Is my baby hungry?

As your baby's cries escalate, you can be sure to hear well meant enquiries of, "are you sure you have enough milk?" or "maybe your milk isn't strong enough?" (By the way this second proposition is NEVER true, even though it was a common belief in your mother's day).

It is much more likely that your baby is simply hungry: it is perfectly normal for a breastfed baby to need feeding every two hours - and that means to hours from the beginning of one feed, to the beginning of the next - not two hours between feeds. In the early weeks, babies' tiny tummies are only the size of their tiny fists, so simply don't hold enough food to go long between feeds, day or night.

Babies regulate the volume and composition of your milk by their sucking and by how often they feed. This will vary as they grow (as their tummies grow and hold more, and as they become more active and expand more energy, they will require a larger quantity of milk), so although you may receive advice to schedule your baby's feeds, this is likely to cause unnecessary crying. It is useful to learn to identify your baby's hunger signals (squirming, grunting and 'rooting' at the breast), to avoid hunger cries (crying is a late hunger signal for most babies).

Is she having a growth spurt?

It is also important to remember that a growth spurt -common at six weeks and three months, but possible at any time- can give your baby an increased appetite, which may cause grizzling if she is not satisfied, whether she is breast or bottle-fed. Most babies double their birth weight by the time they are five to six months old, and triple it in a year. If she is having a growth spurt her hunger cries don't mean you are running out of milk but rather that she will need to suck more often for a few days to give your breasts the message that they need to produce more milk. If you offer a 'top-up' bottle, your baby won't need to empty your breasts and they won't get the message to increase milk production.

Is she hungry, or just thirsty?

Whether she is crying because she is hungry or simply thirsty, your baby will be able to regulate the type of milk she needs, if you allow her to set the pace. The composition of breast milk changes throughout the course of a feeding. The first (fore) milk, is rather like skim milk. This will quench babies' thirst, which is why they often have very short, frequent feeds on hot days (if you feed your baby according to his needs, he won't need bottles of water). As the feeding progresses, the fat content increases and more closely resembles whole milk. Hunger will be satisfied by longer sucking periods when baby gets the fatty, hind milk (like a rich, creamy desert) that is squeezed down into your ducts by the reflex known as 'let-down'. Your baby needs to 'finish' the first breast first, in order to get the hind milk, but if she is satisfied with only one side, you may need to express a little for comfort. One solution, is to feed baby on one side until she chooses to drop off, then burp her and/or have a little play and a nappy change, then give her the other side before you put her back to bed. This way she will seem to go longer before crying for another feed, too.

Watch your baby, not the clock

Trying to impose a strict feeding schedule, rather than watching your baby's cues to be fed, is not only likely to result in more crying, but may be a risk to her health. When you compare a baby's needs to those of an adult (who is generally not trying to gain weight-at least not to double or triple their current size!), it is easy to understand that expecting a baby to eat according to a strict regime which restricts the duration and amount of feeds is not only unrealistic and unkind, but can also contribute to 'failure to thrive'. Consider: how often do you eat, drink, nibble, snack, or sip through an average day? Did you know that you would be having a cup of coffee at four o'clock this afternoon, or did you just feel like one? Did you tell your work colleagues you wouldn't be able to have lunch with them at midday because you are not scheduled to eat until one o'clock? Doesn't your hunger and thirst change according to the weather and your own activity level?

As adults, we eat and drink according to our own body signals, not a predetermined schedule - and so should babies. In fact, the average need of a baby is to breastfeed 8 to 10 times a day, and up to 12 to 14 times a day during growth spurts!
If you follow your baby's lead, your milk supply will catch up with your baby's increased demand whether it is due to a growth spurt or other factors, such as an impending illness, and he will quickly stop crying and settle down into a more predictable rhythm again. Take it easy for a few days, or take baby and a good book to bed with you, and remember, the more your baby sucks, the more milk you will make.

Is she getting enough?

If your baby is solely breastfed( no other foods or fluids are given), you can be confident that she is getting enough milk if she is gaining weight, has a growing length and head circumference, and is having at least six to eight pale (dark urine is a sign of dehydration), wet (cloth) nappies (or at least five full/heavy disposable ones) every day ( scarce amounts of concentrated urine mean your baby does need more breast milk).
If your baby gains weight slowly, consider are you comparing her weight gains with non-breastfed babies? An article published in Essence, the Australian Breastfeeding Association magazine (Volume 42, Number 6) explains: Breastfed babies have different metabolic rates and different sleeping patterns. Artificially fed babies on average have higher intakes of energy and as a result are heavier.

One study (Dewey, 1998) explains some of the differences between breastfed and artificially fed infants. The average weight gain of breastfed babies is lower, even after complementary foods are introduced. The length gain is also less in some studies. Growth in head circumference does not differ by feeding mode. Breastfed infants are generally leaner at 12 months of age. Evidence suggests that there are no adverse effects to the slower weight gain of breastfed infants; they do not differ in activity level and they experience less illness and have enhanced cognitive development.
If you are concerned about your breastfed baby's size, it would be helpful to check out the World Health Organisation Growth standards as these are based on breastfed babies as the 'norm'. Also, whether your baby is large or small, it is worth considering whether this could be influenced by genetics – asking your own mum and your mother-in-law for your and your partner's baby books could provide reassurance that your child is simply following a family pattern.

Useful links

World Health Organisation Growth Standards
www.who.int/childgrowth/en/
www.breastfeeding.asn.au/bfinfo/whochart.html

Increasing your milk supply
Increasing your supply - Australian Breastfeeding Association
www.breastfeeding.asn.au/bfinfo/supply.html

Got Milk? ...milk supply issues
www.kellymom.com/bf/supply/index.html