Sleep Training
After you pass peak colic in the 4-6 week range, you have a little more parenting experience under your belt. That said, people often expect things to settle into a regular “schedule,” which isn’t always realistic. I tell patients that breastfeeding is good preparation for parenthood, since no two days (or even half days) are necessarily the same. Sometimes, it is one step forward and two steps back.
Some parents who are at risk for or suffering from perinatal mood and anxiety disorders need solid nights of sleep to protect their mental health. I always tell patients that mental health is the top priority, because no baby will get breastmilk if it doesn’t have a mom to give it. Often, as a consequence of mom getting the sleep she needs and being in an emotionally healthy place, breastfeeding also becomes easier. And if it doesn’t, then mom is often in a better frame of mind to grieve appropriately or see the “grey” rather than “black and white.” For example, in the setting of low milk production, moms with a healthy mental outlook may wish to continue to pump some breastmilk as their infant receives supplemental formula rather than feeling defeated that they could not exclusively breastfeed. Or, they may feel comfortable stopping without feeling guilty or ashamed.
If you want to sleep train an infant before six months of age (i.e. “train” the infant to sleep longer stretches than he is sleeping naturally on his own) and you want to continue breastfeeding, you need to be careful about your own milk production. Prolactin (the milk-making hormone) peaks overnight, and a baby feeding overnight tells the body to keep making larger volumes of milk. Moms are at risk of early return of their period while breastfeeding if they aren’t feeding overnight. This can not only lead to a dramatic drop in milk production (particularly the week before mom actually bleeds), but it also may lead to unintended early pregnancy (which decreases milk production even more). Therefore, if you need to sleep train for your mental health, you should have a plan in place to stimulate your milk production (such as galactagogues and pumping right before you go to sleep after you feed baby).
If moms and infants are completely in sync (i.e. baby starts to stretch out sleep naturally), it is ok for mom to let her breasts remain full for longer periods of time. Most often, these babies who naturally stretch out sleep like this have a mom with quite a bit of milk (even oversupply or hyperlactation) and they are gaining weight very well. They will feed more frequently during the day to make up for the lack of nighttime feedings.
Four-Month Developmental Leap
Babies start to get extremely distracted with daytime eating around four months of age. Sometimes this starts earlier, at 2-3 months. This is commonly called the “four month sleep regression.” It’s actually a developmental leap, not a regression. Babies are becoming more curious about their environment, and are getting ready to sit up and do more motor activities. They may only nurse during the day at times when they are sleepy (e.g around nap times or wake up in morning), and may nurse for shorter periods of time.
These babies often make up for their lack of daytime calories by feeding more frequently at night. This developmental process and nature’s way of maintaining a mom’s milk production can be interrupted by early sleep training. Again, if parents need sleep for mental health, that is priority. However, if it is less necessary, it is best to follow baby’s cues and feed on demand. This means not forcing a distracted baby to feed during the day (he will become very angry and “refuse” the breast) and allowing a baby to have access to the breast at night.
Weight Gain
The American adage is “an ounce a day keeps the doctor away” in terms of weight gain up to three months old. The World Health Organization goals is 20-30 grams per day (30 grams = one ounce).
This is a guideline for good weight gain, and there may be individual variation. The entire picture and overall trends should be considered and not just a number or percentage on the scale.
For example, babies with moms who had initial hyperlactation that leveled off over several months may have had early supranormal weight gain. They may appear to then drop percentage points at a four or six-month pediatric visit. However, the mom’s milk production variation should be taken into account as well as the baby’s overall health.
If a pediatrician suggests pumping to give an additional bottle, moms with previous hyperlactation should be cautious as they can often shift back into oversupply mode and experience later onset mastitis and plugging. Other examples of variation in weight gain include infants who start crawling very early and therefore burn more calories from activity than sedentary babies of the same age.
If mom has ample or appropriate milk production, you can’t go wrong with feeding the baby on demand and seeing the baby swallow and be satisfied after the feed.
Early Solids
While some pediatricians will discuss starting solids at 4-6 months, this is not recommended by the World Health Organization (WHO). The WHO, a neutral body that does not accept formula funding like many other infant health organizations, recommends exclusive breastfeeding for six months. Early solids increase the risk for gastrointestinal and respiratory infections.
Further, babies do not have the coordination before six months to feed themselves and require spooning and pureed feeds. These early solids decrease the baby’s interest in breastfeeding after they are already starting to feed less during the day. It can take a mother/baby dyad with a balance or even a lower end of supply for breastmilk and tip the scales to need to start supplementing with formula.
