Integrative Lactation Care

As a lactation consultant, it’s my job to provide the families under my care with evidence-based information about parenting choices that can impact their baby’s feeding and development. New parents often assume this is generally limited to how to position the baby for nursing, how to hold a bottle, and when to introduce a pacifier – but infant feeding is influenced by so much more than just what’s going on with baby’s mouth.

Your baby’s feeding (& by association, their development) is influenced by many choices that may seem unrelated, including:

• where they sleep
• what they wear
• how their body moves
• how they were born
• how they spend their awake time

and more. This is what an integrative approach to feeding (and parenting!) looks like – understanding that behaviors & symptoms are never isolated, but rather, connected to the whole.

While this can sometimes feel overwhelming to folks new to integrative care, it’s actually good news – because it means we have MORE tools accessible to us to help us move in the direction we want to go for our own health or our child’s, not less. It also means that we can often make a big impact with just a few small shifts.

For example, we know that sleeping close to baby benefits milk supply, that tummy time improves feeding abilities, and that babywearing supports better digestion. And we’re also finding that restricting a baby’s movement at night has significant negative impacts on feeding.

So today, I’m going to cover a topic that I’ve found many parents blindsided by its impact on feeding: the smart bassinet.

What Does Normal Baby Sleep Look Like?

Before we explore the nuances of smart bassinets, let’s first clarify what is normal for newborns and infants.

1. It is normal and important for babies to wake up at night. Night wakings are highly protective against SIDS & promote optimal feeding rhythms – not just for newborns, but babies of all ages.
2. The normal range of night wakings for babies under 1 year is 1-5 wakings per night. Newborns will wake every 2-3 hours to eat, whereas infants may begin to do longer stretches of 4-6 hours as they get older.
3. Babies are wired to sleep close to a caregiver, and will sleep better in close proximity because they have a felt sense of safety. Many babies struggle to sleep alone for this reason.
4. Sleep is a biological function for all humans, and not a skill that can be taught. Babies wake at night to ask to have their needs met, same as during the daytime. Waking at night is not a bad habit, or a sign of poor parenting – it is completely normal.

Feeding & Sleep: Deeply Interconnected

Now that we’ve established that it is normal and healthy for a baby to wake at night, it’s important to note that sometimes there are challenges that cause babies to wake up abnormally often or to have trouble staying asleep.

How a baby feeds influences how they sleep, and how a baby sleeps influences how they feed. A baby who has had the opportunity to eat to satiation – meaning they got to choose how much they ate, and aren’t still hungry OR overfull – is most likely to sleep comfortably & peacefully. A baby who is hungry will struggle to fall or stay asleep, and a baby who is overfed is more likely to experience GI discomfort, develop reflux, and struggle to fall or stay asleep.

This leads us to the question of whether the smart bassinet influences feeding and development.

How Smart Bassinets Interfere with the Biological Norm

Compare and contrast these scenarios in which a baby wakes up:

1. Regular Bassinet: A baby who is sleeping close to their parent (in a bedside bassinet or safely bedsharing together) begins to emerge from light sleep and is hungry. They are wearing a light sleep sack, but are unswaddled. They begin to show early hunger cues – turning their head side to side, wiggling their body, bringing their hands to their mouth and making smacking sounds. Hearing these noises, the parent begins to rouse, and quietly says to baby, “Oh, hey there, buddy – you hungry?” to let them know they hear them. Baby’s nervous system settles at hearing the parent’s calm voice. Without leaving their bed, parent picks up baby and gets ready to feed them, while baby starts ramping up their active feeding cues. The feed occurs peacefully, baby falls back asleep while feeding, and the parent places the baby back in their sleeping space.
2. Smart Bassinet: A baby sleeping in a smart bassinet (in the same room as parent) begins to emerge from light sleep and is hungry. They are swaddled securely. They attempt to show early hunger cues – trying to move and bring their hands to their mouth, but they are unable to do so. They begin to fuss, and the bassinet responds by increasing motion and white noise. The baby’s nervous system responds to the sensory input and goes back to sleep. 45 minutes later, the baby begins to emerge from sleep and is very hungry. They attempt to show early hunger cues, and the bassinet again responds with increased motion and white noise. However, the baby’s hunger is greater and the sensory input is not sufficient to put them back to sleep. The baby begins to cry loudly, and the parent rouses with a start – “I’m coming, I’m coming!”, they say, their own heart rate increasing as they respond to the crying baby. They unzip the swaddle, pick up baby, and comfort them, bouncing and shushing them. It takes baby a moment to settle before they are ready to eat, and the baby eats ravenously, choking and sputtering on the milk. After several minutes of being held upright, getting burped, and rocking, the baby falls back asleep, and the parent places the baby back in their sleeping space.

Do you note the differences?

In scenario #1, the baby and parent may be waking every 2-3 hours, but the arousal of their respective nervous systems is gentle, slow, and quickly returns to baseline. In scenario #2, baby and parent might be getting a 4-hour stretch, but the awakening is more stressful for both of them, and may even take longer overall.

Is this representative of every baby in either situation? No, of course not – a baby’s individual temperament has a massive impact on how a baby adapts to their environment. But this is a representative of example of how babies on average respond to these respective scenarios. Many parents simply don’t realize that the symptoms in the scenario #2 (crying, feeding challenges, needing time to resettle) are related to usage of the smart bassinet.

Trust with babies is built in small ways through the concept of “serve & return”. Every time a baby makes an ask of us, their brain is building neural connections based on whether & how we respond. When we respond promptly & consistently with warmth and do our best to meet their need, their brain learns: “My caregivers take care of me. The world is a safe & trustworthy place.” This is the basis of secure attachment in the parent-child relationship and the foundation of the child’s lifelong mental health.

