Breastfeeding the four-day-old

What should I expect when my baby is four days old?

By three or four days after birth, the baby should be breastfeeding well, every 2 to 3 hours and 7-10 times in 24 hours. Breastfeeds will last 15 - 20 minutes per side and the baby will likely take both breasts at each feed. Mothers with a large milk supply may find that their babies breastfeed a little more often, faster, and are less likely to take the second side. The breasts have switched from producing colostrum to milk. The baby’s intake quickly increases and the baby begins to gain weight. It is normal for babies at this stage to choke and gulp at the beginning of a breastfeed. The baby’s tummy will make gurgling noises or cause crampy pain, the result of a bowel contraction. This is also normal. The baby should be content when awake and being held but may have a fussy period in the evening or night.

A) Breastfeeding the four-day-old baby

Mothers should ensure that the baby is taking in enough milk, has not lost too much weight, and is not too sleepy.

Table: Typical Breastfeeding Patterns at Four Days of Age

(Links to more information about the topics in the above table: large milk supply; length of time on the breast; amount of time from the start of one feed to the start of the next; one or both breasts)

1) Breastfeeding patterns

Feeds are generally in three stages. Mothers will find the baby starting to spend longer in the alert (“I’m starving”) stage. Babies are often asleep at the end of a breastfeed.

Most babies need the second breast some of the time. If the mother has a large milk supply, babies tend to just want one breast at each feed and will feed more often.  With a more average milk supply, babies are more likely to need both breasts and will feed a little less often. Both are normal behaviours.

2) Nutrition and growth

By two to four days after birth, the breasts will switch from producing smaller amounts of colostrum to larger amounts of transitional milk. This is known as the milk coming in. Mothers who have had a previous baby tend to notice this happening earlier than mothers who have delivered their first baby. With this change, the baby’s milk intake quickly increases and the baby begins to gain weight.

 3) Behaviour at the breast

Offer the breast when the baby shows hunger signs. Now that the milk is in, the baby is taking larger amounts of milk at each breastfeed. While breastfeeding, the baby may now choke, gulp, click, and pant at the start of the breastfeed. These behaviours are normal.

Some babies won’t let go of the breast at the end of the breastfeeding session. Mothers should take the baby off the breast if the baby is not actively sucking or if more than 20 minutes have passed since the start of the feed.

Offer the other breast once the baby wakes and shows more hunger signs; this is usually within 10 minutes.

The baby should be content when awake and being held, and should be able to latch and suck when hungry and stay latched during the feeding. The baby should only let go of the breast for normal reasons.

B) Behaviour patterns

1) Gut symptoms

The baby’s tummy will make loud gurgling noises as the milk moves through the bowel. To push the milk along during and after feeds, the bowel squeezes or contracts. This is called the gastrocolic reflex. These will be more obvious and more painful as the amount of milk increases and will continue for several months. The squeezing can also cause a crampy pain and this too is normal.

2) Fussy behaviour 

If the baby is gulping a lot of air, it may need a burp during or after the feed.

A fussy period may occur in the evening or at night for two to three hours, after which the baby may sleep for up to five hours.

C) Output

The baby should have at least four pees and three stools (poops) a day. The stools are more yellow and less green now and may have small seeds (curds).

D) Changes in the mother

1) Breast changes

The switch from producing colostrum to milk can result in dramatic changes in the breasts, such as filling, heaviness, tenderness, and lumps. If the baby is not breastfeeding effectively, mothers’ breasts can become overfull or engorged.

2) Milk changes

The breasts now make transitional milk which looks milky and has a creamy or yellow colour.