THE FIRST FOUR WEEKS: BABY
Do I HAVE to wake the baby for feedings?
Many babies are sleepy in the first few days of life. This is
especially true if the mother had a long labor, received pitocin
or pain medications or if there is a great deal of molding or
bruising of the baby's head. It is important to wake the baby
for feedings at least every two to three hours during these early
days. The new mother should not "skip a feeding so she can rest,"
unless she is severely tired. Repeatedly skipping breastfeedings
can interfere with the milk supply and cause engorgement.
Many newborns may not wake for hunger pains at first. Letting
the baby sleep may contribute to weight loss and dehydration.
To wake a sleepy baby: stimulate by bathing the baby; undressing
to provide skin to skin contact; talk to the baby, rocking and
patting may also help. Lower the environmental temperature ( the
baby will fall asleep if it is over 80°F (Lawrence and Lawrence
220) ). The mother should be advised to use pain medication only
if needed. Seek medical assistance if the baby seems too sleepy,
doesn't want to nurse as often as expected, or constantly falls
asleep at the breast before at least ten minutes of active sucking
and swallowing.
Once mother's milk is in, she can stop watching the clock. The
baby will now need eight to ten feedings in a 24 hour period.
Nursing styles differ, but I usually recommend that she go no
longer than three to four hours during the day time and one six
hour stretch at night. Of course, if the baby demands more often,
she should feed him.
How do I know if he's getting enough?
Breastfeeding mothers always ask this question. She can be assured
that all is well if at five days of age:
1. Her milk is in, as evidenced by mild engorgement of the breasts.
2. She hears consistent infant swallowing at the breast.
3. The baby has at least six to eight very wet diapers per day.
4. Infant stools have turned yellow and follow most feedings.
5. The baby begins to self wake for feedings every two to four
hours.
6. The baby has eight to ten feedings per day.
7. Satiation occurs (baby relaxes or melts at the breast after
several minutes of nursing with active swallowing).
8. The infant has gained weight from hospital discharge weight.
Mothers often need to be reminded that babies suck reflexively.
Sucking does not always suggest that baby is still hungry. Reflexive
suckling means that baby will suck on anything that is put in
or near his mouth. A baby may empty a bottle of water or formula,
right after breastfeeding, due to this reflex.
Latches scoring self assessment for breastfeeding in the early days.
Should I give my baby supplemental bottles of water or formula
until my milk comes in?
Supplemental bottles of water or formula are not recommended for
the normal healthy newborn. There is a very real danger of ARTIFICIAL NIPPLE PREFERENCE in these early days. There is also some evidence that the hard
surface of the bottle nipple is a super-normal stimulus. When
the baby returns to the breast, he may not react to the soft nipple
and areola with suckling.
A baby must LEARN how to nurse. It is best to avoid the use of bottles of water
or formula for at least the first three weeks. By giving bottles,
the baby may have difficulty learning to do both or he may develop
a preference for the fast, easy flow and/or hard surface of the
bottle nipple. In addition, mother's body must be convinced that
there is a baby to feed while the milk making hormones are at
their highest levels. Bottles of water or formula can lower the
milk supply or lead to painful engorgement. Water and formula
do not prevent jaundice.
What if my baby needs bottles after birth because of a medical
problem?
It would be foolhardy to refuse the use of bottles for a baby
who is ill. If the baby gets used to the bottle and is having
difficulty latching on, the mother should try:
Using football hold for better control of the latch-on;
Dripping water or formula down the breast as the baby attempts
to latch on.
Tell the mother to be patient. A baby should never be FORCED to the breast. She should stop trying if the baby becomes agitated or upset.
If the problem persists, she should seek assistance from a lactation
consultant.
What if my baby won't latch-on at all?
The number one rule is: FEED THE BABY. If she can express enough milk, she should give it to the baby
in a bottle. If she is unable to express enough milk then formula
is necessary.
Remind the mother that if her baby is not latching on that she
needs to pump her breasts at regular intervals (eight to ten times
per 24 hours) to maintain her milk supply until she can get assistance
from a lactation consultant with the latch-on problem.
Is it normal for my baby to have liquid stools?
Normal breastfed stool is almost all liquid with small milk curds.
It is yellow, resembling runny egg yolks and has very little odor.
The baby will most likely have a stool every time he nurses. Sometimes
the stools are rather explosive sounding. Diarrhea in a breastfed
baby is rare. Diarrhea stools are frequent, green in color, full
of mucus and/or blood flecks and are rather foul smelling. If
there is any doubt, the mother should contact the baby's physician
immediately. True diarrhea in a baby quickly leads to dehydration.
The breastfed baby may occasionally have diarrhea type stools
accompanied by colic like crying if a mother is taking stool softeners
after delivery. Stool softeners and laxatives are not recommended
for the nursing mother.
Is it OK if my baby sleeps all day?
