How do I know my baby is getting enough milk?

BABY

• Nurses 10 or more times in a 24 hour period
• Baby has a good, deep latch at the breast
• Audible swallows are heard at the breast
• Has 6 or more wet diapers every 24 hours by day six
• Has 3 or more yellow bowel movements every 24 hours by day six
• Has regained birth weight by the two weeks of age
• Is satisfied after most feedings

MOTHER

• Notices fullness, or swelling, of the breasts by day five
• Notices milk change from yellowish, sticky drops to whitish, mature milk
• Nipples are not very sore

Mothers already have milk in their breasts at the time of delivery. In fact, colostrum, or the first milk, is in the breast starting around 10-14 weeks gestation! This first milk is very high in protein, which acts as a laxative. Babies are born constipated since they do not poop in utero, but have been getting nutrients from mom by actively swallowing amniotic fluid and passively through the blood supply in the umbilical cord. Their first poop is called meconium, which is thick, black, and sticky. Babies have a high need to suck at birth because it actually helps them move their bowels. There is a wave-like motion that starts in the esophagus when they swallow and the wave moves all the way through the GI tract to push the meconium out. Unlimited access to the breast in the first days of life will help this process get off to a good start. Your milk volume increases over subsequent days as the baby is able to get rid of all the meconium in his gut and is ready to process mature milk. Your milk has all the nutrients and calories your baby needs at every stage of development, so you do not need to supplement with bottles of formula or glucose water.

Your baby should quickly progress to 10 or more feedings in a 24 hour period. Infants occasionally need to be awakened for feedings (every 2-3 hours) in the first days or weeks, typically until they have regained their birth weight. Your baby should regain their birth weight by their 2 week check up. Once your baby’s weight gain has been established, you should no longer need to wake up your baby at night. Babies are not born with clocks and the length of feedings will vary greatly. Initially, your baby may feed for only a few minutes, or hang out at the breast for up to an hour! Let your baby set the pace. Active feeding includes the baby sucking strongly with pauses between suckling bursts. As your baby becomes more efficient at the breast, you will start to notice the baby feeding for shorter amounts of time. Some babies need to use both breasts at each feeding to feel satiated, which others feel full after feeding at only one breast. Alternate which breast you offer first at each feeding to equalize your milk production.

Some time between the third and fifth day, your milk volume will increase dramatically as the milk changes from colostrum to mature milk. This perceived filling of your breasts is the normal process of engorgement, which is due to the increased volume of milk as well as body fluids within your breast tissues. Engorgement may feel like hot, firm, and uncomfortable breasts and you may experience body aches. As long as your baby is nursing well, this should only last 24-48 hours. The amount of time and symptoms of engorgement vary from woman to woman, but frequent nursing (every 2-3 hours or more) from birth will help reduce the swelling and tenderness. The more your baby nurses, the less engorgement you will experience. You can tell if your baby is removing milk from your breast when you hear audible swallowing during the feeding and initially your breasts will feel softer or less full immediately after feeding. You may also see drops of milk in your baby’s mouth or around your nipple when your baby unlatches.

Infant urine should be clear. Urine output increased incrementally from 1 or 2 wet diapers on day one, 2 wet diapers on day two, 3 wet diapers on day three, etc., until 6 or more wet diapers by day six. Although some babies may have a reddish “brick dust” in the diaper for the first two days, after the second day this may indicate that your baby is not getting enough milk. After day three, your baby's stool will change from the sticky dark green/brown meconium to a mustard yellow. Yellow breast milk stools are loose and contain seedy curds. Your baby will move from 1 to 4 stools a day for the first five days to 3 or more stools every 24 hours from day six on. Exclusively breastfed babies do NOT become constipated. A fully breastfed baby younger than six weeks not passing enough stools is a red flag for underfeeding, and his weight should be checked immediately!!

Mild tenderness in the nipple at the beginning of feedings is common for the first few days. Many describe it as a tugging or pulling sensation. Severe pain and cracked or bleeding nipples indicate your baby is not latched on correctly. When this happens, your baby may not be able to properly compress the areola (the dark area surrounding your nipple) which is how babies obtain milk. For a proper latch, the areola as well as the nipple should be in your baby's mouth. Your nipple should be far back in your baby’s mouth, where the soft part of the palate is. If just the tip of the nipple is in the baby’s mouth, it will rub on the hard, bony part of the palate which is what causes nipple damage and pain. Achieving a good, deep latch will also facilitate your baby getting enough milk.

Babies are designed to feed frequently. Breast milk is quickly metabolized and digested. It can pass through the infant’s stomach in 48-90 minutes! Indications of hunger include waking from sleep, bringing the hands to the mouth, wiggling, stretching, licking, mouth movements, and increasing noises. Crying is a very late hunger cue, so try not to wait until our baby is crying to let you know he or she is hungry. Feed frequently and as often as your baby desires. This not only assures the baby is adequately fed, but it also helps build your milk supply. Breast milk works on a demand and supply model. The more you feed, the more the breast actually makes. In you have any concerns or questions, don’t hesitate to see your pediatrician or make an appointment for a lactation consultation. It is always best to seek counsel and advice as soon as you notice something doesn’t feel right. Trust you new mother instincts!

Newborns typically lose an average of 7% of their birth weight during the first days of life. This is because they are eliminating birth fluids and meconium. As your milk volume increases, your baby should start to gain approximately 1 ounce every day and and reach his or her birth weight by two weeks of age. Babies tend to gain ½-1 ounce every day for 3 to 4 months and then slow down to gain ½ an ounce a day thereafter.