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Is My Baby Getting Enough Milk?

Oct31

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Hi Amy,

First of all I love everything Amalah!  During my pregnancy I turned to your calendar on a weekly basis and have been a loyal lurker of your blog for years.  My wonderful son was born in February and the months have flown by.  After baby P was born, I resigned from my position and have been loving my work-occasionally-at-home mom lifestyle.  I have been exclusively breastfeeding and when P was 6 months old I started making his babyfood using your “lazy-mom” method. 

A couple of months ago, I got a call from my old job.  My previous boss had quit and they desperately needed me to fill in on a part time, temporary basis.  After some negotiation, my husband and I decided that I should take the offer and work 25 hours a week for the next couple months.  We have a great network of grandmas* that are all happy to watch P and it has been going pretty smoothly, I just miss spending more time with him, and I can’t wait to be back at home.

I’m starting to get a little concerned about P’s eating schedule and thus the email today.  Before I took the job, I would nurse P about 4 to 5 times a day.  Our schedule went a little like this:

Wake Up – Nurse – Solid Food Breakfast a little later – Nap – Wake Up – Nurse – Solid Food Lunch a little Later – Nap – Wake Up – Nurse – Solid Food dinner a little later – Nurse (maybe) – Bed for the night. 

Here and there when he was extra fussy or I just felt like he needed it, I would nurse him.  He usually sleeps through the night but occasionally he would wake up sometime before midnight and I’d nurse him and then he would go back to sleep.

Now that I’m at work, I nurse him first thing in the morning and at night, but he takes bottles of breastmilk mixed with formula (7 – 8 oz) after his naps.  Except when he doesn’t.  Sometimes he just refuses one of the bottles completely, other days he will devour both bottles like they are going out of style.  Part of my concern maybe that it has been a couple months since our well baby 6 month check up, so I don’t have a good gauge of how his weight gain is going, but I’m constantly worrying about this! 

Yesterday his grandma forgot the after morning nap bottle all together, so he went several hours without any milk.  When I picked him up, I was surprised to see the unused bottle, and my mom had thought it was supposed to be for later, so there was  some miscommunication there.  She was like “he ate a great lunch tho!”  grrr.

So the question – a) Does that seem like enough milk?  and b)any advice on getting the grandma’s to pay attention to his schedule?  I typed the entire day up for my mom and she has it on her fridge, and I usually give here a quick blurb about everything when I drop off P.

HELP!  I keep pushing this back telling myself its not a big deal, but a part of me just isn’t sure.  Baby P is very happy on all accounts and is right on target with most of his milestones (at 8 months he’s army crawling everywhere, pulling up a little, babbling away and laughing at his own little jokes.)

Thanks so much!!!
Flustered First Time Mom

*I realize this sounds like a lot of random old ladies, but really it is my mom, my husband’s mom and my husband’s step-mom, who are all in their mid-50′s.

Here’s the thing about babies: They let you know if they are hungry. Even once you’re past the nursing-exclusively stage and trying to cobble together a well-balanced diet of breastmilk/formula/solids, babies are really, really excellent at self-regulating their intake and letting you know if something is “off.” They don’t eat out of boredom or because it’s typed up on a schedule…they eat because they are hungry.

So if your son was consistently not getting enough milk during the day, he’d likely make up for it with more-frequent wakings at night to nurse. If he was getting actually malnourished or losing weight, he’d reserve all that energy he’s using to crawl and babble and just…seem extra quiet and maybe a bit lethargic and you’d KNOW. You’d just know.

By eight months, there really is no set-in-stone amount of milk and/or baby food that ALL BABIES MUST GET EVERYDAY. It varies soooo much. Some babies are still nursing every two hours like clockwork while others happily go every four…or more. Some are wolfing down cube after cube of baby food with a side of bagels and corn on the cob while others are still only interested in cereal mixed with breastmilk.

Here’s a decent overview/guideline piece on this, and how much it varies. In the sidebar, you’ll find specific milk guidelines for nursing and formula. Between 6-8 months, babies nurse every three to four hours. But by 9-12 months (and I’m guessing your son might be getting close to the nine-month mark?), babies space nursing sessions out by four or five hours. For exclusive formula feeders, the goal is at least 24 ounces a day — that’s three 8-ounce bottles. If your son is getting two or three bottles, plus morning/evening nursing sessions, I’d say you’re more than hitting the average of what he “should” be drinking. (And again, every baby is different, and every DAY with every baby can be completely different.)

So there’s nothing really jumping out at me in your letter that sounds crazy out of the ordinary. If your son doesn’t want the bottle, or isn’t asking for the bottle, chances are he doesn’t need that bottle.