When we outsource this responsiveness to a device that isn’t able to attune to the infant’s asks, we miss out on critical opportunities to build that trust.

Smart Bassinet Risks the Manufacturers Won’t Tell You About

Having worked with many families who experienced effects from smart bassinets that they were not prepared for, and having researched this topic extensively, I can tell you that there are numerous risks that manufacturers are not disclosing to the public.

1. Impaired Bonding & Attachment:
   • As discussed above, the smart bassinet disrupts the ability of the infant to communicate their needs to the parent, which impairs the ability of the parent to attune to and respond to their needs.
2. Potential for Increased Risk of SIDS
   • This one may come as a surprise, since the marketing of the Snoo is heavily centered around “safety” by keeping baby on their back. However, there is emerging research that swaddling keeps baby in a state of deeper sleep, when we know that spending more time in light sleep is what helps minimize SIDS risk in infants.
3. Plagiocephaly (Flat-Head Syndrome) and/or Torticollis
   • Swaddling restricts head movement and makes it much more difficult for baby to move in their sleep, which increases the risk of plagiocephaly and torticollis. This impact is increased with a smart bassinet since it artificially extends the periods between awakenings where baby is taken out of the swaddle.
   • Anecdotally, I have seen high correlation of Snoo usage and plagiocephaly/torticollis in my practice.
4. Compromised Weight Gain in Infants
   • The infant’s stomach is small (roughly the size of an egg at one month) and can only accommodate so much volume at one time. Artificially spacing out night feeds (which the smart bassinet does by putting an infant back to sleep when they attempt to show hunger cues) means that overall intake in 24 hours often takes a hit, since it’s not easy (or recommended) to fit 24-32oz in during daytime hours only.
5. Decreased Milk Supply
   • For lactating parents, artificially spaced feedings can also lead to a decrease in milk production. Prolactin, the primary hormone for milk-making, is highest at night, and the postpartum body relies on frequent milk removal at night to sustain a robust milk supply.
6. Body Tension
   • In addition to plagiocephaly, another body-related side effect of keeping baby tightly swaddled all night is that the infant’s body becomes tight and tense, and range of motion can become limited. In my practice, these babies often struggle to lift their arms overhead due to tightness in the shoulders, which can make latching & feeding difficult.
7. Delayed Motor Milestones
   • Body tension & asymmetry from prolonged swaddling can also make tummy time harder, and lead to a cascade of delayed motor milestones.
8. Diminished Parental Confidence
   • The time immediately after a child is born is both incredibly formative time in the parent-child relationship and a tremendous window of neuroplasticity in the parents’ brain. By relying on a device to communicate with the child, the parent loses out on part of a valuable window to build their own skills & knowledge around responding to their child’s needs.

But what if I’m exhausted?

A long time ago, before we had smart bassinets, we had a village. We had a village of caregivers who came together to shower new parents with love, care, and support. They held the baby, held the mother, cooked for them, brought gifts, and helped with overnight support. There was no need for a smart bassinet, because your community was your smart bassinet.

Nowadays, we are isolated and the village is fractured. We are expected to return to work while still deep in the early postpartum time, and to be a functional & productive member of our economic system. It needs to be said that this isn’t fair and it’s why the smart bassinet has gained such popularity. The expectations of parents are absurd.

For the cost of a Snoo ($1700), you can hire a postpartum doula for 50-60 hours of overnight support. You can also use that same $ to purchase a lot of takeout meals, house cleaning support, and other resources that lighten the overall postpartum load and give you more time to rest without any of the risks above.

There are also many other creative approaches to sleep that parents have found to help them cope with the early weeks and months of night wakings, which honor biological norms & instincts toward responsive nurture. Many parents find that cosleeping (either safe bedsharing, or close-proximity roomsharing) is the best way to get a restful night’s sleep, and the research supports that approach.

Closing Thoughts:

Choosing where your baby will sleep is a highly personal choice. My goal, as always, is to empower parents with thoughtful information from an integrative lens, so that you can make the best decision for your family and your baby.

If you choose to use a smart bassinet, consider how you can minimize the potential risks by keeping baby in the same room, using only the lowest possible settings, and incorporating ample body movement during the day.

If you want to learn more about how to navigate sleep with a new baby, including your choices for sleep spaces, how to prepare for safe cosleeping, and how to maximize your own sleep as a new parent, consider my Supported Newborn Sleep course, or a 1-1 sleep consultation (sometimes covered by insurance!).

Rest well!
– Jill

Resources:

McKenna JJ. Night waking among breastfeeding mothers and infants: Conflict, congruence or both? Evol Med Public Health. 2014 Jan;2014(1):40-7. doi: 10.1093/emph/eou006. Epub 2014 Mar 13. PMID: 24627464; PMCID: PMC3982898.

Paavonen, Outi Saarenpää-Heikkilä, Isabel Morales-Munoz, Minna Virta, Niina Häkälä, Pirjo Pölkki, Anneli Kylliäinen, Hasse Karlsson, Tiina Paunio, Linnea Karlsson: Normal sleep development in infants: findings from two large birth cohorts, Sleep Medicine, Volume 69, 2020, Pages 145-154.

https://www.nourishingdev.com/feeding-tongue-tie-blog/tummy-time-feeding-success

https://pubmed.ncbi.nlm.nih.gov/22734604/

https://developingchild.harvard.edu/key-concept/serve-and-return/

https://pubmed.ncbi.nlm.nih.gov/19540517/

https://hekint.org/2019/04/30/swaddling-forever-bound-in-controvers