Breastfeeding Problems: Your New Baby and You (0-6 Months)

It can be frustrating when little problems and annoyances raise their heads, making it seem that breastfeeding isn’t the easiest option. The good news is that almost all problems can be resolved, and after the first few weeks, you’ll find that you settle into a comfortable, pleasurable routine with your new baby.

Q. I find I simply don’t have enough milk at some points during the day. What do you recommend?
A. It can take some time for your milk to become established, and for “supply and demand” to kick in. Continue to allow your baby to suckle, even if there doesn’t seem to be much milk coming out. This will stimulate your body to produce more milk to meet your baby’s demands. It may take a day or so for the milk supply to adjust to your baby’s needs, and the only way to do this is to continue to try to feed her when she is hungry. Make sure that you are relaxed when you feed her. If you are tired and anxious, it might seem as though there is no milk, or not enough. In reality, however, even if your breasts do not feel full to bursting, there will be plenty there for your baby. Take some time to rest, and even retire to bed with your baby for a day or two, to divert your energy toward making milk. Most new moms can use a break, and once you’ve got your supply reestablished, you’ll probably feel much better. Make sure, too, that you are getting enough to eat. You need plenty of energy to produce milk, and an inadequate diet can most definitely affect your milk supply. Eat three good meals a day, with plenty of healthy snacks in between, such as whole-grain toast, fresh fruit, cheese, seeds, and nuts.

★ Did You Know ...
that it’s perfectly normal for your baby to become distracted while feeding? Even hungry babies can lose interest. Try to find a peaceful place to feed and talk to your baby quietly, so that he concentrates on you rather than what is going on around him. If he starts to come off and on, take him off the breast and try again later. He’ll soon realize that feeding time is not playtime!

Q. My nipples are sore and chapped, and latching on is becoming very painful; what can I do?
A. Breastfeeding in the early days can be quite painful as your nipples adjust to regular feeding. It may be cold comfort, but things do improve over time and the best thing you can do is persevere. Make sure that your baby is latching on properly. Her mouth needs to be open wide, with her tongue down and forward, and your nipple should be aimed at the roof of her mouth. When she is properly latched on, she should be drawing in all of the nipple, and some breast tissue into her mouth. If you’re not sure, ask your midwife, doctor, or breastfeeding counselor to watch you feed. After feeds, express a little of the rich, fatty milk and rub it over your nipple to encourage healing. Between feeds, keep your bra and T-shirt off for short periods, to allow the air to get to your nipples. Try a good emollient cream for sore nipples too.

Q. My baby has started refusing my breast; what could be causing this?
A. First of all, make sure that you’re relaxed and in a quiet spot. If you are feeling fraught or anxious, your baby may respond in kind and become fussy or even reject your breast. Make sure that he’s latched on properly, too (see above), as he can become frustrated if he’s working hard to feed, and isn’t getting much milk. You may find it helps to express a little milk first. Sometimes your milk may flow too quickly, causing your baby to choke and to cry after latching on. If this happens, try using a nipple shield, which slows down the flow. Also, it may be possible that you’re eating something that disagrees with your baby.

★ Teething Babies
If your baby is latched on properly, she shouldn’t be able to gnaw or bite, but if she’s teething she may use your breasts for comfort. Remove her from your breast as soon as she’s finished feeding and try rubbing a cold, wet cloth on her gums, or offer her something else to chew on.

Q. My baby often goes for hours between feeds, and my breasts become uncomfortable. What should I do?
A. Some babies do have an amazing capacity to last for hours between feeds. While it may help to express some milk when your breasts are uncomfortable, you don’t want to build up your supply to the extent that you are siphoning off milk and storing it, as well as feeding your baby, because it won’t solve the problem in the long-term. Try offering your breast a little more often, even if he doesn’t seem to be requesting a feed.

Also, some very young babies have not yet developed the strength to wake up and demand to be fed. Sometimes a premature or ill baby is too small and sleepy to cry, instead focusing on conserving energy for growth and recovery. Waking a baby in this situation to offer the breast is a good idea. If your baby isn’t putting on much weight and seems tired and listless, see your doctor or health professional.