Perhaps the 8-ounces-of-milk-in-one-sitting is actually replacing two of your former nursing sessions? I know the mornings when I hand Baby Ike over to a sitter he eats MUCH less frequently than when he’s with me — part of it’s the comfort factor, of course. But part of it is that I don’t believe he gets as much milk from me per feeding as he does in a full bottle.  So he spaces the bottles out much further than nursing sessions.

The only cause for POSSIBLE concern is if the grandmas are actually replacing entire bottles with SOLIDS. Like, maybe the morning pre-nap bottle gets skipped sometimes, no biggie, but then lunch should START with breastmilk/formula, and not baby food. You never want to offer solids before breastmilk or formula at this age (and until 12 months). If you think that’s happening, then yes, definitely stress to whoever is caring for him each day that he MUST get that bottle before lunch. After the bottle, they’re free to offer him as much solid food as he likes.

But the pre-nap, in-between-meals bottles? Eh. I wouldn’t worry about scheduling them so strictly. (I actually find it CRAZY IMPRESSIVE that your baby is so good at putting himself to sleep without a bottle or nursing, and might be a wee bit jealous, you lucky thing.) Maybe he’s too busy right now working on pulling up to stop and eat, but in a couple days he’ll hit a mini-growth-spurt and make up for it. Or he’s just making the move from being a baby who eats round-the-clock and weaning himself onto a more toddler-like schedule of morning/night nursing and three meals a day. Again, there isn’t a one-size-fits-all rule here, and I remain convinced that it’s best to let baby lead the way and takes his cues re: feeding.

If you (understandably) find yourself continuing to stress out about this, there is NO LAW that says you MUST wait until his next well-baby visit to get a weight check done at the doctor’s office. NONE. You would absolutely not be the first mother to ask for one, and any decent pediatrician’s office should be more than willing to schedule five minutes of a nurses’ time to weigh your son and plot the number on his growth chart to reassure you that everything is okay.

And lastly! Because this is Me and My Thing and it would not be a very Amalah-like column if I didn’t mention it: Eight months old is a FABULOUS AGE to start baby sign language. Like, the BEST, because the little mimics pick it up so quickly and it’s like, BEHOLD TWO-WAY COMMUNICATION THAT IS NOT UNGODLY SCREAMING! HUZZAH! Teach him (and the grandmas!) the signs for milk and more. That way, you’ll know for sure that he’s actually getting milk every time he actually wants/needs it, and that the skipped bottles are because he’s setting the schedule, and not because Grandma isn’t paying attention.

Photo credit: Thinkstock

About the author

Amalah

http://www.amalah.com
Amalah is a pseudonym of Amy Corbett Storch. She is the author of the Advice Smackdown and Bounce Back. You can follow Amy's daily mothering adventures at Amalah. Also, it's pronounced AIM-ah-lah.

If there is a question you would like answered on the Advice Smackdown, please submit it to amyadvice@gmail.com.

Amy also documented her second pregnancy (with Ezra) in our wildly popular Weekly Pregnancy Calendar, Zero to Forty.

Amy is mother to rising first-grader Noah, preschooler Ezra, and toddler Ike.


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8 Responses to “Is My Baby Getting Enough Milk?”

  1. Christine Oct 31 at 12:33 pm Reply Reply

    I completely agree with everything that Amy has already written above.  I’m a pediatrician (I work in the ICU only though) and my daughter is probably only a few weeks older than your son.  Everything that Amy’s said above is spot on correct.  I’ll add in that a 7-8 ounce bottle is pretty big, my daughter usually only takes 4 ounce bottles when at day care (she’s there about 6 or 7 days a month, I’m a SAHM the rest of the time).  If your son was hungry he would definitely make it known- cranky, crying, insisting on eating like crazy the moment he gets home, etc. 

    I agree with Amy as well, if you’re really concerned just head in to your doctor’s office for a weight check.  Explain why you’re concerned, likely your pediatrician will ask things about dehydration (how many wet diapers a day, does he seem just as active, does he cry tears, etc) and will be more concerned about that than missing an occasional bottle from a weight gain perspective.  The other thing to remember is that ALL babies will drop a bit in the weight % after they start crawling and then again after they start walking.  They suddenly want to move, move, move and they will burn the calories off like crazy.  So, focus more on hydration and gaining weight overall, not necessarily the % weight because he may have lost a bit.  That’s the crawling!

    Finally, this might be the hardest bit, if after checking everything above you’re still obsessing, maybe think a bit about WHY you’re obsessing so much?  Is it a real concern at that point, are you worried about leaving your son with one of the grandmas more than the other 2, are you feeling guilty about leaving him a few days a week?  Addressing those questions might help as well.  It’s hard enough to not have that time with your son, thinking about those concerns and addressing them might make it easier to concentrate while at work.

