Looking back, I realise even as a midwife, I made the same mistakes with my first baby that just about every new mother makes. I overfed him. Back then, the feeding rule was strictly four-hourly with 10 minutes at each breast. Today, we know this “programming” is the cause of many feeding problems (like colic). Recent research from the US has also found that “feeding mismanagement” puts children at risk of obesity in later life.
South African pregnancy, birth and parenting advisor Sr Lilian, says many feeding problems can be traced back to misunderstanding a baby’s natural feeding pattern. Could this be one of the reasons colic occurs more often with first babies? Or that babies born before their due date by C-section or induction experience “tummy-troubles”? Could it be their digestive systems aren’t ready for milk?
Understanding your baby’s stomach
Your baby’s stomach is a hollow, muscular organ that can stretch when filled. During pregnancy, your baby swallows amniotic fluid that fills, and is then emptied by, the stomach at about the same rate and volume that milk will after the birth. About 20ml or four teaspoons at a time.
There are two valves (sphincters) at each end of the stomach that control filling and emptying. The “full” valve, called the pyloric sphincter, helps prevent reflux. But, when the stomach is over-stretched, this valve comes under strain and your baby will cry in pain or regurgitate milk. When milk is not properly digested, it can lead to diarrhoea or constipation.
Natural feeding patterns
According to neonatologist and neuroscientist Dr Nils Bergman, babies begin life taking in small and frequent feeds. As they grow and their energy needs increase, they drink more and their tummies stretch to accommodate this. Hormones stimulate the flow of the mother’s milk and this flow is called MER (or milk ejection reflex). When breastfeeding hormones kick in, the flow of milk is constant and Dr Bergman says babies can “Spend one minute per hour actually feeding”.
Newborns, especially in the first few days after birth, need to feed at least every two hours. Feeds should be short and fuss-free.
The downside of “trained feeding” for your baby
Dr Bergman explains when babies are “trained” to feed every three to four hours, their brains have to adjust to survival mode. Babies who have to wait three or more hours between feeds use up all their lactose (milk sugar) stores. For energy, their stress (survival) hormones kick in to activate sugar levels (called glycogen) stored in the liver as well as fat stores from the body. If and when this system is slow to respond, the baby becomes hypoglycaemia (low blood sugar levels).
This also means by the time the baby is fed, he is literally starving and quickly drinks as much as he possibly can. Usually more milk than he needs. As the stomach can stretch to hold twice as much as the baby needs, overfeeding makes him uncomfortable. This also means he needs to be burped and his position changed often to make him feel more comfortable. Burping and the constant movement is tiring and overstimulating for the newborn, so he soon becomes agitated and begins to cry. By the time he falls into an exhausted sleep, his glycogen stores are all used up and the cycle starts all over again.
With my second and subsequent babies (I had four) breastfeeding was a breeze. Simply because I let my babies feed when they needed to and finished the feed when they stopped sucking.
Babies are different and many moms still insist on a strict four-hourly routine and disciplining their babies into a feeding pattern that will fit with the family schedule. Dr Bergman agrees that “one size does not fit all”. While some babies are more resilient and quickly adapt to these changes, others may be more sensitive, struggle to cope or just don’t cope at all. These babies will cry often and could become “fussy eaters” when they’re older.
“Most babies are able to cope with long intervals between meals, but to do so, they have had to work extra hard on the carbohydrate and fat metabolism homeostasis. This extra hard work is called allostatic load, and results in physiological systems becoming fatigued and wearing out. In this instance, the pancreas is affected, which could lead to an increased risk of diabetes,” says Dr Bergman.
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