As sleep consultants we rarely advise on nutritional problems and always refer our clients to registered dieticians when we do pick up on problems as we are sleep experts after all and NOT feeding experts. However, when we’re working together with parents who have smaller babies, we always address the feeding issue before addressing the sleep.
When it comes to sleep and nutrition though, it can often be a chicken-or-the-egg scenario: If baby does not sleep well it can affect their feeding and if baby does not feed/eat well it can affect their sleep. I have compiled a list of warning signs we look for regarding feeding issues, as these can have a major impact on sleep.
- Newborns (0 – 3 months)
Newborns will still drink milk at night. They are small, their stomachs are tiny and thus they cannot take large feeds and will wake up regularly to feed. A newborn’s sleep is regulated by hunger, and most of the time when they wake up at night you can assume, they are hungry (of course cramps, winds, reflux etc. can also impact their sleep patterns). If a newborn is struggling with feeding, I can almost guarantee that they will struggle with sleeping. To improve sleeping at this age it is critical to work on baby’s feeding, ensuring that the child is feeding well and taking proper feeds. Babies during the day should not go longer than 3 hours without a feed. Wake your baby even if it is just to feed. If you miss a feed during the day, your baby will make that feed up within the next 24 hours, and that is usually then at night. As for the night, speak to your health care professional about when it is no longer needed to wake your baby up at night to feed.
- 4 – 6 months
The World Health Organisation and the American Academy of Pediatrics recommends exclusively breastfeeding until six months, and we agree with these recommendations. This will ensure the full health benefits of breast-feeding. Most health experts would advise though that just like any other milestones some are ready earlier and some later, and most babies show signs of readiness between 4 and 6 months to start on solids. A parent should remember to never start solids before 17 weeks or after 26 weeks in healthy, full term babies. Your baby has to be developmentally and physically ready to start solids foods and should show signs of readiness. There are risks to both starting solids too late and too early. It is important though to start with protein by 6 months. Babies have a reserve of iron which they receive from their mother’s blood while they’re in the womb. Waiting too long after 6 months to introduce foods (especially protein which includes iron), increases your baby’s risk of iron deficiency. Iron is needed to create haemoglobin, which in turn helps carry oxygen throughout the body. This is also important for restful, good quality sleep. Thus we recommend including protein from 6 months at the latest.
- 6 – 8 months
During this time parents can now move from introduction to exploration with food, and it can be difficult to get the balance between solids and milk right. This can mean that a baby (healthy and full term) might still take an early morning feed at night. Milk is the most important source of nutrients up until 12 months, thus we recommend that you fill baby up with milk and top up with solids. Don’t compromise on milk to increase solids. We usually keep a night feed to start with and give baby a chance to naturally push out the feed at night.
- 9 – 12 months
Very seldom do healthy full-term babies still require a night feeding at this age. During this time is important to have a variety of foods, including iron rich foods during the day.
- Toddlers (12 – 24 months)
After 12 months solids become the most important source of nutrients and with healthy toddlers, any milk feed at night can do more harm than good. Milk at night can fill them up, thereby reducing the amount of solids they eat during the day and increasing their risk of iron deficiency and obesity.
More often than not sorting out sleep and nutrition is done in combination but when we see that either or neither are improving after a week, we recommend that parents discuss these challenges with a dietician who specialises in infant or toddler feeding to ensure the feeding issues are successfully dealt with first.