Breastfeeding Questions
I understand that breastfeeding protects babies against infection. Is this really true?
Yes it is. In developed countries breastfed babies get sick about as often as formula-fed babies; however, their illnesses are shorter and less severe. Many studies have shown that babies who receive human milk are less likely to be readmitted to the hospital in their first year of life. In under-developed countries or in situations where pure running water and good medical care are not available, breastfeeding is even more important. In those countries, feeding choices can literally be a matter of life and death.
How can I tell if my milk is as good as other mothers’ milk?
Good question. Your milk will be different from other mothers’ milk, but “different” is not the same as “not as good.” Your milk may have more or less fat in it, and it will have different anti-infection components in it. It will also have a slightly different nutrient composition. Every mother’s milk is a little different–like a fingerprint.
Some mothers have milk with lots of fat in it. We used to say these mothers had “rich” milk, and we thought that meant that their babies would be healthier. Now we know that mothers who have less fat in their milk tend to have more milk, and their babies grow just as fast as babies whose mothers make high-fat milk. So now we know that high-fat milk is not “better”; it is just different.
Your milk will have different anti-infection properties than someone else’s milk. Your milk will have immunoglobulins (antibodies) that are tailor-made to fight the germs in your home and in your surroundings. Another woman will have immunoglobulins in her milk that are tailor-made to fight the germs in her home and surroundings. The best milk for the baby who lives in your house is the milk your body makes. The best milk for another woman’s baby is the milk her body makes.
Your milk may also have a different nutritional composition. If your baby is born prematurely, for a short while, your milk will have more protein than that of the mother of a full-term baby. If you and another woman both have term babies, but hers is born a month before yours, then your milk will have different types of fats on any given day. The fats in milk change as a baby grows older. This is probably related to the changing developmental needs of the baby. In early infancy, babies have special needs for fats that are related to the developing nervous system. Later, when this system is more mature, fewer of these fats are needed, and fewer will be found in the mother’s milk.
Human milk doesn’t come in grades. It comes “personalized.” The beauty of this system is that your body does it automatically. You really have very little say over it!
If the mother is healthy, is it ever better not to breastfeed?
It could be. Every family needs to choose a feeding pattern that will nurture the child physically, nutritionally, and emotionally. Some mothers and fathers have strong negative feelings about breastfeeding. Emotional factors or past emotional problems can make breastfeeding extremely distasteful or even traumatic for a mother.
While scientists have shown that breast-feeding provides nutritional, immunological (anti-infection), and other advantages to babies, only the parents know all the psychological factors that affect their situation. That is why they are the only ones who can determine the best way to feed their baby. Sometimes mothers who do not want to nurse will choose to pump their milk and feed it from a bottle, but most women who feel this way give their babies formula.
Does breast milk protect babies even if it is supplemented with formula feedings?
Yes. In fact, in many of the studies that have shown better health in breastfed babies, the “breastfed babies” in those studies were being fed other things in addition to breast milk. Some mothers choose to mix breast milk and formula feedings for practical reasons, and their babies are healthier on average than babies who receive no breast milk.
Are there any disadvantages to supplementing breastfeeding with formula feeding?
Yes. When a mother gives formula to her baby, her milk supply is likely to decrease because the baby will nurse less often. This is especially true in the first 2 to 3 weeks, when frequent nursing is necessary to bring the mother’s milk supply up to meet the baby’s needs. And, of course, when a baby gets formula, his diapers will have an adult stool odor instead of the slightly sweet odor normal for the stool of breastfed infants. Also, the baby will receive fewer of the protective substances that breast milk provides. Finally, some babies have a hard time switching back and forth from bottle to breast. Even so, combining breastfeeding and formula feeding is a workable means of providing better nutrition and more health protection than feeding only formula.
For how long is it nutritionally sound for the baby to be only on breast milk or formula?
For healthy term infants, other foods are not required until the baby is about 4 to 6 months old. At this point the baby’s iron stores may be getting low, so iron-fortified cereals are usually added to the baby’s diet. Apart from immediate nutritional needs, it is a good idea to allow babies to experiment with foods around this age when they show an interest. Some experts say that babies have a critical or sensitive period for the introduction of solids around 6 to 7 months, and missing this period might cause feeding difficulties later.
