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Baby still hungry after feeding formula


Formula Feeding FAQs: How Much and How Often (for Parents)

Whether you plan to formula feed your baby from the start, want to supplement your breast milk with formula, or are switching from breast milk to formula, you probably have questions.

Here are answers to some common questions about formula feeding.

How Often Should I Feed My Baby Formula?

Newborns and young babies should be fed whenever they seem hungry. This is called on-demand feeding.

After the first few days of life, most healthy formula-fed newborns feed about every 2–3 hours. As they get bigger and their tummies can hold more milk, they usually eat about every 3–4 hours. As babies get older, they’ll settle into a more predictable feeding routine and go longer stretches at night without needing a bottle.

Talk to your doctor if you have concerns about feeding your baby, especially if your baby is very small, is not gaining weight, or was born early (prematurely).

How Can I Tell When My Baby Is Hungry?


Signs that babies are hungry include:

  • moving their heads from side to side
  • opening their mouths
  • sticking out their tongues
  • placing their hands, fingers, and fists to their mouths
  • puckering their lips as if to suck
  • nuzzling again their mothers' breasts
  • showing the rooting reflex (when a baby moves its mouth in the direction of something that's stroking or touching its cheek)

Babies should be fed before they get upset and cry. Crying is a late sign of hunger. But every time your baby cries is not because of hunger. Sometimes babies just need to be cuddled or changed. Or they could be sick, tired, too hot or too cold, in pain, or have colic.

How Much Formula Should I Feed My Baby?

In the first few weeks, give 2- to 3-ounce (60- to 90-milliliter) bottles to your newborn. Give more or less depending on your baby’s hunger cues.

Here's a general look at how much your baby may be eating at different ages:

  • On average, a newborn drinks about 1.5–3 ounces (45–90 milliliters) every 2–3 hours. This amount increases as your baby grows and can take more at each feeding.
  • At about 2 months, your baby may drink about 4–5 ounces (120–150 milliliters) every 3–4 hours.
  • At 4 months, your baby may drink about 4–6 ounces (120-180 milliliters) at each feeding, depending on how often they eat.
  • By 6 months, your baby may drink 6–8 ounces (180–230 milliliters) about 4–5 times a day.   

Watch for signs that your baby is hungry or full. Respond to these cues and let your baby stop when full. A baby who is full may suck with less enthusiasm, stop, or turn away from the bottle.

Why Does My Baby Seem Hungrier Than Usual?

As babies grow, they begin to eat more at each feeding and can go longer between feedings. Still, there may be times when your little one seems hungrier than usual.

Your baby may be going through a period of rapid growth (called a growth spurt). These can happen at any time, but in the early months are common at around:

  • 7–14 days old
  • between 3–6 weeks
  • 4 months
  • 6 months

During these times and whenever your baby seems especially hungry, follow their hunger cues and continue to feed on demand, increasing the amount of formula you give as needed.

Is My Baby Eating Enough?

At times, you may wonder whether your baby is getting enough nutrients for healthy growth and development. Babies who get enough to eat seem satisfied after eating and are regularly peeing and pooping.

At your baby’s checkups, the doctor will review your baby’s growth chart, track your little one’s development, and answer any questions. Talk to your doctor if you have any concerns about your baby’s feeding and nutrition.

Reviewed by: Mary L. Gavin, MD

Date reviewed: November 2021

Hungry Baby - Why Is My Baby Always Hungry? – Baby Care Advice

We all appreciate that young babies have tiny tummies and are growing at a rate that is faster than any other time in their lives. Hence, they need to eat often. However, when parents express concern about their ‘hungry baby’ this refers to a baby that appears to be excessively hungry, who demands feeds more often than expected, or is eating well above the recommended volume of milk for a baby of his age and size.

The ‘hungry baby’ phenomenon where babies act like they have an insatiable appetite is especially common in babies younger than 3 months of age.

The first step toward finding a solution that will satisfy your baby is to distinguish between the reasons for genuine hunger and the appearance of hunger. In this article, I explain what causes healthy babies to act like they’re excessively hungry and what you can do to promote your baby’s contentment.

Genuine hunger

There are several reasons why babies might be genuinely hungry and need to feed sooner or require more milk than you expect. These include:

1. Normal behavior

2. Cluster feeding

3. Growth spurt

4. Catch-up growth

5. Poor latch

6. Low breastmilk supply

7. Diluted baby formula

8. Extreme vomiting or diarrhea

1. Normal behavior

If you’re a first-time parent, it may be that you are unfamiliar with the huge range of ‘normal’ infant feeding patterns and behaviors. The first step is to clarify your expectations about your baby’s feeding with his healthcare professional.

If it’s confirmed that he’s feeding more often or consuming greater volumes than expected for a baby of his age and weight, consider if any of the multiple reasons for the appearance of hunger, described later in this article, apply.

2. Cluster feeding

‘Cluster feeding’, which is a pattern of frequent nursing in the afternoons and evenings, is an example of normal feeding behavior for breastfed babies. A breastfed baby could demand feeds every one to two hourly when cluster feeding.

3. Growth spurt

How quickly a baby is growing will influence his appetite. Babies' growth occurs in a step-wise pattern. Growth spurts (a period of accelerated growth) are separated by growth plateaus (a period of stagnant growth). During a growth spurt, your baby may appear to be hungrier than usual. If breastfeeding, he may demand nursing more often. If bottle-feeding, he might drain the bottle and want a little more. 

On the flip side, during a growth plateau, your baby’s appetite will reduce and his milk volumes decrease. He might also go longer periods of time between nursing or feeding sessions. 

4. Catch-up growth

Catch-up growth is a period of accelerated, compensatory growth (faster than typical for age) which occurs after the removal or resolution of a problem that previously caused under-nutrition or growth delay.

5. Poor latch

If a breastfed baby is unable to feed to satisfaction as a result of a poor latch, he will demand frequent nursing.

6. Low milk supply

If a breastfeeding mother has a low milk supply, her baby may demand to feed more often. (See our article on How to tell when baby is getting enough breastmilk.)

7. Diluted formula

If a baby’s infant formula is accidentally diluted, perhaps due to using the wrong scoop or not accurately following the manufacturer’s instructions, this would decrease the calories he would receive, and he would want to feed more often. 

8. Extreme vomiting or diarrhea

If your baby vomits often and hence loses much of the milk he receives while feeding, he may demand to feed more often. However, it’s important to take care to avoid overfeeding because it’s one of the most common reasons for healthy babies to vomit.

Similarly, if he has frequent watery bowel motions as a result of a digestive disorder, for example milk protein allergy or intolerance, he may be losing nutrients and calories due to poor digestion, and hence demand more frequent feeding.

