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Sleep and the Breastfeeding Baby Eyla Boies MD, FAAP Up to 50% of parents seek professional help regarding sleep problems with their children.1 Sleep issues are especially troublesome for the new parents and breastfeeding may add to the complexity of sleep in the newborn infant. The following case typifies “sleep issues” parents bring to me every day. Case: Mr. and Mrs. Perlman are seen with their 10 day old infant, Sarah, for her second outpatient visit. Sarah was full term and all appears to be doing well. Sarah is breastfeeding exclusively and is now four ounces over birth weight and on exam she appears alert and vigorous. When I ask about sleep the picture is not so rosy. Whenever her parents try to put her in the bassinette by their bed after breastfeeding, she immediately wakes and starts to cry even though she appeared to be sleeping soundly in their arms before putting her down. Mom and dad look exhausted and are at a loss as to how to proceed. Mrs. Perlman had hoped to exclusively breastfeed for six months but she wonders if she should give formula before she puts Sarah down, because her mother told her formula fed babies sleep better than breastfed ones. When asked how they made it through last night, dad explains that he and his wife took turns holding Sarah on their chest while sitting in a big soft chair where they could rest while holding her. They are tempted to put Sarah in bed with them so they could all get more sleep, but they know the American Academy of Pediatrics (AAP) specifically advises against this practice due to the increased risk of Sudden Infant Death Syndrome (SIDS) if a child sleeps in the same bed as the parent. As I listen to Mr. and Mrs. Perlman, I consider what is known about infant sleep, especially safe sleep in the context of breastfeeding. The Perlmans and I are in a difficult position because even though |
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there has been an explosion of information about infant sleep in the last 15 years, there is much controversy and contradictory information. Polygraphic studies have shown that newborns have very little deep stage III or IV sleep. They transition into REM sleep immediately and spend about 50% of their sleep time in REM sleep and the rest in a light sleep equivalent to Stage I or II in adults. By about four months of age infants have deeper sleep states resembling adult stages III and IV; stages from which arousal is more difficult. Infant breathing patterns and heart rate are dependent upon sleep or state of arousal. Some experts feel the lack of deep sleep in early infancy protects against SIDS. Interestingly, the peak incidence of SIDS occurs in infants is three to four months of age presumably when they are developing deeper sleep states. It is no wonder that Sarah awakens when put in the bassinette, considering she is almost certainly in a light sleep state and has spent the last nine months in direct contact with her mother surrounded by her heart beat, respiratory patterns, and other sensory outputs. She needs the proximity of her mother to transition to a sleep state and to maintain that state. I then consider some of the compelling work of Meredith Small, an anthropologist, who examined sleeping practices of parents and children around the world and of many different cultures where almost all infants sleep with an adult in the same bed (46%) or in the same room but different sleeping surface (21%).2 These cultures generally have a lower rate of SIDS than industrialized countries such as the US. Until the last decade the standard American practice recommended by pediatricians was to put an infant to sleep in a |
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Sleep and the Breastfeeding Baby |