Is My Baby Drinking Enough? The Signs of Effective Breastfeeding

"Is he drinking enough?" It's the question that comes up in almost every one of my breastfeeding consultations. And it's understandable: at the breast, it's very stressful — you can't see the milk being transferred, you don't know how many millilitres the baby is taking. It can be very disorienting, because we like to feel reassured by being able to measure and control things.

So when breastfeeding, we rely on several indicators to know whether baby is drinking enough.

What is effective breastfeeding?

Effective breastfeeding rests on three pillars:

- A baby who transfers milk well: good latch, effective suck, audible swallows.

- Frequent feeds, day and night: 8 to 12 per 24 hours MINIMUM for a young infant: the more effectively the breast is drained, the more milk production is stimulated.

- A pain-free feed: persistent pain is not "normal." It's a signal to review positioning and latch.

So it's neither the duration of the feed nor the sensation in the breasts that determines effectiveness: it's what actually passes from the breast to the baby.

The 4 Reliable Indicators

1. Weight gain

This is the most objective indicator.

• A weight loss of up to 7–10% of birth weight in the first few days is normal.

• Baby starts regaining weight around the milk coming in, around day 3–4.

• He or she generally reaches birth weight again around day 10. If that hasn't happened by day 15, the breastfeeding approach needs to be reviewed and a doctor should be consulted.

After that, you can expect roughly 30 g per day during the first 2–3 months, following baby's growth curve: the goal is for baby to "ride" along their line, without dramatically changing percentiles.

For breastfed babies, we use WHO growth charts rather than those in the French health record, which mainly reflect the growth of formula-fed babies.

2. Nappies

A very concrete indicator, provided you also look at their contents.

Urine:

Day 1: 1 wet nappy

Day 2: 2 wet nappies

Day 3: 3 wet nappies

Day 4: 4 to 5 wet nappies

From day 5 onwards: at least 6 properly wet nappies per 24 hours, with clear to pale yellow urine, no strong odour.

Orange-tinged spots (uric acid crystals) can appear in the very first days. If they persist beyond day 3, this should be reported to the medical team.

Stools:

The first 2–3 days: meconium (black, sticky), followed by stools that gradually shift from green to yellow.

Around day 4–5, stools become yellow, soft, and seedy. In the first few weeks, you can expect at least 3 yellow stools per day, and it's common to have more.

After about 6 weeks, some breastfed babies go longer between stools. This is perfectly fine as long as they remain plentiful and soft and weight gain is on track.

Infrequent stools in the first few weeks should prompt a weight check and a visit to the doctor.

3. The feed itself

Observing a feed tells you a lot. Here's what to look for:

- Audible swallows: after a few quick sucks to trigger let-down, you hear a rhythmic suck-swallow pattern. Towards the end of the feed, swallows become less frequent.

- A baby who detaches on their own or falls asleep, looking satisfied: floppy arms, open hands, relaxed face. In contrast, a hungry baby tends to have furrowed brows, bent arms, and clenched fists.

- A pain-free feed for mum, and nipples that are their normal shape at the end of the feed — neither flattened nor distorted.

- Softer breasts after the feed: this is often a sign that baby has drunk well. Uterine contractions (afterpains) in the first few days also indicate that the breast is being well drained.

If the feed is painful, positioning is the first lever to pull. Dr Pam Douglas' Gestalt approach helps reduce traction on the breast and improve latch.

What Proves Nothing

A lot of anxiety comes from signals that seem logical but aren't reliable:

- The duration of the feed. A drowsy baby who "nuzzles" at the breast for 45 minutes may drink less than a baby who feeds effectively for 10 minutes. What matters is efficiency, not duration.

- Soft breasts that don't leak or aren't engorged anymore. This is normal: after a few weeks, the breasts adapt. It doesn't mean production has dropped.

- The amount expressed with a pump. It depends on the pump, the flange, the time of day, and the mother. It reflects neither your actual production nor what baby extracts at the breast.

