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NetWellness provides the highest quality health information and education services created and evaluated by faculty of our partner universities.
Sunday, March 14, 2010
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NetWellness provides the highest quality health information and education services created and evaluated by faculty of our partner universities.
Sunday, March 14, 2010
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- I breastfeed my baby for almost 1 1/2 hours at a time. Is that normal?
- My 3 1/2 month-old wants to nurse constantly from about midnight until 6 am, latching on, latching off and acting agitated. Will switching to formula, or feeding him solids, help?
- For the past 5 days, my 3 month old son has wanted to nurse about every 1 - 1 1/2 hours for long periods of time. I think he is going through a growth spurt. How long will this keep up?
- The pediatrician said I should feed my new baby every 3 hours, but sometimes the baby sleeps for more than 4 hours. Should we wake him up to feed or wait for him to wake up?
- Our baby lost more than 10% of her body weight after leaving the hospital and we had to supplement my breast milk with formula. Will I ever be able to breastfeed exclusively?
- Our baby seems to latch on well now, but falls asleep almost immediately and does a lot of nonnutritive sucking. How can I encourage/teach her to suck effectively?
- If I am using a breast pump while I have to be away from the baby for a couple of days, will my milk supply go down?
- How much breast milk do women typically pump in one sitting? I can only get an ounce!
- My baby is on pumped milk and formula combined. How much should she be getting each day? She weighs just short of 8 pounds.
- Now that I've stopped breastfeeding, how long will it take for my milk to dry up? When I squeeze my nipple, I still see milk.
- My baby is 3 1/2 months old, and I started giving him rice cereal at night when I don't have as much breast milk. It seems to fill his stomach more. Is this okay? Will it hurt my milk supply?
- Recently my breasts seem to be running out of milk. I am still breast feeding. My child is 4 months. Why is this happening?
- How can I overcome the problem of an insufficient milk supply? I tried to breastfeed, but my baby just wasn't getting enough.
- When I nurse my daughter from one breast, the other leaks about 1/4 - 1/2 cup of milk each time. My milk also tends to squirt out very forcefully from both breasts. How can I stop this?
- Because certain nutrients/antibodies are lost during the freezing and reheating of breast milk, is it recommended to use formula over stored breast milk?
- For how long does my frozen breast milk stay "good"?
- When pumping and storing breast milk for my baby, how do I know how much my baby will need in a single feeding? Can I use a bottle for multiple feedings after it has thawed?
- I had a premature baby and have been pumping and freezing milk. He is finally home and I am finding that a lot of the milk has a soapy/spoiled taste and is separated. What could be wrong?
- I am breastfeeding my 17 month old 3-4 times per day. He drinks water at other times. He doesn't like cow's milk. Is what I'm giving him enough "milk" in his diet?
- I am 8 weeks pregnant with my first baby. I was wondering what the recommended length of time would be to breastfeed. How long is too long?
- My milk supply has always been low, so I have supplemented with formula. My supply has become even lower since my return to work. At what point do the hassles of pumping outweigh the benefits she is receiving from a diminishing supply of milk?
- I have a 19 month who is still breastfeeding. She wants to breastfeed all the time. Should I continue nursing or try and wean her? What is the best method to wean her from the breast?
- My daughter is 8 months and her teeth are coming in. Should I stop breastfeeding?
- My grandson is 4 months old and my daughter is breastfeeding him. He would never take a bottle and now she wants to wean him to a bottle and can't. Any suggestions?
It depends. It depends on the age of your baby and whether the baby was full term. It depends on whether "almost 1 1/2 hours" means around the clock (for about 16 feedings in 24 hours) or whether it means your baby goes longer at certain times of the day or night but then makes up for it at others. It depends on how long typical feedings last and whether your baby usually seems satisfied after feeding. It depends on whether your baby chooses when to end feeding on each breast or if you are the one who stops the feeding to switch sides. It depends on whether your baby is wetting and stooling often enough and what your baby's weight gain pattern has been. It depends on whether this feeding routine has been part of your baby's pattern since birth or if it is more recent, such as during a typical "growth spurt" period.
