Objectives: By the end of this course the student will know the following breastfeeding issues:
Those who have never breastfed before — and even for those who have — it is natural to have some questions. For instance, they may be wondering if their breasts can make enough milk to feed a baby or if they can keep nursing after a mother go back to work. (The answer to both questions is "Yes!")
Why is breastfeeding so good for a baby?
Human milk and infant formula are different. Not only does human milk provide all the protein, sugar, fat, and vitamins a baby needs to be healthy, but also it has special benefits that formulas cannot match. It helps protect a baby against certain diseases and infections. Because of the protective substances in human milk, breastfed children are less likely to have the following:
Research also suggests that breastfeeding may help to protect against Sudden Infant Death Syndrome (SIDS).
Other reasons why human milk is good for a child include the following:
Breastfeeding also provides physical contact, warmth, and closeness, which help to create a special bond between a mother and her baby.
There are also many health benefits for a mother because breastfeeding does the following:
The longer a mother breastfeeds, the greater the benefits will be to her baby and her, and the longer these benefits will last. The World Health Organization (WHO) and many other experts encourage women to breastfeed for as long as possible, 1 year or even longer, because human milk provides the best nutrition and protection against infections.
Who can help
After deciding to breastfeed, it is helpful to have support from family and friends. Although fathers cannot experience the intimate feeling of breastfeeding, they can share many other special, personal moments with their infants. Older siblings can also help by holding the baby, changing diapers, and playing with him.
Before a baby is born, an expectant mother should learn as much as possible about breastfeeding by reading, watching videos, and talking to other women who have breastfed. They should be encouraged to take a breastfeeding class; many hospitals and health organizations offer them. The following are other helpful sources of information:
Before a baby is born, talk to a doctor about plans to breastfeed. It is best to start breastfeeding within the first hour after birth, if possible. Also, while a mother is in the hospital a mother and a baby should remain together as much as possible. "Rooming-in" with a baby during a hospital stay has been shown to help make breastfeeding more successful.
The mother should talk to her obstetrician and pediatrician to make sure any medications that a mother are taking will not harm a baby when they pass through mother's milk. Most medications are not a cause for concern.( See tables below)
How does my body prepare for breastfeeding?
When a mother becomes pregnant, her body naturally starts to prepare for breastfeeding. During the fourth or fifth month of pregnancy her body is capable of producing milk. This first milk, called colostrum, is packed with all the nutrients that a newborn baby needs. It also contains many substances to protect new babies against infections. Colostrum is thick and yellowish or orangish in color. A body will produce colostrum for several days after delivery until mature milk "comes in." The milk then thins, becomes milk-like in color and begins to adjust to the baby’s needs for the rest of the time that a mother breastfeed. One of the special qualities of human milk is that it changes during the time a mother nurse a baby to match the changing needs of a growing infant.
How is human milk produced?
During pregnancy, a body increases its production of a hormone called prolactin. This hormone stimulates the cells in breasts to make milk. The amount of prolactin also increases when a mother nurse a baby. The size of breasts is not a factor in how much milk a mother makes; a baby’s nursing controls milk production. In other words, the more a mother nurse, the more milk a body produces.
Oxytocin is another hormone that increases during pregnancy. This hormone causes tiny muscle cells within the breasts to contract and squeeze milk down the milk ducts toward the nipples. This process, called the letdown reflex, occurs each time a mother nurse a baby.
Does one have to do anything to prepare breasts for breastfeeding?
During pregnancy, a mother does not have to care for a nipples or breasts in any special way. Just make sure bras provide enough support. Since breasts will get larger, buy nursing bras that allow room for growth. Wash breasts with warm water only. Soaps, lotions, and alcohol are not necessary, may be irritating, and should not be used. Ask an obstetrician or family physician to examine a breasts and nipples during pregnancy.
Although not very common, a few women have nipples that are drawn inward, or are inverted. When nipples are inverted, a baby may not be able to grasp the areola properly to get milk.
The problem of inverted nipples usually clears up on its own during pregnancy, as breasts get larger. If this does not happen, inverted nipples can be treated late in pregnancy or soon after the baby is born.
The first feeding after delivery
Immediately after delivery, a baby should be placed on a chest or abdomen, skin to skin. Babies are very alert after they are born, and they are usually hungry, too! A baby’s first feeding can take place within 30 minutes to an hour after delivery. The protection against infection that human milk provides is important immediately after birth. Human milk will also give the baby nutrients to prevent a low blood sugar level. This early taste of mother's milk also stimulates the baby to nurse better later.
