The American Academy of Pediatrics (AAP) and World Health Organization (WHO) both recommend breastfeeding, if possible. Breast milk is full of nutrients and infection-fighting proteins that are passed on from Mom.
But, the benefits are not limited to nutrition...breastfeeding also provides "bonding time" for the mom and baby, and reduces Mom's risk of breast and ovarian cancer1. However, some diseases can be spread through breastmilk, therefore it is important to tell the doctor immediately if Mom has an infection such as Hepatitis or HIV, along with all of the medications the mother is taking, to ensure breastfeeding is appropriate.New parents often have many questions regarding feeding the newest member of their family. Below are some tips to answer some of the more often asked questions. If you have any specific concerns, be sure to discuss with your pediatrician.
Breastfeeding provides "bonding time" for the mom and baby, and reduces Mom's risk of breast and ovarian cancer.
1. Doctors often use the term "breast milk coming in,” but it can take a few days for the mother to start to produce a large supply of breast milk. Typically, mothers know when this has happened because their breasts feel "engorged" or full of milk, there may even be some milk leaking from the nipples. While the baby may not receive much volume of milk during this waiting time, the stimulation of the baby's suck will help Mom make more breast milk. So even if Mom's breast milk has not "come in", there is benefit to letting the baby try to feed: the baby gets to learn how to feed, mom and baby can figure out the best positions for both herself and the baby. Plus, before Mom’s milk has even “come in”, the first milk Mom makes is called colostrum and is extremely rich in fat and dense in nutrients. During this time period, your Pediatrician will very closely monitor your baby’s weight. If the baby loses too much weight, then your Pediatrician may recommend supplementing the breastmilk with formula.
2. During the first month of life, babies should typically be awakened to feed every 2-3 hours, especially during those first two weeks of life, to ensure they are receiving adequate nutrition and gaining weight. However, these frequent feedings can get hectic for parents, especially waking for those nighttime feeds! If Mom is breastfeeding, it's okay to pump milk and then let Dad give one of those nighttime feeds to the infant (Dad’s please chip in here).
Every baby is different in how long they feed, some babies are more efficient and some are a little slower...you’ll get to know your baby’s feeding pattern within those first few weeks. You should plan on waking your baby up every 2-3 hours for that first month of life. Your Pediatrician will be checking the infant’s weight and will let you know if you can space these wakings out.
3. When pumping, the baby should be allowed to feed first, and then Mom can pump. This ensures that she doesn't empty her milk supply before the feed, but instead expresses the "extra" milk for storage and feeding at another time.
4. Breastmilk can be stored in the refrigerator for a week, 2 weeks in a freezer compartment, and up to 6 months in a deep freezer. You should date the milk before storing, so you know when it's okay to use. If you are an organized person and own a labeler, put that to good use.
5. Typically, babies lose weight at first but should regain to their birth-weight by 10-14 days of life. If your baby loses more than 10% of their birth-weight, your doctor will probably advise that you supplement with formula...this is okay! It doesn't mean that you're "stuck" with formula for the rest of the infant's life, and the infant will still get all of the benefits of breast milk, but also the extra calories he or she needs to grow from the formula.
6. A good rule of thumb is that a baby will take 2-3 ounces every 3 hours for the first month of life. An infant under the age of 1 month old should typically not go more than 4 hours without a feed.
7. The American Academy of Pediatrics (AAP) has recommended that a child does not start solids until 6 months of age, and some children are still not ready at this point, so ask your Pediatrician if your child is meeting the appropriate milestones to start solids.
8. When starting solids, try a new one every 3-4 days, this gives you the chance to gauge if the child has an allergic reaction to a food. So how do you know if your child is allergic to a food? Rashes, blood in the stool, and frequent vomiting of the food are the most common signs. Although there are no specific guidelines on which foods to try first, it's probably best to try the vegetables followed by fruits. The vegetables are less sweet and give you a better chance of getting your child to like them.
9. Many babies spit up, or even “dribble” a bit of their feeds. You can help reduce this by burping your infant after you feed them, or even pausing to burp them in the middle of a feed. What is “burping”? Basically, you let the infant take a moment, hold them upright, and gently pat them on the back to help them release some of the air they may have swallowed during the feeding process.
While spitting up can be normal, if your baby is arching their back after each feed or looking uncomfortable, you should let your doctor know as this may be a sign of reflux. While reflux is very uncommon in full-term babies, it can be more common in premature babies (born before 36 weeks gestational age) and it may lead to poor weight gain. If your doctor diagnoses your baby with reflux, there are preventative measures you can use such as elevating the head of the bed, frequent burpings, and even medications that can help reduce the symptoms of this problem. Additionally, if your baby is spitting up a lot after every feed, do let your doctor know, they may have an allergy or even anatomic problem.
"Projectile vomiting”, or spitting up that nearly shoots across the room, is never normal and may warrant additional investigation to be sure the baby does not have a problem called “pyloric stenosis,” which is a thickening at the end of the stomach that can block the food flow and cause the baby to reflexively throw up after each feed.
This is because the food cannot pass through to the small intestines easily and becomes “backed up”...it has nowhere to go but out of the mouth, and may even shoot across the room.
If your baby’s vomit is green (containing bile), or if your infant seems to be in extreme pain, this should be considered an emergency and you should seek medical care immediately.
Vomit containing bile and extreme pain can be signs of serious problems such as volvulus secondary to a malrotation, or abnormal twisting, of the gut (as well as other causes), in which the bowel did not rotate correctly and is positioned abnormally.
The above information is meant to address some of the more common questions regarding breastfeeding and feeding your newborn. Knowledge regarding this new aspect of life should lessen your anxiety and, hopefully, allow you to gauge what is abnormal. If you find anything concerning with your newborn, it is best to seek medical advice or care.
1Newcomb P. A., Storer B. E., Longnecker M. P., et. al Lactation and a reduced risk of premenopausal breast cancer, New England Journal of Medicine: 1994; 330: 81-87.