Nursing mothers often worry that their baby is getting enough breast milk. Learning the signs that indicate a baby is well nourished may help you to breastfeed with confidence.
Signs of a well nourished baby
Like many nursing mothers, there will be times when you will wonder or even worry about your milk supply. You may observe some of the many normal changes that can occur (described in 'False Alarms' below) and mistakenly assume your milk supply has decreased or you may become unnecessarily concerned about the quality of your milk. With just a little explanation and reassurance most of your concerns about your milk supply can be put to rest.
If you can answer 'YES' to the questions in sections 1, 2 and 3 below you can feel confident that your baby is getting enough breast milk. (If you answer 'NO' to any of the questions in 1, 2 and 3, we recommend that you have your baby seen by a doctor for a thorough medical assessment). Sections 4 and 5 have been included to explain that although a 'YES' answer to these questions may be a good sign, 'NO' is not always a bad sign.
1. A healthy active baby.
- Is he healthy?
- Does he demand regular feeding?
- Is he active?
- Is he bright and alert?
2. A steady pattern of weight gain.
- Is he gaining enough weight for his age?
It's an overall pattern of healthy growth that's important. Do not become overly concerned by fluctuations in the amount of weight he gains each week. Included along with his body weight is how much milk is in his tummy and how much urine (pee) is in his bladder. Variations in body fluids alone can contribute to weekly fluctuations of 1/4 lb (or more) for young babies and up to 3/4 lb for older babies. (Try to weight him on the same scales, at the same time, in relation to feeding, each time.)
3. Lots of wet diapers
- Are his diapers heavy with urine?
- Do you change his wet diaper at least 6 or more times each day?
Fluid must go in before it can come out!
4. Contentment during feeding.
- Apart from the need for an occasional burp, does he continue to suck until he falls asleep?
- Can you see and/or hear him swallowing?
- Is he content to remain on your breast for long periods?
- Or when he's finished feeding does he come off your breast calm and relaxed?
Fussiness during feeding is not necessarily an indicator of low supply, nor is your baby's desire to return to the breast shortly following a breastfeed a clear sign of hunger. (See 'False Alarms' below for explanations).
5. General contentment and long naps.
- Is he content between breastfeeds?
- Does he have long naps during the day and/or sleep for long periods overnight?
Although contentment and a sound sleep pattern can be signs of a well nourished baby, irritability and/or wakefulness in a healthy, thriving baby (who is also providing 6 or more wet diapers a day) are rarely due to hunger. Such behavior can occur for many reasons.
1. Your baby wants to breastfeed more often.
Nursing 8 to 10 times (or more) in a 24 hour period is not unusual, particularly for young babies. Babies are in an oral stage of development and have a strong urge to suck. Breastfed babies often seek the breast for comfort when they are tired, in discomfort or pain, or when distressed.
A sudden increase in the number of times your baby wants to breastfeed may be due to a growth spurt or it may be because he has learned to associate sleeping with breastfeeding. (This can occur if your baby frequently fall asleep while breast feeding. See our article on sleep associations for more information.)
2. Your baby wants to breastfeed for longer.
Not all the time your baby spends on your breast is actual feeding. Young babies often spend a lot of time on the breast comfort sucking. To feel contented, many babies want to suck for longer than is necessary to feed.
With practice you will be able to tell the difference between feeding and comfort sucking by observing your baby's sucking pattern while breastfeeding. When he's feeding, his jaw movements are slow and rhythmical (suck - swallow - pause) and you will be able to see or hear him swallowing. When he's sucking for comfort, you will notice his jaw movements will be shorter and quicker (like a flutter) and there is very little or no swallowing seen or heard.
3. Your baby doesn't want to breastfeed for as long.
As babies get older they become stronger and more efficient at breastfeeding. Also mothers' let-down reflex becomes more efficient, so babies are able to get more milk from the breast in less time. As a result feeding time often decreases.
4. Your baby seems hungry soon after being breastfeed.
Because babies are in an oral stage of development, they often seek the breast for reasons other than hunger. (See our article on hungry baby for reasons why babies can 'appear' hungry.)
