As I lay in my hospital bed, a confusing chart stared me down. I was a first-time mom and the maternity ward nurses had left me with a white board, a dry-erase marker and a wailing newborn. I was told to nurse him every two hours, and to record the time of each feed, as well as the details of every diaper change. Instead of following my baby’s natural hunger signs, I was obsessed with this odd schedule that made me too anxious to sleep. Instead of watching my son for hunger cues, I was watching the clock.
“A healthy baby will tell you when he’s hungry,” says paediatrician Rob Everett, the medical lead for paediatrics and mother and baby care at BC Women’s Hospital and Health Centre in Vancouver. Whether your little one is breastfed or bottle-fed, parents should follow a newborn’s lead. “The goal is to try and pick up on signs that the baby wants to feed before he gets hungry and starts crying, because then it’s actually much more difficult to get him to feed.”
Infants actually display hunger in three different states of wakefulness (but they don’t necessarily happen in a sequential or chronological order). There’s the transition state: the simple act of waking. Then there’s the “quiet alert” state, when they give early hunger signs, followed by the “active alert” state, when they are basically yelling at you, in the form of crying.
In the “quiet alert” state, infants become more physically active, stretching and stirring. You may notice your baby open their mouth and begin to root, turning their head to one side as they start nuzzling and moving their chin, mouth and nose around (as if they’re looking for a nipple or a bottle). They might put their hand to their mouth or suck on their fingers. It’s also common to see them smack their lips and stick out their tongue. Babies will latch more easily—and nursing is likely to go more smoothly—if you start the feed at these first indications of hunger.
It's important to catch these “quiet alert” baby hunger signs before your newborn enters “active alert” territory. If you miss these cues, the window between “quiet alert” and “active alert” becomes very narrow. They may learn to skip the “quiet alert” stage altogether and go straight to “active alert,” crying for your attention. But if you tend to start a feed when your newborn is in a calm, “quiet alert” state, they may develop a bit more patience, explains Everett.
Once your little one begins to cry and fuss, they're often agitated and may turn away from the breast or the bottle. (Essentially, they’re “hangry.”) Their face may also turn red as their breathing quickens, and their movements become more frantic.
“A crying baby is burning a lot of calories, and that can tire them out very quickly,” says Kathryn Hayward, a certified lactation consultant and assistant professor of nursing at Dalhousie University in Halifax. “So the infant can go from crying to exhausted, and [could] asleep without feeding.” If you’ve missed the first baby hunger signs, Hayward recommends calming your infant down before frustration builds. Take the time to engage in some skin-to-skin, to cuddle and to speak soothingly to them before trying to nurse or give a bottle again.
Comforting and feeding on demand is your best bet at this young age. Once a baby is a bit older, some controlled crying may be part of your sleep training approach. But a baby younger than four to six months should not, generally, be left to cry for extended periods of time. Talk to your paediatrician about your baby’s temperament, feeding habits, sleep patterns and weight gain before considering sleep training.
Calgary mom of three Asma Salman says that for her, learning her babies’ hunger signals came down to experience. She remembers being in the hospital after the birth of her eldest and feeling overwhelmed by all the information thrown at her. She’d downloaded an app that timed each feed and reminded her which breast to nurse from. But once she realized how much anxiety it was causing her, Salman deleted the app. “The minute I stopped overanalyzing it and just relaxed, listening to my kids became easy-peasy,” she says.
After giving birth to her third child in four years, Salman has learned to trust her intuition and pay close attention to her babies’ cues and body language. Her little ones all shared the same kid of funny, grumpy expression of irritation, which let her know that it was feeding time. “As new parents, we’re so stressed about everything. But it’s biological. We were designed to do this, and babies are born ready to suckle,” she adds.
If your newborn is content to snooze for more than four hours without waking for a feed, does that mean you should let sleeping babies lie? Not quite. In the first few days of life, infants should nurse on demand, and at least every three or four hours, to signal the mother’s breasts to produce milk. But Everett says that healthy babies will eventually fall into their own rhythm. He recommends that for the first month, parents should aim for a minimum of eight to 12 feeds in a 24-hour period. They don’t need to be spaced apart at perfectly even intervals. The feeding pattern may look different for each child: Some babies might sleep for a longer stretch during the day, then cluster-feed small amounts throughout the evening, which is also completely normal.
If you’re unsure of whether your baby has fed enough, Hayward recommends keeping an eye on their fists, wrists and arms. When a newborn is ready to feed, they’ll often have tight fists, and their elbows will be bent and pulled in toward their chin and mouth. Once they begin feeding, you’ll notice their fists begin to unclench and their wrists and arms will unfurl and become more relaxed. If your baby falls asleep while nursing but isn’t fully satiated, they’re likely to tighten up again as you try to unlatch them from the nipple. (That’s an indication they’re still hungry.) Change your baby’s diaper and try to stimulate them a bit before initiating feeding again.
Once your baby is gaining weight steadily and has a healthy number of wet and dirty diapers throughout the day, he’s probably fine to wake on his own schedule. (If you’re lucky, you might get a longer stretch of sleep.) At some point, your little one will, eventually, learn to sleep through the night. (It could happen naturally, or—more likely—you’ll have to work on this skill together over time.) But it’s always best to check with the doctor or midwife who’s been carefully following your baby’s growth and progress.