What diet should I be on during breastfeeding? What medicines can I use?
You can use the same dietary guidelines you used during pregnancy. Be sure you get plenty of calcium and protein and about 500 calories a day more than you consumed before you were pregnant.
Always check with your doctor before taking medicines when you are breastfeeding. Most medications are safe to take while breastfeeding, but some are not. Your doctor will check each medication individually.
I am nursing my baby; don’t I have to watch (or limit) what I eat? Does my diet cause gas in the baby?
For the most part, you can eat anything you want to. Some babies will have colicky periods after the mother eats a particular food, but most will not. A few foods, including cow’s milk protein and possibly broccoli, cabbage, and onions, cause colic symptoms in some, but not all, breastfed babies.
But it would be really foolish to stop eating dairy products or broccoli to prevent a problem that you probably won’t have in the first place. Dairy products are a very important source of calcium and protein for nursing mothers.
If your baby has colic, that is the time to figure out how to treat it and to determine whether something you are eating is causing the problem. Your doctor can help you set up an elimination trial (by eliminating certain food items) to identify the potentially offending food.
When do I stop breastfeeding?
That is up to you and your baby. See how long you enjoy it. The American Academy of Pediatrics recommends that mothers breastfeed for the first 6 to 12 months. A lot of mothers gradually taper off so that they are feeding only at night or in the morning for the last few months of nursing. Mothers who nurse toddlers often nurse only in the morning and at bedtime.
Do I wean abruptly from the breast or should I do it gradually?
Gradually, if possible. Weaning abruptly can be very painful for you and rather traumatic for your baby. It also places you at risk for developing mastitis (redness and swelling of the breasts). If you allow at least 3 to 5 days at each level as you decrease your nursing frequency, you will feel better and the process will go more smoothly.
What should I do if my breastfed baby does not have regular bowel movements?
It depends. Usually nothing. You can expect your breastfed newborn to stool 1 to 12 times a day. On average, babies stool 3 to 4 times a day after the second or third day of life. But many breastfed babies stool frequently–perhaps with every nursing during the first 4 to 6 weeks. In a very young breastfed baby (who is not receiving supplemental formula), infrequent, low-volume stools are an indication of inadequate milk intake. At about 4 to 6 weeks of age, breastfed babies change their stooling frequency. They may switch abruptly from having eight stools a day to as few as one every two or three days, or even less. As long as the baby’s behavior is normal, stool frequency is of little concern in a breastfed baby who is over 4 weeks old.
How much do I feed my newborn?
If you are breastfeeding, nurse your newborn as often as he seems interested. If your baby is sleepy, you may need to wake him for feedings. Most newborns will nurse 7 to 10 times every 24 hours. But it is not always easy to tell when a newborn baby is hungry. Just bring your baby in for a weight check within a week of birth and see how much he has grown. If the growth is okay, the baby is eating enough. If it is not, feed more often and check again. As your baby gets older, he will probably nurse less often.
If you are feeding formula, you can expect your newborn to take about 18 to 22 ounces a day of formula at first. Gradually this intake will increase as your baby gets older. He may be taking 32 ounces a day by the age of 4 months. The exact amount will depend on your baby’s weight, appetite, and needs.
How can I tell for sure that my breastfed baby is getting enough to eat?
If the baby is growing adequately, the baby is getting enough to eat. There are a few clues that are helpful for very young infants (under 4 weeks of age). The baby should be satisfied for at least some period after most feedings. The baby should have at least six soaking diapers a day and one or more dirty diapers with over a tablespoon of stool. Usually babies this age will have several additional dirty diapers with just a little stool (up to 12 a day). Older babies should also have six soaking diapers a day, if they are getting enough to eat, but they will have fewer dirty diapers.
What are the nutritional differences between formula and breast milk?
