March 30, 2021

By Andrea Tran RN, BS, MA, IBCLC

Counting diapers is recommended by lactation consultants and pediatricians as a way to know if your breastfed baby is getting enough milk from you. However, there is some conflicting information circulating about what number of diapers is reassuring.

The number of both wet and soiled diapers you should expect changes as your baby grows.

How many diapers should a breastfed newborn have?

In the first days of breastfeeding the expected diaper count changes daily.

• By the time your baby is 24 hours old he should have at least one wet and one soiled diaper.
• On day two there should be 2 wet and 1-2 soiled diapers.
• By day three and until your milk comes in your baby should have a wet diaper every eight hours and 1-2 soiled diapers.
• The number of wet diapers should increase to at least six every 24 hours within a day of your milk coming in.
• The number of soiled diapers should increase to three to four of a moderate amount on average.
• A soiled diaper has to be at least the size of a quarter to count.
• A bowel movement the size of a quarter is considered small.
• A BM that is approximately three to four inches in diameter is a moderate amount.
• A large amount of stool will essentially fill the diaper.
• Most babies will have a combination of sizes.
• In the first six to eight weeks it is a reassuring sign for a breastfed baby to have lots of soiled diapers.

What should a breastfed baby’s stools look like?

In the first few days, the bowel movements will be meconium stools. Meconium is what is in a baby’s bowel when they are born. It is very dark green, almost black, and very thick and sticky.

After two to three days the stools should become transitional stools. These are greenish-brown in color and have a looser consistency.

Approximately 24-48 hours after the milk comes in your baby should start to have breast milk stools. These will be mustard yellow, very loose in consistency and may look like there are seeds or curds in them.

Is it true that breastfed babies can go days without having a bowel movement?
A baby who is older than six weeks may transition to an infrequent stooling pattern. This is not a cause for concern as long as a baby is continuing to gain weight at an average rate.

In the first six weeks having less than three soiled diapers of moderate quantity may be a red flag that a baby is not getting enough milk. It is recommended that a baby get weighed if they are not stooling frequently enough.

While rare, it is possible for a baby to have less frequent bowel movements while gaining enough weight. As long as weight gain is consistently average having fewer diapers is ok.

If a breastfed baby is not gaining a sufficient amount of weight it would be a good idea to meet with a lactation consultant who can help determine the cause of the low weight gain.

Related: How does milk supply work?

What does it mean if a breastfed baby has green stools?

There can be different causes for green stools.

• If a baby is not getting enough of the fattier milk known as the hindmilk the result can be green stools. Often the stools are described as frothy.
  • A baby can get too much foremilk if a mother has an overabundant supply or if she limits how long the baby breastfeeds on each breast.
  • It’s best to let a baby breastfeed until they indicate they are satisfied by coming off the breast or they are swallowing infrequently.
• An intolerance to a food that a mother is eating can cause green stools. They may also be mucousy.
• A gastrointestinal illness can cause green stools.

How can the diapers change in an older breastfed baby?

As a breastfed baby gets older they may have fewer wet diapers. The number of soiled diapers can vary quite a bit.

As long as a baby is gaining weight at an appropriate rate they are getting enough milk.

When a breastfed baby starts eating solid foods or if she is supplemented with formula the stools may change to a brown color and have a pasty, thicker consistency.

While a breastfed baby’s diapers can provide reassurance or be a warning sign, the ultimate determination as to whether the baby is getting enough milk is the weight gain..

Source

Evans, A., Marinelli, K. A., Taylor, J. S., & Academy of Breastfeeding Medicine. (2014). ABM clinical protocol# 2: Guidelines for hospital discharge of the breastfeeding term newborn and mother:“The going home protocol,” revised 2014. Breastfeeding Medicine, 9(1), 3-8.

Andrea Tran RN, BSN, MA, IBCLC is a freelance writer who has been helping moms and babies breastfeed for over twenty-five years. She is married and the mother of three adult children.