Infant Care: Feed, Sooth and Care for Your Baby

In the first days and weeks of life, if your baby is awake, he or she is usually feeding. Below, we’ve gathered tips on common questions and concerns about the feeding process, including:

• When your breast milk comes in 
• Breastfeeding pumps and bottles
• Formula feeding
• Feeding on schedule or on cue
• Whether your baby is getting enough nutrients 

The following are the American Academy of Pediatrics’ recommendations for breastfeeding babies:

• Breastfeed exclusively for about the first 6 months. The Academy supports breastfeeding for the first year and beyond as long as both mother and child want to, even through the toddler years.
• Your baby should be in a crib or a bassinet in their mother's bedroom, where mom can have easy access.
• A pediatrician or other healthcare professional should evaluate your newborn breastfed infant at 3 to 5 days old and again at 2 to 3 weeks old to be sure your baby is feeding and growing well.
• All exclusively breastfed babies should receive a vitamin supplement. Ask your pediatrician to recommend a vitamin and dosage.

Your mature breast milk will come in two to four days after you give birth, depending on how much your baby nurses in the first days. Newborns need to nurse at least 10 to 12 times each day.

You’ll know your milk has come in when:

• Your breasts increase in size.
• You can hear your baby swallowing after seeing two to three nursing motions at his or her jaw.
• Your breasts slightly decrease in size as your baby feeds.
• You feel some cramping in your uterus and you feel your milk releasing as your baby latches on. This is called a letdown reflex, although not all moms feel these sensations.
• You see white or pale yellowish milk, rather than golden yellow colostrum, leak or spray from your nipples or the corners of your baby’s mouth.

These are signs that your milk is changing from colostrum to mature milk. Nurse your baby frequently (every one to three hours) to establish your milk supply and provide the nourishment your baby needs.

Wake your baby to nurse if he or she sleeps more than four hours in a row. Your newborn’s stomach is about the size of a walnut. It empties quickly and needs to be refilled often.

Breast milk is more easily digested than formula. That means breastfed babies feed more often than formula-fed babies. Frequent feeding will establish your milk supply. The more your baby feeds, the more milk you’ll produce.

Call your pediatrician or lactation consultant if:

• Your milk doesn’t seem to have come in by the third day after you’ve given birth
• Your baby is producing fewer than six to eight wet diapers and several soft, mustard-colored stools each day
• Your nipples become sore

If your baby is nursing well, sucking efficiently and gaining weight, the fifth or sixth week is a good time to introduce a bottle with an artificial nipple if you plan on using a bottle at any point in the future.

You may want to start doing this sooner if you are interested in pumping (or expressing and storing) breastmilk. If your baby still seems to be learning how to suck from the breast, wait until you become a confident nursing couple before trying this.

If your partner wants to feed the baby, or you want to be able to leave the baby for a couple of hours, expressed breast milk in a bottle will make it possible. Learning to pump your milk requires the right pump and some practice. The key is to let down your milk in response to the pump just as you do in response to your baby’s sucking.

According to the Affordable Care Act, health insurance plans must cover the cost of a breast pump. Check the details of your coverage to find out what type of pump is covered (manual or electric). Electric pumps mimic your baby’s suck more closely than manual pumps, and therefore are more effective.

Plan your first pumping sessions for an early morning, when you feel fullest, before your baby wakes and wants to nurse. Don’t worry about taking milk that your baby needs for breakfast. Remember, the more milk you take from your breasts, the more milk your breasts will make. The first few times, you may pump an ounce or less. With practice, many mothers can pump as much as 8 or more ounces in a session!

Store your milk safely in the freezer in small bags or containers designed for the purpose (a lactation consultant can recommend these). For guidelines on storing, freezing and thawing breast milk, see La Leche League.

Formula-fed newborns generally take 2 to 3 ounces of formula approximately every three to four hours in the first few weeks. Feed your baby on demand initially, and if he or she sleeps longer than five hours between feedings, wake your baby up to feed him or her.

Babies usually know how much they need to eat. If they are breastfeeding, they have total control. They feed until they are done. Take a similar approach with bottle feeding. Encouraging your baby to “finish the bottle” is not healthy and can contribute to obesity later in childhood. Your pediatrician can give you a general amount babies take at various ages, but that will just be an average.

Formula comes in different forms:

• Dry (powder)
• Concentrates (which need to be diluted with water)
• Liquid (already mixed)

If you are using a can of powder, be sure to follow the instructions explicitly regarding the amount of powder versus water so that you achieve the correct mixed amount, and shake well. Your baby’s bottles will need to be sterilized.

When feeding your baby formula, make mealtimes moments to be with your baby fully, just as if you were breastfeeding.

Hold your baby close, and return her gaze as she feeds. Babies adore skin-to-skin contact, especially while feeding, so you might open your blouse a little and let her cheek rest against your chest. Let the feeding occur at the baby’s pace, and allow her time for smiles and playing with your fingers as you hold the bottle.

Mealtime, of course, isn’t the only time for quiet closeness with your baby. Reading, massage, rocking and singing will provide the frequent snuggling so important to young babies.

See also:

Scheduling formula feedings

Resources for parents 

You may want to make the days with your baby more orderly by using a schedule for feedings. But newborns are unpredictable. Flexibility will better serve both you and your baby when it comes to feeding—whether by breast or bottle.

Your baby’s need to nurse varies throughout the day as well as from day to day, depending on whether he or she is in a growth spurt. Feed your baby whenever he or she signals hunger—crying, rooting or sucking on his or her hand are all cues—rather than using a schedule of every four hours or so.

Learning to watch your baby’s cues, rather than the clock, will strengthen your mothering skills in ways that reach far beyond feeding.

As babies grow and their stomachs can hold more milk, they drink more at each feeding and can go longer between feedings. Below are some guidelines for feeding, from the American Academy of Pediatrics (AAP).

Your baby will let you know when he or she is hungry. The cues can be pretty obvious:

• Sticking his tongue out.
• Turning her mouth and head toward your breast.
• Putting his hand into his mouth repeatedly; sucking on the hand, clothing, etc.
• Fussing or crying.

Newborns generally eat every two to three hours (eight to 12 times in a 24-hour day). In the first day or two after birth, a newborn may only drink half an ounce per feeding. This increases to 1 or 2 ounces per feeding and then to 2 or 3 ounces by 2 weeks of age.

At 2 months, babies drink 4 or 5 ounces per feeding, every 3 to 4 hours.

At 4 months, babies take in 4 to 6 ounces per feeding

At 6 months, babies drink up to 8 ounces every 4 to 5 hours, which is generally the amount they’ll drink going forward. Solid foods usually start at about 6 months of age.

Bottle-fed babies may be more likely to overfeed, because it’s easier to drink from a bottle than from the breast. Overfed babies may have gas, spit up or vomit, or have stomach pains. Follow the feeding amounts listed above to prevent overfeeding.

Try using a pacifier if your baby continues to fuss after a feeding; he or she may just want the soothing that sucking provides. The AAP advises waiting until 3 to 4 weeks of age before offering a pacifier, to ensure that breastfeeding is well established.

If your baby isn’t gaining enough weight for his or her age (doubling his birth weight by 5 months and tripling by the first birthday), talk to your child’s healthcare provider. You may need to feed your baby more frequently, even if it means waking him or her to do it.

Diapers can tell you whether your baby is getting enough to eat. Newborns should have two to three wet diapers a day in the first few days after birth. After the first week, they should have at least five to six diapers a day.

If you’re concerned about your baby either overfeeding or underfeeding, be sure to talk with your baby’s healthcare provider.

Newborns respond well to being wrapped snugly in a blanket (the swaddling method you were likely taught while still in the hospital). Swaddling recreates the continuous tactile sensation of being in the womb. It’s a great soothing technique, though some infants don’t like the feeling of confinement.

Always put a swaddled baby down to sleep on their back (not their stomach), and monitor the infant periodically to make sure they stay on their back.

Once your baby reaches 2 months of age, the American Academy of Pediatrics recommends stopping the swaddling practice—well before the baby starts to try to roll over. A swaddled baby who can roll over is at higher risk of sudden infant death syndrome (SIDS).

Picking up your baby also works, though not by calming them down. Rather, they become more visually alert and distracted, especially from the vantage point of your shoulder.

Other movements to try:

• Hold and gently rock your baby while you stand, walk, dance or sit. Or try rocking her in an infant swing, cradle or stroller.
• Take a walk outside with the baby in a stroller or sling.
• Put the baby into a car seat, and go for a drive.

Some babies like to be massaged. Try lying on your back, placing your baby on his stomach on top of you, and gently massaging his back.

If you think your baby may be suffering from gas, lay him on a firm surface, and gently massage his stomach in a clockwise motion. Then gently press his knees toward his stomach to expel any air.

Sing softly to your baby, speak gently, or play soft music. Babies are often comforted by nearby rhythmic, repetitive sounds and white noise, such as washing machines, dishwashers, vacuums or fans.

Give your baby a warm bath. Or hold her skin-to-skin and lay her face down on your lap on top of a safely wrapped hot-water bottle. (Never place your baby in direct contact with the hot-water bottle.)

Try getting your baby’s attention with a soft rattle or brightly colored toy. Change the environment around you both; walk into a different room.

Contact your baby’s healthcare provider about a fever using these guidelines:

• Under 3 months of age: Any temperature of 100.4 degrees Fahrenheit (38.0 degrees Celsius) or above taken rectally.

• 3 to 6 months: A temperature of up to 102.2 degrees Fahrenheit (39 degrees Celsius) with other symptoms, or a temp higher than 102.2 degrees Fahrenheit with or without other symptoms. (The doctor may or may not want you to bring your baby in to be seen for a 102.2-degree Fahrenheit fever. It often depends on the other symptoms.)

• 6 to 24 months: A temperature higher than 102 degrees Fahrenheit F (38.8 degrees Celsius) for longer than a day with no other symptoms. If there are symptoms with the fever, contact the healthcare provider sooner.

Call the pediatrician if your baby:

• Shows signs of dehydration: Crying with no tears (though some newborns do not yet have tears), lack of urination for more than 6 hours, sunken eyes or a sunken soft spot on the head.
• Is difficult to wake up or seems severely drowsy and not alert.
• Has blood in the diaper or blood in vomit.
• Has frequent diarrhea or constipation (fewer bowel movements than usual for a few days and seems uncomfortable).
• Experiences rapid breathing or difficulty breathing.
• Vomits often and forcefully (more than spitting up).
• Has a serious cold–with difficulty breathing, nasal mucus for longer than 10 to 14 days, ear pain, or a cough that lasts longer than one week.
• Has a rash that appears infected or suddenly gets an unexplained rash accompanied by a fever
• Has redness or mucus discharge from one or both eyes.