by Alissa Pemberton
BSc (Midwifery), International Board Certified Lactation Consultant & Holistic Sleep Coach
All parents question whether they're doing the right thing by their child, and whether their child is doing the 'right' thing - especially when it comes to sleep.
As breastfeeding parents, I've always felt this experience is only heightened because so much of what's 'normal' completely contradicts instinctive breastfeeding behaviours, and we're constantly inundated with pressures from those around us blaming breastfeeding for our struggles. Don't you just sometimes want to be able to complain that you're tired and for someone to empathise with you - not remind you that it's probably because
So why is night waking so important? In the early months after birth - night waking is essential for a) ensuring baby is able to take in sufficient milk on a regular basis and b) to establish and maintain your milk supply. Breastmilk is very quickly and easily digested so babies need regular feeds every few hours to ensure that their blood sugar levels remain stable. As their stomachs expand and they can take larger volumes (up until around 1 month of age, when volume intake over the day stops increasing, but nutrient quantity in the milk changes to meet demand)
they begin to be able to go longer stretches in between feeds. This combined with more efficient feeding will usually result in a feeding pattern of more like 3-4 hourly, rather than the often 1-2 hourly feeding of a newborn in the first week or two. Breastmilk also in fact contains more calories on average per ounce than formula milk and higher fat content, so giving formula to fill a baby up and help them sleep longer is not necessarily actually giving them anything more (and may result in unwanted side effects like constipation). Breastmilk is rapidly digested in around 1.5-2 hours, vs 4 hours or more for formula milk due to the change in composition and the human body having the exact enz
ymes to digest elements in breastmilk vs formula. This contributes to more frequent normal waking patterns in breastfed newborns. Whilst it may not be the story which our society portrays, breastfed infants are actually digesting at a normal rate, and formula fed infants are taking longer because they do not have the correct enzymes to easily digest the proteins in milk from another species.
Breastmilk is also designed to put your baby to sleep - so there's nothing abnormal about a baby or toddler who won't fall asleep on their own, they're in fact responding to
exactly the way nature designed it. Breastmilk contains tryptophan, an amino acid which the body uses to produce melatonin. This helps not only for your baby to develop their circadian rhythm (the delicate balance between hormones melatonin and cortisol which helps us to sleep and wake at regular times each day, and distinguish day from night) but also actively helps them to fall asleep in the evening and overnight. The act of breastfeeding also releases oxytocin for mother and baby which helps to calm spikes in adrenaline and relax your baby ready to fall asleep. One study showed that parents who breastfed overnight actually got around 45 minutes more sleep per night than those who formula fed, and reported less sleep disturbance and their formula feeding counterparts.
Frequent breastfeeding is also a protective mechanism against SIDS (Sudden Infant Death Syndrome) - Dr James McKenna has done extensive research into breastfeeding, sleep and SIDS and we've seen across multiple studies that not only does breastmilk help to prevent against many childhood illnesses, and reduce the risk of SIDS but the frequent act of breastfeeding through the night and the fact that these infants generally are in lighter sleep than infants who are solely formula fed is also thought to be a protective factor.
Breastfeeding is often oversimplified to JUST be about food How many times have we as breastfeeding parents heard the phrase - 'Surely they don't NEED breastmilk anymore?'. Now that's about as logical as saying that once you hit the age of 40 brocolli and spinach are no longer nutritious. Your child needs breastmilk for as long as you and your child continue to breastfeed. It will always be nutritious and beneficial for them. But there are many more reasons for which breastfeeding becomes linked with sleep and night waking, which have nothing to do with food. Breastfeeding is a method of coregulating. This is especially important with toddlers, who still lack the ability to truly regulate their emotions (this part of our brain continues to develop until we're around 21 years old!). As they get older night waking often becomes much less about food and more about emotional needs, disregulation, non established sleep patterns and yes sometimes habit. Breastfeeding is also a powerful way of reconnecting with mum, and more frequent night feeds are common in babies/toddlers around times when their mum may return to work or they start being away from mum for longer periods of time. This pattern of reverse cycling is a normal response to the increased emotional need and also compensating for milk intake not obtained during the period of time away from mum.