Assuming full (exclusive) breastfeeding, most babies breastfeed at least 8 and up to about 12 feedings in 24 hours for the first several months. Some regularly feed every 2 to 3 hours, others cluster feedings - eating more frequently than every 2 hours at certain times of the day and lengthening the time between feedings to beyond 3 hours at another time(s). More frequent feedings are more typical in younger babies, but some babies continue to eat very frequently after 3-4 months. However, feedings tend to be briefer as infants grow and become more efficient feeders. During 2 to 4 day "growth spurt" periods, which commonly occur between 2-3 weeks, between 4-6 weeks, and again between 12 to 14 weeks, a baby may seem to want to breastfeed around the clock for a few days. It's best to follow the baby's lead because the baby may be telling your breasts to make more milk to keep pace with growth needs. These spurts are soon over.
Typical feedings last about 10 to 30 minutes at the first breast, and somewhat less than this when the baby is interested in also feeding at the second breast. That should include at least 7 to 10 minutes of active sucking - some babies like "fast food" and others seem to savor their meals, as if pausing for different courses. It is best to let your baby set the pace. Milk later in each feeding is higher in calories, so don't switch breasts until the baby self-detaches at the first breast to make sure she/he is getting this "hindmilk." However, if your baby's active sucking does not add up to at least 10 minutes, or typical feedings often last more than 35 minutes on the first breast, it may mean your baby is not breastfeeding as effectively as she might. Also, a baby should usually seem satisfied with the feeding for at least 30 minutes, although there may be times of the day when this does not occur. For example, it isn't unusual for babies to cluster feeds very closely during the evening.
Your baby should always soak at least 6 diapers with urine in 24 hours. You should be changing 3 or more dirty diapers if your baby is less than 4 to 6 weeks; however, some babies stool less often--even going more than 2 weeks in some instances - as they grow. From the end of the first week after birth through the first 3 to 3 1/2 months, your baby should gain at least 0.5 ounces (15 g) a day, or at least 4 ounces (114 g) a week, or at least a pound (454 k) a month (starting with lowest weight after birth--not birth weight). After 3 months rate of weight gain tends to slow somewhat for many healthy, fully-breastfed babies.
If this describes your baby, his/her pattern probably is "normal." It also may be that some of the time your baby is going to breast, she might be happy with a different activity that involves close contact with you or your partner - a walk or dance while carried close in a carrier or sling, for instance. If you have any question about the feeding pattern or you're concerned that your baby isn't breastfeeding as effectively as he/she should, you may want to contact a lactation consultant (IBCLC) or mother support group leader, such as La Leche League, in your area. For a referral to someone in your area, contact: International Lactation Consultant Association, phone: 919/787-5181; email: ilca@erols.com; web site: http://www.ilca.org/ OR La Leche League International, phone: 800-LALECHE; email lllhq@llli.org; web site: http://www.lalecheleague.org/
References:
Neifert MR (1999). Clinical aspects of lactation: Breastfeeding success. Clinics in Perinatology, 26(2), 281-306.
Riordan J & Auerbach KG (1999). Breastfeeding and human lactation (2nd ed.). Sudbury, MA: Jones & Bartlett.
Nighttime waking is very typical during the first year of life. Many babies awake at night for a variety of reasons besides hunger, including restlessness, teething, and loneliness. Sleeping through the night is a developmental and adaptive process that occurs, and may or may not be related to the type of feeding the child is receiving. Usually, a newborn will have one 4-6 hour sleep period, which usually occurs during the night. However, some babies do have their days and nights mixed up.
One way to promote nighttime sleep is to have an environment that promotes sleep - darkness and quiet, with diaper changing only if absolutely necessary. Over time, this should help get him to sleep at night. Your baby also may be going through a growth spurt, and requiring more milk than you are producing. Always allow him to finish completely nursing one side before offering the other breast. Finally if this problem continues, you might want to seek out a lactation consultant in your area.
The research has shown that solids (such as rice cereal) do not result in babies sleeping through the night. Frequent night feedings can be very tiring and stressful. Have you tried to extend the time between feedings by using comfort methods to gradually delay feeding times during the night? You (or someone else) might try walking and/or rocking the baby when he first awakens and gradually delay the feeding intervals until it is five or so hours. Babies who are fed formula do oftentimes sleep for a longer interval, and frequently at night but this is not always the case.
Growth spurts often occur about three months of age, and it sounds like your son is trying to build up your milk supply to meet his needs. Research has shown that twenty minutes of vigorous nursing every hour will increase your milk supply more effectively than longer, but less frequent sessions. Usually this takes just a few days, but you may be playing catch up.
