Breast Feeding Techniques
By Dr. Brown
We have found these suggestions for breast-feeding helpful to thousands of patients. Please review them to optimize feeding for your baby or babies.
Infants who are ideally fed will:
Lose less weight in the first few days of life before regaining back to and beyond birth weight. This weight loss may be up to ten percent of their birth weight. Please note that the typical reason for weight loss is all the bowel movements and wet diapers that babies have in the first few days.
Be happier with less crying per day.
Tend to be less jaundiced (yellow) because the more they eat the more they pass stool and excrete Bilirubin (the chemical that causes jaundice) from the body.
To feed ideally consider the following information:
After three minutes of actively suckling at the breast, the infant has swallowed 75% of the milk from that breast. By five minutes, the baby has gotten 90%. You can hear what your infant does by listening to the swallow noise they make.
Initially, ten to twelve feedings in 24 hours is ideal. Less than this makes for crankier kids and more jaundiced (yellow) infants. High concentrations of Bilirubin can cause injury to the brain.
Although many authorities talk about the "hind milk", (the milk after 20 minutes of constant nursing on one side), as being very rich in calories, it is our experience that nursing this long may tire the baby out and they never get to the second side. This then means they fall asleep and generally wake in about an hour to go for the second side. You can see that means many more hours spent feeding, and maybe not enough time to do the enjoying your baby part! If the infant is not vigorous enough to nurse for 20 minutes on a side and after a few days many are not, they simply do not get to the second side.
If the baby only nurses on one side during a feeding, the full breast also seems to signal back to the mom's brain to make less milk. OOPS! This sets up a cycle of less and less milk, sabotaging nursing success. Therefore the goal is to nurse on both sides each feeding.
The true breast milk "comes in" around 3-5 days of life in the first time mother. Generally it will arrive a day sooner with subsequent babies. It also comes in sooner if you have been nursing 10-12 times in 24 hours. You can do the math and figure out how often that is!
Moms who are dehydrated make less milk, period. DRINK. Since your kidneys are "on the job" right now, listen to what they have to say. You know your urine should be clear or pale yellow. If mom's urine is dark yellow in color, she needs to drink more.
If you think your baby is continuing to lose weight or not doing well, please check in with us!!!! It's always better to play it safe than sorry!
So here are our suggestions for successful nursing
1. Feed each time on both breasts. Begin on one side for 5-10 minutes. If the baby tends to fall asleep before the 10 minutes, plan on shortening the first side to 5-7 minutes next time. For now, if they want to fall asleep on the second side in search of the coveted hind milk, this is okay. In a few weeks, we will suggest not using the feeding as a way to induce sleep however. Then we will talk about allowing them to learn how to fall asleep by themselves to become "independent sleepers".
2. Alternate starting sides. Many moms find it helpful to put a safety pin on the starting side of the brassiere. Sleep deprivation and raging hormones make fuzzy memory common.
3. Different positions on the breast also decrease pain, bleeding and infections of the breast. Try the cross the lap position, the football carry and lying in bed side by side.
4. Feed every 2-2 1/2 hours from the beginning of a feeding to the beginning of the next feeding.
5. Drink 8-12 ounces of water, juice or milk each time you nurse your baby. The fluid you drink now will help you make more milk for the next feeding. PLEASE INCLUDE A SOURCE OF FLUORIDE IN YOUR DIET AS THIS WILL HELP TO BUILD STRONG TEETH FOR YOUR BABY. MOST BOTTLED WATERS HAVE NONE. CHICAGO HAS GREAT WATER AND TAP WATER HAS A PERFECT AMOUNT OF FLUORIDE HERE. THIS IS EASY, VERY CHEAP,YOU WILL SPEND LESS WITH THE DENTIST FOR DECADES AND IT IS "ENVIRONMENTALLY GREEN"!!!
6. Hypothermia in the infant is common but not good for the baby. 98.6 degrees rectally is normal. When the body temp is lower, the child usually is overly sleepy and feeds poorly. Armpit temps and ear temps are unreliable so please take it rectally. Use a bit of lubricant like Vaseline and put the thermometer in the rectum to about one inch. We suggest marking the one-inch mark on the thermometer with a Sharpie marker and when it is inside the rectum you know that you are in far enough. To re-warm a baby, get naked in the bed for 5 minutes and then strip the baby to just a diaper and have skin to skin contact in the bed for a few minutes. Then redress the baby with more clothes and remember the hat. You may need to increase the room temp if the baby continues to get cold. If these suggestions are not working and the baby is still cold, give us a call. Although not common, hypothermia may be a sign of severe illness.
