Timeline of a Breastfed Baby

WHO, as well as many other organizations, recommend breastfeeding for at least two years, with exclusively breastfeeding for the first six months. (For more on delaying solids, click here_)  Now, I realize that this is definitely not "the norm" in America and for some reason we want to push our babies into milestones, whether or not they're ready. Solids, forward facing, weaning, sleeping through the night, etc. etc. etc. These are all milestones that many people seem in a hurry to reach. I've talked a little about car seat safety in past posts but today I'm going to talk about breastfeeding.  I attended a "Milky Meetup" yesterday with a group of local crunch moms. They're a group of babywearing, cloth diapering, exclusively breastfeeding mamas and I love them! They really do help put my mind at ease in regards to birth and breastfeeding. If I learned one thing yesterday, it was to have an "I will" attitude and not an "I'm going to try" attitude.

It seriously amazes how any woman can be pregnant, let alone in her third trimester, and not have any sort of grasp on the basic concepts of breastfeeding, especially if they "plan to try." I get so sad when I read about newborns having to be supplemented with formula because their mom's milk isn't in. (Did you know a day old baby only has a stomach the size of a teaspoon? Filling them up with formula will likely make their tummy sore not to mention you're basically denying them the immunities their mother's early milk will give them!) Not only is this a bad idea for the baby but this interferes with the mom/baby breastfeeding relationship and can actually do more harm than good. This article is so great at breaking down the needs and development of a breastfed baby. It's important to realize how little a baby actually needs in the first few days so you can tell those formula pushing nurses exactly where they can put that can of formula. I've only C&Ped the first month from the article but it goes on much further.

Timeline of a Breastfed Baby

All babies reach milestones on their own developmental timeline. A multitude of factors influence the rate of each baby’s individual growth such as genetics, form of delivery, gestation at delivery, medical issues, effectiveness of the placenta prior to delivery, and so on.

However there is a persistent and understandable demand from first-time mothers for information on what is considered ‘the norm’. This is particularly so with breastfeeding, as understanding breastmilk intake is more complex than looking at the oz mark on a bottle. This is a topic rife with large-scale confusion, especially as breastfeeding mothers are in the minority and can often find themselves, and their health workers, comparing their baby with formula-fed babies.

Breastfed babies are not the same as formula fed babies. One is fed the milk of its own species; the other is fed the milk of an entirely different species, so it is unsurprising that stark differences can be observed.

What follows is a timeline detailing the journey of the average breastfed baby. I hope it will prove to be a useful and reassuring tool for new mothers.

At Birth:

• Given enough uninterrupted time skin-to-skin, your baby may move towards your breast and begin feeding without assistance.
• The first feed helps to stabilise baby’s blood sugars and protect baby’s gut (NCT).
• Most babies will nurse better at this time than they will for the next couple of days. Take advantage of this. “A full-term healthy newborn's instinct to breastfeed peaks about 20 to 30 minutes after birth if he is not drowsy from drugs or anesthesia given to his mother during labour and delivery” (La Leche League). Breastfeeding in the delivery room or the recovery room after a caesarean section lays the hormonal groundwork for your future supply of mature milk.
• If you experience greater than expected blood less while giving birth or have retained placenta inside your uterus after birth, this can lead to milk supply problems.
• Make sure that the midwives are aware that no formula is to be given to your baby unless strictly necessary and not without your consent.
• Your baby will be weighed following his birth.
• At the moment, and for the first few days after birth, your breasts are producing small quantities of colostrum (about 3-4 teaspoons daily). This is a concentrated clear yellow secretion which is high in protein, fat-soluble vitamins and minerals, as well as antibodies that protect your baby from bacterial and viral illnesses.
• Your newborn should not go longer than three hours between feedings. However you may find that he is very sleepy for the first few days and may not be interested in feeding. If this happens, you will need to wake him up. Undressing him and giving skin to skin contact will help wake him up and encourage him to feed.
• As you feed, the hormone oxytocin will help your uterus regain its tone after birth. This process also protects against excessive bleeding as you recover from childbirth. You may feel mild menstrual-like cramps whilst your uterus shrinks.

Day 1:

• Over the next 24 hours, your baby will begin to increase their hunger so they are having eight to twelve feedings per 24 hours. Many babies will feed more frequently than this and it may seem as though your baby is insatiable. This is because his stomach is so small it gets full very quickly and empties very quickly. Feeding frequently is also essential to build up your milk supply, so feed on demand rather than clock watching. To understand why your baby loves to suckle so often, read this beautifully written article by The Leaky Boob.
• Expect at least one or two wet nappies each day for the first few days after birth. It may be difficult to tell if a nappy is wet at this early stage, and it is normal to find pink crystal-like stains. If you are finding it difficult to judge if your baby’s nappy is wet, try putting a cotton ball in the nappy. When your baby urinates, the cotton ball will feel very wet.
• During this period, your baby’s mouth is acutely sensitive to any stimulation. A dummy, bottle, or sucking on your finger stimulates your baby’s mouth differently than your nipple. A newborn can easily become accustomed to this overstimulation of the tongue and hard palate. “Confusion can occur after just one exposure to a bottle or dummy” (Rubin. S). Therefore try to avoid or delay your baby’s contact with non-breast suckling until he is at least 6 weeks old.

Day 2:

• Most babies (whether breastfed or not) will have a small amount of jaundice, which starts after the first 24 hours of birth, reaches a peak around day 3 or 4, and then gradually fades over the next week.
• Frequent breastfeeding or pumping during these crucial days after birth awaken receptors sensitive to the hormone prolactin, a key player in the production of mature breast milk. If you become separated from your baby or your baby is unable to breastfeed, then pump your breasts with an electric breast pump every three hours. Pumping will send your body the message that you intend to breastfeed.
• You may have heard the mantra: "If it hurts, you're doing it wrong". Whilst agonising pain indicates a problem and should receive immediate attention, a moderate level of discomfort is normal during these early days as your breasts adjust to being suckled.

Day 4:

• By now you will have given your baby his first - and easiest - "immunisation" (antibody-rich colostrum) and helped to get his digestive system running smoothly.
• Your baby will be weighed again around this point, probably at home by your midwife. He may lose between 8 and 10 per cent of his original birth weight, as he adjusts to the sudden loss of his beloved placenta. Breastfed babies, who have consumed only teaspoons of colostrum, generally lose more than bottlefed babies (Murkoff. H). This weight loss is quite normal and expected, and you should see your baby start to gain weight soon. Remember also that in the first few days your baby may be weighed on several different sets of scales, which can all give subtly different readings.
• Also around this time, your milk will ‘come in’ and you may find yourself with the infamous ‘melons’ – aka your breasts swelling and becoming engorged and warm. Overabundance at this time is normal as your body learns to predict exactly how much milk your baby needs (note that if you had a c-section or are diabetic, your milk may come in a few days later than this). The engorgement usually settles down within 24-48 hours. As your baby starts to feed regularly your body will adapt to producing the right quantities of milk to nourish him. Engorgement is more uncomfortable for some women than for others and is typically more pronounced with first babies. With subsequent babies, engorgement may occur sooner. You may wish to apply chilled cabbage leaves to ease engorgement, however limit use to 20 minutes, no more than 3 times per day, as cabbage can decrease milk supply.
• It is important once your milk does come in that your breasts are regularly emptied in order to stimulate and ensure a good supply of milk. Also check your breasts for blocked ducts which are more likely to occur around this time. Try to avoid wearing a bra during this short engorgement phase if possible as a bra may compress your breasts and make swelling worse.
• The colour of your early milk will gradually shift from yellow to white. At the moment your creamy transitional milk contains high levels of fat, lactose, vitamins and more calories than the colostrum. The photo bellow shows colostrum on the left expressed on day 4, and on the right is breastmilk expressed on day 8.

• On average, feedings will take about 15-20 minutes on each side, although variations are normal. Your baby may take only one side at a time but it is wise to offer both.
• If you are not happy with how things are going, get help early. It's easier to correct problems early than to be re-building a milk supply next week. I recommend speaking over the phone with a La Leche League leader or attending a La Leche League meeting.
• As a result of your milk coming in your baby will start passing soft mustard-yellow stools (or orange and even green can be normal). At this stage at least one nappy per day should be full of poop and a mess to clean up. This ‘explosive poo’ phase will continue for a few more weeks.
• Whereas in the past few days it may have been difficult to tell that your baby’s nappy is wet, now his nappies should be undeniably wet, however the urine should have no strong colour or smell.
• You may now be feeding around a dozen times over 24 hours. Soon, you will build up to around 20 minutes per feed every two to four hours. Fear not. This frequency is only temporary, and as your milk supply increases and your baby gets bigger, the breaks between feedings will get longer.

Day 5:

• Feeling tired? Night time waking is the result of healthy biology. During these early weeks breastfed babies are hungrier at night than during the day. Your newborn’s hunger naturally corresponds to the rise of your breastfeeding hormones after midnight. These late-night feedings serve to help you to build a strong milk supply. Over time, the situation will evolve, and your baby will sleep more at night and be awake for more hours during the day.
• Some nipple soreness can be present at this time but should resolve itself by day 10. Pain that makes breastfeeding intolerable and /or cracked and bleeding nipples are never normal and needs immediate attention from a health professional familiar with breastfeeding management.
• During these early days you may find relatives and other well-wishers offering to “take the baby off you while you rest/ buy groceries/ get on with the housework”. What would be more helpful however would be to hear: “let me do some housework for you while you get on with nursing and bonding with your baby”. For a not-so-subtle hint, print THIS and put it on your fridge or in another prominent place.

1 Week Old:

• Your baby will tend to gain weight steadily as your mature milk supply is established. Once your baby is regularly gaining weight, it is no longer necessary to wake them to breastfeed. Simply follow your baby’s lead.
• Expect your baby to now gain around 4-7 ounces (112-200 grams) per week for their first month.
• At this point your breasts may feel full but soft. You may frequently leak breast milk and begin wearing breastpads. However note that leaking has no relationship to how much milk you’re making.
• Young babies, both breast and formula fed, are often fussy. This fussiness starts at around 1-3 weeks, peaks at around 6-8 weeks and is gone by 3-4 months. "They want to be 'in arms' or at the breast very frequently and fuss even though you attempt to calm them. They often seem 'unsatisfied' with their feedings and even seem to reject or cry at the breast" (Mother to Mother). It is not unusual for fussiness to happen during the late afternoon and evenings, and is usually NOT due to hunger, wet/dirty nappy, or anything that you can remedy. It is usually NOT related to milk supply, although some mothers worry about this.
• By the end of this week your transitional milk will have turned into mature milk which is thinner and contains more water. It consists of 90 percent water and 10 percent of carbohydrates, proteins and fats necessary for both growth and energy. There is more watery high-protein milk at the start of a feed, gradually gaining higher levels of fat as you go through the feed.

2 Weeks Old:

• Most babies have regained their original birth weight by this age. If this is the case, the frequency of weighing should reduce. Note that there is no compulsory requirement to get your baby weighed. UK Government guidelines state that weighing can occur "if parents wish, or if there is professional concern" (see here).
• If your baby has yet to regain their birth weight, try not to worry, “it can take up to three weeks” (La Leche League). Encourage your newborn to breastfeed frequently during the day as well as during the night. Also wait until your baby has finished feeding from the first breast before offering the second. This way, you can be sure that your baby is getting to the rich, fatty hindmilk.
• You are likely to also notice your baby’s first growth spurt around this time. This means that your baby will actively return to the breast many times for closely linked ‘cluster’ feedings. Typically, this pattern occurs during the late afternoon or evening hours. Growth spurts generally last 2-3 days, but for a few mothers they can last a week or so. This is normal, healthy behaviour and NOT a sign that you have an inadequate milk supply.
• By now at least one nappy per day should be thoroughly soaked.
• Although sucking is a newborn reflex, the mechanics of effective latching on aren't. It usually takes a couple of weeks, and sometimes longer, for mothers and babies to get really good at nursing.

3 weeks old:

• You have reached the stage where your baby will probably have a little neck control and a decent latch which makes this the perfect time to practice the lying down breastfeeding position. Once mastered, this position will greatly aid night time feedings as you can snooze whilst your baby helps himself.

1 month old:

• Your baby’s weight will probably start to slow down a little from his previous rapid gain. Expect your baby to gain an average of 1-2 pounds (1/2 to 1 kilogram) per month now until 6 months.
• Your baby will grow in length by about an inch per month (2.5c.m.) until 6 months.
• Also your breastfed baby may not have many dirty nappies now. Some only pass a stool once or twice a week. Other breastfed babies may pass several per day. It depends very much on the individual. Infrequency is not a sign of constipation. Hard, difficult-to-pass stools are. Constipation is very rare in breastfed babies.
• By exclusively breastfeeding for at least 1 month you have given your baby significant protection against food allergy at 3 years of age, and also against respiratory allergy at 17 years of age (Saarinen. UM and Kajosaari. M).