Is My Baby Really Getting Enough Milk?

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After your baby is born, s/he will need to eat.  I have written before about informed consent in infant feeding.  Today I am specifically going to address breastfeeding moms.  If you’re formula feeding it’s pretty easy to measure how much baby is getting so “is my baby getting enough” isn’t such a concern.  For breastfeeding moms, though, it’s a very common concern, and one that really needs to be addressed.

Almost everyday I see a mom asking if her baby’s getting enough.  In many cases it turns out that a family member or even a doctor assessed the baby briefly and because the baby seemed hungry frequently, was not gaining weight rapidly, or the mom’s breasts were not large/full suggested that perhaps the baby was not getting enough.  There are a lot of myths floating around about these signs and they need to be addressed.  New moms have enough to worry about without having to sort through misinformation.

Common Concerns

There are many signs that new moms are told to watch out for.  Some are valid; some are really not.  Let’s take a look at them.

“My breasts aren’t very big; I couldn’t be making enough milk.”

Your breast size has nothing to do with your ability to make milk.  The milk is made in the ducts deep inside your breasts.  You may not be able to store quite as much at once, but you can certainly produce just fine.  Also, with every pregnancy, your breasts make more milk ducts and you have an increased ability to make milk.  Chances are if it’s only your breast size you’re worried about, you’re doing just fine.

“I don’t feel letdown when I nurse, so my baby’s not getting anything.”

Most women do feel the “letdown reflex” when they breastfeed, but not all do.  Not feeling it, especially after breastfeeding is established, is not necessarily a sign of baby not getting enough.  If your milk truly isn’t letting down, then your baby would unlatch and cry after a few minutes because s/he was not getting much.  In other words, you would know quickly if this were an issue.  If baby is swallowing and seems satisfied after nursing, then it doesn’t matter if you feel letdown or not.

“My breasts don’t feel full, so my baby can’t get enough.”

Your breasts, especially once nursing is well-established, may not feel very full.  That’s okay.  If you are nursing baby, wait a few minutes after baby latches on, then feel gently around the areola.  If you feel some fullness there, then your milk is letting down and baby is doing just fine.  Even if your breasts are soft at other times, that’s okay.  Your breasts may also be softer during growth spurts because there’s not much stored milk.  That’s okay too.  As long as baby seems generally satisfied, it is not a concern.

“I can’t pump much or anything, so I’m not making enough milk.”

A pump isn’t nearly as effective as a baby, and some women don’t respond to pumps at all.  The amount you are able to pump often does not represent what you are making.  Don’t watch your pump, watch your baby — is baby swallowing?  Nurses happily?  Satisfied when finished?  Having wet and dirty diapers?  Don’t worry about what you pump or don’t pump.

“My mom/sister couldn’t make enough milk, so I’m probably not either.”

Unfortunately well-meaning family members may tell new moms stories about their struggles, which may undermine the new mom’s confidence.  However, please know: you are not the same person.  Just because your mom or your sister struggled to produce milk does not mean that you will.  My own mother struggled and gave up after 3 and 5 months (despite LLL meetings and so on).  I breastfed my babies for years with no problems.  Everyone is different.

“My baby eats very frequently, she must not be getting enough.”

Babies, especially little ones, are designed to eat frequently.  This may be anywhere from every 45 minutes to 3 hours, for newborns.  The “four hour schedule” for a breast-fed baby is basically a myth — the vast majority cannot go that long between meals.  Babies will also eat even more frequently during growth spurts (which are often in the early months), may desire to nurse for comfort even if not hungry, may eat more slowly and seem to be nursing often for this reason (especially while learning), and so on.  There are many reasons why baby nurses frequently!  If baby is having plenty of wet/dirty diapers and seems satisfied after eating (however briefly), things are probably just fine.

“My baby doesn’t sleep through the night yet, breastmilk must not be enough.”

Young babies are not designed to sleep through the night.  In fact, doing so before age 4 months can even be dangerous.  A young baby who falls into a deep sleep is more at risk for apnea, getting overly hungry, not gaining weight well, getting too cold, and also slowed brain development.  Young babies are meant to sleep lightly, often, and eat frequently.  It is not uncommon for exclusively breastfed babies to want to eat every 2 – 3 hours around the clock even at 6 – 8 months.  Breastmilk is digested so rapidly and so well that the baby needs more sooner (another reason why babies eat often).  This is how it is supposed to be.  Babies are not supposed to have their tummies made artificially fuller by the harder-to-digest formula just so they will sleep longer.  A baby who is satisfied in all other ways should not be ‘tricked’ into sleeping through the night.  It may backfire anyway, as some babies do not tolerate formula well, and choosing a formula for those who really need it is not a decision to take lightly.

