Six questions tell you most of what you need to know: Is it painful? Are the cheeks full? Can you see and hear swallowing? Is the baby content? Is weight gain on track? What's in the nappy? The numbers to expect are roughly 2–3 sucks per swallow, at least two poos a day for the first six weeks, and six heavy wet nappies a day from around day four.
If you're not sure whether a baby is breastfeeding well, work through the following questions. This is the basic troubleshooting process a peer supporter or IBCLC will go through with you during a feeding assessment.
The six questions
1. Is breastfeeding painful for you?
One of the first things we check. If you're experiencing any pain when breastfeeding, or any nipple damage or trauma, then the baby is probably not positioned well at the breast. That also means they may not be getting as much milk as they could be.
2. Does the baby have full cheeks when attached?
The next thing I look for is nice full cheeks while the baby is attached at the breast. If their cheeks are sucking in at the sides, and they're making lots of noise, it's possible they're not latched as optimally as possible — and again, that means they may not be getting as much milk as they need.
3. Can you see and hear the baby swallowing?
When the milk is flowing, you should be able to see and hear the baby sucking and swallowing. That pattern should roughly be two to three sucks per swallow.
You'll see this by observing the jaw moving up and down — and when the baby swallows there will usually be a pause after those suckling movements.
4. Is the baby content during and between feeds?
A baby who is breastfeeding well will likely be content during feeds and in between them.
It's worth noting that breastfed babies can be a little fussy at the breast during a growth spurt — that's part of how they stimulate milk supply — so we do need to look at the big picture. But if a baby is fussy every time they breastfeed, uncomfortable, moving away from the breast, unlatching, trying to get back on, squirming, tearful and crying, that may be a sign something needs to change.
5. Is the baby gaining weight well?
A baby who is breastfeeding well will also be gaining weight well. The centile chart will show whether they're following the line they should be.
If they're dropping through the lines, they may need additional support — it may be that their position at the breast needs changing, or something else may be going on. It's worth getting a full feeding assessment to find out.
6. What's in their nappy?
We'd expect a baby feeding really well at the breast to be doing lots of wees and poos.
- At least two poos a day, every day, at least for the first six weeks. This may slow down after six weeks when the composition of breast milk changes — but ideally we should still see all babies passing a stool every day.
- Six heavy wet nappies from around day four.
If a baby is not weeing and pooing as expected, or if the poo is an unusual colour or consistency, seeking feeding support from somebody qualified is really important.
The earlier support is in place, the better. It means breastfeeding can be more comfortable, the parent can feel more confident and reassured, and the baby gets the milk they need to thrive. You can find an IBCLC through Lactation Consultants of Great Britain.
Common questions
How many sucks per swallow is normal?
Roughly two to three sucks per swallow once the milk is flowing, with a visible pause as the baby swallows.
How many wet nappies should a newborn have?
Six heavy wet nappies a day from around day four.
How often should a breastfed baby poo?
At least twice a day for the first six weeks. After six weeks this can slow as the milk composition changes, but ideally a stool every day.
Is it normal for a breastfed baby to be fussy at the breast?
During a growth spurt, yes — it helps stimulate supply. But fussiness at every single feed, with unlatching, squirming and crying, suggests something needs changing.
About the author
Charlotte Treitl is an International Board Certified Lactation Consultant and a Babyem tutor, supporting families with infant feeding and teaching practitioners how to carry out a feeding assessment.
Learn to run a feeding assessment
Babyem's accredited training teaches practitioners how to observe a feed, work through exactly these questions, and refer confidently when something is wrong.