Expert: Sally Wendkos Olds - 9/27/2010

Question
QUESTION: Dear Sally i am a mother of 3 month old boy (breastfeeding
only), one month ago my baby was sleeping through the night
about 9 hours without breastfeeding and i was so happy , but
few days ago he started to wake up to nurse, but only once
after 6 hours of sleep , i am not disturbed by this new
pattern but i am afraid that will last more and more
especially that i planned to breastfeed him for 2 years. so
When is the best time to stop night breast feedings and how
? , Cos i have 4 years old daughter and she was sleeping
through the night for 8 hours since she was 2 month and
continued so and i breast fed her for 2 years.in advanced
thank you so much ..

ANSWER: Dear Rasha,

First, congratulations for giving your children the best start in life by breastfeeding them!

As you have already discovered, no two babies are the same. Your son's breastfeeding pattern may be different from your daughter's, but you can still continue to breastfeed him for 2 years if you want to. There is no one time when a baby should stop night feedings. Many babies wake up for night feedings when they are 6 months old, or even older. Much depends on the baby and on the sleeping arrangements. Babies who sleep with their parents tend to wake up at night more often.

I would suggest that you don't try to stop the night feedings until your son goes for about 5 to 6 hours during the day without nursing.

I am attaching an excerpt from my book (see below) with suggestions for stopping night feedings. I hope some of them will be helpful.

Good luck!

Sally
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Sally Wendkos Olds
Author, THE COMPLETE BOOK OF BREASTFEEDING: Olds & Marks, 4th edition, September 2010, published by Workman Publishing, and soon available in most public libraries, bookstores & La Leche League chapters.
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Sleep and Lack of It: Night Feedings
It’s the middle of the night, and everyone, including the family dog, is sleeping peacefully. Everyone, that is, except your new baby, whose lusty bawling pierces your sleep. You wonder when that happy day will come when you can once again know a night of uninterrupted sleep. Hard to say.
  The age at which babies stop waking for night feedings seems to be an individual characteristic unrelated to size at birth, weight gain afterward, the amount of food eaten in a day, or whether this food comes from breast, bottle, or jar. Babies seem to be born with differing needs for sleeping and eating. While the average newborn sleeps about sixteen hours a day, one healthy baby may sleep only eleven hours, while another sleeps twenty-one. After three months babies become more wakeful in late afternoon and early evening, and by six months more than half their sleep takes place at night.
  An occasional baby gives up middle-of-the-night feedings as early as six weeks; many give it up at about three months; and many others need it for a few months longer. In the early weeks you need those night feedings as much as your baby does, so that your breasts will continue to be well stimulated and will not become engorged and uncomfortable by morning.
  Night feedings are easier if you don’t bother changing the baby’s diapers unless he’s absolutely drenched or seems uncomfortable. If a diaper change is necessary, your partner can do this. Meanwhile, you’ll be getting your rest.
It’s best to take your baby off the breast as soon as she falls asleep, since letting an infant sleep on the nipple (even yours!) may cause dental cavities. Saliva does not flow as well at night and cannot wash away bacteria in the mouth. This is, of course, especially important for babies whose teeth have started to erupt. There’s a good argument also for taking your baby off the breast when he’s sleepy but not completely asleep. If you do this with at least some feedings, day and night, you will help him learn to fall asleep without needing to nurse, so that when he’s older he’ll be able to go to sleep on his own.
If your baby is sleeping in your room, you’ll probably hear many sounds from her throughout the night, including little snuffles and whimpers, the equivalent of an adult’s talking in our sleep. If she is really awake and wanting food, you’ll want to nurse her before she cries in earnest, but if she seems to be making these little sounds in her sleep, you can wait until she wakes before you put her to the breast.
  Gradually your baby will go longer between night feedings until one morning you’ll wake up after sleeping for five or six hours, breasts full, wondering what’s the matter and dashing to your baby’s side. Nothing is wrong; your baby has just slept through the night for the first time.
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Encouraging a Baby to Give Up Nighttime Nursing
If you don’t really mind getting up at night, there’s no age by which your baby has to sleep through, so you can just wait until he gives up night feedings himself—and try to catch up on your own sleep by scheduling a nap during the day.
  But if your doctor says your baby is growing well, if he is nursing often and well during the day, if he’s at least twelve weeks old, so your milk supply is well established, and if getting up with him leaves you exhausted and irritable, you may be able to encourage him to sleep for longer stretches at night. (Some anthropologists say that human beings in various cultures regularly sleep in two shifts, with an hour or two of wakefulness in the middle. Seems that young babies have read these textbooks.)
Still, if you want your family, young and old, to follow the typical western sleep schedule, sometimes one of the following will help:
• Try nursing later at night, maybe at midnight, to see whether this will hold your baby till early morning.
• Let your baby fuss (not scream) for five or ten minutes when he wakes during the night; if he’s not too hungry, he may go back to sleep.
• If your baby sleeps in a separate bed, let your partner go to comfort the baby, maybe by rubbing or patting her back or speaking softly to her. From a very early age, your baby associates your looks and your smell with feeding. If you go to her side, she’ll expect to nurse. This is why the father or someone else is often more successful in getting her back to sleep.
* One mom I know stayed in a hotel room for 3 nights while the baby's father and grandmother took care of him. By the time she came back to sleep at home, he wasn't waking at night any more.
* If the baby cries when you leave, go back every few minutes so he can be reassured by your (or your partner’s) presence. If you sit with the baby in the room, stay quiet and look away so he won’t think it’s playtime.
• If your baby is on a “night shift,” sleeping during the day and up a lot at night, reorient him by waking him up and nursing him every two to three hours during the day, and keeping him awake by taking him out, bathing him, playing with him, or sitting him in an infant seat where he can see interesting things and people.
* You might also teach your baby day from night by keeping the lights on during the day, even during naptime, and not making an effort to be quiet.
• Although some parents feed their babies solid foods in the belief that this will help them go longer between nursings at night, there’s no evidence that this does any good. The AAP recommends breast milk alone for six months, but some pediatricians do suggest starting solid foods at about four months, depending on individual needs. (Suggestions for starting solids are given in Chapter 18.)
• Offer a pacifier, if your milk supply is well established and your baby is at least six to eight weeks old.  



