Newborns, especially those born preterm or early term (around 35 to 37 weeks), often exhibit sleepiness while nursing at the breast. I like to call them "pokey" babies.  This is due to a combination of things - their weak facial and oral muscles, the rapid neurological growth that was meant to occur in the womb, and having fewer energy stores due to being born a bit early.  Sometimes full-term but small newborns can act similarly.  And occasionally, there is a full-term, average-sized baby who is pokey, too - just because. 

Regardless, what you might see is that they cry that they are hungry, then latch, but after a few sucks or swallows, they stop, and it's not easy to get them going again.  This can make a breastfeeding session take a LONG time, or it may end with a sleeping baby who did not eat much, so they wake up again to eat shortly after putting them down.  After a while, this can lead to an especially tiring breastfeeding experience and may make you seek out the help of a lactation consultation.

GUIDANCE FOR FEEDING THE POKEY BABY

Here are some effective strategies to assist these sleepy little ones if your breastfeeding goals include nursing directly at the breast:

1. Embrace Skin-to-Skin Contact: A naked baby is more likely to stay awake due to the slight discomfort of being cold. Additionally, skin-to-skin contact can be stimulating, helping the baby to remain alert. However, it's worth noting that this can sometimes have the opposite effect, lulling some babies into sleep due to its comforting nature.

2. The "One-Handed Breast Pump" Technique: This involves gently moving the baby's arm up and down while they breastfeed. This simple motion can be enough to keep a baby awake and engaged, and it is something a partner can do to help while you're feeding the baby. Tickling the baby’s feet can also be effective.

3. Nursing with Compressions: This technique is particularly useful for babies who struggle to extract breast milk efficiently. By gently compressing the breast throughout a nursing session, you can help push a small amount of milk into the baby's mouth. This not only reminds the baby to feed but also eases their effort, especially beneficial for those needing to build strength.  With this technique, the baby will have better milk intake in each feeding session, leading to longer periods of sleep in between.  

4. Rhythmic Feeding and Compressions: Pay attention to your baby’s feeding rhythm. You may not need to use compressions throughout an entire nursing session, but if you notice frequent pauses in sucking (like pausing after just one or two swallows) the compression during the pause can encourage them to continue feeding. This can lead to more efficient feedings, allowing the baby to consume enough breast milk before falling into such a deep sleep that you simply cannot get them to eat anymore.

5. Identifying When the Baby is Done: As your baby slows down towards the end of a feeding, use compressions to determine if they're truly finished or just need a little encouragement to continue. If the baby resumes vigorous feeding after a compression, they weren't done. However, a significant slowdown, lack of response, or only sucking weakly as if for comfort (with no swallowing) indicates that they've finished.

6. Understanding Comfort Sucking: Post-feeding, babies often engage in comfort sucking. While there’s nothing wrong with this, if you're tired or need a break, recognizing this behavior and taking note when your baby shifts to comfort sucking can help you decide when to end the session.

7. Recognizing Variations in Feeding Patterns: Be aware that your baby’s feeding pace may vary within a session, often in response to your body's letdown reflex. Over time, you’ll learn to discern your child's typical eating patterns and how they correlate with your body’s responses.

I want to stress that when I talk about your baby being done nursing at the breast, that does not always mean your baby has eaten enough.  It's important to seek professional lactation care if you have a pokey baby, to help that your feeding plan is working, your baby is getting enough milk, and they are also growing and gaining weight appropriately.  Sometimes babies do need to take some milk by bottle after nursing to gain weight, and an International Board Certified Lactation Consultant or Breastfeeding Medicine Physician can help you figure this out.

Breastfeeding, while rewarding, can be demanding. It is important to make these sessions as efficient and enjoyable as possible, ensuring both you - the mother - and your baby benefit from this experience. Remember, every baby is unique, and what works for one may not work for another. Patience, experimentation, and attentiveness to your baby's needs are key to a successful breastfeeding journey, along with the help of a lactation specialist if there are any breastfeeding difficulties.  And if the stress and worry of feeding a sleeping baby is weighing on you, reach out to a mental health professional as well, to help you navigate the emotional side of this experience.