What’s “normal” for breastfeeding and what isn’t seems to be a common source of confusion. Sometimes mothers think they aren’t making enough milk when they really are because they misinterpret their babies behaviors. By the time we hear everyone else’s opinion on what should be considered normal, it’s hard to know who or what to believe.

For better or worse, our first teachers for how to interpret baby behavior are our own mothers, family, and friends. Unless you have a medical background or formal training in child development, you’ll probably rely on their advice as you assess your own baby’s behavior for the first time. This can be helpful, but it can also be frustrating because their ideas may be out of date or they may have conflicting opinions Grandma tells you that the baby is crying after feeding because he ate too much and his stomach is upset. Your neighbor tells you that the baby didn’t get enough to eat and is still hungry. Your best friend warns you that the baby may be allergic to your milk. Aunt Susie thinks the baby is “colicky” and just needs to “cry it out.” Which interpretation is true? Which are you more likely to believe if you’re already worried about making enough milk?

Normal Baby Behaviors after the Milk Comes In

  • Baby breastfeeds at least 8 to 12 times in 24 hours, spaced approximately two to three hours apart, but sometimes clustered together.
  • Baby sleeps no more than one four-to five-hour stretch once a day until breastfeeding is well established and he is growing appropriately.
  • Baby begins feedings with a few quick suckles, followed by bursts of several sucks with long, drawing jaw movements that pause momentarily so baby can swallow.
  • Baby’s swallows can be heard frequently as a whispered “kuh” or a gulping sound in the first five to ten minutes, then less frequently thereafter.
  • Baby breastfeeds actively for approximately fifteen to forty minutes per feeding but sometimes less if milk flow is very fast.
  • Baby seems to drain one breast thoroughly before taking the other side, or he may not take the second breast at all.

The only true way to know if baby is getting enough is by evaluating his weight gain and diaper output. Baby’s behaviors do also provide clues, but when you have a good understanding of normal baby and breastfeeding behaviors, misinterpretations and misperceptions are less likely to happen. This Blog will help you sort through the realities and myths of normal breastfeeding.

8 Commonly Misinterpreted Baby Behaviors

There are many common infant behaviors that can mislead you to believe that your baby isn’t getting enough milk if you don’t understand what baby may really be saying.

1*Frequent feedings

It’s normal for babies to breastfeed frequently, especially during the early weeks. In the first two days, baby may nurse as often as every half hour, counting from the beginning of one feeding to the beginning of the next. The actual feeding is usually for only short periods, with baby waking to feed at night more than during the day. After the milk comes in, most babies begin feeding every two to three hours, or eight to twelve times in twenty-four hours, on average, though some cultures expect and allow a baby to breastfeed as often as several times in an hour. Newborns aren’t as efficient as they will be later on, and they also need to gain weight faster than they ever will again. How often would you need to eat if you were trying to double your weight in six months and triple it in a year? Babies need frequent opportunities to feed in order to fuel all that growth.

Parents often expect babies to feed at regular intervals around the clock, but some babies will nurse several times over a period of a few hours and then take an extra-long nap. These cluster feeds can occur at any time but happen most often in the late afternoon and evening. Of course, never being satisfied and always wanting to be at the breast can indicate that baby isn’t getting enough. You’ll know if frequent nursing is a problem or not by looking at diaper output and weight gain, as explained in the next Blog 3.

2*Frequency Days and Growth Spurts

Many babies will have “frequency days” when they seem extra fussy and want to nurse much more frequently than their usual pattern. You may even feel like you’re running out of milk” because your breasts are soft, when it’s actually the reverse: your breasts feel soft because baby is feeding so often that he is not allowing much milk to accumulate. The positive side of this is that he is stimulating a higher rate of milk production.

