Is it OK to feed or rock your baby to sleep?

Yes, it's OK to feed, rock or hold your baby to sleep. It's one of the most natural ways babies fall asleep, and for young babies it's often the only way that works. The Australian Breastfeeding Association (ABA) says most babies naturally feed to sleep, even as they get older, and that it isn't a "bad habit". The honest trade-off is that a baby who is always helped to sleep may want the same help when they wake overnight. That's only a problem if it isn't working for your family, and there are gentle ways to change it when you're ready.

Is it OK to feed, rock or hold your baby to sleep?

For newborns and young babies, it's expected. The NHS says breastfed babies may doze off during feeds and suggests carrying on feeding until you think your baby has finished or is fully asleep. It also notes that early on, babies may only fall asleep in your arms or when you're standing by the cot.

There are biological reasons feeding makes babies sleepy. The ABA explains that breastfeeding releases a hormone called cholecystokinin (CCK) in your baby's body, which makes them sleepy, and that young babies, who don't yet make their own melatonin (the sleep hormone), get it through breastmilk.

Rocking and holding are just as normal. The ABA lists rocking, patting and holding among common ways to settle a baby, and suggests trying different holds and rhythms to see what works.

What are sleep associations, honestly?

A sleep association is whatever your baby links with falling asleep: a feed, being rocked, a dummy, your voice, their cot. Pregnancy, Birth and Baby explains that some children expect the same conditions each time they fall asleep, so a baby who is always nursed, fed or rocked to sleep may find it harder to fall back to sleep without the same cues.

HealthyChildren.org makes the same point: babies held or rocked to sleep may struggle to go back to sleep if they wake during the night. A review by Kang and Kim notes that when a child relies on help such as rocking or nursing to fall asleep, frequent night waking is the main sign.

What this doesn't mean:

• It doesn't mean feeding or rocking causes harm. Pregnancy, Birth and Baby points out that everyone has sleep cycles and it's normal to wake between them.
• It doesn't mean your baby will never learn other ways. The ABA says babies can still learn to settle in other ways with other people as they grow.
• It doesn't mean you need to change anything. Night waking is still normal beyond 12 months, the ABA's baby sleep patterns page says, and patterns can seem to "go backwards" at times until about 2 to 3 years.

Different programs see this differently. A study of the Possums sleep program notes that some sleep programs treat breastfeeding to sleep as an undesirable association, while Possums takes a more cued approach; its results on sleep were similar to usual care, with higher breastfeeding rates. See the Possums sleep approach.

Is breastfeeding or bottle-feeding to sleep different?

For sleep, not much: both can help babies drift off. For teeth, there is a difference.

• Breastfeeding to sleep. The ABA's tooth decay page says breastfeeding to sleep or overnight doesn't mean your child will get tooth decay, which is more strongly linked to sugar exposure and poor cleaning. It advises cleaning teeth twice a day from when they first appear.
• Bottle-feeding to sleep. The ABA explains that milk from a bottle can pool around the teeth, especially if a baby falls asleep with a bottle in their mouth, which is why bottle feeding to sleep is linked with decay. HealthyChildren.org says not to put your baby to bed with a bottle.

If your baby is bottle-fed, it's fine for them to get drowsy or fall asleep during a feed in your arms. Take the bottle out once they've finished, and settle them into the cot without one. For responsive bottle-feeding, see paced bottle feeding.

How do you feed or rock your baby to sleep safely?

The biggest risk isn't the feeding or rocking; it's where you and your baby end up falling asleep.

• Watch where you sit. Red Nose warns that sofas and armchairs have soft cushions, gaps and sloped edges that can trap a baby's face or body, and that falling asleep lying down with your baby on your chest is unsafe. It suggests setting up a safe sleep space close by, such as a cot or bassinet in the living area.
• Feeding in bed at night. NICHD Safe to Sleep suggests clearing soft items and bedding from your side of the bed before bringing your baby in to feed, and if you fall asleep, putting your baby back in their own sleep space as soon as you wake. Advice on bed-sharing differs between countries; see bed-sharing.
• Transfer to the cot on their back. Once your baby is asleep, lay them on their back in their own cot or bassinet. Red Nose recommends a safe sleep space in your room for at least the first 6 months, with head and face uncovered.
• Car seats aren't beds. The NHS says if your baby falls asleep in the car, move them to a firm, flat surface to sleep as soon as possible.