Rule out the possibility of a feeding management problem such as lactose overload before assuming the cause is due to milk protein allergy or intolerance, as this is one of the most common reasons for healthy, thriving babies to have frequent, watery stools, extreme gas, and abdominal discomfort.

Needless to say, if your baby appears unwell or is not gaining sufficient weight, consult with his healthcare professional. 

Surprisingly, it's typically babies who have no problems putting on weight that are the most difficult to satisfy. If this is the case, it may be that one of the following reasons is mistaken as hunger.

Why babies APPEAR hungry 

Infant behavioral cues are not easy to read, especially before 3 months of age. There are many reasons why parents might think their baby is hungry when he is not. These include:

1. Misinterpreting behavior cues

2. Frequent feeding patterns

3. Underlying sleeping problem

4. Abdominal discomfort linked to overfeeding

While it's possible for there to be only one cause, generally there is a combination of the reasons listed below.

1. Misinterpreting behavioral cues

Hunger is one of the first things we suspect when a baby fusses, cries, or looks like he wants to suck. However, hunger is only one of many different reasons for babies to display these behaviors. Other reasons include:

Infant reflexes

Infant reflexes such as rooting and hand-to-mouth are often assumed to be signs of hunger. Sucking and swallowing reflexes are often mistaken as confirmation that a baby is genuinely hungry. However, these reflexes can be triggered irrespective of whether a baby is hungry or not.

Sucking urge

Young babies have a strong urge to suck. They often want to suck when tired, overstimulated, bored, uncomfortable, or for pleasure. Consequently, a baby's desire to suck is not proof that he is hungry.

Tiredness cues Babies display signs of tiredness differently than we expect. Tired signs displayed by young babies include clenched fists, waving arm and leg movements, facial grimaces, fussing and grumbling then crying. Infant tiredness cues are often overlooked or misinterpreted as hunger, boredom, or pain. 

Thirst

A thirsty baby may give the impression of hunger. Once a baby starts to eat solid foods, it’s recommended that he be offered small volumes of water during the day in addition to his usual milk feeds.

2. Frequent feeding patterns

Babies can develop a pattern of frequent feeding - often referred to as snack-feeding or grazing - where they take small volumes of breastmilk or infant formula at each feed. As a result, they demand feeds more often.

Snack-feeding is easily identifiable when a bottle-fed baby consumes small volumes. However, it’s not as readily recognizable when a baby is breastfed. Many breastfeeding mothers mistakenly blame low milk supply when their baby wants to nurse every hour or two.

3. Speed-feeding

Babies have an immature nervous system. It takes time for their brain to register that their stomach is full. Speed-feeding means a baby consumes the milk too quickly. Speed-feeding can result in newborn babies overfeeding before they recognize they have had enough. (See How long to feed for ideal feeding duration for age.) 

4. Underlying sleeping problem

An unresolved sleeping problem is a major reason for infant feeding problems including the appearance of hunger, fussy feeding behavior, overfeeding, and underfeeding. A sleep association problem is the most common of all reasons for healthy babies to experience sleeping problems such as brief naps, frequent night awakenings and irritability due to sleep deprivation.

Without understanding the effects of sleep associations on their baby’s ability to fall asleep and remain asleep, many parents mistakenly assume the cause is hunger.

While there are many different props, activities, or conditions that individual babies could learn to associate with the act of falling asleep, feeding to sleep is especially common during the newborn period.

A feeding-sleep association, which means a baby has learned to link feeding with the act of falling asleep, is even more likely to cause a baby to give the appearance of hunger.

Once a feeding-sleep association is established (which can occur in babies as young as 2 weeks of age) the baby will act like he wants to feed whenever he wants to sleep because he's learned that "This is the way I go to sleep".

3. Abdominal discomfort linked to overfeeding

One or a combination of the reasons for the appearance of hunger described above, e.g., misinterpreting behavioral cues, a feeding-sleep association, and speed-feeding in combination with an active sucking reflex will increase the risk of overfeeding in newborns. 

The symptoms of overfeeding can include spitting up, diarrhea, and abdominal discomfort.

What do babies like to do when uncomfortable? They like to suck! If a baby’s desire to suck for comfort is mistaken as hunger, he will be offered another feed, perpetuating the overfeeding cycle.  

What you can do for an insatiably hungry baby

1. Resolve any feeding problem: This includes feeding position, latch, flow rate, supply problems, and bottle-feeding equipment.

2. Resolve any sleeping problem: Better sleep = better feeding, and the combination adds up to a content baby.

3. Don’t assume he’s hungry: If your baby appears hungry sooner than expected, consider the possibility of other causes like tiredness, discomfort, or desire to suck, before assuming the cause is hunger.

4. Satisfy your baby’s sucking needs: Provide a pacifier, or your finger to suck on. He will let you know if he’s not satisfied to suck without receiving milk.

Completing the above steps will go a long way towards helping you to gain more confidence in understanding your baby’s needs and accurately interpreting his behavioral cues. 

How Baby Care Advice can help

We appreciate that unless you have extensive experience in child development and the effect of different infant feeding and settling practices on a baby’s behavior, it can be difficult to know how and where to start to resolve a baby care problem. There are two ways in which we can help you gain a greater understand of your baby’s needs and your role as your baby’s parent and caregiver.

1. Rowena Bennett’s parenting books

2. Baby Care Advice consultation 

3. Rowena's Online Bottle-Feeding Aversion Program

1. Rowena Bennett’s parenting books

‘Your Sleepless Baby’

Good quality sleep not only promotes babies’ contentment it will reduce the risk of feeding problems. Information contained in my book, ‘Your Sleepless Baby’, is designed to help parents to understand their baby’s sleep needs, how their actions influence their baby's sleep, and ways in which parents can improve the quality of their baby's sleep.

2. Baby Care Advice Consultations

Baby Care Advice consultants have extensive experience in providing parenting education and assisting parents to resolve feeding and sleeping problems that affect healthy babies. A Baby Care Advice consultation will assist you to explore all possible reasons for your healthy baby’s discontentment. The information, guidance, and advice you receive will help you to gain greater confidence in your ability to accurately interpret your baby’s behavioral cues and provide for his needs. (For more on our consultation service).

3. Rowena's Online Bottle-Feeding Aversion Program

By Rowena Bennett, RN, RM, CHN, MHN, IBCLC.

Written Revised Aug 2021

Copyright www.babycareadvice.com 2021. All rights reserved. Permission from the author must be obtained to reproduce all or any part of this article.

Prejudices related to breastfeeding

Instead of an introduction, I would like to say that the ideas of modern women about breastfeeding are a collection of prejudices. They are so common that in many books for expectant mothers and in magazines for parents, it is actions based on prejudice that are described as correct and necessary.

