Before you starting thinking about sleep training, you need to look at your child’s eating habits at night. I would strongly recommend that you stop any caloric intake as one of your first steps in getting your child to sleep through the night. Sometimes, stopping night feeds is all you need to do to get your child to sleep through the night. Here’s my guide on how to stop night feeding.
Years ago, I ordered a sleep test on an obese four year old who was waking up multiple times during the night. Since he snored, I thought it was possible that he might have obstructive sleep apnea. As it turns out, he had a different problem. The tech noted that the child was waking up every two to three hours as the mother had told me. What she had not told me was that she was giving him an 8 oz bottle of milk every time he woke up. Thus, we solved two mysteries– why he was waking up, and why he was obese.
The fact is, unless your child is an infant, he does not need to eat between bedtime and wake time. Addressing this issue can help him (and you) sleep better at night.
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Why does feeding at night result in sleep disruption?
Imagine I woke you up every night at 2 AM and gave you an ice cream sundae. One week later, I stop feeding at night. But you still would wake up hungry. This is what happens to some kids. It is unclear why this is the case. I suspect that some parents get in the habit of responding to any nocturnal awakenings with feeding. Just like you might feel sleepy after having that ice cream sundae, they go back to sleep. Over time, the pattern gets reinforced. I call this pattern learned hunger.
When can I stop feeding at night?
There are a couple of questions to consider.
- Is your child growing well? If the answer is no, your child may need those calories at night. If you are not sure how your child is growing, please talk to your pediatrician.
- How old is your child? Bottle fed infants typically can wean off night feeding by 6 months of age. Breast fed infants tend to take longer, up to a year of age. The American Academy of Pediatrics recommends exclusive breastfeeding for six months, with the addition of complementary foods continuting up to a year, or longer “as desired by mother and infant”. It’s important to note that night weaning can lead to weaning altogether. More on this below.
- Do you want to continue night nursing? Some moms, especially those who work outside of the home, value the closeness and extra time that night nursing provides. If that is the case, you don’t need to stop, provided that you are getting enough rest. If not, you may need to make a choice between getting better sleep and dealing with a dwindling milk supply.
How to stop feeding at night
There is one guiding principle here. Don’t go cold turkey. It is equivalent to asking your child to skip a meal every day. They could do it, but they would be miserable (and so would you). Instead, the plan is to make slow incremental changes over time. These changes are relatively easy to make and your child will tolerate them well.
How to stop bottle feeding at night
So, your child is over six months of age, growing well, and still feeding frequently at night. If you child drinks milk (breast, cow, goat, or otherwise) or formula, this is relatively straightforward. There are two ways to to wean this, and I have a strong preference for the first one.
- Wean one ounce a night: Let’s say your child takes three 4 oz bottles a night. You take the last bottle and reduce it by an an oz on night one. On night 2, you reduce bottle 2 by 1 oz. On night 3 you reduce Bottle #1 by 1 oz. When a bottle gets down to 2 oz, substitute a bottle of water. After this step, you get rid of the bottle. Whatever you do, don’t wake up your child if they sleep through a feeding– that is the goal. If they skip a feeding one night but wake up the following night for that feeding, it is OK to give them the scheduled bottle. Expert tip: write this schedule out beforehand. You won’t remember it in the middle of the night.
Here’s this example by by night:
Night 1: 4 oz, 4 oz, 3 oz
Night 2: 4 oz, 3 oz, 3 oz
Night 3: 3 oz, 3 oz, 3oz
Night 4: 3 oz, 3 oz, 2 oz
Night 5: 3 oz, 2 oz, 2 oz
Night 6: 2 oz, 2 oz, 2 oz
Night 7: 2 oz, 2 oz, H20
Night 8: 2 oz, H20, H20
Night 9: H20, H20, H20.
I would limit the water bottles to 2 oz, simply to reduce the amount of urine produced and wet diapers to deal with. If your child doesn’t want the water, that is fine. But don’t give in and give the milk.
