This guideline covers common questions asked about breastfeeding. If your infant is healthy, go directly to the number of the topic that relates to your child.
1. Frequency of feedings to bring in the milk supply.
2. Length of feedings to bring in the milk supply.
3. Signs of adequate milk supply (do I have enough milk?).
4. How to increase milk supply.
5. Supplemental formula.
6. Extra water.
7. Severe engorgement (swelling and pain) of the breast.
8. Sore or cracked nipples.
9. Mother's medicines.
10. Sick infants.
11. Sick mother (with acute illness).
12. Normal stools.
13. Leaking breastmilk
14. Vitamin D and fluoride for breastfed baby
Other topics Include: bottlefeeding questions, spitting up
- Your child looks or acts very sick.
- Age of less than 1 month old and starts to look or act sick in any way.
- Signs of dehydration (less than three wet diapers/day, pink-colored urine, sunken soft spot, very dry mouth).
- Looks deep yellow or orange
- Refuses to breastfeed for more than 8 hours.
- You think your child needs to be seen.
- Doesn't seem to be gaining weight by day five.
- Less than three normal-sized, yellow-colored, seedy stools per day during first six weeks. Exception: May not be present while milk is coming-in until day 5 of life. Less than 6 wet diapers per day. Exception: Two wet diapers per day can be normal while milk is coming in until day 4 of life. The mother has signs of breast infection (red, tender area on breast). Exception: localized engorgement.
- You have other questions or concerns.
- Seems hungry after feedings. Reason: Needs a weight check.
- Needs a formula supplement during first month. Reason: Breastfeeding not going well.
- Breastfeeding question about healthy child and you don't think your child needs to be seen.
1. Frequency of feedings to bring in the milk supply: Every 1½ to 2½ hours for the first month (eight or more times per day). During the day, wake her up if more than three hours have passed since the last feeding. During the night, wake your baby if more than four hours pass without a feeding. After 1 month of age, allow your baby to sleep longer. If your baby is gaining weight well, feed on demand and don’t need to awaken for feedings.
2. Length of feedings to bring in the milk supply: Offer both breasts with each feeding. Ten minutes on first breast and up to 15 minutes on second breast if your baby is actively suckling. Alternate which breast you start on. Needing to stimulate your baby to take the second breast is normal. Length of feedings after milk supply is in (by day 8 at the latest): Allow your baby to nurse as long as she wants to on the first breast (up to 20 minutes) (reason: to get the high-fat, calorie-rich hind milk). You can tell your baby has finished the first breast when the sucking slows down and your breast becomes soft. Then offer the second breast if she's interested. Alternate breasts at the start of each feeding.
3. Signs of adequate milk supply (i.e. your baby is receiving enough breast milk): Three or more good-sized, yellow-colored, seedy BMs (bowel movements) per day. Exception: May not be present while the milk is coming in until day 5 of life. Caution: infrequent BMs are not normal in breastfed babies until age 6 to 8 weeks. Six or more wet diapers/day. Exception: Two wet diapers per day can be normal while milk is coming in - until day 4 of life. Tip: If uncertain about diaper being wet, place tissue in diaper. Satisfied (not hungry) after feedings. Breasts feel full before feedings and soft after feedings. Appropriate let-down reflex. The letdown reflex is the automatic release of breastmilk into the milk ducts just before feeding. It develops after 2 to 3 weeks of nursing. Initially, milk letdown may require 60 to 90 seconds of sucking.
4. How to increase milk supply: Adequate sleep (extra naps), reduced stress (ask for help), relaxed environment, adequate fluids (1 quart of milk and 1 quart of water per day). Minimum: one 8 ounce glass of fluid every four hours while awake. Increase the frequency of nursing and minimize the use of the pacifier. Pump the breasts for 10 minutes after each feeding (see lactation consultant).
5. Supplemental formula: Don't offer your baby any bottles of formula before 3 to 4 weeks old because it will interfere with establishing a good milk supply. Exceptions: The milk is not in (day two and three) *and* your baby is very hungry (especially common in preterms); inadequate number of wet or soiled diapers; the baby is quite jaundiced (reason: prevent dehydration). Method: Give 1 ounce of formula after every other breastfeeding for one or two days. Also see your doctor within 24 hours for a weight check. After your baby is 3 to 4 weeks old and nursing is well established, give a bottle of pumped breast milk or 1 ounce of formula once daily (reason: so your baby will accept bottle feedings if need to leave with a sitter). If you wait until 6 weeks of age, your baby may be unwilling to try the bottle. Until the milk comes in (day three or four), a few babies need supplemental formula, but not water.
6. Extra water: Never needed. Reason: Breast milk contains 88 percent free water.
7. Engorgement (swelling and pain) of the breast (most common 48-72 hours after birth): Nurse your baby more frequently (avoid the use of pacifiers). Express a little milk before nursing your baby. Compress the areola with your fingers or use a manual pump at the start of each feeding to soften the nipple area (reason: for milk release, your baby must be able to latch on to the areola). Pump your breasts, whenever they hurt, whenever you must miss a feeding or whenever a feeding doesn't relieve the pain. Localized engorgement: For localized hard areas or swelling or tenderness due to blocked milk ducts, apply moist heat or take a hot shower and massage the affected area toward the nipple. Call your doctor if not improved after 24 hours of treatment.
8. Sore or cracked nipples (usually due to friction from improper latching on or non-areola grasp): Clean with warm water after each feeding (avoid soap which dries out the skin). · Then coat and lubricate nipple and areola with breast milk for sore nipples. For cracked nipples, apply 100[[][%]] lanolin (no prescription) after feedings. Help your baby latch on to as much of the areola as possible by compressing areola. Prevent the breast from pulling out of your baby's mouth by supporting the breast from below. Start feedings on the side that is least sore. Limit feedings to less than 10 minutes on the sore side. Don't pull your baby off the nipple until she has released her grip. You can break the seal by placing your finger in baby's mouth between the gums. Call back if: not improved after 24 hours of treatment.
9. Mother's medicines: It's best to take your drug at the end of a feeding. Most commonly used drugs are safe: e.g. acetaminophen, ibuprofen, penicillin, erythromycin, cephalosporins, stool softeners, antihistamines, decongestants, cough drops, nose drops, eyedrops, and skin creams. Aspirin and sulfa drugs are safe after 2 weeks old. For all other drugs, call your doctor.
10. Sick infants: Do not discontinue breastfeeding for vomiting, spitting up, diarrhea, cough, jaundice, etc. Continue breastfeeding whenever possible.
11. The mother is sick (has an acute illness): Continue breastfeeding, even if you have a fever. Reason: breast milk carries your antibodies which can protect your baby from the full-blown infection. Try to prevent the spread of infection by good hand rinsing, especially after blowing your nose (for colds) or after using the bathroom. Contraindications to breastfeeding are rare: AIDS, Herpes simplex rash (fever blisters) on the nipple/areola, substance abuse and tuberculosis. Talk with your doctor.
12. Breastfed stools, normal: Breastfed babies pass from four stools per day to one after each feeding during the first two months. The stools are runny, mustard-colored and contain seedy particles. Normal breastfed stools can even become green or have a water ring around them during the first month. At 4-8 weeks of age, most breastfed babies change to infrequent stools. They pass one soft stool every 1 to 7 days. Reason: Complete absorption. Breastfed stools have changed to true diarrhea if: They contain blood or mucus. Develop a bad odor or abruptly increase in number. Your baby feeds poorly, acts sick, or develops a fever.
13. Leaking Breastmilk: Leaking milk is a common problem that nursing mothers experience during the first months of nursing. Usually, the leaking decreases as a balance is established between what the baby drinks and what the breasts make. WHAT YOU CAN DO: Maintain a regular nursing pattern. Try to avoid skipping or postponing feedings. (Reason: more milk leaks from over-full breast). Use disposable nursing pads under your bra. Change pads frequently to keep your nipples dry. Tops (shirts) with patterns hide milk spots better.
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