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Expert Q&A

	By Ann Calandro BSN, RNC, IBCLC Lactation Consultant

My wife and I just brought our second child home yesterday. He is healthy. She is breastfeeding. How do we keep him awake to breastfeed the entire time? He's wet one diaper in the last 12 hours -- is he getting enough to eat?

Most parents come home on the second day from a vaginal birth, and on the third day from a Cesarean birth. It is normal for a newborn baby to have two to three wet diapers and two to three bowel movements each day on the first couple of days of life. The average day that mom's milk increases is the third day, although it could happen a little sooner or later. After the milk increases, the baby will begin to drink a great deal more volume of milk, and the wetting and stooling will increase. What goes in one end comes out the other.

After the milk arrives, to be assured that the baby is drinking enough, count diapers and look for three or more bowel movements and six or more wet diapers every 24 hour period. This increase usually begins about day four. Babies need to nurse eight or more times in a 24 hour period in order to grow well. Sometimes you may need to awaken the baby, especially in the day, to eat. It is helpful to dim the lights, unwrap the baby and take off his shirt, rub his back and place him skin to skin with mother. She may wish to express a drop of milk from her breast in order to tempt him to wake up and eat. (It's kind of like being at the movies and smelling the popcorn. Even if you didn't want any when you came in , after a while you really get to thinking about it.) Same with breast milk for the baby.

If baby is especially sleepy, take a good look at him in a natural light to observe for jaundice, a yellow color in his skin. Press down lightly to blanch the skin and see the tone underneath. If he looks yellow even on his arms and legs, he is getting a higher level of bilirubin, and that can make him extra sleepy. Call your physician if the baby is hard to awaken for feedings and the jaundice appears to be all over his body. Remember that breastfed babies do not get constipated, so if the baby is not stooling frequently after the milk increases, that is a cause for concern. The baby needs more breast milk. Call your Lactation Consultant or health care provider to discuss this. Your baby will need to be weighed sometime during the first week after birth, usually at five to seven days of age, to assure that all is well and the weight that may have been lost during the first few days after birth is being regained. By the time your baby is two weeks old, he needs to be at or beyond his birth weight, stooling and wetting frequently, and becoming more content.

Ann M. Calandro, BSN, RNC, IBCLC"

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