I hope you've been able to keep up with my Breastfeeding Basics series and have found it helpful in some way. If you haven't been following, here are the previous parts: Intro, Part I, Part II, Part III, Part IV, Part V.
Just by chance, this final post in the series coincides with World Breastfeeding Week, so happy WBW to all the current, future, and past nursing moms out there. Keep up the good work!
If you're reading this, it's because you've reached or will soon reach that magical one-year mark, that first birthday, that amazing milestone that says, "We're still alive after a year! We survived infanthood!" Now you've got a toddler on your hands. Maybe she's not walking yet, or maybe she's been walking for a few months, but a one-year-old is, as I'm sure you've noticed, very different from a six-month-old or a three-month-old!
I'm going to call the period from one year to three years "toddlerhood" for simplicity.
Let me start by saying, "You did it!" You did it! You made it to a year!
Toddlers are busy little creatures. They're mobile, they're curious, and they want to get out there and explore. This means that during the day, they likely don't want to sit on you and nurse for long periods of time. Your toddler will be more of a snacker when she's busy, stopping by for a quick cuddle and some yummy milk, then off to find new ways to try to hurt herself or destroy your house. When she's sleepy or unhappy or missing you, she'll probably want to cuddle longer, and at times you'll love it and at other times you'll just want her to go away and leave you alone for a bit.
The difficulty with nursing a toddler is that toddlers tend to be busy even when they're nursing. They try out strange and uncomfortable positions. Many of them have the annoying habit of "twiddling," which is when they play with one nipple while nursing on the other. This can be very annoying. You don't have to let your child annoy you. If your toddler is displaying nursing behaviors that you don't like, it is absolutely your right as the mother to discourage that behavior.
This is the time to introduce "nursing manners." Just as you are beginning to teach your toddler about the right way to act in other situations, you can let her know that she needs to be respectful of you when she nurses. I highly recommend getting her in the habit of treating you nicely when she nurses, or you'll start to resent nursing her.
You may want to start to teach her how to request to nurse, if you haven't already, either by introducing a hand sign such as the ASL sign for "milk" (opening and closing the fingers as if milking a cow), or by teaching her a word to use for nursing. Some kids pick up on the word "boob" or "breast," while others come up with their own term. My son called it "nu" or "nur." I guess he was trying to say "nurse." It's probably smart to come up with a term that wouldn't be embarrassing if it were, for example, yelled at the top of someone's lungs in a busy restaurant. Hearing "baba! baba!" is far less humiliating than having your 18-month-old yell "boobs!!!" in the middle of dinner.
You may also decide that now is the time to cut back on nursing sessions, since breastmilk is no longer your toddler's only source of nutrition. I discussed weaning in the previous post. You may find that your toddler naturally starts cutting back on his own, since he's so busy much of the day learning and exploring. He will probably go through phases of deep attachment, wanting to nurse often, almost like a newborn, and other phases where you'll swear he's ready to wean completely. Both are normal developments of toddlerhood. You can take advantage of the slower periods to start weaning, if you want, or you may want to try offering the breast more often during these slower times to encourage him to keep nursing, if you are not yet ready to wean.
At this point, you'll want to assess your goals. By now, you probably have a good sense of whether you want to keep nursing for a long time or whether you've really had it. If you're not sure, I encourage you to keep at it for now. The WHO recommends nursing until at least two years of age. This is a good place to stress that the benefits of nursing and breastmilk do not vanish when your child reaches one year old. Breastmilk continues to evolve and change as your child grows, and the milk your body makes for your toddler is specially suited to toddlers' quick nursing sessions and higher caloric needs, and it still provides the antibodies, anti-inflammatory agents, and antibiotic substances that have made it so valuable ever since your baby was born.
There are also benefits to you, the mom, of continuing to nurse. The benefits you gain from nursing a baby are cumulative - that is, the longer you nurse, the lower your risks of certain cancers and other diseases. So it's worth continuing if you want to.
The biggest challenge for many moms nursing toddlers, though, is the judgment from others. Some will say that a child is too old to be breastfeeding once he can "ask" for it. Others may tell you that you are doing some kind of harm to your child by continuing to nurse. You may hear that breastfeeding has no benefits after one year, or that you'll never get the baby off the breast if you don't wean, or some other such "wisdom." None of this is true. In fact, around the world, many mothers continue to nurse their children even until four years (and some even longer than that!), and there is absolutely no evidence that it causes any psychological harm. Most children will "self-wean" (choose to stop nursing on their own) between two and four years of age, and it's up to you and your child (and no one else) when it's time to stop.
Lastly, if you plan to have more children, you may start thinking about it while you're still nursing your toddler. While breastfeeding does have contraceptive properties, it's far from 100%, and the less you nurse, the less pregnancy protection you get. If your period has returned, likely so has your fertility.
If you do conceive while you're still nursing, don't feel pressured to wean. It is safe to continue to nurse during pregnancy as long as it doesn't cause contractions or preterm labor. Your OB or midwife will let you know if she thinks it's dangerous for you to continue nursing. The flavor of your milk may change and become unpleasant to your toddler, and he may decide to wean on his own because he doesn't like the taste. Some women find that their milk dries up when they are pregnant, although some continue to allow their toddler to "nurse," even when there's no milk, just for comfort. Many women find that nursing while pregnant is very uncomfortable, either because of breast and nipple soreness caused by the hormonal changes of pregnancy, or just because they generally don't feel well. If your toddler does continue to nurse through your pregnancy, your milk will change back to colostrum sometime late in the pregnancy. Your toddler will likely enjoy this new milk very much. You can even continue to nurse both your toddler and your newborn after the birth. This is called "tandem nursing." Remember that milk production is based on demand, so if you have two children demanding milk, your body will make enough for both. Be forewarned that newborn milk may have laxative properties for your toddler!
Nursing a toddler can be both rewarding and frustrating. The frustration may be in the nursing gymnastics, the twiddling, the demands. But the reward is in the special cuddles, the smile, and, when he starts talking, the compliments! Older toddlers may even tell you what your milk tastes like to them (ice cream?), although whenever I asked my son, he always said my milk tasted like milk. Can't argue with that!
That concludes this Breastfeeding Basics series. I'm happy to answer any questions you have in the comments. Also, remember to check out my new book, The "Yes, It's Normal!" Guide to Breastfeeding!
I'm a breastfeeding counselor with a side hobby in educating parents and caregivers in proper car seat use. I have four sons, one born by c-section and three born by VBAC. I blog about my life with four kids, pregnancy and birth, breastfeeding, and car seats.
Showing posts with label Breastfeeding Basics Series. Show all posts
Showing posts with label Breastfeeding Basics Series. Show all posts
Wednesday, August 3, 2011
Tuesday, July 26, 2011
Breastfeeding Basics - Part V: Six Months to One Year
Thanks for sticking with me so far. I recommend you read the previous posts in this series before jumping in here, unless you have a baby in this age range and you just can't wait to find out what wisdom I have to impart.
Introduction, Parts I, II, III, IV
By now, you should be quite comfortable with nursing. You've gotten this far, which means you've met the first part of the recommendations from the AAP, the WHO, and many other health agencies in exclusively breastfeeding for the first six months. Breastfeeding should be feeling quite routine by now. You know your baby's cues. You've gotten through growth spurts. Your baby may even have a tooth or two, or will very soon. Your baby is growing and healthy and doing all kinds of "tricks," like rolling over, and probably sitting without support. Some babies even begin crawling around six or seven months of age. Your baby is interactive, loves to play, grabs and holds objects of interest and brings them to her mouth.
Introducing Solid Foods
So what's next? Well, at six months of age, if you feel you and your baby are ready, you can begin to introduce solid foods! "Solid" foods means any food that is not breastmilk.
A few things you should know before I start:
First of all, you don't have to give solids if you don't want to or if you feel like your baby isn't ready. Some babies of this age still don't quite know what to do with food when offered, while others have been trying to grab and eat your PB&J for a month already. Breastmilk still provides all of the nutrients, fats, and sugars your baby needs. Before the age of one or so, any solid foods are just for practice, for baby to get used to new textures and flavors and to learn to bring food to the mouth, "chew" it, and swallow it. You don't have to worry if it seems like your baby isn't getting a "full meal" of solids at first. Getting a hunk of banana from the plate to his mouth is an accomplishment all by itself, and getting that banana into his mouth and swallowing it is another. That's why he needs to practice!
Do not give whole (cow's) milk until your baby is over 12 months old.
There are two ways to introduce solid foods. One is to begin with baby cereals and/or vegetable and fruit purees and feed your baby with a spoon. The other is to give your baby safe finger foods and let him learn to pick them up and eat them at his own pace. My first son insisted on being fed purees for a long time before he started understanding how to feed himself, while my second son wanted nothing to do with spoons and purees and wanted finger foods almost from the start. That's not to say he ate much at first, but he learned. Like I said, it takes practice!
So where and how to start? Well, you want to start with a simple food. Rice cereal (found in the baby food aisle - we're not talking about Rice Chex, here!) is a popular first food, for two reasons: 1) It is vitamin-fortified, so your baby is getting necessary nutrients (especially iron); and 2) Rice is basically a hypoallergenic food, meaning your baby is very unlikely to have any kind of adverse reaction to it.
The best way to prepare rice cereal is to put a small amount in a bowl and add some expressed breast milk until it reaches the texture you want. Then you feed it to your baby using a small spoon. He may not quite get the idea at first, or he may just not like the taste. Offer a small amount and see how he does. Give him a few tries before you give up. Try it in the middle of the day, when he is alert and happy, and offer the food after breastfeeding, or in between usual feeding times. You don't want solids to replace breast milk meals just yet!
