How to Tell Your Baby’s Gaining Enough Weight on Breast-milk Alone

Veronica Tingzon, IBCLC By Veronica Tingzon, IBCLC, RLC

I picture a breast with lines, little markers like that on a measuring cup, which can indicate to a nursing mom exactly how much her baby is drinking at each feed. If women had that, I think all moms would be more successful at nursing their infants. It’s a funny image, isn’t it? But, I can’t even tell you how many new mothers I see on a daily basis, that tell me they had “no choice” but to give their infant some formula because the little one was “starving” in the first day of life.

Let me ask you this, do you weigh everything you eat? How do you know that you’re eating enough? The same indicators will hold true for your baby as it does for you - the baby will be full! The following will also be good indicators… A baby who is breastfeeding well will be content and alert. He will have regular bowel movements. She will have pale urine. A diaper of some sort, whether it’s pee or poop (or both) may need to be changed at each feed. And, the granddaddy of all indicators, your baby will grow!

Shall we begin with the first week of your baby’s birth, first? This week will be a little different than the rest. You do have milk, however, it’s not like the liquidy, mature milk that’s to come. While you are in your second trimester of pregnancy, you begin to produce the first milk, called colostrum. Colostrum can be a pale (like honey) or creamy yellow (like butter) color. It is thick in substance. It moves very slowly- like molasses, and it is highly concentrated in protein. Your new little bundle will need very little of this to fill him/her up, but the small quantity requires very frequent replenishment. Your baby may go to breast every hour, at times, in an attempt to store up on some calories in order to get some more substantial sleep. This is called cluster feeding. This is very normal behavior, albeit exhausting.

As the more mature, carbohydrate rich milk fills in to the breast at approximately days 3-5 days post-delivery (sometimes a little longer), baby may begin to stretch out her feedings to 2-3 hours between each feed and take less time to feed. The skill of emptying the breast gets better developed as time wears on. Still allow for him to have periods of cluster feeding.

So, what are the true signs that baby is getting enough nutrition at breast? Diaper counts and weight gain are the truest indicators of your baby’s progress. What goes in must come out, so (especially in the first week) write down each time you feed the baby, each poop or pee she has, and what time it occurred. Break each day into a 24-hour chunk. For every 24 hours, baby should have been to breast a minimum of 8-12 times and had a good feeding with signs of milk transfer (swallowing, seeming satiated, acting content after the feeding).

The diaper count will increase day by day and plateau out after the mature milk comes in. The first 24 hours of life, your baby is expected to only wet one diaper and soil one diaper. The second 24 hours of life, 2 of each are expected. The third day of life, 3 of each are expected, and so on. By the fifth day of life, your milk should be pretty abundant. At this point, the diaper count should hold steady at a minimum of 3-4 soiled, poopy diapers and 6-8 pale, wet diapers or more. Your baby may even poop and/or pee at every feeding! Don’t worry; this will slow down around the baby’s second or third month of life.

Baby’s poop will take on different colors depending on the stage of lactation you’re in. Here’s a description of the appearance of the different poops you’ll see in the first week of baby’s life. The first couple of days, you’re baby’s stool will be dark black. This is called meconium. As the meconium is clearing out of the bowels and your milk is in transition from colostrum to mature milk, green transitional stools will appear. Transitional stools almost look like guacamole. Finally, once the fully mature milk is in, the stools will take a loose, yellow look like that of mustard, and it’ll have some seeds in it that look like small curd cottage cheese. More than the size of a quarter can be counted as a true poop, anything less is just a wet stain.

As I mentioned earlier, weight gain is also an indicator of growth. However, initially baby will lose weight! All babies tend to lose some water weight from birth; 5-7% is the typical weight loss. Some babies even lose up to 10% of their birth weight. This is all normal. But, once the mature milk comes in, your little angel needs to start putting the weight back on. The trend is for a baby to gain from ½ oz. to a full ounce per day. The goal is for baby to recuperate her birth weight by the second week of life (or sooner).

How will you know baby’s weight growth? Initially, you’ll be seeing a lot of the pediatrician. Weight checks are done at each doctor’s visit. After the second month, however, you may feel you have no way to gauge your little one’s progress. Now don’t go run out to purchase an infant scale just yet. You can join a breastfeeding support group. An infant scale is provided at those meetings. You can track your baby’s growth there. La Leche League meetings may also have a scale for the same purpose. Some moms even step on their own bathroom scale with their baby and subtract their weight to determine baby’s weight. If there have been some weight gain or low milk supply issues, purchasing an infant scale or making a lactation appointment with a board certified lactation consultant may be a better option for you.