“Breastfeeding is something incredibly difficult, almost no one is able to feed for a long time, everyone always has a lot of problems and one sheer inconvenience”

There is nothing easier, more comfortable, more enjoyable for mother and baby, and, by the way, cheaper than properly organized breastfeeding. But for that to be the case, breastfeeding needs to be learned. The best teacher in this matter may not be a book or a magazine for parents, but a woman who has been breastfeeding her child for a long time, more than a year, and receiving positive emotions from this. There are women who breastfeed for a long time and perceived it as a punishment. For example, one mother fed a child for 1.5 years and for all these 1.5 years she pumped after each feeding, and when she decided that she was enough and decided to wean the child, she had mastitis due to wrong actions. Now she tells everyone that breastfeeding is hell. She didn't feed her baby properly for a single day.

"Breastfeeding spoils the shape of the breast"

It is true that breastfeeding does not improve the shape of the breast, but the breast changes during pregnancy. It is then that it increases and becomes heavier, and, if its shape contributes to this, it “sags”.

Breast changes during lactation. Approximately 1-1. 5 months after birth, with stable lactation, it becomes soft, produces milk almost only when the baby suckles. After the end of breastfeeding, 1.5-3 or more years after the birth of the baby, involution of the mammary gland occurs, lactation stops. Iron "falls asleep" until the next time. Under natural conditions, the end of breastfeeding always coincides with a decrease in the baby's need for breastfeeding. The chest remains soft, inelastic. The shape of the breast largely depends on the presence of adipose tissue in it, the amount of which decreases during prolonged breastfeeding. After the end of breastfeeding, adipose tissue is gradually restored. If a woman does not feed a child, the involution of the mammary gland occurs within the first month after childbirth. The shape of the breast still does not return to its pre-pregnancy state. And if you think about it and figure out why a woman has breasts at all? It's for breastfeeding.

"Breastfeeding spoils the figure"

Many women are afraid to gain weight while breastfeeding. But usually a woman gains weight mainly during pregnancy, and not when she is nursing. Moreover, if before pregnancy she tried to meet certain fashionable standards, for example, 90-60-90, during pregnancy she returns to her weight, her genetically incorporated physiological norm (and it may be far from fashionable standards) + the well-known 7-10kg per uterus, fetus, amniotic fluid, increased volume of circulating blood and a little bit more for various little things. Weight gain during pregnancy can be significant. Many women begin to lose weight after 6-8 months of feeding, and gradually, in the second, third year of feeding, she “drops” everything that she has accumulated. It turns out that the figure from breastfeeding often just improves.

Very often it turns out that a woman, having stopped breastfeeding 1.5-2 months after giving birth, begins to gain weight. Perhaps this is due to the resulting hormonal imbalance, tk. no woman is designed for such a rapid cessation of lactation.

"You have to prepare the breast for feeding." And then various recommendations follow, from sewing hard rags into the bra to advice to the husband at the end of pregnancy to “dissolve the ducts” of his wife

There is no need to prepare the breast for feeding, it is so arranged by nature that by the time of birth it is quite ready to feed the child. Cloths, for example, can cause skin irritation. Any manipulation of the nipple at the end of pregnancy can lead to very undesirable consequences due to the stimulation of the oxytocin reflex: stimulation of the nipple - release of oxytocin - contraction of the muscles of the uterus under the influence of oxytocin - the uterus is "in good shape" - and, as the worst option, stimulation of premature labor. And in general, has anyone seen a cat with a rag in a bra, or a monkey doing a hardening shower massage?

“With a flat, let alone inverted nipple, breastfeeding is impossible”

Strange as it may seem to people who have never breastfed, a baby's nipple is just a point from which milk flows. If the child sucks in the correct position, then the nipple is located at the level of the soft palate and does not participate in the actual sucking. The child sucks not the nipple, but the areola, massaging, decanting it with the tongue. A breast with a flat or inverted nipple is difficult for a baby to hold in his mouth while suckling and it is more difficult for him to suck on it. Mom should show patience and perseverance in the first days after the birth of a child. Any child is perfectly trained to suck even the most uncomfortable, from our point of view, breast.

The nipple changes shape during sucking, stretches and takes on a more comfortable shape for the baby, usually in 3-4 weeks. There are also various devices called "nipple formers". They are put on immediately after feeding, when the nipple is slightly extended by the efforts of the child and worn until the next application. The nipple formers hold the nipple in an extended position. But even without these things it is quite possible to do.

It is very important for a mother with flat or inverted nipples to ensure that her baby never suckles anything but her mother's breast after birth. The child of such a mother, having sucked on a bottle or a pacifier, quickly realizes that this is a more convenient object for sucking and begins to refuse the breast. In this situation, mom will need even more patience and perseverance.

"You can't keep a newborn at the breast for more than 5 minutes, otherwise there will be cracks"

The child should be kept at the breast for as long as he needs. Feeding ends when the baby himself releases the breast.

If we talk about cracks, then there are only three groups of causes that lead to their formation.

  1. Mom washes her breasts before each feeding. If she does this (and even with soap, and even anoints with brilliant green after feeding - a favorite pastime in Russian maternity hospitals, for example) - she constantly washes off the protective layer from the areola, which is produced by special glands located around the nipple, and dries the skin. This protective lubricant exists just to prevent the loss of moisture in the delicate skin of the nipple, it has bactericidal properties and inhibits the growth of pathogenic microorganisms and, which is especially important for the child, smells about the same as amniotic fluid. The sensitive skin of some women cannot tolerate such exposure for a long time and begins to crack, even with proper attachment of the baby.

  2. Causes related to the incorrect position and behavior of the baby at the breast: the baby is not properly attached and sucks in the wrong position. And if this is true, then 5 minutes after 3 hours is enough for the formation of abrasions, and then cracks. The baby may latch on correctly, but in the process of suckling, he may perform various actions that can lead to cracking if the mother does not know that these actions need to be corrected and not allowed to behave like this. It must be remembered that the child has not suckled before, and does not know how to do it (he knows only the general principle of sucking). Unfortunately, most mothers also do not know how a baby should behave at the breast; they have never, or almost never seen it. What shouldn't a child be allowed to do? "Move out" to the tip of the nipple. This happens especially often if, during sucking, the child does not stick his nose into his mother's breast. If the mother feels that the grip is changing, she should try to press the baby with her nose to her chest. Very often this is enough for the child to “put on” correctly.