You can also start with pureed vegetables or fruits. Bananas, avocados, squash, peas, sweet potatoes/yams, and pears are all great first foods. Most breastfed babies will prefer sweeter foods first, as breast milk is very sweet. You can peruse the baby food aisle at your local supermarket for ideas on first foods - the jars labeled "Stage 1" are generally bananas, pears, squash, sweet potatoes, or applesauce, all of which are good to start with. I don't have anything against jarred baby foods, but if you prefer to prepare your own baby food, simply steam your fruits or veggies until they are very soft, then put them in the blender until you achieve the desired texture. You can freeze the purees in ice cube trays and thaw one per meal (each cube is one ounce of food), or keep them in empty baby food jars in the fridge, or whatever other solution you like. There are lots of ideas out there on the web! Bananas and avocados don't need to be cooked. You can just mash them with a fork!
If you want to try the finger-food method, you want chunks of food that are big enough for the baby to grasp in a fist or between thumb and forefinger. Banana is fantastic for this, or steamed baby carrots. As your baby gets better at grasping and mouthing the food, you can offer other simple, soft foods, including well cooked pasta, peas, potatoes, etc. Always supervise your baby's eating!
When you introduce new foods, start with simple, one-ingredient foods at first so you can observe for any kind of allergic reaction or intolerance. Introduce one new food at a time and wait a few days before introducing another new food, so that if the baby does have a reaction, you'll know what he reacted to. For example, if you give banana on Monday as his very first solid food, give only banana for a few days. Maybe Thursday you'll introduce pears. For the next few days, only give either bananas or pears. Then on Sunday, you could add carrots. Then you can give bananas, pears, or carrots at any given meal, until you introduce a fourth food a few days later. And so on. Once you've accumulated a "menu" of options, you can offer mixtures, like a banana-pear puree, since you know he can tolerate both bananas and pears. As the baby gets older, you'll introduce more interesting and complex foods, but it's good to start simple and small.
There are lots of good websites out there with ideas on what kinds of foods to offer at what ages. Yogurt is an excellent food to offer around nine months of age. Hold off on allergenic foods like peanuts until after a year. There are also other baby cereals, such as oatmeal and wheat, that are good to add to your baby's diet, if you're going the puree route. Oatmeal has a much higher nutritional value than rice and has a more interesting flavor, as well. You can also just give your baby real oatmeal!
Also, don't give a baby younger than one year honey. Honey can cause botulism, a potentially fatal form of food poisoning, in babies under a year old. Cooking the honey does not kill the spores that contain the toxin. After a year of age, the baby's immune system is mature enough to handle the spores.
Other Developments
During the second six months of life, your baby is learning all sorts of things. His brain is developing incredibly fast. He'll start to recognize his name and other important words. He'll start crawling and maybe walking. Along with mobility and increased understanding comes distractibility! Your busy baby may not want to stay at the breast for a long time anymore, which may be good news for you. He'll eat fast and then hop off to go explore again. Most babies nurse faster and less often after six months, which means you're no longer "tied" to your baby. Plus, once you've successfully introduced solid foods, you can get away for a couple of hours without having to worry about leaving a bottle. Whoever is caring for your baby can give him solid foods to keep him busy until you get back to nurse him! Remember that babies under a year old should still be getting the vast majority of their calories from breast milk, so don't let solids totally replace breastfeeding yet.
By the time your baby is approaching 12 months of age, if he is eating solids well, you may be able to start cutting back on nursing if you want. There is no need to cut back or stop if you don't want to! "Extended" breastfeeding past 12 months is still very beneficial for both you and your baby. In fact, the WHO recommends continuing to breastfeed until at least two years of age! We'll talk more about "extended" breastfeeding in the next section on toddler nursing.
But, if you're ready to stop at a year, I'll still say congratulations! You nursed your baby for a year! You made it! If you want to wean, you can start replacing breastfeedings with whole milk (at 12 months) in a cup or bottle and/or with meals of solid foods. Your baby needs the fats from some kind of milk (breast milk, cow's milk, goat's milk, soy milk, almond milk... something like that) for his brain development, so you'll want to make sure he's getting some kind of milk to drink. Weaning from the breast should be a slow process, for yours and baby's sake. If you wean abruptly, your baby will be very unhappy, and you may have to contend with engorgement and other discomfort. Instead, try cutting back by one feeding every few days, to give your breasts time to adjust milk production to the new, lower demand. If you want, you can continue to nurse once or twice a day, e.g. before bed and first thing in the morning. If you want to stop completely, those two are probably the last ones you'll be able to eliminate. Mid-day feedings are the easiest to replace with other foods.
The next and last post in this series will be about toddler nursing, which is a whole new source of enjoyment and frustration. You may have a taste of toddler nursing already, with nursing gymnastics, distractibility, and new habits that may not be totally desirable. But hopefully you're also finding new reasons to enjoy nursing.
Introduction, Parts I, II, III, IV
By now, you should be quite comfortable with nursing. You've gotten this far, which means you've met the first part of the recommendations from the AAP, the WHO, and many other health agencies in exclusively breastfeeding for the first six months. Breastfeeding should be feeling quite routine by now. You know your baby's cues. You've gotten through growth spurts. Your baby may even have a tooth or two, or will very soon. Your baby is growing and healthy and doing all kinds of "tricks," like rolling over, and probably sitting without support. Some babies even begin crawling around six or seven months of age. Your baby is interactive, loves to play, grabs and holds objects of interest and brings them to her mouth.
Introducing Solid Foods
So what's next? Well, at six months of age, if you feel you and your baby are ready, you can begin to introduce solid foods! "Solid" foods means any food that is not breastmilk.
A few things you should know before I start:
First of all, you don't have to give solids if you don't want to or if you feel like your baby isn't ready. Some babies of this age still don't quite know what to do with food when offered, while others have been trying to grab and eat your PB&J for a month already. Breastmilk still provides all of the nutrients, fats, and sugars your baby needs. Before the age of one or so, any solid foods are just for practice, for baby to get used to new textures and flavors and to learn to bring food to the mouth, "chew" it, and swallow it. You don't have to worry if it seems like your baby isn't getting a "full meal" of solids at first. Getting a hunk of banana from the plate to his mouth is an accomplishment all by itself, and getting that banana into his mouth and swallowing it is another. That's why he needs to practice!
Do not give whole (cow's) milk until your baby is over 12 months old.
There are two ways to introduce solid foods. One is to begin with baby cereals and/or vegetable and fruit purees and feed your baby with a spoon. The other is to give your baby safe finger foods and let him learn to pick them up and eat them at his own pace. My first son insisted on being fed purees for a long time before he started understanding how to feed himself, while my second son wanted nothing to do with spoons and purees and wanted finger foods almost from the start. That's not to say he ate much at first, but he learned. Like I said, it takes practice!
So where and how to start? Well, you want to start with a simple food. Rice cereal (found in the baby food aisle - we're not talking about Rice Chex, here!) is a popular first food, for two reasons: 1) It is vitamin-fortified, so your baby is getting necessary nutrients (especially iron); and 2) Rice is basically a hypoallergenic food, meaning your baby is very unlikely to have any kind of adverse reaction to it.
The best way to prepare rice cereal is to put a small amount in a bowl and add some expressed breast milk until it reaches the texture you want. Then you feed it to your baby using a small spoon. He may not quite get the idea at first, or he may just not like the taste. Offer a small amount and see how he does. Give him a few tries before you give up. Try it in the middle of the day, when he is alert and happy, and offer the food after breastfeeding, or in between usual feeding times. You don't want solids to replace breast milk meals just yet!
You can also start with pureed vegetables or fruits. Bananas, avocados, squash, peas, sweet potatoes/yams, and pears are all great first foods. Most breastfed babies will prefer sweeter foods first, as breast milk is very sweet. You can peruse the baby food aisle at your local supermarket for ideas on first foods - the jars labeled "Stage 1" are generally bananas, pears, squash, sweet potatoes, or applesauce, all of which are good to start with. I don't have anything against jarred baby foods, but if you prefer to prepare your own baby food, simply steam your fruits or veggies until they are very soft, then put them in the blender until you achieve the desired texture. You can freeze the purees in ice cube trays and thaw one per meal (each cube is one ounce of food), or keep them in empty baby food jars in the fridge, or whatever other solution you like. There are lots of ideas out there on the web! Bananas and avocados don't need to be cooked. You can just mash them with a fork!
If you want to try the finger-food method, you want chunks of food that are big enough for the baby to grasp in a fist or between thumb and forefinger. Banana is fantastic for this, or steamed baby carrots. As your baby gets better at grasping and mouthing the food, you can offer other simple, soft foods, including well cooked pasta, peas, potatoes, etc. Always supervise your baby's eating!
When you introduce new foods, start with simple, one-ingredient foods at first so you can observe for any kind of allergic reaction or intolerance. Introduce one new food at a time and wait a few days before introducing another new food, so that if the baby does have a reaction, you'll know what he reacted to. For example, if you give banana on Monday as his very first solid food, give only banana for a few days. Maybe Thursday you'll introduce pears. For the next few days, only give either bananas or pears. Then on Sunday, you could add carrots. Then you can give bananas, pears, or carrots at any given meal, until you introduce a fourth food a few days later. And so on. Once you've accumulated a "menu" of options, you can offer mixtures, like a banana-pear puree, since you know he can tolerate both bananas and pears. As the baby gets older, you'll introduce more interesting and complex foods, but it's good to start simple and small.
There are lots of good websites out there with ideas on what kinds of foods to offer at what ages. Yogurt is an excellent food to offer around nine months of age. Hold off on allergenic foods like peanuts until after a year. There are also other baby cereals, such as oatmeal and wheat, that are good to add to your baby's diet, if you're going the puree route. Oatmeal has a much higher nutritional value than rice and has a more interesting flavor, as well. You can also just give your baby real oatmeal!
Also, don't give a baby younger than one year honey. Honey can cause botulism, a potentially fatal form of food poisoning, in babies under a year old. Cooking the honey does not kill the spores that contain the toxin. After a year of age, the baby's immune system is mature enough to handle the spores.
