Mrs. Z. was in the office for her four-month-old daughter’s well visit. Accompanying them was little Ann’s grandmother. Ann seemed to be growing nicely, and her exam was completely normal. She was strictly breastfed. I commended her mom for the fine job that she was doing as Ann’s weight was at the 85th percentile and her height was the 90th percentile. When we started to talk about her feeding schedule, Mrs. Z. whipped out a notepad. Immediately Ann’s grandmother sat up and started to speak.
“I’m just an old grandma,” she started. “But I did raise five children of my own, and I think that Ann isn’t getting enough to eat,” she announced. “I don’t want to be meddlesome, but I think that Ann should get some cereal and vegetables. When I was raising my kids, I started them on solids by three months, and they were all big healthy babies...and they ALL slept through the night!”
I could sense where this was going, and Mrs. Z. confirmed my suspicions. “I feel that I’m doing a good job with the breastfeeding, but I have to feed the baby at least three times a night. I’m not complaining, but I’d give anything for a good night’s sleep,” she confessed. “Mom here swears that if I gave Ann some cereal at bedtime she’s sleep through the night. I must say that I tried it a couple of times, but it didn’t make much difference. My mom says that I need to give her some vegetables or fruit to fill her up. What should I do?” she pleaded.
With that, we discussed her feeding schedule. As it turned out, Ann was eating a total of nine times in a twenty-four hour period. I explained to mom that Ann was becoming a trained night eater. In other words, because of the frequency of her eating, she was “needing” to eat that frequently at night.
Breastfeeding is somewhat like a supply-and-demand proposition. The more the baby eats and empties the breast, the more milk is produced. By looking at Ann’s growth over the past four months, it is clear that mom has more than an adequate milk supply. But, what has happened with mom feeding her so frequently? Ann is getting around two hours worth of milk with each feeding...and as a result, is hungry in the next two hours. During that time, the breast has produced two hours worth of milk, which Ann is crying for. When she is put on the breast, the milk is emptied from the breast giving her enough to last for the next two hours...and so on, and so on.
I explained it to mom and grandmother in this way. Suppose there are two identical babies, both of which are bottle-fed. We keep track of their milk intake daily. Both babies eat the same number of ounces per day (36 oz.) and both babies are growing the exact same as a result. Baby I eats five times in a 24-hour period, getting approximately seven ounces each feeding. Baby II eats nine times in a 24-hour period, averaging around four ounces per feeding. I can almost guarantee that Baby I is sleeping through the night, whereas Baby II is probably getting up at least twice during the night. Both babies are nutritionally doing great, and growing identically. It’s just that Baby I has become accustomed to taking larger feedings; thus, being content for a longer period and eating less frequently. This allows him to sleep longer during the night.
This is why giving a baby a large bowl of cereal at bedtime to “help them make it through the night” is fallacy. If they are on a schedule of eating every two hours, they are going to be hungry in two hours, regardless.
I told Mrs. Z. (much to the skepticism of Ann’s grandmother) to keep up with her fluid intake as she had been doing, and to gradually increase the interval between feedings. Since Ann seemed hungry at two-hour intervals, I told her to wait until two and one-half hours to put her on the breast. Let her eat and empty the breast but do not feed her for another two and one-half hours. When she felt that her milk supply was accommodating this schedule, begin to stretch it out to three hours. After a couple of days she could try to go to three and one-half hours, and then four hours. The result should be that Ann will become used to getting larger amounts of milk. She will then eat less frequently. She would get the SAME number of ounces in a 24-hour period. But she would, in essence, consolidate at least two of these feedings and sleep longer at night.
This made sense to mom. But by the grandmother’s lack of response and her pursed lips I could tell that she wasn’t buying any of it. So, in order not to completely alienate her, I said, “Let’s give this a legitimate try over the next two weeks. If it doesn’t work out we will certainly try grandma’s approach and start some cereal.” Everyone was comfortable with this game plan.
Mom brought Ann back in two weeks as planned. Her weight gain was excellent, and mom was thrilled. Ann was eating five times in a 24-hour period, and was sleeping from 10:00 p.m. until 6:00 a.m.--straight through. Mom was ecstatic and very pleased at how well things had gone, and how easily Ann had made the transition.
I was perplexed, however, by Ann’s grandmother who sat there with sort of a smirk on her face. She didn’t say a word during the entire visit. We said good-bye, and I told mom that I would see Ann for her six-month well visit. While mom was checking out of the office, grandmother covertly caught me in the hall. “I didn’t want to say anything in front of my daughter, but I have given Ann some cereal on a few occasions. I think THAT’S the reason she is sleeping so well.”
I didn’t really think that it made a bit of difference, but I certainly wasn’t going to ruin it for her. “You’re probably right,” I said to her with a wink.