A newborn baby spends most of their time sleeping and feeding but how often should a newborn feed? Should you wake a sleeping baby to feed? Can a baby be too sleepy? This article looks at newborn sleep, how often babies need breast milk and how much, how to tell if a baby is breastfeeding well, and how to feed a sleepy baby.
How long do newborn babies sleep?
Newborn babies sleep a lot, they may sleep for 18 hours out of every 24—usually for two to three hours at a time1 with perhaps one longer sleep of four to five hours2 . It is common for a baby to be particularly sleepy in the first 24 hours after birth 3.
How often should a newborn feed?
Breast milk is easily and quickly digested—even as quickly as one hour—and babies have tiny tummies so they need to feed little and often 4. It is usually recommended that a baby has at least 8-12 feeds in 24 hours i.e. that they breastfeed every two to three hours from the start of one feed to the start of the next (Mohrbacher, 2010) and this ties in with a newborn’s sleep patterns. Some babies may feed more frequently e.g. every hour at first. Frequent breastfeeds will provide plenty of breastfeeding practice, provide baby with a steady supply of food and stimulate the breasts to make more milk.
Can babies be too sleepy?
Yes, sometimes babies can be too sleepy and if they are not getting enough milk because they are so sleepy or not feeding very well they can begin to sleep even more and feed even less. A baby who is not feeding frequently or not feeding well may become more and more difficult to rouse. If a baby is very sleepy, they could be at risk of higher than normal weight loss or poor weight gain, higher than normal levels of jaundice and a sleepy baby is a big risk factor for low milk supply because removing milk from the breasts regularly is an important signal to make more milk. If a baby continues to be sleepy and not feed well after a mother’s milk comes in, there is a higher risk of the mother’s breasts getting engorged or getting mastitis. Mastitis or engorgement can make a mother feel very poorly and reduce a milk supply further.
Encourage a sleepy baby to feed
Encouraging a sleepy baby to have regular breastfeeds and helping them to stay awake long enough to finish a feed will both protect the mother’s milk supply and keep baby well fed to protect their health.
Why might a baby be too sleepy?
Reasons for being particularly sleepy might include:
- A difficult birth or birth interventions such as ventouse, forceps or if a mother has received any pain relieving drugs that have affected baby.
- Prematurity, health issues or other medical reasons can make a baby sleepy.
- Breastfeeding problems. If a baby is not getting enough milk they will have less energy and this can quickly make them more sleepy. Sometimes a baby may seem to be breastfeeding but actually they are sleeping with the breast in their mouth and not swallowing anything or very little.
- Jaundice (yellowing of the skin due to a build up of bilirubin) can make a baby sleepy and is more likely in a baby who is not getting enough milk creating a vicious cycle.
- Overstimulation. If a baby is overstimulated by excessive handling by strangers or even family members, bright lights or constant loud noise they might tend to shut down and go to sleep to escape.
- Missed feeding cues. When a baby is swaddled 5, has a pacifier, is too warm or is not in close contact with his mother there is a higher chance of missing feeding cues so that a baby sleeps for longer and feeds less.
- Severe breast engorgement. Severe breast engorgement after the birth may hinder baby getting milk and any unrelieved engorgement will tend to reduce a milk supply. If less milk is available a baby may become sleepier. Conversely, if a baby is already very sleepy and not feeding well there is a higher chance that a mother may experience painful engorgement (swollen breasts full of milk) leading to a vicious cycle of sleepy baby getting less milk, breasts reducing supply due to the engorgement, less milk for baby and so on. See our articles on Engorged Breasts and Engorgement Relief When Milk Won’t Flow for more information to deal with engorgement.
Is colostrum enough for a newborn baby?
Colostrum is the name for the first breast milk that is present before and straight after the birth, it is low in volume but high in protective factors for the baby. Most healthy newborns arrive well nourished and only need small amounts of colostrum until a mother’s milk volume increases (or “comes in”) around the third day after birth. These small volumes are the perfect amount for a healthy newborn to practice breastfeeding. Although a newborn may sleep a lot and may not need very much milk at a time in the first few days and nights of life, breast milk is quickly digested and babies still need to feed every two to three hours or more often.