5. Your breasts are softer and don't leak as much as they did.
In the early weeks of breastfeeding most mothers produce an abundance of milk and this makes their breasts feel full and/or leak. Around the time her baby is 6 to 8 weeks old, a mother's body has learned how much milk to make. Many mothers no longer have a full feeling in their breasts after this time.
6. You don't feel a let-down.
This has nothing to do with milk supply. Some nursing mothers never feel a let-down and continue to successfully breastfeed.
7. You get little when you pump.
How much breast milk you can pump depends on a lot of different things...
- When you pump in relation to when you last breastfed.
- How frequently you pump.
- How effective your equipment is; and
- How experienced you are at pumping. (Pumping can be a skill that takes practice.)
It's important to remember that your baby is much more effective at getting milk from your breasts than a pump will ever be. A healthy, thriving baby will get more milk than you a capable of pumping.
8. Your baby has fewer bowel movements.
It's very common for the frequency of a breastfed baby's bowel movements to decrease around the age of 4 - 6 weeks. Bowel movements may decrease to one a day or every few days. Some exclusively breastfed babies may even go 7 - 10 days (or more) without a bowel movement. As long as your baby is well, gaining enough weight and is still providing lots of wet diapers each day (6 or more) there is nothing to worry about. (See our article on constipation for more information.)
9. Your baby seems to reject or refuse your breast or fuss constantly while breastfeeding.
Young babies often have times where they appear to reject the breast, i.e. when it's very difficult to get them to latch-on. This will often coincide with "colicky" period, where a baby has been crying inconsolably for a long period of time. This is typical behavior during episodes of colic for both formula fed and breastfed babies and is not a sign that there is anything wrong with your milk supply.
There may also be times when he squirms and wiggles or comes off your breast repeatedly, and appears to be frustrated or in discomfort while feeding. There can be many reasons for this behavior. The most common reason is the one that is most often overlooked - babies habitually behave like this when they are over-tired (which often happens in the evenings).
10. Your baby guzzles down a bottle of formula following a breastfeed.
This is not always a clear sign that your baby was hungry. Many healthy, thriving breastfed babies will guzzle milk from a bottle, particularly if the feeding nipple is fast (allowing the milk to flow quickly).
Sucking is a reflex action for babies (a reflex is an automatic or involuntary response). The sucking reflex is particularly strong in babies younger than 3 months. With age this reflex gradually fades. Inserting a feeding nipple into a your baby's mouth often stimulates a suck reflex.
When a bottle of formula (or breast milk) is offered, the nipple in the baby's mouth automatically triggers the 'suck reflex'. The baby's mouth then fills with milk, which he is then compelled to swallow. The swallowing action triggers the suck reflex and so on. So within a short while it can appear like your baby has "hungrily" guzzled down a bottle of formula, whether he was in fact hungry or not. (As he has no control over his reflexes it may be that he couldn't stop the flow).
11. Your baby's feeding pattern is different to other babies.
It's normal for a breastfed baby to feed more frequently than a formula fed baby because breast milk is digested more quickly than formula - usually in 1.5 to 2 hours. Each breastfed baby will also have different feeding patterns. It's important to remember that every baby (and mother) is different, so each baby has different needs.
12. Your baby is irritable and wakeful.
All babies, both breastfed and formula fed will have good days and not so good days when nothing parents do seems to satisfy them and they continue to cry for long periods. Fussing and/or irritable behavior affects just as many formula fed babies as breastfed babies. Where your baby is healthy, gaining enough weight and passing lots of urine, formula is not the answer to problems such as irritability and wakefulness. Offering formula may potentially create additional problems.
13. You're worried by the color of your breast milk.
Many mothers worry needlessly about the "strength" of her breast milk when they see the color of their foremilk, as it can look "watery'. Unlike the whiteness of cow's milk, human milk has a pearly translucent appearance. Studies undertaken to compare breast milk of hundreds of woman have confirmed that there is no significant difference in the quality of breast milk between breastfeeding mothers.
In a nutshell...
If your breastfed baby is healthy and thriving and passing lots of urine each day (6 or more wet diapers) you have enough breast milk and are meeting his nutritional needs. Changes in his behavior are either normal or due to reasons other than hunger.
Offering formula to a healthy, thriving breastfed baby can negatively affect breastfeeding as it may cause an undersupply of breast milk where an undersupply may not have existed before.
Written by Rowena Bennett