Breastfeeding changes at 4 months are common, but can be frustrating if you don’t know what to expect.
Even though it was more than 10 years ago, I still remember the cute squishy face of my four month old daughter. As a mom and a healthcare provider, 4 months is by far my most favorite age during the first year of life. These little humans are finally starting to develop their social smile, laugh and have joyous interactions with the world around them. You can see the wheels turning inside of their head as they are ready to leap out of your arms and begin their lives.
Unfortunately, this age also brings some changes that can affect your breastfeeding relationship. In my practice as a lactation consultant and breastfeeding expert, I often see mothers want to quit around 4 months because all of these changes feel out of control. They feel like they are failing to support their breastfed baby.
Let’s take a look at these changes in your baby’s behavior and dispel some beliefs so that you can continue to feel confident in your breastfeeding journey.
1. Four month old milestones
Around 4 months old, babies leap into many social, gross motor and fine motor developmental milestones that can throw a wrench in your routine.
Social changes
For the first three months of life, it feels like babies just eat, sleep and need frequent wet diaper changes. When you round the corner to 4 months, babies start to become more social. Their eyes start to open to the world around them, and they learn to interact with it in new and exciting ways. 4 month old babies smile, laugh out loud and pay more attention to siblings and pets.
These social changes can affect a nursing baby by causing them to not want to take the time out of their social schedule to nurse.
Distracted
At 4 months old, babies can become easily distracted during nursing. Rather than concentrate and spend time breastfeeding, they would rather be laughing at the dog and his latest shenanigans.
To address this, you can create a less distracting nursing environment. One effective strategy is to nurse in a quiet, dimly lit room. This helps minimize external stimuli and allows the baby to focus on nursing.
You can also change up your breastfeeding position or nurse at times where your baby is more sleepy, like right before nap and bedtime.
Sleep Regression
Four month olds are famous for going through a sleep regression. In reality, it is not really a regression, but a progression in their sleep. As they reach this age and beyond, babies consolidate their sleep into 90-120 minute cycles which is a maturation in their sleep cycles. They will carry this pattern into adulthood.
The problem comes when they do not know what to do at the end of these cycles because they wake up. As adults, we do the same, but we are so used to it that we don’t even notice it. We are able to put ourselves back to sleep. Babies need to be taught how to put themselves back to sleep. Often, that means waiting a few minutes to respond to the baby and allowing them to try to go back to sleep on their own.
While this is a normal developmental milestone, many breastfeeding mothers interpret this by thinking that her milk supply is not enough to sustain the baby through the night. This is the age when some moms start offering formula milk in the middle of the night because they think that it will help the baby to sleep better. In reality, this is a normal milestone that all babies go through no matter whether they are bottle feeding or breastfeeding.
2. Changes in Growth
Tracking changes in your baby’s growth chart is an essential part of monitoring their development. Your baby’s pediatrician will plot your baby’s weight, length and head circumference on a standardized chart to see how their growth occurs over time.
We are looking for consistent growth trends over time and comparing your baby’s numbers to what is expected for their age. From birth weight to seeing growth spurts, these charts are helpful but don’t always tell the whole story.
Weight velocity slows
Between the ages of 1-3 months of life, babies gain between 20-30 grams per day on average (this is equivalent to 5-7 ounces per week or one ounce per day). As they approach the fourth month of life, their weight gain velocity slows to about 15-20 grams per day on average.
Find genetic potential
Around 4 months, babies may find a different position on the growth chart as they are settling into their genetic potential. Their early weight gain and growth has a lot to do with not only breast milk supply, but also the health of mom during pregnancy. Sometimes, babies at this age will drop percentiles on the growth curve. Exclusive breastfeeding is the standard at age 4 months. However, this drop in percentiles will often cause a breastfeeding mother to worry about her breast milk production.
However, as long as your baby is gaining at the expected velocity of half an ounce per day on average, there is nothing to worry about.
Dropped a feeding
If your fourth month old is dropping percentiles on the growth curve due to poor weight gain or not gaining the half an ounce per day on average, often this is because a feeding got dropped somewhere along the way.
Maybe your baby is sleeping longer stretches at night and used to wake up once for a feeding, but is now sleeping through that time. Perhaps, your routine has changed and your baby is not eating right before bed like they were before. This is generally a simple fix. All you need to do is add back in a feeding somewhere during your day.
