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How can I tell if my newborn
baby is getting enough milk?
By Anne Smith - IBCLC
One
of the biggest concerns that new mothers have is wondering if they will have
enough milk for their babies. This concern is the most common reason for starting
formula supplementation, and also for early weaning .We live in a society that
puts a lot of emphasis on measuring everything, and many of us (and especially
our mothers) were bottle-fed, so you knew exactly to the ounce how much milk
the baby took in at each feeding.
You
can be assured that nearly all mothers can produce an adequate milk supply for
their infant. The human race would not have survived for millions of years
if this was not the case. There is a very small percentage of women who
just “don’t have enough milk”, but this is highly unusual, and is most often
connected to some sort of medical problem, (for example, breast reduction surgery,
maternal medications such as birth control pills, or maternal hypothyroidism). Many
of these medical problems can be corrected.
Women
have two breasts instead of one so that they can nurse twins. It stands
to reason that the average mother with two breasts will be able to produce enough
milk for one baby (at least).
Since
breastmilk intake can’t be measured without using sophisticated scientific equipment,
it is important to know how to tell if your baby is getting enough.
Here
are some guidelines to help you assess your baby’s milk intake:
---Your milk
should “come in” 2-5 days after your baby is born. Your baby is born with
extra fluid in his tissues, which is excreted during the first 48 hours after
birth. This weight loss usually averages 7-8 ounces. His immature
kidneys are not equipped to handle large amounts of fluid during this time. The
small amount of colostrum (the sticky yellow fluid that comes out of the breast
before the milk “comes in”) is perfect for his newborn system to digest, and
provides important antibodies. During the first 24 hours after birth, you usually
produce about 37 ml of colostrum (30ml is an ounce). The baby will get
7-14ml at each feeding, 1/3 to 1/2 ounce each time you nurse.
Usually
on the second or third day, your breasts will start to feel ‘different’: warmer,
fuller, and heavier. You will begin to produce transitional milk at this
time – a combination of colostrum and mature milk, which will look yellowish.
If you don’t feel these breast changes and your baby seems hungry after feedings,
consult a health care professional and have your baby weighed.
---Your baby
should latch on and suck rhythmically for 10-15 minutes on each breast.
He may pause periodically, but should nurse vigorously for most of the feeding.
He should seem satisfied after nursing, and will often fall asleep at the
second breast. If he falls asleep and will not take the second breast, try to
divide the sucking time between the two sides. If he is sleepy, he will
get more milk by nursing for 5 minutes on both breasts rather than 10 minutes
on one. You should hear him swallowing regularly while he is nursing.
---Your newborn
should nurse at least eight times in 24 hours. Many newborns will nurse 10-12
times or more. This includes longer feedings as well as shorter snacknursings. Nursing
every 1 ½ - 3 hours during the day, with one 4 hour stretch at night (if
you’re lucky!) works well for many nursing couples. Don’t expect your
baby to be on a 4 hour schedule – the average newborn will not gain enough weight
that way. You may need to wake your newborn up for feedings – newborns
will often not demand to be fed often enough, especially during the first week
or two. (See article on "Waking
Sleepy Babies" for more information).
---Once your
milk is in, your breasts should feel fuller before feedings and softer after
you nurse. You may see milk dripping or squirting from one breast while
your baby is nursing on the other side. This is a sign that your milk is
“letting down”. Your body doesn’t know that you’re not nursing twins, so
your milk will let down on both breasts at once. You may or may not feel a distinct
sensation associated with the milk ejection, or let-down reflex. Some mothers
feel a very strong physical sensation, sort of a tingling, tightening, or pins-and
needles response as the milk begins to flow. Some mothers never notice
a distinct sensation, and some don’t feel it until they have been breastfeeding
for several weeks.
---Keep track
of your baby’s wet diapers and bowel movements. Other than weight gain,
these are probably the best indicators of how much milk your baby is taking
in.
For
the first couple of days after birth, your baby will pass dark, tarry meconium
stools. This is the stool the baby has been storing since before birth.
