1.4 The First Hours and Days

The First Feed and the Breast Crawl

Given immediate, uninterrupted skin-to-skin contact, a healthy newborn moves through an innate sequence — the breast crawl — described by Widström as nine instinctive stages: birth cry, relaxation, awakening, activity, crawling, resting, familiarization, suckling, and sleeping. With time, most newborns self-attach within about 20-60 minutes of birth.

The IBCLC's role is to protect the time and contact for this to unfold: keep the dyad skin-to-skin, delay non-urgent routines (weighing, bathing, eye prophylaxis can usually wait), and avoid rushing the infant to the breast — forced latching during the early stages interrupts the sequence. A calm, unhurried first hour improves early initiation and the first effective latch.

Normal Newborn Behavior and Feeding Cues

Newborns communicate hunger on a gradient, and feeding to early cues is far more effective than reacting to late ones. Crying is a late cue, and a crying baby is harder to organize and latch — calm the baby first, then feed.

Healthy newborns feed about 8-12 times per 24 hours, including night feeds, often in clusters. Frequent feeding is normal newborn behavior, not a sign of low supply, and it is exactly what drives Lactogenesis II and early supply. Time at breast matters less than effective transfer: watch for a rhythmic suck-swallow-breathe pattern, audible swallowing once milk flows, and a breast that feels softer after the feed. Counting swallows tells you more than the clock.

Colostrum's Role

Colostrum is the first milk — thick, yellowish, low in volume (often only teaspoons per feed), and dense in secretory IgA (sIgA), protein, white cells, and growth factors. Its small volume is perfectly matched to the newborn's tiny stomach and is normal, not a deficiency.

Colostrum also has a mild laxative effect that speeds passage of meconium (the dark, tarry first stool); clearing meconium removes bilirubin from the gut and reduces its reabsorption, lowering jaundice risk. The core counseling message of day 1: small colostrum volume is sufficient, and frequent feeding both nourishes the baby and builds the coming milk supply.

Expected Physiologic Weight Loss Timeline

Newborns normally lose weight in the first days as they pass meconium and shed extravascular fluid. A loss of up to about 7-10% of birth weight is generally within normal limits; loss approaching or exceeding 10% warrants a careful feeding assessment. The weight nadir is usually around day 3-4, after which the infant should gain steadily, regaining birth weight by roughly day 10-14. Trend matters more than any single number — one low weight is data; a continued downward trajectory is a problem.

Early Frequent Feeding and Preventing Early Problems

The single most powerful intervention in the first days is early, frequent, effective feeding (8-12 times per 24 hours) combined with skin-to-skin. Together they prevent the cluster of early problems the exam returns to again and again:

• Hypoglycemia — early colostrum feeds and skin-to-skin help stabilize newborn blood glucose.
• Excess weight loss / dehydration — frequent transfer keeps intake adequate.
• Exaggerated jaundice — moving colostrum through the gut promotes stooling and clears bilirubin.
• Delayed or low supply — frequent removal drives Lactogenesis II and establishes supply through demand.

When to Escalate

Move from coaching to a medical referral when you see persistent lethargy or a baby too sleepy to feed, fewer wet/dirty diapers than expected for the day of life, brick-dust (urate) crystals in the diaper past day 3, weight loss beyond ~10% or continued loss past day 5, or no audible swallowing during feeds. These move the encounter beyond lactation support to a clinical concern that needs evaluation.

Worked Example: A term infant weighs 3,600 g at birth. On day 3, the lowest measured weight is 3,300 g. Loss = (3,600 − 3,300) ÷ 3,600 = 300 ÷ 3,600 ≈ 8.3%. This sits within the up-to-~7-10% normal early range and falls near the typical day 3-4 nadir. The correct response is not to wean or start routine formula. Instead: observe a feed and confirm effective transfer (audible swallowing), reinforce frequent feeding (8-12/24h) to cues, and verify the weight trend turns upward toward birth-weight regain by about day 10-14. If, however, the loss were ~11% with few stools and a lethargic, hard-to-wake infant, the picture would shift to suboptimal intake requiring assessment, a supplementation plan, and possible referral.