You've Decided to Breastfeed! Now What?



Often mothers wonder, “How long should I breastfeed?” The answer is unique to every mother and child. The American Academy of Pediatrics (AAP) and Center for Disease Control (CDC) recommend exclusive breastmilk feedings until 6 months of age and then continue breastfeeding into the child’s second year of life.  The World Health Organization recommends breastfeeding for a minimum of two years, and then beyond as mutually desired by mother and child.





Newborn Stage: Adapting to the New World





Q. How often should I feed my newborn?

A. During the early days, newborns need to feed on cue. Watch for these magical signs, licking, hands to mouth, and turning head from side to side looking for something to eat. Feeding baby is easiest when s/he is showing first signs of hunger. No one wants to learn something new when they are mad. Mothers make milk on a supply and demand basis, so the more milk that is removed from the breast the more milk will be made to replace it. If baby is sleepy, get skin to skin with him/her and when s/he is in a light sleep and smells food nearby s/he is more likely to wake up and eat. The goal is 8-12 feedings in a 24 hour period, not on a schedule. Sometimes babies are ready to eat 33 minutes after ending the last feeding and other times it maybe 3 hours and 41 minutes. Remember, watch your baby, not the clock! For parents that have been used to rigid schedules they find that this is extremely hard, but in a few weeks your baby will set their own schedule, and feedings will become more predictable. Some books and people will tell you to feed on a schedule but this may not meet your baby’s needs. Do we as adults always eat the same amount, at the same time every day? Babies are the same way sometimes they want a big meal, sometimes they want a small meal, and sometimes they just want a snack. When you go to a family dinner does everyone take the same amount on their plate? Do we all finish eating at the same time? Listen to your baby and not others and you will be meeting his/her needs.


Q. How do I know my baby is getting enough to eat? With a bottle I can look at the ounces.

A. What goes in must come out. The first day the baby’s poop will be dark and tarry, but by day 4 they will be yellow with seedy yellow balls. If baby’s poops are still green on day 5 we know that s/he is not getting enough to eat. Also by day 5 s/he should have 6 or more wet diapers in a 24 hour period. Sometimes these two are together sometimes they are not. All babies lose weight to begin with, and are at his/her lowest weight usually on day 3 or 4, but should be back to their birth weight by day 10-14. Once the weight has stabilized, most babies gain 1/2 -1 ounce per day in the first 3-4 months of life. But remember, this is an average, some will put on more than that, others less. When baby goes through a growth spurt they can grow ½ inch and put on ½ pound in a few days’ time. During these growth spurts babies will want to feed all the time and some mothers incorrectly think that their milk is drying up because the breasts don’t feel as full as they did in the first weeks of breastfeeding, or that they have to wait for the breasts to feel full before they feed again. Let the baby empty the first breast before moving on to the second side. How will you know when baby has emptied that breast? First of all, the baby will usually come off of it and refuse to take it back, and it will feel lighter than it did prior to the feeding.


Q. My breasts are so full my baby cannot latch on the breast. What should I do?

A. First, if baby is fed on cue, you are less likely to have problems with this. It is often when you miss emptying the breast that they get that way. If your breasts are so firm that the baby is bouncing off like a basketball, you have several options. If baby is ready to feed right now, do what is called “reverse pressure softening”. To do this center your nipple between the pads of your fingers and gently press toward the chest wall, this will soften the areola and help the nipple standout, making it easier for baby to latch on the breast. Allow the baby to empty the first breast before moving to second side. If the second breast is uncomfortable after completing the feeding, express enough either by hand or pump to make it comfortable. If they are still uncomfortable after this, use cool compresses for 15-20 minutes. This helps to get the extra fluid out of the breast. Sometimes this fullness isn’t milk, it extra fluid that goes to the breast to help make the milk. When overly full this extra fluid can put pressure on the milk ducts and make it hard for the milk to release.


Q. How can I increase my milk supply?

A. Feed the baby on cue, if you want extra stimulation express after a feeding, either by hand or using a good breast pump. A very empty breast signals the brain to make more milk next time. It will not happen overnight but over 3-4 days’ time you should notice an increase in milk production. If you are measuring your milk production by what you see going into the collection container, remember most infants remove more than the pump or your hand. To help with milk release you may find that some breast massage and a little manual expression prior to feeding gets the milk flowing faster for your baby. Different cultures have different beliefs about what helps to increase milk production. For more info on this, look at www.kellymom.com.





Infant Stage: Growing in the New World




Q. My baby is not eating as often or as long as s/he did the first month. How can I make him/her eat longer?

A. Once breastfeeding is well established your body will release milk sooner and baby will be more efficient with his/her suckling so it is a normal progression for feedings to get shorter in length. Also as the stomach expands in capacity baby can hold more milk between feedings. Also newborn breastmilk has more casein in it which is quicker to digest and at around 3-4 months there is more whey which makes a larger curd so takes longer for stomach to empty and baby will have a decrease in the number of bowel movement they have per day. This is a normal progression of things. You may want him/her to feed longer but when babies are done they lock their jaws and will not take anymore. As they get older they turn their head away. Older still they will put up their hands to block your efforts. Attempting to feed them more will not make them any happier or fatter, but will more than likely turn into a test of wills/power struggle.


