Breast-Feeding

Topic Overview

What is breast-feeding?

Breast-feeding is feeding a baby milk from the mother's breasts. You can feed your baby right at your breast. You can also pump your breasts and put the milk in a bottle to feed your baby. But pumping does not help keep up your milk supply as much. Doctors advise breast-feeding for 1 year or longer. But your baby benefits from any amount of breast-feeding you can do.

Breast milk is the perfect food for your baby.¹ Breast milk is the only food your baby needs until about 4 to 6 months of age. You do not need to give your baby food, water, or juice. After that, you will gradually breast-feed less often as your baby starts to eat other foods. But keep breast-feeding for as long as you and your child want to. Your baby continues to get health benefits from breast milk past the first year.

Breast-feeding lowers your child's risk for many types of infections and allergies. Breast milk may also help protect your child from some health problems, such as eczema, obesity, asthma, diabetes, and possibly high blood pressure.^{2, 3, 4, 5, 6}

To compare, baby formula does not help protect a baby from infections and other health problems.

You may recover from pregnancy, labor, and delivery sooner when you breast-feed. You may also lower your risk for breast cancer and for diabetes later on in life.^{7, 8}

Is breast-feeding hard to do?

Breast-feeding is a learned skill-you will get better at it with practice. You may have times when breast-feeding is hard. The first 2 weeks are the hardest for many women. But stick with it. You can work through most problems. Doctors, nurses, and lactation specialists can all help. So can friends, family, and breast-feeding support groups.

How do I plan for breast-feeding?

Before your baby is born, plan ahead. Learn all you can about breast-feeding. This helps make breast-feeding easier.

• Talk to your doctor about breast-feeding. Schedule an exam with your doctor early in your pregnancy. Before your first visit, write down any questions or concerns that you have about breast-feeding. This will help you to remember to talk about them with your doctor. Make sure your doctor knows about any breast reductions, implants, biopsies, or other types of breast surgery you have had.
• Learn how to breast-feed. The staff at hospitals and birthing centers can connect you with people called lactation specialists who can help you learn how to breast-feed. While you are pregnant, you can take a breast-feeding class. Also, get a breast-feeding book for quick reference. Ask your doctor for ideas.
• Plan ahead for times when you will need help. Think about who you could talk to or have come over to help you succeed with breast-feeding after your baby is born. Many women get help from friends and family. Before you have your baby, talk to friends and family members about your plans to breast-feed and how their support is important to you. Also think about joining a breast-feeding support group. After your baby is born, you may feel more "connected" if you talk with other breast-feeding mothers. You may also help each other answer questions about breast-feeding issues.
• Buy breast-feeding equipment. You may need breast-feeding supplies after your baby is born. For example, breast pads, nipple cream, extra pillows, and nursing bras are all helpful. You can buy these items ahead of time. It is also a good idea to buy or rent a breast pump to have on hand when you bring your baby home. Pumping your breasts can help relieve pain and pressure when your milk comes in. And it lets you store extra milk for future use.

How often do I need to feed my baby?

Feed your baby whenever he or she is hungry. In the first 2 weeks, your baby will breast-feed about every 1 to 3 hours. This schedule can make you very tired. But know that your baby will soon start eating more at each feeding, and you will not need to breast-feed as often.

Plan for times when you will be apart from your baby. Use a breast pump to collect breast milk ahead of time. You can store milk in the refrigerator or freezer for times when someone else will be taking care of your baby.

When I breast-feed, can I eat and drink like I did before I was pregnant?

Anything you put in your body can be passed to your baby in breast milk. If you are breast-feeding, do not drink alcohol, take drugs, or smoke. Before you take any kind of medicine, herb, or vitamin, ask your doctor if it is safe.

When should I call my doctor?

Talk to your doctor right away if you are having problems and are not sure what to do. Do not be afraid to call even if you don't quite know what it is that is bothering you. Your doctor is used to parents of newborns calling. He or she can help you figure out if there is a problem, and if so, how to fix it.

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	Breast-feeding: Learning how to nurse

What Is Normal

Benefits of breast milk

Breast-feeding is a natural way to nourish your baby. Breast milk provides your baby with unique nutritional and health benefits, such as:

• Antibodies to strengthen the immune system.
• A reduced risk for eczema.²
• A reduced risk for asthma.³
• Fewer gastrointestinal illnesses (vomiting and diarrhea).
• A possible lower risk of food allergies.
• A reduced risk for becoming obese later in infancy and during childhood.^{9, 10, 11}
• A reduced risk for developing diabetes.⁴
• A reduced risk for high cholesterol later in life.¹²
• A possible reduced risk for high blood pressure later in life.^{6, 5}
• Fewer doctor visits and less chance of needing hospitalization because of infection.¹³

To compare, baby formula does not help protect a baby from infections and other health problems.

