How do I know if my breastfed newborn is getting enough milk?

The frustrating thing about breastfeeding

Bottles have numbers on the side.

Breasts do not.

Which is incredibly rude when you have just produced a baby and would quite like some objective data.

The good news is that there are useful measurements.

They just are not feed duration, breast fullness or how much comes out of a pump.

How many wet nappies should a breastfed newborn have?

For an exclusively breastfed baby, ABA says that by five days old, you are looking for at least five wet disposable nappies or six very wet cloth nappies in 24 hours. The urine should be pale rather than dark and strong-smelling.

That is useful data.

In the early weeks, poo matters too. Before around 6–8 weeks, breastfed babies usually have several soft yellow poos each day. After that, some perfectly well-fed babies poo much less often, so wet nappies and growth remain more useful ongoing measures.

Then look at growth

Weight trends matter far more than whether one particular feed lasted four minutes or forty.

Your baby's weight, length and head growth are looked at over time rather than judged from one feed or one day.

If there is a growth concern, that is the point to look properly at milk transfer and feeding rather than simply telling mum to feed less often or top up automatically.

Does feeding every hour mean I have low milk supply?

Young babies commonly feed 8 to 14 times or more each day.

A baby who wants to feed again in an hour may be hungry, increasing demand, seeking comfort, going through a cluster-feeding period, or simply being a baby.

ABA specifically says babies who are getting enough milk may still feed frequently, cluster feed, be fussy and wake often at night.

Does pumping tell me how much milk I make?

This one matters.

If you attach a pump and get 40 mL, you have learned that the pump removed 40 mL.

You have not learned that your breasts only contain 40 mL or that your baby only gets 40 mL.

ABA notes that expressing is a skill and that babies are usually better at removing milk than a pump.

Likewise, soft breasts do not mean empty breasts.

Breasts continue making milk, and feeling less full after the early weeks is normal as supply regulates.

The signs I would care about most

• Nappies.
• Growth.
• Effective milk transfer.
• Baby's colour, tone and alertness.
• Whether feeding is comfortable and sustainable for you.

Not whether the baby fed for seven minutes instead of twenty.

Not whether they wanted another breastfeed soon afterwards.

Not whether your pump produced an impressive bottle for Instagram.

My eldest daughter was an extremely efficient feeder. She would feed for several minutes, max, and gain weight at exceptional rates. For at least the first eight months of her life, she also usually only needed one breast at each feed.

This was despite being told in hospital after her birth that she should have both breasts at every feed and feed for at least 15 minutes. In retrospect, that was an incredibly arbitrary length of time rather than anything based on how effectively she was feeding.

As she grew, she started asking for the second breast and sometimes the third, fourth, fifth or sixth breast 😂. I learned to trust that she would tell me how often and for how long she needed to feed.

By the time I had our second daughter, I was more confident offering a boob when she asked without obsessively checking the time.

Get help promptly if

Get feeding support if wet nappies are below expectations, weight gain is poor, your baby is unusually sleepy or difficult to wake, feeding is persistently painful, or you are worried milk transfer is ineffective.

If you are worried, an IBCLC, midwife or child and family health nurse watching an actual feed is far more informative than trying to infer your supply from the clock.

My second daughter had a tongue tie and upper lip tie noted in the early days, but because she was gaining weight beautifully, we were not initially referred for further feeding support. As my supply increased, though, breastfeeding became more and more uncomfortable, and my gut told me I wanted someone to properly assess what was happening.

We eventually had the ties released, and in our case I noticed an almost immediate improvement in feeding. Looking back, it also made me wonder whether some of the discomfort I experienced feeding my eldest might have benefited from better feeding assessment and support at the time.

That is our experience, not a suggestion that every visible tie needs treatment. Tongue-tie only needs addressing when it is actually affecting feeding, and the evidence around upper lip-tie and breastfeeding is much less clear.

If feeding hurts or does not seem to be working well, an IBCLC or other clinician with breastfeeding expertise can assess the whole feed rather than diagnosing a tie from appearance alone.