Are you switching breasts early? If you are switching too early (before your son has completely emptied the breast) your son is not receiving hindmilk, which is high in fat and low in volume. The foremilk (or first milk) is high in volume but low in fat. The hind milk is what "fills" him up, because the fat is digested slower than the carbohydrates and proteins. So be sure that he has emptied the breast, by allowing him to decide that he is finished with the first breast. Infants who receive only foremilk are often generally fussy (even at the breast) and slow to gain weight.
Assuming your baby is full term, it would not be unusual for him to have one or two 4-hour feeding intervals a day AS LONG AS he wakes to eat often enough, his daily wet and dirty diaper count is alright, and he is gaining enough weight.
A breastfed newborn should wake to eat at least 8 times, and up to 12 times, a day. A bottle-fed newborn should wake for about 6-8 daily feedings, although some bottle-fed newborns prefer to eat smaller amounts 8-10 times a day.
Whether breast or bottle-fed, a 10-day-old baby should have 6 (or more) soaking wet diapers a day. You also should be changing at least 2-3 dirty diapers daily. No matter how fed, a 10-day-old baby should gain at least 1/2 -1 ounce per day or at least 4-7 ounces a week. Many pediatricians recommend a baby be brought in for a weight check before two weeks of age. If your pediatrician does not have this policy, most will let you bring the baby in for a weight check if you call first.
If your baby's diaper counts have been good and he is gaining weight, ask the pediatrician if you still have to wake him every three hours. Continue to count wet and dirty diapers for several days when you first let your baby sleep four hours. If you notice a decrease in his usual number of wet or dirty diapers, contact the pediatrician to ask if you should resume 3-hour feedings.
Many mothers and babies move to exclusive breastfeeding after similar beginnings, but it may take some patience and persistence. The method used for supplementing can influence your baby's transition to "full-time" breastfeeding and encourage, or discourage, breastfeeding behaviors. As your baby learns to latch on and breastfeeding improves, she might be ready to receive your expressed milk or infant formula via a feeding tube device taped to your breast during breastfeeding. As a baby breastfeeds more effectively, she takes less through the tube device. A feeding tube device also can be used for finger-feeding - if you tape the tube to your finger (finger pad side) your baby receives the supplement while sucking your finger. Syringe-feeding or cup-feeding, using a cup about the size of a medicine cup, also are options. If finger-feeding or using a bottle, encourage breastfeeding behaviors by having her latch on to the finger or bottle teat. Tap her lip and encourage her to open wide and get her tongue over her bottom gum before letting her latch on to either. If bottle-feeding, I'd suggest using a slow-flow nipple, or teat. Usually, this type has "slow flow" printed on the package, but test each by angling the bottle as if in her mouth and watching for about 3 seconds to pass between drips. A slow-flow teat gives a baby time to take a breath between drips so she can keep her tongue over the bottom gum, as for breastfeeding. If she gets used to food coming instantly, you might pump your milk to the point of "let-down" just before breastfeeding, so she won't have to wait as long.
I recommend that you review these suggestions with an International Board Certified Lactation Consultant (IBCLC) or an experienced La Leche League Leader (LLLL) to help fine-tune them to your situation. To locate an IBCLC in your area, contact the International Lactation Consultant Association or La Leche League International.
A baby is more likely to have difficulty breastfeeding effectively if she was born even a little early, was distressed during pregnancy or birth, was affected by medications given to mother during labor and delivery, has some other physical condition that is tiring (an infection, jaundice, etc.) or has a "mechanical" problem such as tongue-tie. A mother and baby may have to "wait out" some of these issues, which can take a few days to a few weeks. Incidentally, many of these babies have difficulty bottle-feeding initially. It's often a feeding difficulty in general, and not just a breastfeeding difficulty. Some mechanical problems can be "fixed," and a mother and baby can work around others.
To encourage effective suckling, keep the baby close and encourage lots of skin contact. Take the baby's shirt off and your shirt off, lay her on your chest and put a sheet or large top over both of you. Let her enjoy being near you without any "pressure to perform" at the breast, but offer the breast when she demonstrates feeding cues, such as licking, rooting, bringing her hands to her mouth, light fussing, etc. If she falls asleep while suckling, gently nudge her to suckle some more, but don't continue if it isn't helping or if either of you becomes frustrated.
