BREASTFEEDING GUIDELINES
– the first couple weeks
What is cluster feeding?
§ Fussiness means hunger until proven otherwise. By the time your milk comes in (day 2-5), your baby is thirsty and hungry.
§ Intense hunger drives your baby to nurse every hour for about 12-24 hours. This frequent stimulation drives the breasts
to make more milk.
§ Formula supplementation stops the hunger drive, so your breast is less stimulated. If you supplement, you must pump.
§ Feedings will space out as your baby’s tiny tummy can hold more milk and your increasing milk supply satisfies his hunger.
§ As you wait for your full milk supply to come in, weight checks confirm weight loss and gain is in the normal range. 4.26
Your baby is born with “extra fluid” to get him by until your milk comes in.
He doesn’t need much milk in the first couple days, which is good, because you don’t have much milk to offer.
Expect your baby to lose weight after birth.
We monitor him to make sure he doesn’t lose more than 10% of his birth weight while waiting for your milk to come in.
Ideally, your milk will come in enough by day 4
so your baby starts gaining 1oz per day by day 4, ideally by drinking just your breastmilk.
Birth weight: _____lbs____oz Today on day____ : ____lbs____oz Gained/lost ______oz in ____days by nursing, & by drinking
Currently _____ oz under birth weight ______oz your pumped breastmilk
Maximum weight loss - ____% ______oz formula or donor milk
The ideal breastfeeding set up
Supply (MOM) Demand (BABY)
Ideally, your milk comes in before your baby loses
more than 10% of his birth weight.
Ideally, your baby is able to remove enough milk
from the breasts to gain 1oz per day.
Ideally, you produce enough milk for your baby to
gain 1oz per day on just breastmilk.
Ideally, your baby will empty your breasts regularly.
Regularly draining the breasts brings the supply in,
increases the supply to full capacity, and
then maintains the supply long term.
If baby can’t do this, the pump must help.
So, if you have enough milk and baby can remove it,
just breastfeed away so supply and demand can work out naturally.
How much milk a typical TERM baby needs each day
AND THUS how much mom ideally produces.
Birth Day 0
~1oz/day ~5-10mL per feed Day 1
Day 2
Day 3
~8oz/day
~30ml
~1oz per feed
Day 4
Day 5
~12 - 20oz/day
~60-75ml
~2-2½oz per feed
Day 6
Day 7
Day 8 – 14 ~20 - 24oz/day
~60-90ml
~2-3oz every 2-3 hrs
Through
6 months
~24 - 32oz/day
LincolnPediatricGroup.com
402-489-3834
Note:
§ The rate at which mothers’ milk comes
in varies, but ideally your milk will keep
pace with your baby’s increasing needs.
§ For some mothers, milk comes in slowly
over 2-3 weeks, and it may take 6 weeks
to reach full volume.
§ Regular milk removal will optimize
production to ideally meet your baby’s
needs.
Note: Premis and smaller babies need a bit
less than what this chart shows at first.
They will eventually need these same
volumes.
24oz/day = 1oz per hour.
If baby ate 3 hrs ago, he’ll need about 3oz now.
§ You can’t measure what baby nurses from
the breast. The chart shows how milk
comes in & how much baby needs.
§ If a bottle is offered, the 3
rd
column shows
how much milk to put in the bottle.
Feed the Baby = Triple Feed (if needed)
Supplement & pump if there are concerns about supply or demand, and thus excess weight loss or failure to gain.
§ Supplement if your baby loses 7% of birth weight within 48 hours or 10% at any time. If it’s getting close,
but it’s clear your milk is coming in and your baby can remove milk well, keep nursing and weigh again tomorrow.
§ Always use available expressed breastmilk first. If there’s not enough, use donor milk or formula as directed.
§ If you supplement, you must pump to keep supply and demand in check.
§ Triple feeding (1.nurse 2.supplement 3.pump) is hopefully temporary, until milk is in & baby removes milk well.
§ NOTE: Excessive weight loss (>10%) may be from an inflated birth weight from maternal IV fluids during labor.
Thus, weight loss may be OK if other parameters fall in line, such as milk is clearly coming in, baby latches and
removes milk, stools transition, baby is eager to eat, etc.
Feeding frequency and promoting sleep at night
§ Babies are born with days and nights mixed up.
§ While in your belly, baby partied while you slept. As you walked about during the day, your baby rocked to sleep.
§ Now that he’s out, you need to rewire his brain to be sleepy at night.
§ How? More calories consumed during the daytime eventually leads to fewer calories needed during the night time.
DAY TIME
Wake to feed every 3 hours, start to start, plus sooner on demand – long term.
§ Start the 3 hour countdown from the start of the most recent feeding session.
§ There’s no need to try to keep him awake between feedings, because you’ll get frustrated.
§ He just needs to be awake enough to get enough to gain weight and stimulate your milk supply.
NIGHT TIME
Before gaining 1 ounce per day, feed every 3 hours, plus on demand.
Once he gains 1 ounce per day, allow one 4-5 hour sleep session, only at night.
When he’s over birth weight (day 10-14), don’t wake your baby at night.
-Don’t expect him to sleep more than 5 hours any time soon, as his tummy is tiny, so he needs to eat more often.
-If he does sleep longer periods, you’ll need to pump at 5 hours, for comfort & to stimulate supply.
