Infant Sleep and Night Feeding Patterns During Later Infancy: Association with Breastfeeding Frequency, Daytime Complementary Food Intake, and Infant Weight

CQ #2 - July 19, 2016

by Anne Eglash MD, IBCLC, FABM

We all know that infant wake up at night, and some infants sleep better than others. By the time infants are over 6 months, parents in the United States increase their expectations for sleeping through the night. Many parents try giving their babies more solids during the day with the hope that the babies will sleep longer at night. This study sought to find whether breastfed or formula fed infants sleep longer, and whether solid food has an effect on duration of infant sleep at night.

In this study from the United Kingdom, mothers who had a term healthy infant 6-12 months of age filled out a survey with questions about duration of breastfeeding, timing of solids introduction, frequency of solid feedings, and frequency of breast or formula feedings.

They found that on average, all infants 6-12 months of age woke up an average of 1.76 times at night. Only 21.4% of infants didn’t wake up at all.

Based on the authors’ findings, what do you think is a true statement regarding day time solid meals, night time awakenings, and night time feedings?

Infants who were fed more solids during the day woke up less at night, and fed less at night.
Babies who were breastfed ate more often at night than babies who were formula fed.
Infants who were fed more solids during the day did not wake up any less at night, but fed less at night.
Babies who were breastfed woke up more often at night than babies who were formula fed.

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Correct Answers: The answer is #3 Brown A, Harries V, Breastfeed Med. 2015 Jun;10(5):246-52, May 14.

Abstract: Infant sleep is a common concern for new parents. Although many expect a newborn infant to wake frequently, encouraging a baby to sleep through the night by a few months of age is seen as both a developmental aim and a parenting success. Many new mothers believe that their infants' diet is related to their sleep; formula milk or increased levels of solid food are often given in an attempt to promote sleep. However, the impact of these in later infancy is not understood. In the current study 715 mothers with an infant 6-12 months of age reported their infants' typical night wakings and night feeds alongside any breastfeeding and frequency of solid meals. Of infants in this age range, 78.6% still regularly woke at least once a night, with 61.4% receiving one or more milk feeds. Both night wakings and night feeds decreased with age. No difference in night wakings or night feeds was found between mothers who were currently breastfeeding or formula feeding. However, infants who received more milk or solid feeds during the day were less likely to feed at night but not less likely to wake. The findings have important implications for health professionals who support new mothers with infant sleep and diet in the first year. Increasing infant calories during the day may therefore reduce the likelihood of night feeding but will not reduce the need for parents to attend to the infant in the night. Breastfeeding has no impact on infant sleep in the second 6 months postpartum.

IABLE Comment by Anne Eglash MD, IBCLC, FABM

On the top of infant sleep, I often feel an undercurrent of competitiveness among families in my practice. Parents tend to compare each other’s infant sleep pattern, to determine who are the most effective parents.

Many breastfeeding mothers tell me that they give a bottle of formula at night so that their babies sleep longer at night. Although we don’t know if this is really true during the first 6 months, this study demonstrates that giving a bottle of formula before bed to 6-12 month old infants will not decrease night time awakenings. Night time awakenings are simply normal, and do not predict ‘better’ babies or ‘smarter’ parenting. Babies under 12 months still have short sleep cycles, and are undergoing a great deal of brain development. After 6 months, they may wake up due to dreaming, teething, other forms of discomfort, and may have difficulty settling back to sleep on their own due to separation anxiety and stranger anxiety. In addition, infant have excitement about their new skills of talking, crawling, pulling up to stand, and a variety of small motor skills.

Perhaps if families know that most babies continue to wake up at night between 6-12 months, they will feel empowered and confident that their parenting styles are not the cause of their baby’s night time demands for attention. I like to tell parents that night time awakening occurs for a short time in their lives, so taking naps and getting to bed early may be the best strategies to cope during this developmental time period.

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Infant Sleep and Night Feeding Patterns During Later Infancy: Association with Breastfeeding Frequency, Daytime Complementary Food Intake, and Infant Weight

Based on the authors’ findings, what do you think is a true statement regarding day time solid meals, night time awakenings, and night time feedings?

Correct Answers: The answer is #3 Brown A, Harries V, Breastfeed Med. 2015 Jun;10(5):246-52, May 14.

IABLE Comment by Anne Eglash MD, IBCLC, FABM

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