The newborn feeding schedule:

What the scientific evidence tells us

© 2008 Gwen Dewar, Ph.D., all rights reserved

This article focuses on the newborn feeding schedule. For more general information about infant feeding, see my articles about the infant feeding schedule and breastfeeding on demand. Those articles review the evolutionary, cross-cultural and clinical evidence in favor of frequent, baby-initiated feedings.

Here I outline the special problems that newborns face--problems that make frequent feedings especially important.

The high-frequency newborn feeding schedule: Why you should feed your baby 8-12 times per 24 hours

Throughout much of the 20th century, Western medical professionals recommended that newborns be fed on a strictly regulated timetable (Fildes 1986). But today, few pediatricians promote a timed newborn feeding schedule. The scientific evidence strongly suggests that newborns—-defined as babies aged 0-4 weeks—-should be fed frequently and on demand. Consider these points:

• Frequent feedings reduce the time it takes for a woman’s milk to come in. In one study, moms who breastfed newborns every two hours began lactating eat least 24 hours earlier than did moms who breastfed every four hours (Salariya et al 1978).

• Frequent breastfeeds increase a mother’s prolactin levels, and high prolactin levels are needed to establish an adequate milk supply. In a U.S. study, breastfeeding frequency of about 10 times a day (range: 7-13 times a day) was associated with sufficient milk (de Carvalo et al 1982).

• Frequent feedings during the newborn period are associated with long-term breastfeeding success. Moms who breastfeed frequently are more likely to continue breastfeeding after the newborn phase (e.g., Salariya et al 1978).

• Newborns are born in a state of starvation (Ellison 2001) and they lose weight over the first few days of life. Whether babies are breastfed or formula fed, they require frequent feedings to regain their birth weights quickly.

• Colostrum, the milk produced during the first few days postpartum, is lower in fat and calories than is more mature milk. It is also produced in smaller amounts. A higher-frequency newborn feeding schedule helps babies compensate for the lower quality of their milk.

• More frequent feedings (8-12 times per 24 hours) during the first weeks of life are associated with greater overall milk intake (De Carvalho et al 1983) and greater weight gain at 15 days (De Carvalho et al 1983) and six weeks (Casiday et al 2004) of age.

• Newborns differ in sucking strength, and this affects how rapidly they empty a breast or bottle (e.g., Pollitt et al 1978). As a result, some babies require longer feeding bouts than others. This is especially true for the lower birth weight baby and the premature baby-—both of whom may lack the strength to suck effectively (Institute of Medicine, National Academy of Sciences 1991).

• Newborns vary greatly in the amount of milk (or formula) they consume during a single feed (e.g., Pollitt et al 1978). As a result, some babies require more frequent feedings to achieve the same daily caloric intake. A demand-style newborn feeding schedule permits babies to adjust to their individual circumstances.

• Breastfeeding newborns don’t overeat. Between days 6-10 postpartum, mothers are capable of producing an average of 1200 g of milk per day. But their babies consume far less than this—-about 500-700 g/day (Casey et al., 1986; Saint et al., 1984).

This sort of evidence has led the World Health Organization (WHO) to denounce the timed-interval newborn feeding schedule as a practice that is “clearly harmful or ineffective” (WHO 1998).

In addition, the National Academy of Sciences advises new mothers nurse at least 8 times a day during the day to establish an adequate milk supply (Institute of Medicine, National Academy of Sciences 1991.) And the American Academy of Pediatrics (APP) recommends that parents feed newborns “whenever they show signs of hunger” (Work Group on Breastfeeding 1997)—an average of 8-12 times a day.

But it’s not clear how many parents are doing this.

The newborn feeding schedule around the world

In industrialized countries, the newborn feeding schedule appears to fall short of the new medical recommendations.

For instance, a Japanese study reported that breastfeeding mothers fed their infants an average of only 4 times (range: 0-11 times) during the first 24 hours of life (Yamauchi and Yamauchi 1990). Over the following 24 hours, breastfeeding frequency increased to an average of 7.4 times / 24 hours.

In a U.S. study, mothers characterized as “feeding on demand” breastfed their babies an average of 6.5 times (range: 5.5-8.0 times) every 24 hours for the first 3 days of life (Maisels et al 1994).

In a large study of 12 different European countries, 1-month old infants got an average of 7.1 breastfeeds per 24 hours (van’t Hof and Haschke 1997).

These infrequent feedings may reflect a kind of culture lag. For several generations, Westerners were advised to observe a strictly-timed newborn feeding schedule. Even though these recommendations have changed, mothers living in Western (and Westernized) societies may persist in feeding babies the way their mothers did (Manz et al 1999).

Whatever the cause, we see a different pattern in the less developed parts of the world.

A 2006 study reported that Nigerian mothers nursed their newborns an average of 13.3 times within the first 24 hours of life (Okechukwu and Okolo 2006). Seven days later, these mothers were still following the same high-frequency newborn feeding schedule.

In rural Guatemala, mothers nurse their 3-month old babies over 10 times a day (Delgado 1982). In rural Bangladesh, mothers nurse their 18-month old children 9.5 times every 8 hours. Presumably, these mothers nurse newborns at least as frequently as they do their older children.

But even these high-frequency feeders seem stingy when compared hunter-gatherer moms. Hunter-gatherer infants feed very frequently—between 2-4 times an hour (Konner 2006)!

What you can do: The international consensus

Although feeding practices vary worldwide, the international medical establishment is in general agreement. These recommendations are endorsed by the World Health Organization (WHO 1998), La Leche League, and the American Academy of Pediatrics (Work Group on Breastfeeding 1997):

Feed frequently

As noted above, newborns get more to eat and gain more weight when they are fed at least 8-12 times a day.

