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Is My Baby Getting Enough Milk?

From New Beginnings, Vol. 25 No. 5, 2008, pp. 44-45

Whether or not baby is getting enough milk is one of the most common concerns of new moms. Since we don't have measurement markers on our breasts, we can't initially "see" that our babies are really getting the milk they need. You can tell baby is getting enough milk, however, by keeping track of dirty diapers, weight gain, and appearance.

Breastfeed Often

A baby needs to breastfeed frequently. Your milk is digested quickly and easily, sometimes in as little as 60 minutes, and small amounts are perfect for baby's tiny stomach. These frequent feedings also help to establish your milk supply. In simple terms, the more milk that is removed from your breasts, the more milk your body will produce. Frequent feedings are good for both of you!

  • A newborn should feed at least eight to 12 times in a 24-hour period.
  • Allow baby to determine the length of feedings: 10 to 20 minutes per breast or longer.
  • Keep in mind that some babies "cluster nurse," which means that they nurse very often for a few hours and then sleep for several hours. The number of feedings in a 24-hour period is more important than the spacing of feedings.
  • A sleepy baby may need to be wakened every two to three hours to feed, particularly if he has jaundice. Talk with your health care provider if baby is lethargic and difficult to wake for feedings.

Weight Gain

age weight gain (per week)
0-3 months 4-7 ounces (110-200 grams)
4-6 months 4-5 ounces (110-140 grams)
6-12 months 2-4 ounces (60-110 grams)

Weight Gain and Appearance

Your baby may lose up to seven percent of his birth weight during the first three or four days. Once your milk "comes in," expect your baby to begin gaining weight. He should regain his birth weight by the time he is 10 to 14 days old.

You also know your baby is getting enough milk by noting that his skin color is good, his skin is firm, and he is filling out and growing in length and head circumference. Your baby should also be active and alert.

Watch Baby, Not the Clock

Watch your baby for signs of hunger, not the clock. Follow baby's feeding cues and do not try to schedule feedings or limit feedings. Early hunger cues include:

  • Baby opening his mouth and moving his head side to side (known as the rooting reflex).
  • Baby making sucking motions with his mouth.
  • Baby begins to chew or suck on his hands or fingers.

Don't wait for your baby to cry to let you know he is hunger. Crying is a very late hunger cue.

Diapers

Counting your baby's diapers can be a helpful indicator as to whether or not he is getting enough of your milk.

baby's age mother's milk wet diapers/24 hrs dirty diapers/24 hrs
1-2 days colostrum (provides immunities and helps with jaundice) 1-2 greenish-black tarry meconium
2-6 days milk "comes in"; bluish color 5-6 wet disposable diapers
(6-8 wet cloth diapers)
At least 3 greenish transitional stools
6+ days milk supply adjusts to suit your baby's needs Same as 2-6 days At least 3-5 very loose stools; bright yellow color that are about 2.5 cm
6 weeks milk supply established Same as 2-6 days Some babies switch to less frequent but large bowel movements

Increasing Your Supply

Mothers throughout the ages have been able to produce plenty of milk for their babies. In certain situations because of a health problem or other complication, a mother may have a reason to be concerned and may need to carefully monitor her baby's weight gain in order to be sure he is getting enough milk. If baby is not gaining well or he is losing weight after the first few days, contact baby's health care provider. Slow weight gain may indicate a serious health problem. If you're concerned about your milk supply, get help. Being in touch with a La Leche League Leader can often provide the information, support, and encouragement that mothers need to be reassured that they are providing plenty of milk for their babies. Steps that will help your baby get as much of your milk as possible include:

Nurse often for as long as your baby will nurse. The more milk that is removed from the breast, the more milk the breast will make to replace it. Frequent breastfeeding helps to establish a plentiful milk supply. A sleepy baby may need to be awakened and encouraged to nurse more frequently. A baby who nurses for excessively long periods may not be nursing efficiently. If you're experiencing this, have a breastfeeding session observed by an experienced LLL Leader or lactation professional.

Offer both breasts at each feeding. This will ensure that your baby gets all the milk available and that both breasts are stimulated frequently. Allow your baby to indicate he is finished on the first breast, then offer the other breast.

Check baby's positioning and latch. Breastfeeding should not hurt. Hold baby close with his whole body facing you so he does not have to turn his head. When he opens his mouth wide, his head should be slightly tilted back with his nose at the level of your nipple. As he approaches the breast with his head slightly tilted back, this will bring him to the breast chin first. This will help you better aim his lower jaw so that he covers more of your breast with his lower jaw than with his upper mouth. As you bring baby onto the breast, aim your nipple toward the roof of his mouth. If you feel comfortable and baby is nursing actively, the latch is good.

Try breast compression to keep your baby interested in breastfeeding. Squeeze the breast firmly with your thumb on one side and fingers on the other to increase milk flow. Keep squeezing until baby is no longer actively sucking, then release. Rotate fingers around the breast and squeeze again. Then switch to the other breast, using both breasts twice at each feeding. Squeeze firmly but be careful not to cause injury to your breast tissue.

Feed your baby only your milk. If your baby has been receiving formula supplements, do not cut these out abruptly. As you improve your breastfeeding techniques with the help of a lactation professional, and as your milk supply increases, you will be able to gradually reduce the amount of supplement. Monitor baby's weight gain and stay in touch with your baby's health care provider during this transition.

All your baby's sucking should be at the breast. If some supplement is necessary, it can be given by spoon, cup, or with a nursing supplementer. Be aware that a pacifier can create more problems than it solves. If you decide to give your baby a pacifier, wait until he is nursing effectively and gaining well.

Use skin-to-skin contact. It may encourage your baby to nurse more often. Skin-to-skin means that baby will be nestled upright between your breasts, clad only in his diaper directly against your skin. Your warmth, smell, and heartbeat will also soothe baby, which in turn aids in his development.

Try to relax. Paying attention to your need for rest, relaxation, and proper diet will help your milk supply and improve your general sense of well-being.

Talk to your health care provider about medicinal herbs or prescription medications to increase your milk supply. A La Leche League Leader can provide references with information about herbs and medication.

If you have concerns...

Some mothers think their babies are not getting enough milk when they are actually getting plenty of milk. Some "false alarms" that worry mothers include:

Your breasts feel different. If your breasts suddenly feel softer or your breasts no longer leak between feedings, it does not mean that you are producing less milk; it simply means that your supply has adjusted to your baby's needs.

Baby seems fussy. Many babies have a fussy time every day that is not related to hunger. Some babies need lots of stimulation and activity; others need soothing. You will learn how to respond to your baby as you find the ways that comfort him. If your fussy baby settles down when you offer him the breast, go ahead and breastfeed. But don't take this as a sign that he is not getting enough to eat.

Baby suddenly wants to feed more often, or seems hungry again soon after being fed. Babies often go through "growth spurts" when they are two to three weeks old and again at six weeks and three months. At these times, breastfeed as often as possible as your supply catches up with baby's demand.

Baby decreases his nursing time, perhaps down to five minutes or so at each breast. As babies get older, they become very efficient at taking the milk so this is a positive sign that breastfeeding is going well, not something to worry about.

La Leche League Leaders are accredited volunteers who are available to help with breastfeeding questions in person, over the phone, or online. Locate an LLL Leader near you at www.llli.org.

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