YOU HAVE TWO options when your milk comes in at Week 2. If your baby is over 2.72kg (6lb) in weight, is gaining weight and is back to her birth weight, and your milk supply meets or is ahead of your baby’s demand, you can move straight to the 7pm to 7am Sleeping Baby Routine (here).
However, if your baby has low weight gain, is not back to her birth weight and your milk supply is not yet meeting demand or is one step behind your baby’s appetite then follow the three-hourly routine outlined here. The benefit of this routine is that your breasts will have extra stimulation from active sucking and your baby will have an extra feed during the day until your milk supply increases. On the downside, this routine can be exhausting for you and your baby as there is less ‘downtime’ between feeds and the added factor of playtime and expressing means very little time is left for rest and looking after your basic needs. This routine is not practical in the long-term but it can be used until your milk supply has increased. Move on to the 7pm–7am routine as soon as you are able to. If you have a low milk supply or are not meeting your hungry baby’s appetite, another option is to follow the mixed feeding routine (Chapter Six) or to temporarily mix feed on the 7pm–7am routine while increasing your milk supply.
With both routines you will now introduce a bottle at bedtime, express your breast milk to maintain and increase your milk supply, and structure some awake time for your baby at each day feed. Try to increase your baby’s awake time from 1¼ to 1½ hours at a time during Weeks 2–3 and 1½ to 2 hours at a time by Weeks 4–6 (this includes feeding, winding and nappy changes, as well as playtime). Some ‘widey-wakey’ babies may be able to stay awake for 1½–2 hours at some feed periods from birth. However, do not let your newborn stay awake for more than two hours at any one feed. This is the maximum awake time for babies aged 1–6 weeks, as your little one also needs quality naps to ensure she has the energy to feed well and thrive.
Activity can be tiring and the amount of awake time your baby has may vary at each feed period. I work on establishing how much time an individual newborn is able to stay awake for and then build on that until two hours of awake time at each feed period is their natural pace. The idea is to encourage moving forward with the routine without backtracking. If, for several weeks, your baby is able to stay awake for two hours happily for each feed period, and then randomly starts falling asleep after an hour, you should try to encourage your baby to wake up and keep to the routine. Any extra time needed for sleep should be taken at night. If you have a sleepy baby from the start who is only able to stay awake for, say, one hour, you should build on that time and gradually encourage a longer time playing, eventually reaching two hours by Weeks 4–6.
As your baby grows she will hit growth spurts and will be wide awake and hungry for 2–4 days and then become very sleepy for a few days after, while growing. I call this a ‘mini weekly growth spurt’. Your baby will have major growth spurts at around three weeks, six weeks and three months.
Babies on my routine rarely have a problem with settling to bed at night. In fact, sometimes it’s a job to keep them awake long enough after the bath to take their bottle before bed! Naturally babies become tired at this time of day and recognise that bedtime is coming. It’s important that you invest time in the bedtime bottle as this will be the key to your baby sleeping through the night. It can take weeks for your newborn to become efficient at this feed, but keep with it as it will eventually all click into place. As with the other day feeds, the aim is to keep your baby actively feeding, winding and waking her if she falls asleep. At this point it’s more about keeping your baby stimulated and awake to take enough milk before bed, rather than making the room dark and peaceful to help send her to sleep as you would a much older baby who is already established.
The bedtime bottle-feed, after the bath, could increase by 30–60ml (1–2oz) per week in the first month, thus becoming the biggest feed of the day, which will enable your baby to sleep for long periods at night. When you first introduce the bottle, you will not know how much milk your baby will want or need so, as a starting point, introduce the bedtime bottle with 60ml (2oz) of milk for a 2–3-week-old baby. If this is easily taken, the next night increase it to 90ml (3oz), and then gradually increase the amount until your baby reaches a comfortable intake that meets her personal appetite. Increasing by only 30ml (1oz) at a time until you have met your baby’s appetite means you won’t overfeed her. From there look to increase the amount gradually by 15–30ml (½–1oz) at a time until your baby has reached the amount she personally needs to sleep through the night. The quantity in the bottle really does need to increase gradually – your baby has a very small stomach. Some babies will increase slowly by 15–30ml (½–1oz) per week, while others will increase their milk intake by 60ml (2oz). This increase will slow and stop once your baby is sleeping through the night.
It’s worth bearing in mind that the amount of milk needed is not always based on the weight of a baby, but also on her appetite and how quickly she is growing. I have often looked after newborn twins where the smaller twin, sometimes a whole 0.45kg (1lb) lighter than her sibling, will drink 30ml (1oz) or so more at each feed than the bigger twin, which can only be explained by a faster rate of growth and a bigger appetite.