Signs of a well-fed baby:
Your infant(s) should make 5-8 watery yellow seedy stools in 24 hours. Fewer than 3 should prompt a call to your doctor. This can usually be during regular hours (please).
Your infant should also make at least 3 wet diapers in 24 hours. Once the milk comes in, there are 5-8 wet diapers. Remember that babies often make stool and urinate at the same time.
Yellowness of the skin occurs in as many as 50% of babies. However, increasing yellowness, especially of the trunk or legs may be a bad signand should prompt a call to the doctor. Jaundice (yellowness) peaks around day 3-4. A blood test will be considered to analyze the degree of jaundice.
While we are always available for emergencies, almost all questions about nursing, bowel functions and infant behavior can be handled during the regular daytime hours Monday-Saturday. These concerns are important, but they are rarely true emergencies.
FLUORIDE FOR THE BABY
Because fluoride is a helpful mineral for the infant to get even from birth to make strong teeth, we also suggest that the mother either drink water that has fluoride in it, like tap water and not bottled water or that the infant get a prescription for fluoride to take daily. Honestly, tap water in Chicago is great and we suggest that moms drink that. Too little fluoride is not good for the baby's teeth nor the mothers!! It is also cheaper to drink tap and easier to not give the baby one more thing daily. It is better for the environment too, no plastic bottles to carry to or from or recycle!
VITAMIN SUPPLEMENTATION
Infants who are exclusively breast fed or combination breast and formula fed should be supplemented with a multivitamin with iron. We suggest Poly-vi-sol with Iron, Tri-ViSol, or D-Visol - 1 ml by mouth daily to be given to the baby in their mouth. All of these drops contain Vitamin D and are non-prescription and can be purchased at your local pharmacy. These can be given at any time of day, at feeding time or in between. When the baby spits it up, the iron may stain the clothes. A cleaning product called Barkeepers Friend will get the stains out. Put a slurry on the stain and launder as usual. This product is found next to Ajax and Comet cleaners at the store. Please continue these vitamins indefinitely, even if you switch your baby to formula.
We hope that after reading this brief suggestion sheet that breast feeding your infant is easier and more pleasurable.
We have found these suggestions for breast-feeding helpful to thousands of patients. Please review them to optimize feeding for your baby or babies.
Infants who are ideally fed will:
Lose less weight in the first few days of life before regaining back to and beyond birth weight. This weight loss may be up to ten percent of their birth weight. Please note that the typical reason for weight loss is all the bowel movements and wet diapers that babies have in the first few days.
Be happier with less crying per day.
Tend to be less jaundiced (yellow) because the more they eat the more they pass stool and excrete Bilirubin (the chemical that causes jaundice) from the body.
To feed ideally consider the following information:
After three minutes of actively suckling at the breast, the infant has swallowed 75% of the milk from that breast. By five minutes, the baby has gotten 90%. You can hear what your infant does by listening to the swallow noise they make.
Initially, ten to twelve feedings in 24 hours is ideal. Less than this makes for crankier kids and more jaundiced (yellow) infants. High concentrations of Bilirubin can cause injury to the brain.
Although many authorities talk about the "hind milk", (the milk after 20 minutes of constant nursing on one side), as being very rich in calories, it is our experience that nursing this long may tire the baby out and they never get to the second side. This then means they fall asleep and generally wake in about an hour to go for the second side. You can see that means many more hours spent feeding, and maybe not enough time to do the enjoying your baby part! If the infant is not vigorous enough to nurse for 20 minutes on a side and after a few days many are not, they simply do not get to the second side.
If the baby only nurses on one side during a feeding, the full breast also seems to signal back to the mom's brain to make less milk. OOPS! This sets up a cycle of less and less milk, sabotaging nursing success. Therefore the goal is to nurse on both sides each feeding.
The true breast milk "comes in" around 3-5 days of life in the first time mother. Generally it will arrive a day sooner with subsequent babies. It also comes in sooner if you have been nursing 10-12 times in 24 hours. You can do the math and figure out how often that is!
Moms who are dehydrated make less milk, period. DRINK. Since your kidneys are "on the job" right now, listen to what they have to say. You know your urine should be clear or pale yellow. If mom's urine is dark yellow in color, she needs to drink more.
If you think your baby is continuing to lose weight or not doing well, please check in with us!!!! It's always better to play it safe than sorry!
