How babies breastfeed and breastfeeding stages

How does my baby act while breastfeeding?

A baby’s behaviour changes during a breastfeed. It also changes from feed to feed and as the baby gets older. When babies are under one month of age, they typically feed in three sucking stages, moving from intense hunger to being more settled and finally to being fed and happy or asleep. Recognizing these stages helps mothers understand when their baby is done and ensures the baby is getting enough milk. Older than one month, babies become more efficient at the breast and feed more quickly. They also become distracted more easily and are often awake at the end of the feed.

A) Describing differences in breastfeeding patterns

Each time a baby breastfeeds, the baby will latch, suck, and finish. If breastfeeding is effective, the baby will not be hungry afterwards. However, babies will change how they suck at each feed, between different feeds, and over time. Recognizing these patterns will help you understand when the baby is done breastfeeding and ensure your baby is getting enough milk.

Feeds can be on one or both breasts. Newborn and younger babies have the most predictable feeds; the feeds of older babies will vary a little more and show more of the baby's personality. 

1) Differences during a feed

Breastfeeding changes as the feed progresses. As the baby's tummy fills and hunger settles, their sucking pattern and body language changes. 

2) Differences between feeds

Babies may be more or less hungry at different feeds and the breast may hold slightly different amounts of milk depending on when the baby last breastfed. Babies may have different reasons for breastfeeding such as hunger, thirst, fear and so forth and these will affect how the baby breastfeeds.

3) Differences over time

Breastfeeding changes as the baby grows and becomes more efficient at breastfeeding. Feeds become shorter and babies become more distractible.  

B) Breastfeeding babies under one month of age; breastfeeding stages

Most babies under one month of age breastfeed in fairly typical patterns described below. Babies change their sucking behaviour as they breastfeed as they go from being very hungry to more settled and finally to being very contented and sleepy. This sucking behaviour can be described in stages.

We have named these three sucking stages:

  1. “I’m starving.”
  2. “I really like this.”
  3. “I’m done.”

Premature babies and newborn babies who are in the first three days of life tend to have a shorter “I’m starving” stage and spend more time in the “I really like this” stage.

C) The first stage: “I’m starving”

During this stage, the baby is taking in large amounts of milk. Studies have shown that healthy breastfeeding infants take in 80% of the total amount of milk from that side in the first five minutes (Howie 1981; Lucas 1979).

You will notice:

  • The eyes are open.
  • The baby is focused on breastfeeding.
  • There are many sucks and only short pauses.

The following sounds and behaviours are normal:

The video below shows the first stage of breastfeeding. This baby is sucking very actively with very few pauses. He is very alert.

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D) The second stage: “I really like this”

During this stage, the baby is still taking in milk but the amounts are smaller.

You will notice:

  • The eyes are closed.
  • The baby is relaxed and is breastfeeding in a pattern of “suck-suck-suck-suck-rest-rest-rest-rest-suck-suck-suck-suck” and so on.
  • The breathing is more relaxed.

As the baby moves through the second stage:

  • The rests get longer and the sucking periods get shorter.
  • The sucks become weaker.
  • The swallow sounds are more widely spaced.

The video below shows the second stage of breastfeeding: This baby is sucking actively but taking regular pauses between sucking periods. Her eyes are closed.

 

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E) The third stage: “I’m done”

During this time, the baby is taking in minimal amounts of milk.

You will notice:

  • The baby is completely relaxed and possibly milk drunk.
  • If sucking:
    • The suck is weak.
    • The baby is using a “suck-rest-suck”pattern or a “suck-suck-suck-long rest” pattern.
  • If not sucking, the baby will only suck when you tickle them or when the breast moves.

The video below shows the third stage of breastfeeding. This baby will only suck when the mother tries to pull the breast out of the baby's mouth.

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F) After the first breast

Once the baby is done feeding, the baby will either:

  • Let go of the breast.
  • Let go of the breast while squeezing their lips together and turning their head.
  • Choke, let go of the breast, and no longer be hungry. This is more likely if the mother has a large milk supply.
  • Stop actively sucking and need to be taken off the breast.

The video below shows a baby letting go of the breast at the end of a breastfeed. She sucks weakly, pauses, and then releases the breast. She is using a nipple shield effectively and it has no impact on breastfeeding behaviour.

Some babies will stop sucking but not let go. When you begin to take a baby off the breast or even move the breast, the baby often starts sucking again. This is only for a few sucks and then they go back to not sucking. At this point, they really are done and you can take them off.

After the first breast the baby, may:

  • Be happy when held.
  • Be asleep and stay asleep when held but wake up when put down.
  • Show hunger signs within a few minutes. 
  • Be asleep but wake up within a few minutes, stretch, and then give hunger signs.
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G) The second breast

Most babies under one month of age will show hunger signs within ten minutes of finishing the first side and will need to breastfeed on the second side. If you have a large milk, supply the baby may not want the second side.

If the baby has hunger signs after the first breast, give the baby the other breast. Babies will again breastfeed in three stages but they may suck a little less vigorously and for a shorter period on the second side, when compared to the first side, as they already have taken in milk from the first breast. 

The baby should not show any hunger signs after the second side. The baby may happily hand suck; this is not a hunger sign.

H) Other breastfeeds

1) The evening fussies

Babies under five months, tend to have one fussy period in the evening that lasts no more than three hours. During thefussies,” the times spent at the breast are short (five minutes, for example) and frequent and the babies can be unsettled when not breastfeeding. Babies will not generally have the usual three breastfeeding stages during this time. This is normal.

2) Breastfeed to sleep

Babies often ask to breastfeed in order to go to sleep. Such feeds are faster than regular breastfeeds and once latched they will be in the “I’m done” stage within 5-10 minutes and come off the breast asleep.

I) Breastfeeding after one month

As babies grow past the first month, feeds become more variable in quality and length and there is more communication between mother and baby.

1) Shorter feeds

After one month, breastfeeding times often shorten. In the second 6 months of life, breastfeeds during the day sometimes last only 5 to 10 minutes. Nighttime feeds are often a little longer.

2) Distractible

Older babies become more easily distracted while breastfeeding. After one month, while still latched onto the breast, they may suddenly turn their heads toward a distraction such as a noise or person entering the room. Alternatively, they may let go, see what is happening, and then resume breastfeeding. These are both normal.

In general, mothers do not need to isolate themselves to breastfeed a distractible baby out of concern that the baby will not get enough milk.

Babies may be a little more focused during nighttime feeds.

3) Have changes in breastfeeding stage length

Older babies generally spend less time in the “I really like this stage” and are more alert while breastfeeding. They will also vary their breastfeeding stage length from feed to feed.

4) Interact with you

While awake, they will explore your body with their hands. They may:

  • Look at you and at their surroundings.
  • Pat, massage, or push on your breast.
  • Play with the other nipple.
  • Pull or hold onto your earlobe, lip, necklace, or clothing.
  • Want to hold a toy.

5) Signs the baby is done breastfeeding

Normal babies are generally very good at letting you know when they are done or if they need more milk. Just listen to the baby and offer the breast when the baby shows hunger signs. Don’t offer the breast if the baby is no longer interested or resists latching.

After the first month, babies who are finished feeding are more often awake than asleep. After feeds, they will be happy and interested in what is happening around them. When they are tired, they will need to breastfeed to sleep.

References

Howie PW, Houston MJ, Cook A, et al. How long should a breast feed last? Early Hum Dev. 1981 Feb;5(1):71-7
 
Lucas A, Lucas PJ, Baum JD. Pattern of milk flow in breast-fed infants. Lancet. 1979;2(8133):57–58