Expert: Sally Wendkos Olds - 5/4/2008

Question
QUESTION: hi,
i am  mother of 11 days old baby girl and since 2 days my baby is spiiting up more often about 2 to 3 times every time i feed her.. wanted to know if its a concern and what can be done to prevent it...she also vommitted once and when she was taken to a pediatrician , the pediatrician said that she is fine and nothing to worry ..it probably happened because she was not burped for a long time.. now my concern is the spitting ups.. its increased and i am not able to make out if she is suffering from indigestion...please help me....thanks

ANSWER: Dear Ashwini,

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

Some of the best fed breastfed babies spit up a lot. This is not a worry as long as she is doing well otherwise -- nursing 8 to 12 times in a 24-hour period, having 6 to 8 wet diapers a day, several soft yellowish bowel movements a day, and gaining weight.

The only time you worry about spitting up is when it is projectile vomiting -- that is, the milk shoots straight out of her mouth for some distance -- and when this happens more than once within a few days.

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.



---------- FOLLOW-UP ----------

QUESTION: Thanks for your reply.
I have another question:
My baby (2 weeks old) seems to sleep quite a lot at a stretch, for around 4-5 hrs during the day and about 5-6 hrs during night. If I try hard to wake her up in the middle, she doesn't wake up and seems to be drowsy. Hence, I can feed her only after she wakes up and she takes around 30 minutes of feed. Also, while feeding her, I need to make her burp every 10 min because she is gassy. So, is it a concern?

Thanks,
Ashwini

Answer
Dear Ashwini,

Your two-week-old baby needs to nurse more frequently than every 4-5 hours. One thing you can try is to go to her at least every three hours around the clock and nurse her while she is still asleep. Some babies will automatically take the breast even while they are sleeping.

One reason she may be sleeping so much is that she may not be getting enough milk and therefore does not have enough energy to wake up and nurse vigorously. I would suggest consulting a lactation consultant or your pediatrician to check her weight and general demeanor to see whether she is getting enough nourishment. The burping every 10 minutes (I assume during feedings) is not necessarily a concern, but when you talk to the doctor or lactation consultant, ask him or her.

Meanwhile, I am attaching an excerpt from my book (see below) for signs that your baby is taking in enough milk.

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.)