Sleep Feeding: Questions and Answers

Gastroesophageal Reflux Disease may lead to a variety of eating and sleep patterns in infants and toddlers. A HealthCentral member named Amy D started a lively discussion on feeding an infant with reflux while sleeping. She wanted to know if she was the only one on the night shift since her son will only eat when he is drowsy or sleeping. It turns out there were many other reflux moms and dads all over the world feeding their hurting babies at night. I consulted a physician and several feeding experts to bring you as much information as possible about Sleep Feeding.

What is Sleep Feeding?

Sleep Feeding is the term used to describe feeding a drowsy or sleeping infant. Sleep feeding may also be referred to as Dream Feeding.

How Does Sleep Feeding Work?

Most newborns begin a feeding in an alert state and gradually become drowsy and end the feeding in a light sleep. Suzanne Evans Morris, Ph.D., founder and director of New Visions (www.new-vis.com) stated, “When we begin to fall asleep, brain waves slow down and alert brain function decreases. The area of the brain that supports automatic, rhythmical sucking and swallowing remains active and strong at first, and then decreases as the baby moves to a deeper sleep.” In addition, research has shown that swallowing decreases during sleep compared to when awake.

While sleep feeding may be a natural process in the newborn period, a parent may use sleep feeding to encourage a young infant to sleep through the night or decrease the number of night feedings. This is a parent driven process with the parent offering the bottle or breast to her sleeping infant just before going to bed. It is hoped that this late night feeding, sometimes referred to as a “top off feeding” will decrease night time hunger. A baby who is moving from a 24 hour feeding schedule to a daytime only schedule may adjust with short term sleep feeding during the transition.

Why is my Baby Sleep Feeding?

While it is common for a newborn to become drowsy during a feeding, an older baby is typically alert and engaged. A small group of babies with GERD may demonstrate a less common pattern and need to be drowsy or asleep to accept a feeding. I asked a physician and a speech therapist why some babies are unable to eat by day. Certainly there are many reasons why a baby won’t eat while awake with pain from a chronic condition such as reflux high on the list.

Other reasons for Sleep Feeding include:

• Illness (respiratory, throat, thrush)
• Milk allergy/intolerance
• Sensory
• Feeding/swallowing difficulties
• Behavioral
• Combination of behavioral and medical reasons

What Does Sleep Feeding Look Like?

An infant with GERD often experiences pain and discomfort during or after a meal. Day after day, the discomfort leads to changes in the way caretakers and infants approach feeding.

Parents describe sleep feeding their baby with GERD:

• “I have to wait until he is asleep to feed him.”
• “When I lean her back in my arm to give her the bottle she cries.”
• “If I show him the bottle, he turns away and arches his back.”
• “When he is almost asleep, I can slip the bottle in his mouth for the feeding. “
• “It is getting harder and harder to feed him now that he naps less during the day. “

A sensitive caretaker will go to great lengths to read the baby’s cues to increase her comfort during mealtime. Some infants are over stimulated by light and sound and feed better in a dark, quiet environment. A sensitive caretaker who is tuned into the needs of her baby may naturally manipulate the feeding environment to decrease stimulation and move toward sleep feeding. Swaddling, rocking, darkening the room and decreasing noise are all ways for a caretaker to decrease stimulation and discomfort during a feeding. A caretaker may try a variety of formulas, bottles and feeding positions before stumbling on sleep feeding as a way to provide nourishment while decreasing pain with eating. It is thought that sleep feeding helps some babies with reflux by turning off the pain during light sleep and allowing the baby to accept nourishment. Perhaps the light sleep slows down the pace of eating for a baby who is struggling to eat due to pain and other issues. Just as a child with reflux is instructed to eat slowly and chew carefully, the slowed pace of sucking and reduced swallowing while drowsy may be a feeding pattern that is well tolerated by a baby with reflux.

Next week: Is Sleep Feeding Harmful?