Check the schedule 

• Watch for signs from your baby that he or she wants to feed. Your baby should wake and "cue" to breastfeed about 8 to 12 times in 24 hours. Your baby will cue by rooting, making licking or sucking motions, bobbing their head, or bringing their hand to the face or mouth. It's important for you to understand these feeding cues. And to put your baby to your breast when he or she cues. Don't wait for your baby to cry. Crying is a late feeding cue. Often a baby latches and breastfeeds better if they don't have to wait until they are crying, frustrated, or too tired to feed. Putting a baby off to try to get them to go longer between feedings is often linked to poor weight gain. And so is frequently offering a pacifier instead of the breast when a baby shows feeding cues.

• For many mothers, milk production increases and babies' weight gains improve if they let chores and activities go for 2 or 3 days. This way they can breastfeed nearly around the clock. When a baby is not breastfeeding, the mother holds him or her skin-to-skin on her chest. This often helps her become more sensitive to the baby's feeding cues.

• Your baby may be a "sleepy" baby who does not cue to feed at least 8 times in 24 hours. Then you will have to wake your baby to feed frequently--about every 2 hours during the daytime and evening hours. And at least every 3 to 4 hours at night. You will need to do this until weight gain improves.

• It can help to write down when your baby nurses, on which side, and for how long. Keep track of this for a full 24 hours, if not longer. Take this record to your healthcare provider or lactation consultant. They can help you find and fix the problem. 

Latching and positioning

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• Be sure your baby is mainly uncovered during breastfeeding. A baby that is bundled papoose-style may get much too warm and comfy. He or she is more likely to doze off too quickly during feedings. If there is a chill in the air, drape a sheet or light blanket over you and the baby as needed.

• If your baby falls asleep within minutes of latching on, massage your breast as he or she nurses. This can provide a burst of milk and re-trigger sucking. You can do this by stroking downward and inward on the breast.

• Make sure your baby is latching on correctly. The latch should be comfortable to you. Your baby's lips should be flanged outward like "fish lips." The tongue should be under your breast. A large amount of your breast tissue should be in the baby's mouth. 

• In general, don't do "switch nursing." That is when your baby breastfeeds at one breast for a few minutes, then the other breast, and then back again. This may interfere with your baby getting enough of the calorie-rich hindmilk. Your baby gets more hindmilk as a feeding continues on one breast. But the switch strategy sometimes stimulates the sleepy baby. So he or she wakes up and starts sucking again.

If your healthcare provider recommends supplementing

• Use your own expressed milk first for any alternative feedings.

• Use an alternative feeding method if it is recommended by your healthcare provider or a certified lactation consultant (IBCLC). There are many alternative feeding options, so let them know if a recommendation does not feel right for you. Alternative feeding methods include:

  • Cup feeding

  • A tube system with a special feeding tube taped to the breast or a finger (Supplemental Nursing System, or SNS)

  • Syringe feeding

  • An eyedropper

  • Spoon-feeding

  • Bottle-feeding

• Several methods require help from a professional, such as an IBCLC, so you can use them correctly. Depending on your baby and the cause of the problem, some methods may work better than others. Also discuss bottle nipple type with the IBCLC if you bottle-feed any supplement. Some types of bottle nipples are less likely to interfere with breastfeeding than others.

Maintaining or increasing your milk supply

• Pump your breasts after as many daily breastfeedings as possible. This is even more important if you are not sure if your baby is effectively removing milk during breastfeeding. Many women find that trying for 8 times per day is manageable. They also find it helpful for their milk supply. 

• Pumping will remove milk well, so your breasts will know to make more milk. Pumping will also express extra milk for feeds. Milk can be removed from the breast by manual hand expression, a hand pump, a battery-powered pump, or an electric breast pump. Use a double-electric or hospital-grade pump to help manage poor weight gain in a breastfed baby. 

Checking baby's weight

• Your baby should be weighed on a frequent and regular basis. Keep weighing your baby until he or she is gaining weight at a good rate. Digital scales are available that allow a healthcare provider or a certified lactation consultant (IBCLC) to get precise pre- and post-feeding weights. This lets the provider measure how much milk a baby takes in during a particular breastfeeding. This can be helpful. But babies take in different amounts at different feedings during a 24-hour period. So a provider may recommend that parents rent this type of scale. Then the baby can be weighed before and after different feedings. A provider also may suggest recording only a daily or weekly weight, depending on the situation.

Call your baby's healthcare provider

If your baby ever shows signs of dehydration, call your baby's healthcare provider right away. Some signs of dehydration in a baby include:

• Fewer stools and wet diapers than normal

• Dry lips

• Sunken fontanelle (soft spot)

• Dark circles around the eyes

• Seeming more tired than normal

In some cases breastfeeding is correctly managed, but the baby still is not gaining enough weight. Then it is likely that some other factor is affecting milk production or the baby's ability to breastfeed effectively. Always talk with your healthcare provider, and your baby's provider.