The difference between NDC's frequent flexible feeds and traditional advice to breastfeed on demand

The traditional advice to 'breastfeed on demand' may be accompanied by unhelpful beliefs

For many years, breastfeeding advocates have recommended that women breastfeed 'on demand'.

In the 1960s and 1970s, it was advised to space out breastfeeds to every four hours, which was believed to best regulate baby's nervous system. The idea of 'demand breastfeeding' was an important concept, which helped counter the routinised approach to breastfeeds which became socioculturally dominant in the 1950s and 1960s in the West with the advent of Scientific Motherhood and first wave behavioural approaches to infant sleep and feeds.

In the 1980s. 1990s, and 2010s, breastfeeding advocates typically recommended breastfeeding every three hours. Babies who dialled up in between these feeds were often diagnosed with medical conditions, such as reflux or allergy. Feeding every two hours or more often was viewed with concern, and felt to be a cause of lactose overload, gut pain, or sleep problems because 'baby's tummy wasn't full'.

The phrase 'breastfeeding on demand' is still commonly associated with the concept of regular 'mealtimes' at the breast, during which satisfying amounts of milk need to be transferred by the baby. Many women say that they are breastfeeding on demand, by offering the breast every two or three hours. This is of course still generous and responsive breastfeeding, which might work for many families. We would view 'breastfeeding on demand' positively as clinicians in our interactions with families.

But there are some significant differences between traditional meanings often attached to 'breastfeeding on demand', and the NDC concept of frequent flexible breastfeeds, which further benefit many or most families. Unfortunately, the concept of 'breastfeeding on demand' as it is still commonly used, undermines breastfeeding success for some women and their babies.

The word demand also unhelpfully suggests that infants are demanding, or wilful, or asserting control over the mother in ways that might exhaust and drain her.

The NDC concept of frequent flexible feeds does not frame breastfeeds as 'mealtimes'

The NDC concept of frequent flexible feeds speciifically aims to

• Normalise 12 episodes of direct breastfeeding each breast in a 24 hour period

• Emphasise the unpredictability of normal spacing of breastfeeds

• Normalises not needing to offer both breasts 'in a feed', in the same way that switching multiple times between breasts over a short period of time is also normal.

I often use the example of my own eating and drinking habits throughout the day and night when I'm explaining the concept of frequent and flexible feeds to parents. I explain that when I pay attention to how often something (whether fluid or solid food) crosses my lips, I see that it is unexpectedly frequent over the cycle of the day. I might take a small handful of nuts on the way out of the house. I might sip a cup of tea over half an hour or longer. I might have a three course main meal. I might snack on a piece of fruit or cut myself a slice of cheese in the afternoon. I drink a few mouthfuls of water. This is highly irregular, or erratic, I say that our babies' needs for milk is the same - highly irregular, or erratic.

• The meal-time concept can keep women locked into breastfeeding chairs, waiting for baby to 'empty' the breast. This can downregulate her supply.

• She might also feel it necessary to offer both breasts, so that the baby is properly satiated. This can

  • Make breastfeeding burdensome, with a great deal of time invested into ensuring the baby has 'had a meal', even including a 'rest and digest' period between 'fnishing' one breast and offering the other, and

  • Increases the risk of a conditioned dialing up in the baby, because of pressure on feeds.

Breastfeeds are the mother's most powerful tool for downregulating her infant's sympathetic nervous system

• Breastfeeds are conceptualised as a dual opoprtunity for both sensory motor nourishment and perhaps milk transfer (both of which dial the baby down).

• Milk transfer is understood to maintain adequate weight gain over a 24 hour period once clinical problems are identified and managed, if the mother is offering frequent flexible breastfeeds with a focus on keeping her little one dialled down.

• NDC normalises very short breastfeeds, and a high frequency of breast feeds (each breast) that is significantly higher than women typically imagine when they are 'breastfeeding on demand'.

A woman offers baby her breast for her own convenience and enjoyment once she's had a baby, without needing to wait for the baby to 'demand'

• The mother and baby are understood as a complex adaptive system, where the needs of both have to be met within the breastfeeding relationship, in order for it to be sustainable and enjoyable.

• The baby is not conceptualised as 'demanding' or making 'demands' but as interacting within a complex system in which the mother sometimes offers the breast and othertimes might offer sensory motor nourishment when the baby dials up

• The mother takes the baby off when she has had enough with breastfeeding (and sees what happens).

• NDC frees women to offer the breast again to dial the baby down even if the baby has 'just breastfed'.