Sleeping Patterns for Babies

My four month old won't sleep through the night. Should I introduce solids?

Introducing solids will not consolidate infant sleep patterns and should not be introduced until around six months of age1,2. Night time feeding is necessary to refill the infant’s small stomach, but also to drain the mother’s breasts of milk and ensure adequate milk supply3. Infant sleep patterns are ever changing and extremely variable from one baby to the next2,3. New mothers can expect their baby to awaken and require feeding throughout the night for up to one year3. Identifiable sleep patterns do not begin to develop clearly until five to six months, at which time parents may begin to notice longer duration nocturnal sleeps2. However, most infants do not begin sleeping for prolonged periods until around 7 months or older, and even then, night-time sleep patterns have not been found to follow a normal curve until at least 10 months, which demonstrates the unpredictable nature of sleep patterns in young infants2.

The majority of mothers introduce solids for reasons they incorrectly perceive as infant readiness4. It is extremely common for mothers to prematurely introduce solids because they believe their baby is hungry or wants something other than milk; the baby may show interest in food that the mother is eating, or the mother may believe that her baby will sleep longer if fed solids4-6. None of these signs indicate readiness for solid introduction4-6. Look instead for good head and neck control and the ability to sit upright unsupported, grasp food and bring it to their mouth6. Infants who are ready to start solids will no longer exhibit the extrusion reflex; if your baby’s tongue immediately pushes food out of their mouth, this is a sign that they are not yet able to safely swallow solids4-6. External factors have also been found to influence the early introduction of solids, where mothers receive pressure from others or gain the misconception that early introduction will reduce the risk of food rejection and allergies4.

Exclusive breastfeeding up to six months of age has a positive impact on cognitive development and lowers the risk of chronic illness1,3,6. In contrast, early introduction of solids significantly increases the risk of gastrointestinal and respiratory conditions, middle ear infections and allergies5,6. Early initiation of solid feeding interferes with the infant’s self-controlled hunger mechanism and inhibits breastfeeding, increasing the likelihood of early breastfeeding cessation6. Parental control of infant energy intake is associated with increased weight gain and obesity risk6.

Current Australian guidelines advise exclusive breastfeeding until around six months of age, when solid foods should be introduced alongside continued breastfeeding1,3,5. At six months of age, infant stores of specific nutrients such as iron and zinc become depleted and breastmilk can no longer satisfy appetite or nutritional needs6. Infant feeding behaviour transitions from sucking to chewing with the loss of the tongue-thrust reflex and maturation of the digestive tract enables starch digestion6. Sleep pattern consolidation does not begin to occur until five to six months of age and babies should not be expected to sleep through the night for the first 12 months of life2,3.

  1. Mindell JA, Leichman ES, Composto J, Lee C, Bhullar B, Walters BM. Development of infant and toddler sleep patterns: real-world data from mobile application. J Sleep Res [internet]. 2016 Oct [cited 2017 Mar 23];25(5):508-16. Available from: http://onlinelibrary.wiley.com/doi/10.1111/jsr.12414/full
  2. Brown A, Rowan H. Maternal and infant factors associated with reasons for introducing solid foods. Mat Child Nutr [internet]. 2016 Jul [cited 2017 Mar 23];12(3):500-15. Available from: http://onlinelibrary.wiley.com/doi/10.1111/mcn.12166/full
  3. The Department of Health. DH Website [internet]. Canberra: DH, 2017 [cited 2017 Mar 22]. Available from: http://www.health.gov.au
  4. Scott JA, Binns CW, Graham KI, Oddy WH. Predictors of the early introduction of solid foods in infants: results of a cohort study. BMC Pediatr [internet]. 2009 Sep 22 [cited 2017 Mar 23];9(1):60-8. Available from: http://bmcpediatr.biomedcentral.com/articles/10.1186/1471-2431-9-60
  5. Kronborg H, Foverskov E, Vaeth M. Predictors for early introduction of solid food among Danish mothers and infants: an observational study. BMC Pediatr [internet]. 2014 Oct 1 [cited 2017 Mar 23];14(1):243-52. Available from: http://www.biomedcentral.com/1471-2431/14/243
  6. National Health and Medical Research Council. Infant feeding guidelines: information for health workers [internet]. Canberra: NHMRC; 2013 [cited 2017 Mar 23]. Available from: https://www.nhmrc.gov.au/_files_nhmrc/file/publications/170131_n56_infant_feeding_guidelines.pdf