Newborn Nursing, Medicated
Birth, Early weeks of Breastfeeding,
Normal Stools, Normal
Weight Loss/Weight Gain; Normal
Bf Patterns as Baby Grows, Normal Physical
Changes in Breasts
What is Normal?
In this age of "scientific feeding" it
can be very confusing as to what is normal. For the mother of the
breastfed infant, "normal" can include many things. This
is because there can be a wide variation of what's natural and normal
for each individual baby. Nursing "on cue" (or "on
demand") allows for the uniqueness of each baby, through all
stages of the baby's individual development and growth pattern.
There are a few guidelines that nursing mothers
can use to be sure that their baby is within the range of what's
considered normal for the breastfed infant. If any new mother is
concerned about her infant, she should seek counsel of a breastfeeding
experienced person, such as an International Board Certified Lactation
Consultant (IBCLC). It is helpful to remember that although many
health professionals are supportive of breastfeeding, many have
training in breastfeeding education or management. Your doctor,
although trying to be helpful, may not give you the most accurate
information for your individual circumstances. That said, it's always
wise to discuss these issues with your health care provider, in
addition to seeing a breastfeeding specialist.
What's Normal for Baby's
It is not unusual for a newborn to be quite able
to nurse immediately after birth, or within the first hour after
birth. Some babies will latch on like they are "old pros",
others may just lick and nuzzle the nipple or breast, but both of
these "feedings" are equally as important. The first feedings
are more of an opportunity for mother and baby to get to know one
another, but having the breast available to the newborn is very
important, since studies show that the licking/nuzzling helps to
stimulate mother's milk supply.
The newborn may latch
well, and nurse, or it may take several tries to get latched
on. Both situations can be normal. Some babies may take a few hours
to recover from labor and delivery, but most if given the chance,
will attempt latch and nursing within about 24 hrs of their birth.
Frequent early feedings are important so that the
newborn receives colostrum, and so mother's milk will "come
in" more quickly.
NOTE regarding Medicated
labor/delivery may result in a newborn that's very sleepy
and disoriented. This may mean that baby cannot latch on and suck
efficiently. If you have had a medicated labor/delivery and you
note your newborn is very sleepy and has no interest in nursing,
this is the time to call for an experienced lactation consultant
for help. Avoiding bottles and pacifiers during this time is VERY
important, to reduce risk of nipple
What's Normal During the
Early Weeks of Breastfeeding?
During the first week, it's normal for baby to be
a little sleepy. It is suggested to offer to nurse newborn babies
at least every two hours during the day, and at least a couple times
during the night (every 3 hrs or so). This may mean you have to
baby to nurse, but by nursing every couple of hours you are
stimulating your milk
supply and ensuring your baby is getting
Some health care professionals, as well as the authors
of some popular books suggest limiting or scheduling
baby's feedings. This is not accurate breastfeeding information,
and should be avoided. It is very important to follow baby's cues
to be fed, rather than allowing baby to "cry" to eat.
Crying is a very late sign of hunger, and by then baby is tired,
in no mood to be patient to work on good latching, and usually will
not nurse very well (or long) before falling asleep.
At about 10 days and again at about 3 weeks of age,
most babies will have a growth spurt, where they may do "marathon"
or "non-stop" nursing for two to three days. After a couple
days, this passes and things calm down again. Another growth spurt
hits at about six weeks of age. These first six to eight weeks are
often the most challenging, after that, it often settles down to
an enjoyable experience for both mom and baby.
It is normal for babies to do what is called cluster
feeding. Baby may nurse every 2 - 3 hrs during the daytime hours,
but during the evening hours, begin to want to nurse "hourly"
for several hours in a row. This sometimes confuses moms and they
begin to think their supply is low, or that their milk isn't satisfying
baby. This is just baby's way of "stocking up" for a longer
stretch of sleep in the nighttime hours.
Sometimes a baby's "fussy time" will co-inside
with cluster feeding, and this too, can be very confusing for mom.
Keep in mind these things are normal.
It is NOT normal for mom to be experiencing
nipples. Most often this is a result of a latch that's not quite
right, or other external issue. With proper help and support, most
of these issues can be resolved fairly quickly.
What Are Baby's Stools
Supposed to Look Like and How Often Should Baby Wet?
