Is my breastfed baby getting enough milk?
Breastfeeding is a skill that mother and baby learn together, like any skill it takes practice over time to become better and for you to feel confident. Exclusive breastfeeding (or breast milk) is recommended for the first 6 months of your baby’s life (1). Breastfed babies will stop drinking when they’ve had enough milk and will show you they are hungry again by demonstrating feeding cues. Milk production is a supply and demand process, in the first few days you will have colostrum and your milk will typically come in between days 2 and 6. It takes at least 2 weeks for milk production to become established and consistent (2) therefore introducing formula milk by bottle during this time will reduce the amount of breast milk you produce.
In the first few weeks of life the number of breastfeeds and the duration of each feed vary widely from mother to mother. Reassuring signs that your baby is feeding enough include 8 to 12 (or more) effective feeds a day, profuse loose yellow stools after Day 4 and comfortable maternal breasts (3).
Skin to skin contact beginning immediately after birth and continuing for many hours each day is the most effective and evidence-based strategy to promote the mother-baby relationship, support typical lactogenesis, avoid breast and nipple pain, promote milk production, ensure adequate nutrition, hydration and comfort for the new-born and enhance the Mother’s confidence and ability to breastfeed and care for her baby (4).
Signs your baby is feeding well
It’s normal for babies to lose some of their birth weight in the first 2 weeks of life, 5-7% is considered normal however if baby loses 10% or more, this is an indicator they aren’t getting enough milk. For most babies their birth weight returns by 3 weeks old and after this time your baby should be gaining weight steadily (5).
In the early weeks the breastfed baby has a biological need to feed approximately hourly and takes small amounts per feed.
Baby feeds 8 to 12 times in 24 hours including 2 to 3 night feeds. It is important to feed at least once overnight as levels of the hormone prolactin (which drives milk production) are higher between 2-6am (6).
Baby is awake for up to 10 hours a day and appears healthy and alert during this time.
Baby actively roots towards and latches onto the breast then initiates rhythmic sucks and swallows with occasional pauses. With effective milk transfer over time you will become more familiar with baby’s swallow sound.
Your baby appears calm and relaxed during feeds.
Baby is well latched to the breast with a wide mouthful of breast, chin touching your breast, their nose is not usually squashed against your breast and there is no pain on sucking.
Baby comes off the breast on their own at the end of feeds appearing content and satisfied.
Your breasts feel softer in the first few weeks after feeds, nipples should look more or less the same after feeds, not pinched, flattened or white.
Baby’s mouth should look hydrated and moist.
The best way you can tell whether your baby is getting enough milk is to look at their nappies. The photo below shows a minimum expected wet and dirty nappies (7).
What can affect your milk supply?
Poor positioning and attachment
Not recognising baby’s feeding cues and attempts at early communication to show you that they are hungry
Not feeding your baby frequently enough
Separation from your baby after the birth e.g. due to medical complications, premature birth etc.
A history of maternal breast surgery
Damaged nipples or pain during feeds
Offering your baby formula milk before breastfeeding is well-established
Some medications (see breastfeedingnetwork.org.uk for more information)
Stress, anxiety or depression
Facial anomalies such as tongue tie or cleft lip or palate (8)
Birth practices including induction of labour and medications administered to the mother during labour:
Epidural anaesthesia or analgesia, especially with fentanyl (9)
Instrument delivery (10)
Caesarean surgical birth (11)
Induction of labour, especially before 39 weeks gestation (12)
When to seek support from a lactation consultant
Babies are born with the inherent ability to move towards the mother’s breast, latch on and begin effectively feeding within about an hour after birth (13). Many factors can impact breastfeeding including maternal factors and the infant’s ability to latch and feed comfortably. There are support options online (NCT, the breastfeeding network, and your midwife or health visitor can also direct you to local breastfeeding support groups.
Lactation Consultants have the knowledge and skills to assess, identify and support conditions that can compromise your baby’s ability to latch on the breast and successfully feed. If you’re worried that your baby isn’t getting enough milk, you’re experiencing pain during feeds or your nipples are sore/misshaped at the end of breastfeeding you can reach out to a Lactation Consultant for specialist support.
At Baby Speak we offer bespoke IBCLC Lactation Consultant appointments for you and your baby. See our bookings page here.
References
Breastfeeding (2024) World Health Organization. Available at: https://www.who.int/health-topics/breastfeeding (Accessed: 23 January 2024).
Children’s Health Queensland (2023) Increasing breast milk supply if your baby is not breastfeeding, Children’s Health Queensland. Available at: https://www.childrens.health.qld.gov.au/health-a-to-z/breastfeeding/increasing-breast-milk-supply/increasing-breast-milk-supply-if-your-baby-is-not-breastfeeding (Accessed: 23 January 2024).
Wambach, K. and Spencer, B. (2021) Breastfeeding and human lactation. Burlington, MA: Jones et Bartlett Learning.
Vehling, L. et al. (2018) ‘Exclusive breastfeeding in hospital predicts longer breastfeeding duration in Canada: Implications for health equity’, Birth, 45(4), pp.440–449. doi:10.1111/birt.12345.
NCT (National Childbirth Trust) (2022) Is my baby getting enough milk from breastfeeding or formula?: Baby & Toddler, feeding articles & support: NCT, NCT (National Childbirth Trust). Available at: https://www.nct.org.uk/baby-toddler/feeding/early-days/my-baby-getting-enough-milk-breastfeeding-or-formula (Accessed: 23 January 2024).
Establishing and increasing your milk supply (2023) The Breastfeeding Network. Available at: https://www.breastfeedingnetwork.org.uk/breastfeeding-information/getting-started-with-breastfeeding/establishing-and-optimising-milk-supply/ (Accessed: 23 January 2024).
Children’s Health Queensland (2023) Increasing breast milk supply if your baby is not breastfeeding, Children’s Health Queensland. Available at: https://www.childrens.health.qld.gov.au/health-a-to-z/breastfeeding/increasing-breast-milk-supply/increasing-breast-milk-supply-if-your-baby-is-not-breastfeeding (Accessed: 23 January 2024).
Genna, C.W. (2023) Supporting sucking skills in breastfeeding infants. Burlington: Jones and Bartlett Learning.
Beilin, Y., Weiser, J. and Bodian, C. et al. (2006) ‘Effect of labor epidural analgesia with and without fentanyl on infant breast-feeding: A prospective, randomized, double-blind study’, Obstetric Anesthesia Digest, 26(3), pp. 104–106. doi:10.1097/00132582-200609000-00002.
Baumgarder, D.J. et al. (2003) ‘Effect of labor epidural anesthesia on breast-feeding of healthy full-term newborns delivered vaginally’, Obstetrical & Gynecological Survey, 58(8), pp. 518–520. doi:10.1097/01.ogx.0000079641.29108.5f.
Karlström, A. et al. (2007) ‘Postoperative pain after cesarean birth affects breastfeeding and infant care’, Journal of Obstetric, Gynecologic & Neonatal Nursing, 36(5), pp. 430–440. doi:10.1111/j.1552-6909.2007.00160.x.
American Congress of Obstetricians and Gynecologists (ACOG). Committee Opinion No. 579: definition of term pregnancy. Obstet Gynecol. 2013;122(5):1139-1140.
Widström, A. et al. (2010) ‘Newborn behaviour to locate the breast when skin‐to‐skin: A possible method for enabling early self‐regulation’, Acta Paediatrica, 100(1), pp. 79–85. doi:10.1111/j.1651-2227.2010.01983.x.