If this does not help, the nipple must be removed and re-inserted correctly. The baby should not suckle the breast incorrectly for a single minute. He doesn’t care how to suck, he doesn’t know that he hurts his mother, he doesn’t know that the wrong position does not allow him to suck out enough milk, he doesn’t know that with the wrong position there is not enough stimulation of his mother’s breast and there will not be enough milk production. You can not let the child play with the nipple. A child who has learned to slide down on the tip of the nipple sometimes begins to pass the nipple back and forth through the parted jaws. Mom, of course, it hurts or is unpleasant, but in most cases, mothers allow this to be done “If only he sucked ...” they say ... Why? It often happens that children who do not feel the touch of the breast with their nose during sucking, or do not feel it very well, begin to make search movements with the nipple in their mouth. Here you need to gently press the baby to your chest so that he understands that he is already in place and there is nothing more to look for. Sometimes, especially if the mother has long and large nipples, the baby grabs the breast in several steps, “climbing” up in several movements. This also happens in cases where the child has already sucked on the pacifier and does not open his mouth well. The nipple is injured so very quickly. To avoid this, it is necessary to properly insert the nipple into the wide-open mouth, bringing the nipple itself past the jaws, as deep as possible. Moms don't know how to breastfeed properly.

A typical picture for maternity hospitals with separate stay is as follows: a baby was brought to the mother for 30 minutes, the baby held everything correctly and sucked well for these 30 minutes, he would still suck, but they came to pick him up and the mother pulls (slowly or quickly) his nipple from mouth. Six such pulls per day is enough for the development of abrasions. You can take the nipple only after opening the jaw with the little finger (quickly insert the tip of the finger into the corner of the mouth and turn it - it does not hurt at all and no one suffers).

Diseases of the skin of the nipples. Most often, mothers are faced with a fungal infection of the skin of the nipples - "thrush". In this situation, the skin most often looks "irritated", it can peel off, itch, cracks may appear, even despite proper application, there may be pain during and after sucking, piercing pains along the milk ducts. This problem is usually solved with the use of specific treatment and also has nothing to do with the topic of preparing the breast for feeding or the time the baby is at the breast.

“While there is no milk, it is necessary to drink more water”

The first day after childbirth, liquid colostrum forms in the breast of a woman, on the second day it becomes thick, on 3-4 days transitional milk may appear, 7-10-18 days - milk become mature. Colostrum is scarce and thicker than milk. This is the main argument in most Russian maternity hospitals in favor of supplementing and feeding the child (otherwise he allegedly suffers from hunger and thirst).

If a child needed large volumes of liquid immediately after birth, then nature would arrange the woman in such a way that she would be flooded with colostrum immediately after childbirth. But the child does not need extra water at all. All he needs he gets from colostrum and milk! The water that is given to the child while the mother has colostrum literally “washes away” the colostrum from the gastrointestinal tract, depriving the baby of the action of colostrum necessary for him. Water is given from a bottle, which leads to "tangled nipples" in the baby and may lead to refusal of the breast. Water causes a false feeling of fullness and reduces the need for suckling in a child. If we give a child 100 g of water per day, he sucks 100 g less milk (this applies not only to a newborn). The kidneys of a newborn are not ready for a large load of water and begin to work with overload. The list of arguments against can be continued, but these are enough.

“While there is no milk, it is necessary to supplement the child with formula, otherwise he will lose weight, starve”

The child is not designed to receive anything other than colostrum and milk. In the first days after birth, one colostrum is enough for him. Weight loss in the first day of life is a physiological norm. Newborns lose up to 6-8% of their birth weight in the first two days of their lives. Most children regain their weight or begin to put on weight by 5-7 days of life. Supplementary feeding with a mixture in the first days of a child's life is nothing more than a gross interference in the functioning of the baby's body. You can call this intervention a metabolic catastrophe. But in most Russian maternity hospitals, this is completely ignored!

In addition, the introduction of supplementary feeding is carried out through a bottle, which very quickly leads to "tangled nipples" and the baby refuses the breast. Sometimes one or two bottle feedings are enough to stop a baby from breastfeeding! The mixture causes a feeling of fullness, lingers in the stomach for a long time, the child has a reduced need to suckle the breast, which leads to a decrease in breast stimulation and a decrease in milk production.

“I feed my baby on demand! He demands from me in 3.5 hours!”

Feeding on demand means putting the baby to the breast for every disturbance or search. The baby needs breastfeeding around every sleep, he falls asleep at the breast and when he wakes up, he is given the breast. A newborn child in the first week of his life can indeed be applied relatively rarely - 7-8 times a day, but in the second week of life, the intervals between applications are always reduced. During wakefulness, the child can ask for a breast up to 4 times per hour, i.e. every 15 minutes! Usually a child fed on demand is applied in the first month of life 12 or more times a day, usually 16-20 times. If a child in the first months of life is applied less than 12 times, then the mother either does not notice his modest requests, or ignores them (meaning a healthy, physiologically mature child).

In the overwhelming majority of cases, at the moment when the child begins to ask for a breast more often, the mother decides that the child is starving and introduces supplementary feeding. And the child asks for breasts not at all because he is hungry. He constantly needs a sense of confirmation of physical contact with his mother. During his life in his mother's belly, he is very used to the following: warm, crowded, I hear my heart beating, my lungs breathe, my intestines growl, I smell and taste amniotic fluid (filling the baby's nose and mouth), almost all the time I suck a fist (studies suck). Only in these conditions the baby feels comfortable and safe. After childbirth, he can get into such conditions only if his mother takes him in her arms, puts him on her breast, and then he will again feel cramped, warm, he will hear familiar rhythms, start sucking and feel the familiar smell and taste (the smell and taste of milk are similar to the taste and smell of amniotic fluid). And a newborn child wants to get into such conditions as often as possible. And a modern mother is waiting, she can’t wait, when the intervals between feedings will increase, when will the child start eating in 3.5-4 hours, when will he stop waking up at night ??? Hurry!!! And, usually, to the timid attempts of the child to ask for a breast, he answers with a pacifier, a rattle, gives some water, talks, entertains. The child is most often applied to the breast only when he wakes up. And he quickly agrees with this position. The child always takes the mother's position. But here a “pitfall” awaits mother and baby - insufficient breast stimulation and, as a result, a decrease in the amount of milk.

“Feeding on demand is a nightmare! It is impossible to sit and feed the child for days!”

That's what mothers who can't breastfeed say. With properly organized feeding, mom is resting! She lies, relaxed, hugs the baby, the baby sucks. What could be better? Most women cannot find a comfortable position, they sit, they hold the child awkwardly, their back or arm numbs, if they feed lying down, it usually “hangs” over the child on the elbow, the elbow and back become numb. Moreover, if the child does not take the breast well, it hurts the mother ... What kind of pleasure can we talk about here? In the first month - one and a half after childbirth, when the child is applied chaotically, without a pronounced regimen, sucks often and for a long time, the mother can feel good only if breastfeeding is organized correctly, it is convenient for the mother to feed, she knows how to do it standing, lying down and sitting, and even moving.

