1. Not getting enough milk!
If your baby is not gaining enough weight, then it may be because he is not getting enough milk (breast or formula). If you're concerned about his weight, your first step would be to increase the amount of milk you offer him and if this fails to increase his weight gains, see a doctor to make sure there's no physical reason.
If your baby is breastfed, your breast milk supply may not be sufficient to meet his nutritional needs. (See our article on How to tell your baby is getting enough breast milk.) However, there are also a number of reasons for a breastfed baby to underfeed, which have nothing to do with low milk supply. If a physically well baby is not gaining sufficient weight it is wise to talk to someone who is experienced in educating mothers on breastfeeding, such as a breastfeeding counsellor or lactation consultant.
If your baby is formula fed, you may need to offer more formula. Take a look at our section on bottle feeding for information on how to estimate how much formula your baby needs' and dealing with common bottle feeding problems. Also check that you are making the formula correctly. If you were making it too weak your baby may not be getting the calories he needs.
Strangely, it's most often the bigger babies (who are experiencing no problems putting on enough weight) that are the most difficult to satisfy. For these thriving infants the problem may be related to one of the following reasons.
2. Lowered breast milk supply in the evenings
It's normal that your breast milk supply can be a little lower in the evenings. This could be a reason why your little one is restless and wants to breastfeed more frequently in the evenings. If he's gaining good amounts of weight, and providing your with lots of wet diapers (6 or more a day), then he's getting enough breast milk over a 24 hour period and it may help to plan your day so that you can allow for more frequent breastfeeding in the evenings.
However... if he's gaining weight well and wants to feed more frequently throughout the entire day, this could be a sign of a growth spurt.
3. Growth spurt
If your baby is formula fed, you may find he's looking for just at little more formula at the end of each feed. An increase in the amount of formula offered at each feeding will normally resolve his restlessness.
If he's breast fed, you may need to offer more frequent breastfeeds, to stimulate an increase in your supply. Restlessness related to a growth spurt should settle within a few days and feeding patterns return to normal. If his feeding pattern does not return to normal, yet his weight gains are good, there may be other reasons for him to "appear hungry".
When a baby cries one of the first things parents think of is hunger. It may seem like a simple enough task to figure out whether your baby is hungry or not, but it's not always as simple as it sounds. Some babies do not know when 'enough is enough' and will eat whenever milk (breast of bottle) or food is offered. Soon after feeding it can appear like they hungry again.
If you feel your baby is feeding more often than you would expect, you may be mistaking his cues.
1. Infant reflexes
While many mammals are born with several reflexes and survival instincts that enable them to stand or run soon after they're born, the human baby begins life with only a few reflexes to ensure survival and these relate mostly to feeding. (A reflex is an action that's performed involuntarily or automatically.)
The rooting reflex is a normal response in newborn babies when the cheek is touched or stroked along the side of the mouth. The infant turns his head and opens his mouth toward the touched side and seeks something to suck. The reflex usually fades by 3 to 4 months of age but it may last until 12 months of age. This is an automatic reflex response and not a clear sign that a baby is hungry.
When the roof of a baby's mouth is touched, he will begin to suck. The sucking reflex is triggered by inserting a finger, pacifier or nipple in to a newborn's mouth. This too is a normal reflex response and not always an indicator of hunger.
Babies also have a hand-to-mouth reflex that goes with the rooting and sucking reflexes. Although present from birth this reflex appears more obvious at around 3 months of age. It's not until around this age that a baby can control his arm movements enough to purposely suck his fingers or hand. Prior to gaining this control, sucking on his fingers or hands is a 'hit or miss' process. (At around 3 months of age this reflex is often mistaken as a sign of teething).
2. Developmental stage
Babies are in an oral stage of development. They often want to suck or feed not only when they're hungry but also when they're tired, in pain, distressed, for comfort or for pleasure. Young babies (under 3 months) have a strong urge to suck. Many will want to suck at times other than feeding to feel contented.
3. Lactose overload
Many healthy, thriving, breastfed babies develop gastric symptoms, such as; excessive gas and frequent watery bowel movements* due to lactose overload, which is associated with large, frequent feeds. These symptoms cause tummy pains. A baby with tummy pain can appear to be hungry because he seeks to feed in a attempt to relieve this discomfort, (which it does but only temporarily). However, the extra feedings could further add to the vicious cycle of lactose overload and gastric symptoms.
*Watery bowel movements without other symptoms is very normal for a breastfed baby and not automatically a sign of lactose overload.
Unfortunately, all too often 'lactose overload' is mistakenly diagnosed as lactose intolerance or food or milk allergy or intolerance (to dairy foods or other foods in the mother's diet). A breastfed baby may be either weaned from the breast onto a lactose-free formula or the mother feels compelled to make dietary restrictions. Both of which are unnecessary and unhelpful in this situation. This problem of lactose overload can be resolved simply by making appropriate changes to feeding management. A mistaken diagnosis may result in a formula fed baby being switched to soy or lactose free formula.
4. Feeding patterns
Babies can often fall into a pattern of frequent feeding or 'snack' feeding, where they takes small volumes of milk (breast or formula) at each feed. But as a result they want to be feed more often. This is very common where are baby is very sleepy during feeds. (See tiredness below).
Although, this will cause your baby no harm, provided he gets enough milk (breast or formula) in a 24 hour period, it can become very exhausting for you trying to keep up with his constant 'demands' for feeding.
A baby will also want to be fed because he's thirsty. If your baby is breastfed, offer the breast whether you think he's hungry or thirsty. If he has started on solid foods it may be helpful to offer him a little water once or twice per day.
If he's formula fed first make sure you are making up his formula correctly. If you were making it too strong this could make him thirsty. If formula preparation is correct and your baby is already drinking sufficient amounts of formula for his age and weight, a little extra water offered between regular formula feeds may help.
