IS MY BABY GETTING ENOUGH?|
During your baby's first few days of life his urine output may be
minimal. Once your milk becomes more plentiful ("comes in"), you should
notice more wet diapers and greater wetness with each one. A good way
to measure urine output is to remember that your baby should have one
wet diaper per day of life during the first week. Urine should always
be pale in color - never orange or brown - and mild-smelling. If you
find it difficult to determine if baby has wet, consider placing some
tissue in the diaper or switch to cloth diapers for a while until you
feel more confident about this. Adequate urine output is a good sign of
In the first few days after birth the baby's dark, tarry stools are
known as meconium. This is the stool that the baby has been storing
since before birth. Within 24-48 hours of your milk "coming in" your
baby's stools should change in color and consistency. You may notice
that they change from dark black to greenish-black to brown, etc.
before they turn to the "classic" yellow "milk-stool" of the breastfed
The stool should be completely yellow (sort of like the color of
mustard) by your baby's seventh day of life. An occasional green stool
is also considered normal. Stools of exclusively breastfed babies
should be loose (pea-soup to toothpaste consistency) and unformed,
often appearing seedy. The odor should be mild. Most breastfed babies
will stool at least 3-4 times per every 24 hours. Stools should be at
least the size of a US quarter.
Two factors may affect your ability to assess your baby's stool output:
hyperbilirubinemia (jaundice) and treatment with antibiotics. The
lethargy that is common with jaundice and exagerrated with light
therapy used to treat this condition can mask the baby's hunger and
cause diarrhea. Antibiotic medication can also cause diarrhea. In these
situations a weight check is advised to assure of adequate intake.
While adequate urine output is a good sign of sufficient hydration,
adequate stool output is a good sign of sufficient nutrition.
"Celebrate stooling and swallowing!" (Linda Shrago, RN, MS, IBCLC)
Once a baby reaches the age of 5-6 weeks he may go several days (7-10
days is not abnormal!) between stools. This is still normal as long as
the stool is loose, unformed, and profuse if several days have passed.
It should not be treated as constipation which is characterized as
hard, dry, pellet-like stools.
The Infant's Cues
Your baby's cues can tell you a lot about his milk intake. When a baby
first goes to the breast he may wiggle and detach several times. His
suck will be like that of a pacifier suck - short and choppy. As your
milk "lets down" (within the first minute or so) the baby should begin
to settle and become more focused with little or no wiggling or
detachment from the breast. His suck will then be more long, drawing,
and rhythmic with a wiggle at the temple or ear and a gliding motion
along the jawline. During the feeding you should be able to either
hear, feel, or see your baby swallowing. He should swallow throughout
most of the feeding. "Celebrate stooling and swallowing!"(Linda Shrago,
RN, MSN, IBCLC)
Once he is full, he may detach himself from your breast. His arms
should be relaxed and he should not be bringing his hands to his mouth
or rooting. If you still see signs of hunger - flexed elbows, clenched
fists, hands to the mouth, rooting, etc. - put your baby back to your
breast. Your breast should feel softer after your baby nurses.
ALL babies should be assessed by a doctor within one week of birth for normal weight!
Babies may lose as much as 10% of their birthweight; however, a loss of
more than 5-7% often indicates that help is needed with breastfeeding
management. Birth weight should be regained by 2-3 weeks of age. If
baby has not regained back to birth weight by 10 days-2 weeks,
adjustments may need to be made. Consult with a lactation consultant
for assistance in determining if breastfeeding management is optimal
for good weight gain.
Once baby is back to birth weight, normal weight gain is about
5-6 ounces per week, although 4-5 ounces is acceptable in some cases.
Some babies may gain even more rapidly than this and still be within
the norm. This rate continues for the first 3-4 months at which time
most breastfed babies normally slow down with weight gain. From 4-6
months of age, average gain is 4-5 ounces per week. From 6-12 months of
age weight gain is typically 2-4 ounces per week. At 6 months, the
average breastfed baby has doubled his birth weight, At one year, he
weighs about 2 1/2 times his birth weight. When figuring weight gain,
remember to always figure from the lowest
point, usually at some point in the first few days of life and try to
weigh baby on the same scales each time in the same weight of clothing
or with no clothing at all.
Other Indicators of Growth
Growth in length and head circumference is also an indicator of
adequate milk intake. During the first 6 months, normal growth in
length is 1 inch per month while normal growth in head circumference is
1/2 inch per month. From 6-12 months of age, your baby should grow an
average of 1/2 inch per month in length and 1/4 inch per month in head
If you notice any of the following, have your baby examined by a doctor and consult with a La Leche League leader or lactation consultant as soon as possible:
- Any day with NO bowel movement (up until 5-6 weeks of age)
- Any day with only ONE bowel movement (up until 5-6 weeks of age)
- Stool not yellow by day 7 after birth
- Losing weight after day 5
- Under birthweight at 2 weeks
- Persistent hunger cues, including rooting or hands to
mouth, excessive fussiness, excessive pacifier use, extremely drowsy or
- Yellow bowel movements that revert to consistently green ones.
Written by Becky Flora, BSed, IBCLC
Last revision: April 15, 2003
"Adequacy of Breastmilk Intake: Assessment and Interventions"
as lectured on by Linda Shrago, RN, MS, IBCLC at the La Leche League
Lactation Specialist Workshop Series VIII, "Breastfeeding: Overcoming
Challenges in Today's World", October 24, 1998.
La Leche League's, "The Breastfeeding Answer Book"(2003)by Nancy Mohrbacher, IBCLC and Julie Stock, BA, IBCLC.
More info at other sites:
"Average Weight Gain for Breastfed Babies"