“After each feeding, you must express the rest of the milk, otherwise the milk will be wasted”

No, you do not need to express after each feeding if breastfeeding is properly organized. If you feed your baby 6 times a day and do not express, indeed, milk can disappear very quickly. If you express after each feeding, then you can support lactation for some time. The terms are different, but rarely it is more than six months, cases of feeding on such behavior for more than a year are isolated.

When feeding a baby on demand, the mother always has as much milk as the baby needs and there is no need to pump after each application. In order for the newborn to completely suck out the breast, it is applied to one breast for 2-3 hours, and to the other for the next 2-3 hours. Somewhere after 3 months, when the child is already applied relatively rarely, he may need a second breast in one attachment, then the next time he is applied to the one that was last.

There is one unpleasant “pitfall” in regular pumping after feeding, which even most doctors are not aware of. It's called lactase deficiency. When a mother expresses after a feed, she expresses just the “hind” fatty milk, which is relatively poor in milk sugar, lactose. She feeds the child mainly with the anterior portion, which accumulates in the breast between rare feedings. There is a lot of lactose in the anterior portion. The child is fed "only lactose", the gastrointestinal tract of the child after some time ceases to cope with such volumes of lactose. Lactase deficiency develops (Lactase is an enzyme that breaks down lactose - milk sugar, it begins to be missed). This is one of the reasons for the development of lactase deficiency; the second, for example, is this: the mother gives the child two breasts in one feeding. But about this separately.

“You should give your baby two breasts at one feeding.”

No, it is not necessary to give two breasts. A newborn baby can be applied for 1.5-3 hours to one breast. Then 1.5-3 hours to another (for example, the baby woke up, sucked a little and didn’t want to anymore, but after 30 minutes he wanted to suck a little more. After 20 minutes, he sucked longer and fell asleep; all these attachments were from one breast; when the baby wakes up, you can offer him another breast). We need this so that the baby sucks the breast to the end, and receives "front" and "hind" milk in a balanced amount. If the baby is transferred to the other breast in the middle of feeding, he will receive less fat-rich hind milk. He will suck mainly the front portion from one breast and add the same from the other. Foremilk is rich in lactose, and after a while the baby can no longer cope with the load of lactose. Lactose intolerance develops.

Transferring a baby from one breast to another can cause hyperlactation in some women, and if the mother also expresses both breasts after each feeding ... There are such mothers. Curtailing excess milk is sometimes more difficult than adding missing ... In some cases, feeding at one feeding from two breasts is necessary to stimulate lactation when there is a shortage of milk. A growing baby, most often after 3-4 months, may need two breasts in one feeding. Then the next application begins with the breast that was last.

“The more liquid you drink, the more milk”

There are mothers who try to drink as much as possible, sometimes up to 5 liters of liquid per day. And a nursing mother should drink only as much as she wants. By thirst. Mom shouldn't be thirsty. And if water is drunk on purpose, and even more than 3-3.5 liters per day, lactation can begin to be suppressed.

“Sucking the fist is very harmful”

The whole end of pregnancy the child sucked the fist, so he learned to suck. Fist sucking is one of the inborn habits of a newborn. After childbirth, the baby begins to suck on the fist as soon as it enters his mouth. At 3-4 months, the fist is the first thing that the baby can put into his mouth on his own. He can do things on his own!!! This is amazing! And at this age, many babies begin to actively suck their fingers and fists. There is nothing wrong with that. Mom only needs to watch the baby a little. If a baby plays with a fist, then he sucks, then he stops, he can not be distracted from this activity. If the baby begins to actively suck the fist, then the baby wants to suck for real, offer him a breast. If the need to suckle the baby is fully satisfied by the breast, then the baby stops sucking the fist by 5-6 months. (Then, at 6-7 months, he begins to “look for teeth”, but this is a completely different behavior). The cam baby sucks almost the same as the breast, opening its mouth wide. Some babies have a very funny behavior when, having stuck to the chest, the baby tries to put his fist in his mouth ...

"My baby needs a pacifier"

The baby is not designed by nature to suckle anything other than the breast (and the fist, in a pinch). A child is always taught to use a pacifier. There are children who immediately push out the pacifier with their tongue. And there are those who begin to suck it. There are mothers who hold the pacifier with their finger so that her child does not push it out. Usually, the first time a baby gets a dummy is when he showed concern and the mother does not know how to calm him down. To calm down, the child needs to suck on the breast, well, they didn’t give him a breast, they gave him something else, he will have to suck what they give ...

“A child often asks for breasts, which means that he is hungry, there is not enough milk for him”

As mentioned above, a newborn child asks to be breastfed often, not at all because he is hungry. He wants to suck, he wants to mom. He constantly needs confirmation of psycho-emotional and physical contact with his mother.

“Sufficient milk or not, we will find out on control feeding”

We will not learn anything on control feeding (the child is weighed before and after feeding, the difference is calculated and find out how much he sucked for feeding). Because:

  • A baby who feeds on demand constantly sucks different portions of milk. In one application 5 ml, in another - 50, in the third - 150. You can get 5 ml. (Once I weighed my daughter after 30 minutes of suckling. She gained 14 g. In the first month of her life, she gained 1200 g - and what would the district pediatrician tell me if this was control feeding in the clinic?)
  • The newborn is designed to receive small portions of milk, but often. The vast majority of newborns in the conditions of feeding 6-7 times a day still suck out small portions of milk, and not 6 times 120 ml. And of course they don't eat. They start gaining poorly or stop gaining weight, or lose weight altogether.

Whether or not enough milk is available can be determined in two ways:

Wet diaper test. (This is a test for wet diapers, not for used diapers, because you need to know exactly the number of urination). If a child older than 7 days pees more than 6-8 times a day, his urine is light, transparent, odorless, then he receives a sufficient amount of milk. Usually the child pees during wakefulness every 15-30 minutes. If a mother uses diapers, but wants to find out if there is enough milk or not, she needs to remove the diapers from the child for three hours. If the baby pees 3-4 times or more in three hours, then you can not count further. If you peed 3 times or less, we count for 6 hours. If in six hours he peed 4-5 times or more, you can not count further, if less than 4, we count further. And so on… Weekly weight gain (for a child older than 7 days) should be between 125 and 500 g.

