Why your baby might be feeding round the clock

Midwife, lactation consultant and mum of five, Stephanie Callaghan-Armstrong talks us through some reasons why your baby might be feeding round the clock.

Cluster feeding, reflux, fussiness, and even purple crying – this is some of the language you may hear about before you have your baby.  While most mums to be know it’s normal for babies to feed often and have unsettled times, nothing can quite prepare you for how difficult some of these things can be especially when you’re tired, and it can have quite an impact on your breastfeeding journey. Your precious baby who was so chilled out in their first days after birth might have suddenly started being insatiably hungry, spilling after feeds, crying all the time and be very hard to settle.  Sometimes, baby is happy only when attached to your breast and won’t settle or sleep off your breast for any length of time, so you end up feeding all day and all night!

These scenarios are real life breastfeeding/settling/sleep challenges that I help new mums with often as a lactation consultant and midwife, and sometimes it can be a really frustrating time, especially when you’re already so tired and still recovering from birth. So, let’s explore what is considered normal, and then troubleshoot some of the common challenges you may come up against with your newborn.

There is always ‘that other mum’ in your coffee group or friend circle who has the perfect baby who goes to cafes with her and sleeps like a dream. But the truth is, most babies have unsettled periods, don’t sleep through the night until they are around a year old (or beyond!), and are reactive to foods you eat, through your milk. My advice for these mamas is to take it slow and go with the flow. Try not to compare your baby with others and do expect that it’s a round the clock exercise to feed and care for baby, at least at first. I remember having to really dig deep to be grateful through those long nights up with my little ones, but I can still picture myself mindfully holding them tight, etching their cute tinyness into my heart and memories. Now they’re tweens and teens, and although every age and stage is my favourite, there’s nothing quite like having your tiny baby in your arms.

A word on sleep

It’s normal for a new baby to spend a lot of time sleeping, in fact up to 17 out of 24 hours for many, though there are always exceptions. Babies have sleep cycles of about 45 minutes each and have lighter REM (dream) and deeper sleep periods just like adults. Most newborns don’t have the ability to self-soothe, so require some help such as white noise, a darkened room, swaddle wrapping, or rocking/patting if they stir, to help them consolidate cycles and get a more restorative sleep.

Babies can’t differentiate day from night until they're around 3 months, which is when their melatonin (aka the sleepy hormone) levels starts increasing at night. Interestingly though, mama’s melatonin is passed through the breast milk, which may help bubs settle better during the night from day dot. As babies get older and their stomach can hold more milk, your breast milk will have good levels of hind milk (the rich creamy milk that takes longer to digest) and baby will hopefully stretch out feeds a bit and start sleeping longer stretches.

Growth spurts

Babies generally go through growth spurts around the 6 week, 3 month and 6 month marks. The clever clogs spend a few days frantically feeding to up your supply to meet their body’s new requirements. Although it’s pretty amazing, it can be so hard on poor mama – in mind, body and soul. If you can, just surrender and set up camp in bed or on the couch and feed, feed, feed. 24-48 hours later, voila! Like magic, your supply has increased and recalibrated. If you’re bottle feeding, follow baby’s lead and feed on demand just as you would if you were breastfeeding. 

Cluster feeding

Cluster feeding is very normal, but it sometimes comes as a bit of a shock to first-time parents. It can either happen at a particular stage (like a growth spurt or developmental stage) but it can also happen regularly at a particular time of day. Most babies generally cluster feed during the evening hours, which can be quite inconvenient if you’re trying to get other kids fed plus yourself. But it’s actually baby’s way of filling their tummies and topping up with calories to do longer stretches of sleep overnight, so that’s a win!

Delegate dinner to someone else for while if possible, or failing that get it organised earlier in the day when baby is more settled. You could also eat your main meal much earlier in the day and have a snack later on, and be sure to include plenty of protein, and drink lots of water to help boost your supply for the feeding marathon you’re about to begin.

If you’re wanting to introduce baby to a teat/bottle for expressed milk feeds, this could be the time of day to do it so it gives another family member an opportunity to help.

It isn’t recommended to introduce a teat to baby before 4 weeks old, when breastfeeding is fully established.

Troubleshooting

Sometimes it’s tricky to determine if baby is cluster feeding due to a physical need (growth spurt or filling tummy up to consolidate sleep) or if it’s for an emotional need. If you suspect they are unsettled and no amount of feeding seems to alleviate the issue, we need to figure out what’s causing them distress.

An unsettled baby can present as ‘fussing’ – only happy when feeding but also sometimes throwing their head around and unlatching, bringing up their knees, flailing their arms, and giving high-pitched screams. Their stools can be explosive and frothy, greenish in colour and contain mucous or even have blood in them. This is telling us their gut is distressed or not absorbing milk proteins well. Baby may have too few wet nappies also. If baby is dehydrated, there are often little orange crystals in the nappy called urates.

Your diet can affect your breast milk and make baby unsettled and ‘windy’ or ‘gassy’. Research isn’t so clear on this, but subjectively I see many babies react to foods such as citrus, and ‘windy’ foods such as beans, broccoli, cabbage and tomatoes. Also common allergen foods such as dairy, wheat and soy, and too much of anything – coffee, sugary drinks, chocolate, and even fruit – sorry!

