“I’m pumping. How will I know how much milk my baby needs?”
Lactating mothers raise many “enough” questions. It’s easy to assume that the “enough” question will have an obvious answer. Everyone else can easily see the amount of milk in the bottle, right? Well, the enough “answer” is not always obvious.
Let’s revisit a few basic principles.
First, the amount of milk the mother produces may or may not be enough to meet her baby’s needs at any point in time. In the supply-and-demand equation, maternal milk volume is the “supply” and infant need is the “demand.” More on that in a minute.
Second, we tend to think of “enough” as a reflection of the minimum need. But babies who are fed with a bottle — regardless of what’s in the bottle — can be taking more than enough. That is, they are overfed.
Age affects caloric needs
Age of the baby matters. Was your baby born at term or preterm? Are you 1 day, 1 week, or 1 month postpartum?
If we’re talking “days” then there’s a big difference in amount of milk you’ll produce for a 3-day-old infant compared to the amount you’ll produce for a 7-day-old baby. And, more to the point, the amount of milk a 3-day old needs is greater than what a 7-day old needs.
But if we’re talking months, that’s different.
Multiple studies have shown that around 3-4 weeks after birth, healthy mothers with regular breast stimulation produce about 750-800 ml (25-27 ounces) of milk in a 24-hour period. Sure, there are individual differences. So, let’s round up and say that most mothers will produce 25-30 ounces a day for several months. Volume of milk does not increase much thereafter.
That’s an adequate amount to meet the needs of an exclusively breastfed baby who is a month old up to about 6 months old.
Once the baby starts taking solid food — around 6 months or so — the mother generally doesn’t have quite as much milk because the baby is then taking less and less milk.
Does the 6-month old baby have “enough” milk when fed less than 25-30 ounces of milk each day. Yes. I’ve given more details about the baby’s needs at 6 months.
Illness can affect the infant’s needs
Up until now, I’ve described what getting enough milk looks like in healthy situations. The amount of milk the unhealthy baby needs is different.
Here’s a simple way to demonstrate my point that infant need is not necessarily equivalent to maternal milk volume.
At one month, the mother of a preterm baby is likely to be producing 25-30 ounces of milk. But if her baby is born many weeks before term, the amount of milk he needs may be only a small fraction of that amount.
On the flip side, some conditions may mean that the mother is producing an adequate volume of milk, but the infant needs more milk than a healthy baby.
A baby who has gastroesophageal reflux disease is one example one who is not getting enough milk. (GERD, not to be confused with gastroesophael reflux GER.) The baby is taking the milk in but bringing it back up again. The baby with pyloric stenosis has a similar situation. The amount of milk the mother is producing is completely unrelated to the problem.
Babies with cystic fibrosis, liver disease, celiac disease, and some types of heart disease have trouble absorbing enough nutrients and calories to gain weight.
Any of these babies — and others with certain conditions — are at high risk for failure to thrive. They are not consuming enough milk to meet their needs. No matter how “normal” the mother’s milk volume is, those babies might not be getting enough milk.
Overfeeding can result from worries about getting enough milk
Simply stated, mothers who are pumping are often worried about not being able to produce enough milk. Hence, they vigorously pump many times a day. They or another caregiver — often those who at daycare — give the baby what’s in the bottle. And often, too many bottles are given.
We have no evidence that babies fed human milk from a bottle will self-regulate their intake the way they do when they are fed at the breast. Hence, overfeeding is a possible concern.
The bottom line
Parents and professionals need to be acutely aware that the question of “enough milk” isn’t the same as the volume of milk a mother produces. And the healthy baby’s need for food and fluid varies at different points in time. The compromised baby has even more complex needs.
Looking at the amount of milk in the bottle is helpful. But it’s not the criterion on which to base a judgment of “enough”.
Have you questioned whether your baby was getting enough milk when pumping? Share your experiences in the comments below!