Feeding a Newborn in the First 3 Days: Colostrum, Weight Loss and Black Poop

How often should a newborn feed in the first 3 days?

At least 8 to 12 times in 24 hours, and often more. The NHS says that in the first week your baby may want to feed very often, every 1 to 3 hours in the first few days and perhaps every hour to begin with, and gives at least 8 to 12 feeds, or more, every 24 hours as a rough guide for the first few weeks. The American Academy of Pediatrics sets the same floor for a breastfed newborn: at least 8 to 12 times every 24 hours.

The figures in this article are for breastfed babies, because that is what the cited guidance describes. Stool colours are the exception and apply to formula-fed babies too.

Question	What the guidance says
How often to feed?	At least 8 to 12 times in 24 hours, or more (NHS, AAP)
How much colostrum per feed?	About a teaspoon (NHS)
When does milk come in?	Around 2 to 4 days after birth (NHS)
How much weight loss is normal?	No more than 8 to 10% of birth weight in the first few days (AAP)
When is birth weight back?	Many babies within 7 to 14 days; some take longer, especially after a cesarean (ABM)
Wet nappies	2 or 3 in the first 48 hours; at least 6 heavy ones a day from day 5 (NHS)
Stools	1 or 2 black, tarry on days 1 and 2; at least 2 greenish to yellow on days 3 and 4; yellow and loose, 3 to 4 a day by days 5 to 7 (AAP)
First check-up	No more than 48 hours after leaving hospital (AAP)

Feeds bunched close together, often called cluster feeding, fit within that guidance, because the NHS figure is a minimum: "or more". The AAP describes a well-fed newborn as seeming satisfied for an average of 1 to 3 hours between feeds, and an average means many gaps are shorter.

The frequency is also what builds the supply. The NHS says the more you breastfeed, the more your baby's sucking stimulates your supply and the more milk you make, that it is not possible to overfeed a breastfed baby, and that in the beginning it can feel like you are doing nothing but feeding. Night feeds matter in particular: the NHS notes that your body produces more of the milk-making hormone prolactin at night. Once mature milk arrives after a few days, it says, feeds become fewer but longer.

How much milk does a newborn need in the first days?

About a teaspoon per feed. For the first few days your baby drinks colostrum, which the NHS describes as usually thick and golden yellow, and so concentrated that your baby only needs a small amount, about a teaspoonful, at each feed. That small volume is expected. The AAP adds that you may not hear your baby swallowing while they take small sips of colostrum in the early days.

Around 2 to 4 days after birth, the NHS says, your breasts may become fuller, which is what is meant by your milk coming in. When breast milk comes in covers that change, how much a baby takes as it happens, and how to handle engorgement.

Is black poop normal for a newborn?

Yes, for the first day or two. It is meconium, which the AAP describes as a thick black or dark green substance that filled your baby's intestines before birth; once it has passed, the stools turn yellow-green.

The colour should then change over the following days. For a breastfed baby the AAP describes 1 or 2 blackish, tarry stools a day on days 1 and 2, then at least two stools on days 3 and 4 that are starting to look greenish to yellow, and by 5 to 7 days old yellow, loose stools with small curds, at least 3 to 4 a day. It describes them as yellow liquid with particles that remind many parents of little seeds, and notes a breastfed baby will often stool with each feed in the first month. Formula-fed babies pass meconium too, then usually have tan or yellow stools that are firmer, though in the AAP's words no firmer than soft clay.

What does a pink or brick-red stain in the nappy mean?

Usually very concentrated urine, not blood. The AAP says that as long as your baby is wetting at least four nappies a day, there is probably no cause for concern, and to consult your pediatrician if the pinkish staining persists.

How much weight do newborns lose in the first days?

Up to 8 to 10% of their birth weight. The AAP says a well-nourished breastfed newborn should lose no more than 8% to 10% of their birth weight in the first few days before starting to gain again, and the NHS calls weight loss in the first 3 to 4 days normal, with steady gain after that.

For a baby born at 3,400 g, 10% is 340 g, so a reading of 3,100 g on day three is inside the expected range.

Above 10% is where clinicians look more closely. The Academy of Breastfeeding Medicine says a loss of more than 10% of birth weight should prompt a careful breastfeeding assessment. It also notes that many, but not all, newborns regain their birth weight within 7 to 14 days, and that some take longer than 14 days, especially babies born by cesarean. At two weeks, the AAP says a baby still under birth weight, or not gaining at least 5 to 7 ounces (about 140 to 200 g) a week since your milk came in, is a reason to see your pediatrician. A sudden run of near-constant feeds a week or two later is often the 2-week growth spurt.

How many wet nappies should a newborn have?

Two or three in the first 48 hours, then at least six heavy, wet nappies a day from day 5, in the NHS's figures. The AAP gives the same endpoint: 6 or more wet nappies a day, with nearly colourless or pale yellow urine, by 5 to 7 days old.

Modern disposables make wet hard to judge. The NHS suggests pouring 2 to 4 tablespoons of water into an unused nappy to feel what a wet one should be like. Between days, the Academy of Breastfeeding Medicine uses a simple rule: fewer than one wet nappy and one stool per day of life (one on day 1, two on day 2, three on day 3) should prompt a careful breastfeeding assessment. Counting nappies in a log rather than from memory makes that rule easy to check.

When should you call a doctor or midwife in the first week?

If you are breastfeeding, these are the signs the AAP and the Academy of Breastfeeding Medicine name. Contact your midwife, pediatrician or family doctor if:

• Your baby has lost more than 10% of their birth weight.
• There are fewer wet nappies or stools than days of life.
• After 7 days, your baby has fewer than 6 wet nappies and 4 stools a day, the urine is dark yellow or specked with red, or the stools are still dark rather than yellow and loose.
• Your baby sleeps longer than 4 hours at night or often misses feeds. The AAP says to wake them and encourage them to feed. If you cannot wake them or they will not feed, call straight away.
• Feeds are consistently shorter than about 10 minutes or longer than about 50 minutes.
• Your baby still seems hungry after most feeds. The AAP says to have them weighed right away.
• Five days have passed and your milk has not come in, or your breasts do not feel as though they are filling. The AAP says to have your baby weighed immediately.
• There are large amounts of blood, mucus or water in a stool. The AAP says to call your pediatrician immediately.

Book the first check-up for no more than 48 hours after you leave hospital, as the AAP advises; the Academy of Breastfeeding Medicine says babies discharged before 48 hours of life should be seen within 24 to 48 hours of discharge. The weight taken at that visit is how your pediatrician tells whether your baby is getting enough milk.