“Encourage breastfeeding on-demand,” (1) states Step 8 of the 2020 Baby-friendly Hospital Initiative Guidelines and Evaluation Criteria for Facilities Seeking and Sustaining Baby-friendly Designation. During the month of August, we will be looking at several aspects of demand, baby-led, or cue-based feeding. This week we will take a closer look at infant stomach capacity and feeding frequency.
In a 2013 journal article, Dr Nils Bergman noted that the standard current practice of having full-term healthy infants feed every 3 to 4 hours is widely accepted but has “no randomized controlled trials (RCTs) or observational studies identified which address[ed] feeding frequencies or feed intervals. Only case series and descriptive studies were found, and it was not possible to provide additional recommendations due to insufficient evidence,” (2).
In a literary search, Bergman located only 6 research articles containing any data identifying infant stomach capacity for newborns, all of which supported a stomach capacity of 20 mL. In conclusion, Bergman discusses this capacity, saying “A stomach capacity of 20 mL translates to a feeding interval of approximately 1 hour for a term neonate. This corresponds to the gastric emptying time for human milk, as well as the normal neonatal sleep cycle. Larger feeding volumes at longer intervals may, therefore, be stressful and the cause of spitting up, reflux, and hypoglycaemia,” (2).
The Cochrane Database of Systematic Reviews, in 2016, compared baby-led with scheduled (or mixed) breastfeeding and found no evidence from randomised controlled trials evaluating them on the success of breastfeeding for healthy newborns. They, therefore, recommended, “that no changes are made to current practice guidelines without undertaking robust research, to include many patterns of breastfeeding and not limited to baby-led and scheduled breastfeeding... that [also] takes the mother's perspective into consideration,” (3).
Although at first glance these two studies may seem to contradict each other, it is good evidence to show how little we actually know about how much and how frequently newborns feed. Cue-based feeding has been shown in multiple studies to lead to more breastfeeding initiation, exclusivity, and duration. Scheduled feeding methods were popular in the early and mid-1900s, and some of those same types of scheduling can be found in books, on websites, and through some healthcare professionals. The most powerful statement from the Cochrane Review reads, “It is important especially in the early days that someone sits with the mother for the duration of a breastfeed and provides guidance on practical aspects such as recognising infant feeding cues, milk production and transfer, responsive breastfeeding, attachment and positioning,” (3).
Kathy Parkes, MSN-Ed, RN, IBCLC, FILCA CHC
Professional Development Educator
1. Baby-Friendly USA, Inc. (2020). The Baby-Friendly Hospital Initiative. Interim Guidelines and Evaluation Criteria for Facilities Seeking and Sustaining Baby-Friendly Designation. https://www.babyfriendlyusa.org/news/bfusa-releases-interim-guidelines-and-evaluation-criteria/
2. Bergman, N.J. (2013). Neonatal stomach volume and physiology suggest feeding a 1-hr. intervals. Acta Paediatrica; 102: 773-777.
3. Fallon, A., Van der Putten, D., Dring, C., Moylett, E.H., Fealy, G., and Devane, D. (2016). Baby-led compared with scheduled (or mixed) breastfeeding for successful breastfeeding (Review). Cochrane Database of Systematic Reviews; Issue 9, Art. No. CD009067.
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