Signs of a low milk supply

Low milk supply – perceived vs real

As a new parent, the hardest thing to trust in, is that your baby is getting enough milk while breastfeeding. You don’t get to see how much they’re drinking, if they’re even getting any milk at all. It’s stressful, nobody wants to starve their child.

The number one reason for parents to quite breastfeeding is due to a perceived low milk supply. This means that they didn’t actually have a real low milk supply, but something made them feel and believe that their baby isn’t getting enough milk. This is why it’s important to know the signs of adequate milk intake and the signs that there may be a real low milk supply issue.

So how do you know if your baby is getting enough milk while breastfeeding?

Signs of adequate or inadequate milk intake:

– Your baby is being fed frequently. At least 8-12 times or more in a 24-hour period.

How often should a baby be breastfeeding?

– Clear signs of sucking and swallowing.

There will be times where your baby will very obviously be swallowing milk. It may sound like gulping to you. This is during a letdown where the milk flows more quickly than usual.

– Your baby is having enough wet and dirty diapers per 24-hour period.

1+ wet and 1+ stool on day 1

2+ wet and 2+ stools on day 2

3+ wet and 2+ stools on day 3

4+ wet and 2+ stools on day 4

5+ wet and 2+ stools on day 5

6+ wet diapers and 2+ stools every day from day 6 onwards.

After about day 4, we expect brick dust (the orange looking urine) to disappear completely, if it persists for much longer it would be best to have you and baby assessed by an International Board Certified Lactation Consultant (IBCLC), as this can be a sign of delayed lactogenesis and/or dehydration.

After about day 4, we expect stool to be mustard yellow with no green, brown or meconium. If your baby’s stool does not transition to mustard yellow after about 4 days, it would be best to have baby checked to ensure adequate milk intake.

After about 6 weeks, sometimes a bit sooner, breastfed babies may have less frequent stools. As little as 1 in 10 days can be normal. But wet diapers should always remain the same.

– Your baby is gaining weight as expected.

This will greatly vary from each individual baby, but the expected weight gain per week in the first 4 months is between 140-250g per more per week.

If your baby is gaining less than 140g per week or gaining excessive weight of more than 400g or so each week, it may be a good idea to contact an International Board Certified Lactation Consultant (IBCLC) to do an assessment of both you and your baby to ensure everything is as it should be.

– During awake times, baby seems to be active and alert.

– Your baby seems content after a feeding.

They will relax, open their clenched fists and release the breast on their own. Although cluster feeding, very regular feedings and fussiness is normal in babies, it can signal a problem if your baby is never satisfied after a feed. An excessive sleepy baby can also signal that there may be something wrong.

– Baby is growing well in weight, height and head circumference and they’re hitting their milestones as expected.

A perceived low milk supply

What is a perceived low milk supply?

A perceived low milk supply is when a mother who is producing enough milk, believes that she isn’t producing enough milk. There are many reasons why this can happen.

Reasons for a perceived low milk supply:

– Growth spurts

Growth spurts are short periods of rapid growth in babies, toddlers and children. During growth spurts they will usually start feeding much more frequently, they may cluster feed and they may have increased night wakings. Most babies may also become very fussy during a growth spurt, and it may seem like they get frustrated at the breast. So, it makes sense why many parents may believe the milk supply is no longer enough. A lot of parents even quit breastfeeding as they believe their milk has dried up. But it’s important to know that this is completely normal, and it will subside with 3 days to a week.

– Cluster feeding

Cluster feeding is when a baby, toddler or child suddenly breastfeeds much more frequently than they usually do. Cluster feeding can happen at any time during the day and babies may want to feed for a few hours at a time. They may also become very fussy and seem frustrated at the breast. Cluster feeding is normal, and it happens for different reasons such as building and establishing the milk supply, growth spurts, mental development phases, sleep regressions and times of discomfort and illness.

– Frequent feeding

Sometimes parents just aren’t prepared for normal feeding behaviors. Sometimes we expect a baby to feed every 3-5 hours and sleep through the night from the very beginning, but this is not normal for babies to do. Babies are meant to feed frequently during the day and night as breastmilk digests very quickly and thew frequent feeding also reduces the risk of SIDS. How often should a baby breastfeed?

– Frequent waking

As already mentioned above, frequent feeding is very normal behavior for babies and toddlers. Breastmilk digests quickly, frequent waking reduces the risk of SIDS and it’s completely normal for a baby or toddler to require assistance in falling back to sleep by breastfeeding.

– Fussy behavior

Fussy behavior is also very normal in babies and toddlers especially, this can be due to many reasons such as discomfort, pain, illness, mental development, sleep regressions and growth spurts. Fussy behavior while breastfeeding can also be normal due to a few reasons such as growth spurt spurts, during the evening when the milk flow is a bit slower, infant dyschezia and a fast letdown reflex. But if a baby is always fussy during and/or after a feed and it doesn’t seem to pass after a few days to a week, it would be best to consult an international Board Certified Lactation Consultant (IBCLC) to assess and rule out any issues that may be present.

– Cluster feeding and fussiness in the afternoon

Cluster feeding and fussiness in the evenings can be due to things like the flow of the milk being a bit slower in the evenings than during the day, being overwhelmed and overstimulated after a long day, it could be overtiredness or babies can simply be filling up for a bigger stretch of sleep at night.

