How to tell your breastfed baby is getting enough milk
by Cordelia Uys, NCT Breastfeeding Counsellor
August 2021
When a baby is bottle fed, it’s easy to tell how much he or she is drinking, and of course this is reassuring. But how can you tell whether a breastfed baby is consuming enough milk?
Newborns:
Nappies:
A newborn baby’s nappy output is the best way of telling whether they’re drinking enough. In the first week, the colour and texture of your baby’s poos will change on a daily basis, and the volume of pee will increase.
Day 1-2:
Pees: 2 or more per 24 hours
Poos: 1 or more meconium poo. Meconium is the substance that is in your baby’s bowel from before birth, and which they excrete in the first couples of the days. It’s black, dark green or dark brown, and extremely sticky.
Day 3-4
Pees: 3 or more per 24 hours. Nappies will be feeling heavier.
Poos: 2 or more per day. Poos will be less sticky and going from dark brown to having a greenish tinge.
Day 5-6
Pees: 5 or more heavy wet nappies per 24 hours.
Poos: 2 or more soft or runny yellow or mustard-coloured poos. These should be bigger than a £2 coin.
From Day 7
Pees: 6 or more heavy wet nappies per 24 hours.
Poos: at least 2 good-sized yellow or mustard-coloured poos. These can sometimes be runny, sometimes seedy, and sometimes have the consistency of curry.
What is a heavy nappy?
A heavy nappy is one weighing 45g or more. You can pour 45ml of water into a clean nappy to get an idea of the weight.
A job for dads or partners
Having one person in charge of nappy changing makes them more aware of the change in poo colour and consistency. And if dads can do the majority of nappy changing, they will quickly become more confident in handling their baby.
Frequency and length of feeds
Breastfeeds can last anywhere between 5 and 45 minutes. How long a baby spends on the breast tells one very little about the volumes they’re consuming. What is very important is for a baby to be feeding frequently, meaning 10 to 14 times from both breasts in 24 hours, or more. 8 feeds in 24 hours is the bare minimum required to establish and maintain a milk supply.
Poos after 6 weeks
We expect breastfeed babies who are drinking enough milk, to poo twice a day for the first 4 to 6 weeks, but after that, some breastfed babies can go a week or more without doing a poo. This isn’t a cause for concern as long as the baby is otherwise well, and the poo is soft and plentiful when it finally arrives. This change in stooling habits happens because the protein content of a mother’s milk alters considerably during the first month. Milk contains two types of milk protein: whey and casein. The proportion of whey to casein in colostrum (a mother first milk) is 90:10, but by around one month this will have changed to 60:40; casein takes longer to digest than whey.
The other important sign that a baby is getting enough milk is their weight. Here’s what to expect:
A 5-7% weight loss when the midwife weighs your baby on day 5 after birth is normal.
A 10% weight loss is sometimes considered normal, especially if your baby’s nappy output is good, but this amount of weight loss might be a sign that you need to see a breastfeeding specialist.
Babies should regain their birth weight by 2 to 3 weeks.
It’s recommended to weigh a baby on the same scales each time, without a nappy or any clothes on.
Weight loss after IV fluids during labour
Any amounts of extended IV fluid during labour will affect birth weight as the baby will be a bit oedematous (waterlogged) at birth due to the fluids. Also, it's good to be aware that if a syntocinon hormone drip is used in labour, it can cause fluid retention and therefore artificially inflate birth weights. In UK hospitals babies are always weighed shortly after birth and that weight doesn't take fluid retention into consideration: http://www.nancymohrbacher.com/articles/2011/10/31/newborn-weight-loss-and-iv-fluids-in-labor.html?fbclid=IwAR3KzMdAt_LPBNCNQMXvpySc6If5eP6eKNg5CvFZievHpfRKM7DBy-S5gSk
Weight loss after a caesarean birth
When babies are born via caesarean, it’s best practice to use their weight at 24 hours as the reference for weight loss, rather than their birth weight, as intravenous fluids given to a woman during a caesarean can be transferred to her baby, and artificially inflate their birth weight. This fluid is excreted in the baby’s urine within 24 hours.
Average weight gain for breastfed babies
Baby’s age Average Weight Gain
0-4 months: 155 – 241 grams per week
4-6 months: 92 – 126 grams per week
6-12 months: 50 – 80 grams per week
Once your baby has regained their birth weight, as long he or she is gaining weight and there are no health concerns, they don’t need to be weighed more than:
Once a month up to 6 months of age
Once every 2 months from 6 to 12 months of age
Once every 3 months over the age of 12 months
Please remember that babies grow in spurts, so frequent weighing past the first couple of weeks can be misleading and make parents worry unnecessarily.
Faltering growth
According to Shel Banks, IBCLC and NHS infant feeding specialist, who contributed to the NICE Guidelines on Faltering Growth:
Broadly speaking, faltering growth should be considered if:
Baby loses more than 10% of their birth weight in the first week of life
Baby has not regained birth weight by the age of three weeks
Baby consistently loses weight after first week of life
Baby falls through the centiles on the UK WHO Growth charts as follows:
More than 1 centile space if baby is born below 9th centile
More than 2 centile spaces if baby is born between 9th and 91st centile
More than 3 centile spaces if baby is born above 91st centile
Waking babies for feeds
Until your baby has overtaken their birth weight and is producing at least 6 heavy wet nappies (45g or more) and 2 good-sized poos in 24 hours, the recommendation is to wake them for feeds if they are sleeping longer than (approximately) 3 hours. A baby who isn’t getting enough milk might not have the energy to wake up and signal their hunger. One four-hour stretch at night should be okay if your baby is feeding frequently at other times.
Links:
NCT What’s in a nappy: https://www.nct.org.uk/sites/default/files/related_documents/What%27s%20in%20a%20nappy%20(ENGLISH%20VERSION)%20FINAL%20WITHOUT%20BLEED.pdf
Dads and nappy changing: https://theswaddle.com/bonding-with-your-baby-change-diaper/#:~:text=But%20studies%20have%20shown%20a,strengthens%20the%20parent%2Dchild%20connection.
Length of feeds: https://www.emmapickettbreastfeedingsupport.com/twitter-and-blog/do-minutes-matter
Caesarean birth and weight loss: https://pubmed.ncbi.nlm.nih.gov/29356561/
Average weight gain for breastfed babies: https://kellymom.com/bf/normal/weight-gain-metric/
How often to weigh a baby: https://www.nhs.uk/conditions/pregnancy-and-baby/baby-reviews/