Is My Baby Getting Enough Milk?
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. And this is a good thing!! We are not supposed to know how
much the baby is getting but rather is baby getting enough. 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. In the short term, there are ways to
know if baby is satisfied by looking at how well the baby feeds, and
even just looking at the baby after a feeding – is the baby content,
satisfied, is he rooting or sucking his hand?
Ways of Knowing
The following are NOT good ways of judging
Baby's breastfeeding is characteristic. A baby who is obtaining
good amounts of milk at the breast sucks in a very characteristic way.
When a baby is getting milk (he is not getting milk just because
he has the breast in his mouth and is making sucking movements), you
will see a pause at the point of his chin after he opens to the maximum
and before he closes his mouth, so that one suck is (open mouth wide
> pause > close mouth type of sucking). If you wish to
demonstrate this to yourself, put your index or other finger in your
mouth and suck as if you were sucking on a straw. As you draw in, your
chin drops and stays down as long as you are drawing in. When you stop
drawing in, your chin comes back up. This same pause that is visible at
the baby's chin represents a mouthful of milk when the baby does it at
the breast. The longer the pause, the more
the baby got. Once you can recognize this pause you will realize that
so much of what women are told about timing the baby on the breast is
meaningless. For example, it is meaningless to suggest to mothers to
feed the baby twenty minutes on each side. Twenty minutes of what?
Sucking without drinking? Sucking and drinking (some pausing in the
movement of the chin)? All long pause-types of sucks? A baby who does
this type of sucking (with the pauses) for twenty minutes straight might
not even take the second side. A baby who nibbles (doesn't drink) for
20 hours will come off the breast hungry. Our website nbci.ca shows
video clips of drinking at the breast. If the baby comes off the breast
while doing this kind of drinking with long pauses, then baby is
probably saying, I have had enough. If baby is continually just sucking
without drinking (therefore little or no pausing) baby will still be
hungry. Play detective, what is baby’s chin doing as he seems to
“finish”? If the milk is flowing well the baby can either choose to
drink it or take a little break (in fact the baby does not need to suck
continuously and most babies do not). If the milk is not flowing well,
then baby will be ‘forced’ to just suck without drinking. If this is the
case, use compression to help more milk to flow (see information sheet Breast Compression).
Baby's bowel movements (stools, poops). For the first few days
after birth, the baby passes meconium, a dark green, almost black,
substance which has collected in his intestines during pregnancy. It is
passed during the first few days, and by the third day, the bowel
movements start becoming lighter, as the baby drinks more milk. Usually
by the fourth 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
cream in consistency (full of air bubbles). The variations in colour do
not mean something is wrong. A baby who is getting only breastmilk,
and is starting to have bowel movements that are becoming lighter by day
3 of life, is doing well.
Without becoming obsessive about it, monitoring the frequency and
quantity of bowel movements is one of the best ways, next to observing
the baby’s drinking (see above, and videos at nbci.ca to see if the baby
is getting enough milk). After the first three to four days, the baby
should have increasing bowel movements so that by the end of the first
week he should be passing at least two to three 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 fourth or fifth day
of life 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 a very reliable sign.
Some breastfed babies, after the first three to four weeks of life, may
suddenly change their stool pattern from many each day, to one every
three days or even less. Some babies have gone as long as 20 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 five 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 if possible, but certainly within a
couple of days. If this same baby is soaking at least 6 heavy wet
diapers (see #3, Urination), then baby is most likely fine and getting
enough. Generally, and only as a general rule, small, infrequent bowel
movements during this time period mean insufficient intake. There are
definitely some exceptions and everything may be fine, but it is better
Urination (pees). If, after about 4 or 5 days of age, the baby is soaking six
diapers in a 24 hour period, (the diapers should be soaking, not just
damp or just wet) you can be reasonably sure that the baby is getting a
lot of milk (if he is breastfeeding only). 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 almost colourless after the first few days,
though occasional darker urine is not of concern.
During the first two to three 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 judge
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 (see the video clips at nbci.ca to
see babies breastfeeding well or not). 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 that
is not red. Fixing the latch and using compression will usually fix the
problem (See information sheet Protocol to Increase Breastmilk Intake).
If fixing the latch and breast compression do not result in better
intake, there are ways of giving extra fluid without giving a bottle
directly (see the information sheet Lactation Aid). Limiting the duration or frequency of feedings can also contribute to decreased intake of milk.
Notes on scales and weights
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 who are breastfeeding perfectly well never feel engorged or
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 woken for feeds or who is "too good" may not be getting enough milk.
There are many exceptions, but get help quickly.
The baby cries after feeding. Although babies sometimes cry
after feedings because of hunger, there are also other reasons for
crying. See also the information sheet Colic in the Breastfeeding Baby.
Do not limit feeding times. “Finish” the first side before offering
the other. Remember, play detective and watch baby’s chin—this will tell
you if baby has been actually feeding or just going through the
The baby feeds often and/or for a long time. For one mother
feeding every three hours or so may be often; for another, three 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 breastfeed.
It is not true that the baby gets 90% of the feed in the first 10
minutes. Let the baby determine when he is ready for feeding and things
usually come right, if the baby is sucking and drinking at
the breast and having at least two to three substantial yellow bowel
movements each day. Remember, a baby may be on the breast for two hours,
but if he is actually feeding or drinking (open wide > pause >
close mouth type of sucking) for only two minutes, he will likely 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 (see the information sheet 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 (see the
information sheet Lactation Aid).
"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 available, and
this is usually because he is latched on poorly, and/or the milk is not
flowing well. Breast Compressions might need to be used (information
sheet Breast Compressions). These problems can often be fixed easily.
The baby will take a bottle after feeding. This does not
necessarily mean that the baby is still hungry, and using this ‘test’ is
not a good idea, as bottles may interfere with breastfeeding. Babies
will often take more liquid from a bottle even if they are already full.
The five 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 (four to six weeks of age), they may no longer fall
asleep but rather start to pull away or get upset. The milk supply has
not changed; the baby has changed. Get the best latch possible and use
compression to help you increase flow to the baby (see information
sheets When Latching and Breast Compression and watch the video clips at nbci.ca.
Scales are all different. We have documented significant differences
from one scale to another. Weights have often been written down wrong.
A soaked cloth diaper may weigh 250 grams (half a pound) or more, so
babies should be weighed naked.
Many rules about weight gain are taken from observations of growth of
formula feeding babies. They do not necessarily apply to breastfeeding
babies. A slow start may be compensated for later by fixing the
breastfeeding. Growth charts are guidelines only.
Questions? First look at the website nbci.ca or drjacknewman.com. If the information you need is not there, go to Contact Us and give us the information listed there in your email. Information is also available in Dr. Jack Newman’s Guide to Breastfeeding (called The Ultimate Breastfeeding Book of Answers in the USA); and/or our DVD, Dr. Jack Newman’s Visual Guide to Breastfeeding (available in French or with subtitles in Spanish, Portuguese and Italian); and/or The Latch Book and Other Keys to Breastfeeding Success; and/or L-eat Latch and Transfer Tool; and/or the GamePlan for Protecting and Supporting Breastfeeding in the First 24 Hours of Life and Beyond.
To make an appointment online with our clinic please visit www.nbci.ca. If you do not have easy access to email or internet, you may phone (416) 498-0002.
Is My Baby Getting Enough? May 2008
Written and Revised by Jack Newman, MD, FRCPC 1995-2005
Revised by Edith Kernerman, IBCLC, and Jack Newman, MD, FRCPC © 2009