Early in my career as a pediatrician, I spent my days in the hospital caring for babies in the first couple of days of their life. As time went on, I began to miss seeing the bigger kids and watching children grow up. These are things that I anticipated enjoying as I became a general pediatrician. While I adored the young babies and all of the benefits of working in the hospital, the older babies called me back to general pediatrics. And I’m not going to lie to you, it was the 4 month old babies that were the main deciding factor in my return to caring for kids of all ages. This has always been my favorite age for many reasons.
Even as a mother, I enjoyed this age more than any other part of the first year of my daughter’s life.
While 4 months of age is a delightful time for many reasons, it can also throw a wrench in your breastfeeding path if you don’t know what to expect. It is not that babies at these age change so dramatically that you need to learn a whole new set of skills. Often, it is a time where babies change in a way that causes mothers to doubt that their breast milk is enough for their baby anymore.
If you can anticipate these changes and understand what is normal, you will be less likely to quit breastfeeding. That is my goal for writing this article for you.
Breastfed Babies At 4 Months of Life, What Changes?
Between the ages of 3 and 4 months of life, a baby’s growth velocity begins to slow. At this age, they gain weight at a rate of about 15-20 grams per day (half an ounce per day). This is in comparison to their rapid growth of an ounce per day in the first few months of life. While this is a normal and expected change, sometimes it can throw new mothers off course when they see their little one not make moves on the growth chart.
In addition, four month old babies eat larger volumes of breast milk, fewer times per day. Often, these kiddos will consume 3-4 ounces per feeding instead of the 2-3 ounces they were taking previously. Also, at this age there can be a change in night feedings. Some babies will sleep longer stretches at night and feed less often. As long as your baby is gaining weight appropriately, this is a very welcome and acceptable change for most parents.
4 month old Baby Milestones
Babies at four months undergo important milestones and developmental changes. They can start rolling over from tummy to back and can grasp objects and bring them to their mouth. Additionally, they begin to babble and make more vocal sounds, showing signs of early language development. At this age, babies also experience an increase in drool and frequently engage in hand to mouth movements.
As we discussed earlier, babies take more ounces per feeding less often. If you are mostly direct breastfeeding, you don’t necessarily know exactly how many ounces your baby is taking, but you will notice that they eat less often.
For exclusively breastfed babies, we recommend waiting until 6 months of age to begin introducing solid foods to your baby. Breast milk should continue to be their sole source of nutrition.
In addition, your baby’s sleep patterns undergo changes around the age of 4 months. This is commonly referred to as the “4 month sleep regression.” However, it actually signifies a progression in their sleep development. During this stage, babies start consolidating their sleep into 90-120 minute intervals, which remains the same sleep pattern throughout their lifetime. It is termed as a regression because babies may wake up at the end of these intervals and if they are unable soothe themselves back into sleep, they cry out for assistance.
These milestones lead to significant changes in a baby’s feeding schedule and breastfeeding patterns.
Your baby feeding schedule will change whether you feed formula, breast milk or a combination of the two. Formula-fed babies also go through changes in feeding and sleeping patterns at this age.
Nursing Frequency Changes
Newborn babies usually breastfeed every 1-3 hours, or around 8-12 times a day. In the first few days after birth, they may breastfeed even more often until they regain their birth weight. Babies between 1-6 months old tend to breastfeed about 7-9 times a day. Older babies, 6-12 months, may breastfeed 4-6 times a day.
In addition, babies will have growth spurts which cause them to cluster feed or breastfeed more frequently for a period of time. At any age, it is important to feed your baby on demand or any time that they show signs of hunger.
Breastfed infants typically require frequent feedings throughout the day and night at younger ages. As they grow older, they may start taking larger amounts of breast milk less frequently. However, I typically don’t see breastfed babies take more than 5-6 ounces of breast milk at any one feeding. In addition, their total volume of breast milk per day remains static. Babies require 24-32 ounces of breast milk in an entire 24 hour period throughout most of the first year of life.
Download my breastfeeding math guide to learn more important breastfeeding numbers.
Hunger Cues in Younger vs Older Babies
Newborn and young babies have specific signs of hunger and fullness cues. Hunger cues can be seen as rooting, sucking on fists or fingers, making sucking noises, licking lips, and being fussy or restless. Crying and turning their head from side-to-side with their mouth open are later signs of hunger. Conversely, fullness cues in newborn and young babies may include slowing down or stopping sucking, turning away from the breast or bottle, becoming sleepy or relaxed, and looking content.
