The Academy of Breastfeeding Medicine recently published their clinical protocol #37- ‘Physiological Infant Care- Managing Nighttime Breastfeeding in Young Infants’. The goal of this protocol is to understand normal infant feeding overnight, and the benefits/risks of unphysiological behaviors, such as sleep training or pumping and bottle feeding overnight.
The protocol recommends responsive feeding, advising at least 8 feeds at the breast every 24 hours, but no restrictions on the frequency or length of breastfeeds, as responsive feeding is associated with exclusive breastfeeding.
Breastfeeding at night is considered normal and may naturally decline after adding complementary foods at 6 months. However, some infants will breastfeed more often at night when they are away from their mothers during the day.
The protocol recommends allowing infants to set their circadian rhythm in the first few months by exposing infants to a normal daytime environment when napping, such as avoiding dark rooms or significantly reducing ambient noise.
Nighttime separation of mothers and infants can cause infant distress and elevated cortisol levels, even if the infant is not crying. In addition, nighttime separation in the first 4 months for long periods may not be safe, and may explain why close proximity of the infant with the mother at night is associated with a lower risk of sudden infant death syndrome (SIDS).
The authors of the protocol discuss challenges to physiological infant care, such as parental and societal expectations that infants should be sleeping all night by themselves in a crib, and that breastfeeding at night contributes to maternal stress and depression due to less sleep.
They discuss that strategies to improve maternal sleep at night including pumping and bottle feeding and non-breastmilk feeding increase the risk of premature weaning. These strategies don’t necessarily improve maternal sleep, since they require artificial lighting and getting out of bed, both of which are probably more disruptive of maternal sleep as compared with bedsharing and nursing throughout the night. Research has shown that breastfeeding mothers who bedshare or are in proximity with their infants at night report sleeping well and often don’t recall how often their infants nursed overnight.
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June Myers
Thank you for your helpful information! It’s always a worry to cross public health guidance as far as co-sleeping. Hopefully your protocol will lead to more people in that realm appreciate what normal looks like. There are safe ways to do everything and unsafe ways as well. I very much appreciate your work!
Aruna Sangisetty
Once milk production stabilized around 6 weeks it should be mother child adjustment about frequency and timing
Bed sharing to fulfill needs of both
Child adjusts to frequency drink more for 4 hrs than 3 hrs
mother provides according to child’s need
Chid after 4 months physiologically can sleep through night without getting hypoglycemia
Mother having set time to be able stop night feeding and sleep through night as most of them go back to work will be willing to sacrifice little more easily is practical approach
Rates of breast feeding drops around 6 weeks because of these practical issues
Giving practical guidelines thinking of mother child unit may be beneficial approach to increase breast feeding rates