Do Older Babies Need Night Feedings?

Has somebody told you that your baby doesn’t need to breastfeed at night past a certain age?  This age often varies by advisor. However, science tells us that in many cases, this simply isn’t true.

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Why? Babies and mothers are different and these differences affect baby’s need for night feedings. Some babies really do need to breastfeed at night, at six months, eight months, and beyond.  This is in part because if their mother has a small “breast storage capacity” and tries to sleep train her baby, her milk production will slow, along with her baby’s growth. To find out what this means and if this applies to you, you need to know the basics of how milk production works.

Degree of Breast Fullness

Two basic dynamics are major influencers of milk production. The first, “degree of breast fullness,” refers to a simple concept: Drained breasts make milk faster and full breasts make milk slower. Whenever your breasts contain enough milk to feel full, your milk production slows.1 The fuller your breasts become, the stronger the signal your body receives to slow milk production.

Breast Storage Capacity

This second basic dynamic refers to a physical characteristic known as breast storage capacity, which varies among mothers.2 This physical difference explains why feeding patterns can vary so much among mothers and why one breastfed baby does not need to breastfeed at night while another one does.

Breast storage capacity is the amount of milk your breasts contain in your milk-making glands at their fullest point of the day. Storage capacity is not related to breast size, which varies mainly by how much fatty tissue is in your breasts. In other words, smaller-breasted mothers can have a large storage capacity and larger-breasted mothers can have a small capacity.

Both large-capacity and small-capacity mothers produce plenty of milk for their babies. But their babies feed differently to get the daily volume of milk they need.3 After baby’s first month, a mother with a large storage capacity may notice that her baby:

  • Is satisfied with one breast at most or all feedings.
  • Is finished breastfeeding much sooner than other babies (sometimes just five minutes).
  • Gains weight well on fewer feedings per day than the average eight or so.
  • Sleeps for longer-than-average stretches at night.

If this describes your breastfeeding experience, your baby may already be sleeping for longer stretches at night than other babies you know. But if after the first month of life your baby often takes both breasts at feedings, feeds on average longer than about 15 to 20 minutes total, typically takes eight or more feedings per day, and wakes at least twice a night to breastfeed, your breast storage capacity is likely to be small or average. 

Again, what’s important to a baby’s healthy growth is not how much milk he receives at each feeding, but rather how much milk he consumes in a 24-hour day. Breastfed babies of both large- and small-capacity mothers receive plenty of milk, but their breastfeeding patterns will necessarily differ to gain weight and thrive.4 For example, a baby whose mother’s breasts hold six ounces or more (180 mL) may grow well with as few as five feedings per day.  But to get this same 30 ounces (900 mL) of milk, if a mother’s breasts hold only three ounces (90 mL), a baby with a small-capacity mother will need to feed ten times each day.  (This may not apply in the same way to a mother who’s pumping.)

How These Dynamics Affect Night Feedings

How does this apply to night feedings? A mother with a large storage capacity has the room in her milk-making glands to comfortably store more milk at night before it exerts the amount of internal pressure needed to slow her milk production. On the other hand, if the baby of the small-capacity mother sleeps for too long at night, her breasts become so full that her milk production slows.

In other words, if you are a mother with an average or small breast storage capacity, night feedings may need to continue for many months in order for your milk production to stay stable and for your baby to thrive. Also, because your baby has access to less milk at each feeding, night feedings may be crucial for him to get enough milk overall. Again, what’s important is not how much milk a baby receives at each individual feeding, but how much milk he consumes in a 24-hour day. If a mother with a small storage capacity uses sleep training strategies to force her baby to go for longer stretches between feedings, this may slow her milk production and compromise her baby’s weight gain.

Each mother-baby pair is unique. Babies will outgrow the need for night nursings at different ages, so a simple rule of thumb doesn’t consider either the emotional needs of the baby or his physical need for milk.

References

1Daly, S. E., Kent, J. C., Owens, R. A., & Hartmann, P. E. (1996). Frequency and degree of milk removal and the short-term control of human milk synthesis, Experimental Physiology, 81(5), 861-875.

2Cregan, M. D., & Hartmann, P. E. (1999). Computerized breast measurement from conception to weaning: clinical implications. J Hum Lact, 15(2), 89-96.

3Kent, J. C., Mitoulas, L. R., Cregan, M. D., Ramsay, D. T., Doherty, D. A., & Hartmann, P. E. (2006). Volume and frequency of breastfeedings and fat content of breast milk throughout the day, Pediatrics, 117(3), e387-395.

4Kent, J. C. (2007). How breastfeeding works. Journal of Midwifery & Women's Health, 52(6), 564-570.

