Physiological Infant Care - Managing Nighttime Breastfeeding in Young Infants

Publication Date: March 15, 2023

Summary of Recommendations

Help parents understand normal physiology and to care for their infants in a responsive manner. It is important for health professionals to understand the normal physiological expectations and educate parents accordingly. Professional organizations should work to minimize the impact that advertising has on promoting nonphysiological practices. (IIB)

In the absence of hazardous circumstances, mothers sleeping in proximity to their infants is recommended. Breastfeeding with proximate sleep in the absence of hazards may allow mothers to maximize their rest and well-being if sleep deprivation is a concern. Breastfeeding with proximate sleep may protect against sleep-related death, and is associated with responsive infant feeding and longer durations of any and exclusive breastfeeding. (IIB)

Mitigate potential risks of bedsharing while allowing the infant to sleep within arms' reach. Using a sidecar attached to the adult bed if concerns exist for hazardous circumstances, or if hazardous circumstances could sometimes exist (e.g., if parents occasionally use alcohol or sedating substances). (IIB)

Mitigate potential risks of bedsharing by teaching safe positioning in bed. Owing to lack of data for exclusively pumping dyads, it is unknown whether these dyads represent a hazardous circumstance for bedsharing. The C-position (cuddle curl) should be taught to exclusively pumping parents, recognizing that bedsharing is common and may occur unintentionally. (III)

Avoid nonphysiological disruptions to maternal and infant nighttime sleep as strategies for improving parental well-being. These include nighttime pumping, bottle feeding, and placing the infant to sleep outside the parents' reach. Consider a dim red light if the need for lighting is anticipated. (IIB)

Encourage the mother and infant to return to sleep without interruption after nighttime breastfeeding while bedsharing. Avoid burping the infant after breastfeeding, and avoid unnecessary diaper changes during the night. A barrier cream applied to the diaper area can help prevent diaper dermatitis. (II/IIIC)

Sleep training in approximately the first 6 months of life is contraindicated, and sleep training in the first year is not recommended. A cued care program for infant sleep may be a physiological-based alternative for parents who desire a sleep intervention. (IIB)

Encourage the mother to sleep when the infant sleeps, when this is possible, and remind parents that not all sleep must occur during the nighttime hours. (IIB)

Encourage the mother to get help with other household tasks so that she can focus on breastfeeding and caring for the infant. (IIB)

Encourage the safe use of baby carriers during the day to promote physical contact with the infant. Baby-wearing can help mothers manage daytime tasks while keeping the infant calm. (IA)

Including some supervised “tummy time” may be important to help achieve developmental motor goals. (IIB)

Avoid early introduction of solids or breast milk substitutes such as formula as a strategy to improve infant or maternal sleep. Avoid exposure to formula marketing materials in hospitals and health care settings. (IIB)

Encourage parents to directly monitor infant feeding and sleeping cues, and discourage use of tracking apps and monitoring devices for infant feeding and sleeping. (II/IIIC)

Advocate for at least 12 weeks of paid maternity leave in countries that currently do not have it. (IA)

Recommendation Grading


The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.



Physiological Infant Care - Managing Nighttime Breastfeeding in Young Infants

Authoring Organization

Publication Month/Year

March 15, 2023

Document Type


Country of Publication


Document Objectives

A central goal of the Academy of Breastfeeding Medicine (ABM) is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient. The ABM empowers health professionals to provide safe, inclusive, patient-centered, and evidence-based care. Pregnant and lactating people identify with a broad spectrum of genders, pronouns, and terms for feeding and parenting. There are two reasons ABM's use of gender-inclusive language may be transitional or inconsistent across protocols. First, gender-inclusive language is nuanced and evolving across languages, cultures, and countries. Second, foundational research has not adequately described the experiences of gender-diverse individuals. Therefore, ABM advocates for, and will strive to use language that is as inclusive and accurate as possible within this framework.

Inclusion Criteria

Female, Adult, Infant

Health Care Settings


Intended Users

Nurse, nurse midwife, nurse practitioner, physician, physician assistant, social worker



Diseases/Conditions (MeSH)

D001942 - Breast Feeding, D007225 - Infant Food, D007223 - Infant


Breastfeeding, infants, nighttime

Source Citation

Zimmerman D, Bartick M, Feldman-Winter L, Ball HL; Academy of Breastfeeding Medicine. ABM Clinical Protocol #37: Physiological Infant Care-Managing Nighttime Breastfeeding in Young Infants. Breastfeed Med. 2023 Mar;18(3):159-168. doi: 10.1089/bfm.2023.29236.abm. PMID: 36927076.