This blog entry is intended for mothers who have just had a baby and need basic information about the baby’s behaviour, poos, feeding, sleeping, weight gain, or when to seek specialist medical advice.
In these times of lockdown, isolation and cancellation of health check appointments, many of you have doubts about whether your baby is feeding properly. This is why we have created this post, so you can assess the health of your baby and see if there is something that’s not normal.
Newborn babies are very dependent on their primary caregiver, who is usually their mothers. This is why your baby is likely to want to be very closely held by you all the time. Babies don’t usually like to be in a moses basket, cot or away from you and this social distancing and stay-at-home-indefinitely situation we are experiencing is no exception.
Breastfeeding is very pleasant for babies, but it does not only provide them with food in form of nutrition and fluids. It is just as normal, that because of the effort and relaxation this suction motion means to them, they end up falling asleep and relaxing directly at your breast.
Your baby does not use you as a dummy/pacifier, but she uses you as a mother, and it is totally normal for the baby to “use” the breast for everything: relaxing, sleeping and of course eating.
Another thing you probably already have noticed when the baby was in your womb, is that they have hiccups, sometimes even several times a day. This is not unusual and has nothing to do with their diet, it is simply a matter of immaturity of their nervous system. As your baby grows, the hiccups will become less frequent.
It is also an experience to discover that babies are very noisy: they make little and louder noises all day (even at night when they’re sleeping) and their tummies rumble after feeding, which is not at all uncommon, these are totally normal situations.
By the way, babies burp and break wind, sometimes they sound just like adults and it seems impossible that such a small human being can make such a loud noise.
Poo and wee (what’s in the nappy)
Baby’s first bowel movements are very distinctive: meconium. They are black, sticky and very dense poo, where the baby expels the remains of amniotic fluid and other cells it has swallowed during pregnancy. The early, concentrated milk or colostrum the baby drinks is a natural laxative and helps them to relieve themselves more easily.
As soon as the baby starts drinking mature breast milk, which is usually after 48-72 hours after birth, the stools change in colour to become greenish and finally yellowish.
Newborn poo, when yellow, is very liquid and sometimes you can see very peculiar tiny white lumps.
And what about baby’s wet nappies? As your baby grows, she or he will wee more frequently. The first few days she or he will have 1-3 wet nappies a day, this will then increase to 6 or more from the 5th or 6th day of life.
In the first two or three days, the baby’s urine may be concentrated (darker) or even have orange spots. These are urate crystals that are produced by the concentration of the urine.
From the moment you have mature milk and around the 5th or 6th day of life, the urine should be clear and not leave any urate stains in the nappy.
In their first few months babies sleep a cumulative 12-16 hours during a period of 24 hours. You might think that they would sleep more and you now may be surprised that they sleep less than you thought. Babies have very short sleep phases, and they feed frequently, but they also fall asleep at the breast, and most of all they hate cots and moses baskets.
If your baby sleeps a lot, don’t hesitate to wake her or him up. There is a saying “never wake a sleeping baby”, but there is absolutely no truth in this. Of course, babies must sleep, but it is very important that they eat frequently in order to regain and multiply their birth weight quickly.
In the first few days after coming home from the hospital or birth centre, you may notice that your baby is increasingly demanding more and more feeds. They can be all kinds of feeds: short and frequent, then the baby lets go and starts again a few minutes after, or they can be longer feeds… but the most important thing is that weight gain starts from the 5th day of your baby’s life.
From the 5th to 6th day of a baby’s life, they should feed between 8 to 12 times in a 24 hour period. And it doesn’t matter how they are distributed. Sometimes they are calmer in the morning and can go for around 2 or 3 hours without breastfeeding. As the afternoon passes and the night arrives, babies begin to demand feeds more often and frequently and to be more nervous at the breast.
Sometimes, we think babies are nervous and cranky because of wind or colics, but what really happens to them is usually tiredness and over-stimulation. When babies are like this, they usually show it by crying and being restless at the breast. This can give you the feeling that your baby rejects the breast and doesn’t want to feed, but in fact, it’s just exhausted.
