Nighttime feeding in Turkish children and its association with anemia


Background: Children who continue to wake up at night to be fed after 6 months of age are called trained nighttime feeders. Nighttime feeding may be associated with dental and medical complications, in addition to causing sleep deprivation in children and parents, as well as with iron-poor nutrition. Methods: We surveyed 614 Turkish children aged 6 months to 5 years from three centers (2 urban and 1 rural) to determine the prevalence of nighttime feeding. We also sought to determine factors associated with continuation of nighttime feedings after 6 months of age. Results: Fifty percent of the participants were night- time feeders. Nighttime feedings were given once, twice, and three times or more to 19.9%, 15.6%, and 14.5% of the participants, respectively. The rural population had a higher rate of nighttime feeding (57.0% rural vs 46.6% urban, p = 0.016). 168 urban children (median age 25 months) had blood count data. Fifty percent of these children were given night-time feedings: 19.6% once, 17.9% twice, and 12.5% three times or more. Nighttime meals were breast-feeding in 51.2%, cow’s milk by bottle in 33.3%, and other in 15.5%. Mean hemoglobin level of nighttime feeders was significantly lower: 11.3 ± 1.3 g/dL vs 12.2 ± 1.0 g/dL in non-nighttime feeders (p < 0.001), even dropping to 10.8 ± 1.4 g/dL in those that were fed 3 times or more at night (p < 0.001). 31.0% of nighttime-feeders were anemic compared to 17.9% in those that did not receive nighttime feedings (p = 0.048). We also noted that intense nighttime feeding was associated with lower MCV (p < 0.001) and lower ferritin levels (p < 0.001). Conclusions: Nighttime feeding is prevalent among Turkish children, especially among the rural population. Nighttime feeding was also noted to be associated with anemia in this study. Nighttime feeding should be screened for and treated in children after 6 months of age.

Share and Cite:

Trabzon, M. , Turunçkapı, M. , Özdemir, Ö. , Özgönenel, M. , İnce, D. and Özgönenel, B. (2012) Nighttime feeding in Turkish children and its association with anemia. Open Journal of Pediatrics, 2, 67-72. doi: 10.4236/ojped.2012.21011.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Howard, B.J. and Wong, J. (2001) Sleep disorders. Pediatrics in Review, 22, 327-342. doi:10.1542/pir.22-10-327
[2] Mindell, J.A. and Owens, J.A. (2010) A clinical guide to pediatric sleep, diagnosis and management of sleep problems. 2nd Edition, Lippincott Williams & Wilkins, Philadelphia.
[3] Thiedke, C.C. (2001) Sleep disorders and sleep problems in childhood. American Family Physician, 63, 277-284.
[4] Sadeh, A., Tikotzky, L. and Scher, A. (2010) Parenting and infant sleep. Sleep Medicine Reviews, 14, 89-96. doi:10.1016/j.smrv.2009.05.003
[5] Menghini, G., Steiner, M. and Imfeld, T. (2008) Early childhood caries-facts and prevention. Therapeutische Umschau, 65, 75-82. doi:10.1024/0040-5930.65.2.75
[6] Mohebbi, S.Z., Virtanen, J.I., Vahid-Golpayegani, M. and Vehkalahti, M.M. (2008) Feeding habits as determinants of early childhood caries in a population where prolonged breastfeeding is the norm. Community Dentistry and Oral Epidemiology, 36, 363-369. doi:10.1111/j.1600-0528.2007.00408.x
[7] Slabsinskiene, E., Milciuviene, S., Narbutaite, J., et al. (2010) Severe early childhood caries and behavioral risk factors among 3-year-old children in Lithuania. Medicina (Kaunas), 46, 135-141.
[8] Van Everdingen, T., Eijkman, M.A. and Hoogstraten, J. (1996) Parents and nursing-bottle caries. ASDC Journal of Dentistry for Children, 63, 271-274.
[9] Zhong, Z.Q. (2009) The relationship between the infant nursing bottle caries and the feeding patterns, oral health behavior and parents’ oral health information. Shanghai Journal of Stomatology, 18, 588-591.
[10] Tully, S.B., Bar-Haim, Y. and Bradley, R.L. (1995) Abnormal tympanography after supine bottle feeding. Journal of Pediatric, 126, S105-S111.
[11] Celedon, J.C., Litonjua, A.A., Ryan, L., Weiss, S.T. and Gold, D.R. (2002) Bottle feeding in the bed or crib before sleep time and wheezing in early childhood. Pediatrics, 110, e77. doi:10.1542/peds.110.6.e77
[12] Wake, M., Morton-Allen, E., Poulakis, Z., Hiscock, H., Gallagher, S. and Oberklaid, F. (2006) Prevalence, stability, and outcomes of cry-fuss and sleep problems in the first 2 years of life: Prospective community-based study. Pediatrics, 117, 836-842. doi:10.1542/peds.2005-0775
[13] Brotanek, J.M., Schroer, D., Valentyn, L., Tomany-Korman, S. and Flores, G. (2009) Reasons for prolonged bottle-feeding and iron deficiency among Mexican-American toddlers: An ethnographic study. Academy of Pediatrics, 9, 17-25. doi:10.1016/j.acap.2008.10.005
[14] Demir, K. (2011) Ilgaz nüfus müdürlügü.
[15] Mindell, J.A. (1999) Empirically supported treatments in pediatric psychology: Bedtime refusal and night wakings in young children. Journal of Pediatric Psychology, 24, 465-481. doi:10.1093/jpepsy/24.6.465
[16] Ferber, R. (1985) Solve your child’s sleep problems. Simon & Schuster, New York.
[17] Mindell, J.A. (2005) Sleeping through the night: How infants, toddlers, and their parents can a get a good night’s sleep. Harper Paperbacks, New York.
[18] Gartner, L.M., Morton, J., Lawrence, R.A., et al. (2005) Breastfeeding and the use of human milk. Pediatrics, 115, 496-506. doi:10.1542/peds.2004-2491

Copyright © 2024 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.