Breastfeeding is expected to be given on demand, as much as the baby needs, and several health specialists recommend this. However, some specialists often offer indications of estimated times of how long the baby should remain on each breast and how often the baby should be awakened to feed, which confuses one on the concept of "free demand."

As its name indicates, free demand refers to offering the breast without worrying about schedules or specific duration between feedings; the objective is to prioritize the baby's needs, regulated by their nutritional requirements and emotional bonding.

As we mentioned above, it is recommended among health centers and specialists to breastfeed every 3 hours and with a duration of 15-20 minutes for each breast, this in itself has no scientific basis, and is mostly based on obsolete concepts about breastfeeding or the comfort of the mother. "Free demand" requires much commitment from mom to feed with a certain regularity, interrupting her daily activities and sleep cycle.

We recommend that you consider all the enormous and proven benefits breastfeeding provides for your baby to find the best way to offer the free demand. At first it will be challenging to adapt, but eventually, you and the baby will find a rhythm and routine. It is also important to try to include your partner in this new routine.

For example, many moms choose to co-sleep (sleeping together with the baby in the same bed) or at least have a crib near their bed for nighttime feedings, so that they can also rest.

Speaking about the times previously discussed (3 hours between feedings, 15-20 min each feeding), let's look at it from an updated point of view:

Time between feeds:

Nature is wise, and it is precisely by having our child close to us that we can anticipate their needs. Since they are only able to communicate through crying, it is likely that we will be a little late in meeting their needs when the crying comes.

Nursing Duration.

The time between feedings is important to avoid early withdrawal, rather than leaving your baby suckling for too long.

When your baby is suckling avidly, the first milk that is released is rich mainly in sugars (especially lactose). A mature milk (the one produced when breastfeeding is adequately established, approximately 15 days after the birth of your baby) generally has 2 compositions at each feeding. It is of a lighter consistency, watery and sweet, and its primary function is to quench the baby's thirst and provide the brain's energy requirements.

After this need is quenched, the composition of the milk gradually changes and becomes denser and thicker, with a concentration of fatty acids, to help the baby gain weight as part of their growth.

Both kinds of milk additionally have large amounts of proteins, vitamins, antibodies and other nutrients, the difference lies precisely in the light and sugary composition of the first milk vs. the dense and creamy composition of the second.

There is no exact rule or a way to know when the first milk passes to the second milk in a feeding, but it is known that it ranges from 10 to 15 min. Therefore, if we cover the rule (badly recommended) of giving 15-20 min of each breast, we are leaving nothing or almost no time for the baby to generate the let-down of the second milk, leaving only the first watery milk rich in sugar.

The result? A baby who does not gain weight, or gains it very slowly, and with data of a false lactose intolerance (high sugars in stool study or greenish, explosive, phlegmy stools) and the next thing that is usually done is either a restrictive diet for the mother or, in the worst case, an instruction to discontinue breastfeeding.

False intolerance is actually a logical response to an excessive intake of lactose that the baby's small intestine fails to fully digest and is associated with this, reducing sugars are triggered, increasing intestinal acidity, causing a breakdown in the bacterial flora.

This does not mean that all cases are similar, indeed there are babies with lactose intolerance known as "galactosemia", which is a congenital disease with which you are born and live all your life, however, its incidence is very low (about 1 in 50,000 people) a Pro lactation Pediatrician should properly diagnose this to avoid misdiagnosis.

So what is the rule?

Regulate your baby's feedings so that he satisfies his hunger one breast at a time, this way you will not only provoke the let-down of the second milk in the feeding, but you will begin to develop a breastfeeding pattern.

Many moms usually dedicate feedings to one breast and, with the help of a ribbon (that you can make or buy) that they place on their bra, they identify which breast their baby last nursed from, to start the next feeding with the other breast.

When should I be concerned to identify if my baby is not feeding properly?

There are certain signs that may tell you that breastfeeding is not being correctly established:

Pain while the baby is feeding.
Pain after feeding.
A very long feeding (more than 50 min. Approx.).
No wet diapers.
There is a weight loss of more than 10% of its birth weight.
You have wounds or cracks in your nipples.
Reddened or hard areas, a feeling of fullness in the breast, or fever.

Practically all of these signs indicate an improper latch that can have different origins, both emotional (for example, fear or anxiety of the mother) and physical (such as a short lingual frenulum). To find a solution, it is important that you seek a lactation consultant in person, to help you find if there is any detail in the latch and with their guidance, identify something physical that requires attention from the pediatrician.

How do I know if my baby is gaining weight correctly?

Your pediatrician will help you make sure your baby is growing correctly.

To measure growth, we use charts called "Height and weight percentiles", which are a correlation between your baby's weight, height, and head diameter, taking into consideration their age and sex. When these measurements are taken, they are plotted and it is verified whether or not it is within the percentiles considered as normal or if on the contrary, it is outside these (either below, which would suggest that the baby is not being nourished properly, or above which would suggest that the baby is gaining too much weight).

Now, the percentiles were created under controlled conditions, and it is difficult to consider in a graph the different conditioning factors for each baby, so a low percentile can come out this way, not because the baby is not being nourished correctly but because of genetics, for example, if parents are short in height and/or thin by nature, or vice versa.

It would be very irresponsible to base a judgment of malnutrition or obesity only on the performance of a graph, only with a punctual pediatric follow-up and considering all the external factors is that it can be clearly determined if the baby is actually having some abnormal performance in their expected growth.

What are the key points to know that my baby is feeding correctly?

- By suction. The grip is key, and obeys a series of movements and specific positions of the mouth to know that it is being performed correctly. A good latch does not hurt. To learn more about latching, go to our "How to breastfeed" section.

- For urine and bowel movements. The amount of wet diapers, the consistency of urine and stool say a lot about how well your baby is feeding. To learn more about bowel movements, go to our "Bowel Movements in Breastfeeding" section.

- For your growth monitoring conducted by your pediatrician. Considering percentile checks and other factors, monthly follow-up by your pediatrician, at least during the first year of life, is vital to achieve optimal developmental control.

- By creating feeding and resting patterns. Although erratic at first, as the mother-child relationship is established, it is expected that the baby's feeding and resting patterns will be regulated, establishing a rhythm.

They are NOT points to consider:

- The hardness or softness of your breasts. As breastfeeding becomes established, your breast begins to produce milk the moment they sense suction, so you stop feeling that hardness/softness cycle.

- If your baby suddenly asks to breastfeed more than usual. There are identified times when your baby will demand more milk to increase production, for more information go to our section "Growth spurts and separation distress".

- By the amount of milk you express with the breast pump. Under no circumstances compare pumping vs. a suckling baby, going by this metric is entirely wrong.

- If your breast does not leak milk. Not all moms experience milk let-down to the point of leaking milk, and that doesn't mean your milk production is low.

We will expand on these points in our "Breastfeeding Myths and Problems" section.

Breastfeeding on Demand