Remember your teenage days? Mom would buy a certain amount of groceries each week. Then, suddenly, you started eating ravenously, and before the week was up, the cupboards were bare, and you were searching for more food. Were you starving to death? No, you were just extra hungry, and the stockpile of groceries was temporarily depleted. All that was needed was an extra trip to the grocery store to meet your additional needs. When the growth spurt stopped, your appetite returned to normal. It’s the same with babies.

Frequency days generally happen around two to three weeks, six weeks, three months, and six months, with baby usually returning to his previous feeding pattern in three to seven days. It was once thought that these spurts were baby’s way of increasing milk production to meet his growing needs, much like bottle-fed babies tend to take more formula over time. However, we now know that babies stimulate temporary increases in milk production that settle back down again when the growth spurt is over.

3*Less Frequent Feedings

While frequent feedings worry some mothers, others become concerned that they must not have enough milk when their baby begins to nurse less frequently. If a newborn is feeding fewer than eight times a day after the first few days of life, it is possible that he is conserving calories because he isn’t getting enough milk. But more often, a growing baby is able to take larger feedings, allowing him to go longer between meals, This may be especially true if you have a large storage capacity, allowing baby to take as much as he can handle in a single feeding Diaper output will usually tell you which is the case.

4*Short Feedings

Perhaps You’ve heard that baby must feed for a specific amount of time at each breast in order to get enough milk or to get to the “hindmilk.” This isn’t true, because all babies and breasts respond differently. Some babies are able to transfer large amounts of milk in as little as five to ten minutes, particularly when the mother has a strong milk flow, After the first few weeks, shorter feedings may also be a matter of baby simply having learned how to nurse more efficiently so that he gets the same amount of milk in less time. Or he may be “snacking” in between longer feedings or as part of a cluster feed. Fluctuations in milk supply throughout the day can also affect the length of breastfeeding.

On the other hand, some newborns stop feeding early out of discouragement or fatigue. They may not be able to get milk out easily due to a latching or suck problem, or because the milk isn’t flowing as fast as they want or expect after having experienced faster flow from a bottle. Babies can also become frustrated by slow milk flow because the mother’s milk production has decreased for some reason.

5*Baby Cries and Takes a Bottle after Breastfeeding

While an underfed baby may indeed gulp down a bottle after breastfeeding, some will take a bottle even after consuming enough milk at the breast. Is the bottle offered because baby truly needs it or because someone else wants to feed him or thinks he needs it? Was baby doing just fine before, and now his having accepted the bottle after a feeding shakes your confidence? Or was he crying, and the bottle seemed to calm him down?

Sometimes what’s really happening is that baby is being stuffed into a stupor in a very unnatural way. Just because a bottle stops the fussing doesn’t automatically mean that he needs more to eat. Think about how mothers handled this before bottles and formula were invented. Crying can mean things other than hunger; baby may just need more sucking time, or he may have become upset during or after a feeding because of allergies, gas, or reflux. Don’t be afraid to call your pediatrician if his crying is worrisome, and be persistent if your gut says that something is wrong and you aren’t satisfied with the answers. It isn’t always about your milk supply!

Sometimes what’s really happening is that baby is being stuffed into a stupor in a very unnatural way. Just because a bottle stops the fussing doesn’t automatically mean that he needs more to eat. Think about how mothers handled this before bottles and formula were invented. Crying can mean things other than hunger; baby may just need more sucking time, or he may have become upset during or after a feeding because of allergies, gas, or reflux. Don’t be afraid to call your pediatrician if his crying is worrisome, and be persistent if your gut says that something is wrong and you aren’t satisfied with the answers. It isn’t always about your milk supply!

