66 Mount Lucas Road, Princeton, NJ 08540-2733, USA
tel 609-924-4892, fax 609-921-9380
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Mark B. Levin, M.D., F.A.A.P.
John M. Cotton, M.D., F.A.A.P.
Timothy J. Patrick-Miller, M.D., F.A.A.P.
Louis J. Tesoro, M.D., F.A.A.P.
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We are happy to answer any general questions about medical topics and about ouor practice. We can answer specific questions only regarding patients who are currently enrolled in our practice. The material provided on this website is for informative purposes only. If you need specific advice, please contact your treating physician.
This page includes information on the following clickable topics:
Duration, Milk Production, Positioning, Frequency/Sucking/Weight Loss, Urinating, Your Diet, Engorgement, Sore Nipples, Thrush, At Home, Bottles, Solid Foods, Colic, Burping, Gastro-esophageal Reflux, Insufficient Milk, Breastmilk Storage
We want your breastfeeding experience to be successful and enjoyable. The following information is aimed toward achieving that goal. Please fell free to call us with any questions.
The duration of breastfeeding varies from family to family. We recommend that you nurse your infant for as long as you are comfortable through the first year. If you are returning to work outside the home and would like to continue nursing, we would be happy to discuss ways of accomplishing this with you. Most infants do not require the addition of solid foods until four to six months of age. At a time suitable to your infant's needs, your doctor will recommend adding solid foods to your infant's diet.
Breast milk production usually begins a few days after delivery. Until this happens, most infants will suck for brief periods and fall asleep. Infants usually begin to suck more vigorously and consistently at 2-3 days of age. During these initial nursing periods, your baby will be benefiting from colostrum immunologically and you will be teaching each other new skills. Newborns usually lose weight during the first few days, but thereafter start to gain. When your milk comes in, the baby may nurse one side then fall asleep, only to awaken an hour later to take the other side. Within a short time, your supply will adjust to the baby's needs so your infant can nurse on both sides at one feeding. Some babies normally prefer to continue to nurse on one side at a feeding. If your milk supply is abundant, the baby may continue to take only one breast per feeding. Drink lots of fluids letting your thirst mechanism be your guide, relax and have confidence in nature!
The following hints may help to make your breastfeeding experience more rewarding.
To start, hold your baby in a comfortable position. Some people prefer the "chest-to-chest" position and others like the "football hold". Bring the baby to the breast, not the breast to the baby. Stroking the baby's cheek will encourage the baby to take most of the areola (the pigmented area around the nipple) in his or her mouth.
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Most infants are sleepy for the first two days. Consequently, your infant may not be interested in sucking very often. Conversely, some infants nurse avidly from the start. Both patterns are normal. Weight loss is common during the first few days of life until your milk comes in and your infant is nursing well. Start off by offering the infant the breast when you sense he or she wants to nurse (cues include crying and rooting and sucking on any available objects, such as hands and linens), but at least every 2-3 hours. Nurse for as many minutes as you are comfortable at each feeding. At the onset of milk production, infants may need to suck for 10-30 minutes to stimulate a letdown response and get all of your milk. Alternate which breast you offer first at each feeding.
Expect to nurse every 2-4 hours during the day. longer intervals during the nighttime are desirable. Many infants have a period of frequent feedings, usually in the evening to early night. Half to one hour intervals are common during this period. Feedings get less frequent as an infant gets older. You will learn by experience to differentiate cues for cuddling, diaper changing and sleep from the baby's cues for hunger, such as rooting, sucking on his or her lips or hands or fussing when rested and changed.
Until your milk comes in, your baby may urinate only 2-4 times per day and have only 1-2 bowel movements daily. More is also normal. Once your milk is in, you can expect your baby to soil as many as 10-12 diapers daily. The initial bowel movements are greenish-black and sticky (meconium). Subsequent breastmilk stools are usually watery and yellow, perhaps with curds or a seed-like character.
Eat a variety of foods. Most infants tolerate any food a mother eats. Some infants, however, will become gassy and perhaps uncomfortable as a result of some foods in the mother's diet. If this happens to your infant, contact us to discuss how to remedy the situation. The next section lists the foods that are often implicated as the cause for a gassy uncomfortable baby. Avoid cigarettes, alcohol and caffeine. For your own benefit, continue your prenatal vitamin and mineral supplements while nursing. Contact us before taking any drugs while you are nursing.
