Clinical Reference Systems: Pediatric Advisor 10.0
Babies who are breast-fed have fewer infections and
allergies during the first year of life than babies who are
fed formula. Breast milk is also inexpensive and served at
the perfect temperature. Breast-feeding becomes especially
convenient when a mother is traveling with her baby.
Overall, breast milk is nature's best food for young babies.
How Often to Feed
The baby should nurse for the first time in the delivery
room. The second feeding will usually be at 4 to 6 hours of
age, after he awakens from a deep sleep. Until your milk
supply is well established (usually 4 weeks), nurse your
infant whenever he cries or seems hungry (demand feeding).
Thereafter, babies can receive enough milk by nursing every
2 to 2-and-1/2 hours. If your baby cries and less than
2 hours have passed, he can be rocked or carried in a
frontpack. However, waiting more than 2-and-1/2 hours can
lead to swollen breasts (engorgement), which decreases milk
production. (Feeding less frequently is OK at night, but no
more than 5 hours should pass between feedings.)
Your baby will not gain adequately unless he nurses eight or
more times per day initially. The risks of continuing to
nurse at short intervals (more often than every 1 and 1/2
hours) are that "grazing" will become a habit, your baby
won't be able to sleep through the night, and you won't have
much free time.
How Long Per Feeding
Nurse your baby 10 minutes on the first breast and as long
as he wants on the second breast. Your goal is to have your
baby nurse for a total of about 30 minutes at each feeding.
Often you will need to stimulate your baby before she will
take the second breast. Remember to change the breast you
start with each time.
Once your milk supply is well established (about 4 weeks
after birth), 10 minutes of nursing per breast is fine when
you are in a hurry (since your child usually gets over 90
percent of the milk in this time). However, try not to
nurse for periods shorter than 20 minutes. Your baby needs
the calories. Shorter feedings may lead to a need for more
How to Know Your Baby is Getting Enough Breast Milk
In the first couple of weeks, if your baby has three to four
good-sized bowel movements per day and six or more wet
diapers per day, he is receiving a good supply of breast
milk. (Infrequent bowel movements are not normally seen
before a baby is 1 month old.) In addition, most babies
will act satisfied after completing a feeding.
Your baby should be back to birth weight by 10 to 14 days of
age if breast-feeding is going well. Therefore, the 2-week
checkup by your baby's physician is very important.
The presence of a letdown reflex is another indicator of
good milk production.
The Letdown Reflex
A letdown reflex develops after 2 to 3 weeks of nursing and
is indicated by tingling or milk ejection in the breast just
before feeding (or when you are thinking about feeding). It
also occurs in the opposite breast while your baby is
Letdown is enhanced by adequate sleep, adequate fluids, a
relaxed environment, and reduced stress (such as not
expecting much housework to get done). If your letdown
reflex is not present yet, take extra naps and ask your
husband and friends for more help. Also consider calling
the local chapter of La Leche League, a support group for
Do not offer your baby any routine bottles during the first
4 to 6 weeks after birth because this is when you establish
your milk supply. Good lactation (breast milk production)
depends on frequent emptying of the breasts. Supplemental
bottles take away from sucking time on the breast. If your
baby is not gaining well, see your physician or a lactation
specialist for a weight check and evaluation.
After your baby is 6 weeks old and nursing is well
established, you may want to offer your baby a bottle of
expressed milk or water once a day so that he can get used
to the bottle and the artificial nipple. Once your baby
accepts bottle feedings, you can occasionally leave your
baby with a sitter and go out for the evening or return to
work outside the home. You can use pumped breast milk that
has been refrigerated or frozen.
Babies do not routinely need extra water. Even when they
have a fever or the weather is hot and dry, breast milk
provides enough water.
Pumping the Breasts to Relieve Pain or Collect Milk
Severe engorgement (severe swelling) of the breasts
decreases milk production. To prevent engorgement, nurse
your baby more often. Also, compress the area around the
nipple (the areola) with your fingers at the start of each
feeding to soften the areola. For milk release, your baby
must be able to grip and suck on the areola as well as the
nipple. Every time you miss a feeding (for example, if you
return to work outside the home), pump your breasts. Also,
whenever your breasts hurt and you are unable to feed your
baby, pump your breasts until they are soft. If you don't
relieve engorgement, your milk supply can dry up in 2 to 3
A breast pump is usually not necessary because pumping can
be done by hand. Ask someone to teach you the Marmet
Collect the breast milk in plastic containers or plastic
bottles because some of the immune factors in the milk stick
to glass. Pumped breast milk can be saved for 48 hours in a
refrigerator or up to 3 months in a freezer. To thaw frozen
breast milk, put the plastic container of breast milk in the
refrigerator (it will take a few hours to thaw) or place it
in a container of warm water until it has warmed up to the
temperature your baby prefers.
