The ‘Second Night Syndrome’ is Abnormal and This is Why

Written by Jody Segrave-Daly, MS, RN, IBCLC

As a NICU/nursery nurse and IBCLC who has worked with newborn babies my 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 it is not based on any scientific research but rather on a theory that describes the behavior of exclusively breastfed newborns on their second day of life. It’s a frightening phrase for new parents to hear, as “syndrome” is defined as a group of signs and symptoms that characterize a particular abnormality or condition. 

 

What is Normal Newborn Behavior

Babies 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 encouragement from their parents to wake them up for feeding sessions. Some babies are so sleepy that they nurse for 5 minutes or suckle on a bottle for 5 minutes or less and fall back asleep. It’s well known that babies fast during this time, and if they have enough caloric reserves, they may tolerate this fasting period without complications.

Nursery nurses are skilled in 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.  Hypoglycemia has serious complications if uncorrected with supplementation. All babies transition from intrauterine to extra-uterine life and require skilled nurse observation.

After babies begin to ‘wake-up’ from their deep recovery sleep period on their second day of life, they will exhibit stronger hunger cues to nurse or bottle-feed every 2-3 hours and 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 very demanding during this time because they are hungry.

Newborn babies are very easy to console after their feeding by being held and snuggled. Every nursery nurse will tell you something is wrong if a baby is not content after feeding. 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.   Breastfeeding every 2-3 hours also stimulates the milk-making hormone cascade, which brings in a mother’s milk in 2-3 days.  If your sleepy baby is not nursing effectively, self-expression of colostrum or pumping is necessary. Feed your baby with your expressed colostrum.

Supplementing is necessary if you are not producing enough because drops of colostrum are not enough to sustain your baby’s hunger and thirst. Check our resources on breastfeeding latch, safe positioning while breastfeeding, and how to supplement your baby while protecting your milk supply.

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 -30 mL. 

  • Term newborns weighing over 6 pounds will feed for the first three days of life, nearly every 3 hours.
  • Term newborns who weigh less than 6 pounds will feed the first three days of life every 2-3 hours.
  • After three days, feed on demand according to your pediatrician’s guidelines.
  • A newborn should not go greater than 4 hours without a successful and satisfactory feeding, especially in the first days of life.
How Much Milk Does My Baby Need?
  1. 1-24 hours old: 15-30 mL 
  2. 24-48 hours old: 20-40 mL
  3.  48-72 hours old: 25-50 mL

These are approximate volumes as some babies may take more milk per feeding depending on the fuel reserve they are born with, their weight, their gestational age, and many other variables. For example, a 9-pound baby may want to take 45 ml at each or some feedings. If they do take more, that is okay. A 24-hour volume intake is the most important consideration, as babies can vary from feed to feed, as exhibited by their hunger cues. 

#2 Why Fed is Best- CaloriesColostrum(1)

Colostrum has fewer calories(3 calories/5 ml) than mature human milk (5 calories/5 ml).

But what about the newborn stomach size?

The newborn stomach size is 4-5 times larger than the parents are being told. Why? To prevent babies from being supplemented is my first guess. 

What does the research say about the newborn stomach size?

The Newborn Stomach Size Myth: It is NOT 5-7 mL

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 the 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 cried while frantically nursing, and nothing consoled them

Signs of infant hunger.

PLEASE know the second night of your baby’s life should never be hell. If your baby is crying non-stop despite adequate breastfeeding, a heel stick check of their glucose (blood sugar), bilirubin, electrolytes, 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 from complications of insufficient breastfeeding. *Note: Your baby can be supplemented if you wish to avoid the stress of blood work.

 

What does research say about colostrum production and milk supply?

Research tells us the delayed onset of full milk production is common, so we cannot ignore the abnormal behavior of a non-stop crying baby,  knowing there will be babies who need to be supplemented until the milk supply is adequate. At least 1 in 5 mothers have delayed the 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. 

 

Even Baby-Friendly has admitted that DOL2 is common. BFUSA: “Delayed lactogenesis is actually increasingly common because the risk factors for it are potentially increasing,” Dr. Rosen-Carole 

Baby-Friendly USA Acknowledges Their Mistakes; Are They Going To Make Real Changes In The New Year Or Are They Providing Lip Service To Mothers?

 

Did you know Bottle-feeding babies do not experience ‘second-night syndrome’

Our ability to see how much milk they consume allows us to provide them with what they need and want. There is no guessing involved. 

The good news about temporary supplementation

 Studies show supplementation, when necessary, nearly doubles exclusive breastfeeding rates at three 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 to increase exclusive breastfeeding rates before hospital discharge. 

What to expect in the first days home FOR Breastfed Babies

Most breastfeeding families are discharged from the hospital before the arrival of lactogenesis 2 (milk arrival). Mothers have told us they are at home when their baby begins to become very fussy and not satisfied after constant breastfeeding. 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.