6*Baby Chokes, Sputters, and Arches at the Breast

If your baby chokes and sputters while breastfeeding perhaps arching and pulling off, crying, or not nursing for long periods at the breast it could be an indication of too much milk! If so, your baby may gain weight rapidly, or his weight gain may be slower due to his struggles with the strong milk flow. He may cry a lot and act very irritable or restless, especially after feeds. Gulping, choking, sputtering, or coughing during breastfeeding are common, as are biting, clamping down, pulling on the nipple, arching, stiffness, or even screaming. Feedings often seem like battles, with baby having a “love-hate” relationship with the breast and nursing fitfully on and off, feeding for only five or ten minutes total. He may burp a lot, spit up after feedings, and be very gassy, and his stools are often green, watery, foamy, or explosive. Your milk may spray forcefully when he comes off the breast, especially early in the feeding. You may feel very full much of the time, even while offering both breasts, and battle plugged ducts that could lead to breast infections. If this sounds familiar, try feeding on one side per feeding for twenty-four hours as a starting point to see if it helps.

7*Regular Fussiness in the Late Afternoon or Early Evening

In the first three months of life, many breastfed babies fuss in the late afternoon and early evening. Mothers often worry that this is a sign that baby isn’t getting enough to eat, especially if their breasts feel deflated. As discussed in Blog 1, the most likely explanation for this common phenomenon is that your milk reserves have been drained throughout the day and baby is now withdrawing milk as it is actively made. In fact, this is more likely to happen if you have a larger storage capacity and baby sleeps longer at night and then removes milk faster than it is being made during the day time in order to get all his meals in.

When there is little accumulated milk in the breasts, the force of the milk flow is reduced. Since babies often prefer a faster flow of milk when they are hungry, they may become impatient and irritable when the flow is slower late in the day. This fussy time may also coincide with tiredness and overstimulation, which decrease their patience and contribute to crankiness. When offered a bottle at this time, baby may take it eagerly, reinforcing fears that he’s starving. Most of the time, the reality is that you have plenty of milk over twenty-four hours, just not a lot right now, and that’s OK.

Early evening “fussiness” can also be the result of a frustrated infant whose mother is refusing to offer the breast again because baby just fed.” Nursing frequently may be baby’s way of compensating for less available milk at the end of the day; if large meals are not available, lots of smaller ones will do. Frequent feeding also may be his way of tanking up before a long sleep. If he calms down right away when put to the breast, the problem more likely is about unrealistic expectations.

To get the most milk possible into baby during this time, try breast compressions to increase the force of the flow see BLOG 5 and then alternate with cuddles, movement and singing. Sooner or later, baby will fall into a long, deep sleep. You can also try a galactogogue (milk-stimulating) herbal tea(see BLOG 12) in the late afternoon.

8*Baby Not Sleeping Through the Night

“Is your baby sleeping through the night?” is one of the first questions new parents hear from friends, relatives, and even from physicians. It stems from a common cultural belief that babies should be sleeping several hours at night as early as three months of age and has become an expectation and measurement of parenting success. Some people even define a “good baby” as one who sleeps through the night. However, sleeping for longer than four hours more than once or twice per twenty-four hours in the first month may indicate baby is not getting enough milk and sleeps to conserve calories.

It is normal for a baby, especially one who is breastfed, to continue to awaken periodically at night during his first year of life. He may nurse one to three times between 10:00 P.M. and 4:00 A.M. and take more milk at night than in the daytime. An important factor in determining how long he can go between feedings is your milk storage capacity and whether you can deliver more milk at a given feeding. Infants of mothers with a large capacity breast-feed less often overall and eventually take a longer break than do infants of mothers with smaller storage capacity.

Many parents report that their baby initially started to sleep longer hours at night only to have that end after a month or two, leaving them to wonder what went wrong. Actually, it really is what went normal.” Remember, there is more going on in baby’s life than just eating. The discomfort of teething or an illness can awaken him, searching for comfort. The excitement of increased mobility as he masters rolling over crawling, or standing can cause him to wake up, looking for mom. Life may just be too exciting in the daytime to eat, so he nurses more at night when the world is dark and less stimulating. If you recently went back to work, baby may also wake more often to make up for missed daytime feedings or even just to touch base and make sure you’re still there for him.

