It is common to hear a wide range of what is “typical” with all things newborn, particularly in
regard to sleeping and feeding patterns. When it comes to a breastfed infant, there can be
significant variation from what is spouted from one mother to another, particularly in the
anonymity of online parent support groups where statements are often made without filter or
moderation. Among books published on infant care, those on sleep have dominated the
market. With a wealth of conflicting information touted as truth, it can be hard to navigate
what to follow. To get sleep themselves, parents can often find they are easily swayed
towards any new recommendation that promises the largest number of consecutive hours of
sleep from your infant.
SLEEP:
For years, hospital nurseries have offered the temptation of a full night’s sleep to new parents.
Today nurseries are being phased out as the Baby Friendly International, 10 steps to
Successful Breastfeeding protocol is more widely implemented. Upon returning home after
birth, many families find themselves wanting to put their baby, who is often cooing and
grunting, in a separate room. However, according to research in 1991 by Keefe, Waldenstrom,
& Swenson, mothers and babies get more sleep together than separated.1
Infants sleep differently than adults, spending more time in the rapid eye movement (REM)
cycle but fewer hours consecutively asleep. The REM cycle is when dreams occur and is
considered light sleep. Non-REM sleep is the deeper, less arousable sleep stage. While an
adult sleep cycle is 90 minutes long, switching between non-REM and REM sleep during this
time, a newborn has a 45-60 minute long sleep cycle. The first 20 minutes of a newborn’s
sleep cycle are REM sleep, followed by non-REM sleep, meaning almost half of a baby’s
sleep time is comprised of REM.2
Newborns sleep approximately 8 hours cumulatively during the day and 8 hours during the
night. However, these 8 hour segments are broken into multiple sleep cycles throughout the
24 hour period. Most infants do not sleep through the night until they weigh 12-13 pounds or
are 3 months of age at the earliest.2 Having your baby sleep through the night at 3 months of
age has often become the expectation though not the most common finding. Most studies on
infant sleep are derived from studying formula-fed infants, results of which are not fully
transposable to the breastfed infant. It has been shown that breastfed infants often sleep
through the night later than formula-fed infants and are more likely to wake to feed.3 While
some infants can sleep through the night earlier, circadian rhythms allow most infants to sleep
through the night by 1 year of age.3
Many infants consume up to 1/3 of their daily milk intake during their nighttime feedings.
The frequency of feeding also maintains a robust milk supply, negating the Feedback
Inhibitor of Lactation (FIL) chemical effect of slowing milk production when the breast is
full. For this reason, stretches of sleep longer than 6 hours, especially in the first 12 weeks
of life, can lead to a lower milk supply for the course of breastfeeding.3
A reasonable expectation entering parenthood is that infants will sleep in the range of 16-20
hours a day but for only 45 minute to 3 hour intervals, until circadian rhythms develop
between 3-12 months. This expectation can ease the concern that you must have a baby
sleeping through the night in the early months.3
FEEDING:
In 2001, Benson studied the nursing patterns of the first 60 hours of life and found that infants
breastfed the most during the hours of 9 pm-3 am and the least between the hours of 3 am-9
am.
A huge component of feeding pattern frequency relies upon prioritizing, establishing, and
protecting a mother’s milk production. Variations in the timing of a mother’s milk coming in
and in the overall volume can exist due to a mother’s health history and on how many
pregnancies the mother has had. Milk production is expected to increase on day 3 or 4
postpartum, generally resulting in a more satisfied baby and a shorter breastfeeding duration
at each feeding. In the first 2-4 weeks postpartum, feedings are irregular and not scheduled.
When parents choose to put their breastfed baby on a feeding schedule, it often impacts
mother’s overall milk production as it limits the infant’s access to the breast according to
hunger cues. Growth spurts occur regularly, approximately every 3 to 6 weeks, for the first
few months of life. Growth spurts are marked by more frequent feeding intervals with periods
of time where feedings are clustered together, followed by periods of rest.1
Many sources recommend breastfeeding 8 times a day which equates to feedings every 3
hours. More accurately, most infants feed between 8-12 times per day.Atypical infant
stomach is the size of a cherry at birth, meaning the small volume of breast milk is quickly
digested, which correlates with the expected high frequency of feedings.3 Babies fed from the
breast do not feed on a set schedule, allowing normal variations of intake volume and
frequency to teach the infant to learn satiety and practice eating according to internal cues.
As infants exit the newborn stage, around 4 weeks postpartum, it is expected that the mother’s
milk production should be at full capacity, producing an average of 25-30 ounces per day. This
is a volume adequate enough to sustain an infant through his or her first year of
breastfeeding. Due to metabolic rates slowing, babies consume the same overall volume of
milk per day from 1 month to 6 months of age. However, with time, these feedings become
more efficient and might occur less frequently.1
Due to a faster flow of milk, bottle-feeding often lends itself to a higher quantity of milk fed per
feeding and a decreased frequency of feeds.1 The expectation of a feeding schedule evolved
from bottle-feeding norms and is most easily applied when an identical amount of milk is
given at each feeding. This, however, is not easily replicated in breastfeeding. Flexibility in
breastfeeding is key to maintaining adequate milk production based on an individual baby’s
needs.1 In the course of a day, there are natural ebbs and flows of milk volume and fat
content, with higher fat content being more common in the evening when the breast is less
full due to frequent feedings. A mother’s levels of prolactin, which is the hormone responsible
for milk production, rise in the middle of the night to allow for more milk expression. Newborns
are often more wakeful at night and instinctively follow the mother’s hormonal cues of higher
prolactin resulting in the intake of a larger volume of milk.
Expectations may need to be reassessed once the baby arrives. In scenarios of poor
breastmilk intake, meaning less than 25 ounces per day, no matter the cause (e.g., poor
feeding efficiency, difficulty latching, low milk production, infrequent feedings), there will likely
be a natural impact and possible disruption to both feeding and sleeping consistencies and
frequencies. In both feeding and sleeping, familial preferences and expectations can vary
between cultures. These preferences and expectations, along with your baby’s unique
personality and health status, will influence and guide the reality of your baby’s routines.
Citations:
1 Mohrbacher. BreastfeedingAnswers. 2nd ed.Arlington Heights, IL: Nancy Mohrbacher
Solutions; 2020.
2 Childrens Hospital of Philadelphia. Newborn-Sleep Patterns.Accessed September 6,
- https://www.chop.edu/conditions-diseases/newborn-sleep-patterns#:~:text=Generally
%2C
%20newborns%20sleep%20about%208,weigh%2012%20to%2013%20pounds.
3 Ball, Helen. La Leche League International. Infant Sleep. Published September 2016.
Accessed September 6, 2022. https://www.llli.org/infant-sleep/#:~:text=Newborns%20sleep
%20for%2020%20or%20so%20hours%20a,as%20REM%2C%20Rapid%20Eye%20Movement
%2C%20and%20non-REM%20sleep. - Contributed by : Danielle Chu RN, BSN, IBCLC