Feed whenever your baby shows signs of hunger

Remember that each newborn is different. Some may be fine with feeding every two hours. Others may want (and need) to nurse every 30 minutes. Be sensitive to your baby’s hunger cues. These include

• Rooting (searching for a breast)

• Hand-sucking and hand-to-mouth movements

• Increased alertness or restlessness

Don’t wait for your newborn to cry. Crying is a very late sign of hunger, and once a newborn begins crying it may take time for him to settle down and feed.

Don't restrict time at the breast (or bottle)

This may prevent your baby from taking in enough calories. If you’re breastfeeding, a strictly timed newborn feeding schedule may also deprive your baby of high-fat hind milk.

Wake a sleeping baby if she's overdue for a feeding

The American Academy of Pediatrics advises parents to awaken sleeping newborns if they haven’t fed for four hours or more. Waking a baby might sound like a bad idea, but it’s a common practice in Non-Western cultures (Worthman and Melby 2002).

Watch the diaper count

By the fourth or fifth day postpartum, newborns should produce at least six wet diapers a day. Urine should be clear or pale yellow. If your newborn is voiding less than six times a day-—or if your newborn’s urine is dark yellow or orange-—she’s probably not getting enough milk. Consult your pediatrician.

Watch your baby's weight

Newborns lose weight after delivery. But weight loss should stop by around five days of age. By one to two weeks, most newborns have regained their birth weights. Again, check with your pediatrician to make sure that your baby’s weight gains are on target.

For more details, download the American Academy of Pediatrics' paper on breastfeeding and the newborn feeding schedule.

References: The newborn feeding schedule

Nutrition during lactation (1991) is an excellent resource for parents who want detailed information about the newborn feeding schedule and other breastfeeding issues. It is available online. For more information regarding the newborn feeding schedule, see these publications (cited in the article above):

American Academy of Pediatrics. 1997. Breastfeeding and the Use of Human Milk. Pediatrics 100 (6): 1035-1039.

Casiday RE, Wright Cm, Panter-Brick C, and Parkinson KN. 2004. Do early infant feeding patterns relate to breast-feeding continuation and weight gain? Data from a longitudinal cohort study. European Journal of Clinical Nutrition 58(9): 1290-1296.

Casey CE, M.R. Neifert MR, Seacat JM, and Neville MC. 1986. Nutrient intake by breastfed infants during the first five days after birth. Am. J. Dis. Child. 140:933-936.

de Carvalho M., Robertson S, Merkatz R, and Klaus M. 1982. Milk intake and frequency of feeding in breastfed infants. Early Hum. Dev. 7:155-163

Fildes VA. Breasts, bottles and babies. 1986. Edinburgh: Edinburgh University Press.

Freeman V, van't Hof M, and Haschke F. 2000. Patterns of milk and food intake in infants from birth to age 36 months: the Euro-growth study. J Pediatr Gastroenterol Nutr. 31 Suppl 1:S76-85.

Huffman SL et al. 1987. Suckling Patterns and Post-partum Amenorrhea in Bangladesh. Journal of Biosocial Science, 19:171

Institute of Medicine, National Academy of Sciences. 1991. Nutrition during lactation. Washington, DC: National Academy Press.

Kaucher M, E.Z. Moyer EZ, Richards AJ, Williams HH, Wertz AL, and Macy IG. 1945. Human milk studies. XX. The diet of lactating women and the collection and preparation of food and human milk for analysis. Am. J. Dis. Child. 70:142-147.

Konner M. 2005. Hunter-gatherer infancy and childhood: The !Kung and others. In: Hunter-gatherer childhoods: Evolutionary, developmental and cultural perpectives. BS Hewlett and ME Lamb (eds). New Brunswick: Transaction Publishers.

Maisels MJ, Vain N, Acquavita AM, de Blanco NV, Cohen A and DiGregorio, J. 1994. The Effect of Breast-Feeding Frequency on Serum Bilirubin Levels. American Journal of Obstetrics & Gynecology 170(3):880-883.

Manz F, van’t Hof MA, and Haschke F. 1999. The mother-infant relationship: Who controls breastfeeding? Lancet 353: 1152.

Okechukwu and Okolo 2006. Exclusive breastfeeding frequency during the first seven days of life in term neonates. Nigerian Postgraduate Medical Journal 13(4): 309-312.

Pollitt E, Gilmore M, and Valcarcel M. 1978. The stability of sucking behavior and its relationship to intake during the first month of life. Infant Behav. Dev. 1:347-357.

Saint L, Smith M, and Hartmann PE. 1984. The yield and nutrient content of colostrum and milk of women giving birth to 1 month post-partum. Br. J. Nutr. 52:87-95.

Salariya EM, Easton PM and Cater JI. 1978. Duration of breastfeeding after early inititation of frequent feeding. Lancet 2 (8100): 1141-1143.

Whitehead RG, Rowland MGM, Hutton MA, Prentice AM, Muller EM, and Paul AA. 1978. Factors Influencing Lactation Performance in Rural Gambian Mothers. Lancet ii: 178 – 181.

The World Health Organization, 1998. Postpartum care for mother and newborn: report of a technical working group.

Worthman CM and Melby M. 2002. Toward a comparative developmental ecology of human sleep. In: Adolescent Sleep Patterns: Biological, Social, and Psychological Influences, M.A. Carskadon (ed). New York: Cambridge University Press, pp. 69-117.

Yamauchi Y and Yamauchi I. 1990. Breast-feeding frequency during the first 24 hours after birth in full-term neonates. Pediatrics 86: 171-175.