Exclusive breastfeeding is recommended for the first six months of life with continued breastfeeding to two years and beyond once family foods are introduced at six months of age. No other liquid or food is needed in the first six months, unless medically indicated and recommended by a physician. Breastfed babies should receive a daily vitamin D dose of 400 IU until one year of age or until the baby’s diet provides this amount of vitamin D. All parents can obtain a copy of the provincial breastfeeding resource, Breastfeeding Basics, online at http://www.novascotia.ca/dhw/healthy-development/documents/breastfeeding-basics.pdf or by seeing their doctor’s office or local public health office.
Frequency of Feedings
Babies’ tummies can’t hold much at one time, so they need to be fed often- day and night. Most newborns need to feed every 1-3 hours. Most babies will feed at least 8 times in 24 hours, though some babies will feed more often and some will feed less often. Look and listen for cues that your baby is hungry. Common hunger cues include: holding hands or fists over his chest, sucking on a finger or fist, turning toward mom’s body with an open mouth, smacking lips, making sucking sounds, sticking out tongue, crying.
Typically, a baby begins breastfeeding with a period of quick sucking to stimulate his mother’s milk to flow (letdown). While feeding, your baby will have a suck and pause rhythm. Baby will suck about 10-15 times, then pause for a few seconds rest, and so on. As your milk comes in, listen for the sound of your baby swallowing.
You will know baby is breastfeeding well if:
· You can hear baby swallowing while feeding
· Baby is content after breastfeeding
· Baby has wet or dirty diapers each day (after the first week, baby should have 6-10 wet or dirty diapers each day)
· Baby is growing and gaining weight
· Breasts feel softer after a feeding
Length of Feeding
Baby may want one or both breasts during a feeding. Switch breasts when baby stops suckling vigorously and/or comes off on her own. Some babies nurse for shorter periods and others for longer periods.
Breastmilk changes throughout a feeding. The milk at the beginning of the feeding is low in fat (to quench thirst) and increases in fat content, as the feeding progresses (to satisfy hunger). Only baby knows if he’s had the right amount of both and is satisfied. At the next feeding time, offer the breast that the infant finished on.
Babies have times when they grow very fast. For most babies, these growth spurts happen at around 10 days, 3 weeks, 6 weeks, 3 months, and 6 months. Growth spurts usually last for only a few days. During a growth spurt, babies usually want to breastfeed more often or for longer at each feeding (often called “cluster feeding”). There is no need to watch the clock if baby is breastfeeding at least 8 times in 24 hours and gaining weight well.
Babies vary a great deal in how much sleep they need. If your baby is very sleepy, you will need to put extra effort into keeping him or her awake during feedings.
Try things like:
· Undressing your baby before a feeding
· Rubbing baby’s face with a cool cloth
· Breast compression also helps keep baby interested in feeding. To do this, hold breast with one hand well back from the nipple and squeeze firmly but gently. Continue squeezing until she stops swallowing, then release and try again. This will keep your milk flowing and baby’s interest up.
You may need to wake an overly sleepy baby to feed every two or three hours at night during the first few weeks.
How to Increase Milk Supply
Many women may feel that their milk supply is low when in fact it may be fine – milk supply adapts to the baby’s needs.
To ensure baby is getting enough milk:
· Breastfeed on demand and breastfeed often. Milk supply increases with the baby’s demand for milk – more frequent feedings will tell the body to make more milk.
Be sure the baby is positioned and latched on correctly.
· Offer both breasts at each feeding and nurse long enough at each breast so that the baby gets the high-calorie hind milk. (Switch breast when the baby stops suckling vigorously, or when the baby comes off on his own).
· Express milk after feeding by hand expressing or use a pump (hand pump, battery operated or electric). Pumps can often be rented instead of buying one – check your local hospital, drug store or Public Health office for information.
· Avoid pacifiers – all suckling should be at the breast.
· Drink plenty of fluids and to get lots of rest.
· Seeing a primary care provider for other options and details.
Almost all babies can be breastfed babies. If you are separated from your baby during the first few hours after birth, you can start to express milk by hand or using a pump. Breast milk can be fed to the baby via cup feeding, finger feeding, or feeding syringe.
If you are experiencing any challenges breastfeeding, see a Public Health Nurse or Lactation Consultant for support.
If concerned baby is not getting enough milk, track the number of wet diapers and bowel movements in 24 hours. If baby’s bowel movements have not changed to a yellow colour by day three to five, see a doctor or public health nurse immediately.
