Q&A: What to do if you are falling asleep while feeding an infant

BySara Kellner

ByFern R. Hauck, MD, MS, FAAFP

Fact checked byCarol L. DiBerardino, MLA, ELS

Key takeaways:

Falling asleep during nighttime feeding is common among new parents.
Parents should remove bedding and pillows while feeding at night and keep their baby’s crib close in case they doze off.

Falling asleep while feeding an infant can pose dangers, but there are many steps parents can take to reduce these risks during nighttime feedings, according to an expert.

“I think it is very important for pediatricians and others who are caring for newborns to tell the parents or folks who are feeding their infants that it is a common occurrence,” Fern R. Hauck, MD, MS, FAAFP, the Spencer P. Bass, MD Twenty-First Century Professor of Family Medicine at the University of Virginia, told Healio. “In fact, it is almost a 100% guarantee that at some point, they will fall asleep while feeding.”

Hauck and colleagues surveyed new mothers with infants about how often they fall asleep while feeding. Out of 1,259 respondents, 28.2% reported falling asleep while feeding usually or sometimes, and 83.4% of those who fell asleep said it was unintentional.

Falling asleep was more common among women who were feeding their infants in bed vs. in a chair (33.6% vs. 16.8%; adjusted OR = 0.41; 95% CI, 0.31-0.56). Compared with women who only breastfed, those who used breast milk and formula (aOR = 0.71; 95% CI, 0.56-0.9) or formula alone (aOR = 0.31; 95% CI, 0.22-0.42) were less likely to fall asleep during nighttime feedings, Hauck and colleagues wrote.

“Women who breastfeed release certain hormones which make them sleepy,” Hauck said. “Even if they try to fight it, it might be difficult.”

The survey was part of a previous study by Hauck and colleagues that educated new mothers about either safe sleep practices or the benefits of breastfeeding. One of the interventions involved nurses discussing the topics with mothers at their birth hospital, followed by text or email links to videos about one of the topics for 2 months.

In their most recent study, the researchers learned that women who watched safe sleep videos were less likely to fall asleep while feeding compared with those in the breastfeeding group (aOR = 0.4; 95% (95% CI, 0.25-0.65).

Healio spoke with Hauck about the risks of falling asleep while feeding infants and how pediatricians can talk to their families about it.

Healio: What risks are associated with falling asleep while feeding?

Hauck: When a mother is falling asleep while feeding her infant, she is going to either be in bed with the infant or on a couch or a chair. In any of those situations, there is the risk of overlying the infant, causing a suffocation risk to the infant. It is even more likely to happen in those situations is if there is bedding around the baby, there is the risk that the baby could get tangled up in the bedding or the baby’s face could go down into a pillow, causing suffocation or airway obstruction. This can also happen on a couch with soft cushions and pillows.

If the mother has the baby on the side that is open, then the baby could potentially roll off and fall onto the floor. Depending on the surface of the floor and how high that is, they could have a head injury or some other injury that is quite dangerous.

Healio: How can pediatricians counsel mothers with infants about falling asleep while feeding? What advice can they offer to keep infants safe?

Hauck: The safest place to feed would be in bed because mom is lying down, and she has more space to create a safe zone around her, which means removing the pillows, and comforters from anywhere the baby might be feeding. Whereas if she is on a chair or couch, there are hazards like a tighter space with more likelihood to overlay or of the baby getting covered with cushions or pillows. It is better not to feed at night in these locations if mom is sleepy and might fall asleep.

We do recommend that infants sleep in the same room as their parents in the first 6 months of their life, so mom could have the crib or bassinet right next to her bed. When she feels herself drifting off, she could put the baby right back into his or her safe sleep space without having to get out of bed. If she has a partner or family member around, they can observe and once mom falls asleep, they could take the baby and put them back in the crib or bassinet.

Some moms set an alarm for themselves, so if they do fall asleep, the alarm will wake them up. Or — it sounds a little strange — they could turn on the TV if they have one in the room and watch a show or movie to keep them awake.

Healio: Are the videos you made about safe sleep practices available for others to use?

Hauck: We do make the videos available to hospitals or health centers that want to use them. We just have them sign an agreement that they're not going to sell them or use them for profit because these were developed under a contract with the NIH.

We also have three other grants now that are active for three other studies that are using some version of these videos. In one of the studies, we got feedback from parents and health professionals [about] how we can make the videos even better. Some of the advice we got was to have more parents involved in the videos, rather than just health professionals doing the teaching. So, we added a bunch of parents to our videos, including fathers and mothers, and we have more ethnic and racial diversity in our videos.

We are starting the intervention in the prenatal period because that is the time when parents are making decisions about what cribs they are going to get, what equipment they are going to use, what sleep position they may want to use. Our moms are deciding how to feed their babies during this time.

We found in our first study that the people who received the videos by text were more likely to open them, so we are just doing text messaging. In another study, we are enrolling women in Facebook groups to disseminate information about safe sleep, breastfeeding or general sleep habits.

Healio: Where can pediatric providers learn more about this?

Hauck: There is a video abstract on the Pediatrics website for this study, so even if they do not want to read the article, they could just watch the video. My colleagues and I have a book called Infant Safe Sleep: A Pocket Guide for Clinicians. The first edition is already available; the second edition is coming out in 2025 with advice for physicians about how to address a variety of challenges in the sleep environment for infants. Other resources would be the AAP, the CDC and the National Institute of Child Health and Human Development’s Safe to Sleep campaign. First Candle, a SIDS and bereavement organization, is very good, too.