How do I know if my baby is getting enough breast milk?

This is the number one question I field every day. We can't measure what comes out of our breasts. We can't feel how much is going into our babies during a feeding. Our breasts go through so many changes and one's breasts can feel full, filling, engorged and soft. In all these cases, your baby can be taking in plenty of milk. So how is a new parent to know if the baby is receiving enough milk?

Luckily there are measurable, objective methods to determine if your baby is eating enough and growing adequately. 

1. What goes in, must come out! A baby 7 days old and older should have a minimum of 6 wet diapers every 24 hours and 3-4 stools every 24 hours. In the first week after birth these numbers are smaller and should be carefully tracked. They are as follows:
Day 1: 1 urine, 1 stool
Day 2: 2 urine, 2 stools
Day 3: 3 urine, 2 stools
Day 4: 4 urine, 3 stools
Day 5: 5 urine, 3 stools
Day 6: 6 urine, 4 stools
Day 7: 6 + urine, 4+ stools
If your baby has less than the numbers above, you must call your Pediatrician. If your baby has more than these numbers, that is great! It is normal to see 8-10 diapers every 24 hours by day 7 of life. Usually by day 4 or 5 the stool also will change to a yellow color and become 'seedy' in consistency. 

2. The baby's weight over time will tell you how the baby is doing while breastfeeding. Baby's can lose up to 7% of their birth weight in the first week of life. They should get back to their birth weight by day 7-10 days post birth. They usually will then gain 1/2 to 1oz a day after that in the first month of life.

Pumping is not an accurate method to evaluate how much your baby is taking from the breast.The baby, in general, will remove twice as much milk from the breast as even the best double electric pump can remove. Pumping is very different from breastfeeding. It is mechanical. Some women don't respond very well to a pump or may be using a pump that is not ideal for their breast. The size of the flanges and the suction power and cycles also effect milk removal amounts. Pumping is a great addition while breastfeeding in many circumstances but it is not a measure of how much your baby is transferring from your breast.

3. An additional method to evaluate your baby's intake is a direct measure during a feeding. A weight is done prior to nursing and then retaken after the feeding. The difference will be the amount your baby took from your breast. For example, if your baby weighed 3000 gm before the feeding, and then weighed 3045 gm afterwards, we can deduce that your baby took in 45 ml or 1 1/2 oz of breast milk during that particular feeding. Some people will want to have this evaluation done to make sure breastfeeding is going well or if they are experiencing any difficulties. An International Board Certified Lactation Consultant (IBCLC) will include this in their evaluation and observe a full feeding to develop a working care plan for you and your baby.

4. Observing your baby can also tell you if they are satisfied after a feeding. In the first few weeks of life, many babies are very sleepy in general and the following items are not reliable. When babies start a feeding, often their hands are clenched in  fist. When they are full, their hands relax and their fists open up. Their body is very relaxed and they may sleep. If your baby continues to cry and display hunger cues after a long feeding especially more than once, you should seek help from your Pediatrician and an IBCLC.

I hope this blog will give you more confidence in breastfeeding. These are general educational guidelines. They are not to be taken as medical advice. Please reach out to a Doctor if you have any concerns about your baby's intake.