Breastfeeding: How Do You Know Your Baby Is Getting Enough Milk?

Check the way your baby sucks

Your baby's mouth should be open wide and his lips turned out while sucking at your breast. Your baby has short, rapid sucks for 1 to 2 minutes at the beginning of the feeding until the breast milk starts to flow.

Sucking slows as the baby starts to drink. You should hear your baby swallow. It sounds like a "kaa" sound. As baby drinks, the mouth opens very wide, there is a pause, and then the mouth closes. If your baby has this open- pause- close type of sucking for most of the feeding, your baby is getting enough breast milk.

It is normal for your baby to have many sucks and swallows, then have a short rest before sucking and swallowing again. Check with a breastfeeding specialist if your baby does not have this open- pause- close type of sucking.

What successful breastfeeding looks like

  1. He opens his mouth.
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  1. He pauses when his mouth is open wide.
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  1. He closes his mouth.
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Check with your baby's doctor if:
  • You do not hear your baby swallow.
  • You do not see the open–pause–close kind of suck.
  • Your baby goes to sleep after sucking for a few minutes only.
  • Your baby seems to be hungry all the time.

Check your baby's bowel movements (poo)

Colour

The colour of your baby's bowel movements in the first week tells you if your baby gets enough colostrum (first breast milk).

  • In the first 2 days, your baby passes dark, greenish-black, sticky bowel movements called meconium. Breastfeed every time your baby shows interest in feeding. Colostrum helps the baby get rid of meconium.
  • By day 3, as baby gets more colostrum, the bowel movements become lighter and a greenish-brown colour.
  • By day 4 and 5, the bowel movements become yellow as your supply of breast milk increases.
  • Bowel movements for a baby getting only breast milk are yellow and may be seedy, pasty or runny.

Number and size of bowel movements

Your baby usually has 1 or 2 bowel movements in the first 2 days.

After the first 2 or 3 days until 4 weeks, your baby should have a minimum of 2 bowel movements in 24 hours. If your baby has a minimum of 2 bowel movements in 24 hours, they should each be about 2 tablespoons in size. Many breastfed babies have a bowel movement with every feeding.

After the first 4 weeks of your baby's life, the pattern of bowel movements may change to 1 bowel movement every 1 to 10 days. If your baby's stomach is soft, your baby is content, breastfeeding well, and having 6 to 8 heavy wet diapers every 24 hours, this small number of bowel movements is normal.

Number and colour of bowel movements per day by age

Age Colour of bowel movements Number of bowel movements per 24 hours

Day 1 and 2

Greenish-black and sticky

1 to 2

Day 3 and 4

Greenish-brown

minimum 2

Day 5

Becoming yellow

minimum 2

Day 6 to 4 weeks

Yellow and may be seedy

minimum 2, may be every feed

 
Check with your baby's doctor if:
  • Your baby is still having dark, greenish-black, sticky bowel movements on day 5.
  • Your baby has less than 2 bowel movements in 24 hours up to 4 weeks.
  • After 4 weeks, your baby is not having a bowel movement and seems uncomfortable or is having less than 6 to 8 heavy wet diapers in 24 hours.

Check your baby's urine (pee)

Colour

When your baby is drinking enough breast milk, urine should be a clear pale yellow colour and not smell. Pull the plastic backing off a disposable diaper to check the colour of the urine. This will help you make sure baby is taking enough breast milk. Urine should not be a dark yellow colour. Babies sometimes have pink spots in the urine in the first few days.

Feed your baby more often if there are pink spots in the urine or the urine is dark yellow in colour. Try feeding your baby every 2 hours. Ask your doctor to check your baby.

Amount and number of wet diapers

For the first 6 days, your baby should have as many wet diapers as she is days old.

Baby's age in days Minimum number of wet diapers in 24 hours

1

1

2

2

3

3

4

4

5

5

6 and older

6 to 8

The diaper should get heavier with urine every day, especially after the third day as your supply of breast milk increases. Once your baby is a week old, your baby should have 6 to 8 soaked diapers in 24 hours. A wet diaper should feel the same as 2 tablespoons (30 cc) to 4 tablespoons (60 cc) of water on a dry diaper.