If a mother had a vaginal delivery, a mother can nurse in bed or in a chair in the following ways:
If a mother had a Cesarean-section delivery she can nurse a baby in the following ways:
She should always take time to make herself comfortable. She should not be shy about asking for help during the first few feedings. Just as with learning anything new, it may take several feedings before a mother and a baby become a skilled nursing team.
Touching a breast to the center of a baby's lips stimulates a baby to open his mouth widely. This is called the "rooting reflex". As this occurs, pull a baby straightforward onto the nipple and areola. Keep in mind that when a baby is correctly positioned, or "latched-on," a nipple and much of the areola are pulled well into the baby’s mouth. A baby’s lips and gums should be around the areola and not on the nipple. This is why it is important for the baby’s mouth to be open wide.
A mother can help a baby latch-on by holding the breast with a free hand. Place fingers under the breast and rest a thumb lightly on top (back behind the areola). Make sure a baby is properly lined up at a breast. Also be sure fingers are well back from the areola so they do not get in the way.
When the baby first nurses there will be a tugging sensation. If the latch-on hurts, pinches, or produces pain, the latch-on may be incorrect. Break the latch-on by slipping a finger into the corner of a baby’s mouth, reposition, and try again. It can take several tries.
If her nipples are not sore, breastfeeding should not be painful. If it hurts while a mother breastfeeds, then a baby may not be latched-on correctly and may need to be repositioned.
Correct latch-on is very important. As it:
If a baby is latched-on correctly but a mother still has pain while breastfeeding, talk with a pediatrician.
Babies use their lips, gums, and tongues to get the milk to flow from the breast. This is known as suckling. Simply sucking on the nipple will not draw milk and may hurt the nipple.
Most babies will nurse actively if they are hungry and positioned correctly. For the first few weeks after birth until breastfeeding is well established, breastfeeding newborns should not be given any supplements (water, sugar water, formula, etc.) unless there is a medical reason for it. A baby who is breastfeeding regularly and effectively will get all of the water and nutrients she needs. Some authorities believe that introducing a bottle or using a pacifier may cause nipple confusion and interfere with the establishment of breastfeeding. Others disagree and feel that nonnutritive sucking is good and does not interfere with breastfeeding. Ask a pediatrician for more information.
What is "let-down"?
The letdown reflex occurs every time a mother breastfeeds. The first few times a mother breastfeeds this letdown reflex may take a few minutes. Afterward, letdown will occur much more quickly, usually within a few seconds.
The signs of letdown are different for each woman. Sometimes when a baby starts to nurse, a mother may feel a brief prickle, tingle, or even slight pain in a breast. Or, milk may start dripping from the breast that's not being used. These feelings and milk flow are signs of the letdown reflex. This means a body is making it easier for a baby to nurse.
A mother may feel strong cramping in a uterus when mother's milk lets-down. The hormone Oxytocin, which stimulates milk flow, also causes the muscles of the uterus to contract. Nursing helps a uterus go back to its original size. This cramping is totally normal and is actually a sign of successful nursing. The cramping should go away in a week or so.
To help the letdown process along, try these tips:
How to take care of breasts during breastfeeding?
By the third or fourth day of breastfeeding, mother's milk will change from colostrum to what looks more like skim milk. Her breasts will also go from feeling soft to firm. If nipples leak, use a nursing pad or clean folded handkerchief squares inside a bra to catch the leaking milk. Be sure to change these often. Do not use plastic-lined pads because they will prevent air from circulating around her nipples.
Between feedings, gently pat a nipples dry. This helps prevent them from getting irritated. A mother may also want to apply a little expressed colostrum, human milk, or medical grade modified lanolin on nipples to prevent dryness.
How often should she nurse?
Breastfed babies tend to feed more often than formula-fed babies, usually 8 to 12 times a day. The main reason for this is that their stomachs empty much more quickly because human milk is so easy to digest.
Initially, a newborn will probably nurse every couple of hours, regardless of whether it's day or night. By the end of the first month, a baby may start sleeping longer at night. Let a baby feed on demand—that is, whenever he is hungry. Watch for different signals from a baby, rather than the clock to decide when to nurse. When a baby is hungry, he may do any of the following:
It is best not to wait until a baby is overly hungry before a mother breastfeed.
Some newborns can be sleepy and hard to wake. Do not let a baby sleep through feedings until mother's milk supply has been developed. If a baby is not demanding to be fed, wake her if 3 to 4 hours have passed since the last feeding. If this persists, call a pediatrician.
What is engorgement?