Q. My baby still seems hungry after feeds; how do I know that I am producing enough milk?
A. If your baby is growing and putting on weight normally, has at least six wet diapers a day, as well as regular bowel movements, is alert when she is awake, but also sleeps well, she is getting plenty of milk. Sometimes babies have growth spurts that make them hungrier for short periods of time; these often occur around three weeks, six weeks, three months, and six months. You will need to feed her more frequently during these periods to build up your milk supply to meet the new demands. It normally takes only 24 to 48 hours for this to happen, so don’t panic.

Sometimes babies vomit after feeding, leaving them very hungry. If your baby spits up more than a tablespoon or so of milk after feeds, pay a visit to your doctor to establish the cause.

Around the four or five month mark, your baby may seem to need more and more milk and may appear less satisfied after feeds. This may be a sign that she is almost ready to start some solid foods.

In most cases, however, you simply need to feed your growing baby more often until things settle down.

Q. My baby wakes continually throughout the night for feeds, and I’m becoming exhausted; what can I do?
A. First of all, make sure that he is getting plenty of milk during the day, at regular intervals. Babies who develop the habit of snacking tend to wake more frequently than those who have good feeds every three hours or so, since their bodies have not become adjusted to increasing gaps between feeds. If your baby does wake up at night, get him up, change his diaper, and settle him down for a good, long feed. While it does mean that you will have to wake up properly, it’s worth considering—he’ll go for longer the next time and he’ll soon get used to one good feed. If he wakes again, try to settle him without a feed, and he’ll soon realize that waking and calling for you isn’t going to get him another one.

Q. My baby constantly falls asleep while feeding; should I wake her up?
A. Babies often fall asleep at the breast, because they are comfortable and deeply relaxed. It’s perfectly acceptable to encourage this, but only if they are getting a good feed before they drift off. If your baby is getting only a little milk before she falls asleep, she is likely to wake soon, demanding more—a process that can go on all day and night! It’s best to gently nudge her, and switch positions, to encourage her to keep suckling. Sit her up and talk to her, and when she’s awake again, put her back on the breast. My mother tells me that she used to tickle my feet to keep me awake. Also try to avoid “big feeds” when she is very tired.

Q. I have a real problem with leaking; could I be making too much milk?
A. Leaking seems to be a problem that occurs mainly in the first weeks of breastfeeding. Before your supply has been “matched” to your baby’s needs, you may produce more milk than your baby needs, causing your breasts to leak and even spurt milk. Try feeding your baby before your breasts become too full. Even if he takes only a little, it can help to ease the flow. Over time, your breasts will respond to your baby’s needs, and become less full. If your baby is ill, or if he has slept longer than usual, you may experience very full, painful, leaking breasts. Try expressing a little milk, and put it in the freezer for a later date. Sometimes breasts leak when your let-down reflex suddenly and unexpectedly kicks in. You may hear your baby—or even another baby—cry, which gets things started. Try crossing your arms across your breasts and hold them firmly for a few minutes, to stop the flow, and keep a supply of breast pads on hand.

Q. I don’t enjoy breastfeeding at all and want to give it up, but I feel incredibly guilty. Does it matter that much?
A. Breastfeeding should be a pleasurable experience for both mom and baby, and if you don’t enjoy it, it can become negative for you both. Breastfeeding for even a short time gives your baby the best start in life, and you should feel proud that you have managed to give her that. Sometimes it simply doesn’t work out, and there are a wide range of good formulas on the market that will ensure your baby gets exactly what she needs. Try not to feel guilty—you can make bottle-feeding sessions warm, nurturing, and positive.

Q. I would like to stop breastfeeding, but my baby refuses a bottle. What do you recommend?
A. First of all, experiment with some different bottle teats. Some of the flatter ones are more similar to the nipple, and he may find this less offensive. Start by offering him expressed milk in a bottle, which he’ll find familiar and less distressing. Try dropping one feed at a time, and offering the bottle when you know he’ll be hungry—perhaps first thing in the morning. It can sometimes help to have someone else offer the bottle, because if he’s near to you, and can smell your milk, he may hold out for the real thing. Make sure the bottle-feeding experience is cozy and nurturing. It can be difficult, but persevere, and he’ll get there. If he’s hungry, he’ll eventually give in, and one or two successful bottle feeds will make things much easier in future.

