I’ve read your suggestions on improving a new mother’s chances of continuing the nursing relationship. I agree with you, except for one point with which I take issue. You, and my first son’s pediatrician, both recommend nursing no more frequently than every hour-and-a-half to two hours. How do you respond to the idea that lactation is based on supply and demand, and that a baby about to have a growth spurt instinctively knows to nurse more in order to build up the mother’s milk supply for upcoming growth spurt? I fought off my first child when he demanded to nurse what seemed like all day at about six weeks. I spent the day in tears, knowing that he was not being satisfied in some way. After a half-day of this turmoil, I called a La Leche League leader who said “Six weeks? ! Honey, nurse that baby; it’s probably a growth spurt!” I nursed that baby every 45 minutes, and within 36 hours, he was back to a livable schedule. Why do pediatricians believe that this is unhealthy? You seem very supportive of breast-feeding, and I’m very happy to see that in the medical community. Thank you
Christine Dellamaggiora – Raleigh, North Carolina
Dr. Greene’s Answer:
Thank you for your comments. As I am sure you have noticed, there are as many opinions on breast feeding and timing as there are advisors. This is appropriate, since each mother-infant pair is unique. What works for one pair will not necessarily work for another. Some babies have more frequent feeding. One of the most important tasks of parenting is learning to observe your baby’s cues, observe your own cues, and to blend these observations together to determine the best course of action.
I’m not surprised about your experience with your child. Often infants will nurse more frequently in response to increased caloric needs — perhaps in anticipation of a growth spurt. On the other hand, I have frequently seen situations where the baby nurses every 45 minutes and either the mom, or the baby, or both are unhappy and exhausted. Babies like to suck when they are hungry, but also like to suck for oral stimulation and comfort. Sometimes babies are fed when they want to suck, but are not really hungry. Since they don’t eat much when they are offered food at this time, they get hungry soon thereafter. They cry because they are hungry, so mom offers food again, but because the baby is tired by this time, he or she doesn’t eat much before falling into a light sleep. Just about the time mom puts the baby down (and tries to get something done or take that much needed nap), the baby wakes up crying for food. Mom gets up to feed the baby, but her body hasn’t had the time to make a sufficient supply of milk. Now, even though the baby wants to eat enough to get full, he or she can’t. As you can see, a cycle of small, frequent feedings begins.
As you pointed out, sometimes a baby will initiate a cycle of frequent feeding, often for a short-lived growth spurt. This can work quite well, but sometimes either the mother or the baby has trouble going back to a normal schedule when the temporary frequent-feeding schedule is no longer useful. They can get stuck. In these situations, where the mother, or the baby, or both are exhausted, the best way to break the cycle is to delay feeding for at least two hours (from beginning to beginning). This will enable the baby to get good and hungry, and it will give the mother’s body time to make more milk. At the next feeding the baby will eat more, which will keep him or her satisfied even longer.
The general recommendations I make are meant to be an educational and thought-provoking resource. They reflect what I’ve learned (about health, kids, and life for that matter) through education, experience, and observation. I understand that there are times these guidelines aren’t the best for an individual or for a specific family. It is my hope that you will use what I recommend as a stimulus for making your own decisions on how best to care for your children. Only you can determine that.