Should an infant be awakened to feed?

Infant Feeding Schedules: When to Wake an Infant for Feeding

Infants should generally be fed according to their natural sleep-wake cycles rather than awakened for feeding, except in specific circumstances such as newborns, preterm infants, or those with poor weight gain. 1

General Principles for Infant Feeding

Healthy Term Infants

• Allow infants to establish their own feeding patterns based on hunger cues
• Feeding should coordinate with the baby's natural sleep cycle to encourage natural patterns between sleep, awake time, and feeding 1
• Excessive crying periods should not occur because of predetermined feeding schedules 1

Special Circumstances Requiring Scheduled Feedings

Wake infant for feeding when:

1. Newborn period (first few weeks of life) - to establish feeding and ensure adequate nutrition
2. Preterm or low birth weight infants - who may need more frequent feedings for growth
3. Poor weight gain - infants not meeting expected growth parameters
4. Medical conditions requiring strict nutritional management

Age-Specific Feeding Considerations

Newborns (0-1 month)

• Newborns sleep approximately 70% of the day (14-17 hours) with sleep distributed throughout the day 2
• May need to be awakened every 2-3 hours to ensure adequate nutrition until birth weight is regained and consistent weight gain is established
• Once consistent weight gain is established, can transition to on-demand feeding

Infants 1-6 months

• As infants mature, sleep patterns naturally consolidate 2
• Between 1-3 months, rhythms in sleep-wake cycles begin to emerge 2
• Feeding should be timed to coordinate with the baby's natural sleep cycle 1
• Breast milk or formula is the mainstay of nutrition during this period 3

Infants 6-12 months

• Complementary foods should be introduced between 17-26 weeks (4-6 months) 1
• Feeding schedules become more predictable
• Nutritional requirements increase for protein, vitamins, and minerals 3
• Daytime activities and feeding should occur during daylight hours to help establish circadian rhythms 2

Special Considerations

Preterm Infants

• Preterm infants are at increased risk of SIDS and require specialized feeding approaches 2
• May need more frequent feedings to ensure adequate growth
• Trophic feedings (small volume of feeding given at the same rate for at least 5 days) may be used to enhance feeding tolerance 4
• Breast milk is preferred but may need fortification to meet nutritional needs of very low birth weight infants 4

Infants with Chronic Lung Disease

• Feeding should be timed to coordinate with the baby's natural sleep cycle 1
• May require more careful monitoring of feeding tolerance and respiratory status during feeds
• Continuous naso- or orogastric tube feedings may be necessary in young, immature infants 1

Common Pitfalls to Avoid

• Creating rigid feeding schedules that disrupt natural sleep-wake cycles
• Ignoring hunger cues by strictly adhering to predetermined feeding times
• Inconsistent approaches to sleep and feeding routines that undermine healthy pattern development 2
• Overfeeding to encourage longer sleep periods, which can lead to excessive weight gain

When to Consult a Healthcare Provider

• If infant is not gaining weight appropriately
• If sleep problems persist beyond 2-3 weeks despite consistent approaches 2
• If there are concerns about breathing patterns during sleep
• If feeding issues are significantly affecting family functioning

By respecting an infant's natural feeding patterns while ensuring adequate nutrition, parents can help establish healthy eating habits and support optimal development.