Oooh it’s the mother of all dilemmas, determining if you’re little-one is getting the milk and nutrients he needs to grow big and strong. Here’s a few newborn cues and clues to help you…

Breastfeeding is often said to be a science and an art. I believe mastering this new skill also requires an element of faith or belief, as each woman develops trust in her own body’s ability to nurture her highly dependent newborn.  Questions about whether baby is getting enough cross every breastfeeding mother’s mind at some time. Here’s how to know all is well (or not) and how to ensure baby thrives.

The Breastfeeding Series by Lois Wattis

Part 1: What to Expect in the First Days After Baby is Born

Part 2: How to Breastfeed Comfortably (For Both Mother and Baby)

From feed to feed:

During the breastfeed observe baby’s jaw action.  When feeding effectively baby’s whole jaw will move rhythmically with his suck/swallow/breath action. By listening for swallowing sounds, watching baby’s feeding action and even counting how many sucks baby does between swallows, mothers can gauge how well baby is drinking.  Baby needs to maintain the head tilted back position (described and illustrated in Part 2 of this series -HYPERLINK) throughout the breastfeed, enabling him to swallow the milk comfortably and efficiently – just the same as adults need to tilt their heads back to drink from a glass or bottle. Baby’s cheeks should appear full and his lips should be curled outwards.  If baby’s cheeks are dimpling inwards as he sucks he does not have his tongue positioned correctly and he is not really feeding effectively.

Monitor how baby feeds:

The mother should take notice of how baby is feeding – the rhythm and depth of his jaw movement and the pauses between sucking episodes. It is a normal pattern of feeding for baby to suck and pause, and as baby’s tummy fills up the sucks get shorter and the pauses get longer. As baby nears the end of that phase of the feed he may rest as he pauses, his chin may tremble or mum may feel little fluttery sucks. Baby may partially or fully release his latch, and appear satisfied and probably sleepy. How well the baby fed is more important than how long baby was at the breast.  A baby can take a large volume of milk in a short time (5 or 10 minutes) if he is optimally positioned and  attached, whereas a poorly positioned and attached baby may drink far less milk even when he has been at the breast for 30 minutes or more.

How do your breasts feel?

A mother can also be guided by how her breast feels after the feed to indicate how much milk baby drank. Does the breast feel softer or less heavy than it did at the beginning of the feed? Each breastfeed is usually comprised of a few instalments. Young babies particularly need to take each ‘meal’ in a few stages, with rest times in between each stage to allow comfortable digestion. Always return baby to the starting breast at least once before offering the second breast.  Baby will show you he is full by appearing comfortable and satisfied, and probably look ‘milk drunk’ and sleepy. If he settles easily after burping and nappy changes if required, he has had enough. If he doesn’t, he probably needs a bit more breastfeeding – sometimes it is only a few extra minutes which satisfies baby. Trust your baby’s cues, and you will soon gain confidence when judging whether he has completed his breastfeed.

From day to day: Baby’s output

Baby’s output – his wees and poos – are a reliable guide to whether he is taking sufficient volumes of breastmilk at each feed. In the first day of baby’s life we expect one wee and a few black ‘meconium’ poos; second day of life two wees and a few poos which may be brownish ‘transitional’. From day three we expect three wees and the poos will be changing to yellow-ish ‘mature’ poos. When baby is a few days old and the mother’s milk has ‘come in’ his output becomes established at around eight nappies per 24 hours.  If baby is feeding well, many of his nappies will be wet and pooey, and they may total more than eight per day. The breastfed baby’s mustard-yellow coloured poo is quite runny or like fluffy mousse and it may have little grainy looking bits in it – this is all normal. When a baby is taking adequate amounts of breastmilk he should produce at least 2 poos every 24 hours.  His wees will look pale yellow coloured, and some nappies should be quite heavily wet.

If a baby is not taking adequate breastmilk volumes the amount of poo reduces, however the wet nappies continue.  If a breastfed baby less than 6 weeks-old produces less than two poos each 24 hours this is an early indication that the baby is not obtaining enough breastmilk. This situation needs to be checked by a midwife, child health nurse or doctor as soon as it is recognised.  If baby’s output fits the normal description above you can be assured baby is getting enough breastmilk.

Post six weeks: Baby’s output

After about 6 weeks of age baby’s anal sphincter begins to work more effectively and can hold on to poo for longer, so it becomes normal for these older babies to poo less frequently. As long as the urine output continues to require six or more nappies per day, baby feeds regularly (at least six times each 24 hours) and settles well between feeds, plus his weight gain is consistently good, the reduced poo output is not a concern. I emphasise, less than two poos per day is NOT normal for a baby less than 6 weeks old.

From week to week: Baby’s weight 

Newborn babies should be weighed weekly for the first month or two of their lives. A well fed baby will regain his birthweight within the first two weeks of life, and continue to grow in length, head circumference and weight over the next few months. Baby will have his most rapid period of growth during the first three months gaining about 150 grams per week, however weight gains will vary from week to week and also from baby to baby. Mother’s milk production peaks during this time at about 750-800 mls per day, and the constituents of her breastmilk are continually adjusting automatically to her baby’s changing requirements as he grows. The rate of baby’s weight gain slows down by about 50% after about three months but a well baby’s physical growth and development continues to astonish and reassure his parents that they are doing a great job in their new roles.

Breastmilk provides the very best nutrition for your baby. Baby will benefit most if he is exclusively breastfed for the first six months of his life (ie no other foods or milk except breastmilk). A breastfed baby does not need additional water; breastmilk contains all the fluid baby needs for hydration. Extra water given orally does not provide any nutrition, however it makes baby less hungry and can cause baby to miss out on feeding which he actually needs. A breastfed baby is likely to feed more frequently during warm weather to quench his thirst, just as adults drink more frequently in warm weather for the same reason.  Water can be given when baby starts solid foods which the World Health Organisation recommends can be offered from around six months of age. ‘Baby Led Weaning’ is an excellent way to introduce family foods. Ideally breastmilk continues to be the main source of nutrition for baby during the second half of his first year of life, and beyond as it continues to provide valuable immune factors throughout toddlerhood.

Buy the book

This is an excerpt from New Baby 101 – A Midwife’s Guide for New Parents, which includes videos How to Breastfeeding Your Baby, How to change a baby’s nappy/diaper – disposable and cloth, and Five Ways to fold traditional cloth square nappies (no pins required!). The eBook is available from the author’s website. New Baby 101 is also available as an App for your smartphone via Google Playstore and iTunes Appstore.