New mothers often wonder how to tell if their infant is getting enough breast milk. Since the breasts don’t have measurements listed on them, we need to investigate whether babies are getting enough milk in other ways. Sometimes breastfed babies can trick you into thinking that they are getting enough milk when they are not. These are a few of the signs that I look for as a breastfeeding medicine expert.
Timely breastfeeding
First, a good rule of thumb to ensure that your new baby is getting enough breast milk is to frequently offer feedings to your baby. Newborn babies should eat 8-12 times per day on average in the early days and weeks of breastfeeding. Until your baby regains their birth weight, you should wake your baby to offer them a feeding every 2-3 hours during the day and every 4 hours overnight. Newborns should not go any longer than 4 hours between feedings in those critical early days.
Once your baby has proven good weight gain, you no longer have to wake them at night for feedings. You can allow them to sleep a little longer. However, in the early days after birth try to not go any longer than 5 hours without initiating a nursing session. Your milk production may suffer if you go long periods of time between feedings.
Audible swallowing
When your baby nurses, their first few sucks at the breast are often very rapid as they are working to elicit the letdown reflex. Once they have caused the milk to let down, they will change into a nutritive sucking pattern. This is when they are drawing milk from the breast with longer and deeper sucks, followed by an audible swallow after a few sucks.
On the other hand, sometimes babies will fall into a more non-nutritive sucking pattern. I often see this in infants who are sleepy in the early days of life or premature infants. These babies get onto the breast and excitedly suck to elicit the letdown reflex. Then, as the milk begins to flow, they slowly drift off to sleep and begin to suck shallowly and rapidly. Often, they are happy to just let the milk drip into their mouth. You may hear a swallow every few minutes, but it is not the active suck-suck-suck-swallow pattern of a baby who is actively eating.
If the baby does not progress beyond the initial letdown sucking pattern or consistently reverts back to a non-nutritive “fluttery” sucking pattern, likely your baby is not transferring much breast milk. If your baby is doing this “non-eating” sucking pattern, you can try changing up your feeding position. Additionally, if you find that your baby is very sleepy at the breast, you can try a technique that is called “switch nursing.” This just means that when the baby starts to get sleepy on one side, you switch to the other side and then back again. Most babies will get a full feeding in after offering “four sides” or each breast twice.
After trying some of these suggestions, if your breastfeeding sessions are not improving, you may need the help of a breastfeeding specialist.
Calm and Content Baby
After a feeding, a baby who is getting enough breast milk will appear happy and relaxed. They may fall off the breast in a state of relaxation or deep sleep, which is a positive indication that they have consumed a sufficient amount of breast milk.
If a baby appears frantic after attempting to feed or continues to cry despite a feeding, it may indicate that the baby is not receiving sufficient milk from breastfeeding. Moreover, babies who seem excessively sleepy or do not feed for extended periods of time are likely not receiving enough milk.
Your Breasts Soften
After the onset of copious milk production which occurs about 3-5 days after giving birth, your breasts will feel full before each feeding. Once your baby reaches their birth weight and your milk supply adjusts, your breasts may not feel as firm but should still feel like they are filling with milk between feedings. A baby that feeds effectively will remove breast milk and leave a soft breast afterwards.
If you continue to experience fullness in your breasts after feeding or feel pain while breastfeeding, it is possible that your baby’s latch is not correct. Poor latching can result in inadequate milk transfer from the breast.
Risks of the Nipple Shield
Additionally, nipple shields can be useful tools for breastfeeding mothers who are unable to get their baby to latch well. However, one of their potential drawbacks is a decreased milk transfer and/or decreased milk production over time. When you are using a nipple shield, be sure that your baby is still achieving a deep latch by taking in more than just the end of the nipple shield into their mouth. In addition to ensuring a deep latch, your goal should be to wean from the nipple shield over time.
If you are unable to get your baby to latch deeply or are having trouble weaning from the shield, be sure to consult with a breastfeeding specialist.
Weight Gain
Your baby should initially lose weight after birth but their weight should stabilize around 1 week of life. Then, your baby begins to gain weight once your milk comes in. Weight gain indicates that the baby is receiving sufficient milk. After that, your baby should regain their birth weight by 2 weeks of life. Between 1-6 months of age, babies gain 20-30 grams per day on average or about 5-7 ounces per week.
Additionally, you may notice cluster feeding during growth spurts. Milk production increases due to this frequent feeding pattern and will supply the baby with extra calories to grow. After a few days, the baby’s feeding pattern will return to normal.
Appropriate weight gain is a great indication that your breastfeeding baby is getting enough milk.
Diaper Changes in the Early Days
In the early days of life, you should expect your baby to have one wet diaper for each day old they are until they reach 5 days old. After 5 days of life, your baby should have at least 5 wet diapers per day.
On the other hand, we care less about the amount of poopy diapers your baby has and more about the color of their stool in those early days. Initially, all babies will have a sticky black stool that we call meconium. The baby’s poop will be sticky and black for the first two days of life and then transition to a green color.
After the transitional stool, a breastfeeding baby will have yellow stool that has little specks of white in it. In order to know that your baby is getting enough breast milk, you should observe this color change over the first few days of life. For example, I would be worried that your baby is not getting enough breast milk if they were still having black and sticky stools past 3 days of life.
Later Diaper Patterns
Often, after the first week of life, your breastfeeding baby will have a poopy diaper after every feeding. Then, as time goes on, your baby may have a stool every few days. Your baby’s body uses breast milk very efficiently and this decreases the amount of times that they need to poop. It is pretty rare for an exclusively breastfeeding baby to be constipated.
Sometimes counting dirty diapers can be confusing for parents. Babies are pretty dramatic when it comes to having bowel movements. If this is a concern for you, be sure to discuss this indicator with your baby’s pediatrician.
Ways to Help Your Baby Feed Better
Although complete resolution of all breastfeeding difficulties may not be possible without assistance, there are things that you can try at home.
Pay Attention to Early Feeding Cues
Nursing your baby when they are first starting to get hungry and not waiting until they are hangry will help them to feed better.
Early feeding cues include:
Sucking on hands or fists
Growing restless in the crib or bassinet
Alertness
Late feeding cues:
Crying
Avoid Bottles and Pacifiers in the Early Days if Possible
Bottles and pacifiers are useful tools for babies. However, they can interfere with establishing a good breastfeeding pattern if they are used too early. For example, parents will often desire to ease their baby’s crying by putting a pacifier in their mouth. And while this is not a bad thing to do, it is better to offer the breast first in the early days of life in order to establish breastfeeding.
Effective Latch
For every single feeding at the breast, pay close attention to your baby’s latch. In order to establish a robust milk supply, latching your baby correctly is key.
Steps to an effective latch:
Bring the baby to the level of the breast by using pillows
Line the baby’s nose up with your nipple
Stroke the side of the baby’s mouth with the breast
Wait for the baby to open their mouth widely
Bring the baby towards the breast in a quick motion while you are grasping behind the areola
Assess whether the baby is latched deeply by how it feels to you (no pain) and you can see baby’s upper and lower lips flanged out and around a mouthful of breast tissue
