10 Breastfeeding Milestones

This blog presents 10 breastfeeding milestones, starting with a term baby arriving home from the hospital.

1. Primary care provider (PCP) follow-up after the hospital stay

The American Academy of Pediatrics (AAP) recommends a health supervision visit within 48 to 72 hours after discharge from the hospital or at 3 to 5 days of life. (1)

2. Back to birth weight

An infant is expected to lose weight after birth, dropping down as far as 8-10%. If all is going well, an infant should be back to birth weight by 2 weeks.

3. Growth charts

Use World Health Organization (WHO) growth charts up to 2 years of age, Centers for Disease Control (CDC) growth charts after 2 years (apologies for being USA centric here)

4. Vitamin D supplementation

A breastfeeding infant should receive 400 IU of Vitamin D a day or the mother can take 6,400 IU a day. (1) We like the one-drop a day way – giving the baby one drop of a vitamin D supplement that contains 400 IU. Start this as soon as possible.

5. Duration of breastfeeding

The WHO and AAP recommend exclusive breastfeeding for about 6 months, with complementary food introduction at about 6 months, and as mutually desired by mother and child, supports continued breastfeeding until 2 years or beyond. (1,2)

6. When to start a pacifier

Per the AAP, start a pacifier when breastfeeding is established, around 3 weeks. (1)

7. Stooling strike

The scenario often goes like the following. The infant is healthy and has been exclusively breastfeeding, with good weight gain and frequent stooling (often with every feed). Suddenly, the infant stops stooling. This occurs around 6 weeks and can last for days or a week or weeks. The infant shows no other concerning signs like weight loss, vomiting, fever, or excessive fussiness. No one is sure why this happens, some postulate it could be due to gut maturation.

8. When to start a bottle

Speaking with colleagues who I would consider to be "experts" in lactation medicine, there seems to be agreement on WHEN to start a bottle of expressed milk - at around 3 weeks. HOW to collect the milk is a bit more nuanced. If a mother produces plenty of milk, collecting the milk passively while feeding might work (for example, using a Haaka on the non-feeding side). For a mother who is more of an exact producer, pumping in the morning is a good idea. Offer the bottle using paced feeding. Does the milk in the bottle need to be warmed? Some do, some don’t. See what you think.

9. Growth spurts

During a growth spurt, breastfed babies nurse more often and can act fussier than usual. A growth spurt usually lasts 2-3 day. Classic times for a growth spurt are around 3 weeks and 6 weeks of age – but - they can occur at any time in the first year.

10. Breast milk storage 4-5-6

• The recommendations from the CDC and Academy of Breastfeeding Medicine (ABM) are similar: store human milk for 4 hours in room temperature, 4 days in the refrigerator, and for 6 months in a regular freezer. To be exact it is “4-4-6” but “4-5-6” is a way to remember it (and close enough!). (1,3)  
• However, as my daughter was an exact producer and every expressed drop was precious, we used “8-8-12” which are the outer limits of the acceptable ranges: 8 hours in room temperature, 8 days in the refrigerator, 12 months in the deep freeze. We would always smell it and taste it too!

 References

1. Meek JY, Noble L. Breastfeeding and the Use of Human Milk. Pediatrics. 2022;000()):e2022057989
2. World Health Organization. WHO website
3. Eglash A, Simon L, and the Academy of Breastfeeding Medicine. Academy of Breastfeeding Medicine Clinical Protocol #8. Breastfeed Med. 2017;12(8):390. ABM protocols are available for free online: ABM Protocols