I think my baby is NOT getting enough breastmilk. What can I do?
1) Is your baby feeding often enough? The simplest and most effective way to increase your baby's milk intake is to breastfeed more often. Babies need at least 6 feeds in 24 hours in the first few months. For most babies, 6 will not be enough; they need 8-12 feeds in 24 hours (or more) to take in enough milk. More frequent feeding also means your breasts are relatively 'emptier' (they are never completely empty), which means that your breasts will speed up milk production, increasing your milk supply.
2) Is your baby feeding for long enough to get a balanced feed? The fat content of your breastmilk steadily rises and usually doubles from the beginning to the end of the feed. If you let your baby decide how long to feed, he will usually be getting enough of both the breastmilk and the fat that he needs. Have you only been offering one breast per feed? Some babies only need one breast per feed, other babies need both. Some babies start off just needing one and change as they grow older. You could try offering your baby the second breast. Try offering top-up breastfeeds 20-60 minutes after your baby's normal breastfeeds.
3) Is your baby sleeping longer at night? Long night sleeps (and therefore missed feeds) can also decrease your baby's milk intake and weight gain. You might consider waking your baby during the night to feed or fit in extra daytime feeds. Is your baby attaching and suckling effectively? Babies who are failing to thrive may have a poor sucking action, so they don't empty and stimulate your breasts enough. Face-to-face assessment of this by a health care worker may be needed.
4) Does your baby have a tongue-tie? This can lead to poor attachment and mean that they cannot drain the breast effectively. An IBCLC can also check for this. In many cases the tongue-tie is snipped, leading to much more effective feeding for the baby and more comfortable feeding for the mum.
5) Have you been using a nipple shield? Provided a nipple shield is used properly, it should not cause supply problems. However, if your baby's weight gains continue to be low, it could be that your baby is not transferring milk well through the shield. Consult a lactation consultant to check that your baby is attached properly on the shield. If you baby cannot feed well without the shield, you will also need to express your milk to protect your milk supply and to provide more milk for your baby.
My baby is getting enough breastmilk. What's causing the low weight gains?
If your baby appears to be underweight, with wrinkly, loose skin and yet has a good nappy count indicating enough milk intake, it may be that your baby has an underlying medical condition which is causing a slow weight gain. There are many conditions which could affect weight gain. Some of the common ones include:
1) infection (anything from a cold to a urinary infection)
2) vomiting or frequent posseting (eg pyloric stenosis or severe reflux) - can mean a baby does not retain enough milk to grow a sensitivity to foods in the mother's diet could be a cause of low weight gain (usually along with other symptoms, such as 'colic').
Your medical adviser will be able to help you investigate these and other areas.
My baby is getting enough breastmilk. Is my baby just meant to be small?
Some adults are naturally petite and so are some babies. If your baby appears to be happy and healthy, is meeting developmental milestones, does not appear underweight (does not have loose wrinkly skin) and has a good wet/pooy nappy count, then your baby's low weight gains may be due to family factors (genetics).