See Jan’s sleep feeding question and answer from last week more information on sleep feeding.
Sleep feeding (also known as Dream Feeding) is not harmful when it is used as a short term feeding method for a baby who experiences pain and discomfort from eating due to Gastroesophageal Reflux Disease (GERD). Many parents and physicians agree that sleep feeding allows a baby in pain to receive nourishment, stay hydrated and gain weight. At the same time, every attempt should be made to determine why a baby is unable to eat when awake and alert. "It is developmentally necessary for the baby to process hunger and satiety." states Joan Dietrich Comrie, M.S., CCC-SLP of Carolina Pediatric Dysphagia (www.feeding.com). "Dream Feeding takes this process away. Parents need to discuss this with their pediatrician or medical team so further evaluation or treatment by a feeding specialist can be completed if necessary."
I am not aware of any research on Sleep Feeding but it seems possible that night feedings, when the stomach is full and the baby is reclined may set up a chain reaction resulting in a worsening of GERD symptoms. During sleep, the Lower Esophageal Sphincter is most relaxed and there is less saliva production/swallowing to wash away the acid so a full stomach may lead to more reflux episodes at night.
When a parent tells me the baby is sleep feeding, I urge them to seek assistance from the doctor right away. Sleep feeding may lead to poor intake of fluids and a minor illness such as a stomach virus or sore throat may lead to dehydration. In rare cases, sleep feeding escalates into a full feeding strike where the baby refuses to take any nourishment by mouth. Always check with the doctor or go to the emergency department if your baby is drinking less than expected or is showing signs of dehydration.
What Does the Doctor Need to Know?
You will need to clearly describe the feeding pattern to the doctor. It isn’t enough to say that you are exhausted from night feeding. Doctors are used to seeing a mother with dark circles under her eyes from caring for a baby. Your doctor needs to know that the weight gain and other signs of health are attributed to your extraordinary efforts to feed your baby. It might be necessary to keep a journal for a few days so the doctor can see the pattern of eating during naps and night time when your baby is more likely to be in a light sleep. Otherwise, your doctor will look at your growing baby and assume there isn’t a problem with eating.
Some doctors will look at the feeding pattern and assume you have not done your job as a parent to take control over the night and "teach" you baby to eat by day. You may need to advocate for you baby and describe other signs of distress about feeding and digestion such as fussing and crying during and after feeding or turning away from the bottle. I know one mom who brought the bottle to the doctor’s appointment. The doctor was not very concerned about her description of the feeding problem until she pulled the bottle out of the diaper bag and showed it to her baby who reacted by crying and turning away.
The doctor will work with you to determine the reason for the feeding pattern based on the history, symptoms and pattern of growth. It may be necessary to have additional testing or schedule an appointment with a Pediatric Gastroenterologist or a feeding specialist. Once a treatment plan is in place, it may take weeks or months to see improvement. Sleep feeding may have started as a reaction to the pain from acid reflux and escalated into a behavioral response to eating. The memory of pain may linger in the form of disinterest or anxiety about eating. It can be challenging for parents and professionals to sort out the cause and effect.
I’m Exhausted. How can I cope with Sleep Feeding?
While you are working with the medical team to determine the cause and treatments for Sleep Feeding, you will still be on the night shift for a while longer. Most parents report they are desperate for their baby to get sleepy so they can provide a feeding. Once the baby gets older and naps are less frequent, you may feel anxious about getting enough calories and ounces in. It may be necessary to feed an older infant every few hours at night if she only naps 1-3 times each day.
Be sure to ask for assistance from a family member or friend since fatigue and stress are common reactions to caretaking when you are Sleep Feeding. If you are fortunate enough to have the financial resources to hire help, you are encouraged to find a babysitter or nanny for the weeks or months when Sleep Feeding is the bridge to awake feeding.
Part 3 Sleep Feeding: Treatment Options