The First Month: Feeding and Nutrition

Breastmilk or formula should be your child’s sole nutritional source for the first six months, and the major source of nutrition throughout the first twelve months. When you add solid foods to your baby’s diet, continue breastfeeding until at least 12 months. During this time, you and your pediatrician will need to pay attention to her pattern of feedings and make sure that she’s getting enough for growth. Regular checkups and monitoring of growth is the best way to ensure this.

Here are some important points to keep in mind about feeding:

• Establishing a pattern of feedings does not mean setting a rigid timetable and insisting that your baby breastfeed for a set amount of time or eat a full 4 ounces (120 ml) at each feeding. It’s much more important to pay attention to your baby’s signals and work around her needs. If she is bottle-fed, she probably will cry at the end of her feeding if she is not getting enough. On the other hand, if she is getting an adequate amount in the first ten minutes, she may stop and fall asleep.
• During the first month, breastfed babies indicate interest in feeding when they begin to root (reflexively turn toward the breast) or place their fist in their mouth and start sucking. Crying is a late sign of hunger. It is easier to get the baby to latch on and feed when she is showing the early signs of rooting or lip smacking.
• Your baby should be fed at least every two to three hours on demand, with attempts to feed eight to twelve times a day. During the first month, your baby should be feeding through the day and night. In fact, it may be troubling if your baby is sleeping contentedly through the night; she may not be getting enough to eat.
• Generally, your baby will feed adequately in about fifteen to twenty minutes. By this time, she will frequently begin to look drowsy or fall asleep. If she still acts hungry after feeding well on the first breast or wakes up during a diaper change, offer the other breast. Very long feedings may indicate that the baby is not latched on well or ingesting enough milk to become full or satiated.

Growth spurts can occur at different times for different babies. At the beginning of the second week and again between three and six weeks, your baby may go through growth spurts that may make her hungrier than usual. Even if you don’t notice any outward growth, her body is changing in important ways and needs extra calories during these times. Be prepared to feed her more often if she’s breastfed; more frequent breastfeeding will stimulate more milk production by the mother’s body.

If your baby is bottle-fed, try giving her slightly more at each feeding. If your baby has a nutritional problem, she’s likely to start losing weight or not gain adequately. There are some signals that may help you detect such a problem. Your breasts will typically become quite full from two to five days after giving birth. After this time, you should notice that your breasts feel full and somewhat firm before feeding and soften after feeding. While your baby nurses on one breast, you may notice some milk dripping or spraying from the other breast.

If you fail to notice fullness in your breasts after five days or you don’t see milk dripping from your breast at the start of each feeding, you may not have an adequate milk supply or the baby may not be providing enough stimulation when she sucks. These also may be signs of medical problems that are unrelated to your baby’s nutrition, so call your pediatrician if they persist. Every infant should have a checkup within three to five days after birth and forty-eight to seventy-two hours after hospital discharge to help detect any problems.

Most babies this age begin to spit up occasionally after feedings. That’s because the muscular valve between the esophagus (the passage between throat and stomach) and the stomach is immature. Instead of closing tightly, it remains open enough to allow the contents of the stomach to come back up and gently spill out of the mouth. This could be normal, may not harm your baby, and will resolve as your baby grows, usually by one year of age. If your baby is gaining weight appropriately and does not have any other problems, it should reassure you. But if spitting up occurs frequently or is associated with diarrhea, rash, or failure to gain weight, this may indicate a food allergy or problem with the gastrointestinal tract and your physician should be contacted.

You also do not necessarily need to be concerned if your newborn has a bowel movement every time she feeds—or only once a week. If your infant is otherwise feeding normally, there is a wide range of acceptable bowel patterns.