If a you, your partner or your previous infant had colic related to maternal diet, omitting the offending food(s) on this list makes sense. If there is a family history of food allergy, those foods should be avoided, as well. If neither condition exists, feel free to take advantage of the nutrients in these foods until or unless your infant displays behavior that suggests otherwise. Some foods that commonly cause gas in a nursing infant are medicinal iron, milk and milk products, chocolate and caffeine-containing beverages, citrus fruits and juices, onions, peaches, pineapple, tomatoes, broccoli, cauliflower, cabbage, carrots, white beans, eggs, peanut butter, chicken and tuna. Caffeine predictably diffuses quickly into breast milk 15-30 minutes after ingestion. The rate at which other foods enter the breast milk depends on the mix of foods in the mother's stomach and her digestion rate. This variability sometimes makes identification of the offending agent difficult. You need not restrict your diet unless your infant displays frequent fussy behavior.
Breast engorgement is a tense swelling of the breast, occurring between days 3 and 6 and signifying milk production. It lasts for 1-3 days. Frequent nursing alleviates some of the pressure you may experience. Other things that might help include warm washcloths applied to the breasts, a warm shower and massaging gently with your finger tips before feeding to soften your breasts. After feedings, ice or cool compresses will also help to relieve pain and tenderness. If your infant can not latch on well because of engorgement, hand express or use a breast pump for a minute at the start of a feeding to relieve the fullness in the front of the breast. Firmness of the breast after a feeding is usually caused by breast glandular tissue, not residual milk. This firmness will dissipate in a few days.
Sore nipples can be avoided by proper positioning and skin care. Use pillows to support the baby at the level of the breast. Make sure the baby is facing you in a "chest-to-chest" or "football hold" position. The baby should be taking the areola into his or her mouth, not just the nipple. An ice cube applied to the nipple for 20-30 seconds before nursing will numb the skin a bit and stimulate a nipple erection, allowing the baby to latch on more easily. Rotate the infant's position on the breast at each feeding to assure emptying of all the lobes of the breast. You may lubricate your skin after nursing with a small amount of colostrum or modified lanolin. At the end of a feeding, be sure to break the suction with your finger at the corner of the infant's mouth, rather than pulling the infant away from the breast. Exposing your skin to the air between feedings can help avoid chapping as a consequence of leaking milk. If you see a lacy white coating anywhere in the baby's mouth, contact us. This may represent a common yeast infection called "thrush".
At home, once your milk supply is established, it is best to wait for about 2 hours from the start of one feeding to the start of the next. This allows time for the baby's stomach to empty and for your breasts to accumulate enough milk for a full next feeding. Mothers who nurse too often find insufficient time for sleep and other desirable functions. Feeding every 2-4 hours during the day and every 3-5 hours (or longer) overnight seems to work best in the first few months of life. Most infants feed 6-10 times per day once milk production is established. Some infants prefer to "cluster" or "bunch" feed, that is, feed often in bursts for a period of hours. Although inconvenient for you, this is also a normal pattern. Most mothers are comfortable nursing 7-20 minutes per side. If your infant falls asleep on the first side with prolonged nursings, try limiting the baby's sucking time to 7-10 minutes on the first breast. Then burp the baby and feed as long as the baby wants on the second side. Alternate which breast you offer first at each feeding. Expect 6-8 wet diapers and 2-8 watery yellow stools per day once your milk is in.
Some mothers who plan to return to work outside the home and fathers who would like to participate in feedings ask about introduction of a bottle. Unless instructed otherwise by your doctor, try to avoid introducing a bottle for the first two weeks, as it may interfere with nursing. If supplementation is required because of insufficient milk supply (an uncommon situation) or feeding difficulties, contact us regarding the method that is best for your infant. If you plan to introduce a bottle for a relief feeding or one of the reason enumerated above, the two week mark is a good time to do it since most 2 week olds can nurse and take a bottle without trouble. Some infants may refuse a bottle if it is offered too late.
Major growth spurts, lasting about a week, occur at about 6 and 12 weeks of age. Your baby will most likely eat more often during these times. Most infants do not need solid foods until 4-6 months of age. Pumped breast milk or formula may be given to your infant in a bottle if you are unavailable to nurse. Water may be offered as a supplement on very hot days in the summer or to placate your infant for a few minutes until you are ready to nurse.
Parents sometimes experience difficulty comforting their infant despite the fact that their infant is well nourished and has no medical condition. We call this type of infant "colicky". The term colic means that an an infant suffers from periods of crying and discomfort for any of several different reasons. In the absence of illness, an infant can be colicky by swallowing air and not burping well, by being allergic or intolerant to a particular component of a feeding, by having gastro-esophageal reflux or by having a fussy temperment. Only rarely is any internal anomaly related tot his behavior. Being a responsible parent who is unable to quiet or console a colicky baby can be very frustrating. It is not unusual for parents of a colicky baby to become angry and depressed. A conversation with your baby's doctor, sometimes supplemented with an examination, can usually pinpoint the cause. We have foound that colic drops (simethicone) are only marginally useful. We do not recommend herbal remedies (chamomile tea, gripe water, etc.) since they are not helpful if dilute and are potentially toxic if concentrated.
