Guest post: “It’s really common for babies not to breastfeed in a regular pattern.”

[MumsnetGuestPosts]

Anyone who has ever breastfed a baby will know that they can feed a lot. But sometimes it’s difficult to trust that your baby knows what they’re doing. Concerns about not having enough milk or whether they’re feeding too much are among the top reasons for stopping breastfeeding, often before women feel ready to do so.

I started researching breastfeeding as a new mum myself after a health professional told me that if my son was feeding every two hours it must mean he wasn’t getting enough milk. Looking at her, and then at my 99th percentile baby, I decided we really needed a greater understanding of what was normal when it came to breastfeeding and the messages new parents received.

Breastfed babies feed frequently because breastmilk is easily digested. Feeding them responsively, ie whenever they want to be fed, is also important in building milk supply. The more milk that’s removed from the breast, the more milk that will be produced, and vice versa. Attempting to put a strict routine in place can actually reduce the amount of milk you make and increase the likelihood of ending up with difficulties or pain.

If you look up how often babies are meant to breastfeed, lots of websites suggest 8–12 times in 24 hours. But talking to thousands of women in my research, it’s clear that, although some babies will feed regularly (every two or three hours), other babies will feed much more frequently. Some babies in my research are feeding up to 26 times a day or more.

In cultures where babies are carried in a sling all day and there are no restrictions on feeding, babies can feed up to four times an hour. No one would suggest that this is practical or desirable for everyone but how often these babies were feeding was not a sign that something was wrong. Unfortunately, here, we seem to spend a lot of time telling new mothers that their baby is feeding too much. How often have you been asked whether your tiny baby is a ‘good baby’ or felt pressure to put them into a feeding routine?

It’s also really common for babies not to breastfeed in a regular pattern. Known as cluster feeding, this is when babies feed on and off several times over a period of a few hours, often in the early evening. Their suck often feels different – less powerful and they may doze in between bouts. It’s also completely normal and 95% of breastfeeding mothers taking part in my research say that their babies do it. Cluster feeding helps increase milk supply but is also about comfort. Babies have a natural desire to suck, especially when feeling unsettled. It’s no coincidence that it often happens at the busiest time of the day, when your full attention is not on them.

Although feeding so frequently is normal, it can be exhausting, especially at first. But once you’re in the rhythm of feeding, most women say breastfeeding gets much easier. Feeds might be more frequent but they are quicker, especially at night. And most importantly, you can never forget to take the milk out with you…

If you’re worried about how often your baby is feeding, it’s important to check for signs that they’re getting enough milk, such as nappy content, whether they look hydrated and hearing them swallow as they feed. La Leche League has further information here. If you are at all worried contact your health professional or the National Breastfeeding helpline who can support you if your baby needs more milk. This might involve expressing milk to give to your baby or, in some cases, formula supplementation. You should be supported through this process to enable you to return to exclusively breastfeeding if you want and if this is possible.

Amy is the author of The Positive Breastfeeding Book: Everything you need to feed your baby with confidence, published by Pinter & Martin Ltd.

[ProfessorAmyBrown]

@BottomleyPottsSpots2

This is a great post - and I have to say that your book is brilliant. I've given it to a number of friends having their first baby, and it's been of real use to all of them - it doesn't 'judge' formula feeding at all, but does support breastfeeding really well. It's matter-of-fact and full of practical advice.

Thank you - really glad to hear you found it useful. And absolutely, given the majority of women end up mixed feeding for one reason or another we thought it was really important to make sure info about mixed feeding / giving formula / stopping breastfeeding / is in there. I wanted it to be about helping women meet their own goals rather than suggesting one way works for everyone.

[ProfessorAmyBrown]

@NCB2019

My breastfed babies all fed in a consistent pattern... continuously for the first 4 months of their life. Unless in the car or pram! 😂

... someone in the research actually wrote when asked how often their baby fed 'all the bloody time'

[ProfessorAmyBrown]

@Knitclubchatter

i'm happy you've written a book on this and are making money (presumably) but this is pretty basic info. the kind of thing i knew by the time i was maybe 12 years old?

I'm really interested if you'd be happy to share where you grew up and whether someone directly told you this information or you learnt it through seeing other babies around you? As this is fantastic if you knew by 12 ! I would guess that the majority of us don't get this information growing up and that is the problem.

[ProfessorAmyBrown]

@Ifsomeonehadtoldme

Precisely why I’m going to quit.