---------- FOLLOW-UP ----------

QUESTION: Dear Sally thank you for helping ,i followed your advice and
breast fed my baby at midnight while he is sleeping and he
stopped wakening me at 3 am ,but now my baby started to
sleep all night now , starting 7:30 PM till 6:30 AM , but
the problem now is engorged breasts , and my question is (is
my body able to adopt this pattern - breastfeeding every two
hours during the day then no breastfeeding all night long? ,
or should i keep feeding him before i go to sleep at
midnight while he is sleeping  until he is on solid food at
6 month old ... now he is 3 month 11 days..Really i am so
thankful for your help ..thank you ..

Answer
Dear Rasha,

I'm really happy to hear that your baby is sleeping through the night -- that's a wonderful milestone for parents.

Your breasts will adapt to this new schedule. However, I would suggest that you try to stretch out your son's feedings during the day, from every 2 hours to every 3 hours if you and he can manage it. Until your body does adapt, you can express just a little bit of milk from your breasts when they become engorged, so you'll be more comfortable. I'm attaching another excerpt from my book, on dealing with engorgement. Hope these suggestions help.

I'm coming to Germany myself on Oct. 3. My daughter, who lives in Hunfelden, will be in Berlin taking part in a piano competition, so I'll be there to cheer her on. She nursed all 3 of her children.

Good luck!

Sally
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Sally Wendkos Olds
Author, THE COMPLETE BOOK OF BREASTFEEDING: Olds & Marks, 4th edition, September 2010, published by Workman Publishing, and soon available in most public libraries, bookstores & La Leche League chapters.

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Ways to Relieve Engorgement
The most important and effective way to relieve engorgement is to remove as much milk as possible from your breasts, as frequently as possible, either by nursing your baby often or by using a good breast pump. Some of the following remedies may help.
• Feed your baby frequently, eight to twelve times in a twenty-four-hour period in the first few days after birth, even if you have to wake her to nurse.
• Express or pump a little bit of milk just before feedings to soften your breasts and make the nipple easier for your baby to latch onto.
* The technique of reverse pressure softening (RPS) is sometimes helpful in the first two weeks postpartum using gentle pressure to relieve some of the congestion in the breasts. Ask your lactation specialist to teach you how to do this.
• If your breasts are severely engorged, massage them once or twice a day before feeding, starting gently at the outer edges with your fingertips and going toward the nipple area. A mild cream may make the process easier, but don’t get any on the areola, because that would make it harder for you to express milk. It may help to do the massage in the shower.
• Apply warm, moist compresses about ten or fifteen minutes before a feeding (and before a massage). Between feedings, apply cold compresses. The warm compresses aid the let-down reflex, and the cold packs relieve swelling and pain. Apply cold in an ice pack, a bag of frozen vegetables, or a blue freezer pack wrapped in a thin towel. Apply heat in a moist-heat pad, a small hot water bottle wrapped in a towel, a towel soaked in hot water, or in a hot shower. If you use a heating pad, be very careful not to burn your skin.
 • Wear a firm bra for support. Be sure it’s not too tight, since this can make you more uncomfortable and also cause other problems. If you use breast shields (see below), wear a bra that has enough room to insert the shields. Try taking off your bra while you’re nursing, to be sure it’s not constricting your milk ducts.
• Apply fresh cabbage leaves to your breasts. This simple home remedy seems to help some women. Pull two outer leaves from an ordinary head of cabbage, strip out the large vein in each leaf (or alternately, leave this in and crush the leaf as if you were crumpling paper into a ball). Then cut a hole for your nipple and wash the leaf to get rid of any chemical residue. Chill them for about ten minutes if you want to. Then wrap the leaves around the irritated areas of your breasts. They’re convenient, cheap, not injurious, and disposable, and some women report that they relieve pain. You might try it if you don’t mind staining your bra—and smelling like dinner.
• Wear a silicone breast shield (also known as a milk cup, breast shell, or Woolwich shield) inside your bra for 30 minutes before feedings to soften your areola and bring out your nipple.
• If you cannot breastfeed right after childbirth, express or pump your milk until you’ll be able to nurse your baby. An electric pump is easiest and most efficient (see Chapter 11).
• Take a pain reliever—either one of the over-the-counter agents listed in the box on page tk (Chap. 10), or something your doctor can prescribe that will not affect your baby or your milk.
• If only one breast is engorged because your baby is consistently not suckling from it, this may be a sign of a possibly serious medical problem. To rule this out, see your obstetrician.