Clean a sore nipple with water after each feeding. Do not
use soap or alcohol because they remove natural oils. At
the end of each feeding, the nipple can be coated with some
breast milk to keep it lubricated. For cracked nipples,
apply 100% lanolin (no prescription necessary) after
feedings. Try to keep the nipples dry with loose clothing,
air exposure, and nursing pads.
Sore nipples usually are due to poor latching on and a
feeding position that causes undue friction on the nipple.
Position your baby so that he directly faces the nipple
without turning his neck. At the start of the feeding,
compress the nipple and areola between your thumb and index
finger so that your baby can latch on easily. Throughout
the feeding, hold your breast from below so the nipple and
areola aren't pulled out of your baby's mouth by the weight
of the breast. Slightly rotate your baby's body so that his
mouth applies pressure to slightly different parts of the
areola and nipple at each feeding.
Start your feedings on the side that is not sore. If one
nipple is extremely sore, temporarily limit feedings to 10
minutes on that side.
Vitamins/Fluoride for the Baby
Breast milk contains all the necessary vitamins and minerals
except vitamin D and fluoride. Full-term dark-skinned
babies and all premature babies need 400 units of vitamin D
each day. White babies who have little or no sun exposure
(less than 15 minutes of sun exposure twice a week) also
need vitamin D supplements. From 6 months to 16 years of
age, children need fluoride to prevent tooth decay. For
children up to 3 years old who are breast-feeding and not
drinking any water, 0.25 mg of fluoride drops should be
given each day. This is a prescription item that you can
obtain from your child's physician.
Vitamins for the Mother
A nursing mother can take a multivitamin tablet daily if she
is not following a well-balanced diet. She especially needs
400 units of vitamin D and 1200 mg of both calcium and
phosphorus per day. A quart of milk (or its equivalent in
cheese or yogurt) can also meet this requirement.
The Mother's Medications
Almost any drug a breast-feeding mother consumes will be
transferred in small amounts to her breast milk. Therefore,
try to avoid any drug that is not essential, just as you did
Some commonly used drugs that are safe for you to take while
nursing are acetaminophen, ibuprofen, penicillins,
erythromycin, cephalosporins, stool softeners,
antihistamines, decongestants, cough drops, nosedrops,
eyedrops, and skin creams. Aspirin and sulfa drugs can be
taken if your baby is more than 2 weeks old AND not
jaundiced. Consult your physician about all other drugs.
Take drugs that are not harmful immediately after you
breast-feed your child so that the level of drugs in the
breast milk at the time of the next feeding is low.
Some of the dangerous drugs that can harm your baby are
tetracyclines, chloramphenicol, antithyroid drugs,
anticancer drugs, or any radioactive substance. Women who
must take these drugs should not be breast-feeding or should
request a safer form of treatment. Another group of drugs
that should be avoided because they can suppress milk
production are ergotamines (for migraine), birth control
pills with a high estrogen content (most birth control pills
are OK), vitamin B6 (pyridoxine) in large doses, and many
Burping is optional. Its only benefit is to decrease
spitting up. Air in the stomach does not cause pain. If
you burp your baby, burping two times during a feeding and
for about a minute is plenty. Burp your baby when switching
from the first breast to the second and at the end of the
Introduce your child to a cup at approximately 6 months of
age. Total weaning to a cup will probably occur somewhere
between 9 and 18 months of age, depending on your baby's
individual preference. If you discontinue breast-feeding
before 9 months of age, switch to bottle feeding first. If
you stop breast-feeding after 9 months of age, you may be
able to go directly to cup feeding.
Call Your Child's Physician within 24 Hours If:
- Your baby doesn't seem to be gaining adequately.
- Your baby has less than six wet diapers per day.
- During the first month, your baby has less than 3 bowel
movements per day.
- You suspect your baby has a food allergy.
- You need to take a medication that is not mentioned in
- Your breasts do not become full (engorged) before
feedings by the time your baby is 5 days old.
- You have painful engorgement or sore nipples that do not
respond to the recommended treatment.
- You have a fever (also call your obstetrician).
- You have other questions or concerns.