How do I know if my breastfeeding baby is getting enough milk?

From birth to about 4 months of age, babies average 8 to 12 nursings in a day. At 4 to 6 months of age, the average is about 6 times a day. At 6-8 months, babies become more efficient and nurse less often - about 4-5 times a day. At 9 to 12 months, the average baby nurses only about 3-4 times a day, but is still taking in large volumes of milk at these few nursing sessions. Babies older than 12 months should be eating a full diet of 3 meals and 2-3 snacks and averaging only 1-3 nursings per day.

How long should a mother plan to breastfeed her baby?

Breastfed babies have fewer allergies, less constipation or diarrhea, and fewer stomach upsets. Babies who receive breastmilk for the first 4 months of life have 50% fewer ear infections than infants who receive formula. It is especially beneficial to give the baby breastmilk during the first 6 months of life while the gastrointestinal tract is maturing.

The breastfeeding mother also benefits. Women who breastfeed lower their risk of ovarian and breast cancer. Adults who were breastfed as infants, have less risk of developing diabetes and heart disease.

Ideally, breastfeeding would continue throughout the first year of life. However, the nutritional and psychological benefits continue beyond the first year. It is up to each mother to decide when to wean. World wide, the average age for weaning is 4 years.

How do you prevent pain with breastfeeding?

Severe pain that starts early and becomes progressively worse, is not normal. The mother may notice that the nipples are creased, wedged, or white after nursing. They may crack, crust, or bleed. Germs may enter through the cracks and cause a breast infection.

Using the best possible positioning and latch on will help both kinds of pain, but may not solve the problem. A correctly positioned baby looks like this:

Pain that occurs after weeks of painless nursing may signal a fungal infection, especially if the infant has recently had thrush (white patches in the mouth which don't rub off). It is easily cured with medication. The medications used for this are safe and inexpensive. Because this condition can be easily confused with other problems, see a health care provider or Lactation Consultant if you think you have a fungal infection.

What is engorgement and what does a mother do about it?

To relieve mild engorgement, first try standing in a warm shower, allowing the water to run over the breasts or lean down into a basin of warm water. Milk may begin to flow out and relieve the tightness. If the shower doesn't help, or if the breasts are hard and tight, cover both breasts with an ice pack (ice cubes in a plastic bag).  Cold decreases the swelling of the tissues.  Apply the ice packs for 3-4 minutes every 2 hours until the milk begins to flow.

Once relieved, engorgement usually doesn't come back. If the breasts continue to feel overly full, consult a Lactation Consultant.

How can I continue to breastfeed after I go back to work?

Decide if you want to give breastmilk or a combination of some pumped breastmilk and some formula.  Some women are able to pump at work and provide all breastmilk for the baby.  Moms who aren't able to pump at work can send formula to the daycare and nurse when they are with the baby.

Once the bottle is introduced, the baby should continue to get one bottle a day, though it could be as little as an ounce of pumped breastmilk or formula. The infant may prefer for someone other than the mother to give the bottle and may want to be held differently than for breastfeeding.

About 2 weeks prior to returning to work, begin slowly modifying the baby's feeding pattern to more closely resemble what it will be after you go to work. For instance, if you plan to pump at work at noon, begin pumping at home at that time. Give the baby the pumped milk by bottle. After a few days to allow you and baby to adjust, begin omitting the mid morning nursing and give a bottle instead. Slowly continue making changes, allowing several days between each change. Continue to nurse in the evening and during the night to maintain your milk supply. Many women find that in time, the body makes less milk during the day and more milk in the evening and night.

Day care staff may need to know that pumped breastmilk normally separates and looks different from formula. Show them how your baby likes to be held for bottle feeding. Talk about ways to comfort the baby. Ask them not to overfill the baby near the end of the day because you'll be needing to nurse.

Some babies will switch easily back and forth from breast to bottle; other babies will have a preference. An occasional baby will resist taking a bottle and will prefer to wait until Mom is available for nursing. Some babies who have been sleeping most of the night, will begin to awaken more often to nurse to make up for missed daytime feedings.

Each baby and mother pair is unique. These are just a few of the many options available to mothers who want to continue to provide breastmilk for their baby after returning to work.