Many moms wonder how to tell whether or not their babies are getting enough milk, especially in the first weeks and months of their children's lives. When all the baby does is sleep, it can be extremely hard to tell if they are hungry or not.
In 2012, Landon Johnson arrived via C-section. He was a healthy baby boy who passed away just 19 days after his birth. His mom, Jillian Johnson, recently made national headlines after she bravely shared the story of Landon's untimely passing with new moms in attempt to save others from suffering the same heartbreaking loss she did.
Johnson told People magazine that "pressure" is a nice word to describe what she felt from the nurses and lactation consultants who attended to her in the hospital after Landon arrived as she attempted to breastfeed her screaming son for 14 hours straight. She also wrote in a blogpost for The Fed Is Best Foundation, "I had no idea that he was inconsolable because he was starving...literally."
The Fed Is Best Foundation is an organization that was founded by Christie del Castillo-Hegyi, an emergency physician who researches newborn brain injury and breast-feeding complications, and Jody Segrave-Daly, a newborn nursery and newborn intensive care unit nurse and certified lactation consultant. What is their goal? As stated on GlobalNews.ca, it is to counter “alarming trends in infant feeding, namely a rise in hospitalizations for feeding complications in exclusively breastfed newborns who don’t receive enough breastmilk, including increasing rates of jaundice, hypoglycemia, and dehydration, which can threaten a newborn’s brain.”
If mom answers "yes" to the following 15 questions, her baby may be underfed.
15 Does The Baby Make Clicking Noises While Feeding?
Along with Baby straining to suck and getting dimpled cheeks while feeding, if he makes a clicking noise while eating, this could be another sign that he isn't latching properly. The American Council of Science and health states on their website that breastmilk is undisputedly the best nutrition for Baby, but also recognizes the fact that breastfeeding isn't always possible.
In short, even experts agree that, when it comes to nourishing a newborn, each mom should do what is best for herself, her baby and her personal situation.
Their site states, "Breastmilk has health benefits that are not found in formula, such as antibodies that ward off infection. However, we at the Council respect that breastfeeding (or pumping breast milk) may not be the best choice for a new mother and support the idea that every parent should choose what works best for their family, without judgment or guilt."
The Fed is Best Foundation also recognizes that "Breast is Best," but not always possible. Their mission reads, "The Fed Is Best Foundation believes that babies should never go hungry and mothers should be supported in choosing clinically safe feeding options for their babies. Whether breastmilk, formula, or a combination of both."
14 Wetting Less Than 6 Diapers In 24 Hours?
One of the best ways to determine whether or not Baby is taking in enough milk is to pay attention to her output. If she isn't wetting at least six diapers within a 24 hour period, this may be yet another sign that she's underfed.
According to Fit Pregnancy, "Your baby's diaper output is a reliable indicator that all is well. He should have at least six wet diapers by day six and four stools by day four." Everyone has heard stories about the mom who makes a detailed record of her baby's wet and poopy diapers. This may seem extreme, but if a parent is concerned about a baby's nutrition, taking note every time she takes a wee or messes her diaper may be one of the best ways to determine whether or not to be concerned.
Keeping a close watch on Baby's diapers during the first 14 days of life is a good way to ensure she is getting enough nourishment. Sudden changes in the number of wet diapers or messy diapers a baby has in one day could be a sign that she is not getting adequate nourishment. Keeping a close eye on diapers can give parents peace of mind, or a quick heads up if Baby is in danger.
13 Does The Baby Have Dimples When Latched?
If Baby's cheeks have dimples only when sucking, it could be a sign she's straining to get something out of a breast that isn't providing what she needs or that her latch isn't allowing her to draw milk out properly.
So what is normal and what is not? Fit Pregnancy states, "When your baby first latches onto your breast, he will suck rapidly, which helps release the milk. Then he should progress into a deep, slow pulling motion as he swallows; you may not only feel this motion, but also see his jaw drop down and hear him as he does this. If your baby isn't getting enough milk, you may see him sucking rapidly but not swallowing slowly and rhythmically."
New moms who know what to look for in their breastfed babies may notice signs of underfeeding that are often difficult to catch.
Baby Ariya's mom shared on the Fed Is Best site, "Who knows what would have happened to her if I continued to exclusively breastfeed? I know now that deciding to give her a bottle was the smartest thing I could have done. What's not fair about my situation, and plenty of other women's, is the pain, the judgement, the overwhelming sense of failure that came with having to, and choosing to, give a bottle to my baby."
12 Do The Girls Still Feel Full?
If Mom's breasts are still sore, engorged or firm after a feeding, it may be a sign that Baby isn't getting the sustenance she needs. After breastfeeding, breasts should feel soft to the touch. Many moms pump after feedings to collect any remaining breastmilk to store for later use, or to increase their supplies. It's normal for milk to be left behind after a feeding, but if breasts aren't softer after Baby eats, this could be a sign that she is underfed and may need supplemental bottle feedings until the issue can be resolved. However, for many new moms, feeding Baby formula is easier said than done.
"The 'breast is best' ideology is so ubiquitous, so sneakily persuasive, that even those determined to remain open-minded to feeding options are overcome with guilt and panic when they press that first bottle of formula against their newborn’s lips," writes Strauss.
She continues, "I’ve known many moms over the years whose prepartum insouciance was no match for the combination of vulnerability-inducing postpartum hormones and heavily biased lactation consultations offered by their hospitals. In fact, I was one such mom, and I felt like an absolute failure for having to give my son formula before my milk came in. That the alternative was his starving—dangerous for a newborn—did little to put me at ease."
11 Sucking On Fingers After Feedings?
Does Baby constantly have her hands in her mouth, or does she seem to be constantly rooting around looking for her next snack? Susan Burger, M.H.S., Ph.D., I.B.C.L.C., is a lactation consultant with New York-based Lactescence in the City. She told Fit Pregnancy, "If a baby has many feedings that last longer than an hour, or wants to nurse very often with less than an hour between feedings, there may be problem." Additionally, if Baby is constantly noshing on her digits between meals, he may be searching for something to satisfy his every-growing hunger and thirst.
Many babies like to chew on their hands, but if Baby is also unsettled, cranky or overly tired, she may be sending Mom a message by constantly searching for something to suck when she's not feeding. The good news is, if moms know what to watch for, they can determine that their baby needs more food before it's too late.
Jillian Johnson told People magazine, "I just want people to educate themselves so they don't make the same mistake I did. I couldn't sit by any more and have another mom feel what I feel every day. I don't want any parent to have this hole in their heart. Nothing can fill it."
10 Does The Baby Suffer From Persistent Jaundice?
Jaundice is a common condition among newborn babies, and, according to AmericanPregnancy.org, is actually "more common in breastfed babies and tends to last longer." The site explains that breastfeeding jaundice and breast milk jaundice are two separate conditions. Breast milk jaundice "is seen in otherwise healthy, full-term, breastfed babies." While there is not a known cause for why it occurs, many medical professionals have speculated that "it may be linked to a substance in the breast milk that is blocking the breakdown of bilirubin."
Breastfeeding jaundice occurs when Baby is underfed. If baby isn't getting enough milk due to a shortage of Mom's supply, a poor latch or another issue, he may experience a buildup of bilirubin due to lack of bowel movements.
Breastfeeding jaundice will usually resolve itself once Baby is given adequate nutrition.
Many of the problems that result when a newborn is underfed can be prevented if mothers trust their instincts. A new mom shared her story about feeding her baby Ariya on the Fed Is Best site. She wrote, "Nothing was coming from pumping or self-expressing. I was ashamed to ask for formula in the hospital, but I couldn't hear her scream anymore...it ripped me apart to hear her in pain. I was faced with some resistance when asking for formula, but I insisted and they provided it anyway."
9 Are The Girls Misshapen Or Pinched After Feedings?
If Mom's nipples are pinched or misshapen after feedings, it may be a sign that Baby is not latching correctly. When Baby does not draw milk out of the breasts in the right way, his sucking technique may alter the shape of Mom's nipples.
Additionally, while breastfeeding may feel slightly uncomfortable from time-to-time, it should not be painful. Lactation consultants can often help determine if Baby is latching correctly or not. Moms shouldn't be overly hard on themselves if they don't get the hang of breastfeeding right away.
According to the Fed Is Best Foundation, 1 in 5 moms don't make enough milk to sustain their babies during the first few days after their little ones arrive.
Global News states that between 10 and 25 percent of exclusively breastfed babies lose excessive amounts of weight in their first days of life and 10 percent of babies fed exclusively at the breast suffer from hypoglycemia (low blood sugar), which has been linked to developmental complications.
Additionally, the number one reason newborns are re-hospitalized is lack of proper nutrition. Misshapen nipples may be one of the first signs that something isn't right. Moms should never hesitate to seek help if they worry their babies may not be getting enough to eat.
8 Is The Baby's #2 Solid Or Infrequent?
Along with the amount if soiled diapers a baby has each day, the consistency of a little one's poops are worth taking note of. Fit Pregnancy states, "Stool color is also important: While the first bowel movements are typically black and sticky, they should be green by day three or four and yellow by day four or five. The consistency of the stools should also be seedy or watery."