Find a comfortable position so baby is close to the breast and you are relaxed without straining any muscles, try sitting or lying down.
Hold baby close at the same level of your breast so baby directly faces the breast and doesn’t have to turn his head or strain to reach the breast. Using firm pillows or blankets will assist in bringing baby up to level of the breast.
Baby’s ear, shoulder and hip should be in a straight line and his head tilted slightly back, so that he is not pulling at the breast and can swallow easily. Baby’s body should be well supported so baby feels secure. Bring baby to the breast, not the breast to baby. Baby’s head should be at nipple level or slightly below when ready to latch on.
During the early weeks, most mothers find breastfeeding goes more smoothly if they support their breast while latching on and throughout the feedings.
Support the breast with your free hand using a C-hold (thumb is on top of your breast, fingers are underneath) well behind the areola (the darker skin around your nipples).
Encourage baby to open his mouth wide. To do this, lightly touch baby’s lips with your nipple. Go from upper to lower lip and back again.
When baby’s mouth is open wide like a yawn, draw baby close. The nipple should be centered upward in the baby’s mouth. To support a good latch and posture, draw baby to the breast.
As baby latches on, draw baby even closer to the breast. Baby’s mouth needs to cover a large part of the areola. Baby’s chin should be tucked in closely to the breast.
Other ways to encourage baby to open wide are to say the word “open”, and open your mouth and gently pull down on baby’s chin as baby begins to mouth. Baby needs to open wide and take the nipple deep into his mouth for a good latch-on. If he goes onto the breast well, he will take a large mouthful of breast tissue and be off centre, so that his lower jaw takes in more areola than his top.
Taking Baby Off
If baby does not go on the breast well, gently take him off by first breaking suction on the breast and then try again. To break suction, gently place a clean finger into the corner of baby’s mouth and press against the breast. Allowing baby to stay on the breast if it hurts, or if baby is not sucking well, can make nipples sore and breastfeeding ineffective. When baby is latched-on well, you should feel little or no pain.
Vitamin D and Vitamin Supplementation for Breastfed Infant
Vitamin D helps build strong bones. Vitamin D drops are recommended for all breastfed babies starting at birth until one year of age, or until baby’s diet includes at least 400 IU of vitamin D from other foods. Your breastfed baby needs only Vitamin D drops, not multivitamin drops. Check your vitamin dropper to make sure you are giving your baby the right amount. Not all brands have the same kind of dropper. Clean the dropper after each use. “No name” drops are just as good as brand name.
Duration of Exclusive Breastfeeding
Exclusive breastfeeding is recommended for the first six months of life for healthy term infants, as breast milk is the best food for optimal growth. Babies can start trying solid foods at 6 months. At first, babies will eat very small amounts of solid food. Breast milk will continue to be the main source of nourishment while baby learns how to eat solid foods. Breastfeeding can be continued for 2 years and beyond.
The first foods that are introduced should contain iron. Foods that contain iron include infant cereals fortified with iron and pureed meat, poultry, fish, tofu, cooked eggs, and well cooked legumes. After iron-rich foods have been introduced, try different fruits and vegetables.
Breastfeeding During Illness
Breastfeeding your baby is the best way to strengthen his/her resistance to your germs (and other germs around them) and to keep your baby healthy. Your baby can’t catch cold germs through your breast milk, though he/she can become infected through other contact with you. Breastfeeding keeps babies healthy by protecting them from ear infections, allergies, diarrhea, vomiting, and anemia (low iron).
To minimize the spread of infection, always wash your hands before handling your baby or baby’s belongings and also before feedings.
To speed your own recovery as well as keep up your milk supply and your strength while you have a cold or flu, drink extra fluids ( a cup of fluid every hour while you are awake), be sure to take a vitamin supplement, and eat a healthy diet. Check with your primary care provider if you need medication, but do not take anything without your primary care providers’ approval.
If you are experience gastrointestinal upset you can still continue to breastfeed. Breastfed babies appear to be protected from most infections. Wash your hands, especially after going to the bathroom, before touching your baby or anything baby might put into his/her mouth. Drink plenty of fluids to replace those lost through diarrhea or vomiting.
Where can I find more information?
See your Public Health Services Offices, a list of offices is available at: http://novascotia.ca/DHW/about/phs-offices.asp
Visit http://www.first6weeks.ca, a website that is there to support you in your first six weeks and beyond. It is about providing you with information and the support you need to continue.