It is normal for the stools
of the breastfed baby to be mostly liquid, with small curds
that resemble cottage cheese (some say it resembles runny egg yolks).
It has very little odor. Usually the baby will have a bowel movement
each time he/she nurses. It may or may not sound "explosive".
These liquid stools are not diarrhea. Diarrhea in the breastfed
baby is rare. A baby who has diarrhea would have stools that are
very frequent, usually green and full of mucus (and/or specks
of blood), and almost always foul smelling.
A breastfed baby should have six to eight wet diapers
a day until around six weeks of age; and five to six wet diapers
a day thereafter; and two or more good-sized bowel movements every
day for the first 6-8 weeks.
At around the age of six weeks, the stooling pattern
of a breastfed baby may change. It is not uncommon for the breastfed
baby to skip days between bowel movements. Some babies skip every
other day, some go every two or three days, some once every 5 -
7 days, and some babies hold out for up to 11 or 12 days at a time
- then have quite a FULL diaper when they DO go!
There is absolutely no reason to intervene and try
methods commonly used to "induce" a bowel movement (such
as prune or other types of juices, water, glycerin suppositories,
or using rectal stimulation). If artificial stimulation is done
too often, the baby's system can become dependant upon this stimulation
to "go", and no longer is able to have a normal bowel
movement on their own.
In most cases, as long as baby is not acting ill
(lethargic, crying in pain, etc.), the tummy is soft, not rigid
or distended, skipping days between stools is not cause for alarm,
however, mother should not hesitate to ask her health
care provider to check her baby to be sure there is no physical
The breastfed baby's stools may change in color,
and baby may even have an occasional green stool. Consistently
green stools, however, may indicate a problem, such as imbalance
in foremilk/hindmilk, or sensitivity to something in mom's diet,
such as dairy. Green stools do not always indicate a problem.
What is Normal Weight Loss?
It is normal for breastfed babies to lose from 7%
to 10% of their birth weight, and it can take up to 3 weeks for
the breastfed baby to regain birth weight. Weight should always
be calculated from lowest weight ever, not birth weight, for the
most accurate picture of the baby's growth. See "Why
Babies Lose Weight" for more information.
A breastfed baby's rate of weight
gain may vary widely. A complete picture of baby's growth should
be viewed, not just an assessment of weight gain. Growth in length,
and head circumference are as important as actual weight gain. Genetics
play a part in how baby gains, as well as where and how the baby
is weighed. Weight checks should ALWAYS be done on the same
exact scales and in the same type of clothing (or done with baby
Patterns After Eight Weeks:
The following suggestions are "average" recommendations
- keep in mind there is no "one size fits all" for nursing frequency. Some
babies have predictable patterns, others nurse on irregular pattern. Some
mom/baby pairs can go longer than others between nursing sessions depending
on mom's storage capacity.
A mom with larger storage capacity might note that her baby goes longer
between feedings, and a mom with smaller storage capacity might note her baby
nurses more often. (Remember, storage capacity is not related to breast size.)
It is helpful to keep note of baby's weight gain and elimination patterns when
"judging" whether or not baby is nursing enough
From eight weeks (2 months) to a year, here are suggested
minimum number of times a breastfed baby should be nursing, in a 24 hr span:
From 2 - 4 months baby should nurse at least
6 times in 24 hr period
From 4 - 7 months baby should nurse at least
5 times in 24 hr period
From 7 - 12 months baby should nurse at least
4 times in 24 hr period
spurts will likely occur at around 10 days, 3 weeks, 6 weeks, 3 months,
4 months, again at 6 months, at 9 months and again around a year. Increased
nursing can also be the result of the approach of a new developmental stage,
illness, teething, or a result of change or usual routine, or increased stress
or activity at home
Some mothers become concerned if baby begins to
nurse in very short sessions. Most breastfeeding experts advise
that if the baby continues to have plenty of wet diapers, regular
bowel movements, is gaining weight well and meeting developmental
milestones, then baby is getting enough breastmilk. Even sessions
as short as five minutes can be normal, as long as baby continues
to grow and do well.
It is important to remember that breastmilk should
be the baby's primary source of nutrition throughout the first year.
