How much milk does a newborn need?

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.

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6 Comments on “How much milk does a newborn need?”

  1. Shannon Says:

    Thanks, Dr. Roy! I think that a lot of new moms think their milk is supposed to come in after the baby nurses the first couple of times. If it doesn’t, they give up and say they don’t have a enough milk to feed their baby and they “had” to give the baby formula. I’ve heard of nurses telling this to new moms as well. On the flip side, I’ve known mothers who were determined to breast feed and it took almost 4-5 days for their milk to come in and their baby was perfectly healthy. Babies are excellent self regulators of food in-take; it’s natural.

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  2. Samantha Says:

    Thank you! I wish more nurses knew this – when I was in the hospital after the birth of my son, the nurses were constantly telling me he wasn’t eating enough and even tried to bring in formula for me to give him (I was exclusively breastfeeding). I nursed him on demand, which was often, but they were concerned he wasn’t having long, lengthy nursing sessions. Ugh! I’m due with my second in about three months and this time around I know enough to not stress about it as much and to trust that the baby will nurse as much as she needs to. Again, thanks!

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  3. christiedch Says:

    Dr. Roy, if 15 cc the whole first day were enough for a newborn baby, why is it that a meta-analysis of the newborn stomach capacity looking at its size through ultrasound and autopsy actually measuring the newborn stomach at birth found it to be 20 mL. In addition, it is attached to the small intestines so a 1 day old can actually take in much more. In addition, if 15 mL of colostrum were enough, which by the way, provide 9 Calories of the 100 Calories/kg/day a newborn requires to feed all its living cells, why do so many exclusively breastfed babies get admitted for starvation jaundice and hypoglycemia? And why are they crying their heads off for hours before they become lethargic and too weak to eat if 15 cc were enough? The logic you use would be similar to me saying, if I gave you a piece of bread as your daily allowance of food and that is all I had to feed you. The fact that one piece of bread was all that went into your stomach the whole day, it must be all that you need. Never mind you telling me you are hungry all day long. You must be getting used to extrauterine life. That is all I had to give you so that is all that your probably needed and Mother Nature must have made feeding perfect.

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  4. Dr. Roy Says:

    Christie, the conclusions are about babies in the 1st 24 hours of life. For that first day, I see more problems with overfeeding than underfeeding (as in, this baby who’s 2 hours old is spitting up and “needs a different formula.”) The intake needs change dramatically over the next few days, as a baby’s physiologic ileus resolves and genuine hunger kicks in. I’m not starving any babies, or encouraging anyone to do that.

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  5. christiedch Says:

    I would be interested to know where the concept of a physiologic ileus comes from and what scientific literature supports that concept because I do not know how that entity would be measured or confirmed. From my historical research of feeding practices before the WHO guidelines, postpartum nurses report that bottle fed and breastfed babies were routinely fed 2 ounces per feed every 3 hours even on the first day of life and these volumes were regularly tolerated. Hypernatremic dehydration was rare during that time and so was severe jaundice from starvation/dehydration unlike today. I observed that newborns could tolerate and be pretty happy with 2 ounces per feed with my 5.5 lb twins who I refused to hospitalize for jaundice and dehydration unlike with my first by feeding them formula on demand until my milk came in. They took 2 ounces every 3 hours or 16 ounces in 1 day and only gained 1 ounce. Which means their metabolic requirement was 15 ounces. My milk came in by 4 days and it’s a good day I supplemented so they didn’t develop complications from exclusive breastfeeding.

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  6. Dr. Roy Says:

    Ileus refers to an immobile GI tract (a lack of organized peristalsis), in this case similar to what happens to (some) post-partum women, or people after surgery, or people experiencing any other sort of intense medical stress. Many newborns seem “stunned” and not super-interested in feeding. When these babies are fed big volumes of formula, they often spit up. Not all newborns experience this, but many do. Within 24 hours things seem to settle down and babies are more active and wakeful, and become “better” feeders.

    Hypernatremic dehydration isn’t seen in this 1st day of life (at least not with a healthy term baby).

    I think what you’re trying to do is attack an overly dogmatic insistence on exclusive breastfeeding. That wasn’t the point of the post.

    You may be interested in related posts:
    https://pediatricinsider.wordpress.com/2013/06/20/can-a-wee-drop-o-formula-help-breastfeeding/
    https://pediatricinsider.wordpress.com/2014/12/15/the-economic-benefits-of-breastfeeding-a-call-for-honesty/
    https://pediatricinsider.wordpress.com/2014/09/03/breastfeeding-and-post-partum-depression-a-possible-cure-a-possible-cause/

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