Feeding FAQ: 0-8 Weeks – Breast Feeding

My daughter of 4.5weeks weighs 10lbs 10ozs. She is fully breast fed. I have trouble in getting her to take a full feed before becoming sleepy. She then does not settle well in her cot at naptimes or in the evening. I have tried swaddling her but she gets very upset

I would like to follow the routines with my 4.5 week old daughter as I have done so with my first child, now aged 4, with great success. However, from day one it has been a real struggle. The main problem is that my daughter doesn’t feed for very long. She will stay on the breast for a maximum of 15 minutes, before falling asleep or crying. She never ever empties the breast so I worry that she is not getting any hind milk. As a consequence she then wants to feed 2 hours later, or even earlier, which makes me concerned she might develop colic. I have tried to wake her up mid-feed by changing her nappy etc but feel that each feed takes so long and seems to blend with the next.

She never settles for her morning nap unless I feed her or wear her in a sling – in fact she seems to hate her cot. She will settle in her pushchair or a sling but the moment I put her in her cot she screams and becomes more and more hysterical. She has liked to be cuddled to sleep since birth. She tends to feed at 7 am but then falls asleep by 8.15am – then wakes if I put her in her cot and won’t go back to sleep.

She does sleep well at lunchtime and in the afternoon but will not settle in the evening, sometimes staying awake till 10pm. She is very unsettled in the evening, crying and fussing. We thought she might have silent reflux as when she screams she arches her back and clutches at me or her chest and will wake suddenly screaming as if in pain. The doctor gave her Gaviscon which she spits out and then becomes hysterical so I have given up on that. Every day I try to follow the routine as I want it to work but every day by lunchtime the routine has gone pear-shaped. How do I get her to feed longer, go longer between feeds and settle in her cot? Another thing, she hates being swaddled and will scream if I restrict her arms, so I half-swaddle her.

My daughter feeds at the following times:
7.30am 15 minutes [takes 30mins to take this feed]
8.45am 5 minutes, sucked her self to sleep
9.15am woke and then sucked herself to sleep
10.30are 15minutes
11.30am 15minutes
2.30pm 15 minutes
4.00pm 5 minutes
6.00pm 15 minutes
7.00pm all evening wanted to suck, fell asleep at 10pm
10.30pm fed on and off until midnight
3.30am 10minutes

She weighed 9lbs 7ozs at birth and now weighs 10lbs 10ozs.

My daughter naps at 8.45-9.15am, 9.20-10.30am, 11.40-2.30pm and 4.15-5.15pm

Keeping a sleepy baby awake during breast feeding can take time and perseverance. To help your daughter stay awake better make sure she is not overdressed and so getting too warm and snuggly when feeding. Try feeding her dressed just in a body suit [all in one vest]. Make sure that the room you are in is not too warm. The combination of having less clothes and feeling cool air to her skin should help her stay more awake.

At the first sign of your baby falling asleep whilst feeding, unlatch her from your breast and lay her down on a safe surface, preferably the floor. You can use a blanket or play mat underneath her. Being away from the warmth of your body should help her come round and want to feed again. In the early weeks with a sleepy baby you may need to do this several times during a feed but it will ensure she takes a full feed. At this age she may still only want to feed from one breast and it can take 25-30 minutes for the breast to be fully emptied. Once you feel she has finished one side completely, change her and offer her the second which she may or may not want. If she is sleepy during the feed and needs to be put down to wake again it may take her nearer 40 minutes to fully empty one side.

An indication that your baby is taking enough milk for her needs is a steady weight increase of 6-8ozs a week. In four weeks your daughter has gained just over one pound. Allowing her 10-14 days to get back up to her birth weight this means she is only just gaining at the accepted rate. If you are at all concerned about her weight increase then discuss this with your health visitor.

Your baby’s sleepiness in her daytime feeds is probably one of the reasons for her unsettled evenings. She is already taking two good naps in the day and the amount of time she is sleeping during feeds is adding to her daytime total.

Another reason for unsettled evenings in young babies is hunger. As you are fully breast feeding and caring for another child your supply by 6pm may well be low.

Using the split feed method at 5pm/6.15pm should help your daughter take a good feed at this time. Make sure she is awake from her afternoon nap by 5pm. Offer her one breast and then let her have a short break before her bath. Once she is dressed and ready for bed feed her in a low lit room offering her the second breast. If she does not settle within ten minutes of going into her cot, offer her a top up feed of expressed milk by bottle. Using expressed milk in a bottle will ensure your daughter gets all the milk she needs to sleep well in the evenings and it will ensure that hunger is not the reason for her being unsettled.

Some mothers who have a problem with a low supply at 6pm decide to feed their baby at 5pm offering both sides then giving an expressed feed after the bath.

To check your supply at 6.15pm choose a day when you have someone to help you. Feed your daughter from one side at 5pm. Whilst your daughter is being bathed by someone else, express and see how much milk you do have at this time of day. Your daughter can then be offered the feed in a bottle. If you feed your baby on and off all evening you will not have sufficient milk to offer her a good feed at 10pm. Also, if your baby does not sleep well in the evening she will not feed well at 10pm and this will make for unsettled nights.

Getting your daughter to settle into her cot for naps without too much fuss will take consistency and perseverance. Once you are sure she is feeding well at 7.30am and has not become too sleepy at this feed you can work on getting her used to being put in her cot for the morning nap. Once she shows signs of tiredness take her to her room and allow her to have a wind down of at least 15 minutes. If she totally resists being swaddled you still can hold her quietly, with no eye contact, and encourage her to become relaxed and ready to sleep. Before she is fully asleep, settle her into her cot. She may protest at leaving the warm comfort of your arms but, if properly fed, winded and ready to sleep, this protest should not be for too long. If you always settle her in the same way, allowing her a wind down time and watching she does not sleep during her feeding time she will learn how to settle herself alone.

Look at the notes about establishing a routine on pages 105-107 of The Contented Little Baby Book. You may also find it helpful to read the section on Sleep Associations, page 22 of The Complete Sleep Guide.