Got Time?

By Jennifer Cox

New moms are often confused by conflicting advice over when and for how long to feed their newborns. Should they feed "on demand?"

or by a schedule? Should they limit the time Baby spends at the breast, or leave him on indefinitely? One breast per feeding or two? What if the baby doesn't cooperate?

mom nurse
​The typical 3 to 4 hour feeding schedule that we think of as the norm has been molded by years of watching formula fed infants consume relatively large, non-physiologic feeds. Typical volumes of colostrum in the first days could be measured in teaspoons rather than ounces. Formula also has been shown to have a longer gastric emptying time, which may also contribute to the long intervals between feedings for bottle fed infants.

Research on frequency and duration of normal newborn infant feeding demonstrates that unrestricted feeds in the first few days help insure earlier "mature milk" production, help minimize initial infant weight loss (and possibly associated jaundice), and are associated with longer duration of breastfeeding. Lactation professionals recommend offering the breast whenever hunger cues (sucking movements or sounds, hand-to-mouth movements, rapid eye movements, cooing or sighing) are evident, and allowing the baby to determine the duration of feedings at each breast. After the first 24 hours of life, most babies fed by watching these signals will feed at least 8-12 times per day (some will space feeds evenly and others will "cluster feed"). The "happy to starve" baby, who never seems to ask for feedings, will need to be awakened at least 3 hour intervals until good weight gain has been demonstrated.

Duration of feeds is also best determined by the baby's signals. Many babies will nurse 10-20 minutes on one side and then nurse for a shorter time on the other breast. Others will nurse on only one breast per feeding, and arbitrarily interrupting to switch sides will result in a baby who refuses to relatch. If a baby has a pattern of refusing the second breast there is no point in ending his feeding prematurely just to fight with him. The baby who suckles only a few minutes each feed, or seems to nurse for hours without being satisfied, should have feeds observed and assessed to make sure he is really latched on and feeding.

Many popular books emphasize scheduling of feeds as key to good parenting, and often new parents, uncertain of their ability to interpret their baby's signals, feel safer sticking to "expert" advice. One recent bestseller, Secrets of the Baby Whisperer, offers a rigid scheduling chart for the first few days instructing "new mums" to limit first day feedings to 5 minutes each side (the chart does allow eventually increasing duration to up to 20 minutes each side, while progressively spacing out feedings). Babywise emphasizes scheduled feedings from day 1. No research supports either of these approaches as reasonable for newborns. Parents who need to be in control of a predictable feeding schedule, but who also want to breastfeed, are better advised to put off the scheduling agenda until the baby is at least a few weeks old and feeding is well-established. Spending those weeks learning to read their baby, instead of focusing on the clock, may also give them the confidence to trust their judgment (and their baby's signals).