Babies frequently want to feed when they're tired. A common sleep association for babies can be feeding to sleep (breast or bottle). If your baby has learned to associate feeding with sleeping, he will also want to feed when he's tired because he's learned that "this is the way I go to sleep".
Babies display signs of tiredness differently than we expect. Tired signs for a young baby are displayed as clenched fists, waving arm and leg movements, facial grimaces, fussing and grumbling then crying. These signs are often misinterpreted as boredom or hunger.
1. Big babies need feeding more frequently.
FALSE: A bigger baby needs more milk than a smaller baby at each feed but there is no reason why a bigger baby would to need to be fed more often than a smaller baby of the same age.
2. You may not have enough (breast) milk.
TRUE & FALSE: If your baby's not gaining enough weight, your supply may not be sufficient. But don't automatically blame low supply, there are also other reasons for a breastfed baby to underfeed and therefore struggle to gain sufficient weight. However, if your baby is gaining enough weight, you have enough milk.
Sadly, many breast feeding mothers wean their babies to formula in the hope that it will be more satisfying. Unfortunately this rarely helps and the same pattern of behavior most often continues on formula as well. (See our article on How to tell when your baby is getting enough breast milk).
2. Your (breast) milk may not be strong enough.
FALSE: Breast milk provides the same amount of calories per ounce as formula. Studies comparing breast milk among hundreds nursing mothers have shown that the "strength" of breast milk remained consistent.
Don't be confused by the color of breastmilk. Breastmilk is not white like cow's milk. It can have a watery translucent appearance. Breastmilk is the perfect food for babies.
3. Bigger babies need stronger milk.
DEFINITELY FALSE: If your baby is thriving, yet wants to feed more regularly than would be expected for his age and weight, the problem does not lie with the actual milk but is due to other reasons. A bigger baby may need a little more milk than a smaller baby but he does not need stronger milk.
Offering your baby stronger formula can seriously affect his health. Never offer stronger formula unless instructed to do so by your baby's doctor.
4. Switching formula helps.
RARELY: There's very little difference between infant formulas. Except for specialty formulas designed for premature babies and babies with cardiac or other specific conditions, all formulas have the same amount of energy (calories) per ounce.
Cow's milk formulas are classified as whey dominant or casein (curd) dominant, describing the main protein type in the formula. Although providing the same amount of calories per ounce, casein dominant formula is digested more slowly than whey dominant formula. Some babies find a casein dominant formula more satisfying.
5. Big babies need to start on solids sooner.
FALSE: It can be very tempting to start solids at an earlier age than recommended or for an older baby, to try to "fill him up" with large amounts of solid foods. However, this rarely helps and if solids given too early (or too much) it can create additional problems.
A bigger baby doesn't need to start solids sooner than a small baby, he just needs more milk. If he's already drinking more than would be considered normal for his age and weight, then there may be other reasons for him to appear hungry.
6. A baby needs to be fed more often if he has reflux.
FALSE: If he's gaining good amounts of weight, there's no need for him to feed more frequently. Babies with a frequent feeding pattern can often over-feed and reflux (gastro-esophageal reflux). Overfeeding has the potential to make reflux worse, as the baby may bring up excessive milk.
In other words, frequent feeding may be causing him to reflux more often rather than his reflux causing him to become hungry sooner.
1. A pacifier
Sucking is not only a means of obtaining nourishment; it also has a pleasurable calming effect on infants. There'll be times when your baby may be comforted by a pacifier rather than feeding. Don't worry! If he's hungry he'll soon let you know because he won't be content to suck on a pacifier for long if it's a feed he's wanting.
2. Offer your finger
You can offer your finger instead of a pacifier (little finger palm up postion, which a slight curl so that the tip of your finger touches your baby's hard palate).
For a formula fed baby who's already drinking acceptable amounts of formula for his age and weight, it can be helpful to cooled boiled water once or twice a day between regular formula feeds, whenever you feel your baby may be thirsty. Offer only 1 ounce (30ml) at a time for a baby under the age of 6 months and up to 2 ounces (60ml) for babies over the age of 6 months.
Breast fed babies don't need additional water for hydration until they start solid foods. However, a little water will cause no harm. If you choose to give your baby water limit the amount to no more than 1 ounce (30ml) twice a day and make sure it is not offered too close to fed time (within 1 hour of an expected breastfed) as he might be full from the water an not drink as much breastmilk when it is offered. Also avoid offering water directly after a breastfed, which may mean he might not have finished feeding but then fills up on water.
3. Offering pumped (expressed) breast milk following evening feeds
Provided your baby's breast fed of course! Pump (express) after morning breastfeeds, when your milk supply is often at its highest, and offer this after evening breastfeeds, only if your baby remains unsettled following the breastfeed.
4. Establishing a FLEXIBLE feeding and sleep routine
You may have received advice like "stretch out feeding to 3 hourly" and have possibly tried this without success. To encourage a better feeding routine you need to also look at establishing a better sleep pattern at the same time, otherwise your attempts are likely to fail.
We all understand a baby will not sleep for long if he's hungry but few people realize that it is often lack of sleep that affects feeding patterns (and feeding behavior) - rather than the other way around. If a baby's tired he is likely to not feed well or he may look for more frequent feeds for comfort.
Through a consultation at BabycareAdvice.com, we can advise on feeding (breast, formula or solids) to ensure a healthy balance that will meet your baby's nutritional needs. After a thorough assessment to discover the reason for your baby's increased hunger, we can explain ways in which you can encourage his contentment by providing individually tailored advice on how you can improve his feeding pattern and behavior, and improve sleep patterns.
If you would like more information about our consultation service click here.
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Added Nov 2003. Reviewed 2008; Sept 2013.