You might choose to breastfeed or bottle-feed your baby while sleeping in a bid to influence his nighttime feeding pattern, or perhaps because its now the only way he will feed without dispute. If sleep feeding your baby is something you plan to try, or would like to change, this article may help you decide the next step to take.
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What is sleep feeding?
Sleep feeding, sometimes called dream feeding, occurs when a baby feeds while drowsy or asleep. Baby might be awake at the start, then fall asleep while feeding and continue eating during light sleep. Or a feed might be provided when baby is already in a drowsy state, while sleeping, or as he begins to arouse from sleep.
Sleep feeding can be baby led – something baby does in response to an underlying feeding or sleeping problem. Or Parent led – something a parent initiates in an attempt to resolve an infant feeding or sleeping problem.
Reasons some babies prefer sleep feeds
Feeding your baby in a drowsy or sleepy state might not be something you choose to do, rather it could be something you feel compelled to do if he rejects feeds when awake, does not eat enough when feeding while awake, or because he appears to favor feeding in a sleepy state.
Your baby could partially sleep feed. Perhaps he takes some milk awake, then falls asleep while feeding and finishes the rest, or you might wait until he’s asleep before offering the remainder of his feed. Alternatively, your baby might exclusively feed during sleep.
Some reasons babies appear to prefer sleep feeding include:
1. Sleepy newborns
The time and effort to feed consumes a great deal of energy for a newborn. Newborn babies characteristically begin feeding in an alert state, become drowsy once their initial hunger is satisfied but continue sucking during light sleep, stopping only once deeply asleep or when the bottle is drained.
Most newborns have a strong desire to suck at times in addition to feeding. They particularly enjoy sucking when tired. Newborns have an active sucking reflex, which means they are likely to feed, awake or during light sleep, whenever a feed is offered.
2. Feeding-sleep association
When a baby repeatedly falls asleep while feeding, feeding can become a sleep association (something he psychologically links with the act of falling asleep). A feeding-sleep association means a baby will seek to feed (by rooting, sucking his fist, fussing or crying) whenever he is tired and ready to sleep, irrespective of whether he’s hungry at the time or not, because past experiences have taught him that this is how he goes to sleep. Reliance on feeding as a sleep association increases the risk of broken sleep. (See Sleep Associations for explanation). So baby’s naps may be cut short causing him to awaken still tired. As a result, he tolerates only short periods awake before tiring and then starts crying to be fed to sleep once again. If a feed is denied, he becomes progressively more distressed. If a feed is provided, he quickly falls asleep. When fed on demand, a baby who has developed a feeding-sleep association that causes broken sleep will appear to want to feed frequently, perhaps more often than expected, and feed mostly in a sleepy state. If his nutritional needs are met during sleep feeds, this eliminates the need to feed while awake, and it becomes increasingly more likely he will feed solely in a sleepy state out of habit.
3. Behavioral feeding aversion
Pressure applied in an attempt to compel a baby to feed or continue feeding when he doesn’t want to, makes feeding an annoying, unpleasant or stressful experience for baby (and parents). When repeated time and time again, pressure to feed can cause a baby to develop a behavioral feeding aversion. Sleep feeding is a situation that commonly evolves when a baby has developed a behavioral feeding aversion due to pressure.
When averse to feeding, baby becomes distressed and refuses to feed either as soon as he realizes he’s going to be fed or after consuming a small amount (typically, a similar amount each time). However, when drowsy or asleep, and therefore less aware, he lets down his guard, sucking instincts kick in and he feeds well with minimal resistance. After discovering that baby feeds without objection in a sleepy state, many parents choose to wait until their baby is drowsy or lightly asleep before attempting to feed him. That way they can avoid feeding battles. Over time the balance between awake and sleep feeds can shift towards baby being solely fed drowsy or while sleeping.
Due to advancements in brain development, babies become progressively more aware of their surroundings during light sleep as they mature. Around 5 months of age, it generally becomes increasing more difficult to sleep feed a baby who has become averse to feeding while awake. If baby senses he’s being fed while sleeping, he will either resist or stop feeding, and if the parent persists he will wake and vigorously reject the feed. When sleep feeding fails, parents may find they have no means to ensure their baby receives sufficient quantities of milk and as a consequence baby’s weight falters. (See Feeding Aversion for more.)
The 3 problems described above can occur in isolation, or they can be connected. A sleepy newborn is susceptible to developing a feeding-sleep association if parents don’t take active steps to prevent this from occurring. As a result of a feeding-sleep association, over time baby may develop a habit of feeding in a drowsy or sleepy state. Frustration over the fact that baby rejects feeds while awake can cause a parent to try to gently pressure their baby to feed. If pressured to feed, this can cause a baby to develop an aversion to feeding, adding another layer of complexity to this problem. This situation can occur if baby is breastfed or bottle-fed.
