I was compelled to write this article by yet another friend who came to me worried about a niece or nephew (in this case, a nephew) who was suffering from slow weight gain but whose parents were under the impression that they should not breastfeed him more than every three hours. They had gotten this from their pediatrician, or some baby book, and now was forced to turn to formula to pack in the calories.
I joked (halfheartedly) with my friend, that I was going to title this article not Scheduled Feedings and Breastfeeding, but Just Feed the Baby, Damnit! I can joke about this now only because my memories from falling for the conventional bad advice about scheduled feedings with my first daughter are many years behind me. While she slowly, and unknown to me, starved in her first five days of life, I clung to the faulty notion that my new life with a baby would remain solidly in my control if only I took charge from the start by managing our schedule.
What I learned from my vastly different experiences nursing my two babies is that this notion of scheduled feedings represents a huge misinformation problem, both on the part of new parents and even pediatricians. Instructions are comforting, and new parents are much happier hearing "feed your infant every three hours" than "feed your infant when they are hungry – after all, they know how to read a clock, but not yet how to read a baby.
With my second daughter, I fed her pretty much all the time. Anytime she was awake and willing, I offered her the breast. When she was hungry, she ate – when she wasn't, she didn't (known as feeding on cue, or feeding on demand). I think those first few weeks, she nursed between 15 and 25 times a day. Her average feed was about 5 minutes, and amazingly, she slept 6 hours a night by the third night.
Now a new parent might think that feeding 25 times a day might seem insane, but it was actually so much less stressful to know her needs were met, to be able to not worry if there had been enough feedings, and the biggest prize of all – to be able to allow her (and thus myself) to sleep at night because I knew she had eaten enough during the day.
The American Academy of Pediatrics in their policy statement on "Breastfeeding and the Use of Human Milk – Recommendations on Breastfeeding for Healthy Term Infants" writes that in "the early weeks of breastfeeding, mothers should be encouraged to have 8 to 12 feedings at the breast every 24 hours, offering the breast whenever the infant shows early signs of hunger such as increased alertness, physical activity, mouthing, or rooting." They further elaborate that once "breastfeeding is well established, the frequency of feeding may decline to approximately 8 times per 24 hours, but the infant may increase the frequency again with growth spurts or when an increase in milk volume is desired." (Section 6, italics mine) It is worth noting that 8 feedings (which would be every 3 hours) is the *minimum* recommendation for newborns.
The most well-known book promoting scheduled feeding is Gary Ezzo's On Becoming Babywise, released in 1993, which promises that if you follow his plan, your baby will sleep through the night by 8 weeks, an appealing concept. However, in April 1998, after several negative reports surrounding this book, the AAP issued a media alert stating "Recent media reports have focused on the issue of whether scheduled feedings or demand feedings are best for babies. In response to these reports, the American Academy of Pediatrics (AAP) reaffirms its stance that the best feeding schedules are ones babies design themselves. Scheduled feedings designed by parents may put babies at risk for poor weight gain and dehydration."
An AAP News article by Matthews Ames MD was also published in April 1998, entitled "'Babywise' advice linked to dehydration, failure to thrive." For more information and a summary of concerns about Ezzo and Babywise, see the resource links below.
For alternative resources to books such as Babywise, consider Dr. Sears's "The Baby Book or LLLI's "Learning a Loving Way of Life."
2005 Policy Statement on Breastfeeding
AAP Media Alert Regarding Scheduled Feedings
Excellent TriFold Brochure for Parents and Health Educators Regarding Responsive Parenting and the Problems with Scheduled Feedings, Ezzo and Cry-it-Out
Summary of Concerns about Ezzo and Babywise
Alternatives to On Becoming Babywise:
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