Five months of the baby feeding this frequently is enough. Can’t cope any longer without ever getting a nights sleep. And since he’s rather scream for forty minutes and pass out than have a bottle of ebm seems cold turkey might be the only answer!

Sorry to hear you're in such a tough place. I remember the 5 month bit feeling like hell with each of mine. And likewise, none of them would ever take a bottle either and I thought I was going slowly insane. If it helps at all, there are a couple of studies that have tracked how often breastfed babies feed and it shows they peak at around 5 months and just when you think you're going to go crazy, it drops back down again. In the data I'm currently writing up the same thing happens - feeding so often at about 18 - 20 weeks but then it falls considerably. Have you got anyone supporting you in talking it through and how it could be managed or how to cut back or stop if that's what you're wanting? You can call someone on the National breastfeeding helpline who would help you through the night feeding issue and give you some advice if you stop on making sure you don't get too engorged.

[Ifsomeonehadtoldme]

Yup three private IBCLCs and an NHS one and copious reading. I can’t look after my three year old because of it or indeed go anywhere or do anything. He’ll only nap in a carrier so I haven’t slept more than five hours a day since he was born. I now cry regularly because I’m so exhausted.

Going to have to be cold turkey I think since I can’t work out where I would substitute a feed. Didn’t want to do that to him; don’t really care about my comfort given I’ve been uncomfortable for the better part of 14 months.

[ProfessorAmyBrown]

@Ifsomeonehadtoldme

Yup three private IBCLCs and an NHS one and copious reading. I can’t look after my three year old because of it or indeed go anywhere or do anything. He’ll only nap in a carrier so I haven’t slept more than five hours a day since he was born. I now cry regularly because I’m so exhausted.

Going to have to be cold turkey I think since I can’t work out where I would substitute a feed. Didn’t want to do that to him; don’t really care about my comfort given I’ve been uncomfortable for the better part of 14 months.

It sounds really, really tough, I'm so sorry. Give the helpline a ring (or they have a web chat option). They may have solutions for you and will help talk you through what you can do next //www.nationalbreastfeedinghelpline.org.uk .

Do they feed that much in the day too? I am assuming that the IBCLCs checked to make sure there wasn't another underlying issue.

I'm also wondering if a doula or someone similar would be able to help in caring for you and easing the load a bit whilst you work it out. But do contact the helpline as they are free, and support women through stopping as well as keeping going. They will be able to point you to any local support.

[Ifsomeonehadtoldme]

That’s during the day. At night he takes about 90 mins of sucking to settle so it’s 8:30/ 9 by the time I’m downstairs then dinner isn’t done til ten. Takes me a long time to go to sleep then he’s up at 1/2 for around an hour then again st 4/5 for another hour then we have to get up at 6:30 to get older one to nursery. I walk about four hours a day with carrier strapped to me as he won’t settle. He feeds at least every ninety minutes.

I’ve phoned the helpline. They were kind but the only solution was that he won’t starve himself so don’t worry about it. HV told me the only answer was to struggle through to six months though it’s not like weaning helps for a very long time. She then referred me to a local NHS specialist who again was kind but was faced with angel baby who wasn’t fussing at all. Every feed is a battle. ice trued spacing I’ve tried clustering. Given I’ve had two horrendous experiences I can only assume the equipment is broken and I shouldn’t have tried to use it again.

[Jellybean100]

I loved your book, I have recommended it to all my friends and will continue to do so. I wish I had read it before the birth of my first child.
It’s really really helped me with my second. Thank you x

[SnuggyBuggy]

I think HCP need to be better at advising women on BF

[AlphaJura]

Very important and info to get out there. I've bf 3 babies for a year each. Had various problems which I overcame with good family support (my mum is very pro breastfeeding) and help from books and websites like la leche league and kellymom. As pp said, feeding constantly and cluster feeding is normal but doesn't mean it's easy. I think health professionals should put more emphasis on the fact that breastfeeding needs to be established and not to write things like they 'should' be feeding very x amount of hours. Also, support for the mother is paramount. All too often you hear mothers saying they are going undermined by family who are trying to help, they see the mother is exhausted but instead of offering to pick up the slack around the house, look after older children or let the mum rest with baby, they suggest topping up with formula because 'baby isn't getting enough' or is 'very hungry'. It's sad when you hear people say they gave up because their 'milk didn't come in', they don't realise it can take a few days or 'they didn't have enough milk'. Chances are, they did but they didn't give it enough time to get established. I've also heard some shocking things gps have said to mothers. They in particular, seem to be offering very outdated and wrong advice, looking at it purely from a nutritional point of view, when it isn't just that.