“My baby isn’t gaining weight very rapidly/is low on the percentile chart for his age.  He needs more.”

Doctors say this one a lot and it drives me crazy.  It is not uncommon for breastfed babies to gain more slowly and to weigh less than their formula-fed counterparts.  It is not wrong for a baby who is born small to remain on the low side of the growth curve.  It is not wrong for a baby to be fairly thin/lean.  If the baby is gaining weight steadily (even if very slowly), is happy, active, satisfied after eating, having plenty of wet/dirty diapers, is meeting milestones, etc. — then exactly how much baby weighs or what his percentile is should not matter at all.  And if a doctor ignores all the other signs and tries to insist upon supplementing only based on numbers on a chart — find a new doctor!

“My baby is very fussy and rarely seems satisfied after eating.”

This may be a sign baby isn’t getting enough.  It may also be a sign that something you are eating is disagreeing with baby.  Investigate your diet — dairy, soy, gluten, and corn are among the top potential allergens.  To see a difference you must cut out all of the offending food(s) including any ‘hidden’ sources in processed food.  If baby is arching back during or after feedings, screaming, seems gassy, has diarrhea (usually bright green), chronic diaper rash, or eczema, these are all red flags for food allergies.  If baby has none of these signs, and isn’t having enough wet/dirty diapers, then a low milk supply may be the culprit.

“My baby spits up a lot and isn’t gaining weight well.”

This is often a sign of food allergies.  Try changing your diet, as above, to see if cutting out offending foods changes anything.  Severe food allergies may lead to a serious lack of weight gain and even failure to thrive, so this issue needs to be addressed, and quickly.  It is not normal for baby to spit up several times a day or to spit up quite a large amount.  (My babies never spit up at all…unless I consumed a food they were sensitive to, then they spit up some.  They never seemed bothered by it and it wasn’t large quantities, but they would quit spitting up entirely when I cut out the problematic food.  Even ‘normal’ spitting up may or may not be normal.)

“My baby doesn’t wet/dirty his diaper very often.”

This is a big red flag, especially in the early days, and needs to be addressed within 24 hours.  If your baby goes more than 4 hours without a wet diaper, try nursing very frequently.  If another hour goes by and there is still no wet diaper, call a doctor.  This especially true if baby is only a few days old as it could be other serious issues and not just a lack of milk.  Now — before you freak out, make sure the diaper isn’t wet.  Sometimes pee only a little bit at once, not completely soak a diaper.  A baby who is wetting lightly but fairly often is probably fine, and sometimes it can be hard to tell if the diaper’s a little wet or not.  If the diaper seems like it might be wet, then just keep watching baby.  Dry lips, skin that doesn’t immediately snap back if gently pinched, or dark-colored urine if/when baby does go are signs of dehydration.  Call if you have a concern.

“My baby is not meeting developmental milestones and seems fretful/hungry.”

Not meeting milestones on time — alone — could be any number of things, not necessarily related to eating.  If baby also seems hungry, doesn’t have many wet diapers, isn’t gaining weight well, then this could be a sign of not getting enough milk.  A baby who is not meeting milestones needs to be assessed, however, to determine what the cause is.

What if My Baby Isn’t Getting Enough?

Some women really don’t make enough milk for their babies.  For many there are ways to increase milk production naturally and safely.  Try these:

• Nursing more often
• Frequent skin-to-skin contact with baby
• Pumping after nursing or in between feedings
• Consuming oatmeal
• Taking brewer’s yeast
• Drinking mother’s milk tea
• Supplementing with fenugreek
• Stopping hormonal birth control (if using)
• Ask your doctor about other potential medication interactions (if you are on anything)
• Drinking plenty of water
• Resting more often
• Consuming more fat (raw olive oil seemed to help me)

For most women who are experiencing a temporary dip in supply or making almost, but not quite enough — these will do the trick.  Some women may benefit from seeking a lactation consultant’s help to see if their baby’s latch is correct, and to find out if their baby may be lip- or tongue-tied, as these can affect nursing quite a lot.  Ask for help and explore ‘uncommon’ avenues if the usual stuff isn’t working!

For women who are simply not making a fully supply despite all of these tips above (and it does happen), supplementing may become necessary.  In this case, please do research on all your options.  Check into donor milk, homemade formula, and various commercial formulas.  Choose the best option for your family.

What concerns have you heard about not making enough milk?  Did you struggle with this?