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]

@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

thank you

[ProfessorAmyBrown]

@SnuggyBuggy

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

Things are getting better with training. I think unfortunately some still trained at a time where there was little information (some health visitors tell me that they barely covered breastfeeding). We also really want to make sure breastfeeding is covered in sufficient depth in medical schools and are publishing a book soon on supporting breastfeeding for medics

[ProfessorAmyBrown]

@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.

Yes I fully agree - I think a lot of issues stem back to that and a lack of responsive feeding in general because everyone keeps telling women it's either a sign something is wrong, or something you should avoid as you have to be in control of the baby. And KellyMom and La Leche league are brilliant websites - I think I read most of KellyMom with my own babies

[ProfessorAmyBrown]

@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.

Ha at demanding baby - how dare these small, pretty helpless creatures try to persuade someone to feed them

[ProfessorAmyBrown]

@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

Ok so cross wires here slightly. The MadeAtUni link is a clip to us talking about all my research over the last 14 years (so that's the 30,000). On the back of it Mumsnet asked me to write a guest piece on feeding frequency and cluster feeding. But there is only limited room in a post .

So to try and answer your points

1. The 26 weeks quote is part of some research I am writing up at the moment. I did the project because I kept coming across the 'your baby will feed 8 - 12 times' thing and thought that didn't fit with a lot of women I talked to and I didnt know where that info came from.
   

Looking at the literature I'm still not sure. Just like much of this general area there is a lack of published evidence. There is one study published in Australia that suggests most babies feed between 8 - 14 times in 24 hours with a reported range in their study of 6 - 18 (but thats not 8 - 12 times)

Kent, J. C., Mitoulas, L. R., Cregan, M. D., Ramsay, D. T., Doherty, D. A., & Hartmann, P. E. (2006). Volume and frequency of breastfeedings and fat content of breast milk throughout the day.Pediatrics,117(3), e387-e395.

There's not much more from 'Western' countries. If you look at cultures where mum and baby are close all day, baby is carried in a sling etc, and there are no expectations on limiting feeds then babies feed much more. Two studies in Bangladesh observed how many feeds over an 8 hour period and they both found babies were feeding every hour or so in that period (but they didn't measure at night)

Ghosh, R., Mascie‐Taylor, C. N., & Rosetta, L. (2006). Longitudinal study of the frequency and duration of breastfeeding in rural Bangladeshi women.American Journal of Human Biology: The Official Journal of the Human Biology Association,18(5), 630-638.

Zeitlin, M. F., & Ahmed, N. U. (1995). Nutritional correlates of frequency and length of breastfeeds in rural Bangladesh.Early Human Development,41(2), 97-110.

Then there is the famous anthropological study of a very remote tribe - they found the average frequency of feeds was 4 times an hour and the longest break they witnessed was 55 minutes. Feeds were just a few minutes long though from within the sling.

Konner M. Nursing frequency and birth spacing in] Kung hunter-gatherers. IPPF medical bulletin. 1978 Apr 1;15(2):1-3.

But that only tells us what is biologically 'normal' in cultures that are vey different to ours. So the research I hope to publish soon takes a snapshot of feeding frequency from a large group of women (18,000) and I've plotted the average number of feeds per 24 hours for various ages. It's showing that there is a wide variety of normal and the average frequency of feeds per day goes up and down over time (in line with what we kind of knew about growth spurts anyway).

The variation in feeds is large, ranging from 6 - 26 feeds a day. It's important to point out that all women just recorded one day, so we don't know from this if those babies were always feeding that much (although 96% of women said their baby shows variation in frequency of feeds from week to week). I would like to do more detailed research looking at what's happening in those high frequency babies.

It's also really difficult to actually define a feed in babies who feed very frequently. Although we had instructions about how to count a feed (e.g. a clear break) some people might count several feeds as one, whist others might say it was more.

Once we've published I'll come back and link it here

As for your point out maternal wellbeing. That's another question and an important one that needs further research and understanding as it is a major issue. Back when I did my Phd I looked at why women didn't want to responsively feed. It being overwhelming, anxiety provoking, impacting on the other things they needed to do were all reasons. And again it's got to be about balance for that family.

However I would like to see a system where more investment in women and families (better paid, longer leave, cheaper childcare for older children if that's what is wanted and more support and care in general) meant that it wasn't quite so hard.

[ProfessorAmyBrown]

@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.

Unfortunately a common feeling. We actually did some research looking at the impact of those books. Although they worked for some (about 15 - 20% of those who responded) they didnt for most, with the finding that they could leave you feeling like a failure

[ProfessorAmyBrown]

@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.

I like it - we should badge it more as 'entertainment for your baby'

[ProfessorAmyBrown]

@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.

I'm really glad it helped and sorry you got such bad advice.

Yes that 8 - 12 times a day thing appears to be nonsense (see my other long post just above) but I can't find any evidence for it. The closest thing I found suggested 8 - 14 times a day was what most babies did, but again some babies were feeding more like 19 times. Most babies in the data I hope to publish soon were more like 12 - 14 times but with a good number over 14 who just liked a more snack like approach.

They key bit is to follow your baby's lead whilst also keeping an eye they are getting enough, but there will be huge variation in that. I mean, how often do adults eat and drink throughout the day. I bet its more than 8 - 12 times if you take into consideration all drinks of water etc. But there will be some people who do much less.

[bigmamapeach]

Thanks a lot for the info, ProfessorAmyBrown

It will be good to see the full details published.

If you are still writing up, will you consider including some mention of the issue around "normal" including "OK for the mum"? eg, how well she is coping with the feeding frequency, is she getting enough sleep etc. Some measure of her sleep quality, ability to self-care. If the data isn't there, it could be something to look at in future studies.

