Is breastfeeding supposed to hurt?

Breastfeeding is not supposed to hurt. In the beginning, even if you are doing everything correctly, your nipples may feel very sensitive, but you should not be in pain. This sensitivity usually passes in about a week or two. Pain is usually experienced when the baby is latched on incorrectly and is attached to only the tip of your nipple. When this happens take the baby off the breast immediately by breaking his/her seal with your finger and start over again. Do not suffer through a painful latch and allow the baby to continue nursing. When the baby is latched on correctly, your areola will be almost completely covered, (depending on your size), and you will not be in pain. Make sure you support your breast with the opposite hand, sometimes lifting it up even more than you think you should, as this helps your nipple get in the proper position in the baby’s mouth. Unfortunately, once you have damaged your nipples by nursing with an incorrect latch, you may be in pain with subsequent feeding even though the baby is latched on properly. Using the correct latch and alternating feeding positions should help the soreness.  If not, see a lactation consultant for an evaluation.

How do I know my newborn baby is getting enough to eat?

There are a few concrete ways to tell if your newborn baby is getting enough to eat. After your milk comes in, your baby should have 6-8 pale yellow wet diapers each day, and 3-5 yellow seedy stools per day. Your baby should be nursing at least 8-12 times in 24 hours, and these feedings should last anywhere from at least 10 to as long as 45 minutes. You should hear audible swallowing with each feeding and your breasts should feel lighter and softer after the feeding. Your baby will appear relaxed and satisfied.  It is often helpful to keep track of feedings, urine and stool output on a sheet of paper, so that you can refer back to it, as the days tend to blend together! Your baby should be gaining weight regularly at each checkup. He/she should be back to his/her birth weight by their two week check up and then should gain at least 4-7 oz. per week in the first months of life. Lastly, your baby should have periods of both sound sleep and alertness between feedings, and generally seem satisfied, with the occasional bout of unhappiness! If you are at all concerned about your baby, take him/her into the pediatrician for a quick weight check. It will do a lot to ease your mind and increase your confidence.

How do I know if the postpartum depression I am experiencing is normal or something to be concerned about?

During the first two weeks after you have your baby, you may experience anxiety, moodiness, and the occasional “baby blues”. Kathleen Huggins R.N., M.S. writes in the Nursing Mother’s Companion, that “this is all very normal and is due to fatigue, stress and the sudden change in hormones that occurs after delivery.” However, if this continues beyond two weeks, or starts later and progresses so that you experience any of the following symptoms, you need to seek help from a professional. These symptoms include: fatigue or lack of energy, crying often, tenseness, nervousness, a change in eating and sleeping habits, panic attacks, lack of interest in usual activities, poor concentration, forgetfulness, confusion, excessive worry or guilt, and recurrent disturbing thoughts or compulsive behaviors. Symptoms that require immediate assistance from a mental health professional include thoughts of suicide, fears of harming the baby, sounds and voices heard when no one else is around, thoughts that seem not your own or out of your control, sleeplessness lasting 48 hours or longer, inability to eat, and inability to care for your baby.

If you have any of these concerns, please notify your obstetrician for referral. Women and Infants Hospital has a Day Program for women suffering from depression and anxiety during pregnancy and postpartum. The phone number is 401-274-1122 x2870.

Two excellent resources for mothers suffering from any degree of postpartum depression are the book This Isn’t What I Expected: Recognizing and Recovering from Depression and Anxiety after Childbirth, by Karen Kleinman and Valerie Raskin and the organization Depression after Delivery Inc. whose number is 1-800-944-4PPD.                                                                  

When do I need to call my baby’s doctor?

You need to contact your baby’s pediatrician if the baby has:

• fever of 101 degrees or greater rectally (99 degrees under his arm)
• is lethargic
• has decreased urine or stool output
• is nursing poorly
• simply doesn’t seem to be acting like him or herself
• is inconsolable 

You know your baby better than anyone, and if you are at all concerned, make the phone call. It is much better to err on the side of caution, and your doctor can best help you determine if there is anything to be concerned about.

