When The Breastfeeding Baby Keeps Falling Asleep Before They're Full

AKA "The Power nap"

We all know it's totally normal for breastfeeding babies to fall asleep when they've finished their dinner.  We know that in the first few days after birth it's also not unusual for baby to "forget" what they're were doing and take a quick snooze mid-feed, particularly if they're a little jaundiced or have had a more tiring delivery.

But what about when baby is consistently falling asleep before they're full?

It tends to go like this - baby drinks the first milk ejection or letdown, a nice suck/swallow ratio can be seen and this tends to be the part of the feed everyone watches.

As this naturally slows down, instead of pausing and then starting to drink with a regular swallow pattern again - baby adds more and more sucks for each swallow, becoming slower and slower until they're asleep. 

Except they're not. 

If you try and move them they will suddenly spring back into action.  Eyes open, hand comes back to mouth - rooting ensues.  Baby was taking a power-nap whilst waiting for more milk, they were not ready to leave the restaurant thank you very much.

I hear lots of solutions to resolve this.  Strip the baby down, blow on them, use a cold wet cloth to rouse them (yikes!), change a nappy.  Much doesn't tend to work for long though and so it goes like this:

mum blows on baby
baby takes three sucks
baby goes back to sleep
mum blows on baby
baby sucks a few more times
baby goes back to sleep
mum blows on baby
baby ignores blowing
mum blows AND tickles hands
baby suck a few more times
baby falls back asleep
mum undoes baby grow a bit, blows and tickles hands
and so on and so forth

It's probably easier to ask the question - why is the typical term, healthy baby persistently falling asleep before they're full?

A big reason babies fall asleep at the breast or bottle, is when the flow (for whatever reason) becomes too slow to be worth staying awake for.  Lots of sucking without swallowing lots of milk, isn't a sensible idea for a small human with limited energy supplies - they want bang for their buck.

We know this as if we take a "power-napper" and increase milk flow, baby's eyes spring open!  Oh we're back in action?  Nice one, I'll wake up then...

WATCH THIS CLIP - when additional milk is given, we can see the shutters ping open.

Of course, in a symptom solving society the answer seems obvious - increase milk flow, breast compress and switch feed.  Indeed short-term this can help, particularly for the sleepy newborn or baby who is a little early/small and simply running out of energy too soon.

A common reason for many "breast hangers" is a shallower than optimal latch, resulting in reduced milk transfer.  

I had an interesting discussion last week over on "Occupy Breastfeeding".  This was the stunning image posted.  Mum looks radiant but oh my days look at that teeny latch.

I love seeing breastfeeding in all sorts of positions and attachments, I'm not for a second suggesting we only show "optimal" images - this mum has clearly overcome a difficult time getting baby latched and feeding well and the resulting photo is glorious.  

I do though think we have to acknowledge when a latch is shallow - because we seem to have a nation of people who can't recognise the difference or who believe it doesn't matter and I don't think it's really helping anyone.  If we saw a heap of well attached babies, the odd shallow latch wouldn't need a mention - but we see so few breastfeeding images and we've lost so many skills around feeding...

Perhaps this baby had just fallen asleep at the end of a lovely feed and slipped shallow as mum moved to take the pic?  Who knows, it doesn't really matter as long as we can acknowledge that whilst it's a stunning picture, that latch as we see it won't work for many.

To some a shallow latch won't be a huge deal, particularly in the early days.  Some can compensate well,  especially when demands are small and milk supply is abundant.  Some mums are happy to feed half hourly day and night as baby gets older, or hold them upright or sling-wear to compensate for the colic, wind or reflux.  We're re-framing this as "normal", but for some mums, tapas style eating around the clock isn't always sustainable.  Some will experience mastitis from the regularly ineffective breast drainage, whilst for others the tiny mouth causes problems for baby if not for mum.  From reducing the transfer, to gulping air a myriad of symptoms can follow.  

I'll take it as a compliment to be accused of "being very big on latch" (I'm still not entirely sure whether the pun was intended, but I chuckled anyway).  I think we underestimate mothers to suggest they're going to stop breastfeeding en-mass because whilst they believed until now everything was completely fine, someone pointing out it doesn't quite look like a textbook may prompt them to abandon the breast and reach for the bottle.  If whatever your doing is working for you and your baby, run with it!   

I propose though,  mums are more likely to stop breastfeeding when despite telling everyone they have some concerns, they're pacified that it's just a (never ending) growth spurt, or their baby is fine with a teeny tiny mouth and perhaps she just has insufficient glandular tissue or baby has an allergy?

The Global Beastfeeding project has uploaded some great clips, including exploring why latch matters for many.  Here is a still from their clip showing a deep latch versus shallow latch or "nipple hanging".

In action this means we can't see the corners of baby's mouth:

The problem I think is the myth that refuses to die.  The pain myth.  How often do we hear the two key questions?  

• Are you in pain?
• Is your baby gaining weight? 

As though these are the only markers of effective feeding.

***Newsflash:  Babies can have an incredibly shallow latch and not cause pain.***

These babies will typically have slower gain, and/or feed super frequently or for long periods to compensate. Not all though, sometimes mum has so much milk, baby is full after drinking the milk that pours out with the first milk ejection (lactose rich milk) resulting in typical or above average gain.

In order to cause damage a baby has to to:

a) Have enough of something in their mouth to damage it

b) Be doing a compensatory action that causes damage.  Whether that's pushing the nipple up to the hard roof of their mouth, pinching and trapping it, rubbing their tongue against it or sucking extra hard like a vacuum cleaner.  

Sometimes a baby's suck is so disorganised they don't generate enough suction to cause pain to anything - it's weak and ineffective, like a sock in a washing machine.  These babies may also have initial early latching problems and trouble staying on the breast (lack of effective suction).  Sometimes mum is show positions to try and compensate for this which gets baby on, but not necessarily transferring milk as well as they could.

All of this also fails to recognise that the very mechanics of breastfeeding, mean that even if a baby doesn't latch "optimally", the act of suckling (creating a seal and rippling the tongue) - will assist in shifting them in to a deeper latch.

Normalising the weeny latch as "fine" doesn't really I suspect help many beyond the early weeks - we need to up our game in terms of breastfeeding education to help parents recognise when their baby is latched and drinking well, versus hanging out eating tapas style.