AT WEEKS 4–6 the consistency of your breast milk thins. Think of your milk starting out as cream (colostrum), changing to full-fat milk, then to semi-skimmed and then to skimmed by four months. As this happens the flow of your milk dramatically speeds up which can speed up the whole feeding process. When this happens you may need to cut down the length of time you breastfeed your baby for the pre-bath feed. Day feeds may become shorter as your baby can drain your breast in less time, but I would always allow an hour to make sure he is full until he is sleeping through the night.
You may have only one night waking at this stage, or your baby may even be sleeping through the night. When this happens, express both breasts before you go to bed at 8–9pm. It is unrealistic to think your breasts can supply enough milk in the 12-hour day period and be inactive at night, so expressing at this time of the day helps maintain a good milk supply and aids your comfort through the night.
The longer your baby sleeps through the night the more a solid habit of sleeping becomes, which also coincides with unsettled day naps. Again, it is unrealistic to expect your baby to sleep so well at night, so early on, and also have three solid naps in the day. You are still teaching your baby the difference between night and day, and to sleep at night and decreasingly sleep during the day. To help combat this unsettled period, extend your baby’s playtime by 10–15 minutes, adjust his feed times to accommodate early waking during the day or start swaddling him for the daytime naps. It’s also important to understand that consistency of solid night sleeping will be down to meeting your baby’s needs during the day.
Babies have ‘mini growth spurts’ on a weekly basis and the routine won’t always go to plan. Just allow the routine to be flexible. Continue to encourage awake time and make sure your baby is full at each feed to ensure a good night-time sleep. If at this stage you are getting frequent night wakings or your baby is unsettled between feeds then check:
The routine timings are interchangeable as they all end the day at the same time. Sticking to the same timings will help set your baby’s body clock but there is no reason why you can’t move from one routine to another every so often, depending on night and morning wakings or to simply plan around appointments and activities. Below are some alternative routine feed timings:
So you can see how flexible your routine can be to suit your baby’s sleep needs.
Once your baby is sleeping through the night and has reached his maximum milk intake, you will need to be consistent with your routine to maintain results. Your routine from Weeks 8–10 should start to require less effort as feeds speed up as your baby’s gut has matured and he now starts to become self-winding, is able to stay awake with ease, settles himself for naps and starts being able to stay awake in motion, which takes all restrictions out of your previous daily routine. From Weeks 10–12 your baby’s rate of growth will have started to slow a little and his appetite will plateau. Once established and out of the newborn stage, the longer your baby sleeps through the night the more flexible the routine becomes as his appetite will go up and down slightly, he sleeps less during the day and is able to wait happily for feeds. Allow your routine to become more flexible with milk intake and timings, but do keep to the bedtime routine to keep consistency with bedtime and sleeping through the night.
Once your baby is sleeping through the night change the starting breast every morning. You will now have four breastfeeds per day and, unless you start each day on the opposite breast, you will be starting each feed with the same starter breast and the other breast may not get the same stimulation.
By now you should really be enjoying playtime with your baby and starting to get a few smiles. Your baby may start to track and follow so using a cot mobile for awake time and toys dangling from the arches of a play mat may start to hold interest, but most babies are still more interested in black-and-white images and their parents’ faces. A baby’s attention span shortens as the weeks go by with the ability to see at a distance and follow movement, and static black-and-white toys will no longer offer the same entertainment by Weeks 6–8. Your baby may decide that the best place to be is with you, being carried around and complaining about being put down to play. It is important, however, that he still has some time playing on his own and is not being picked up and put down every few minutes when he grizzles. It will only make for a more demanding and insecure baby who is less able to play by himself. Whenever your baby cries to be picked up, use your voice to soothe him, rotate his toys, try tummy time or move him to a different area of the house – perhaps in his chair where he can watch you. Simply holding your baby’s feet can give him security of your touch and will often calm and distract. Toys with squeaky and rustle sounds, such as the Lamaze Jacques the Peacock, are also a big favourite at this time.
