Increased Night Nursing in an Older Baby

Mothering an infant is exhausting.  I don’t even want to say it “can” be exhausting.  I think it just is pretty universally.  New babies need a lot of care and attention. At some point in recent human history, someone seems to have gotten the idea that mothering babies shouldn’t be this way.  Part of the theory became that babies are some sort of automatons that can and should be fed and changed when necessary, but otherwise shouldn’t and don’t need to interact with the world continually.  Someone got this idea, and told parents that touching, playing with, and even feeding their babies regularly was bad or harmful.  Some have promoted the idea that a baby shouldn’t disrupt your “normal” life, as if mothering isn’t the most important job in the world.  The proposed solution here is to force the infant to become regulated (or scheduled, or trained) to match the needs of the parent.  There are social reasons why this kind of idea could gain traction in the 20th century, even if it went against nature and didn’t really work that well.

One of the areas of care that parents were most encouraged to try to regulate is infant feeding.  Part of the advice was to keep infant feeding on a schedule and to try to eliminate night feeding as early as possible.  The legacy to this day is an obsession with this idea of eliminating night feeding.  The very question that we all ask each other continually  about how a new baby sleeps is really a question as to whether night feeding has been eliminated or not.  Babies who wake in the night are usually fed, and then they go back to sleep (and so can you).  So if you think about it, the question of sleeping through the night is really not a sleep regulation question, even if we frame it this way with all sorts of sleep training advice.  It’s a nighttime hunger and feeding question.

Very new babies physically need to eat very frequently.  In the first couple of days and weeks, a baby’s stomach is actually really small.  When a baby is born, her stomach can only hold 5-7ml of milk.  That’s less than two teaspoons.  (So if you’re getting advice to give supplement your newborn with 5ml, especially before feedings, you’re going to fill the baby up entirely on formula.)   This is why just little amounts of colostrum in the first few days given every hour or two is all that’s needed for a newborn.  By about 10 days of age, a baby’s stomach can hold about the volume of a chicken egg, and it stays about there for quite some time.  Your stomach holds the volume of a softball.  When considering the frequency of feeding babies, consider yourself.  How often do you put something in your mouth, including little bites of food and sips of water?  It’s probably every 90 minutes or so all day, and you may get up for a drink in the 6-8 hours most American adults put themselves to bed at night.  You, as an adult, also produce a hormone while you’re sleeping that slows down how fast your kidneys take water out of your system.  You don’t pee as often at night as you do during the day for this reason.  People don’t start making this anti-diuretic hormone on a cycle that controls nighttime urine production until 2-6 years of age.  So babies pee out their fluids all night, and get thirsty as a result.   Why should babies, with their tiny stomachs and round the clock elimination, be expected to eat and drink less frequently during the day than adults do in the daytime, and not be expected to also require fluid replacement frequently at night?  The answers are not so much to found found in the annals of “crunchy” parenting.  There are sound biological reasons for infant night waking.

So maybe we can expect newborns to need to wake up every 2-4 hours at night, but what about older babies, say 4-6 months of age.  Them, too.  At this age, infants should still be on an entirely liquid diet.  The liquids they take, formula or breastmilk, are not very nutritionally dense.  Both have about 22 calories per ounce.  Formula is digested more slowly, so a formula fed baby may feel satisfied longer than a breastfed baby, but both will probably get hungry or thirsty at least once or twice in an 8 hour night.  Dr. Sears seems to think that babies who are deliberately not fed at night gain weight slower, but he doesn’t give a study to back it up.  I would think this is actually true because night feeding typically makes up about 20% of an infant’s daily caloric intake.  Cutting that night feeding out would cut out the opportunity to have at least some of those calories.

With all this, some parents are still distressed when their 4-6 month old babies continue to or even ramp up their wakings for food at night.  Rightly so.  It’s exhausting to get up and feed babies.  But what’s going on that a baby this age should still be waking at night, and should it be discouraged?

At 4-6 months of age, babies’ bodies are are getting big enough and ready to start eating a non-liquid diet.  They’re not necessarily ready to eat solids, but they’re working on it.  They’re moving around more and growing, and need more calories.  At this time, they also develop the ability to feed themselves.  Everything is getting ready for the next stage of their development; starting solid foods.  But not quite yet.  It’s not an on/off switch.  4 months is really too early to start a baby on solids.  They build up to it, and for many babies, night waking and feeding actually increases in frequency between 4 and 6 months.  But should anything be done about it?

Yes.  Feed the baby more often, and not less.  I know. You’re already going crazy with no sleep at night trying to feed your 4 month old who won’t get off the boob and night.  What do you do?