So here are our suggestions for successful nursing
1. Feed each time on both breasts. Begin on one side for 5-10 minutes. If the baby tends to fall asleep before the 10 minutes, plan on shortening the first side to 5-7 minutes next time. For now, if they want to fall asleep on the second side in search of the coveted hind milk, this is okay. In a few weeks, we will suggest not using the feeding as a way to induce sleep however. Then we will talk about allowing them to learn how to fall asleep by themselves to become "independent sleepers".
2. Alternate starting sides. Many moms find it helpful to put a safety pin on the starting side of the brassiere. Sleep deprivation and raging hormones make fuzzy memory common.
3. Different positions on the breast also decrease pain, bleeding and infections of the breast. Try the cross the lap position, the football carry and lying in bed side by side.
4. Feed every 2-2 1/2 hours from the beginning of a feeding to the beginning of the next feeding.
5. Drink 8-12 ounces of water, juice or milk each time you nurse your baby. The fluid you drink now will help you make more milk for the next feeding. PLEASE INCLUDE A SOURCE OF FLUORIDE IN YOUR DIET AS THIS WILL HELP TO BUILD STRONG TEETH FOR YOUR BABY. MOST BOTTLED WATERS HAVE NONE. CHICAGO HAS GREAT WATER AND TAP WATER HAS A PERFECT AMOUNT OF FLUORIDE HERE. THIS IS EASY, VERY CHEAP,YOU WILL SPEND LESS WITH THE DENTIST FOR DECADES AND IT IS "ENVIRONMENTALLY GREEN"!!!
6. Hypothermia in the infant is common but not good for the baby. 98.6 degrees rectally is normal. When the body temp is lower, the child usually is overly sleepy and feeds poorly. Armpit temps and ear temps are unreliable so please take it rectally. Use a bit of lubricant like Vaseline and put the thermometer in the rectum to about one inch. We suggest marking the one-inch mark on the thermometer with a Sharpie marker and when it is inside the rectum you know that you are in far enough. To re-warm a baby, get naked in the bed for 5 minutes and then strip the baby to just a diaper and have skin to skin contact in the bed for a few minutes. Then redress the baby with more clothes and remember the hat. You may need to increase the room temp if the baby continues to get cold. If these suggestions are not working and the baby is still cold, give us a call. Although not common, hypothermia may be a sign of severe illness.
Signs of a well-fed baby:
Your infant(s) should make 5-8 watery yellow seedy stools in 24 hours. Fewer than 3 should prompt a call to your doctor. This can usually be during regular hours (please).
Your infant should also make at least 3 wet diapers in 24 hours. Once the milk comes in, there are 5-8 wet diapers. Remember that babies often make stool and urinate at the same time.
Yellowness of the skin occurs in as many as 50% of babies. However, increasing yellowness, especially of the trunk or legs may be a bad signand should prompt a call to the doctor. Jaundice (yellowness) peaks around day 3-4. A blood test will be considered to analyze the degree of jaundice.
While we are always available for emergencies, almost all questions about nursing, bowel functions and infant behavior can be handled during the regular daytime hours Monday-Saturday. These concerns are important, but they are rarely true emergencies.
FLUORIDE FOR THE BABY
Because fluoride is a helpful mineral for the infant to get even from birth to make strong teeth, we also suggest that the mother either drink water that has fluoride in it, like tap water and not bottled water or that the infant get a prescription for fluoride to take daily. Honestly, tap water in Chicago is great and we suggest that moms drink that. Too little fluoride is not good for the baby's teeth nor the mothers!! It is also cheaper to drink tap and easier to not give the baby one more thing daily. It is better for the environment too, no plastic bottles to carry to or from or recycle!
VITAMIN SUPPLEMENTATION
Infants who are exclusively breast fed or combination breast and formula fed should be supplemented with a multivitamin with iron. We suggest Poly-vi-sol with Iron, Tri-ViSol, or D-Visol - 1 ml by mouth daily to be given to the baby in their mouth. All of these drops contain Vitamin D and are non-prescription and can be purchased at your local pharmacy. These can be given at any time of day, at feeding time or in between. When the baby spits it up, the iron may stain the clothes. A cleaning product called Barkeepers Friend will get the stains out. Put a slurry on the stain and launder as usual. This product is found next to Ajax and Comet cleaners at the store. Please continue these vitamins indefinitely, even if you switch your baby to formula.
We hope that after reading this brief suggestion sheet that breast feeding your infant is easier and more pleasurable.