§ Wake small babies (less than 6½ lbs or less than 38 weeks) at 4 to 5 hours for a while after returning to birth weight.
§ Sleep safety - Arrange a safe environment for night feedings, as you’ll be so tired that you may fall asleep while nursing.
§ 12 midnight is bedtime for now - Your newborn’s tummy capacity is tiny, so he’ll get hungry within 5 hours. Feed him
well before midnight so you’ll all hopefully get to sleep in the deep of the night. As his tummy holds more milk, he’ll
sleep longer stretches. Then he’ll need a bit more to drink during the day, to make up for what he missed overnight.
§ Consider taking shifts over-night - Some moms like help with night feedings. Working in shifts ensures that each
caretaker gets a bit more sleep, & thus can be more alert during night time feedings.
An option is this: Mom sleeps 5 hours uninterrupted from 8pm to 1am, while her helper is on duty to feed every
3 hours. At the 1am shift change, consider a dream-feed, ie nurse or bottle feed a sleeping baby. The caretaker
now sleeps 5 hours while Mom is on duty 1am to 6am. Hopefully baby sleeps most of that time.
In the first couple weeks, you’ll likely need to wake your baby for many feedings.
As he gains weight, and thus energy, he should wake up on his own for more and more daytime feedings. 4.26
Milk is in -- The ideal breastfeeding pattern after the first week or so
Check-ups will confirm weight gain over time. In between check-ups, the behavior pattern below indicates that your baby is most likely getting enough to gain 1oz/day.
You can hear
swallowing
Self-awakens in 2-3 hours
during the day
to demand the next feeding.
6 wets.
2-4 yellow
stools.
Acts content
or sleeps
THE IDEAL BREASTFEEDING SESSION
Breastfeed on demand – not on a schedule
§ Feeding patterns fall into place and change according to stages of growth and development. Don’t restrict feedings or
“make baby wait” for the next feeding. You don’t know how much he drank last time, so if he acts hungry, nurse again.
§ Your breasts are most full in the morning, because while sleeping, energy is used to make milk.
o Early in the day, your baby drinks more each time and thus less often.
o Late in the day, your energy is spent elsewhere, so less milk is produced, and your baby nurses longer and more frequently.
§ As long as he gets enough over all, it doesn’t really matter when he gets it.
Fussiness means hunger until proven otherwise.
§ In the first 2 weeks, you’re building your milk supply & baby’s getting back to birth weight.
§ No binky in the first few days! If your baby wants to suckle, milk should come from whatever he suckles.
Before & As milk comes in
§ Alternate breasts equally, about 10-15 minutes per side.
§ Listen for swallow sounds (airy “k” sounds) after a couple suckles. Sounds get louder & more often as milk increases.
Once milk is in - the ideal breastfeeding session
Keep baby on the first breast as long as you can hear swallows to get it empty so baby gets the hind milk.
How to get the first breast empty and how to know it’s empty.
Before latching, hand express some drops & gently massage your breasts to stimulate let-down hormones.
How many minutes?
Most babies take 15-20 minutes to empty the first breast.
Some slam down a breast in 5 minutes. Others take 30-40 minutes.
One breast or both?
Most babies nurse 1½ breasts. Some need only one breast. Others always empty both breasts.
§ If your baby takes both breasts, start the next feeding with the one you ended with last time.
Using these guidelines, you’ll figure out how long it takes YOUR baby to nurse and
whether YOU need to nurse from one breast or both. It’s all EVOLVING!
If everything falls into place, just breastfeed for the first 3-4 weeks. You don’t need to supplement or pump
if baby removes milk well & your supply meets your baby’s needs. Let supply & demand work out naturally.
At 3 WEEKS, pump and freeze extra milk, IF you can produce extra. Feed the baby before the freezer.
Also at 3 weeks, start practice bottles regularly, to avoid bottle refusal & prepare for time away. 4/26
SKIM MILK
(foremilk)
When baby first
latches, skim milk comes
out for the 1st minute or
so, while baby suckles
quickly to stimulate the
oxytocin hormone.
When the hormones kick
in, milk lets down & flows,
& milk transitions to
whole milk.
WHOLE MILK
§ For the next 10 minutes or so, whole milk comes out.
§ The nipple stimulates the
suck reflex
at the roof of the
mouth.
§ The mouth fills & milk stimulates the
swallow reflex
in
the throat.
§ The flow of milk drives the reflexes, which are animal
instincts to stay awake & eat.
§ After
5 -10 minutes
or so, you'll hear less swallowing,
because less milk is flowing, because baby already
drank it.
§ Now baby is less hungry, right when they're getting to
the high calorie hind milk.... and now they want to
sleep.
§ You'll need to prompt baby to wake up & finish the
breast, so they can get the hind milk.
CREAMY MILK (hind milk)
§ When you don't hear swallowing
anymore, compress the breasts,
like a tube of tooth paste, to
squirt milk into the swallow
reflex.
§ Keep doing this.
§ When baby doesn't swallow
when you squirt, it's because
there's no more milk.
§ Consider the breast empty.
§ Put baby to the 2nd breast.
§ If they're hungry, they'll latch
there, & that flow of milk will
make it all happen again.
LincolnPediatricGroup.com
402-489-3834
VIDEO