• How to be sure your newborn is well fed
• Seek medical help immediately if --

How to be sure your newborn is well fed

The first week of your baby's life is so exciting - and yet sometimes so confusing. Why is your baby crying? Is he or she hungry? Why is your baby sleeping so much - or sleeping so little? How can you tell whether your baby is receiving enough milk from the breast?

First of all, trust your intuition -- if you are concerned about your baby, call for medical advice. Please do not hesitate. As new parents you are supposed to have a lot of questions and concerns. Make a list of your baby's symptoms and call us.

Here are some guidelines for your first week:

• Number of wet diapers. For the first week, the number of wet diapers should be at least equal to your baby's age in days: day 1 - one wet diaper, day 4 - four wet diapers and so on. What is "wet"? Take two ounces of water and pour it in a diaper. This is how your baby's diaper should look and feel. Note the heaviness of the diaper. Watch the color of the urine which should be pale yellow or clear, not dark and smelly.
  
  
• Number of soiled diapers. You should see two or more meconium stools daily for the first two or three days. On day 4, look for AT LEAST three orange-brown to yellow stools. By day 7, look for AT LEAST six yellow stools, and ideally one during every breastfeeding.
  
  
• Number of feedings. Your baby should be waking and asking for food (by rooting or mouthing its fingers) every two to three hours fora total of at least eight feedings in 24 hours. Let your baby feed as long and as often as he or she wants. If your baby needs to be woken for all or most of its feeding, call us to make sure your baby is healthy.
  
  
• A good feeding (first three days). Ideally your baby will feed for at least 10 minutes and perhaps take both breasts. During a good feed the baby's lower jaw moves steadily with only brief pauses to rest, and the baby does not have to be stimulated to keep feeding but feeds steadily on its own. A full baby will release the breast by itself (the mother does not end the feeding) and is either asleep or contentedly awake. A full baby generally does not cry after a feeding.
  
  
• A comfortable latch. Your baby needs to be attached to the breast correctly in order to transfer food. A good latch does not hurt. Sharp pain when the baby latches on, even if it eases after a minute or two, usually means the baby's tongue is squeezing your nipple instead of your breast tissue.
  
  
• Swallowing. Each jaw movement counts as one suck. Your baby should swallow every third suck when the breasts contain colostrum and almost EVERY suck when the mature milk comes in (by day 4). A swallow may be an obvious gulp (especially when the milk is in) but more typically you will hear a soft, nasal exhalation. Listen for this in a quiet room. If you watch your baby's chin you will notice short, choppy movements when the baby is not swallowing and longer, slower movements when the baby is swallowing.
  
  
• Pacifiers. None for the first two weeks at least. If your baby wants to suck, offer the breast. This stimulates a good milk supply and guards against underfeeding.
  
  
• Supplements. If all goes as nature intended, no supplements are required for a breastfed baby. Check with your baby's doctor if you feel your baby is not satisfied with breastmilk alone.
  
  Remember: Only your baby's doctor can confirm your baby's health. The above guidelines are just that - guides. If your baby meets all the milestones given above but you are concerned, seek medical advice.

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Seek medical help immediately if --

• The baby has not urinated in 24 hours.
  
  
• The baby has no stools on day 4.
  
  
• The baby cannot latch onto breast (do NOT keep trying).
  
  
• The baby is lethargic, does not wake up for feedings, or is difficult to wake.
  
  
• The baby latches onto breast readily, sucks a minute or two and then appears to go to sleep.
  
  
• The baby feeds endlessly (most feedings are an hour long) and the baby is still not satisfied. Baby sleeps briefly (less than an hour) before waking and crying for another long feeding.
  
  
• Mature white milk is not evident on day 4. (When the milk is "in" the breast will feel firm before a feeding and obviously softer afterward. Baby commonly may spit up. Breasts may leak.)
  
  
• Breasts are painfully hard and swollen. This engorgement is usually an indicator that the baby is not breastfeeding often enough or long enough. Full and firm breasts are good - hard, painful, hot breasts are not.

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