Within a day or two of your milk coming in, his stools will change in both color
and consistency. These early transitional stools may be brownish or greenish,
and will be loose and unformed (kind of a pea soup consistency). By the
time your baby is 4 or 5 days old, he should be having “milk stools”: Yellowish
and seedy, sort of like a mixture of mustard and cottage cheese. He should
have at least 2-5 substantial bowel movements in each 24 hour period, and may
pass a stool every time he nurses during the first few weeks of life. If he
is stooling less frequently, it may mean that he is not getting enough milk.
During
your baby’s first couple of days of life, he will probably wet only once or
twice a day, since he is receiving only colostrum. After the milk comes
in, he should wet 6-8 times in 24 hours. It is often hard to tell whether
a super-absorbent disposable diaper is wet or not, since the gel inside acts
like a wick to draw the moisture away from the surface. You can put a piece
of toilet tissue inside the diaper the help you be sure. The urine should
be pale, colorless, and mild smelling. Dark, concentrated urine may mean
that the baby is not getting enough milk.
---Most mothers
experience some nipple tenderness during the early days of nursing. The
discomfort is usually worst when the baby first latches on, and eases off during
the feeding. If the pain is severe, lasts all the way through the feeding,
if your nipple tissue cracks or bleeds, or the pains persists beyond one week,
it may mean that your baby is not latching on correctly. This can not only
cause you extreme discomfort and makefeedings unpleasant, but can also cause
your baby to not obtain enough milk. Check yourbaby’s weight, and consult
a breastfeeding specialist who can evaluate your nursing technique. Latch on
problems can often be easily corrected.
The
only way to be absolutely sure that your baby is getting enough milk is to check
his weight regularly. Remember that it is normal for him to lose 5-7 %
of his weight in the first couple of days (doctors often become concerned when
weight loss approaches or exceeds 10%). For the average baby, this is close
to a half a pound weight loss (often more for larger babies). You need
to ask what your baby’s discharge weight is when leaving the hospital, because
that is the figure you will be calculating his weight gain from, not from his
birth weight. For example: your baby weighs 7 lbs 8 oz at birth. 48 hours
later when you leave the hospital, he weighs 7 lbs 1 oz. Once your milk
comes in, your baby should gain about an ounce each day for the first several
months of life. Most babies will regain their birth weight within 2-3 weeks
. Many doctors are pleased if the baby has regained his birth weight by
2 weeks , and will do a weight check at that time. I like to see babies regain
their birth weight by 10 days, and most babies will do that if breastfeeding
is progressing smoothly. Some doctors check the babies weight around the
third day of life, and then make a follow-up appointment for 2 weeks to see
if he has regained his birth weight. I strongly encourage mothers to check
the weight at about 1 week - at that point, her milk should be in, the baby
should have good urine and stool output, he should be gaining weight, and any
breastfeeding difficulties can be addressed. Breastfeeding problems are
much easier to remedy if recognized and treated early. Most doctor’s offices
will offer free weight checks, since the doctor does not actually have to see
the baby at that time (just ask the nurse to put the baby on the scale).
The information you get will be invaluable – either you will know that breastfeeding
is going well, and you can relax, or your will know that there is a problem
that needs to be addressed and you can take care of it before a little problem
develops into a big one.
One last note
on this topic:
Every mother’s nightmare is that she won’t have enough milk and her baby will
become dehydrated. Horror stories abound, and unfortunately, this has (rarely)
occurred. There is absolutely no reason for this to happen if you follow
the above guidelines. True dehydration is an extremely uncommon medical
occurrence, and there are warning signs which indicate that your baby needs
more fluids immediately. If you notice any of the following symptoms (especially
if they occur concurrently with other “red flags” such as low urine and stool
output), contact your doctor ASAP.
- lethargy
- listlessness
- weak cry
- dry mouth or eyes
- the fontanel (soft
spot) on the baby’s head is sunken in or depressed
- the skin loses
its resilience (when you pinch it, it stays pinched looking)
- fever
About the Author
Anne Smith, anne@breastfeeding-basics.com
http://www.breastfeeding-basics.com
Anne Smith is an IBCLC – International Board Certified Lactation Consultant
and La Leche Leader since 1978. More importantly, she is a mother to 6 breast
fed kids with twenty plus years experience of counseling nursing mothers. Her
site, www.BreastfeedingBasics.com
, provides expert advice and solutions to breast-feeding problems and gives
basic information on how to breast feed. Anne also features her recommended
breast feeding products and breast pumps.
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if you have any questions or comments!