If Mom notices that Baby's poop are infrequent, she shouldn't worry too much unless the amount of time between bowel movements stretches out longer than a few days. As mentioned above, infant poops should be watery and runny. If Baby's BMs are solid or dry, this may be a sign he's underfed.
New mom Alison shared on the Fed Is Best website that her milk didn't come in until her son was nearly four days old, so she supplemented with formula until it did. She wrote, "I am 100% sure that if we had not found your website and had as many conversations as we did about what we think is right for our child, I would not have so willingly embraced formula during the early critical days of our son's life. Thank you for helping us have a healthy baby."
7 Is There Soreness After Feedings?
In addition to nipples becoming misshapen at the end of a feeding, if Baby is not latching correctly, Mom may experience sore nipples during and after feedings. Sometimes, nipples can become chafed, raw and extremely sore. This is not normal. If Baby is latching how she should be, feeding her should not be painful.
Breastfeeding may feel slightly strange, and Mom may feel a tugging sensation, but if it has become a pain-filled ordeal, the baby may not be feeding correctly, and, as a result, may not be getting enough milk.
Strauss writes, "Women are told to avoid formula and bottles in the early days of breastfeeding because, many breastfeeding advocates claim, it might confuse the newborn and make them less interested in feeding from the breast. I was told exactly this in the well-regarded New York City hospital where I delivered."
She continued, "The lactation consultant in charge of giving a breastfeeding presentation to new moms made it sound as though nipple confusion was an inevitability (far from it), and one taste of formula would be a death knell for breastfeeding (actually, it can lead to breastfeeding success.) Here’s how she put it: 'The billion-dollar formula industry makes formula nice and sweet, so once babies get a taste of that they don’t want anything else.' I knew it wasn’t true, and yet, I couldn’t help but internalize the message."
6 Does The Baby Seem Sleepy And Lethargic?
According to Fit Pregnancy, if Baby isn't getting enough milk, she "may take long pauses while nursing or repeatedly fall asleep at your breast." Babies who aren't getting adequate nutrition may at first be inconsolable, but, over time, if their need for sustenance is not met, they may grow sleepy or lethargic. It's normal for newborns to sleep often, especially during the first few weeks of life, but if Baby isn't alert even when awake, this could be a sign that something is amiss.
If mothers are better informed about the warning signs of underfeeding, and what to do if and when they see them, the problem of newborns not receiving adequate nutrition could be largely prevented.
Del Castillo-Hegyi has provided a list of recommendations she feels will help prevent newborn starvation. According to Slate.com, her recommendations include, "a requirement for mothers to hand express milk before they feed to ensure there is something for their children to eat; twice-daily weighing for exclusively breastfed newborns in the hospital and at home to ensure they aren’t losing a dangerous amount of weight; daily glucose monitoring for newborns to ensure they are not hypoglycemic; and universal education for mothers on the threats of dehydration, jaundice, and hypoglycemia, as well as the complications that might arise from letting such conditions go untreated."
5 Feeding Less Than Six Times Per Day?
As has been previously stated, every baby is different, however, if Baby is feeding less than six times per day, she may not be getting the adequate nutrition she needs to grow and thrive. Watch Baby for other signs she is underfed, if these are present in addition to infrequent feeding, seek the help of a medical professional.
On feeding, BabyCentre.co.uk states, "Let your baby be your guide, and feed him as often as he wants to feed. There's no need to set up a breastfeeding routine during the first few days and weeks. On the first day, your baby will probably feed at least three to four times. After the first sleepy day or two have passed, your baby may seem hungry most of the time. And he probably is, since he'll digest a feed within a couple of hours".
The site continues, "At this point, your baby will probably want to breastfeed at least eight times a day. Though he could feed a lot more than that, such as every hour or so. By the end of the first week, his feeds will probably have settled down to six to eight a day. There's no maximum number of feeds a day when you're demand-feeding in the early days and weeks. The more your baby feeds, the more milk your breasts will be stimulated to produce. It's normal for newborn babies to want to feed very frequently."
4 Does The Baby Wake Up Often?
If Baby is waking often, never sleeping for extended periods of time, and doesn't seem settled after a feeding, this could be yet another sign that he's underfed. Adding the exhaustion a mom feels while caring for a newborn to a situation in which Baby is rarely sleeping, can cause things to get overwhelming quickly.
According to ACSH.com, "The first few days of life (up to four) of a newborn are a time when the mother's breast milk has not yet come in. If the baby latches onto the breast and nurses, they will drink colostrum which delivers a high dose of nutrients and immune components in a small volume. But, breastfeeding a newborn in the first few days of life is difficult - flooded with exhaustion, excitement and exhaustion (yup...there is that much exhaustion) - even in the best of circumstances."