★ Breastfeeding To Sleep
Many babies seek the breast when they are sleepy because it’s comforting and familiar. There is nothing wrong with breastfeeding a baby to sleep. You don’t want her to become dependent on you feeding her to fall asleep, though. Begin the transition to settling her without milk when you’re both ready.

This recipe was published in 'First Meals & More Your Questions Answered With 50 all-new “recipes to the rescue” by Annabel Karmel - p22 to p25'.

The Art of Breastfeeding: Your New Baby and You (0-6 Months)

Breastfeeding offers a magical opportunity to develop a close, intimate bond with your new baby, and gives him the best possible start to life. Your breast milk provides all of the ingredients he needs for optimum health, growth, and development, and has plenty of benefits for you, too.

Q. What are the advantages of breastfeeding?
A. Breast milk provides a perfect start for your baby, affecting health and development on many different levels. For one thing, the composition of breast milk changes constantly, to allow for your baby’s individual growth and changing nutritional needs. Research has found that breastfed babies have fewer incidences of vomiting, diarrhea, gastroenteritis, as well as other infections and illnesses (it is especially important for premature babies to be breastfed as it strengthens their immune system). Breast milk also reduces the risk of chronic constipation, colic, and other tummy disorders, and promotes growth. There is a reduced risk of childhood diabetes in breastfed babies, and they are considerably less likely to become obese or develop heart disease in later life. Research suggests breastfeeding exclusively for six months may protect against allergies, asthma, and eczema. There is also a reduced risk of SIDS (sudden infant death syndrome): research has found that of every 87 deaths from SIDS, only 3 took place in breastfed babies. The emotional benefits are well-documented—breastfed babies enjoy a warm, bonding, and emotional relationship with their mothers. Finally, breast milk is convenient— it’s sterile, needs no preparation, and it’s free.

★ Did You Know...
that breastfeeding has benefits for you too? Women who breastfeed reduce their risk of developing breast, uterine, and ovarian cancers— by as much as 25 percent for breast cancer. The risk of osteoporosis and rheumatoid arthritis is reduced significantly, too. It is also easier to shed pregnancy weight, because breastfeeding burns on average 300–500 calories a day.

Q. Should I be demand-feeding my baby?
A. In the early days, it’s a good idea to feed as often as your baby wants, simply because your body has to adjust the amount of milk produced to ensure that your baby gets what he needs. After a few weeks, you can choose to continue to feed upon demand, or set up a routine. There are benefits for both approaches, and you’ll need to decide what works best for you.

Some childcare experts believe that feeding on demand prevents any problems with milk supply, and also encourages emotional security, because you are meeting your baby’s needs as and when he needs you to—teaching him trust. It is also now believed that babies who are fed when they are hungry learn to recognize hunger “cues,” and develop a habit of eating to these cues, which is an important step in preventing obesity.

Some women, however, prefer to feed babies according to the clock—often every three or four hours. When babies cry between feeds, they are soothed, but not with milk. This can make life easier, knowing when you’ll be sitting down for a feed, and when you have a little more time. Some women don’t enjoy breastfeeding in public, and this approach means that you can schedule trips between feeds.

There’s no reason, however, why you can’t adapt things to include a little of both approaches. For example, you may wish to feed on demand throughout the day, and then wake your baby before you go to bed to fill up his tummy, and give you a little more sleep. You may also want to feed before setting out on a long journey, or to fall in with a family routine. That doesn’t mean you are ignoring his requests for food, but that you are rescheduling the feeds a little to avoid having to breastfeed at times that are less convenient.

★ Brainy Babies
Breastfed infants develop higher IQs and have improved brain and nervous system development—to the extent that breastfeeding is considered by many as the fourth trimester. Also, the way babies suck on the breast promotes development of facial structure, enhancing speech.

