HUG Newsletter: The Four-Month-Old

As I enter the room Keema, Katherine and Yolanda’s robust four-month-old, is wiggling on Katherine’s lap.  As I walk closer to these mothers, Keema  turns toward Katherine’s mother’s breast. Mom looks tired as she leans over, picks up and undresses her daughter for her routine check up.

Breastfeeding has gone wonderfully for this trio. As a full-term baby, Keema crawled right up to Katherine’s nipple within thirty minutes of birth. Lots of time spent skin to skin, and frequent breastfeeding, contributed to an abundant milk supply.  The baby seemed predictable and has been getting up only twice at night. But over the past two weeks Keema’s behavior is confusing her mothers. Keema seems to wiggle more at night. So Katherine picks her and puts her to the breast  — now 4-5 times during the night. The baby nurses for about 20 minutes before falling back to sleep.

During the day the number of Keema’s feeds have dropped off a bit. When she’s on the breast she is easily distracted by their barking dog or Yolanda stirring the pasta for dinner.

In addition, Keema seems to want to spend every hour practicing rolling over. She fusses and complains as she struggles to get from stomach to back. After a few minutes of contentment, she is determined to get from back to stomach. Everyone in this household is tired and grumpy! Kathrine and Yolanda assume their baby is not satisfied with mother’s milk and ask if it’s time to add some formula.

What an interesting example of when a “Touchpoint,” “Leap,” or “bump along the road” has been misunderstood as a breastfeeding problem!

As discussed in a previous newsletter,  developmental surges can cause changes in baby’s behavior and in her breastfeeding pattern. These times of change are predictable. Breastfeeding families need to know what’s happening in order to avoid adding formula or giving up breastfeeding all together.

“Wonderful!” the lactation consultant (LC) says. “It sounds like Keema is having two important four-month-old surges in her development: she’s rolling over and she’s increasingly curious about, and interested in, the world around her. I would expect her to wake up more at night and to be a little ‘off’ as she goes through these changes.”

The LC goes on to explain that the increase in nighttime feeding has shifted more of her 24-hour calorie needs from daytime to nighttime —  a phenomena called Reverse Night Feeding. Because this shifting is a result of a surge in baby’s development and not hunger, Keema does not actually need more calories at night.  To cut back on this nighttime feeding the LC encourages Kathrine to cut in half the amount of time she nurses her baby at each feeding during the night.

Kathrine calls in several days to report her surprise that “It WORKED!” Slowly over a week Keema gave up those night time feedings and has now returned to sleeping 6-8 hours before feeding again.

© HUG Your Baby 2018