How do we know that breastfeeding is going well in the first few days? 1) Baby latches on properly and stays at the breast for a good amount of time 2) Baby feeds with sufficient frequency 3) Baby’s output – measured in poops and wet diapers – is normal for age.
While it is easy enough to remember these 3, it can be difficult for a new mother with a brand new baby to remember exactly how many times she breastfed in the last 24 hours, or for how long. She may or may not recall how many times her baby had a wet diaper or passed stool. I’ve had patients who kept strict journals and wrote down to the exact minute the time and duration (and side) of each breastfeed. But at 8-12 breastfeeds a day, this practice can get pretty overwhelming and exhausting.
To make life a little simpler for my patients and to help me keep an eye on them better, I designed a graphic chart that can be used in the first week. It has been a huge help to me and to many mothers I have shared it with. I am sharing it here today.
To see the full chart and/or print out a copy, click here: BF Checklist
Before you start, it’s important to know how to use this chart properly and to understand that this is simply a guide to help document your progress. Every child is different. The majority of babies who are breastfeeding well will fall within the norms in this checklist. When a baby does not, it simply means your physician/nurse/counselor needs to evaluate you and your baby more thoroughly. Either way, recording your progress in the first week is a big help to you and your physician, and to anyone else who is going to assess your breastfeeding progress. I find that using this chart (or something similar) can help pinpoint problems early on so that they are corrected/addressed before they become too serious.
*Edit: When a baby is not meeting the minimum number of wet diapers, it is important to reassess an infant’s position and latch, and to breastfeed more often.
What each column means:
Days: Each day represents a 24-hour period beginning from the moment your child is born. So if you deliver at 2 pm today, Day 1 starts at 2 pm and ends at 2 pm tomorrow, and so on.
Changes in milk and breasts: A short description of what to expect is written under each particular day. THESE ARE GUIDES and are NOT hard-and-fast rules. But they serve to remind the mother that Mature Milk does not come in until the baby has been breastfeeding for several days.
Frequency of Feeding: Every baby is different. Most babies will average 8-12 breastfeeds in a day. It is rare for a brand new baby to breastfeed less than 6 times a day everyday and be breastfeeding successfully. Consistently feeding more than 12 times a day is also not typical. A baby that feeds the usual 8-12 times a day at regular intervals would be feeding about every 2-3 hours. However, not many babies will have perfectly-spaced feeding intervals. It is very normal for the time between feeds to vary. A 1 day-old baby might nurse once, fall asleep and breastfeed again 4-5 hours later, and then every 1 1/2-2 hours for the next 18 hours (and this is fine!). Also, babies tend to feed less on the first day and more frequently from the 2nd day onward. This is perfectly normal.
To keep track of the number of feeds, mark 1 figure every time you breastfeed (whether this is at 1 or both breasts). You needn’t worry too much about how far apart the feeds are, as long as you are meeting the minimum number of feeds per day (8 from day 2 onwards). If you are not, then this is a signal to reevaluate your progress.
Tracking stools and wet diapers: Adequate output is one of the most reassuring gauges of successful breastfeeding. Mark a diaper image for every wet diaper the baby has, and mark a poop every time the baby passes stool. If you are marking off a good number of stools and wet diapers, then breastfeeding is most likely going well and there is no need to worry. It can sometimes be difficult in the early days to believe that you are making the right amount of milk for your baby. That a baby is peeing and pooping often means he/she is getting enough. This chart was designed to show the usual range for number of feeds, stools and wet diapers. Darker figures are the ideal minimum, and lighter figures are ‘extra’ but still within the normal. So on Day 4 for example, a baby would ideally have at least 4 wet diapers, and maybe up to 6 (more than 6 is unusual but absolutely fine!).
How many minutes should you nurse each time? Mothers should first offer one breast and allow the baby to nurse until he/she falls off the breast. The baby can then have the second breast if he/she so desires. It is not a good idea to keep babies on the clock, as every baby is different. Once breastfeeding is established, some babies might feed for 5 minutes at 1 breast and be done. Others will take 20-30 minutes at 1 breast. Still others will want both breasts and will breastfeed for 40 minutes. So why does the chart ask you to feed at least 10 minutes from 1 or both breasts? Early in my practice I discovered that some mothers believe that any amount of time at the breast is sufficient. They put their baby to the breast for 2 or 4 minutes and consider that a full breastfeed. They would say that their baby breastfed 8, 10 or 12 times in the last 24 hours (which sounds just right), but those feeds were extremely short periods at the breast. In the early days, this is generally a red flag. Therefore what the chart recommends is the minimum amount of time that a baby should be actively feeding at the breast. If the baby would like to feed longer then that is perfectly fine, but when a baby consistently does not stay at the breast long enough to have a good feed, further evaluation is necessary.
I hope those of you who are new moms and those who take care of new moms and their babies will find this chart helpful. Try it out or pass it on to new-mommy friends and let me know how it works for you!