Breast milk is recommended by the World Health Organization as the best source of nutrition for infants, and more and more mothers and families are recognizing the benefits of breastfeeding. However, because many mothers are new to breastfeeding, they are always worried that they are not getting enough breast milk and feel that their babies are not getting enough. The survey shows that most parents judge whether their babies are full or not based on the time of breastfeeding or whether they are crying, and research shows that these methods are not scientific. So, how exactly can you tell if breastfeeding is sufficient? Check your baby’s sucking When sucking on the nipple, your baby’s mouth should be wide open and lips slightly facing outward. At the beginning of breastfeeding, the baby sucks briefly and frequently for 1 C 2 minutes until the milk starts to flow. When the baby starts to swallow, sucking slows down. The mother should learn to listen to her baby’s swallowing and hear the “gurgling” sound of swallowing, with the mouth opening wide, followed by a pause, and finally closing the mouth. If you see the baby’s mouth open – pause – shut up form, it means that the baby is eating milk normally. It is normal for a baby to pause briefly after a few minutes of breastfeeding to rest for a while and then continue to eat milk. If your baby eats milk] with an open-mouth-stop-shut pattern, you should consult a lactation specialist. Please consult your doctor if: 1. You do not hear your baby’s “gurgling” swallowing sounds. 2. 2. you do not see the open-mouth-stop-shut sucking pattern. 3. Your baby sucks for a few minutes and then goes to sleep. 4. The baby always seems to be in a hungry state. Check the color of your baby’s bowel movements (stool) You can tell if your baby is getting enough colostrum (early breast milk) by the color of your baby’s stool in the first week. During the first 2 days, your baby passes black or dark green sticky stools (meconium). At this point, you should nurse your baby at the first sign that he or she wants to eat, as colostrum will help him or her to pass the feces. On day 3, as the baby’s intake of colostrum increases, the stool becomes lighter and greenish-brown in color. On the 4th and 5th day, the baby’s stools start to turn yellow as more and more breastmilk is consumed. Babies who are exclusively breastfed will have yellow or yellow-green stools that are fluffy and pasty. Frequency and volume of stools During the first 2 days of life, the baby usually has 1 – 2 stools. After 2 or 3 days and up to 4 weeks, the baby should have at least 2 stools every 24 h, and each stool should be at least 2 tablespoons (about 30 ml). Many breastfed babies will have a stool after each feeding. After the baby is full term (4 weeks), it is normal to have a stool every 1C3 days. If the baby’s abdomen is soft, the baby is feeding normally, and the diaper is wet 6C8 times per 24h, then it is normal for the stool to be less frequent. Number and color of stools per day over time Age Stool color Every 24 h Day 1 C 2 Dark green and sticky 1 C 2 times Day 3 C 4 Greenish brown At least 2 times Day 5 Turning yellow At least 2 times Day 6 C4 weeks Yellow or yellowish green At least 2 times, also after each feeding Consult your doctor if: Your baby’s stool is still dark dark green and sticky on the 5th day after birth. Your baby has less than 2 stools per 24 h before full term (4 weeks). Your baby does not pass stools for a longer period of time after full term (4 weeks) and does not look comfortable, or has less than 6C8 diapers per 24 h. Check the color of your baby’s urine When your baby is getting enough breast milk, the urine is clear, light yellow and odorless. A piece of plastic can be placed under the disposable diaper to check the color of the urine and to help determine if the baby is full. Your baby’s urine should not be dark yellow; diapers sometimes have pinkish spots in the first few days of life. If you find this spotting in the urine or if the urine is dark yellow, you should increase the frequency of your baby’s feedings and try to feed your baby every 2h. It is best to have your baby examined by a doctor. The degree and frequency of wetting of the diaper The number of diaper changes should be equal to the age of the day during the first 6 days of life. The degree of wetting and heaviness of the diaper increases every day, especially after the third day when breast milk increases significantly. When the baby is 1 week old, the diaper should be wet 6 C 8 times per 24 h. Compared to dry diapers, wet diapers contain the equivalent of 2 – 4 tablespoons (30 – 60 ml) of water. Consult your doctor if: During the first week, the number of wet diapers per day is less than the age of the baby (e.g. less than 2 on day 2 and less than 3 on day 3), after 1 week the number of wet diapers per 24 h is less than 6C8. 1.The baby’s urine is dark yellow. 2.The baby has pink spots in the urine, or the volume of urine is reduced and is dark yellow. Check the baby’s weight and length Check the baby’s weight and length to make sure they are normal. Check your baby’s weight 2 days after discharge from the hospital and again at 1 week until your baby’s weight gain reaches normal. Have the doctor mark your baby’s growth chart as normal during vaccinations in the 1st year or during a follow-up physical examination. Check your baby’s sleep-wake pattern During the first month, your baby should wake up 8 C 12 times per 24 h for breastfeeding, or 1 time every half hour to 3 h. Breast milk is easier to digest than cow’s milk and babies are more likely to feel hungry. Breastfeeding lasts about 15 C 45 minutes at a time. As your baby gets older, the frequency of feedings will gradually decrease to 6 C 8 times per 24 h. Check your baby’s appearance A well-nursed baby will cry loudly, have periods of awakening, be responsive and have a very wet mouth. Consult your doctor if: 1. The baby looks irritable and restless. 2.The baby looks weak. 3.The baby cries weakly. 4. The baby has a very dry mouth. The baby needs to be woken up for feeding. Have your baby checked by a hospital lactation specialist as soon as possible. If your baby is not nursing well, it is very important to maintain adequate breast milk, which needs to be expressed or pumped using a breast pump. Do not use the following methods to assess if your baby is full Breast swelling relief: On the 3rd or 4th day of your baby’s life, the majority of mothers will experience milk swelling. The swelling will decrease after a few days, but you will still feel swollen before breastfeeding. After a few weeks this swelling will gradually decrease and these changes do not indicate a decrease in the amount of breast milk. Your baby is breastfeeding more often than before: When your baby is growing rapidly (known as the fast growth period), your baby will breastfeed more often to increase your breast milk intake. This increase in the frequency of feedings does not mean that your breast milk is decreasing. This increase in the frequency of feedings usually lasts for 2 C 3 days and indicates that the amount of breast milk is also increasing to meet your baby’s needs. Babies usually have a rapid growth period at 2C3 weeks, 6 weeks and 2C3 months. Expressing by hand or with a breast pump can only express or suck out a small amount of breast milk: Most well-fed babies are nursed directly by their mothers, rather than drinking breast milk expressed by a breast pump. Many mothers can not express a lot of breast milk, but their babies grow healthy. Babies need to feed intensively: i.e., babies eat milk once an hour for 3C4 hours straight and then will sleep for longer periods of time. Some babies usually need this intensive feeding in the evening to prepare for a full night of sleep. Little to no milk leaking from the breast: This is normal for many women. The baby likes to cry, but weight gain is normal. There are 3 ways you can tell if your baby is getting enough milk: the way your baby sucks; how your baby eats and sleeps can also help you tell if he/she is getting enough milk; do not tell if your baby is getting enough milk by how your breasts feel and how much milk you can express. If you think your baby is not getting enough breast milk, go to the hospital to check your baby. If you have any questions about breastfeeding, please go to the hospital for consultation and examination.