Breastfed infants tend to eat more frequently than formula-fed infants, and this can surprise parents. In the early days, 10-12 feedings a day (or more) is completely normal. Once the milk “comes in” at day 3-5, feedings often spread out somewhat, to every 1-3 hours, or 8-12 times a day. It is normal for young infants to have times during the day when they cluster-feed, meaning that they feed every hour for 2-3 feedings in a row. This tends to happen when they are quite awake, such as in the morning or in the evening.

Infants who continue to feed every hour around the clock ought to be further evaluated. A weight should be checked and plotted on a growth curve, to be sure that they are transferring sufficient milk.

The most common reasons for excessive feeding frequency include:

• Poor milk removal- this would be identified by performing a pre and post-feed weight on a digital scale sensitive to 2 grams. If the infant takes a volume that only allows satiation for an hour, and the mother can express significantly more milk than what the infant took, then the infant didn’t transfer milk well. This is often due to infant sleepiness at the breast, but can also be due to infant feeding problems such as gastroesophageal reflux, tongue-tie, or other health issues. A lactation specialist should be involved in evaluating this situation.
• Maternal low milk supply– Even if the infant is gaining adequately, the supply may be marginal, such that the infant needs to feed very often to gain sufficiently. The low supply can be from several causes, see the section on Low Milk Supply. A subset of mothers with a low supply have a small amount of glandular tissue, meaning that they make small amounts of milk at one time. The infant has to feed often to obtain sufficient milk.

Parents may desire a plan to resolve such frequent feedings. If the infant is not removing sufficient milk, the mother will need to express milk after feeding and supplement the infant, while a lactation specialist determines the underlying problem and solution. If the mother’s milk supply is low, the infant will need supplementation with donor milk or formula, as the lactation specialist determines how to help the mother increase her supply.