Is my baby getting enough breastmilk?

How do you know if your breastfed baby is getting enough to eat? The answers lie in their diapers and on a scale.

If you have questions or concerns about your milk supply or how much milk your baby is getting from the breast, I cannot emphasize enough how important it is to visit an International Board Certified Lactation Consultant (IBCLC) for individualized assessment and guidance.

The dirty truth

Poop quantity and, to an extent, color are low-tech ways of answering the question of whether a baby is getting enough to eat. Poop should change from black, sticky, tarry meconium to slightly-less-horrifying dark green to yellow and seedy within the course of 5 days after birth. After that, poop color can vary in color and consistency and be normal.

Quantity is more important than color once meconium has passed. A sufficiently-fed newborn will have 3 to 4 large (credit-card sized) stools by day 4 of life. Sometimes a baby will poop with each feeding, in which case the stools may be smaller. Wet diapers are not as good of an indicator of intake. They are still significant and you want to see 6 or more per day, but urine without stool is a sign that baby needs more food.

The scales have it

Weight gain is the best indicator of adequate milk intake. The standards that many IBCLCs follow say that weight gain of 5 to 7 ounces per week (3/4 to 1 ounce per day) is a marker of a baby being fed enough. Most babies lose weight after birth; they should no longer lose weight after day 5, and should be back at (or above) their birth weight by day 10 (ideally) or 14 (at the latest). Depending upon your care provider(s) and the gestational age of your baby, there may be concern if your baby loses more than 7–10% of birthweight.

Of course, simply weighing a baby isn’t always so simple:

  • The scales used need to be reliable and consistent. That is, they need to show the weight correctly and different scales need to be measuring weight the same.
  • The way babies are weighed needs to be the same each time. You’ll have inaccurate readings if you weigh your baby with clothes on at one appointment and with a diaper on at the next.
  • Initial birth weight can be influenced by IV fluids given before birth. Sometimes the weight recorded at 24 hours after birth gives a more accurate picture.

There are some other indicators of a baby “getting enough” that are less conclusive but can help to flesh out the big picture:

  • Breasts feeling less full after a feeding.
  • A baby who is waking herself for feedings, and not sleeping longer than 3 hours at a time if under birth weight.
  • A baby who is reasonably content, growing well, and meeting milestones.

When baby is not getting enough

If diaper output and weight gain are within normal, you can rest assured that your baby is getting enough to eat. But what if they’re not? First, you’ll want to talk to your care provider. They can assess your baby to rule out medical concerns. As a breastfeeding parent, you’ll want to reach out to an IBCLC as well. Sometimes care providers will suggest supplementation without digging deeper into the issues, but giving a bottle will not magically fix breastfeeding.

Sometimes a baby is not getting enough. If you’re having pain with breastfeeding, it’s likely that your baby is not latching well. Sometimes, this can be a simple positioning fix. Other times, things are more complicated (like tongue tie or other structural issues).

Sometimes a baby is getting enough but needs more energy then she is getting, such as with heart defects. (This is why it’s important to contact your health care provider.)

Sometimes the issue lies with milk supply, and there are things you can do to optimize your milk production.

Many times, a baby not getting enough while breastfeeding is a combination of several things. This is why it’s important to seek help from the pros, as they can tease out the details of your health and breastfeeding history and put together a plan to feed your baby and protect your milk supply going forward.