Feeding your baby milk at the breast offers the added convenience of having a ready food source at all times that does not require special preparation.

How breast-feeding affects the mother

Soon after your baby is born, breast-feeding helps your body recover from the stresses of pregnancy, labor, and delivery. Breast-feeding also lowers your risk for developing breast cancer.⁷ The longer you breast-feed, the more this risk is reduced.⁷ It may also lower your risk for getting diabetes later on.⁸

Your body produces the hormone prolactin, which prepares your body for breast-feeding during pregnancy. After your baby is born and the placenta is delivered, prolactin immediately stimulates milk production. The amount of prolactin you produce depends on how often you breast-feed: the more often you breast-feed, the more prolactin your body generates, and the more milk your breasts make. This is why it's so important to breast-feed every 1 to 3 hours in the first days after the birth.

Breast-feeding also stimulates your body to release oxytocin, which helps your uterus contract, bleed less, and return more quickly to its prepregnancy size. You may feel these contractions occur in the first few hours after birth, which are known as afterpains. The contractions may be slightly uncomfortable and last for a day or two.

Oxytocin also stimulates the let-down reflex, which occurs just before or soon after feeding or pumping begins. Let-down is often described as a tingle or an ache. If this is your first baby, you may not notice this sensation for the first few weeks.

Your body's hormones stabilize when your baby is about 3 months of age. At this time, you begin to lose the full feeling in your breasts between feedings. Your milk supply should remain the same even with this change.

The breasts first produce colostrum, followed by transitional milk after a few days. Mature breast milk usually is produced about 10 to 15 days after delivery. This milk contains about 50% fat calories, 45% carbohydrate calories, and 5% protein calories. Most of the carbohydrate is milk sugar (lactose), which helps babies absorb calcium.

You may find that losing weight is easier with breast-feeding. However, weight loss rates after delivery vary among women. Focus on eating a balanced diet to get adequate vitamins and minerals needed for breast-feeding. Eat an additional 500 nutrient-rich calories a day over the recommended amount for nonpregnant women of your height and weight; this is 200 calories over your recommended calorie intake during pregnancy. Talk with your doctor about continuing to take your prenatal vitamins while breast-feeding.

You can quickly become exhausted during your baby's first weeks. Allow others to help you when possible, so you can focus on breast-feeding and can nap with your baby.

You are not likely to become pregnant in the first 6 months of exclusive breast-feeding (which means you are feeding your baby on demand and not using formula, food, or water to supplement his or her diet). However, talk with your doctor about birth control while breast-feeding if you want to ensure that you do not get pregnant right away. After your baby is 6 months of age, you need to use a birth control method if you want to avoid pregnancy, regardless of whether you are breast-feeding exclusively.

Problems such as sore or cracked nipples, blocked milk ducts, or breast infection (mastitis) sometimes occur while breast-feeding. Most of these conditions are minor, easily treated, and do not significantly interfere with breast-feeding. For more information, see the Home Treatment section of this topic.

Some women notice that they become aroused during breast-feeding. Although this sensation is similar to a sexual response, it is not sexually driven. It is your body's way of preparing for breast-feeding. Do not worry or be ashamed if this happens to you.

Learning how to breast-feed

To breast-feed properly and prevent problems, you will need to learn basic breast-feeding techniques, including proper latch-on . Basic breast-feeding positions include:

• Cradle hold .
• Cross-cradle hold .
• Football hold .
• Side-lying position .
• Australian hold .

Focus on the following as you start to breast-feed:

• Try different positions to find those that are most comfortable for you and your baby. For example, use the cross cradle hold at one feeding, and the football hold at the next. Feeding in different positions may reduce nipple soreness.
• Keep your baby's head and chest facing your chest so your baby's body is aligned straight and his or her mouth is positioned right in front of your nipple.
• Start each new feeding with the opposite breast you started with at the last feeding. This routine helps you to empty each breast well.

Many hospitals and birthing centers have lactation consultants available to help you learn these positions and techniques. If a lactation consultant is not available during your hospital stay, check into breast-feeding support resources in your community. Early assistance is the key to breast-feeding success.

Women who have had a cesarean delivery may prefer positions in which the baby doesn't rest on the abdomen, such as the side-lying position or the football hold.

Breast-feeding: Learning how to nurse

Newborn feeding schedules

After you deliver your baby, plan on breast-feeding within the first hour and with skin-to-skin contact. Talk to your doctor and hospital staff ahead of time about this strategy. Usually this request can easily be met unless the baby has a health issue that needs to be addressed first.

