How do I know my baby is getting enough milk when they are not being weighed?

Concerns and questions over whether your baby is gaining weight are common, after all the responsibility of feeding our baby can feel huge! But in this time of lockdown and reduced maternity support, it can be even more of a worry.

Often the frequency of a baby’s feeding habits can be a surprise for new parents and without the right support and information it’s easy for a mother to feel she hasn’t got enough milk for her young baby’s growing needs.  Many women I speak to worry about not having enough milk, and I often hear that well-meaning friends and relatives have commented on how the baby should be made to wait for 3 hours, or sometimes longer, or to top up with a bottle of milk after a breastfeed.  Unfortunately this advice, if followed, actually has the opposite effect on the mother’s milk supply, and therefore the baby’s growth too.

On average, a baby born at around 40 weeks of pregnancy can only fit around 5mls (a teaspoon) of milk into his or her tummy in the first 24 hours of life.  This increases to around 25/30ml by about day 3, and 60/80ml by about day 10.  Even though a baby only drinks small quantities of milk, it can still take them 20 minutes or more to finish feeding.  Just like adults, each baby is unique and some eat more quickly than others, so it’s important to let the baby decide when he or she has finished; that way babies will drink until they are full, ensuring they get enough calories to grow well, and stimulate the mother’s milk supply adequately.

Every time milk is removed from the breast, more is made.  However, if milk is left in the breast then a protein called FIL (Feedback Inhibitor of Lactation) increases, which slows milk production.  Therefore, the more often a baby feeds at the breast, the more milk a mother is able to make.  Most people are not symmetrical and this applies to breasts too.  A lot of women have breasts that vary slightly in size, this is quite normal.  The size of a woman’s breasts bears no relation to the quantity of milk she will make.  Large breasts may contain a small amount of glandular tissue and vice versa.  It is not possible to tell by looking!  Allowing a baby to feed as often, and for as long, as he or she needs to, most women’s breasts will make enough milk for their baby.  If you think of the breast as a glass, it doesn’t matter the size of the glass – you can still drink lots of water in a day if the glass is small, you will just need to drink more often.

So even if you feed your baby for as long and as often as he or she wants, how do you know it’s all working?  Weight gain and growth is something that can be measured but at the moment, while you are seeing your midwife less often, you may not know your babies weight. Many babies lose a little weight in the first few days and this is completely normal.  If the mother has had IV fluids during labour then the baby’s weight can be slightly inflated at birth and this can mean the baby loses a little more weight than otherwise as they lose the excess fluids taken on during birth.  On average, a baby will gain anything between around 110g-220g a week in the first four months.  As you can see there is a range of “average” and at different times babies put on different amounts of weight.  It can actually be important not to weigh a baby too often as some weeks babies won’t put on much weight which can cause unnecessary worry.  But when your baby isn’t being weighed, how do you know your baby is doing well?

One of the easiest ways to do this is to check what’s coming out the other end 🙂  If milk is going in at the top, then something will be coming out the other end.  It’s amazing how important the contents of your baby’s nappy becomes!  When your baby is born his bowel contains meconium.  This is the first poo you baby will pass and breastmilk helps your baby’s digestive system start to work; the colostrum works a little like a laxative helping your baby pass meconium – a sticky, black/dark green bowel motion.

In the first 2 days your baby should produce one or more poos a day, and two or more wees a day.  On days 3 and 4, your baby will produce three or more poos a day, which will become more green coloured and possibly a little softer, and three or more wees a day.  On days 5 and 6, your baby will produce three or more soft yellow poos.  The poos change to yellow as all the meconium has been passed and your baby starts to drink and digest more milk.  By now you will notice that you are producing more milk.  From day 7 onwards, your baby will produce at least two soft yellow poos, possibly a lot more, which is quite normal.  They may also look a little “seedy”, which is fine.  Your baby should also be producing six or more heavy wet nappies a day. After 6 weeks of age, some babies may only poo every few days, or even longer! This is normal for some breastfed babies, and not something to stress about. At all ages your baby’s wee should pale in colour and not smell strong. More on nappies and what to look for here.

