From Barbara Robertson
What is 2nd Night Syndrome? 2nd-night syndrome is a common feature of newborn behavior. It typically occurs on the 2nd night after birth, when the baby’s behavior shifts from sleepiness to greater wakefulness, often asking to nurse frequently. Our colleague, Jan Barger, has discussed this. In her description of this she says, “All of a sudden, your little one discovers that he’s no longer back in the warmth and comfort – though a bit crowded – womb where he has spent the last 9 months – and it is SCARY out here!” No wonder babies are upset!” Correct! Infants are upset, but our takeaway message to families is that this is normal and your baby is fine. And, happily, there are things you can do that may help.
What does 2nd Night Syndrome look like? The key sign of this is that the baby wants to be held continually and nursed frequently. This is expected behavior. The baby is shifting from being fed through the umbilical cord and held constantly in the womb, to now needing to eat themselves and realizing they are not always being held. People often classify this behavior as “fussy” or “starving”. Suzanne Colson discussed infants needing to transition from the womb to the world. The baby was warm, fed, and cuddled 24/7 in the womb, and in Western society, we tend to try to put the baby down, away from us, to sleep. As the baby becomes more alert, they instinctively know this isn’t where they belong. They are safest in their birthing parent’s arm, right next to their food source for easy access. The baby may appear more wakeful, irritable, and cry more frequently. They want to cluster-feed, nursing for long periods of time and/or in short, frequent bursts, especially in the evening or at night. Again, they seek constant contact and to be held.
What are the theories as to why Second Night Syndrome is happening? To begin with, as mentioned, there is a significant environmental adjustment for infants. They go from a warm, cozy, noisy, dark womb to the world where noise, light, and temperature are inconsistent and often unpleasant. This change can be overwhelming for a baby. Babies in the womb are also being fed constantly, so the idea of being hungry is new as well. Their stomachs are tiny and expect frequent, small feeds. Frequent feeds also stimulate the parent’s milk supply, progressing from colostrum to transitional milk to mature milk. A review of research on secretory activation found that frequent milk removals are precisely what is needed at this point. The baby’s intake needs are going to increase over the next few days from about 0.5 oz (15 mLs) per feed to about 2-3 oz per feed in the next week. By frequently removing milk, the baby signals to the parent’s body that it is time for secretory activation, leading to a full milk supply. A fascinating study found that, among exclusive pumpers, the number of milk removals was critical for reaching and maintaining this stage. If the parent did not maintain frequent milk feedings, they would move out of secretory activation.
Why does it happen in the evening and at night? One theory is that the surrounding environment is loud and chaotic during the day. If the family remains in the hospital, many staff members are in and out of the room throughout the day. It is usually bright. There are often many visitors, especially if it is the first baby. All of this can cause the baby to feign sleep, thereby appearing calm. Once the chaos subsides, the lights are dimmed, and the baby “wakes” up, ready for interaction and feeding.
What can be done about Second Night Syndrome? In many ways, this increased behavior in the baby is the parent’s first opportunity to set the tone for the relationship. The parent has a choice: give the baby what they need at this moment, or fight it. Note that I used the word “need,” not “want.” The first stage of human development, according to Erik Erikson, is trust vs mistrust. Will the parent be present for the baby, or prioritize their own needs (or societal expectations) over the baby’s needs? What does the baby want? The bottom line is they want to be close to their parent. They want to be held skin-to-skin constantly. Skin-to-skin contact soothes the baby and helps them regulate their body. Make sure the baby doesn’t have mittens on. One of my interns once said that babies “see” with their hands. They also want access to their food source (the breast/chest) as often and as long as they feel they need to access it. After the baby feeds, gently shift so that the parent and the baby are comfortable. If you try to put the baby down somewhere, they will most likely wake again. If the baby is to be moved, the family should wait until the baby is in a deep (REM) sleep. The baby begins in light sleep, and if moved, they will wake. Keep in mind that infants move in and out of REM sleep more quickly than adults, approximately every 30 minutes. We encourage the parent to rest as much as possible during the day. The adage “sleep when the baby sleeps” is no joke in the early weeks.
Ensuring the family has as much support as possible greatly helps, so the parents’ only primary job is to meet the baby’s needs. Getting family and friends involved is a great idea. Hiring a doula for the first week or two can be a good solution. Remember, too, during the day, keep things calm, dark, and quiet so the baby doesn’t feel the need to play possum. Using calming techniques can also be effective. Rocking, walking, shushing, and letting the baby suck are great ideas.
Again, Second Night Syndrome (SNS) is a normal developmental hurdle, not an illness. The baby isn’t starving, and there is nothing wrong with the baby. The baby intuitively knows that the safest place for them to be is at or near the breast/chest. This intense need is very temporary. The sooner the family learns how to meet their baby’s particular needs, the sooner this tends to pass.