Is My Breastfed Baby Getting Enough?

Becky Flora, BSed, IBCLC

Urine Output
During your baby’s first few days of life his urine output may be minimal. Once your milk becomes more plentiful (“comes in”), you should notice more wet diapers and greater wetness with each one. A good way to measure urine output is to remember that your baby should have one wet diaper per day of life during the first week. Urine should always be pale in color – never orange or brown – and mild-smelling. If you find it difficult to determine if baby has wet, consider placing some tissue in the diaper or switch to cloth diapers for a while until you feel more confident about this. Adequate urine output is a good sign of sufficient hydration.

Stool Output
In the first few days after birth the baby’s dark, tarry stools are known as meconium. This is the stool that the baby has been storing since before birth. Within 24-48 hours of your milk “coming in” your baby’s stools should change in color and consistency. You may notice that they change from dark black to greenish-black to brown, etc. before they turn to the “classic” yellow “milk-stool” of the breastfed baby. The stool should be completely yellow (sort of like the color of mustard) by your baby’s seventh day of life. An occasional green stool is also considered normal. Stools of exclusively breastfed babies should be loose (pea-soup to toothpaste consistency) and unformed, often appearing seedy. The odor should be mild. Most breastfed babies will stool at least 3-4 times per every 24 hours. Stools should be at least the size of a US quarter.

Two factors may affect your ability to assess your baby’s stool output: hyperbilirubinemia (jaundice) and treatment with antibiotics. The lethargy that is common with jaundice and exagerrated with light therapy used to treat this condition can mask the baby’s hunger and cause diarrhea. Antibiotic medication can also cause diarrhea. In these situations a weight check is advised to assure of adequate intake.

While adequate urine output is a good sign of sufficient hydration, adequate stool output is a good sign of sufficient nutrition. “Celebrate stooling and swallowing!” (Linda Shrago, RN, MS, IBCLC)

Once a baby reaches the age of 5-6 weeks he may go several days (7-10 days is not abnormal!) between stools. This is still normal as long as the stool is loose, unformed, and profuse if several days have passed. It should not be treated as constipation which is characterized as hard, dry, pellet-like stools.

The Infant’s Cues
Your baby’s cues can tell you a lot about his milk intake. When a baby first goes to the breast he may wiggle and detach several times. His suck will be like that of a pacifier suck – short and choppy. As your milk “lets down” (within the first minute or so) the baby should begin to settle and become more focused with little or no wiggling or detachment from the breast. His suck will then be more long, drawing, and rhythmic with a wiggle at the temple or ear and a gliding motion along the jawline. During the feeding you should be able to either hear, feel, or see your baby swallowing. He should swallow throughout most of the feeding. “Celebrate stooling and swallowing!”(Linda Shrago, RN, MSN, IBCLC)

Once he is full, he may detach himself from your breast. His arms should be relaxed and he should not be bringing his hands to his mouth or rooting. If you still see signs of hunger – flexed elbows, clenched fists, hands to the mouth, rooting, etc. – put your baby back to your breast. Your breast should feel softer after your baby nurses.

Weight Gain
ALL babies should be assessed by a doctor within one week of birth for normal weight! Babies may lose as much as 10% of their birthweight; however, a loss of more than 5-7% often indicates that help is needed with breastfeeding management. Birth weight should be regained by 2-3 weeks of age. If baby has not regained back to birth weight by 10 days-2 weeks, adjustments may need to be made. Consult with a lactation consultant for assistance in determining if breastfeeding management is optimal for good weight gain.

Once baby is back to birth weight, normal weight gain is about 5-6 ounces per week, although 4-5 ounces is acceptable in some cases. Some babies may gain even more rapidly than this and still be within the norm. This rate continues for the first 3-4 months at which time most breastfed babies normally slow down with weight gain. From 4-6 months of age, average gain is 4-5 ounces per week. From 6-12 months of age weight gain is typically 2-4 ounces per week. At 6 months, the average breastfed baby has doubled his birth weight, At one year, he weighs about 2 1/2 times his birth weight. When figuring weight gain, remember to always figure from the lowest point, usually at some point in the first few days of life and try to weigh baby on the same scales each time in the same weight of clothing or with no clothing at all.

Other Indicators of Growth
Growth in length and head circumference is also an indicator of adequate milk intake. During the first 6 months, normal growth in length is 1 inch per month while normal growth in head circumference is 1/2 inch per month. From 6-12 months of age, your baby should grow an average of 1/2 inch per month in length and 1/4 inch per month in head circumference.

“Red Flags”
If you notice any of the following, have your baby examined by a doctor and consult with a La Leche League leader or lactation consultant as soon as possible:

• Any day with NO bowel movement (up until 5-6 weeks of age)

• Any day with only ONE bowel movement (up until 5-6 weeks of age)

• Stool not yellow by day 7 after birth

• Losing weight after day 5

• Under birthweight at 2 weeks

• Persistent hunger cues, including rooting or hands to mouth, excessive fussiness, excessive pacifier use, extremely drowsy or lethargic

• Yellow bowel movements that revert to consistently green ones.

Becky is a board certified, registered lactation consultant (IBCLC, RLC) in practice with Breastfeeding Essentials in Kingsport, TN. She is the mother of 4 children ranging in ages from 7-13 whom she all breastfed proudly!