Written by Jody Segrave-Daly, RN, MS, IBCLC
As a NICU/nursery nurse and IBCLC who has worked with newborn babies her entire nursing career, I was mystified when I first heard the phrase “second night syndrome.” When I began to research where the phrase came from, it became clear that this phrase is not based on any scientific research, but rather based on a theory that describes behavior of exclusively breastfed newborns on their second day of life. I think it is a frightening phrase for new parents to hear, as the word “syndrome” is defined as a group of signs and symptoms that occur together and characterize a particular abnormality or condition.
Babies can go into a very deep, recovery sleep period after the first 2 hours from birth. This period can range from 8-12 hours after birth and is often a time that babies may not wake up on their own to feed every 2-3 hours. Babies often need gentle encouragement from their parents to wake them up for feeding sessions. Some babies will nurse for 5 minutes or suckle on a bottle for 5 minutes or less and fall back asleep. It’s well known that babies are fasting during this time and if they have enough caloric reserves, they may tolerate this fasting period without complications. Nursery nurses are quite skilled with performing clinical assessments of babies to ensure they are stable. They are looking for signs of hypoglycemia or low blood sugar levels, jaundice and other abnormal clinical markers. Ten percent of healthy, full-term exclusively breastfed newborns develop hypoglycemia in the first days of life and may require specialized care until they are stable. All babies are transitioning from intrauterine to extra-uterine life and need skilled observation from the nurse while they are bonding with their parents in their room.
After babies begin to ‘wake-up’ from their deep recovery sleep period on their second day of life, they will begin to exhibit stronger hunger cues to nurse or bottle feed, every 2-3 hours and they become much more alert. This is a new opportunity for parents to bond because their babies become alert again, opening their eyes while gazing at their parent’s adoring faces. Some babies are a bit demanding during this time because they are very hungry. Newborn babies are very easy to console after their feeding by being held and snuggled. Every nursery nurse will tell you if a baby is not content after feeding, something is wrong. I suspect this is where the word “syndrome” came from, which describes abnormal infant behavior.
What does the newborn feeding pattern look like?
Breastfeeding: Every 2-3 hours a baby will nurse for at least 15 minutes on each breast and burp. Parents can change the baby’s diaper and then cuddle while baby is falling back asleep. Breastfeeding every 2-3 hours also stimulates the milk-making hormone cascade, which brings in a mother’s full milk supply in 2-3 days. Make sure to check our resources on breastfeeding latch and safe positioning while breastfeeding.
Bottle and formula feeding: Sometimes, bottle feeding will take about half as much time as breastfeeding, but similar feeding patterns occur because of the same caloric needs and the same infant stomach size, which is roughly 20 mLs.
Common volumes of formula per feeding by age:
- 1-24 hours old: 15-30 mL
- 24-48 hours old: 20-40 mL
- 48-72 hours old: 25-50 mL
These are approximate volumes as some babies may in fact take more milk per feeding depending on the fuel reserve they are born with, what size they are, their gestational age and many other variables. If they do take more, that is okay. Ultimately, your newborn is the only one who knows what volume of milk they need to meet their needs.
Frequency of feeding for bottle-feeding babies:
- Term newborns that weigh over 6 pounds will feed the first 3 days of life, close to every 3 hours.
- Term newborns who weigh less than 6 pounds will feed the first 3 days of life, every 2-3 hours.
- After 3 days, feed on demand according to your pediatrician’s guidelines.
- A newborn should not go greater than 4 hours without a successful and satisfied feeding especially in the first days of life.
Some breastfeeding mothers talk about the “second night syndrome” by describing it as absolute hell! They describe their babies as nursing non-stop and as soon as they take baby off the breast they cry frantically. The only time their babies are not crying is when they are breastfeeding. Some mothers say their babies even cry while frantically nursing and nothing consoles them. The second night of your baby’s life should never be hell. If your baby is crying non-stop despite adequate breastfeeding, an immediate physical assessment by the RN or MD should be made to determine why your baby is crying and if immediate supplementation is necessary. A check of their glucose, bilirubin and weight should be performed by a nurse, physician or nurse practitioner to assess whether a newborn is being sufficiently fed and whether supplementation is needed to protect your newborn. Research tells us that 1 in 5 mothers have delayed onset of full milk production, so we simply cannot ignore the abnormal behavior of a non-stop crying baby, knowing there will be babies who need to be supplemented.
