What to Expect During the Early Weeks of Breastfeeding

Elimination patterns & problems

Breastfed babies should urinate six or more times a day. In the first two days, your baby may wet only a couple of times in twenty-four hours. As your milk comes in more abundantly, the number of wet diapers steadily increases. By the fourth or fifth day of life, your infant should urinate after most feed-ings, producing at least six to eight wet cloth diapers each twenty-four hours. The urine should be colorless (dilute), not yellow (concentrated).

Because disposable diapers are so absorbent, it can be difficult to tell whether or not your baby has wet. Even if you anticipate using disposable diapers in the long run, you might want to have your baby wear cloth diapers for the first week or two. Or, you can place a piece of tissue paper in your baby's disposable diaper to help tell whether she has urinated. To get an idea of how a wet diaper feels, you can pour one to two ounces of water onto a dry diaper.

A red or pink "brick dust" appearance on the diaper suggests your baby is not getting enough milk. "Brick dust" on the diaper results when uric acid crystals form in concentrated urine. It is not an uncommon occurrence among breastfed infants during the first day or two, when the quantity of colostrum the baby drinks is low. Once your milk starts increasing in abundance, however, a breastfed baby should be able to consume sufficient volume of milk to produce clear urine.

WHEN TO SEEK HELP: The presence of uric acid crystals in a baby's urine after the fourth or fifth day raises the suspicion of inadequate milk intake. Unfortunately, both parents and health professionals often misinterpret this valuable clue and mistake it for other phenomena. For example, little girls sometimes have a slight amount of vaginal bleeding a few days after birth as a result of the mother's high hormone levels during pregnancy. When handling a telephone inquiry, a health professional might attribute a parent's report of a reddish color in a little girl's diaper to slight vaginal bleeding. If a boy baby has been circumcised, urate crystals on the diaper might be confused with blood from the circumcision site. If your breastfed baby has a "brick dust" appearance in the diaper after your milk has come in, contact her physician and ask to have her weighed to determine whether she is getting enough to eat. You also should notify your baby's doctor if your infant has fewer than six wet diapers each day after the fourth or fifth day, or if her urine is dark yellow or scant in quantity.

A breastfed baby's bowel movements should start to turn yellow in color by the fourth or fifth day of life. These yellow "milk stools" appear shortly after your milk comes in abundantly and your baby is consuming generous quantities of milk. The movements are loose, about the consistency of yogurt, with little seedy curds. Some people describe their appearance as a mixture of cottage cheese and mustard; others liken them to butterscotch pudding. Milk stools generally are a large cleanup job, not just a dot or streak.

WHEN TO SEEK HELP: If your baby is still having dark meconium or green-brown "transition" stools by five days of age and has not yet had a yellow bowel movement, this is a probable sign that she is not getting enough milk. Contact your baby's doctor and arrange to have your baby weighed.

Breastfed babies usually pass four or more sizable bowel movements each day for at least the first month of life. Many breastfed newborns will pass a yellow milk stool with every nursing during the early weeks of life. This frequent stooling pattern is not diarrhea. It is entirely normal and suggestive of adequate milk intake.

Beginning around one month or so, the number of bowel movements usually starts to decrease. By a couple of months of age, it is not uncommon for an exclusively breastfed infant to go days-even a week or more-without having a bowel movement. This pattern is not considered constipation because when a stool is finally passed, it often is loose and large (indeed, a mudslide!). Unfortunately, some parent education materials I have read inappropriately blur the two distinctly different stooling patterns of younger and older breastfed infants. Parents often are taught that breastfed infants can stool as often as every feeding or as infrequently as once a week. While both extremes can be normal, they are normal at different ages. The breastfed newborn has the frequent stooling pattern, while the older fully breastfed baby may go days without a bowel movement.

WHEN TO SEEK HELP: If your newborn is having fewer than four stools each day, or if the bowel movements are scant in amount (just a stain on the diaper), it could mean she is not getting enough milk. Contact your baby's doctor and arrange to have her weighed. I am impressed that parents typically are excellent observers of the contents of their baby's diaper. But health professionals don't always do our part in communicating to parents what's normal and what's not. The simple observation of a baby's stooling pattern is a valuable, yet often overlooked, clue to a baby's nutritional well-being.