I have a lump in my breast and am not sure what to do about it because I am nursing. What do you recommend?

Nursing mothers frequently get lumps in their breasts while nursing and they are often tender. This is usually due to a plugged milk duct and can be relieved by massaging the lump gently downward towards the nipple while nursing or pumping. Warm compresses also help dissolve it. Many times you will feel it disappear right between your finger tips. If it persists for more than a few days despite your efforts to loosen it up, you should contact your doctor or lactation consultant to have it evaluated.

My pediatrician told me that my baby has thrush and I am nursing. Do I need to do anything?

Yes, current recommendation is that mother and baby are treated simultaneously with antifungal medications prescribed by both health care providers.  You will be given specific instructions regarding use of these medications. Many times, when only one of you is treated the infection is just passed from baby to mother and then back again.

All items coming into contact with the baby’s mouth need to be boiled and/or washed in hot water daily.   

Continue breastfeeding during thrush treatment.  Symptoms may seem resolved within 3-5 days but it is important to continue with the full course of treatment.  If symptoms have not resolved after two weeks, consult your physician again.

How long should I breastfeed my baby?

The American Academy of Pediatrics recommends that “exclusive breastfeeding is ideal nutrition and sufficient to support optimal growth and development for approximately the first 6 months after birth. It is recommended that breastfeeding continue for at least 12 months, and thereafter for as long as mutually desired.”

When can I start putting my baby on a schedule?

The recommendation is to feed your baby on demand once he has returned to his birth weight.  This means to feed your baby when he awakens.  Do not wait until baby starts to cry.  A crying baby is more difficult to latch and mom is more stressed. Instead as baby shows signs of hunger, such as, finger sucking, stretching, or just beginning to wake, pick the baby up and feed him. The more you feed them during the daytime, the more rest you will have between feeds at night. Both you and the baby will fall into a rhythm that will meet both of your needs.

If your baby has not returned to his birth weight within 2 weeks of life, please consult with your physician. 

When is the best time to introduce a bottle to my baby?

The best time to introduce a bottle to a breastfed baby is between 3-4 weeks. We recommend exclusive breastfeeding up until that point. By then, breastfeeding is usually well established, and nipple confusion is not an issue. We recommend using expressed breast milk in a bottle with a nipple with a wide base.

Have someone else (Dad, grandma) give the baby the bottle, as sometimes breastfed babies won’t initially take it from their mother. It is usually also a good idea to leave the house while this is going on. If the baby sees, hears, or smells you, the baby may protest and wonder why you are not feeding him/her.

When should I start feeding my baby solid food?

The American Academy of Pediatrics recommends exclusive breastfeeding until 6 months of age. Many mothers are very anxious to give their baby solids and often succumb to pressure from well meaning relatives and friends to start solids earlier than they need to. Breast milk is the ideal nutrition for the first six months and it is sufficient to support their growth and development up until then.

Many pediatricians recommend holding off on solids until six months of age, and usually ask parents to look for certain developmental cues to be exhibited before starting solids. These cues are the ability to sit up by themselves or in a high chair, open their mouth when they see food coming, turn their head away if they don’t want to eat or drink, close lips over a spoon and scrape the food off the spoon with lips, and finally keep food in their mouths rather than squeezing it back out. If your baby can do these things, it’s probably time to give solids a try.

You might want to pick up a copy of Child of Mine: Feeding with Love and Good Sense by Ellen Satter RD, as it is an excellent reference regarding infant feeding and helps clear up a lot of the confusion regarding introducing solids.

When will my baby sleep thru the night?

Unfortunately, there is no definitive answer to this question.  It is important to remember that every baby is different. Our best advice is to get a copy of the book, Healthy Sleep Habits, Happy Child by Dr. Marc Weissbluth. He does a wonderful job of helping you understand the importance of infant sleep, and teaches you how to recognize when your baby is tired. He also makes you realize the things we do as parents that keep babies from getting the sleep they need. He points out effective measures that you can use very early on to promote good sleep habits.

