Sleep & the Breastfed Baby

6-12 Months


Studies show that the majority of babies are still waking one or two times a night at 6-12 months of age regardless of whether they are breastfed or formula fed.1 In my practice as a lactation consultant working with nursing babies young and old, many start sleeping through the night around 9 months. They may continue to occasionally wake and need to be settled after a bad dream or other sleep disturbance, but are not necessarily nursing at night. Although night nursing is biologically normal, its not unreasonable to expect or encourage a 9+ month old to night wean. Milk supply always decreases when baby sleeps through the night (unless mom pumps at night) but after 9 months most babies are able to make up the gap in decreasing milk supply with an increase in solid foods. This is a natural part of gradual weaning. Just keep in mind that based on the studies available, night weaning does not always lead to sleeping through the night.1

My older baby is up several times a night, how can I reduce nightfeedings?

Ensure ample daytime breastfeeds. Between 6-8 months, most babies need to maintain the same amount of breastmilk in their diet and probably are not ready to drop breastmilk feedings yet. Most breastfed babies cannot simply take bigger less frequent feedings, since most women only produce an average of 3.5 oz per breastfeeding.2 Breastfed babies need the same feeding frequency to maintain their overall milk intake (around 27oz per 24 hours3) until they are proficient at eating nutrient dense solid foods. Decreasing breastfeeding frequency prematurely leads to a hungry baby waking up at night. If your baby is night nursing often, take a look at his daytime feeding patterns. If his daytime milk feeds are only around 5-6 times per day, this may explain why he still needs 2-3 night feeds to get to the typical need of 8 breastfeeds per 24 hours. Eliminating night feedings means more of those feedings must be pushed into daytime hours, not eliminated altogether. Once baby is eating a significant amount of solid foods he may be able to decrease his overall milk intake, and drop some breastfeedings out of his day/night.4 Of course, every baby is different and some babies are able to thrive with bigger less frequent feedings, but those babies will be growing on track (maintaining percentiles on the WHO chart for weight) and sleeping well. If your baby was growing well and sleeping well you probably wouldn't be reading this article! Here are some averages for breastmilk intake:

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Please note this chart is based on averages!3,4 Every mother/baby pair has a unique "magic number" mostly determined by mom's milk storage capacity and influenced by baby's solid food intake. There is a lot of room for diversity as long as baby is growing on track. For more information see The Magic Number & Long-term Milk Production and Feeding Patterns for Older Babies. Lactation Consultants can determine your baby's per feed intake by weighing baby on a very sensitive scale before/after breastfeeding.

Ensure opportunities for nutrient dense solid foods.
 Before 6 months, studies have not found any benefit to a baby's sleep when solid foods are introduced.5 After 6 months, increasing the quantity of solid food intake does seem to help babies night wean although they may still wake.1 Slim babies will especially benefit from nutrient dense solid foods offered right after nursing. Avocado, salmon, and scrambled eggs are all foods high in healthy fats and protein to help fill a baby's tummy. Baby should be allowed to set the pace for solid food intake without pressure from caregivers, as pressured spoon feeding can lead to childhood obesity.4 However, sometimes babies who are not given enough opportunity to eat solid foods will be waking at night hungry. Have older babies sit with the family at every meal so they can learn and gain interest by watching family members eat. Offer soft table foods from all the food groups (proteins, fats, grains, produce, etc). For more information, see my article on Baby-led Solids or attend a Baby-led Solids & Weaning Class.

Have a consistent sleep routine. Most 6-12 month olds are taking two naps per day. Having a consistent wake time, nap times, and bedtime can all help baby's night sleep be more predictable. The No Cry Sleep Solution offers gentle suggestions for how to create an age appropriate sleep routine. Baby should nap in a dim room with white noise - especially if there are noisy siblings in the house. Try to nurse baby before naps until baby is drowsy but not sound asleep. Falling asleep on his own may help him be able to resettle at night. Read more sleep tips from Babycenter.

Try gentle sleep training techniques, if desired.
If your baby is nursing more than once or twice a night (ages 6-8 months) or still night-nursing after 9 months and you've tried the above 3 steps, then some very gentle sleep training may be an option for your family. Never sleep train your baby out of pressure from friends or just because its considered "normal" in our culture for a baby to sleep through the night. Only you can make the decision if it is right for your family. Some gentle sleep training approaches are 1) Reducing the duration of night feeds - gently end the feeding after 5 minutes. 2) Move baby into a separate room. 3) Ask dad to rock baby, offer pacifier, or pat baby's back. 4) Allow baby the opportunity to settle by waiting up to 10 minutes before going in the room. These approaches work best if tried in order listed and each step is given at least one week of consistent effort before moving to the next step.

Remember, this too shall pass! Although the season of tending to an infant's nighttime needs feels long and exhausting, it doesn't last forever and it is part of the developmental process of building a foundation of love and trust with your baby. Children eventually learn to sleep through the night - except for the occasional nightmare, bedwetting, and midnight tummy bug. Although it may be hard to imagine now, the time will come that you may look back fondly at those late night snuggles and wish you could have those precious moments back. 

References
Breast milk volume and composition during late lactationJ Pediatr Gastroenterol Nutr., 1984
Infant sleep and bedtime cereal J Dis Child, 1989
Baby knows best? The impact of weaning style..., Nutrition & Metabolism, 2012