Is it possible for me to breastfeed long-term (at least six months exclusively and up to a year or longer) as recommended by the American Academy of Pediatrics if I decide to have a routine for my day instead of completely demand feeding my baby?

Unlike other pages in the breastfeeding section that are based on facts (like jaundice and mastitis), this page is based purely on experience and opinion (although factual knowledge of lactation plays a role in some of my conclusions). Because the level of organization needed will vary from family to family, and even baby to baby (some have special needs that dictate how much order is necessary or even allowable), it would be impossible to say what is best or even workable for every family. So, if you are happy with the way things are going in your home, and the choices you are making are working well for you, then read no further! This page is primarily designed to help either those families that are looking for a little more predictability in their day, or those families that are looking to find balance in order (as opposed to expecting a strict schedule).

One thing I want to point out right from the start is that demand feeding is often misdefined and misunderstood to mean erratic nursing without any predictability. Demand feeding is NOT feeding your baby every time he or she cries. Another way of saying demand feeding is the term "cue feeding." These terms mean exactly the same thing, but one sounds less harsh than the other to some folks. Cue feeding is where you allow your baby’s hunger cues to guide the feeding instead of trying to establish a specific pattern for feeding. I have found that following a cyclical pattern with my babies (as opposed to trying to establish a by-the-clock schedule) essentially allowed me to cue feed my babies. You won't doubt whether your baby is hungry or needs something else. While there is absolutely nothing at all wrong with comfort nursing, some moms prefer to offer other kinds of comfort to their babies as a rule so that their baby may also be comforted by others in the mother's absence. This is obviously a personal decision that does not necessarily negatively affect the baby's well-being. The important thing is that the need for comfort be met--however you learn to do it in a way that works with your baby and your family's needs.

One of the things that interested me greatly during the time that I was preparing for the birth of my second child was the wide spectrum of information available on feeding methods once a baby was born. No, I am not talking about breastfeeding vs. formula feeding--using formula was not an option as far as I was concerned. I am speaking of the wildly differing views on how often and under what circumstances a mom should bring her baby to the breast. The moms I knew during my pregnancy tended to have a pretty predictable pattern to their day and I remember asking them how they accomplished that. When I had my first baby, in 1987, the medical professionals at the hospital told me to breastfeed him on a four hour schedule, which I knew by the time I was expecting a baby in 1997 was not the right thing to do. At the same time, I wondered how in the world anyone established a sense of routine without resorting to an actual feeding schedule. At the time, I was still teaching, and my day (as it had been for ten years) was broken up into little 50 minute segments for my classes. I didn’t want my day to be THAT orderly(!), but knew I did not prefer to just "wing it" either. This is where personality and experience come together with information for each individual to find a balance.

I had read a few breastfeeding resources that encouraged women to nurse completely on demand, which at the time seemed to be somewhat random to me (I later learned that even babies that are completely demand fed usually develop a pattern that their mom finds pretty easy to recognize). I remember one book, in particular, encouraged moms to look to animals and primitive societies for examples of the "natural" way to feed a baby (citing examples of babies that nursed up to several times an hour), which didn’t feel like a "fit" for our family. On the other hand, a friend gave me a copy of My First Three Hundred Babies, which advocated a very strict feeding schedule and I thought to myself, "That is nuts!" While I knew that once my baby was born I would probably find a rhythm that worked for me, I was pretty nervous about "starting over." My other child was almost ten and I was anxious to have a routine that would allow me to still attend all his sporting and extracurricular events. Even though I knew I could breastfeed anywhere, I was not small breasted and wasn’t sure how well I would be able to nurse discreetly, plus I wasn’t sure how I would feel about nursing in public anyway (in hindsight, it wasn’t all that hard!). I didn’t expect our life to stay the same once the baby came, but I was concerned that I would not adequately be able to meet the needs of both children. Of course, that is where God comes in! We had prayed for almost seven years for that baby, and God certainly wasn’t going to abandon us when the baby arrived as requested! Still, I was concerned that if I tried to develop a routine that I would be unable to make enough milk for my baby long-term, so I continued my reading and interviews of friends that had breastfed for at least 12-18 months. I concluded from my research that to even suggest a schedule for breastfeeding women, when research has shown that the dynamics of a schedule are not good for the breastfeeding mom or baby, is irresponsible as it may lead to insufficient weight gain in the baby, or milk supply problems in the mother. Yet, surely, for the mom desiring to help her baby develop some type of organized pattern, it is possible to have some sort of expectation of a predictable routine. It is my view that breastfeeding is a cooperative relationship, where neither the mother OR the baby must call the shots all the time. To me, that means, a loving, unselfish mother meets the needs of her baby, and at the same time confidently provides gentle guidance so that both needs may be met. My intent in writing this essay is to assure moms that desire order and routine in their day that it is possible to breastfeed successfully, without need of supplementation (until solids are begun after six months or longer) for at least a year or longer as desired.