The first half of playtime is the best time for self-play, so put your baby down to play on a play mat while you express and look after yourself. Ensure you don’t give your baby tummy time sooner than 30 minutes after a feed, as you need to allow time for digestion. The end of the playtime, as your baby starts to get tired and grumpy and needs distracting, can be reserved for one-on-one chat time with you. Finally enjoy a cuddle before his nap. Remember to check for wind during your baby’s playtime. Wind is formed while digesting milk and can be the cause of grizzles or falling asleep during playtime. Most newborns therefore need to burp a few times before going down for a nap.
| Week 4 Onwards: The 7pm to 7am Sleeping Baby Routine | |
| 7am | Start on left breast Feed for 25–30 minutes each side Express any remaining milk Total awake and playtime (including feed): 2–2¼ hours |
| 9am/9.15am | Nap |
| 10.30/11am | Start on right breast Feed for 25–30 minutes each side Express any remaining milk Total awake and playtime (including feed): 2–2¼ hours |
| 12.30/1.15pm | Nap |
| 2.30/3pm | Start on left breast Feed for 25–30 minutes each side Total awake and playtime (including feed): 2 hours |
| 4.30/5pm | Nap |
| 6pm | Start on right breast Feed for 5–10 minutes each side |
| 6.30pm | Bath (34–35°C) |
| 6.45/7pm | Bottle-feed: expressed breast milk/formula 180–260ml (6–9oz) |
| 7/7.30pm | Bedtime (swaddled) |
| During the night | 12am–3am: 15 minutes on each side 3am–4am: 10 minutes on each side 4am–5am: 15 minutes total, keep baby swaddled 5am–6am: No feed zone |
This routine now continues until weaning (at around 4–6 months), bearing in mind that the daytime sleeps will continue to get lighter as your baby sleeps more heavily at night. This is especially true of the afternoon nap, which reduces to 20 minutes in some cases and this is the first nap that your baby will drop. When this happens, it is a good idea to alter the afternoon routine and only have a three-hour gap between the last two feeds of the day. Change the routine feed timings to: 7am, 11am, 3pm, 6pm pre-bath feed, 6.30pm bath, 6.45pm bottle. You want to focus on a solid long midday nap. If you find your baby is unsettled on his second nap of the day, reduce his morning nap to ensure a longer more solid nap at lunch, which will benefit your baby’s temperament when he starts dropping the afternoon nap.
Many of you will be reading this book because you have run into problems with on-demand feeding and now want to try to encourage your baby into a routine. The flexibility of my routine makes this quite simple. If your baby is snacking and taking small quantities of milk frequently, he will need to increase his milk intake gradually and you will need to work on increasing your milk supply. The greater your baby’s appetite and the greater his milk intake, the longer the milk intake will sustain him between feeds.
Under six weeks of age, start with the three-hourly routine for the first few days to a week to help maintain enough milk intake during the day and allow time for your breasts to increase their supply at each feed. Then move on to the 3½-hourly routine, aiming for the 7pm–7am routine within two weeks of starting a routine, which will allow for bigger feeds and increased awake time. It may take a while for your baby to get used to taking more milk at each feed if he is currently used to snacking. If he is sleeping a great deal in the day, wake him for feeds and try to keep him awake afterwards for as long as you can, aiming for two hours at each feed period and building the routine gradually. Do not let him go more than four hours between feeds during the day. Conversely, at night your baby should not be fed more often than four-hourly. Split the bedtime feed with a bath, as suggested, to increase his milk intake before bed. The case study below shows how quickly you can turn things round from chaos to calm.
Jessica and Lucy (four weeks old)
Jessica contacted me on a Monday needing help with her four-week-old baby, Lucy. Lucy weighed 4.59kg (10lb 2oz) and was feeding every 2–3 hours, day and night. Jessica had trouble with thrush on her nipples and Lucy would not latch on to the breast properly, so Jessica was expressing her breast milk and Lucy was taking about 90ml (3oz) per feed. Lucy was sleeping well in the day, but was awake all night. She was not having any playtime and was being put straight to bed after each feed. Although she was having a bath at 6.30pm, Lucy did not have a feed afterwards but was being put straight to sleep.
