Experts | Newborn Sleep and Breastfeeding Part 2

Today Lorna from Orchard Green Parenting is back with part 2 of her newborn routine.

When you have a newborn baby you will have your own priorities, perhaps breastfeeding is the most important thing to you, or sleep, or something else. Listening to the many and varied advice out there can give the impression that you have to pick just one thing, but it is possible to have a baby who breast feeds and also sleeps well. You might want to have a look at part one for some tips for the very first days, today we are looking at what to do after your milk comes in and your baby starts being a little more awake, perhaps around day three or four onwards.

It is important to realise that with such a young baby your goal is not to have them sleeping through the night. At first you are just aiming to have them settle in their bed with minimal help from you and sleep well until they next need a feed, with any longer stretches of sleep happening at night. With that in place most babies will naturally sleep for longer as and when they are ready, at a different age for each child.

  • Establish two set points to your day – morning and bedtime. 7am and 7pm work well for many families but 6-6 or 8-8 can be good too. The important thing is to be consistent.
  • During “night” keep the lights dim, avoid too much noise or chatter and generally try to get your baby fed and back to sleep as quickly as possible. Don’t wake them for feeds or have any playtime after feeds, the aim is to sleep as much as possible. You can even leave the baby swaddled while they feed.
  • During the day throw open the curtains, bring baby into the living room, and chat away to him with lots of eye contact and smiles. You want there to be an obvious difference, as different as, well, night and day!
  • During the day feed your baby every three hours, even if that means waking her up. If she is hungry sooner then do feed her but make sure she really is hungry and not looking for something else. If your baby doesn’t feed enthusiastically at 3 hours you might consider stretching to four hourly feeds, but three hourly suits most newborns.
  • Now that your baby has woken up a bit and doesn’t need to sleep all the time try to keep them up for a short play after each feed. This breaks any association between feeding and sleeping.
  • Look out for the subtle sleep cues, turning away from stimulation, staring into space or that first yawn. It might be just an hour or so after waking, so keep an eye out and don’t let your little one get too tired. When you spot those cues swaddle your baby and put them in their cot or Moses basket, in a quietish room with the curtains closed. If your baby needs some reassurance pat their tummy or rub their head gently but don’t pick them up unless they are upset. If they are content to lie in bed without you, leave them to it!

Before you know it you should be able to pop your little one in bed and leave them to settle to sleep without too much trouble, where they will sleep peacefully until they are ready for the next feed. At feed times they will nurse enthusiastically before staying awake for a play. Feeds will be timed differently for each baby but there should be more of them during the day than there are at night and you should be able to predict a rough pattern that is your baby’s normal routine.

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3 thoughts

  1. Having read both parts of this article, there are several points I feel should be mentioned.

    After birth, a baby generally loses up to 10% of birth weight, in some cases more. I cannot say if it is the same everywhere, but particularly with the maternity team at the hospital where I gave birth, it is encouraged that the breast is offered frequently until birth weight is re-established and a good latch achieved. This includes through the night, with feeds every three hours maximum, waking baby if necessary. For us this was a two week period.

    The schedule may be more frequent for a premature baby, or a baby that loses in excess of 10% of their birth weight.

    We are told that 3 hours is a long time for a newborn to go without suckling. This is because breastmilk is far more quickly and easily digested than formula, and can be fully digested after just 90 minutes. A newborn, still tired from birth, may not wake for a feed naturally, despite being hungry.

    While posts like these have their value, attention to the advice of your own maternity team is important for the health of your newborn.

    As fot making sure a baby is really hungry for a day feed at such a delicate age, and separating feeding from sleeping, not enough can be said with regards to comfort nursing. A small baby, particularly a newborn, may simply want to comfort nurse for just a few minutes here and there in addition to feeds, and may want to nurse to sleep. Baby’s of this size have not and cannot yet learn to self-soothe. Even comfort nursing offers nutritional benefits, as feeding still occurs. This point I feel would be fully suported by the internationally reknowned La Leche league, who can be found online by googling ‘LLL’.

    Additionally, aside from waking our daughter at three hourly intervals through the night, we were baby-led for day feeds and routine. We never set a schedule for her, she has set her own. She sleeps 9pm-8am, with feeds where she requires them. At 3 months, she usually has a stretch of 3 hours and a stretch of 6.5 hours of unbroken sleep at night. She takes up to another total of 5 hours sleep by napping during the day.

    And yes, I do talk to her and smile at her if she wakes in the night. She finds this comforting while we work to expel any wind, during nappy changes if she wants them, and while settling down to feed.