A reclining position amy cause the bby to swallow excessive amounts of air. This results in the same colicky behavior. Feeding the infant in a more upright or seated posture will usually resolve the problem.
Burping a baby can sometimes be challenging. Some babies do everything in their power to retain swallowed air, despite their parents' best efforts! But knowing and taking advantage of an infant's anatomy can aid a parent's effort in thwarting this gas retention. The top (fundus) of this stomach lays to the upper left side of the baby's abdomen. The esophageal opening of the stomach, however, is nearer to the center of the abdomen, slightly lower and toward the back. When it is time for a burp, cradle the baby face-up with the baby's head toward the left, and slightly tip the infant so the baby's left shoulder is lower than the buttocks. Pat the baby gently with your underneath hand for a few seconds, thereby floating the air bubble from the fundus up towaard the esophageal opening. After a few pats, bring the baby forward to a seated position or put the baby up against your shoulder (with a spit diaper in place unless you like wearing digested milk!) and pat the baby's back. With this maneuver, more often than not, you will be rewarded with a burp, be it wet or dry, thus avoiding the eventuality of gas stopping at every bend in the baby's gastro-intestinal tract and causing hours of colicky pain and lost sleep.
We expect that it is Nature's intent that when food is swallowed it should stay in the stomach until the first phase of digestion is completed, then pass in an orderly, comfortable fashion through the lower stomach opening (the pylorus) into the small intestine for further processing. Sometimes the stomach contents, comlplete with the acid from the stomach, passes retrograde up the esophagus, or food pipe, instead, causing pain. We refer to this as gastro-esophageal reflux, or, more commonly, heartburn. Having experienced this, most of us can empathize with infants who have this condition. The constant crying of an infant with gastro-esophageal reflux (GER) can be mistaken for colic. If the usual remedies for colic fail, or symptoms last beyond the first three to four months, GER must be considered. Modes of therapy for GER include maternal dietary changes, feedings thickened with infant cereals, anti-reflux positioning (elevating the head of the infant's bed about thirty degrees and placing the infant to sleep on his or her abdomen), antacids and medications that stimulate gastric motility. If GER is a suspected problem, consult your child's doctor for individualized care.
Finally, there is the fussy baby, the infant infant who fusses for no apparent reason. Some babies just need to be held more than others. Spontaneously discovered parental behaviors, such as walking the floors or rocking the infant, are time-honored, successful, short-term techniques. Strap-on infant carriers are useful to free your arms while carrying your baby. Some parents use a baby swing or cradle to soothe their infant. These do no harm to the baby's spine and are acceptable for brief periods of time until about four months of age. A warm bath can often settle a fussy baby. Some babies just need to be left alone to fuss for a brief period of time before they settle down. Sometimes it is difficult to figure out which baby is which. Here again is an area where your child's doctor can assist. A frank discussion of infants' needs and parenting styles can often lead to a satisfactory resolution.
If you are concerned about having enough milk for your baby, contact us to arrange a weight check. We can work with you if it is necessary to increase your milk supply. If you feed at least every 3 hours during the day and every 4 hours at night, drink to satisfy your thirst (about 2-3 quarts of fluid through the day), get plenty of rest and nurse the baby in a quiet relaxed environment, your milk supply will likely be more than adequate. Keep track of the number of feedings and the number of the baby's bowel movements and wet diapers.
For breast milk storage, first clean your breast pump, if you are not manually expressing milk. The best time to pump is one hour after an early morning feeding or midway during a long stretch (at least 5 hours) between feedings when you will not be nursing. An alternative approach is to pump after each feeding through the day to collect your milk a little at a time. Cleanse your breasts with water and your hands with soap. After a feeding (but at least 2 hoursbefore the next anticipated feeding), express your milk into a clean (measuring) cup or jar. If it is not used immediately, you may refrigerate the milk for up to 48 hours. Otherwise, pour the expressed milk into a ziplock plastic bag, labeled with a piece of masking tape indicating the date and time of storage, and place it immediately into your freezer. Subsequent pumpings can be added to the frozen milk in the plastic bag in a layered fashion and immediately replaced in the freezer until about 4 ounces are accumulated. Milk is good for up to 6 months in a regular freezer, up to 12 months in a large deep freezer and 24-48 hours in the refrigerator once defrosted. To defrost the milk, place a plastic bag of milk in a saucepan of warm water until the milk is all liquid and warm. Do not microwave breast milk. Pour the milk into whatever container you will be using and serve it to the baby.
As always, contact us with any questions you may have.
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