Behavioural States

Reading Your Infants Cues

Your infant is ready to listen and respond to you when:

  • He has a relaxed open facial expression
  • His breathing is regular and relaxed
  • Your infant’s limbs are tucked close to his body
  • Your infant’s mouth is relaxed and slightly open
  • Your infant’s eyes are open or open in response to your voice
  • Your infant calms upon hearing your voice

Your infant requires time to rest when:

  • He closes his eyes or turns away
  • His breathing becomes irregular
  • He may stretch or wriggle
  • His body becomes limp or stiffens or the arms and legs straighten
  • He places his hand over his face (palm outward with fingers splayed)
  • He frowns, grimaces, yawns , grunts or hiccoughs
  • He falls asleep

Infant Coping Behaviours

  • Brings hand to mouth or touches face. May cover eyes and ears
  • Hand clasping or pressing one foot over the other
  • Moves body, lift or turns head to get comfortable
  • Sucks hand
  • Presses feet against bedding or cot
  • Grabs or holds onto bedding, tubes or clothing


Sleeping and Waking Behavioural States

Babies  have six characteristic levels of arousal but it is not always easy to tell which is which in a preterm infant as these states are immature and often fleeting.

Deep Sleep

Also referred to as “Quiet Sleep” because the infant does not move apart from occasional small startles. Breathing is slower and more regular than other times. This state becomes more noticeable after 32 weeks gestation.

Light Sleep

Also referred to as “Active Sleep” because the infant moves about more. Rapid Eye Movements (REM) may be observed: breathing tends to be faster and more irregular than in quiet sleep.

Photo of a premature child asleep in a baby seat.


This is an important part of the sleep cycle and the infant may appear “half awake” as if trying to wake up or trying to go to sleep. Some infants may require your assistance to go to sleep (comforting hold) or to wake up (see if your infant opens his eyes in response to your greeting).

Quietly Awake

It may be some time before you see your infant with his/her eyes open and in the early days the facial expression may appear strained or glazed. During periods of quiet wakefulness you can watch how your infant responds to you ie does he turn his head towards you when you speak? When he needs some time out does he turn away from your voice? It is important to read your infants cues in particular during moments of stress or when he needs a break. Some infants will close their eyes and go to sleep when they are feeling overwhelmed and others get hiccoughs, yawn or sneeze.

Actively Awake

Preterm infants are often quite active with their eyes closed and it can be difficult to know they are awake or not. Fussy behavior indicates that the infant requires something to change or stop. Over time you will discover methods of settling your infant.


Preterm infants seldom cry but demonstrate that they are upset with agitated movements, grimaces and a crying facial expression.

Pain and Discomfort-How can you help

Cues that indicate that your infant may be in pain include tightly fisted hands, grimacing, bulging forehead, eyes squeezed shut, fast heart rate and changes in breathing. If you think that your infant is experiencing pain always raise your concerns with the medical team.

Non-Nutritive Sucking (NNS)

NNS is a natural sucking behavior for infants.  Sucking a soother or a finger are examples of NNS. NNS plays an important role in the care of preterm infants and infants who have difficulty feeding normally and require tube-feeding.

The benefits of NNS include:

  • Making tube-feeding a more pleasurable experience for the infant
  • Helps the infant associate sucking with feeding
  • Contributes towards a pleasurable positive oral experience
  • Stimulates digestion
  • Provides comfort during difficult procedures

Size appropriate soothers are used on the neonatal units in order to satisfy the infant’s sucking needs. Parents should discuss the choice of soother with the staff who will direct them to choose a correct soother for their infant. During NNS the mother may put some of her breastmilk on the soother or even offer her breast to the infant and encourage them to suckle.  It is important to note that NNS does not affect the infant’s ability to breastfeed.