The general recommendation is for newborns to breast-feed on demand. This means to follow your baby's cues, such as eagerly sucking on fingers or rooting, to know when he or she wants to feed rather than following a schedule. Feeding the baby directly at the breast is the best way to maintain milk production. This means you breast-feed whenever your baby appears to be hungry, rather than setting a strict schedule. This strategy helps you produce more milk and ensures that the baby is well nourished.

During the first few days or weeks, on-demand feedings occur every 1 to 3 hours (about 10 to 12 sessions in a 24-hour period). You may have to wake a sleepy baby to feed in the first few days after birth. These early feedings often are short; sometimes a newborn breast-feeds for only a few minutes on each breast or only on one breast. These feedings are important to increase your milk supply over the first few days. It is important to let your baby breast-feed at least 15 minutes on a breast. This allows your baby to get the foremilk, which has water and needed nutrients, and hindmilk, which has more fat and calories to satisfy your baby's appetite. Over time, feeding sessions will become longer.

It is normal for a baby to lose up to 10% of his or her birth weight within the first week. By 2 weeks of age, newborns should weigh as much or more than they did at birth.

Your milk supply increases as your baby's needs increase. You may be surprised at the number of diapers your newborn goes through every day. Newborns younger than 2 weeks should have at least 1 or 2 bowel movements a day. Babies older than 2 weeks can go 2 days and sometimes longer between bowel movements. It's usually okay if it takes longer than 2 days, especially if your baby is feeding well and seems comfortable.

The number of diapers a newborn wets is sometimes difficult to determine because disposable diapers are so effective at wicking moisture. In general, however, during the first week your newborn normally has at least 2 or 3 wet diapers a day. After that, your baby will have at least 6 to 8 wet diapers a day.

Breast-feeding through the first year

At around 3 months of age, feedings become quicker and less frequent. Your baby is able to drink more milk at one time and your body naturally and easily adjusts. However, your baby's feeding patterns often fluctuate within the first 6 months. Needs typically increase during growth spurts, which usually occur around the following ages:

• 10 days to 2 weeks
• 5 to 6 weeks
• 2½ to 3 months
• 4½ to 6 months

During growth spurts, your baby may seem to be hungry every 1 to 2 hours. By feeding your baby on demand, your milk supply increases. After about 2 to 4 days, you will have increased your milk supply at each feeding to satisfy your baby for a longer period. The number of feedings will then gradually decrease.

Doctors usually recommend against supplementing during the first 6 months. This means that you do not supplement your breast-fed baby's diet with formula, food, or water, even during a growth spurt. Doing so can decrease your milk production. Early bottle feedings can also make it more difficult for your baby to latch on to your breast.

Research shows that feeding a baby only breast milk for his or her first 6 months provides all the needed vitamins, minerals, and antibodies.¹⁴ But to help prevent rickets and other diseases, most doctors suggest daily vitamin D supplements for children, starting by age 2 months. Talk with your doctor about how much and what sources of vitamin D are right for your child. Vitamin D for babies is usually a liquid supplement that you add to a bottle of breast milk with a dropper or drip into your baby's mouth.

The American Academy of Pediatrics recommends that you breast-feed until your baby is at least age 1. When your baby is 6 months of age, you can start slowly adding iron-fortified foods along with other foods to his or her diet.

By the age of 1 year, your baby may only breast-feed twice a day. The health and nutritional advantages of breast-feeding are not limited to one year. If you choose to breast-feed for longer, your baby will continue to benefit. If you are unsure about whether you want to start weaning your baby, talk with your doctor.

Common Concerns

You may sometimes doubt your ability to successfully breast-feed. It is common to have questions and occasional struggles. Remember, most breast-feeding issues are easily resolved when you know what to expect and have support from others.

Getting started and keeping it up

You may be unsure about how to begin breast-feeding. A lactation consultant is available at many hospitals and birthing centers. These consultants help you and your baby learn good breast-feeding techniques, such as getting a good latch and learning a variety of feeding positions.

Unless your baby is born needing immediate medical care, it is best to begin breast-feeding within 1 hour of birth. Also, immediate skin-to-skin contact with your baby after delivery may help promote long-term and successful breast-feeding.

With practice, you will get better at using the basic breast-feeding positions.

• Cradle hold
• Cross-cradle hold
• Football hold
• Side-lying hold
• Australian hold

Try alternating feeding positions to encourage complete emptying of your breasts. Using different holds can help prevent you from developing plugged milk ducts.

Women who have had a cesarean delivery may prefer positions in which the baby doesn't rest on the abdomen, such as the side-lying position or the football hold.

Because the first 2 weeks of breast-feeding often are the most challenging, you may question your ability to continue. Your body is recovering from childbirth and adjusting to hormonal changes that can exhaust you and make you feel overwhelmed. You may also struggle with minor problems, such as nipple soreness or breast engorgement, that may make breast-feeding uncomfortable.