The site continues, "The Fed Is Best organization supports the idea that babies should be fed formula during their first days if waiting for their mother's milk takes too long. However, what is unclear is the line between the normal 3-4 day waiting period for the mother's milk to come in and dangerous dehydration - which is incredibly difficult to diagnose in a newborn."
If baby is dehydrated, he will have a difficult time settling down, feeling satisfied, or getting the blessed sleep both he and Mom desperately need after his arrival.
Some babies sleep better than others, but if a tot seems to never really settle into a peaceful slumber, it may be because he's hungry. According to Fit Pregnancy, "If your baby seems content and well fed after feeding sessions, all is likely going well. But a baby who appears overly lethargic—or, conversely, who is constantly screaming for food—may not be getting enough milk."
3 Slowly Regaining Pounds?
It's not uncommon for a baby's weight to drop a bit after delivery, but if he's slow to regain the weight, or seems to be losing weight, this could be a sign that he's underfed. According to Fit Pregnancy, "It's normal for your baby's weight to fluctuate a bit in the first days or week of life. A newborn may lose about 5 percent to 7 percent of weight by his third or fourth day and be perfectly fine, but if he has a weight loss of 10 percent or more, there could be a problem."
BabyCentre.uk explains, "If you had intravenous fluids during the last six hours of your labor or birth, it can contribute to your baby's weight loss, as he needs to lose the fluid he took on board. After a few days, your baby should start to gain weight again. If he is weighed when he's between five and seven days, you may be able to see that he is starting to grow. By 14 days, most babies are at or above their birth weight."
Writer Elissa Strauss wrote about her experience with breastfeeding in a powerful piece published on GlobalNews.ca. She shared, "A lactation doctor I was seeing encouraged me to rent a scale to weigh my baby before and after feeds to see how much milk he was getting. I would plot it all down and then top him up with what I was pumping after the feed. I was obsessed with tracking his weight."
Strauss continued, "After two weeks of a manic weigh-feed-weigh-supplement-pump routine, the lactation doctor sensed something was wrong. She said I couldn’t sustain this and advised me to stop pumping and supplement with formula."
2 Is The Baby Frequently Irritable?
While all babies cry, if baby is upset non-stop, and can't be consoled, this may be a sign he isn't getting the nutrition he so desperately needs to survive and thrive. According to ACSH.org, "The practice of supplementing with formula in the first few days of life is in direct contrast with people who support exclusive breastfeeding. Breastfeeding advocates warn that offering formula to a newborn will make breastfeeding more difficult in the future. This is because the mother may not make adequate amounts of breastmilk if their breasts are not being emptied and also because the baby may prefer formula and refuse breastmilk."
Dr. del Castillo Hegyi disagrees. As previously mentioned, her own baby was diagnosed with multiple developmental challenges including autism spectrum disorder (ASD) and ADHD after suffering dehydration and being hospitalized during his first few days of life. She believes his delayed feeding may have caused her son's disorders, however, this hypothesis has never been proven.
Perhaps Strauss said it best when she wrote, "What’s surprising is not how many mothers have difficulty with breastfeeding; what’s surprising is how many manage in spite of all the obstacles thrown in their way.” If Mom suspects her baby is underfed, she should seek the advice of a medical professional as soon as possible. If Baby is hungry, all of the problems listed above can be solved simply by filling his hungry tummy with a delicious meal.
1 Unsettled After Feedings?
Johnson now knows that her newborn son's non-stop crying was a sign that something wasn't right. She assumed he was colicky or just adjusting to life on Earth, when, in reality, he was slowly starving.
If Baby is inconsolable, even after feedings, it may be a sign he isn't getting the nutrition he needs. Yes, babies cry, but if the wailing is non-stop, consider the fact that hunger may be the cause.
In an open letter posted on the Fed Is Best website, co-founder of the foundation, Castillo-Hegyi shares that because she attempted to exclusively breastfeed her son, he went without food "for a few days." This caused him to be re-hospitalized and admitted into the neonatal intensive care unit, and he was later diagnosed with multiple developmental disabilities.
Castillo-Hegyi's experience led her to research the effects of underfeeding on newborns. After searching through peer-reviewed journals, she shared, "[I] found that there is ample evidence showing the links between neonatal jaundice, dehydration, hypoglycemia and developmental disabilities.” She continued, "the answer to the epidemic of developmental disabilities,” (which include autism spectrum disorder, ADHD, sensory processing disorder, severe speech delay, seizure disorders, and motor impairments), “we are seeing may be found in this vulnerable period.”