Expert: Sally Wendkos Olds - 3/6/2011

Question
My 2 month old has just begun sleeping through the night.  He generally goes to sleep between 7 and 8PM.  I let him sleep until 10, get him up, change his diaper and breast feed him.  By 11pm I put him to sleep in a bassinet by my bed.  He then sleeps until 6:30 in the morning.

My question is, how often should I make sure he is eating during the day?  Before sleeping through the night, he was eating every 3-4 hours including nighttime feedings.

Answer
Dear Kimberly,

Congratulations for giving your son the best start in life by breastfeeding him. And lucky you, that he is sleeping through the night already!

If he seems to be gaining weight appropriately, has enough wet and soiled diapers, and shows the other signs of adequate nutrition, you can let him set his daytime schedule. Probably he will want to nurse about every 3 hours or so during the day, for a total of 6 to 8 times during a 24-hour period. I am attaching an excerpt from my book (see below) that offers some guidelines for seeing whether a baby is getting enough to eat. Some of it is oriented toward a younger baby -- but you'll see which parts apply to your situation.

Good luck!

Sally
--------------------------------
Sally Wendkos Olds
Author, THE COMPLETE BOOK OF BREASTFEEDING: Olds & Marks, 4th edition, September 2010, published by Workman Publishing, and available in most public libraries, bookstores & La Leche League chapters.

---------------------------------
Is My Baby Getting Enough Milk?
This is the big question to which every mother wants a resounding YES! answer. Fortunately, there are some solid criteria so you may be able to answer the question yourself. The following checklist is adapted from one that Dr. Marvin S. Eiger (coauthor of the earlier editions of this book) suggested that his patients follow.
  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.

BOX
Judging Intake by Output
Day of Baby’s Life   Stools per Day*   Color of Stool      Size of Stool
1 to 2         1 to 2         blackish, tarry      from a smudge to
about 1 Tablespoon each   

3 to 4         3 to 4         brownish-blackish   about 1 Tblsp. each   
  
4 to 6         4 to 6         brownish-yellowish   about 1 Tblsp. each

6 to 30         8 to 10 (normally)    yellowish       1-2Tblsp. or more
                          after each feeding)

30 and later      may be infrequent    yellow        variable               (up to 10 days
without a stool)

*If mother’s milk is a day or two late coming in, as is common with first-time moms, adjust the chart accordingly.

END BOX

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 box above at the appropriate ages?
  Your baby should be having regular bowel movements in a quantity of at least one tablespoon (one-half ounce) or more. Some babies have a stain in the diaper after almost every feeding. 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. They should be fairly messy to clean up. (Sorry about that!) But they don’t stain as much as the b.m.’s of formula-fed infants.
  If a baby over five days old is passing dark or hard stools or fewer than those listed in the table, this is a sharp warning that she is probably not getting enough nourishment. If your baby is two weeks old or younger and goes two days without having a bowel movement, call your doctor since this may signal a problem.
  However, if your baby is one month or older, is nursing well, and shows no change in appearance or behavior, there is no cause for alarm if he goes up to ten days without a bowel movement, even if he has been having them every day up till now. You can wait for four or five days without a stool before calling your doctor, and the likelihood is that the doctor will reassure you that healthy babies of this age often change their bowel habits abruptly and that there is nothing to worry about.
For a helpful chart illustrating how your breastfed  baby’s bowel movements may look and how you can keep track of them, go to http://www.lactnews.com/ddiary.html . You can download one copy of  “Diaper Diary”  or buy pads of 50.

• By the third or fourth day, does your baby have six or more very wet diapers per day, with colorless or very pale urine?
  Today’s disposable diapers are so absorbent that they rarely feel wet. To check for urination, 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. If you’re willing to sacrifice one diaper you can pour a couple of ounces of water on it and then heft it to see what a wet diaper feels like. Another technique is to put a tissue inside the diaper and see if that gets wet. Or you could use cloth diapers for the first few weeks. (They make good burping cloths – and, eventually, great dust cloths.)
  If you see a pink or reddish "brick dust" stain on your baby’s diaper after the first couple of days of breastfeeding, this may mean that he is not getting enough milk. This kind of stain is caused by the formation of uric acid crystals in concentrated urine. It’s common within the first couple of days because the baby is not taking in sizable amounts of colostrum, but if you see it after the fourth day you will want to call your doctor to see whether your baby is gaining enough weight.

Your Baby’s Appearance and Behavior
• Does your baby seem satisfied and content for an average of two to three hours between feedings in the first month or two?
• In the first month or two, does your baby nurse eight to twelve times in every twenty-four-hour period, for ten to twenty minutes on each breast?
• After three 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, supple, and resilient?
• Does your baby have bright eyes, good color, an alert manner, and a smooth head, with no dent that might indicate a sunken fontanel (the soft spot on a baby’s skull)?
• By the third month, is your baby nursing six to eight times in a twenty-four-hour period, and does the baby seem contented for up to five or six hours at least once during the twenty-four hours?

Your Baby’s Weight
• At your baby’s first doctor’s visit, was her initial weight loss less than  percent of birth weight? (Breastfed babies should normally have an office visit within twenty-four to forty-eight hours after early hospital discharge, then at seven to fourteen days of age, again at one  to two months.)
• Did your baby regain birth weight by two to three weeks of age?
• Is your baby gaining an average of from 4 to 6 ounces a week (about one-half ounce a day) or a pound a month? These are averages: different babies gain at different rates and the same baby’s growth is variable from week to week. Weight gain should be measured from the baby’s lowest weight since birth, not birth weight.

Your Nursing Experience
• Can you hear swallowing sounds when your baby is at the breast, in a ratio of one or two sucks per swallow for the first five or ten minutes of nursing?
• Do your breasts feel fuller before a feeding and softer afterward?
• 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 harder at the breast.) The only time you want to supplement with formula is if your baby’s doctor recommends this.