Thoughts about Night-time Infant Behavior and Breastfeeding
We receive plenty of phone calls at the Lactation Care office from exhausted, sleep-deprived parents with questions about normal infant feeding and sleeping patterns. Parents call us wondering when their little one will “sleep through the night.” They ask when baby’s pattern of frequent night feeds will come to an end and more “normal” sleep will resume for the household. Many new parents are asked by well-intentioned friends and family members if baby is “sleeping through the night yet????” This is a developmental milestone all new parents look forward to and many expect it to be reached by the time baby is 3 months of age. Often this magical age of 3 months comes and goes and longer sleep durations are more the stuff of dreams than reality. Concerned, many parents fear baby’s frequent waking and subsequent night feeding is symptomatic of something wrong with baby (eg. Is he sick in some way?), wrong with their parenting (eg. are we too lenient and creating or perpetuating a bad habit?), or even wrong with breastfeeding (eg. Is my milk supply inadequate?). They compare their experience to those of formula-feeding or combination-feeding families and correlate breastfeeding with increased night waking (and being tired…and cranky!). They want to do what’s best for baby, but enough is enough! Sleep deprivation is a form of torture after all! The tacit ideas that breastfeeding = good and sleep deprivation = bad are incongruent with one another. Confused, they call us seeking information and guidance on how to navigate night-time parenting, breastfeeding, and getting enough sleep.
Adequate sleep is increasingly sited as an important factor in one’s overall health. A healthy lifestyle includes nutritious meals, adequate hydration and sufficient rest. This is true for adults, young people, and babies alike. We know that breastfeeding provides optimal and unmatched nutrition and ensures sufficient hydration to babies for the first six months of life. But what about sufficient rest and a good night’s sleep? How to balance the sleep and rest needs of babies and their parents and other family members is a big challenge that new families face.
Babies are little people with tiny tummies. They need care and attention throughout the 24 hours of any given day. Especially in the early weeks, babies really do need to wake at night to feed; it’s part of their physiology. As time goes on, babies grow and are able to go for longer periods between feedings. And yet, we see wide variations in terms of the timing of intervals between feedings and stretches of sleep or settling periods.
An informal poll of the staff at Lactation Care revealed some interesting stats. Our babies consistently slept through the night starting at around age 2 to 2.5 years and ranging through 4 years. The mean was 3 years. Sample size is 21 breastfed children. Yes, folks, years. Some of these sweet children were kind enough to occasionally sleep longer stretches as soon as a few weeks post birth, but none of them maintained that pattern until much, much later in their development. We offer these stats not as a prescriptive for your family, but merely as anecdotal evidence that 3 months is perhaps not a realistic expectation for baby’s readiness to sleep for longer stretches at night. So what is reasonable? Let’s look to some science for some guidance…
Helen Ball is an anthropologist with close to two decades of experience in researching breastfeeding, infant sleep and SIDS. She is Professor of Anthropology at Durham University, England where she runs the Parent-Infant Sleep Lab. Helen created and runs ISIS – the Infant Sleep Information Source (www.isisonloine.org.uk.) This is a free online resource providing evidence based information to parents and health care staff about normal infant sleep. At this site, information is provided complete with citations to the evidence that supports it.
This kind of information may be quite helpful to parents of young ones. Knowing about the biological norms of sleep patterns can help parents to frame their experience and expectations of their baby’s behavior. At her site, Professor Ball describes “settling” as “sleeping through a night time feed for a stretch of up to 5 hours.” Studies show that infants settle at different ages; some are ready at about 3 months of age, some not until later. In addition, there can be a difference in settling behaviors between breastfed and formula fed infants. As mentioned earlier, night waking is a physiological norm among breastfed infants. Breastmilk, by design, is digested quickly and easily. Therefore, an infant may be ready for the next feed after about 2 to 3 hours. This feeding behavior feels really demanding and is taxing on new and experienced parents alike. It is also very adaptive and plays a vital role in supporting a mother’s ability to maintain an adequate and healthy milk supply. Frequent emptying of the breasts encourages the body to produce more milk. Feeding a baby on cue around the clock ensures that baby gets enough to eat and that a mom’s body makes enough milk. Happily, both mom and baby are dosed with the hormone prolactin with each feed. In addition to its role in milk synthesis, prolactin provides the added benefit of allowing both mom and baby to fall into a restful sleep more quickly, thus mediating the effects of sleep deprivation. This normative pattern of night feeding also provides protection against pregnancy for the first six months, helping to space out pregnancies naturally. Furthermore, this frequent waking may offer baby protection from SIDS. Additionally, babies who have their needs responded to during the nighttime hours show lower levels of the stress hormone cortisol. Research on the impacts of this phenomenon are in the beginning stages and may shed light on how early exposure to stress impacts human development over the lifetime. It appears that all this night-waking and feeding has some less-than-obvious benefits after all.
As parents get to know their baby and their baby’s patterns, it can be helpful to remember that each baby is on his or her own timetable in terms of growth and development. They are constantly growing and maturing physically, cognitively and emotionally. There is no one set age at which babies reach particular milestones. For example, babies will roll over, or sit up or get their first tooth or reliably sleep a longer stretch of time at night when they are ready to do so. Parenting in a responsive way, taking their cues from their own little ones will help parents to support their babies to grow and develop at their own optimal pace.
That’s all well and good for baby, you may say, but it doesn’t change the fact that many new parents are exhausted and need help and support to get through the prolonged period of sleep disturbance that they are experiencing. For moms returning to work outside the home at 12 weeks or so postpartum, fatigue is a huge issue. Being patient and singing a few Kumbayas isn’t going to cut it! Parents may find it useful to focus on strategies that help them cope with an infant’s night time wakefulness. Accept offers of help from friends and family members. In the early weeks at home with a baby, limit visitors unless they are helpful. Invite visitors to bring a meal and to complete a chore while they are visiting. (Some parents even post a list on the refrigerator or another central location of tasks needing completion.) Rest when you can; if possible nap when your baby is napping. If your baby goes to bed early in the evening, consider resisting the temptation to catch up on paperwork or watch TV. Take advantage of the chance to grab a nap before the next feeding. If there are 2 parents in the household, figure out what ways you can support and help each other. If you are going it alone, consider a budget line-item for outsourcing outside help for anything and everything you can afford to delegate. Remember that it will not be forever that your little one wakes so frequently; it may not make dealing with the intensity of his or her needs easy, but it may make it feel a little less daunting and more manageable. Trust in the knowledge that your baby will not go off to college needing to nurse to sleep. And if anyone asks you how baby is sleeping, the ready answer is, “Like a baby!”