Chapter Eight

The Early Weeks

Week 1: Three-hourly Feeding

Your baby’s routine in the first week will depend on how much she weighs and her appetite. Below is an example of a three-hourly routine. This routine starts at 7am, but you can choose the earlier start time of 6am to get an earlier night. This routine is for the first week only. Some premature babies may want to start on a four-hourly routine from birth giving them longer between feeds, and therefore more sleep, for maximum growth. Feeding three-hourly can be exhausting for a tiny baby and, as formula milk takes longer to digest, feeding four-hourly means they benefit from larger feeds less often.

If your baby is under 2.72kg (6lb) you may want to wake her for the first feed of the night between 10pm and 12am, until she reaches her birth weight, but ideally you should do this for no longer than a week as otherwise you will be setting your baby’s body clock to wake and feed at around this time every evening.

The staggered bedtime feed is designed to be the biggest feed of the day and gives enough milk to sustain your baby until past 1am very quickly, leaving only one waking during the night. The nights should be baby-led: if your baby weighs over 2.72kg (6lb) and you are happy with her daily milk intake, let her wake naturally through the night. In my routine I encourage parents to wait two minutes when their baby wakes and cries to make sure she is truly ready for a feed (if she does not resettle back to sleep). See here for more on my two-minute rule.

Week 1: Three-hourly Bottle-feeding Routine
7am 60–120ml (2–4oz) bottle
Total awake and playtime (including feed): 1–1½ hours
8/8.30am Nap
10am 60–120ml (2–4oz) bottle
Total awake and playtime (including feed): 1–1½ hours
11/11.30am Nap
1pm 60–120ml (2–4oz) bottle
Total awake and playtime (including feed): 1–1½ hours
2/2.30pm Nap
4pm 60–120ml (2–4oz) bottle
Total awake and playtime (including feed): 1–1½ hours
5/5.30pm Nap
7pm 30–60ml (1–2oz) bottle maximum
7.15/7.30pm Bath (34–35°C)
7.45/8pm 60–120ml (2–4oz) bottle
8.30/9pm Bedtime (swaddled)
During the night 60–120ml (2–4oz) bottle maximum whenever your baby wakes
Change your baby’s nappy before the feed
Swaddled for the last 30ml (1oz)

Notes on routine

Weeks 2–3

Baby-led nights

Once 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.

Night feeds

Night waking and feeds should get gradually later with the increase in your baby’s awake time and milk intake during the day. The later your baby wakes during the night, the less milk and less stimulation she should have during a night feed:

Keep your baby swaddled for any night feed after 4am, which keeps stimulation to a minimum and helps with settling back to sleep smoothly and quickly after the feed. There is no need to change your baby’s nappy, unless it is dirty. By the time you reach this stage your newborn’s body clock should have adjusted to only passing stools during the day.

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.

Keep all lights as low as possible during night feeds and avoid talking to your baby or giving her any kind of stimulation so that she can settle more easily back to sleep. Feed your baby, wind her and put her straight back to bed – this will help to teach her the difference between night and day.

Try not to react straight away if you hear your baby crying. Use the two-minute rule to see if she is truly ready to be fed or whether she settles back to sleep. The two-minute rule should be used night and day for sleep, naps and playtime. During the night 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 for two minutes they will often go back to sleep if swaddled and tucked in. This encourages self-settling.

Top tips for night feeding

Room temperature

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.

Below are two examples of the 7pm to 7am Sleeping Baby Routine for bottle-fed babies. The first has flexible feed timings, while the second is a non-flexible four-hourly feeding routine. The milk quantity is based on a two-week-old baby weighing 2.72–4.08kg (6–9lb).

Weeks 2–3: 3½–4-hourly Bottle-feeding Routine
7am 120–180ml (4–6oz) bottle
Total awake and playtime (including feed): 1½–2 hours
8.30/9am Nap
10.30/11am 120–180ml (4–6oz) bottle
Total awake and playtime (including feed): 1½–2 hours
12/1pm Nap
2.30pm 120–180ml (4–6oz) bottle
Total awake and playtime (including feed): 1½–2 hours
4/4.30pm Nap
6pm 60ml (2oz) bottle
6.30pm Bath (34–35°C)
6.45pm 120–180ml (4–6oz) bottle
7.15/8pm Bedtime (swaddled)
During the night 90–120ml (3–4oz) bottle maximum whenever your baby wakes
Wind every 30ml (1oz)
Change your baby’s nappy before the feed
Swaddled for the last 30ml (1oz)
Weeks 2–3: Four-hourly Bottle-feeding Routine
6am 120–180ml (4–6oz) bottle
Total awake and playtime (including feed): 1½–2 hours
7.30/8am Nap
10am 120–180ml (4–6oz) bottle
Total awake and playtime (including feed): 1½–2 hours
11.30/12pm Nap
2pm 90–150ml (3–5oz) bottle
Total awake and playtime (including feed): 1½–2 hours
3.30/4pm Nap
6pm 60ml (2oz) maximum
6.30pm Bath (34–35°C)
6.45pm 120–180ml (4–6oz) bottle
7.30pm Bedtime (swaddled)
During the night 90–120ml (3–4oz) bottle maximum whenever your baby wakes
Wind every 30ml (1oz)
Change your baby’s nappy before the feed
Swaddled for the last 30ml (1oz)

Notes on routine