“If applied frequently, the baby will suck everything out quickly, the breast is soft all the time – there is no milk. It is necessary to “save” milk for feeding”

When feeding a child on demand, the breast becomes soft about a month after the start of feeding, when lactation becomes stable. Milk begins to be produced only when the baby suckles. The breast is never “empty”, in response to the sucking of the child, milk is constantly produced in it. If the mother is trying to fill her breasts for feeding, waiting for the breasts to “fill up”, she gradually reduces the amount of milk by such actions. The more mother attaches the child, the more milk, and not vice versa.

“The stomach needs to rest”

But the child's stomach doesn't work very well. Milk there only curdles and is quickly evacuated to the intestines, where the actual digestion and absorption takes place. This is the prejudice from the old song about feeding according to the schedule after 3 hours. The newborn does not have a clock. No mammal makes even intervals in feeding its newborns. The body of the child is adapted to the continuous flow of mother's milk, and he does not need to rest at all.

“After each feeding, keep the baby upright for 20 minutes”

Do not hold the baby upright after each feeding, especially if the baby has fallen asleep. Most of the time the baby lies on its side. If he burps a little, then the diaper just changes under his cheek. It is necessary to hold the artificial man vertically so that he does not spill the 120g poured into him. And we are talking about babies who are fed on demand and receive small portions of mother's milk. In addition, the cardiac sphincter of the stomach needs training, which it can only receive if the child is lying down.

“You need to sleep at night”

At night, you need to not only sleep, but suck your breast. Most newborn children are so arranged that they sleep from 10-11 pm to 3-4 am, then they begin to wake up and ask for breasts. In a child of the first month of life, applications in the morning hours (from 3 to 8) are usually 4-6. Night feedings with properly organized breastfeeding look something like this: the baby got worried, the mother put it to the breast, the baby sleeps sucking and the mother also sleeps, after a while he lets go of the breast and sleeps more soundly. And such episodes happen in a night 4-6. All this is easy to organize if the mother sleeps with her child, and for this she needs to be able to feed lying down in a comfortable position.

If the baby sleeps separately from the mother, in his own bed, then he stops waking up for morning feedings, sometimes already a week after birth, sometimes by 1.5-2 months. Most modern mothers take this with relief, because. for them, finally, the night running back and forth, nodding while sitting in a chair or on a bed over a sucking child, and some also pumped at night ... And here they are waiting for a pitfall called insufficient stimulation of prolactin and, as a result, a decrease in the amount of milk . A mother and her child are a wonderful self-regulating system. While the baby has a need to suck in the morning, his mother produces the maximum amount of prolactin, just from about 3 to 8 in the morning.

Prolactin is always present in the female body in small amounts, its concentration in the blood increases significantly after the baby begins to breastfeed, most of all it is obtained in the morning hours from 3 to 8 in the morning. Prolactin, which appeared in the morning, is engaged in the production of milk during the day. It turns out who sucks at night, stimulates his mother's prolactin and provides himself with a decent amount of milk during the day. And whoever fails to suckle at night, he can quite quickly be left without milk during the day. No mammal takes a nightly break from feeding its young.

“I lost my milk because of my “nerves””

Milk production depends on the hormone prolactin, the amount of which depends on the number of times the baby is latched on and nothing else. The experiences of the mother on any occasion do not affect him. But the release of milk from the breast depends on the hormone oxytocin, which is engaged in the fact that it contributes to the contraction of muscle cells around the lobules of the gland and thereby contributes to the flow of milk. The amount of this hormone is very dependent on the psychological state of the woman. If she is frightened, tired, in pain or in any other discomfort during feeding, oxytocin stops working and milk stops flowing from the breast. A child cannot suck it out, a breast pump does not express it, and it cannot come out with its hands ...

The manifestation of the “oxytocin reflex” was observed by every breastfeeding woman: when a mother hears the crying of a child (and not necessarily her own), her milk begins to leak. The body tells the mother that it is time to apply the baby. In a situation of stress or fear, nothing like this is observed. (Relationship to the ancient instinct of self-preservation: if a woman runs from a tiger and she smells of leaking milk, the tiger will find her faster and eat her, so while she runs in fear through the jungle with a child under her arm, the milk will not leak when she gets to the safety of the cave - and calmly settle down to feed the child, the milk will come again.)

Modern stressful situations work like those tigers. In order for milk to flow out again, you must try to relax during feeding, think only about the child. You can drink soothing herbs, shoulder massage, calm conversation helps well. Anything to help you relax. And most modern mothers are not able to relax during feeding, it is uncomfortable for them to sit or lie down, it can be painful to feed - all this prevents the manifestation of the oxytocin reflex - milk remains in the breast, which leads to a decrease in lactation.

"The baby is too fat, it is necessary to limit the number of feedings and give water"

A breastfed child gains 125 to 500 g per week, or 500 to 2000 g per month. Usually, by 6 months, a child born with a weight of 3-3.5 kg weighs about 8 kg. The rate of gain is very individual, there is never any talk of "overfeeding", children who are actively gaining weight grow rapidly in length and look proportionate. Children who gain 1.5-2 kg per month in the first half of life, usually sharply reduce weight gain in the second half of the year and can weigh 12-14 kg by the year. There is never a need to limit the number of feedings, much less to give water.

“Baby lacks nutrients, needs complementary foods from the age of 4 months”

The need for other food manifests itself in a child of about 6 months of age, when he begins to actively wonder what everyone is eating there. And if a mother takes a baby to the table with her, he begins to actively take an interest in the contents of his plate. This behavior is called active food interest, and it indicates that the child is ready to get acquainted with new food and can begin it. Nevertheless, breast milk remains the main food of the child in the first year of life, and in many cases even at the beginning of the second, contains absolutely all the nutrients the child needs and much more.

"A nursing mother should have a strict diet"

Food should be habitual. It is preferable not to use exotic foods in the diet that are not characteristic of the "native" climatic zone. A breastfeeding mother may have interesting nutritional needs, and they must be met in the same way as the desires of a pregnant woman. A woman should eat according to her appetite, and not stick food for two into herself. And, of course, you need to try to eat healthy food. Do not use products containing preservatives, dyes and other unhealthy substances.

“A child should be fed for no more than a year, then there is nothing useful in milk anyway”

After a year of lactation, the quality of milk does not deteriorate at all. Milk continues to be a source of all the necessary nutrients for the child, and in addition, it supplies enzymes that help the child absorb food, contains the baby's immune defenses, and a lot of other substances that are not found in artificial mixtures, or in baby food, or in food. adults (hormones, tissue growth factors, biologically active substances and much, much more).

And don't forget that breastfeeding is not only nutrition, it is a special way of communication between mother and baby. Breastfeeding is necessary not only to eat, but also, for example, to sleep peacefully, or to receive comfort, support in difficult times. All this is necessary not only in the first year of life.

Lilia Kazakova, pediatrician,
Head of Breastfeeding and Child Care Consultants.

