Babble

Feeding on Schedule v. Feeding on Demand

LALECHE LEAGUE

DR. COHEN

BABYCENTER®

BABYFIT.COM

GARY EZZO (BABYWISE)

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  PRO DEMAND: LaLeche League "Cue Feeding: Wisdom and Science"

  It is now commonly accepted that infants, most especially breastfed infants, thrive best when allowed to feed as they indicate their needs. Nevertheless, some mothers continue to believe that they must wait for their breasts to "fill up" between feedings in order to have enough milk for their babies, and some popular sources of advice for parents urge mothers to stick to a feeding schedule in which even young infants are fed at 3- to 4-hour intervals. Some infants may be able to thrive on scheduled feedings, but many others do not. Recent research on the breasts' mechanisms for regulating milk production provides a better understanding of the importance of demand feeding and the role of infant appetite in the regulation of milk production. ...read the full article

  It is now commonly accepted that infants, most especially breastfed infants, thrive best when allowed to feed as they indicate their needs. Nevertheless, some mothers continue to believe that they must wait for their breasts to "fill up" between feedings in order to have enough milk for their babies, and some popular sources of advice for parents urge mothers to stick to a feeding schedule in which even young infants are fed at 3- to 4-hour intervals. Some infants may be able to thrive on scheduled feedings, but many others do not. Recent research on the breasts' mechanisms for regulating milk production provides a better understanding of the importance of demand feeding and the role of infant appetite in the regulation of milk production.

  Supporters of schedule/routine feedings believe that longer intervals make for hungrier babies who will demand more aggressively and who will obtain the higher fat milk available at the end of a feeding. However, Woolridge has shown that prefeed fat levels are inversely related to the length of the interfeed interval. Fat concentrations of milk can be maximized by increasing both feed frequency and the amount of milk removed from the breast at a feeding. When feed frequency and duration are restricted by predetermined feeding schedules, the result may well be lowered infant fat intake, symptoms of breast milk insufficiency, and underfeeding. A baby who is getting ready to feed displays cues even before he awakens. At first, baby may wiggle, toss and turn, or be restless in his sleep. If his hand is near his face, he may begin to root towards it and even attempt to suckle it or anything else near his mouth. If these early cues are ignored, the baby begins to "squeak" and fuss slightly and eventually works up to a full cry, expressing that he is now overdue for his needed nourishment. An experienced breastfeeding mother with baby nearby usually quickly discerns baby's needs and puts him to the breast early in this sequence of cues. For the mother who is scheduling her baby and/or sleeping apart from him, however, it is much different.

     

  A newborn who is left to cry for even a few minutes can become very disorganized and have a more difficult time latching on and sucking correctly. As a result he often does not take as much milk as he needs, and if this scenario is repeated, mother's milk production will decrease over time. This is yet another way in which feeding schedules can inhibit maternal milk production. In an attempt to prevent excessive crying, some proponents of infant schedules promote the use of pacifiers to delay feedings and/or eliminate non-nutritive sucking at the breast. Such interventions are not without risk. A recent study has documented that pacifier use is associated with a shorter duration of breastfeeding, while another study found that mothers who utilize pacifiers for their infants frequently exercise a higher degree of behavioral control while breastfeeding, often leading again to shorter duration of breastfeeding overall.

      

  Empirical and theoretical evidence combined continues to support current recommendations of the American Academy of Pediatrics that babies, most especially breastfed babies, need to be fed on cue and should be allowed to set their own routine, rather than placed on a predetermined schedule. It is our further conclusion that practices which interfere with babies' cues have been responsible for low weight gains, failure to thrive, milk supply failure, involuntary early weaning, and possibly even some cases of colic, as well as infant regression and depression due to lack of parental responsiveness to baby's frantic cues. Maternal milk production and infant intake are influenced by many factors, including frequency of feeding during the establishment of lactation, maternal milk storage capacity, infant stomach capacity, milk fat content, and the degree of breast emptying at any given feeding. Thus the evidence is very strong that arbitrary scheduling of breastfed infant feedings is inadvisable for any mother who desires to breastfeed successfully. click to close

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  PRO DEMAND: Dr. Cohen, excerpt from The New Basics "Schedule"

  Some child experts say you should put a baby on a sleeping and feeding schedule beginning at birth. I say that if you follow their dubious advice, you'll waste a lot of time and energy and drive yourself crazy. ...read the full article

  Some child experts say you should put a baby on a sleeping and feeding schedule beginning at birth. I say that if you follow their dubious advice, you'll waste a lot of time and energy and drive yourself crazy.

  Lucy has her own schedule. I suggest that you adopt her schedule at first, and then let her slowly adapt to yours.

  As for Lucy's feeding schedule, it starts out all over the map. She can feed for hours on end and then sleep for several hours. Follow her lead. Interfering with her rhythm will just bother her, and in the end she'll only nurse if she wants to anyway.