- All other methods: The other ways to do this include increasing the amount of time between feeds, and reducing calories in each bottle. I don’t like the first way, because then you drag out the intervals when your child is potentially crying. I don’t like the second because a) it’s too complicated to figure out how to dilute the milk night to night b) milk + water = gross.
How to stop breastfeeding at night
This is a bit of a more complicated topic. I reached out to my friend and former colleague Dr. Sylvia Romm for more information on this topic. Sylvia is a pediatrician and the founder of Milk On Tap, a company which provides lactation support to families via the internet. Here’s what she has to say about the evolution of nocturnal feeding in infants:
- All babies are born eating every 2–4 hours, even at night
- A mother’s body only makes more milk if milk is emptied from the breast. If milk is left in the breast, the body gets the signal that it should make less milk
- Women have different capacities for milk storage (it doesn’t have anything to do with breast size). Women with larger capacities can go longer before their breasts are full, and therefore can go longer before their milk supply is affected. Women with smaller capacities have to feed more often, or their milk will go down.
- In the early weeks, breastfed babies should rarely go longer than 4 hours without eating, not only to ensure that the baby is eating enough, but also to ensure mother’s milk supply is established. Even then, most women need to breastfeed at least 8 times per day, although some women can breastfeed often during a period of time (usually during the night, called cluster feeding) and can go longer chunks of time at other times in the day without affecting their supply.
- After about 4–6 weeks, some women can start to feed their children less often, generally moving towards 6 times per day. These are usually women with a larger capacity. These women can start to find that they may be able to go longer stretches at night.
- At this age, most babies will still want to wake often at night, and so night feedings are more for the baby.
- At 2–3 months, some babies can go for longer stretches at night (by that I mean starting to break the 6 hour mark). That’s when mother’s supply can begin to be an issue. Mothers without the larger capacity report that they can never go more than 6 hours without breastfeeding, or their supply starts to go down.
- There are no studies out there that look at this topic, but from my anecdotal experience, I believe that the push to sleep train at 4 months in the US contributes to women “not making enough milk”, or saying that their “milk just dried up”. This is a common age for mothers to both report that they are encouraging their babies to sleep longer and for women to report that their milk supply is failing to keep up with their baby’s needs.
- However, that’s OK, As long as mothers realize that night weaning may lead to complete weaning at this age.
- Many mothers report that they need to do an extra pump or feed at night once their child is sleeping longer at night. If you do feed, trying a dream feed (where you don’t wake up the child but feed them anyway) can both help a child sleep longer and help mother keep up her supply.
As Sylvia points out, there is actually not much research to provide guidance with night weaning. She notes that this can be a “confusing and difficult journey for parents and baby.”
Sylvia notes are a couple of different ways to go about night weaning.
- You can shorten each night feeding session: This can be hard to do, however, as it is hard to be disciplined and watch the clock in the middle of the night.
- You can space out the feeds: If your child feeds on a pretty regular schedule, you can try to stretch out the interval between feeding. However, this is pretty hard to do if your kid is crying.
- Get Dad (or the non-nursing partner) involved: This might be the most effective method, Syliva says, “I’ve found that the most successful method is moving the child out of the bed and picking a middle of the night wake up that’s usually a feeding, but sending dad in to the kid instead. That way the baby can be comforted back to sleep, but they learn that it’s not a feeding time. Dad can’t give in, so that temptation is removed. It gets dad involved, and gives mom more sleep. Honestly, I love daddies, but usually if the baby isn’t fed, the kiddos just start sleeping through that wake up.”
Note that options 2 and 3 are going to be pretty difficult if you are bedsharing with your child. So you may want to move your child out of your bed first. (Here’s my post on how to stop cosleeping the least painful way possible).
The Take Home
Many families, especially those who are breastfeeding, may struggle with letting go of night feeds. However, when you are ready to do so, making the changes above can go a long way towards an uninterrupted night of sleep. Please share this article if you find it useful, and leave any questions you have in the comments.
The post How to Stop Night Feeds in Your Child and Sleep Better appeared first on Craig Canapari, MD.