BREASTFEEDING QUESTIONS

 

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Breastfeeding Advice (Topics 1-12)

  1. Frequency of Feedings to bring in the milk supply:
    • Every 1½ to 2½ hours for the first month (8 or more times/day).
    • During the day, wake her up if more than 3 hours have passed since the last feeding.
    • During the night, wake your baby if more than 4 hours pass without a feeding.  After 1 month of age, allow your baby to sleep longer at night.
  2. Length of Feedings to bring in the milk supply:
    • Offer both breasts with each feeding.
    • 10 min. on first breast and up to 15 min. 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.
  3. 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 2nd breast if she's interested.
    • Alternate breasts at the start of each feeding.
  4. Signs of Adequate Milk Supply (i.e. your baby is receiving enough breast milk):
    • 3 or more good-sized, yellow-colored, seedy BMs (bowel movements)/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.)
    • 6 or more wet diapers/day.  (EXCEPTION:  2 wet diapers/day can be normal while milk is coming in - until day 5 of life.)
    • (Note: 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.
  5. 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 oz. glass of fluid every 4 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).
  6. Supplemental Formula:
    • Never routinely supplement with formula before 4 to 6 weeks old (reason: it will interfere with establishing a good milk supply).
    • EXCEPTION:  medical indications to prevent dehydration or severe jaundice to prevent dehydration or severe jaundice include the following:  
      The milk is not in (day 2-4) AND your baby is very hungry (especially preterms), inadequate number of wet or soiled diapers or the baby is quite jaundiced (reason: prevent dehydration).  Method:  give 1 oz. of formula after every  breastfeeding for 1 or 2 days.  Also see your doctor within 24 hours for a weight check.
    • After nursing is well established, give a bottle of pumped breast milk or 1 oz. of formula once daily (reason: so your baby will accept bottle feedings if need to leave with a sitter).
    • Until the milk comes in (day 3-5), a few need supplemental formula, but not water.
  7. Extra Water:
    • Never needed (reason: breast milk contains 88% water).
    • Until the milk comes in (day 3 - 5), a few need supplemental formula, but
      not water.
  8. 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.
  9. 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 it 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.
  10. 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, penicillins, erythromycin, cephalosporins, stool softeners, antihistamines,  cough drops, nose drops, eyedrops, and skin creams. . Avoid pseudoephedrine because it reduces milk production in some
      mothers.  Aspirin and sulfa drugs are safe after 2 weeks old.  For all other drugs, call your doctor.
  11. Sick Infants:  Do not discontinue breastfeeding for vomiting,spitting up, diarrhea, cough, jaundice, etc.  See the appropriate guideline for that symptom.  Continue breastfeeding whenever possible.
  12. 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 stools (for diarrhea).
    • Contraindications to breastfeeding are rare: AIDS, Herpes simplex rash (fever blisters) on the nipple/areola, substance abuse and tuberculosis.  Talk with your doctor.
  13. Breastfed Stools, Normal:
    • Meconium stools are dark greenish-black, thick and sticky. They normally are passed during the first 3 days of life.
    • Transitional stools (a mix of meconium and milk stools) are greenish-brown and more loose. They are passed day 4 to 5 of life.
    • Milk stools without any meconium present are seen from day 6 onward.
    • Breastfed babies pass from 4 stools per day to 1 after each feeding during the first  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.
    • Between 4 and 8 weeks of age, most breastfed babies change to infrequent stools. They pass 1 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
    Consultants:  Marianne Neifert, M.D., Joy Seacat, CHA and Lisbeth Gabrielski, RN.

Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Pediatric SelfCareNavigator. Copyright © 2000-2004 Barton Schmitt, M.D. FAAP

Reviewed 8/2004

Revised 8/2004

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