What does routine mean as I use it? It means a predictable order or pattern to the day. Some would even refer to what I describe as a repetitive cyclical pattern. There are some basic approaches that I found most people take when establishing a routine. Feed the baby upon waking (sleep/feed/awake) , feed the baby when it is time to sleep (feed/sleep/awake), or feed the baby before and after sleep (feed/sleep/feed/awake). After considering those basic choices before our second child was born, I decided that I might be able to avoid sleep problems later on by not establishing a habit where my baby depended on feeding to sleep for each time of napping or nighttime sleep. That opinion was highly influenced by reading the work of sleep experts Drs. Ferber and Weissbluth. That is not to say that my second baby never fell asleep while nursing (as a matter of fact, in the early months, he most often did fall asleep while nursing), just that I did not seek to establish that as a pattern or habit. It is my personal experience and that of many others that a baby who is encouraged to take in a good feeding, and who follows a sleep/feed/awake pattern will easily develop a consistent routine with good sleeping habits. Now there were times, especially during a growth spurt, that I found the pattern changed for a few days, but generally speaking, it was pretty easy for things to get back on track once the growth spurt was over without any effort from me. Times of illness or teething also brought temporary changes in the pattern. At no point am I suggesting the practice of "holding a baby off" to feed at a set, specific time every day--that is a rigid schedule, and I discourage that--but I am saying that I have found a predictable pattern to the day is helpful to the family as a whole, including the baby. Interestingly enough, I found that following a pattern with my second child, helped me know without a doubt when my baby was giving me a cue to be fed. A cue to be fed, by-the-way, is not the same as a baby that cues to be nursed a few sips of foremilk on a hot, dry day. Since I never used water or juice supplements of any kind until my baby was taking solids with us at the table, it only made sense to offer a quick drink when my baby was thirsty. I think it is important to add here that I was most focused on the sleep/feed/awake pattern of the routine with our second child. My fears at approaching parenting a new baby again after almost ten years were pretty similar to those new parents experience. Once I got some experience under my belt I found I was pretty confident to do whatever seemed best at the time and not worry about it. Our third child had a need to nurse more frequently and he still developed good sleeping habits. I found with him that nursing before and after some of his naps helped him nap better too. What is important is that you take the time to figure out what works best with your own baby, and let that guide you instead of your fears. If you make every choice with your baby's routine as a preventative measure to avoid possible future problems (which may never happen anyway), then you remove the most important part of deciding a routine from the picture--your assessment of what will work best for YOUR baby. Making parenting choices with a small baby based on fear of the future can also remove the joy of the early months of parenting.