With the bedtime bottle you will also need to be aware, and take into consideration, how much milk your baby is taking before the bath, as this will have an impact on the bedtime bottle-feed. If you are unable to increase your baby’s milk intake with this bottle, then look to reduce the pre-bath breastfeed by five minutes on each breast. If you have fast-flowing milk, your baby could be getting 90–120ml (3–4oz) in as little as 10 minutes. Ideally she would be taking no more than 60ml (2oz) at the pre-bath feed.
The bedtime bottle-feed is the key to your baby sleeping through the night. Make sure you find the right teat and bottle for your baby’s sucking style (see here) and wind her every 15–30ml (½–1oz), or even more regularly if you have a particularly windy baby. Warm the milk before giving your baby a bottle as newborns do not like drinking cold milk – it’s harder to digest and can give your baby stomach ache. To test the temperature of the milk, shake some on the inside of your wrist. If it stings it is too hot; it should feel warm or you should feel nothing. You can also reheat the milk if it has cooled during the feed. Use a bottle warmer or a jug of hot water, and always test the temperature after reheating. It’s commonly thought that it’s a good idea not to heat a baby’s milk as it risks creating a fussy feeder. However, during the newborn stage it’s all about digestion, and warm milk is easier to digest. Once you reach the baby stage – from 12 weeks – your baby’s gut is less sensitive and can handle cooler milk.
Once your milk has come in, you will still need to maintain a good supply. To help this you need to rest, eat and drink well, and express, collecting milk for the bedtime bottle. Express for 15–20 minutes no later than 20 minutes after the two morning feeds (10 minutes if using a double pump). Any later than this and you will be expressing milk produced for the next feed and therefore depriving your baby of that milk. Have the breast pump set up and ready to go before starting feeds. Preparation will not only save you time but keep the feed and expressing within the time allocated. Add an extra express between 8pm and 9pm once your baby is waking up at night past 1am or 2am and is likely to be waking only once in the night to feed. Expressing before you go to bed will help to maintain a good milk supply and keep your breasts comfortable for you to sleep as your baby gradually wakes later through the night. Don’t be tempted to add this to your routine before she is regularly waking past 1–2am otherwise you will not have enough milk for the first night feed.
A mother has her most plentiful milk supply in the morning as, in theory, she has had a good night’s sleep (more sleep = more milk). During the day, milk production reduces and your supply depletes, which leaves you at the lowest point of milk supply come the evening feed. However, this is when your baby needs her biggest feed of the day to set her up for the night ahead. As a result of milk depletion babies can be hard to settle in the evenings due to hunger, wanting to cluster feed and not wanting to be put down at bedtime. To combat this, express milk after the two morning feeds which will allow you to stagger the bedtime feed, introducing a bottle-feed after the bath. This is sometimes called the ‘split feed’ but I will call it the ‘staggered feed’: a short breastfeed of 10–15 minutes maximum (including winding) each side before the bath and a longer bottle-feed after the bath. The combination of the bath and staggered feed results in 4–8 hours of undisturbed sleep.
Expressing
Express within 20 minutes of finishing a feed to avoid stealing milk produced for the next feed. Express for 3–5 minutes on the first breast and then change sides. Repeat this a few times or, if using a double pump, start the stimulating mode and full cycle twice. Massaging your breasts while expressing will help to release the milk. Make sure you express for no more than 20 minutes (10 minutes on a double pump). You may not get very much milk at first but, don’t despair, the amount will soon increase.
Keep your expressed breast milk in the fridge (it will keep for up to five days). If you are expressing more than you are using, which is normal, freeze the remaining milk daily (it will keep for up to six months in the freezer). This can then be used later on when weaning or if you ever need ‘emergency’ milk.
Toys, activity stations and setting up stimulating play areas, such as a play mat or baby chair, can make a huge difference to the length of awake time your baby can manage. Most babies are sleepy at the end of a feed and this is usually due to milk digestion rather than tiredness. Change your baby’s nappy after a feed to encourage waking. Most babies also spring to life with the help of a black-and-white toy or picture.
During playtime, you will need to wind your baby several times, around 10–15 minutes apart, to alleviate any wind formed while digesting milk. This will also help your quest for a longer and happier playtime as a baby will naturally start to fall asleep as the wind builds while digesting.