Other Developments
During the second six months of life, your baby is learning all sorts of things. His brain is developing incredibly fast. He'll start to recognize his name and other important words. He'll start crawling and maybe walking. Along with mobility and increased understanding comes distractibility! Your busy baby may not want to stay at the breast for a long time anymore, which may be good news for you. He'll eat fast and then hop off to go explore again. Most babies nurse faster and less often after six months, which means you're no longer "tied" to your baby. Plus, once you've successfully introduced solid foods, you can get away for a couple of hours without having to worry about leaving a bottle. Whoever is caring for your baby can give him solid foods to keep him busy until you get back to nurse him! Remember that babies under a year old should still be getting the vast majority of their calories from breast milk, so don't let solids totally replace breastfeeding yet.
By the time your baby is approaching 12 months of age, if he is eating solids well, you may be able to start cutting back on nursing if you want. There is no need to cut back or stop if you don't want to! "Extended" breastfeeding past 12 months is still very beneficial for both you and your baby. In fact, the WHO recommends continuing to breastfeed until at least two years of age! We'll talk more about "extended" breastfeeding in the next section on toddler nursing.
But, if you're ready to stop at a year, I'll still say congratulations! You nursed your baby for a year! You made it! If you want to wean, you can start replacing breastfeedings with whole milk (at 12 months) in a cup or bottle and/or with meals of solid foods. Your baby needs the fats from some kind of milk (breast milk, cow's milk, goat's milk, soy milk, almond milk... something like that) for his brain development, so you'll want to make sure he's getting some kind of milk to drink. Weaning from the breast should be a slow process, for yours and baby's sake. If you wean abruptly, your baby will be very unhappy, and you may have to contend with engorgement and other discomfort. Instead, try cutting back by one feeding every few days, to give your breasts time to adjust milk production to the new, lower demand. If you want, you can continue to nurse once or twice a day, e.g. before bed and first thing in the morning. If you want to stop completely, those two are probably the last ones you'll be able to eliminate. Mid-day feedings are the easiest to replace with other foods.
The next and last post in this series will be about toddler nursing, which is a whole new source of enjoyment and frustration. You may have a taste of toddler nursing already, with nursing gymnastics, distractibility, and new habits that may not be totally desirable. But hopefully you're also finding new reasons to enjoy nursing.
Wednesday, July 13, 2011
Breastfeeding Basics - Part IV: Six Weeks to Six Months
By now, you've read the Introduction and Parts I, II, and III of this series. I hope that you're finding breastfeeding and mothering in general to be getting easier.
I debated how to divide up the next few sections. I considered doing a post just on the next six weeks, up through three months, and then do a three to six month post. But, I chose to combine these because most of the issues I want to cover could come up really at any time, from birth to six months, and not that much changes from here on out until you start offering solid foods (to be covered in the next part). What I'll do, then, is divide Part IV into two subsections, up through three months and then up through six months, and then cover the more universal issues that may arise.
Six Weeks to Three Months
By now, you've weathered at least two growth spurts. When you come out of the six-week growth spurt and into "after the first six weeks" territory, you'll realize how much your baby has grown. You'll notice that he nurses more effectively, probably for a shorter amount of time, and, if you're lucky, maybe less often as well. In the next six to eight weeks, your baby will start smiling (if he hasn't already), laughing, showing better and better head control, showing interest in grabbing items, and recognizing and showing delight in human faces, especially those of his close family. His hunger signals should become more obvious and readable to you, and you're probably starting to see some real personality emerge. Your baby isn't just a needy lump anymore (no offense, but, really, in those first few weeks, they don't do much but eat, sleep, cry, and poop, right?). He's an enjoyable human being in his own right, and you can actually start to play with him and interact with him.
In addition, you are starting to feel more like yourself again. Sure, you're probably feeling sleep-deprived, but the major aches and pains and soreness and general not-yourself-ness you felt after the birth should be greatly improved. Your postpartum bleeding should be done with or mostly done, you've been back for your postpartum visit with your OB or midwife, and you're much more up-and-at-'em than you have been since the baby was born.
This is a good time to point out the symptoms of postpartum depression. This is only tangentially relevant to this blog post, so I'm pointing you elsewhere for detail. Basically, if you're feeling melancholy, depressed, overly anxious, having disturbing thoughts or desires about harming yourself or your baby, strong feelings of guilt or failure, etc., please seek help. These feelings are not normal and you don't have to live with them or expect to "snap out of it" on your own. There are plenty of resources out there to help identify, diagnose, and treat postpartum depression (PPD), and many of the medications used for the treatment of PPD, if needed, are safe for breastfeeding.
By the time you reach about three to four months postpartum, your milk production should have largely adjusted to the needs of your baby. You'll find you're feeling engorged less often, if at all, and hopefully leaking less (if this was a problem for you to begin with). You may also find, if you're pumping, that it's harder to produce as much for the pump. This is all due to the switch-over from hormonally driven production to demand-based production. In the first phase of breastfeeding, milk production is stimulated and controlled by hormones. As time goes on, the automatically-produced hormones cease, and your baby's demand - the amount of milk she takes in and the frequency of her feedings - instead stimulates the breasts and brain to produce milk in line with what your baby needs.
Be forewarned that there is another growth spurt around three to four months of age.
Three to Six Months
Now is the time to sit back and enjoy the progress you've made. Making it to six months exclusively breastfeeding is a great accomplishment! In these three months, just keep nursing on demand. Don't worry about giving water or other foods. Just nurse your baby when he's hungry!
During this time, you may find your baby is developing some annoying habits. Some babies will suddenly decide they only like to nurse in certain positions or places. Many babies become very distractible around four months of age because they've suddenly become aware of the world around them and want to participate. It can definitely be frustrating to have the baby pop on and off the breast constantly while nursing. Whenever practical, you can nurse in a darkened, quiet room to minimize distractions. At least this way, he'll get a good meal in a few times a day, even if the rest of the day is more erratic. As he gets more used to the world "happening" around him, and he starts to make the connection between popping off the breast and being hungry, he should become more reliable again.
Also during this time, your baby will probably start teething. Symptoms of teething may include excessive drooling, difficulty finding a comfortable position lying down, suddenly refusing to nurse, wanting to nurse more, chewing on hands (or your nipples), chin or cheek rash (due to the drool), diaper rash and mucousy poop (due to swallowing excess saliva), stuffy nose, mild fever (not higher than about 99 degrees Fahrenheit), red, inflamed gums, ear infection or ear ache, difficulty sleeping, and general fussiness. Some babies show almost none of these symptoms, while others may have all of them. Teething can make nursing difficult for both of you, as it may hurt him to suck, and his latch may suffer as he tries to adjust his latch to the changes in his mouth. Also, these symptoms may go on for weeks before a tooth actually comes through. It's usually not quite as hellish as I'm making it sound here, and you'll find effective ways to help soothe and calm your baby. It may be as simple as allowing him to chew on a cool washcloth, or you may want to give him Infant Tylenol (as directed!!) to help dull some of the pain of teething. Once the tooth comes through, you may have to help him readjust his latch once more so that it's comfortable for you.
Bottom teeth should never come in direct contact with your breast, as a baby with a proper latch should put his tongue over his bottom teeth. The top teeth should rest only lightly on the breast and not dig in. If you have tooth marks on your breast, you may need to help him readjust his latch. Often, he will adjust it on his own in a day or so as he figures out what to do with this new thing in his mouth.
If your baby bites you during this time, it is typically not meant aggressively. He may just be seeking relief from the teething symptoms. The best way to deal with biting while nursing is to immediately put the baby down, make an exaggerated sad face, and say "No bite! That hurts Mommy!" Then allow him to nurse more. If he associates biting with not nursing, he should stop biting. If you yelp or make a funny noise but don't withdraw the breast, he may think it's funny and start biting more often just to see your reaction. It's difficult, and it hurts, but you definitely want to stop this behavior quickly if it happens.
Common Issues
Thrush
Thrush is an infection caused by yeast. Thrush can be present on your nipples or in the baby's mouth or both. It is passed back and forth by nursing. Symptoms of thrush in the mother may include suddenly very sore nipples, especially at latch-on, pink or red or scaly nipples, cracking or bleeding nipples despite no change in baby's latch, a burning sensation within the breast during nursing or let-down, concurrent vaginal yeast infection. Symptoms of thrush in the baby include whitish patches in the mouth that do not wash away, pain in the mouth, excessive gassiness if the yeast invade the digestive tract, yeasty diaper rash. Mother and baby may show some or all of these symptoms, possibly not simultaneously. It can be very difficult to positively diagnose thrush.
There are many treatments for thrush. Some work better for some people. You may need to work at it for a few weeks to find the best treatment for you and your baby. Options range from prescription Nystatin (either cream for you or an oral suspension for baby's mouth and for your nipples), over-the-counter Monistat or Lotrimin (cream to apply to your nipples), gentian violet, grapefruitseed oil, or a combination of the above. A good place to get ideas for how to identify and treat thrush can be found here.
Plugged Ducts and Mastitis
A plugged duct is exactly what it sounds like - when a milk duct become clogged with solidifying milk. This usually occurs due to unresolved engorgement but can happen any time, especially if your baby has gone longer than usual without nursing. It can also occur if you are wearing restrictive clothing such as a bra with an underwire that is not properly positioned.
A plugged duct must be treated, as it can lead to mastitis, which is an infection of the milk duct. Untreated mastitis can lead to abscess or even loss of milk. It is important to identify and treat plugged ducts and mastitis promptly.
A plugged duct feels like a sore spot on the breast. I associate the feeling of a plugged duct with the way a bruise feels or a tender muscle after a cramp or strain. It will be a single spot on your breast, and you can usually feel a lump at that spot if you prod with your fingers.
