Care Plan: What to Do if Your Baby is Not Getting Enough Overall

Making sure your baby is getting enough breast milk overall is very important in the first few weeks. If you feel she's not satiated or doing well on the breast, you need to figure out a way to fix the problem for the following reasons:

Your baby needs a full feeding to grow and thrive.Your milk supply could drop from not being properly drained at each feeding. This will perpetuate the problem. Mentally, you might need to take a break from feeding around the clock.

The signs of a thriving and satisfied baby can be found in these areas:diapers, weight gain, and infant behavior.

The first two are easily measurable. If your baby isn't stooling and urinating enough, or if she isn't gaining weight well or at all, then she isn't getting enough nourishment and you'll need to supplement. Infant behaviour isn't as easy to measure, but it's still an important sign. When you look at it with diaper output and weight gain, it can help you determine if your baby isn't thriving.

Here are the most common behavioural signs that a baby isn't getting enough at the breast:

• Persistent feeding: This is when you literally can't put your baby down. After a long session of nursing you think she's asleep, put her down and then 20 minutes later she's up again, crying and rooting. This feeding around the clock can be rough on you, especially if it goes on for weeks.
• Fussiness after feedings: If your baby just finished feeding yet still seems fussy and hungry, she probably didn't get enough. This doesn't include occasional "cluster feeding" periods that occur in the early weeks. If this pattern is ongoing, it can signal a problem.
• Shuts down: On the other hand, if your newborn baby is sleeping longer after a feeding, it could be a sign she's not getting enough. Some babies "shut down" rather than cry if they're not getting enough food. If she is only breastfed and sleeps for long periods of 4 hours or more without waking at night, her intake isn't quite where it should be.

That's not to say you should worry every time your baby cries or takes a long nap. It's important to consider all of the above signs.

For example, if her weight gain is inching along—gaining about half an ounce a day—and she's urinating and stooling a few times a day, yet she's always fussy or shuts down, she might be "gaining and not thriving" and needs more to eat. You can offer a bottle after a breastfeeding session is over, and if she takes a significant amount over ½ ounce, you'll have your answer: She's not getting enough at the breast, and you'll need to supplement feedings.

If your baby takes larger volumes of supplementation (3 to 4 ounces) once or twice a day, she's probably not getting full at the other feedings. In this case, it's best to start a regime of supplementation after each feeding until you've solved the problem.

If you have to supplement your baby, don't worry that breastfeeding isn't working. In most cases, the problem isn't hard to fix. If you follow a Care Plan: How to Increase your Milk Supply, your baby will be well on her way to getting a full feeding from your breasts.

Supplementing

Supplementing your baby means you're offering more food from a bottle. While your priority is to supplement with expressed breast milk, there are certain cases where it's just not possible and other alternatives, such as milk-bank milk and infant formula, are needed.

If you can, you should supplement with your own breast milk that you pumped after each feeding; you'll be one cycle ahead—the milk you pumped from the last feeding will be used at the next. If your baby isn't getting enough at the breast because of a low milk supply, you might need to supplement with something besides breast milk, especially while you're increasing your supply. With regular pumping your milk supply should grow, reducing or eliminating the need for supplementation.

(Learn more: What should I supplement with?)

Tips for success

• Your baby needs a full feeding each time to grow and thrive and to ensure that your milk supply stays at the optimal level.
• If your baby displays patterns of persistent feeding or fussiness after feedings, or sleeps for long periods of time (over 4 hours) after feedings, she might not be getting enough.
• Supplementing after feedings ensures that your baby is getting enough and helps elevate your milk supply if it's low during the early stages of breastfeeding.

Source: Heather Kelly is an International Board Certified Lactation Consultant (IBCLC) who also sits on the Bravado Breastfeeding Information Council Heather has been practicing in New York City since 2001.