How often should I breastfeed my baby?
Charlotte Young

Many mums receive conflicting information about how often they should feed their baby. Some are told three hourly, some four and some are even told that if they feed more frequently baby will get into the habit of snacking. I’ve seen mums jiggling their crying baby whilst trying to get them to accept a pacifier - with the words “you can’t be hungry; I only fed you an hour ago!”

The trouble is that because the majority of mums formula feed - having a long gap between feeds is now considered the norm. But trying to apply this to a breastfed baby, can for some mums spell the end of breastfeeding. For others it can as above, lead to a frustrated baby and a confused mother!

In fairness, I can understand why formula feeders lean towards schedules. Making a bottle under the DOH guidelines is a faffy and time consuming process - not to mention the cleaning, sterilising etc that follows. Given a breastfeeding mum only has to open her shirt - it’s a pretty different ball game.

Where did schedule feeding come from?
Scheduled feeding was once a popular method of feeding and irrespective of the wants and needs of each baby; feeds were given according to the clock. In the 18th Century, unhygienic conditions resulted in diarrhoea and illness. Dr William Cadogan believed this was due to overfeeding and advised the implementation of rigid feeding schedules. In part his theory was most probably correct, consuming food at that time was likely to be a risky business, but no differentiation was made between other foods and breast milk. His theory was widely read and thus a major contributor to the concept of regulating food intake.

Why scheduling isn’t a good idea for breastfed babies?
Before I tackle the many myths surrounding feeding and why you shouldn’t feed on demand - let’s look at why it’s a good idea.

Each Mum & Her Breast milk Are Unique
Formula is static - it doesn’t change from one feed to the next. A set amount of powder is added to a set amount of water, thus a set amount of calories, vitamins and minerals are delivered.

Breastmilk changes each feed with the calorific content varying widely throughout the day. Furthermore, the amount baby consumes at each feeding also varies feed to feed.

Whereas a bottle is made up of X ounce - all breasts vary and mums can hold different amounts in their initial store with a huge range of up to 300% difference from mum to mum. (Breast size is not a good indicator of production or storage capacity).

Mums have the ability to make the same mean amount over 24 hours but what differs is the amount immediately available at each sitting. It therefore follows that the feed spacings required for a baby to thrive will differ, because this intricate relationship between baby and mum is unique to each nursing pair.

Formula has higher protein levels
In mammals, high levels of protein are found when animals are expected to gain weight quickly - for example a calf doubles his birth weight in around 7 weeks.

Breast milk is lower in protein. This is characteristic of milk when the young gain weight steadily, for example a baby is expected to double his birth weight in around six months. It is also unique in its makeup, with different components making up the protein eg amino acids that are not found in cow’s milk but are important to the development of the brain and the eyes (formula companies have to add this later)

If we observe nature, when protein levels are low the young generally stay close to mum and feed little and often - e.g. monkeys. When it is high the young feed infrequently - e.g. cows. Not only does this highlight why different feeding patterns are to be expected, but also demonstrates breast milk is intended to be consumed frequently and in smaller amounts. Formula companies do modify formula, to bring protein levels more in line with the levels a breastfed baby receives; but a lot still remain higher which has been linked to obesity.

The experiences that shape the brain come from close contact between mother and baby when baby is held and carried. Baby cows need to learn where to find the best grass in the meadow; baby humans need to learn how to work with others so that everyone’s needs get met.

Sears.

Humans are also built to digest human milk - the milk of another species takes longer and puts more strain on the immature digestive system, again contributing to longer feed spacings than normal. Human milk contains enzyme and lipase that breaks the fat down to enable better absorption into the bloodstream.

Make more milk mum!
Whereas powder from a tub is scooped out to make as much, or as little milk as required - this obviously isn’t the case for breasts!

In the very early days of breastfeeding, cue feeding is particularly important due to Prolactin receptors. Put very simply; the more baby feeds, the more receptors are developed. The more receptor sites are developed, the more milk mum is capable of producing.

Prolactin levels fall in the first three months post-partum and therefore the number of receptors is crucial to the success of long term breastfeeding. This can be why women who have claimed to be successfully schedule feeding for the first couple of months then go on to have an unusually high milk supply rate failure at three or four months.

After the early post partum period, the only indication a mum’s body receives about how much milk to make for her baby is how regularly and to what degree that afore mentioned initial store is removed. To up supply baby will begin feeding more frequently - a mum trying to adhere to a strict routine or with preconceptions of how often her baby should feed may try to calm the baby by using a pacifier, rocking or walking. This prevents the vital signals reaching her body telling her to make more milk and her supply doesn’t increase to meet demand.

Baby May Be Thirsty
Write down everything that passes your lips in a day - how often do you go four hours without a drink or something to eat?

Whereas formula fed babies may receive water alongside their “meal”, breast milk provides the perfect balance and no extra supplements are required or recommended. Baby may slot a shorter feed in when he/she requires a drink, especially during hot weather or humidity (a breastfed baby still requires no supplements)

Breastfeeding isn’t just about food
Formula is purely about nutrition - gaining weight and receiving vitamins and minerals.

