Nurture with Lydia: Breastfeeding Red Flags
Signs your baby may not be getting enough milk, how to notice them and what to do about it. Guest blog written by Lydia Emmanuel-Desir (Nurture with Lydia), Breastfeeding Counsellor and mother to a 2 year old.
Whilst breastfeeding is natural, it’s also a learned skill that no one is expected to master straight away. It takes a little time to get the hang of it, but it’s also important to ensure your baby consumes enough milk to grow and thrive whilst you’re still learning.
It can feel difficult to know whether breastfeeding is going well, especially when you’re at home with your baby trying to figure things out. Read on to learn how you can tell if your baby is getting enough milk and what to do if they aren’t.
Slow/no weight gain
Babies tend to lose some weight in the days following their birth, and they should regain their birth weight within the first couple of weeks. And how does a baby gain weight? Total volume of milk consumed. So it’s really important to get breastfeeding off to a good start to ensure they are transferring enough milk. Your baby should be weighed regularly by a midwife until they’re discharged, but there will be a weigh-in centre that you can take your baby to if you’d like to have them weighed.
If your baby is slow to gain weight, hasn’t gained any weight or has lost too much weight, you may be advised to supplement (“top up” each breastfeed with formula or expressed breastmilk). It’s important to get feeding support alongside any supplementation and find the root cause of the poor weight gain, otherwise the additional milk is just masking the problem rather than fixing it.
Once your baby regains their birth weight it’s important to ensure that they continue to gain weight steadily and, if they were supplemented with additional breastmilk or formula for a period of time, then it’s helpful to monitor their weight if you transition back to exclusive breastfeeding. Getting to the root cause of the slow weight gain with skilled feeding support is crucial, otherwise the problems will likely return once you stop supplementing with additional milk.
Less than 8 feeds in a 24 hour period
Your baby should be feeding a minimum of 8 -12 times in 24 hours – 7 would be too little. It’s also normal for your baby to feed much more frequently than 8-12 times, so just make sure to feed responsively and lean into cluster feeding as this is your baby’s clever way of stimulating your milk production and increasing your milk supply. Expect cluster feeding (a period of very frequent feeding) in the early days and sporadically throughout their first year of life.
If your baby is having less than 8 feeds in a 24 hour period then you’ll need to wake them more frequently for feeds. Sleepy newborns can sleep through their hunger cues and then wake up very hungry and frustrated so ensuring they’re offered the breast frequently means that they will hopefully be more content. Ensure they’re also alert before they latch to ensure they can stay awake and actively feed.
After a few months you may find that your baby starts to feed less than 8 times – if they are thriving in every other way, it’s not a cause for concern. It’s a natural reduction in feeds as they become more efficient at feeding and transferring milk.
Insufficient nappy output
Enough wees and poos is a really helpful sign that milk is going in and that your baby is hydrated – especially between weigh-ins. Nappy output expectations differ depending on your baby’s age. Below are the number of wet and dirty nappies for the first 4 weeks of your baby’s life.
Image caption: Source: UNICEF mother’s breastfeeding checklist
Feeds are too short or too long
A feed should generally be between 5 and 40 minutes. If a baby latches and falls asleep quickly at the breast, they are not actively feeding and it wouldn’t be counted as a full feed. If they feed for longer than 40 minutes it can be an indication that they’re not transferring milk very well.
The lengths of feeds with vary as they won’t need the same amount at every feed, and if there’s a period of cluster feeding then it’s normal for them to go on and off having smaller feeds each time. But, generally, you should find that most feeds are between 5 and 40 minutes. If they are consistently outside of these time frames you may find that other red flags in this article also become apparent. Seek skilled feeding support as soon as you can and try to get a face to face feeding assessment so that you can get feedback and advice to improve breastfeeding for you.
Pain when breastfeeding
When you first start breastfeeding, it’s normal to feel a little discomfort as you get used to your baby sucking on your nipples so frequently. But there should not be constant pain, and you shouldn’t have to soldier on or suffer during feeds. Whilst pain is not normal, it is common in the early days and weeks and you get the hang of breastfeeding. This is because your baby’s latch may be shallow during the feeds, especially if you don’t get face to face support early on to help you latch your baby well.
A shallow latch means that your baby is clamping down on your nipple using the hard palate at the top of their mouth rather than the soft palate further back in their mouth. This is why it’s important to understand how to achieve a deep latch and avoid any nipple trauma.
Behaviour during and between feeds
Observing your baby’s behaviour can indicate whether they’re able to latch and feed well or not. If feeding is going well then your baby should relax into the feed. It might be a bit of a faff getting them latched, they may come off and on and squirm around – they may cry sometimes as they are very hungry – but once they’ve latched, stimulated your letdown and the milk is flowing, they should relax more.
Between feeds it’s also great to see them have small periods of being awake and content, even if they show hunger cues very soon after. A hungry baby will not seem content between feeds so this is a good indicator that they were satisfied with their previous feed. Of course a lot of babies won’t be awake much at all but these periods of contentedness should increase as they get older and more alert.
Audible & visual swallowing
A baby’s swallow reflex is driven by enough milk pooling in their mouth. Watch your baby feeding and try to recognise their suck-swallow pattern; when they first latch they will suck continuously to trigger your letdown and get your milk flowing. After that they will fall into a suck-swallow pattern. A suck is more of an up and down jaw movement, whereas a swallow has more of a wave like motion. They will also start to puff out a little bit of air after they swallow which you’ll be able to hear.
These are encouraging signs that baby is consuming milk. If you only see sucks and no swallows, then please seek support.
What do I do if baby isn’t getting enough?
Seek skilled feeding support. Whether that’s the infant feeding team at your local hospital, local charities and support groups or a private feeding specialist like myself – support is out there. Unfortunately it’s not as readily available as it should be, but there’s lots of options if you need to find support.
If breastfeeding is not going well and you’re advised to supplement each feed with additional expressed milk or formula, this is a short term fix to increase your baby’s weight. Of course it’s important that your baby is well and healthy, but it’s also important to protect your milk supply by draining your breast as frequently as your baby would normally breastfeed (8-12 times in 24 hours) and seeking support to find the root cause of your challenges and help you to get things back on track.
My top tips if you'd like to breastfeed:
Prepare your support! If you do encounter any breastfeeding challenges, you can get help swiftly if you've already done the research. Speak to your midwife during pregnancy, ask family/friends/colleagues about any recommendations of support groups, do your own research and find out what level of support is in your community.
You can follow Lydia on Instagram and visit her website, Nurture with Lydia to learn more about all types of feeding. If you'd like to book an antenatal or postnatal session with Lydia, email hello@nurturewithlydia.com.
