Breastfeeding and Maternal Perceptions of Infant Sleep, Settle and Cry Patterns in the First 9 Months

Abstract

This study evaluated relationships between maternal perceptions of infant sleep, settling and crying patterns and breastfeeding. A prospective observational study of 91 mothers of healthy, term infants was conducted with follow ups over 9 months after discharge from a Western Australian maternity hospital. Feeding information, sleep, settle and cry behaviours, maternal bother at infant behaviours and confidence were measured using the Sleep and Settle Questionnaire. Breastfeeding confidence was measured using the Breastfeeding Self-Efficacy Scale—Short Form. Questionnaires were administered at 2 and 6 weeks, 3, 6 and 9 months. Linear mixed models were used to assess associations between maternal bother, feeding method and infant characteristics. The feeding method was not associated with maternal bother, and cessation of breastfeeding did not result in a change in bother scores (p = 0.34). Duration of infant crying in the day, evening and night, frequency of night waking and duration of settling to sleep in the day were associated with increased bother scores. Higher breastfeeding self-efficacy and maternal confidence were associated with lower bother scores (both p < 0.01). Maternal bother is associated with infant behaviours that require parental input, but not breastfeeding status. Resources that address parental expectations regarding infant sleep while providing strategies to support maternal wellbeing and breastfeeding are needed.

Maternal Reports of Preterm and Sick Term Infants’ Settling, Sleeping and Feeding in the 9 Months after Discharge from Neonatal Nursery: An Observational Study

“…Using the same SSQ measures in a cohort of mothers of healthy term infants, Perrella et al [ 30 ] observed similar trends with increasing nighttime sleep over time, night waking at all timepoints and highly variable crying and settling durations [ 30 ]. While these findings are consistent with previous studies that found no difference between preterm and healthy full-term infant sleep, the majority of these studies reported on infant sleep patterns > 9 months post-hospital discharge [ 13 , 35 ].…”

“…Linear mixed modelling was used to examine a range of factors influencing the outcome of maternal bother over time, such as infant crying, settling and sleep, feeding and maternal characteristics. As per the analysis of the healthy term cohort [ 30 ], a linear mixed model was fitted with total bother score as the response and individual infant as a random effect. Univariable associations were assessed, and purposeful selection with a p -value cut-off of 0.1 was used to arrive at a subset of covariates for a multivariable model.…”

“…Higher maternal confidence in their own and their partner’s ability to settle their infant was associated with decreased maternal bother scores within our cohort ( Table 5 ). It has been reported that confidence regulates thought-induced stress, and mothers with lower confidence in their parenting abilities may perceive a wider range of infant behaviours as problematic [ 30 , 42 ]. Thus, mothers with higher confidence may have more positive perceptions of their infant’s sleep behaviours and report less bother.…”

“…The primary aim of this study was to describe and compare breastfeeding outcomes between the two cohorts, previously reported by Perrella et al [ 29 ] A secondary aim was to describe infant sleep and settling behaviours, the degree of maternal bother associated with these behaviours and maternal breastfeeding confidence and satisfaction of the sick/preterm and healthy cohorts across the first 9 months following hospital discharge. Outcomes of the healthy term cohort have previously been reported [ 30 ]. The focus of this paper will be to describe the outcomes of the sick/preterm cohort.…”

Breastfeeding and Sleeping Patterns Among 6–12-Month-Old Infants in Norway

“…In future studies, it is recommended to use several methods of sleep measurement to increase internal validity. There is inconsistent evidence of the interplay between night waking frequency, night sleep duration, and breastfeeding among small children (Perrella et al, 2022 ). However, our findings add to the limited body of evidence on breastfeeding and frequent infant night waking.…”