If you are having difficulty establishing a routine for both you and baby, please contact Healthy Babies, Happy Moms, Inc. for a sleep consult.

How can I work outside the home and continue to breastfeed?

If you plan to work outside the home and be away from your baby, but want to continue to exclusively breastfeed, you will need to use a breast pump. We recommend using a double electric breast pump, as it saves time, and does the best job of maintaining your milk supply. You will need to pump while you are at work at the same time you would be feeding your baby if you were at home.

Can I get a flu shot while I am breastfeeding?

Yes, you can. According to the CDC it is recommended that everyone over 6 months of age receive a flu shot. If you have questions or concerns please ask your health care provider.

Does a breastfed baby need vitamins?

Questions regarding Iron and Vitamin D are the most common.

The AAP recommends a daily intake of Vitamin D of 400IU per day for all infants and children beginning in the first few days of life.

According to Dr. Jack Newman, “a baby who is exclusively breastfeeding needs no extra iron until six months of life, more or less. The best way for a 6 month old baby to get iron is through his food, and the easiest way for a baby to increase his iron intake is through meat.”

Can I take medication while breastfeeding?

Almost all medications will have a statement somewhere on their packaging that states “Do not take if you are pregnant or breastfeeding unless under the advice of a physician.” This makes most mothers think that they should not take anything when nursing.

The reality is, according to Dr. Thomas Hale, Ph.D., “that babies get approximately 1% of the total maternal dose of a drug.” He has written a very thorough book, Medications and Mother’s Milk, that lactation consultants, physicians and pharmacists can refer to in order to help determine the risk to an infant from maternal medications. Before taking any medications, or quitting breastfeeding altogether because of medications you need to take, talk to a professional with access to that resource.

What is a nursing strike?

A nursing strike is a when a baby very suddenly refuses to nurse. It is different from weaning in that weaning is usually a gradual process. Nursing strikes typically occur in babies that are 6-12 months old. It is sometimes caused by illness, separation from the mother, a change in the taste or supply of the milk, or teething. The baby usually resumes nursing but it may take a few days and sometimes as much as two weeks to get back to normal. In the meantime, continue to offer the breast and pump if the baby refuses so that you maintain your supply. Many mothers have the best luck getting their babies to nurse when they are sleepy. Provide the baby with plenty of opportunities to drink from a cup, rather than a bottle, so he/she stays well hydrated. Most importantly, do not take it personally, just be patient and know that this too will pass.

How can I tell if my baby is having a growth spurt?

During a growth spurt, babies nurse very frequently. In fact, it may seem like all you do in nurse, and you may feel as though your breasts are completely empty. Your baby may be fussy and never seem satisfied. This usually lasts a couple of days and (fortunately!) is either preceded or followed by a lot of sleep.

Growth spurts typically occur around three weeks, six weeks and three months of age. It is important to remember that your baby is trying to increase your milk supply to accommodate his/her growing body and appetite. Unfortunately, many mothers interpret this increased demand as a sign that they are not making enough milk, and offer formula. The baby then nurses less, the mother makes less milk, and then needs to give bottles because her supply is decreasing.

If you can recognize this behavior for what it is, and just know that you will need to spend a few days nursing your baby, you will usually have a very happy baby when it is over with! And one that sleeps a little longer between feedings too!

Do I have to use a breast pump in order to breastfeed successfully?

No. Breast pumps are a wonderful invention and a great convenience.

In order to maintain your milk supply, you will need to pump or hand express if you are separated from your baby during a feeding time (i.e. work, school, maternal or infant illness).

Should I be breastfeeding my baby if I am sick with a virus or bacterial infection?

Yes, for the majority of infections, you can continue breastfeeding. Your baby has probably already been exposed to your infection and the antibodies in your milk will offer the baby protection against whatever illness you have. If you have concerns about a specific infection, please consult you health care provider.

Practice good hand washing and avoid coughing or sneezing on the baby. Drink plenty of fluids and nurse as much as the baby wants to.

Refer to Medications and Mother’s Milk by Thomas Hale Ph. D. regarding any medications you may need to take during the illness.