Over the past few weeks I’ve had several questions from parents on a problem referred to as sleep feeding. What is it? Why do babies do it? What can I do about it? And (perhaps the most interesting issue) where did this problem come from? Here’s my take. And I’ll modify this over time as I learn more.
What is sleep feeding?
Quite simply, sleep feeding is a popular term used to describe babies who feed nearly exclusively when asleep. Better put, these are babies who have such a difficult time feeding when awake that their sleep state appears to relax them to the point that they are more organized and able to feed. Parents are consequently forced to put their baby to sleep in order to help them maintain their intake. Mention of the problem in our current body of medical literature is scarce, if not absent.
But while the popular discussion of sleep feeding is new, the problem is not. I describe the phenomenon of sleep feeding in my 2007 book, Colic Solved – The Essential Guide to Infant Reflux and the Care of Your Crying, Difficult-to-Soothe Baby (see page 46). And over the past 10 years I’ve evaluated and treated many babies with sleep feeding.
Most babies I have seen with sleep feeding represent variants where some feeding can be completed while awake but only with a great deal of effort.
What causes sleep feeding?
As someone who has made a living evaluating feeding and digestive disorders in babies, I have found that the vast majority of infants with sleep feeding in my practice suffer with symptoms of acid reflux. Here’s what happens:
1. Babies with their recumbent posture, poor gastric emptying, loose lower esophageal sphincters and liquid diets are naturally prone to reflux. Those with significant reflux sustain inflammation or irritation in the swallowing tube (esophagus).
2. Painful esophageal inflammation leads to painful feeding marked by frequent pulling from the bottle or nipple.
3. If not treated, babies continue to struggle to feed and potentially develop an aversion to feeding.
4. Parents discover that feeding goes better when sleeping and the pattern is facilitated in order to maintain appropriate milk intake.
Another problem that can predispose to a pattern of sleep feeding in babies is milk protein allergy. Allergy can create inflammation just like that seen with acid reflux. And while we always have to consider anatomic problems in any baby with feeding issues, those with anatomic issues in the throat or swallowing tube are unlikely to feed any better when asleep. In other words, the plumbing won’t change with state of arousal.
It’s important to look beyond the pattern of feeding while asleep in order to identify what’s behind an infant’s feeding issue. In other words, the nature and pattern of feeding while awake often offers clues to the presence of reflux esophagitis in a baby. And the same is true for allergic inflammation in the gut. Other signs and symptoms as detailed in my book will help identify the baby with subtle signs of reflux or painful feeding.
In theory, any condition that interferes with smooth, comfortable feeding could lead a parent to help a baby develop sleep feeding. Consequently acid reflux should not be assumed to be the primary problem. It needs to be diagnosed based on clinical criteria.
What can parents do with a sleep feeding baby?
It’s important for parents to understand that sleep feeding appears to be a reactive phenomenon rather than a primary problem or condition. In other words, feeding during sleep is a pattern that develops out of necessity in a child with an issue that prevents effective feeding while awake. What’s the primary issue? Consequently our attention needs to be on identifying what’s going on to create such problematic feeding. This is not an issue that you can resolve on the Internet or through the advice of others in a chat room. While support is critical, a hands-on assessment by a trained expert is critical.
Here are a few things to keep in mind when getting help for your baby:
· Look and treat. Look for and treat conditions that predispose to painful or difficult feeding. Acid reflux and allergy need to be firmly excluded.
· Enlist an expert. If acid reflux has been firmly excluded, consider an assessment by a pediatric speech pathologist or occupational therapist experienced in infant feeding. Two things are critical here: pediatric specialization and infant feeding experience. You want to find a therapist who spends all of their time with children and has extensive clinical experience in infant feeding disorders. If you live in a small community, seeking the input of a speech pathologist or OT who dabbles in children may be a waste of time. Beat a path to the nearest city with pediatric services. If your pediatrician isn’t immediately comfortable assessing your baby look for consultation with a pediatric gastroenterologist.
· Simple feeding difficulty or long standing aversion? Recognize that when a baby’s primary feeding problem is identified and treated early, normal patterns of eating while awake can often be resumed. The baby older than 5-6 months of age, however, may potentially have aversive behaviors that persist long after the primary problem has been addressed. This mandates therapy by a professional experienced in infant feeding therapy.
· Never force feed. While tempting, force feeding a baby with an underlying feeding issue is likely to compound the stress, fear and anxiety already associated with the bottle or breast.
Why are parents talking about sleep feeding?
This is possibly the most interesting question surrounding the sleep feeding phenomenon. Why wasn’t anyone talking about this last year, for example. Is this some sort of new issue? A modern epidemic perhaps? Hardly. As I mentioned, sleep feeding has been around as long as reflux has plagued babies. The current discussion is just one step in the sequence of recognizing the problem of reflux in babies.
It’s interesting to note that “sleep feeding” or “dream feeding” as a concept has become popularized recently due to social networking – Chat rooms and other forms of social media are allowing mothers with sleep feeding babies to share their experiences and recognize that their baby’s unusual behavior may not be that unusual. This is a clear example of how e-patients empower themselves and actually get answers.
Should your pediatrician know about sleep feeding?
I would have to say that as someone who takes referrals from 200-300 well-trained pediatricians, knowledge about sleep feeding and its relationship to acid reflux disease is not standard. Remember that acid reflux disease in infancy and childhood is still a relatively new concept. And considering that this phenomenon hasn’t been reported in the medical literature I wouldn’t expect it to be in the minds of primary care physicians. Keep in mind, however, that there remain physicians in practice who don’t believe that acid reflux disease is much of a concern in children. This is one more reason to be informed.
Most babies suffering with sleep feeding will typically demonstrate other signs of reflux or allergy. But bringing these issues to the forefront during a doctor’s visit is more likely to result in intervention and appropriate treatment.
Help me to help you
If your baby is a sleep feeder I would love to hear from you. While I can’t offer medical advice, our discussion will help me learn about the patterns of sleep feeding encountered by parents. Email colic1 at mac dot com.