Clinical Reference Systems: Pediatric Advisor 10.0
How Do I Know My Baby Is Getting Enough Milk?
You can't see exactly how much milk your baby takes while
nursing. However, you can tell whether breast-feeding is
off to a good start if you know what to look for. The
following patterns are typical of well-nourished, breast-fed
babies during the first month of life.
- You start producing milk abundantly 2 to 4 days after
your baby is born.
If your baby seems hungry after most nursings or you do
not think your milk has come in by 5 days after
delivery, tell your baby's doctor and have your baby
- Your baby latches on to your breast correctly and sucks
rhythmically for at least 10 minutes at each breast.
Your baby may pause sometimes while breast-feeding.
However, he should nurse vigorously during most of the
feeding. You should hear your baby swallow regularly
A baby usually gets more milk by nursing at both breasts
than by nursing from one side only. If your baby
usually falls asleep and will not feed at the second
breast, it is best to divide the time the baby does
nurse between the two breasts. For example, a sleepy
baby usually will obtain more milk by nursing 5 minutes
at each breast than 10 minutes at one breast. Start
each feeding on a different side so both breasts get the
same stimulation and emptying.
- Your newborn nurses at least eight times every
Nurse your baby every 1 and 1/2 to 3 hours, with
possibly a single longer stretch (up to 5 hours) between
feedings at night. Time the feedings from the beginning
of one nursing to the beginning of the next. Very few
breast-fed babies gain enough weight if they are nursed
every 4 hours (that is, only six times every 24 hours).
Sometimes you may need to awaken your baby to nurse.
Some babies just don't demand to feed as often as they
- Your baby appears satisfied after nursings and may fall
asleep at the second breast.
Breast-fed infants who appear hungry after most feedings
-- who cry, chew their hands, or often need a pacifier
after nursing -- may not be getting enough milk.
- Your breasts feel full before each feeding and softer
after your baby has nursed.
One breast may drip milk while your baby nurses on the
other side. After the longest time between feedings at
night, your breasts should feel particularly full.
- Your baby urinates six or more times a day once your
milk has come in.
The urine should be colorless, not yellow. If it looks
like the diaper has reddish brick dust on it, your
baby's urine probably is too concentrated and your
infant may not be getting enough milk.
- Your baby's bowel movements 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 meconium or green or brown stools by 5 days
of age, your baby probably is not getting enough milk.
- Your baby has four or more good-sized bowel movements
Many breast-fed babies have a bowel movement every time
they nurse during their first 3 to 4 weeks of life. If
your newborn is having fewer than four bowel movements
each day, your baby may not be getting enough milk.
- Your nipples may be a little tender for the first
several days of nursing, especially at the beginning of
feedings. The discomfort should be nearly gone by the
end of the first week of breast-feeding.
Nipple pain that is severe, lasts throughout a feeding,
or continues more than 1 week after birth probably means
your baby is nursing incorrectly. If your baby doesn't
latch on properly to nurse, your infant may not be
getting enough milk. If you do have very sore nipples,
ask your infant's doctor to check your baby's weight and
to refer you to a breast-feeding specialist who can look
at how your baby is nursing.
- Two or three weeks after delivery you may notice the
sensations associated with the milk ejection, or milk
Breast-feeding causes the release of the hormone
oxytocin. This hormone causes the uterus to cramp.
These "after-pains" with breast-feeding are more
noticeable than any early breast sensations. They
usually go away 7 to 10 days after the birth of your
The sensations of the milk ejection reflex are a
tingling, pins-and-needles, or tightening feeling in
your breasts as milk begins to flow. When your milk
let-down occurs, 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 nursing. If you
don't notice any signs of milk let-down, your milk
supply may be low. (A few women breast-feed
successfully without noticing sensations of the milk
- Once your milk comes in, your breast-fed baby gains
about 1 ounce each day for the first couple months of
The only way to be absolutely certain that your baby is
getting enough milk is to have your baby weighed
regularly. If your baby is not gaining enough weight,
your milk supply may be low or your baby may not be
nursing effectively. Such breast-feeding difficulties
are easier to overcome if you recognize and treat them
early. Your baby's doctor can help develop a feeding
plan tailored for you and your baby or can refer you to
a breast-feeding specialist.
Written by Marianne Neifert, M.D., and the clinical staff of
The HealthONE Lactation Program, Rose Medical Center,
Denver, CO. (303) 320-7081.
Copyright 1999 Clinical Reference Systems