To treat a plugged duct, nurse on the affected breast as often as possible (but don't let the other side become too engorged!). You can also pump or hand-express in between feedings. Keep the breast as empty as possible. Massage the affected area as you nurse and pump to encourage the plug to break free. Apply moist heat to the site of the plug to encourage milk flow. Direct the hot water from the shower to the breast as well, and massage while applying heat or in the shower. Get plenty of rest and drink lots of fluids to keep your immune system as strong as possible to fight off infection. After about 24 hours, you should find yourself feeling better. Sometimes the site of the plug may feel tender for a day or two after the plug is released.
Symptoms of mastitis include general fatigue, possible fever, increased pain in the affected breast, redness on the outside of the breast that corresponds to the site of the plugged duct, and flu-like symptoms. These symptoms usually come on quite suddenly and in conjunction with a plugged duct. Begin treating the plugged duct and rest and drink plenty of fluids. If your home treatment is effective, you should feel better within 12 to 24 hours. If your symptoms get worse, or you do not feel better within 24 hours, call your doctor, as you may need antibiotics to help clear the infection.
Pumping and Storing Milk
You may need to return to work after six weeks, or you may decide that you'd like to be able to be away from your baby during the day for other reasons. If you plan to continue exclusively breastfeeding, you'll need to pump and store breastmilk for the baby to eat while you're away. It is best to start pumping a few weeks before returning to work. I'm not going to get into a lot of detail here, as this is meant to be short. I'll just give you a few highlights.
I debated how to divide up the next few sections. I considered doing a post just on the next six weeks, up through three months, and then do a three to six month post. But, I chose to combine these because most of the issues I want to cover could come up really at any time, from birth to six months, and not that much changes from here on out until you start offering solid foods (to be covered in the next part). What I'll do, then, is divide Part IV into two subsections, up through three months and then up through six months, and then cover the more universal issues that may arise.
Six Weeks to Three Months
By now, you've weathered at least two growth spurts. When you come out of the six-week growth spurt and into "after the first six weeks" territory, you'll realize how much your baby has grown. You'll notice that he nurses more effectively, probably for a shorter amount of time, and, if you're lucky, maybe less often as well. In the next six to eight weeks, your baby will start smiling (if he hasn't already), laughing, showing better and better head control, showing interest in grabbing items, and recognizing and showing delight in human faces, especially those of his close family. His hunger signals should become more obvious and readable to you, and you're probably starting to see some real personality emerge. Your baby isn't just a needy lump anymore (no offense, but, really, in those first few weeks, they don't do much but eat, sleep, cry, and poop, right?). He's an enjoyable human being in his own right, and you can actually start to play with him and interact with him.
In addition, you are starting to feel more like yourself again. Sure, you're probably feeling sleep-deprived, but the major aches and pains and soreness and general not-yourself-ness you felt after the birth should be greatly improved. Your postpartum bleeding should be done with or mostly done, you've been back for your postpartum visit with your OB or midwife, and you're much more up-and-at-'em than you have been since the baby was born.
This is a good time to point out the symptoms of postpartum depression. This is only tangentially relevant to this blog post, so I'm pointing you elsewhere for detail. Basically, if you're feeling melancholy, depressed, overly anxious, having disturbing thoughts or desires about harming yourself or your baby, strong feelings of guilt or failure, etc., please seek help. These feelings are not normal and you don't have to live with them or expect to "snap out of it" on your own. There are plenty of resources out there to help identify, diagnose, and treat postpartum depression (PPD), and many of the medications used for the treatment of PPD, if needed, are safe for breastfeeding.
By the time you reach about three to four months postpartum, your milk production should have largely adjusted to the needs of your baby. You'll find you're feeling engorged less often, if at all, and hopefully leaking less (if this was a problem for you to begin with). You may also find, if you're pumping, that it's harder to produce as much for the pump. This is all due to the switch-over from hormonally driven production to demand-based production. In the first phase of breastfeeding, milk production is stimulated and controlled by hormones. As time goes on, the automatically-produced hormones cease, and your baby's demand - the amount of milk she takes in and the frequency of her feedings - instead stimulates the breasts and brain to produce milk in line with what your baby needs.
Be forewarned that there is another growth spurt around three to four months of age.
Three to Six Months
Now is the time to sit back and enjoy the progress you've made. Making it to six months exclusively breastfeeding is a great accomplishment! In these three months, just keep nursing on demand. Don't worry about giving water or other foods. Just nurse your baby when he's hungry!
During this time, you may find your baby is developing some annoying habits. Some babies will suddenly decide they only like to nurse in certain positions or places. Many babies become very distractible around four months of age because they've suddenly become aware of the world around them and want to participate. It can definitely be frustrating to have the baby pop on and off the breast constantly while nursing. Whenever practical, you can nurse in a darkened, quiet room to minimize distractions. At least this way, he'll get a good meal in a few times a day, even if the rest of the day is more erratic. As he gets more used to the world "happening" around him, and he starts to make the connection between popping off the breast and being hungry, he should become more reliable again.
Also during this time, your baby will probably start teething. Symptoms of teething may include excessive drooling, difficulty finding a comfortable position lying down, suddenly refusing to nurse, wanting to nurse more, chewing on hands (or your nipples), chin or cheek rash (due to the drool), diaper rash and mucousy poop (due to swallowing excess saliva), stuffy nose, mild fever (not higher than about 99 degrees Fahrenheit), red, inflamed gums, ear infection or ear ache, difficulty sleeping, and general fussiness. Some babies show almost none of these symptoms, while others may have all of them. Teething can make nursing difficult for both of you, as it may hurt him to suck, and his latch may suffer as he tries to adjust his latch to the changes in his mouth. Also, these symptoms may go on for weeks before a tooth actually comes through. It's usually not quite as hellish as I'm making it sound here, and you'll find effective ways to help soothe and calm your baby. It may be as simple as allowing him to chew on a cool washcloth, or you may want to give him Infant Tylenol (as directed!!) to help dull some of the pain of teething. Once the tooth comes through, you may have to help him readjust his latch once more so that it's comfortable for you.
Bottom teeth should never come in direct contact with your breast, as a baby with a proper latch should put his tongue over his bottom teeth. The top teeth should rest only lightly on the breast and not dig in. If you have tooth marks on your breast, you may need to help him readjust his latch. Often, he will adjust it on his own in a day or so as he figures out what to do with this new thing in his mouth.
If your baby bites you during this time, it is typically not meant aggressively. He may just be seeking relief from the teething symptoms. The best way to deal with biting while nursing is to immediately put the baby down, make an exaggerated sad face, and say "No bite! That hurts Mommy!" Then allow him to nurse more. If he associates biting with not nursing, he should stop biting. If you yelp or make a funny noise but don't withdraw the breast, he may think it's funny and start biting more often just to see your reaction. It's difficult, and it hurts, but you definitely want to stop this behavior quickly if it happens.
Common Issues
Thrush
Thrush is an infection caused by yeast. Thrush can be present on your nipples or in the baby's mouth or both. It is passed back and forth by nursing. Symptoms of thrush in the mother may include suddenly very sore nipples, especially at latch-on, pink or red or scaly nipples, cracking or bleeding nipples despite no change in baby's latch, a burning sensation within the breast during nursing or let-down, concurrent vaginal yeast infection. Symptoms of thrush in the baby include whitish patches in the mouth that do not wash away, pain in the mouth, excessive gassiness if the yeast invade the digestive tract, yeasty diaper rash. Mother and baby may show some or all of these symptoms, possibly not simultaneously. It can be very difficult to positively diagnose thrush.
There are many treatments for thrush. Some work better for some people. You may need to work at it for a few weeks to find the best treatment for you and your baby. Options range from prescription Nystatin (either cream for you or an oral suspension for baby's mouth and for your nipples), over-the-counter Monistat or Lotrimin (cream to apply to your nipples), gentian violet, grapefruitseed oil, or a combination of the above. A good place to get ideas for how to identify and treat thrush can be found here.
Plugged Ducts and Mastitis
A plugged duct is exactly what it sounds like - when a milk duct become clogged with solidifying milk. This usually occurs due to unresolved engorgement but can happen any time, especially if your baby has gone longer than usual without nursing. It can also occur if you are wearing restrictive clothing such as a bra with an underwire that is not properly positioned.
A plugged duct must be treated, as it can lead to mastitis, which is an infection of the milk duct. Untreated mastitis can lead to abscess or even loss of milk. It is important to identify and treat plugged ducts and mastitis promptly.
A plugged duct feels like a sore spot on the breast. I associate the feeling of a plugged duct with the way a bruise feels or a tender muscle after a cramp or strain. It will be a single spot on your breast, and you can usually feel a lump at that spot if you prod with your fingers.
To treat a plugged duct, nurse on the affected breast as often as possible (but don't let the other side become too engorged!). You can also pump or hand-express in between feedings. Keep the breast as empty as possible. Massage the affected area as you nurse and pump to encourage the plug to break free. Apply moist heat to the site of the plug to encourage milk flow. Direct the hot water from the shower to the breast as well, and massage while applying heat or in the shower. Get plenty of rest and drink lots of fluids to keep your immune system as strong as possible to fight off infection. After about 24 hours, you should find yourself feeling better. Sometimes the site of the plug may feel tender for a day or two after the plug is released.
Symptoms of mastitis include general fatigue, possible fever, increased pain in the affected breast, redness on the outside of the breast that corresponds to the site of the plugged duct, and flu-like symptoms. These symptoms usually come on quite suddenly and in conjunction with a plugged duct. Begin treating the plugged duct and rest and drink plenty of fluids. If your home treatment is effective, you should feel better within 12 to 24 hours. If your symptoms get worse, or you do not feel better within 24 hours, call your doctor, as you may need antibiotics to help clear the infection.
