Newborns are hard work! They want to feed all the time, be held by a care giver, and struggle with their normal gut functions. However, our chilled out babies are also really challenging as they can be very difficult to feed. This blog post is to help those parents struggling with a sleepy feeder.

Babies tend to “wake up” somewhere between weeks 2 and 3 of life. Before then, many babies will not demand feed appropriately, nor do a good job at the breast – they simply fall asleep. If this is not recognised by the parents, babies can be at risk of losing too much weight or poor weight gain, jaundice and then ongoing excessive sleepiness. The mum is also at risk of losing her milk supply.

In our breastfed babies, I suggest ensuring a baby under 2 weeks of age and/or not yet back to birth weight, to be fed every 3 hours (ie at least 8 feeds in 24 hrs). This does not mean waiting until the 3 hour mark to offer the breast (you should offer the breast every time the baby makes any feeding cues), but instead, waking the baby at the 3 hour mark after the last feed started, if it is not already demanding. Feeding cues include: starting to wake up, poking their tongue out or licking their lips, turning their face to find a nipple, sucking on something, a grizzle or a cry. The last 2 cues are actually late feeding cues, and ideally babies should be offered the breast before they are crying for it. In our sleepy babies, their feeding cues can be more subtle. I would suggest not wrapping your sleepy baby in the day time. Wrapping can hide feeding cues, and they may wake from sleep and then go back to sleep without signalling for a feed. Anytime a sleepy baby starts to rouse from sleep, I would encourage this, and offer the breast.

When the baby is at the breast, really tune into their sucks and swallows. A swallow is best heard, rather than seen. It will be a soft click sound that may happen with every suck (such as during a let down), or after several sucks (at the start of a feed, or after the let down has finished). If the baby is not suckling well, they may not be transferring (drinking) milk and therefore not swallowing very often. If the baby is not sucking much, they are essentially having a cuddle. Which is lovely, but they also need to be fed! And a sleepy feed often means a long feed and at some point you will want to go to the toilet, or eat something, so you may as well make the time you set aside to feed your baby as productive as possible.

My tips for encouraging a sleepy feeder to suck and swallow at the breast are:

• Feed baby in a nappy only. A warm baby will just fall asleep.
• Get a wet flannel out to further wake baby up if they fall asleep quickly on the breast.
• Tickle their cheek or chin to try and stimulate their suck reflex.
• Let the baby fall away from your breast a little (ie threaten to take them away from the breast). This will usually upset them enough that they come back and suck well for a time.
• If that doesn’t work – take them off the breast.
• At this point, they may need a nappy change, a cold flannel, or some tickles to wake them up. If just taking them off the breast is enough for them to be unhappy and wake up, then we go to switch feeding.

Switch feeding is where we offer breast A only for as long as the baby is sucking and swallowing well. After the above tactics are not successful in encouraging good sucks and swallows, then we take baby off and offer breast B. This could be anywhere from 2 to 10 minutes. The time is not important. What is important is that the time at the breast is productive. That the baby is swallowing milk. Then we repeat with breast B. In the time baby is on breast B, breast A is now refilling. When the baby is no longer feeding well on breast B, we switch back to breast A, and the baby will now get rewarded with another good let down and a fuller breast. We continue to offer as many breasts (at least 4-6) until the baby seems very satiated. This style of feeding will transfer more milk to baby than if a sleepy baby is left on breast A for 10-20 mins, and then breast B for 10-20 mins. It should also shorten the total feed time. A breastfeed that is going over 40-60 mins is starting to get into “marathon feeding” territory and there is a very good chance the baby is not actually drinking much milk from the breast.

Switch feeding is useful for when mum has a lower supply, and also a good technique for improving supply. The breast refills quickest when it is empty, so when the suck/swallow ratio is high (ie maybe 6 sucks then 1 swallow), it is time to switch to the other breast and let the first one re-fill.

The best thing you can do for you and your baby in the early weeks is really tune into their sucks and swallows at the breast. Make sure you can hear lots of swallows. And if they are not sucking and swallowing well or often – intervene! Some babies need a bit more help than others.

– by Dr Briony Andrew

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