PS, if the very-frequently feeding babies are in very hot places (like the !Kung in Kalahari and Bangladesh), babies may need to feed that often just to make sure they don't get dehydrated. Doesn't necessarily mean that would be normal in the UK! Need to know how the mums are coping with it, too.

[ProfessorAmyBrown]

@bigmamapeach

Thanks a lot for the info, ProfessorAmyBrown

It will be good to see the full details published.

If you are still writing up, will you consider including some mention of the issue around "normal" including "OK for the mum"? eg, how well she is coping with the feeding frequency, is she getting enough sleep etc. Some measure of her sleep quality, ability to self-care. If the data isn't there, it could be something to look at in future studies.

PS, if the very-frequently feeding babies are in very hot places (like the !Kung in Kalahari and Bangladesh), babies may need to feed that often just to make sure they don't get dehydrated. Doesn't necessarily mean that would be normal in the UK! Need to know how the mums are coping with it, too.

Absolutely will do

[RicStar]

OP I think it is important to add it is also normal if your baby feeds every few hours. I have 3 babies - 2 of whom were not interested in feeding if they had been fed recently. One of whom would and still does eat more frequently if offered the chance.

Once ds1 was a very few weeks old he really did only want around 6-8 (max) feeds per day. One (dd) who did cluster feed a little in the evenings but only until she was about 8 weeks old.

I believe babies who are having wet and dirty nappies and gaining weight are normal. I also believe mum needs to do what works for them both with the support she actually has.

I never put mine on any kind of routine but worried a lot they didn't feed enough as it was not like I read about on here etc. They gained weight and stuck to their curve like they had read all the old fashioned books.

[Peachy8]

Great article! I went to a session at a children's centre and a lady was telling me my 8 month old was using me as a dummy in the night as he isnt sleeping through yet our 24 hour open bar (or bra!) works just swell for us

[ProfessorAmyBrown]

@RicStar

OP I think it is important to add it is also normal if your baby feeds every few hours. I have 3 babies - 2 of whom were not interested in feeding if they had been fed recently. One of whom would and still does eat more frequently if offered the chance.

Once ds1 was a very few weeks old he really did only want around 6-8 (max) feeds per day. One (dd) who did cluster feed a little in the evenings but only until she was about 8 weeks old.

I believe babies who are having wet and dirty nappies and gaining weight are normal. I also believe mum needs to do what works for them both with the support she actually has.

I never put mine on any kind of routine but worried a lot they didn't feed enough as it was not like I read about on here etc. They gained weight and stuck to their curve like they had read all the old fashioned books.

Yes absolutely! The data I have shows that - some women were feeding as little as 6 times a day and it worked for them. The key is on a) being responsive to what your baby wants and b) checking they're getting enough. But in between that there is a whole load of normal, rather than some 8 - 12 times a day. Actually wondering now what the range would be for adults eating and drinking per day

[ProfessorAmyBrown]

@Peachy8

Great article! I went to a session at a children's centre and a lady was telling me my 8 month old was using me as a dummy in the night as he isnt sleeping through yet our 24 hour open bar (or bra!) works just swell for us

One day people will realise the irony... perhaps.

[RidingMyBike]

Need a huge improvement in how women are prepared antenatally. I did a breastfeeding antenatal class in NHS hospital and was told to expect frequent feeding and cluster feeding - but it was presented as cutesy and snuggly and lovely. And it really wasn't. It was like being in hell. I hated it. Could have done with a lot more practical information, especially about how to cope with all this when you have very little family support around.

Also good to see acknowledgment that some babies will need formula and some mums won't be able to make enough milk. I had no idea of this, and neither had almost all the HCPs I encountered - which resulted in them exhorting me to keep on 'cluster feeding' when actually my milk wasn't even in yet and my baby was starving. This resulted in an emergent readmission to SCBU with hypernatraemic dehydration.

[SnuggyBuggy]

The lack of family support somewhat puts me off having another child. I'd have to leave toddler DD to her own devices and hope for the best whilst stuck on the sofa breastfeeding all day.

[ProfessorAmyBrown]

@RidingMyBike

Need a huge improvement in how women are prepared antenatally. I did a breastfeeding antenatal class in NHS hospital and was told to expect frequent feeding and cluster feeding - but it was presented as cutesy and snuggly and lovely. And it really wasn't. It was like being in hell. I hated it. Could have done with a lot more practical information, especially about how to cope with all this when you have very little family support around.

Also good to see acknowledgment that some babies will need formula and some mums won't be able to make enough milk. I had no idea of this, and neither had almost all the HCPs I encountered - which resulted in them exhorting me to keep on 'cluster feeding' when actually my milk wasn't even in yet and my baby was starving. This resulted in an emergent readmission to SCBU with hypernatraemic dehydration.

Yes don't get me started on the sugar coating - why is there a belief we can't handle the idea things might be tough? Wrote this a while ago theconversation.com/breastfeeding-is-not-easy-stop-telling-new-mothers-that-it-is-98026

And yes definitely needs an overhaul. Antenatal classes seem to focus on the birth which of course is important but one day (ish). I'm not saying reduce time on that, but certainly need equal or more education about what babies are actually like in terms of the reality of feeding and complications.

[Knitclubchatter]

My close friends referred to feeding while doing housework as “milkshake”. I remember vacuuming while nursing and doing dishes with the little one resting on the sink edge.

[ProfessorAmyBrown]

@Knitclubchatter

My close friends referred to feeding while doing housework as “milkshake”. I remember vacuuming while nursing and doing dishes with the little one resting on the sink edge.

We need an emoji for that