March 30, 2012

New parents and sleep: what to expect

Ah, sleep. It seems so precious and limited when babies are young. New parents quickly learn not to take a good nights' sleep for granted.

When should breastfed babies be expected to sleep throughout the night? Sleep is a work in progress during the first year of a baby's life. There is no easy answer.

The first month

In the first few weeks after birth, babies almost always fall asleep at the end of nursing. Their tummies are full, they just worked for their meal by actively nursing, and they are warm and cozy in mom's arms. Who wouldn't take a snooze after this?

Months 1-3

As the weeks go on, babies will breastfeed until they are full, fall into a relaxed mode at the breast, and shut their eyes to sleep. For almost all babies, nursing becomes associated with sleep. It is not a bad idea to start putting the baby down for a nap or sleep when the baby appears drowsy but not fully asleep yet. This will help the baby learn to transition him/herself to sleep without nursing.

Breastfed babies tend to eat more often than formula fed babies. Formula is harder to digest, and formula fed infants take a higher volume at each feeding compared to breastfed babies. A 3-month-old formula fed baby typically takes six to eight ounces per feed every three to four hours, and a breastfed baby will often take four ounces every two to three hours. This means that breastfed babies are more likely to wake up at night to eat, after three to six hours of sleep, compared to a formula fed baby. There are no strict rules about this. We all know that babies are individuals, too, and some babies are deep sleepers — never stirring to noises or touch — whereas other babies are light sleepers and easily awakened. Throw in a stuffy nose, gastroesophageal reflux, or some sort of pain, and what babies will do at night can be anyone's guess.

Months 4-6

At this point breastfed babies begin reducing their frequency of nursing. After all they just doubled their birth weight (whew!), and now they intend to triple their weight by 1 year, in the next eight months. This means their calorie needs decrease, and they begin breastfeeding closer to every four hours rather than every two to three hours.

By this time, many breastfed babies start to sleep longer, such as six to eight hours over night. This is the point at which parents gain the expectation that the baby will sleep all night, and they start comparing notes with other families about infant sleep.

Why won't breastfed babies sleep all night?

Breastfed babies are notorious for reverse-cycle nursing at four to five months when moms go back to work, which means they like to nurse at night. Breastfed babies often prefer to nurse rather than to receive bottles, so many babies will hold off on bottle feeding at daycare, and increase their frequency of nursing in the evening and overnight. In addition, four-to-five-month-old babies are distracted by life! They are busy bodies, wanting to know what their siblings are doing, who is walking thru the door, and what the sounds are outside. They are so busy checking everything out that they often nurse for a short four to five minutes at each feeding during the day.

The price of curiosity? Their hunger catches up with them at night! Babies at this age may also wake up at night due to transient stages of fear, discomfort, and change in routine. Parents should not have the strict expectation that their babies will sleep through the night at this age. It may help to ensure that the baby takes in adequate calories during the day, and that the baby is in a comfortable routine throughout the day, while avoiding late afternoon or early evening naps.

Breastfeeding is actually most successful if babies wake up to nurse at least once per night at this age. If the baby sleeps longer than six to seven hours at night, mom's prolactin level goes down. Prolactin is the hormone that tells the breasts how much milk is needed. If the baby goes a long period without nursing, such as eight to 10 hours, not only will her milk supply go down, but her menses will come back, further lowering her milk supply, and increasing her chances of pregnancy.

Months 6-9

Babies should start solid food at around 6 months of age. As long as the solids incorporate protein and fats, breastfed babies will sleep longer at night, with a decrease in nursing frequency. Babies should still nurse five to six times in 24 hours. This is where the sleep controversies come in. Is it time to force the baby to sleep all night, or is it OK to breastfeed a crying baby in the middle of the night? Many parents have a hard time deciding whether the baby is hungry or wants to nurse for comfort. Advice at this point needs to be individualized. Some babies rely on that nighttime feeding for adequate calories, especially if they are not keen on solids yet. Other babies nurse for comfort for only a few minutes, just looking for a cozy way to get back to sleep.

Before families make a decision that night time breastfeeding is no longer needed, it is best for the baby to be seen by his/her physician to make sure growth is adequate, and there is not another reason for frequent awakening. However, breastfeeding mothers may notice a decrease in their milk supplies when the baby takes long stretches of sleep, or more than seven hours. Nine-month-old babies are notorious for waking up frequently, whether breastfed or formula fed. This is the month of stranger and separation anxiety, in addition to excitement about new skills, such as first words, first crawl, or first step. Babies who were good sleepers often start to wake up at this age, sometimes several times at night. Hang in there parents, it does improve after a few weeks!

Months 10-12

By this point, breastfed babies are transitioning to an adult diet, partaking in the family meal but in a modified form to prevent choking. They are often nursing four times a day or more. As long as these babies are healthy and eating regular meals, they should not have a nutritional need to nurse at night. This is easier said than done! Babies still like to have the reassurance, company and warmth by nursing at night when they wake up.

Many moms prefer to nurse their babies back to sleep, while others look for advice on how to stop nursing at night. Either approach is fine; it is the parents' decision, assuming that the baby has normal growth and development. Just remember your child is just a baby and that full night's sleep is yours in the future. Before you know it, you will seek advice on how to get your 13-year-child out of bed for school each morning!