Pumping and Storing Milk
You may need to return to work after six weeks, or you may decide that you'd like to be able to be away from your baby during the day for other reasons. If you plan to continue exclusively breastfeeding, you'll need to pump and store breastmilk for the baby to eat while you're away. It is best to start pumping a few weeks before returning to work. I'm not going to get into a lot of detail here, as this is meant to be short. I'll just give you a few highlights.
- Pumping takes practice. Your body is used to responding to your baby's sucking, not to a pump. You'll need to figure out ways to stimulate let-down with the pump. Some helpful hints include keeping a picture of your baby with you when you pump, relaxing as much as possible while pumping, not looking at the pump while using it, having something nearby that you associate with nursing (even a video or audio recording of your baby on your phone can help!).
- You want to pump more than you need. You may not want to have too much more than you need, but you may have "off days" where you don't produce as much, or you might spill your milk one day (boo!), or you might have a mommy-brain moment and forget to properly refrigerate your milk, or your baby may suddenly be extra-hungry one day and drink more than usual while you're gone. Having extra milk in the freezer as backup will be helpful!
- Pump on a schedule. If possible, pumping on a regular schedule will mimic your baby's reasonably regular feeding habits, stimulating your breasts to produce the milk you need when you need it.
- Storing milk: Breastmilk can be stored at room temperature for four to six hours, in a fridge for up to three days, in a standard freezer for four to six months, and in a deep freezer for six to 12 months. You can store milk in the most convenient way for you, in a bottle, milk storage bag, ice cube tray, or whatever other solution you find. Make sure the receptacle is clean and can be frozen safely (if you're putting it in the freezer).
Keep at it! You've made it through the hardest part. In the next section, we'll talk about introducing solids and what to expect as your baby approaches her first birthday!
Tuesday, July 5, 2011
Breastfeeding Basics - Part III: The First Six Weeks
I hope that by now you've read the first three installments of this series, the Introduction, Part I, and Part II. This post will address the first six weeks postpartum.
Your milk should have come in full force before the end of the first week of your baby's life. You'll be practicing attaining a good latch, experimenting with the most comfortable and convenient ways to hold your baby, and getting used to responding to your baby's cues and needs. You're starting to recover from the birth but still basking in the glow of having a newborn baby.
You may also be feeling quite overwhelmed. You're having to wake often at night to feed your baby. You feel like you're constantly feeding, changing diapers. You feel like you have no time that is your own. And you're still not quite used to this "parenthood" business.
Hang in there! It does get easier.
There are two bits of advice I would offer all new mothers in regard to breastfeeding.
The first is, "Keep nursing!" You have probably gathered by now that the more you nurse, the more milk you make, and the more practice you and your baby get at breastfeeding. Nursing on demand is the main key to a successful breastfeeding relationship.
The second piece of advice is "Give it six weeks." The first six weeks are hard. I won't sugarcoat it. Your hormones are crazy, you're sleep-deprived, you're still recovering from the strain of the birth (and possibly still healing from tears, episiotomy, or c-section), you're nursing constantly, and you feel like you don't even have a moment to pee or eat without the baby needing you. I know. It's hard. It's okay to admit that it's hard. It's okay to be frustrated if the baby starts fussing just as you sit down to eat your dinner. But, there's something about that six-week mark that makes the future seem brighter. Once you've gotten through six weeks, you're feeling better, you and the baby are better at this breastfeeding thing, you've been through two growth spurts, so the baby may be spreading out his feedings a bit, and you're starting to get into your role as a mommy.
Hang in there.
It does get easier.
A few practical points to help you keep going.
Nursing in Public
By the time your baby is a few weeks old, you've undoubtedly needed to be out and about with him, even if it's just to doctor's appointments or the grocery store. And if you were out for more than an hour or two, you probably needed to nurse him while you were out. Some women don't mind nursing in public, while others hate it. It can be uncomfortable, especially if you're still new to nursing and are not keen on the idea of exposing your breasts for any passer-by to notice. Also, you may have gotten used to nursing at home, in a comfortable chair, using pillows to help support the baby.
Here are a few tips to make nursing in public easier on you.
Your milk should have come in full force before the end of the first week of your baby's life. You'll be practicing attaining a good latch, experimenting with the most comfortable and convenient ways to hold your baby, and getting used to responding to your baby's cues and needs. You're starting to recover from the birth but still basking in the glow of having a newborn baby.
You may also be feeling quite overwhelmed. You're having to wake often at night to feed your baby. You feel like you're constantly feeding, changing diapers. You feel like you have no time that is your own. And you're still not quite used to this "parenthood" business.
Hang in there! It does get easier.
There are two bits of advice I would offer all new mothers in regard to breastfeeding.
The first is, "Keep nursing!" You have probably gathered by now that the more you nurse, the more milk you make, and the more practice you and your baby get at breastfeeding. Nursing on demand is the main key to a successful breastfeeding relationship.
The second piece of advice is "Give it six weeks." The first six weeks are hard. I won't sugarcoat it. Your hormones are crazy, you're sleep-deprived, you're still recovering from the strain of the birth (and possibly still healing from tears, episiotomy, or c-section), you're nursing constantly, and you feel like you don't even have a moment to pee or eat without the baby needing you. I know. It's hard. It's okay to admit that it's hard. It's okay to be frustrated if the baby starts fussing just as you sit down to eat your dinner. But, there's something about that six-week mark that makes the future seem brighter. Once you've gotten through six weeks, you're feeling better, you and the baby are better at this breastfeeding thing, you've been through two growth spurts, so the baby may be spreading out his feedings a bit, and you're starting to get into your role as a mommy.
Hang in there.
It does get easier.
A few practical points to help you keep going.
Nursing in Public
By the time your baby is a few weeks old, you've undoubtedly needed to be out and about with him, even if it's just to doctor's appointments or the grocery store. And if you were out for more than an hour or two, you probably needed to nurse him while you were out. Some women don't mind nursing in public, while others hate it. It can be uncomfortable, especially if you're still new to nursing and are not keen on the idea of exposing your breasts for any passer-by to notice. Also, you may have gotten used to nursing at home, in a comfortable chair, using pillows to help support the baby.
Here are a few tips to make nursing in public easier on you.
- Wear nursing-friendly clothing - The most comfortable ensemble I've found for nursing in public is a standard nursing bra under any tank top or camisole (or a nursing tank!), with a loose-fitting t-shirt or blouse over that. You unhook the bra, lift the top shirt, and pull down the neckline of the undershirt so that only a few inches of boob are exposed, just long enough for the baby to latch. You can let the top shirt fall over the baby's head or drape over the breast that is in use so that no skin is showing. The undershirt covers your stomach, sides, and back, and the baby's head covers the rest.
- Purchase or make a nursing cover - There are many brands of nursing cover out there, from a hat for the baby to an apron-like contraption for mom. If the first tip doesn't offer you the coverage you want, or you are not able to wear such an ensemble for some reason, a nursing cover can be helpful. In a pinch, you can also drape a blanket or towel across your shoulder to cover the baby.
- Practice at home - If you know you're going to be in nursing-in-public situations often, get some practice at home, first. Try nursing cross-legged on the floor, or sitting in a dining-room chair, or even in your car in the driveway or garage. If you get some practice holding the baby without your comfy chair or pillow fort, nursing in public will come more easily as well. Also, practice in front of a mirror so you can see how little skin is actually exposed while you nurse.
- Find nursing-friendly locations at places you frequent - Many malls now have family-care areas that include comfortable and private nursing stalls. See if yours offers such an amenity, as it can be very helpful. Baby stores such as Babies R Us often have Mother Rooms, with a comfortable chair and a door that closes so you can nurse privately. Most department stores have no problem with your using a fitting room stall to nurse, or they may have a lounge area in or near the restroom that would be more comfortable. You can also ask at many stores if there is a private location you could use, other than a restroom. I have also found it quite comfortable to nurse in my car in a pinch.
"Colic"
Many, many babies, regardless of how they are fed, go through a fussy period in the evening from about two weeks of age until about three months of age. This fussy period can last anywhere from an hour to three or four hours, and usually consists of the baby crying or fussing for no apparent reason, nursing often, and being very difficult to soothe. This is usually called "colic," although most medical professionals don't actually know what causes it. This time every day or evening can be very stressful, as hearing your baby cry and not being able to comfort him is upsetting. There are plenty of books and websites out there offering miracle cures for "colic," but, as with hiccups, some techniques work better for some people than others. In the end, you just have to find the best way to get through it. If there are other caregivers around, don't be afraid to take turns holding the baby, rocking him, dancing around, singing to him, etc. Sometimes white noise such as static from the radio or running the vacuum cleaner can be soothing. If he wants to nurse, nurse him. This frequent nursing is called "cluster feeding," and nursing is often the best comfort you can offer. Many babies also calm down during a ride in the car, if you can manage it. The good news is that for most babies, this fussy period peaks at around six weeks of age and gradually gets better and better (lasting for less time or not happening every day) over the next six weeks after that.
Food Sensitivities
Very few babies actually react to something their mother is eating. Yes, proteins and some other substances from what you ingest do get into the breastmilk in small quantities, and some babies may be sensitive to these substances. If your baby shows increased fussiness, gassiness, spitting up, or a rash after you eat a specific type of food, try eliminating that food from your diet for a few days or weeks and see if the symptoms improve. If the symptoms are more constant, it may be something you eat all the time. The most common culprits are dairy products and eggs. Some babies are also sensitive to nuts, soy, and caffeine. If you believe your baby is reacting to something in your diet, you'll need to completely eliminate that food from your diet for at least two weeks to really get a sense of whether it's making a difference. Keep in mind that common foods like dairy products and eggs make their way into many foods you eat, even if they aren't specifically milk or egg products, so check package labels carefully.
Remember, though, that unless you have a reason to think your baby is reacting to something you're eating, you should feel free to eat whatever you want (within reason!). You don't have to restrict your diet unless your baby is sensitive to something you're eating.
