Breastfeeding

Breastfeeding has many benefits. Some are well proven, such as protection against diarrheal and respiratory illnesses, ear infections, SIDS, necrotizing enterocolitis (a very serious intestinal condition usually seen in premature babies), decrease in doctor visits and hospital admissions. Other benefits are possible or likely – decrease in allergic disease, decrease in the risk of future obesity/ high cholesterol/ adult onset diabetes, improved development in early life, higher IQ in later life, decrease in the risk of type 1 diabetes and other autoimmune disorders. Moreover, the breastfeeding time is very special and enjoyable to most mothers and babies.

Even though breastfeeding is a very basic process, it is still a skill that has to be learned by both the mothers and the infants. Frequently, the parents are overwhelmed by a variety of issues that arise in the first days. These issues tend to resolve quickly. It is extremely important, however, to seek help PROMPTLY. The help may come from a post-partum nurse or a doula, a family member, your child’s pediatrician or a lactation consultant. We recommend that if your baby is breastfed, you bring him/ her in to us for an exam no later than 1-2 days after the discharge from the hospital.

Below is some general information that the parents of a breastfed baby may find useful.

Breastfeeding is Going Well If…

  1. Colostrum is present once the baby is born. Even though it may only give your baby a teaspoon per feeding, it is enough provided that he/she has adequate wet diapers and meconium, and appears calm and satisfied after nursing.
  2. The milk is in between the 3rd and the 5th day. You will typically hear or see the baby swallow it, and it may leak around the sides of the mouth. Mild engorgement may be felt as fullness in the breasts, and they may be somewhat hot, painful, and tender to touch. The baby usually provides prompt relief by suckling and removing the milk.
  3. Transient nipple pain or discomfort resolves after 15-30 seconds of latching on, and usually disappears within a couple of weeks.
  4. The baby latches with a wide open mouth on the areola. The nipple is not misshapen, flattened, or bruised after feeds. The baby feeds quietly, without clicking or smacking noises.
  5. The baby feeds 8-12 times (about 20-40 minutes per session) in 24 hours. She/he may be very sleepy and have to be woken up for feeds in the first 1-2 weeks. The baby may “cluster” feed in the evening and early night every 1 to 1 1/2 hours.
  6. The number of wet diapers is at least 1 in the first 24 hours, at least 2 in the second 24 hours, and so on till one week of age. Then, 6-8 wet diapers in 24 hours is expected. The bowel movements are usually yellow, orange, or greenish, very soft to runny, often with every feeding or every other feeding.
  7. The baby regains birth weight by 14 days of age at the latest.
  8. The baby is content after feeds.

Common Early Concerns And Their Solutions

  1. Milk is not in by the third day – this may happen in cases of unusually stressful labor and delivery, and will probably come in the next 1-2 days. Solution: first, you need to ensure that the baby is not dehydrated, has normal urine output, has not lost excessive weight, and is not excessively yellow. Speak with a doctor or a lactation consultant promptly. You will be advised to come in for an exam.
  2. Excessive engorgement may be felt as “rock”-hard breasts that are exquisitely painful and tender, with only some relief provided by nursing. The nipple may become so stretched and flattened that the baby cannot latch. Solution: before feeds, massage and apply warm compresses. Pump just enough to soften nipples and start the milk flow. After feeds, apply cool compresses and chilled cabbage leaves. Do not pump to empty the breast, unless the baby is completely unable to nurse. Take an analgesic (Ibuprofen 600 mg every 6-8 hours, with food) if the above measures do not relieve the pain. The excessive engorgement should level off within about 2 days.
  3. Jaundice, or the yellow discoloration of the baby’s skin, is very common. It is often mild and self-limited, but may become excessive and need to be addressed quickly. Solution: if your baby left the hospital with any degree of jaundice, see us within 2 days of discharge or sooner, if recommended by your discharge pediatrician.
  4. Persistent nipple pain with nursing is usually due to incorrect latch and a possible superficial nipple infection (rarely, some other causes). Solution: see a lactation consultant for an observation of a feed/ breast examination.
  5. Mastitis, or infection within the breast, is usually seen as the redness extending from nipple outward, tenderness and pain over affected area. The mother may have fever and flu-like symptoms. Solution: most often, prompt treatment with antibiotics is advised. If the baby continues to take the infected breast, continue to nurse on that side. IF the baby refuses the breast because of possible change in taste, pump to empty the breast and discard the milk.

Medications and Breastfeeding

  1. LactMed Database is the place where you may find information regarding specific medications. Note that most common medications are acceptable to take while nursing.
  2. Pain control with acetaminophen (Tylenol) and ibuprofen (Motrin, Advil) is preferred to narcotics (Codeine and Percocet), which have the potential to make a baby too sleepy.
  3. Over-the-counter cold medications (decongestants and antihistamines) are safe, but can reduce the milk supply. The effect is reversible, and it is important to drink plenty of fluids. A decongestant nasal spray is a preferred topical alternative.

Miscellaneous

  1. Pacifier use is welcomed and encouraged as soon as breastfeeding is well established (good latch, good milk supply, good weight gain).
  2. Vitamin D supplementation is recommended for any breastfed baby, unless he/she is also getting at least 30 oz of formula per day. The dose is 400 IU per day, and may be given in the form of any over-the-counter baby multivitamin or as just vitamin D drops.
  3. Prenatal vitamins should be continued to be taken by mothers, since the breastmilk is made at the expense of the mother’s nutrient stores.

Useful Breastfeeding Internet Resources

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