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Breastfeeding - not enough milk

breastfeeding; feeding; breastmilk; breast; supply; low; frequent; feeds; let; down; sugery; operation; implant; reduction; areola; nerves;

Some babies do not suck well enough or demand enough feeds for the breasts to make enough milk, but it is very rare that a mother can't make enough milk for her baby (except after some types of breast surgery). Women with small or large breasts can make enough milk by feeding according to their baby's appetite. Some will need to feed frequently and others less often.

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Mothers may worry that they may not have enough milk - maybe their baby is feeding often, or they do not know if their baby is growing well enough.

Some mothers also worry about whether their milk is good enough for their baby.

  • Breastmilk looks more watery and blue-ish than cow's milk. This is how it is supposed to look and it does not mean that it is too 'weak'.
  • The quality of breastmilk remains very high, even if you are not eating well. Breastmilk will be made using your body's stores of nutrients, vitamins and minerals.

If the information here does not help you to sort out your concerns, seek help, so you can continue to breastfeed and have a satisfied baby.

Is there enough milk?

Feeding often

  • Young babies need to feed often as they can only drink a small amount at a time. It is normal for newborns to feed 8 – 12 times in 24 hours.
  • It may take a few weeks for your milk supply to adjust to your baby's needs and it is normal for everyone to have days when supply seems to be lower than usual. Feeding often helps to boost your supply.
  • Your baby may have more frequent feeds at one particular time of the day (usually in the evening) and go longer between feeds at other times. This is normal - just follow your baby's cues.
  • At some stages babies need more milk than at other stages because of their pattern of growing. They may demand more feeds than usual. This is a way of increasing the milk supply.

If a baby wants to feed often and does not seem content this can be a sign that a baby is not getting enough milk.

Crying

A baby may be crying because he is hungry, but there are many reasons why babies may be unsettled that don't have anything to do with breastfeeding. See topic Crying baby.

Sucking

Sucking can be a sign that a baby is ready for a feed, but babies may suck a lot on their fingers and hands when they are not hungry.

  • Babies are born with a sucking reflex called the 'rooting' reflex so they can open their mouth and latch onto the breast to feed. This reflex can also cause them to suck on their fingers and hands. This sucking is usually not a sign that a baby is not getting enough milk.

Breast changes

There will be some times when your breasts do not feel as full as at other times.

When your baby is several weeks old your breasts may feel softer and may not leak as much and this can be normal.

Signs that your baby is probably getting enough milk

  • Your baby is gaining some weight (although there may be ups and downs). Your child and family health nurse or your doctor can help you know if your baby is growing well and help you plot your baby's growth on the growth chart.
  • Your baby's muscles feel strong and he has a good skin colour - so he looks well.
  • Your baby is bright and alert, with some contented times.
  • Your baby is having three to four (or more) dirty nappies each day in the first 1 to 2 months. The poo will usually be fairly runny and straw-coloured with small soft lumps (it often looks like seedy mustard). After 2 months some babies poo much less often, so this can't be used as a sign any more.
  • Your baby is wetting nappies at least six to eight times a day.
    • This will be more obvious in cloth nappies, as the nappy will feel wet straight away. For more absorbent disposable nappies the nappy will not feel wet after small wees, and it may seem like your baby has fewer wees. If you are concerned you will need to check the nappies often. Four heavy wet nappies a day are usually okay. Your baby's urine should be pale and not smell.

What to do if it seems that you may not have enough milk

If, after checking, you are not certain about whether your baby is getting enough milk, get your baby checked by your doctor, child and family health nurse or lactation consultant. They will be able to check your baby's health and weigh her, and help you decide what to do next.