Growth Spurts
One last topic to cover. After the first week of rapid growth, your baby will probably fall into a fairly predictable pattern of nursing. And then, suddenly, you'll find that he won't stop nursing, possibly for hours at a time. After two to three days of this strange and frustrating nursing behavior, he will suddenly spend a day sleeping almost the entire day, waking less often than usual to eat and possibly making you fear something is terribly wrong. If your baby follows this pattern at around three weeks of age and again around six weeks of age, he probably just experienced a growth spurt. The best possible thing you can do during a growth spurt is nurse on demand. As annoying or frustrating as it can be to have the baby attached to you for what may actually be hours at a time, it's important to remember that this is very short-term, and that it means your baby is headed for a period of rapid growth. Providing him with the milk he needs is vital. Plus, the frequent nursing will help increase your milk supply to meet the demands of your bigger baby!
If this increased, frequent nursing lasts for more than three days, you should see a lactation consultant to make sure you're producing enough milk or that your baby is getting enough. If the excessive sleep lasts for more than a day or so, you should see your pediatrician to make sure nothing else is going on. Also, watch your baby for signs of lethargy (acting tired, not wanting to nurse, seeming sleepy or "limp") and dehydration (dry mouth and skin, sunken fontanel, dry eyes, dark urine). If you see anything unusual or concerning, absolutely call your pediatrician immediately!
I think that's all you need for now. Remember, give it six weeks! Keep at it! It does get easier. The next post will cover six weeks to three months, the second half of the "newborn" or "fourth trimester" period.
Monday, June 27, 2011
Breastfeeding Basics - Part II: The First Few Days
In the previous post, I discussed briefly some of the basic details about how breastfeeding works and what you need to know before the baby is born. If you haven't yet given birth, or if you've recently given birth but haven't read that post yet, it'd be a good place to start.
(This post is written with the assumption that you gave birth to a normal, healthy, full-term baby. Most of the advice in this series - especially the early posts - simply does not apply if you have an extraordinary circumstance such as a premature baby, a baby in the NICU, a baby with a cleft palate or other physical impediment to breastfeeding, etc.)
Now that you actually have a baby to feed, let's talk about what's going to happen in the first few days postpartum.
Hunger Cues
How will you know when your baby is hungry? Well, your best bet to start with is to offer the breast whenever the baby fusses. Even if he's not hungry, it's a great way to comfort him. If he doesn't want to suck, he won't. If he does, you'll be giving him what he needs. Pretty soon, you'll start learning his hunger cues. A hunger cue is a young baby's way of letting you know he needs to nurse. A fairly typical cue is fussing accompanied by "rooting," which is when the baby turns his head toward anything brushing his cheek and tries to suck on it. This may be your finger, a blanket, or, of course, your nipple. The rooting reflex is how the baby looks for the breast and is an excellent clue to look for if you think he may be hungry. Some babies may also open and close their mouths, wave their arms, or stick out their tongues. You'll start to recognize your own baby's cues. Remember that crying is a late sign of hunger, and by the time he starts crying, he's already been hungry for a while and is getting desperate.
Nurse That Baby!
In the first few days of life, it may seem like all you're doing is nursing. This can be frustrating, as it seems like you barely put the baby down to change his diaper, only to have him start fussing to eat again. And feedings seem to take forever. Your arms get tired. You can't find time to pee or eat. And he'll only sleep if you're holding him.
I know this is an adjustment, but I hope that you're also enjoying your new baby, taking this time to bond with him and get to know him a little, memorizing his face and his little ears, the cute little noises he makes when he sucks, and the random waving of his arms. If you're in a hospital, enjoy the fact that someone else is taking care of you. If you're at home, let your loved ones care for you while you focus on your baby.
All of this constant nursing is very, very good for both you and baby. I mentioned in the previous post that breastfeeding takes practice. Just like any other skill, the more you do it, the more you work at it, the better at it you get. The frequent nursing gives you and your baby lots of opportunities to practice various positions and holds and that all-important latch.
The most important benefit is that nursing is stimulating your breasts and your brain to produce milk, and all the colostrum and milk your baby is taking in will help him grow, pass along antibodies and beneficial bacteria, and protect him.
Avoiding Bottles
I also mentioned in the previous post that it's generally recommended to avoid any kind of artificial nipples (pacifiers and bottles) before about the fourth week of life. Sometimes you can get so overwhelmed with the constant nursing that the idea of giving just one bottle, or of offering a pacifier, so you can have an hour or two without baby attached to you is very attractive. Keep in mind that this period is only a few weeks, and that as overwhelming as it is, you are doing yourself and your baby a world of good by letting him nurse as often and for as long as he wants. This intense period will end, and things will get easier.
If you do need a break, sometimes passing the baby to Daddy or Grandma or some other caregiver for an hour will allow you to rest, go to the bathroom, eat something, or just doze for a bit. Sometimes the baby will go longer between feedings if someone else is holding him, because he doesn't smell or sense the milk nearby. Don't deny the baby a feeding, and make sure he's satisfied before handing him off, but it's perfectly okay (and healthy) for you to take an hour for yourself when you need it.
As a side note, if you are in a situation where you must supplement your baby with expressed breastmilk or formula, there are ways to feed him without using a bottle. These include a Supplemental Nursing System, finger feeding, syringe feeding, or cup feeding. You should talk with a lactation consultant about which method will work best for you and how to do it.
When Your Milk "Comes In"
For the first two to six days postpartum, your baby will be subsisting off of the miraculous substance called "colostrum," which is produced by your body before you start making mature milk. If this is your first baby, your milk may take as long as six days to fully appear. If you have had a baby before, and especially if you nursed a baby before even for a little while, your milk may come in as quickly as 48 hours after giving birth.
You can tell your milk has come in because your breasts will suddenly feel very full, very large, possibly hard to the touch, and possibly painful. This is called "engorgement," and engorgement happens when you have more milk in your breasts than you need or that your breasts can comfortably hold. Some babies have difficulty latching when you are engorged. You can relieve engorgement by squeezing out some of the milk with your hands, using a breast pump to remove some of the milk, using warm compresses or standing in the hot stream of water from the shower to encourage milk flow, and, of course, nursing the baby. Be careful not to remove more than enough milk to be comfortable, or you will stimulate more milk production and continue the cycle of engorgement.
You can also tell your milk has come in because instead of the thicker, golden substance you've been seeing, you'll see a thinner, white liquid.
Pain
The first few days or weeks of breastfeeding may be painful. While you'll hear over and over again that if your technique is good, if the baby's latch is good, then you won't feel pain, some women may have a baby with a perfect latch and yet still experience some pain. It's important to know "good" pain from "bad" pain.
First of all, engorgement itself can be painful. If the pain localizes to a "lump" or "bruised" spot on your breast, this may be a plugged duct or the beginnings of mastitis, which you want to make sure to treat right away. If it's just a general breast soreness, relieving the engorgement should also relieve the pain.
Secondly, some women experience nipple pain with nursing during times of hormonal changes, such as the first few days or weeks postpartum. Your nipples may feel sore, or you may experience some pain when the baby latches. If a lactation consultant has evaluated the baby's latch and it seems to be fine, you may be experiencing normal-for-you pain that will pass once your hormones settle down. However, if your nipples become bruised or cracked and bleeding, or if your nipple looks like the tip of a new tube of lipstick after nursing your baby, then the baby's latch is likely in need of adjustment, and you should see a lactation consultant immediately.
Some women experience let-down as a painful sensation. Let-down is when the milk is released into the milk ducts and flows down toward the nipple. While some women don't feel any sensation at let-down, for others it can be very noticeable. As your supply adjusts to meet your baby's demand, the intensity of the let-down often also decreases.
Finally, nursing your baby releases the hormone oxytocin, which is the same hormone that stimulates uterine contractions during labor. The oxytocin released while nursing will also stimulate your postpartum uterus to contract, helping to bring it back down to its normal size and limit your postpartum bleeding. While these contractions are good things, they can be quite painful for some women. Your doctor likely recommended or prescribed a pain reliever such as ibuprofen. Take it as directed to help with this pain, as there is certainly no need to suffer.
I don't want to scare you away with all this talk about pain. The pain of nursing should not be excruciating, it should not last more than a few days or weeks, and it should not make you dread nursing your baby. If the pain is unbearable or causes you to avoid allowing your baby to nurse, or if your nipples are showing signs of damage, please see a lactation consultant.
Positions
There are many comfortable ways to hold your baby while nursing. One popular way is the "cradle hold," in which you hold the baby along your forearm, supporting his head in the crook of your elbow, with your hand supporting his back, bottom, or thigh (depending on how big your baby is). Another common one is the "football hold," or clutch hold, where you hold the baby face-up on your arm, against your side, much the way a football player holds a football (hence the name). This position is popular for women who have had a c-section or who are nursing twins, as it keeps the baby off your stomach. There are several other ways to hold your baby in order to nurse him comfortably. Usually there will be someone in the hospital to help you with these different positions. You can also see illustrations online, such as here. It is helpful to find a few that work well for you and practice with them. The most important thing to remember is that the baby should not have to turn his head or strain to find the nipple.
Keep it up! The first few days and weeks can be difficult, but the hard work pays off. I hope you'll join me for Part III, which will discuss the next few weeks up to what I call the "magical six-week mark."
(This post is written with the assumption that you gave birth to a normal, healthy, full-term baby. Most of the advice in this series - especially the early posts - simply does not apply if you have an extraordinary circumstance such as a premature baby, a baby in the NICU, a baby with a cleft palate or other physical impediment to breastfeeding, etc.)
Now that you actually have a baby to feed, let's talk about what's going to happen in the first few days postpartum.
