When you have your first baby and are breastfeeding, at the beginning everything is new. So it is very easy to miss important warning signs, because it can be quite complicated to distinguish what is normal from what is not normal. When should you go and see your health care professional?
In the following we will discuss any doubts or fears you might have and list important warning signs and when you should get checked out by a health care professional (midwife, lactation consultant, GP, pediatrician).
The baby sleeps a lot or doesn’t wake up enough for feeding
Breastfeeding works on demand once the baby has regained her or his birth weight. Only at this point, she will be strong enough to demand the feeds she needs. However, in the very first days, when a baby has either low birth weight, was born prematurely or because she simply is a “sleeping beauty”, a baby can sleep too much and eat too little. But beware of this dangerous vicious cycle! When a baby sleeps too much, it doesn’t eat and because they don’t eat, they sleep even more. The saying “if the baby is hungry she will cry” just doesn’t apply to the very beginning of their life. Just because a baby sleeps seemingly peacefully, it doesn’t mean that she had enough milk in those very first days.
This is why, at the very beginning, it’s best to make sure to breastfeed regularly at least 8-12 times in 24 hours and if necessary, wake the baby.
The baby has lost more than 10% of her birth weight
Usually, when a baby has lost more than 10% of her weight, you will be discharged from hospital with the clear instruction to top up milk (supplementation).
When we talk about top ups, we always think first of artificial milk from a bottle. But it doesn’t have to be that way. As a first option for milk top ups, you should be offered to give your baby your own expressed breast milk, that is if you can and want to pump.
A baby who has lost so much weight needs a lot of milk to recover and as much skin-to-skin contact as possible. In case of not being strong enough to feed, it might be also necessary to delay direct feeding from your breast until your baby has regained more energy (information about alternative, non invasive feeding techniques like the finger-syringe technique or cup-feeding in our App).
My baby is 5 days old and hasn’t started to gain weight yet / is still losing weight
Babies lose weight until about the third day of life and start gaining it from around the fifth day.
In the first 6 weeks they gain about 20-30 grams per day. If this is not happening and the baby continues to lose weight, it is necessary to intervene and various things need to be assessed by a health professional/lactation consultant: the baby’s latch, the frequency of feeds, the breastfeeding positioning and technique and other various circumstances that may have lead to a drop in milk production.
If the baby does not have a soiled nappy/poo every day and only breastfeeds, this indicates that she is not eating enough and should increase her milk intake. Please don’t wait and get professional help quickly, as the more time passes, the weight loss often increases.
My baby is over 4 days old and doesn’t poo
Your exclusively breastfed baby should have at least 3 soiled nappies/diapers/poos of the size of a tablespoon a day. If the poos are smaller, they do not count. A baby who poops little may not be eating enough. So it is important to evaluate the weight development and see if she should drink more milk.
If you have given your baby even just one artificial milk top up, this rhythm of soiled nappies may vary and might be misleading in proving that the baby gets enough milk.
My baby is over 4 days old and there are orange marks in the nappy/diaper
Orange marks in the nappy/diaper are caused by a high concentration of urine and the appearance of urate crystals.
Urates are common in the first two days of life, but afterwards they can indicate that the baby needs more milk. If the urate crystals do not stop, please talk to your health care professional (GP, paediatrician or midwife).
My baby cries all the time
Babies cry and they do so to communicate with you. Most babies cry at certain times of the day and night and this is common and very normal for them. But if your baby cries all day long or cries inconsolably when she wants to breastfeed, do not hesitate to consult your midwife/lactation consultant or health care professional, so they can observe your baby and a complete feeding session.
My baby doesn’t latch
Whether your baby has latched onto your breast previously or not, this situation requires to be checked by the midwife/lactation consultant and the pediatrician/GP.
A baby who shows a lot of difficulty when latching and is exclusively breastfed can lose a lot of weight which is totally counterproductive.
In these cases the first option is always to express your breast milk and top up / supplementation with a non-invasive method (see syringe-finger technique, cup- or spoon-feeding).
My baby is 15 days old and has not regained her birth weight
Breastfeeding is wonderful, but babies have to gain weight too. If they don’t, or only gain very little weight, we can’t wait and should intervene. Again the first option is simple: start topping up with expressed breast milk.
If your baby has enough soiled nappies/diapers, that is more than 4 or 5 poos a day of at least the size of a tablespoon, but does not gain weight, you should see your pediatrician/GP/health care professional to rule out that your baby has a urine infection (which is usually with no symptoms).
My baby vomits everything she eats
If your baby has episodes of projectile vomiting and really brings up everything she feeds and you notice her getting weaker and more upset, don’t hesitate to go as fast as possible to your nearest A&E/emergency care services at your hospital.
(For more information on all things breastfeeding, download the LactApp mobile app and get personalised answers to your breastfeeding questions.)