Health professionals in general are unaware of the behavioral reasons why this common feeding problem develops. They are therefore unable to advise parents on how to encourage their baby to return to willingly feeding while awake. But we can! Baby Care Advice professionals have extensive experience in supporting parents to resolve these and other types of feeding problems. Book a consultation to find out how.
Fact or fiction?
Babies who suffer from acid reflux prefer to sleep feed.
FALSE: When a baby displays distressed behavior during feeds, this is commonly attributed to pain associated with acid reflux. [As is most other problematic behavior displayed by healthy babies when the reason is unclear.] Sleep does not prevent a baby from feeling pain. If pain is the reason for a baby’s distress at feed times when awake, pain would cause baby to awaken and display distressed behavior when sleep feeds are attempted. Pain associated with the burning effects of acid reflux is not exclusive to awake feeds, and it does not suddenly disappear simply because the feed has stopped. A baby experiencing pain during feeds will scream long after feeding has ceased. (See Reflux for more.)
A behavioral feeding aversion is far more likely to be the reason for a baby to display aversive or distressed feeding behavior while awake and yet feed well during sleep. In the case of a behavioral feeding aversion, baby’s distress ends soon after parents stop trying to feed their baby, and he feeds well during sleep because he’s unaware that he’s being fed and therefore does not resist.
Problems associated with sleep feeding
Most newborn babies will occasionally or often sleep-feed without any obvious complication. However, regardless of whether it is something that is initiated by a parent or baby, there are potential problems linked with sleep feeding.
- Sleep deprivation: A feeding-sleep association can result in broken sleep, which could then cause infant distress due to sleep deprivation.
- Underfeeding: A chronically sleep-deprived baby might fall asleep before completing the feed. A rigid feeding schedule in this case could result in underfeeding.
- Overfeeding: Newborns babies are susceptible to overfeeding because they have an active sucking reflex. Offering feeds that are not demanded could create or add to an overfeeding problem. [The GI symptoms associated with overfeeding are commonly mistakenly blamed on reflux, milk allergy or intolerance. See Lactose Overload for more.]
- Tooth decay: The frequency of swallowing decreases during sleep compared to awake. Milk can pool in baby’s mouth providing food for bacteria that cause tooth decay to flourish.
- Aspiration: Feeding in a sleepy state increases the risk that a baby might choke or inhale milk into his lungs.
- Respiratory infections: Studies show that babies who sleep feed are at increased risk of developing respiratory infections.
- Financial strain: The search for a solution that will encourage baby to return to feeding while awake can be an expensive one. The first thing that parents usually try is switching formula, often multiple times. Then different nipples and bottles. When this fails, as it generally does for this type of problem, most parents will then seek medical advice. Typically babies who display aversive behavior when awake are diagnosed with acid reflux. [A diagnosis of acid reflux mostly occurs because medicos in general are unfamiliar with the management of problems such as a feeding-sleep association, feeding aversion, overfeeding and other behavioral problems commonly affecting physically well babies. See Why Others Fail.] So baby is prescribed medications, in some cases multiple medications, which may be switched many times. If medications fail to improve the situation, which they will if the source of the problem is behavioral, next baby may be diagnosed with suspected milk allergy or intolerance and switched to a hypoallergenic formula. If that doesn’t help, baby may be referred to one or more medical specialists, a dietician, speech or occupational therapist, and possibly undergo a series of diagnostic tests. [No amount of medication or dietary change will make a difference if the source of baby’s troubles is behavioral and not physical.]
- Parental stress: When a baby will only feed in a sleepy state, ensuring he gets enough to eat dominates family life. Feeds need to be timed precisely to when baby has just fallen asleep or when he’s stirring awake. Because babies can be in light sleep for a short period of time, the amount of milk taken at each feed may be small, which means baby requires feeding more often than average for age. Most parents feel they’re housebound because they don’t want to miss a feeding opportunity by going out with baby. Parents might choose to sleep feed baby multiple times during the night in a bid to increase his total daily milk intake. The stress associated with hours trying to ensure baby gets enough to eat, exhaustion from providing multiple night feeds, numerous health visits and the associated financial strain, can take a significant toll on parents’ physical and emotional health.
Reasons parents offer dream feeds
You might choose to sleep feed your baby in the late evening for one of the following reasons.
