Table 3.2 Neonatal states classification scale
State Characteristics
Quiet sleep Regular breathing, eyes closed. Spontaneous activity confined to startle and jerky movements at regular intervals.
Responses to external stimuli are partially inhibited, and any response is likely to be delayed. No eye movements, and state
changes are less likely after stimuli or startles than in other states.
Active sleep Irregular breathing patterns, sucking movements, eyes closed but rapid eye movements can be detected underneath the
closed lids. Infants also have some low-level and irregular motor activity. Startles occur in response to external stimuli and
can produce a change in state.
Drowsiness While the newborn is semi-dosing, eyes may be open or closed; eyelids often flutter; activity level variable and interspersed
with mild startles. Drowsy newborns are responsive to sensory stimuli but with some delay, and state change frequently
follows stimulation.
Alert inactivity A bright alert look, with attention focused on sources of auditory or visual stimuli; motor activity is inhibited while
attending to stimuli.
Active awake Eyes open, considerable motor activity, thrusting movements of extremities, and occasional startles set off by activity;
reactive to external stimulation with an increase in startles or motor activity. Discrete responses are difficult to distinguish
due to general high activity level.
Crying Intense irritability in the form of sustained crying, and jerky limb movement. This state is difficult to break through with
stimulation.
