Ask the Doctors

Dear Doctor: I just had my first baby, and I'm breastfeeding him. I really enjoy the experience, and our pediatrician says he's hitting his weight milestones. But my mother-in-law is afraid he's not getting enough nutrients and is pressuring me to switch to formula. How do I know if my newborn is getting enough breast milk?

Dear Reader: Congratulations on your new baby and on the good reports from your pediatrician. We hope we can help you quiet your mother-in-law's concerns.

If you're healthy and are eating a balanced diet, then your breast milk has everything your baby needs to grow and thrive. It contains protein, fat, carbohydrates, vitamins, minerals and water for hydration. Breast milk is also a rich source of bioactive compounds that help strengthen your baby's brand-new immune system.

When your son nurses, he's taking in a remarkable food source that, in addition to being easily digested, helps him to absorb the nutrients that it contains.

It's not unusual to wonder whether your baby is getting adequate nutrition. We live in a world of food pyramids and portion sizes. Food and the nutrients it contains have become things that we measure down to the last ounce, gram and calorie. So the process of feeding an infant from one's own body, where it's hard to quantify exactly what and how much a baby is getting, can cause anxiety.

Your pediatrician's reassurance that your baby's weight is on target means he is getting the nourishment he needs. There are also some solid useful hallmarks that indicate whether things are going well.

In the first four or five days after birth, you should be getting four to six wet diapers per day. Babies who are well-hydrated will have pale or clear urine. If the baby's urine turns deep yellow or orange, like the color of apple juice or weak tea, it's a sign that he's not getting enough milk to support hydration.

How much stool a baby produces is another sign of how well breastfeeding is going. Within the first month, breastfed babies will be producing two or three bowel movements per day. Some, because breast milk can act as a natural laxative, may have a bowel movement with each feeding. After that, as the bioactive compounds we mentioned earlier help the baby's gut to mature, you'll notice that the number of bowel movements drops to about one (and occasionally fewer) per day.

With their tiny stomachs (at birth, a baby's tummy can hold about a teaspoonful or 2), newborns need to eat frequently. At 10 days old, they can comfortably hold up to 2 ounces. Newborns need to feed every two to three hours. As they get older, the frequency drops, and each baby will develop her or his own feeding pattern.

Being a new mother is challenging enough. Having a family member add to your worries makes things even harder. Perhaps introducing your mother-in-law to the excellent information available at womenshealth.gov (enter the word "breastfeeding" into the search box) can help calm her fears.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

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