There are many reasons why your baby would wake more often to feed at night. Regardless of what you find online or from well meaning family and friends, there is no specific, developmental weight or age when a child no longer needs to feed overnight. There is no scientific or medical standard or recommendations for when a baby no longer needs nutrition at night. Society also says babies shouldn’t need tended to at night time and that we should teach them, often from a ridiculously early age, not to need us at night. In reality, we are not in control and neither are our babies. We’re in a mutual relationship where we are learning what our babies need and when they need it. Reasons why babies wake to feed over night:

💡Growth spurts

💡Developmental leap

💡You were gone at work and they missed you or want breast milk straight from the breast

💡Teething

💡They were distracted during the day because the world is an amazing place to learn in and they’re making up for calories over night 

💡Sickness

💡They had a bad dream or are scared without you

💡Because they’re human

Per current research, 78% of babies wake up at least once a night and 60% of waking to feed until 1 year (Brown, 2015). That’s NORMAL. Between 12-18 months your toddler may still occasionally wake to feed. Or they may just need an adult to help them transition back to sleep. It’s not until 24 months that the human baby has matured enough to not consistently need an adult to help them transition back to sleep over night and should be getting all of their calories during day time hours. 

We know that active muscle tone begins to develop at around 36 weeks gestation. Between 36-40 weeks, the baby is curled up in a smaller and smaller space, developing stronger muscles by pushing up against the ever constructing walls of the uterus. Babies born at gestational term have a tightness to their bodies called physiological flexion from being in this position. Physiological flexion provides some passive stability for the newborn baby to use as their learning to move around a world that is impacted by gravity. Because of this flexion, and being in that tight space, many babies come out with tension in their bodies and sometimes asymmetries in how their body moves or looks. Many also will have a head turn preference to one side based on how they sat inside your body. How a baby was born, how long the pushing stage was, and interventions like forceps and vacuums can also cause tension in baby’s body which can in turn impact breastfeeding. This can make the head, neck and shoulders or jaws tight which in turn can make for a chompy/clamping or shallow latch. Or for a baby that’s not comfortable feeding on one side or in certain positions. 

I recommend a lot of oral motor and body exercises for the babies I see in my practice to help stretch them out and release that tension after birth. Whenever exercises are being done, it’s best to do them on a calm, happy baby. If your baby starts calm and becomes agitated or doesn’t tolerate the exercise, stop!! You’re either doing the stretches too hard or the baby isn’t ready for that exercise. Something else is going on that needs addressed first. We don’t want to cause an aversion or unnecessary stress. Don’t just push through. This is part of respecting your baby’s cues. If a provider is having you do exercises and your baby is always crying or fussy, speak with your provider about how to modify the activity to match baby’s skill level. 

Yes, you can work out while breastfeeding and still maintain a good milk supply!! While exercise in and of itself won’t impact milk supply, going too far into calorie deficit is what can drop milk supply for some. Nurse baby or pump just before exercising to avoid the uncomfortable feeling of engorgement or fullness during your workout. Some find wearing a tight sports bra can put pressure on the breast and increase the risk of plugged ducts for some. If that’s the case for you, just make sure to shake your breasts and do a little lymphatic drainage massage immediately post work out when you take your bra off. Post-exercise, lactic acid levels in your breast milk may temporarily change. Studies have shown that lactic acid levels in breast milk are significantly elevated for up to 90 minutes after MAXIMAL or exhaustive exercise, which may change the flavor of milk (but not the nutrients). BUT research has not shown a noticeable increase in lactic acid buildup after moderate exercise (50% & 75% intensity). Most studies have found no difference in acceptance of the breast, even after maximum intensity exercise.

Struggling to make it to the gym? There is also a lot of pressure on “bouncing back” after having a baby. Take your time and don’t look at other peoples journeys. It took you 9 months to grow the baby and it can take time to feel like your new normal and get into a workout routine. In the beginning, especially when recovering from birth and caring for baby, you may have less time and stamina for working out. You’re not alone. Start with a shorter or gentler exercise and add duration/difficulty over time. Prioritize your overall well-being — including your mental health — over a societal expectation to look or be something that may not even be realistic. And remember: breastfeeding is exercise. You burn about 20 calories for every ounce of breast milk you express (either from feeding or pumping). That adds up to an average of 500 extra burned calories a day, which is equivalent to:

1 hour of rock climbing 🧗‍♂️

1 hour pedaling a bike 🚴🏻 at 13-14mph  

2 hours of water aerobics 🏊🏼‍♀️

1 hour of rowing 🚣‍♀️ at a moderate pace

30 minutes of stair climbing 🧗‍♀️

50 minutes of jumping rope 👟

1 hour of steady lap swimming 🏊🏼‍♀️

45 minutes of hiking 🥾

30 minutes of 🥋 martial arts

30 minutes of cross country ⛷ skiing

1 hour of down hill ⛷ skiing

Flanges are the horn shaped part that actually touch the breast. You also need to be mindful of the flange you’re pumping on. Most companies will send a standard 24mm flange. Sometimes they’ll send a larger size as well. They can’t send every flange size they make as that would be expensive and create too much waste. But they don’t always make it clear that the flanges that come with the pump are not one size fits all. And in my practice I hardly EVER use the 24 or bigger flanges unless we’re using a silicone insert. For almost all of my families we’re sizing down. Some times significantly smaller. 

