Scheduled Verses On-Demand Feeding
Any one in the lactation world will know that two factors that can greatly affect the success of breastfeeding as well as benefit thereof is:
- The duration that you breastfed for
- How often you breast feed (the frequency)
In this piece we have written we will focus on frequency of breastfeeding. Defining exact guidelines for appropriate frequency and duration of breastfeeding is difficult because it depends on several things such as (1):
- Time of birth
- Time of day
- Age of infant
- Geographical location
To assist mothers with how often they should breastfeed their babies to ensure that they get enough to promote proper growth, two methods are described in research namely:
- On-demand (or baby-led feeding)
- Scheduled feeding
On-demand feeding per definition is defined as feeding according to baby’s desire to feed and according to the baby’s feeding cues (2,3). According to the World Health Organisation, on-demand breastfeeding supports effective breastfeeding and is seen as best practice. On-demand feeding further encourages waking up a baby if he/she has slept too long or if the mother’s breasts are overfull or engorged (2).
Advantages of On-Demand breastfeeding include (1,3):
- Faster development of the mother’s breast milk supply
- Decreased episodes or risk of breast engorgement
- Decreased crying of the infant (reducing the believed need to supplement with infant formula)
- Increased breastfeeding duration
- Faster weight gain
- Mother able to better respond to infant
Scheduled feeding refers to feeding that occurs in definite time frames or allocated times (1). Commonly used time duration for scheduled feedings is to feed every 3 to 4 hours in a 24-hour period. The breastfeeding session is guided around a set time that the baby should suck from a single or both breasts. Scheduled breastfeeding is believed to restrict the length or frequency of the breastfeeds, which is believed to interfere with hormone adaptation processes, resulting in breast engorgement and insufficient breast milk production (2). Scheduled breastfeeding was commonly used in the past as it was believed to allow stomach emptying to occur. Night feeds were also restricted because it was believed to prevent diarrhoea, vomiting and sore nipples. All of which we know nowadays that are far from the truth.
So How Can Mothers Identify When Their Baby Is Hungry?
A mother can identify if her baby is hungry by looking out for feeding cues. Feeding cues are categorized in two categories: early feeding cues and late feeding cues.
Early feeding cues include (2):
- Display of rooting reflex (baby’s mouth will turn to the direction where a stimulus was felt: for instance, when mother places finger on the baby’s check, the baby will turn head to the mother’s finger)
- Sucking on hands or fingers or clothes
- Fussing and making noises
- Arousal from sleep
Late feeding cues include (2):
- Full cry
Once the baby has late feeding cues it is important to first calm the baby, because it becomes increasingly difficult for the baby to attach to the breast if distressed (3).
- Fallon, A., Van der Putten, D., Dring, C., Moylett, E.H., Fealy, G. & Devane, D. Baby-led compared with scheduled (or mixed) breastfeeding for successful breastfeeding. Cochrane Database of systematic reviews, 7.
- WHO (World Health Organisation). Evidence for the ten steps to successful breastfeeding. Geneva.
- South Africa. Department of Health. Protecting, promoting and supporting exclusive and continued breastfeeding: a breastfeeding course for health care providers toolkit. Pretoria.