First of all, if you can plan way ahead, get a longer maternity leave or adjust your family budget to stay home until your baby is 6-12 months of age so you don’t have the pressure of getting to a job after meeting the needs of your baby during the temporary and normal developmental stage.  I know that is WAY not possible for most people.  If that’s you, start writing campaigns and supporting organizations to get 6-12 months of paid maternity leave to be a paid entitlement in this country.  Yes, a paid entitlement.  Let new moms collect social security at a mother’s pension for 6-12 months after the birth of a baby if they choose to stay home that long.   Forcing employers to pay it won’t work because loopholes will be created in the law that will make it so no woman of childbearing ago will be employed as a full time employee of any company that isn’t huge.  We’ll be put on the books as whatever class of employee, like a contractor or a 37.5 hour a week “part time” employee, that the loopholes in the law allow to keep us from receiving the benefit.  We need to prioritize the most important, and unpaid, job in the country – raising small children to be healthy.  That takes their mothers being available to them.

Second, if you’re already in it.  Try to cluster feed before bed.  Try to get the baby to load up on feedings in the evening hours.  Many babies automatically do this.  You can encourage it.  Another thing you can do is to pump and get someone else, like Dad, to take some of the night feedings.  If you’re already pumping during the day because you’re working, try breast massage and compressions during pumping to express more milk.  Also try to get in an extra pumping outside of the work hours, perhaps right in the morning.  This could get you and extra bottle that dad can give the baby at night.  Another strategy at this age for minimizing how night feeding affects your sleep is to practice safe cosleeping or bedsharing.  Many moms who safely bedshare report that they allow their babies to simply nurse as they want overnight and are not awakened to the point that is interrupt sleep to initiate breastfeeding.  If you’re interested in reading more about this, I recommend Dr. James McKenna’s research at Notre Dame.

Lastly, and this may sounds obvious, make sure when you guys do wake up that the baby knows that even if you’re up to eat, it’s still night time.  Babies 4-6 months of age are really interested in the world around them, and it could be easy to tell the baby that middle of the night feeding time is also a great middle of the night exclusive play-with-mommy-time.  This especially happens to moms who go back to work around this time.  You might find that you’re baby figures out that night time is fun time when you’re home and starts trying to flip days and nights, turning into a night owl and party animal.  Don’t give mixed signals.  Keep the lights off.  Don’t play or turn on the TV.  Also, if this is going on, ask her daytime caretaker to try not to let her sleep as much during the day so that she can sleep at night.  Babies aren’t dumb.  You’re your baby’s favorite person.  She might figure out that staying up nursing at night is the way to get more quality time with you, but it’s not great for your relationship in the long run.  Try to keep night time for sleeping.

Finally, there’s always a lot of bad advice out there that’s just not evidence based, but based on anecdote, “it worked for so-and so,” or “traditional” wisdom.  Not everyone agrees, but I prefer to make my decisions based as much on evidence as I can.  Many people will tell you that a little cereal will help your baby sleep at this age and “won’t hurt.”  The most common things “wisdom” will come up with for your sleepless baby are early solids and extinguishing.  Well, peer reviewed evidence says that it does not help babies sleep better. If that’s not enough, the CDC says that giving solids too early causes actual harm.  They say: “early introduction of solid foods has also been linked to increased risk of obesity, diabetes, eczema and celiac disease.”  So please don’t.  And as for extinguishing, that’s also known as letting your baby cry until she exhausts herself and gives up and goes to sleep.  Please don’t.  It “works” for only a few people, and by that, I mean that they get a few weeks of their baby going to sleep before they have to listen to their baby cry and cry and vomit in his crib again.  It’s not a magic bullet, and it doesn’t work the way “they” say it does even if the baby does stop crying temporarily.  I’ll discuss what does happen from an evidence based perspective in another post.  I’d ask you to pitch that old advice out with early solids.

So if you’re struggling with a 4 month old having the “Regression,” I’m sorry, and I feel your pain.  My son went through this regression for about 8 weeks – for most babies is lasts for about 6.  For those weeks, he would not sleep unless he was literally attached to my boob.  I was a zombie.  Try to get some sleep.  Most babies do go through this, and it seems to be a normal phase having to do with increased awareness and caloric need.  It should pass around 6 months of age after the baby starts eating food, but try not to rush that.  Instead, try to take naps.  Minimize your sleep interruptions by getting someone to help. You weren’t meant to do all this work alone and shouldn’t have to.  Remember – sleep when baby sleeps; clean when baby cleans.  And good luck.  You’re doing great.





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