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 no formal 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 First Nursing?

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 Births:

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 confusion.

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 wake baby to nurse, but by nursing every couple of hours you are stimulating your milk supply and ensuring your baby is getting enough milk. 

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 severe sore 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 problem.

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 naked).  

Normal Breastfeeding 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

Growth 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:

http://breastfeeding.hypermart.net/development.html 

http://kellymom.com/bf/older-baby/index.html 


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 Discharge"

"Breast discharge" is normal during pregnancy as the body prepares for lactation. It is not abnormal for mom to leak colostrum. 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 .

Release 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 sure.

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 & Auerbach
The Ultimate Breastfeeding Book of Answers, Dr Jack Newman MD
The Breastfeeding Answer Book, LLL