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Breastmilk Management & Baby Weight Gaining Tips

different bottles of milk

Have you ever been told that you have “skim milk” for breastmilk? Perhaps you brought your baby in for a weight check and they didn’t gain as much as was expected. This is often when a mom gets told that somehow her milk is responsible. That is devastating to hear and quite simply, just not true.

Your milk is tailored to your baby’s needs. Breast milk is changing all the time for your growing baby’s needs. Your milk changes during a feeding, over the day, and during the length of your lactation journey. 

Although it is adapting and adjusting constantly, breastmilk composition remains fairly consistent. There are slight variations because we are all unique individuals. The mother’s gut health, diet, and environment play a role and account for the small variations in her milk compared to another person’s milk. 

There is no such thing as “skim milk” or “low fat” milk 

Milk facts:

  • Milk collected from mothers whose babies were born prematurely shows that their milk is higher in protein and fat compared to milk from mothers of full-term babies.
  • Increasing the healthy fats in your diet will boost the fat quality of your breast milk, but not the quantity of overall fat in your breast milk.(2) 
  • Mature milk of full-term infants contains:(1)

0.9 g/dL protein

3.5 g/dL fat

6.7 g/dL glucose - the main carbohydrate in breastmilk

65-70 kcal/dL calories or energy

Circadian rhythm of breastmilk:

  • Prolactin is the hormone signaling milk to be made. It peaks between 2-5 am and is lowest in the late afternoon.(3) What this means is that middle-of-the-night milk removal is critical to maintaining milk supply. 
  • Iron is higher overnight than during the middle of the night
  • Fat is higher during the evening hours than early in the day
  • Melatonin and tryptophan peak at night which helps develop the baby’s biological clock deciphering day from night.(4)

Breastmilk changes:

  • As your baby nurses - the fat profile in milk increases towards the end of a feeding. It peaks about 30 minutes after your baby nurses.(5) Milk at that time will be higher in fat and decrease as time goes by.
  • During the day & evening- your breasts are naturally less full in the early evening hours. Your baby may cluster feed during this time, loading up on milk that has a higher fat content and hormones that help them drift off to sleep for a longer stretch of sleep.
  • Depending on how often you nurse your baby - longer periods between nursing sessions mean your breasts will be more full and have more volume. More milk volume means your baby will be getting more carbs and water compared to fat as they begin to nurse.
  • Less full breasts = more fat - When your breasts are less full because you are nursing your baby more often, the milk has a higher fat content when they begin to nurse.(6)
  • Breastmilk color may vary - your milk can look rich yellow, creamy white, lighter white, blue, green, and more. It is a living substance and varies depending on when you last nursed or pumped, foods you eat, medications and supplements you take, and from the beginning of milk removal versus towards the end of a pumping or nursing session. All are variations of normal and safe for your baby.

Expected weight gain for breastfed babies(7)

  • Babies lose an average of 5 - 7% of their birth weight in the first few days after birth
  • Losing up to 10% of their birth weight is considered acceptable
  • A Baby’s weight at 24 hours old may be a more accurate representation of true birth weight
  • Babies lose the most weight in the first 2 days after birth
  • Your baby should regain their birth weight by the time they are 2 weeks old
  • During the first 3 months, your baby will gain about 1 ounce per day
  • By 4 months old, your baby will double their birth weight
  • From ages 6 - 12 months old, your baby will gain about 3 - 5 ounces per week
  • Your baby will triple their birth weight by about 1 year old
  • Boys gain weight faster than girls
  • Babies grow about 10 inches in length during the first year of life

Breastfeeding management & weight gain tips

  • Nursing on demand is not on a schedule. Guidelines for how many times your baby should nurse are often the minimum times a baby should nurse to gain weight. When babies are held, worn in a sling, and have unrestricted access to nursing, they will nurse much more frequently. Truly nursing on demand, babies may nurse 2-4 times an hour.(8) 
  • Weight gain issues - when we dig deeper into the situation, it is often because the baby is not getting enough milk volume. If your baby seems to nurse all the time, the issue may be more complex than just time at your breast and you should reach out to your IBCLC to help you problem-solve.
    •  Total milk intake should be 24-30 oz from about 10 feeds per 24 hours.
  • Breast compressions and using the Breast-Ease heat pack during nursing can help move some of the fat in your milk down the ducts.
  • If you are experiencing a low supply, lactation supplements can help boost your production while you work on other aspects of breastfeeding management.
  • Gentle stroking, shaking and massage before nursing or pumping combines water and fat in your milk so your baby gets some more of the fat sooner.
  • Your breast releases milk with more water and carbs which quenches your baby’s thirst before milk that has more fat is reached. When nursing sessions are close together, there is not as much of a build-up of volume and the milk will naturally be higher in fat right off the bat when your baby begins to nurse. Think of the breast as a container with water at the bottom, closest to the nipple, and fat on top. Just like a container, the fat tends to stick more to the ducts as it sticks to the side of a container. As your baby removes milk, the fat will begin to mix in, too.
  • Middle of the night - babies are designed to breastfeed often. As your baby gets older, they explore their world more and may nurse for shorter periods during the day and make up for it during the night when prolactin levels are also higher and there is more milk available to them. Breastfeeding or milk removal at night is protective of milk supply. Most babies continue to wake at least 1-2 times during the night for the first 2 years of life.
  • The root cause of your baby’s weight gain issue or milk supply may be more than one reason. Contact your IBCLC to rule out oral restrictions or other structural barriers.
  • Get rid of interference known to disrupt breastfeeding and appropriate weight gains like swaddles, separate sleep environments, and not enough time being carried or worn by the breastfeeding parent.

And I will repeat……….

There is no such thing as “skim milk” or “low fat” milk

Your milk is amazing and perfectly designed to nourish your baby. 

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Footnotes:

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3586783/
  2. Aumeistere L, Ciproviča I, Zavadska D, Andersons J, Volkovs V, Ceļmalniece K. Impact of Maternal Diet on Human Milk Composition Among Lactating Women in Latvia. Medicina (Kaunas). 2019 May 20;55(5):173. doi: 10.3390/medicina55050173. PMID: 31137596; PMCID: PMC6572110
  3. https://pubmed.ncbi.nlm.nih.gov/2106085/
  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7468880/#:~:text=Circadian%20fluctuations%20in%20human%20milk,synchronise%20with%20its%20external%20environment.
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3819380/
  6. https://kellymom.com/nutrition/milk/change-milkfat/
  7. https://www.who.int/tools/child-growth-standards/standards
  8. https://parentingscience.com/infant-feeding-schedule/

Other Resources:

https://www.unicef.org.uk/babyfriendly/breastfeeding-the-dangerous-obsession-with-the-infant-feeding-interval/


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