What is 'normal'?Apr 13, 2023
This question comes up so much in both my professional and personal lives. In fact, I've even found myself wondering about this when I had my own children- despite having a medical degree and further qualifications in breastfeeding!
You see, there is nothing like the combination of sleep deprivation and the most intense, burning love you have ever felt in your life- to make you begin to question everything. Everything from "is my baby feeding enough?" to "is my baby pooing enough" to "what is that small (probably imperceptible) lump on my baby's head?".
Everything, and I mean everything, is called in question.
As parents we so dearly want what is best for our baby that whether we realise it or not, we begin on this quest for perfection from day one. Feeding exactly the amount of times the breastfeeding experts tell me I need to feed. Doing tummy time just the perfect amount that I read about on that paediatric physios blog to prevent flat spots on my baby's head. Putting down our baby "drowsy but awake" so they don't get used to falling asleep on me.
Even more exhausting because this thing that we're unconsciously aiming for... perfection- is impossible.
The reason it's impossible, is because the range of what is normal is actually huge. I'm talking grand canyon huge. For example, the range of the normal amount of hours that a newborn should sleep for just after birth is from 9-20 hours per day. That means that those babies that are happily sleeping 9 hours a day as just as normal as the babies that are happily sleeping 20 hours per day. It's just a matter of each parent working out the magic number for their own child. So those cute little tables that tell you exactly what time you should wake your baby and what time you should put them down- well if they work for you, great. That probably means that your baby resembles the baby the author had in mind when they created that table. But for all of the rest of us, that timetable simply won't work. And that 100% doesn't mean there is a problem with us as parents or with our baby.
One rule of thumb I tend to stick to is that anyone who tries to tell you anything in absolute eg. this program will 100% make your baby sleep through the night is as good as a snake oil salesman. Because there simply isn't absolutes in life.
But there are some ranges of normal that you can look out for when it comes to your baby in terms of feeding, sleeping and growing...
- Most newborns will feed at least every 2-3 hours after the first 24 hours of life.
- It would be uncommon to expect a newborn baby to go longer than 3-4 hours between feeds- and if you find your baby is consistently needing to be woken at 4 hours for a feed then please seek out help from your family doctor, IBCLC or Maternal and Child Health Nurse.
- That being said, it is very common for newborns to want to feed more often than that- especially for brief periods of cluster feeding at some point in the 24 hour period.
- Try to roll with it and if your baby is showing signs of hunger then just offer a feed- you generally can't go wrong if you start by offering a feed then troubleshooting after that.
- As I mentioned above- the range of normal newborn sleep is actually HUGE!
- It is simply a matter of following your baby's lead and working out the right amount for them based on watching for cues that they are tired→ things like rubbing eyes, red eyelids, being fidgety or fussing or getting to the point of crying.
- When we talk about 'sleeping through the night', we're actually only talking about the period between midnight to 5 am. So according to the definition, your baby is "sleeping through the night" if they sleep between midnight and 5am without waking.
- For a baby less that 6 weeks old, most newborns would be expected to have at least a little bit of poo in their nappy at most nappy changes. This doesn't mean the nappy needs to be full, but there will generally been some smears.
- A well hydrated and breastfed newborn poos will look like mustard seeds- an off yellow sort of colour and smooth or 'seedy' looking in texture.
- If you notice bub straining to poo that's OK- as long as the consistency is soft when it comes it means that bub isn't constipated.
- After 6 weeks of age, a fully breastfed baby can begin to space out their poos a bit more where anything up to 10 days can be normal for them.
- If you notice any blood or mucous in your baby's poos then seek advice from your doctor.
- As always, if you're worried about anything at all speak to your family doctor.
- You can expect a newborn to have a mildly wet nappy at just about every feed.
- Some nappies will be more wet than others based on the volume of the most recent feed- looking out for the wetness indicator on modern disposable nappies is a good visual marker of wetness. For cloth nappies, you will learn how to gauge the difference between a full and not so wet nappy pretty quickly.
- Look out for at least 5-7 good wet (disposable) nappies each day or 6-8 if you're using clothe nappies.
- The simple rule of thumb that we use to monitor your baby's growth is 150g/week as a minimum in the first few months then 120g/week thereafter.
- Keep in mind that growth can average over a few weeks- so lower growth one week might even out against a growth spurt in another week.
- Try not to focus too much on your baby's weight gain→ that's our job as healthcare providers.
- If you're keeping an eye on your baby's wet and dirty nappies + level of alertness then they are more important markers of growth for you to focus on.
- As always though, if you have any concerns then seek out advice from your family doctor, IBCLC or Maternal and Child Health Nurse.
There you have it... the perhaps surprising advice that 'normal' is a bit of a fairy tale and you have my absolute permission (not that you need it!) to do what works... until it doesn't. Then do something else.
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