With proper planning, preparation, and support, you can breast-feed successfully. Physical conditions that may interfere with breast-feeding usually are minor, treatable, and temporary. For example, if you feel that you don't have enough milk, your health care professional can help you solve the problem.

Breast-feeding: Learning how to nurse

Your milk supply and your baby's growth

During the first few weeks, you may have concerns about whether you are producing enough breast milk for your baby. The key to increasing breast milk production is emptying your breasts well and frequently. This means breast-feeding every 1 to 3 hours. Frequent breast-feeding increases your prolactin levels, which stimulates the breasts to produce more milk.

Most babies lose weight in the first several days after birth but regain it within a week or two. Weight gain is more rapid after mature milk is produced, about 10 to 15 days after you deliver your baby. After breast-feeding is established, your baby will also get more hindmilk, which provides additional fat and calories. Look for signs that your baby is getting enough milk and is growing well. If you continue to have concerns, see the When to Call a Doctor section of this topic.

If you are unsure whether your baby is getting enough milk, talk to your doctor. He or she can help you to determine the problem, if one exists. Do not supplement your breast-fed baby's diet with formula unless your doctor recommends it. Extra feedings with formula can interfere with your breast milk production and may lead to early weaning.

Typical bowel patterns of a breast-fed baby

Breast-fed babies usually have a small stool after every feeding for about the first 4 to 8 weeks. Stools are yellow, seedy-looking, and soft or runny. Gradually the pattern changes, and your baby will start to have larger stools. Newborns younger than 2 weeks should have at least 1 or 2 bowel movements a day. Babies older than 2 weeks can go 2 days and sometimes longer between bowel movements. It's usually okay if it takes longer than 2 days, especially if your baby is feeding well and seems comfortable.

Your health and breast-feeding

Almost all mothers of newborns are able to breast-feed. However, talk to your doctor before breast-feeding if you:

• Have a chronic or infectious disease. Women living in developed countries who are HIV-positive should not breast-feed. Women who have conditions such as cystic fibrosis need to be monitored while breast-feeding.
• Use medication. Talk with your doctor before taking any nonprescription or prescription medication to ensure that your breast milk will not be affected.
• Have had breast surgery. If you have had breast reduction, augmentation, or biopsy, you will need to be closely and consistently monitored when you begin breast-feeding. Any of these surgeries may affect your ability to produce breast milk. Before your baby is born, talk to your doctor about any breast surgery you have had.
• Use drugs or abuse alcohol. Any substance that you use while breast-feeding, including smoking, can harm your baby.
• Have a minor illness. You can continue breast-feeding when you have a minor illness (such as the flu or a cold). Try to rest as much as you can and drink fluids. A mother's health very rarely interferes with breast-feeding. You should not breast-feed if you have active tuberculosis, HIV, or cancer that is being treated with chemotherapy. Talk to your doctor if you have any questions or concerns about breast-feeding when you are sick or if you need to take prescription or over-the-counter medications for your symptoms.

While you are breast-feeding, take extra care to avoid exposure to poisonous substances, such as fish that may contain mercury. Some of these substances can be passed on to your baby through breast milk.

Breast-feeding your sick baby

Breast-feed your baby who is ill whenever possible. Breast milk provides antibodies, nutrients, and fluids that are important for recovery. For more information, see the When to Call a Doctor section of this topic.

Some babies are born with problems that interfere with their ability to breast-feed right away. However, many of these babies can be fed breast milk using special techniques, such as cup-feeding or a feeding device called a supplemental nursing system. Circumstances that may delay feeding at the breast include:

• Premature birth. Premature babies often can be fed breast milk from a cup or with a supplemental nursing system. You may need to pump frequently to get your milk production started.
• Metabolic disorders.
• Cleft lip or cleft palate. If your baby is born with a cleft lip or palate, a lactation consultant may teach you ways to breast-feed, or breast milk can be fed to your baby using a bottle and special nipple.
• Low Apgar scores, which usually result in only a minor delay.

In rare cases, a breast-fed baby develops a sensitivity that shows up after the mother has eaten food that contains cow's milk or other dairy products. If a sensitivity is diagnosed by your doctor, continue breast-feeding while avoiding dairy foods. Talk to your doctor about proper food choices and other suggestions for a baby with this problem.

Breast appearance

Many women notice differences in how their breasts look and feel while during pregnancy and after having a baby. Initial changes (such as breast enlargement) are related to the body's preparation for milk production. Other changes, such as a darker color and increased size of the areola (the dark circle around the nipple) and more prominent nipples, are sometimes permanent. Changes generally are minor and result from pregnancy, not breast-feeding. Some changes, such as sagging, are influenced by heredity, the type of bra you wear, and the effects of aging.

