No Latch in 12 Hours
Term infants normally lose about 7% of their birth weight before they begin to gain weight by day 4-5, and then regain birth weight by day 10 (AAP, 2005). This respite from high caloric/fluid requirements provides infants time to learn the process of effective suckling, when a mother’s breasts are soft. (A newborn with weight loss of 10% in the first several days is not equivalent to an infant who is 10% dehydrated.)
Instead of intake, the appropriate focus should be on keeping infant and mother together, teaching techniques to assist with latch on, and promoting milk production by hand and/or pump expression. If and when supplementation is medically needed, attention should be given to appropriate volumes as well as modes of feeding that have been demonstrated to be least likely to interfere with ultimate breastfeeding.
Compared to bottle-fed infants, well-fed, breastfed infants consume less than half as much in the first couple of days (Dollberg, 2001, Riordan J. 2005. J Hum Lact. 2005 Nov;21(4):406-12. Indicators of effective breastfeeding and estimates of breast milk intake.)
As supplementation and the use of artificial nipples has been shown to interfere with infants acquiring breastfeeding skills, (Dewey, 2003 and Howard, 2003) the use of spoon or cup-feeding is recommended here.
Neonatal Feeding Amounts for the First Five Days Following Birth (Full-term Infants)
Birth - 24 hours
24 - 48 hours
48 - 72 hours
|Infants 37 - 38 weeks AND 6 pounds or less||5 ml (1 tsp) every 2 - 3 hours, at least 8 times in 24 hours||5 ml (1 tsp) every 2 - 3 hours, at least 8 times in 24 hours||5 ml (1 tsp) every 2 - 3 hours, at least 8 times in 24 hours|
|Infants < 37 weeks OR < 6 pounds||5 ml (1 tsp) every 2 - 3 hours, at least 8 times in 24 hours||10 ml (2 tsp) every 2 - 3 hours, at least 8 times in 24 hours||15 ml (3 tsp) every 2 - 3 hours, at least 8 times in 24 hours|
- If baby continues to have difficulty attaching to breast, and supplementation is determined to be necessary for medical reasons, begin feeding using “alternative feeding measures”, such as spoon, cup, syringe or finger-feeding.
- Breast expression: Begin hand expression at least 8 times per 24 hrs. By 24 hours, add pumping if the infant is too sleepy to attach and nurse effectively. The frequency should be 8 times every 24 hours, with no more than a 5 hours interval at night.
- Practice skin-to-skin contact as much as possible, avoiding maternal-infant separation.
- Other measures after 48-72 hours: (Dewey, 2003;Howard, 2003; Ferber, 2004):
Apply nipple shield if the baby is unsuccessful latching, preferably not until milk volume is up.
When possible, avoid use of pacifiers; use holding and skin-to-skin to sooth infant.
Even the smartest babies in the world take a bit of time to figure out how to breastfeed. Lucky for us, there’s no urgency to get calories in, for the first couple of days. The “baby steps” of learning will come more naturally if we keep him (her) skin-to-skin with you and just practice breastfeeding. There are lots of things we can do to help him (her) learn. In the mean time, we also need to ‘phone in your order’ for lots of milk, because s(he’ll) need it after 3 days.
Most babies do a lot of sleeping in the first day.
Your baby is just recovering from the birth.
Your baby is just trying to figure out the world.
You are doing a great job.
Put on your light if your baby starts moving around or wakes up. I’ll come in and help you.
This is a learning time for both of you.
This is hard now, but it will get easier.
Babies At Risk
- C-section Mothers
- Mothers with multiples
- Infants who have not latched-on or nursed effectively for 12 hours
- Mothers of NICU or PSCN infants
- Infants supplemented more than once in 24 hours
- Infants < 38 weeks or less than 6 pounds
- Infant with loss of 10% birth weight
- Mothers with breast surgery
- Mothers with a history of breastfeeding failure
- Antepartum mothers at risk of preterm delivery