Expert: Sally Wendkos Olds - 4/12/2008

Question
My little girl is 100 days now and weighs 14lb 7oz. I have nursed her exclusively with breastmilk except the second week when she was hospitalized with jaundice. My problem is that recently for some reason she does not eat well. She just ate for about 5 minutes on each side and stopped. She cried if I tried to force her to eat more. And that 5-minute feeding sometimes could last her 4-5 hours. However, she eats quite well before she sleeps at night, around 10 minutes on each side. I just wonder whether this is normal and whether I should take her to her pediatrician. Also I wonder whether it is ok to feed her with water during two feedings. Thanks.

Answer
Dear Xiangping,

First, congratulations for giving your daughter the best start in life by breastfeeding her!

To check whether your baby is getting enough nourishment and liquid, the best thing to do is to check her urine and stool. If she is having soft bowel movements and is not constipated, she is probably getting enough to eat. She doesn't have to have a bowel movement every day -- but she should have them easily, with no heavy straining or pain, and they should be soft and yellowish. Also, she should have about 6 wet diapers a day, with colorless or pale yellow urine. I am attaching an excerpt from my book (see below) for signs that a baby is getting enough nourishment.

Most pediatricians advise against giving water to breastfed babies during the first six months --they don't need it if they're getting enough breast milk and it may make them feel full so that they won't take enough milk.

As for why she suddenly stopped nursing, this could be for a number of reasons. Have you been eating something different so that your milk tastes different? Or does she have a cold that makes it hard to breathe through her nose while nursing?

I would say to wait a couple of days and see if her eating picks up, and if not, call your pediatrician.

Good luck!

Sally
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Sally Wendkos Olds
Author, THE COMPLETE BOOK OF BREASTFEEDING: Eiger & Olds, 3rd edition 1999, published by Workman Publishing & Bantam Books, and available in most public libraries, bookstores & La Leche League chapters. Now in revision for a fourth edition, with Laura M. Marks, M.D.
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Your baby is probably getting enough to eat if you can answer yes to all of the following questions. If you cannot, call your baby's doctor right away.

Your Baby's Urine and Stools
The evidence in your baby's diapers is the most important sign of his or her adequate milk intake.
  * Does your baby have the number, color, and size of stools described in the Table below, at the appropriate ages?
  Your baby should be having regular bowel movements in a quantity of at least 1 tablespoon (1/2 ounce) or more. After the first few days, they should be yellow and loose, with small curds. They may smell and look like yogurt, or like a mix of cottage cheese and mustard. If a baby over five days old is passing dark stools or fewer than those listed in the table, this is a sharp warning that she is probably not getting enough nourishment.
  
  JUDGING INTAKE BY OUTPUT
DAY OF BABY'S LIFE      STOOLS PER DAY      COLOR OF STOOL
  1 to 2         1 to 2         blackish, tarry
  3 to 4         3 to 4         brownish-blackish
  4 to 6         4 to 6         brownish-yellowish
  6 to 30         8 to 10         yellowish
           (normally 1 after
           each feeding)
  30 and later   may be infrequent       yellow
           (up to 10-14 days
            without a stool)
  
* By the third or fourth day, does your baby have six or more wet diapers per day, with colorless or very pale urine?
  Since today's disposable diapers are so absorbent that they don't feel wet, you can check for urination by putting a piece of toilet tissue inside the diaper and then feeling that. Or pinch the bottom of the diaper; if the padding does not spring back to its original shape, the diaper is wet. Also, if it's wet it will feel heavy. Or you could use cloth diapers for the first few weeks. (You could let it be known that diaper service would be a wonderful baby present.)

Your Baby's Appearance and Behavior
  * Does your baby seem satisfied and content for an average of 2 to 3 hours between feedings in the first month or two?
  * In the first month or two, does your baby nurse 8 to 12 times in every 24-hour period, for 10 to 20 minutes on each breast?
  * After 3 days of age, when you open your baby's mouth during a nursing session, can you see milk inside and is the inside of your baby's mouth pink and moist?
  * Is your baby's skin soft and supple?
  * Does your baby have bright eyes and an alert manner?
  * By the third month is your baby nursing 6 to 8 times in a 24-hour period and seem contented for up to 5 or 6 hours, at least once during the 24 hours?

Your Baby's Weight
  * At your baby's first doctor's visit, was her initial weight loss less than 7 percent of birth weight? (Breastfed babies should normally have an office visit within 24 to 48 hours after early hospital discharge, then at 7 to 10 days of age, again at 3 weeks, and again at 6 weeks.)
  * Did your baby regain birth weight by two weeks of age?
  * Is your baby gaining an average of from 4 to 6 ounces a week (about 1/2 ounce a day) in the first month?

Your Nursing Experience
  * Can you hear swallowing sounds when your baby is at the breast, in a ratio of 1 or 2 sucks per swallow for the first five or ten minutes of nursing?
  * Do your breasts feel fuller before a feeding and softer afterwards?
  * When you nurse from one breast, does milk drip from the nipple of your other breast?   Can you feel the tingling of a let-down reflex as you begin to nurse? The presence of either of these signs affirms that your milk is flowing, but their absence does not mean that it is not.

NOTE: Do not test for hunger by offering your baby a bottle after a nursing. Many infants have such a strong urge to suck that they'll often take milk from a bottle even when they are not hungry. (Doing this may sabotage the course of breastfeeding, since some babies enjoy the ease of getting milk from a bottle and are less motivated to work a little harder at the breast. Furthermore, offering a bottle too soon can cause temporary nipple confusion, which you may need professional help to reverse.)