While I spend a lot of time normalizing baby sleep – especially how wakeful babies are normal, and healthy; it’s important to note, there are red flags that an underlying issue might need to be addressed. Bear with me as I flip the script from normal to abnormal sleep, you’ll know what red flags to be aware of, and when to relax knowing all is well with your baby’s sleep.

Hourly Waking 

Generally speaking – waking hourly could mean there is an underlying issue keeping your baby from sleeping longer stretches. Please know this refers to consistent hourly waking, not the occasional back to back hourly waking early in the morning, or when your child is healing or going through a big developmental leap. There may be more to the story if your baby never settles into a 2-3+ hour stretch of sleep.

Oral Restrictions (Tongue Ties)

Many oral restrictions go undiagnosed, and in some cases even after being diagnosed – remain untreated. The truth is, releasing these restrictions can have health benefits beyond breastfeeding and sleep. Here are the basics of a tongue tie from Dr. Chelsea Pinto from the Breathe Institute in Los Angeles:

Everyone has a little cord of tissue connecting their tongue to the floor of their mouth, called a frenulum or frenum. We all have a frenulum, but 5-10% of us are born with frenulums that are too thick, too short or too tight – preventing the tongue from lifting up, and sometimes even from sticking out. 

What we’re looking for in babies is for the tongue to be able to lift up and over the lower jaw, for a complete suction and seal around the breast or bottle. When there isn’t a complete seal, you may hear clicking while feeding, which means the baby is taking in air, which can lead to discomfort and fussiness from gas. Milk may also spill out of the corners of the mouth.

Other symptoms of oral restrictions include: baby being underweight, or baby feeding around the clock. Babies with undiagnosed tongue ties have to work over time to get the milk from the bottle or breast. This tires them quickly and they may fall asleep before taking in a full feed, and need to feed much sooner. 

The Mother will likely feel pain or discomfort when baby nurses, due to the latch being too shallow, or in some cases because the baby can’t elevate the tongue to properly latch. The baby may even clamp down on the breast, ouch! 

Snoring and Mouth Breathing

Mouth breathing and snoring are common symptoms that an oral restriction may be present and obstructing the airway. The baby may also be uncomfortable lying flat – this is due to the position of the tongue, and from the tongue being able to seal to the roof of the mouth. When lying flat the tongue flops towards the throat, making it hard to breathe.

If an oral restriction goes undiagnosed, the roof of the mouth can form high and narrow because the tongue isn’t able to rest properly to form the palate. The roof of our mouth happens to be the bottom of our nasal cavity. A high palate pokes into the nasal cavity, which obstructs breathing. Humans are designed to breathe through their nose. Overtime, babies (or adults) will have to resort to breathing through their mouth to get enough air. Breathing through the mouth is designed to get a large amount of air quickly – which usually means we are in distress. Because of this design, our fight or flight mechanism is triggered when we breathe through our mouth – even when we are sleeping! Instead of focusing on getting plenty of oxygen and releasing serotonin like we do when we breathe through our nose, our body is now producing stress hormones like cortisol. This is an additional layer that can lead to frequent and very fussy wakes. 

If you suspect your baby has an oral restriction, it’s important to address this before making any changes to sleep. While oral restrictions are becoming more widely understood, it’s important to find a dentist who has experience with pediatric oral restrictions.

Remember – waking every 2-3 hours is normal and healthy for young babies, it’s when they are consistently waking every hour, to feed, or from discomfort that is considered a red flag. For older babies who continue the pattern of waking every 2-3 hours, this pattern can also be shifted anytime, without sleep training or any form of separation from the parent.

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