How do I know if my baby is getting enough breast milk? The signs that count

A breastfed baby is getting enough milk if they have 6 or more wet nappies a day from day 5, are gaining weight steadily and you can hear them swallowing during feeds. You never see the amount go in, and you do not need to.

That last part is the bit nobody tells you. With a bottle you can read the ml off the side. With breastfeeding the evidence is indirect, which is why so many parents lie awake convinced there is not enough. Here is what to look at instead, and when a worry is worth a phone call.

How do I know if my baby is getting enough breast milk?

There are six signs, and you want most of them, not all of them on every single feed.

• Wet nappies. 6 or more in 24 hours from day 5 onwards, with pale urine.
• Poos. Regular soft yellow poos in the early weeks, usually several a day once your milk is in. After about 6 weeks some breastfed babies go days between poos and that is normal.
• Weight. Back to birth weight by 10 to 14 days and then a steady climb, which the PHN checks.
• Swallowing. You can hear or see swallows during the feed, a quiet "kah" sound after every one or two sucks once the milk is flowing.
• Softer breasts. Your breasts feel softer and lighter after a feed than before it, especially in the first weeks.
• A settled baby. A baby who is content after many feeds. Not every feed. Newborns are also unsettled because of wind, tiredness and simply being new here.

If the nappies and the weight are in order, the baby is getting enough, regardless of how short a feed seems or how often they want to go back on. The general guide to feeding enough covers the same signs for bottle-fed babies, and if you are combining or topping up, the how much formula guide has the amounts.

How many wet nappies means enough milk?

6 or more wet nappies in 24 hours from day 5. Before that the count builds up day by day, roughly one wet nappy on day 1, two on day 2, three on day 3 and so on, because your milk is only coming in around day 3 to 5.

A "wet" nappy with a modern disposable can be hard to judge, because they soak everything up so well. A properly wet nappy feels heavier than a dry one, like about 3 tablespoons of water poured in. If you are not sure, pour that much into a dry one and feel the difference. Urine should be pale. Dark yellow or orange urine, or orange brick-dust marks in the nappy after day 4, means ring your PHN the same day.

How often should a breastfed newborn feed?

8 to 12 times in 24 hours, and the feeds will not be evenly spaced. Some will be 20 minutes apart and some 3 hours apart, with a long stretch of near-constant feeding in the evening. That works out at a feed roughly every 2 to 3 hours on average, counted from the start of one to the start of the next, but averages are not what a newborn does. Our guide to how often a newborn feeds goes into the first days in more detail.

Feed on cue rather than by the clock. Early cues are rooting, hand-to-mouth, lip smacking and stirring from sleep. Crying is a late cue, and a crying baby is harder to latch, so try to catch them before that. In the first 2 weeks, if a baby has gone 3 to 4 hours without feeding, wake them.

How long each feed lasts varies as much as how often. Some babies are done in 10 minutes, some take 40. Let the baby finish the first breast, then offer the second. The amount a breastfed baby takes is not measured and does not need to be.

Is cluster feeding a sign of low supply?

No. Cluster feeding, where a baby feeds almost back to back for two or three hours, usually in the evening, is normal newborn behaviour. It is the single most common reason parents decide their supply has dropped, and it is almost never that.

Two things are going on. Evening milk is naturally a bit lower in volume and the baby is tanking up before a longer sleep. And frequent feeding is exactly how a baby tells your body to make more milk, so cluster feeding is building supply, not reporting a shortage. It peaks around 2 to 3 weeks and again during growth spurts, then eases.

Speaking of which: expect a growth spurt at about 2 to 3 weeks, 6 weeks and 3 months, when feeds suddenly increase for a few days. Same rule. Feed to the cues, check the nappies and it settles.

What does a good latch look like?

The latch is where most early feeding problems start and where most of them are fixed. A good latch looks like this:

• A wide open mouth, like a yawn, taking in a big mouthful of breast, not just the nipple.
• Chin touching the breast and the nose free or just brushing it.
• More areola visible above the top lip than below the bottom lip.
• Rounded, full cheeks rather than dimpled or sucked in.
• No pain after the first few seconds. A brief pull as the baby latches is normal. Pain that continues through the feed is not.

To get it, line the baby's nose up with the nipple, wait for the wide gape, then bring the baby to the breast quickly with the chin leading. If it hurts, slide a clean finger into the corner of the mouth to break the seal and try again. A poor latch is fixable in one session with someone who knows what they are looking at, so if it is still hurting after the first few seconds of every feed, get help now rather than in a week.

How much weight should a breastfed baby gain?

Most babies lose some weight in the first few days, usually up to about 7 percent of birth weight, and are back to birth weight by 10 to 14 days. After that, a rough guide for the first 3 months is about 150 to 200 g a week, though it comes in fits and starts rather than a neat line. The PHN weighs the baby at the home visits and clinic checks and plots it in the child health record. Our guide to newborn weight gain explains the centile lines.

Weight is the sign that overrides all the others. A loss of more than 10 percent of birth weight, or not regaining birth weight by 2 weeks, needs a PHN or GP review that week, and often a feeding plan alongside it. Do not weigh at home on kitchen scales, the numbers will drive you mad. Let the PHN do it on the same scales each time.

Where can I get breastfeeding help in Ireland?

First, the signs that mean ask for help sooner rather than later:

• Fewer than 6 wet nappies a day after day 5, or dark urine
• Weight loss beyond 10 percent, or not back to birth weight by 2 weeks
• A very sleepy baby who does not wake to feed, or falls asleep within a minute or two of every feed
• Painful, cracked or bleeding nipples
• A baby who is unsettled after every feed and never seems satisfied

And the people who can help:

• Your public health nurse. The PHN visits in the first days and you can ring the health centre between visits. They will weigh the baby and watch a feed.
• Hospital lactation consultants. Most maternity hospitals run a breastfeeding clinic or a phone line you can use after discharge. Ask the ward before you go home.
• Cuidiu breastfeeding counsellors and local support groups, and La Leche League groups, both run by trained volunteers who have breastfed themselves. Both are free.
• HSE mychild.ie breastfeeding pages, which include a live chat with a lactation consultant and a list of local groups.

Nobody at any of these will think you are wasting their time. The earlier a feeding worry is looked at, the easier it is to fix.

How do I keep count of feeds and nappies when I am this tired?

For the first days, a notepad by the bed works. Time, which side, wet or dirty. It is only when the PHN asks "and how many wet nappies yesterday?" and you genuinely cannot remember whether it was four or seven that the notepad starts to fall down. Lullagram logs each breastfeed by side and length with a tap, counts the wet and dirty nappies beside it and shows the 24-hour totals so you can answer the PHN with numbers instead of a guess. Both parents see the same log. It is free to try on Android, iPhone and web.

This is a guide, not medical advice. If you are worried about your baby, ring your PHN or GP.