Occasionally a change in baby’s sleep pattern can indicate that baby needs more food, but there will be other clues to validate this. If nothing has changed in your life, such as starting on a new medication or routine separation from baby, and he is still gaining well and producing lots of diapers, then his sleep pattern is probably related to something other than your milk production.

Reading baby’s body language to Gauge Milk Intake

Contentment after a feeding can be a good sign. However, babies who aren’t getting enough to eat can sometimes fall asleep and initially appear content when they have not taken in enough. How do you tell the difference between a baby who is truly full and one who is apparently content but still hungry? Babies may not speak with their mouths, but they sure do speak through their expressions and posture!

A baby who is getting only a little milk out of the breast will quickly slow down to a “flutter” suck and doze off without letting go of the nipple, He often has a puzzled or worried expression, with furrowed eyebrows and wrinkles in the forehead as if to say, “Something isn’t right; why isn’t this working?” as he keeps trying to get more milk. His body never fully relaxes while nursing, and his hands may be tightly fisted and close to his face. If he has difficulty latching on to the breast, he may flail his arms about desperately, adding more chaos to the situation. And when taken off the breast, he may immediately awaken or go through a series of “cluster feeds'” that never seem to end. A baby looking for more milk may tug and pull at the breast, or push and knead it with his hands like a kitten. This in instinctive behavior is designed to induce another milk ejection, which usually happens if milk is still available. As baby alternately pulls and pushes, he may act “antsy” and unsettled until milk flows again. Less patient (or fed up) babies will come off the breast or even refuse to latch after a while, arching stiffly and screaming as if to say, “Not again! I told you this isn’t working!” Mothers often interpret this to mean that baby dislikes breastfeeding, but that’s not the case at all. Babies are biologically designed to want to breastfeed. What may be frustrating them is not being able to figure out how to get more milk faster.

Another nonverbal message is tightly closed lips, which seem to say, “I’m done for now, thank you.” Babies do have their individual limits in how long they are willing to keep trying, and babies born early especially have less stamina, lt is important to interpret the messages correctly so that you can change, or help baby to change, what is not working for him right now. When feedings are stressful or filled with conflict breastfeeding can become a trust issue for the baby. Respecting what he is communicating to you will help rebuild his trust in the breast.

Another nonverbal message is tightly closed lips, which seem to say, “I’m done for now, thank you.” Babies do have their individual limits in how long they are willing to keep trying, and babies born early especially have less stamina, lt is important to interpret the messages correctly so that you can change, or help baby to change, what is not working for him right now. When feedings are stressful or filled with conflict breastfeeding can become a trust issue for the baby. Respecting what he is communicating to you will help rebuild his trust in the breast.

There are also positive baby cues that signal when things are going well for baby. As the milk begins to flow and baby starts swallowing, his eyes open, and the wrinkles and perplexed expression he may have had begun to fade away, as if he is thinking, “Well look at this! I can’t believe I’m getting this much! Can it be true?” And as he begins to fill up, baby’s fists open up, his arms relax, dropping away from his face, and his eyes slowly close. Mothers often comment on their babies’ “milk drunk” expression at the end.

Normal Maternal Breastfeeding Experiences

  • Your breasts felt tender at some point during pregnancy, particularly during the first trimester
  • Your breasts increased in size.
  • Your areolas darkened.
  • The veins on your breasts became more visible.
  • Your breasts felt fuller, firmer, and perhaps warmer as your milk “came in” between the second and fourth day postpartum.
  • You experienced uterine cramping or gushes of blood, called lochia, during feedings in the first few days after birth in response to baby suckling or pumping (these become stronger after each birth).
  • Your breasts feel softer after feedings.

6 Commonly Misinterpreted Maternal Indicators

Some experiences may lead you to believe that you don’t have enough milk, yet they are not necessarily reliable signs when taken alone, though several together may indeed be reason to investigate further.