Q. How will I know if my baby is getting enough milk?
A. This is a concern that plagues many new moms. Unlike the contents of a bottle, breasts do not supply a “set” amount of milk per feed and do, in fact, adapt constantly to provide your baby with exactly the right amount she needs, according to her demands. There is an element of trust necessary here—believing that your baby is getting what she needs. If your baby is a healthy color, putting on weight, alert and looking around when she is awake, and has regular wet and dirty diapers, she’ll be getting enough. If, after losing a little weight in the first few days (which is entirely normal), your baby puts on weight slowly but surely, all is well. Breastfed babies do tend to gain weight more slowly than their bottle-fed peers, but this is simply a natural process. Your doctor usually plots your baby’s growth on percentile charts in her Child Health Record book —talk to her if you’re worried.

Q. Will it confuse my baby to have a bottle from time to time?
A. Many breastfeeding experts believe that offering a bottle will cause “nipple confusion,” mainly because different types of sucking are involved. Sucking from a bottle requires less effort from babies, and they can quite easily become accustomed to getting milk more quickly and efficiently. However, if you can establish a successful pattern of breastfeeding over the first six weeks, your baby will develop the skills he needs to continue, and shouldn’t find it too daunting to switch back and forth. In order to keep up the supply, which is based on your baby’s demands, it’s a good idea to avoid supplementing with formula milk too often.

Q. Is it OK to drink a little alcohol if I’m breastfeeding?
A. Alcohol enters your milk in much the same way that it does your bloodstream. Within about 20 minutes of drinking, it will appear in your milk. If you are feeling tipsy, you can expect your baby to feel pretty much the same. If you do want a couple of drinks, it’s best to have them after you’ve breastfed, giving your body a chance to clear the alcohol before the next feed. No more than one or two units a week is recommended for breastfeeding moms.

Q. Is it necessary to feed from both breasts during every feed?
A. The most important thing is to ensure that your baby gets both types of milk produced by your breasts—the thirst-quenching foremilk, and the more calorific and nutritious hind milk. If your baby flits from one breast to the other, without emptying either, she may not be getting enough of the latter. In the early weeks, before the demand for your milk has been established by your baby, your breasts will overproduce quite substantially. A little baby may well be full after emptying the contents of one breast, in which case, it’s fine to stop. However, do move her on to the other breast for your next feed, to avoid becoming engorged, and to ensure that your body begins to make the correct amount of milk to meet your baby’s needs. Within a few weeks you should be producing the right amount for your baby, and she will be able to manage both breasts in a sitting.

Q. How long should my baby feed on each breast?
A. It’s obviously difficult to work out whether your baby has actually managed to get both fore- and hind milk, because you can’t see what is going on. A good feed normally lasts about 20 to 30 minutes. If he’s “snacking,” falling asleep on the breast, or losing concentration and looking around instead, he probably isn’t getting all of what he needs. It may well be that he isn’t particularly hungry, and you’ll be better off trying again later. If you are demand breastfeeding, which means feeding your baby when he is hungry rather than to a set schedule, you might need to urge him to finish a feed properly, or return to the same breast until he has emptied it.

Q. If there are allergies in my family, is it advisable to breastfeed?
A. Unfortunately, if there is allergy (such as asthma, eczema, hayfever, or food allergies) in the family, the likelihood of a baby being “atopic” (the inherited predisposition to allergies) is very high. A huge amount of research has looked at ways of minimizing the potential for “high risk” babies to develop allergies in later life, but very few factors have been shown to make any difference at all. However, there is good evidence that exclusive breastfeeding can help. Current advice is to aim to breastfeed exclusively for six months, although it seems that it is the first four months that have the biggest impact in preventing food allergies and eczema. If there is a strong family history of allergy and you aren’t able to breastfeed exclusively for this long, talk to your doctor, who may recommend that you try a special hypoallergenic milk formula.

Q. Should I wake my baby for a late night feed before I go to bed?
A. Personally, I think it’s OK to wake your baby. If you don’t get much rest, you may find it hard to be a good mother. I think there is more chance of your baby starting to sleep through to a civilized hour if woken and fed just before you go to bed.

Q. How long will expressed milk last?
A. Expressed milk will last for about four hours at room temperature and, if you refrigerate it immediately after expressing, between 24 and 48 hours. If you are taking expressed milk out with you, keep it in a cool bag with ice packs, and it should last 24 hours or so.