Experts recognize that breastfeeding is not just
a method of feeding for the infant, but includes a wide range of
physiologic and emotional needs. Too often we hear comments like
"he is just using you for a pacifier" or "he couldn't/shouldn't
need to nurse already, he just ate". These comments rarely
take into account an infant's
various needs both physical and emotional. They do not help
to solve possible breastfeeding problems, and they do nothing to
ease mother's concerns!
If there is a concern, the situation should be carefully
be evaluated by someone experienced in breastfeeding issues and
management. Most of the time the problem can be solved by adjusting
nursing patterns. Supplemental feedings are not needed when lactation
is going well. If breastfeeding is NOT going well,
the introduction of a supplement may make things worse, and should
be offered with the guidance of an experienced lactation consultant.
Any time mother feels concerned about short feeding
sessions, or what is "normal", she should speak to an
experienced lactation consultant, or her breastfeeding support group
for accurate information and support.
For more information on what to expect as baby grows:
Normal Physical Changes in the Breasts
When baby is first born, mom's body doesn't know
how much milk is required, so it just makes milk- and "lots"
of it! This results in a very full feeling for most moms during
the first several weeks of breastfeeding. Somewhere around the six
or eight week mark (most commonly around six weeks - but sometimes
not till around the 3 month mark!!), mom will notice her breasts
don't have that "full" feeling they used to have. It almost
feels like there's NO milk there at all.
This is not the case though; it's simply a normal
physical change that occurs when the body learns to regulate the
supply. There is no need now for the body to make "excess"
milk; it's learned to make just the amount the baby needs.
Many times this change will occur around the six
week mark - right when baby is having a growth spurt, which can
REALLY confuse mom and cause her great concern if she is
not aware that these two things can happen at about the same time.
Nursing frequently will increase milk supply to meet the baby's
needs - supplementing during this time would signal the body NOT
to produce as much milk, so the supply would then reduce, which
is not what mom wants at all!
Other physical changes in the breast include the
feeling - or suddenly NOT feeling - the letdown. Again, this
is not any indication of milk supply or production - it's just a
normal adjustment that the body makes.
NOTE About "Breast
"Breast discharge" is normal during pregnancy as
the body prepares for lactation. It is not abnormal for mom to leak
It is also not abnormal if she doesn't.
Leaking can continue for a time post partum and/or
after a nursing baby weans (a mom may continue to produce small
amounts of milk for weeks, or even months after weaning). For some
women, ANY stimulation to the breast; (i.e. "checking" to
see if milk can still be expressed, stimulation during sexual intercourse,
etc.) can cause production to continue if she is extra sensitive
to the stimulation.
However, if milk is still present, especially if
it is in large amounts, 6 months after weaning, it's a good idea
to have an evaluation by a physician, because although this is a
normal condition for most women, continued production, discharge
or leaking can also be a symptom of something else as well. Many
times, it's simply that the hormones causing milk production are
out of balance. This condition is called galactorrhea .
of a liquid other than breast milk can be a sign of infection,
inflammation, or a tumor in the breast. Green
or yellow nipple discharge can be common, often a result of
benign cysts, such as those associated with fibrocystic changes
(your basic lumpy, bumpy breasts). Studies have shown that 50 to
80 percent of nipple discharge cases are unrelated to any disease,
but if you are experiencing a discharge
of liquid from the breast (not associated with breastfeeding)
it is wise to have a prompt evaluation by a physician, just to be
Will My Breasts Remain
"Saggy" Once Baby Weans?
Sagging is a concern for many mothers, but this
is not a result of breastfeeding. Sagging is a physical change related
to pregnancy, NOT to breastfeeding, and some studies have
indicated that the degree to which a mother "sags" could
be related to the degree of change in the breast during pregnancy.
Other studies seem to indicate that sagging may be a genetic factor.
Most mothers do feel that their breasts are a little
"saggy" during the latter part of breastfeeding, and upon
weaning, but this "saggy" or "floppy" feeling
is eventually replaced by a fuller feeling as time goes on and the
body fat fills in around the milk producing glands.
Resources include but are not limited to:
Breastfeeding and Human Lactation, Riordan &
The Ultimate Breastfeeding Book of Answers, Dr Jack Newman MD
The Breastfeeding Answer Book, LLL