Breastfeeding mothers frequently ask how to know their babies are
getting enough milk. The breast is not the bottle, and it is not possible to
hold the breast up to the light to see how many ounces or millilitres of milk
the baby drank. Our number obsessed society makes it difficult for some mothers
to accept not seeing exactly how much milk the baby receives.
However, there are ways of knowing that the baby is getting enough. In the
long run, weight gain is the best indication whether the baby is getting enough,
but rules about weight gain appropriate for bottle fed babies may not be
appropriate for breastfed babies.
Ways of Knowing
1. Baby's nursing is characteristic. A baby who is obtaining good amounts of
milk at the breast sucks in a very characteristic way. When a baby is getting
milk (he is not getting milk just because he has the breast in his mouth and is
making sucking movements), you will see a pause at the point of his chin after
he opens to the maximum and before he closes his mouth, so that one suck is
(open mouth wide--> pause-->close mouth). If you wish to demonstrate this to
yourself, put your index or other finger in your mouth and suck as if you were
sucking on a straw. As you draw in, your chin drops and stays down as long as
you are drawing in. When you stop drawing in, your chin comes back up. This same
pause that is visible at the baby's chin represents a mouthful of milk when the
baby does it at the breast. The longerthe pause, the more the baby got. Once you
know about the pause you can cut through so much of the nonsense breastfeeding
mothers are being told—like feed the baby twenty minutes on each side. A baby
who does this type of sucking (with the pauses) for twenty minutes straight
might not even take the second side. A baby who nibbles (doesn't drink) for 20
hours will come off the breast hungry.
2. Baby's bowel movements. For the first few days after delivery, the baby
passes meconium, a dark green, almost black, substance. Meconium accumulates in
the baby's gut during pregnancy. It is passed during the first few days, and by
the third day, the bowel movements start becoming lighter, as more breastmilk is
taken. Usually by the fifth day, the bowel movements have taken on the
appearance of the normal breastmilk stool. The normal breastmilk stool is pasty
to watery, mustard coloured, and usually has little odour. However, bowel
movements may vary considerably from this description. They may be green or
orange, may contain curds or mucus, or may resemble shaving cream in consistency
(from air bubbles). The variations in colour do not mean something is wrong. A
baby who is breastfeeding only, and is starting to have bowel movements that are
becoming lighter by day 3 of life, is doing well.
Without becoming obsessive about it, monitoring the frequency and quantity of
bowel motions is one of the best ways, next to observing the baby’s drinking, of
knowing if the baby is getting enough milk. After the first three to four days,
the baby should have increasing bowel movements so that by the end of the first
week he should be passing at least two to three substantial yellow stools each
day. In addition, many infants have a stained diaper with almost each feeding. A
baby who is still passing meconium on the fourth or fifth day of life, should be
seen at the clinic the same day. A baby who is passing only brown bowel
movements is probably not getting enough, but this is not very reliable.
Some breastfed babies, after the first three to four weeks of life, may
suddenly change their stool pattern from many each day, to one every three days
or even less. Some babies have gone as long as 15 days or more without a bowel
movement. As long as the baby is otherwise well, and the stool is the usual
pasty or soft, yellow movement, this is not constipation and is of no concern.
No treatment is necessary or desirable, because no treatment is necessary or
desirable for something that is normal.
Any baby between five and 21 days of age who does not pass at least one
substantial bowel movement within a 24 hour period should be seen at the
breastfeeding clinic the same day. Generally, small, infrequent bowel movements
during this time period mean insufficient intake. There are definitely some
exceptions and everything may be fine, but it is better to check.
3. Urination. With six soaking wet (not just wet) diapers in a 24 hours hour
period, after about 4-5 days of life, you can be reasonably sure that the baby
is getting a lot of milk (if he is breastfeeding only). Unfortunately, the new
super dry "disposable" diapers often do indeed feel dry even when full of urine,
but when soaked with urine they are heavy. It should be obvious that this
indication of milk intake does not apply if you are giving the baby extra water
(which, in any case, is unnecessary for breastfed babies, and if given by
bottle, may interfere with breastfeeding). The baby's urine should be almost
colourless after the first few days, though occasional darker urine is not of
During the first two to three days of life, some babies pass pink or red
urine. This is not a reason to panic and does not mean the baby is dehydrated.
No one knows what it means, or even if it is abnormal. It is undoubtedly
associated with the lesser intake of the breastfed baby compared with the bottle
fed baby during this time, but the bottle feeding baby is not the standard on
which to judge breastfeeding. However, the appearance of this colour urine
should result in attention to getting the baby well latched on and making sure
the baby is drinking at the breast. During the first few days of life, only if
the baby is well latched on can he get his mother's milk. Giving water by bottle
or cup or finger feeding at this point does not fix the problem. It only gets
the baby out of hospital with urine that is not red. Fixing the latch and using
compression will usually fix the problem. If relatching and breast compression
do not result in better intake, there are ways of giving extra fluid without
giving a bottle directly. Limiting the duration or frequency of feedings can
also contribute to decreased intake of milk.
The following are NOT good ways of judging
Your breasts do not feel full. After the first few days or weeks, it is usual
for most mothers not to feel full. Your body adjusts to your baby's
requirements. This change may occur quite suddenly. Some mothers breastfeeding
perfectly well never feel engorged or full.
The baby sleeps through the night. Not necessarily. A baby who is sleeping
through the night at 10 days of age, for example, may, in fact, not be getting
enough milk. A baby who is too sleepy and has to be awakened for feeds or who is
"too good" may not be getting enough milk. There are many exceptions, but get
The baby cries after feeding. Although the baby may cry after feeding because of
hunger, there are also many other reasons for crying. Do not limit feeding
times. “Finish” the first side before offering the other.
The baby feeds often and/or for a long time. For one mother feeding every
three hours or so may be often; for another, three hours or so may be a long
period between feeds. For one, a feeding that lasts for 30 minutes is a long
feeding; for another, it is a short one. There are no rules how often or for how
long a baby should nurse. It is not true that the baby gets 90% of the feed in
the first 10 minutes. Let the baby determine his own feeding schedule and things
usually come right, if the baby is suckling and drinking at the breast and
having at least two to three substantial yellow bowel movements each day.
Remember, a baby may be on the breast for two hours, but if he is actually
feeding or drinking (open wide—pause—close mouth type of sucking) for only two
minutes, he will come off the breast hungry. If the baby falls asleep quickly at
the breast, you can compress the breast to continue the flow of milk. Contact
the breastfeeding clinic with any concerns, but wait to start supplementing. If
supplementation is truly necessary, there are ways of supplementing which do not
use an artificial nipple.
"I can express only half an ounce of milk". This means nothing and should not
influence you. Therefore, you should not pump your breasts "just to know". Most
mothers have plenty of milk. The problem usually is that the baby is not getting
the milk that is available, either because he is latched on poorly, or the
suckle is ineffective or both. These problems can often be fixed easily.
The baby will take a bottle after feeding. This does not necessarily mean
that the baby is still hungry. This is not a good test, as bottles may interfere