Expert: Sally Wendkos Olds - 9/29/2007

Question
I have a few questions for you today. First I am a mother of three and am exlusively breastfeeding for the first time. I have a six week old son who in the past would feed for 10-15 mins. every two hours during the day and every 3-4 at night and now is only feeding for 4-6 mins. still every two hours. When he comes off of the breast he seems content and when I try to put him back on he just plays with my nipple. (so it is not that he is too tired to feed, he just spits me out and is done, sometimes even with a smile:) His birth weight was 7.5 and is now 11.10 so his weight gain has been great so far. My only fear is that A: since this just started about a week ago, I fear my next visit to the doc. he will have lost weight. and B: it is going to decrease my supply. Also, I am now only feeding on one side per feeding due to the fact that I think my let-down was WAY too strong for him (he would choke all of the time, still does occasionally. Would the one sided feedings have anything to do with his new eating habits (although,I changed that about 3 weeks ago)? My other question is that when he is nursing in the beginning of the feeding he will suck a few times and then the suction is broke (a click) and then he sucks again then the suction is broke, and so on for the first 5-10 sucks and then he just sucks. but it seems as though his latch has gotten shallower. Ugggh what is going on, is the whole breastfeeding thing becoming a disaster, it seems as though it is going to be next week and he won't be feeding right at all, I am really nervous that these are all signs of something going wrong with his breastfeeding. Please help, any advice you can give would be greatly appreciated!! Thanks!

Answer
Dear Sara,

First, congratulations for giving your son the best start in life by breastfeeding him!

It doesn't sound as if the one-sided feedings have changed his eating habits, since, according to your report, he still seems satisfied after a feeding -- and flashes you one of those winning smiles! It does sound as if your let-down may be so strong that too much milk spurts out in the beginning of a feeding. That may be causing the choking and the latching release. You might try expressing a few drops just before you nurse him, so that the rest of the milk will come in an easier to manage amount.

Overall it doesn't sound as if you have anything to worry about. From your description the breastfeeding is not a disaster. It's very common for babies to change their feeding patterns from time to time -- just to keep us on our toes.

I am attaching an excerpt from my book (see below) which offers ways to tell if your son seems to be getting adequate nutrition. I hope it helps.

Best regards,

Sally

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.
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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.)
  END OF BOX