I discuss the feed pattern in breastfeeding babies in this video.
It is very important to get the cues right and not to push the baby to complete the feed volume. Overfeeding can happen even with breastfeeding (I will share the video link below). It is very important to educate the parents right from the start regarding the feeding pattern, so we can prevent reflux from happening. In the first 7-10 days, we expect the baby to feed almost every 2 hours-this is because the milk production is increasing, the baby has a small stomach and the volume is gradually increasing. This frequent feeding pattern helps to empty the breasts and encourages the establishment of lactation. After the milk output has increased (we can make this out by the improving urine output, satiety, sleep pattern as well as weight gain during clinic reviews), the mother can be advised to relax about the cue interpretation. Most experienced mothers start spacing feeds reasonably well at this time, and breastfed babies can go 2-5 hours between feeds. Educate the mother that the longer the gap between feeds (with an upper limit of 5-6 hours), the better it is in colic, reflux, and stool frequency/nappy rash. Unless we try to space, babies keep persisting with the pattern they are used to, and since the milk output has increased, they get excessive milk at a high frequency. This impacts their ability to digest the lactose load as well (as this is gradually increasing in the babies, and a rapid load will mean they exceed their ability to digest the lactose)-this leads to the physiologic lactose intolerance that we referred to earlier (will link the write-up on lactose intolerance). The babies have an active gastrocolic reflex, and the more often they feed, the more often they pass stools. Combining this with physiologic lactose intolerance, you have a higher risk of diaper or nappy rash as well. Colic tends to be more related to this and because they feed before the stomach is emptied, reflux occurs as well. As you can see, these patterns are all linked. And it is important to start the education early, so the mother watches for signs of improving output and avoids entering this cycle.
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