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
lots of milk at the breast sucks in a very characteristic way. The
baby generally opens his mouth fairly wide as he sucks and the rhythm
is slow and steady. His lips are turned out. At the maximum opening
of his mouth, there is a perceptible pause which you can see if
you watch his chin. Then, the baby closes his mouth again. This
pause does not refer to the pause between suckles, but rather to
the pause during one suckle as the baby opens his mouth to its maximum.
Each one of these pauses corresponds to a mouthful of milk and the
longer the pause, the more milk the baby got. At times, the baby
can even be heard to be swallowing, and this is perhaps reassuring,
but the baby can be getting lots of milk without making noise. Usually,
the baby's suckle will change during the feeding, so that the above
type of suck will alternate with sucks that could be described as
"nibbling". This is normal. The baby who suckles as described above,
with several minutes of pausing type sucks at each feeding, and
then comes off the breast satisfied, is getting enough. The baby
who nibbles only, or has the drinking type of suckle for a short
period of time only, is probably not. This is the best way of knowing
the baby is getting enough. This type of suckling can be seen on
the very first day of life, though it is not as obvious as later
when the mother has lots more milk.
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.
Meconium is passed during the first few days, and by the 3rd 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 lotion in consistency (from air bubbles).
The variation in colour does not mean something is wrong. A baby
who is breastfeeding only, and is starting to have bowel movements
which are becoming lighter by day 3 of life, is doing well.
Without your becoming obsessive about it, monitoring the frequency
and quantity of bowel motions is one of the best ways of knowing
if the baby is getting enough milk. After the first 3-4 days, the
baby should have increasing bowel movements so that by the end of
the first week he should be passing at least 2-3 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 fifth day 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 yet definite.
Some breastfed babies, after the first 3-4 weeks of life, may suddenly
change their stool pattern from many each day, to one every 3 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 5 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 means insufficient
intake. There are definite 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 sure that the baby is getting a lot of milk. 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 clear as water after
the first few days, though an occasional darker urine is not of
During the first 2-3 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 measure 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
which is not red. If relatching and breast compression do not result
in better intake, there are ways of giving extra fluid without giving
a bottle directly (handout #5 Using a Lactation Aid). Limiting the
duration or frequency of feedings can also contribute to decreased
intake of milk.
The following are NOT good ways of judging
1. 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
2. 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 help quickly.
3. The baby cries after feeding. Although the baby may cry
after feeding because of hunger, there are also many other reasons
for crying. See also handout #2 Colic in the Breastfeeding Baby.
Do not limit feeding times.
4. The baby feeds often and/or for a long time. For one
mother every 3 hours or so feedings may be often; for another, 3
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 2-3 substantial yellow bowel movements
each day. If that is the case, feeding on one breast each feeding
(or at least finishing on one breast before switching over) will
often lengthen the time between feedings. Remember, a baby may be
on the breast for 2 hours, but if he is actually breastfeeding (open—pause—close
type of sucking) for only 2 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 (handout #15 Breast
Compression). 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
(handout #5 Using a Lactation Aid).
5. "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 there, either because he is latched on poorly, or the suckle
is ineffective or both. These problems can often be fixed easily.
6. 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 with breastfeeding.
7. The 5 week old is suddenly pulling away from the breast
but still seems hungry. This does not mean your milk has "dried
up" or decreased. During the first few weeks of life, babies often
fall asleep at the breast when the flow of milk slows down even
if they have not had their fill. When they are older (4-6 weeks
of age), they no longer are content to fall asleep, but rather start
to pull away or get upset. The milk supply has not changed; the
baby has. Compress the breast (handout #15 Breast Compression) to
Please Note: On occasion, it may be necessary to
supplement a baby who is breastfeeding. If this is done by bottle,
a bad situation may become worse. A lactation aid is a method of
supplementing without giving a bottle and may allow you to supplement
temporarily and get back to exclusive breastfeeding. It is generally
easy to use. In an "emergency" situation, extra fluid can be given
by spoon, cup or eyedropper until a lactation
aid can be started.
Handout #4. Is My Baby Getting Enough? Revised
Written by Jack Newman, MD, FRCPC
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Is My Baby Getting Enough