Aside from preventing nipple pain, telling if a baby is getting enough milk is the most common concern of breastfeeding mothers. In our culture, we hear so many stories of low milk supply that we tend to not trust breastfeeding, despite the fact that our bodies provided all the nourishment our babies needed during pregnancy! We also focus on numbers, quantities, and bottles, making it challenging for a breastfeeding mother to feel confident her baby is getting enough to eat. Thankfully, babies provide us with many signs of milk intake. Knowing what to look for, along with seeking help from an International Board Certified Lactation Consultant (IBCLC) if you have any concerns, can provide assurance and avoid any issues.
The old saying, “What goes in, must come out,” applies perfectly to breastfed babies. Your baby should have one wet diaper for every day outside the womb, up to day 3-5 when a mother’s milk supply becomes more abundant. Starting at 3-5 days of age, your baby should have at least 6-8 very wet diapers per 24 hours. Urine should be light yellow to clear in color and have no odor.
In the early days after birth, babies excrete a black, thick stool called meconium. By day 3-4, stool should be transitioning to a greener color and by day 5, it should be a yellow color and semi-liquid in consistency, sometimes having a seedy texture. Often in the early days, newborns stool after every feeding. This may begin to taper off as your baby gets older, but even after six weeks of age, babies should always have 1-2 stools per day.
- Learn to Identify Swallowing
While some babies have obvious, audible swallowing, some babies are much quieter. When a baby swallows, you will see a significant drop and then a pause underneath the chin. The longer the pause, the larger the swallow of milk. Jack Newman has some excellent videos to aid in identifying swallowing at the breast.
- Watch the Baby
Newborn babies should nurse at least 8-12 times every 24 hours. As babies get older, they become more efficient at the breast and feedings are less frequent, taking a shorter amount of time. When a baby is full of milk, they will discontinue showing signs of hunger such as rooting, sucking on hands, showing tension in the body and face, or crying. They may show signs of drowsiness, sleep, come off the breast spontaneously, or enter a quiet-alert state.
A baby’s hands can be compared to a gas gauge in a car. When the tank is full of gas (milk), a baby’s hands will be open and relaxed. When a baby is very hungry, fists will be clenched and tight, showing the tank is in need of filling.
- Weight Gain
Babies are born with extra fluid so that in the first days after birth, it is normal for them to loose weight. Although up to 10% weight loss was once considered normal, recent guidelines by the World Health Organization show a weight loss over 7% may be of concern. After 5 days of age, your baby should be gaining weight each day, reaching birth weight by day 8. Appropriate weight gain after this age is as follows.
- 0-3 months, 1-1.5 ounces (30-40 grams) a day
- 4-6 months, 4-5 ounces (110-140 grams) a week
- 6-12 months, 2-4 ounces (60-110 grams) a week
Unreliable indicators of milk intake can lead to unnecessary supplementation and a lowered milk supply. These include…
It is especially important to remember that babies cry for all sorts of reasons other than hunger. Crying is often related to infant stress. Stress during pregnancy and birth, the expectation of solitary sleep, separation of mother and baby, a lack of postpartum support, gut issues, overstimulation, and numerous other things contribute to fussier babies in our culture. The evening hours are a very common time for babies to be fussy., lots of skin-to-skin contact, babywearing, and sensitive, responsive caregiving, along with a good understanding of normal newborn behavior, make a huge difference in crying and stress levels.
- Baby Takes Milk from a Bottle After Breastfeeding
When a baby cries, a common scenario is for parents to assume the baby must be hungry and offer a bottle of formula. The baby likely drinks the bottle and stops crying, so they assume the baby was hungry. However, it is very easy to overfeed a baby with a bottle. Placing a bottle nipple in a baby’s mouth triggers the reflex to suck, and drinking from a bottle is quick and easy. Babies can eat so fast, they don’t realize they are full. Similar to adults, overeating makes them sleepy, so they stop crying.
- Unable to Pump Milk
The amount of milk a mother can pump has no relation to the amount of milk a mother’s body is making. The suction of a breast pump is completely different from the way a baby removes milk from the breast. Our bodies are made to release milk for our babies, not for a machine. Pumping is a learned skill and may take practice. Under normal circumstances, your baby is much more efficient at removing milk from your breasts than a pump.
- Your Baby is Feeding Very Frequently:
It is normal for newborns to nurse frequently. Feedings are not usually evenly spaced, and at times, newborns nurse almost every hour. Babies also have “growth spurts” when they seem to want to nurse almost constantly for a day or so. Breastfeeding on demand during these times will allow your supply to catch up to the needs of your baby. Paying attention of other indicators of milk supply during these times can be helpful.
- Your Breasts Feel Soft or are Not Leaking:
Every mother’s anatomy is different. Even if your breasts started out feeling very full, eventually they will adjust to exactly what your baby needs. Some women never leak milk or feel full, but have plenty of milk for their baby.
Contact Your IBCLC or Healthcare Provider if:
Your baby is not able to latch
Your baby is too sleepy to latch or falls asleep quickly at the breast
Your baby is not having enough wet or soiled diapers
Your baby loses more than 7% of his birth weight
Your baby is not up to birth weight by the 8th day after birth
There are many variations of normal infant behavior and breastfeeding, as every baby and family has different circumstances. If you are not assured by the information above, it is important to have a thorough evaluation from an IBCLC, who has extensive training in assessing breastfed babies and can provide the reassurance and/or assistance you need to meet your breastfeeding goals.