Breastfeeding in the first month: what to expect

Not sure how to establish lactation and increase milk production? If you need help, support, or just want to know what to expect, read our first month breastfeeding advice

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The first weeks of breastfeeding are a very stressful period. If at times you feel like you can't handle it, know that you are not alone. Feeding your baby all day long is completely natural and helps produce breast milk, but can be quite tiring at times. Be patient, think about yourself and remember: after the first month, when milk production stabilizes, it will become easier.

How often should a baby be breastfed?

Babies are born with a small stomach that grows rapidly with increasing milk production: in the first week it is no larger than an apricot, and after two weeks it is already the size of a large chicken egg. 1.2 Let the child eat as much as he wants and when he wants. This will help him quickly regain the weight lost after birth and grow and develop further.

“Be prepared to feed every two to three hours throughout the day. At night, the intervals between feedings can be longer: three to four or even five hours, says Cathy Garbin, a recognized international expert on breastfeeding. Some eat quickly and are satiated in 15 minutes, while others take an entire hour to feed. Do not compare your breastfeeding regimen with that of other mothers - it is very likely that there will be nothing in common between them.

At each feed, give your baby a full meal from one breast and then offer a second one, but don't worry if the baby doesn't take it. When the baby is full, he lets go of his chest and at the same time looks relaxed and satisfied - so much so that he can immediately fall asleep. The next time you feed, start on the other breast. You can monitor the order of the mammary glands during feeding using a special application.

Why does the child always ask for a breast?

The first month is usually the hardest time to breastfeed. But do not think that because the baby is constantly hungry and asks for a breast almost every 45 minutes, then you do not have enough milk.

In the first month, the baby needs to eat frequently to start and stimulate the mother's milk production. It lays the foundation for a stable milk supply in the future. 3

In addition, we must not forget that the child needs almost constant contact with his mother. The bright light and noise of the surrounding world at first frighten the baby, and only by clinging to his mother, he can calm down.

Sarah, mother of three from the UK, confirms: “Crying is not always a sign of hunger. Sometimes my kids just wanted me to be around and begged for breasts to calm them down. Use a sling. Place the cradle next to the bed. Don't look at the clock. Take advantage of every opportunity to relax. Forget about cleaning. Let those around you take care of you. And not three days, but six weeks at least! Hug your baby, enjoy the comfort - and trust your body."

Do I need to feed my baby on a schedule?

Your baby is still too young for a strict daily routine, so
forget about breastfeeding schedules and focus on his needs.

“Volumes have been written about how to feed a baby on a schedule, but babies don't read or understand books,” Cathy says. - All children are different. Some people can eat on a schedule, but most can't. Most often, over time, the child develops his own schedule.

Some mothers report that their babies are fine with scheduled feedings, but they are probably just the few babies who would eat every four hours anyway. Adults rarely eat and drink the same foods at the same time of day - so why do we expect this from toddlers?

Offer your baby the breast at the first sign of hunger. Crying is already the last stage, so be attentive to early signs: the baby licks his lips, opens his mouth, sucks his fist, turns his head with his mouth open - looking for the breast. 4

What is a "milk flush"?

At the beginning of each feed, a hungry baby actively suckles the nipple,
thereby stimulating the milk flow reflex - the movement of milk through the milk ducts. 5

“Nipple stimulation triggers the release of the hormone oxytocin,” Cathy explains. “Oxytocin circulates throughout the body and causes the muscles around the milk-producing glands to contract and the milk ducts to dilate. This stimulates the flow of milk.

If the flushing reflex fails, milk will not come out. This is a hormonal response, and under stress it may not work at all or work poorly. Therefore, it is so important that you feel comfortable and calm when feeding.

“Studies show that each mother has a different rhythm of hot flashes during one feed,” Kathy continues, “Oxytocin is a short-acting hormone, it breaks down in just 30-40 seconds after formation. Milk begins to flow, the baby eats, the effect of oxytocin ends, but then a new rush of milk occurs, the baby continues to suckle the breast, and this process is repeated cyclically. That is why, during feeding, the child periodically stops and rests - this is how nature intended.

The flow of milk may be accompanied by a strong sensation of movement or tingling in the chest, although 21% of mothers, according to surveys, do not feel anything at all. 5 Cathy explains: “Many women only feel the first rush of milk. If you do not feel hot flashes, do not worry: since the child eats normally, most likely, you simply do not understand that they are.

How do you know if a baby is getting enough milk?

Since it is impossible to track how much milk a baby eats while breastfeeding, mothers sometimes worry that the baby is malnourished. Trust your child and your body.

After a rush of milk, the baby usually begins to suckle more slowly. Some mothers clearly hear how the baby swallows, others do not notice it. But one way or another, the child himself will show when he is full - just watch carefully. Many babies make two or three approaches to the breast at one feeding. 6

“When a child has had enough, it is noticeable almost immediately: a kind of “milk intoxication” sets in. The baby is relaxed and makes it clear with his whole body that he is completely full, says Katie, “Diapers are another great way to assess whether the baby is getting enough milk. During this period, a breastfed baby should have at least five wet diapers a day and at least two portions of soft yellow stool, and often more. ”

From one month until weaning at six months of age, a baby's stool (if exclusively breastfed) should look the same every day: yellow, grainy, loose, and watery.

When is the child's birth weight restored?

Most newborns lose weight in the first few days of life. This is normal and should not be cause for concern. As a rule, weight is reduced by 5-7%, although some may lose up to 10%. One way or another, by 10–14 days, almost all newborns regain their birth weight. In the first three to four months, the minimum expected weight gain is an average of 150 grams per week. But one week the child may gain weight faster, and the next slower, so it is necessary that the attending physician monitor the health and growth of the baby constantly. 7.8

At the slightest doubt or signs of dehydration, such as
dark urine, no stool for more than 24 hours, retraction of the fontanelle (soft spot on the head), yellowing of the skin, drowsiness, lethargy, lack of appetite (ability to four to six hours without feeding), you should immediately consult a doctor. 7

What is "cluster feeding"?

When a baby asks to breastfeed very often for several hours, this is called cluster feeding. 6 The peak often occurs in the evening between 18:00 and 22:00, when many babies are especially restless and need close contact with their mother. Most often, mothers complain about this in the period from two to nine weeks after childbirth. This is perfectly normal and common behavior as long as the baby is otherwise healthy, eating well, gaining weight normally, and appears content throughout the day. 9

Cluster feeding can be caused by a sharp jump in the development of the body - during this period the baby especially needs love, comfort and a sense of security. The growing brain of a child is so excited that it can be difficult for him to turn off, or it just scares the baby. 9 If a child is overtired, it is often difficult for him or her to calm down on his own and adult assistance is needed. And breastfeeding is the best way to calm the baby, because breast milk is not only food, but also pain reliever and a source of happiness hormones. 10

“Nobody told me about cluster feeding, so for the first 10 days I just went crazy with anxiety - I was sure that my milk was not enough for the baby,” recalls Camilla, a mother from Australia, “It was a very difficult period . I was advised to pump and supplement until I finally contacted the Australian Breastfeeding Association. There they explained to me what was happening: it turned out that it was not about milk at all.

