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Sleep & the Breastfed Baby, 6-12 months (Part 3)

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

For babies under 6 months, click here instead.

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 our practice as lactation consultants 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 no longer nursing at night on a regular basis. Although night nursing is biologically normal, its not unreasonable to encourage a 6-8 month old to only need one or two nightfeeds and a 9+ month old to night wean. Milk supply always decreases when baby sleeps through the night (unless mom pumps at night) but by 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 However, there are several things you can do to help an older baby sleep longer stretches at night.

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 7-8 breastfeeds per 24 hours. Eliminating night feedings means more of those feedings must be pushed into daytime hours, not eliminated altogether. To learn more about normal variations in breastfeeding patterns for older babies, please read our article here.

2. 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 for other reasons.¹ Babies with lower BMI will especially benefit from nutrient dense solid foods offered right after nursing. For example, 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 our article on Baby-led Solids or attend a Baby-led Solids & Weaning Class.

3. 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 app Huckleberry offers gentle suggestions for how to create an age appropriate sleep routine customized for your baby. 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. Below is a typical routine for a 9 month old:

4. 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.

5. 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 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.

Need help building a routine that works for you baby and promotes restful sleep? Book a consult so we can help!

Mamas in the north Charlotte and Lake Norman area, we encourage you to setup a home visit so we can help you address these issues. If you are out of our travel area, you can setup a virtual consult with us or google "lactation consultant near me" to find local help.

References

1 Infant Sleep and Night Feeding Patterns During Later Infancy, Breastfeeding Medicine, June 2015

2 The Magic Number and Long-Term Milk Production, Clinical Lactation, 2011

3 Maternal versus infant factors related to breast milk intake, Pediatrics, 1991

4 Breast milk volume and composition during late lactation, J Pediatr Gastroenterol Nutr., 1984

5 Infant sleep and bedtime cereal, J Dis Child, 1989

6 Baby knows best? The impact of weaning style..., Nutrition & Metabolism, 2012

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