by Jack Newman, MD, FRCPC

Here's What You'll Find Below:Ways to know -- how baby nurses
Ways to know -- baby's bowel movements (poops)
Ways to know -- urination (pees)
Unreliable ways to tell

Breastfeeding mothers frequently ask how to know their babies are getting enough milk. The breast is not the bottle, and it is not possible to hold the breast up to the light to see how many ounces or milliliters of milk the baby drank. Our number obsessed society makes it difficult for some mothers to accept not seeing exactly how much milk the baby receives.

However, there are ways of knowing that the baby is getting enough. In the long run, weight gain is the best indication whether the baby is getting enough, but rules about weight gain appropriate for bottle fed babies may not be appropriate for breastfed babies. In the short term, there are ways to know if baby is satisfied by looking at how well the baby feeds, and even just looking at the baby after a feeding -- is the baby content, satisfied, is he rooting or sucking his hand?

Ways of Knowing

1. Baby's breastfeeding is characteristic. A baby who is obtaining good amounts of milk at the breast sucks in a very characteristic way. When a baby is getting milk (he is not getting milk just because he has the breast in his mouth and is making sucking movements), you will see a pause at the point of his chin after he opens to the maximum and before he closes his mouth, so that one suck is (open mouth wide > pause > close mouth type of sucking).

If you wish to demonstrate this to yourself, put your index or other finger in your mouth and suck as if you were sucking on a straw. As you draw in, your chin drops and stays down as long as you are drawing in. When you stop drawing in, your chin comes back up. This same pause that is visible at the baby's chin represents a mouthful of milk when the baby does it at the breast. The longer the pause, the more the baby got.

Once you can recognize this pause you will realize that so much of what women are told about timing the baby on the breast is meaningless. For example, it is meaningless to suggest to mothers to feed the baby twenty minutes on each side. Twenty minutes of what? Sucking without drinking? Sucking and drinking (some pausing in the movement of the chin)? All long pause-types of sucks? A baby who does this type of sucking (with the pauses) for twenty minutes straight might not even take the second side.

A baby who nibbles (doesn't drink) for 20 hours will come off the breast hungry. Our website nbci.ca shows video clips of drinking at the breast. If the baby comes off the breast while doing this kind of drinking with long pauses, then baby is probably saying, I have had enough. If baby is continually just sucking without drinking (therefore little or no pausing) baby will still be hungry.

Play detective, what is baby's chin doing as he seems to “finish”? If the milk is flowing well the baby can either choose to drink it or take a little break (in fact the baby does not need to suck continuously and most babies do not). If the milk is not flowing well, then baby will be "forced" to just suck without drinking. If this is the case, use compression to help more milk to flow (see information sheet Breast Compression).

2. Baby's bowel movements (stools, poops). For the first few days after birth, the baby passes meconium, a dark green, almost black, substance which has collected in his intestines during pregnancy. It is passed during the first few days, and by the third day, the bowel movements start becoming lighter, as the baby drinks more milk. Usually by the fourth day, the bowel movements have taken on the appearance of the normal breastmilk stool.

The normal breastmilk stool is pasty to watery, mustard colored, and usually has little odor. However, bowel movements may vary considerably from this description. They may be green or orange, may contain curds or mucus, or may resemble shaving cream in consistency (full of air bubbles). The variations in color do not mean something is wrong. A baby who is getting only breastmilk, and is starting to have bowel movements that are becoming lighter by day 3 of life, is doing well.

Without becoming obsessive about it, monitoring the frequency and quantity of bowel movements is one of the best ways, next to observing the baby's drinking (see above, and videos at nbci.ca to see if the baby is getting enough milk). After the first three to four days, the baby should have increasing bowel movements so that by the end of the first week he should be passing at least two to three substantial yellow stools each day. In addition, many infants have a stained diaper with almost each feeding. A baby who is still passing meconium on the fourth or fifth day of life should be seen at the clinic the same day. A baby who is passing only brown bowel movements is probably not getting enough, but this is not a very reliable sign.