How long should a newborn sleep without feeding?
How long a baby should sleep in one go will partly depend on how much milk they are getting at the breast during a breastfeed and how many total feeds they get during any given 24 hour period. Feeding in clusters with occasional longer periods of sleep is normal especially when there are at least 8-12 feeds over a 24 hour period. If a baby is waking for lots of frequent feeds and feeding actively with plenty of swallows of milk and plenty of wet and dirty nappies and gaining weight, they can usually be left to sleep and feed on demand to their own timetable. If not, then reminding and encouraging a sleepy baby to breastfeed every two to three hours during the day and every four hours at night can be important to avoid them being underfed.
How can I tell if my baby is feeding well?
Although babies can feed well in light sleep6, just because a sleepy baby is attached to the breast (“latched”) this is not a guarantee that they are drinking well. It’s important to be able to distinguish active feeding from flutter sucking and comfort nursing. When a baby is feeding actively, even if they look like they are asleep, the baby’s jaw will move as they suck and they will swallow regularly e.g. in a pattern of one or two sucks per swallow for 10-15 minutes or more at a time from one or both breasts. The length of time a baby is attached to the breast is not as important as how effectively that baby is feeding. Even if a baby is latched on for an hour, if he isn’t feeding actively with plenty of swallows of milk he might not be getting enough milk.
Latch is important
A baby’s attachment at the breast (latch) affects how easily they can keep milk flowing during a breastfeed. If a baby is mostly sucking on the nipple without a big mouthful of breast tissue, he is more likely to fall asleep after the initial let-down when the flow slows, and breastfeeding is more likely to hurt. Flat, inverted or large nipples can make it more difficult for a baby to get a good latch and a baby with a tongue-tie might find it difficult to feed effectively. See Latching Tips for ideas to help your baby get a deeper latch and contact a breastfeeding specialist if you need help. Pain, sore nipples, and prolonged engorgement are signs that you may need help with breastfeeding.
How can I tell if my baby is getting enough milk?
Although we can’t see how much breast milk a baby has taken from a breast, knowing how to spot active feeding, listening for swallows of milk, monitoring your baby’s dirty nappies, and weighing your baby regularly will all help confirm they are getting enough milk. For more information on gauging your baby’s milk intake see Is My Baby Getting Enough Milk? Breastfed Baby Poop and Understanding Your Baby’s Weight Chart.
- Listen for swallows. Is your baby feeding actively?
- Check dirty nappies. Are you seeing at least three dirty nappies with soft mustard coloured poop by day four or five?
- Weigh your baby. Check your sleepy baby’s weight regularly. If they are not gaining appropriate amounts of weight they may need help to get the milk they need.
The following video from Global Health Media discusses how to tell your baby is getting enough milk including how to tell your baby is drinking well at the breast (skip to two minutes in to see effective sucking and swallowing).
How can I wake my sleepy baby to feed?
If your baby is not waking at least 8-12 times in 24 hours he may need reminding when to feed. Ideas to wake and feed a sleepy baby include:
- Look for light sleep and feeding cues. A baby can breastfeed in light sleep and it’s easier to latch or wake a baby in light sleep i.e. when his eyes are moving under his closed eyelids (rapid eye movement or REM) and he is starting to move, fidget or fuss in his sleep. Other feeding cues include a baby sucking his fists or fingers, opening his mouth and turning his head from side to side to search for the breast (rooting). It can be helpful to cluster feed in these light sleep/more active periods.
- Hold your baby. Sometimes just picking up and holding your baby in a breastfeeding position will motivate him to begin rooting and latch on (attach to the breast). Holding your baby as much as possible allows you to spot those moments when your baby is in light sleep and try to latch him on.
