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Life in the first 6 months of being a parent! Feeding methods and parental factors.

In this series of mini blogs we look at life in the first 6 months of your baby’s life. Week 2 discusses how feeding methods and parental factors affect baby sleep.

Does feeding method make a difference to baby sleep?

There is evidence to show that exclusively breastfeeding mothers get the most sleep in these early months and that mixed feeding mothers get the least! This is not meant to discourage a mother from mixed feeding her baby, as any amount of breastmilk is highly beneficial. It is merely meant to demonstrate what effect parental behaviour can have on baby sleep. Let me elaborate!

Breastfeeding – not compatible with sleep?

Breastfeeding mothers who co-sleep with their babies – whether this is in the family bed or in an adjacent baby sleep space get the most sleep of all mothers despite their babies waking more frequently. This is because the baby is in close proximity and because breastfeeding induces melatonin in the mother and passes to the baby. Therefore, despite more waking, mum and baby settle quickly back to sleep, and often mum is unaware of how many times her baby may have fed in the night.  Why is baby waking more frequently? Most likely due to the need for a breastfeed to induce sleep – i.e. baby associates breastfeeding with how they get to sleep so every time they stir and move through a sleep cycle, they need a quick feed to resettle them. This is only a problem if mum deems it so and has been the biological norm throughout human history.

So, what is a bottle-feeding mum doing differently?

Firstly, bottle feeding babies are not as safe in the parental bed as a breastfeeding baby – this is due to baby being in a deeper sleep and baby not associating the breast with night-time comfort. This means baby is more likely to be closer to mum’s face rather and therefore nearer pillows. Breastfeeding mums also assume a curved side lying sleep position automatically, which bottle-feeding mummies do not seem to do.

Secondly, getting up to prepare a bottle (regardless of prep method or whether it is expressed breast milk) is generally much more disruptive to maternal (or paternal!) sleep than offering a quick breastfeed. Therefore, bottle feeding mums will often offer an alternative source of comfort and settling. This reduces baby’s dependence on one method of settling only, in addition it takes time to get up and prepare a bottle thus baby is naturally having to wait before comfort and/or milk arrives.

Whether this is beneficial or not depends on your point of view – sometimes baby will be very cross about the wait and therefore take into more air, feed more vigorously and take longer to settle after a feed – obviously not ideal at 3am! Sometimes however, baby will stir, shuffle about, whinge a little and then drift off back to sleep. If mummy has to get up to make a feed, she is likely to wait to see if baby is really going to shout for this feed before leaving the warmth of her bed – therefore she gives her baby a chance to resettle themselves, and they start to learn this skill.

Breastfeeding mummies know that if they offer the breast quickly at first sign of baby stirring then baby will drift off to sleep after that feed without a fuss. There really is no right or wrong between these 2 scenarios.

So how does the poor mixed feeding mummy end up with less sleep?

Interesting Kendall-Tackett et al (2011) report no statistical difference in maternal physical health and self-reported energy levels between mixed and fully formula feeding mums. Although these mums did report increased tiredness over formula feeding mums. In a large Chinese study, however, it appeared that partially breastfed infants woke more frequently than exclusive breastfed babies and formula fed infants (Huang et al, 2016). Increased night waking among partially breast-fed infants in the above study may be explained by more frequent infant feeding among partially breast-fed infants compared to exclusively formula-fed infants. It may be that the exclusively breastfeeding mums did not realise how often their babies were feeding?

So, what about regressions and leaps?

Are these a ‘thing’? We have seen in part 1 that a baby’s sleep changes dramatically at around 4-5 months – is this really a regression or a huge development?

Leaps is a term coined by Frans Plooij and his wife in their popular ‘Wonder weeks’ book and app – they describe weeks during a baby’s first 20 months which are particularly disruptive to sleep. The research behind this book has not been able to be replicated and it was based on a very small sample size. Regardless of the debate of the validity of the research, there is no doubt that as a baby makes physical and cognitive developments, their new perspective of their world will understandably lead to disruptions in sleep.

What parental factors do we need to think about?

Family dynamics – some of the factors which influence how a family feels about their sleep situation are listed below. Often a parent feels that improving a child’s sleep will improve their sleep and therefore their daytime functioning. While this is true in some cases, often there are lots of variables in each family’s situation.

Factors such as; parenting without support, the influence of surrounding community or culture and whether grandparents/partner and/or friends are supportive, can have a huge influence on how a parent feels about sleep.

Herman et al (2012) found less parenting stress was related to more positive parenting perceptions. As parental stress will affect child behaviour and stress levels (Barsade, 2002) supporting a parent with a holistic approach may improve family sleep by itself.