There are several nutritional differences between formula and human milk. For example, the types of fats in human milk are more easily digested than those in formula and may contribute to better neurological development. There is less iron in human milk than in formula. However, the iron in human milk is better absorbed than iron from formula, so the baby gets all he needs. Human milk proteins form fluffy curds smaller in size than proteins in formula, and they are more readily absorbed and pass through the digestive tract more quickly than do the proteins in formula.
Is it true that formula-fed babies will sleep through the night better than breastfed ones because the formula stays with them longer?
Yes, they will sleep a little longer. Formula-fed babies may average about 3 to 4 hours between feedings while breastfed babies may average 2 to 3 hours.
Can I supplement breastfeedings with formula to delay frequent feedings?
When you start giving formula to a breastfed baby, you actually disturb the normal mechanism for regulating your milk supply. This means that you have to take the responsibility of seeing that your breasts get adequate stimulation and regular emptying so that your supply does not drop if you do not want it to.
If the baby is nursing well, then the mother can safely add formula as long as she empties her breasts often enough to maintain her milk production. For most women, six thorough breast emptyings during every 24-hour period will be enough to maintain milk production. Some women may need more, some less.
If a breastfed baby is feeding too often, you need to find out why. For example, some babies who want to nurse every hour are not emptying the breast when they nurse because they are not nursing properly. They are hungry within a short time because they have not taken much milk, and the mother’s milk supply is low because the baby is not emptying her breasts. Giving formula in this case can cause the mother to lose her milk supply completely.
The answer is that sometimes you can supplement to delay frequent breastfeeding safely and sometimes you can’t. A good lactation consultant can be a great help if you have questions.
I am breastfeeding. At what stage is it recommended to start a supplemental bottle?
Supplemental feeding is an option, not a recommendation. Supplemental feeding should not begin before two to three weeks after birth. If you know that you will be giving a bottle later on, you can start giving one at about this time and keep it up on a regular basis so that the baby will not refuse to take a bottle when you go back to work or when you get ready to leave him for a while. The best option is to put expressed breast milk in the bottle and avoid giving formula until you decide to reduce your milk supply.
Is it okay to use goat’s milk?
Goat’s milk is not suitable as a sole or even primary source of nutrition. It is lacking in folate (a B vitamin) and a deficiency may result. Goat’s milk is also low in iron and in carbohydrates, and has a high renal solute load, which means it can stress the kidneys.
What kind of formula do you recommend as a supplement to nursing?
Generally, any regular cow’s–milk-based formula is suitable. Your doctor or health care professional can help you to select a formula, and it is important to have good advice when making this decision.
What formula is closest to breast milk?
All regular commercial infant formulas are manufactured to be as close to human milk as possible. Manufacturers go to great lengths to produce nutrients that will match those found in human milk. Some formulas are closer in one way, and others are closer in other ways. But being close is not the same as being identical. Human milk is so elegantly designed that it delivers a higher percentage of its nutrients to the baby than formula can. A formula that had the same amount of iron as that of breast milk could lead to iron deficiency in the formula-fed baby, but the same amount of iron in breast milk is enough! So you see, this is not as simple a question as it seems.
Rather than looking at the composition of the formula, it is better to look at the effect of the formula on the baby. From this perspective, the formula that makes your baby happiest and healthiest is the closest to your breast milk. Your doctor or health care professional can assist you in choosing a commercial formula preparation that meets your infant’s particular needs.
How long does my baby need formula before switching to cow’s milk?
The American Academy of Pediatrics and other authoritative bodies worldwide recommend that cow’s milk, full cream milks, and evaporated milk not be introduced until the infant is at least 12 months of age. Cow’s milk contains little iron and can strain a young baby’s kidneys.
There are some days that my son doesn’t eat well; what can I do?
Be patient. Even babies have days when they don’t have much appetite. Sometimes breastfed babies have “nursing strikes” when they refuse to eat much of anything for 24 hours or more. Check your baby’s mouth to see if something is hurting him. He may be cutting a tooth or he may have a sore in his mouth which makes it difficult for him to eat. Watch his behavior. If he acts sick, call his doctor.
What if I want to go back to work and still want to breastfeed my child? How can I resolve this dilemma?
It is not as hard as it may seem.
You can:
- Pumb at work and leave expressed milk for the baby.