Feeding on demand not only ensures that a baby’s hunger is satisfied, but it also helps prevent engorgement. Engorgement occurs when breasts become too full with milk. A little engorgement is normal, but excessive engorgement can be uncomfortable or painful. If breasts do become engorged, try the following:
It is important to keep breastfeeding. Engorgement is a temporary condition and will be most quickly relieved by effective milk removal.
Once the engorgement passes, breasts will become soft again. This is normal and is exactly what should happen.
How to express breast milk
A mother can express milk manually with her hands or with a breast pump. Breast pumps are used to ease engorged breasts or to collect milk when mothers are away from a baby (for example, if a mother are ill or at work). Pumping enables a mother to continue to breastfeed by keeping mother's milk production stimulated. If milk is not emptied from the breast regularly, it sends a message back to a body to stop making milk.
To express milk manually:
Some women prefer hand expression because it can be done silently and does not require special equipment. Other women may find it easier and faster to express milk with a breast pump. Pumps are manual, battery-operated, or electric. A mother can find manual pumps in most pharmacies and baby stores. Do not buy those that look like a bicycle horn, because they cannot be cleaned properly and milk may become contaminated.
Good hand pumps have two cylinders, one inside the other, attached to a rigid funnel-like device that fits over the breast. As a mother slide the outer cylinder up and down, negative pressure is created over the nipple area. This causes milk to collect in the bottom of the cylinder. This collecting cylinder can be used with a special nipple to feed a baby without transferring the milk. The entire pump can be cleaned in the dishwasher or by hand with soap and hot water.
Some hand pumps have a handle to squeeze that creates a negative pressure and draws the milk into a bottle. These may have a soft, pliable flange that fits around the nipple and areola and produces mother's milking action while pumping.
For most women, electric pumps stimulate the breast more effectively than manual expression or hand pumps. They are used mainly to keep breastfeeding going when a mother is not able to breastfeed for several days or more. These pumps are easier and more efficient than hand pumps, but they are much more expensive. However, a mother may be able to save money by renting an electric pump from a hospital or a medical supply store.
When shopping for an electric pump to buy or rent, make sure that it creates mother's milking action and is not simply a sucking device. Pumps that express milk from both breasts at the same time increase the amount of milk and save time. No matter which type of pumps a mother choose, make sure that all parts of it that come into contact with a skin or milk can be removed and cleaned. Otherwise, the pump will become a breeding ground for bacteria, and the milk will not be safe for a baby.
How long does breastfeeding take?
While some infants nurse for only 10 minutes on one breast, it is quite common for others to stay on one side for much longer. Some feedings may be longer than others depending on a baby’s schedule and the time of day. Some babies may be nursing even though they appear to be sleeping. If a baby has fallen asleep at a breast, or if a mother needs to stop a feeding before a baby is finished, gently break the suction with a finger. Do this by slipping a finger into a baby’s mouth while he or she is still latched-on. Never pull the baby off the breast without releasing the suction.
When a mother breastfeeds, alternate between which breast she offers first. (A mother may want to keep a safety pin or short ribbon on a bra strap to help a mother remember on which breast a baby last nursed.) While a mother should try to breastfeed evenly on both sides, a baby may prefer one side to the other and nurse much longer on that side. When this happens, the breast adapts its milk production to a baby’s feedings. Remember, a baby’s feedings control how much milk a breasts produce. It is important to let a baby nurse on both sides so that each breast gets stimulation over the course of a day.
A mother will soon get to know a baby’s feeding patterns. Each baby has a particular style of eating, some slower, some faster. Learning a mother's own baby's eating patterns makes it easier to determine when she is hungry, when she has had enough, how often she needs to eat, and how much time she needs for feedings.
Spitting up, hiccups, and other reactions
Spitting up is a common reaction that infants have during or after feeding, and some just spit up more easily than others. There is usually no need to be concerned when a baby spits up. Unlike formula fed babies, the spitting up of human milk does not smell bad and does not stain clothing or linen. If a baby does spit up, do the following:
If the baby repeatedly vomits, especially in a forceful manner (shooting out), call a pediatrician right away.
Most babies also hiccup from time to time during feedings. If this happens, a mother can continue to nurse a baby, hiccups will stop on its own.
How can I tell the baby is getting enough milk?
There are several ways a mother can tell whether a baby is getting enough milk. One is by the number of wet diapers he has in a day. Make sure he has at least six wet diapers per day with pale yellow urine, beginning around the third or fourth day of life. An infant should also have several small bowel movements daily (there may be one after every feeding in the first few weeks). During the first week of life, an infant should have at least two stools per day. From about 1 to 4 weeks old these should increase to at least 5 per day. As a baby gets older, bowel movements may occur less often, and may even skip a number of days. Bowel movements of breastfed babies usually smell somewhat sweeter than the stools of formula fed babies.
