About how many feeds I am aiming for - I'm actually aiming for the baby to self-regulate, and for the parents to experience how much better a baby feeds when hungry, instead of when some pre-determined time period has elapsed.   

What usually happens when the parents start watching the baby to see whether the baby is going to wake before the alarm goes off, is that they start to notice more subtle signs of readiness to feed, and responding to them.  

The other thing that happens is that the baby's intake actually improves, because feedings are taking place when baby is hungry.  Instead of failing at attempts to cajole baby into feeding at scheduled times, the parents start succeeding at feeding a hungry baby.  The baby responds by being more tuned in and showing much more satisfaction.  In fact, the 'every three hours' method is notoriously unsuccessful at ensuring a minimum of intake because most of the parents' time is spent trying to rouse and feed a drowsy, over-satiated baby.  It just plain doesn't work well enough as a feeding plan, and it doesn't build confidence in the parents or make the baby happy either.

I am with them during at least one feed, and I point out signs of effective feeding when I see them - the baby settling in, swallowing, having longer, rhythmic jaw excursions, spending more time feeding and less time fretting than before, and of course producing urine and hopefully stools.  But the bottom line is the daily weight check.  Remember, I am talking about the first week of life.  Daily weighing *from day 3* until you see a convincing upward slope is not too frequent.  If a baby is unhappy at any time, we investigate.  And if a baby continues to lose weight from day four on, we are more active in offering the baby expressed milk in the expectation that feeding will be more effective when the baby has been fed.  A baby who is able to be with its mother on the postnatal ward is not going to be compromised by letting a plan like this have 24 hours to work in between weight checks.   

The typical pattern I've come to expect in near-term babies who are prevented from having a big loss of weight in the first couple of days by being actively fed expressed milk or donor milk or even formula, is that they remain at their lowest weight for up to a week, about 5% below birth weight, going neither up nor down, before they just kind of wake up and start feeding.  You can't just sit there and wait for them, you have to keep the mother's supply up by expressing and you have to keep feeding them, but at some point in that week their behavior changes and they just start to thrive, literally.  It takes a lot longer for that to happen if they are on scheduled, measured feeds, because they never experience hunger and so are never motivated to seek out food, and they may even develop signs of aversion to feeding.  They needn't be starved, just allowed to develop an appetite :-)

I usually talk about how babies feed 12-20 times a day in the first few days if everything is going normally, and that it should not be less than 8 feeds a day to make pretty sure the baby is getting enough, but some babies take in plenty in fewer feeds too.  I try not to give so much attention to number of feeds, but to how the baby is behaving and how feeds are going.  

Rachel Myr
Kristiansand, Norway




If the baby is blatantly incapable of effective suckling, of course we feed the baby some other way, usually cup.  I'm talking about babies who are on the verge of being able to do it all themselves and who need a fair chance in order to do so.      

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