[AgentCooper]

Yes yes yes. I read a well known book prior to my DS’s birth which suggested you put your baby on a 3 hourly feeding routine from the word go, regardless of feeding method, because ‘if you feed on demand, you will get a demanding baby.’

Thank God for Mumsnet or else i’d have thought there was something wrong with me or DS. I missed the NHS breastfeeding workshop because I was induced at 37 weeks.

[bigmamapeach]

The page that is linked to for the "research" says there is a dataset with 30,000 mothers, but where is the published scientific paper with the results?

madeatuni.org.uk/swansea-university/tackling-uks-low-breastfeeding-rate

"Amy worked with more than 30,000 mothers, collecting data on what normal baby behaviour looks like and the damage strict baby care routines can have, both for breastfeeding and maternal wellbeing. "

I'm wondering how we know that eg, feeding up to 26 times per day is normal;

"Some babies in my research are feeding up to 26 times a day or more."

Remember there are two people in the equation, the mum and the baby (well actually may be other family members affected too, like Mum's partner if there is one), but the mum and baby are most important.

For a lot of things to do with behaviour, it may seem "normal" for one person but not "normal" for the other. How the mum is coping is important too.

Can the researcher clarify how it is checked that frequent feeding at the upper end of the range is in fact normal - that there is not, for example an undiagnosed problem in the baby (like failure to thrive, poor weight gain, medical problems that are causing them not to feed well) or that the very frequent feeding is having a negative impact on Mum?

I'm sure there is loads and loads of variability but would think it's really important not to just tell mums: "well what baby is doing is normal" (however it is exhausting the mother). And you absolutely don't want to let possible maternal concern around a feeding problem pass without investigation.

So having some specific limits on this and being able to see the data and how the families were characterised and evaluated in the study would be useful. Thanks

[AnnaFiveTowns]

God yes and I wish somebody had told me this when I brought my first new born home. Instead I read that dreadful "contented baby" book and felt like a complete failure.

[dontfollowmeimlosttoo]

I absolutely agree that family need to be more supportive.. I remember when baby was around 4 weeks old I'd been up most of the night breastfeeding . I told my mum this ( who was coming to visit ) she said you must go to bed and il give him a bottle .. I was like a bottle of what ?! She was like oh yea I didn't think .. I forgot .
Also health visitors always ask me " and is he going longer now between feeds " ( in a hopeful tone ) making me feel I'm doing something wrong as he feeds a lot . My baby is very healthy weighs 17 and half pound at 4 months . I feed him when he wants .

[SnuggyBuggy]

Family do make a difference. In my case the most helpful thing was DM telling me that DD probably fed all the time because she was bored and had nothing better to do because she couldn't move much. I don't know how medically accurate this was in hindsight but it stopped me worrying.

[ArchbishopOfBanterbury]

I am so glad I had your book, and a few others, to reassure me that my 90th percentile boy, currently 9 weeks old, is doing okay.

I've had a health visitor and a midwife both advise me to stop bf, after I told them it still hurt at 4 weeks. That him feeding so frequently, and my nipples being sore, is a sign he needs hungry baby formula. I pushed back, knowing that my nipples would toughen up, and the clustering would relax eventually. It has.

The 8-12 times a day guidance is bull and needs to be removed from the materials. Definitely fake news! Mine fed at least 30 minutes of each hour in the day for the first few weeks, and often would be constantly attached, switching left to right but never stopping.

He's fine, and so am I, but the misinformation could have easily made me stop if I hadn't had access to books and proper support, which so many women don't.

[cannotmakemymindup]

Yes to so much of what you've said.
My baby is now five but I remember my sister saying she should be feeding every four hours and I should get her in a routine. My baby was not her son who was nearly 10Ilbs when born and with a stomach to match!
I was happy with my baby feeding hourly between naps during the day and sleeping for 8 hours straight from 8 weeks old at night. But I did feel like lots of people were thinking isn't she feeding to often?

I think a lot of people worry about over production to with feeding to frequently. That's always the thing with expressing and breast feeding a baby that you could end up with to much. The thing is I enjoyed being able to express so my husband could do a feed before bed. People were always warning me but what they didn't realise is I had a very strong let down so expressing was important for my daughter otherwise my milk was to fast for her, I had to let the tap run for a bit as such before feeding her. Plus she could always have the bit I just expressed after my breast was 'empty' then not missing out on it.