  • Check that your baby is attaching (latching) and sucking properly.
    • Check your baby's position (see 'Positioning and attaching your baby' in the topic Breastfeeding - a new baby)
    • Check whether your baby is sucking well - after a few rapid sucks a baby should start to suck and swallow in a regular rhythm, as she starts to get milk. After a few minutes she may stop for a little rest before sucking again. If she seems to be going to sleep after a few sucks you may need to try to wake her up, perhaps by stroking her, tickling her feet, unwrapping her or undressing her.
    • Get someone who knows about breastfeeding to watch you feed if you are not sure.
  • Give more frequent feeds than usual for a few days.
    • The main thing that helps you to make plenty of milk is your baby sucking milk from your breasts, so in general, the more often a baby feeds the more milk will be made.
    • It is usually best to feed babies whenever they are hungry (demand feeding) so that you will go on making the right amount of milk for your baby.
    • If your milk supply is low you need to feed often. It is very important not to space feeds.
  • Offer both breasts at each feed, changing sides several times if your baby will only suck briefly.
    • Giving one side only every 3 or 4 hours often leads to a mother not having enough milk.
  • Try a top-up feed at the breast about half an hour after main feeds if your baby is still unsettled. This gives her more milk and gives your breasts more stimulation.
  • Try offering the breast to soothe your baby for a few days instead of other comforting strategies, like a ‘dummy’.
  • Get more rest and relax when you can.
  • Help your milk let-down more quickly by enjoying feed times; try breathing deeply, listening to music and removing distractions, like your phone.
  • Try frequent ‘skin to skin’ contact and breast massage, in between and during feeds.
  • Make sure you are eating and drinking well.
  • Talk to your doctor - there are some medicines which may help increase the amount of milk you have
  • If your baby is not sucking well or will not go back to the breast, express any milk left after feeds. Expressing will stimulate your breasts and help your milk supply to increase. (Breastfeeding - expressing and storing breastmilk). Express as soon after a feed as you can to allow time for the milk to build up again before the next feed.
  • If you are smoking, stop or cut down as this can make your milk supply less.

Unless you are told to by your doctor or child and family health nurse, do not give bottles of formula.

  • If your baby has had a bottle of formula and is not feeling hungry when it is feed time, he may be less interested in the breast and your milk supply may then go down even further.
  • Once your baby is used to getting a lot of his milk from a bottle, it can be very hard to get back to full breastfeeding.
  • You can give extra milk at the breast through a supplementer (supply line) - see the topic Breastfeeding - devices to help with breastfeeding

Breast feeding after breast surgery

Some women find that they are able to breastfeed after having breast surgery, such as

  • Breast implants (increasing the size of the breast)
  • Breast reduction
  • Surgery for breast cancer

However some women are less successful, and some are unable to breastfeed.

  • If there has been an incision (cut) around the edge of the areola this may have damaged the nerves to and from the nipple so that the let-down reflex does not occur. If the surgery was only on one side, starting feeding on the side where the surgery did not occur may stimulate a let down on the affected side.
  • Removing some of the breast tissue (breast reduction) may affect the nerve supply and milk ducts, making an attempt to breastfeed unsuccessful.
  • A breast implant may be able to be inserted without damaging the nerves to the nipple or the milk producing parts of the breast, but some women find that they are still unable to breastfeed after having an implant. There is no evidence that the material that is used for a breast implant has any effects on the health of the mother, or on her baby if she is able to breastfeed.

Your surgeon will be able to discuss with you the possible impact of surgery on breastfeeding and surgical options.

Resources

South Australia

  • Parent Helpline - 1300 364 100
  • Your local Child Health Centre - call 1300 733 606 for an appointment 9am to 4.30pm.  
  • Book that can be downloaded - Women's and Children's Health Network (South Australia): "Breastfeeding your baby".

Australia

References

Australian Breastfeeding Association 'Breastfeeding information'
http://www.breastfeeding.asn.au

 Raising Children Network Raising Children website is produced with the help of an extensive network including the Australian Government.
http://raisingchildren.net.au/ 

Pregnancy, birth and baby Pregnancy, Birth and Baby is a national Australian Government service providing support and information for expecting parents and parents of children, from birth to 5 years of age. 
http://www.pregnancybirthbaby.org.au/ 

Brodribb W (2006) Breastfeeding Management (3rd Edition) Australian Breastfeeding Association

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The information on this site should not be used as an alternative to professional care. If you have a particular problem, see a doctor, or ring the Parent Helpline on 1300 364 100 (local call cost from anywhere in South Australia).

This topic may use 'he' and 'she' in turn - please change to suit your child's sex.

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