Low Milk Supply Management

How much milk is enough milk?

• Give breastmilk for 1-2 years or longer.
• Your baby needs ONLY breastmilk for the first 6 months.
• For the first couple days of life, you'll make about 1-3 oz per day of colostrum.
• Ideally by day 2 to 4, your milk will come in at around 8 oz per day. 
• By day 5-7, your milk will ideally increase to around 12-20 oz per day.
• During the 2 ^nd week of life, your milk will ideally increase to around 24-32 oz per day.
  • Note that premature babies or those who are small for gestational age will often need less than these volumes at first. But, eventually they will need the same as big babies, so it's best to try to get your milk supply established within the first couple weeks, regardless of your baby's size. Extra pumping is often necessary. 
  • Click here to ready more about premature babies. 
• From week 2ish through 6 months old, most babies need somewhere between 24-32 oz per day in order to feel satisfied and to gain enough weight.
  • If you are strictly nursing, you obviously can’t measure the milk, so these numbers are simply for reference, and are only estimates. 
  • Click here to read how a baby behaves if they're NOT getting enough.
• More calories are needed at 6 months. Start solid foods and keep milk intake at about 20-24 oz per day, as best you can tell.
  • A variety of nutrients will come from an expanding menu.
  • Sources of protein and calcium other than milk become essential.
  • Foods fortified or high in iron and vitamin A are important.
• At about 1 year old, milk intake can decrease to about 16 oz per day if there are other sources of calcium and protein.
• Do not feed your baby regular cow’s milk or goat’s milk while under 1 year old. It is not properly fortified and is difficult for them to digest properly. If there isn’t enough breastmilk to meet the volumes noted above, it is best to feed formula to make up the difference.

How much weight should a baby gain?

• Babies lose weight after birth.
  • Click here to view a video about normal newborn weight loss.
• When milk is in, ideally by day 4, expect your baby to gain about 1 oz per day. Getting back to birth weight by day 10 - 14 is a common benchmark. Babies who didn't lose much weight should get there sooner by gaining 1oz per day. Some take a bit longer, but all is good if they are gaining 1oz per day.
• Expect 1oz per day weight gain for the first 2-3 months.
• After about 3 months, you can expect a slower rate of gain, which ideally follows the growth curve. 
• Breastfed babies tend to gain a bit more than formula fed babies in the first 2-3 months, but the rate of gain then slows down so they are trimmer than formula fed babies.
• At each well child visit, your baby’s height, weight and head circumference is plotted on the growth curve to confirm adequate growth. A healthcare provider will help you interpret the growth curve based on several factors. 
  • If your baby's growth curve shows slow weight gain, consider her behavior.
  • Click here to read more about how a baby behaves if they're not getting enough.
    • If she is fussy and “hungry all the time,” she might need a bit more to eat to be satisfied. If your breastmilk supply isn’t enough, donor milk or formula will be necessary.
    • If your baby gained more than needed early on, she might slip down on the weight curve, often around 3-6 months old. If she acts content after nursing and doesn't appear too thin, continue frequent nursing on demand and recheck her weight in a few weeks.
      • If her weight continues to “fall on the curve,” or your baby is lazy (weak) or irritable (hungry), a more thorough evaluation and intervention is needed to increase your baby's calorie intake and rule out other health problems.
        • Click here to view a video with triple feeding instructions.
      • Monitor your baby’s weight closely and stay in contact with the doctor.

Understand milk production

• The placenta separates --> progesterone drops --> prolactin increases --> milk cells turn on.

• When a cell is emptied, it turns back on to make more milk. 
• If a cell remains full, a feedback inhibitor stops production until the cell empties again.
• More frequent and thorough drainage results in an increased rate of milk production.

Strategies to increase milk supply

• Optimize the frequency and completeness of milk removal – at least 8 times per day, plus on demand, is ideal.
• Enhance oxytocin release to stimulate your milk let-down.
  • Relax; Skin-to-skin; Get a painfree latch; 
• Use breast compressions during nursing to prompt your baby to continue swallowing and empty the breast. Click here to view a video about an ideal breastfeeding session.
• Galactagogues are drugs, herbs, and foods to increase milk supply.
  • Before your consider this, click here to learn more. 
• Pump your breasts to empty if you supplement with your breastmilk, donor milk, or formula, to keep supply and demand on track. If you pump to stimulate more milk supply, be sure not to pump right before a nursing session, because the pump will steal the feeding. Pump immediately after nursing, to get out whatever is left behind. 
  • Click here to view a video with instructions for triple feeding. 
  • Click here to view a video with instructions for pumping. 
  • "Power pumping" is too hard, not proven to help, and will make your breasts sore. 

Tips to maintain milk supply over time

• Continue doing things to increase your supply as noted above (unless you struggle with over-supply). 
• Accept help from others! Stress and fatigue steals energy away from milk production.
• Your supply may decrease if you restrict calories to lose more weight than 1 pound per week.
  • Exercise is fine, as long as you eat enough extra calories.
• Drink enough fluid that you never feel thirsty.
• Pump after 5 hours if baby sleeps through the night. For some, if the breasts remain full for long stretches night after night, they misinterpret this as not needing to produce as much milk. 
• If your baby gets sick and nurses less for a few days, pump a few times per day to keep your supply stimulated.
• Avoid medications that can affect supply (antihistamines, birth control pills, etc)
• Pregnancy can decrease your milk supply.
• Regular alcohol and nicotine inhibit the let-down and thus decrease milk supply.
• Plugged ducts and mastitis limit milk removal and thus supply. Address these issues promptly.
• Wean from a nipple shield if possible, as it may limit how much milk is removed, and thus supply.
• Back to work stress may decrease supply. 
• Avoid over-feeding expressed breastmilk at daycare so your baby doesn’t eat more calories there than when home with mom.
  • Click here to learn more about managing return to work.
• Solid foods should not replace milk intake. Nurse before offering food so the hunger drive will maintain good milk removal. At day care, consider offering food before expressed breast milk.

Perceived low milk supply

Perhaps you feel that your supply is too low, but it's actually enough. 

Common misunderstandings

• Your breast tissue was likely swollen with fluid when your milk first came in, so your breasts felt full even after milk removal. After 2-3 weeks, the tissue swelling resolves. When you notice that you feel deflated after nursing, and thus smaller overall, you might think you've lost some milk supply. 
• Your baby's feeding pattern may be different than the "norm." Some babies nurse so quickly that it's hard to believe they can get enough in such a short time. Others drink a lot at each feeding, so they nurse less often. 
• Pumping to “see how much milk is in there” can be deceiving and confusing.
  • By 1-2 weeks of age, you'll produce around 24oz in 24 hours, which is around 1oz per hour. So, if your breasts were emptied 3 hours ago, you'll have about 3 ounces in your breasts now. However, it's not quite that simple. 
    • You will likely be able to pump more milk in the mornings compared to the evening, because you make more milk after resting over night. 
    • The pump may not remove milk as well as your baby, so you might think you’re not producing enough. 
    • If you pump right after nursing, your baby may have emptied that breast, so you won’t pump much out. 
    • One breast might always produce less milk than the other. This is OK if the other breast makes up for it.