How to know if your baby is eating enough: key signs

How do you know if your baby is getting enough to eat? Getting to know your baby's signs of fullness is just as interesting as learning to recognise the hunger cues. Because the goal we set ourselves with breastfeeding is to feed your baby until they show these signs of fullness and are satisfied.

Signs that your baby is full

A baby who has been fed adequately and who is “satisfied” relaxes their hands and facial muscles, stops giving hunger cues while awake and, in general, seems more content for a while after the feed. Not forgetting that feeding a baby frequently is normal and is not a sign of inadequate feeding, as long as your baby seems satisfied or full after the feed.

When a baby feeds more often, this is what is known as “cluster feeding”, which could be translated as “feeding in clusters”. It is a completely normal behaviour and very common in newborns, characterised by the fact that they do not manage to settle completely after each feed, and it may happen to you on occasion without it being anything to worry about. When it happens, we look at how to improve the feed, assessing the position, the latch, etc.

Normally, your baby should settle or rest comfortably between feeds. If your baby does not settle or does not seem satisfied between feeds, they may not be transferring milk effectively and an assessment by your midwife or a health professional would be advisable, to assess the situation, without being alarmist.

How do you know if a newborn baby is feeding well?

There are some signs that will tell us that our baby is feeding well, as the Spanish Association of Paediatrics reminds us.

• Your baby has a physiological weight loss in the first 3 or 4 days, of between 6 and 10%, which they regain around day 10 or 14 of life, with a subsequent gain of more than 20 g per day.
• A malnourished baby, at birth, should not lose weight, or should have only a minimal weight loss.
• Another sign is that your baby is an active baby, who sucks vigorously and is relaxed once the feed is over.
• Your baby starts with a fast suck, and this sucking slows down as you watch your baby swallow; you can feel your milk flowing, the let-down reflex and your breast feeling emptier.
• They suck vigorously for anything from a few minutes up to 10-15 minutes; every baby is different, which is why this parameter ranges between a few minutes and 15 minutes.
• Your baby wets 4-6 nappies a day from day 4 onwards. They pass soft stools 5-6 times a day, or spaced out every 2-3 days but plentiful.

Risk factors in newborn feeding

There are risk factors that, as professionals, make us pay closer attention to babies who may not manage to feed adequately. In the following cases, the recommendation is closer supervision and help with latching, supporting the mother as much as possible and answering her questions.

• Newborns of 35 to 37 weeks who are not admitted and go home with their mother in the first 48-72 hours.
• Inadequate breastfeeding: poor position, incoordination, biting or weak sucking.
• Neurological problems. Babies sedated by medication during birth or by maternal treatments.
• Babies who have received supplements in hospital.

What if my baby is very sleepy?

If your baby always falls asleep, the guidelines recommend trying to wake them with “burping pauses”, changing their nappy, or rubbing their head, back, arms or feet. You can also help your baby feed by compressing your breast during the feed and expressing colostrum or milk by hand. It may fall directly into your baby's mouth, or you can offer it afterwards with a spoon, cup or Happymami bottle. Expressing milk is important for any baby who is not transferring milk successfully, because it gives the mother's body an important signal to produce more milk.

Do I have enough breast milk?

The answer is probably yes, and the truth is that most women can produce enough milk; it is rare when they cannot. But of course, establishing and maintaining an adequate breast milk production depends on how often and how effectively milk is removed, which means that your production will respond to the demand you make on your body.

As a guide, in most cases it is usually enough to have at least eight feeding or milk expression sessions in 24 hours, and provided that each session empties the breast completely.

To ensure your breast is completely emptied, steps should be taken to wake a sleepy baby, correct a painful latch if you have one and/or express milk by hand or with a breast pump after the feed. If we improve how often and how effectively we feed, your milk production will increase within 24 to 48 hours.

Signs that your baby is not feeding well

There are signs that may make us think that your baby is not getting enough breast milk; knowing them will be very important in order to act quickly and put things right.

Weight curve (NEWT)

At a general level, we have a very interesting American tool: if your baby's weight is below the 75th percentile of the nomogram (NEWT) https://newbornweight.org, this will be a warning sign of insufficient intake by a baby.

Bear in mind that in this weight loss tool, the higher percentiles correspond to a greater weight loss compared with other babies of the same age. This is different from the percentile charts we usually check in growth charts, where the higher percentiles indicate a greater weight gain.

Signs that might make you think your baby is not feeding well

During the first three or four days after birth, the signs of insufficient intake that justify a feeding assessment are:

• Fewer than one wet nappy per day of age (that is, the goal is at least one wet nappy on day 1)
• Fewer than one bowel movement a day
• Urate crystals in the nappy
• Dry mucous membranes
• Decreased skin turgor

Serious signs that your baby is not feeding well

• Sunken eyes and/or a sunken anterior fontanelle
• A thready radial pulse or cold extremities

I think my baby isn't eating enough, what should I do?

Today, babies in developed countries have routine check-ups during infancy, which include reviewing the newborn's feeding behaviour. These check-ups cover the signs of an effective latch and of established breastfeeding, as well as the assessment of warning signs indicating that there is no adequate feeding.

If you are unsure whether your baby is getting enough, the best thing to do is to go to your usual health professional for a full assessment of the situation, so as to get the best possible result.

Bibliography

1. Fabm AKMI. Initiation of breastfeeding . Uptodate.com. 2022 . Available at: https://www.uptodate.com/contents/initiation-of-breastfeeding
2. Materna L, Guillen AM, Dalmau Serra J, De Neonatología S, De Nutrición S, Fe L, et al. Alimentación del recien nacido sano . Aeped.es. . Available at the following link