Wednesday, February 10, 2010

Help! My breastfed baby wakes me up every few hours all night long.

Dear readers and parents,

A common concern breastfeeding mothers report is that although their child is at the age to be physically able to sleep through the night (around 3-4 months)they keep mommy up by waking up 3-4 times a night to nurse. What is going on?

When babies are first born they need to eat every 2-3 hours throughout the day and night in order to get enough calories. At birth, most infants stomachs are only the size of a quarter. This means they need less milk to fill them up but they burn through the milk quickly thus needing to eat more often. When your baby reaches the age of 3 or 4 months they have probably developed some sort of routine and are understanding the difference between nighttime and daytime sleeping. They can also go for longer stretches without eating. At this age the goal is to fill up their day time tummies so their longest stretch will be in the middle of the night.

Sometimes a breastfed baby begins to sleep longer stretches around 3 months which is very exciting for parents. However, at some point around 4-6 months they begin to wake up more often (every 2 hours) and stop sleeping long stretches in the middle of the night. Today's question is Why?

What may be happening...

As a breastfeeding infant, your baby's primary goal is to begin developing a secure relationship with their caregiver which means they learn to trust that you as their parent will meet their needs when they need something. To an infant they are just beginning to understand this world and how to survive. So the goal for parents is to be attentive and loving to their infants during the first 3 months of life so their baby learns that they are safe. After the first 3 months your baby has probably learned that they are safe and well taken care of but now they are beginning to have preferences and are learning how to get what they "want" not necessarily what they "need". As parents your job now is to try to meet your babies needs by giving them what they want but also begin introducing boundaries and teaching them self soothing skills. Now it is time to make parenting decisions. Your breastfed infant has now learned that they love breastfeeding and they love their mommy. What is probably going on in the middle of the night is that they "want" you. They "want" to snuggle, they "want" to pacify on the breast, they may wake up and "want" you to put them back to sleep. Often they are not waking up to eat.

Now that you know what may be going on for your baby, now what do you do about it? Before we begin any changes in the nighttime feeding arrangement, we must first look at your babies routine during the day. Babies need structure and routine. It helps them understand what is coming next and what is expected of them.

Step #1: Routine

Review or establish a routine for your baby. Your routine can be flexible but should have some structure. Begin by purchasing a notebook and start recording what time your infant wakes up in the morning, times they eat, and designated bedtime. If you do not have a routine start by writing out your ideal routine that would work with your family's schedule.

Things to look for when reviewing your baby's routine...
1. How often do they eat? How long at each feeding? How long of stretch imbetween feedings.
2. When are your babies naps during the day? How long? How does your baby fall asleep? Where are her naps? Is their a routine at bedtime so she knows it is time to sleep?

It is common if you are reading this that you realize that your baby does not have a routine. That is okay, however it is time to establish one and begin following it daily. A baby's daytime routine is directly related to sleeping through the night. Creating a routine for your breastfed baby is the first step to increase stretches of sleep at night.

Step #2 Baby Checklist

Now that you have a set routine (check former blog post for more info), lets look for possible night waking causes.
Ask yourself...

1. Is my child eating enough during the day?
2. Is my child getting at least 2-4 hours (2-3 naps daily) of sleep during the day?
3. Is my child sleeping more than 4 hours during the day?
4. Does my child no how to fall asleep without the breast?

These questions will point you to the possible solution...

1.If your baby eats every 2 hours throughout the day, this is not a long enough stretch for your baby's body to adjust to going longer stretches at night. At five months, your baby should be able to go at least 3 hours between each feeding. The way to correct this is to start at the beginning of the day and only offer the breast after 3 hours. During the first stretch your baby will more than likely get hungry at their normal 2 hours but you need to distract them and hold them off to 3 hours. This will retrain them to eat more at each feeding thus increasing the amount of food they eat throughout the day.

2. If your baby is not getting at least 2 hours of sleep during the day, then your child is overtired and is having difficulty staying asleep. The solution is to develop a daily sleep routine and help your child get longer naps. Naps should be in the crib (or your families designated sleep area). It should be dark and calm in the room with a form of white noise to drown out daytime noises and to help keep baby sleeping. Pick a designated time for bedtime and try to stick with it. Again focus on developing routine. Create bedtime routine that may consist of a bath and books or just pj's and sometime in the rocking chair.

3. If your child is sleep more than 4 hours during the day, I would suggest keeping it to a 4 hour maximum. The best way to do this is to have a set routine with two 2 hour long naps which are at the same time everyday. Wake your baby up buy turning on the lights and turning off the white noise at about 2 hours.

4. More than likely your baby does not know how to go to sleep without the breast so they wake up often and need you to soothe them or they are waking up because they miss you and just "want" you to put them back to sleep. If this sounds familiar, it may be time to start crib training. Another helpful thing is to have dad go in the room and put her back to sleep with a bottle if it is time to eat. This will show your baby that it is not always mom and this usually encourages them to stay asleep.

Step #3 Make Changes

Now that you have an idea of what may be causing the night wakings, try one of my suggested solutions. If you need additional support or if you think it may be time for crib training, you can contact myself or your local postpartum doula for support.

Postpartum Doulas

Best of Luck,


Michelle Chrastil, MA CPD NCC
Honest Family Services, LLC.

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