Making the transfer stick

The ABA suggests holding your baby until they're in a deeper sleep, which takes about 20 minutes, before you transfer them. A study by Ohmura and colleagues found that carrying a crying baby while walking calmed them, while simply holding them did not, and that 5 minutes of carrying helped crying babies fall asleep. Laying a sleeping baby down could either wake them or deepen their sleep, depending on how long they'd been asleep. The authors suggested 5 minutes of carrying, then 5 to 8 minutes of sitting before laying your baby down, but said this needs more research (they also declared a related patent application).

The NHS Best Start in Life guide reassures parents that it's very common for babies to fall asleep while held and then wake when put down, because they just want to be near you.

When might you want to change it?

There's no age by which you must stop. Some reasons families decide to make a change:

• every waking needs a long feed or rock, and you're exhausted
• your baby only settles with one person, and that's not sustainable
• you're returning to work or someone else will be doing bedtimes
• you're ready to drop night feeds; the NHS says night feeds may no longer be needed from 6 to 12 months, though some babies still need them (see night weaning plan)
• feeding to sleep no longer feels comfortable for you

If none of these apply, there's nothing you need to fix.

How can you gently change feeding or rocking to sleep?

Change one thing at a time and give it a week or two before judging.

1. Move the feed earlier. Feed at the start of the bedtime routine, then do a nappy change, story and cuddle, so feeding isn't the very last step.
2. Feed or rock until drowsy, not fully asleep, then finish settling in your arms or in the cot. See drowsy but awake.
3. Use lighter help. Karitane's stepped approach suggests starting small: soothing words, then sitting beside the cot, then gentle patting or rocking, with picking up and cuddling at the top. As your baby calms, step back down to less help.
4. Try in-cot settling. A hand on your baby's tummy, patting or a soft "shh" while they lie on their back. See shush-pat.
5. Share the settling. The ABA says babies can learn to settle with other people; a partner or another carer doing some settles can help.
6. For older babies, structured but gentle options include responsive settling and, from about 6 months, gradual retreat.
7. Go back a step if your baby becomes distressed. Comfort them, then try again another time.

Many families keep one feed-to-sleep, such as the first night waking or a hard nap, while changing others. That's fine.

What does the evidence say about feeding or rocking to sleep?

There's no good evidence that feeding or rocking a baby to sleep is harmful. The ABA describes feeding to sleep as normal and supported by research, and the Öztürk study found a program that allowed cued feeding gave similar sleep results to usual care, with more babies still breastfed.

The case for gradually reducing help rests mainly on the sleep-association idea described by HealthyChildren.org, Kang and Kim and Pregnancy, Birth and Baby, and on behavioural sleep research in older babies. For young babies, the Ohmura study suggests carrying and a short wait before laying down can help, but it's one study that its authors say needs confirming.

When should you get help?

Feeding or rocking to sleep isn't a medical issue, but some changes in sleep or feeding are. Following the NHS urgent help guide:

• Call your local emergency number (000 in Australia, 999 in the UK, 911 in the US) if your baby is struggling to breathe, has blue, grey or blotchy skin or lips, is floppy or hard to wake, has a seizure, or is under 3 months with a temperature of 38°C (100.4°F) or higher.
• Call your local emergency number (000 in Australia, 999 in the UK, 911 in the US) or go to an emergency department if your baby has had no wet nappies in 12 hours.
• Get medical advice the same day if your baby isn't feeding or seems unwell.
• Talk to your child-health nurse or a breastfeeding counsellor (a breastfeeding helpline (the Australian Breastfeeding Association on 1800 686 268 in Australia, the National Breastfeeding Helpline on 0300 100 0212 in the UK)) if feeding to sleep is the only way your baby will feed, feeds seem very long or painful, or you're worried about weight gain.

If exhaustion is getting on top of you, call a parenting support service (Tresillian or Karitane in Australia, your health visitor in the UK, your pediatrician's office in the US). If you have thoughts of harming yourself or your baby, call a crisis line (Lifeline on 13 11 14 in Australia, Samaritans on 116 123 in the UK, 988 in the US) or your local emergency number (000 in Australia, 999 in the UK, 911 in the US).

How do the options compare?

For the bigger picture, see the sleep training overview.