- Leave formula while you are at work and nurse when you are with the baby.
- Nurse during your lunch hour or on breaks.
Your choice may depend on your work situation:
- Is there a private place for you to pump?
- Do you have access to a refrigerator or a place to put a cooler?
- Is there a good daycare facility on site or nearby?
Whatever you decide to do, it is a good idea to discuss your plans with your employer before you return. If you can, make arrangements to go back to work half a week early. Start work on a Thursday or Friday and take off on Wednesdays for a few weeks. This will allow you and your baby time to adjust gradually.
Here is an important pointer:
Frequency: If you want to breastfeed without giving formula, be sure to nurse and/or pump at least six times every day. You can nurse several times in the evening, and nurse once and pump once in the morning before you leave. If your milk supply seems to be dropping, nurse very frequently (10 to 12 times/day) on the weekend to stimulate your supply. Many working mothers find that their volumes are high on Monday and low by Friday.
How do I store my breast milk at work?
The best way is to keep it cold, but not frozen. Freezing reduces some of the value because it kills most of the living cells in the milk. You can put it in a refrigerator or in a small cooler with an ice pack. Your baby can drink it in the next day or so. If you want to store milk for later use, for example, if you plan to take a business trip without your baby, then you can freeze a little at a time until you have enough. This is what you will need to do before you go back to work.
What kind of container should I use?
I’ve heard that it is not good to use glass bottles. Oh no, glass is fine–in fact, it is excellent. At one time there was some concern that the live cells in the milk stuck to the glass, but now we know that it happens only temporarily. You can use glass or hard plastic or even baggie bottles. The baggie bottles have a couple of disadvantages: some of the immunoglobins stick to them– but not all or even most; and they can be punctured, so you might contaminate the milk accidentally or lose some. The advantage of baggie bottles is that they are presterilized and compact.
Glass bottles can break and they take up a lot of space, otherwise they are great. Hard plastic bottles won’t break, but they do scratch. This means they become harder to clean properly when they get old, so it is important to replace them periodically. If I were choosing for myself, I would use glass, but it is really up to you.
Pumps and equipment: There are many different kinds of pumps available. Some come with attractive carrying cases and coolers specifically designed for working mothers. You don’t have to buy a pump, of course. Hand expression is the easiest and cleanest way to express milk, but it takes practice.
Wash your hands thoroughly and rinse your breasts with clean water before pumping or hand expressing. All equipment should be thoroughly clean. When you hand express, remember to compress just behind the milk sinuses and roll the fingers forward to force the milk out of the nipple. If you have trouble, a lactation consultant can show you how to hand express efficiently.
What should I look for in a breast pump?
Find one that is easy to use and to clean. Several good hand pumps are available, including double-cylinder pumps and pumps that can be operated with one hand. The old-fashioned “bicycle horn” pumps should be avoided. They are hard to clean and may hurt the breast because they produce too much suction. Battery-operated pumps are easier to use than hand pumps, but replacing batteries can be both inconvenient and costly.
If you select an electric breast pump, one with alternating positive and negative suction will give you the best results. These high-quality electric pumps are very expensive, however, and usually are leased or rented by mothers of hospitalized infants.
Does the amount and type of liquid I drink affect my milk production?
Contrary to popular misconception, you cannot increase your milk supply by drinking a lot of liquids. It may be that your milk supply will decrease if you become dehydrated, however. You should drink something whenever you are thirsty, and you will probably be thirsty often. After all, you will be producing about 25 ounces of milk every day, and even people who are not nursing need to drink six 8-ounce glasses of water a day.
The type of liquid can be important to your health and can affect the composition of your milk to some extent. If you drink caffeinated drinks, you will have caffeine in your milk. Water, milk, and juices are excellent choices for most nursing mothers.
Does the type of food I eat affect my milk, for example, chocolate or hot, spicy foods?
Most nursing mothers can eat any food they want without causing their babies discomfort. This includes chocolate, spicy foods, cabbage, onions, broccoli, and all the foods usually included on the “don’t eat” lists so often distributed. Occasionally, some babies have problems with certain foods that the mother eats. After your baby is born, if you suspect such a problem, discuss it with your doctor. In the meantime, enjoy all the kinds of healthy foods that you normally like.