The fit of the flange can make or break your pumping experience. Too small and friction can cause pain and even damage (and pain makes it difficult for milk to let down). Too large and the breast may not be stimulated well, which inhibits your let down to have milk flow. When too much areola is pulled into the flange, the tissue swells around the nipple pores and can prevent milk from efficiently emptying from the breast, resulting in plugged ducts, pain, tissue breakdown, and eventually a reduced milk supply. Using too large of a flange from the beginning may even prevent you from bringing in a full milk supply. Do you ever pump for 20+ minutes and still feel like there’s milk in there? Most likely too large of a flange. The stimulation from the pump is triggering you to make more milk, but the size of the flange is preventing you from emptying that milk efficiently. Poor flange fit can also impact the suction of your pump and how well it functions with your body. If you have the suction all the way to the highest level and aren’t emptying well, you flange is too big. 

Yes, you can work out while breastfeeding and still maintain a good milk supply!! While exercise in and of itself won’t impact milk supply, going too far into calorie deficit is what can drop milk supply for some. Nurse baby or pump just before exercising to avoid the uncomfortable feeling of engorgement or fullness during your workout. Some find wearing a tight sports bra can put pressure on the breast and increase the risk of plugged ducts for some. If that’s the case for you, just make sure to shake your breasts and do a little lymphatic drainage massage immediately post work out when you take your bra off. Post-exercise, lactic acid levels in your breast milk may temporarily change. Studies have shown that lactic acid levels in breast milk are significantly elevated for up to 90 minutes after MAXIMAL or exhaustive exercise, which may change the flavor of milk (but not the nutrients). BUT research has not shown a noticeable increase in lactic acid buildup after moderate exercise (50% & 75% intensity). Most studies have found no difference in acceptance of the breast, even after maximum intensity exercise.

Struggling to make it to the gym? There is also a lot of pressure on “bouncing back” after having a baby. Take your time and don’t look at other peoples journeys. It took you 9 months to grow the baby and it can take time to feel like your new normal and get into a workout routine. In the beginning, especially when recovering from birth and caring for baby, you may have less time and stamina for working out. You’re not alone. Start with a shorter or gentler exercise and add duration/difficulty over time. Prioritize your overall well-being — including your mental health — over a societal expectation to look or be something that may not even be realistic. And remember: breastfeeding is exercise. You burn about 20 calories for every ounce of breast milk you express (either from feeding or pumping). That adds up to an average of 500 extra burned calories a day, which is equivalent to:

1 hour of rock climbing

1 hour pedaling a bike at 13-14mph 

2 hours of water aerobics

1 hour of rowing at a moderate pace

30 minutes of stair climbing

50 minutes of jumping rope

1 hour of steady lap swimming 

45 minutes of hiking

30 minutes of martial arts

30 minutes of cross country skiing

1 hour of down hill skiing

Not every baby needs 15 minutes per side. Some babies take a full feeding in only a few minutes, and from just one breast per feeding. Other babies may feed for a few minutes off each side. Older, more distractible  babies are efficient eaters with more important things to do than state at your chest. They may graze at the boob a few minutes at a time or want to go back and forth from side to side. 

In general, you know baby is getting enough breast milk when you have a pain free latch where the nipple goes in and out of baby’s mouth the same shape. You can hear baby swallow and don’t need to keep them awake at the breast for them to continue feeding. Baby should be making lots of heavy wet diapers and pooping daily or every other day. They also gain weight to their own curve and are a similar size of your unique family genetics. 

If your baby typically latches for you, and feeds well, and refuses to latch, they most likely are done. Follow your baby’s lead and get to know their feeding habits. Trust your baby and trust your body. If you’re concerned about how your baby is feeding, schedule and appointment with a breastfeeding expert: an IBCLC lactation consultant. 