As your baby gets older, they have similar fullness and hunger cues, but will often become much more efficient at breastfeeding. I have seen a four month old baby transfer 4 ounces of breast milk from mom’s breast in under 5 minutes. It is a huge change from the earliest days of feeding, when one breastfeeding session could take an hour at a time. As a result of this efficiency, your sleep schedule and feeding schedule will become more predictable.
Volumes of Breast Milk and Formula by Age
Every baby is different, but there are some general principals that apply to different aged babies with regards to breast milk consumption. Remember that 24 hour volumes stay static while individual feeding volumes and intervals will change.
- Newborns to 2 months consume 2-4 ounces of milk per feeding every 2-3 hours (including overnight)
- 2-4 month olds consume 4-6 ounces of milk every 3-4 hours (may start sleeping longer overnight stretches at this age)
- From 4-6 months, breastfeeding babies take 4-6 ounces of milk every 4-5 hours during the day (may feed at night at this age, but many babies sleep all night)
- From around 6-12 months, babies continue to take 4-6 ounces of milk per feeding, and their 24 hour volume of breast milk decreases as their solid food consumption increases
Breastfeeding babies usually won’t take more than 6 ounces from the bottle at a time. Formula-fed babies, on the other hand, often take 8 ounces of formula per feeding after 9 months old.
Formula-fed babies generally take larger volume feedings (usually up to 8 ounces at a time) because formula does not change as the baby ages like breast milk does. Breast milk is efficiently used by the baby’s body and adjusts to meet their needs as they grow.
Monitoring Baby’s Weight
The main indicator that your baby is getting enough breast milk is an appropriate weight gain for age. Counting wet diapers can also help to gauge if your baby is on the right track, but weight gain is the most important.
From age 1-3 months, breastfeeding babies gain 20-30 grams of weight per day (or 5-7 ounces of weight per week). Generally, from ages 4-6 months, their weight gain slows down to 15-20 grams per day.
Additionally, recognizing signs of overfeeding is important. You may be tempted to give your baby increasing volumes of milk per feed due to pressure from outside sources.
Thankfully, it is really difficult if not impossible to overfeed a directly nursing baby. However, if your baby is taking breast milk from the bottle, it is certainly possible to overfeed. Overfeeding can result in excessive weight gain, digestive problems, and discomfort. But most devastatingly, it can result in you giving up breastfeeding because your body can’t keep up with those volumes.
A More Predictable Pattern
As your baby grows, their daily routine will become more predictable with feeding, diaper changes, and sleep. At 4 months old, most babies still require 3-4 naps a day and can sleep for 10-12 hours at night. Typically, babies take two naps in the morning and one or two naps in the late afternoon or evening. During the day, a 4-month-old will typically be awake for 1.5-2 hours at a time. In a 24-hour period, babies at this age need about 24-30 ounces of breast milk and tend to eat every 2-3 hours during the day.
Sample Daily Schedule for a 4 Month Old Baby
Of course, every baby is different and will not adhere to this schedule. This is just a sample of how to fit enough sleeping and feeding sessions in a given day. Some babies need more sleep than this and others need less.
| 7:00 am | Wake and Feeding |
| 8:30 am | Nap (about an hour) |
| 9:30 am | Wake and Feeding |
| 11:30 am | Nap (about an hour) |
| 12:30 pm | Wake and Feeding |
| 2:30 pm | Nap (about an hour) |
| 3:30 pm | Wake and Feeding |
| 5:00 pm | Short Nap (about 30 minutes) |
| 7:00 pm | Feeding |
| 7:30 pm | Bedtime * |
* May add in a dream feed before you go to bed if needed
How Can 127 Pediatrics Help You in Your Breastfeeding Journey?
At 127 Pediatrics, we offer direct primary care pediatrics and lactation support to our local community. If you live near Colleyville and would like to schedule a breastfeeding medicine consult with Dr. Wadley, simply fill out a form on the website and we will get you on the schedule. In addition, we offer virtual lactation consults both in and outside of Texas. We are also pleased to announce that we will be offering online breastfeeding education in the coming months.
Be sure to sign up to receive our weekly newsletter so that you can stay up to date on the latest breastfeeding news.
© 127 Pediatrics, May 2024
This article is for information purposes only. Please consult your personal physician for medical advice.
Dr. Wadley is the owner, pediatrician and lactation consultant for 127 Pediatrics. She opened this practice in July 2018 as a way to give families in her community a different option for pediatric and lactation care.