Can I drink alcohol if I breastfeed?
It is best to avoid alcohol when you breastfeed. If you do drink on occasion, remember to wait a few hours before nursing your baby.
Alcohol will get into your breast milk, and it is toxic to your baby’s brain cells just as it is to yours. The difference here is that your baby is not able to break down the alcohol as easily as you do, and your baby’s brain cells are more sensitive because they are still developing. Fortunately, your system removes the alcohol from your milk whether you empty your breasts or not. So if you take a single drink and wait for a few hours before you nurse, almost all the alcohol in your milk will be removed and broken down just as it has been removed from your blood stream.
Can I breastfeed if I smoke cigarettes?
Yes, you can. The choice is yours to make. You will have nicotine in your milk and you will be exposing your baby to nicotine. This is probably not good, but at the same time you will be giving your baby many protective components that he could not get from formula. If your baby is exposed to cigarette smoke, he will be more likely to become ill, and your baby may need all the protection he can get.
Please talk to your doctor about programs to help you stop smoking, and NEVER allow yourself or anyone else to smoke in the same room with your child.
I am breastfeeding and my baby seems to be hungry every 2 hours. What can I do to stretch the time between feedings to 3 to 4 hours?
Babies commonly nurse every 1 1/2 to 2 hours during the first week or two of life. Once the mother’s milk supply is established, the time between feedings usually lengthens. By the end of the first month, most mothers and babies have
adjusted to a feeding schedule that is mutually satisfying.
During periods of rapid growth, babies may increase the frequency of feedings. This pattern change is usually temporary, lasting just a few days.
Some babies appear to have their nights and days reversed! Frequent nursing during the day may encourage the baby to sleep longer between feedings at night.
Breastfeeding mothers need to remember to take time out to rest during the day when the baby is sleeping. A daytime nap can help the mother who is up several times each night. Most mothers also learn to rest while nursing the baby. The side-lying nursing position is ideal for this.
My baby falls asleep during breastfeeding time, what should I do?
Your baby may be similar to the so-called "placid baby." These babies are typically described as being "so good," with demands for being fed as few as 4 to 6 times daily. They often fall asleep early during a breastfeeding session and may experience poor weight gain if a mother does not intervene.
Some ideas for feeding this type of baby are as follows:
- Nurse frequently, every 2 1/2 to 3 hours during the daytime hours and on demand at night.
- Nurse during wakeful periods when possible. Keep your baby near you so that you can be aware of these periods when they occur.
- Prior to nursing use gentle arousal techniques. Loosen blankets and clothing. Apply cool water to face.
- Stroke the baby from throat to chin during breastfeeding.
- Nurse your baby after a bath. Usually bathing is stimulating to the baby and he will be more awake.
- Change the diaper between offering the first and second breast as a method to keep the baby awake.
My baby has started nursing more often. Why doesn’t my breast milk satisfy my baby anymore? What do I do?
Babies periodically experience growth spurts. During these times, the baby’s appetite increases and the number of breastfeeding experiences per day may suddenly increase. The increase in feeding frequency stimulates the mother’s body to produce more milk to meet the baby’s increased nutrient needs.
The mother’s milk supply usually increases after a few days and a more routine feeding schedule returns.
I tried to nurse my baby for two weeks and he refused to take my nipple. I let my milk dry up. One day the baby started nursing. Can I get my milk reestablished?
Lactation can often be reestablished. The suckling experience serves as the primary stimulus to milk production. Initially, the baby will receive little or no breast milk from nursing. To meet the baby’s nutritional needs, formula can be provided by a nursing supplementation system. The supplementation system delivers formula through a small tube attached to the mother’s breast, so that when the baby suckles, the supplement is given to the baby directly. As the mother’s milk increases, the formula provided by the supplementer will be correspondingly reduced. Some mothers have found the use of oxytocin nasal spray helpful in enhancing the let-down reflex. Several other medications have been used to start lactation. All medications used to produce let-down or flow of breast milk should be used under the supervision of a physician.
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