Emotional health of the parents is not the only factor in influencing family sleep, physical health made worse by lack of sleep is often an issue (Walker, 2017). This also makes it very hard for the parent to have the resilience or ability to make changes. Financial and work situation is often a motivator for parents to make changes as they are concerned about how they will manage work on a lack of sleep. This might result in a situation where the child’s sleep is developmentally normal, but the parent cannot manage their daily tasks on top of poor sleep (Meltzer and Mindell, 2007).

Sometimes the family’s antenatal experience has led to unresolved issues, such as a child not being planned, or health issues of the unborn baby, mother or any other siblings. There is evidence that in-utero environment for babies of mothers with anxiety or depression affects that child’s sleep once born (O’Connor et al, 2007).

Parental biological chronotype –morningness or eveningness (known as chronotype) is determined mainly by genetics and refers to whether a person is naturally more alert in the early morning or evening. 40% of the population are morning types, 30% are evening types and the rest are in between (Walker, 2017). There is some evidence to suggest that morning types report more positivity than evening types (Biss and Hasher, 2015). It may be fair to say though that if a morning-type adult has a child who takes a long time to settle for bed, they will struggle with this. Likewise, an evening-type adult may find early rising in their child particularly hard to deal with. Thus, it is prudent to discuss these aspects with parents and factor them into any suggestions made to improve sleep.

Personality – La Vigouroux et al (2017) looked at the personality types of parents who experience burnout. They found that parents who have difficulty maintaining affectionate relationships with their children, those that struggled to respond to their children’s needs and those who found implementing boundaries hard – were at the most risk of parental burnout. In addition to the above, considering whether parent and child are more extroverts or introverts will also help resolve sleep problems. An introverted parent may find a high-need wired lively child exhausting. Conversely an introverted baby or child may find some parental social occasions or being passed around much more stressful. Both situations will impact upon sleep or perception of sleep problems. Siblings may also factor into this – for example if the new baby or younger child is a different personality type to older sibling(s) the parent may need to use different techniques with each child.

Blog will continue in part 3 where we look at day-time rhythms, naps and family diet.

Rachel Greaves is a midwife, public health nurse and accredited sleep coach. She volunteers at local breastfeeding support groups and works privately at Goodnight Solutions 

References

Huang, X, Wang. H, Chang. J, Wang. L, Liu. X, Jiang. J, and  An. L (2016) Feeding methods, sleep arrangement, and infant sleep patterns: a Chinese population-based study. World Journal of Paediatrics. 12(1) pp 66-75 Accessed at: http://www.wjpch.com/UploadFile/010%20%2013-201.pdf

Kendall-Tackett. K, Cong. Z and Hale. T (2011) The Effect of Feeding Method on Sleep Duration, Maternal Well-being, and Postpartum Depression. Clinical Lactation. 2(2) pp22-26 http://breastfeedingmadesimple.homestead.com/kendall-tackett_CL_2-2.pdf

Herman. M, Mowder. B, Yasik. A and Shamah R.  (2012) Parenting Beliefs, Parental Stress, and Social Support Relationships. Journal of Child and Family Studies.21(2) pp190-198

Walker. M (2017) Why we sleep. Chapter 2 Caffeine, jet lag and melatonin. pp13-37 Allen Lane. London.

O’Connor. T Caprariello. P, Robertson Blackmore. E, Gregory. A, Glover. V and Fleming. P and the ALSPAC Study Team. (2007) Prenatal Mood Disturbance Predicts Sleep Problems in Infancy and Toddlerhood  Early Human Development 83(7) Accessed at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2853892/

Biss, K and Hasher, L. (2012). Happy as a lark: Morning-type younger and older adults are higher in positive affect. Emotion, 12(3), pp437-441. Accessed at: http://dx.doi.org/10.1037/a0027071

Le Vigouroux. S, Scorla. C, Raes. M, Mikolajczak. M and Roskam. I (2017) The big five personality traits and parental burnout: Protective and risk factors. Personality and Individual Differences 119, pp216-219 Accessed at: https://www.sciencedirect.com/science/article/abs/pii/S0191886917304658

Life in the first 6 months of being a parent!

In this series of mini blogs we look at life in the first 6 months of your baby’s life. Week one discusses what normal baby sleep looks like.

What is normal young baby behaviour?

Our society and cultural expectations have changed over the years, as have our experiences and expectations as parents. However, our babies’ innate behaviour and needs have not!