Making sure your baby’s latch is good is important as it not only impacts how feeding feels for you physically, but also how easily and well your baby can remove milk from the breast. You may feel some discomfort for the first few seconds when your baby latches, but this should stop. Your baby should be facing your body (tummy to mummy) and latched to the breast with their chin close into the breast making an indent, which usually means the nose is not buried in the breast. Your baby’s back and neck should be in a straight line, your baby should not have to turn their head to get to the breast, and their head will be tilted back slightly, rather than face planted into your breast. You will be able to see the areola above the top lip, and your baby’s bottom lip will be further down the areola (if you can even see that bit). The top lip will usually be straight (not curled under), and the bottom lip flared out (though you probably won’t be able to see it). There is a good video of latching here. Your baby’s cheeks should remain full and rounded when feeding, and it should be comfortable for you.

After the feed, your nipple should still be its usual shape, though may be a little longer than before the feed, it should not be squashed or misshapen in any way though. If a feed continues to hurt after the first few seconds, take your baby off the breast, and re-latch.

At the start of the feed, your baby will usually take lots of quick sucks. This helps the milk to start flowing. After a few seconds, or even minutes, the milk ejection reflex or let down will happen. This is when milk flows faster and in higher quantity. Some mamas feel this as a tingling, even slightly painful, possibly all the way up under the armpits, others don’t feel it at all – both are normal 🙂  At this point, your baby’s suckling pattern will change to longer, deeper sucks with a swallow between every couple of sucks. You may notice a pause when your baby does this and some babies may swallow with every suck. This part of the feed is when babies get most of their milk.

As the feed continues, your baby will begin to suck less, they will get sleepy, the pauses will become longer, and the sucks may become fluttery and less vigorous. This is normal.

Follow your baby’s cues to feed, feeding as often as they want to. It is normal for a baby to have an irregular feeding pattern. Sometimes they may want to feed again after 10 minutes, other times it might be 2 hours. Follow your baby’s cues. Either way, your baby should feed between 8 and 12 times in 24 hours as a minimum.

Another way you will notice your baby is growing is by the fact their clothes fit differently? Are their toes reaching the end of their onesie? You’ll probably be taking lots of pictures of your baby, look back over a few days and notice the difference in their size 🙂

Frequent feeding, your baby not wanting to be put down, unsettled evenings, not being able to express much milk, soft breasts, no leaking, a baby that wakes often… none of these are indicators that you do not have enough milk for your baby. Most of the time it is just normal baby behaviour, providing you are seeing wet and dirty nappies and your baby is growing.

In fact, those late afternoon/early evening/all evening constant bouts of feeding are completely normal for a baby. It’s called cluster feeding and can be concerning if you are not expecting it. During growth spurts, your baby may have a day or two of cluster feeding, often around 10 days, 3-4 weeks, 6 weeks, 12 weeks and 4 months, though they often happen at other completely random times too! Again, following your baby’s cues is always the best thing to do, but if you are worried in any way about your baby’s health or behaviour, always seek medical advice.

It can be hard to feel confident of something that we haven’t done before, and having a baby that seems unsettled or unhappy is enough to make any mother concerned.  If you are worried about your baby’s behaviour, development, or health then you should always seek advice.  A mother’s instincts are often right and sometimes it can take a while to get to the root of the issue, so keep asking and talking to people who have been well trained and have good experience until you are satisfied.

You can find some great information here about how milk production works, and on this page for what to expect in the early days of breastfeeding.  If you are worried about how often your baby is feeding, you might feel reassured after reading the information on this page.

Please feel free to comment on this post, or ask questions.  You can also contact me directly vie email:  denise.ives@thebreastroom.org