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The Informed Parent

Sleep, Glorious Sleep

by Louis P. Theriot, M.D., F.A.A.P.
Published on Dec. 17, 2007
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Few things in life can compare with the joy of bringing a new baby home from the hospital. It is a magical experience that far exceeds the expectations of the long pregnancy. After about four months, some parents are experiencing a phenomenon that wasn’t quite planned for…sleep deprivation. Often times this situation can seem like it will last forever. However, it is temporary and in many cases there is a remedy.

The Browns are proud parents of Amy, a beautiful 4 ½-month-old girl. Mrs. Brown is exclusively breast feeding and doing a wonderful job. At her two month well visit Ann’s weight plotted at the 50th percentile. At her four month visit her weight was at the 75th percentile. She had a normal examination, and developmentally she was meeting all of her milestones. Mom was pleased with how the breastfeeding was coming along. She didn’t plan on starting solids until Ann was six months of age.

A few weeks after Ann‘s four month visit Mrs. Brown came in for a consultation about sleep issues. While the baby was thriving and doing fine, both Mr. and Mrs. Brown were about at the end of their respective ropes due to lack of sleep. It seemed that Ann was waking every 2-to-3  hours during the night to feed. “She eats really well,” Mrs. Brown explained. “So I have to believe that she is truly hungry.”

At this point I took a detailed feeding history and found that Ann was eating approximately nine times in a 24 hour period. Mom was putting her on each breast for ten minutes each side, and getting a good burp in between. Clearly she was doing the right things as was evident by the baby’s weight on her growth curve.

I asked Mrs. Brown if she found that Ann was “hungry” every three hours, or if that was just the routine that had fallen into place. Her response was quite interesting. She looked up into space, shook her head and, in a baffled voice, said, “I don’t really know!”

I assured her that the milk supply was more than adequate and that she was doing a great job. I told her that I thought we could easily remedy the sleep situation. Ann had become a “trained night feeder.” Basically what had happened was that Ann was being fed every three hours. And, as a result, she was getting three hours worth of breast milk each feeding. Naturally she would be hungry in another three hours. Thus the cycle was self-promulgating and Ann would wake up hungry in the middle of the night. What Mrs. Brown now needed to do was gradually increase the interval between each feeding, allowing the baby to get larger volumes of milk and then be content for longer periods of time.

Mrs. Brown seemed a bit apprehensive about this. She was appropriately concerned about how to stretch out the feedings. I told her that the stimulus for milk production was Ann’s ability to empty the breasts at each feeding. This stimulated the breast to produce more milk. I recommended that she start by going 31/2 hours between. If Ann seemed hungry at 3 hours, she could offer her a pacifier, or put her in a Snuggli and try to entertain her to divert her attention. When she did feed the baby, she should eat well and fully empty the breasts allowing them to now produce 31/2 hours worth of milk. After a short while, Ann should be content to eat every 31/2 hours. Then she should be able to stretch the feedings to every 4 hours. Over time, Ann should be able to get larger volumes of milk at each feeding and be content for longer periods of time. She would essentially consolidate a couple of feedings throughout a 24 hour period. In other words, she would be getting the same amount of milk in a 24 hour period to allow for good growth, but doing so in a fewer number of feedings.

Mrs. Brown was willing to try anything to be able to get a decent nights sleep. She said she would give this a try and we would meet in three weeks to see how things were going. I did not hear from Mrs. Brown until our re-check three weeks later. As the nurse was weighing Ann, Mrs. Brown was beaming and said that she and her husband were truly grateful. Now they were getting eight hours of sleep a night and were thrilled. I plotted Ann’s weight on her growth curve. Sure enough, she was in the 75th percentile. Mom told me that it didn’t take long before Ann was going 4-to-41/2 hours between feedings and was perfectly happy in between. We calculated that in a 24 hour period Ann was eating about six times. I know that this was sufficient for her because 1) she maintained the 75th percentile for weight 2) she was happy and content in between feedings and 3) Ann was sleeping up to eight hours a night.

It is easy for parents to fall in the trap of conditioning their babies to become trained night feeders. The remedy is not giving cereal at bedtime, or merely letting the babies cry it out. It is simply a matter of supply and demand--basically re-distributing the volume of milk a baby takes each 24 hour period. One baby who is strictly breast fed, may eat nine times a day, getting 36 ounces of breast milk per day and be on the 50th percentile for weight. Another baby, also breast fed, may only need to eat 5-to-6 times a day, yet also get 36 ounces of milk and be on the 50th percentile for weight as well. Both babies are doing fine nutritionally. One is not better off than the other. It is simply a matter of the parents’ comfort level and how much a good night’s sleep is valued.




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