Once you have established breastfeeding and your baby has regained her birth weight, is over 2.72kg (6lb) and is gaining weight, which should all happen at around Week 2, in contrast to your day routine you should let your baby wake of her own accord for feeds at night. This is where my technique differs from other baby experts who advise waking your baby on the dot for each feed day and night, or waking her for a ‘dream feed’ (a booster feed which is given before the parent would naturally go to bed). On my routine your nights are ‘baby-led’: if your baby is hungry, she will wake for a feed at night. By encouraging the majority of your baby’s milk intake during the day, combined with the staggered feed and bottle at bedtime, there is no need to wake your baby for a dream feed. As your baby’s day feeds and awake time increase over the weeks so will the length of time she sleeps at night, getting the much-needed rest to grow and thrive. As a result your baby will learn the difference between night and day very early on and night feeds will become efficient and short. You will also get the much-needed rest you need to recover and take care of your new baby.
When breastfeeding your baby will get into a routine much quicker than your breasts, which can leave you feeling full, uncomfortable and unable to last until your baby naturally wakes. Your breasts will also need extra stimulation to make up for the loss of stimulation from your baby as she sleeps longer at night at this early stage. Once your baby is waking past 1am, waking only once in the night or sleeping through the night, introduce a ‘power pump’ and express before you go to bed at 8–9pm. This will keep you comfortable and able to sleep until your baby naturally wakes, add extra stimulation to maintain a good milk supply and help you understand your milk supply and flow speed. As your milk supply increases overall, so will the amount of milk you express at this time. As the weeks go by your flow of milk will speed up. This express will show you how quickly your milk is released which will also help you to gauge how long it takes to drain your breast. Bear in mind that you will have much more milk at the start of the day.
Night waking and feeds should get gradually later through the night with the increase in your baby’s awake time and milk intake during the day. The later your baby is waking through the night, the shorter the feed should be:
Once your night feed has reached 4am, keep your baby swaddled. This will help keep the feed short, keep stimulation to a minimum and help her go back to sleep quickly after the feed. No nappy change is required unless it is dirty. Try using a larger size nappy for nights to accommodate a full night’s sleep without changing. Make sure the nappy is fitted securely around the legs to prevent any leaks.
If your baby has slept all the way through until 5am or 6am, she has slept the majority of the night so feeding at this time will be stimulating and she will most likely want a breakfast feed, not a snack, to get back to sleep. Feeding at this time will dramatically interfere with the 7am feed which can have a knock-on effect on your whole day routine. If your baby wakes at this time, keep her swaddled and cuddle her back to sleep by holding her on your chest firmly (cover up any naked skin which will only frustrate and not calm your baby – use a muslin or pop a top on), patting her back and bottom, and breathing deeply. This is a form of the ‘shush and hold’ technique (see here). As a very last resort, let your baby suck on your finger which will calm and soothe her. Stay in your baby’s bedroom or go back to your bed in the dark. Start your day at 6am and switch your routine to the four-hourly 6am routine that day. This is the only time of day I would advise letting your baby suck your finger or cuddling your baby back to sleep as I don’t believe in babies sucking for comfort. It creates wind and has a negative effect on the morning feed.
When feeding your baby in the night, keep the lighting as low as possible so you can barely see and avoid talking or creating any stimulation. Feed your baby, wind her and then put her straight back to bed – this keeps the night-time feeds short and sweet so your baby is easy to settle. The more stimulation, the more awake your baby becomes, and the harder she will be to settle back to sleep. Swaddle your baby for the last 2–5 minutes of the breastfeed or the last 30ml (1oz) if giving a bottle, but where possible you should always breastfeed in the night even if you are mixed feeding. This will make for a calm transition from breast to bed.
Use the ‘two-minute rule’ for night waking. Allow a two-minute pause when your baby has woken to see if she settles back to sleep or is actually ready for a feed. Some babies grizzle, stretch and grunt for a while before waking properly, but please let your baby grizzle undisturbed. The chances are that she is still in ‘sleep mode’ with her eyes closed. If you rush in to feed your baby whenever you hear a cry or grizzle, you are not allowing her a chance to resettle. You may be starting a feed she is not ready for, only for her to wake again a few hours later when she is actually ready for milk. At night, babies go through lots of lighter periods of sleep and during those light periods they can twitch, turn, grizzle, and even cry a bit, but if left they will often go back to sleep.
Top tips for night feeding
It’s important to ensure that your baby does not overheat or get too cold. If a baby is cold she will wake; if she is too hot overheating becomes more of a danger. Everyone thinks that it’s necessary to keep a baby warm with lots of layers, even putting on hats and mittens indoors, because babies are unable to regulate their own temperature. However, this is usually for the first few weeks of life until they start gaining weight and body fat. Even so, babies release heat through their skin so it’s important to keep the room temperature above 18°C degrees at all times and not use hats indoors.
