Baby Sleep When She Is Sick

Before anything about sleep: a baby under 3 months with a temperature of 38C (100.4F) or higher is a phone call today, whatever else is or is not going on. Sleep during an illness is a week of worse nights, more naps in your arms and more waking than she has had in months, and it goes back to roughly where it was afterwards. The part that matters is knowing which signs are ordinary and which mean you stop reading and ring somebody. Those come first on this page, on purpose.

This page gives no medicine and no dose advice of any kind — nothing about pain relief, fever, coughs or anything else you can buy. That is a conversation with a person who can weigh her and knows her history: your pediatrician, your GP, your health visitor, or a pharmacist.

Get help straight away for any of these

These are the signs that do not wait until morning. Ring 999 or 111 in the UK, or your pediatrician or emergency number where you are, if she:

• is very hard to rouse, floppy, or not responding to you the way she normally would;
• is breathing fast, working hard to breathe, or grunting with each breath;
• looks blue, unusually pale, or mottled;
• has a rash that does not fade when you press a glass against it;
• has a fit or seizure;
• is not feeding at all;
• has had far fewer wet nappies than usual.

A baby under three months with a temperature of 38C or more belongs on that list regardless of how well she otherwise seems. And a worry you cannot talk yourself out of is itself a reason to ring — nobody who answers that phone thinks you are wasting their time.

The fever thresholds, by country

The two national bodies word this differently, so use the one for where you are standing rather than whichever came up first in a search.

NHS, United Kingdom. Ask for an urgent GP appointment or call 111 if a child is under 3 months with a temperature of 38C or higher; is 3 to 6 months with a temperature of 39C or higher; or has had a high temperature for 5 days or more. A high temperature is very common in young children and usually returns to normal within one to four days.

AAP, United States. A rectal reading of 100.4F (38C) or higher counts as a fever, and rectal is the most reliable measurement in infants. Call your pediatrician immediately if a baby of 3 months or younger has a rectal temperature of 100.4F or higher, even with no other symptoms. Notify the doctor at 101F (38.3C) or more between 3 and 6 months, or 103F (39.4C) or higher over 6 months.

One NHS instruction is worth repeating here because it is so widely got wrong: do not undress a child or sponge them down to bring a temperature down. A high temperature is the body's natural response to infection, and cooling the skin does not treat what caused it.

Wet nappies, the signal you can count

Output is the check that works at three in the morning without a thermometer, and it is the one worth knowing properly because the ordinary version of it looks alarming.

The AAP's figure is that a baby who is ill or feverish, or who is in extremely hot weather, may produce about half her usual number of wet nappies and that can still be normal. So a drop is expected. What is not expected is fewer than four wet nappies in a day — that is a phone call, not a wait-and-see.

Count them rather than estimate them. A wet nappy at four in the morning is forgotten by ten, and the answer to "how many today?" is the most useful thing you can hand whoever you ring. A printed day sheet with a line per nappy turns a vague impression into a number.

No medicines and no doses, and why

Said once is not enough, so it gets its own section: nothing on this site tells you what to give a baby or how much. Doses depend on weight, age and what else is going on, and no version of that advice is safe to publish to everybody at once.

Ask a pharmacist for the everyday questions and your GP, health visitor or pediatrician for the rest. A pharmacy is open longer than a surgery, and a pharmacist will tell you when the answer is to ring somebody else. In the UK, 111 exists for the calls that do not feel like a 999 and do not fit into a working day.

Why illness wrecks nights

Every reason below is physical rather than behavioural, which is the thing to hold on to when the fourth night in a row falls apart.

A blocked nose makes feeding hard, because a small baby has to stop feeding to breathe, and it makes lying flat harder still. A cough interrupts the lightest part of every sleep cycle, which is the part she travels through to link one cycle to the next. Earache is worse lying down. A temperature makes everything restless. And a day spent asleep on you, fed little and often, is not the day her body clock was expecting.

Extra sleep during a common illness is ordinary. So is waking her for feeds if she is taking less than usual — output is what you are protecting, and a sleepy baby who is not drinking is the version of extra sleep that needs a phone call rather than a quiet house. What is not ordinary, and belongs in the first section of this page rather than this one, is a baby who is unusually difficult to wake or who is not responding to you as she normally would.

Expect the week to be worse than the fortnight before it and roughly as good as the fortnight after it. It is not a regression, it is not a habit forming, and it is not caused by anything you did.

Safe sleep gets stricter, not looser

Illness is when the shortcuts get tempting: a pillow to prop her up, a car seat left in the cot because she breathed better in it, a night on the sofa with her on your chest. Every one of those raises risk at the point where a baby is least able to cope with it, and none of them treats a cold.

So the rules hold, and hold harder. Babies sleep on their back, on a firm flat mattress, in a cot clear of blankets, pillows, bumpers and soft toys, in your room. Nothing goes under the mattress to tilt it, no wedge, no rolled towel and nothing weighted on or over her. Never fall asleep with her on a sofa or in an armchair — that is the genuinely dangerous place, and it is where an exhausted parent at four in the morning ends up. If you are going to be up, be up somewhere you will not drop off, or put her down in the cot and lie down yourself.

Feeding upright and extra time on your shoulder before you put her down are the versions of "prop her up" that are actually available. The cot stays flat and empty, and the room temperature guide covers the other thing people reach for when a baby is ill: fewer layers, not more, and a room in the ordinary band.

Getting back to normal afterwards

Wait a few days after she is well, then go back to what you were doing before rather than inventing something new. The habits an illness leaves behind — an extra night feed, a return to being rocked, naps only on you — usually fade within a week or two once the routine goes back to its old shape.

If one of them is still there after a fortnight and you would rather it were not, change one thing at a time, in an ordinary week, and give each change three or four nights before judging it. The bedtime routine guide is the easiest place to start, because it changes the front of the night rather than the middle of it. If the days themselves have gone crooked — naps in the wrong places, a bedtime that has drifted an hour late — the wake windows by age guide will tell you what the awake stretches should roughly be, and the page on the four-month change explains why a fortnight of broken nights so often gets blamed on the wrong thing.

Anybody else looking after her while she is recovering needs the same information you have: the numbers, the surgery, what she is taking and when she last fed. The babysitter information sheet has a line for each of those, and a sheet on the worktop beats a text message to somebody who is holding a baby.

When to ring anyway

None of the thresholds above is a full list, and a baby can be seriously unwell without a fever at all. If she cannot be settled at all, is feeding poorly, is not gaining weight, is unusually sleepy, or her cry does not sound like her usual one, ring your pediatrician, GP or health visitor today rather than waiting for a number to be reached. Trust the change in her rather than the reading on a thermometer. This page is general information, not medical advice, it does not discuss medicines, and it cannot see your baby.