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Is My Newborn Eating Enough?

When my daughter, Elizabeth, was born, I was determined to succeed at breastfeeding. And it sure looked easy in all the baby books. The problem was, Elizabeth apparently hadn't read the books and refused to breastfeed the recommended ten minutes per side. I actually set a portable alarm clock and watched it nervously during feedings, and when she abandoned the second breast after only a few minutes -- or worse, fell asleep -- I became frantic.

Was my baby starving? Was I a bad mother? Instead of looking like that picture of perfect motherhood in my baby book, I spent most of our nursing sessions in tears. I was afraid to look like a failure, and thought that calls to my pediatrician should be reserved for major, life-threatening events, like broken limbs and the plague. Finally, I called the breastfeeding support group La Leche League, and they assured me that Elizabeth was normal -- some babies are just very efficient at nursing. In fact, her falling asleep after nursing was a sign she was full, not sick. At her two-week checkup, my pediatrician confirmed that she was gaining weight -- and told me that he was always available to answer questions.

Experts say my experiences -- and my distress -- are all too typical. Why are we so worried? For one thing, babies can't tell their parents why they're not eating. Wouldn't it be great if your child could say, "I'm not sick, Mommy. It's just that Daddy and the leaf blower are more interesting than my bottle." So, how can you avoid going crazy? Here, some guidelines about infant eating behavior -- and parental behavior -- specifically for her age group.

Birth to six months

The American Academy of Pediatrics (AAP) does recommend nursing 10 to 15 minutes on each breast, 8 to 12 times a day. But breastfeeding isn't an exact science, and, unfortunately, many moms make the mistake I did and look to these guidelines as if they were the law.

"When you give moms, particularly young moms, a hard rule, they worry when their child doesn't fit that rule," says William H. Dietz, M.D., Ph.D., editor of The AAP Guide to Your Child's Nutrition and director of the division of nutrition and physical activity at the Centers for Disease Control and Prevention in Atlanta. Many healthy babies won't breastfeed according to AAP guidelines. Variables, particularly in the intensity of a baby's suck and the force of a woman's letdown (the reflex that causes the release of breast milk), can affect how much an infant is getting at each feeding. For example, my daughter may have gotten more milk in 7 minutes than another child would in 20.

A better measure of whether your child is getting enough to eat is how frequently she is urinating and how satisfied she seems, says Dr. Dietz. Look for six to eight wet diapers a day and three or four with stool, says Carol Huotari, research librarian at the La Leche League Center for Breastfeeding Information in Schaumburg, Illinois, and a certified lactation consultant. Because disposable diapers are designed to feel dry, she says, they can be deceiving. She suggests pouring a ¼ cup of water in one and checking it to get the feel of a wet diaper.

Moms who choose formula have a better handle on how much their babies are eating -- they can measure it. Most young babies consume two to three ounces at a feeding, for a daily total of two to three ounces per pound. But formula-fed infants have surges and drops in appetite just like the rest of us; a baby may guzzle at one feeding, and then wait longer until the next and be fine.

Weight gain may be the most important factor in determining whether a baby is eating properly. Some weight loss after birth is normal, but a baby should not lose more than 10 percent of his weight in the first few days (that's about 13 ounces in an eight-pound baby).

A breastfed baby may initially lose more weight than a bottle-fed one because her mother's milk has not come in, or they're both still learning to breastfeed, says Marianne Neifert, M.D., Babytalk contributing editor and author of Dr. Mom's Guide to Breastfeeding. If a breastfed baby isn't gaining enough weight, a doctor may recommend supplementing with formula. Weight loss in a bottle-fed baby is more alarming since it isn't a milk-supply problem.

{C}Warning signs that a newborn (breast- or bottle-fed) may not be eating enough include: He breastfeeds for less than ten minutes at a feeding, he wets fewer than four diapers a day, his skin remains wrinkled beyond the first week, or he doesn't develop a rounded face by three weeks. Babies who vomit most or all of their food or have very loose stools eight or more times a day may have allergies or digestive problems. Remember, however, that even if your baby doesn't exhibit these warning signs, you don't have to live with anxiety. Don't make my mistake; schedule an appointment with your pediatrician to have your baby weighed anytime you are concerned.

As your baby grows, a general rule is that his weight will double at about 4½ to 5 months, although smaller babies may double earlier. But this doesn't mean your baby has to be topping the growth charts to be healthy. "Every mom wants her baby to be at the 98th percentile for height and weight  -- and that concerns me," says William J. Klish, M.D., professor of pediatrics at Baylor College of Medicine at Texas Children's Hospital, in Houston, noting that America is suffering from an epidemic of obesity. "It's not what percentile they're growing at, as long as they continue to grow at that percentile."

Percentiles for height and weight should be fairly close, notes Dr. Neifert. A child with a big gap -- say 98th percentile for height and 25th for weight or vice versa -- may have eating problems. Keep in mind that exclusively breastfed babies may not conform to pediatric growth charts since the charts are based on a sampling that included few infants who were breastfed for more than a couple of months. Breastfed babies often grow quickly in the first three months and then become lower in weight than their bottle-fed peers.

So the bottom line is, if you are worried about your child's eating habits to the point where you are tearful, angry, frustrated, and at your wit's end... you are perfectly normal. In fact, it's a sign of good parenting that you care so much about your child's nutrition. If the anxiety is getting to you, however, there's no need to sit alone and worry. Call your pediatrician. Don't let your appetite-anxiety deprive you of one of the great joys of parenthood -- sharing meals with your child. This may be hard to believe during the pea-flinging years, but dinner really can grow into a treasured time together.