[AquarianSquirrel]

Agree with you, Archbishop, feeding frequency is often unhelpful information and can lead to mother's questioning themselves when their baby doesn't fall into that bracket.

Wish I knew about cluster feeding before ds. My mum has breastfed 4 children but we never had a proper discussion about it. Probably chatted more about prams and baby baths!!

It seems like the trickier aspects of breastfeeding are brushed over because rates are so low (particularly in the UK) and midwives/HV's don't want to put mothers off. However, this often has the opposite effect. With mothers thinking cluster feeding means their supply is low and therefore baby is not "getting enough".

Also, the fact that breastmilk is more easily digestible than formula, meaning more feeds are needed, is not well known, so mums often switch to formula to "supplement". The baby feeds less frequently (because it's harder to digest) and the mum thinks the baby is more satisfied. This particularly applies to the night and the mythical "sleeping through"!! My sister slept for 12 hours from a few months old and my brother was a terrible sleeper for years (both breastfed), so much of it comes down to the individual.

Either way motherhood/parenthood is hard but I wish everytime we talk about breastfeeding we didn't have to stipulate "this is not an attack on ff parents" or ff parents didn't feel they have to apologise/quickly explain why they're not breastfeeding when they see you feed your child. It's all so stressful nowadays and we need to support eachother, whilst simultaneously trying to increase the breastfeeding rate for it's myriad benefits to mother (reduced risk of certain cancers which increase the longer you feed), baby (health and immunity benefits, a sleep aid and for pacifying tantrums!) and for society as a whole (decreased illnesses which cost the nhs/businesses money). Aaand breathe!

[ShadowKitty]

I breastfed on demand but with my first it was constant to the point my nipples were so raw I was feeling faint from the pain every time he latched on. I introduced a dummy quite early and if I hadn't, I would have given up breastfeeding. As it was, with the dummy to help him sleep, I was able to accommodate the feeding on demand and cluster feeding and all the other challenges of breastfeeding for 10 months till he weaned himself. I get what a pp is saying about being 'used as a dummy' as I've heard it a lot when people have had enough and can't continue to breastfeed - the need to feed and suckle is natural and intense frequency is normal but it can be helpful to use a dummy, a little mixed feeding or whatever if it helps you continue breastfeeding if that's what you ideally want to do. But yes, I agree that I was totally unaware of how unpredictable a breastfed babies feeding pattern is and it should be better articulated to new mums.

[SnuggyBuggy]

I agree with AquarianSquirrel, the reality of breastfeeding does need to be more publicly discussed. The whole let's not tell women in case it puts them off approach isn't working in the UK if you look at initiation and continuation statistics.

[ProfessorAmyBrown]

@Ifsomeonehadtoldme

That’s during the day. At night he takes about 90 mins of sucking to settle so it’s 8:30/ 9 by the time I’m downstairs then dinner isn’t done til ten. Takes me a long time to go to sleep then he’s up at 1/2 for around an hour then again st 4/5 for another hour then we have to get up at 6:30 to get older one to nursery. I walk about four hours a day with carrier strapped to me as he won’t settle. He feeds at least every ninety minutes.

I’ve phoned the helpline. They were kind but the only solution was that he won’t starve himself so don’t worry about it. HV told me the only answer was to struggle through to six months though it’s not like weaning helps for a very long time. She then referred me to a local NHS specialist who again was kind but was faced with angel baby who wasn’t fussing at all. Every feed is a battle. ice trued spacing I’ve tried clustering. Given I’ve had two horrendous experiences I can only assume the equipment is broken and I shouldn’t have tried to use it again.

If you want to send me a PM or email me I can see if I can help

[ProfessorAmyBrown]

@SnuggyBuggy

I agree with AquarianSquirrel, the reality of breastfeeding does need to be more publicly discussed. The whole let's not tell women in case it puts them off approach isn't working in the UK if you look at initiation and continuation statistics.

