This has to be one of the most common questions I get asked by new mothers. “How do I know if my baby is getting enough?” This can be the most frustrating and the most confusing for new mothers. So I felt to help ease your concern I would give you some suggestions to make sure your baby is in fact feeding well, some sure fire tips that baby is in fact getting enough, and the average weight gain for breastfed infants.
From the moment your baby arrives into this world, there little instincts kick in instructing them to eat. Babies are not born hungry they are born with a need to suck. Babies are full of meconium (a polite way to say your baby is full of poop!). Colostrum is your baby’s first meal. Colostrum is full of rich antibodies and is a natural laxative which lines the baby’s gut and helps get rid of the meconium. We call it ‘Liquid Gold” because it literally looks like liquid gold with it’s thick yellow color, but more importantly is the most important meal your baby will ever receive. Your body begins to produce Colostrum during the 14th week of pregnancy. So you see you already have more then enough for your baby at birth. Your baby’s stomach is the size of their fist, which isn’t very big…they generally only need about 15-20ml initially, which is less then 1 oz. We know that our body knows to produce more milk and transition into mature milk based on how often the breast is stimulated. When the breast is stimulated (nursed by the baby or pumped) it stimulates to the pituitary gland to produce prolactin receptors to cause your body to make, make, make and for you to produce, produce, produce. The more your baby is at the breast in the first 3 days the more milk you will have at 3 months. One of the most important things to remember is that you CAN”T OVER FEED A BREASTFED BABY! Breastmilk is perfect food, designed specifically for their little bodies. The more they want to nurse the better in those few first weeks.
In the hospital your nurse, pediatrician, Lactation Consultant most likely instructed you to look for the baby’s feeding cues to let you know when it’s time to eat. Those cues include licking their lips, sticking out their tongue, gnawing on their fist, rooting towards mom. When you see those cues, pick up your baby and feed them. Some literature out there will tell you to feed the baby every 3 hours round the clock, nurse 15min on one side then 15min on the other. Very routine, very precise. The problem with this is that you aren’t considering your baby’s growth spurts which happen at 2 weeks, 6 weeks, 3months, 9 months. Just like you and I, some babies will eat more one day then another. If you become to militant on watching your clock and not watching your baby for cues to eat, you will end up with a screaming kid on your hands, and frustrated mommy to boot! We don’t issue watches to the babies at birth, they have no idea when the clock says to eat, they just know when they want it they want it. Become a baby watcher not a clock watcher… the baby will tell you, and FYI-crying is the very last cue they give. It is a lot harder to latch on a crying baby then one who is just beginning their feeding cues.
Ideally we want you to feed your baby at least 8 or more times in a 24 hour period. For some babies that may end up being every 3 hours, but for some they may nurse every couple of hours in the daytime, then evening comes they cluster feed eating every hour, then at night sleep 5 hours. That is okay as long as the baby has had a minimum of 8 feeds, no less. If they baby hasn’t met that quota then yes you need to wake him up. This pattern will continue for the first 8 weeks of life. If the baby wants to feed more often, let them! Again you can’t over feed a breastfed baby.
When you feed you want to let the baby completely empty a breast. How do you know that the baby has done that? Look at their jaw motions, their hand, and the behavior. A baby will be alert at the start of a feed with a clenched fist and suck vigorously for the first 2 minutes, this is to stimulate the milk ejection reflex. After this time, your baby will settle into a suck swallow ratio of 2:1. You will begin to hear your baby audible swallowing and their jaw will be gliding forward. Towards the end of the feed their little hand will relax out of a fist and become very flacid. Your breast will feel more empty and your baby will feel satisfied. This may take 5 minutes or 25 minutes depending on your baby..,but I would never end a feed until the baby has stopped the audible swallowing. By doing this you allow the baby to get the hind milk which has the rich fat and proteins which help with weight gain. Also while baby is feeding, stoke the breast in a downward motion, this will allow more milk to flow thus increasing the quantity. Here is a great little guide to help you know your baby is getting plenty of your breastmilk:
BIRTH TO 6 WEEKS
WEIGHT GAIN: If baby is gaining well on mothers milk alone, then baby is getting enough. That is the first and most accurate measure. A 5-7% weight loss during the first 3-4 days after birth is expected. Your baby will usually regain their birth weight by 10-14 days of life. Once your milk transitions from Colostrum to Mature Milk the average weight gain is 4-7oz a week. If this is not happening then you need to make an appt. with a Lactation Consultant to evaluate why.