Remember, this is temporary. Try to prepare dinner for yourself in the afternoon, when the baby is fast asleep, so that in the evening, when he begins to often breastfeed, you have the opportunity to quickly warm up the food and have a snack. If you are not alone, arrange to carry and rock the baby in turns so that you have the opportunity to rest. If you have no one to turn to for help and you feel that your strength is leaving you, put the baby in the crib and rest for a few minutes, and then pick it up again.

Ask your partner, family and friends to help you with household chores, cooking and caring for older children if you have any. If possible, hire an au pair. Get as much rest as possible, eat well and drink plenty of water.

“My daughter slept a lot during the day, but from 23:00 to 5:00 the cluster feeding period began, which was very tiring,” recalls Jenal, a mother from the USA, “My husband tried his best to make life easier for me - washed, cleaned, cooked, changed diapers, let me sleep at every opportunity and never tired of assuring me that we were doing well.

If you are concerned about the frequency of breastfeeding, it is worth contacting a specialist. “Check with a lactation consultant or doctor to see if this is indicative of any problems,” recommends Cathy. “Resist the temptation to supplement your baby with formula (unless recommended by your doctor) until you find the cause. It may not be a matter of limited milk production at all - it may be that the child is inefficiently sucking it.

When will breastfeeding become easier?

This early stage is very special and does not last long. Although sometimes it seems that there will be no end to it, rest assured: it will get easier soon! By the end of the first month, breast milk production will stabilize, and the baby will become stronger and learn to suckle better. 2.3 Any problems with latch on will most likely be resolved by this time and the body will be able to produce milk more efficiently so inflammation and leakage of milk will start to subside.

“The first four to six weeks are the hardest, but then things start to get better,” Cathy assures. It just needs to be experienced!”

The longer breastfeeding continues, the more benefits it brings, from saving on formula and improving sleep quality 11-13 to boosting your baby's immune system 14 and reducing your risk of certain cancers. 15

“When you feel like you're pushing yourself, try to go from feed to feed and day to day,” says Hannah, a UK mom. “I was sure I wouldn’t make it to eight weeks. And now I have been breastfeeding for almost 17 weeks, and I dare say it is very easy.”

Read the resource Breastfeeding beyond the first month: what to expect

Literature

1 Naveed M et al. An autopsy study of relationship between perinatal stomach capacity and birth weight. Indian J Gastroenterol .1992;11(4):156-158. - Navid M. et al., Association between prenatal gastric volume and birth weight. Autopsy. Indian J Gastroenterol. 1992;11(4):156-158.

2 Neville MC et al. Studies in human lactation: milk volumes in lactating women during the onset of lactation and full lactation .Am J Clinl Nutr .1988;48(6):1375-1386. at the beginning and at the peak of lactation." Am F Clean Nutr. 1988;48(6):1375-1386.

3 Kent JC et al. Principles for maintaining or increasing breast milk production. 2012;41(1):114-121. - Kent J.S. et al., "Principles for Maintaining and Increasing Milk Production". J Obstet Ginecol Neoneutal Nurs. 2012;41(1):114-121.

4 Australian Breastfeeding Feeding cues ; 2017 Sep [ cited 2018 Feb ]. - Australian Breastfeeding Association [Internet], Feed Ready Signals; September 2017 [cited February 2018]

5 Kent JC et al. Response of breasts to different stimulation patterns of an electric breast pump. J Human Lact . 2003;19(2):179-186. - Kent J.S. et al., Breast Response to Different Types of Electric Breast Pump Stimulation. J Human Lact (Journal of the International Association of Lactation Consultants). 2003;19(2):179-186.

6) Kent JC et al . Volume and frequency of breastfeedings and fat content of breast milk throughout the day. Pediatrics. 2006;117(3): e 387-395. - Kent J.S. et al., "Amount and frequency of breastfeeding and fat content of breast milk during the day." Pediatrix (Pediatrics). 2006;117(3):e387-95.

7 Lawrence RA, Lawrence RM. Breastfeeding: A guide for the medical profession. 7th ed. Maryland Heights MO, USA: Elsevier Mosby; 2010. 1128 p . - Lawrence R.A., Lawrence R.M., "Breastfeeding: A guide for healthcare professionals." Seventh edition. Publisher Maryland Heights , Missouri, USA: Elsevier Mosby; 2010. P. 1128.

8 World Health Organization. [Internet]. Child growth standards; 2018 [cited 2018 Feb] - World Health Organization. [Internet]. Child Growth Standards 2018 [cited February 2018].

9 Australian Breastfeeding Association . [ Internet ]. Cluster feeding and fussing babies ; Dec 2017 [ cited 2018 Feb ] - Australian Breastfeeding Association [Internet], Cluster Feeding and Screaming Babies; December 2017 [cited February 2018].

10 Moberg KU, Prime DK. Oxytocin effects in mothers and infants during breastfeeding. Infant . 2013;9(6):201-206.- Moberg K, Prime DK, "Oxytocin effects on mother and child during breastfeeding". Infant. 2013;9(6):201-206.

11 U.S. Department of Health & Human Services [Internet]. Surgeon General Breastfeeding factsheet; 2011 Jan 20 [cited 2017 Feb] - Department of Health and Human Services [Internet], "Breastfeeding Facts from the Chief Medical Officer", Jan 20, 2011 [cited Feb 2017]

12 Kendall-Tackett K et al. The effect of feeding method on sleep duration, maternal well-being, and postpartum depression. clinical lactation. 2011;1;2(2):22-26. - Kendall-Tuckett, K. et al., "Influence of feeding pattern on sleep duration, maternal well-being and the development of postpartum depression." Clinical Lactation. 2011;2(2):22-26.

13 Brown A, Harries V. Infant sleep and night feeding patterns during later infancy: Association with breastfeeding frequency, daytime complementary food intake, and infant weight. Breast Med . 2015;10(5):246-252. - Brown A., Harris W., "Night feedings and infant sleep in the first year of life and their association with feeding frequency, daytime supplementation, and infant weight." Brest Med (Breastfeeding Medicine). 2015;10(5):246-252.

14 Hassiotou F et al. Maternal and infant infections stimulate a rapid leukocyte response in breastmilk.

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