Going back to work or school

Being away from your baby for long periods when you work or go to school requires planning and support for long-term breast-feeding success. Some workplaces allow women to have their newborns with them at work. For most, this is not an option. If you will be at work without your baby, be sure to select a breast pump that is convenient and comfortable. Explore your options for using a comfortable and private area at work or school to pump. Many workplaces and colleges have areas set aside for mothers to pump. Regular pumping is necessary to ensure that your breasts produce enough milk and to prevent your breasts from becoming uncomfortable and engorged. Consider how to properly store breast milk both at work and at home.

If possible, you may want to consider going to school or working part-time or three-quarter time for at least your baby's first year. Or you may want to investigate whether a flexible working schedule is possible. For example, depending on your type of position, some employers may allow you to work some hours at home.

Routine Checkups

Prenatal visits

At your prenatal visits, talk to your doctor about your plans to breast-feed. Make sure he or she is knowledgeable and is able to guide you through the planning and initiation process. Ask for recommendations on books, classes, or support groups. You may also be referred to a lactation consultant.

A breast exam is a routine part of all first prenatal visits. Breast lumps and cysts will be evaluated to give your doctor a baseline from which to monitor any future changes in your breasts. Your nipples will also be examined. This helps your doctor to identify physical traits, such as inverted nipples, that may require special preparation for breast-feeding.

Talk to your doctor about how to handle any chronic health condition you have and how it might affect breast-feeding. Also ask about any medications you take (both prescription and nonprescription) and whether they are safe to continue during pregnancy and breast-feeding.

Prenatal visits are a good time to talk to your doctor about where to have your baby. Check the breast-feeding policies of the hospital and birthing centers you are considering. It is much easier to breast-feed when you are in a supportive environment, such as a facility that has a lactation consultant on staff, encourages keeping the baby in the room with you (rooming in), and has a policy of not supplementing your baby's diet, even within the first 3 to 4 hours after a cesarean delivery, unless medically necessary.

After your baby is born

The doctors at the hospital or birthing center will help you to initiate breast-feeding, ideally within the first hour of your baby's life. Often a lactation consultant is available to help you throughout your stay and can be contacted after you return home. Lactation consultants are an important resource to reassure you and help you promptly address any problems.

Your baby should have a well-baby checkup before 1 or 2 weeks of age. The following will be assessed:

• Growth, including weight, length, and head size
• Activity level
• Breast-feeding patterns and whether you are having any problems

Call your doctor at any time you feel you need breast-feeding support. If possible, make an in-person visit with your baby or have someone knowledgeable about breast-feeding come to your home.

You will also have a postpartum exam scheduled approximately 6 to 8 weeks after giving birth. Although most breast-feeding issues are resolved by this time, this appointment offers you another opportunity to talk about any related problems or concerns. It is also a time to discuss birth control while breast-feeding.

When To Call a Doctor

During pregnancy

Prenatal visits are a good time to talk to your doctor about your breast-feeding plans. Ask about breast-feeding classes and other resources, such as a breast-feeding support group.

If you develop any unusual lumps or cysts in your breast, have them evaluated by your doctor. Although you can expect some breast changes (such as increased size and tenderness) during pregnancy, talk to your doctor if you have a concern.

While breast-feeding

It is important to talk to your doctor before taking any medication, whether it is prescription or nonprescription. Most problems that require medication can be treated with one that is safe to take while breast-feeding. The mild pain relievers acetaminophen (Tylenol) or ibuprofen (Advil or Motrin) are safe to take for pain or fever while breast-feeding.

Your doctor or a lactation consultant can help treat problems that may affect your breast-feeding experience. Call your doctor if pain persists after trying home treatment measures. For more information, see the Home Treatment section of this topic.

Talk to your doctor if you are consistently losing or gaining more than 1 lb (0.5 kg) a week.

A doctor can also treat a breast infection (mastitis) that can make breast-feeding difficult and painful. If you have these symptoms, you may need antibiotic medication to treat a bacterial infection or nystatin to treat a yeast infection on the breast's surface. If the yeast infection is in the ducts (ductule), you will need a different medication.

Call your doctor now if you have:

• Increasing pain in one area of the breast.
• Increasing redness in one area of the breast or red streaks extending away from an area of the breast.
• Drainage of pus from the nipple or another area of the breast.
• A fever of 101 °F (38.3 °C) or higher.

Call your doctor today if you have:

• Swollen glands (lymph nodes) in the neck or armpit.
• A fever less than 101 °F (38.3 °C).

Call your doctor in 24 hours if you have cracked and bleeding nipples after trying home treatment.