Hunger Cues
How will you know when your baby is hungry? Well, your best bet to start with is to offer the breast whenever the baby fusses. Even if he's not hungry, it's a great way to comfort him. If he doesn't want to suck, he won't. If he does, you'll be giving him what he needs. Pretty soon, you'll start learning his hunger cues. A hunger cue is a young baby's way of letting you know he needs to nurse. A fairly typical cue is fussing accompanied by "rooting," which is when the baby turns his head toward anything brushing his cheek and tries to suck on it. This may be your finger, a blanket, or, of course, your nipple. The rooting reflex is how the baby looks for the breast and is an excellent clue to look for if you think he may be hungry. Some babies may also open and close their mouths, wave their arms, or stick out their tongues. You'll start to recognize your own baby's cues. Remember that crying is a late sign of hunger, and by the time he starts crying, he's already been hungry for a while and is getting desperate.
Nurse That Baby!
In the first few days of life, it may seem like all you're doing is nursing. This can be frustrating, as it seems like you barely put the baby down to change his diaper, only to have him start fussing to eat again. And feedings seem to take forever. Your arms get tired. You can't find time to pee or eat. And he'll only sleep if you're holding him.
I know this is an adjustment, but I hope that you're also enjoying your new baby, taking this time to bond with him and get to know him a little, memorizing his face and his little ears, the cute little noises he makes when he sucks, and the random waving of his arms. If you're in a hospital, enjoy the fact that someone else is taking care of you. If you're at home, let your loved ones care for you while you focus on your baby.
All of this constant nursing is very, very good for both you and baby. I mentioned in the previous post that breastfeeding takes practice. Just like any other skill, the more you do it, the more you work at it, the better at it you get. The frequent nursing gives you and your baby lots of opportunities to practice various positions and holds and that all-important latch.
The most important benefit is that nursing is stimulating your breasts and your brain to produce milk, and all the colostrum and milk your baby is taking in will help him grow, pass along antibodies and beneficial bacteria, and protect him.
Avoiding Bottles
I also mentioned in the previous post that it's generally recommended to avoid any kind of artificial nipples (pacifiers and bottles) before about the fourth week of life. Sometimes you can get so overwhelmed with the constant nursing that the idea of giving just one bottle, or of offering a pacifier, so you can have an hour or two without baby attached to you is very attractive. Keep in mind that this period is only a few weeks, and that as overwhelming as it is, you are doing yourself and your baby a world of good by letting him nurse as often and for as long as he wants. This intense period will end, and things will get easier.
If you do need a break, sometimes passing the baby to Daddy or Grandma or some other caregiver for an hour will allow you to rest, go to the bathroom, eat something, or just doze for a bit. Sometimes the baby will go longer between feedings if someone else is holding him, because he doesn't smell or sense the milk nearby. Don't deny the baby a feeding, and make sure he's satisfied before handing him off, but it's perfectly okay (and healthy) for you to take an hour for yourself when you need it.
As a side note, if you are in a situation where you must supplement your baby with expressed breastmilk or formula, there are ways to feed him without using a bottle. These include a Supplemental Nursing System, finger feeding, syringe feeding, or cup feeding. You should talk with a lactation consultant about which method will work best for you and how to do it.
When Your Milk "Comes In"
For the first two to six days postpartum, your baby will be subsisting off of the miraculous substance called "colostrum," which is produced by your body before you start making mature milk. If this is your first baby, your milk may take as long as six days to fully appear. If you have had a baby before, and especially if you nursed a baby before even for a little while, your milk may come in as quickly as 48 hours after giving birth.
You can tell your milk has come in because your breasts will suddenly feel very full, very large, possibly hard to the touch, and possibly painful. This is called "engorgement," and engorgement happens when you have more milk in your breasts than you need or that your breasts can comfortably hold. Some babies have difficulty latching when you are engorged. You can relieve engorgement by squeezing out some of the milk with your hands, using a breast pump to remove some of the milk, using warm compresses or standing in the hot stream of water from the shower to encourage milk flow, and, of course, nursing the baby. Be careful not to remove more than enough milk to be comfortable, or you will stimulate more milk production and continue the cycle of engorgement.
You can also tell your milk has come in because instead of the thicker, golden substance you've been seeing, you'll see a thinner, white liquid.
Pain
The first few days or weeks of breastfeeding may be painful. While you'll hear over and over again that if your technique is good, if the baby's latch is good, then you won't feel pain, some women may have a baby with a perfect latch and yet still experience some pain. It's important to know "good" pain from "bad" pain.
First of all, engorgement itself can be painful. If the pain localizes to a "lump" or "bruised" spot on your breast, this may be a plugged duct or the beginnings of mastitis, which you want to make sure to treat right away. If it's just a general breast soreness, relieving the engorgement should also relieve the pain.
Secondly, some women experience nipple pain with nursing during times of hormonal changes, such as the first few days or weeks postpartum. Your nipples may feel sore, or you may experience some pain when the baby latches. If a lactation consultant has evaluated the baby's latch and it seems to be fine, you may be experiencing normal-for-you pain that will pass once your hormones settle down. However, if your nipples become bruised or cracked and bleeding, or if your nipple looks like the tip of a new tube of lipstick after nursing your baby, then the baby's latch is likely in need of adjustment, and you should see a lactation consultant immediately.
Some women experience let-down as a painful sensation. Let-down is when the milk is released into the milk ducts and flows down toward the nipple. While some women don't feel any sensation at let-down, for others it can be very noticeable. As your supply adjusts to meet your baby's demand, the intensity of the let-down often also decreases.
Finally, nursing your baby releases the hormone oxytocin, which is the same hormone that stimulates uterine contractions during labor. The oxytocin released while nursing will also stimulate your postpartum uterus to contract, helping to bring it back down to its normal size and limit your postpartum bleeding. While these contractions are good things, they can be quite painful for some women. Your doctor likely recommended or prescribed a pain reliever such as ibuprofen. Take it as directed to help with this pain, as there is certainly no need to suffer.
I don't want to scare you away with all this talk about pain. The pain of nursing should not be excruciating, it should not last more than a few days or weeks, and it should not make you dread nursing your baby. If the pain is unbearable or causes you to avoid allowing your baby to nurse, or if your nipples are showing signs of damage, please see a lactation consultant.
Positions
There are many comfortable ways to hold your baby while nursing. One popular way is the "cradle hold," in which you hold the baby along your forearm, supporting his head in the crook of your elbow, with your hand supporting his back, bottom, or thigh (depending on how big your baby is). Another common one is the "football hold," or clutch hold, where you hold the baby face-up on your arm, against your side, much the way a football player holds a football (hence the name). This position is popular for women who have had a c-section or who are nursing twins, as it keeps the baby off your stomach. There are several other ways to hold your baby in order to nurse him comfortably. Usually there will be someone in the hospital to help you with these different positions. You can also see illustrations online, such as here. It is helpful to find a few that work well for you and practice with them. The most important thing to remember is that the baby should not have to turn his head or strain to find the nipple.
Keep it up! The first few days and weeks can be difficult, but the hard work pays off. I hope you'll join me for Part III, which will discuss the next few weeks up to what I call the "magical six-week mark."
Wednesday, June 22, 2011
Breastfeeding Basics - Part I: What You Should Know Before You Give Birth
By the time you're about ready to give birth, you have had to make lots of decisions. You've decided where to give birth and how, you've picked out or purchased all kinds of baby gear, and you've agreed on a name or two you like. And, hopefully, you've made a decision about how you intend to feed her. You've no doubt read about all the pros and cons of breastfeeding and formula feeding. You've been "informed" by friends, family, coworkers, and the barista at Starbucks about what the best choice is. And, if you're reading this, you've probably decided that you'd like to give breastfeeding a shot. It seems like the healthiest thing for baby, and probably for mom. It's definitely got all sorts of benefits you'd like to take advantage of. And you're a bit staggered by the cost of formula.
But all those books have so much information in them! Which one do you read? What do you really need to know right now?
Before you go into labor, or lie down on the gurney to go to the OR, or arrive at the hospital for your induction, before your water breaks and you start making frantic phone calls to your family letting them know the baby's coming, you should have a few vital bits of information stored away so that you can initiate breastfeeding as soon as possible and have some idea of what to expect. When I had my first baby, despite assuming I was going to breastfeed, I found out very quickly that there was a lot I didn't know about this process that was supposed to be "natural" and "normal" and "instinctive." Sure, it's instinctive for baby, but mom actually has to learn a few things. (And, to be honest, the baby has to practice a bit, too!) I was bombarded with advice from people all around me, and, in the end, my son ended up formula-fed. I was shocked at how much I didn't know going in. I want to help you avoid that shock. Thus, this first segment in a series of posts.
Defining Terms
First, there are terms and phrases you'll hear in relation to breastfeeding. Here are a few you should know right away.
Latch: The baby's "latch" is the arrangement of the baby's lips, tongue, and gums on your nipple and areola. The quality of his latch affects how efficiently he can remove milk from your breasts and swallow it, as well as how comfortable (or uncomfortable) breastfeeding is for you. If the baby is latched well, he should be taking your nipple far back into his mouth, and his lips should be flared around your areola. He should not be chewing or sucking on the nipple directly, and his tongue should be over his bottom gums. The latch usually should be "asymmetrical," meaning the bottom jaw is farther up on the breast than the upper jaw.
Exclusive Breastfeeding: Exclusive breastfeeding means that nothing is ingested by your baby other than breastmilk - no water, no formula, no juice, no cereals, no foods of any kind. The American Academy of Pediatrics and the World Health Organization recommend exclusive breastfeeding for the first six months of a baby's life, at which point solids may be introduced. (This definition allows for the administration of Vitamin D drops, if recommended by your doctor. Some babies may need a Vitamin D supplement, but your pediatrician will discuss this with you.)
Colostrum: Colostrum is a special substance produced by your breasts in late pregnancy and in the first few days after birth. It is a thick, golden substance full of antibodies, concentrated nutrients and proteins, and other substances vital to a newborn’s health. Colostrum is sometimes called “liquid gold” because of the unique beneficial properties it contains and the short period of time in which it is produced. Colostrum is the only food your baby needs in the first few days of life.
