PC2023: Breastfeeding During Naptime and Bedtime Routines During Infancy and Toddlerhood

Background: Feeding is a common component of sleep routines for infants and toddlers. Despite the established benefits of both bedtime routines and use of breastmilk, little is known about the specific inclusion of breastmilk within those routines, especially at naptime. Thus, the aim of this study was to examine the prevalence of breastmilk use within naptime and bedtime routines during early childhood.

Methods: Mothers of 465 infants and toddlers (4-36mos; M=18.5mos) completed an online questionnaire addressing questions about naptime and bedtime routines, as well as the Brief Infant Sleep Questionnaire–Revised (BISQ-R). The sample included infants (4-11.9m; n=147), younger 1-year-olds (12-17.9m; n=87), older 1-year-olds (18-23.9m; n=75), and 2-year-olds (24-36m; n=156).

Results: Overall, 21% (n=92) of mothers reported giving breastmilk during naptime routine at home and 37% (n=173) of mothers reported giving their child breastmilk during a bedtime routine. Breastmilk feeding (by nursing and/or bottle) was consistently less common at naptime than at bedtime, with inclusion of breastmilk for infants more common than for 2-year-olds: infants (35% naptime vs. 65% bedtime), younger 1-year-olds (21% naptime vs. 41% bedtime), older 1-year-olds (19% naptime vs. 29% bedtime), and 2-year-olds (8% naptime vs. 13% bedtime). Across all ages, mothers perceived sleep-related problems at similar rates regardless of whether or not breastmilk was included in the bedtime or nap routine, (p > .05; nap problem 33.7% with naptime breastmilk vs. 23.4% without; sleep problem 39.9% with bedtime breastmilk vs. 38.0% without). Mothers of infants, ages 4-11.9 months, however, reported increased naptime problems (40.8% vs 22.5%, p=.067) and sleep problems (40.0% vs 23.1%, p=.038), when breastmilk was part of the sleep routines.

Conclusion: Breastmilk (breast or bottle) is a common part of a naptime or bedtime routine, especially during infancy. However, it is less likely to be included in the naptime routine than at bedtime. No differences in mothers’ perceptions of either naptime or overall sleep problems were found based on inclusion of breastmilk or not, collapsed across early childhood. However, mothers of infants who include breastmilk in sleep routines report more difficulties than those who do not. Pediatricians are encouraged to discuss with families sleep routines at naptime, as well as at bedtime, and to encourage breastfeeding mothers of infants to problem solve solutions to sleep issues, such as feed as the first step of the routine rather than the last step.

Funding: Johnson & Johnson Consumer Inc.