Breastfeeding is about so much more. When infants are very small - every need bar a nappy change can be met by the breast. If they’re tired it delivers relaxing, sleep inducing hormones, if they’re hungry or thirsty they are nourished. If they need comfort/holding - where is more relaxing than snuggled up hearing mums heartbeat and feeling her warmth?

Consider what a pacifier actually is, a plastic nipple. Not only do baby’s find the act of sucking comforting but the British Medical Journal lists breastfeeding as an analgesic (pain reliever) and so schedule feeding deprives baby of this most natural soother.

This is the biggest kept breastfeeding secret that the “parenting gurus” don’t want mums to know. No more trying to work out what that that cry means or what they are trying to express - the breast will meet whatever need it is. As over the coming weeks and months mums get to know their little ones, they learn to know what baby is telling them, without a manual!

Breastfeeding also supports baby’s immature immune system. Babies who are sick will often increase their nursing frequency, and researchers now believe that they do so not only for the comfort that it brings, but also to increase the baby’s intake of abundant antibodies and immune factors available through mother’s breast (Dettwyler).

On a bigger scale - breastmilk contains components that prevent and kill cancer and stem cells which are recognised as future health markers - babies fed to a schedule are likely to receive significantly less than their cue feeding peers.

Reduced Engorgement - Frequent feeding helps to reduce painful engorgement not only in the initial period post partum when milk “comes in” but also on an ongoing basis. Leaving long periods between feeds can lead to a build up of milk in the breasts which in turn can result in engorgement, blocked ducts, mastitis and even breast abscesses.

Ah but, I hear some cry - feeding on demand causes its own problems. Let’s look at those:

Frequent Or Long Feeds Cause Sore Nipples -
It was once thought baby suckling too frequently or for too long could cause sore nipples, but we now know this is not the case. There is no link with frequency or duration providing positioning and attachment are correct. Imagine wearing a pair of ill fitting shoes; ten minutes may give you sore toes whilst a whole evening could leave you bruised and limping. This is exactly what happens when a baby is not positioned properly at the breast - the more baby feeds the sorer mum becomes.

Ironically, those who suggest limiting feeds to reduce or prevent nipple soreness could in fact contribute to its occurrence. A newborn that is left to cry for even a few minutes can become very disorganised and tired. This in turn can lead to difficulty latching on and sucking effectively, or baby just falling asleep.

Baby Will Drink Too Much Milk
Another common concern is a cue fed baby may consume too much milk and become overweight. There is no link to “excessive breastfeeding” and obesity, on the contrary research indicates when a baby is allowed to manage their own intake they do this extremely well and establish healthy long term eating habits. As breast milk composition is constantly changing it adapts to meet each individual baby’s needs, including those who feed more frequently.

On the flipside, both formula and bottle feeding have been shown to increase the risk of obesity in later life.

Breasts Need To Refill
Another common myth to support scheduled feeding is that the breasts need to “fill up” before feeds. In fact, mums breasts are never empty; there is a continuous trickle even once the initial store is drained. Research demonstrates that the less milk within the breast, the higher the fat content.

Frequent Feeding Encourages The Baby To Snack
Some infants allowed to cue feed will take smaller feeds every hour and a half or so, whilst others will fill their boots and not show signs of wanting more for several hours. Cue feeding allows the baby to follow his or her own natural pattern - small regular snacks are actually a very healthy way to eat, so why the problem if baby does this? (After all it’s not as though there lots of prep/making/sterilising to do every time!) Dietitians encourage eating little and often to optimize the digestive system and maximize growth and development.

So how often?
Typically a breastfeed baby will feed 1 1/2 - 3 hourly, although this may vary if baby is unwell, teething or heading towards a big developmental milestone. There are also recognised “fussy periods” (previously called growth spurts) where baby may want to feed more - the early ones are typically; 3 weeks, 5 weeks, 12 weeks & 17 weeks (these fussy periods occur regardless of how baby is fed, see here for more information.

Crying is a later hunger cue, early cues include; putting their hands to their mouth, moving their heads around a lot towards to breast (called rooting), and making mouthing movements. Feeding when you see an early cue, before baby is crying prevents gulping of air which can result in colic/wind.

Conclusion
In countries where people cannot afford watches and “experts” have not interfered mums can no more count feeds per day than they can kisses on their newborns head, these mums have completely different concept of what is “normal” and do not struggle with milk supply issues or breastfeeding problems in the same way mums in the western world do.

I believe it is important for a mother to accept her baby’s uniqueness from birth and to regard breastfeeding as a mothering tool rather than purely a source of nutrition.

Further recommended reading:

http://www.fix.net/%7Erprewett/evidence.html
http://www.lalecheleague.org/ba/May99.html
http://www.lalecheleague.org/NB/NBJulAug03p126.html