    As a new mother, I was given mountains of advice, some useful and some not. But the most important piece of advice I received is that there is no substitute for the natural instincts of a mum.

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    1. Hello Jessicasmum,

      Thank you for your thoughtful comment. I’m so sorry if some of what I wrote was not clear and perhaps gave you the wrong impression on one or two points.

      Of course I would always recommend following medical advice if your newborn is premature, very small or has any other medical condition such as loosing more weight than is usual after birth. In those sorts of scenarios no website, article or book can ever know the details of your baby’s needs and none, from any source, should be used instead of the advice of a professional who does know you and your baby. These short posts were intended only for parents of healthy babies born at term.

      As you say, advice varies between different medical establishments. I have personally cared for newborns of all sizes and with a range of medical needs, born at a number of different hospitals and under the care of various doctors. None of those parents were advised to schedule night feeds if the baby was content to sleep. Even the very premature and tiny babies were fed no more than three hourly in hospital and I have often been advised that it is fine to let them sleep once they are out of hospital, that if they are unable to wake themselves to feed they will not be sent home. I have also had discussions with hospital staff regarding a baby who had slightly low blood sugar and was told that the time between feeds was not overly important, it is the total quantity of milk over 24 hours that really matters. This was proven by blood tests. Frequent snack feeds (due to being woken before getting hungry or fed when awake but not looking for food) actually resulted in less milk being consumed compared to allowing the baby to go a little longer between feeds if he was happy to do so.

      Again, although no doctor I have worked alongside has recommended scheduled three hourly feeds at night, if your own medical team feel it is necessary in your case then of course I would never try to overrule them.

      I suggest three hourly feeds during the day for most babies to ensure that intake over 24 hours is kept high. Also to prevent a situation where a baby (usually a few weeks old) who is ready to sleep a little longer has this sleep during the day, meaning they need to wake more frequently at night to get the total amount of milk they need. As you say, newborns can’t be expected to go too long without milk. However, I’m sure you noticed that I did not suggest imposing any particular routine and stated that babies should be fed sooner if they were hungry (night and day), but that the maximum should be three hours during the day. I’m pleased to hear that you allowed your daughter to develop her own routine, that’s exactly what I intended when I said that over time “feeds will be timed differently for each baby but… you should be able to predict a rough pattern that is your baby’s normal routine.”

      I do apologise if my phrase “really hungry” suggested that I meant the baby should be very hungry. I intended to say that they should be genuinely hungry and not in search of something else. After three or four days babies do tend to become much more wakeful and my experience shows that many parents are confused by this and assume that the baby must be hungry if they are not asleep, as was the case in the first day or two. Often, though, the baby might want to be entertained, or need a nappy change or one of many other things. In those situations offering a feed might distract them for a few minutes, or even put them to sleep, but it is not truly meeting the baby’s needs. Meeting the newborn’s other needs is also important, offering the breast at every sound or movement may be denying them other things. But of course if they wish to feed then they should.

      I did not mention self-soothing, nor did I say that babies should be left to fall asleep alone unless they are happy to do so, which some individuals are. I said that parents should soothe their babies to sleep using a variety of hands on methods, such as stroking, rocking, patting etc according to their baby’s preferences. As I mention at the beginning of both posts, this approach is not the right one for every parent but it is a good middle ground between harsh sleep training methods and feeding to sleep, which can lead to sleep problems later on. Most newborns do need help to fall asleep, but there are many forms of comfort other than feeding.

      I also did not say that parents should avoid speaking or making eye contact at night, and I’m very pleased that you do those things. It would be so sad if any parent felt obliged to sit in silence, staring in the other direction! I do recommend avoiding too much noise and chatter as loud conversations and games can be too stimulating overnight, so it’s best to stick to a low voice and quiet smiles rather than games of peek a boo or watching TV.

      I hope that clears things up a little for you. I work with a large number of parents, all with different situations and different priorities, I always tailor any plan or advice to them individually and would never try to claim that one method was right or wrong for all families (except where there is clear medical evidence) These posts were aimed at parents of healthy babies who want to establish breastfeeding while also encouraging sleep in the baby’s own bed at a young age, including sleeping through as soon as the baby is ready. Not all parents will fit into that category and everyone should follow their instincts and inclinations when choosing their own goals and priorities. Whatever those are, I help to achieve them in a way the parents are comfortable with, which is sometimes very different to the approach detailed in these posts. After all, there is no “one size fits all” in parenting!

      Lorna

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