"How do I know my baby is getting enough?" is one of the questions I am asked more than almost any other. Because you cannot see how many millilitres your baby has taken from the breast, the worry is completely understandable. In my experience most parents who ask me this have a baby who is doing just fine, they simply have not been shown what to look for. The good news is that your baby's body gives you clear, reliable signs. Here is what matters.
The most reliable signs
What comes out is the best guide to what is going in. In the first week, nappies change day by day as your milk comes in:
- Wet nappies: roughly one on day one, building up so that from around day five your baby has at least six heavy wet nappies in 24 hours. Urine should be pale and odourless.
- Dirty nappies: by day four or five, at least two soft yellow poos a day, each around the size of a £2 coin or bigger. Frequent yellow poos are a reassuring sign of good milk intake in the early weeks.
Feeding behaviour. A baby who is feeding well usually:
- Feeds responsively through the day and night. Many newborns feed 8 or more times in 24 hours, though some content, thriving babies feed a little less often, and that is fine if they are growing well. You can read more in How often should a newborn feed.
- Has a deep, comfortable latch and rhythmic sucking, with pauses where you can see or hear swallowing.
- Comes off the breast on their own and seems settled or sleepy after most feeds.
Weight and growth. Some early weight loss is normal, and most babies are back to their birth weight within the first two to three weeks. After that, steady weight gain along their centile is the clearest longer-term sign that feeding is going well. See Newborn weight loss, what is normal and when to worry for more.
What is not a reliable sign
The thing I spend most time reassuring parents about is that plenty of normal newborn behaviour gets misread as "not enough milk". These are usually not cause for concern on their own:
- Feeding often, or for a long time. Frequent feeding is normal, and is how your baby builds your supply. It is not proof it is low. See cluster feeding for more.
- Fussiness in the evening, or wanting to be held and fed a lot.
- Feed length. An effective feed can take anywhere from about 5 to 40 minutes, and some babies stay on the breast longer just for comfort. How long a feed takes, on its own, tells you very little.
- How much you can pump. A pump is far less effective than a baby at removing milk, so what you express is not a measure of your supply.
- Your breasts feeling softer after the first few weeks. That is normal as your supply settles to meet demand. If you are still worried, read Is my milk supply low.
When to get help
Most of the time, feeding is going better than it feels. But some signs do need prompt attention.
Contact your midwife, health visitor or GP if:
- Your baby has fewer wet or dirty nappies than described above, or dark, strong-smelling urine.
- Your baby is very sleepy and difficult to wake for feeds.
- Feeding is painful, or your baby never seems settled after feeds.
- You are worried about weight, or your baby seems unwell.
Call 999 or take your baby straight to A&E if your baby:
- Is floppy or unresponsive
- Will not wake for feeds
- Is having trouble breathing, or their lips, tongue or gums look blue or grey
- Has a sunken fontanelle
- Is visibly jaundiced and unwell with it, for example floppy, hard to wake or not feeding. Yellowing shows most clearly in the whites of the eyes, the gums, and the palms and soles
- Has dark urine or pale, chalky stools
How a consultation helps
When a parent books me because they are not sure their baby is getting enough, a feeding assessment takes the guesswork out of it. I watch a full feed from start to finish, check the latch and how well your baby is transferring milk, weigh your baby on my scales, and go through their nappies and growth with you. More often than not I am able to reassure you that all is well. Where it is not, we find the reason together and make a plan.