How Infant Eating and Sleep are Connected
Eat… Sleep… Poop… simple right? What else is there to it? When we set out as new parents, we know there will be tired days and sleepless nights. We know that newborns require constant love and support. What we don’t always anticipate is just how draining it can be to go through months and months of a baby not sleeping longer than 45 minutes and not understanding what you are doing wrong. When any one of those 3 (eat-sleep-poop) functions goes awry, it seems that the other 2 follow suit just as quickly.
Before I get too ahead of myself, allow me a quick introduction. My name is Emily Merritt, I am a registered Speech Language Pathologist with the College of Audiologists and Speech Language Pathologists of Ontario. I am also the owner of Wellington County Speech Therapy and have been working with the paediatric population since 2015. More recently, I became a mom in 2023. I was one of the lucky ones. My wonderful colleagues gifted me Bailey AKA Midnight Mama Sleep Consulting, as a baby shower gift. A gift that admittedly at the time, I wasn’t sure was all that great…. Oh boy was I wrong. My daughter Ava was born on March 9th . Everything was great! Except…feeding was hard, sleep was hard, and I was shattered. We started working with Bailey when Ava was 4 months old, and I never looked back. This experience has inspired a new pathway within my career. I now spend time helping new parents and their infants with feeding challenges. I am here today to talk about how feeding impacts sleep, and hopefully help people (who, like me), really need some support.
Let’s dive in. As with most topics related to infants, feeding and sleep is a very nuanced relationship. It would always be nice to have black and white answers, but alas, that is not the way it is. A quick disclaimer. This information is meant to provide general information regarding infant feeding development. It is not intended to substitute a formal assessment from a Speech Language Pathologist, nor should it be replacing the advice of your doctor, paediatrician, lactation consultant or dietician. If you have any concerns about your baby’s development, please seek out support from a local professional.
Please note, by no means is this a comprehensive review of all the current research out there. Just a sampling of what we currently know.
Q: What does feeding have to do with sleep?
First, we must consider where you child is at in their development. Typical, healthy, full term, newborns have very small stomachs, for this reason they need to feed often. This can be further complicated with early feeding challenges such as:
Shallow Latch/Swallowing air while feeding.
Oral ties (tongue tie/lip tie/ buccal tie) and open mouth breathing.
Difficulty coordinating suck-swallow-breathe patterns.
Unknown allergies or aversions.
Reflux/Gas
Pre-term birth/Low birth weight
If you are concerned about any of the challenges I just mentioned, I would highly recommend you seek out support. Do not be shy to get a second opinion as sometimes more than one is needed to fully understand all the options and hear information from more than one perspective. Sometimes nothing is wrong, it is just a new skill for both you and your baby. Whether you are bottle or breastfeeding, these things take time to learn. Be patient with yourself and your baby.
As your baby grows, other challenges can arise related to feeding and sleep. They include:
Night Wakings: Even as stomachs grow, a baby can require frequent feedings, leading to night wakings for both breastfed and formula-fed babies. These night feedings are essential for their growth and development but can disrupt parental sleep patterns.
Sleep Associations: Babies may develop sleep associations with specific feeding methods, making it challenging for them to self-soothe and fall asleep independently without assistance from parents.
Ongoing Digestive Issues: Some babies experience digestive issues related to feeding, such as reflux or colic, which can disrupt sleep patterns and cause discomfort during nighttime feedings.
Q: Does introducing solids improve sleep?
Well, it could, but it is not a magical solution. Brown and Harries (2015) found that babies that received more milk or solid feeds during the day were less likely to feed at night. However, in this study the babies analyzed were just as likely to wake, even if it was not for the purpose of a feed. So here, we may be seeing the impact of some of those sleep association challenges. Hot tip… this is when you call Bailey!
Next, let’s look at a randomized control trial in 2018 by Perkin et al. In this study, two groups were compared. The first, an Early Introduction to Solids (introduction at 3 months of age) was compared to a Standard Introduction of Solids (at 6 months of age).
It was found that the early introduction group slept significantly longer and woke less often than the standard introduction group. Note that both groups were also exclusively breastfed throughout the study. A big thing to notice here is the type of study. A randomized control trial is the gold standard for research. It gives us confidence in the results. There were also an impressive number of participants with 1303 babies in the study.
Other studies related to infant health and obesity note that the quality of food matters. Just adding rice cereal to a bottle may not be the best answer. In addition, using food to soothe can have a negative impact on health. A meta-analysis (i.e. a summary of all the research on this topic) by Birch et al, (2012) looked at interventions to prevent obesity during infancy. Soothing methods outside of feeding as the first response to nighttime crying had evidence for greater amount of nighttime sleep, less settling time, and fewer night wakings.
Q: Can breastfed babies sleep through the night?