Also, breast-feeding problems may be exaggerated by postpartum depression. Many women experience some feelings of depression in the first few weeks after child birth. This is commonly known as the "baby blues," and it usually resolves on its own. However, some women's bodies respond to changing postpartum hormone levels with a lasting depression that requires treatment. Talk to your doctor if your baby is more than a few weeks old and you continue to have trouble sleeping (insomnia) or concentrating, or if you frequently feel sad, tearful, anxious, hopeless, or irritable.

Problems for the breast-feeding infant

Continue breast-feeding your sick baby. Breast milk is the best nutrition for your baby if he or she is vomiting or has diarrhea.

All babies, regardless of how they are fed, need close monitoring to ensure they are healthy and growing and developing normally. Call your doctor if your baby is not eating well for any reason or has any of the following symptoms:

• A rectal temperature higher than 100.4 °F (38 °C)
• Blue or very pale skin color, which may indicate anemia
• Yellowing skin tone, which may indicate jaundice
• Fussiness or sleepiness that interferes with breast-feeding
• Weakness, listlessness, or lack of interest in feeding
• Thick, white patches in the mouth and cheeks, which indicate a yeast infection (thrush), or signs of a diaper rash

Also, call your doctor if you do not observe any of the above symptoms, but you strongly feel that something about your baby is not right. Your baby is probably fine, but it is always best to follow through on your instinct.

Signs of poor eating in a baby include:

• Not reaching his or her birth weight by 2 weeks of age or other signs of insufficient weight gain.
• Wetting fewer than 6 diapers a day.
• Passing little or no stool in the first 4 weeks, or passing stools that are dark green and contain mucus after the first few days. However, it is normal for your baby to have fewer stools starting around 4 to 8 weeks of age. As long as stools remain soft and he or she is feeding well, it should not be a concern.
• Having problems latching on to the breast.

Who to See

Health professionals who can help you prepare for breast-feeding during pregnancy include:

• A nurse or nurse-midwife who is specially trained in caring for pregnant women.
• A lactation consultant.
• A family medicine doctor who treats pregnant women or infants.
• An obstetrician, or obstetrician and gynecologist (sometimes referred to as an "ob/gyn"), a doctor who cares for pregnant women and delivers babies.
• A pediatrician, a doctor who specializes in the care of children.

If you have special dietary needs, consider consulting a dietitian to help you plan healthy meals while you breast-feed.

Home Treatment

Learning how to breast-feed

In the first few days after delivery, breast-feed your baby every 1 to 3 hours even if you have to wake your baby. Frequent breast-feeding increases your prolactin levels, which stimulates your breasts to produce more milk.

You can help prevent and solve many problems when you become familiar with basic breast-feeding techniques, such as proper latch-on and feeding positions. The basic breast-feeding positions include:

• Cradle hold .
• Cross-cradle hold .
• Football hold .
• Side-lying position .
• Australian hold .

Alternate which breast you start with at each feeding. Also use a different position frequently. At first, you may change the hold you use each time you feed your baby. These practices help ensure that all areas of your breast empty well during the feeding. Using different positions and alternating breasts for each feeding may help to prevent sore nipples or blocked milk ducts.

Women who have had a cesarean delivery may prefer positions in which the baby doesn't rest on the abdomen, such as the side-lying position or the football hold.

The first few weeks of breast-feeding can be challenging because of the changes to your body and routine. With preparation and support, you can learn the skills necessary to breast-feed successfully.

Breast-feeding: Learning how to nurse

Treating early minor problems

Minor problems are common during breast-feeding. Most breast-feeding challenges can be solved at home with help from your doctor or lactation consultant as needed. These types of problems often include:

• Breast engorgement, which can cause painful breasts and flattened nipples, making it difficult for a baby to latch on for feeding. Gently massage your breasts and express or pump some milk to soften your nipple and areola before breast-feeding. This will help your baby latch deeper onto your breast, past your nipple and onto your areola. Wearing a supportive, well-fitting bra also may help, and applying cold compresses to your breasts occasionally after breast-feeding may reduce swelling and pain. For more information, see the topic Breast Engorgement.
• Sore or cracked nipples. You can help relieve the pain from sore or cracked nipples by rubbing a few drops of breast milk on the nipple and areola and allowing letting it dry completely. Try using a hair dryer on a low, cool setting to help your nipples dry more quickly. It may also help to apply pure lanolin cream on your nipples.
• Blocked milk ducts and mastitis. Blocked milk ducts may cause a painful lump in the breast. Untreated blocked milk ducts can lead to an infection, which will require a visit to your doctor. Massage the affected area toward the nipple before breast-feeding and during feeding. This simple measure can help release the milk plug. Also, this is one time you should always feed your baby on the affected side first. Your baby is usually more eager at the start of a feeding. The stronger sucking force helps empty the breast and unblock the duct.
• Poor let-down. Practice relaxation techniques; breast-feed in comfortable, quiet, and familiar spots; eat properly; and drink plenty of fluids. Your doctor may prescribe oxytocin if your let-down does not improve within a few days of starting breast-feeding.
• Breast milk leaking. Your let-down reflex may be stimulated unintentionally. Be prepared by using absorbent pads that you change frequently. You can use washable or disposable pads, but do not use pads that have a plastic backing.
• Low milk supply. More frequent breast-feeding usually helps increase your milk supply within 48 hours. You can also try pumping both breasts for 10 to 15 minutes each after you have just fed your baby. You should notice an increase in your milk supply after 2 to 4 days of the extra pumping. Other factors sometimes affect milk production; however, it is rare to have a true milk deficiency. Contact a lactation consultant if you think your milk supply is too low.