As a health professional, I often recommend adding a feeding first thing in the morning or right before bed. I rarely advise you to start waking your baby in the middle of the night for a feeding unless their weight gain is really worrisome.
3. Babies become more efficient
Another issue that I see frequently in my practice is that older babies breastfeed for shorter periods of time. This worries a mother who is used to her baby taking a long time to feed. Again, this causes her to doubt her breast milk supply.
Newborn breastfeeding
Newborns are terribly inefficient at the breast for the most part. Often their mouths are tiny and they are not strong enough to transfer a large volume of breast milk in a short period of time. Plus, they have teeny tiny stomachs that need to be filled with milk frequently in order to cause them to grow. Frequent feedings and around the clock nursing sessions are part of the newborn life.
However, there is light at the end of the tunnel. In general, by 4 months your baby will feed less often and for shorter periods of time.
Unfortunately, when you go from feeding 8-12 times per day for 30 minutes at a time to feeding much less often for 5-10 minutes at a time, you might start to worry about your milk flow. But don’t stress, this can be totally normal.
Difference at 4 months
First, as long as your four month old is gaining about half an ounce per day on average, it is okay if their feedings only take 5 minutes. If you are still concerned about your breastfeeding sessions being so short, you can do a weighted feeding to see how much the baby is transferring. Your lactation consultant or even the nurse at your pediatrician’s office would be happy to weigh your baby before and after a feeding to see how much milk they took in.
Next, you can also estimate your flow of milk by using an electric breast pump to measure how much breast milk you are producing per feeding.
4. Breastfeeding Strikes
Nursing strikes are very frustrating and can occur at any age. Older babies strike for different reasons than younger babies.
Potential Causes
Babies may initiate a nursing strike for several different reasons:
- Teething pain
- Upper respiratory infection / ear infection
- Severe pain
- Change in taste of the breast milk
- Uncomfortable breastfeeding position
What to Do
If you can identify the source of their nursing strike, it is much easier to resolve the problem. You can treat teething pain with oral analgesics, your pediatrician can give your baby antibiotics for an ear infection or can help you to find the source of your baby’s pain. Sometimes your milk will change if you are on your menstrual cycle or even if you are pregnant again.
After you have figured out the source of the issue, patience and time are the next steps in returning to breastfeeding following a nursing strike. Lots of skin to skin contact, bathing with the baby, nursing in a quiet and dark room can all help you to overcome this breastfeeding challenge.
Sometimes, you may need to use your electric breast pump to express milk for your baby to take while you are working on getting them back to the breast.
Enjoy this age!
Hopefully, this article will set your mind at ease if you are suddenly having breastfeeding problems at 4 months.
Early in my career, I was a newborn hospital pediatrician and took care of babies in the hospital. Every moment of the day, I was helping mothers breastfeed their babies and ensure that the newborns were healthy. While I absolutely loved doing that job, I missed watching kids grow and getting to be part of their lives for a long time.
As I contemplated a career change, I realized that I especially missed the 4 month old babies. This is my favorite age because your little one is still a baby, but is growing more social and interactive. You get to glimpse tiny moments of their budding personality as well.
So, enjoy this time.
How Can 127 Pediatrics Help You?
At 127 Pediatrics, we offer concierge level pediatric and breastfeeding care. If you are near Colleyville, Texas and would like to know more about our in person services, fill out a contact form on our website for a free meet and greet. If you are not close to our practice, but would like breastfeeding support, we offer an array of services. From free resources like this blog or our YouTube channel all the way up to paid resources such as our online breastfeeding overview course. We would be honored to be part of your breastfeeding journey.
© 127 Pediatrics, January 2024
Please note that this article is purely for informational purposes and should not be interpreted as medical advice.
Dr. Andrea Wadley owns and operates 127 Pediatrics, a pediatric and lactation practice in Colleyville, TX. She specializes in pediatrics, breastfeeding medicine and offers house calls only. Additionally, Dr. Wadley is the owner of the 127 Pediatrics Online Breastfeeding Medicine and Education Center. We have many free resources for breastfeeding mothers. Subscribe to our YouTube channel or download a free breastfeeding checklist.
