Is it normal for a 3-month-old to eat every 1.5 to 2 hours per night?

Question

I had issues with breastfeeding my now 3-month-old since day one. I had almost no milk and had to start topping up with formula. I tried to increase my production with fenugreek and pumping. Now I am topping once in the morning and once evening. Generally he eats around 180ml of formula per day.

What bothers me is our days and nights are a total mess. He is eating every hour sometimes even half an hour. I try to give him formula but he rarely wants it. During the night he is waking every 1.5 hour or 2 hours. He is most of the time falling asleep on my breast. I fear that he is not eating enough but he is gaining weight and he is peeing and pooping. He is also happy, not crying etc.

Is it normal that he eats so often and what to do or did I just managed to screw up everything?

Answer 1

According to the La Leche League it is normal if a breastfed baby is asking for food every 1.5-2 hours. They also mean if the baby generates enough pee and poo (about 4-5 wet diapers and 1-5 poo) and gains weight, then her/his development is normal. Plus, if he is happy as you described, I would assume that he is all right. If you have issues with evening care and with supplemental feeding I would recommend you to consult a lactation or breastfeeding professional (IBCLC) if available at your vincinity.

Read more about LLL recommendations below. The LLL is in general a good source in breastfeeding questions. https://www.llli.org/breastfeeding-info/

Answer 2

Is it normal for a 3-month-old to eat every 1.5 to 2 hours per night?

Yes, it is "normal" for some babies to do so, and since this is your baby's pattern, it is "normal" for him. (Note that "normal" simply means that it falls within a curve which includes N participants in a study, and that 95% are considered within "the norm".) Falling outside the norm is not necessarily bad. It's simply outside the norm.

It sounds like there is a lot going on here, probably concern that your baby is feeding so often because you aren't making enough milk, and possibly as well some degree of sleep-deprived bewilderment. Both of these concerns are very reasonable.

However, there is another reason besides nutritional needs that your baby may be feeding so often at night: he has become accustomed to falling asleep on the breast and when he spontaneously awakens during the night, he can't go back to sleep without it, so he wakes you up and wants to nurse.

Is this OK? Most researchers would say baby-led feeding is best according to the studies available at this time. (See the studies cited in another answer.)

However, many pediatricians are acutely aware that this schedule is hard on moms. One "solution" that seems on the surface to be reasonable is to supplement breastfeeding with formula so that the baby has more food in his tummy and might sleep longer if he awakens due to hunger. Whether it really helps (except in the event of failure to thrive) or if the baby complies with this advice is another matter.

When I was at the end of my rope with my firstborn feeding every 45-60 minutes during the night, my pediatrician (God bless him!) advised adding a bit of rice cereal to the nightly supplementary feeds. I honestly don't remember if it worked, I was in such a fog. But it gave me something to cling to for hope. (It's not like the baby needed it; they were in the 95th%ile for weight!)

Today there are other options that might help your baby to sleep for longer periods or to help you get more sleep: noise generators, safe co-sleeping (not bed sharing), evaluations for sleep problems in infants and babies (infant sleep interventionists), etc.

The best place to get your questions answered is in a visit to your baby's Primary Care Provider. They can assess much better than we can if your baby is getting enough nutrition, and can offer advice on (or a referral for) helping you both to get more sleep.

did I just managed to screw up everything?

Not at all. You'd be surprised to learn how screwy babies sleep/feeding patterns are in the first five months of life (until they develop a normal circadian rhythm). I vividly remember writing in bold letters in My Baby's First Year book, "Baby slept for two straight hours for the first time ever!" sometime in the third month. So my heart goes out to you.

Answer 3

https://www.thebump.com/baby-month-by-month/3-month-old-baby

Breastfeeding: How often should a 3-month-old nurse? Feedings are typically about every three or four hours at this age but each breastfed baby may be slightly different.

Bottle feeding: How much formula for a 3-month-old baby? Typically five ounces about six to eight times a day.

If your baby is getting 180 mL of formula a day, he's likely getting enough food. So his behavior is likely really really hard on you, but he's not starving. Maybe he's comfort sucking, and a pacifier would suffice at night?

Answer 4

"What bothers me is our days and nights are a total mess. [...] I honestly have no idea if it's normal that he eats so often and what to do."

The question has 2 parts:

"[Is it] normal that he eats so often?"