1*Inability to pump or express much milk

The amount of milk you can pump may or may not be an accurate measurement of your milk production, Effective pumping depends on the quality of the breast pump, the fit of the kit, the density of the breast tissue, and your overall comfort with and response to pumping. Some mothers release milk very easily to even a low quality pump and are able to drain their breasts quite well, but most respond best to a consumer- or hospital-grade pump. A few women don’t seem to be able to extract milk efficiently with any kind of pump. Pumping can provide some clues to how much milk you are making, but it should not be your only measuring stick. If you are pumping after breastfeeding, baby may have taken most of the available milk. If you’ve been using a consumer-grade pump and experienced a gradual decrease in milk yield over several weeks or months, it’s possible that it may not be your body that is to blame, but rather the pump. (see BLOG 11

Hand expressing to see how much milk you have is also not always an accurate measurement of your milk supply. Hand expression is a skill that can be valuable in stimulating your milk production, but most mothers need practice to become adept at it, and it is still not as effective as a baby who is nursing well.

2*Little or No Engorgement

A mother who has been nursing frequently from the start does not always feel significant discomfort as her milk comes in, though most mothers do experience some feelings of fullness and warmth. Although you may expect the experience of the milk coming in to be painful frequent removal of milk often helps to avoid or minimize engorgement.

3*Not Feeling Milk Ejection

Not all mothers feel the milk ejection reflex happen. When they do, they’re more likely to feel those in the beginning as a full breast releases; the sensation tends to dampen with less milk. Leaking from the opposite breast during a feed usually indicates that milk ejection is occurring, especially when the baby begins swallowing audibly at the same time. After several months, sensations of milk ejection often diminish even for those mothers who felt them easily early on.

4*Not Leaking

Leaking between feedings is not by itself an accurate way to gauge your milk supply. It has more to do with the tension of the muscles in your nipples, which differs from woman to woman, than with milk production. While leaking can be a very positive sign that there is milk in your breasts and some mothers leak more as their milk production increases, leaking alone does not indicate how much milk you have.

5*Softer Breasts

In the beginning, your breasts may often feel very full before each feeding. After about six weeks, though, the milk supply becomes more harmonious with baby’s needs, and the breasts begin to feel softer and less full more of the time (unless it has been an unusually long time between feedings). If you breastfed previously, you may also find that with each new baby your breasts seem to get softer sooner and make this adjustment more quickly.

In the beginning, your breasts may often feel very full before each feeding. After about six weeks, though, the milk supply becomes more harmonious with baby’s needs, and the breasts begin to feel softer and less full more of the time (unless it has been an unusually long time between feedings). If you breastfed previously, you may also find that with each new baby your breasts seem to get softer sooner and make this adjustment more quickly.

6*Milk Wrong Color or Too Thin

Human milk is often somewhat bluish but can vary in color depending on the foods you eat. These variations do not affect the quality of the milk and are certainly not harmful to baby. Fluctuations in the amount of fat in your milk depend on the degree of fullness of the breasts, the time of day, and the age of your baby. Factors such as smoking can also influence the fat content of the milk. However, breastfed babies compensate for these changes by regulating the amount of milk they take. If you have milk that is lower in fat overall, baby will take a larger volume in order to get enough calories for his needs assuming he has unrestricted opportunities to nurse.

Where Did My Milk Go?

Baby just came off the breast and needed a little break, but now he’s ready for more. You can feel that your breast has milk, but he’s fussing and it isn’t flowing. What happened? Without any forces continuing to push or pull the milk out, milk will draw back up into the ducts and ductules like a sponge soaking up water. This can be confusing to both you and baby when the milk is not coming out as it was doing just a little while before. But be reassured that if there was milk there a few minutes ago, it is still there. It just needs a little stimulation for another milk ejection to get things going again.

Do You Have Enough Milk?

Now that you have a good understanding of normal breastfeeding, the next BLOG will show how to know for sure if your baby is getting enough milk. If he isn’t, the BLOGS that follow will guide you toward the steps to making more milk for your baby.

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