What to Expect During the Early Weeks of Breastfeeding

Hunger cues; demand feeding; nix the pacifier

Breastfed newborns should appear satisfied after nursings. Generally, a well-fed baby is a contented baby. In the first two days, when the volume of colostrum is relatively low, your baby may act hungry very soon after the last nursing. By the third day, however, when your milk starts to come in abundantly, your baby should appear more content after nursings. Breastfed newborns usually fall asleep at the second breast and act satisfied between feedings.

Sometimes new parents don't recognize their baby's hunger cues because they mistakenly assume that an infant who just finished nursing must automatically have obtained sufficient milk. The surprising truth is that an infant can go through the motions of breastfeeding, nurse from both sides, and still not consume much milk. Several explanations are possible. Perhaps the baby has been latched on incorrectly or has a faulty suck. Maybe the milk ejection reflex wasn't triggered, or the mother's milk production is insufficient. Obviously, the first thing to do when a baby appears hungry after nursing is to return him to the fullest breast for another chance at feeding.

Of course, not all fussiness in a breastfed baby is due to hunger. Babies need human contact as much as they need food. An infant may cry because he wants to be held and doesn't want to be separated from his mother. Even a well-fed baby may want to be carried and held to make him feel safe and secure.

WHEN TO SEEK HELP: Breastfed infants who appear hungry after most feedings (e.g., crying, sucking on their hands, rooting, requiring a pacifier to be consoled) may not be getting enough milk. Signs of apparent hunger in an infant should not be ignored, even if the baby is feeding on a proper routine. Contact your baby's doctor and have your infant weighed. If your baby really isn't getting enough to eat, the sooner the problem is recognized, the more readily it can be remedied.

Demand feeding should mean frequent feeding. Decades ago, when bottle-feeding was the predominant method of feeding infants in the United States, scheduled feedings became popular. Babies were fed by the clock, usually at four-hour intervals. A baby who showed signs of hunger sooner than four hours often was made to wait until the appointed feeding time. Because such rigid scheduling of feedings didn't account for babies' unique needs, some experts began to advocate more flexibility in feeding infants. The term demand feeding was used to describe feeding a baby whenever he showed signs of hunger instead of feeding by a rigid schedule.

In recent decades, feeding babies on demand has become the norm. Certainly, feeding a baby when she shows signs of hunger seems appropriate and empathetic. However, some well-meaning parents misapply the concept by allowing a sleepy, nondemanding baby to feed too infrequently. Feeding on demand was meant to give a parent permission to nurse again if their baby seems hungry sooner than expected. A newborn shouldn't be allowed to sleep five or six hours without feeding just because he "hasn't demanded." Nor should "demand feeding" be used to justify a newborn going all night without breastfeeding, even if he is willing to sleep through. In summary, demand feeding reminds us to feed hungry babies more often than we might expect them to need to be fed. It shouldn't be misinterpreted to let sleepy babies go too long without nursing.

Postpone pacifier use for breastfed newborns. The use of pacifiers is a widespread childrearing practice, both in the United States and in other countries. Although many experts have cautioned that early pacifier use can undermine the successful establishment of breastfeeding, little scientific evidence has existed to support this claim. Now several recent studies have confirmed that early pacifier use is linked to early weaning. In one study, infants using pacifiers at one month of age were three times more likely to have discontinued breastfeeding by six months of age. The risk of early weaning was greater for "frequent" users (during the whole day and night to help them fall asleep) as compared to "partial" users.

Based on my experience, I agree that early pacifier use before breastfeeding is well established can sabotage long-term breastfeeding. A baby who is "corked" or "plugged" with a pacifier may not learn to nurse as effectively as the baby who does all, or most, of his sucking at the breast. While some hungry babies will spit out their pacifier and vociferously demand a feeding, other underfed infants are more passive. They fool us by acting content to suck nonnutritively on a pacifier when they really need to be obtaining milk. The younger the infant, the harder it is for parents to interpret their baby's cues. It's just not possible in the early weeks to reliably distinguish when a baby only needs "comfort sucking" and when the infant needs "nutritive sucking." Once a pattern of consistent weight gain has been achieved, it is much less risky to introduce a pacifier. After four to six weeks of successful breastfeeding, a mother will have acquired much experience in interpreting her baby's cues. She will be more adept at recognizing signs of hunger and evaluating the quality of a feeding and will be less likely to confuse hunger with the urge to suck.