If you count the total number of feedings, you can see how your case fits in the actual distribution of what is observed in real life among different mothers/infants (average = 11 times per 24 hours, standard deviation = 3 times, range = 6 to 18 times). Note that these are actual observations (= what is) of healthy infants. These are not recommendations based on any specific "desired" outcomes (= what should be). Nor are these observations healthy targets. They simply reflect the facts on the ground in one particular study - the actual feeding practice.

It is hard to estimate the number of feedings in your case, because you did not say how long your child sleeps at night (when he feeds less frequently).

See: "Volume and Frequency of Breastfeedings and Fat Content of Breast Milk Throughout the Day", Jacqueline C. Kent, Leon R. Mitoulas, Mark D. Cregan, Donna T. Ramsay, Dorota A. Doherty, Peter E. Hartmann in Pediatrics Mar 2006, 117 (3) e387-e395; DOI: 10.1542/peds.2005-1417

Infants breastfed 11 +/- 3 times in 24 hours (range: 6–18) [...] Night breastfeedings were common and made an important contribution to the total milk intake. [...] Breastfed infants should be encouraged to feed on demand, day and night, rather than conform to an average that may not be appropriate for the mother-infant dyad. [...] Healthy, exclusively breastfed 1- to 6-month-old infants consume 0 to 240 g of milk between 6 and 18 times during 24 hours, with 64% of infants breastfeeding 1 to 3 times at night. [...] This will provide a normal reference range to enhance clinicians' support for breastfeeding mothers. [...] Data were collected from 71 mothers who were exclusively breastfeeding on demand healthy, term infants who were aged between 1 and 6 months.

"What bothers me is our days and nights are a total mess. [...] I honestly have no idea [...] what to do."

• As others, such as @Rekabeka, pointed out, consult a healthcare professional. I would add: in person. They can rule out specific health or feeding issues, beyond the most obvious (weight gain, pee, poop), take into consideration wellbeing of only the infant, but also the parents. Take the advice on this site with a grain of salt: we are not familiar with your specific case.

• Gradually space out the feeds. In my personal experience, I and others found this book useful: Suzy Giordano, Lisa Abidin (2006) "Twelve Hours' Sleep by Twelve Weeks Old: A Step-by-Step Plan for Baby Sleep Success". Caveats: (a) This book is not based on clinical studies, (b) I am not a healthcare professional, (c) See the references below for much, much more context and nuance.

SEE ALSO:

Parenting Science blog post: "The best infant feeding schedule: Why babies are better off feeding on cue". It summarizes a lot of research on the topics of feeding schedules and their effects on health outcomes. This blog provides more depth and relevant context to the more narrow and specific statements above. Note that the blog does not suggest spacing out the feeds.

A recent good-quality Cochrane review on the topic provides a different take on this issue (below). The age of infants covers that of the OPs, see references 1-10:

Fallon A, Van der Putten D, Dring C, Moylett EH, Fealy G, Devane D. "Baby-led compared with scheduled (or mixed) breastfeeding for successful breastfeeding." Cochrane Database Syst Rev. 2016 Sep 28;9:CD009067. doi: 10.1002/14651858.CD009067.pub3.

Authors' conclusions

This review demonstrates that there is no evidence from randomised controlled trials evaluating the effect of baby-led compared with scheduled (or mixed) breastfeeding for successful breastfeeding, for healthy newborns. [...]

What does this mean?

We looked for studies that compared baby-led with scheduled (or mixed) breastfeeding for successful breastfeeding for healthy newborn babies. However, no studies were found that met the inclusion criteria. It is 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. Future exploratory research on baby-led breastfeeding is also needed that takes the mother's perspective into consideration.

FAQs + limitations of my answer:

• Can I assume that "three month old must be right in the middle" [of the distribution, which has the range of 6-18 times per day]?

No. The Kent et al. article simply provides the observed distribution of the number of feedings per day.

• Is 11 feeding per day a healthy target/recommendation?

No. It is the mean (average) of the observed distribution. Note also that this is only one study, and like any other single study, should be treated skeptically.

• The answer seems self-contradictory - why is that?

Evidence in personal experience and in scientific research is often contradictory. Evidence, as shown above, may not always support only one single feeding recommendation for all mothers, all babies of the same age 100% of the time. A responsible answer should discuss competing views, and present more than one-sided evidence (if it exists).