Charlotte Young

Many mums receive conflicting information on how often they should feed their baby. What impact does schedule feeding have on the breastfeeding relationship and how can cue feeding make a difference?

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. Despite the advances in breastfeeding research, understanding how milk is produced and how the breasts work, some parenting “experts” and text books still endorse this method. It is often sold as creating a stable routine to help a mum create order from the chaos a new baby brings, but does this order come with a price?

Where does scheduled feeding originate from?

In the 18th Century, unhygienic conditions resulted in diarrhea 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.

This theory continued into the 19th Century when routine and regularity were embraced with vengeance, in fact these ideas developed to the point of tyranny and still persist today.

Common Myths

Frequent Or Long Feeds Cause Sore Nipples - There is no research or evidence demonstrating the ill effects of “too much” breastfeeding. 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. Research indicates 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 disorganized and tired. This in turn can lead to difficulty latching on and sucking effectively or falling asleep. As a result baby may not take enough milk to drain the breasts fully which can have a negative impact on supply.

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 can establish healthy long term eating habits. Breast milk composition is constantly changing (unlike formula) and adapts to meet each individual baby’s needs.

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 and conversely the same is true, as a baby is trying to gain weight fatty milk is extremely important.

Frequent Feeding Encourages The Baby To Snack - Breast milk is low in protein. This is characteristic of mammalian milk when the young gain weight steadily, for example a baby is expected to double his birth weight in around six months. 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. If we observe nature, when protein levels are low the young feeds little and often, when it is high the young feed infrequently. Not only does this highlight why different feeding patterns are to be expected from formula and breastfed babies but also demonstrates breast milk is intended to be consumed frequently in small amounts.

Eating 3 large meals a day is also not in keeping with the human body. Dietitians encourage eating little and often to optimize the digestive system and maximize growth and development.

Cue Feeding Leads To An Overtired Baby – This is perhaps the most confusing of myths. Breastfeeding releases hormones that relax and calm a baby. Any breastfeeding mother can vouch for the fact that newborns fall asleep easily at the breast especially when very young. Thus logically frequent feeding would lead to increased sleeping.

Why is cue feeding important?

Each Mum & Her Breast milk Are Unique - Formula is unable to change to meet the specific needs of each infant, the nutritional content of one bottle is the same at each and every feed. Breast milk, is not an exact science. The calorific content of breast milk varies widely throughout each feeding, and indeed the day due to changing fat content. In addition, research indicates different mums can hold different amounts in the 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.

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.

Important For Supply - Cue feeding is particularly important due to Prolactin receptors. Prolactin receptors are sites that allow the Prolactin (the milk making hormone) within the blood, to move into the milk producing cells and stimulate the synthesis of breast milk components. The more receptor sites, the more milk production capability is increased.

The number of receptors is determined in the early weeks/months of feeding and the more baby feeds the more receptors are developed. Prolactin levels fall in the first 3 months post-partum and therefore the number of Prolactin 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 in months 3-4.

The only indication a mums body receives about how much milk to make for her baby is how regularly and to what degree that initial store is removed, therefore a baby feeding frequently sends all the right signals to its mum and her supply meets his demands. A mum trying to adhere to a strict routine or simply 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 so a perceived problem can become a real problem

Considering the most common reason women give for stopping breastfeeding today is insufficient maternal milk this is particularly relevant. Those around her who fail to completely understand the mechanics of breastfeeding may suggest supplementation with a formula, compounding the mums belief she is unable to nurture her baby adequately when realistic breastfeeding management is the issue.

Mental Impact - Aside from the physical factors whether one chooses to schedule feed or cue feed can also impact mums mental outlook both short and long term. When one has unrealistic expectations about how a baby will behave it can be frustrating and upsetting for a mum whose baby does not “fit this mould”, she may perceive she has insufficient milk even when she does not or that the quality is somehow lacking because her baby cannot wait 4 hours for its next feed or fails to gain weight. During growth spurts can cause baby to feed almost constantly and become fussy at the breast, a mum trying to stick to a schedule can find her milk does not step up to meet supply if she ignores these vital cues. It is worth noting fussing and very frequent feeding could also be a sign of attachment to the breast not being complete - click here for further information

Breast Feeding Is More Than Just Food – The idea of a schedule does not allow for teething pains or fussy periods. Nursing is extremely comforting for a baby. 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.

Another vital benefit of breastfeeding is to assist an immature immune system. Breast milk helps to protect baby from all the organisms a mum has immunity to, and, if a baby contracts an illness that mum has not been previously encountered, he will transfer this organism through his saliva to the breast. Antibodies are then manufactured locally within the breast and passed back to baby via breast milk.

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 antibodies and immune factors available through mother’s breast (Dettwyler, website). Babies seem to “know” when they have been exposed to a virus or bacteria, and know when they need to breastfeed more frequently to help them fight it off; most importantly, they sense it before parents realize that an illness is developing.

Baby May Be Thirsty - Whereas formula fed babies 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)

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