I could see that Lucy was not taking enough milk at each feed so I advised Jessica to increase her bottle to 120–150ml (4–5oz) per feed during daytime feeds and decrease the night feeds to a maximum of 90ml (3oz). I also recommended reducing the size of the feed before her bath to a maximum of 60ml (2oz) and introducing a larger feed after the bath. I asked Jessica to try to keep Lucy awake after the daytime feeds so that she was awake for 1½–2 hours at each feed period, timed from the start of each feed. I suggested the following routine:
| 7am | 150ml (5oz) bottle of expressed breast milk Awake for 1½–2 hours |
| 10.30am | 120–150ml (4–5oz) bottle of expressed breast milk Awake for 1½–2 hours |
| 2/2.30pm | 120–150ml (4–5oz) bottle of expressed breast milk Awake for 1½–2 hours |
| 5.30/6pm | 60ml (2oz) bottle of expressed breast milk |
| 6/6.30pm | Bath |
| 6.30/7pm | 120–150ml (4–5oz) bottle of expressed breast milk or formula Awake for 1½–2 hours (including feeds and bath) |
| 7/7.30pm | Bed |
| Night feeds | 4 hours minimum apart, 90ml (3oz) bottle of expressed breast milk, 30 minutes maximum |
Jessica telephoned to report a great improvement. She was very happy that the routine had fallen into place quite quickly, although it had taken Lucy a couple of days to take a full 120–150ml (4–5oz) at each feed. Once Jessica had increased intervals between feeds to every 3½ hours, it was easier to get Lucy to take 150ml (5oz). Jessica had found it hard to keep up with expressing her milk so she was supplementing with formula at the bedtime bottle. Lucy was still having two feeds at night which were also formula (90ml/3oz at 11pm and 3am). However, Lucy was hard to settle after these feeds and was awake for hours at a time. I discovered that, when Lucy woke at night, Jessica was in the habit of getting Lucy up and taking her downstairs to prepare the bottle. I advised Jessica that she should stop using formula for the night feeds, and give no more than 90ml (3oz) of expressed breast milk for each of these night feeds as expressed milk makes for a lighter meal than formula. Instead, she should use formula as needed during the day and give only formula at the staggered bedtime feed. At night, Lucy should not be taken downstairs. Jessica should prepare the night-time bottles and then go in to Lucy so she could go straight from cot to bottle, be winded well and then straight back to bed. Lucy should have minimal stimulation at night – keep the lights low, no talking and only change her nappy before a night feed and only if dirty on the second night feed. Jessica had also mentioned that Lucy was not happy during playtime but had not been given any toys or pictures to look at. I suggested making some simple black-and-white pictures for Lucy to help entertain her.
I also felt Jessica could increase the daytime feeds to 180ml (6oz). The increase of milk would discourage night waking and encourage the first night feed gradually getting later through the night, waking between 3am and 5am. Whatever time Lucy woke, Jessica should be sure to start the day at 7am. To help Lucy to stay awake after her daytime feeds, I recommended various play options – a play mat, using black-and-white toys, putting Lucy down to play somewhere where she could see Jessica (for example, in her baby chair), having tummy time and having one-on-one chat time. I emphasised how important it was to keep Lucy awake for 1½–2 hours in the daytime.
Jessica rang me absolutely thrilled. Lucy was only waking briefly at around 11pm, but was resettling herself, and then again for a feed between 3am and 4am. She was taking a quick feed of 20 minutes and going straight back to sleep. Lucy was now taking 150–180ml (5–6oz) at day feeds and 180–200ml (6–7oz) of formula before bed and was having good awake time in the day.
My final advice was to remember not to jump to Lucy’s every cry and to leave her for two minutes before going to her at night, as I felt she was probably waking out of habit, especially as she was taking 180–200ml (6–7oz) before bed. If Lucy grizzled or did ‘start–stop’ shouting, so not properly crying at night, I advised Jessica to leave her a little longer than two minutes to see if she settled herself. When stop–start crying a baby is half asleep and not fully awake. Jumping to help too quickly will often stimulate her awake rather than resettle her. Also moving forwards with the routine, I advised Jessica to increase Lucy’s milk intake until she was sleeping through the night. In just one week, Lucy went from being awake most of the night to waking only briefly for a short feed. It might take a little longer for Lucy to sleep through the night than it would have done if Jessica had started the routine at birth, but I felt that, in another month, Lucy should be sleeping through the night.
My routine will take you up to the weaning stage. The only differences with the routine between the newborn stage and the now established baby stage are:
Though the blanket advice from the Department of Health is to wean your baby at six months (26 weeks) of age, I do things a little differently and, if necessary, wean babies on to solid food ever so slowly from four months. Research evidence has proven that babies are digestively ready to be weaned on to solid food between four and six months, but, for some reason, the government advice has been set at six months. Waiting until six months with a baby who is ready to be weaned from four months will cause night waking, disruptive days and frustration, which may be mistaken for teething which occurs at around the same time. Starting solids as soon as you see the signs that your baby is ready (see below) means that you are able to take a slower approach to introducing solid food, which is, of course, better for your baby’s digestion.
As babies get older, they have much more of an opinion on everything, including what goes into their mouths. There is certainly a difference between a baby of four months and a baby of six months in this respect. Starting weaning at six months often means it can be a stressful process as it’s a rush to get your baby fully weaned as quickly as possible. A baby who is actually ready for food from four months can spend two weeks simply introducing a few spoons at one meal a day, and this gives you time to build the quantities. For those of you with babies who are not ready to wean until 5–6 months, enjoy the ease of milk feeding as it all gets a bit messy from here on in!
Below are signs to look out for when deciding if your baby is ready to be weaned:
Please talk to your health visitor or GP for advice if you feel your baby is ready to be introduced to solid food before six months.