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How Do I Know My Baby is Getting Enough Breastmilk?
By Sherri Hedberg, IBCLC

A question often asked by breastfeeding mothers during the early weeks, but not as difficult to answer as you may think. These are the sure signs that your baby is thriving on breast milk.

Wet Diapers and Bowel Movements - an exclusively breastfed baby should average 6-8 wet diapers and 2-5+ BMs in 24 hours after the first 3 days of life. (Before that time, he should have at least one BM per day of life. Example: 1st 24 hours = 1 BM, 2nd 24 hours = 2 BMs, etc. in addition to wet diapers.) Remember that disposable diapers can hold several wets in each. If you want to be sure, simply place 1/4 c of water in a disposable diaper and place it next to the changing table. You can 'weigh' a diaper to estimate how many wets are in it. You will also notice a change in the color and consistency of BMs as your mature milk comes in. They will change from the 'tarry' meconium to a mustard colored (or green) cottage cheese consistency - this is the breast milk stool. It will be very loose, sometimes just a smudge on the diaper, and have a sweet odor.

Frequency of Breastfeeding - In the early days, babies should be breastfed an average of every 2-3 hours during the day and at least every 4 hours at night. Nursings usually last approximately 30 minutes. Don't be surprised if your baby doesn't fall into the 'average' category. He may very well want to nurse more often and that is just fine. We do get worried when a baby is going for long stretches between nursings (more than 4 hours during the day) because usually these babies do not nurse well once they are put to the breast - often termed 'sleepy babies', these babies are at most risk of getting insufficient milk. Don't be afraid to wake your baby to nurse. Again, don't be afraid to wake your baby to nurse! In time, these babies will begin to self-wake to feed, but you may need to coax them a bit in the beginning. We also look for other signs of breast milk transfer such as swallows during nursing and the baby acting satisfied at the end of the feeding. But remember that wet diapers and BMs are a more accurate way of judging how much your baby is getting. There are some babies who just come out being very efficient nursers who can get all the milk they need in a short amount of time.

Weight Gain - On average, babies usually gain 4-6 ounces a week during the early weeks. There are also other signs of growth such as length and head circumference. Also, genetic factors can play a part here. If you and/or your partner are thin/tall, then your baby may follow along your same path and grow quicker in length than in weight. Illness can also affect weight gain. It is very important to look at the entire picture when there is concern over weight gain. If a baby is otherwise doing well, having good diapers and healthy, then there is little reason to worry.

If you ever have a concern that your baby isn't getting enough, call and talk to a trained health care professional before you reach for the formula. Since offering a supplement too early can actually do harm to your milk supply, it is important to be sure it is absolutely necessary. Often times it is the mother's perception that the baby isn't getting enough rather than fact. This is particularly true during growth spurts that occur around 2 weeks, 6 weeks, 3 months and 6 months. All of a sudden a baby will ask to nurse more often and the mother may think he is not getting enough when he is simply trying to get the milk supply ready for the spurt. So, pick up the phone before rushing to the store.

Also feel free to pop in to the pediatrician's office for a weight check if you need to. Anything that is going to give you the security you need to be sure your baby is doing well is fine. And remember that you know your baby best . . . you will know when there is a problem well before it becomes critical - and there are many things that can be done to increase your milk supply should it become necessary.

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