WET DIAPERS: After the first week of life, baby should be having 6 or more wet diapers with urine that is pale yellow and mild smelling. A sufficiently wet diaper is about 3tbls or 45ml of fluid.
DIRTY DIAPERS: After day 4 baby should have 3-4 poopy diapers. By day 4 the poop should be a yellow seedy consistancy. If it is still black or green evaluation may be needed by your pediatrician or Lactation Consultant. By day 5 of life the size of the stool should be the size of a US quarter 2.5cm or larger.
AFTER 6 WEEKS
WEIGHT GAIN: Baby should be gaining well on moms milk alone and gaining weight adequately.
Average weight gain for breastfed babies:
0-4mo: 4-7oz a week
4-6mo: 4-5oz a week
6-12mo: 2-4oz a week
WET DIAPERS: 4-5 sopping wet diapers per day, about 4oz per diaper. Diapers will be wetter in the morning, especially with older babies. Urine should be pale and mild smelling.
DIRTY DIAPERS: Depends on the child!!!
The number of dirty diapers ranges from many per day to 1 every 7-10days. After 4-6weeks, some babies switch to an infrequent pooping pattern. Breastfed only babies can go days without a bowel movement because the body is absorbing all the nutrients. As long as baby is gaining well, and the poop is soft and profuse it is perfectly okay. If the baby goes longer then 7 days without a bowel movement consult your pediatrician.
The amount of milk needed for proper infant growth is estimated around 2.5 to 3 times their body weight in ounces, per day, for the first 6 months. For example if your baby weighs 8lbs the average amount of milk your baby should be taking in is between 20-24 oz .
If ever you feel unsure about your baby’s weight gain, you can always go to a breastfeeding support group to have your baby weighed. Also, if your still thinking that there is no milk transferring during a feed then you can always schedule an appointment with a lactation consultant who can do pre and post feed weights to show you specifically how much your baby is taking in.
Most importantly trust your instincts, and watch your baby. If your baby is meeting their milestones, then you know your doing well!
Copyright© 2011 Danielle Gauss – JustBreastFeeding.com. All Rights Reserved.
I love your site. I have had a really hard time breastfeeding and have consulted with 2 lactation gals and gone to several support groups here in San Diego. The lactation specialist through Scripps recommended I use the nipple shields. They really help, but I am trying to figure out a couple of things with them. 1). Even when I invert them etc. they kind of flip off. 2). It seems to take him longer to feed with them-does that make sense? 3). He is sometimes fussy when he gets off them-he would feed all day I feel like if I let him–his jaw is moving and swallowing. 4). He does delatch from them during certain feedings. He has gained a good amount of weight although I don’t know how much since the nipple shields have been in use. I would be really interested in your opinion about these things. He is 4 weeks old. Feeding was initially excruciating, became painful yet tolerable and is much better now . It usually feels pretty good with the shields but sometimes can still hurt a bit. Thanks!
I am so glad that you find the site helpful. Most likely the baby just went through his first growth spurt which would account for the frequent feeds. That happens right around the 3rd week. It is possible if the nipple shield is not being put on correctly, or you are not using the right size (medela 24mm) it can cause your nipples to be more sore and decrease milk transfer. Check to make sure you are using the correct size. It also may be that your little one is ready to get off of the shield, but that is up to you. Make sure however, that when you latch him, that you are leaning back, bringing him to you, and that his ear, shoulder, hip are in a line. His cheek should be touching the breast, and from your point of view, you should not see your areola. If you are seeing your areola he is not latched correctly. If you still need help let me know, I’m not too far from San Diego 🙂
Thanq… Very much