– Not pumping a lot of milk

If you’re not pumping much or any milk at all, it could be due to things like a bad quality pump, the wrong size flanges, not replacing the silicone pump parts regularly and not pumping frequently or long enough. It also depends on when you pump, if you pump right after baby has fed, you will definitely not be able to pump a lot of milk. Some women never really pump much milk at all and yet they still have a good enough supply to directly breastfeed their babies. Babies are much more efficient in removing milk from the breast than a pump. It’s important to remember that the amount of milk you pump, is absolutely no indication of your milk supply at all.

– Your baby will drink an entire bottle of milk after breastfeeding

Babies will almost always accept a bottle if you offer it, even right after they breastfed. This happens because babies have a natural instinctive reflex called the sucking reflex, which means not only do they have a high sucking need, but they will automatically suck almost anything that stimulates their mouth and tongue. Babies can also not regulate bottle feedings on their own, unlike when they’re breastfeeding where they control the flow by the way they suck, they don’t have much choice with a bottle. If you don’t pace feed and you just tip a bottle into their mouth, they will keep sucking and swallowing until you stop the feeding.

– Your breasts don’t or no longer leaks milk

Some women may leak from pregnancy until well into the first year, others may never leak at all. Leaking is absolutely not a sign of low milk supply. Most of the time when you do leak and it suddenly stops, it’s probably due to your milk supply stabilizing to your baby’s needs and therefore it no longer produces too much milk.

– Your breasts feel soft

When your breasts feel soft after a feed, or even all day long during a growth spurt, it’s a good thing. It means your baby is probably drinking efficiently and draining the breast well and your supply is well established and stabilized. Some mothers may feel their breasts are fuller than usual when it’s time for a feeding or if they’ve gone too long between feedings, but this may eventually stop, and the breast will feel soft most or all of the time. This is once again happening when the supply stabilizes, for some it may take weeks and for others it may take months. But soft breasts are usually not a cause for concern. If you’re breastfeeding frequently and your baby has enough diapers and is growing well, everything is just fine with your milk supply.

Reasons for a real low milk supply:

– Supplementation

When you’re supplementing with anything other than breastfeeding directly at the breast, such as water, formula or any other liquid, your baby will take less milk from the breast. It will then signal your breasts to make less milk. It’s important to remember that milk supply works on supply and demand, what the baby demands, the body will supply. So, if there’s less demand, there will automatically be less supply.

– Scheduled feedings

Breastfed babies should be fed on demand. This means they should be fed whenever they let you know they’re hungry.

– Pacifiers

Pacifiers can cause confusion between breast and pacifier which can cause a low latch and damaged nipples. This not only increases the risk of inadequate milk transfer, but also to infections such as Mastitis. If pacifiers are not used responsibly, it may cause babies to breastfeed less due to the hormone cholecystokinin tricking their bodies into thinking they are full when in reality they are not This once again means babies will then feed less which means less demand for the breasts and therefore less supply. Pacifiers can also cause parents to miss feeding cues and this stretches out feedings which can cause a lower milk supply.

– Nipple shields

When low quality and wrongly fitted nipple shields are used, it can cause less stimulation to the nipple, less milk intake for baby, which will equal a lower milk supply.

– Sleepy baby

Some newborns are very sleepy in the first few days or even weeks. This can be due to the type of labor or medications used during or after labor. Some babies may just be sleepy with no explanation. But if a baby doesn’t wake up by themselves in the early days or weeks, it can cause them to receive inadequate amounts of milk and it can cause a low milk supply, because the baby is feeding less than they should, the body makes less milk than what is actually needed to sustain a baby. How often should a baby breastfeed?

– Medical reasons baby

Babies may have issues causing them to be more insufficient at the breast than ideal, which will cause inadequate milk intake and eventually a low milk supply. Issues can include heart conditions, jaundice, oral ties, hypo and hypertonic muscle tone, prematurity, illness and many other anatomical and health conditions.

– Medical reasons mother

Mothers can also have issues that can cause a low milk supply. This includes things like breast surgeries, breast trauma, underdeveloped breast tissue, hormonal conditions such as PCOS, thyroid conditions, retained placenta, postpartum hemorrhage, anatomic issues, severe stress, smoking and excessive alcohol use.

– Herbs and medications

Some herbs and medications can cause a low milk supply or even dry the milk supply up completely. This includes herbs such as parsley and peppermint, sage, lemon balm, thyme, oregano and many more. Medications include things like hormonal birth control, pseudoephedrine, huge quantities of vitamin b and antihistamines.

To check if certain herbs or medications are breastfeeding and supply safe, websites such as e lactancia can be used or alternatively you can always contact an International Board Certified Lactation Consultant (IBCLC) to advise you.

Supply can be increased in many ways including medications, galactagogues and pumping. The best way to increase your supply is by breastfeeding more frequently. The more the demand, the more the body will supply. In case of a real low milk supply, especially in medical situations, it is absolute best to get into contact with an International Board Certified Lactation Consultant (IBCLC) to help assess the issues and then help with a feeding plan to best increase your supply if possible. If you know you have a risk factor for real low milk supply, you can get into contact with an IBCLC during pregnancy to help optimize your supply from the very beginning while also monitoring your baby to ensure adequate milk intake.