- Skin-to-skin. Remove your baby’s clothes so that he is skin-to-skin or lightly dressed against his mother’s chest. Being held in skin-to-skin contact in a tummy down position against a mother’s chest is a great position to trigger a baby’s feeding reflexes. In this position, babies will often start actively searching for the breast using their hands and mouth even if they are not fully awake. Skin-to-skin contact can therefore encourage more breastfeeds7. The mother’s body will keep baby warm, a blanket can be draped over mother and baby as needed. See Why Skin to Skin? for more explanation of how helpful this technique can be used at any time in the early weeks not just after the birth. Remember to remove any scratch mittens.
- Change baby’s nappy. Changing a baby’s nappy will often rouse them. Some parents combine this with gentle massage of hands and feet.
- Different positions. Try holding your baby in different breastfeeding positions to see if any help him to stay awake. Some babies may be more wakeful in a rugby hold or in an upright position such as a straddle hold compared with a traditional cradle hold. Some may be more active in reclining positions while some may fall into a deep sleep. You can see the different positions to try in Breastfeeding Positions for Newborns.
- Dimming the lights. Bright lights can make a baby want to shut their eyes which encourages sleep, try soft lighting instead.
- Quiet time. Try to create a peaceful atmosphere so baby does not get overstimulated. Passing a baby around family members and constant loud noise can cause some babies to “withdraw” and go to sleep to escape.
- Avoid a dummy. A dummy can encourage a baby to sleep longer. Sucking releases hormones to pacify or calm baby back to sleep and can therefore lead to missed feeding opportunities. See Pacifier, Dummy or Soother, Yes or No?
What if my baby is too sleepy to breastfeed?
If, despite trying the ideas above, your baby is still not waking up to breastfeed, or is latching but not actively getting enough milk, supplements of expressed breast milk will keep them well fed. Topping your baby up every two to three hours will give him more energy to wake up to breastfeed at the next feed. A baby is much more likely to be able to breastfeed effectively if they are gaining weight. Expressing your milk as often as baby ought to be feeding (at least eight times a day) will stimulate the breasts to make more milk and provide the perfect supplement for your baby. If you can’t express any breast milk to keep your baby well fed, and if donor milk is not available, your baby may need infant formula until you can get more help with your milk supply.
- Check in with your health professional if your baby is consistently too sleepy to breastfeed to make sure they are not poorly or getting dehydrated.
- Hand expressing or pumping your milk will protect your milk supply and provide a breast milk supplement to keep your baby fed until they can breastfeed. See Hand Expressing, How to Increase Milk Supply When Pumping and How Long Does Breast Milk Last?
- Supplementing a sleepy baby. A sleepy baby can be given small amounts of expressed breast milk (or formula if needed) by teaspoon, syringe or bottle. If your baby is alert and awake but not ready to latch on, another option is to offer a cup feed. Although a bottle teat could introduce a bottle preference or teat confusion it can be helpful for a very sleepy baby who needs larger volumes. Following the ideas in Tips to Bottle Feed your Breastfed Baby and Best Bottle for a Breastfed Baby can help minimise any problems. If a baby is too sleepy to breastfeed properly a supplemental nursing system is probably not going to be helpful at this stage as it relies on a baby sucking actively.
- Check in with a breastfeeding specialist for tailored suggestions to help your baby breastfeed well and maximise your milk supply.
Baby not gaining weight
Although many babies lose a little weight at first, normal weight gain after the first few days of life is 30-40g (1oz) per day. If your baby is sleepy and not gaining weight, or very little, keeping him well fed is often the key to him getting better at breastfeeding and being less sleepy. An intense pumping routine will both protect your milk supply and provide a breast milk supplement to feed him. Urgent breastfeeding support from a breastfeeding specialist can check whether attachment, positioning, tongue function or other reasons for low milk supply are at play apart from having a sleepy baby.
Take action sooner rather than later
The sooner you can turn things around the quicker breastfeeding can get back on track. There is no advantage to just keep weighing a baby without taking action in the hope that a sleepy baby’s weight will miraculously pick up on its own. To get changes you will likely have to make changes. Sometimes simply improving the latch and position, using both breasts per feed, using breast compressions and reminding a sleepy baby to breastfeed every couple of hours will be enough. If this doesn’t improve weight gain within 24-48 hours however, an intense routine of pumping and topping up to satiety after breastfeeds can turn things around quickly see Baby Not Gaining Weight and Supplementing an Underweight Baby for much more information.