Note: Some babies will be sleepy and lethargic when they do not receive enough colostrum, which is the opposite of a non-stop crying baby. These babies must also be supplemented if they are not feeding well. 

If a mother has concerns about her baby not being well-fed, she must call the pediatrician or family physician immediately. You may supplement your baby after nursing sessions, especially if your milk is not enough to keep your baby safely fed. Research has shown that properly managed supplementation to relieve hunger in the first days of life will not impact your breastfeeding relationship and may 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.

What happens when a newborn hunger cries are ignored? 

My Three Day Old Baby Went Limp And Turned Blue; She Was Starving And I Almost Lost Her

Unfortunately, 1 in 71 exclusively breastfeeding babies are rehospitalized because of insufficient milk intake during the first days of life. 

Cluster Feeding

Unfortunately, the phrases “cluster feeding” and “second-night syndrome” are often confused with each other. I wrote about what cluster feeding is and how to know the difference. 

Painful nipples from prolonged nursing

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.  

The 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 when supplementation may be necessary to protect your baby and your breastfeeding relationship. 

 

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Jody Segrave-Daly’s 32-year nursing career has been dedicated to caring for healthy and medically fragile babies in the nursery and NICU. When she began her community-based infant feeding practice ten years ago, she was unprepared to see the significant numbers of babies suffering from accidental starvation complications. The stories she heard were the same —distressed mothers were being told never to supplement their crying, sleepy, jaundiced, and dehydrated babies — or risk ruining their breastfeeding relationship and milk supply. She has comforted countless mothers worldwide who believed it was rare to under-produce breast milk and often felt betrayed by their lactation and healthcare teams, their bodies, and the social pressure that insisted “Breast Is Best.” Now a staunch advocate for the Fed Is Best movement; Jody works to debunk those myths while supporting families to breastfeed, mix-feed, pump-milk-feed, formula-feed, and tube-feed their babies.  She uses evidence-based science and her years of clinical experience to support SAFE infant feeding.  If you need help, please join our support group or  contact me directly at jody@fedisbest.org 

 

If I Had Given Him Just One Bottle, He Would Be Alive.

My Baby Scream-Cried The Entire Second Night In The Hospital

How To Prepare For Supplementing When Breastfeeding Your Baby In The Hospital

Feed Your Baby—When Supplementing Saves Breastfeeding and Lives

Just One Bottle Would Have Kept My Baby Off Life Support

FAQs Part 2: Does The Fed Is Best Foundation Believe All Exclusively Breastfed Babies Need Supplementation?

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:

  1. Send us your stories!  Share your successes, struggles, and everything in between with us. Every story saves another child from experiencing the same and teaches another mom how to feed her baby safely. Every voice contributes to change. Send to: Jody@fedisbest.org
  2. 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, and 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 of the Foundation’s work is achieved via its supporters’ pro bono and volunteer work.
  3. 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 you know. Share the Fed is Best campaign letter with everyone you know.
  4. 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.
  5. Print out our letter to obstetric providers and mail it to your local obstetricians, midwives, and family practitioners who provide obstetric care and hospitals.
  6. 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 for the mother’s rights to honest, informed consent on the risks of insufficient feeding of breastfed babies.7.Send us messages of support. We work daily to make infant feeding safe and supportive of every mother and child.  It is your messages of support that keep us all going. The work we do is very emotional and heavy. Thank you!

Thank you so much from the Founders of the Fed is Best Foundation!

 

 


Resources and additional education LINKS

 

How To Prepare For Supplementing When Breastfeeding Your Baby In The Hospital – Fed Is Best

Hospital Drops Baby-Friendly Program After Doctor’s Baby Was Harmed – Fed Is Best

 

 

 

 

The Loss Of Our Son Has Devastated Our Family – This Time I Will Be Supplementing With Formula After Every Nursing session

Hospital Drops Baby-Friendly Program After Doctor’s Baby Was Harmed – Fed Is Best

 

 

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:

    1. 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.
    2. 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, and 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 of the Foundation’s work is achieved via its supporters’ pro bono and volunteer work.
    3. 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.
    4. Write a letter to your health providers and hospitals about the Fed is Best Foundation. Write to them about feeding complications your child may have experienced.
    5. Print out our letter to obstetric providers and mail them to your local obstetricians, midwives, and family practitioners who provide obstetric care and hospitals.
    6. Write your local elected officials about what is happening to newborn babies in hospitals and ask for the legal protection of newborn babies from underfeeding and of the mother’s right to honest informed consent on the risks of insufficient breastfeeding of breastfed babies.
    7. Send us your stories. Share with us your successes, your struggles and everything in between. Every story saves another child from experiencing the same and teaches another mom how to feed her baby safely. Every voice contributes to change.
    8. Send us messages of support. We work daily to make infant feeding safe and supportive of every mother and child.  Your messages of support keep us all going.

Donate to Fed is Best

Thank you so much from the Founders of the Fed is Best Foundation!

