Brazelton Neonatal Behavioral Assessment Scale (NBAS)
Parents should know about the behavioral states of the newborn which will help them organize the feeding and sleeping time for newborn babies. During the early weeks the infant sleeps most of the time and wakes up only to take feeds. So the feeding and sleeping time of newborn babies are interrelated during the first few month of life.
The Neonatal Behavioral Assessment Scale was developed by Dr.Brazelton in 1973. This scale helps the parents and the doctors understand the infant’s language. A child may not be able to communicate verbally during the first year of life. During this early period of life, an infant can communicate with body movements, cries and visual responses. The Neonatal Behavioral Assessment Scale helps to know what the infant is trying to communicate. The Neonatal Behavioral Assessment Scale gives valuable information about the needs of the infants for their optimal development.
The NBAS assesses the infant’s behavior on 28 behavioral items. Also the infant behavior is organized in to six discrete behavioral states and they may reflect an infant’s inborn ability to regulate arousal. These six states are quiet sleep, active sleep, drowsy, alert, fussy and crying. A positive interaction between the mother and the baby occurs during the alert state.
Parents actively participate in an infant’s behavioral state regulation, alternately stimulating or soothing to prolong the social interaction. In turn, the parents are regulated by the infant’s signals, responding, for example with letdown of milk in response to cries of hunger.
Sleeping time for newborn babies
Almost immediately after birth, a newborn looks alert and readily suckles if given the opportunity. But this may be affected if the mother has taken or given medications like analgesics and anesthetics and also if the newborn does not get enough oxygen due to various causes. This initial period of alertness usually lasting for about 40 minutes is followed by a period of sleep. After that, periods of alertness alternate with sleep.
As mentioned above there are six behavioral states that are described in infants. Initially sleep and wakefulness are evenly distributed throughout the 24 hours. An infant during the first week sleeps for more than 16 hours a day. The daytime and the nighttime sleep are almost equal.
Inside the womb, the growing fetus does not differentiate between day and night. Once the baby is born, the same issue continues. The babies sleep most of the day. During the first few weeks the infant may wake up two to three times during the night. From about two to three months the infant will sleep through the night. The newborn wakes only for feedings. The length of naps may be quite variable. Some sleep 6 hours or more at a stretch.
There are two phases of sleep – the REM sleep and Non –REM. The Rapid Eye Movement (REM) sleep is the light sleep and the Non-Rapid Eye Movement sleep is the deep sleep. It is during the REM sleep that a person wakes up. Adults have well organized sleep pattern. But in newborn babies, the light sleep is more and the sleep gets disrupted. So during the first few weeks, the baby may wake frequently during the night. This will obviously disturb the parent’s sleep and can be frustrating. The infant needs help to fall asleep till the sleep pattern gets more organized which will take about 2-3 months. The help may be in the form of cuddling, rocking or singing till the baby settles down.
Neurological maturation and learning account for consolidation of sleep in to longer periods. Infants whose parents are more interactive and stimulating during the day learn to concentrate their sleeping during the night. At around 3 months of age, the infants sleep for about 15 hours of which the night time sleep accounts for about 10 hours. At one year of age a child sleeps for about 13 hours of which night time sleep accounts for about 11 hours. Sleeping only during night time may be seen from 4 years of age. To help the baby sleep more during the night, the mother should avoid stimulation during nighttime feedings.
The baby should be allowed to sleep in a crib or a bassinet. The American Academy of Pediatrics does not encourage bringing the infants to sleep with the mother on the same bed. This is based on the finding that it can lead to sudden infant death syndrome (SIDS) due to increased risk of suffocation.
Feeding time for newborn babies
After the baby is born, feeding should be started immediately. As mentioned earlier a baby remains alert for about 40 minutes immediately after birth and the mother should start to breastfeed within this time. If the baby is delivered by cesarean section, the mother may be drowsy due to anesthesia and in these circumstances, feeding should be started within 4 hours.
Infants must be not be overaroused as it can make the behavior erratic Underaroused infants are not able to feed and interact. The baby needs to take feeds frequently at least during the initial few weeks. Though there is no need to wake the baby up for feeding, the mother should wake the baby if the sleep extends for more than 5 hours especially during the first two months.
Whether the infant is breastfed or given formula feeds, feeding should be done on demand. There is no specific time to feed the baby. On demand feeding means feeding when the baby is hungry. The infant may cry, may put the fingers in the mouth or making sucking noises which all indicate the infant is hungry. A newborn baby needs to be fed every 2-3 hours. The interval should be calculated from the beginning of each feed and not after the end of the feeding. Frequent breastfeeding also increases the milk production. Exclusive breastfeeding is advised till six months of life.
If the baby is breastfed, the baby should be allowed suckle for 15-20 minutes. If the baby is on formula feeds, about 2-3 ounces should be given during each feeding. The mother can know that the infant is adequately fed:
- If the baby produces 4-6 wet diapers a day
- If the baby passes several stools a day
- If the baby sleeps well after each feed
- If the baby is gaining weight
Since the baby swallows air during feeding, it is essential to burp the baby after each feed. If burping is not done, the baby may regurgitate whatever is fed.