A baby’s feeding patterns are also an important sign that he is feeding enough. A newborn may nurse every 1½ to 3 hours around the clock. If a baby sleeps for stretches of longer than 4 hours in the first 2 weeks, wake him for a feeding. It is most important that a baby is latched-on properly during feedings. (See "Latching-on".) Listen for gulping sounds to know that a baby is actually swallowing the milk and not just sucking. Also look for slow, steady jaw movement.
A baby should be steadily gaining weight after the first week of life. During the first week, some infants lose several ounces of weight, but they should be back up to their birth weight by the end of the second week. A pediatrician’s office will weigh a baby at each visit. Keep in mind that a baby may breastfeed more often during growth spurts.
Signs that baby is getting enough milk are as follows:
Most breastfeeding babies do not need any water, vitamins, or iron in addition to breast milk for at least the first 6 months. Human milk provides all the fluids and nutrients a baby needs to be healthy. By about 6 months of age, however, a mother should start to introduce an infant to baby foods that contain iron. A pediatrician may prescribe Vitamin D if there is a need for it.
The American Academy of Pediatrics and the American Academy of Pediatric Dentistry recommend that breastfed infants (as well as bottle fed infants) not receive fluoride supplements during the first 6 months of life. After 6 months of age, check with a pediatrician to see if a mother need to give a baby fluoride.
If a baby cannot or will not nurse, or if a mother is having problems with breastfeeding, it is important that the mother call a pediatrician as soon as possible. Refusal to breastfeed may be a sign of illness that needs prompt attention.
Do I need to be careful about medication and food?
Most medications are safe to take during breastfeeding, but there are a few that can be dangerous for the baby. To be sure, let a doctor and a baby's pediatrician know that the mother is breastfeeding. Get approval for all medications, including non-prescription drugs. Also, take the medication just after a mother nurse rather than just before. (See Tables Below)
Some birth control pills also might affect mother's milk production, but effects vary from woman to woman and with the type of pill. Discuss this with a doctor.
While a mother is nursing, she should avoid drinking alcohol because it can pass through mother's milk to a baby. If a mother chooses to drink alcohol, drink it just after a mother nurse rather than just before.
Do not smoke while breastfeeding, or around children at all! Secondhand smoke is dangerous to all children, but especially to newborns. It increases the risk of SIDS.
Try to avoid caffeine or at least reduce intake while a mother are breastfeeding. Caffeine tends to build up in babies’ systems because their bodies cannot get rid of it very easily. A morning cup of coffee is not likely to harm a baby, but too much caffeine can cause problems such as poor sleeping, nervousness, irritability, and poor feeding. Try using decaffeinated coffee and tea and avoid colas and other carbonated drinks that have added caffeine. (See Tables Below)
Sometimes breastfeeding babies react to certain foods that their mothers eat. A mother might notice that after eating spicy or "gassy" foods, a baby cries, fusses, or even nurses more often. Since babies with colic often have similar symptoms, the best way to tell the difference between a food reaction and colic is by how long symptoms last. With food reactions, symptoms are usually short-lived, lasting less than 24 hours. Symptoms caused by colic occur daily and often last for days or weeks at a time. If a baby gets symptoms every time a mother eat a certain type of food, stop eating that particular item.
In rare instances, a breastfed infant may be allergic to the cow’s milk in a diet. Symptoms can appear anywhere from a few minutes to a few hours after she breastfeeds and may include: diarrhea, rash, fussiness, and gas.
To tell whether a baby is allergic, a mother needs to cut out all dairy products from a diet for 2 weeks. Then one by one, return each dairy product to a diet to see whether a baby has a reaction after nursing.
Special situations and breastfeeding
Many parents are concerned that breastfeeding has to stop if the mother gets ill. During most illnesses, including colds, flu, bacterial infections, and even surgical conditions, breastfeeding can and should continue. Both the mother and baby benefit if it does.
If a mother is breastfeeding, by the time a mother show symptoms of an illness, a baby has already been exposed to it. The best thing to do is to keep breastfeeding. This is because a mother has already started to produce antibodies that through mother's milk protect a baby from getting infected. If a mother stop breastfeeding when cold or flu symptoms appear, a mother actually reduces a baby's protection and increases the chance of the baby getting sick.
If mothers are unable to breastfeed an infant while they are ill, she should keep up mother's milk supply by expressing milk for a baby either by hand or using a pump. The milk can then be fed to the baby.
