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by Nils Bergman, MD

Birthing parents are often given the recommendation to wake their babies every three hours for feeding.  We asked Dr. Nils Bergman, on our BWI Board of Advisors and who teaches our Kangaroula Workshops to provide evidence-based research addressing feeding schedules in neonates, as well as the importance of neonatal sleep cycles in both full term and preterm infants. 

Neonatal Sleep Cycles

In neonatal sleep, the first month of life, I don’t consider states of sleep-in isolation but primarily as a single series of phases of a sleep cycle. That sleep cycle is one hour or less which matches the master clock of the neonatal brain, which is “tik tock” between hunger signals and satiety signals.  BUT, that only works on the NON-SEPARATED child. The child separated from his mother takes one hour to reach quiet sleep and is then not cycling. When I have measured it firsthand, there are a variety of states during this time ranging from vigilance to freeze to dissociation -various states of fear.

Waking a baby in the middle of a sleep cycle is not good.  

So the three hourly sleep of both a separated neonate and infant under one year, is not a good thing for both sleep quality and feeding requirements. In fact, it is the WORST for toxic stress effects.  A baby with mother/baby skin-to-skin contact in the first month, and in carry-care for the first year, will not sleep for three hours, and will wake when ready to feed.  Over the course of five to nine months, this adjusts to an adult pattern.  Waking a baby in the middle of a sleep cycle is not good.  But we do not easily recognize the sleep cycle, which is only one hour anyway, even in us as adults, this is true.  But the separated baby has poor quality cycles.  Therefore, I do not teach three hour cycles for infant feeding!

Preterm Infants

Preterms do not give cues…and if they are small and frail, I would feed them hourly and preferably with a sleep monitor that allows care to synchronize with the Quiet Sleep phase (repair time and memory formation, but growth is the whole cycle).  But the principles for best care of preterms is what is best for neonates and infants i.e. small and frequent feeds adjusted to the sleep cycle.  The feeding time is also the emotional connection time between mother and baby. 

A formula fed baby sleeping alone is different.  He normally sleeps for three hours or more.  But we have to ask, ”Is this ‘normal’?”

Nils Bergman MD Dr. Bergman was born in Sweden and raised in Zimbabwe, where he also later worked as a mission doctor. He received his medical degree (MB ChB) at the University of Cape Town, and later a Masters in Public Health at the University of the Western Cape. During his years in Zimbabwe, he completed a doctoral dissertation (MD, equivalent to PhD) on scorpion stings. He has worked in rural South Africa, Zimbabwe and Sweden, and was Senior Medical Superintendent of Mowbray Maternity Hospital in Cape Town, overseeing 18000 births per year. Dr Nils Bergman calls himself a Public Health Physician, and currently promotes and researches skin-to-skin contact on a full-time basis.  He is an Honorary Senior Lecturer at the University of Cape Town, South Africa, and a research affiliate of the South African Medical Research Council. He developed and implemented KMC, Kangaroo Mother Care for premature babies. His research was recently published in the New England Journal of Medicine and the World Health Organization has adopted a policy of Mother/Baby Skin-to-Skin contact as a result of his research.