Considerations for eliminating night time feeding
Making decisions about how to manage feeding overnight for babies is very individual to every family. When it comes to breastfed babies, there is much conflicting information about how long a baby might need to be fed in the middle of the night. Some doctors say 4 months, some say 6, some say 9 months and some lactation consultants will tell moms that at any time their child wakes in the middle of the night, they should be fed. This can be very confusing and can make it hard to determine when your child no longer needs feeding at night. For formula fed babies, if your child is eating 32 ounces during the day, then it is likely that they don’t need to be eating more at night although, again, this is very individual. And, for many formula fed babies, they will not eat more during the day when they are eating overnight. Always though, I encourage families to have a conversation with their pediatrician to determine what their individual child needs with regard to nutrition overnight.
Given all the confusion regarding overnight feeding, I can offer what I find to be the guiding factors when determining plans for how to manage feeding overnight for babies.
Age: It is normal for most babies under 4 months old to still need some feeding overnight. For any child under 4 months, I typically find that it is best for this to be child led as a baby this age won’t usually accept any other soothing that isn’t feeding if they are truly hungry. There are certainly babies under 4 months who are no longer interested in being fed, and if there are no weight concerns, then this can be fine. Please just be aware that there can be a growth spurt associated with the 4 month sleep regression so even if a baby has stopped eating in the middle of the night prior to 4 months, they may be hungry again while in this big developmental leap. I have seen some babies also have a growth spurt around 5.5 months although this is less common then at 4 months.
Developmental: As your baby is moving past 4 months, you may notice that your child is more distracted when you are attempting to feed them during the day and is now eating more at night. This is often related to the developmental factors that lead your baby to become more alert and aware during the day then they were in the previous months. Distraction can take many forms. It can mean that if anyone is walking around where you are trying to feed your baby, it is too exciting for your child to want to eat. It could be that a pet wanders through the room and has suddenly captured your baby’s attention. It could even be a strong breeze blows throw and suddenly feeding is done. As a result, now your baby may be more interested in eating in the middle of the night when there are less distractions. In its most extreme form, this is referred to reverse cycling when your baby is now taking in the majority of their calories at night and just sort of nibbles and snacks during the day. This also means that now your child is less motivated by hunger to want to eat during the day when there are clearly more exciting things happening.
Behavior: In most cases where babies are starting to eat more at night and less during the day, I find that feeding is being used as a means of helping a baby go back to sleep at night. I do want to be clear that this isn’t a problem until you feel like it is a problem for you, your child and/or your family. That is the point in time when you will be motivated to change this. It becomes easiest to change the association between feeding and sleeping when you are sleep training. With sleep training, you are helping your child learn how to fall asleep and back to sleep independently. For a child who still needs feeding overnight either due to growth concerns or because parents aren’t feeling ready to eliminate feeding overnight yet, I will often have parents incorporate feeding as a dream feed (or sometimes more then one dream feed depending on various circumstances). This is a feeding that isn’t being used to help the child go back to sleep. It serves the purpose of both ensuring that your child is getting calories overnight, and also it can help parents who are concerned about hunger be consistent in their response to their child knowing that their child has been fed. The goal with dream feeds is to start to phase out the feeding as you can see that your child’s wake ups are less related to hunger and more related to behavior—ideally, with sleep training, the wakings resolve pretty quickly. I will typically start to eliminate feeding once the night wakings are disappearing. If it is a child under 6 months, I will sometimes have parents hold onto the feeding until they have gone for their 6 month check up to ensure that all is on track with their child’s growth and development. In some cases, once the feeding overnight is gone, the early morning wake ups (which tend to be the last to resolve for children as their overall sleep improves), often improves drastically. While that may sound counterintuitive to many who expect that early morning wake ups are related to hunger, I actually find that when children’s sleep is less disrupted overall, they are able to get into a good sleep pattern and often sleep later. Go figure?!
If you are confused by how to manage feeding overnight for your child or are looking for support and guidance for how to get to a place where your child is able to sleep through without needing feeding, reach out to discuss how we can work together towards your family’s sleeping goals.