   

  Babies are wonderfully self-regulating eating machines. The problem is that many books, doctors, nurses, and other experts will advise you to wake up a new baby on a rigid three-hour schedule to offer food. This clinical approach often contributes to breastfeeding failure. If you wake Lucy up to breastfeed and she isn't interested, you may feel a sense of failure and lose confidence in your ability to nurse. Moreover, since she's initially only half-awake, you may be tempted to give her a bottle, which she'll probably take, since it's easier. That will further deepen your sense of failure, and that's when you, like so many mothers I see, will say, 'I couldn't breastfeed. I didn't have enough milk.'

   

  The best way to synchronize your schedule with Lucy's is to do what other animals do when they have babies. They stay cuddled together, and when one wakes up, the other one may too, and when everyone wakes up at the same time, they do lunch. If Lucy wants to sleep for four or five hours, let her. If she wakes up ravenously hungry, it just means she needed a long snooze. If she wakes up after just an hour, she may be hungry, or she may not. The best way to know is to offer her food. Over the next week, Lucy will wake up a little more rhythmically (every three hours on average), not because you've imposed that schedule on her but because she is settling into her natural rhythm.

   

  In some instances, this natural method will go awry and lead to a condition I call 'overnursing,' in which Lucy eats a little, sleeps a little, eats a little, sleeps a little, and so on, all day long. This is very draining for the mother, who loses any opportunity to sleep or recover. That's when I do recommend imposing a schedule." click to close

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  MIDDLE GROUND: BabyCenter® "What is Feeding on Demand?"

  Feeding on demand simply means feeding your baby whenever he signals that he's hungry — usually by crying or sucking on his hands — rather than according to a set schedule. ...read the full article

  Feeding on demand simply means feeding your baby whenever he signals that he's hungry — usually by crying or sucking on his hands — rather than according to a set schedule.

  Keep in mind that young babies have tiny stomachs — about the size of a walnut. Easily digested breast milk quickly fills their little stomach and is absorbed, so it's no wonder they need to eat again relatively soon.

  If your baby seems hungry soon after eating (fussy, sucking on his fist, or rooting at your breast), go ahead and feed him again. Keep in mind, too, that babies are just hungrier on some days than on other days and will want to eat more than usual. These days are called "frequency days" and are thought to precede growth spurts.

  If your baby's hunger cues are slight or nonexistent, be sure to wake him at least every three hours and encourage him to nurse. A newborn who regularly sleeps longer than three to four hours needs close monitoring to make sure he gains enough weight. click to close

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  MIDDLE GROUND: Babyfit.com "Breastfeeding: Demand & Scheduled Feedings: What's a Mother to Do?"

   

  To me, neither demand nor schedule feeding properly or adequately described the mother-infant breastfeeding relationship. I wanted to be able to feed my hungry infant even if the clock didn't indicate it was time. Also, I didn't want to over-feed my infant and nurse him when he really needed other types of attention. Instead, I prefer the terms "nursing on cue" or even "responsive breastfeeding." You and your infant are a nursing team. Is your baby trying to tell you that she is hungry? Does he need to be held, comforted, and loved? Is she tired and in need of a nap? One of the challenges and joys of mothering is learning how your baby communicates. ...read the full article

  Breastfeeding: Demand & Scheduled Feedings: What's a Mother to Do? By Becky Hand, Licensed & Registered Dietician

   

  To me, neither demand nor schedule feeding properly or adequately described the mother-infant breastfeeding relationship. I wanted to be able to feed my hungry infant even if the clock didn't indicate it was time. Also, I didn't want to over-feed my infant and nurse him when he really needed other types of attention. Instead, I prefer the terms "nursing on cue" or even "responsive breastfeeding." You and your infant are a nursing team. Is your baby trying to tell you that she is hungry? Does he need to be held, comforted, and loved? Is she tired and in need of a nap? One of the challenges and joys of mothering is learning how your baby communicates.

  Infants are helpless and dependent. It's important to be responsive to your baby's first hunger cues. By consistently and responsively meeting your baby's needs, you'll foster deep trust and contentment in your child. What are the pre-cry hunger cues?

  • Squirming
  • Increased alertness or activity
  • Making rooting motions
  • Snuggling or rooting at the breast
  • Sucking on hands
  • Clenching fist by the face
  • Putting fist in mouth
  • Making sucking sounds or little sucking motions
  • Brushing a hand across face

  Newborn infants should be nursed whenever they show these pre-cue hunger signs. Remember that crying is a LATE indicator of hunger.

  During the first weeks of life your baby should nurse often because his stomach is so tiny. Every 2-3 hours is normal, with 8-12 feedings in a twenty-four-hour period. Frequent breast-feedings will build up your milk supply. Therefore, let your infant nurse whenever he needs to or seems interested. If your baby sleeps more that 3-4 hours between feedings, it may be necessary to wake him to nurse.

