Topics to discuss with patients during their well baby visit during the first 3-5 days. Perform a careful nutritional assessment at this visit, particularly if breastfeeding was not well-established before hospital discharge.


  • Head circumference, weight and length
    • Plot measurements on growth charts (link to Optimizing Nutrition for Newborns and Infants/Nutrition Assessment Tools/Term Infant Growth Tools/WHO Growth Charts for Infants 0 to 24 Months)
    • Birth weight likely not regained until 7 to 14 days particularly for breastfed infants
      • The newborn weight tool provides hour-by-hour weight loss norms based on data from >100,000 exclusively breastfed newborns
      • Weight loss >10% of birth weight is generally considered excessive and requires further evaluation
  • Jaundice, which is often associated with dehydration and hypernatremia
  • Overall hydration, particularly for breastfed newborns
  • Patterns of stooling and voiding, which are good indicators (after the first few days of life) of the adequacy of milk intake
    • Initially, urination may be infrequent because of the relative dehydration of the newborn, but immature renal concentrating ability may result in continued voiding despite dehydration
    • Urine may initially be dark or contain uric acid crystals, but by day 4 or 5, an infant should pass 6 or more clear, dilute urines each day
    • Initial elimination of meconium may be unrelated to feeding, but the transition to breast milk stool is a key indicator of intake


  • Describe hunger cues and the potential of overfeeding formula-fed infants
  • Confirm formula-fed infants are receiving iron-fortified formula
  • Confirm vitamin D supplementation for breastfed infants
  • Stool patterns
    • stools of the normal human milk–fed newborn are often loose and may be confused with diarrhea if parents are accustomed to seeing the firm, brown stools typical of formula-fed infants
    • Once an infant has a good milk intake, the stool will begin to transition in color from black to brown to green and then to yellow, seedy stools by day 4 or 5 after birth
    • Well-nourished breastfed infants usually pass a medium-sized yellow stool at least 3 to 4 times per day, or as often as with every feeding
  • Reinforce the importance of care of the mother
    • Remind the mother to eat when hungry and drink when thirsty

Consider Referral

  • If there are problems with breastfeeding refer to a lactation consultant
    • Attempt to determine reasons for inadequate milk supply before supplementing with formula
  • Excessive weight loss >10% of birthweight
  • Dehydration or hypernatremia
    • Lethargy
    • Doughy skin
    • Weight loss
    • Fever
    • Reduced urinary frequency
    • Irritability

Additional Resources

Last Updated



American Academy of Pediatrics