Yes absolutely! It seems to be shrouded in mystery and 'it will be magical' thinking when like anything, it can be really tough. Women aren't delicate flowers - we can take a bit of realistic information (it makes things easier in the long run)

[ProfessorAmyBrown]

@ShadowKitty

I breastfed on demand but with my first it was constant to the point my nipples were so raw I was feeling faint from the pain every time he latched on. I introduced a dummy quite early and if I hadn't, I would have given up breastfeeding. As it was, with the dummy to help him sleep, I was able to accommodate the feeding on demand and cluster feeding and all the other challenges of breastfeeding for 10 months till he weaned himself. I get what a pp is saying about being 'used as a dummy' as I've heard it a lot when people have had enough and can't continue to breastfeed - the need to feed and suckle is natural and intense frequency is normal but it can be helpful to use a dummy, a little mixed feeding or whatever if it helps you continue breastfeeding if that's what you ideally want to do. But yes, I agree that I was totally unaware of how unpredictable a breastfed babies feeding pattern is and it should be better articulated to new mums.

Yes absolutely - and again the same issue arises that women aren't given enough information about how to use a dummy effectively if that's what they want. There is some evidence that they can reduce milk supply but only if they're used too often to delay a wanted feed. There's a really interesting study that shows if women really want to breastfeed and they use a dummy, their milk supply was fine, but when women weren't sure, their supply dropped. It suggests if you understand the potential risk of a dummy and take steps to avoid those things, then it will likely be fine.

However instead we end up with a blanket health message - usually because of a lack of investment and time for health professionals to just be able to sit and support breastfeeding. Almost every issue can be brought back to this in some way it seems.

[ProfessorAmyBrown]

@AquarianSquirrel

Agree with you, Archbishop, feeding frequency is often unhelpful information and can lead to mother's questioning themselves when their baby doesn't fall into that bracket.

Wish I knew about cluster feeding before ds. My mum has breastfed 4 children but we never had a proper discussion about it. Probably chatted more about prams and baby baths!!

It seems like the trickier aspects of breastfeeding are brushed over because rates are so low (particularly in the UK) and midwives/HV's don't want to put mothers off. However, this often has the opposite effect. With mothers thinking cluster feeding means their supply is low and therefore baby is not "getting enough".

Also, the fact that breastmilk is more easily digestible than formula, meaning more feeds are needed, is not well known, so mums often switch to formula to "supplement". The baby feeds less frequently (because it's harder to digest) and the mum thinks the baby is more satisfied. This particularly applies to the night and the mythical "sleeping through"!! My sister slept for 12 hours from a few months old and my brother was a terrible sleeper for years (both breastfed), so much of it comes down to the individual.

Either way motherhood/parenthood is hard but I wish everytime we talk about breastfeeding we didn't have to stipulate "this is not an attack on ff parents" or ff parents didn't feel they have to apologise/quickly explain why they're not breastfeeding when they see you feed your child. It's all so stressful nowadays and we need to support eachother, whilst simultaneously trying to increase the breastfeeding rate for it's myriad benefits to mother (reduced risk of certain cancers which increase the longer you feed), baby (health and immunity benefits, a sleep aid and for pacifying tantrums!) and for society as a whole (decreased illnesses which cost the nhs/businesses money). Aaand breathe!

Again, yes! My new research I am hoping gets published soon was born out of seeing the frustration and messages that women were getting about how much and when and why their baby should be feeding. It will show the sheer variety of what is normal (and over time as a baby gets older) rather than the seemingly non evidenced based 8 - 12 times a day.

When doing the research I couldn't find any research published on cluster feeding or feeding for reasons other than hunger, even though anyone who works to support breastfeeding or who has breastfed a baby knows they exist. So on the surface it might end up being one of those papers that will get criticised for being really obvious but hopefully it will actually help as something people can refer to.

[ProfessorAmyBrown]

@cannotmakemymindup

Yes to so much of what you've said.
My baby is now five but I remember my sister saying she should be feeding every four hours and I should get her in a routine. My baby was not her son who was nearly 10Ilbs when born and with a stomach to match!
I was happy with my baby feeding hourly between naps during the day and sleeping for 8 hours straight from 8 weeks old at night. But I did feel like lots of people were thinking isn't she feeding to often?

I think a lot of people worry about over production to with feeding to frequently. That's always the thing with expressing and breast feeding a baby that you could end up with to much. The thing is I enjoyed being able to express so my husband could do a feed before bed. People were always warning me but what they didn't realise is I had a very strong let down so expressing was important for my daughter otherwise my milk was to fast for her, I had to let the tap run for a bit as such before feeding her. Plus she could always have the bit I just expressed after my breast was 'empty' then not missing out on it.

Again yes, I really wish people would stop pushing their opinion on women when they are perfectly happy with what they are doing and its working for them...