CASE STUDY
GROWTH AND DEVELOPMENT
THE INFANT NOT SLEEPING THROUGH THE NIGHT
Case study objectives:
• Understand the normal physiology of sleep
• Apply developmental factors of the child to the physiology of sleep
• Understand parental role in sleep disturbances
• Apply the cultural factors that may influence the normal physiology and management of sleep hygiene issues in the family
Case presentation and discussion
NF is an 8 month old female who presents today at your rural health clinic with her mother and her paternal grandmother. Mom is concerned because NF, who has been sleeping through the night, is now awakening at around 2AM and crying as though something is wrong. This has been going on for about 4 weeks. Mom worries that NF may have an ear infection because she pulls at her ears while she is crying. Mom also notes that when she gets NF out of the crib, she stops crying and seems to want to play. When this happens, Mom gives NF a bottle of formula to calm her down but she drinks only 1-2 oz. Mom admits that her baby’s night waking really frustrates her, and she becomes irritable with NF in these earl morning hours.
Upon further review of NF’s chart and additional questioning of her mom, you learn that NF was born via spontaneous vaginal delivery at 40 weeks gestation to her mom at the age of 22 and her father a 22 yar old Hispanic male. They have no other children. The father works full time at a car dealership and the mom recently returned to work at Starbucks 12-15 hours a week. NF was diagnosed with GERD but the spitting up never interrupted her sleep. In fact, the symptoms of reflux dissipated after she began eating solid food by spoon. NF’s mother is the primary care taker and usually gives NF a bottle about 1 hour before she puts her in her crib at around 8PM every night practicing “back to sleep” recommendations. NF uses a silk blanket, called her “meese”, to help soothe herself to sleep and usually falls asleep around 8:15PM or so. NF’s mother gets her up around 8:30 AM when Dad is leaving for work. She began sleeping all night at around 4 months of age. She naps twice daily, 1 hour in the morning around 10 AM and approximately 2 hours in the afternoon, around 2PM.
At this point NF begins to fuss and you observe her mother’s attempts to comfort her. Mom appears frustrated and hands her off to her paternal grandmother.
Observing this interaction, you ask if there have been any changes in the family’s routine at home or any new different stressors, good or bad, that the family is currently experiencing. NF’s mother admits that approximately 1 month ago, NF’s dad’s company downsized and he suffered a decrease in his pay. These events required the family to move into the paternal grandmother’s home. Grandma interjects that when NF cries at night, she goes to her and gives her a bottle, then rocks her back to sleep. NF;s mother says that a week ago they moved NF into their bedroom to avoid waking the grandmother.
Case Presentation and Discussion questions:
1. What questions will you need to ask the family related to the presenting complaints?
2. Describe the normal physiology of sleep.
3. Discuss normal sleep patterns as an infant progresses through infancy, the toddler state, childhood, and through adolescence.
4. Utilizing Erickson’s and Piaget’s stages of Development, discuss how the major developmental tasks that are occurring for NF may affect sleep patterns.
5. Is a complete physical examination necessary and why or why not?
6. How might the family’s beliefs and expectations affect their perceptions of sleep problems and how they should be managed?
7. What other cultural influences in this family may affect the baby’s sleep behavior as well as the decision to see medical care?
8. How do you plan to treat this baby’s sleep disturbance?
9. Discuss separation anxiety and how the parents and family members can provide the infant comfort away from contact with parents.
10. When should you see this family again?
