Ensuring Adequate Newborn Feeding During the First Few Days
A fundamental element of successful newborn feeding is safe and adequate feeding. Despite what many parents have heard, inadequate colostrum or breast milk in the first days after birth is common. Knowing how to recognize a well-fed versus an underfed newborn is vital to ensuring safe newborn feeding.
For infants who do not get adequate colostrum or whose exclusively breastfeeding mother develops delayed onset of full milk production, supplementation with banked donor milk or formula is essential to protecting their health and brain development. This can be done while maintaining the stimulus to produce milk by supplementing only after adequate time nursing, or manually expressing or pumping both breasts.
Want to learn more about this topic?
Do you want to learn more about breastfeeding while ensuring safe and adequate feeding?
Dr. Christie and board-certified lactation consultant Lynnette Hafken have just released the online Fed Is Best Breastfeeding Course, where they discuss all the things that you will not hear from a breastfeeding book or class. In it they include secret tips and tricks that you normally have to pay hundreds of dollars to learn about, for the same cost of a hospital breastfeeding class. Click below to get in on the training!
Learn more about newborn feeding whether it is through breastfeeding, bottle feeding, pumping, or formula feeding with these articles: Paced Feeding, Material Components of Bottles, How To Wake a Sleepy Newborn
Good vs. Ineffective Newborn Breastfeeding Session
The following is text from Chapter 6 of the Fed Is Best book, “The First Few Days: How to Ensure Sufficient Feeding” available in a printable format. To read the full chapter, click the button below to order the book, available in paperback, e-book, and audiobook.
Note to mobile users: The following is best viewed in landscape or horizontal view.
| Good Breastfeeding Session | Ineffective Breastfeeding Session |
|---|---|
| Baby is actively sucking and swallowing with a few short breaks. | Baby is latched but mostly sleeping while on the breast. |
| Nurses at least 10 - 15 minutes on each breast. | Baby does not sustain sucking or swallowing. |
| Baby is satisfied after feeding. | Baby must be frequently awoken to keep him latched or swallowing. |
Markers of a Well-Fed Newborn
- Satisfied with most feedings
- Calm and able to sleep for 2-3 hours
- Wakes easily for feeds at least every 3 hours
- No more than 75th percentile weight loss on the NEWT
- No more than 7% weight loss from birth weight, per the AAP
- Saliva in the mouth and on the lips
- Skin that doesn’t wrinkle
- Flat soft spot (fontanelle)
- Minimal yellowing of skin, limited to the face
- Wet diapers have clear or light yellow urine with no red specks
Learn more about making sure your newborn is fed adequately with these articles: Ways to Supplement Breastfeeding, Nursing in Public, Bottle Refusal in Breastfed Babies
Signs of a Hungry Newborn
Blood Markers of a Well-Fed Newborn
| Blood Marker | Levels |
|---|---|
| Glucose | > 50 mg/dL in the first 48 hours; > 60 mg/dL after 48 hours |
| Total Bilirubin | < 13.5 mg/dL is the lowest risk for brain development |
| Sodium | 135-145 mEq/L |
We support all types of newborn feeding. Learn more about pumped milk feeding in these articles: Preparing to Pump Checklists, Drops in Milk Production During Exclusive Pumping, Choosing a Breast Pump
Term Newborn Breast Milk or Formula Requirement per Feeding
The full daily caloric requirement of a term newborn is an average of 110 kcal/kg/day. Half of this (or 55/kcal/kg/day) is the resting energy expenditure, which is the minimum number of calories required to support brain and organ function. The other half is the energy needed for feeding, digestion, absorption, storage, and elimination. Both breastfed and formula fed newborns have the same caloric requirement.
The average newborn will take less than their full caloric requirement (about half) for the hours after birth during a relatively sleepy “recovery period” if fed breast milk or formula to satisfaction. Once they wake up from this period or run low on caloric reserve, they become hungry for their full caloric requirement.
Every newborn is born with different caloric and fluid reserves to tolerate a short period of underfeeding. Some will need more than the following volumes; some will need less.
The following table provides the estimated breast milk or formula requirement of an average 3 kg/6.6 pound term newborn during the recovery period and when they become hungry for their full requirement. A baby may safely receive smaller volumes if fed as frequently as every 2 hours as long as they receive the same volume of milk per day as they would if fed every 3 hours. This is not meant to be a schedule; babies should always be fed on demand. Most babies are able to avoid unsafe conditions if given access to the milk they are hungry for.
To calculate your baby’s full daily milk requirement based on their age and weight, go to the Fed Is Best Daily Milk Calculator.
Newborn Feeding Amount Chart
| Day After Birth | Volume per feed (oz) per lb | Volume per feed (oz) per kg | Volume per feed if fed every 3 hours |
|---|---|---|---|
| Post-Birth Recovery Period (8-12 hours after birth) | 0.15 | 0.35 | 0.5 to 1 oz |
| When baby becomes hungry for full feedings | 0.3 | 0.7 | 2 oz |
Want to learn more about this topic?
Do you want to learn more about breastfeeding while ensuring safe and adequate feeding?
Dr. Christie and board-certified lactation consultant Lynnette Hafken have just released the online Fed Is Best Breastfeeding Course, where they discuss all the things that you will not hear from a breastfeeding book or class. In it they include secret tips and tricks that you normally have to pay hundreds of dollars to learn about, for the same cost of a hospital breastfeeding class. Click below to get in on the training!
To learn more about this topic, read the Fed Is Best book available on paperback, e-book, and audiobook.
References
FromFed Is Best: The Unintended Harms of “Breast Is Best” and How to Find the Right Approach for You and Your Baby, Benbella, 2024.
FAO/WHO/UNU Expert Committee. “Human Energy Requirements Report of a Joint FAO/WHO/UNU Expert Consultation,” October 17, 2001. http://www.fao.org/3/y5686e/y5686e.pdf