A mother's unique breast capacity and rate of milk synthesis dictates how much milk she has available in the breast at each feed, and infant hunger dictates how much the baby will take at each feed. Neither of these factors are amenable to manipulation.

Kent et al (2006) ¹ in their study of 71 thriving, exclusively breastfed babies ranging in age from 1 to 6 months, found:

• they averaged 11 feeds (range 6 - 18) per 24 hrs.
  
• 10 of the babies always fed from both breasts per feed;
• 19 babies always fed from one breast per feed;
• the majority of babies sometimes fed from one and sometimes fed from both breasts;
• 2/3 of babies fed at night, and consumed 20% of their total daily intake at this time.
  

These researchers concluded that all mothers and babies are unique and mothers should respond to their babies' cues rather than striving to be average.

Before you can answer this question you need to know how much breastmilk is normal at the various stages of lactation. The average is as follows:^{1 2 3}

Age of baby	24hr volume	Infant intake
Approximate conversion: divide millitres by 30 to obtain volume in ounces
Note: Individual breastmilk intake (and therefore production) does not significantly change between 1 and 6 months of age
Day One	37ml (7 - 123ml)	few drops - 5ml/feed
Day Two	84ml (44 - 335ml)	5 - 15ml/feed
Day Three	408ml (98 - 775ml)	15 - 30ml/feed
Day Five	705ml (452 - 876ml)	depends on feeding frequency, volume available and infant appetite
1 - 6 months	780ml (500 - 1350ml)	30ml - 135ml/feed (6 - 18 feeds/day)

The colostrum received by the baby in the first few days contains highly concentrated immunoglobulins and other protective factors (1.2 Breastmilk Immunology). Also, babies are usually born somewhat 'waterlogged' and therefore a few days of low oral intake assists the infant to clear the excess fluids. The baby is in more need of immunological protection than nutrition in the first few days.

Physiologically the newborn's stomach is not able to hold volumes larger than this. At birth the gastric wall is non-compliant and non-relaxing, which, when combined with the hypomotility of the duodenum, results in early satiety and frequent regurgitation in the first few days.⁴

In the first 3 days postpartum it can be assumed that the intake is adequate if the baby is positioned well, latches well and suckling actively. After secretory activation (average range of clinical onset is 50-73 hrs postpartum) ⁵ it is essential that mothers know how to recognize signs that their baby is feeding well.

As you assess breastfeeding each day, teach the mother to:

• observe the sucking pattern. Baby should be seen to move from a quick suck:suck:suck pattern (a stimulation pattern) to a slower suck:swallow:breathe:suck:swallow:breathe pattern (the nutritive pattern) which is sustained for 2 to 3 minutes. Baby may pause after this and repeat the pattern again. Observation of this pattern confirms milk transfer is occurring.
• after most feeds the baby will appear satiated
• baby's mucous membranes will be moist
• urine and stool output will indicate adequate intake (If it's coming out, it must have gone in!)

Age	Urine output	Stool output
0 - 24 hours	one wet nappy/diaper	one or more meconium stools
24 - 48 hours	two wet nappies/diapers	one or more meconium stools/possible transitional stool
48 - 72 hours	three wet nappies/diapers	transitional stool
from Day 4 onwards	6 - 8 thoroughly wet nappies/diapers, with clear urine	soft, yellow, curdy (at least daily, preferably more frequent) until about 6 weeks

Developmentally the infant is not functionally ready to take complementary foods earlier than 6 months of age. At, or soon after 6 months, strengthening of the infant's musculature allows him to independently control his head and sit up. The development of fine motor coordination of more distal muscles, including the tongue and lips and their function of bringing in and manipulating more solid food in preparation for swallowing, is indicative of his ability to handle these foods at this age. ⁹

Coincidentally, at around 6 months of age, most infant's energy needs for growth and development are beyond the provision of breastmilk alone and appropriate complementary foods are required to provide additional calories and nutrients for future growth.¹⁰

Between 6 and 24 months of age is a critical time for promotion of optimal growth, health and behavioral development with longitudinal studies demonstrating this is the peak age for growth faltering, deficiencies of certain micronutrients, and common childhood illnesses.

The World Health Organisation ¹¹ recommends the following guiding principles for appropriate complementary feeding to ensure nutritional well-being continues once complementary feeding begins:

• continue frequent, on demand breastfeeding until two years old or beyond;
• practise responsive feeding (e.g. feed infants directly and assist older children. Feed slowly and patiently, encourage them to eat but do not force them, talk to the child and maintain eye contact);
• practise good hygiene and proper food handling;
• start at six months with small amounts of foods and increase gradually as the child gets older;
• gradually increase food consistency and variety;
• increase the number of times that the child is fed, 2-3 meals per day for infants 6-8 months of age, and 3-4 meals per day for infants 9-23 months of age, with 1-2 additional snacks as required;
• feed a variety of nutrient rich foods;
• use fortified complementary foods or vitamin-mineral supplements, as needed; and
• increase fluid intake during illness, including more breastfeeding, and offer soft, favourite foods.
• Avoid giving drinks with low nutrient value, such as tea, coffee and sugary drinks. Limit the amount of juice offered to avoid displacing more nutrient-rich breastmilk.

Breastfeeding and breastmilk continues to provide protection and growth factors as well as being a quality food source for as long as the child is breastfed. There is no stage of lactation where breastmilk stops having these beneficial effects.

The introduction of complementary foods from 6 months of age is the beginning of the weaning process. The weaning process can take as long as the mother and baby want it to take. Based on maintaining a normal level of health and development the American Academy of Pediatrics states breastfeeding should continue for at least the first 12 months of life and beyond with the addition of appropriate complementary foods from 6 months.¹³ The World Health Organisation states babies should receive breastmilk until at least their second birthday and beyond, with the addition of appropriate complementary foods from 6 months of age.

Despite health professionals having this knowledge, the number of babies who are being exclusively breastfed at 6 months of age, and the number of babies receiving any breastmilk at 12 months of age is much less than it should be in most countries.