The ideal sleeping environment is a room temperature of 18–21°C with your baby dressed in a vest bodysuit, a Babygro or sleepsuit, a swaddle, roll pillows (if using) and one thick, stretchy blanket or two thinner blankets to tuck her in (see Chapter Thirteen for more on swaddling, sleep positions and tucking in). If in the summer months the temperature goes up, reduce the layers by removing the sleepsuit/Babygro first and use a thinner blanket to tuck your baby in. You should always keep the swaddle and a thin blanket, or even a large muslin, to tuck her in. If the room temperature reaches over 24°C look to cool it down by letting air in or using a fan, with the air flow not directly on your baby.
The ideal feeding/awake time temperature is 19–20°C. This is a little warmer than the sleeping temperature because I advise babies to be fed in a vest bodysuit, which means their arms and legs are exposed, but the room should be no hotter than 20°C as babies heat up while they are feeding and digesting.
| Weeks 2–3: Three-hourly Routine for Low Milk Supply | |
| 6am | Start on left breast Feed for 30 minutes each side Express any remaining milk for 10–20 minutes Total awake and playtime (including feed): 1½–2 hours |
| 7.30/8am | Nap |
| 9am | Start on right breast Feed for 30 minutes each side Express any remaining milk for 10–20 minutes Total awake and playtime (including feed): 1½–2 hours |
| 10.30/11am | Nap |
| 12pm | Start on left breast Feed for 30 minutes each side Total awake and playtime (including feed): 1½ hours |
| 1.30pm | Nap |
| 3pm | Start on right breast Feed for 30 minutes each side Total awake and playtime (including feed): 1½ hours |
| 4.30pm | Nap |
| 6pm | Start on left breast Feed for 10–15 minutes each side (30 minutes maximum) |
| 6.30pm | Bath (34–35°C) |
| 6.45pm | Bottle-feed: expressed breast milk/formula 60–120ml (2–4oz), winding every 15–30ml (½–1oz) |
| 7.15/7.30pm | Bedtime (swaddled) |
| During the night | Baby-led: feed for 15 minutes each side whenever your baby wakes Wait two minutes on waking to see if she resettles Change your baby’s nappy before the feed Swaddle for the last 5 minutes of the feed |
Once your baby is over 2.72kg (6lb) in weight, is gaining weight and is back to her birth weight, and your milk supply meets or is ahead of your baby’s demand, you can move on to the 7pm to 7am Sleeping Baby Routine. The benefit of this routine is that your baby has more time to digest milk between each feed, which allows her stomach to empty between feeds and therefore for her to build an appetite to feed. At this stage your baby will also become more efficient at feeding and will take a gradually increasing amount of milk at each feed. On this routine you, as a mother, will have time for expressing, looking after yourself and resting between feeds, which can be more beneficial for your milk supply than feeding every three hours. This routine also introduces increased awake/playtime between feeds, which in turn encourages long sleep periods at night. Unlike other baby routines which state the ideal nap length, my routine focuses on your baby’s awake time. Your baby’s nap times will decrease as her awake time increases.
Breastfeeding on my 7pm–7am routine will take up to an hour in the first 6–8 weeks for all day feeds. Make sure you change sides when you have run out of milk on the first side (see here for how to check your breasts for milk) or have fed your baby for 30 minutes (this includes winding). This is important, as it means your baby will suck for long enough to reach the rich ‘hindmilk’ that she needs to enable longer periods between feeds. If you swap breasts before your baby reaches the hindmilk, and therefore give two lots of foremilk, it will result in your baby ‘snacking’ as you will not have filled her up at each feed. This will also decrease your future milk supply as you will not have drained and stimulated your breasts to produce enough milk for the next feed. You should complete the feed (including winding) in one hour. Thirty minutes of active feeding and winding is long enough to drain one breast.
