dur-ing the day to make up
for sleep lost at night. Suggestions for
eliminating or at least coping with night
waking are (a) delay
bedtime by 1 hour; (b) shorten an
afternoon sleep period; (c)
do not respond immediately to infants at
night so they can
have time to fall back to sleep on their
own; and (d) provide
soft toys or music to allow infants to play
quietly alone dur-ing this wakeful time.
Reassuring parents that infants take
varying lengths of time to adjust to night
in assuring them their child is normal.
Suggesting parents use
the time they are awake at night to do
such things as solve a
problem at work, watch the late show, or
plan a shopping list
may help them view the situation as a
constructive time
rather than a problem.
Constipation
Breastfed infants are rarely constipated
because their stools
tend to be loose. Constipation may occur
in formula-fed in-fants if their diet is
deficient in fluid. This can be corrected
simply with the addition of more fluid.
Some parents misinterpret the normal
pushing move-ments of a newborn to be
constipation. When infants defe-cate,
their faces do turn red, and they grimace
and grunt. As
long as stools are not hard and contain no
evidence of fresh
blood (as might occur with a rectal
fissure), this is normal in-fant behavior.
If constipation persists beyond 5 or 6
months of age, en-courage parents to
check with the infant’s health care
provider
about measures to relieve this. Adding
foods with bulk, such as
fruits or vegetables, and increasing fluid
intake generally re-lieves the problem.
Apple juice (3 or 4 oz) or prune juice (0.5
to 1 oz daily) may be given as a temporary
measure.
All infants with a history of constipation Infants with either Hirschsprung’s disease
for more than or hypothyroidism

1 week should be examined for an anal need therapy to correct the disorder.
fissure or tight anal
Loose Stools
sphincter. Softening stools and thereby
Many new parents are unfamiliar with the
relieving the pain of
consistency or
defecation often solves the problem and
color of normal newborn stools, so they
helps the fissure to
mistakenly report
heal. If an unusually tight anal sphincter
normal stooling as diarrhea. Stools of
exists, parents will
breastfed infants are
be given instructions to manually dilate
generally softer than those of formula-fed
the sphincter two or
infants. If a mother
three times daily until it dilates
takes a laxative while breastfeeding, an
sufficiently. One of the first
infant’s stools may be
symptoms of Hirschsprung’s disease
very loose. An infant who is formula fed
(aganglionic megacolon,
can have loose stools
or lack of nerve innervation to a portion
if the formula is not diluted properly.
of the colon) is con-stipation. If no stool is
present in the rectum of a constipated Occasionally, loose stools may begin with
the introduc-tion of solid food, such as
infant on rectal examination, this disease
fruit. Malabsorption syndrome
is suggested
(celiac disease), or an inability to digest
(Sondheimer, 2008). A careful history
fat, may manifest
must then be taken to
themselves first by loose stools and a
assess for other symptoms of
distended abdomen and
Hirschsprung’s disease: ribbon-like stools,
bouts of diarrhea, and a distended deficiency of fat-soluble vitamins (see
abdomen (see Chapter 45).
Chapter 45). When talking to a parent about loose
stools, ask about the
Chronic constipation also may occur in
children with duration of the loose stools, the number
of stools per day, their
congenital hypothyroidism (decreased
functioning of the color and consistency, and whether there
is any mucus or
thyroid gland). Therefore, an infant with
constipation also blood in them. Is there associated fever,
cramping, or vomit-ing? Does an infant
should be carefully observed for
continue to eat well? Appear well? Seem
characteristic signs of hy-pothyroidism,
to
such as lethargy, protruding tongue, and
fail-ure to meet developmental be thriving? Is an infant wetting at least
milestones (see Chapter 48). six diapers daily?
Infants with associated signs and
symptoms such as fever,

cramping, vomiting, loss of appetite, a

decrease in voiding,

and weight loss should be examined by

their health care

provider because this suggests an

infectious process.

Dehydration occurs rapidly in a small

infant who is not eat-ing and is losing
body fluid through loose stools.