I’m not an expert but mammals appear to be divided into caching species (i.e. hiding their young when mum goes off to hunt for food) and carrying species, whereby mum carries her infant and feeds it frequently. Dr Blurton Jones in 1972 concluded from several anatomical, behavioral and physiological comparisons, including the composition of the milk, that humans are a carrying species, which breast feed their young frequently. In addition, to this Dr Emmy Werner (again 1972 – busy year!) studied groups of infants in ‘traditionally’ reared rural communities’ verses ‘Westernised’ urban infants across 5 continents. Dr Werner found that traditionally reared infants had greater motor development than the urban infants. These traditionally reared infants, regardless of the continent, lived within an extended family system with many caretakers, breastfed on demand, day and night, had constant tactile stimulation with the body of the adult caretaker who carried the infant on her back or side, and slept with him. As these infants were with an adult continually, they participated in all adult activities, with frequent sensorimotor stimulation and had no set routines for feeding or sleeping. Interestingly, many parents in our Western society often comment their baby appears most settled when ‘out and about’ or when surrounded by the normal daily rhythm of adult life.

Baby brain development!

Due to evolution and the development of the large human brain, babies must be born at a stage of maturity when other mammals would remain safely in the uterus. For these large heads to fit through their mother’s pelvis babies are born gestationally very immature. This is also seen in marsupials, such as kangaroos and koalas, but they have the convenience of a pouch supplied with a nipple! Normal human baby behaviour includes frequent breastfeeding and sleeping for short periods in bodily contact with a parent. In the first 3 months feeding and sleeping are very closely linked – conveniently feeding releases gut-induced melatonin and promotes sleep.

As human babies have lots of brain development to do, human milk is high in sugars to facilitate this. This means that our babies must feed frequently. Compare this to the young of a sea-based mammal, for example, who have milk with very high fat content to allow their young to be left for several days while their mothers hunt for food in the ocean.

Due to this human baby immaturity mother-infant attachment is needed from birth, long before the baby develops true infant-to-mother attachment. During this time babies like to be held and carried, for their own security, as a baby can do little to overcome a potentially dangerous separation except cry to ensure they are picked up again. In the early weeks and months, this close carrying and care tends to be provided by the mother or primary care giver. As the first year progresses into the second, infants may have several attachment figures, usually including father, siblings and grandparents, depending on who has cared for them. In non-parental childcare they develop attachments to care-givers if the care is sensitive and favourable.

Robin Grille writes a reassuring article about parental guilt and postnatal depression, in which he makes the point that parenting was not supposed to be done in isolation. In the past raising small children was done as a group – long before the mother became exhausted, she was supported by other adults caring for the child. Yes, the mother breastfed and slept with her child, but she also had help and support during the days and nights.

Where does that leave us as new parents?

Unfortunately, our society has moved on and values babies who are content being placed down. This is compounded by the workload most parents face. Even whilst on maternity leave – most new mothers often have emails, social media, health appointments, expectations to be at groups and must look after either older siblings or do household chores.

Add into this mix parental exhaustion (either from pregnancy, workload, birth or the early days of baby’s life) and underlying anxieties about parenthood or a pre-existing mental health problem. It is therefore, not surprising that a young baby who can be placed down is desirable or necessary!

Babies pick up on their parents’ emotions very quickly. From a survival perspective a baby needs to be near his carer, they have no other way of protecting themselves. A baby is designed to read body language, therefore a parent who is depressed, frustrated, anxious or cross is going to induce those emotions in their baby. The baby will not know why their parent is upset; they are using an innate survival mechanism which the primitive brain is assuming is an immediate threat to the baby – i.e. an imminent attack by a sabre tooth tiger! In this situation, baby does not want to be left behind if the parents run, so by crying the baby is ensuring that they are noticed by the parent and therefore picked up and stay safe.

There are not many situations where the above scenario is true these days – however this has not altered baby behaviour. This does not mean to say that parents cannot experience or show these emotions but is does explain why baby may react as they do. When parents do feel like this – taking some time out to stop and breath, cuddle your baby and reconnect can make everyone feel better.

For many new parents their tiny babies sleep well in the first few weeks at home, and then they wake up about week 4 and decide that they will not be put down again ever! This can either go 2 ways – parents wondering what on earth they have done wrong or parents accepting this as the norm and carrying and co-sleeping with their baby. The next scenario is a parent who is happy to do this for a few weeks but then starts to become really exhausted with the relentlessness of the carrying. Some parents surrender to this and happily carry their babies’ long term, others would like to do the same, but logistics prevent them and for other parents this scenario is just not either physically, logistically or emotionally practical.

What can we do to support new parents and their babies in this situation?

Firstly, look at feeding – is the baby’s reluctance to be put down a symptom of tummy ache – does baby need to be in an upright position to be comfortable? Is frequent waking caused by either under or over feeding? This is not meant to be a piece on breast or formula feeding – but feeding and sleep cannot be separated in the first 2-3 months.