A baby can be overly sleepy in the newborn period. Some infants
just stir around a little in their cradle, and if left alone,
will fall back to sleep. It is important for the mother to observe
the infant for sleep-wake cycles. She should attempt to wake the
baby when he begins to stir.
To wake the baby mother should pick him up, unwrap him, talk to
him, play with him, and/or rub his feet. Any combination of these
may be needed to wake the baby for feedings.
What if my baby is awake all night? Will he ever sleep through
the night?
For about the first four weeks, most babies have their days and
nights mixed up. In utero, the mother's daily activities "rocked"
the baby to sleep during the day. Remind her of what happened
every time she got into bed at night: the baby would wake up and
begin to kick. The baby should settle into a normal day/night
routine soon.
Babies begin to sleep through the night (defined as sleeping a
six-hour stretch) somewhere around eight to twelve weeks of age.
Some babies take longer. Body weight may also play a role. Many
babies begin to sleep through the night when they weigh twelve
pounds. There are the occasional few who don't sleep through the
night until toddlerhood. Mothers frequently believe that if they
give the baby formula or start solid food, the baby will sleep
better. Feeding method makes no difference! Giving the baby cereal
will not make the baby sleep through the night. It could backfire
and make the baby more wakeful or cause gastric distress.
What about parenting advice that recommends scheduling feedings
or not allowing the baby to nurse on demand so he will learn a
routine?
Unfortunately, this idea has become popular again lately. Babies have no sense of time. Letting him cry it out, even for a few minutes can be an eternity of abandonment for a baby. Mothers should be told to listen to their instincts, not ill placed advice. A baby's needs should come first, within reason. If the advice she is following feels wrong for her baby, she should stop. Severely restrictive schedules and unrealistic behavior expectations can lead to failure to thrive and often results in child abuse.
Should my baby be in his own room?
Multiple studies have shown that a baby sleeping close to mom has a lower risk of Sudden Infant Death Syndrome [SIDS]. I firmly believe that as long as the baby is still nursing at night he should be close by. Many mothers have told me that if they don't have to get out of bed to feed the baby, they can fall back to sleep much easier. Having the baby close, where mother can just pull him into bed with her to nurse is wonderfully easy.
On the other hand, some mothers find that they cannot sleep well if the baby is too close because they wake up every time the baby makes a sound. Mother nature has made new mothers sleep lighter for a good reason: newborns choke frequently. The mother sleeps lighter to be able to wake easily if any danger is perceived.
The AAP recommends that "the infant’s crib or bassinet be placed in the parents’ bedroom, which, when placed close to their bed, will allow for more convenient breastfeeding and contact." There are special cribs made side-car style that connect to mom's bed so baby can be slid over to feed then safely put back in their own bed.
Soft surfaces, bumper pads, waterbeds, blankets, sheets, pillows, heated mattress pads etc... are all dangerous for baby; sleeping on the stomach and entrapment are significant causes of infant death. The most dangerous is falling asleep with a baby if you are in a stuffed chair or couch. An infant should never share a bed with older children.
Is it OK to have my baby in my bed?
The American Academy of Pediatrics4 states that bed sharing "can be hazardous under certain conditions." The AAP's task force on SIDS recommends "that infants not bed share during sleep. Infants may be brought into bed for nursing or comforting but should be returned to their own crib or bassinet when the parent is ready to return to sleep. This of course, applies only to normal sleep. The mother (or father) who is taking pain medication, sleeping pills or drinks ANY amount of alcohol will sleep very deeply; the baby should not be brought to the bed.
Breastfeeding mothers often find it more convenient if the baby sleeps in the bed with them for night feedings. Although the possibility of rolling over on the baby exists, most mothers cradle the baby in their arm while they are asleep. On occasion, I have asked mothers if they sleep with a small pet in the bed and ask if have they ever rolled over on it, to prove the point. Because mothers become amazingly light sleepers, they are aware of the baby's every movement. If a mother were to roll over on her baby, the baby would struggle and mother should wake up.
Should mom decide to co-sleep with her baby some warnings are in order. Extra pillows can be a hazard if the baby is in mom's bed. Parents should be warned to never put the baby face down on a traditional waterbed. The waterbed mattress can fold up around the infant's face or trap the infant so that he cannot move his head to breathe. Also the parent's bed should be in the center of the room, away from any walls on the sides and/or bottom. Headboards should not leave any space where the baby might fall in and become trapped. Parents often place a rolled towel at the head of the bed to help prevent trapping. Babies have died when they have become trapped between the mattress and the wall. A baby should never be left in an adult-sized bed alone. Babies are more mobile then parents realize. It is easy for the baby who is left alone to squirm or crawl into cracks and crevices or under pillows and blankets and suffocate.
Questions after the first 4 weeks
Storage of EMM (Expressed Mother's Milk)
Copyright Marie Davis, RN, IBCLC 1999
Last reviewed: