Infant Weight Loss is Normal...Initially
You’ve probably heard that it is typical for newborns to lose 7-10% of birth weight in the first few days after birth. This is primarily due to a shift in body fluids due to the obvious change in their environment.

They start by drinking small amounts of colostrum, a very calorie-dense form of milk that precedes mature milk. Colostrum starts transitioning to thinner, more abundant milk in a 24-48 hour process around days 3-5, or possibly slightly later if you had gestational diabetes, a cesarean birth or were on magnesium sulfate for high blood pressure.

Once the parent’s milk has come in, the average baby gains 5-7 oz/week. We expect to see babies starting to regain weight by day 5, and like to see them back at their birth weight by the end of the second week.Â
How Much Milk is Baby Actually Getting?
When the baby is feeding at the breast, it’s challenging to get a sense of how much they are taking in. And in these early days they don’t eat much anyway, because their stomach is very small and colostrum is delivered in small amounts to accommodate for that. So we use other clues to make sure they are getting enough to eat. This is how you will start learning your baby!Â
First, and some might say, most annoyingly, we count the number of wet and poopy diapers. You will surely ask yourself if this is truly necessary. It feels like…it shouldn’t be. I honestly get it, I asked the same question myself. The reason we do it is because measuring output is the most direct way to measure input, when we cannot SEE what is going in (like we would in a bottle). If your baby is not producing the expected amount of diapers for that day, then we start to worry that they didn’t get enough milk to produce wet or poopy diapers, and that’s one clue we have that there might be an issue. If you’re changing diapers constantly, and even changing diapers in the middle of a diaper change (!!), that’s a great sign that you’re on the right track with feeding.

The second clue we get is from Baby’s behavior. Newborns have two modes: sleeping and crying. Both are normal, and we usually see a mix of both. They do a lot of sleeping, and then when they cry, they usually have a reason - they are communicating a need like hunger, fatigue, discomfort. It can be hard to wake a sleepy newborn who is well fed and healthy - sometimes they are just totally out, and no amount of stripping them down, rubbing them all over, and dangling a nipple in their mouth will convince them to eat. That’s ok - you can try again in half an hour and see if you get more traction then. You just want to see that at most feedings, they wake up and eat. Likewise, a well fed and healthy newborn is going to do some crying for you. They have been fairly rudely yanked from their dark, quiet, cozy womb life and there is a lot for them to orient to - and they will have thoughts! They don’t like to be cold, they don’t like to be jabbed with needles (duh!), they don’t like when their arms and legs are flailing about, they don’t like realizing they are hungry, etc. etc. They also arrive with personalities, and some will be soothed more quickly than others. But all should be soothe-able, eventually. The crying should be intermittent. For example, if they cry all night the second night (second nights are infamous for this), they should make up for it by sleeping the next day.Â

A dehydrated baby is going to do too much of either sleeping or crying. Too much sleeping will look like sleeping through all the feedings, all day long and all night long, and the same the next day. They don’t wake up to feed, and they are difficult to keep awake for feedings. Their body tone is what we would describe as lethargic - weak, not holding any tension, listless. On the other hand, some dehydrated babies will cry constantly. They cry before a feeding, they cry after a feeding, they cry all night, they cry all day. They may fall asleep eventually, and sleep a little from pure exhaustion, but they are crying a lot. You may find yourself wondering, Is this cluster feeding?? Cluster feeding is a developmental stage that occurs later - newborns feed sporadically and sometimes the feedings are clustered together especially if they’re not taking long feedings, but if your baby is crying constantly, they are probably just hungry.

So what do you do if you think your baby might be hungry and dehydrated? There’s a very simple test: Feed the baby. When in doubt, we feed the baby! This is always our priority. You can pump colostrum or breastmilk to offer by bottle, or you can use donated human milk (ask the hospital if you’re still there) or you can use formula. It honestly doesn’t matter that much at this point because our priority is - say it with me - feed the baby! These are early days, and if your goal is to breastfeed, there is no reason whatsoever that you would not meet that goal even if you supplement with some formula for a few days. Most urgently, we need to see what is going on, and if Baby takes that bottle down super fast and then stops crying and sleeps for the first time in 24 hours, then we know that they were hungry. And we know we’re going to keep doing that, WHILE we pump the breasts to make sure the milk supply comes in, WHILE we see a lactation consultant to check on all the things.Â

The most important thing to remember in those first few days is to trust your instincts. If you feel like your baby seems genuinely distraught and is constantly crying, or they are sleeping too much and you really cannot rouse them, follow up with all the resources at your disposal at the hospital or call your pediatrician. And if you cannot access any of those providers quickly enough to get their medical opinion - or you do not agree with their opinion - then you follow your instincts and FEED THE BABY! It is not possible to overfeed a newborn. If they are not hungry, they won’t take the milk. When they’re done, they’ll indicate this to you by stopping sucking or pulling off the bottle. You can’t mess up the feeding, so you might as well try. You are the experts on your baby - you’ve got this!
~ Naomi, Infant Feeding Expert*
*If you need help to schedule your bundled Infant Feeding session with Naomi…email Elizabeth Parish.Â
Comments