Let’s assume that baby is being fed responsively when he/she asks for it – either for nutrition or comfort. Let’s also assume that there are no breastfeeding, supply or anatomical problems which may affect feeding. Let’s assume that if bottle feeding (either formula or expressed breast milk) that baby is being fed by a paced technique where they can regulate their intake and take breaks as needed. Let’s further assume that there are no cow’s milk protein allergies or reflux in the picture. If any of the above are suspected, then a feeding assessment and/or medical review is recommended.

What does normal young baby sleep look like?

Again, this piece is not an academic essay and I will use some more accessible terminology when describing sleep cycles.  Simply put – light sleep is a term for rapid eye movement sleep (REM or more commonly known as dreaming sleep) and quiet (or deep) sleep is known as non-REM sleep. As babies mature this sleep changes and incorporates REM sleep, light sleep – stages 1 and 2 and non-REM sleep stages 3 and 4.

In the first few months babies spend the majority of their sleep time in light REM sleep. This is thought to be due to the huge amount of brain development taking place – in REM sleep there is almost double the blood flow to the brain than in quite/deep sleep. This light, rousable sleep is also thought to be protective against SIDS.

A young baby’s sleep consists of cycles of around 30-40 minutes, baby enters light sleep first then shifts to deep sleep and back to light sleep etc. As this sleep shifts are relatively simple babies find this easy to achieve. Disruption to these sleep cycles is likely when babies are in pain – for example reflux or CMPA – this is often seen as a baby who only sleeps for 20 minutes or so when placed down.

Babies do not produce their own melatonin until about 3-4 months of age, up until then the precursor of melatonin, tryptophan, is available in breastmilk. The first circadian rhythm (i.e our body rhythms over the 24-hour period) to develop in a new-born is the body temperature fluctuation which appears at 1 week of age. By 3-4 months the baby’s light/dark circadian rhythm is established. There is evidence to suggest that a baby who is exposed to 12 hours of dark, quiet and reduced stimulation and 12 hours of light, noise and daytime activities, over the 24-hour period will develop this circadian rhythm sooner than a baby who is not shown these differences.

How does this sleep change?

As babies develop over these early weeks and months, they are gradually able to spend more time awake in between sleeps. Especially around the 3-4-month period parents often feel their baby is so alert and distractible that they are unable to settle to sleep and often struggle to achieve much day-time sleep. At this stage overtiredness is often a factor as babies may not show obvious signs of being tired. In fact, an overtired baby can appear livelier as they produce adrenaline and cortisol to keep themselves going. Frustratingly overtiredness often results in more fractured and disrupted night-time sleep, therefore it is essential to consider daytime sleep when addressing night-time sleep.

Often this combination of being awake longer, being less able to calm or settle, being more distractible and being overtired, leads to a fractious fussy baby who resists being put down.

Somewhere between 3 and 6 months the baby’s sleep cycle matures into a ‘sleep architecture’ that lasts all their lives! This change in sleep pattern is extensive and often results in worse sleep for several weeks. Instead of a simple light/deep cycle, the baby’s brain is now moving in between 2 stages of deep sleep (NREM 3and 4), 2 stages of light sleep (NREM 1 and 2) and REM sleep. Each sleep cycle therefore ‘looks’ something like this; NREM1-NREM2-NREM3/4-NREM2- NREM1-REM.

The biggest change to this is the fact that babies are now going straight into deep sleep rather than drifting from light to deep sleep as they did as newborns.  These many stages can cause frequent waking as the baby is not used to this pattern and at each transition, they may wake – this is much more likely if they are overtired. When a baby is overtired, they ‘crash’ straight into the NREM3/4 and do not get to practice the changes in sleep state. Therefore, over the night period every time their brain moves into a different sleep state they wake up. When this change in sleep architecture is combined with a sleep association provided by the parent (for example feeding, rocking, cuddling etc) then every time the baby’s brain changes sleep state the parent is needed to help baby settle again.

Blog will continue in part 2 which will look at whether feeding method affects sleep, and the influence of parental factors on baby sleep.

Rachel Greaves is a midwife, public health nurse and accredited sleep coach. She volunteers at local breastfeeding support groups and works privately at Goodnight Solutions 

References

Cook. P (1997) The Species-Normal Experience for Human Infants: A Biological and Cross-Cultural Perspective. Early Child Care: Infants and Nations at Risk Melbourne: News Weekly Books. Accessed at; https://www.naturalchild.org/articles/peter_cook/ecc_ch1.html

Grille. R (2019) Parent Guilt – A Silent Epidemic. Accessed at: https://www.naturalchild.org/articles/robin_grille/parent_guilt.html

Grille. R (2019) Post Natal Depression – Mental Illness or Natural Reaction? Accessed at; https://www.naturalchild.org/articles/robin_grille/post_natal_depression.html