Parents frequently ask, “How do I know if my baby is getting enough milk?” Decades of scientific research and my own clinical experience have shown that this is one of the most frequently voiced concerns. But the better question is how to recognize signs of newborn satiety. There’s a difference.
Whether the baby is “getting enough milk” can be a more complicated issue. Almost always, it can be explained by (1) milk production (2) milk let-down, or (3) milk transfer (consumption).
But it’s possible that there’s some deep underlying problem that is not immediately apparent. For the moment, however, let’s go with the idea that mother and baby are healthy. In that case, try these simple 5 steps to recognizing signs of newborn satiety.
Audible swallowing
Keep in mind these four central facts about audible swallowing
- Audible swallowing means that someone can actually hear the baby swallow.
- The person who hears the swallowing might not be the one who is offering the breast.
- The presence of audible swallowing is frequently but not always a reassuring sign.
- The lack of audible swallowing is always a worrisome sign if the “listener” knows what to listen for, and if the baby is more than several hours old. How worrisome? Well, that depends on how many hours we’re talking about, and the birth circumstances. (Like all of my posts, this is information, not medical advice.)
Babies may or may not swallow the first time they’re offered the breast. It may take a little time and a few attempts. But presuming a full-term, healthy baby was born shortly after my 8-hour shift began, it was possible for me to hear a suckling baby swallow before I went off duty.
During the first at-breast experience, the mother can seldom hear the baby swallowing. Someone else in the room might have a better shot at it. Usually, those first few times, it’s difficult to hear swallowing unless you’re really close to the action.
Why is it so tough to hear the swallowing in those first hours after birth?
Well, it’s because they quietly swallow small amounts very infrequently. Decades ago, lactation physiologist and legend Dr. Michael Woolridge showed that it takes about 0.6 ml of fluid to trigger the swallow response in a newborn.
My beloved friend Debi Bocar, RN PhD IBCLC said she once counted 16 sucks before she heard a swallow. I never tried to make an exact count, but I have no doubt that she’s right. In addition to my clinical experience, I have some science to substantiate her claim.
The mother has very little colostrum during the first few days. Hence, the baby must suck many times to get that 0.6 ml of fluid to trigger the swallow response.
In the first few days, listen for periodic soft, breath-like sounds during swallowing.
Then, when the mother’s milk supply is abundant, anyone can hear a newborn swallowing. By this time, the absence of audible swallowing suggests that the baby is not getting the milk.
By the end of the first month, it’s very easy to hear swallowing.
And once, when I was sitting in the hair salon some 10 feet from woman who was breastfeeding, I heard an older infant gulping!
Shifting gears
More signs of newborn satiety are related to what I call “shifting gears.” Watch for the 3 phases of successful sucking.
Phase 1: The baby suckles with several short, firm sucks.
Phase 2: After the milk let-down occurs, the initial patterns of short, firm sucking shifts into long, slow, rhythmic sucks interspersed with short pauses. Swallowing occurs during the pause.
Phase 3: As the baby’s stomach fills, sucking action down-shifts. You’ll hear several quick, light, audible sucks in a row, followed by a long pause, then more sucking.
Shifting gears is a good sign that the baby is getting enough milk.
Disappearance of hunger cues
When the baby has had enough milk, all of the hunger signs will disappear.
Posture/affect: relaxed
When the baby’s tummy is full and he’s satisfied, it’s more than just the disappearance of hunger cues which I described earlier. The baby appears very relaxed and drowsy.
After a successful feeding, it’s not unusual to see a baby with his fist in his mouth, but the fist is loose, not tense. He’ll probably look like he’s in a state of bliss!
Sleeping
One of the most obvious signs of newborn satiety is when the baby falls asleep while feeding. A sleeping baby is a very contented baby
You may even see a drop of milk at the edge of the baby’s mouth.
Have you wondered how to tell if a newborn had enough milk? Did you look for signs of newborn satiety? Share your thoughts in the comments below!