Reflux and Colic are two different things and are big topics all on their own. But, in a nutshell, almost all babies can get both at some stage or another. They can be pretty mild, or severe and can be quite serious and take a major toll on parents.

Reflux is when milk ‘repeats’ or comes up from the stomach through the oesophagus and often burns because of the stomach acid it takes with it. It can be silent like heartburn or spilly which is baby spitting up. Colic tends to be from pain further down in baby’s intestines caused by wind or indigestion. It’s also a label given to inconsolably fussy babies when we assume baby has pain or discomfort from gas, or even an unknown reason.

A simple way to prevent reflux is to keep baby upright or above a 45 degree angle after feeds for about 20 minutes, until some of the milk in their tummy digests. Just the same as an adult, what we eat can make us more prone to reflux so as previously mentioned regarding diet, watching mum’s diet for foods that may be more likely to ‘repeat’ and upset baby may help prevent or reduce reflux in baby.

Overfeeding can also be an issue, so watch for that and try to reduce if you suspect that could be the cause. Giving baby breaks during feeds to burp can help. If your milk supply is too plentiful, cold cabbage leaves applied to the breast area may help as the enzymes in cabbage are said to reduce supply. Go easy on expressing if baby is feeding well off your breast, as expressing is sending your body signals to produce even more milk.

Correct latching and ensuring there is a good seal between baby’s mouth and the breast is key, so that baby isn’t sucking lots of air into their stomach when feeding. There could be a tongue tie or an anatomical issue preventing feeding from being optimum, and your midwife or a lactation consultant will be able to help asses this. 

Some natural remedies that could be useful for tummy upsets are Rhuger, Infacol, gripe water, colic powder and even comfort sucking on the breast or on a dummy can help, as baby swallows saliva which can reduce the burning sensation.

I also recommend seeing a cranio- osteopath as there have been many success stories for unsettled refluxy/colicky babies after osteo treatment. Gently correcting the placement of the baby’s tight skull bones etc from childbirth can help a lot with gut motility. It amazes me how gentle it is and how well it works for lots of families.

Sometimes baby can be unsettled due to mum not producing enough milk. Babies will cry when they’re hungry and may always seem to be looking for food with their mouth (look up the rooting reflex – this is a tell-tale sign of hunger). Keeping an eye on baby having an adequate weight gain is important, 25 grams a day is average and your midwife should weigh baby at their visits.

Having feeds spot checked by your midwife or lactation consultation for latching and nutritive sucking will be helpful – checking sucks and swallows and being aware if your breasts feel full before and then softer after feeds. Is baby having enough wet and dirty nappies? When baby is not having adequate milk they will have reduced output and often their stools can be greenish and very scant. Extra expressing may help increase your supply after each breastfeed, and if the weight gain is very slow, baby may need expressed milk top ups. There are some natural remedies around to help increase your supply and in some instances you might benefit from prescribed medication.

Purple crying

From about 2 weeks of age and peaking at 8 weeks (usually resolving at about 12 weeks), purple crying is a condition where babies cry inconsolably, especially in the evenings, for no apparent reason and are very hard or impossible to settle.

The message here is that baby needs soothing and comforting rather than being treated for reflux or colic.

Having support to cope with baby is key. If you’re on your own, being able to put baby in a safe place while you have a breather if you are becoming completely overwhelmed yourself, can be helpful. Everyone knows to "never shake a baby", but in the heat of the moment you need to ensure their safety.  Often comfort sucking on a breast can help soothe babies, even if it’s for short periods of relief. Swaddle wrapping baby tight can help them feel safe too or wearing baby in a sling or carrier. For sleeping, baby should ideally be on their own sleep surface and on their back. Pepi pods, bassinettes or co sleepers that attach to your bed are all great options.

Other causes for an unsettled baby are teething (which starts around the 4 month mark) and if they get sick. Baby being sick can make them cry and be extra wakeful because they can have trouble breathing from a respiratory virus, have fevers or are in pain. The good news is that breastmilk can protect them from more severe illnesses as your milk is filled to the brim with antibodies. There are natural remedies to help with teething, and it’s a good idea to have baby Pamol and Nurofen ready to go should you ever need it urgently. Always seek medical advice if you are ever concerned. Taking it all day by day is the best way to go, remembering for the first 12 weeks to embrace it as the 4th trimester. Your baby is unique and it takes time to figure out what works best for you both and your family.

The never-ending nights and the disrupted sleep does feel like it goes on forever but it’s true what they say, the nights are long but the years are short! Your breast milk is like liquid gold and giving it to your baby has so many benefits for you both for life.

Stephanie Callaghan Armstrong is a mum of five, experienced Lead Maternity Carer, Midwife and Lactation Consultant and also runs a breast pump rental and sales business with husband, Dr Mikey from The Barnstead in Coatesville. Find her at babymed.co.nz, @babylove.midwife.life and @babymednz on Instagram.