Protocol to Increase Breastmilk Intake

by Jack Newman, MD, FRCPC

Most mothers have lots of milk or could have had lots of milk if they had gotten off to a good start and had good hands-on help. The problem is often that the baby is not getting the milk that is available. Sometimes mothers seem to have a lot of milk which flows very quickly at the beginning of a feeding, but the baby fusses or falls asleep when the flow slows down later in the feeding. Although the following symptoms are not necessarily due to the baby's not getting enough milk flow from the breast, this Protocol can be used to help resolve concerns about:

  • The sleepy or "lazy" baby. Babies are not lazy, incidentally. They respond to milk flow and if flow is slow, they tend to sleep at the breast especially if they are under a few weeks of age. Babies also seem to want to "use the mother as a pacifier." Yes, sucking is pleasurable for the baby, but if the baby gets better milk flow and is truly "full" often the baby won't want to just suck at the breast.
  • The baby who pulls or fusses at the breast.
  • The baby who is fussy or "colicky" (see also the information sheet on Colic in the Breastfed Baby).
  • Frequent or long feedings or the baby who does not seem to wake up for feedings.
  • Jaundice (see also the information sheet on Jaundice & Breastfeeding).
  • A too-rapid milk flow, "Over-active letdown," babies choking or coughing at the breast or breasts that don't seem to drain adequately.

To Ensure the Baby Drinks as Well as Possible

1. Get the best latch possible. In order to accomplish this it is best to get help from someone who knows how to help mothers with breastfeeding. Anyone can look at the baby at the breast and say the latch looks good. We tend to teach the latch differently from most others. Naturally we think our approach is very effective and often is.

A baby latched on well is on the breast asymmetrically, covering more of the areola with his lower lip than his upper lip, with his chin in the breast but not his nose, and his head is slightly tipped backwards compared to the rest of his body. When the baby is latched on well, the mother has no pain, and the baby gets milk well from the breast. See the information sheet When Latching and the video clips at the website nbci.ca. Get good "hands-on" help.

2. Know how to know a baby is getting milk. When a baby is getting milk, he will have an open mouth wide -- pause -- close mouth type of suck. He is not getting milk just because he has the breast in his mouth and is making sucking movements. When he is sucking and not getting milk his chin moves down and up rapidly with no pausing of the chin at the maximum opening -- this means "I am not getting milk flow into my mouth."

If you wish to demonstrate this to yourself, put your index finger into 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 will come back up.

This pause that is visible at the baby's chin represents a mouthful of milk when the baby does it at the breast. Actually the baby does this pause when he gets milk from finger feeding or a bottle, too. The longer the pause, the more milk the baby got, so it is obvious that the frequently advised "feed the baby 20 minutes on each side" makes no sense. A baby who drinks very well (as opposed to sucking without drinking) for say, 20 minutes straight, will likely not take the other side. A baby who nibbles (doesn't drink) for 20 hours will come off the breast hungry. You can see video clips of babies drinking (or not) at the website nbci.ca.

Note that when baby stops sucking, "taking a break," this is not the pause we are referring to. Note also that it is normal for babies not to suck continuously without a break. Just ensure that when he begins to suck again he is also drinking.