Breastfeeding: Is My Baby Getting Enough Milk?

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KEY POINTS

• There are signs to watch for and things you can do during your baby’s first month to make sure she gets enough breast milk.
• You should breastfeed your baby whenever she shows hunger cues, like waking from sleep, looking alert, bringing a hand to her mouth, turning her head, or moving her mouth or tongue.
• Keep track of your baby’s wet diapers and bowel movements. Ask your healthcare provider or lactation expert if you have questions.

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You cannot see exactly how much milk your baby takes while breastfeeding. However, you can tell whether breastfeeding is off to a good start if you know what to look for. Here are some signs to watch for and things you can do during your baby’s first month to make sure she gets enough breast milk.

• You should start producing a lot of milk 2 to 4 days after your baby is born. If your milk hasn’t come in by 4 days after birth, or your baby seems hungry after most feedings, tell your baby's healthcare provider.
• Your baby should latch on to your breast correctly and suck rhythmically for at least 10 to 15 minutes at each feeding.

  Your baby may pause at times while breastfeeding. However, she should breastfeed strongly during most of the feeding. You should hear your baby swallow regularly while breastfeeding.

  Keep your baby at the first breast until it is well drained. When your baby starts to suck less strongly, swallows less, or starts to doze off, you can burp her or change her diaper to wake her and move her to your other breast. Generally, babies get more milk by breastfeeding at both breasts. Since the first breast gets drained better, start each feeding on a different side. This way, both breasts will get about the same stimulation and draining.

• Your baby should breastfeed at least 8 times every 24 hours. Breastfeed your baby as often as she shows hunger cues, like waking from sleep, looking alert, bringing a hand to her mouth, turning her head, or moving her mouth or tongue. Crying is a late sign of hunger and your baby may not breastfeed well after crying too long. For the first few weeks, you can expect your baby to want to breastfeed about every 1 and 1/2 to 3 hours, with a single longer stretch (up to 5 hours) between feedings at night. Newborns who breastfeed fewer than 8 times in 24 hours or sleep through the night are not likely to get enough milk. At times, you may need to wake your baby to breastfeed. Some babies just don't demand to be fed as often as they should, especially in the first few weeks of life.
• Your baby should seem satisfied after breastfeeding and may fall asleep at the second breast. Breast-fed babies who still seem hungry after most feedings — who cry, chew their hands, or often need a pacifier after breastfeeding — may not be getting enough milk. Call your healthcare provider or lactation consultant to check your milk supply and your baby’s ability to breastfeed successfully (transfer milk).
• Your breasts should feel full before each feeding and softer after your baby has breast-fed. One breast may drip milk while your baby breastfeeds on the other side. When there is a longer stretch between feedings at night, your breasts should feel very full.
• Your baby should urinate 6 or more times a day once your milk has come in. The urine should be colorless, not yellow. After your baby is older than 3 days, her urine may look like brick-red dust on the diaper if she is not getting enough milk.
• Your baby's bowel movements should look like cottage cheese and mustard by the 4th or 5th day of life. Bowel movements that look like cottage cheese and mustard are called "milk stools." If your baby is still having dark green or brown stools by 5 days of age, talk with your healthcare provider or lactation consultant.
• Your baby should have 4 or more bowel movements each day. Many breast-fed babies have a bowel movement every time they breastfeed during their first 3 to 4 weeks of life
• Once your milk comes in, your breast-fed baby should gain weight quickly — at least 1 ounce a day for the first couple months of life. Have your baby weighed regularly. Weight gain is the best way to know your baby is breastfeeding well. If your baby is not gaining enough weight, your milk supply may be low or your baby may not be breastfeeding properly. These problems are easier to overcome if you recognize and treat them early. Your baby's healthcare provider can help develop a feeding plan for your baby or can refer you to a lactation consultant.
• By 2 or 3 weeks after delivery you may feel the milk ejection, or milk let-down, reflex. Breastfeeding causes the release of the hormone oxytocin. Oxytocin causes your uterus to cramp as it helps your uterus return to its normal size after delivery. Oxytocin also helps your breasts eject milk. The let-down reflex feels like tingling, “pins and needles,” or tightening in your breasts as milk begins to flow. When your milk let-down happens, your baby may start to gulp milk. Milk may drip or spray from the other breast. You may find that just hearing your baby cry causes your milk to let down, even before your baby starts breastfeeding.