Signs of an over supply:
😳Baby gulps quickly at the breast, feeds for only a few minutes and then refuses the breast, or bites during let down to slow the flow

😳Baby gains weight quicker than expected

😳Baby has a high amount of spit up, coughing or choking during or after feeding

😳You can pump a large volume in a very short amount of time (I knew one mom that could pump 8 ounces in 5 minutes 😳😳) 

The over supply may be caused by:

🌼Hormone imbalance

🌼Excessive pumping or Haakaa use in the early days after birth

🌼Certain medications 

🌼Some babies’ tongues stimulate the nipple differently, sending a signal to continue to make milk. This can occasionally be seen in the tongue tie population

🌼With every pregnancy you have more milk making glands and it can increase supply with each new baby

Coping with an oversupply:

💗Side lying or laid back nursing uses gravity to slow your milk flow

💗If baby cannot keep up with your flow, pull baby off during your first or fastest let down and allow your milk to flow into a nursing pad or towel. Latch baby once the flow slows

💗Avoid pumping or using a Haakaa as this tells your body to continue making more milk than you need

💗Try block feeding (feed on only one breast for a designated block of time, like 2-4 hours)

💗If baby is gaining weight too quickly (1+ pounds or more per week) and is spitting up heavily, time your feeding to end before baby over eats. Use a pacifier or distraction to help baby’s mouth be satisfied with sucking while the tummy has time to digest and tell the brain it’s actually full

Usually as supply regulates around 11-14 weeks, the symptoms go away and no further intervention is needed. Some of these symptoms can mimic other issues, so work with an IBCLC and weigh baby before and after several feedings can give you an idea of what’s actually going on. 

BREAST CHANGES

Breasts are made of a network of ducts, covered by a layer of fatty tissue. During pregnancy, estrogen and progesterone enlarge the milk ducts and multiply the glandular tissue that produces milk. After birth, estrogen and progesterone drop and prolactin and oxytocin rise. Prolactin makes milk production and oxytocin releases it into the ducts. Extra blood and fluid fill the breast just after birth to supoort your body adding hormone receptors in the breast to make milk. The blood and fluid surrounds the ducts and this extra pressure is what makes your breasts feel full between feeding. This blood and fluid reabsorb around 6-8 weeks once supply is established and you won’t feel that full/soft feeling except when you go a really long time between feeding or pumping. Breasts go back to prepregnancy size when supply regulates around 11-14 weeks but continue to make milk. When you wean from breastfeeding, it can take several months for prolactin levels to return to baseline (which is why you may still see milk for months after weaning). Once you stop breastfeeding, the milk making structures actually self-destruct – a process that involves massive cellular suicide, and the removal of the debris. Around 6 months after weaning, the milk-producing tissue is replaced with fatty tissue. If you return to your pre-pregnancy weight, your breasts most likely will return to the same size. They may not be as “perky” because the skin is a bit more stretched and the connective and fatty tissues in the breasts often shifts during pregnancy and breastfeeding. While they may look smaller after weaning most of us can expect that our breasts will return to a similar size as they were pre-pregnancy. They’re just a little more lived in and well loved. 

While some things we hear about babies are common, that doesn’t mean they are normal. The idea that breastfed babies don’t need to poop daily has been normalized, but in reality, isn’t true!! The idea that there’s very little waste produced from breast milk is not based on scientific evidence and can actually prevent finding the true reason for baby’s lack of poop. 

In the newborn stage, prior to 6 weeks, pooping tells us if baby is getting the appropriate volumes of milk from the breast. Many times when a newborn isn’t pooping, it’s a sign they’re not getting enough breast milk. As you increase milk volumes, baby starts to poop! Decreased milk intake can happen when baby has a tongue tie and can’t efficiently move milk from the breast, if feedings are scheduled (waiting for every 3 hours) or if baby is being sleep trained too early. Low milk supply can be caused by retained placenta, thyroid or hormone disorders or when there is a breast surgical history like a reduction. 

Constipation can have other root causes. 

🧬For some, it may be that their digestive biome is not ideal… things like antibiotics given to mom during pregnancy/birth or antibiotics given to baby shortly after birth shift the biome where it doesn’t ideally absorb and process milk. Introduction of formula also changes the gut microbiome. Some babies may have difficulty digesting certain formulas and may struggle with pooping until the right one is found. 

💃🏻Not getting enough movement, tummy time or being in one position for too long (sitting in positioning devices like a dockatot for hours a day) decreases movement through the gut. Allergies and intolerances are another culprit. 🦷Babies who are teething may have a temporary change and miss a day or two and then return to daily stooling. 

🤢Illness, change of environment (maybe a holiday/ move of house), change of daily rhythm etc can all play a role, and temporary changes are to be expected.

Every person is unique and so there isn’t any “one size fits all” reason why an infant may be struggling with constipation/infrequent stooling. If you baby isn’t pooping regularly, an IBCLC can help figure out what may be going on and refer you to the right specialist as needed.