To simplify a complex biochemical process, the answer is "no," you should not run out of milk while separated from your baby if you understand that the breasts make milk based on the amount of milk that is removed from them. The more milk that is removed by an effective baby or pump, the more milk is made. The converse also is true. The less milk that is removed, the less milk is made. However, it takes a mother's brain and breasts a day or two to translate an increase or decrease in the amount of breastfeeding or pumping into more or less breast milk production. That is why breastfeeding "how-to" books recommend a mother and baby begin breastfeeding (or pumping if a baby or mother has a health issue to be resolved) as soon as possible after birth and continue with frequent breastfeedings (or pumping sessions) thereafter.
Most fully breastfed newborns breastfeed 8-12 times in a 24 hour period. To maintain adequate milk production if separated from a baby for hours or days, a mother can pump in a way that copies her baby's breastfeeding routine. In most situations, this means pumping so that the total number of breastfeedings and pumping sessions is at least eight in 24 hours. A mother can increase the number of pumping sessions if her baby often breastfeeds more than that number. During the day, most mothers plan on a pumping session about every three hours and on one at night if travel takes them from home. The number of pumping sessions usually decreases later in the second half of a baby's first year as the baby replaces more breastfeedings with solid food feedings.
If a mother finds pumping is not keeping up with the amount of milk her baby takes while she is away, she should ask herself if she is:
If you are separated from your baby due to employment or school hours for several days a week, try a light-weight, hospital grade, self-cycling breast pumps. These are the quickest and easiest way to get increased volumes of milk when pumping. Some of these breast pumps may be purchased, and others are available through rental. A lactation consultant or La Leche League Leader** in your area should know where you might locate this type of pump.
In most cases, when a mother finds milk production is not keeping pace with the amount of breast milk her baby takes while she is away, increasing the number of pumping sessions usually increases milk production within a few days.
** To locate a lactation consultant or La Leche League Leader in your area, contact: International Lactation Consultant Association or La Leche League International.
Women vary in the amount of milk they express in a sitting, so there is no "standard" answer for this. If you are not already using a self-cycling, hospital-grade electric breast pump, consider renting one for a few weeks. Unless you are confident your baby is suckling (removing milk from your breasts) effectively, you also will want to pump/express milk for AT LEAST 8 minutes at a time, or for at least 100 minutes, in 24 hours. Many mothers find it helps to pump for about 10 minutes immediately after most breastfeedings. Others also pump between some breastfeedings. Try this routine for at least 3 days to give milk production a chance to pick up. As your baby becomes more adept at breastfeeding in the next days or weeks you can decrease pumping/expressing milk.
An 8-pound baby probably will take about 16-20 oz. in 24 hours, which is about 2-2 oz. per pound of body weight. Keep track of the number of wet and dirty diapers-she should wet at least 6 diapers and dirty at least 2-3. I would suggest keeping your milk separate from any formula, rather than mixing the different substances together. You don't want any of your valuable milk to be wasted if she can't take all that is offered, and it's good to keep the taste and odors separate, too.
Essentially, the milk-producing glands in your breasts have involuted, or "dried up," since you only notice milk when the nipple is squeezed. It is not unusual for an area of the breast to continue to produce drops or small amounts for weeks, months or even years after a child has weaned. Some women describe this milk as being "cheesy" in consistency rather than liquid.
By continuing to squeeze milk out, you may be encouraging that area to continue to produce milk, since milk production is related to milk being removed. Other types of nipple stimulation, such as during love-making also may contribute to continued production of small amounts of milk. There do not appear to be any reports of slight ongoing production causing any health problem for a mother.
Reference:
Mohrbacher N & Stock J (1997). The breastfeeding answer book (rev. ed.). La Leche League International: Schaumburg, IL.
Is there a way to provide your child with breast milk if you can't produce your own? There are human milk banks in different parts of the USA and other countries, but La Leche League does not maintain a human milk bank at either the local or international levels. Different milk banks have different "rules" as to which babies are given priority for available milk, but usually babies receive it based on medical necessity. Authorized human milk banks screen potential donors. Donors freeze their milk for delivery to a milk bank where it is thawed, cultured, and pasteurized. For more information, contact the Human Milk Banking Association of North America, Inc. (HMBANA); 888-232-8809, E-mail: milkbank@capecod.net or their web site.
