I'm worried my baby isn't getting enough milk. How can I know for sure?

Rather than worrying and wondering about whether your breastfed baby is getting enough milk, check the following signs:

NUMBER OF WET DIAPERS

• A baby who is getting enough milk will have 4 to 6 wet diapers a day by the fourth day after birth (6 to 8 wet diapers if you're using cloth--which hold less).

• To learn what a wet diaper feels like, put two tablespoons of water on a clean diaper. Cloth diapers will be more noticeably wet than super-absorbent disposables.

• It may be easier to judge the wetness of a disposable by comparing its weight to a dry diaper than by the way the surface of the diaper feels to the touch.

• After the first month or so, your baby's wet diapers will be even wetter--the equivalent of 4 to 6 tablespoons of water.

• The color of the urine tells you whether baby is getting enough milk to keep him adequately hydrated. Pale or water-colored urine suggests adequate hydration; darker, apple-juice-colored urine (after the first four days) suggests that baby is not getting enough milk. If your baby is not getting sufficient amounts of milk, you may notice a "brick dust" residue on the diaper, due to urate crystals from overconcentrated urine (a normal finding in the first few days), which should disappear after increasing baby's milk intake. (Check Latch-on Basics and Signs of Efficient Latch-on and Suck for tips on improving baby's nursing.) Talk to your doctor to determine if your baby needs extra milk during the time he is learning to breastfeed more efficiently.

NUMBER AND NATURE OF BOWEL MOVEMENT

If lots of stools come out, lots of milk must have gone in.

• In the first few days, infants' stools gradually change from the sticky black meconium stools to green, then brown. Within a day or two of mother's milk "coming in." they become "milk stools," which are yellow and seedy--the color of mustard and the consistency of cottage cheese.

• Between week one and week four, babies who are getting enough hindmilk will produce at least 2-3 yellow, seedy stools a day. Because breastmilk is a natural laxative, some breastfed babies produce a stool with each feeding, which is a good sign that baby is getting enough milk. When a baby has only two or three bowel movements a day, expect to see a substantial amount in the diaper--more than just a stain.

• After the first month or two, as the gut matures, the frequency of bowel movements decreases. At this stage, your baby may normally have only one bowel movement a day; some breastfed babies have one bowel movement every 3-4 days, yet are still getting enough milk. (You'll see other signs of adequate growth.)

While urine output tells you that baby is getting a sufficient quantity of fluid in the milk, stool output tells you about the quality of the milk, (i.e., whether baby is nursing long enough and well enough to trigger mother's milk ejection reflex, which brings the creamier, high-calorie hindmilk). When week-old babies are not producing sufficient stools, it's time to take a closer look at what's going on at the breast. Check the Signs of Efficient Latch-on and Suck and get help from a lactation consultant. Talk to your doctor to determine if your baby needs extra milk during the time he is learning to breastfeed more effeciently.

EVALUATING THE FEEDING

• Usually your breasts will feel fuller before and softer after a feeding. Changes in fullness will be less noticeable when baby is older and your breasts become more efficient at producing the exact amount of milk your baby needs.

• Most mothers will notice a milk ejection reflex a few minutes after the feeding begins. If you don't feel any sensation in your breasts, watch your baby. His sucking will strengthen and you'll hear more frequent swallowing when the milk ejection reflex increases the milk flow.

• Other signs that affirm that your baby is getting enough milk include seeing a few drops of milk leaking from the sides of baby's mouth and hearing baby swallow after every one or two sucks. Baby should generally seem content during and after a feeding.

• If you feel your baby sucking vigorously, hear her swallowing through much of the feeding, notice your milk ejection reflex, and see your baby drift contentedly off to sleep, chances are she's getting enough milk.

WEIGHT GAIN

Your doctor will check your newborn's weight gain a few days after you leave the hospital, and perhaps again a week or two later.

• Most infants, whether breastfed or bottle-fed, will lose an average of five to seven percent of their birth weight in the first days of life, due to the loss of excess fluid. How much they lose depends on the plumpness of the baby and individual variations in fluid retention, as well as on how well they are nursing.

• When mothers and babies share an uncomplicated birth and feed frequently with a good latch-on, babies lose less weight. Babies who get off to a slow start at breastfeeding (either because of a medical complication or problems with latch-on) tend to lose more.

• Babies who are getting adequate amounts of milk will weigh within an ounce or two of their birth weight when they come into our office for the one-week check-up. Some infants normally take a couple of weeks to regain their birth weight, especially if they lose a lot initially.

• When you are discharged from the hospital, remember to ask the nurses to tell you baby's weight. This is a figure your doctor will want to know at your baby's first check-up, since weight gain is measured from baby's lowest weight, not the birth weight.

• After regaining his birthweight, the average infant gains 4 to 7 ounces a week, or a minimum of one pound a month. Some babies gain weight quickly in the first months after birth; others gain more slowly, but are still within the normal range.

DON'T WORRY ABOUT YOUR MILK SUPPLY

• Breastfeeding is a confidence game, and nothing undermines a mother's confidence like being afraid her baby isn't getting enough milk. If your baby is producing enough wet diapers and bowel movements and he is gaining sufficient weight, he is getting enough milk.

• Feeding frequently, feeding frequently, "cluster feeding" or wanting to nurse soon after the last feeding are not necessarily signs that your baby is hungry. Babies nurse for lots of reasons besides hunger. Baby may be seeking just the closeness and comfort of breastfeeding, or may need a little more sucking to ease himself into sleep.

• If the diaper count is telling you that baby is getting enough milk, don't worry about your milk supply. Nurse your baby frequently throughout the day. Be sure he is latched on and sucking well, and then don't worry.

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