Bottle feeding babies do not have ‘second night syndrome’ because we can see how much milk they are eating and they have access to the volume they need. Many mothers make enough colostrum to fully feed their babies but at least 1 in 5 mothers will not. We must provide timely supplementation for these babies while a mother is instructed on how to stimulate both breasts adequately until the onset of a full milk supply. Studies show supplementation, when necessary, nearly doubles exclusive breastfeeding rates at 3 months.
Preventing breastfeeding complications from inadequate colostrum intake is the ethical and safe thing to do as no baby should be underfed and forced to cry out in hunger in order to increase exclusive breastfeeding rates before hospital discharge.
What to expect in the first days home FOR Breastfed Babies
Most breastfeeding mothers are discharged from the hospital before their full milk supply is in. Some mothers will find their babies will be very fussy and not satisfied after constant breastfeeding and become increasingly jaundiced. They panic when they realize their baby needs more than their milk can provide and they don’t know how to supplement their baby or how to prepare formula safely.
Some babies will be very sleepy and lethargic when they are not receiving enough colostrum, which is the exact opposite of the non-stop crying baby. These babies will also need to be supplemented if they are not feeding well.
If at anytime a mother has concerns about her baby not being well-fed, it is necessary to call the pediatrician or family physician immediately. You may supplement your baby after nursing sessions especially if your milk is not in in order to keep your baby safely fed. Research has shown that properly managed supplementation in the first days of life to relieve hunger will not impact your breastfeeding relationship and may in fact protect it. More importantly, it can protect your baby from serious complications due to insufficient feeding. It is also recommended for a mother to see her pediatrician the next day after discharge (within 12 hours) from the hospital.
Unfortunately, the phrases “cluster feeding” and the “second night syndrome” are phrases that are often confused with each other. I wrote about what cluster feeding is.
When is cluster feeding considered normal?
- It happens only after a mother’s full milk supply is in, after birth.
- It is during a limited time period of 3-4 hours in 24 hours.
- The breastfeeding mother has adequate milk supply.
- Baby is having plenty of dirty and wet diapers.
- The baby is gaining enough weight.
Painful, cracked and bleeding nipples are a serious complication of frequent and prolonged nursing and sore nipples are one of the top reasons why moms stop nursing. Taking necessary pain medication while in the hospital often masks nipple pain and when a mom gets home, with scabbed bleeding nipples, nursing becomes unbearable. Telling mothers to keep breastfeeding for lengthy periods of time to pacify a hungry baby is the perfect storm for a traumatic and resentful initial breastfeeding experience.
Take Home Message
It is important to keep breastfeeding a pleasant and gentle experience for both mom and baby. This can be achieved with preparation, flexibility, knowing the difference between a hungry and satisfied baby and knowing the signs of when supplementation may be necessary to protect your baby and your breastfeeding relationship.
HOW YOU CAN SUPPORT FED IS BEST
There are many ways you can support the mission of the Fed is Best Foundation. Please consider contributing in the following ways:
- Join the Fed is Best Volunteer group to help us reach Obstetric Health Providers to advocate for counseling of new mothers on the importance of safe infant feeding.
- Make a donation to the Fed is Best Foundation. We are using funds from donations to cover the cost of our website, our social media ads, our printing and mailing costs to reach health providers and hospitals. We do not accept donations from breast- or formula-feeding companies and 100% of your donations go toward these operational costs. All the work of the Foundation is achieved via the pro bono and volunteer work of its supporters.
- Share the stories and the message of the Fed is Best Foundation through word-of-mouth, by posting on your social media page and by sending our resources to expectant moms that you know. Share the Fed is Best campaign letter with everyone you know.
- Write a letter to your health providers and hospitals about the Fed is Best Foundation. Write them about feeding complications your child may have experienced.
- Print out our letter to obstetric providers and mail them to your local obstetricians, midwives, family practitioners who provide obstetric care and hospitals.
- Write your local elected officials about what is happening to newborn babies in hospitals and ask for legal protection of newborn babies from underfeeding and of mother’s rights to honest informed consent on the risks of insufficient feeding of breastfed babies.
- Send us your stories. Share with us your successes, your struggles and every thing in between. Every story saves another child from experiencing the same and teaches another mom how to safely feed her baby. Every voice contributes to change.
- Send us messages of support. We work every single day to make infant feeding safe and supportive of every mother and child. Your messages of support keep us all going.
Thank you so much from the Founders of the Fed is Best Foundation!