Even with more serious illnesses, such as breast abscess, gall bladder surgery, or severe infections, a mother usually only need to stop breastfeeding for a short period. There are a few infectious diseases that mothers have that can be transmitted through human milk to the baby, including HIV and untreated tuberculosis. Mothers in the United States with HIV are advised not to breastfeed.
Similarly, mothers with tuberculosis should not breastfeed until appropriate treatment has been started. Mothers with hepatitis B can breastfeed their infants if the infant receives the hepatitis B vaccine in the first few days after birth. There is no evidence that hepatitis C is transmitted by breastfeeding. Mothers with chronic hepatitis C are often advised that they can nurse their infants, but they should discuss this with their physician. Other types of infections need to be evaluated by the obstetrician and pediatrician, but nearly all will be found to be safe for breastfeeding.
Mastitis is an infection of the breast. It causes swelling, burning, redness, and pain. This usually occurs in just one breast and may also cause a nursing mother to feel feverish and ill. If a mother has any of these symptoms, she should let a doctor know at once so that treatment can be started. Lots of rest, warm compresses, antibiotics, breast support, and continued breastfeeding are all that are usually needed.
Mastitis occurs when mother's milk duct gets blocked and bacteria infect a portion of the breast. Rest and good nutrition will help a mother get back her energy. Also, frequent nursing will help drain breasts and prevent the infection from spreading.
A mother should not stop breastfeeding while she has mastitis since the infection will not spread to mother's milk. It is important to keep the milk flowing in the infected breast. If it is too painful to have a baby nurse on the infected breast, open up both sides of a bra and let the milk flow from that breast onto a towel or absorbent cloth. This relieves the pressure as a mother feeds the baby on the opposite side. Pumping the affected side may also be necessary.
If a baby is not positioned properly or does not latch-on well when a mother start breastfeeding, a mother might end up with cracked or sore nipples. To prevent cracked nipples, position the baby better and be sure the baby’s lips and gums are on the areola and not on the nipple. Also, try to vary a baby’s position at each feeding. Get help from a pediatrician or a lactation consultant.
The best treatments for cracked nipples are dryness, light, and warmth. Do not wear plastic breast shields or plastic-lined nursing pads that hold in moisture. Instead, gently pat nipples dry then apply human milk or medical grade modified lanolin. Wash breasts only with water, not soap. Many creams and lotions, which must be removed before nursing, will not help and may actually make the problem worse. If these steps do not solve the problem, consult a doctor for further advice.
Some studies show that breastfeeding may offer some protection against breast cancer. However, if a woman already has been diagnosed with cancer and has had a malignant tumor removed, the doctor may advise against breastfeeding due to the follow-up treatment on the affected breast. If a woman has a benign (noncancerous) lump or cyst removed, it is safe to breastfeed afterward.
There is still some question as to whether it is safe to breastfeed if a mother have silicone breast implants, but there is no conclusive evidence that infants are harmed. The surgery for breast implants usually does not interfere with milk ducts or the nipples unless the incision was made around the edge of the areola. This surgery should not prevent successful nursing. However, plastic surgery to reduce the size of breasts may interfere with breastfeeding, especially if the nipples were transplanted. If a mother has had plastic surgery on her breasts, she may only find out whether or not she can successfully breastfeed by trying.
Premature babies, twins, and triplets
Many premature and seriously ill babies are able to breastfeed. If a baby is not able at first to nurse, a mother can collect mother's milk and feed a baby by tube or cup. Express mother's milk at the times when a baby would usually feed, so that a body becomes used to the schedule, usually about eight times per day by electric breast pump. Most hospitals have breastfeeding experts to help a mother get started. Once a mother starts to breastfeed, she should let a baby nurse often to build up her milk supply. Human milk has been shown to be very beneficial to premature and sick newborns by helping growth and preventing many diseases.
If a mother has twins, it is possible to breastfeed them at the same time, having one baby at each breast. A mother can hold one baby at each side, called the "football hold," or a mother can cradle them both in front of a mother with their bodies crossing each other, as they would have been in utero. Alternate the breast each baby uses at each feeding or at least once a day. If this is too difficult, or if the mother is not producing enough milk, she may supplement feedings with formula.
With triplets it is possible to breastfeed, but most mothers supplement feedings with formula. Nurse two of the babies at a time and give formula to the third. At the next feeding, give the formula to a different baby. It is important that all three babies have a chance to breastfeed.
NURSING AFTER RETURNING TO WORK
Human milk has the same important benefits for older babies as it does for infants. Just because a mother are returning to work does not mean a mother have to stop breastfeeding. A mother can do both! Knowing that a mother is providing mother's milk for a baby while away and nursing when a mother is home will help ease the transition back to work.
The following are different ways working women manage breastfeeding:
Be sure to select a childcare provider or center that supports breastfeeding and can safely handle the milk and feedings per instructions. Also, engage the support of a boss, human resources staff, occupational nurse, and coworkers. Assure them that pumping milk will not interfere with a work. And since studies show that breastfed infants do not get as sick as often as formula-fed infants, a mother may even miss fewer days of work to care for a sick baby.
If possible, go back to work on a part-time or flexible schedule at first. This can help a mother and a baby adjust to the new routine. If this is not possible, go back to work midweek, to make it easier for mother and a baby to adjust.
At work a mother will need to find a quiet, private place to express milk if a company does not have a lactation room or someplace else set aside for a mother. An office, a break room, or wherever privacy can be assured can work just fine. It takes 15 to 30 minutes each time a mother expresses milk (usually twice a day). A mother will need access to soap and water to wash her hands before expressing. A mother will also need a refrigerator or a small cooler and ice packs where a mother can keep milk cold until a mother get home.
How to store and prepare expressed milk
Follow these safe storage and preparation tips to keep a expressed milk healthy for a baby.
Weaning a baby from the breast
There is no "right" time to wean. It depends entirely on the desires and needs of a mother and a baby. Either one of a mother can begin the weaning process.
Some babies lose interest in breastfeeding between 9 and 12 months of age or after they learn to drink from a cup. If a mother notices this starting to happen, she should not try to force a baby to keep breastfeeding. Understand that this is not a rejection of a mother but the first sign of a child’s growing independence.
A mother may feel sad, guilty, lonely, or depressed about giving up the closeness and intimacy that comes from breastfeeding. These feelings are natural. Cuddle and interact with a baby even more, and remember that weaning is a natural step in helping a child to grow up.
A mother can wean a child first to a bottle and then to a cup, or directly to a cup. During weaning, a mother can express milk with which to feed a baby from the cup or bottle, or a mother can use infant formula. Because formula cannot provide all the special nutrients and protective qualities that mother's milk can, a baby benefits the longer she drinks human milk.
If a mother chooses to supplement breastfeeding with formula, she will still need to express milk. This keeps mother's milk production going and prevents breasts from getting engorged.
If using a bottle, introduce it gradually over several days. Use it with one feeding and work a way up to more. It helps if a baby is not extremely hungry, because then she may be more patient when trying out the bottle. It also helps if a spouse or a caregiver introduces the bottle when a mother is not around. Many babies will get very upset if they are given a bottle when their mother is in the house; they may even refuse the bottle because they want to breastfeed instead. Do not force a baby to take a bottle. It may take time. Excess pressure on the baby to take a bottle may cause her to refuse the bottle totally.
After bottle-feedings have started, some babies may get frustrated when they breastfeed because the milk does not flow as fast from the breast as from a bottle. The following may help.
Introducing baby to a cup
Weaning to a cup has the following advantages over a bottle:
To introduce a baby to a cup, start with a trainer cup that has two handles and a snap-on lid with a spout. Or a mother can use a small plastic glass. This will keep spills small as a baby tries holding the cup (and throwing it) different ways. Do not be surprised if a baby treats the cup as a plaything at first.
Offer mother's milk when available, starting with just one meal a day. It may be easiest to substitute a cup for breastfeeding at the midday feeding first and the nighttime feeding last. (Nighttime feedings are often a source of comfort and calming before sleep.)
Be patient and wait until a baby can get most of the liquid down his throat before a mother fill the cup with juice or milk. Since weaning is a process, it may take months before a baby is willing or able to take all of his liquids from a cup. Proceed gradually and let his willingness and interest guide a mother.
To begin weaning a baby from the breast, substitute a feeding with either a cup or bottle for a feeding in which a mother breastfeed. The midday feeding may be easiest to start with. Babies may be more attached to the first and last feedings of the day because they get comfort as much as nutrition from them. Once a mother has stopped breastfeeding entirely, a breasts will stop producing milk very quickly.
Breastfeeding: a natural gift
For some mothers and babies, breastfeeding goes smoothly from the start. For others, it takes a little time and several attempts to get the process going effectively. Like anything new, breastfeeding takes some practice. This is perfectly normal. If a mother needs help, she should ask nurses while she is still in the hospital, or, a child's pediatrician, a lactation consultant, or a breastfeeding support group. Remember, the most important keys to successful breastfeeding are proper positioning and correct latch-on.
Until a mother and a baby develop a feeding routine, stay positive and try not to get discouraged. Remember, mother's milk gives a baby more than just food. It also provides important antibodies to fight off infection and has medical and psychological benefits for both of a mother. Breastfeeding is the most natural gift that a mother can give a baby.
American Association Of Pediatrics
Extensive research, especially in recent years, documents diverse and compelling advantages to infants, mothers, families, and society from breastfeeding and the use of human milk for infant feeding. These include health, nutritional, immunologic, developmental, psychological, social, economic, and environmental benefits.
Human milk is uniquely superior for infant feeding and is species-specific; all substitute-feeding options differ markedly from it. The breastfed infant is the reference or normative model against which all alternative-feeding methods must be measured with regard to growth, health, development, and all other short- and long-term outcomes.
Epidemiologic research shows that human milk and breastfeeding of infants provide advantages with regard to general health, growth, and development, while significantly decreasing risk for a large number of acute and chronic diseases. Research in the United States, Canada, Europe, and other developed countries, among predominantly middle-class populations, provides strong evidence that human milk feeding decreases the incidence and/or severity of diarrhea, lower respiratory infection, otitis media, bacteremia, bacterial meningitis, botulism, urinary tract infection, and necrotizing enterocolitis. There are a number of studies that show a possible protective effect of human milk feeding against sudden infant death syndrome, insulin-dependent diabetes mellitus, Crohn's disease, ulcerative colitis, lymphoma, allergic diseases, and other chronic digestive diseases. Breastfeeding has also been related to possible enhancement of cognitive development.
There are also a number of studies that indicate possible health benefits for mothers. It has long been acknowledged that breastfeeding increases levels of oxytocin, resulting in less postpartum bleeding and more rapid uterine involution. Lactational amenorrhea causes less menstrual blood loss over the months after delivery. Recent research demonstrates that lactating women have an earlier return to prepregnant weight, delayed resumption of ovulation with increased child spacing, improved bone remineralization postpartum with reduction in hip fractures in the postmenopausal period, and reduced risk of ovarian cancer and premenopausal breast cancer.
In addition to individual health benefits, breastfeeding provides significant social and economic benefits to the nation, including reduced health care costs and reduced employee absenteeism for care attributable to child illness. The significantly lower incidence of illness in the breastfed infant allows the parents more time for attention to siblings and other family duties and reduces parental absence from work and lost income. The direct economic benefits to the family are also significant. It has been estimated that the 1993 cost of purchasing infant formula for the first year after birth was $855. During the first 6 weeks of lactation, maternal caloric intake is no greater for the breastfeeding mother than for the nonlactating mother. After that period, food and fluid intakes are greater, but the cost of this increased caloric intake is about half the cost of purchasing formula. Thus, a saving of >$400 per child for food purchases can be expected during the first year.
Despite the demonstrated benefits of breastfeeding, there are some situations in which breastfeeding is not in the best interest of the infant. These include the infant with galactosemia, the infant whose mother uses illegal drugs, the infant whose mother has untreated active tuberculosis, and the infant in the United States whose mother has been infected with the human immunodeficiency virus. In countries with populations at increased risk for other infectious diseases and nutritional deficiencies resulting in infant death, the mortality risks associated with not breastfeeding may outweigh the possible risks of acquiring human immunodeficiency virus infection. Although most prescribed and over-the-counter medications are safe for the breastfed infant, there are a few medications that mothers may need to take that may make it necessary to interrupt breastfeeding temporarily. These include radioactive isotopes, antimetabolites, cancer chemotherapy agents, and a small number of other medications. Excellent books and tables of drugs that are safe or contraindicated in breastfeeding are available to the physician for reference, including a publication from the AAP.
Increasing the rates of breastfeeding initiation and duration is a national health objective and one of the goals of Healthy People 2000. The target is to "increase to at least 75% the proportion of mothers who breastfeed their babies in the early postpartum period and to at least 50% the proportion who continue breastfeeding until their babies are 5 to 6 months old." Although breastfeeding rates have increased slightly since 1990, the percentage of women currently electing to breastfeed their babies is still lower than levels reported in the mid-1980s and is far below the Healthy People 2000 goal. In 1995, 59.4% of women in the United States were breastfeeding either exclusively or in combination with formula feeding at the time of hospital discharge; only 21.6% of mothers were nursing at 6 months, and many of these were supplementing with formula.
The highest rates of breastfeeding are observed among higher-income, college-educated women >30 years of age living in the Mountain and Pacific regions of the United States. Obstacles to the initiation and continuation of breastfeeding include physician apathy and misinformation, insufficient prenatal breastfeeding education, disruptive hospital policies, inappropriate interruption of breastfeeding, early hospital discharge in some populations, lack of timely routine follow-up care and postpartum home health visits, maternal employment (especially in the absence of workplace facilities and support for breastfeeding), lack of broad societal support, media portrayal of bottle-feeding as normative, and commercial promotion of infant formula through distribution of hospital discharge packs, coupons for free or discounted formula, and television and general magazine advertising.
The AAP identifies breastfeeding as the ideal method of feeding and nurturing infants and recognizes breastfeeding as primary in achieving optimal infant and child health, growth, and development. The AAP emphasizes the essential role of the pediatrician in promoting, protecting, and supporting breastfeeding and recommends the following breastfeeding policies.
of Health Care Professionals In Promoting and Protecting Breast Feeding
To provide an optimal environment for breastfeeding, pediatricians should follow these recommendations:
TABLE 1. Drugs of Abuse: Contraindicated During Breast-Feeding [*]
TABLE 2. Maternal Medication Usually Compatible With Breast-Feeding*
TABLE 3. Drugs That Are Contraindicated During Breast-Feeding
TABLE 4. Food and Environmental Agents: Effect on Breast-Feeding
Breast Fed Babies Do Better? Is Cognitive Ability and Academic
'98) - In the debate over whether babies should be on the breast or
bottle, few points may prove as persuasive as the results of a new study
indicating that breast feeding is associated with detectable increases
in child cognitive ability and educational achievement.
The study was reported in
the January 1998 issue of the journal Pediatrics that is published by
the American Academy of Pediatrics. The report is by L. John Horwood and
David M. Fergusson from the Christchurch School of Medicine in
Christchurch, New Zealand.
The study looked at the
relationships between the duration of breast feeding --- how long
children were on the breast -- and their cognitive ability and academic
achievement over a period of 8-18 years. The data were collected in the
course of an 18-year longitudinal study beginning at birth of over 1000
From birth to a year of age,
information was collected on maternal breast feeding practices. Then,
over the years the children were tested on a range of measures of
cognitive and academic performance. These included "measures of
child intelligence quotient; teacher ratings of school performance;
standardized tests of reading comprehension, mathematics, and scholastic
ability; pass rates in school leaving examinations; and leaving school
Longer breast feeding was
found to be associated with consistent and statistically significant
were differences between the mothers who breast fed and those who bottle
fed. The mothers who chose to breast feed as a group tended to be older,
to be better educated and from upper socioeconomic status families. They
tended to be in a two-parent family, did not smoke during pregnancy and
enjoyed above average income and living standards. The rates of breast
feeding also increased with increasing birth weight.
take these various factors into account, statistical regression
adjustments were made for maternal and other factors associated with
breast feeding. Nonetheless, the duration of breast feeding remained a
significant predictor of later cognitive or educational outcomes.
feeding, it is concluded, is associated with small but detectable
increases in the cognitive ability and educational achievement children.
These effects are reflected in a range of measures including
standardized tests, teacher ratings, and academic outcomes in high
school. The beneficial effects of breast feeding in the New Zealand
study were long-lived and extended throughout childhood into a motherng
New Zealand study is not alone in suggesting that breast feeding helps
children's cognitive abilities and academic achievement. Longitudinal
studies have consistently shown that breast fed babies do better in
these respects than bottle-fed babies.
makes the difference? Is it the experience of being on the breast? Or is
it the breast milk itself? Data from an experimental study of pre-term
(premature) babies show that children whose mothers elect to express
their own breast milk later have higher developmental scores and higher
intelligence quotients. Thus, the breast milk itself appears beneficial.
is in breast milk that is so good for the brain? Research has suggested
that the helpful factors may be long-chain polyunsaturated fatty acids
including, in particular, docosahexaenoic acid (DHA). When DHA was added
to infant formulas, pre-term babies appeared to show better visual
acuity and cognitive abilities.
The New Zealand
investigators observe that their findings "underwrite the need to
encourage breast feeding and/or to continue to develop improved infant
formulas with properties more similar to those of human milk...."
They do believe that their results most likely "reflect the effects
of polyunsaturated fatty acid levels and, particularly, DHA levels on
The Nutrition Information
Center of New York Hospital-Cornell Medical Center and Memorial
Sloan-Kettering Cancer Center recently advised that DHA is
"included in infant formulas worldwide, but not in the U.S."
(underlined in the advisory). Assuming DHA is required for optimal brain
development -- a reasonable conclusion at this time -- the question
arises. Why are infant formulas in the United States not supplemented