How to Tell If Your Baby is Getting Enough Milk from Breastfeeding

By Michelle Roberts, registered nurse and certified lactation consultant at CHOC Children’s

Every year in August, we celebrate World Breastfeeding Week. This year’s focus is “Sustaining Breastfeeding Together.” As a lactation consultant, the most common question I get from parents of a breastfed infant is, “How do I know my baby is getting enough?” When we bottle feed an infant we can look at the measurements on the bottle to determine the exact amount that a baby gets. When a mom is breastfeeding, she may be concerned because she can’t see the amount taken. A common reason women give up on breastfeeding is feeling they are not producing enough milk.

Here are 5 key indicators a baby is getting enough milk directly from the breast.

  • Breastfeeding 8-10 times minimum per day. Newborn babies should be breastfed a minimum of 10 times per 24 hours. As the baby gets older and is gaining appropriate weight, they may cut back to 8 times per 24 hours. We recommend keeping a breastfeeding log. Start by downloading a template breastfeeding log.
  • Latches well and maintains latch. Babies should latch and remain latched without coming on and off throughout the feeding. It can be difficult to transfer adequate milk if they are not staying on the breast. For the most part, breastfeeding should not be painful. If you are experiencing bleeding or scabbing, the latch is not deep enough and can lead to low weight gain and low milk supply.
  • Audible swallowing. A baby’s suck pattern and frequency of swallowing will change throughout the first three to five days. When a baby is first born, they will be sucking more often than swallowing but as mom’s milk supply increases, the swallowing should increase too. Mom’s milk usually increases between Day Three and Day Five after giving birth.
  • It is important to track a baby’s diapers to make sure they are producing enough diapers based on their age. Your birth hospital or your pediatrician will provide you with a diaper log that will show you how many wet and dirty diapers are expected based on your baby’s age.
  • Weight Gain. All newborn babies lose some weight shortly after birth. Your pediatrician will determine if they lose too much weight. Once mom’s milk supply has increased in volume, the baby should gain an average of 1 oz. per day.

What do you do if you are not sure your baby is getting enough at the breast?

Your pediatrician is always a great person to help you determine whether your baby is doing well. It is also helpful to reach out to women in your life that have breastfed. Call your mom, your sister, a neighbor or a friend for support. It is also beneficial to be aware of your resources within your community. Most birth hospitals have lactation consultants that can work with you on an outpatient basis. A lactation consultant will be able to determine the amount of milk a baby transferred from your breast to your baby’s stomach by using a breastfeeding scale. They can also assist with supplementing at the breast directly.

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World Breastfeeding Week is Aug. 1-7

CHOC Children's Clinical Nutrition and Lacation ServicesBy Joanne DeMarchi, MA, RD, IBCLC, lactation consultant at CHOC Children’s

In recognition of World Breastfeeding Week (WBW), below are some helpful guidelines for working moms who wish to breastfeed.

WBW is celebrated every year in more than 170 countries. Its purpose is to encourage breastfeeding and improve the health of babies around the world. It also encourages government agencies, professional health organizations and advocates to work together to promote awareness of the many benefits of breastfeeding. This year’s theme, “Breastfeeding and Work – Let’s Make it Work!” revisits the 1993 WBW campaign on the Mother-Friendly Workplace Intitiative. Much has been achieved in 22 years of global action supporting women in combining breastfeeding and work.

The American Academy of Pediatrics (AAP) recommends exclusive breastfeeding after birth and continuing until a baby is at least six months old. Nutritious complementary foods should then be added while a baby continues to be breastfeed for one year or beyond.

According to the Centers for Disease Control and Prevention (CDC) Breastfeeding Report Card – United States 2012, exclusive breastfeeding rates in California are 21.7 percent. Although these rates are improving every year, supporting breastfeeding mothers who return to work is key to increasing these numbers. Breastfeeding mothers are encouraged to use these strategies:

  1. Buy or rent a double electric breast pump before returning to work. Breast pumps are a covered benefit under most insurance plans. Choosing a high-quality electric pump is particularly important for working moms.
  2. Utilize professional support to solve breastfeeding issues. Most birth hospitals offer lactation consultations. WIC and La Leche League support groups are available in most communities. Kellymom.com posts helpful evidence-based information for breastfeeding moms.
  3. When moms return to work, they can utilize a pump room at their worksite. The Patient Protection and Affordable Care Act requires employers to provide “reasonable break time and a place” for an employee to express breast milk.
  4. Breastfeeding may lower health care costs, fosters better employee retention rates, and boosts productivity and loyalty to employers.
  5. The USDA provides a variety of breastfeeding resources at http://wicworks.nal.usda.gov/breastfeeding.

 Learn more about CHOC Children’s Clinical Nutrition and Lactation Services.

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Benefits of Breastfeeding

Mother_Breast_feedingBREAST MILK BENEFITS FOR MOM AND BABY
“Breast milk is the ideal food for babies. It has the vitamins, protein and fat that a baby needs to grow. It’s easy to digest, contains antibodies that help the baby fight off illnesses and lowers the baby’s risk for having asthma, allergies and becoming obese,” says Dr. Bixby, CHOC’s medical director of lactation services. Babies exclusively breastfed for the first six months also tend to have fewer ear infections, respiratory illnesses and diarrhea, Dr. Bixby says. Plus, breastfeeding helps mom and baby bond. The American
Academy of Pediatrics, the American College of Obstetricians and Gynecologists, and the World Health Organization all strongly recommend breastfeeding. And, it’s free!