An emotional need is just as valid a reason to wake overnight as a physical one.
So when are babies actually capable of sleeping longer, even when they're breastfeeding?
Here's where the conflicting information for parents comes out. There have been many studies looking at what's 'normal' for babies - but it's important to remember that no health professional or well meaning friend or relative can tell you what's normal for yours. They are not the ones there with you throughout the night who know your child best.
It's also important to remember that the sleep industry is very poorly regulated, and many so called 'sleep professionals' even a vast majority of the household names who have written bestselling books have not had specific training in infant feeding or sleep, and do not always base their recommendations on research. One study of 640 by Sadler showed that only 16% of babies were sleeping through the night at six months, and the majority did not consolidate sleeping through the night regularly until 12 months and beyond.
"Over half of babies between 9-12 months will wake at least once in the night, and approx 30% of 18 month olds will still wake at
least once during the night"
So I know it's normal, but for me - it's just unsustainable right now... "Every baby who falls asleep breastfeeding or wakes frequently through the night will eventually stop falling asleep breastfeeding and stop waking frequently through the night"
A lot of parents ask me - if I do nothing, will they eventually sleep? Yes! I often say this to parents to reassure them that not only is it normal for your baby or toddler to want the breast to fall asleep, but they won't always want it. Now it might be that after a year or two years of this YOU are ready to make a change, and that's completely fine, but the reality is that if you're not, or you don't have the energy or capacity to make a change, that they will eventually stop on their own.
So where's the line between breastfeeding being normal and becoming a habit?
There isn't any credible research to support when a baby might 'transition' from normal patterns of feeding to sleep to this becoming a habit for them, but like with anything, if things are always done in the same way each time they begin to form habits. We know that babies under the age of around 3-6 months are incapable of forming habits, good, bad or otherwise. It's also important to remember that many babies will breastfeed and sleep longer stretches naturally and this is perfectly fine - breastfeeding and poor sleep do not go hand in hand. Many parents worry that the older their child gets the harder it will be to wean or to move away from breastfeeding to sleep. In my experience there is an optimum window for this - beginning to introduce other ways of falling asleep, or introducing another caregiver prior to 6 months or beyond 12 months tends to be the easiest and most successful for parents. The window between 6-12 months is a period of rapid developmental change, physical milestones, disruptions like teething or starting nursery in many countries, as well as babies going through a natural stage of separation anxiety all of which have an impact on sleep.
At any point however - we can work gradually with your child to change that habit. Here's a top tip -
If your baby or toddler is currently reliant on breastfeeding to sleep (firstly don't feel any need to change if it's working for you!) you can gradually help support them to develop other ways to fall asleep or resettle overnight in addition to breastfeeding by habit stacking. Habit stacking involves introducing other sleep cues, triggers and comfort measures AS WELL AS breastfeeding, rather than taking away the thing they are most reliant on (likely to result in tears for everyone, and completely unescessary). Begin next time you're feeding your child off to sleep, you can start this from newborn or at any age. Rather than JUST feeding them off to sleep, introduce 4-5 other sleep triggers, all of which are sustainable for someone else to continue if there isn't a boob on offer. These might include:
Auditory triggers: like white noise (or pink noise for babies over six months), a bedtime song (this is a favourite of mine, pick any song you enjoy and know the words to and sing on repeat while your child is feeding off to sleep) Sensory triggers: this could include a comforter (remove once your child is asleep for little ones under 12 months), a sleeping bag (or swaddle for newborns), deep pressure touch or massage
Physical triggers: these could be stroking their head or back, patting their bottom, massaging their leg.
All of these triggers are easy to be replicated by your partner or another caregiver to help settle them to sleep if you're not available, or need a break. Introducing these new sleep triggers whilst continuing with the one they were previously reliant on (feeding to sleep) is a great well to help support them gently towards more independent sleep whilst also acknowledging their physical and emotional need for night feeding. You can use this habit stacking at nap time, bedtime and during overnight wakes.