A baby's digestive system continues to mature after birth. Research in the in the 1970s and 1980s demonstrated that the infant cereal sometimes recommended for full-term infants as young as several weeks old was poorly digested by a baby's system, did not help babies sleep at night, and exposed babies to a potential allergen. Pediatricians then began to suggest that parents wait until at least four months to introduce cereal or any other solid foods. Research since then has led many pediatricians to suggest to parents that they wait until at least six months to introduce any other food to the breastfed baby when that baby is growing appropriately on breast milk alone.
Quite possibly, feeding cereal to your baby is affecting milk production. Research has shown that babies do not get calories from solid food, in addition to the calories they receive from breast milk. Rather, a baby replaces some of the breast milk he takes in each day with the new food, such as rice cereal. Since the baby is taking less from the breast, the breast responds by making less milk. The effect on production depends on how much other food a baby receives.
If your baby has been gaining weight and growing appropriately, you've probably been making plenty of milk in spite of his increased feeding frequency in the evening or night. Women don't make the same amount of milk around the clock. There are times of the day when you may produce more milk than others. This does not mean you aren't making enough milk. Also, many breastfed babies experience a so-called "growth spurt" at some point between 3-3 1/2 months. During this time, a baby will "request" to breastfeed more frequently for several days. Milk production increases within a few days to meet the increased demand, and then there is a return to that baby's usual number of daily feedings. If a mother is unaware of the signs of a growth spurt and introduces a supplement or cereal because she's concerned about milk production, her body will not have the opportunity to increase production to meet the amount of breast milk her baby now requires.
To increase milk production, a mother simply offers less and less cereal (or offers none) and breastfeeds, or pumps, more frequently for several days. Incidentally, "The Womanly Art of Breastfeeding" by La Leche League International has an excellent chapter on when and how to begin adding solid foods to the breastfed baby's diet.
There are many possible reasons for a decrease in your milk supply. If you become pregnant, there will be a decrease in your milk supply. If you are pumping, the pump is not as effective as the baby, so your body will make less milk. If you are pumping on a regular basis, you should increase the frequency of your pumping and the length of time you pump. Your supply will decrease during times of emotional and physical stress, and if you take in large amounts of alcohol and caffeine, you can inhibit let down. Some over-the-counter medications can also decrease your milk supply. As your baby grows, he will become more efficient with emptying your breast, and will nurse for less time, and you may think you have less milk. The best way to determine if your child is getting enough milk is to consult his health care provider, and to work closely with him/her to monitor your child's growth.
There are some questions to consider, such as how often did your first newborn breastfeed in 24 hours and how long did a typical feeding last? What was her wet and dirty diaper count the first month? How was her weight gain-from her lowest weight, not birth weight?
The more a baby breastfeeds, the more milk your body should produce. When a baby sucks effectively, it "tells" the breast to make more milk. The more a baby removes milk (effectively), the more milk is produced. On the contrary, the less a baby breastfeeds, the less produced. The key word is "effective." The most common cause of insufficient milk production is an insufficient amount of breastfeeding for a particular baby. Often it is due to trying to "schedule" breastfeedings or because a mother doesn't understand normal feeding patterns for breastfed babies. Some mothers think their normal breastfed baby isn't getting enough milk because of more frequent feedings.
A baby that is unable to remove milk effectively may be the second most common reason for insufficient milk production. Prematurity, the effect of labor and delivery medications and anesthetics, jaundice, infection, certain health conditions and variations in the structures in a baby's mouth may all contribute to ineffective sucking. Suspect ineffective sucking if the newborn frequently (one or more*):
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(* Any baby may demonstrate one or more of these signs occasionally.)
When a baby breastfeeds ineffectively, the mother is more likely to develop sore, red, bruised, raw, blistered, or cracked nipples. Her nipples may appear creased, flattened, misshapen or white at the end of a feeding. She also may experience a plugged duct or mastitis due to poor milk removal. In addition to baby "causes," there can be mother-related causes. A few women are born with an insufficient amount of milk-making tissue in their breasts, although that is unusual. Other maternal causes known to, or suspected of, contributing to milk insufficiency include:
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Last Reviewed: Jun 17, 2002
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Tina Weitkamp, RNC, MSN Associate Professor of Clinical Nursing College of Nursing University of Cincinnati |
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Karen Kerkhoff Gromada, MSN, RN, IBCLC Adjunct Clinical Instructor Parent Child-Health Nursing Department College of Nursing University of Cincinnati |
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