No one really knows what to expect when having a baby. One thing new parents learn quickly is that an unsettled baby makes you second-guess everything.
It can be really challenging trying to figure out the needs of this tiny, vulnerable person you’ve just met. And it breaks your heart when it feels nothing you do will console them.
It’s no wonder the most common question I’ve been asked in over a decade of Midwifing families is “how do I know (she’s) getting enough milk?”.
Whether breast or formula feeding, it’s normal for new mums to constantly analyse how much goes in… and what comes out.
Your baby’s input and output can tell you a lot about their wellbeing and hydration.
Long bouts of sleepiness OR sleeplessness, inconsolable crying, fussy at the breast, very unsettled baby, or a baby wanting to feed constantly will make most parents quick to assume their baby isn’t getting enough milk.
But rarely this is actually the problem.
If breastfeeding, the first thing to know in determining if your baby is getting enough milk is what are NOT signs of low milk supply.
- Wanting to suck often
- Feeding frequently or unsettled after a feed
- Lots of wakings or short naps
- Short feeds, or long feeds
- Takes a bottle after a breastfeed
- Breasts feel soft or ‘empty’
- Breasts are softer than normal
- Unable to pump any/much milk
- Small breasts
- You don’t feel a let-down
- Breasts don’t leak
These factors often make mothers feel like they don’t have enough milk, yet in isolation of the below points, they do not determine low milk supply.
So how do you know if your baby is getting enough breast milk?
1. Wet Diapers
Most parents who think ‘is my baby getting enough breast milk?’ are worried about a baby’s unsettledness.
However, wet diapers are actually more of an indication that your baby is getting enough breast milk than fussiness.
Any baby older than a week old that is well hydrated should have at least 5-6 wet diapers (wees) in 24 hours, from a week old.
Another sign baby is probably taking in enough milk in the first week is transitional stools.
A Midwife is reassured in the first week by seeing a newborn’s stools changing from dark green sticky meconium, to less sticky khaki green/brown, and then curdy and mustard colour.
2. How Many Wet Diapers For A Newborn?
For a newborn baby from birth to day 6, you’d expect one wet diaper on day 1, two wees on day 2, three on day 3 etc. until they are a week old.
3. How To Tell If Baby Is Still Hungry After Breastfeeding
The ‘floppy arm test’ is one I teach to all new parents. Really start to watch your baby’s physical cues as they feed at the bottle or breast.
You will start to notice at the beginning of a feed their hands are often clenched, limbs stiff and elbows tucked in.
As baby becomes sufficed, notice how their limbs become soft, their hands relax, and often if you pick their arm up and let it go, it will just drop down floppy.
When finished a feed, a full baby may appear ‘milk drunk’, which is a reassuring sign they are getting enough breast milk.
If they are rooting around with their mouth, they may be wanting more feed.
Sometimes a baby wants more, but isn’t staying latched.
This may because you need to pause and burp them before re-latching, they may be distracted by the fascinating world around them, or they may be having difficulty maintaining a latch due to fast flow or oral restrictions.
4. Baby Is Fussy After Feeding
If baby doesn’t relax after a breastfeed, that does not mean you have a low supply.
They may just be alert and wanting to gaze around, having a developmental leap and learning the world around them.
If baby is not settled after a feed, which is quite common in the evening, this does not necessarily mean they are still hungry, but it is very normal to wonder if they are getting enough breast milk.
Where wet nappies and weight gain have been sufficient, a baby who is still unsettled after a breastfeed may also be tired, overstimulated, have a dirty nappy or sore tummy, or be uncomfortable – the list goes on.
Sometimes it can feel like you’ve tried absolutely everything to settle them, only to get back to square one and they finally settle. Sometimes this takes hours.
Remember, if baby cries after feeding and burping, that alone is not an indication of low milk supply.
5. Newborn Weight Gain
Weight gain is an important aspect of knowing if your breastfed baby is getting enough milk, so your Midwife or GP will check this regularly in the first 6 weeks after birth.
In the first week, it is very normal and common for a baby to actually lose within 10% of their birth weight.
So if your baby was born at 3.5Kg, it would be totally ok for them to lose up to 350g in the first week if they have normal wet nappies and no other issues such as not latching/sucking, low blood sugar, etc.
After this initial weight loss, we anticipate a newborn baby to gain approximately 150g/week.
Whether your baby does this, or gains 400g a week – both are normal. Your baby is getting enough breast milk.
Weight gain will eventually plateau as your baby gets older and they find their genetic potential.
For breastfeeding mums, it’s important to remember lower/slow weight gain doesn’t necessarily indicate low supply, nor should it be the reason for cessation of breastfeeding, unless this is what the mum wants.
If you are breastfeeding and worried about your baby’s weight, the best professional to discuss this with is an International Board Certified Lactation Consultant (IBCLC), many of whom now offer Skype or Zoom consultations as well as in-person.
The Australian Breastfeeding Association website and free phone hotline of Breastfeeding Counsellors also has great information on helping a breastfed baby to gain weight.
6. Signs of Newborn Dehydration
Alongside wet nappies and weight gain, there are a few other signs a breastfed baby is hydrated and getting enough milk.
Sunken Fontanelle – Fontanelles are the ‘soft spots’ of a baby’s skull. There is a diamond shaped fontanelle above their forehead, and a smaller diamond shaped fontanelle near the base of their head.
If a baby is dehydrated, their diamond fontanelle will often be sunken so that it looks like a dip in their head. This is something to leave to the experts to assess though, as often a fontanelle can look a little sunken in a well baby and cause great concern for a parent even though it is normal.
Jittery Baby – A baby who is critically unwell from dehydration or low blood sugars may become jittery. Think tremors. A jittery baby needs urgent healthcare.
Lethargic Baby – A baby that has lethargy is different to a baby that is having a sleepy period. Signs a baby is lethargic include inability to wake them despite stripping them down/nappy change, inability or no interest in feeding, or lack of alertness. Lethargy can occur if a baby’s blood sugars drop too low from inadequate milk intake and should be reviewed by a health professional immediately.
Ultimately, the key points to remember are diapers, diapers, diapers. The best way to know your baby is getting enough milk is to count their wet diapers. 5-6 wees per day, with adequate weight gain, can reassure you that baby is probably absolutely fine.