Breastfeeding the two-day-old

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

A two-day-old baby should breastfeed every 2 to 3 hours and 7-10 times in 24 hours. Feeds last 15-20 minutes on each side, and the baby will likely take both breasts at each feed. Feeding frequently and well during the first few days helps the mother produce milk. Before leaving the hospital, mothers should ensure the baby is breastfeeding well and be able to identify breastfeeding problems, express milk, and access help. The baby should be content when awake and being held, and should be able to latch and suck when hungry. They may have a fussy period during the evening. It is normal for babies to lose some weight during the first few days.

A) The transition to home

Healthy, full-term babies who have been born in hospitals usually leave for home during the first few days after birth. This can be a stressful time for families, and good planning is essential (Evans 2014). Before discharge, a health-care provider should ensure that breastfeeding is going well.

Mothers of new babies should:

B) Breastfeeding the two-day-old baby

Table: Typical Breastfeeding Patterns at Two Days of Age

Breastfeeding

Typical baby

Length of time on each breast (minutes)

15-20

Amount of time from start of one feed to the start of the next (hours)

2-3

Number of breastfeeds in 24 hours

7-10

One or both breasts

Usually both

1) Breastfeeding patterns

Mothers should ensure that their baby is breastfeeding well. Feeding frequently and well during the first few days helps the mother’s milk come in sooner.

If the mother has already had a baby, the milk may come in on Day 2 after birth and the feeding patterns will more closely resemble those of a baby on Day 4.

It is normal for babies to lose some weight during the first few days.

Babies who are at risk of poor feeds or whose mothers are at risk of a low milk supply should receive extra support and be closely monitored.

Babies who are sleepy and suck weakly or infrequently may be entering the sleep hunger cycle or may be sick. Such babies should be seen by their health-care provider as soon as possible.

 2) Nutrition

The baby’s stomach is small. The amount of colostrum the baby takes in is increasing but still small.

 3) Behaviour at the breast

Mothers should offer the breast when the baby shows hunger signs. 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.

Mothers should 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. The baby should only let go of the breast for normal reasons.

C) Behaviour patterns

1) Gut symptoms

As the amount of colostrum increases, mothers start to hear their baby’s tummy gurgling and the baby may be uncomfortable. The bowels are working and pushing the colostrum and stool along. This is the gastrocolic reflex and is normal and a good sign. It will increase in intensity as the baby takes in more colostrum.

2) Fussy behaviour

Babies are usually more alert on the second day and less happy when put down. They continue to benefit from being held in skin-to-skin care.

Healthy newborn babies often have a fussy period during the second day after birth. It tends to occur during the evening or night and does not usually last longer than three hours. This is normal and indicates the baby is healthy and vigorous.

Sick or weak babies who do not suck well may not have the energy to fuss. Fussing more than three hours can indicate the baby is not getting enough milk.

Premature babies who are born at 36 weeks or more, also often have a fussy period on Day 2, but their fussing tends to occur in the middle of the night. Within a few weeks, it becomes an evening occurrence.

The fussy period is followed by a long period of sleep of up to five hours. Outside of the fussy period, the baby should be happy and have a normal feeding pattern the rest of the day.

The evening fuss tends to persist for four months or so.

D) Output

The baby should have at least two pees and two stools in a day. The stools lighten in colour and start to appear olive green.

E) Changes in the mother

1) Breast changes

The breasts may start to feel heavier as they start making more colostrum and prepare to make milk. Milk can come in on Day 2 if mothers have had a baby before. If this is their first baby, it is normal not to note any changes until Day 3.

2) Milk changes

The colostrum looks clear and yellow. If the milk is in, the milk will become creamy and yellow. This is transitional milk.

References

Evans A, Marinelli KA, Taylor JS. ABM Clinical Protocol #2: Guidelines for Hospital Discharge of the Breastfeeding Term Newborn and Mother: “The Going Home Protocol,” Revised 2014. Breastfeeding Medicine 2014;9(1)
 
Wennberg RP, Watchko JF, Shapiro SM. Maternal Empowerment - an underutilized strategy to prevent kernicterus? Curr Pediatr Rev. 2017 Aug 27