Some of you might be wondering how such a routine based on a cyclical pattern can work in actual daily practice without it becoming a schedule by the clock. In the beginning I was just trying to figure out what worked best for each baby, so I want to make it clear that every mom should expect that there will be a matter of weeks or perhaps even two months, where you will need to journal what is happening with your baby so you can get a clearer picture. This is how it worked for me. Starting from birth, when my babies woke up I offered to nurse them. Most of the time, they were very willing and interested in nursing at that time. I love to hold my babies, and think that especially during the newborn period this bonding time is important. By the time I had four children (three that were four and under) I made an investment in a baby sling to help me have more use of my hands even when holding the baby. I quickly realized that the sling would have been helpful with all my babies! So, after feeding and changing, there was usually a cuddling time. If I had something I needed to do where the sling was in my way, I took advantage of the baby swing or baby bouncy seat during that time too as long as the baby was content there. Those of you with several little ones under the age of five know that it can sometimes get hairy trying to meet everyone’s needs at once. Once my baby got fussy, I took a quick glance at the clock. Sometimes, without realizing it, two hours had passed from the start of the last feeding! If that was the case, I generally assumed my baby was likely ready to nurse again, but just in case, I always checked for a soiled diaper first. If my baby was feeling fussy and only an hour had passed, I would go through my mental list first: soiled diaper, baby too warm or cold, any obvious cause of discomfort, need to burp, need to be held, sleepy and needed to be helped off to sleep, etc. If none of those things seemed to comfort the baby, then I usually tried to see if he wanted to nurse. The clock merely helped me keep track of how long it had been since the baby had last nursed--it never kept me from offering to nurse my babies. Because I also tried to wake my babies at or near the same time daily, by the time they were 3-4 months old, they did tend to nurse around the same times every day. That was a matter of natural development though--never my intent. My fourth was the only different one. His naps were very consistently at or near the same time, but his nursing continued to vary based upon his needs that particular day. I simply took him everywhere with me so it was never a problem for us. By the time he was 6 months old I could usually get away by myself for two hours if I needed to do that. Before that time my husband would take over once he got home from work so I could take a quick walk, shower, or simply go to my room to be alone and read a book between feedings.

While many books decry the concept of rigid scheduling, very few actually give concrete information for moms desiring to establish a sense of order or routine to her day. Unfortunately, most books that are published with the purpose of helping establish some type of routine or sleeping pattern have faulty breastfeeding advice in them. One book that has become somewhat popular as well as controversial, On Becoming Babywise by Gary Ezzo and Dr. Robert Bucknam, describes an approach that some have found helped them muddle through the process of establishing a routine. On the other hand, there are also reports of many moms that have experienced either milk supply problems or babies that didn't gain weight adequately when this book was used as a reference. The authors state the emphasis should be on a parent's assessment of what the baby needs and what has already been done, rather than impulse or reflex and offering nursing as the first choice to solve every problem (of course, very few lactation sources recommend the breast as a solution to every problem anyway). Most moms that I know who have breastfed successfully using this book have had to significantly adjust the recommendations given for breastfeeding moms and babies. Parents who attempt to use this source to establish a rigid schedule (ie. set times for feeding every day vs. realizing that it is the pattern and parental assessment that is important) will probably find that long-term breastfeeding is not possible. Trying to set up an unreasonable expectation for the baby to feed only at preset times during the day can lead to inadequate intake for your baby and milk supply problems for you. Inadequate intake can lead to dehydration and failure to thrive (FTT) in your baby. I have personally counseled many moms that thought their baby was having a napping problem (consistently waking earlier than normal for them) when in actuality the baby was going through a growth spurt. Since the moms mistook hunger cues for napping problems, milk supply suffered and several of the babies suffered slow or serious weight gain problems. For example, I have records of several babies that didn't gain any weight at all or even lost a few ounces up to a pound between the 2 and 4 month well-baby checks (see case studies). Believe it or not, the signs for lower milk supply or inadequate weight gain don't happen overnight. Urination, along with milk supply was decreasing gradually in these mom/baby pairs, happening so slowly that it wasn't immediately obvious. Also, most moms discontinue charting diapers once the baby is past 6-8 weeks. It is critically important for a breastfeeding mom to realize that adequate production of milk is tied to her willingness to flex to handle low supply cycles and growth spurts. Because all moms and babies are different, it is impossible for any book to be a definitive guide or a complete resource. You must be responsible to know your baby and what is working best for your family. As with all resources available to you as parents, you must together, as husband and wife, decide your priorities, and then from within that framework decide what approach to take. For us, breastfeeding was a high priority, and we arranged our goals accordingly. Because the central goal of this book is establishing a routine, there are times when advice is given that is contradictory to establishing a good breastfeeding relationship. For instance, the use of supplemental bottles is more or less encouraged in this book, and it is my opinion that offering a bottle instead of nursing is a preferential issue. While many moms may feel it is important to them that their babies are willing to take a bottle in their absence, it is not true that a bottle must be introduced by a certain age to insure that a baby will take one. If a baby won't take a bottle, cup feeding is an easy and reasonable alternative. Also, if a baby has a difficulty making it at least 2.5 to 3 hours between feedings, parents are advised to find out what is causing this "uncooperative stance" in their baby, and the use of supplemental bottles to test milk supply is suggested in the "four-day test." It is my opinion that milk supply problems often begin with a doubt that is followed by offering a supplemental bottle "just to see." If you are in doubt of whether or not your supply is sufficient, check out my information on supply and healthy growth indicators, and talk to a certified lactation professional or a breastfeeding knowledgeable physician about whether or not it is necessary to supplement. Because breastmilk and formula are just NOT the same or even close to being equal, supplementing with formula should be a very last resort (see my page on formula). If my baby was unable to go 2.5 to 3 hours between feedings, I would evaluate how best to develop a different kind of routine in order to continue providing the best nutrition, breastmilk, for my baby (vs. thinking my baby is being uncooperative as Babywise suggests). Besides, research shows not all moms have the storage capacity to allow for longer intervals (such as 2.5 to 3 hours) and not all babies have the ability to go that long for some reason (reflux babies, for instance often do better with smaller feeds spaced more closely together). I'd like to think that if God put me in that situation, He would have something specific for me to learn from what would be required of me to honor His design in breastfeeding my baby. As a Christian with a worldview that begins with a belief in a wise Creator, I believe that we are wise to learn more about how God made our bodies to work so we can honor that design in the choices we make for feeding our babies.