 

 

Dr. del Castillo-Hegyi Raises Awareness at the U.S. Task Force for Research Specific to Pregnant and Lactating Women at the NIH

Bethesda, MD—On February 26, 2018, Dr. Christie del Castillo-Hegyi, Co-Founder of the Fed is Best Foundation traveled to the NIH to raise awareness on the gaps in breastfeeding protocols, research and education that is leading to common and serious complications in exclusively breastfed newborns.

PRGLAC Participant List, February 26-27, 2018

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What Is “Cluster-Feeding”And Is It Normal?

Written by: Jody Segrave-Daly, MS, RN, IBCLC

Cluster feeding is a phrase that is used to describe infant feeding behavior(s). Generally, it’s breastfeeding or bottle feeding that is in a different pattern from your baby’s typical feeding pattern. It is described as breastfeeding sessions or bottle-feeding sessions that are much shorter and more frequent, for 3-4 hours of the day. It often happens during a baby’s fussy period of the day. The Academy Of Breastfeeding Medicine defines cluster feeding as “several short feedings close together.”  However, new mothers are being told constant and prolonged feeding around the clock in the hospital is “cluster feeding,” and this is where confusion that can result in harm begins. There is a point when cluster feeding becomes a clear sign of insufficient breast milk and/or insufficient transfer of milk, and those signs must be taken seriously for the health and safety of the infant. Mothers tell us they receive conflicting information and as a result, they become very frustrated, lose confidence and want to stop breastfeeding. Or, they persist with exclusive breastfeeding due to incorrect advice, and negative outcomes occur.

Cluster feeding is also a phrase that sometimes is also called “comfort-feeding.”  As parents, we react to infant cries and feeding cues, so naturally, we will assume a baby is hungry and when we feed them, they will be satisfied. But some babies will snack and will not take a full feeding during their cluster-feeding time; this is normal. Some babies simply want to suckle on a pacifier after nursing or bottle feeding. This is because their bellies are full, but they want to suckle for soothing and not for feeding of milk.  Some breastfeeding babies will suckle, using non-nutritive sucking patterns for soothing only. Some babies will also want to be held and snuggled or may want to be carried or want movement while suckling too!   

Cluster feeding can also happen during growth spurts as well, but babies generally take in more milk during this time. It can also happen during times when a baby is not feeling well, teething or is tired or cranky.  And it’s true—some babies don’t cluster feed at all. My exclusively breastfed babies never did and preferred sucking on a pacifier, after nursing for comfort. 

When is cluster feeding considered normal?

  • It happens 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.

If you are concerned that you are not making enough breast milk, or your baby isn’t transferring enough milk, you can do a simple check to see if you are.

SSS1

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Starvation Jaundice and Bilirubin-Induced Brain Injury in Breastfed Newborns

Lecture Delivered by Dr. Lawrence Gartner, Director of Baby-Friendly USA

We have uncovered a lecture provided to lactation consultants at a prominent breastfeeding conference given by Baby-Friendly USA Director, Dr. Lawrence Gartner, who discussed the risk of brain injury from starvation-related jaundice, called kernicterus, 90% of which occurs to breastfed babies who lose excessive weight, according to his lecture. Yet despite this training, no information on the risk of preventable brain injury from starvation-related jaundice in breastfed newborns exists in patient-directed breastfeeding literature published by breastfeeding advocacy groups other than our own.

 

 

 

 

Exclusively Breastfed Newborns Have Double the Risk of Being Rehospitalized

By Christie del Castillo-Hegyi, M.D.

This week, the journal Academic Pediatrics, published a study conducted by the Newborn Weight Loss research group led by Drs. Valerie Flaherman and Ian Paul, which consisted of 143,889 healthy, term and near-term newborns born at the Baby-Friendly Northern California Kaiser Permanente hospital system from 2009-2013.[1] They included newborns who were discharged from their birth hospitalization without requirement of intensive care, which includes newborns who developed jaundice before discharge. They looked at the effects of mode of feeding, namely exclusive breastfeeding and exclusive formula feeding during the birth hospitalization on the rates of rehospitalization and number of outpatient follow-up visits. In addition, they looked at the effects of percent weight loss on the same outcomes.

Overall, 6.2% (1 in 16) of the healthy term newborns studied were readmitted; 4% were vaginally delivered and 2.2% were Cesarean delivered. This represents 8921 newborns over the five year period, almost 5 babies per day. They showed that exclusively breastfed newborns had slightly more than double the risk of being rehospitalized, even when adjusted for gestational age, birth weight and maternal race/ethnicity. Exclusively breastfed newborns also had significantly more (32% more) outpatient visits in the first 30 days after birth compared to exclusively formula-fed newborns. The leading cause of readmission was for hyperbilirubinemia or jaundice and need for inpatient phototherapy. The purpose of phototherapy is to reduce blood bilirubin levels in order to prevent or limit brain injury, a complication of insufficient feeding and dehydration commonly found in exclusively breastfed newborns before the onset of copious milk production (lactogenesis II).

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