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Lactation and Infant Sleep

Updated 04/22
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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 or human milk-fed babies be expected to sleep throughout the night?

Sleep is a work in progress during the first few years of a child’s life. Having a baby who sleeps through the night is not an indication of excellent parenting, and having a baby who wakes frequently in the night is not a sign of poor parenting. It should not be expected that infants or toddlers sleep uninterrupted all night. There is no easy answer. The best strategy for infant and toddler sleep is usually a safe one that is most functional for your family. Please speak with a trusted healthcare provider if you have questions or concerns about your infant’s sleep.

Risk Reduction with Bedsharing

Families don’t typically discuss bedsharing with their physicians, and the Centers for Disease Control recommends not bedsharing. However, multiple studies have shown that a large percentage of parents will share a sleep space with their baby at some point whether intentionally or by accident. We do not have strong data regarding low-risk bedsharing and how this affects the risk for suffocation or sudden infant death syndrome (SIDS), but we do know that unsafe bedsharing practices increases the risk of infant injury and/or death. Bedsharing often supports breastfeeding dyads, because mothers who sleep next to their breastfeeding infants tend to breastfeed more often and longer. Breastfeeding has also been shown to protect from SIDS. As with many other behaviors, such as driving in a car, we can discuss how to make bedsharing as safe as possible, if it is unavoidable. Below are recommendations for decreasing the risk of death or injury associated with sleeping in the same bed as your baby.

The Following Recommendations Reduce the Risks Associated with Bedsharing:

  • No one who lives in the home should smoke cigarettes or vape, even if it is done outside.
  • The lactating parent or partner sharing the bed must not use alcohol, marijuana, sleeping pills or other medications or substances that cause drowsiness.
  • The baby feeds at the breast and sleeps next to the lactating parent.
  • The baby is healthy and full term. Bedsharing is not considered safe for infants who were born preterm or low birth weight.
  • The baby is placed on their back to sleep.
  • The baby is lightly dressed and not swaddled, which prevents overheating and allows the baby to move if needed.
  • The lactating parent and infant are in a bed with a safe sleeping surface.
    • No pillows or comforters near baby
    • No soft bedding
    • No stuffed animals
    • No other adults, older siblings, or pets (Newborns should only be in bed with the lactating parent and/or their partner)
    • No risk of the infant falling out of the bed, or being caught between the bed and the wall, or the bed and the headboard
    • Not sleeping in a chair, recliner, or sofa

Additionally, the cuddle curl is a common position that lactating parents use with infants. In this position, the parent lies on their side and forms a “C” position around the baby with the arm closer to the mattress above the baby’s head, baby positioned on their back at the level of the parent’s breast, and the parent’s legs curled up under where baby is sleeping. In this position, it is much harder to roll towards your baby and baby is ideally positioned to latch on and feed as needed through the night.

If you or your baby have any other delivery complications or medical conditions, please discuss whether you and your baby have any additional factors that make bedsharing riskier that are not included in this document.

The First Month

In the first several weeks after birth, babies almost always fall asleep at the end of nursing. Their tummies are full after working for their meal by actively nursing, hormones and fats in the breastmilk promote sleep, and babies are warm and cozy in their parents’ arms. Who wouldn’t take a snooze after this? This is totally normal behavior and it is fine to enjoy those close snuggles with your little one.

Months 1-3

As the weeks go on, babies will breastfeed until they are full, fall into a relaxed mode in the parents’ arms, then shut their eyes to sleep. For almost all babies, nursing is a natural way to enter sleep. Parents can try to set the baby down for a nap or sleep when the baby appears drowsy yet not fully asleep, but many parents find that this does not work. Babies are smart, and if they feel left alone and unsafe, they may cry. Alternatively, many parents choose to transfer their baby to a crib or bassinet once the baby is in a deeper stage of sleep. Some parents utilize babywearing to allow the baby to nap while they perform other tasks. It is important to be aware of safety tips with babywearing, to keep the baby safe.