★ Sterilizing Bottles
It’s impossible to create a germ-free environment for your baby. However, warm milk is a perfect breeding ground for germs, so it’s important to sterilize the bottles and teats you use for expressed milk. In the first year, your baby will be at her most vulnerable to germs, and carefully washing bottles will not be enough.

Q. Can I continue to breastfeed when I return to work?
A. If you have access to a breast pump at work, it may be possible to breastfeed exclusively (you’ll need to refrigerate the milk and keep it at the same, cool, temperature while you transport it home). Before you return to work, you can freeze a supply of milk—it will last about three months. You'll obviously need to top off this supply. If you’re able to feed your baby before you go to work, immediately upon your return, and perhaps again before bedtime or during the night, it is perfectly possible to breastfeed exclusively.

Some mothers who breastfeed parttime, alongside bottle-feeding, find that their babies are reluctant to go back to the breast. However, if you can manage to offer the same feeds each day—perhaps morning and evening— your baby will get used to the routine. Your breasts will also begin to produce milk at the appropriate time.

This tip was published in 'First Meals & More Your Questions Answered With 50 all-new “recipes to the rescue” by Annabel Karmel - p12 to p15'.

What You Can Expect: Your New Baby and You (0-6 Months)

Your new baby will gradually settle into a routine of feeding and sleeping, growing more alert and investigating her world as she stays awake for longer periods. Your baby will grow more in this period than at any other time in her life. Settle in and enjoy the process of bonding.

Copyright © 2009 Dorling Kindersley Limited - All rights reserved

Q. Why is it so important to breastfeed for the first few days?
A. While the longer you breastfeed your baby, the greater the benefits, you’ll be giving your baby a better start even if you can manage it just for a few days. Breast milk is designed to provide complete nourishment for a baby for at least six months after birth. Before milk is produced, a mother’s breasts produces colostrum, a deep-yellow liquid containing high levels of protein, nutrients, and antibodies. A newborn baby who feeds on colostrum in the first few days of life is better able to resist the bacteria and viruses that cause illness. Your milk, which begins to flow a few days after childbirth when your hormones change, is a blue-white color with a thin consistency and provides the perfect balance of nutrients for your baby. Some moms are alarmed that it looks “weak” or even “skimmed” next to the rich, yellowy color of formula milk, but it is important to remember that it’s been designed this way for a reason, and provides easily digestible nutrients that are just right for a baby.

Q. How often do babies need to be fed?
A. Your baby’s appetite and needs will change constantly as she grows and develops, and it is important that she is fed when she is hungry. At the outset, you may be feeding your newborn every two hours or so, but it is almost impossible to overfeed a breastfed baby. For the first month of life, your baby needs between 8 and 12 feeds every day. As she grows and begins to take more at feeding time, she will go a little longer—sometimes up to three or four hours—between feeds. As you get to know your new baby, you’ll recognize her signs of hunger, and know when she needs to be fed.

Q. Is milk all my baby needs for the first six months?
A. Breast milk and/or formula milk are perfectly designed to be a complete food for babies, providing them with nutrients, such as protein, fat, carbohydrates, vitamins and minerals, calories, as well as liquid to keep them hydrated. In the case of breast milk, your baby will get some additional benefits, such as antibodies against infections, as well as hormones, EFAs (essential fatty acids), enzymes, and living cells which fight infection. If you are bottle-feeding, EFAs and other elements, such as probiotics, may also be added to your baby’s formula to ensure your baby’s health. At present, the WHO (World Health Organization) recommends exclusive breastfeeding for six months, but you may feel that your baby is ready for solids a little earlier than this. If this is the case, speak to your doctor.

★ Your Baby’s Tummy
Your baby’s tummy is smaller than you may think. At birth, it’s roughly the size of a chickpea, growing to the size of a cherry in the first week. By four weeks, her tummy will be the size of a walnut, and it remains much the same until she is six months old, when, in most cases, her tummy will be the size of her fist.

This tip was published in 'First Meals & More Your Questions Answered With 50 all-new “recipes to the rescue” by Annabel Karmel - p9 to p11'.