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Health Library : Pediatrics

 

Breastfeeding

Breastfeeding your child:

Nature designed human milk especially for human babies, and it has several advantages over human milk substitutes. Your milk contains just the right balance of nutrients, and it contains them in a form most easily used by the human baby's immature body systems. Because it was developed for your human baby, your milk also is gentlest on your baby's systems.

Getting started with breastfeeding:

The process of breastfeeding and your milk change as your baby grows and develops. A newborn's feeding routine may be different from that of a breastfeeding 6-month-old. As your baby grows, the nutrients in your milk adapt to his or her needs. The anti-infective properties also increase if you or your baby is exposed to some new bacteria or virus.

  • Early breastfeeding
    The first weeks of breastfeeding should be considered a learning period for both you and your baby. Do not expect to work as a coordinated team immediately. Give yourselves plenty of time to recuperate from labor and birth, develop a daily routine, and overcome any initial breastfeeding difficulties. Those first days home from the hospital can be busy  and overwhelming.

    It may help to keep a simple checklist chart to mark daily feedings and diaper counts until your baby is gaining weight appropriately. To make a chart, take a piece of paper and number down 24 hours from midnight to 11 p.m. Then make several columns for breastfeeding, wet diaper, and stool, and put a check in the appropriate column as it occurs. (Some mothers add extra columns for pumping sessions and alternative feedings. if their baby is having difficulty and they must express milk and offer it or a substitute at times.)
  • Day 1
    Most full-term, healthy babies are ready and eager to begin breastfeeding within the first half hour to 2 hours after birth. Then, many sleep or act drowsy for the next 2 to 20 hours, so a baby may not be very interested in breastfeeding again on his or her birth day. However, your baby should breastfeed at least 8 times that first day. Expect to change only a couple of wet and dirty diapers during the first 24 hours.
  • Days 2 to 4
    Although he or she may need practice with latching on and sucking, by the second day, your baby should begin to wake and cue (show readiness) for feedings. Your baby should eat 8 to 12 times per day. Babies often don't eat at regular time intervals and might cluster some of these feedings closely together. These frequent feedings provide your baby with antibody-rich first milk, called colostrum, and tell your breasts to make more milk. Allow your baby to suckle until he or she is finished. When he or she finishes at one breast, you can burp and change his or her diaper before offering the second breast. When you feed your baby next, offer the alternate breast first. Some mothers find it helpful to wear a bracelet or loose rubber band on the wrist to remember which side to offer first at the next feeding.

    As with Day 1, you probably will change only a few wet and dirty diapers on baby's second and third days; do not be surprised if your baby loses weight during the first several days. If you are  worried about your baby's weight, consult with your pediatrician. The number of diaper changes and your baby's weight will increase when your milk "comes in."

    You may feel uterine cramping when breastfeeding the first 2 or 3 days, especially if this is a second or subsequent baby. This is a positive sign that your baby's sucking has triggered a milk let-down, also called the milk-ejection reflex (MER). It also means your uterus is contracting, which helps minimize bleeding. A nurse can give you something to take before feeding if needed for the discomfort. Some mothers briefly feel a tingling, "pins and needles," or a flushing of warmth or coolness through the breasts with milk let-down; others notice nothing different, except the rhythm of baby's sucking.

    Because your baby still is learning, you may experience nipple tenderness when he or she latches on or during a breastfeeding. If you have nipple pain when your baby latches, ask your nurse to watch you feed your baby. She can sometimes make suggestions that will make nursing more comfortable. Milk nipple tenderness usually disappers by the end of the first week. If tenderness persists, develops into pain, or nipple cracking is noted, contact a certified lactation consultant.
  • Days 3 to 5
    The volume of breast milk produced increases dramatically at about 3 or 4 days after birth, and the milk is said to have "come in." Your baby probably will drift off after his or her 8 to 12 feedings and act more satisfied after a meal. Over the next day, you will likely be changing more wet diapers. The number of dirty diapers also increases, and the stools should be changing in color and consistency. From the dark, tarry meconium stool, they should progress to softer and brown color before becoming a mustard-yellow and loose and seedy. Weight gain should also pick up within 24 hours of this increase in milk production, so your baby begins to gain at least half an ounce (15 g) a day.

    You may notice that your breasts feel fuller, heavier, or warmer when your milk comes in. Some mothers find their breasts become uncomfortably engorged due to increased milk volume and tissue swelling. Then the breasts feel hard and tight; the areola and nipple may seem stretched and flat, making it difficult for a baby to latch on. In these cases, it can be helpful to massage the breasts, squeeze some milk from them, or even use a breast pump for a couple minutes prior to nursing. The most important thing to do when your milk first comes in is to move the milk out of your breasts by feeding your baby frequently.

If your baby has difficulty latching on because of severe engorgement (uncomfortable swelling in your breasts):

  • Soften the nipple and areola by expressing some milk and then let baby latch on.
  • Breastfeed or express milk by hand or breast pump frequently (every one to two hours); your breasts should feel noticeably softer after breastfeeding or pumping.
  • Apply cold packs or sandwich bags filled with ice or frozen vegetables to your breasts for 20 to 30 minutes after a feeding or pumping session. The application of cold packs has been shown to relieve the swelling that may interfere with milk flow. Some women report improved milk flow if they also apply warm compresses to their breasts for a few minutes immediately before breastfeeding or milk expression, but there are no studies that support this as effective. Using heat for more than a few minutes could increase the amount of swelling.
  • Days 5 to 28
    Your baby will become more proficient at breastfeeding as the first weeks progress. Expect to feed your baby about 8 to 12 times in 24 hours. Allow your child to nurse until he or she releases your nipple. You can then burp your baby, change his or her diaper, and switch to the second breast. Usually, a baby will breastfeed for a shorter period at the second breast, and sometimes he or she may not want to feed on the second breast at all. Simply offer the second breast first at the next feeding.

    Babies who guzzle their food nonstop may self-detach in 10 to 15 minutes; babies preferring to savor their meals often take 20 to 35 minutes on the first breast, because they tend to take a few several-minute breaks between "courses." Whichever type your baby is, it is important to let him or her choose when to let go of the breast, as this self-detachment will increase the amount of higher fat/higher calorie milk (hindmilk) your baby takes in.

Your baby should:

  • Soak 6 or more wet diapers a day with clear or pale yellow urine.
  • Pass three or more loose, seedy, or curd-like yellow stools.
  • Begin to gain weight. Babies typically gain two-thirds to one ounce each day up to 3 months of age.
  • Talk to your baby's care provider if you think that your baby is not eating enough or is not gaining enough weight.

Your baby probably will go through several 2- to 4-day "growth spurt" periods when he or she seems to want to eat almost around the clock. Babies commonly experience a growth spurt between 2 to 3 weeks, 4 to 6 weeks, and again at about 3 months. It is important to let your baby feed more often during these spurts. Within a few days, your baby will have returned to a more typical pattern.

Let your baby set the pace for breastfeeding. Pay attention to his or her feeding cues. The number of feedings each baby needs and the length of time each feeding lasts will vary from baby to baby. Trying to force a breastfed baby to wait longer between feedings, or to fit a particular feeding schedule, can result in poor weight gain and decreased milk supply.

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