1. Change baby’s nighttime feeding pattern
Some babies will have their longest block of continued sleep in the first half of the night and wake in the early hours of the morning to feed. Dream feeding your baby before you go to bed could potentially encourage him to have his longest block sleep from that point onwards, thereby increasing your hours of uninterrupted sleep.
2. Reduce the chance of baby waking at night
In general, babies under the age of 6 months require one or more feeds during the night. Providing your baby with a feed while asleep, before he wakes to demand one, may enable him to continue sleeping. The benefit is you don’t need to settle him back to sleep.
3. Increase baby’s milk intake
Providing a sleep feed or two at night might increase your baby’s total daily milk intake.
How to dream feed
A dream feed is the feed that you give baby before you go to bed. Aim for the feed to be between 10pm and 11pm, but allow 2.5 to 4 hours to go by since your baby's last feed.
- Keep lights low. Avoid talking or loud noise.
- If breastfeeding, gently take your sleeping baby into your arms.
- Dream feed a bottle-fed baby in his crib. Prop him on a pillow so that he feeds in a semi-reclined position. Remove the pillow and lay him flat once he has finished feeding. [Never leave your baby to feed unsupervised or leave a pillow in the crib with a baby.]
- Without waking him gently rub your nipple or the nipple of the bottle across his lips. If he doesn’t react, try to gently open his mouth and insert the nipple.
- Burping is usually not necessary because babies generally swallow very little air while sleep feeding. If you feel your baby needs burping, try sitting him in an upright position. Rub his back rather than pat. If he has not burped within 2 minutes, give up.
- If you have picked your baby up, return him to bed while he’s still sleeping. If he begins to awaken at any time, try making a shushing sound to soothe him back to sleep.
- Only change his diaper if its heavily wet or soiled.
Automatic, rhythmical sucking and swallowing is strong during light sleep but decreases as sleep deepens. With a dream feed, your baby may have already been sleeping for a number of hours, and its possible that he could be deeply asleep. If he’s not sucking, you may need to arouse him slightly by stroking his cheek, chest, a hand or foot. If you’re not able to arouse him enough so that he feeds, try a different time tomorrow night.
If you’re already sleep feeding your baby during the day, perhaps because it’s the way he feeds best, you have probably already figured out that feeding him during light sleep (i.e. when drowsy, or shortly after he has fallen asleep, or when he is arousing from a nap) works best.
Disadvantages of dream feeding
Many parents swear that a late evening sleep feed (dream feed) promotes better sleep for their baby and therefore better sleep for themselves. However, others find feeding their baby during sleep does not provide the benefits they hoped for. And in some cases, it has unintended and unwanted consequences; for example:
- Baby doesn’t suck: Babies tend to spend longer periods of time in deep sleep during the first half of the night. If your baby is deeply asleep when you attempt to sleep feed him, there’s a good chance he’s not going to suck. Also the ability to feed while sleeping decreases as a baby gets older.
- Baby still wakes at the same time: There’s no guarantee that a dream feed will help your baby to remain asleep for the period you hope he will. For many babies dream feeding makes no difference to their nighttime sleeping pattern. They continue to wake at the same time regardless of whether they receive a dream feed or not. [Hunger is not the only reason that babies wake during the night. The presence or absence of familiar sleep associations has a strong influence over a baby’s ability to fall asleep and remain asleep, more so the older, and thus more aware, baby becomes.]
- Destabilize baby’s internal body clock: If your baby is not waking to demand a feed around the time you dream feed him, then how do you know he actually needs feeding at that time? The older your baby becomes the more likely it is that sleep feeding will hinder the natural progression of his circadian rhythms (24-hour internal body clock). Sleep feeding can disrupt a baby’s natural sleep-wake patterns causing him to wake more often during the night. It also has the potential to provide more milk than a baby needs to consume during the night, and by doing so decrease his appetite and desire to eat the next morning.
- You might lose sleep: Without achieving the benefits you hoped for, sleep feeding could mean you are needlessly sacrificing some of your sleep by staying up late or getting up at a set time to provide your baby with a feed that he may not need.
Disadvantages also include the potential problems associated with sleep feeding listed above.
Written by Rowena Bennett
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How we can help!
When sleep feeding is parent led, it may be easy enough to stop. Where we can help is to provide advice on ways to resolve the problem that prompted you to choose to sleep feed your baby in the first place.
When sleep-feeding is baby led, its seldom a matter of simply no longer feeding baby while asleep as baby is likely to continue to reject feeds while awake. In this situation, the underlying problem that steered baby towards sleep feeding must be addressed before he/she will willingly feed while awake. A consultation with one of our experienced health professionals can help pinpoint the cause and provide an effective plan to resolve the problem.