  The primary purpose is to feed your baby in a compassionate, unrestrictive way. After about 2-3 months of growing, maturing, and developing, infants settle into a routine of their own. A routine that will vary from baby to baby and from stage to stage.

      

  This routine will change often throughout the first year of life as growth and development continue: solid foods are introduced, table food and sippy cups are given, nap and sleeping rituals change, but always with the desire for your infant to receive the best nourishment and nurturing possible. click to close

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  STRICT SCHEDULE: Gary Ezzo (Babywise) "Preparation For Parenting"

  PFP is based on the belief that childrearing is a responsibility given by God to parents. Parents are to guide, nurture, and train their children.

  When a woman becomes a mother, she does not stop being a wife, daughter, sister, friend, or neighbor. A mother feeds her baby when he is hungry, but takes advantage of the first few weeks of life to guide the baby's hunger patterns by a basic routine. A baby is a welcome member of the family, and not the center of it. With this in mind, everybody wins, baby, mother, father, and the often-forgotten siblings. A husband/wife relationship is a basic prerequisite for optimal parenting and both the husband and wife need to be active in parenting of their child. ...read the full article

  PFP is based on the belief that childrearing is a responsibility given by God to parents. Parents are to guide, nurture, and train their children.

  When a woman becomes a mother, she does not stop being a wife, daughter, sister, friend, or neighbor. A mother feeds her baby when he is hungry, but takes advantage of the first few weeks of life to guide the baby's hunger patterns by a basic routine. A baby is a welcome member of the family, and not the center of it. With this in mind, everybody wins, baby, mother, father, and the often-forgotten siblings. A husband/wife relationship is a basic prerequisite for optimal parenting and both the husband and wife need to be active in parenting of their child.

  What is Parent-Directed Feeding (PDF)? It is a proactive approach to infant care. It creates and maintains healthy patterns for your baby, which enhance all phases of development. At the same time, PDF is flexible enough to meet the growing emotional needs of the child through infancy and the toddler years. The PDF plan involves more than just feeding a baby. It is a twenty-four hour strategy designed not only to meet the baby's needs, but those of the entire family. PDF is made up of three basic activities that are repeated in rhythmical cycle throughout the day: feeding time, waketime, and naptime.

  What has caused the popularity of Preparation for Parenting and On Becoming Babywise?

  1) Healthy Sleep

  A sampling of 520 babies revealed that PDF helps babies organize nighttime sleep. By the end of the ninth week for "Babywise" participants, 87 percent of breastfed girls and 77 percent of breastfed boys begin sleeping through the night (7 to 8 hours). By 12 weeks, both groups reach 97 percent success, and both start sleeping 10 to 11 hours at night.

  2) Successful Breastfeeding

  Despite numerous benefits to breastfeeding, the Academy notes that in 1995, 59.4 percent of women in the United States were breastfeeding exclusively or in combination with formula-feeding at the time of hospital discharge; only 21.6 percent of mothers were nursing at six months, and many of these were supplementing with formula." (Pediatrics, December 1997, pp. 1036-1037). A convenient sampling of more than 240 mothers following the PDF principles demonstrated that 88 percent of mothers who start with the program breastfeed, and 80 percent of those moms breastfeed exclusively, and 70 percent continued into the sixth month. The average PDF mom breastfeeds 33.2 weeks.

  In summary, we believe infants, pretoddlers and toddlers with healthy eating and sleep habits, are more content, easier to manage, faster learners, and happier children.

  How should a parent respond when a baby cries?

  This question is very difficult to answer, especially for first-time parents. [. . .] Discern the cause behind the cry, and then respond appropriately. In addition, parents learn when it is normal or abnormal for their baby to cry, and what may be causing the baby to cry. [. . .]

  Nothing beats breastfeeding for physiological benefits to baby. That is plain fact. Mother's milk is the complete and perfect food nothing short of miraculous. Easily digested, it provides excellent nutrition and contains the right balance of proteins and fats. It also provides additional antibodies necessary for building your baby's immune system.

  When it comes to nourishing baby, mother's milk is clearly superior to formula. Now for the stickier issue of nurturing. Is breast superior to bottle? In times past, experts said yes. Stressing the value of breastfeeding, they associated bottle-feeding with child rejection. [. . .] In truth, studies over the last sixty years which attempted to correlate methods of infant feeding with later emotional development failed to support any of these conclusions. A mother's overall attitude toward her child far outweighs any single factor, including manner of feeding.

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ADDITIONAL LINKS

• 
  Lisa Marasco, BA, IBCLC "Examining the Evidence for Cue feeding of Breastfed Infant"

• 
  BabyCenter® "On Becoming Babywise: A Flawed Parenting Philosphy?"

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  Garry Ezzo (Babywise) "Myths and Misconceptions; Babywise Authors Set the Record Straight"

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  Dr. Spock "Finding the Best Feeding Schedule"

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