If you are still struggling to get a good milk supply and your baby is not settling or maybe waking early for feeds due to hunger, you can top up with expressed milk or formula after the two morning feeds, keeping this top-up within the hour allocated for feeding. Breastfeed for 20 minutes on each side, or 30 minutes on one side and 15 on the other, then offer a top-up bottle, starting at 60ml (2oz) and increasing if needed. If you are finding that you are using both expressed milk and formula during the day, which includes your bedtime bottle, save the formula for the bedtime bottle where it will be most beneficial as it is heavier, takes longer to digest than breast milk and therefore will sustain your baby for longer, making it perfect for encouraging longer periods of sleep at night. If you are finding you need to top up regularly and are not happy with mixed feeding, there are a few things you can do to encourage a more productive milk supply (see here). It can take weeks to get a tip-top milk supply and, while being in recovery with sleepless nights, your baby’s demand can often be one step ahead of your milk supply. This routine allows you to get the milk supply benefits of a good night’s sleep, as well as the extra stimulation of expressing, so your breasts don’t lose out when your baby is sleeping for longer periods at night. If you are unable to meet your baby’s daily demand and you want the routine to work in giving you a full night’s sleep, then mixed feeding is the answer (see Chapter Six).
If you want to investigate your milk supply once you are established, for instance because you are unsure of how much milk your baby is getting, you suspect you have a low milk supply, a fast let-down or initial flow, or you simply want to understand how your milk flow personally works for you, then the best way to do this is to express a full feed and offer your baby a bottle instead for that feed. You will need to express for 30 minutes on a double pump or 45–50 minutes on a single. Express 30 minutes before the feed is due and then again once you have finished feeding your baby so you are expressing as close to the feed time as possible. Ideally, get someone else to bottle-feed your baby while you express. Stop and switch sides once the flow stops or, if double pumping, stop and restart the stimulating mode once the flow has stopped.
If you want to check the speed of your milk flow, time how much milk you get in the first two minutes of expressing and record it, then again after another three minutes, which will give you the amount of milk you have expressed in five minutes. Then record how much milk your extract at five-minute intervals until you have finished. This should give you a good idea of when you should be breaking a feed to wind your baby. If your milk comes through quickly at first, then break to wind after two minutes on each breast and extend the amount of time between wind breaks as your milk flow slows down.
The best feed to do this ‘breast milk test’ is the mid-morning feed. You will have less milk at this time than at the first morning feed, but more than at the afternoon feed, so it will give you an average. The information you gain from this test, alongside the evening express, should give you a better understanding of your personal flow and milk supply. Be aware that your milk supply will go up and down for all sorts of reasons, such as your energy levels, activity, and your liquid and food intake. The speed of your milk flow will increase throughout the weeks as your milk thins and increases.
It may take weeks before you will be able to be consistent with the routine, depending on the night feed timings and morning waking. For instance, if your baby wakes at 6am, you would then be on a 6am, 10am, 2pm, 6pm routine for that day. The routine start time is bound to vary until your baby learns to sleep through the night. You can also change the routine to fit in with an appointment. For example, if you have an appointment at 11.30am, you could wake your baby earlier, changing the routine to feeding times of: 6.30am, 10am, 2pm, 6pm pre-bath feed, 6.30pm bath, 6.45pm bottle, 7/7.30pm bed. By ending the day at the same time you are able to get back on to your 7pm–7am routine the next day.
Alternative routine feed times
If you find changing the start time each morning confusing, you can wake your baby every morning at the same time no matter what happens at night. If you do this, make sure that the later you feed during the night, the smaller you make the feed (see here). Also the later your baby wakes the more stimulated she becomes so you need to keep feeding quick, quiet and dark with little to no stimulation.
It’s a good idea to keep a baby routine diary. The easiest way to do this is to buy a diary that has one day per page. This helps you to see the pattern that is developing and work out your routine for each day.
| Weeks 2–3: The 7pm to 7am Sleeping Baby Routine | |
| 7am | Start on left breast Feed for 30 minutes each side Express any remaining milk within 20 minutes of finishing the feed Total awake and playtime (including feed): 1½–2 hours |
| 8.30/9am | Nap |
| 10.30/11am | Start on right breast Feed for 30 minutes each side Express any remaining milk within 20 minutes of finishing the feed Total awake and playtime (including feed): 1½–2 hours |
| 12/1pm | Nap |
| 2.30pm | Start on left breast Feed for 30 minutes each side Total awake and playtime (including feed): 1½–2 hours |
| 4/4.30pm | Nap |
| 6pm | Start on right breast Feed for 10–15 minutes each side (30 minutes maximum) |
| 6.30pm | Bath (34–35°C) |
| 6.45pm | Bottle-feed: expressed breast milk/formula 60–150ml (2–5oz) |
| 7/7.30pm | Bedtime (swaddled) |
| 8/9pm | Express once your baby is regularly waking past 1am or 2am |
| During the night | Baby-led: for 10–15 minutes each side maximum whenever your baby wakes Wait two minutes on waking to see if she resettles Change your baby’s nappy before the feed Swaddle for the last 5 minutes of the feed |