  2. MR Oct 31 at 12:43 pm Reply Reply

    ITA with Amy. Baby will let you know if he isn’t getting enough. But if he for some reason didn’t, you would still know if you paid attention to your baby at all (which you obviously do). Since nursing/bottles are baby’s primary source of fluids, you would know right away if he wasn’t getting enough because you wouldn’t be changing as many diapers. If you are still changing those heavy pee diapers plenty during the day, he is getting enough. He would then start to show lethargy after his diapers drop off. From your own account, he is a happy, healthy, active baby, which all says he is getting enough. Going back to work is tough, and it can play tricks with your mind that your daycare provider isn’t caring for baby as well as you would. In your case, your daycare providers are all grandma to your baby boy, so they all have a vested interest in spoiling him and loving him. It sounds like he is in wonderful hands. He is getting some time to learn to be independent from mommy, but still gets plenty of time with mommy too. It is hard watching baby grow up. But they will always still love mom.

  3. Olivia Oct 31 at 12:53 pm Reply Reply

    My daughter also only ever drank 4 oz at a time while I worked. It was also around that age that she began reverse cycling and would just sip on bottles (and waste my pumped milk!) and eat a bite or two of food during the day. Then it was all night buffet at the boob to make up for it.

  4. Emily Oct 31 at 3:44 pm Reply Reply

    I’m with Christine – I heard it’s better on their stomachs to eat more smaller bottles. My child continues to eat every 2 hours all the way to now (13months). She would never drink more than 5oz (except first thing in the morning, she’d take 6). She eats great solids, etc, but she knew the difference – when she wanted liquid, there was no giving solids – I think they know what they need in general. I go with the standard healthy diet advice – 6+ dirty diapers a day. And my pediatrician told me (at your child’s age) that our goal was 24-30 ounces of liquid a day. My child is an over 100% baby though, so I’d call and check with your pediatrician if you’re really concerned with having a number.

  5. Karen Oct 31 at 6:34 pm Reply Reply

    I agree with Amy and everyone else. My DD also never drank more than 4 oz at any age. Like your son, she was EBF with pumped bottles for daycare and a breastmilk-formula combo the last few months. I always have wondered who uses the big giant bottles from Babies R Us? I think my daughter was engaged in all the new people and activity when she wasn’t with me and probably didn’t need to snuggle for huge bottles when she could be sticking her hand in another kid’s mouth – how fun! Another thought coming from a fellow PT working mom who uses home daycare and “grandma’s daycare” is that daycare providers and babysitters seem to resist detailed instructions, and the more detailed you make them, the more they resist them. This seems especially true of grandma’s. If you are leaving everything that they will need while they watch him – bottles, food, etc. and you return to a happy, rested boy then don’t think too much more about it. I’m a bit anal retentive myself but I don’t want to fracture the very good relationship with my daycare by overanalyzing their operation, and I don’t want my mom to start dumping bottles and claiming my kid drank them just to keep me off her back, etc. It sounds like you have a fabulous setup here and bonus cash before the holidays – total win-win!

  6. tasterspoon Nov 03 at 6:09 pm Reply Reply

    I also don’t understand the 8 oz bottles. But I sympathize, I also googled extensively on how much my baby should drink when she started day care and was frustrated by the general vagueness. Though your ped is the best source of advice for you, the acceptable range seemed to be 16-24 oz/day, which allows for considerable variance. My baby had boobs in the morning and night, and two 5ish oz morning/afternoon bottles (i.e. between meals, not at them), which is exactly what I pumped. So I estimated she was getting about 20 oz day, assuming she nursed the same amount I pumped per session. Like you, though, I still WONDERED, because my baby was so skinny (18%). But at her 9 month appt the ped said that because she was tall (98%) not to be concerned, that if she were starving her growth would have slowed. So though I agree with what others have said about your baby letting you know if he’s hungry, here’s another vote for just going for a weight/height check to relieve your mind.

  7. tasterspoon Nov 03 at 6:16 pm Reply Reply

    I also remind myself, when my mom or dad babysits and doesn’t do things as I would and I feel the frustration building, that somehow they did all right with me, and it’s not such a bad thing if my baby learns to be flexible.

  8. Erica Nov 22 at 9:29 am Reply Reply

    My daughter, who is now 2 and a half, was down to only 2 6oz. bottles a day when she was 10 months old. I freaked out b/c I thought for sure she wasn’t getting enough formula. My ped told me exactly what Amy states above – she will let you know when she needs more. We were aggressive in introducing new foods, and the dr told me she was just really interested in things besides formula and not to worry (as long as she had wet diapers of course).

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