How Much Milk does My Baby Need & Is My Baby Getting Enough Milk?

 

Day	24hr volume produced	Infant intake	Stomach capacity
1	37ml (7 - 123ml)	few drops - 5ml/feed	7ml
2	84ml (44 - 335ml)	5 - 15ml/feed	13ml
3	408ml (98 - 775ml)	15 - 30ml/feed	27ml
5	705ml (452 - 876ml)	45 - 60 ml/feed	57ml
1 - 6 months	800ml (478 - 1300ml)	30 - 135ml/feed	not available

How often to feed?

In a study of 71 thriving, exclusively breastfed infants ranging in age from 1 to 6 months, it was observed that the infants:

• averaged 11 feeds (range 6 - 18) per 24 hrs
• 10 of the babies always fed from both breasts each feed
• 19 babies always fed from one breast each feed
• 42 infants sometimes fed from both breasts and sometimes fed from only one
• 2/3 of babies fed at night, and had their biggest feed at this time, consuming 20% of their total daily intake.

These researchers concluded that mothers should respond to their babies' cues rather than striving to be average.

So what are feeding cues?

Responding to early feeding cues is the most effective way to meet the infant's needs.
Mothers need to know they can learn their infant’s feeding cues, and by responding to the early cues their infant need not become distressed before feeds:

• Early cues
  • wiggling, moving arms or legs
  • rooting, fingers to mouth
• Mid cues
  • fussing, squeaky noises
  • restless, crying intermittently
• Late cues
• full cry, aversive screaming pitch, color turns red

So is my baby getting enough milk?

• After most feeds, baby will appear calm 
• Baby's mucous membranes (etc lips) is moist
• Urine output & change in stool colour (If it's coming out, it must have gone in!) Important for parents to understand!
• Baby's growth (according to weight on growth chart)

Day	Urine Output	Stool Output
1	one or more wet nappy/diaper	one or more meconium stools
2	two or more wet nappies/diapers	one or more meconium/transitional stools
3	three or more wet nappies/diapers	transitional stool
4+	6 to 8 thoroughly wet nappies/diapers, with clear urine	soft, yellow, curdy (at least daily until about 6 weeks)

Meconium Stool

Transitional Stool

Yellow, seedy Stool

What about my baby's growth?

Evidence shows that formula-fed infants deviate substantially from healthy breastfed infants. In 2006, WHO released the WHO Child Growth Standards which were developed over nine years of collected data from a Multicentre Growth Reference Study (MGRS) of 8440 healthy breastfed infants from a wide international sample of six countries.

These growth curves provide a single international standard that represents the best description of physiological growth for all children from birth to five years of age and establish the breastfed infant as the normative model for growth and development. 

Please ensure that your paediatrician uses the WHO growth chart and not the previously used growth charts (National Center for Health Statistics/World Health Organisation) which were based predominantly on artificially-fed infants and early introduction of solids,and are now considered outdated and should no longer be used. 

Here are some RED FLAG signs of when you should be worried:

1. Output is LESS than expected.

Output is a direct indicator of intake.
You should be concerned if your baby's urine is concentrated or smelly, and lack of daily bowel motions or green, scant starvation stools, and encouraged to make an urgent appointment with your health care provider.

2. Breastfeeding is painful.
Breastfeeding should not be painful!
Nipple damage is always the result of an abnormality in breastfeeding. Poor milk transfer to the infant is frequently associated with nipple pain or damage.
Painful breasts may be a symptom of severe engorgement, or mastitis.
Please seek immediate help from an expert in breastfeeding management.

3. Increasing jaundice.
Jaundice is a normal physiological state for the majority of breastfed infants. It peaks at Day 3 then gradually fades.
Increasing jaundice causes sleepiness and poor feeding; and conversely, poor feeding causes increasing jaundice. Jaundice should not be seen below the level of the umbilicus or extremities. If you suspect your infant has increasing jaundice,consult your infant's health professional. 

With all these information given, we still cannot conclude a "one size fit all" method of ensuring baby is getting enough milk and growing well, because there are various individual cases which cannot be fitted into the normal variant like for example:

• Child was born large, but is genetically determined to be slighter - or vice versa.
• Child has had a temporary illness, losing weight which will be quickly regained when healthy again.
• Inadequate nutritional sustenance to support growth; or excessive, or poor quality foods causing obesity.
• Chronic illness that prevents normal growth.

 So it is best to consult a paediatrian which has ample knowledge on breastfeeding with regards to this.