- A baby who asks for the breast often. Frequent feeds, especially in the evening, are perfectly normal in an infant. Growth spurts and the need for closeness contribute to this, as explained in this article: Feeding rhythm and frequency.

- Crying. We often attribute it to colic or reflux. But if weight gain is slow, crying may simply be hunger: Baby crying — what are the explanations?

In the end, to know whether baby is getting enough at the breast, you need to look at a bundle of information: none of these signs in isolation is enough to draw a conclusion. Only weight, nappies, and observation of the feed are truly informative.

The Indicators Evolve Over the Weeks

And this too is very disorienting! In the first year, the baby changes, and as soon as you feel you've "cracked the code" and understood baby's signs… they grow and evolve… and the signs change.

For example, after 6 weeks, feeds may become shorter and more efficient, and stools may become less frequent. This is normal as long as baby is gaining weight and wetting nappies. Babies no longer fall asleep at the breast systematically, and may become fussy if you push them to keep feeding when they're done.

When Should You See a Doctor?

See a doctor urgently if:

- the number of wet nappies is very low, or the urine is dark and foul-smelling

- baby is lethargic, hard to wake for feeds, or crying in an unusual way

- the fontanelle is sunken

- jaundice is worsening

Book an appointment with the doctor soon if:

- baby hasn't regained birth weight by day 10–15

- the weight curve is stalling or shifting percentiles significantly

- feeds are painful or baby falls asleep at the breast without feeding effectively: an IBCLC lactation consultant can help

- stools are infrequent or remain dark after day 5

In Case of Doubt

- Weigh baby and review the situation with the doctor, midwife, or community health nurse (PMI). Some causes of slow weight gain are not related to breastfeeding (e.g., urinary tract infection).

- Have a feed observed by a trained professional: this is the best way to identify a latch that needs improvement.

- Optimise positioning so the feed is more effective and less painful.

- Stimulate production if needed: more frequent feeds, and pumping as a supplement when indicated (when should you pump?).

- Offer top-ups if weight gain is too slow, on medical advice or the recommendation of the lactation consultant, while protecting the milk supply (see mixed feeding).

In Summary

To know whether your baby is drinking enough, don't rely on a single indicator: look at their weight, their nappies, how they feed, and their behaviour. If these indicators are all green, you can be reassured, even if your baby feeds often and even if your breasts are soft.

Bibliographic Sources

WHO Multicentre Growth Reference Study Group. WHO Child Growth Standards: length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: methods and development. Geneva: World Health Organization; 2006.

The guide to using the new WHO growth curves for healthcare professionals. Paediatr Child Health. 2010;15(2):91-98. PMCID: PMC2865942.

WHO, UNICEF. Protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services: the revised Baby-friendly Hospital Initiative. Geneva: World Health Organization; 2018.

Kellams A, Harrel C, Omage S, Gregory C, Rosen-Carole C; Academy of Breastfeeding Medicine. ABM Clinical Protocol #3: Supplementary feedings in the healthy term breastfed neonate, revised 2017. Breastfeed Med. 2017;12(3):188-198. doi:10.1089/bfm.2017.29038.ajk

Evans A, Marinelli KA, Taylor JS; Academy of Breastfeeding Medicine. ABM Clinical Protocol #2: Guidelines for hospital discharge of the breastfeeding term newborn and mother: "The going home protocol", revised 2014. Breastfeed Med. 2014;9:3-8.

Berens P, Eglash A, Malloy M, et al.; Academy of Breastfeeding Medicine. ABM Clinical Protocol #26: Persistent pain with breastfeeding. Breastfeed Med. 2016;11:46-53.

Feel free to contact me for advice or questions: "My Baby Moon" by Elise Armoiry, IBCLC lactation consultant & founder of My Baby Moon.

Over 2,500 families supported since 2014.

PharmD by training, specialised in breastfeeding and sleep, trained with Dr Pam Douglas (NDCLC Lactation Consultant)

Email: info@mybabymoonibclc.com

Tel: 07.49.50.67.82

Website: https://www.mybabymoonibclc.com/

Book an appointment with Elise

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