BENEFITS OF DONOR MILK
In the case where a mom can’t produce or sustain her own milk supply, for whatever reason, donor human milk is an excellent alternative to a mother’s breast milk or formula, says Dr. Bixby. “Donor milk isn’t as good as the mother’s own milk but it’s way better than formula, especially for preterm babies or those with gastrointestinal or digestive issues that make it harder for the baby to digest food. Breast milk is designed to help move the gut better. It is a limited resource so at CHOC, we mostly use donor milk for preterm babies under 32 weeks old and also at times for some of our surgical patients.”

LACTATION SERVICES AT CHOC
CHOC’s Clinical Nutrition and Lactation Services department seeks to be a helpful source of nutrition and lactation information for patients, their families and the community. Individualized, family-centered and culturally sensitive lactation care is part of CHOC’s interdisciplinary approach to healthcare and wellness. CHOC has board-certified lactation consultants on hand to help patients who are breastfeeding or receiving donor breast milk. For information about inpatient lactation services at CHOC, call (714) 509-8455.

FAST FACTS

  • Percentage of infants in California who were breastfed in 2013: 91.6
  • Percentage of infants nationwide breastfed at 6 months (infants born in 2010) – up from 35% of infants born in 2000: 49%

View the full feature on Babies and Breastfeeding

Dr. Bixby
Dr. Christine Bixby
CHOC Neonatologist

PHYSICIAN FOCUS: DR. CHRISTINE E. BIXBY

Dr. Bixby is CHOC’s medical director of lactation services. Dr. Bixby completed her fellowship in neonatology at Harbor UCLA Medical Center and also completed her residency and internship training in pediatrics at Harbor UCLA Medical Center. She completed a fellowship in neonatology in a joint program between CHOC and Harbor UCLA Medical Center. Dr. Bixby specializes in caring for premature infants and is involved in research studies focusing on issues related to breast milk, establishing a milk supply and using breast milk for premature babies.

Dr. Bixby’s philosophy of care: “My philosophy of care is to bring in the parents and family as part of the healthcare team and making sure they are educated and  comfortable with the care we are giving their children.”

EDUCATION:
University of California, Davis, School of Medicine

BOARD CERTIFICATIONS:
Neonatal-Perinatal Medicine

More about Dr. Christine Bixby

This article was featured in the Orange County Register on July 7, 2014, and was written by Amy Bentley.

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Nutrition for Breastfeeding Moms

Nursing mothers are providing their babies with nutrients to help ensure their growth – but what about mom’s diet?

In the latest CHOC Radio podcast, CHOC Children’s clinical dietitians Sue Freck and Gina O’Toole address many questions that breastfeeding moms may have about their own nutrition.

Listen in to hear the dietitians, who both work in CHOC’s neonatal intensive care unit, discuss how many extra calories a nursing mother should eat, what foods to be mindful about, and much more.

Breastfeeding Premature Infants

breastfeeding_preemiesParents of premature infants face many new challenges as they help their special infant grow and flourish, and breastfeeding is often one of them.

“Breastfeeding a preemie is possible but the exclusive breastfeeding of a baby, especially the earlier premature babies, is not always nutritionally appropriate,” says Dr. Christine Bixby, a CHOC Children’s neonatologist who specializes in caring for premature infants.

There’s rarely a case where a premature baby can’t get some breast milk, she says. For example, in CHOC’s neonatal intensive care unit (NICU), nurses add powdered formula to breast milk to increase the nutrient levels.

“The breast milk is the best base, so we add some nutrients and that helps the baby grow,” says Dr. Bixby, who is involved in research studies focusing on issues related to breast milk, establishing a milk supply and using breast milk for premature babies.

Mothers of premature babies often have difficulty producing milk or sustaining production, Dr. Bixby says.

“Oftentimes moms are unable to make milk early in the process or sustain it, which given the prematurity of their baby, isn’t surprising,” Dr. Bixby says.

So, while the baby is at CHOC, lactation consultants and other specialists are available to help and encourage a mother to pump, if possible. The best way for a mother of a premature baby to establish a milk supply is to begin pumping as early as possible, ideally within six hours of delivery, she says. The mother should attempt to pump regularly, which physicians understand can be challenging when her baby is in the NICU.

For early feedings, donor human milk is an excellent alternative to a mother’s breast milk. CHOC purchases breast milk from a milk bank to offer babies whose mothers cannot produce milk, Dr. Bixby says. Milk donors are tested and the banked milk is completely safe, she adds.

Specialized formulas are also available for later feedings and following discharge. These both provide extra nutrients to help older premature babies grow, Dr. Bixby says.

“If the milk doesn’t come, regardless of why, it’s not worth dwelling on it,” she says. “Parents should ask their doctor about the best formula available and focus on creating a nurturing and loving environment for their baby.”

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  • World Breastfeeding Week is Aug. 1-7
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