Breast Feeding Guide

Babies who are breast fed have fewer infections and allergies during the first year of life than babies who are fed formula. Breast milk is also inexpensive and served at the perfect temperature. Breast feeding becomes especially convenient when a mother is traveling with her baby. Overall, breast milk is nature’s best food for young babies.

How Often To Feed

The baby should nurse for the first time in the delivery room. The second feeding will usually be at 4- 6 hours of age, after he awakens from a deep sleep. Until your milk supply is well established (usually 2-3 weeks), nurse your infant whenever he cries or seems hungry (“demand” feeding). Thereafter, babies can receive adequate breast milk by nursing every 2-21⁄2 hours. If the baby is sleeping and more than 3 hours have passed since the last feeding during the day, wake him up. We want to see 8-12 nursing sessions within a 24 hour period in order to establish an adequate milk supply. During the night, allow one 4-5 hour interval if the baby is sleeping, your baby will not gain adequately unless he nurses 8 or more times per day initially.

How Long Per Feeding

Nurse your baby 10-15 minutes on each breast. Your goal is to have your baby nurse for a total of about 30 minutes at each feeding. It’s common to need to stimulate your baby before he will take the second breast. Remember to alternate which breast you start with each time. Once your milk supply is well established (about 2-3 weeks after birth), 5-10 minutes of nursing per breast is fine(since your child usually gets over 90% of the milk in this time).

How To Know Your Baby Is Getting Enough

In the first couple weeks, if your baby has 3 or more good-sized bowel movements per day and 6 or more wet diapers per day, he is receiving a good supply of breast milk (Caution: infrequent bowel movements are not normally seen before the second month of life.) In addition, most babies will act satisfied after completing a feeding. Your baby should be back to birth weight by 10-14 days of age if breast feeding is going well. Therefore, the 2-week checkup by your baby’s physician is very important. The presence of a letdown reflex is another indicator of good milk production.

The Letdown Reflex

A letdown reflex develops after 2-3 weeks of nursing and is indicated by tingling or milk ejection in the breast just before feeding (or when you are thinking about feeding). It also occurs in the opposite breast while your baby is nursing. Letdown is enhanced by adequate sleep, adequate fluids, a relaxed environment, and reduced stress (such as low expectations about how much housework gets done). If your letdown reflex is not present yet, take extra naps and ask your husband or friends for more help. Also, consider calling the local chapter of La Leche League, a support group for nursing mothers.

Supplemental Bottles

If your baby is nursing well and is gaining weight adequately, you do not need to offer your baby any routine bottles during the first 4 weeks after birth. Good lactation depends on frequent emptying of the breasts. Supplemental bottles can take away from sucking time on your breast. Although, if your baby is not gaining well, sometimes supplementation is needed. See your physician or a lactation specialist for a weight check and evaluation.

After your baby is 4 weeks old and nursing is well established, you may want to offer him a bottle of expressed milk once a day so that he can become accustomed to the bottle and the artificial nipple. Once your baby accepts bottle feedings, you can occasionally leave your baby with a sitter and go out for the evening or return to work outside the home. You can use pumped breast milk that has been refrigerated or frozen.

Extra Water

Babies do not routinely need extra water. Even when they have a fever or the weather is hot and dry, breast milk provides enough water.

Pumping The Breasts To Relieve Pain Or Collect Milk

Severe engorgement (severe swelling) of the breasts decreases milk production. To prevent engorgement, nurse your baby more often. Also, compress the area around the nipple and areola with your fingers at the start of each feeding to soften the areola. For milk release, your baby must be able to grip and suck on the areola as well as the nipple. Every time you miss a feeding, pump your breasts (for example, if you return to work outside the home). Also, whenever your breasts hurt and you are unable to feed your baby, pump your breasts until they are soft. If you don’t relieve engorgement, your milk supply can dry up in 2-3 days.

For women returning to work, a breast pump is necessary. Ask our staff or the hospital’s lactation consultant where to rent or purchase one.

Collect the breast milk in a container of your choice – BPA free plastic bottles, bags, or glass bottles. Check out our breastmilk storage guide for rules on how long breastmilk can be in the fridge or freezer for. To thaw frozen breast milk, put the container of breast milk in the refrigerator (it will take a few hours to thaw) or place it in a container of warm water until it has warmed up to the temperature your baby prefers.

Sore Nipples

At the end of each feeding, the nipple can be coated with some breast milk to keep it lubricated. Do not use soap or alcohol because they remove natural oils. For cracked nipples, apply 100% lanolin (no prescription necessary) after feedings.

Sore nipples are usually due to poor latching on and a feeding position that causes undue friction on the nipple. Position your baby so that he directly faces the nipple without turning his neck. At the start of the feeding, compress the nipple and areola between your thumb and index finger so that your baby can latch on easily. Throughout the feeding, hold your breast from below so that the nipple and areola aren’t pulled out of your baby’s mouth by the weight of the breast.

Start your feedings on the side that is not sore. If one nipple is extremely sore, temporarily limit feedings to 10 minutes on that side.

Vitamins For The Baby

Breast milk contains all the necessary vitamins and minerals except Vitamin D. All full term babies and all premature babies need 400 units of Vitamin D each day. Vitamin D supplements are recommended for all breast feeding infants. In fact, new AAP guidelines suggest vitamin D for all babies from the first days of life into adulthood.  Vitamin D drops are only unnecessary if your child is drinking more than 32 ounces of formula a day.

Vitamins For The Mother

A nursing mother can take a multivitamin tablet if she is note following a well-balanced diet. She especially needs 400 units of Vitamin D and 1200 mg of both calcium and phosphorus each day. A quart of milk (or the equivalent in cheese or yogurt) can also meet this requirement.

A Mother’s Medication

Almost any drug a breast-feeding mother consumes will be transferred in small amounts into the breast milk. Therefore, try to avoid any drug that is not essential, just as you did during pregnancy.

Some commonly used drugs that are safe for you to take while nursing are Acetaminophen, Ibuprofen, penicillins, Erythromycin, cephalosporins, stool softeners, antihistamines, decongestants, mild sedatives, cough drops, nose drops, eye drops, and skin creams. Aspirin and sulfa drugs can be taken if your baby is more than 2 weeks old and not jaundiced. Consult your physician about all other medications. Take medications that are not harmful immediately after you breast feed your child so that the level of medication is lower in the breast milk at the next time of feeding.

Burping

Burping is optional. The only benefit is to decrease spitting up after feeds. Air in the stomach does not cause pain. If you burp your baby, burping 2 times during a feeding and for about 1 minute is plenty. Burp your baby when switching from the first breast to the second and at the end of the feeding.

Cup Feeding

Introduce your child to a cup at approximately 6 months of age. Total weaning to a cup will probably occur somewhere between 9-18 months of age, depending on your baby’s individual preference. If you discontinue breast feeding before 9 months of age, switch to bottle feeding first. If you stop breast feeding after 9 months of age, you may be able to go directly to cup feeding.

CALL OUR OFFICE During regular hours if:

• Your baby doesn’t seem to be gaining weight adequately.
• Your baby has less than 6 wet diapers per day.
• During the first month, your baby has less than 3 bowel movements per day.
• You suspect your baby has a food allergy.
• Your breasts are not full (engorged) before feedings by day 5.
• You have painful engorgement or sore nipples that do not respond to recommended treatment.
• You have a fever (also call your obstetrician).
• You have other questions or concerns.

If you have any further questions regarding breastfeeding, please feel free to contact our office and ask to speak with one of our nurses or our PA and lactation specialist, Kate Shand.

Recommended Readings: Breastfeeding