You usually can take acetaminophen (such as Tylenol) and ibuprofen (such as Advil) while breast-feeding to help relieve discomfort from some of these problems. However, talk to your doctor before taking any medication (prescription or nonprescription).

If problems persist or symptoms are severe, talk to your doctor. For problems related to technique or positioning, you also can talk to or visit a lactation consultant.

Breast infections are treated with prescription medications and home treatment measures. Infections that sometimes occur with breast-feeding include:

• A yeast infection, which may affect you and your baby. The baby often has white patches in his or her mouth (thrush) or a diaper rash, while your nipples may be extremely sore. You may also experience stabbing pains in your breast, especially as you start to breast-feed and in between feedings. You and your baby must both be treated with medication for a yeast infection.
• Mastitis, which may cause a fever, flu-like symptoms, and pain in the breast with an inflamed, red, dimpled, or swollen area. An untreated infection may lead to an abscess, which can cause a firm, often painful mass in the breast. For more information, see the topic Mastitis.

Established breast-feeding

After you have established a routine, breast-feeding becomes easier. However, you may face situations that can periodically present challenges to your normal breast-feeding routine such as storing breast milk. These situations include:

• Returning to work outside the home. Plan ahead and think about how you can successfully incorporate breast-feeding into your work schedule.
• Teething. When your baby's primary teeth start to come in, usually between 6 and 12 months of age, you both have to make a few adjustments. Your baby may have a temporary loss of appetite because his or her mouth is sore. Teething babies may bite the breast, not knowing that it causes pain. Usually, a firm "no" and a stern expression are enough to control this behavior. It may also help to stop breast-feeding when your baby is finished actively eating and then give him or her cold teething items to chew on.
• Illness. When your baby has a minor illness, such as a cold or flu, continue breast-feeding. Breast milk is still the best nourishment. If your baby is unable to eat as usual, use a breast pump to express milk at your regular feeding times. However, make sure your baby does not become dehydrated. Sometimes a sick baby will cup-feed breast milk if he or she won't take the breast. Be sure to take your baby to a doctor if symptoms continue or become worse. For more information, see the When to Call a Doctor section of this topic.
• Digestive problems. Some babies develop a cow's milk protein sensitivity. If this occurs, stop milk and dairy products in your diet. Talk to your doctor about when to reintroduce these foods into your diet.
• Travel. Plan ahead to include times and places for breast-feeding your baby or pumping your breasts.

Other factors that can affect breast-feeding include:

• Your approach to weight loss while breast-feeding. Weight loss should be gradual and not compromise your health or your baby's health. Focus on eating a balanced diet that includes enough calories.
• Your activity and rest. Getting exercise and adequate rest are both important for your recovery from pregnancy and for optimal breast-feeding.
• Your support. Although the first 2 weeks of breast-feeding usually are the most challenging, you may have other times when you need extra help. Have people you can contact, such as friends and family who have breast-fed or a lactation consultant. Other support is available through local hospitals or clinics and support organizations, such as La Leche League. For more information, see the Other Places to Get Help section of this topic.

Also, consider the following while you are breast-feeding:

• It can take time to resume a sexual relationship with your partner. Use birth control methods if you want to lower your pregnancy risk. Women who are breast-feeding can still become pregnant.
• Be careful about being exposed to poisonous substances while breast-feeding.

Special circumstances and breast-feeding

• Breast-feeding during pregnancy can be continued unless you are at risk for preterm labor. You will have special dietary needs to address and possibly more noticeable fatigue and nausea.
• Breast-feeding multiple-birth infants is possible but can be physically and emotionally challenging.
• Breast-feeding both a newborn and an older child is possible. However, the youngest should have priority. This is critical during the first few days, when your newborn needs your colostrum.
• Supplementation is sometimes needed for healthy babies, such as when the mother does not eat meat or dairy products, or they do not live in an area with fluoridated water. Most doctors suggest daily vitamin D supplements for children, starting by age 2 months. Talk with your doctor about how much and what sources of vitamin D are right for your child.
• Relactation, which is stimulating your body to again produce breast milk and start breast-feeding or taking measures to stimulate your body to produce breast milk when you have not been pregnant recently (such as for an adopted baby). Although relactation is difficult, your chances of success increase if you have previously breast-fed.
• Cup-feeding your baby may be recommended if your baby is unwilling or unable to feed from the breast or requires supplementation. This technique may be used for both premature and full-term infants. It may be tried as an alternative to bottle-feeding (which may interfere with breast-feeding later) or to inserting a feeding tube in a baby's stomach.

