Expert: Sally Wendkos Olds - 2/19/2007

Question
Hello.  I am the mother of a 4 and a half week old infant.  When I nurse him, he nurses steadily for up to half an hour on one breast, then he falls asleep.  I sit him up to burp him and he wakes up enough to go to the next breast.  Then he eats there for up to another half hour and goes to sleep again.  I try to pull him off to lay him down, but he wakes up and starts screaming and chewing his fist until I put him back on the breast.  I know for a fact that he is getting milk, so why is he doing this?  Why does he act like he is being murdered for me to put him down?  If I pull him off the breast and leave him in my lap, he stays asleep, but the second he is off of me he's screaming.  He doesn't do this when he goes to bed for the night, but he does sleep cuddled to my chest.  What's wrong with him?

Answer
Dear Misty,

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

Your baby is very young so he may not yet know the difference between waking and sleeping. Also, he may want that closeness with your body for reassurance. This behavior is probably temporary. I wouldn't worry about it.

However, you might check to be sure that he is getting enough milk. I am attaching an excerpt from my book (see below) that will give you some signs to help you judge this.

If you decide that he is getting enough milk, you might try this: A vigorously suckling baby usually gets enough breast milk in 10-15 minutes per breast, so you might try taking him off the first breast after this time instead of letting him stay on for the full half hour, since he has such a violent (!) reaction when he comes off after that time. So take him off, burp him, and then let him nurse at the other breast for another 10-15 minutes. Good luck!

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