In addition to the above concerns, there are places in the book where there are conflicting messages. For instance, some places say to have a routine, as opposed to a schedule, but then charts are provided for moms to make out a sample schedule as a guideline. Yes, the book does say to "feed a hungry baby," but there are also places that state it is not good to consistently feed your baby closer together than 2.5-3 hours. It is suggested that a baby who cannot make the "minimum" time between feedings would be better off having formula supplements instead of the mom just adjusting her own expectations. Again, not all moms have the same storage capacity, and not all babies can handle taking in the same amount. A careful, critical reading of the book On Becoming Babywise will reveal that the authors place a greater importance on the schedule over the importance of breastfeeding. The main stated purpose for the book is to get the baby to sleep a certain amount of time at night without need of parental interaction, not to help you breastfeed a certain length of time. If you decide to follow the suggestions for establishing a routine found in the book, keep that fact in mind, because you may find your goal to breastfeed long term at odds with the authors' emphasis on scheduling first. If you are looking for a good resource for breastfeeding information, my personal favorite is the book The Nursing Mother's Companion by Kathleen Huggins. I think she does a great job of presenting information that is accurate without focusing on any parenting philosophy per se. If you are interested in reading a book that gives ideas for helping your baby learn how to sleep better that does NOT offer bad advice about breastfeeding, I recommend the book, The No Cry Sleep Solution: Gentle Ways to Help Your Baby Sleep Through the Night by Elizabeth Pantley. If you have read the book On Becoming Babywise or are considering reading it, or if you have taken or are considering taking Preparation for Parenting (the religious counterpart to Babywise), then you may find it helpful to read my essay on the GFI materials and these case studies. Also, check out this link to an updated review of On Becoming Babywise (the 2001 edition): http://www.ezzo.info/Articles/bw2001review.htm.

The suggestions that are the most helpful for the establishment of a routine, in my experience, are these:

1. Spend the first few weeks getting to know your baby. Those first few weeks are precious and will never come back, and those times of cuddles and kisses with your new baby are priceless. Your focus needs to be on getting comfortable getting your baby to latch to feed and getting as much rest as possible! During the first few weeks you are still going to be working out the kinks in communication with your baby, and the added stress of feeling like you have to work on establishing a routine is usually not best.
2. Establish a predictable pattern or cycle without necessarily focusing on the exact time intervals between feedings. A baby that is encouraged to get in a good feeding that is following a predictable pattern will generally fall into a 2-3 hour pattern without much work on your part. This doesn’t mean simply choosing a pattern and then forcing it on your baby. I know with my second child, if the feed/wake/sleep pattern had not worked for him I would have been willing to try it other ways. Remember that your baby is unique and the experiences of others may not necessarily apply to you and your baby.
3. If you like, allow your baby to learn how to settle to sleep on his/her own (putting baby to bed for naps and nighttime sleep while drowsy but still awake can greatly decrease most crying or fussing). At the same time, don't worry so much about it that you fail to enjoy some opportunities for rocking and cuddling the baby! Above all, be willing to recognize what is or is not working for your baby. Small babies should not be crying for long periods of time--after all--naptime should be about sleeping! Poor sleeping can lead to poor feeding which can in turn lead to poor sleeping. This type of vicious cycle can be hard to break. For more thoughts on helping your baby sleep, check out, The No Cry Sleep Solution: Gentle Ways to Help Your Baby Sleep Through the Night by Elizabeth Pantley.
4. At some point (I usually wait for at least 4-6 weeks so I can get as much sleep as possible!), begin establishing a regular start time for your baby's day to begin. This is when you will begin to notice you can really set your clock by your baby! This is really not a new idea as moms who breastfeed and work outside the home have been doing it for years. After all, they need to nurse the baby before they leave for work every day and they have to be at work within a certain time frame! I have found that within a week or two of establishing a set start time for my day that except for growth spurt days and illnesses, my baby’s feeding times were so predictable it was amazing. Yes, this means waking your baby in the morning! :-) While you are in the process of trying to get a predictable start time for your day established, you may have to figure out what you are going to do when your baby wakes earlier than that time. I always handled any waking earlier than one hour before my ideal start time as still "nighttime" and put the baby right back to sleep. With some snags here and there, this approach generally worked for us. Only one of mine consistently woke earlier than I would have liked long term, and I just had to accept the fact that he is more of a morning person than I am :-D
5. Keep a journal so you can track your baby's progress. This will help you remember what works and doesn't, and will help you keep track of your baby's healthy growth patterns. Most pediatricians do not schedule a visit between 2 and 4 months for babies who have previously gained weight well. There is no reason why you cannot take your baby in for a weight check between those two scheduled well-baby checks. Most offices will just let you come in and use the scale for free.
6. Also helpful in the process is establishing a network of supportive friends and/or family. Talk to moms who like the concept of routine and have breastfed for at least a year. Develop a network of friend that will let you vent on your frustrating days who won’t give you quick, unhelpful answers like, “just wean your baby.” Regardless of what parenting philosophy you embrace, everyone has rough days and that is when supportive friends are most important.

If you don't want to try to establish a specific pattern for a routine, but you still wonder if there will be any predictability to your day at all, then you may be interested in another approach some take that actually worked the best with my fourth baby (are you noticing a pattern with my story yet? I used a different pattern for each baby to meet his own unique needs). As long as you work to get in a good feeding each time you nurse your baby (trying to keep baby awake for a feeding can sometimes be very very difficult in the newborn period, but I have a few suggestions on my sleepy baby page that may be helpful), you will probably find that a typical 2-3 hour feeding pattern will happen. If you journal once you bring your baby home from the hospital (a good idea to do regardless of your goals), you can note wet and poopy diapers (which will help you track intake), and what times your baby usually nurses. You will probably notice within a month or two that a pattern is establishing itself. Some moms call this their "baby putting himself on a schedule!" Not all babies will do this on their own, but if you don't like the other ideas, perhaps this one will be helpful for you. My fourth baby had a great deal of trouble with reflux and did the best with smaller feedings spaced closely together. I journaled with him to see what would work the best for him and found that he did the best nursing before and after his naps. He gained weight great and we were all much happier! By the time he was six months old, he was still nursing about every two hours or so, but I also noticed that he was sleepy at about the same time every day, and I could count on him napping at about 10:00 a.m. and 3:00 p.m. Without ever once trying to schedule him, he developed a schedule himself with more predictability than my other boys. What matters is finding what will work best for YOUR baby, not the exact pattern that you follow.

My own stats for breastfeeding with my approach to routine:

• baby #1~8 weeks: weaned due to lack of support
• baby #2~exclusively for nine months, self-weaned at 14 months during a subsequent pregnancy
• baby #3~exclusively for seven months, self-weaned two weeks before his second birthday
• baby #4~exlusively for almost 12 mo. with very little food intake even up to 17.5 mo. due to reflux, gagging problems. Weaned at two years.

updated 7/06