Trained Night Feeder

THE PROBLEM

Your child is over 4 months of age and awakes and cries to be fed one or more times during the night. This behavior usually occurs every night and has been present since birth. Such a child is called a “trained night feeder.” The child is usually bottle-fed or breast-fed at bedtime until he falls asleep. When he awakens in the night, he is not tired; you and your spouse are.

From birth to 2 months of age, most babies normally awaken twice each night for feedings. Between 2 and 3 months, most need one middle-of-the-night feeding. By 4 months, about 90% of infants sleep more than eight consecutive hours without feeding. Normal children at this age (and premature babies who have reached 11 pounds) do not need any calories during the night to remain healthy.

Several factors can cause a child to become a trained night feeder:

• Nursing or bottle-feeding the baby to sleep. If your child’s last memory before falling asleep is sucking the breast or bottle, this becomes his security (transitional) object. A transitional object is something, like a blanket or teddy bear that helps a child cross over from wakefulness into sleep. A child who falls asleep while being fed does not learn to comfort himself and put himself to sleep. When he awakens during the night, as most children normally do following each sleep cycle, he cannot return to sleep without the breast or bottle.
• Leaving a bottle in the crib is a no-no. In addition to promoting sleep problems, leaving a bottle in the crib (unless it contains only water) can lead to a form of severe tooth decay known as “ baby bottle caries.” It can also cause ear infections because milk can travel easily from the throat to the ear through the Eustachian tube when the baby drinks lying down.
• Offering frequent daytime feedings. Some mothers misinterpret “feeding on demand” to mean “feed the baby every time he cries.” This can lead to feedings as often as every 30 to 60 minutes. The baby’s stomach gets conditioned to being fed small amounts frequently instead of waiting at least two hours before feeding at birth, and waiting at least four hours by 4 months of age. As a result, the baby will have hunger pangs during the night and wake up several times to be fed. This habit is called “grazing.” It occurs more often in breast-fed babies whose mothers use nursing as a pacifier, instead of a satisfier. Excessive fluid from frequent night feeding also increase awakenings caused by soaked diapers. This in turn will increase the chance your little one will develop a diaper rash.

If you follow the basic recommendations outlined below, your child’s sleep habits will usually start to improve within two weeks. The older the child, the harder it is to change her sleep habits. Infants over 1 years of age will vigorously protest any change and fight sleep through the night until they are 3 or 4 years of age, when busy daytime schedules finally exhaust them. By that time, of course, you’ll be exhausted too.

THE SOLUTION

Gradually lengthen the intervals between daytime feedings to four hours or more. Nighttime feeding intervals cannot be extended if the daytime intervals are short. Gradually postpone daytime feeding times until they are more normal for your child’s age. If you currently feed your baby every hour, go to 1 ½ hours. If he cries, provide cuddling and a pacifier. It is important to provide your baby with periods of holding and cuddling separate from feeding times.

For every time you feed your baby, there should be four or five times that you snuggle him without feeding. When you baby accepts a 1 ½-hour schedule, go to two hours. The feeding interval will increase to three or four hours by four months of age when I start most babies on solids.

At naptime and bedtime, place your baby in the crib drowsy but awake. When your baby starts to act drowsy, place her in the crib. If she is very fussy, rock her until she settles down or is almost asleep, but stop before she’s fully asleep. If she falls asleep at the breast or bottle, it is best to awaken her. To help dissociate feeding from the bedtime ritual, consider feeding her one hour before bedtime or naptime.  Her last waking memory needs to be of the crib and mattress, not the breast or bottle. She needs to learn to put herself to sleep. She will need this self quieting skill to cope with normal awakenings at night.

When your baby cries at naptime or bedtime, make brief contact every five to 15 minutes. Visit your baby before he becomes very upset and difficult to console. Younger or more sensitive infants may need to be checked on every five minutes.