If your baby is not waking up for feeds or skipping feeds altogether, remember that breastfeeding is only on demand when the baby is gaining weight, is not sick and is not premature. So if your baby is very small, has not regained her or his birth weight, is sick or premature, do not hesitate to offer the breast once more when in doubt! It is best to be very proactive during these first few days and, if necessary, wake your baby up and offer your breast.
If you think that your baby is not sucking enough, gets tired or if you are in doubt about whether she is drinking enough milk, you can do breast compressions to encourage her to breastfeed and make sure she is drinking all the milk she needs.
Babies lose about 7-10% of their birth weight in the first 3 days of life.
From the 5th day of life your baby should start to gain weight. Ideally, they should gain between 20 and 30 grams per day, always bearing in mind that babies do not gain weight regularly: one day they do not gain at all, the next day they do gain a lot, then they stay the same for a while. This means that it is not advisable to weigh your baby every single day and even less so to weigh him/her after one single feed. To check the weight of your baby before and after a single feed, is not a useful way to know how breastfeeding is going, because the amounts of milk your baby will get at each feed will be very different every single time you breastfeed.
And, finally, within 15 days of birth your baby should have regained her or his birth weight again.
In these days of confinement and self-isolation and with health visitor’s clinics cancelled, it is very difficult to get your baby weighed, but you can try to do it at home. Here are some ideas on how you can tell if your baby is gaining weight:
- With an adult scale: always put the scales on a hard flooring (no carpet), you could use a light basket or similar item with a blanket on top. Weigh the baby naked, then subtract the basket and blanket on its own from the baby’s weigh+basket+blanket. Remember: stay very close and never leave the baby unattended. Alternatively weigh yourself holding the baby and then yourself on your own, subtract the values and the difference should be the baby’s weight.
- With kitchen scales: make sure the scale works for up to 5kg. Put the scale on the floor and a light basket with a baby blanket on top, put in the baby, use tare (0) function if possible, otherwise subtract basket and blanket weight from baby + basket + blanket weight.
- For bigger babies: with luggage scales and a baby/infant car seat (group 0, 0-12 months like MaxiCosi), always keep it close to the floor. Baby in car seat – car seat on its own = baby’s weight.
Warning signs – what’s not normal
It is completely normal if you are unsure of what is or is not normal for a breastfed newborn and may have many doubts about it.
Jaundice: Jaundice is the yellowing of a baby’s skin and mucous membranes (inside mouth and nose). It is common for newborns to have jaundice. As the baby starts to poo more frequently, this yellowish skin color should go away. If you notice that the jaundice increases and your baby starts to have yellow arms or legs, do not hesitate to seek medical advice as soon as possible.
Grey skin: The colour of the baby’s skin should be pinkish (for white babies, darker shades for other pigmentations). If your baby has grey skin or red or blue spots on the skin, do not hesitate to go to A&E and seek emergency medical care as soon as possible.
Very sleepy, unresponsive baby: Immediately after birth, babies go into a longer sleep phase and 6-12 hours of sleep is normal. Once they have overcome this lethargy period, the baby should ideally wake up and feed frequently.
If your baby is sleeping a lot, it is important that you encourage her/him to feed or offer her/him milk using, for example, the syringe and finger technique and most importantly, seek medical advice as soon as possible.
Urates (little urine lumps) after the first three days of life: If reddish spots appear in the nappy after the first three days after birth, it may mean that the baby is not getting enough milk. In this case, do not hesitate to seek professional medical advice and start to express milk with a breast pump and offer your additional milk in alternative ways if it is confirmed that your baby is not getting enough milk.
No mustard-coloured poo after the 5th day of life: Your baby is feeding properly if, from the 5th day after birth, poos are a minimum size of one tablespoon and mustard-coloured. If your baby has had even one single formula milk feed, this can cause fewer poos. In any case, it would be useful to evaluate whether your baby is getting enough milk.
Do you have any more questions?
If you have any more questions about breastfeeding and motherhood, we can help. Please download our free app, LactApp for iPhone or Android. In the contact section of the app, you can find an in-app consultation channel, where our experts will answer your questions.