How to Determine Baby is Getting Enough Milk

Crying is a late indicator of hunger. Rather than watching the clock it is recommended that a mother watch for signs that her newborn is hungry, such as the rooting reflex, chewing/sucking on hands or fingers, or vocalization. Babies may feed at both beasts or just one breast per feeding. Mother should watch for babt to fall asleep or detach from the breast on his own. 

Often, if nursing is delayed until the crying stage, it can cause stress for both mother and baby. Stress can affect let down by increasing cortisol, which may inhibit or delay the oxytocin (let down) response. Also, a stressed and crying baby may have trouble latching and nursing. It is best to be alert and watch for early hunger cues and not to wait for the late, crying stage.

Meeting growth and developmental milestones and appropriate output should be the focus rather than a specific timetable for feeding. A baby who is breastfeeding well should be gaining weight after day 5 post-partum, and will regain her/his birth weight somewhere between 8 days and 14 days; if it takes longer than that, breastfeeding should be evaluated more closely.29

Some research suggests that babies born to mothers who have significant IV fluid during labor may be born with even more fluid to be shed – if a mother reports a significant weight loss after birth, but nursing seems to be going well in general, ask whether she had IV fluids. (Note: mothers who have had a cesarean section, epidural/spinal anesthesia or treatment for beta-strep will have had IV fluids.)30,31

That said, using growth charts and developmental guidelines can assess overall progress, but with a new baby it’s important to know that s/he is getting enough at most feedings. Assessing diapers in between regular weight checks gives the best overall picture of what’s going on in the early weeks.32

In addition to good “output”, a baby who is nursing well will usually nurse 8 – 12 times a day (that’s a minimum of 8 times in 24 hours in the first month of life). Not only does this allow a baby to get enough calories, it also allows a baby to practice his new nursing skills more frequently. Remind a mother that if a baby nurses 12 times a day, and gets it right 7 – 8 times out of 12, the good skills are reinforced more often than not. If she’s only nursing 6 – 7 times, and 2 or 3 of those don’t go well, the baby isn’t feeling what it’s like to get it right as often.

Babies who aren’t nursing well could nurse less frequently than outlined above, or a lot more frequently. If a baby isn’t getting enough calories, he is likely to conserve energy by sleeping a lot, or nurse all the time to take more calories in.

Once a baby begins to gain weight after birth, she/he should gain somewhere between 4 to 7 ounces a week for the first 2 – 3 months of life (boys are often slightly ahead of girls on growth charts), and be on track to double birth weight by 5 – 6 months of age. Some babies will gain more or less in any given week. At around 6 weeks of life, the stools may become less frequent, even as infrequent as every 3 days for breastfed infants.

Ankyloglossia (Tongue-Tie)

The Academy of Breastfeeding Medicine defines ankyloglossia, partial as, “the presence of a sublingual frenulum that changes the appearance or function the infant’s because of its decreased length, lack of elasticity, or attachment too distal beneath the tongue or too close to or onto the gingival ridge”. Complete ankyloglossia, when the tongue is extensively fused to the floor of the mouth, is exceedingly rare, so the ankyloglossia referred to here is partial.

If the infant has ankyloglossia, the tongue is not able to extend as far out of the mouth as normal, and can prevent the infant from fully elevating their tongue, which can inhibit breastfeeding, by causing nipple pain for the mother as well as decreasing the efficiency of milk transfer. Ankyloglossia is present in about 3.2%-4.8% of full-term infants, but it is present in 12.8% of infants experiencing breastfeeding problems.

The ABM protocol discusses this issue in detail:

“Various methods have been suggested to diagnose and evaluate the severity of ankyloglossia and to determine the criteria for intervention. Short- and long-term consequences of ankyloglossia may include feeding and speech difficulties, as well as orthodontic and mandibular abnormalities and psychological problems…There is a growing tendency among breastfeeding medicine specialists to favor releasing the tongue of the infant to facilitate breastfeeding and to protect the breastfeeding experience. To date, no randomized trials exist to demonstrate frenotomy for ankyloglossia is effective in treating infant or maternal breastfeeding problems.”

They also offer recommendations for management of the ankyloglossia. This may range from “breastfeeding assistance, parental education, and reassurance” to a release of the tongue tie, most commonly the frenotomy, the simple ‘snipping’ of the tongue-tie. It could also involve “excision with lengthening of the ventral surface of the tongue or a z-plasty” but those procedures have additional risks of general anesthesia.  For more information visit:  ABM Protocol #11