Dr. Bob: I get confused with infant feeding schedules. I know that every time my baby cries that they do not need to be fed but it can be hard to pick up on cues. Am I overfeeding or underfeeding my baby? Related to that, how often should my infant be pooping? Sometimes it seems like all I do is change diapers.
Answer: Taking care of a new baby can be confusing and challenging, especially since everyone will have advice. Consult with your pediatrician and look for expert advice from the American Academy of Pediatrics (healthychildren.org) when you need it. Let’s review infant feeding and pooping.
- Hunger cues – crying can be a late sign so look for hunger cues like licking lips, rooting, opening mouth, fussiness.But remember that crying is not necessarily a sign of hunger every time. Often times crying is a signal for cuddling (being comforted) and/or needing a diaper change. Over time, you will be able to tell the difference.
- In a previous column I emphasized the advantages of breastfeeding but sometimes infants are just bottle fed.I should remind all new mothers that exclusive breast or formula feeding is recommended for the first six months. Both of these provide the optimal nutrition before solids are added.
- Be sure that the formula is mixed to the proper proportions.Formula that is too dilute or too concentrated is potentially dangerous to the baby.
- Bottle fed babies tend to eat every 2 to 3 hours initially or a minimum of 8 times a day.The initial amounts can be under a full ounce but will advance quickly to 3 to 4 ounces at a time, usually about every 3-4 hours by one month of age. The feedings might progress to 6-8 ounces for the 4-5 feedings per day by 6 months of age. In my experience, about 24-30 ounces a day is plenty of formula.
- How to determine if the baby is getting too much or not enough?Well, your pediatrician will be checking the weight and assessing growth at every visit so check with them. Be sure to make all of these appointments. Spitting up can be a signal of overfeeding. Too rapid weight gain can also be a signal. Too slow weight gain might be a sign of too little formula or that the formula is not being mixed correctly.
- A great way to assess infant intake is by what comes out – urine and poop.Initially, the baby will have at least 2-3 wet diapers a day. This will quickly progress to 5-6 wet diapers a day. My personal experience with my two sons was more than that! It is really hard to tell how much urine is in diapers these days since special chemicals are added to make them super absorbent though you can usually tell by how heavy they feel. This can be a good clue for parents. Stool frequency can vary greatly. Breast fed or bottle fed babies will usually have a different frequency. Breast fed babies tend to have less frequent stools initially than bottle fed babies. My experience over 40 years confirms that variation in stool frequency is usually not a cause for concern. Babies frequently strain when having a bowel movement and rarely does that mean that they are constipated. It is just a reflection having a bowel movement when lying down.
Again, I understand any confusion you might have. Your pediatrician is such a valuable resource. Do not hesitate to discuss this with them.
Dr. Saul is Professor of Pediatrics (Emeritus) at Prisma Health and his website is www.mychildrenschildren.com. Contact Dr. Bob at askdrbobsaul@gmail.com with more questions.