Q. I have to return to work, when should I start introducing a bottle?

A. The sooner the infant gets a bottle, the sooner you will have to express your milk, or your supply will go down. For some babies, if given a bottle before breastfeeding is well established, the mother may have a harder time with breastfeeding. Some people refer to this as nipple confusion. Babies do suck differently between a pacifier, a bottle and the breast. This is why it is best to let baby learn how to breastfeed well before moving on to something else. If you want your child to have a pacifier, introduce that at around 3-4 weeks. If you are going to have to return to work, don’t wait until just before you go back to work to introduce the bottle, do this at around 4-6 weeks, and use a slow flow nipple (keep in mind that there is no actual “standard” for a slow flow nipple). It is usually best to have someone other than yourself, such as dad, grandma, or a friend, be the one to try bottle feeding your baby. Breastfed babies often want only to nurse with mom, and may show confusion if she suddenly offers a bottle in place of her breast. However, a hungry baby may happily take a bottle from dad or grandma in his or her mother’s absence, and allowing someone else to offer it can ease its introduction. If you find that you are having trouble getting him/her to take the bottle, you can try paced bottle feeding. (See the video link on paced feeding here!) At the beginning, the goal is to get infant to accept the artificial nipple, not to get them to take the whole feeding at the bottle. Start out with small amounts, say 1- 1 ½ ounces, and increase it if baby takes it all next time. Offer the bottle at least 3-4 times a week so that they will readily accept it when you have to leave them with the child care provider. There is no perfect bottle for all breastfeeding babies, purchase the sample bottles of 2-3 types that you think that you would like to use. Make sure they are readily available, because one of the worst things you can do is get a specialty bottle, and later find that it is no longer stocked by the stores.


Q. When should I start offering other foods besides breastmilk? My mother says that I should give rice cereal in the bottle so he/she will sleep longer.

A. CDC and AAP recommend nothing but breastmilk feeds until the child is at least 6 months of age. There are junctions in the gut that are not fully closed until about that time, and introducing foods early are more likely to lead to food allergies. Also studies have shown that rice cereal in the bottle will not make babies sleep for longer periods of time, and it is this frequent arousing that is one of the reasons that they feel like SIDS is decreased in breastfed infants. Readiness for foods is when baby shows signs of reaching for other people’s food, and able to take a spoon feed without gagging. Those first foods don’t have to be commercially prepared baby foods; things like avocado or banana mashed up, smashed sweet potatoes, or plain oatmeal without extras make great first foods for baby.





Toddler Stage: Exploring the New World





Q. Now that my baby is growing up, how do I keep him/her nursing longer?

A. Each child weans at different ages, some wean when they realize that they can drink from a sippy cup and keep moving. Others need their mother’s milk for extended periods of time. If you have a busy toddler who is easily distracted during nursing, try feeding in the bed before starting your day. Nurse last thing in the evening when they are ready to go to bed for the night, you may also find that they will nurse at night but too busy during the daytime. You will find what works the best for your child because you know him/her best.


Q. My toddler has bitten me during nursing. How can I make him/her stop?

A. Kids will not bite themselves, so the biting usually occurs at the end of the feeding. If the gums hurt from teething try letting them chew on a cold wash rag prior to nursing. If baby bites down instead of pulling them off the breast, pull them into the breast so their nose is blocked and they will open their mouth and let go. Do this often enough they will realize that if they bite it will result in them not being able to breastfeed.


Q. My family thinks that I am making my child a baby by still nursing. How do I handle this?

A. Remind your family that benefits of breastfeeding continue as long as your child breastfeeds. Breastfeeding does not come with an expiration date! As your child is exploring his new world breastfeeding provides him/her with a feeling of security in this unfamiliar world. Remind them that the natural weaning process occurs at a slow rate, offer the breast and if child refuses for several days in a row they are now indicating that they are ready to wean.


Q. I want to get pregnant again and continue to breastfeed. Is this possible?

A. Lots of women get pregnant while breastfeeding, especially after 6 months when the child is getting complimentary foods. If you want to continue to breastfeed your toddler during your pregnancy, you can normally do so safely, unless you have a history of preterm labor. If your toddler is still breastfeeding along with the newborn, this is called “tandem nursing.” Just remember you will need more fluid and calories to feed two, so drink to thirst and eat like you are feeding twins (yay!). Keep in mind that the newborn needs to have priority in the milk department, but your toddler needs to also feel like they are still important. Do something special every day with each child. Let the toddler assist in taking care of the baby by bringing diapers, wipes, clothes, sing, and dance for new baby.