Nursing on demand: When you hear the expression “nurse on demand,” this means that you should put your baby to your breast whenever she seems hungry and allow her to nurse for as long as she wants. You will learn your baby’s hunger cues through observation and trial and error. This is the healthiest way to feed a young baby, as it will ensure that the baby is getting enough to eat and will aid in establishing a healthy milk supply so that you can continue producing enough milk for your baby.
Skin-to-skin: Putting a baby “skin-to-skin” refers to the baby being held against the chest of a caregiver (usually the mother), with the adult shirtless and the baby naked or only in a diaper. The direct contact of the baby’s skin with the skin of a caregiver helps the baby to regulate his own body temperature, lets him hear the calming sound of a heartbeat, and helps him regulate his own breathing and heart rate. Putting the baby skin-to-skin with the mother directly after birth promotes the release of beneficial hormones in baby and mother, stimulates milk production in the mother, and calms the baby. You can request that your baby be put skin-to-skin with you immediately (or within one hour) after birth, as the baby will instinctively seek out your nipple and begin to nurse.
Lactation consultant (IBCLC): A lactation consultant is a medical professional who is specially trained to help new mothers (and babies) learn to breastfeed, keep up on the latest research regarding breastfeeding, feeding techniques, and information, do breastfeeding research, provide advice and education to nursing mothers, and diagnose and treat breastfeeding difficulties and issues. International Board Certified Lactation Consultants (IBCLCs) receive thousands of hours of hands-on and classroom training in order to become breastfeeding experts. A good IBCLC is your best resource for any breastfeeding questions you may have and to help solve any breastfeeding problems you may encounter. Many hospitals now employ IBCLCs who can come to your room in the postpartum ward to help you learn to breastfeed your baby.
But all those books have so much information in them! Which one do you read? What do you really need to know right now?
Before you go into labor, or lie down on the gurney to go to the OR, or arrive at the hospital for your induction, before your water breaks and you start making frantic phone calls to your family letting them know the baby's coming, you should have a few vital bits of information stored away so that you can initiate breastfeeding as soon as possible and have some idea of what to expect. When I had my first baby, despite assuming I was going to breastfeed, I found out very quickly that there was a lot I didn't know about this process that was supposed to be "natural" and "normal" and "instinctive." Sure, it's instinctive for baby, but mom actually has to learn a few things. (And, to be honest, the baby has to practice a bit, too!) I was bombarded with advice from people all around me, and, in the end, my son ended up formula-fed. I was shocked at how much I didn't know going in. I want to help you avoid that shock. Thus, this first segment in a series of posts.
Defining Terms
First, there are terms and phrases you'll hear in relation to breastfeeding. Here are a few you should know right away.
Latch: The baby's "latch" is the arrangement of the baby's lips, tongue, and gums on your nipple and areola. The quality of his latch affects how efficiently he can remove milk from your breasts and swallow it, as well as how comfortable (or uncomfortable) breastfeeding is for you. If the baby is latched well, he should be taking your nipple far back into his mouth, and his lips should be flared around your areola. He should not be chewing or sucking on the nipple directly, and his tongue should be over his bottom gums. The latch usually should be "asymmetrical," meaning the bottom jaw is farther up on the breast than the upper jaw.
Exclusive Breastfeeding: Exclusive breastfeeding means that nothing is ingested by your baby other than breastmilk - no water, no formula, no juice, no cereals, no foods of any kind. The American Academy of Pediatrics and the World Health Organization recommend exclusive breastfeeding for the first six months of a baby's life, at which point solids may be introduced. (This definition allows for the administration of Vitamin D drops, if recommended by your doctor. Some babies may need a Vitamin D supplement, but your pediatrician will discuss this with you.)
Colostrum: Colostrum is a special substance produced by your breasts in late pregnancy and in the first few days after birth. It is a thick, golden substance full of antibodies, concentrated nutrients and proteins, and other substances vital to a newborn’s health. Colostrum is sometimes called “liquid gold” because of the unique beneficial properties it contains and the short period of time in which it is produced. Colostrum is the only food your baby needs in the first few days of life.
Nursing on demand: When you hear the expression “nurse on demand,” this means that you should put your baby to your breast whenever she seems hungry and allow her to nurse for as long as she wants. You will learn your baby’s hunger cues through observation and trial and error. This is the healthiest way to feed a young baby, as it will ensure that the baby is getting enough to eat and will aid in establishing a healthy milk supply so that you can continue producing enough milk for your baby.
Lactation consultant (IBCLC): A lactation consultant is a medical professional who is specially trained to help new mothers (and babies) learn to breastfeed, keep up on the latest research regarding breastfeeding, feeding techniques, and information, do breastfeeding research, provide advice and education to nursing mothers, and diagnose and treat breastfeeding difficulties and issues. International Board Certified Lactation Consultants (IBCLCs) receive thousands of hours of hands-on and classroom training in order to become breastfeeding experts. A good IBCLC is your best resource for any breastfeeding questions you may have and to help solve any breastfeeding problems you may encounter. Many hospitals now employ IBCLCs who can come to your room in the postpartum ward to help you learn to breastfeed your baby.
How Does Milk Production Work?
This is definitely something you need to understand before you actually have a baby to nurse. This is the one bit of information that I wish I'd known before my first son was born.
In the first few days and weeks after giving birth, milk production is driven largely (although not entirely) by hormones. Toward the end of pregnancy, you start producing large amounts of prolactin and other hormones, which stimulates the breasts to start making colostrum, the thick, golden substance defined above. After giving birth, usually within two to six days, the colostrum you are already producing will be replaced by mature milk, which looks like, well, milk. This switch-over to mature milk should happen regardless of whether you've started breastfeeding, since it is hormonally driven, but if you don't stimulate continued milk production by nursing a baby or pumping your breasts, milk production will gradually taper off and eventually stop. What this boils down to is, in order to make milk and continue making milk, you need to nurse a baby and continue nursing a baby.
Breastmilk production and supply are driven by demand. As your baby nurses, he drains the milk from your breasts. This milk removal sends a hormonal signal to your brain, which sends more hormones back to your breasts to signal them to make more milk. If there is no demand placed on the breasts for more milk (i.e., no baby is nursing, or you are not removing the milk by pumping it), then the breasts will stop producing milk. The less often you remove milk from your breasts, the less milk you will produce. The best way to ensure a good milk supply is to nurse your baby whenever he is hungry and allow him to nurse until he is full. This will signal your brain and breasts to keep producing milk.
Weight Loss
It is normal for a baby to lose 5 to 7% of his birth weight in the first few days of life. Babies are born "full," meaning that they have been receiving nutrition nonstop through the umbilical cord right up until they are born. A newborn baby's stomach is about the size of a golf ball and is not elastic. This means it can only hold a very small amount of food at a time, which is all he really needs anyway. The colostrum provided by your breasts, as long as you are feeding the baby whenever he is hungry, is sufficient to provide his nutritional needs in the first few days of life. Once your mature milk comes in, the baby should start putting on weight again. The goal for most babies is to regain that birth weight by about two weeks of age.
A small weight loss (less than half a pound for most full-term, healthy, normal-weight babies) is not cause for concern, and does not mean you need to offer any supplemental feedings of formula. If you have any concerns about your baby's weight loss and gain patterns, you should talk to your pediatrician.
As an example of a normal weight loss and gain pattern, my second son was born 7lbs., 6oz. When we were discharged from the hospital less than 48 hours later, he weighed only 6lbs., 14oz., a loss of 8 ounces. However, by his two-week follow-up visit with the pediatrician, he weighed 8lbs., 1oz., which means he gained back those eight ounces, plus another 11 ounces, in two weeks.
This only applies in the first few days of life until your milk comes in. If your baby is losing weight after having started to gain, you should have the baby evaluated immediately by a pediatrician, and you should be seen by a lactation consultant to determine if you have a sufficient milk supply and if the baby is getting enough to eat.
Pacifiers and Bottles
I promised this would be short, so there's just one more topic to discuss. The introduction of a pacifier or bottle too soon in the breastfeeding relationship may cause problems with the baby's latch and desire and ability to feed from the breast. This is not true of all babies, but it can and does happen, and is called nipple confusion or nipple preference. In order to avoid problems in the early days, lactation experts generally recommend that you wait until about four weeks of age before introducing any kind of artificial nipple. What this means is, in the hospital, you should inform the nurses immediately that you do not want your baby to be given a pacifier or offered a bottle - even a bottle of breastmilk.
Why?
Well, the reasons are different for pacifiers and bottles. With pacifiers, they can often become a crutch to allow you to delay or avoid feeding the baby. If the baby learns to comfort-suck from the pacifier, he may not give you the proper hunger cues and may even skip a feeding. In the early days and weeks of life, it is important that the baby feed as often and for however long he wants to, in order to put on weight and achieve the rapid growth that is normal and necessary for a young baby. When your baby is a bit older (three to five weeks), has established a good breastfeeding relationship, has demonstrated good growth, and knows how to latch properly and eat his fill, then introducing a pacifier is less of a problem and may even be beneficial.
The problem with bottles is different. A bottle is generally easier to drink from than the breast. Bottles tend to drip regardless of whether the baby sucks. When the baby swallows, more milk comes from the bottle nipple, forcing the baby to swallow again, which causes more milk to flow. Because this takes so little effort, some babies will "forget" how to latch and suck properly at the breast, especially those who are already having trouble staying latched and maintaining the stamina to feed effectively. There is also evidence that even one bottle of formula can interfere with the proper population of beneficial bacteria in the gut and expose and sensitize a baby to proteins not found in human milk.
That's it! I hope this summary helped condense things for you into a manageable bite, so that when you do go into labor or give birth, you'll feel like you have the knowledge you need to get started.
The next segment in this series will address topics important relevant to the first few days of your baby's life.
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