Human milk fed babies tend to eat more often than formula fed babies. Formula takes longer to digest, and formula fed infants typically take higher volumes at each feeding compared to breastfed babies. A 3-month old formula fed baby may take 4-6 ounces (120-180 ml) per feed every 3-4 hours while a breastfed baby will often take 2-4 ounces (60-120 ml) every 2-3 hours. Human milk fed babies are more likely to have shorter stretches of sleep overnight compared to formula fed babies. More frequent awakening over night may be one reason why breastfed infants have a lower risk of sudden infant death syndrome. It is best to feed your baby based on their needs, to maintain your milk production and ensure proper infant growth. Babies at 1-3 months of age often sleep for 3-5 hours at a time overnight before awaking for feeding or reassurance. Babies are individuals too – 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, gastro-esophageal reflux, or pain, and what babies will do at night can be anyone’s guess.

This period of a baby’s life can be exhausting. Hang in there, they will eventually learn to sleep longer stretches. As a lactating parent, if you are finding that you need more rest, it can be helpful to enlist the help of your partner or another adult and start your night earlier, such as 8 or 9 pm, and sleep in later in the morning. It is also reasonable to pump a bottle of milk a few hours before the next infant feeding, and leave the milk for your partner or another caregiver to feed the baby, while you take a 5 hour break overnight. In addition, it can be helpful to have your partner or another adult take responsibility for all nighttime activities other than feeding, such as changing diapers, soothing the baby, and bringing you water and other supplies as needed.

Months 4-6

At this point, many breastfed babies have reduced their frequency of nursing. After all they just doubled their birth weight (whew!), and their plan is to triple their weight by 1 year of age, over the next 8 months. They may breastfeed closer to every 4 hours rather than every 2-3 hours. By this time, some breastfed babies sleep longer stretches overnight. This is the point at which parents might expect that the baby will sleep all night. Remember each mother-baby pair is unique. Some babies may continue nursing frequently overnight depending on many factors. Many babies wake up because they feel unsafe and want to see a parent, especially after mom has gone back to work and the baby is in daycare. It is not uncommon for infants at this age to take smaller volumes overnight, depending on how well they fed during the day. If you are finding you need more rest, you can continue to use some of the strategies discussed above to get longer stretches of sleep at night.

Why Won’t Babies Sleep All Night?

Breastfed babies are notorious for reverse-cycle nursing at 4-5 months when their lactating parents go back to work, which means they like to nurse at night. Because some breastfed babies prefer to nurse rather receive bottles, they may take insufficient volumes via bottles at daycare, and increase their frequency of nursing in the evening and overnight. In addition, 4-5 month old babies are distracted by life! They are busybodies, wanting to know what their siblings are doing, who is walking thru the door, and what the sounds are around them. Such distractions often lead to short feeds during the day. The price of curiosity? Their hunger catches up with them at night!

After 4 months of age, babies may 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.

Babies who wake up to nurse in the middle of the night are contributing to breastfeeding success. Every time the baby breastfeeds, the lactating parent’s body produces more prolactin, which is the hormone responsible for producing milk. If the baby takes an 8-10 hour break from breastfeeding, and the parent does not pump during this time, not only might the parent’s milk production go down, but menses may come back, further lowering milk production and increasing the chances of pregnancy. Most lactating parents find that no more than a 7 hour break from nursing or pumping overnight helps to maintain their milk production.

Months 6-9

Research indicates that babies are healthiest if they begin solid food at around 6 months of age. As long as the solids incorporate protein and fats, human milk fed babies will probably sleep longer at night, with a decrease in nursing frequency. Babies should still nurse 5-6 times in 24 hours. This is where the sleep controversies come in. Is it time to expect 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 surrounding lactation and sleep 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, looking for a cozy way to get back to sleep. Before families make a decision that nighttime 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.

Nine month old babies are notorious for waking up frequently, whether breastfed or formula fed. This is a normal developmental stage, not a ‘regression’ as it seems that 9 month olds experience stranger anxiety, separation anxiety, in addition to excitement about new skills, such as pulling up to stand, crawling, and finger feeding. Babies who were good sleepers often have a period of nighttime awakening at this age, sometimes several times at night. You may find your family needs to briefly use some of those newborn strategies mentioned above to help both parents get rest. Hang in there, it does improve after a few weeks!

Months 10-12

By this point, many breastfed babies are eating a variety of food at the table with their family, in a modified form to prevent choking. They are often nursing 4 times a day or more and some infants continue to wake at night to feed. Babies still like to have the reassurance, company and warmth of nursing at night when they wake up. Many lactating parents 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, it takes time for infants and young toddlers to sleep through the night but they all will get there. Before you know it, you will be seeking advice on how to get your 13-year-old child out of bed for school each morning!

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