Resources

Weight loss in infants

Infants are expected to lose some weight after birth. Babies who are born by C-section usually lose a little bit more weight than infants born vaginally. Per the Academy of Breastfeeding Medicine statement, if weight loss is in the range of 8-10% while everything else is normal, including the physical exam, infant requires “careful assessment and possible breastfeeding assistance.” Weight gain usually starts with the beginning of lactogenesis II (or “mature milk” coming in) around day 2-4 after delivery. Most babies get back to their newborn weight by day 10-14 of life. However, there are some conditions that may affect lactogenesis II and your newborn’s weight gain. In our clinic, we will conduct a comprehensive medical history of you and your baby, a thorough breast exam, full child exam, will weigh your child before and after feeding, and will provide lactation support to address lactation-related issues that you may have.

Newborn Weight loss tool: https://newbornweight.org/

Breastfeeding

For the first few days after the birth of your child, you will produce colostrum, a nutrient-dense milk. Colostrum is usually yellow in color and thick in consistency, however it can also be white in color and watery in consistency. Colostrum coats your baby’s gut and provides protection from infections and helps to build your baby’s immunity. In the first day of life, because of their small stomach’s size, babies usually take 5-10 ml (or 1-2 teaspoons) of colostrum every feeding. Newborn babies feed on demand, usually about every 1-3 hours, day and night, with average 8-12 feedings in 24 hrs. As your baby grows, their stomach’s size gets bigger, therefore milk intake will increase and the time between feedings will increase as well. In our clinic, we will help you to understand what amount, frequency and duration of feeding and/or supplementation is appropriate for your child based on your child’s medical history, gestational age, size at birth, growth rate and other requirements.

When is your baby ready to eat?

As long as your baby does not have any significant health issues, we encourage feeding on demand. Which means feeding your baby when they show you their hunger cues, such as moving their mouth in the direction of something that is touching their cheek, opening their mouth and moving the head side to side, sucks on hands/fingers, sticks out their tongue, nuzzle against your breast. Crying is usually a late sign of hunger, plus it is hard to latch a crying baby. It is best to nurse your baby before they are upset or cry. However, if your baby cries and you are not able to nurse them, try to calm them down by putting them on your chest and doing skin to skin. In our clinic we will demonstrate and assist you and your baby with different feeding techniques and positions.

How Do I Know My Baby Is Getting Enough?

One of the ways to know if your baby is getting enough to eat is by counting your baby’s output, the number of dirty and wet diapers. In the 1st 24 hours of life your infant may have 1-2 wet diapers, after day 3-4, you probably will see 6 or more wet diapers in 24 hours, with the urine being clear or very pale. If urine looks dark yellow or amber or if you see orange/red/pink crystals in a wet diaper it may indicate your baby is not getting enough fluid and you need to call your baby’s provider. While having orange/red/pink crystals can be normal in the first few days or life, it can be a sign of dehydration in older babies. Newborn stool, or poop looks greenish- black and tarry in the first few days of life, then it looks greenish-yellow as “milk comes in.” After day 3 or 4, the baby’s stool looks more yellow and seedy and by then your baby will have 4 or more stools in 24 hours. In our clinic, we will assess if your baby is getting enough to eat by asking you about frequency, amount and duration of feedings and/or supplementation, your child’s sleep duration, tracking your baby’s weight loss and weight gain, measuring your infant’s milk intake amount during breastfeeding, tracking your baby’s weight-for-age percentiles.

What should I do if I am having a hard time with breastfeeding?

It takes time to establish successful breastfeeding. If it is an option, while you are still in the hospital you can request help from a lactation consultant, Midwife, OB-GYN or Pediatric Provider. When you get home, look for a lactation consultant in your area. An International Board-Certified Lactation Consultant (IBCLC) is a trained healthcare provider who specializes in clinical management of breastfeeding and you can find one in your area by searching online at: https://uslca.org/resources/find-an-ibclc/ Our office has experienced IBCLC providers with many years of experience at your convenience as well. At Tongue to Toes Newborn and Family Clinic we are excited to help your baby thrive and to help you to achieve your feeding goals.

Your and your baby’s health care team

Since we are not yours or your baby’s primary care clinic, we strongly recommend you follow up with your Primary Care Provider, your Midwife or OBGYN with any questions you have related to your baby’s general health. We also recommend you consult with your child’s Pediatric Provider with any questions related to your baby’s health, growth and development. The American Academy of Pediatrics recommends babies get checkups at birth, 3 to 5 days after birth, and then at 1, 2, 4, 6, 9, 12, 15, 18 and 24 months. Please make sure you contact your baby’s Pediatric Provider’s office and schedule recommended appointments with them.

References:
1. Academy of Breastfeeding Medicine. ABM Clinical Protocol #3: Hospital Guidelines for the Use of Supplementary Feedings in the Healthy Term Breastfed Neonate, Revised 2009. DOI: 10.1089/bfm.2009.9991
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3. Lauwers J, Swisher A. Counseling the nursing mother: A lactation consultant guide. Burlington, MA: Jones and Bartlett Learning; 2016
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8. Andreas NJ, Kampmann B, Mehring Le-Doare K. Human breast milk: A review on its composition and bioactivity. Early Hum Dev. 2015 Nov;91(11):629-35. doi: 10.1016/j.earlhumdev.2015.08.013
9. Hord NG, Ghannam JS, Garg HK, Berens PD, Bryan NS. Nitrate and nitrite content of human, formula, bovine, and soy milks: implications for dietary nitrite and nitrate recommendations. Breastfeed Med. 2011 Dec;6(6):393-9. doi: 10.1089/bfm.2010.0070
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11. Feldman-Winter L, Kellams A, Peter-Wohl S, et al. Evidence-Based Updates on the First Week of Exclusive Breastfeeding Among Infants ≥35 Weeks. Pediatrics. 2020;145(4):e20183696. doi:10.1542/peds.2018-3696
12. Watson J, Hodnett E, Armson BA, Davies B, Watt-Watson J. A randomized controlled trial of the effect of intrapartum intravenous fluid management on breastfed newborn weight loss. J Obstet Gynecol Neonatal Nurs. 2012 Jan;41(1):24-32. doi: 10.1111/j.1552-6909.2011.01321.x
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15. https://www.healthychildren.org/English/family-life/health-management/Pages/Well-Child-Care-A-Check-Up-for-Success.aspx