Unintended Consequences

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What’s a breastfeeding mother to do?  Is it riskier to bedshare with her baby during the night or is it riskier not to?  That’s what a survey of 4789 U.S. mothers with babies under one year clarified.1

In the U.S. parents are admonished never to sleep with their babies.2 The Milwaukee, Wisconsin health department, for example, uses the image of an adult headboard transformed into a tombstone as a warning about the dangers of bedsharing. (Click here for a video on this campaign.) 

Bedsharing appears even more dangerous when—as often happens in the U.S.—infant deaths are blamed on it even when other more hazardous practices are present, such as adult alcohol intoxication and drug use and when the “bed” is actually a recliner, chair or sofa.  One Scottish study, for example, found that the risk of an infant dying was nearly 67 times higher on a sofa compared to an adult bed.3

According to the U.S. mothers surveyed, despite their awareness of these public campaigns, nearly 60% of their babies shared their beds for at least part of the night.  Among the mothers who attempted to follow the recommendations against bedsharing, 55% fed their babies at night in chairs, recliners, or sofas and 44% of these (25% of the total) reported falling asleep some of the time in these much more dangerous places.  In other words, their attempts to “follow the rules” often led to the unintended consequence of much riskier behaviors.

The authors of this survey concluded that safe-sleep campaigns should include information on safe bedsharing, because when this information is absent, parents will continue to bedshare in unsafe ways.  The Japanese experience confirms this.  As bedsharing as has become more common in Japan (it is now the cultural norm), rates of SIDS have decreased. 4What’s different there is that Japanese families bedshare safely.  Families sleep together on futons on the floor away from walls, so babies cannot fall far or get trapped.  Fluffy pillows and bedclothes are not used. 

To save more lives, U.S. safe-sleep campaigns should consider taking a page from the Japanese playbook.  By emphasizing how to create a safe sleeping environment—rather than trying to browbeat parents into avoiding bedsharing—more babies’ lives would be spared.  And as an extra plus, more families would also get a better night’s sleep.

For a brochure for parents on safe sleep, click here.

References

1Kendall-Tackett, K., Cong, Z., and Hale, T.W.  Mother-infant sleep locations and nighttime feeding behavior.  Clin Lact 2010; 1(1):27-30.

2American Academy of Pediatrics, Task Force on SIDS.  The changing concept of sudden infant death syndrome: Diagnostic coding shifts, controversies regarding the sleeping environment, and new variables to consider in reducing risk.  Pediatrics 2005; 116:1245-55.

3Tappin, D. et al.  Bedsharing, roomsharing, and sudden infant death syndrome in Scotland: A case-control study.  J Pediatr 2005; 147:32-37.

4McKenna, J., Ball, H., and Gettler, L.T.  Mother-infant cosleeping, breastfeeding and sudden infant death syndrome: What biological anthropology has discovered about normal infant sleep and pediatric sleep medicine.  Amer J Phys Anthropol, Suppl 2007; 45:133-61.

For More Sleep, Breastfeed

Fatigue is a fact of life for new parents no matter how their newborn is fed.  When sleep is at a premium, they may consider their alternatives.  If a new mother's partner takes over some night feedings, will she get more sleep?  Will giving formula at night make baby sleep longer?  According to research, neither of these strategies produces the desired results.  One U.S. study of 133 new mothers and fathers during the first three months postpartum found that mothers who exclusively breastfed averaged 40 to 45 minutes more sleep at night than those whose babies also received infant formula.  Why didn’t sharing night feedings help mothers sleep more?  Because the mothers’ sleep was significantly disrupted while the baby’s father fed the baby.  The researchers wrote:

“…formula feeding not only failed to improve parent sleep, but actually resulted in parents getting less sleep, even when fathers helped during the night with…feedings” (Doan, Gay & Lee, 2007, p. 204).

Exclusive breastfeeding leads to more sleep, and it also leads to better sleep.  Compared with women without children and formula-feeding mothers with babies the same age, Australian research found that breastfeeding mothers spent more time in deep sleep (Blyton, Sullivan, & Edwards, 2002).  The exclusively breastfeeding mothers had “a marked alteration in their sleep architecture,” giving them longer periods of slow-wave sleep, a type of deep sleep.  The researchers concluded that “enhanced SWS may be another important factor to support breastfeeding in the postnatal period” (Blyton et al., 2002, p. 297).

 

References

Blyton, D. M., Sullivan, C. E., & Edwards, N. (2002). Lactation is associated with an increase in slow-wave sleep in women. Journal of Sleep Research, 11(4), 297-303.

Doan, T., Gardiner, A., Gay, C. L., & Lee, K. A. (2007). Breast-feeding increases sleep duration of new parents. J Perinat Neonatal Nurs, 21(3), 200-206.