Newborn Behavior and Communication

Newborn feeding patterns vary by infant, age and sometimes time of day. Often, babies will increase the number of times they are feeding in a 24- hour period. This is called cluster feeding and is normal. Cluster feeding can occur in the early evenings and may come with a little more fussiness than usual. Encouraging the mother to find a comfortable spot to settle in to feed and nurture her infant is optimal.  

There are also times when a baby’s body is changing, and he may spend 1 – 2 days cluster feeding or spend longer times breastfeeding than previous patterns. These periods are often called growth spurts, although they may not be specifically related to a change in growth.  

Mothers often feel a change in the infant’s feeding frequency or intensity means a change in her milk production. Reassure mother that cluster feeding is common, especially during the early days of breastfeeding when infants are prone to spend more time in light sleep. Feedings will fall into a more routine pattern as baby gets older.

Hunger and satiety cues help parents assess when the infant is ready to start and end a feeding. When bottle-feeding, missed satiety cues can lead to overfeeding, discomfort, reflux or vomiting.

Hunger Cues

The following signs that can indicate baby's readiness to feed

• Head bobs searching for nipple (rooting)
• Lip smacking, sticking out tongue, mouth opens
• Hand to face/mouth 
• Rapid eye movement under eyelids
• Small body movements (kicking)
• Small sounds

Satiety Cues 

Cues that signal the infant's desire to end the feeding. 

• Suckling stops or a change in the pattern or degree of suction is noted
• Spontaneous release of the breast
• Falling asleep
• Turning face from breast paired with relaxation of the hands and body

• Provide anticipatory guidance for feeding pattern changes and related fussiness at the 2-day follow-up and again at the 2-3-week well baby check. Tips for mom include: 
  • Hold baby skin-to-skin. Research shows that skin-to-skin is beneficial for months after birth.
  • Plan appropriate play-time with baby.
  • Take baby out for a walk.
  • Carry baby in a baby sling. 
  • Give baby a warm bath.
  • Recommend a break for mom by having someone else care for the baby if infant fussiness or feeding becomes difficult to manage.
• Discourage timed feeding, rather educate parents on the bigger clinical picture of breastfeeding (satiety cues, weight gain/loss, intake and output, comfort of mother). Perform visual feeding assessment, weight check and review intake and output to verify normal growth and development. If unable to visually assess feeding, refer to a Lactation Consultant for further assistance.
• If normal growth is established, reassure and educate mom on expected newborn growth patterns and support 8-12 or more feedings as a normal expected pattern. 
• If there has not been adequate growth and development, identify the cause. Refer mom to a lactation consultant to assist with breastfeeding issues.
• Explain the small size of baby's stomach and expected physiologic stomach capacity to help reinforce why frequent feedings are needed.

1. Brazelton, T. B., & Sparrow, J. D. (2006). Touchpoints: Birth to Three: Your child's emotional and behavioral development (2nd ed.). Merloyd Lawrence. 
2. Campbell, S. H., Lauwers, J., Mannel, R., & Spencer, B. (2019). Core curriculum for interdisciplinary lactation care. Jones & Bartlett Learning. 
3. Fouts, H. N., Hewlett, B. S., & Lamb, M. E. (2012). A biocultural approach to breastfeeding interactions in Central Africa. American Anthropologist, 114(1), 123–136. 
4. Heinig, M. J., Follett, J. R., Ishii, K. D., Kavanagh-Prochaska, K., Cohen, R., & Panchula, J. (2006). Barriers to compliance with infant-feeding recommendations among low-income women. Journal of Human Lactation, 22(1), 27–38. 
5. Kent, J. C., Mitoulas, L. R., Cregan, M. D., Ramsay, D. T., Doherty, D. A., & Hartmann, P. E. (2006). Volume and frequency of breastfeedings and fat content of breast milk throughout the day. Pediatrics, 117(3), e387–e395. 
6. Lawrence, R. A., & Lawrence, R. M. (2016). Breastfeeding: A guide for the medical profession (8th ed.). Elsevier. 
7. Sadurni, M., Pérez Burriel, M., & Plooij, F. X. (2010). The temporal relation between regression and transition periods in early infancy. The Spanish Journal of Psychology, 13(1), 112–126.
8. Sisk, P. M., Lovelady, C. A., Dillard, R. G., & Gruber, K. J. (2006). Lactation counseling for mothers of very low birth weight infants: effect on maternal anxiety and infant intake of human milk. Pediatrics, 117(1), e67–e75. 
9. Stuart-Macadam, P., & Dettwyler, K. A. (1995). Breastfeeding: Biocultural perspectives (1st ed.). Aldine De Gruyter. 
10. Woolridge, M. W., Baum, J. D., & Drewett, R. F. (1980). Does a change in the composition of human milk affect sucking patterns and milk intake?. Lancet (London, England), 2(8207), 1292–1293. 
11. Woolridge, M. W., Ingram, J. C., & Baum, J. D. (1990). Do changes in pattern of breast usage alter the baby's nutrient intake?. Lancet (London, England), 336(8712), 395–397.