Why yes, yes, they can! I can tell you that without even “geeking” out on the research. As a mom with an exclusively breastfed baby, you can get there. Sooner than you think! But let’s take a moment to “geek-out” anyways. The research is very inconsistent on this topic. In a 2021 study, it was observed that despite having more nighttime wakings, breastfed infants had overall longer night and total sleep durations compared to formula fed babies. (Jafar 2021) No difference for partially versus exclusively breastfed.
In a 2012 study by Weinraub et al., looking at sleep habits of children from 6-36 months of age, it was seen that 66% of children were waking once a week at 6 months of age, this did not increase when measured at 15 months, 24 months, or 36 months of age. However, 34% woke 7 nights a week at 6 months, dropping to 2 nights by 15 months and 1 night by 24 months of age. This group were more likely to be boys, score higher on the 6-month difficult temperament assessment, be breastfed at 6 and 15 months old, and mothers had a higher rate of depression at 6 months postpartum. There were babies in both groups that were breastfed.
Things to remember here:
These studies did not examine the methods that parents were using to soothe their children back to sleep.
Sleep training was not involved within these studies.
Both studies did have evidence of breastfed and formula fed babies sleeping well!
There are pros and cons from a sleep perspective to feeding approaches: Breast milk contains components that promote better sleep, such as tryptophan and melatonin, while formula-fed babies may experience longer sleep durations due to the slower digestion of formula. (Mindell & Owen, 2015)
At the end of the day, you need to feed your baby the way you want to feed your baby. A fed baby is the best kind of baby! From there, look for sleep support that suits your needs.
If you have made it this far, congratulations! You have made it through a sampling of some of the research out there related to feeding and sleep. Clear as mud? It feels a bit like that. Here are some take aways that I got from digging deep into this topic:
Sleep is a challenging topic for so many families.
There is no black and white answer about the dynamic of feeding and sleep.
There is hope that ALL babies can achieve good sleep habits and longer sleep at night.
Feeding your baby is a very personal choice and there is no wrong one!
Get support if you think something is going wrong with feeding. Some examples include:
-Your baby is very gassy.
-Your nipples are bleeding or there is a lot of pain associated with nursing.
-Your baby is sleeping with their mouth open (without congestion)
-Your baby is snoring.
-You are having a hard time finding a bottle your baby can take.
Thank you so much for taking the time to read. For more fun related to paediatric speech, language, literacy and feeding follow me on Instagram: @wellingtoncountyspeechtherapy
Emily Merritt, M.Sc., SLP
Speech Language Pathologist
Reg. CASLPO
Wellington County Speech Therapy
References
1. Kendall-Tackett, K. A. (2010). "Infant Feeding and Sleep: A Review of the
Literature." Journal of Prenatal & Perinatal Psychology & Health, 24(4), 249-258.
2. Brown, A., & Harries, V. (2015). Infant sleep and night feeding patterns during
later infancy: association with breastfeeding frequency, daytime complementary
food intake, and infant weight. Breastfeed Med, 10(5), 246-252. doi:
10.1089/bfm.2014.0153.
3. Perkin, M. R., Bahnson, H. T., Logan, K., Marrs, T., Radulovic, S., Craven, J.,
Flohr, C., & Lack, G. (2018). Association of Early Introduction of Solids With
Infant Sleep: A Secondary Analysis of a Randomized Clinical Trial. JAMA
Pediatrics, 172(8), e180739. doi:10.1001/jamapediatrics.2018.0739
4. Birch, L. L., Anzman-Frasca, S., & Paul, I. M. (2012). Starting Early: Obesity
Prevention during Infancy. In A. Drewnowski & B. J. Rolls (Eds.), Obesity
Treatment and Prevention: New Directions: 73rd Nestlé Nutrition Institute
Workshop, Carlsbad, Calif., September 2011 (pp. 81-94). Nestlé Nutrition
Institute Workshop Series. S. Karger AG. https://doi.org/10.1159/000341300
5. Abdul Jafar, N. K., Tham, E. K. H., Pang, W. W., Fok, D., Chua, M. C., Teoh, O.-
H., Goh, D. Y. T., Shek, L. P.-C., Yap, F., Tan, K. H., Gluckman, P. D., Chong, Y.-
S., Meaney, M. J., Broekman, B. F. P., & Cai, S. (2021). Association between
breastfeeding and sleep patterns in infants and preschool children. The American
Journal of Clinical Nutrition, 114(6).
6. Weinraub, M., Bender, R. H., Friedman, S. L., Susman, E. J., Knoke, B., Bradley,
R., Houts, R., & Williams, J. (2012). Patterns of developmental change in infants'
nighttime sleep awakenings from 6 through 36 months of age. Developmental
Psychology, 48(6), 1511–1528. https://doi.org/10.1037/a0027680
7. Mindell, J. A., & Owen, J. (2015). "Breastfeeding and Infant Sleep." In J. A.
Thomas, & M. H. Hummel (Eds.), Breastfeeding: Best for Baby and Mother.
Springer International Publishing.
