Where will you be when (not if) you fall asleep while feeding your baby?

Healthy newborns wake easily and often to feed, and a “good sleeper” in this age group is one that lets you know when he or she is hungry, is an efficient and effective feeder, and settles after the feeding and falls back asleep.  Modern societal expectations often do not allow for or encourage new mothers to sleep during the 16-20 hours/day that a newborn sleeps.  There is often housework, family and visitors, thank you notes, older siblings, and far too often at least in the U.S., an earlier-than-it-should-be return to work.  The “village” that traditionally swooped in and surrounded the dyad with care and support is often spread across miles, even oceans, and these mothers, while still recovering from birth, are left alone as their partner returns to work.  It is not surprising that new mothers find themselves exhausted and in “survival mode” during which time the recommendations that they have heard to feed a certain way or have the baby sleep a certain way may fly out the window as they desperately try to achieve a little more sleep.  And even though they may or may not be planning to, mothers of newborns are falling asleep while feeding their babies.

In addition, depending on where they turn for information, the recommendations for infant feeding and safe sleep can be confusing and may appear to be at odds with one another.  We know that mothers who bedshare with their infant breastfeed for longer.  We also know that where babies start off the night is not always where they end up in the morning.  We know that breastfeeding is protective against Sudden Infant Death Syndrome (SIDS), but also that bedsharing may pose a risk for a sleep-related infant death, particularly in the setting of other risk factors such as prenatal smoking, formula feeding, maternal substance use, sedating medications, maternal obesity, prematurity, and the presence of soft bedding in the sleep environment.  Some organizations recommend bedsharing as a means of supporting breastfeeding and cite data about the physiologic patterns and postures of mothers and babies when they bedshare.  Other recommendations focus on safe sleep and recommend breastfeeding as a strategy to reduce the risk of SIDS but recommend against bedsharing to avoid an unintended sleep-related death.

Should You Sleep Train Your Baby at 2 Months?

A Wall Street Journal article from May 2, 2016, “Can You Sleep Train Your Baby at 2 Months?, by Sumathi Reddi, a weekly consumer health column writer, quotes a pediatrician who routinely teaches parents to train babies to sleep through the night beginning at age 2 months. Dr. Michel Cohen bases his advice on the experience of training his own children a decade ago.  He encourages other pediatricians in his practice to follow the same advice. Dr. Cohen states that, “It actually works better at 2 months than at 4 months.”

Can you sleep train your baby at 2 months?  Perhaps.  Should you sleep train your baby at 2 months might be the better question.  Evidence on infant sleep and development does not support the practice.  A systematic review conducted in the UK showed that sleep training in the first 6 months of life did not prevent sleep or behavioral problems later on, nor did it protect against postnatal depression. It may even worsen maternal anxiety and lead to further problem crying after 6 months of age. J Dev Behav Pediatr. 2013 Sep;34(7):497-507  Sleep training at 2 months involves a significant increase in infant crying, which is stressful not only for babies, but for the whole family. Middlemiss and colleagues showed that when babies were allowed to “cry it out” at night, this resulted in babies having very high levels of stress hormones, such as cortisol, increasing heart rate and blood pressure. Early Hum Dev. 2012 Apr;88(4):227-32.  Alternatively, babies who learn early on that a caring adult will respond to their crying by feeding and holding are less likely to experience stress and isolation, especially during those early months of life, when brain development and connections between brain cells are occurring in rapid fashion.  Young babies and mothers are hard wired to be together frequently.