What is Normal?

“Is this normal for a breastfeeding baby/breastfeeding mom?” In the early days, even veteran breastfeeders can need some reassurance because every baby is different and what is normal varies from baby to baby.

“What is normal?” “Help! My mother/brother/sister-in-law/best-friend/pediatrician said this isn’t normal!” “Is my baby eating too much?” “Is my baby eating too little?” “Should I wake baby up to eat?” “Shouldn’t baby be sleeping longer?” “My breasts are hard!” “My breasts are soft!”

Chances are pretty good that it’s normal. “Normal” does not necessarily mean “The experience that most/all people have”. It means that it’s normal for your baby and for your body, and for your nursing relationship.

So let’s address “what is NOT normal”.

It’s not normal or healthy if your baby is making too few wet diapers per day. Before your milk comes in your baby’s diaper count for the day should match the day of life. So on day one, one wet. On day two, two wets. On day three, three wets. You might see more wets if you had an IV while in labor or if your baby were born via c-section. (Expect these babies to “lose more weight”- it’s water weight.) Once your milk comes in, baby should start making 6-8 wets per day. A “wet” diaper for a newborn (birth to six weeks) is considered  at least 3 tablespoons of liquid. A “wet” diaper for a baby after 6 weeks is 4-6 tablespoons of liquid. Not sure if your baby’s diaper is “damp”, “wet” or “soaked”? Pour either 3 or 4 tablespoons of water into a clean dry diaper, and see what it feels like. That’s wet. More than that is “soaked” and counts as two wets. A poopy diaper is also generally counted as a “wet” diaper.  Sometimes if baby’s been sweating a lot, or has been ill, diaper count can go down for a day or so without being a big issue (especially if baby’s older). But consistent low diaper count can be a sign that baby’s not getting enough milk and that mom might either have some supply issues or that there might be a “milk transfer” issue caused by a weak/ineffective suck, high palate, poor latch, or a severe tongue tie.

It’s not normal or healthy for your baby to have strong smelling concentrated or dark urine. Sometimes baby’s urine might have a slight tinge of color (my son’s always turned a bit pinkish if I ate a lot of beets). Strong concentrated urine can be a sign of dehydration, though. “Brick dust” in the diaper is also considered a worrying sign.  Before jumping to conclusions about if your baby’s urine is strong and concentrated, make sure that they have not been sitting in the wet diaper for a period of time. Normal urine will become strong and smelly too if it’s left in a diaper for too long.

Once a baby has regained birth weight it’s not normal for baby to lose weight or not gain weight consistently instead of gaining weight. If baby’s losing weight, there’s a problem somewhere. Often the problem is an incorrectly calibrated scale. Make sure your provider checks that the scale is properly functioning before each weight check. If the scale is properly functioning and baby is being weighed the same way each time (ie: in a clean diaper or diaper-free), make sure that the weight difference can’t be accounted for by something as simple as “baby hadn’t pooped in a week at the last weigh-in, and just had three blow-out diapers in a row just before this weigh-in”. If baby’s absolutely losing weight, there’s a problem that needs to be addressed. If baby’s making enough wet diapers, baby might have an intolerance to something in your diet (such as dairy or soy which are common culprits). Baby might have a metabolic disorder which is causing low weight gain. There might be a milk transfer issue caused by a high palate or a tongue/lip tie or another physical issue with baby or mom. Mom might have over-supply or foremilk imbalance. Seek support in breastfeeding forums if your baby is losing weight. Find out about things such as breast compressions, block feeding, nursing frequency, things to increase supply, etc. Formula MAY be needed as a last resort, but before that you can try things such as pumping your milk, refrigerating it, skimming the fat off the top and spoon-feeding the fat to the baby after each nursing.

Weight loss can sometimes be totally normal, too. Most babies will either level out on the growth charts or lose a bit of weight once they become more mobile. Or during teething. Or if they’ve been sick. Formula is not the answer to any of those causes of “weight loss” or “slow gain”.

Other Non-Normal Things

Sometimes there are definitely issues, such as reflux or silent reflux. Genetic disorders such as PKU or galactosemia. Sensitivities to something in mom’s diet. Thrush. There’s a lot that can be “abnormal” so it’s always a good idea to seek out more information if you’re in doubt or if your motherly instinct says “there is something wrong here.”

What IS normal, though?

A lot of things. It can be perfectly normal for a newborn to nurse constantly while awake- and even while asleep. It can be normal for a newborn to sleep through the night immediately, and only nurse every 3 hours during the day. It’s DEFINITELY normal for baby to completely change things around on you every once in a while. It’s normal for baby to scream for random reasons during/before/after a feed. Cluster-feeding where baby will nurse for hours and want to switch breasts constantly.. Normal. Baby having a preference for one breast over the other? normal. Baby having absolutely no schedule at all? Totally normal. (And more common than not.)

It’s also totally normal for your baby to do things that absolutely drive you stark raving mad.  Humans are illogical beings that learn to mostly pretend to be logical for social reasons. Infants have absolutely no desire or ability to be logical. They’re likely going to drive you insane at various points. Breathe deep. It’s normal.

Focus less on “normal” and more on “Is baby healthy? Is baby meeting milestones? Is baby making enough wet diapers? Are there things about this nursing relationship that I think could possibly be improved?”

If there are things that you’d like to change, classify them as “goals” rather than as “things that may not be normal”. Seek advice from experienced breastfeeders, see if there’s anything that you can do to help you feel better about the situation, or if there’s possibly something that you can tweak to make things feel a bit more like they’re running smoothly. You’ll discover things that you might not even imagine existed. Things like hypoallergenic infant probiotics, ring slings, “one ounce per hour” rules of mom/baby separation.. All sorts of advice exists out there to help make your life easier without involving bottles, formula, weaning, etc. A lot of advice out there makes breastfeeding easier with breastfeeding advice, not with weaning advice.

Just make sure you’re seeking advice in the right places. Find people that had experiences similar to yours. (If you think you have low supply, don’t accept advice from someone who could squirt milk across the room and hit a bulls-eye/pump 10 ounces in 5 minutes after nursing triplets. Seek someone out who had low/normal supply.) Find people that had similar goals to yours and that MET them. (If you want to nurse for 2 years, ignore advice from the woman who nursed for 3 months and quit. )

Breastfeeding can generate a lot of questions even from supportive people who mistake normal infant behavior for a problem. Reassure yourself about the reasons behind your baby’s behavior and you’ll feel better.

[originally posted at the now defunct custommademilk blog, updated for nurshable.com]

  3 comments for “What is Normal?

  1. elenmum
    July 29, 2012 at 10:30 am

    my 3 month old is ebf and has gained a lb a week since birth, last week he was 18lb 13oz and on the top percentile line, hes also 62cms but the HV had a go, an said if he carries on we’ll have to look at his eating habits. surely its normal for bf babies to gain weight rapidly in first few months? isnt it?

    • sarah
      July 29, 2012 at 12:06 pm

      Usually EBF babies will gain rapidly for the first 3 months and then their gain will slow some.

      Is he EBF at the breast or does he get any bottles?

Leave a Reply

%d bloggers like this: