Pinky McKay IBCLC
If you feel anxious about how much milk your breastfed baby is getting, you aren’t alone. One of the most commonly reported reasons for women stopping breastfeeding low milk supply.
While it’s an absolutely primal response to worry that your baby is getting enough milk – after all there are no markers on your breasts telling you ‘full’ or ‘empty’ – there are some reliable signs that your baby is getting enough milk. So, instead of worrying or allowing undermining comments about your milk supply create self-doubt, here is a checklist to help you believe in your boobs:
You can hear your baby swallowing
At first your newborn may take 5 to 10 sucks before swallowing, this is because colostrum, the first ‘milk’ is thick and comes in small amounts. This means your baby has to work hard to extract it from your breasts. However, once your milk ‘comes in’, usually somewhere between the second and sixth day, your baby’s sucking will stimulate your ‘letdown reflex’ and he will swallow or gulp quickly to manage this initial fast milk flow. Then as the feed progresses, he will settle into a slower deep sucking action with more regular swallows.
You should hear your baby swallowing every suck or two (‘suck swallow’ or ‘suck, suck swallow’). If your baby is sucking many times before swallowing and/or making clicking noises as he sucks, get a lactation consultant to observe a feed and check your baby’s latch and oral function.
Watch your baby’s chin and ears
One way to see your baby is feeding effectively and taking in good mouthfuls of milk is his sucking action. During active sucking, you will be able to see your baby’s muscles in front of his ears wiggling – this indicates a strong efficient suck that uses the entire lower jaw.
Now, think about how you suck from a straw: as you suck in a mouthful, your chin drops down, as long as you are ingesting fluid. Similarly, as your baby sucks at the breast, it will look as though he is pausing (with his chin down) between ‘chomps’, as he sucks in milk. The longer this pause, the bigger the mouthful he will be getting and the more milk he will be drinking. A baby who is sucking effectively (as opposed to ‘nibbling’) may finish a feed quite quickly, so be guided by your baby’s sucking and swallowing, rather than by how long he feeds at the breast.
Watch your baby’s hands
As your hungry little baby starts to feed, his hands will usually be clenched tightly but as the feed progresses and he becomes satiated, his hands will gradually relax and open.
Your baby is alert and contented
If your baby is generally happy and alert, with bright, moist eyes and clear skin that fits well, there is usually no need to worry about how much milk he is getting. If he comes off the breast, looking ‘milk drunk’ with milk dribbling from his mouth, this is a good sign he is drinking all he needs.
However, if your baby is lethargic and sleepy at the breast, if he is crying and unsettled (there can be various reasons for this, not just hunger) or if he is feeding constantly (it is normal for babies to cluster feed, especially in the evenings but this won’t be constant around the clock), please get your baby checked by a health professional.
Check the nappies
A good sign that your baby is getting enough milk is his nappy out put – what comes out must have gone in!
Wees: you can expect your newborn to have at least one wet nappy on day one, two wet nappies on day two, three wet nappies on day three, up to five wet nappies on day five. After this, if your baby is having nothing but breast milk, he should be having at least six very wet cloth nappies or five heavy, wet disposable nappies every day.
If your baby is peeing only scarce amounts of concentrated urine, this means you will need to feed more often and you should check with your child health nurse or family doctor and call in a breastfeeding expert such as an IBCLC lactation Consultant to observe and help with your baby’s feeding.
Poos: your breastfed baby’s bowel motions are also an important indicator that he is getting enough milk. At first your new-born will pass thick, black, sticky meconium, that is present in your baby’s gut before he is born. Although your breasts will produce small amounts of colostrum at first, as you milk ‘comes in’ this meconium will be passed, and your baby’s bowel motions will transition from black to ‘greenish brown’ and then to mustard yellow in colour by day 4 or sooner.
For the first six weeks, your baby should do at least 2 soft or runny yellow bowel motions the size of the palm of his hand each day. After this, babies may continue to do frequent bowel motions, or they may space these out for several days. As long as your baby is otherwise thriving and their poo is soft and yellow, you don’t need to worry. If your baby does formed stools or is uncomfortable, please consult your health carer. If you are also giving formula, this will affect the colour, formation and smell of your baby’s bowel motions.
Just like adults, babies’ weight and growth will vary along a spectrum. Usually babies’ growth will be plotted along a percentile chart. Remember, there have to be babies along this entire range: A higher percentile is simply a reflection of your baby’s size in comparison to other babies the same age, not a reflection of you as a mother and how well you are feeding your baby. For instance, a baby who is on the 50th percentile just means that 50% of babies will be above this percentile and 50% of babies will be below.
You only need to be concerned if your baby is slipping down several percentiles if his weight gain is very slow. Even then, sometimes a larger baby at birth may gain weight more slowly and a baby who is lighter at birth may grow more quickly. Weight at birth is more related to conditions in utero where growth after birth is genetically influenced. Babies can also have growth spurts and weight gains tend to slow as your baby becomes mobile and more active.
Weight loss at birth: According to The Australian Breastfeeding Association, your baby may lose 5 to 10% of his birth weight in the first week but should regain this by 2 to 3 weeks. Some of this very early weight loss can be due to IV fluids during labour that have passed through to your baby so are not necessarily an indicator of your milk supply, but a loss of more than 10% may be cause for concern.
Recommended weight gains: Australia’s National Health and Medical Research Council recommends weight gains of 150 grams a week from birth to three months; 100 to 150 grams a week between three and six months; and 70 to 90 grams a week from six to twelve months. Rather than worrying about weight gains each week (whether you are weighing your baby weekly or not) it is helpful to consider your baby’s weight over a month as weight gains can be influenced by your baby’s health and development and also whether your baby had had a bowel motion or a feed right before being weighed.
If you are concerned about your baby’s size, whether your baby is large or small, it would be helpful to check out the World Health Organisation Growth standards as these are based on breastfed babies as the ‘norm’. Also, it is worth considering whether your baby’s growth could be influenced by genetics – asking your own mum and your mother-in-law for your and your partner’s baby books could provide reassurance that your child is simply following a family pattern.
Pinky McKay is an Internationally Certified Lactation Consultant (IBCLC) and best-selling author of Sleeping Like a Baby and Parenting by Heart. She is also the creator of Boobie Bikkies and Boobie Brekkie, all natural and organic foods to nourish breast-feeding mothers and support a healthy milk supply. Download Pinky’s free ebook ‘Making More Mummy Milk, Naturally’
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