The Pediatric Insider
© 2010 Roy Benaroch, MD
Honk honk honk. (Traditionally, this would be “beep beep beep,” but I have my phone set to alert me with a bicycle honk for new text messages. It’s a riot at 3 am.)
“Newborn nursery.”
“Yeah, this is um… the doctor, calling back…someone.”
“The nurse needs to reach you, please hold.”
…and that’s why you shouldn’t kiss a pig. Did you know it’s bicycle safety awareness week?Your call is very important to us. Please hold for the next available…
“Yes, this is the nurse. What do you need?”
“You called me.”
“Who?”
“Me. The doctor. Doctor Me.”
“About Baby Grisham?”
“I don’t know who about. You called me. I’ll be there in the morning.”
“This can’t wait. The baby is spitting a lot, and needs a change in formula.”
“What?”
“We’ve been giving him Enfalac, but he’s spitting, so I need an order to change him to Simamil.”
“How old is this baby? What baby?”
Sigh. “Baby Grisham, born at 2300 hours.”
Doing math in my head. I can’t ever figure out those ‘hours’ times. “So he’s…three hours old?”
“Yes, mom’s not breastfeeding, and he’s spitting up his Lactosimacare.”
“How much?”
“A lot.”
“No, I mean, how much are you giving him?”
“Only 2 ounces.”
“OK, here is what I want you to do. Let the baby sleep in the room with mom, and stop feeding him so much. In two or three hours, give him just a little bit.”
“A little bit?”
“Yes, just a teaspoon. Five ccs, that’s it.”
“He’ll be hungry!”
“No he won’t. Normal newborns less than a day old barely need anything to eat. If you look at breastfed babies—and those are the babies eating the way they’re really supposed to eat—they get maybe, tops, an ounce of milk taken in over the whole first 24 hours of life. And they do fine. Just stop drowning this baby, and he’ll be fine, too.”
A study just published in The Journal of Pediatrics confirms what I’ve been saying for years: normal newborn babies need to take in very, very little over their first day of life. Ninety healthy, term, exclusively-breastfed babies were weighed very carefully with an ultra-sensitive scale before and after feedings to determine exactly how much milk was ingested. The average intake for the entire first 24 hours of life was 15 ccs—that is, one tablespoon. The range was from 1 to 30 ccs. That fits with exactly what we ought to expect from the physiology of a newborn and of a new mom. A newborn has just been through a traumatic transition, and has a gut that’s filled with sticky mucus. The normal “peristaltic waves” that push food along through the gut to help digestion haven’t yet begun. So it makes sense that a normal newborn isn’t quite ready to accept a full meal on the first day of life. It also fits exactly with what we know about a normal, healthy mom. Milk doesn’t “come in” until about 48-72 hours after a baby is born. Moms aren’t supposed to have a good milk supply during a baby’s first day of life. Now, some babies are going to get impatient and yell about this. That doesn’t mean they’re extra-hungry. It does mean that some babies, like some nursery nurses, don’t like to wait!
All of this assumes a healthy full term baby without additional risk factors for low blood sugar or other problems. If you’ve got a baby with special health circumstances, you need more specific advice and guidance.