Health Education

Breastfeeding — Beyond the First Few Weeks

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As your pediatric provider, we have several breastfeeding goals at your babies two week well child visit. We want your baby gaining weight and mom nursing pain free. If this is not the case, we will continue to work with you to reach your breastfeeding goal. Even if breastfeeding is going well, questions do continue to come up. Below we review some of the most common questions.

I think my milk supply has decreased? What can I do?

If you are concerned about your milk supply, realize that more breastfeeding makes more milk. The two most important things to help your milk supply is stimulating your breasts more frequently and draining the breasts well. Think back to your magic number and make certain you are feeding or pumping that frequently. The magic number, as described by Marsha Walker in her book Breastfeeding Made Simple, is the number of times your baby breastfed in 24 hours when things were going well and you felt you had a full supply of breast milk. Some specific ideas:

  • If your baby starts sleeping longer at night, they may need to feed more frequently during the day.
  • If you have been feeding on one breast, you may need to feed on both breasts.
  • If your baby used to feed 8 times a day but now only feeds 6 times per day and your schedule prevents more feedings, consider adding a couple of pumping/hand expressions per day to increase frequency. Many mothers add a pumping after the early morning feeding to make certain the breasts are well drained after the night; another common time is at night right before you go to bed.
  • While you are feeding, add in breast compressions and massage to help drain the breast.
  • Realize also that babies patterns change as they get older. Many babies will sleep longer at night and cluster feed more during the day.
  • If your baby is fussy or you are concerned, schedule a visit with your provider to get a weight check, evaluate those concerns and then with help decide on the next step.
  • Many women fear their milk has decreased when breast swelling naturally decreases, approximately 1 month after delivery. At this time your breasts may no longer feel full before feeding and may feel softer after feeds. If your baby is swallowing regularly, wetting, stooling, and seems content, your supply is probably just fine.
  • Your baby suddenly wanting to eat more frequently can also be a source of concern. Growth spurts commonly occur at 3 weeks, 6 weeks, 3 months and 6 months. During growth spurts your baby will feed more frequently for several days and then start to space out feeds. It is your baby’s way of increasing your supply to meet their increasing needs.

What are the signs of a breast infection?

The most common signs of mastitis are fever, body aches, breast redness, warmth and pain. Mastitis is an infection of the breasts triggered by the milk not draining. The earliest sign is an aching breast. When discovered early, frequent feedings, and breast massage will usually be sufficient to resolve the problem. Some mothers benefit from warm compresses during feeds to let their milk let down and others from cool compresses to decrease inflammation; Use the compress that feels comfortable to you.

When infection sets in, you might feel tired with aching joints, nausea, fever and flu-like symptoms. Don't stop nursing; emptying your breasts is essential to resolving the infection. If you are not having success at home, consider an appointment with our lactation consultant or Dr. Witt for in office breast massage. We have had success with hands on techniques to help improve breast drainage and speed resolution. If your symptoms are not improving within about 24 hours of increased feedings and breast massage, oral antibiotics may be necessary. In the meantime, check your bra to make sure it is not too tight, continue the compresses over the entire breast to relieve blockage, rest as much as possible, drink plenty of fluids and nurse as frequently as you can beginning on the affected side. Frequent bouts with mastitis may imply improper nursing technique. If this happens, call us. It may be prudent to have a lactation consultant observe your technique.

When should I be concerned about thrush?

The classic symptoms of thrush include a nipple rash, white patches in the baby’s mouth and breast or nipple pain. Thrush is caused by a fungus called Candida Albicans. This is the same organism responsible for women’s vaginal yeast infections and also babies yeast diaper infections (not normal diaper rash). Candida Albicans are present in and on all bodies, but an infection occurs when the amount increases beyond normal. Yeast grows well in warm, moist, sugary environments.

Signs of thrush in mothers:

  1. Red, itchy, flaky, cracked, burning nipples
  2. Sore nipples unresponsive to basic treatment
  3. Persistent breast pain or burning during or after feeding
  4. Vaginal yeast infections.

Signs of thrush in infants:

  1. White spots inside the cheeks
  2. White spots inside the lips
  3. Difficulty eating (less common)
  4. Yeast diaper infections (persistent small red bumps in diaper area and into leg folds).

**Please note: babies often have white tongues unrelated to thrush; therefore a white tongue alone is not used to diagnose thrush.

How is thrush treated?

A small amount of thrush in a baby’s mouth is very common and not necessary to treat if there are no feeding problems and mom is not symptomatic. Thrush is usually treated, after discussion with your healthcare provider, if mother is symptomatic or baby is having trouble feeding. Treatments include both topical or oral antifungals. Because yeast grows well in warm, moist environments it is important to look at your environment. Make sure breast pads and burp clothes are changed frequently. Many families boil pacifiers, and teething toys. Avoid sugary and fermented foods. Eating garlic and yogurt, and taking acidophilus or lactobacillus may also help!

What should I do if I get plugged duct?

Feed your baby while applying a warm compress and gently massaging around the plugged duct. Symptoms for a plugged duct include a local area of swelling and tenderness. To resolve a plug, frequent feedings, warm compresses prior to feeding and breast massage are important. Some mothers benefit by latching with the baby’s chin positioned toward the lump.

When massaging, focus on massage in front of and around the plugged area. Gentle hand stroking away from the plugged area toward the arm pit may help decrease swelling. You can alternate massage, hand expression and breastfeeding to work out the plug. The goal is to see the milk flowing and for the pain and redness to subside. Massaging with olive oil may help. If your efforts at home do not resolve the plug, a visit with one of our lactation consultants may help. You should be seen if the plug persists or if you have problems with recurrent plugged ducts.

What do I do if I have persistent breast lump?

If your lump continues despite treating it like a plugged duct than you should be evaluated by your ob/gyn. Sudden, tender lumps are usually a sign of a plugged duct (see above). Lumps that change with time maybe related to small cysts that fill and then are emptied of milk during feeding. Lumps that do not resolve should be evaluated by your ob/gyn.

Why does my baby pull away from the breast?

Your baby can pull off for several reasons: to burp, at the very end if your baby is full and satisfied, slow flow or rapid flow. Sometimes if the flow slows down after the initial let down, some babies become impatient with the slower flow. If this is the case try breast compressions while feeding. Some women with a generous milk supply, may have a very strong let down and rapid milk flow. These babies may choke while feeding or pull off the breast to control the flow. You can help this by trying different positions including feeding your baby in a more upright position, utilizing the football position, and leaning back.

What if the baby begins to lose interest?

Typically this occurs when the baby is more sociable at about 3 months and is interested in other activities. Babies are easily distracted at this age and will pull your nipple, areola and breast with them to see what is going on. If you need to finish a feeding, go to a quiet room and relax — the feeding will proceed in a much smoother fashion.

Some babies will have a nursing strike and refuse to nurse for a period of time. This can occur when teething, with thrush or with ear infections. Sometimes it occurs without a clear reason. During a nursing strike, focus on keeping the baby calm. Skin to skin is very important. Try to feed the baby when sleepy, not distracted, and laying down or in the bathtub. Most nursing strikes will resolve with patience and your baby will return to direct breastfeeding. If it persists, have your baby evaluated to make certain there is no medical reason, such as an ear infection, for the strike.

When can I offer a pacifier?

It is generally recommended to wait until breastfeeding is well established to offer a pacifier. Some babies have a high need for non-nutritive sucking. This need can be met with a breast, a finger or a pacifier. Once your milk supply is well established, latching on is easy and comfortable, and your baby is gaining weight and back to birth weight, then a pacifier can be offered.

When should I offer my baby a bottle?

The timing will depend on how well the baby is feeding and your individual preferences. We are happy to talk to you about a plan. Many mothers are very concerned their baby will never take a bottle unless introduced at the right time. We find this remains very individual for each baby.

In general if you are going back to work, it is common to introduce a bottle at 3 to 4 weeks of age or several weeks before you return to work. Many women find it helpful for the father or significant other to introduce the bottle. Some babies will take the bottle easily and others will need multiple tries and may have a preference as to the type of bottle nipple used.

When should I start pumping?

This will vary depending on your baby’s needs, your milk supply, and your time apart from your baby. We are happy to discuss this with you as we see you and your baby. If you are returning to work, many mothers find it helpful to build in an extra pumping session a couple of weeks before returning to work. This allows them to store up some milk. Remember it will take a couple of days between starting the extra pumping session for your body to start making more milk.

What can Dad do?

Studies have shown that support from dad is essential for breastfeeding to succeed. There is a much higher chance of early weaning if dad does not support the decision to breastfeed. Dads are often wondering what they can do if mom is breastfeeding. There are lots of ways to help:

  • Comforting the fussy baby
  • Kangaroo care and holding your baby skin to skin
  • Providing the non-nutritive sucking
  • Baby massage
  • Taking care of baby while mom takes a nap
  • Carrying a baby in a sling
  • Playing with the baby
  • Diapering
  • Bathing the baby
  • Caring for other children
  • Helping with household chores