About Breastfeeding > Getting off to a Good Start

How to Know When Your Baby is Getting Enough Breastmilk

Breastfeeding is very different from bottle feeding. There is no measurement, no timing and no limit – and these are good things. Your baby will tell you when he is hungry and, when latched well, you will see the extended drop of the chin, or ’pause’ which indicates a mouthful of milk. You will also notice ‘nibbling’ movements of the chin and these are known as ‘non-nutritive sucking’ movements. These are important also as they encourage your milk letdown ( see Milk Ejection Reflex¹) and help with the baby’s digestion. Breastfeeding will involve a combination of these ‘pauses’ and ‘nibbling’ episodes, ideally more deep pausing movements than nibbling.

Once the number of pauses begins to decrease and you see that the baby is nibbling, hence not transferring milk, use compressions². Only use compressions when the baby is nibbling, not when he is drinking or when taking a break. Once the compressions aren’t working, switch sides and repeat. Young babies come to the breast to drink, they do not come to comfort nurse. Keep him drinking, which may require you to switch sides more frequently or repetitively, depending on your milk flow.

Now you can change his diaper! If he settles after his diaper change, then he is ready to nap. If not, he may need a little more breastmilk to settle him.

During those first couple of weeks at home, there won’t be any schedule or timetable and that’s the way it should be. Your baby’s job is to ‘make you make milk’ and so nursing him when he cues to feed is the best way to establish a healthy milk supply. Rest, relax and enjoy your baby. Don’t look at the clock, no need for lists, just let Mother Nature take over. You will see that your baby will soon start to space his feeds and establish his own ‘schedule’.

Indicators for a well fed baby

Wet Diapers:
Day one - 1 wet diaper in 24 hours
Day Two – 2 wet diapers and so on.
By day Six, your baby should be producing 5-6 heavy wet diapers³ a day.

Bowel Movements:
Your baby’s first bowel movements are called Meconium⁴ ; a thick, black/brown sticky substance. By day 3, these dark bowel movements will change to dark green, then green, until by day 5 you will see the normal breastfed baby yellow, liquid, seedy bowel movements. If your baby is still producing meconium at day 5, seek some help from your lactation consultant, public health nurse or health care provider. By Day 6 your baby should be producing a minimum of 2-3 soft yellow stools in 24 hours.

Waking up to nurse: Your baby should self wake to nurse and appear alert. Be mindful of early feeding cues; smacking of the lips, hands to face, gentle awakening. Crying is a late cue. Typically your baby will feed at least 8 times in 24 hours.

Adequate Weight Gain
Breastfed babies gain an average of 1oz ( 30gms) a day for the first month and then around ½ oz a day a 4 months. Breastfed babies and formula fed babies have different growth patterns. Please see the World Health Organization’s Growth Standards charts for more information.

Baby Appears Content after Breastfeeding
Your baby should appear calm and ready to sleep.

No Nipple Pain
Breastfeeding should not hurt! If you are experiencing pain, please seek help with the latch. Pain is an indication of a poor latch which means that the baby is not removing milk efficiently. Over a short period of time this could affect your milk supply.

Appendix:
1 - Milk Ejection Reflex or ‘Let Down’ is caused by the presence of a hormone called oxytocin. This hormone enables contraction of the milk cells within the breast, causing a sudden flow of milk. Some mothers may feel a tingling, others describe it as painful pressure and some mothers don’t feel it at all. It can be triggered by the sound of a baby crying and it is not unusual for some breastfeeding mothers to experience let downs while out shopping or sitting in the park…..

2 - Compressions. Compressions are used to convert ‘sucking’ or ‘nibbling’ movements ( and hence no milk transfer) into drinks. An infant who is left to suck/nibble will ultimately fall asleep at the breast and so will want to nurse more frequently. Babies come to the breast to drink and will respond to flow. Babies like fast flow. A young infant will fall asleep before being fully fed and an older baby will fuss and pull away from the breast. Compressions are helpful in those first few days because they help the baby to receive more colostrum – the ‘liquid gold’ that plays an important role in providing the baby with nutrients and immunological components that establish antibacterial function and protection against allergies. When you notice that the baby is nibbling and not drinking, encircle your hand that isn’t holding the baby around your breast. Try and hold as much breast tissue as you comfortably can by using a C hold, and squeeze gently. This increases the internal pressure of your breast and so ‘compresses’ the milk structures within your breast. Maintain the pressure while the baby continues to drink. You will notice that you have now converted some of those ‘sucks’ or ‘nibbles’ into drinks. When the baby stops for a break, release your hand. If he starts to drink again, don’t compress but if you see that he is continuing to nibble, compress. Once you find that the compressions aren’t working i.e. you aren’t seeing many drinks,( you will always see the odd drink because you are constantly making milk), switch sides. Continue with breastfeeding, observing the transfer of milk and then use compressions as needed. Remember to compress only when the baby is ’sucking’, not drinking. Don’t compress when he is taking a break.

3 – Heavy wet diaper. Pour 3 tablespoons into a disposable diaper and feel the weight of it. That is what is referred to as a ‘heavy wet diaper’.

4 – Meconium is composed of materials ingested during the time the infant spends in the uterus. Most newborns will pass the first meconium stool within 8 to 24 hours after birth. Within 2 to 3 days the stools will appear greenish black to greenish brown. These transitional stools may be watery or thick in texture and they are odorless and less sticky than meconium. By day 5, yellow, watery, seedy stool should be observed.

Guidelines for Nursing Mothers Poster (PDF)
http://www.beststart.org/resources/breastfeeding/pdf/magneng.pdf

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