Breastfeeding Newborn & Infant Pregnancy & Birth Thrive


Mother breastfeeding her five days old baby
Written by Jessika Firmage

| by Meghan Johnston, IBCLC

When a baby is brought to the breast many things are happening concur- rently with the natural act of breast- feeding which are not specific to eating. The skin-to-skin contact which occurs every time baby sucks at the breast helps warm baby up and stabilizes heart and respiratory rates (1). Oxytocin is released which decreases mom’s chance of hemorrhaging immediately after birth and increases bonding as mom and baby get to know each other (2, 3). Bringing baby to the breast also gives mom and baby a chance to relax and recali- brate from a highly stimulating new life. Each of these steps put together form an engaging dance between mom and baby, a dance that com- forts, warms, and protects baby.

Among all the steps of this dance, there is one that–although it has been present since mid-pregnancy–is only available to baby during the first couple days of life. It is consumed briefly and only in small amounts but its impact is huge: Colostrum.

Low in fat, but high in protein and immunoglobulins, colostrum is extremely easy to digest and acts as a laxative. The laxative effect of colostrum is very important for an infant who is working on passing his first stool, meconium.

The passage of meconium, and subsequent early stooling, will assist with the removal of excess bilirubin before it can be reabsorbed into the bloodstream. Since jaundice is the product of elevated bilirubin concentrations in the blood, infants who do not pass meconium quickly are at greater risk of jaundice due to the reabsorption of bilirubin present in the infant’s stool (4). Colostrum gets to work immediately by assisting baby’s very first bowel movement!

The process continues: Baby’s gut is permeable during the early days and weeks of life, leaving your baby at greater risk of allergens and pathogens passing through the loose junctions between baby’s gut cells (5,6,7). Once these allergens escape the gastrointestinal tract and enter baby’s blood stream, sensitization can occur leading to serious food allergies or other illnesses (5). Present in breastmilk are various types of human growth factors, including epidermal growth factor, nerve growth factor, insulin-like growth factor, and somato- medin C, with epidermal growth fac- tor having the highest concentrations in colostrum (7). These growth factors work to seal the loose junctions in ba- by’s gut so he isn’t as vulnerable to his new microbial environment (5, 7).

Sealing baby’s gut isn’t the only way colostrum helps to ensure the health of a brand new baby whose immune system is quite immature (8). While in utero baby receives immunoglobulin G or IgG via mom’s placenta. IgG is useful but works only in baby’s circula- tory system (9). Another immunoglobulin, secretory Immunoglobulin A or sIgA, is highly concentrated in colostrum and works directly where baby is most likely to experience pathogenic insult, the mucous membranes of the throat, lungs, and intestines (9). Colostrum has 13 grams per liter of this valuable immunoglobulin, while mature milk has 1 to 3 grams per liter. That’s a big difference (10, 11)! Even with this drop in concentration it is important to note that overall daily production levels of sIgA remain consistent forthe duration of breastfeeding. However as your colostrum transitions to mature milk, the sIgA concentrations are diluted with other important nutrients which baby needs to grow (10,11).

Considering that baby’s immature immune system is experiencing the world of pathogens for the first time, it makes sense that sIgA concentrations are so high initially. It’s small amounts of milk for a small tummy, but large amounts of immunoglobulins for a large world.

Even in amounts small enough to be measured in teaspoons, colostrum is just what baby needs to fill up his little tummy. During the first day of life baby’s stomach is quite small, about the size of a shooter marble. This means no more than a few drops to one teaspoon (5 mls) is all baby needs to be satiated (12, 13). As a new baby contentedly suckles at the breast he is enjoying a feast that fills up his tiny tummy with a volume and content that is exactly what he needs. Although 5 milliliters may not seem like a meal to mom, it is certainly a complete meal for baby on his first day of life. Due to the rigid nature of the newborn stomach, consuming more than the small amount a mother’s body makes will result in regurgitation as baby gets rid of what his inflexible stomach is unable to accommodate (14). So while mom blows raspberries on that smooshy belly, she can know that, like puzzle pieces, her colostrum and baby’s stomach are a perfect match!

With this knowledge of infant anatomy one can understand the importance of a low volume but nutrient- dense food for infants during the first few days of life; it also gives a clear reason for all those short but frequent feeds baby asks for. Those frequent feeds, along with infant growth, relax the stomach and by the end of the first week baby will enjoy larger meals of 1.5 to 2 ounces (12, 13, 14). By one month there’s quite a bitmore variation, some babies will continue to enjoy just one-and-a-half ounces per feed while others will take four- and-a-half ounces (12, 13, 15). This means if a baby prefers meals on the smaller side of normal, mom is likely to receive requests from baby to feed more often. Some mothers report feeding their baby every hour. These early weeks can seem like a lifetime, the days are long but the year is so very short, and soon enough mom will be the one bugging her toddler to come sit down andeat.

As milk transitions from colostrum to mature milk, mom will likely notice some changes both in her breasts and in her baby. Baby’s sucking pattern will evolve to include more gulping. Mom’s breasts may begin to leak or feel more full (16). Some mothers report no noticeable changes in their breasts while others report discomfort and engorgement, but the most notable changes will be in baby’s bowel movements. During the first day or two baby’s stool will be a thick, greenish-black meconium. In the few days that follow the stools will become less black and more green to yellow as mom’s breasts fill with mature milk. Eventually someone will be changing lots of diapers (and clothes) with loose yellow/orange stool in them. The entire process of milk transitioning from colostrum to mature milk usually takes three to four days with the visual changes in baby’s stool taking about one week (4, 17).

Like a couple learning the tango, mom and baby need each other to engage in their own dance. A woman’s body is designed to feed her baby and her baby is designed to receive food from her. This dance starts on the first day as mom’s colostrum helps baby acclimate to life outside the womb, and continues throughout the span of the breastfeeding relationship. Sometimes it will be graceful and sometimes they’ll stumble. Each step is pieced together, each partner gives and takes, and at the end there is a dance filled with conversations without words and beautiful nuances that contribute to both baby’s physical and emotional development.

From the time mom and baby take their first steps as a breastfeeding dyad, to the very last nursing session, they are performing a dance with endless purpose.

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About the author

Jessika Firmage