How do I know if my baby is getting enough breast milk?

By Jane Barry, Philips Avent

It is impossible for breastfeeding mothers to know exactly how much breast milk their baby is getting with each feed. Instead of looking at the volume markers on feeding bottles, it’s necessary to look for other, more subtle signs that your baby is getting enough milk to grow and thrive.

This is not a difficult process, but takes just a little confidence and skill in learning what other signs to look for.

But I have to know!

If you are a person who likes to know precisely how much volume of breast milk your baby is drinking, then you may find the lack of clarity in breastfeeding to be difficult. But breastfeeding is so valuable and beneficial, that this issue is worth overcoming. Babies benefit from being exclusively breastfed for the first six months of life. After this time, they can be introduced to solid foods which supplement their breast milk intake. So in many ways, the sooner you can learn what to look for, the more relaxed you will be.

Breastfeeding is not an exact science. Other than the benefits which are very clear, there is enormous variation in the timing, spacing and amount of feeds each individual baby needs. We used to think that all babies should be fed every 3-4 hours until they were three months of age and by then their feeds could be extended and overnight feeds stopped. But the study and understanding of infant nutrition has grown so much that there have been many changes made to the recommendations around infant feeding guidelines.

But I don’t have enough breast milk!

One of the most common reasons for stopping breastfeeding is when mothers feel they don’t have enough breast milk. In reality, this isn’t always true. It can be hard not to interpret your baby’s cry as being due to hunger, but many times crying is due to tiredness, frustration, boredom, discomfort or simply overstimulation.

Reassuring signs that your breastfed baby is getting enough breast milk:

  • They are having at least six to eight very heavy wet nappies each day. Their urine (wee) is pale and not concentrated and/or smelly
  • Their poos are soft, yellow/mustard colour. Breastfed babies may not poo each day, especially once they are past two months of age. Breastfed babies who are getting enough breast milk do not become constipated
  • Your baby is bright, alert and responsive with moist lips and good skin tone
  • They are reaching their developmental milestones
  • They are having a steady weight gain when averaged out over a four week period. Breastfed babies tend to gain a lot of weight in the first few months and then their weight plateaus. They gain weight in a different pattern to bottle fed babies
  • Their muscles can be felt underneath their skin
  • They are reasonably content for some time in-between their feeds

What is an average weight gain for my breast fed baby?

  • From birth to 3 months: 150-200 grams per week
  • From 3 months to 6 months: 100-150 grams per week
  • From 6 months to 12 months: 70-90 grams per week

Remember: Weight gains can vary from week to week and it is recommended that weight gains are assessed over a four week period. It is the rate of growth which is the important issue, which is why percentile charts are so valuable. Check in your baby’s Personal Health Record Book (PHR) for either the Centre for Disease Control (CDC) or World Health Organisation (WHO) Growth charts.

Plot your baby’s weight, length and head circumference measurements on each allocated graph and compare your baby’s individual growth since their birth. If your baby crosses percentiles, either up or down, then further investigation of their growth may be necessary. Check with your Child Health Nurse, GP or paediatrician if you are concerned.

What contributes to low breast milk intake?

There are many factors which can lead to low breast milk supply and some of them are clearer than others:

  • Not feeding frequently enough
  • Incorrect attachment so the nipples and breasts are not being stimulated properly
  • Cigarette smoking, drinking alcohol or taking illicit drugs and substances
  • Maternal tiredness and time demands which limit a mother’s availability for breastfeeding
  • Bottle feeding with formula which then affects a baby’s eagerness to suck on the breast
  • Maternal illness
  • Use of nipple shields
  • Abnormal nipples – sometimes previous breast surgery such as reduction or augmentation has an effect on reducing supply
  • Poor maternal nutrition, though this is very uncommon in Australia.

What can I do if my breast milk supply is low?

  • Check your baby is growing well and showing signs of good health
  • Make sure that your baby is attaching properly to the nipple and breast 
  • Offer breastfeeds more frequently. This may be as often as 2.5 – 3 hourly
  • Offer both breasts and when your baby slows down their sucking, then “switch” them onto the other breast for more stimulation
  • If your baby is showing signs of hunger within 30 minutes of completing a breastfeed, then re-offer another breastfeed
  • Allow your baby to finish one breast first before offering the second side
  • Avoid using supplementary feeds. These can lead to a lack of interest and impact on effective breastfeeding
  • Express your breast milk after and in-between feeds. But try to avoid expressing within 2 hours of the next breastfeed. We've also provided some tips for expressing below
  • Make sure you are eating a healthy and well balanced diet
  • Drink plenty of water, enough to satisfy your thirst. For most lactating women this is around 2.5 – 3 litres a day
  • Avoid drinking too much caffeine such as tea, coffee, energy and cola drinks
  • Try to get as much rest as you can. An afternoon lie down can make an enormous difference to breast milk supply in the evenings, not to mention energy levels
  • Avoid exercising excessively or going on weight-loss/calorie restriction diets

Boosting breast milk supply. Tips for expressing: 

  • Learning the mechanics of expressing can take time and practice. Don’t be discouraged if you don’t get the hang of it the first few times you try
  • Unless you are stopping breastfeeds altogether, expressing should be done in combination with breastfeeding and not replace it
  • The amount of breast milk expressed is not an indicator of how much breast milk the baby gets when feeding. Expressing tends to collect less milk than the baby obtains when feeding
  • Express both breasts, even if you feel one is producing more milk than the other
  • If your breasts are very full and your baby is having trouble latching on, then you may want to express a little before feeding. Keep this expressed breast milk (EBM) for future feeds
  • Expressed breast milk can be stored in the refrigerator or freezer for limited periods of time
  • Some mothers prefer to hand express initially, until they have “let down” and then use a pump
  • Try using different styles of pumps until you find one which suits you. Manual, single eclectic, twin electric breast pumps all have similar features but vary in their practical applications
  • It is important to feel comfortable when expressing and for it to be a relief rather than cause pain
  • Look for a pump which mimics the baby’s sucking action (visiting the Expo is a great place to do your research!)
  • Whilst your baby is feeding on one breast, you could express the other. This is a useful technique for mothers who have trouble letting down during expression.

Where to go for help

  • Your Child Health Nurse or local Community Health Centre
  • A lactation consultant
  • Your General Practitioner
  • Your baby’s paediatrician
  • Your primary healthcare provider
  • Australian Breastfeeding Association
  • Mother’s groups, on-line support forums and Mouths of Mums

References:
NHMRC Eat for Health Infant Feeding Guidelines Information for Health Workers 2012

Note: The views and advice expressed on this blog post are those of the author and are not representative of the Pregnancy Babies & Children's Expo.

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