Weaning

It is best for you and your baby if you continue breast-feeding for a full year. If you continue to breast-feed beyond 1 year, your baby will continue to benefit. After the first year, look for signs that your baby is ready to wean. Talk to your doctor if you have questions about weaning.

Whenever you decide to wean, keep in mind the following:

• Suddenly stopping breast-feeding may be harder for both you and your baby than a gradual decrease in feeding frequency.
• If you stop breast-feeding before your baby is 12 months old, gradually introduce a formula. It may take some time to find the formula that is best for your baby.
• If you stop breast-feeding when your baby is between 6 and 12 months of age, talk to your doctor about how to incorporate an appropriate diet. For example, you may need fewer formula feedings and more cereals; or your baby may be able to use a non-spill cup instead of a bottle.
• The longer you breast-feed, the fewer side effects you will feel from weaning (such as engorgement). Home treatment to reduce discomfort caused by weaning includes applying cold compresses on the breasts, hand expressing or pumping small amounts of milk for comfort, and taking nonprescription pain relievers (such as acetaminophen or ibuprofen).
• Your baby may show a few signs of readiness and still not respond to your attempts to wean. If this is the case, try feeding your baby in a dimly lit, quiet, and private place. This may make your baby lose interest because it is an environment that lacks stimulation and interaction, which is often what he or she seeks when breast-feeding or bottle-feeding.

Other Places To Get Help

Online Resource

Organizations

Related Information

• Avoiding Mercury in Fish
• Bottle-Feeding
• Breast Engorgement
• Growth and Development, Ages 1 to 12 Months
• Growth and Development, Newborn
• Jaundice in Newborns (Hyperbilirubinemia)
• Labor, Delivery, and Postpartum Period
• Mastitis While Breast-Feeding
• Tongue-Tie
• Weaning

References

Citations

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2. Gdalevich M, et al. (2001). Breast-feeding and the onset of atopic dermatitis in childhood: A systematic review and meta-analysis of prospective studies. Journal of the American Academy of Dermatology, 45(4): 520-527.

3. Dell S, To T (2001). Breastfeeding and asthma in young children. Archives of Pediatrics and Adolescent Medicine, 155(11): 1261-1265.

4. Owen CG, et al. (2006). Does breastfeeding influence the risk of type 2 diabetes in later life? A quantitative analysis of published evidence. American Journal of Clinical Nutrition, 84: 1043-1054.

5. Martin RM, et al. (2004). Does breast-feeding in infancy lower blood pressure in childhood? The Avon Longitudinal Study of Parents and Children (ALSPAC). Circulation, 109(10): 1259-1266.

6. Martin RM, et al. (2005). Breastfeeding in infancy and blood pressure in later life: Systematic review and meta-analysis. American Journal of Epidemiology, 161(1): 15-26.

7. Collaborative Group on Hormonal Factors in Breast Cancer (2002). Breast cancer and breastfeeding: Collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries, including 50,302 women with breast cancer and 96,973 women without the disease. Lancet, 360(9328): 187-195.

8. Stuebe AM, et al. (2005). Duration of lactation and incidence of type 2 diabetes. JAMA, 294(20): 2601-2610.

9. Hediger ML, et al. (2001). Association between infant breastfeeding and overweight in young children. JAMA, 285(19): 2453-2460.

10. Gillman MW, et al. (2001). Risk of overweight among adolescents who were breastfed as infants. JAMA, 285(19): 2461-2467.

11. Grummer-Strawn LM, Mei Z (2004). Does breastfeeding protect against pediatric overweight? Analysis of longitudinal data from the Centers for Disease Control and Prevention Pediatric Nutrition Surveillance System. Pediatrics, 113(2): e81-e86.

12. Singhal A, et al. (2004). Breastmilk feeding and lipoprotein profile in adolescents born preterm: Follow-up of a prospective randomised study. Lancet, 363(9421): 1571-1578.

13. Talayero JMP, et al. (2006). Full breastfeeding and hospitalization as a result of infections in the first year of life. Pediatrics, 118(1): 92-99.

14. Kramer M, Kakuma R (2006). Optimal duration of exclusive breastfeeding. Cochrane Database of Systematic Reviews (1). Oxford: Update Software.

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