Q. I recently had my first baby, and a friend of mine told me how much more convenient it will be if I get my baby on a set feeding schedule. She told me that was the way she got her baby to sleep through the night. How can I schedule my baby's feedings?

A. In general, be cautious about anyone aside from your doctor giving you advice about your baby, especially when it comes to feeding schedules. Every baby is different in nutritional needs and feeding patterns, and different parents have different lifestyles. Personally, I prefer the term "feeding routine" to the more rigid term "schedule." It's important to work out a feeding routine that gets your baby's nutritional and emotional needs met, yet fits in, as much as possible, with your family's lifestyle. Use these precautions when establishing a routine with your baby.

Beware of baby trainers. A new and risky business has cropped up for new parents  -- baby trainers who promise to come to your home and get your baby on a schedule. This claim is particularly attractive to mothers of multiple babies, parents with busy lifestyles, or those with babies who are night wakers and frequent feeders. In my practice, I have had both good and bad experiences with baby trainers. In some instances, especially for parents of multiples, hiring professionals to get babies on a predictable feeding routine and to help them sleep for longer stretches is a survival necessity. However, I've also seen babies who were too rigidly and insensitively "trained" to go longer stretches between feedings and to sleep through the night before they were ready. These babies are often referred to us for a medical condition called "failure to thrive." Thriving means growing optimally not only physically, but emotionally and intellectually as well. The reason some babies fail to thrive on schedules is simple: The hunger cue is very strong, and the only person who really knows how often and how much baby should be fed is baby himself.

Scheduling babies too rigidly and at too young an age often involves the old "let him cry it out" advice. For example, a baby will cry because he's hungry. Mom looks at her watch and thinks "It's not yet time for his feeding. I'll let him cry so he learns to wait for a bottle at a predictable time." Over time, two problems emerge from this type of scheduling: The baby loses confidence in his own hunger cues and his need to be held, and mom loses trust in her ability to accurately read baby's need for food and comfort. The result is a lose/lose situation in which the scheduled pair drift apart. In my pediatric practice, this is the most common reason babies are referred to us for failure to thrive.

Scheduling ignores growth spurts. In the first six months, babies go through growth spurts approximately every couple of weeks. They are cued to eat more frequently because they're growing more. Rigid scheduling often doesn't take these growth spurts into account, and you run the risk of baby being undernourished (both nutritionally and emotionally) during times of increased need for food and holding.

Rigid scheduling  -- not for breastfeeding babies. Scheduling is a bit easier for formula-fed babies. Since formula takes longer to digest, many formula-fed babies can go longer between feedings. Yet, optimal breastfeeding for optimal growth (i.e. thriving) operates on the supply-and-demand principle. Mom makes enough milk for baby's nutritional needs, and when baby goes through a growth spurt, he nurses more frequently and mom makes more milk. Teaching the breastfeeding baby to "wait" and a mother to ignore her inner signals to nurse is the most common cause of insufficient milk supply in a mother and insufficient growth in the baby. Getting baby on a schedule defies what we know about basic biology and mother care, as a mother is hormonally wired to respond to her baby. When a baby cries, the blood flow to her breasts doubles, accompanied by an overall biochemical response to pick up and nurse her baby. Thus, both mother and baby fail to thrive with rigid scheduling.

Watching the clock instead of your baby is risky. Like so many aspects of infant care, it's a question of balance. Try to develop a feeding routine that gets your baby enough food and touch, and you enough rest. Instead of using the term "schedule," call it a "flexible routine," which means you are open to adjusting your baby's routine during these changing developmental stages.

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