How much milk do newborn babies need?
A rough guide to the amount of milk a newborn baby might need every two to three hours is copied below. The amounts change as baby grows and may fluctuate daily with growth spurts or periods of illness. Some babies may need more or less than these amounts. Although we can’t see how much milk a breastfed baby is getting direct from the breast; feeding well on demand (8-12 feeds in 24 hours), having plenty of wet and dirty nappies, and gaining 30-40g (1oz) per day in the first three months are good signs of getting plenty of milk.
- First 24 hours: 2-10ml breast milk per feed 8
- 24-48 hours: 5-15ml breast milk per feed (ABM, 2017)
- 48-72 hours: 15-30ml (o.5-1oz) breast milk per feed (ABM, 2017)
- 72-96 hours: 30-60ml (1-2oz) breast milk per feed (ABM, 2017)
- 2-3 weeks: 60-90ml+ (2-3oz+) breast milk per feed 9
- 1-6 months: 90-150ml (3-5oz) breast milk per feed or a total of 750-1035ml per day (25-35oz) (Mohrbacher, 2010)
Breastfeeding the sleepy baby
Getting baby latched and drinking well at the start of a feed is not always the end of the story. Once the initial let-down subsides, a sleepy baby is quite likely to fall asleep again before he has finished the feed.
How do I keep my baby awake during feedings?
The following ideas can help your sleepy baby to feed effectively:
Skin-to-skin. Undressing your baby and placing them skin-to-skin on your chest maximises their feeding reflexes and helps stimulate feeding cues.
Position and latch. If your baby is not latched and positioned well it will be difficult for them to get milk (and breastfeeding may hurt!). Check positioning in Breastfeeding Positions for Newborns and see Latching Tips and Why Does Breastfeeding Hurt? Try different positions, upright positions may help your baby stay awake to breastfeed longer.
Breast compressions. Putting gentle pressure on the breast with a free hand while baby suckles can help to keep milk flowing at a faster pace and so keep a baby feeding longer. See What is Breast Compression?
Keep switching sides. As soon as sucking slows on the first breast offer the other breast before baby falls asleep. By switching and repeating you can help to keep baby awake and feeding actively for longer.
Look for active feeding. Watch your baby carefully. Is he actively moving his jaw to suck and can you hear swallowing or see the pause in his suck as he swallows? Watch for the baby who is frequently flutter sucking or comfort nursing but not swallowing anything. If your baby isn’t getting enough milk he will probably fall asleep hungry and your milk supply will continue to drop.
Express and top up if needed. If baby is still falling asleep before he has had enough to eat, pumping and topping him up with expressed breast milk will help his energy levels for feeding longer at the next feed. The more breast milk your baby gets the sooner he will be more wakeful and better able to breastfeed effectively. And pumping will protect your supply, only by frequent emptying of the breasts will they know to make more milk.
Get support. Mothers across the world have traditionally taken several weeks to nest with their newborn baby and get breastfeeding established. Finding support with preparing meals or looking after older children can be invaluable. Your sleepy baby will benefit from your focussed attention to get breastfeeding established. And if your otherwise healthy baby continues to be sleepy or is not feeding very well seek the help of a breastfeeding specialist e.g. an IBCLC lactation consultant.
Babies do sleep a lot but they will normally wake every two to three hours to feed. If a baby is not waking to breastfeed and is constantly sleeping longer than two to three hours, reminding them to breastfeed can both keep your baby well fed and healthy and also protect your milk supply. Hand expressing or pumping your breast milk to provide a supplement for a sleepy baby may sometimes be needed for a while. There is no advantage to keep weighing a sleepy baby every few days and watching their weight stay the same (or go down) hoping it will pick up eventually. Getting help with breastfeeding as soon as possible will be much more effective in protecting your milk supply and getting breastfeeding on track.