Check with your baby's doctor if:
  • Your baby has less than one wet diaper per day of life in the first week (for example, less than 2 on day 2, 3 on day 3) or 6 to 8 soaked diapers in 24 hours after the first week.
  • Your baby has dark yellow urine.
  • Your baby has pink spots in the urine and the urine is dark yellow in colour and decreased in amount.

Check your baby's gain in weight and height

Your baby's doctor should check your baby's weight and height carefully to make sure your baby is growing well. Have your baby's doctor check your baby's weight 2 days after you leave the hospital and again in the first week until the baby starts to gain weight. Visit your doctor at least once a week until your baby is gaining enough weight.

Your doctor will want to see your baby throughout the first year for immunizations and routine check-ups. Ask your doctor to show you your baby's growth chart.

Check your baby's sleep and waking patterns

In the first month, your baby should wake to feed 8 to 12 times in 24 hours, or every 1 1/2 to 3 hours. It is normal to have one longer period of continuous sleep of 5 hours in a 24-hour period. Breast milk digests more easily and quickly than formula, so your baby may get hungry faster.

Your baby feeds for about 15 to 45 minutes. Feedings will gradually decrease to 6 to 8 times in 24 hours as your baby gets older.

Check how your baby appears

A baby who is breastfeeding well has a strong cry, has alert and content periods, and baby's mouth appears wet.

Check with your baby's doctor if:
  • Your baby seems very fussy.
  • Your baby appears weak.
  • Your baby has a weak cry.
  • Your baby's mouth appears dry.
  • Your baby needs to be wakened to feed.

Arrange to see a breastfeeding specialist as soon as possible.

It is important to maintain your milk supply if your baby is not breastfeeding well. This is called expressing or pumping milk.

For more information, please see "Expressing Breast Milk for Your Hospitalized Baby."

These are signs you should NOT use to assess if your baby is getting enough breast milk

  • Your breasts start to feel softer again: Most mothers say their breasts feel full, tender, and swollen by the third or fourth day of their babies' lives. After a couple of days your breasts will feel more comfortable, but will still feel full before your baby feeds. This feeling of fullness also lessens as the weeks go by, except when you miss a feed. This change in feeling does not mean that you are producing less milk.
  • Your baby starts to breastfeed more often than before: When your baby grows quickly (called growth spurts), he or she will want to feed more often to increase your milk supply. Feeding more often does not mean that you are running out of milk. This increased feeding usually lasts 2 or 3 days. This means your milk supply is increasing to meet your baby's needs. Babies often have growth spurts at 2 to 3 weeks, at 6 weeks, and at 2 to 3 months.
  • You can only take (express) a small amount of milk from your breast with your hand or a breast pump: Babies who breastfeed well are a lot better at getting milk from your breast than a breast pump. Many mothers who cannot express large amounts of breast milk have healthy growing babies.
  • Your baby cluster feeds, meaning your baby feeds every hour for 3 to 4 hours then sleeps for a longer period: Babies often feed like this in the late afternoon and evening to prepare to sleep through the night.
  • Your breasts leak little or no milk: This is normal for many women.
  • Your baby is fussy but has been gaining weight well.

Key points

  • There are 3 ways you can tell whether your baby is getting enough breast milk: how your baby sucks at the breast; the number, amount and colour of wet diapers and bowel movements your baby has in 24 hours; and by your baby gaining weight.
  • Your baby's feeding and sleeping patterns may also give clues as to whether baby is getting enough milk at the breast.
  • Do not use the way your breasts feel or how much breast milk you can express to tell if your baby is getting enough milk.
  • If you think your baby is not getting enough milk, ask your doctor to check your baby.

Debbie Stone, RN, IBCLC, RLC

Joyce Touw, BScN, PNC(C), RN, IBCLC, RLC

11/6/2009

At SickKids:

If you are concerned that your breastfeeding baby is not getting enough breast milk, a lactation consultant can see you and your baby. Please call the Breastfeeding Program at 416-813-5757 and press 2.

 




Notes: