How do we know that baby is getting enough milk?

Not everyone thinks of comfort when thinking about baby getting enough milk, but actually, the first sign that I ask about is mom’s comfort. How is this related to how much milk baby is getting? Because if feeding is uncomfortable, that's a red flag that something's wrong, not only with the latch (which may look fine from the outside), but in the action of feeding. If a baby is feeding efficiently and transferring milk from the breast, getting lots of milk into their mouth and swallowing, that’s efficient feeding. If they are causing pain, it means that their latch and mouth movements are not efficient. Comfort for mom is not just about mom. We want keep that in mind, and reach out quickly for professional lactation help if there is any breast or nipple pain. 

Next obvious sign is insufficient diaper output. What comes out tells us what went in. Here’s an easy way to remember this: one wet and one dirty diaper on the first day, two on the second three on the third, and so on until about six days when we expect about six to eight wet, and at least four to six yellow bowel movements. About the colors - sorry if this is TMI, but baby poop descriptions are totally necessary - the first bowel movement, called meconium, is very dark and sticky. If baby is getting enough milk the color lightens every day - first black, then dark brown, then light brown, finally a yellow mustardy color. 

Jaundice can be a sign of not getting enough milk because skin color is related to dirty diapers. Stay with me, I’ll explain. Bilirubin is what causes skin to appear yellow in jaundice. It’s also what causes the poop to be dark. So pooping out that meconium stool with plenty of breastfeeding, gets rid of the bilirubin which can cause jaundice. FYI giving formula to jaundiced babies is not typically recommended because the formula has iron in it that can be constipating, preventing the baby from getting rid of bilirubin. Makes sense, right? 

Now onto another sticky subject, weight loss, and weight gain. Infants can lose up to 10% of their weight in the first seventy two hours of life, before they start gaining again. Once they start gaining we expect about one ounce per day, reaching their birth weight again by two weeks of age. A baby who is under their birth weight at two weeks of age should be evaluated, because that’s a red flag that they need additional help. At that point I’d suggest an IBCLC (International Board Certified Lactation Consultant) in addition to the pediatrician. 

 A simple sign that baby is getting enough milk, that requires no numbers, only gentle observation, is that there are times when baby seems satisfied between feedings without a pacifier or swaddling. Picture a baby going into a restful sleep on its own after a feeding. 

 Once we get past the two week mark, things should start to settle into a nice pattern, and possibly even a routine (which is different than a schedule). 

Let’s divide the warning signs into parent signs, baby signs and feeding signs. The parent should have no pain during or between feedings. The parent shouldn't feel engorged, unless baby misses a feeding. Those full and tight breasts that happen in the first couple of days, should be gone by two weeks and the breasts should feel relieved or softer after a feeding.

The baby is fed on demand and shows feeding cues eight to 12 times per day. They  seem content and satiated after a feeding and have some time between feedings where they're happy, satisfied, and settled. They shouldn't have crying or colic or spitting up more than occasionally. Their daily diaper output should be at least six wet diapers and three to four yellow bowel movement. 

The feeding will be about eight to 12 times per day, lasting anywhere between five to 30 minutes. I'm very well known for saying that we don't time feeding.  If you come into my office, You won’t find a clock on my wall. We watch the baby, not the clock. That being said, if the baby is feeding for more than 30 minutes and still seeming hungry, that's another red flag that the baby's having difficulty getting milk. There’s lots of reasons why the baby may not be getting enough milk. One of them might be low milk supply, but there are other reasons as well. 

Other feeding signs that demonstrate efficient feeding is staying latched to the breast, not popping on and off, or pulling at the nipple, or gagging or choking when the milk comes down. 

You should see and hear a rhythmic motion to the feeding.  You see and hear sucks and swallows. There's no chomping or biting. And it doesn't just seem like sucking, without any swallows.

If you are unsure about any of the above, reach out for professional guidance, preferably an IBCLC. The following signs warrant urgent medical attention: low diaper output, dark urine or bowel movements beyond the first couple of days, long feedings with baby never seeming satisfied, jaundice, spitting up after every feeding, or crying after every feeding. 

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