M AT E R N A L A N D C H I L D H E A LT H

H A L D I M A N D - N O R F O L K H E A LT H U N I T

HEALTHINFO

Breastfeeding... Getting off to a good start

Breastmilk…Is the only perfect milk for babies all over the world. The World Health Organization recommends exclusive breastfeeding for six months, and continuation for up to two years. Here are some tips, tricks and advice for breastfeeding in the first week or two, when both you and your baby are learning.

Right from the First FeedGive baby the chance to latch himself at the breast soon after birth. Sometime in the first hour, newborns are ready to latch and feed. Latching early can prevent trouble later. Baby will also benefit from being skin to skin with mom. It’s soothing for both, keeps baby warm, triggers mom’s milk making hormones and helps make this first feed easier. Let baby lead the way.

Feeding, the First Few DaysDay 1: Baby is sleepy from birth. He may feed, but not very long or very often. He’s getting colostrum, the first milk. It’s very high in carbohydrates, protein and immunities. It gives lots of concen-trated nutrition, even though it is a very small quantity. It protects baby against infection and it helps baby to pass the meconium from his bowel. Passing meconium helps to decrease the risk of jaundice.

Day 2-3: Baby wakes up. He may feed constantly. He’ll still be getting colostrum. It is important that your breasts are being stimulated to produce milk. Let baby feed often.

Day 3-5: For many women the breasts start producing mature milk at about this time. The breasts will be full and if you aren’t feeding often, may become engorged. The best way to deal with engorgement is letting the baby feed often.

A Good Latch, Right from the StartThe one thing to remember is that if it hurts, it isn’t a good latch no matter how good it looks.

1. Whatever feeding position you use, be comfortable.

2. Hold baby tummy to mummy, nose to nipple.

3. Bring the baby towards the nipple and tickle his lips with it. Wait for a very wide-open mouth, like a yawn.

4. Bringthebabyontothebreast.Hischinwilltouchfirstandwill be pushed into your breast, while his nose will be just clear of your breast. More of your breast is covered by his lower jaw and lip than by the upper jaw.

5. If you have pain, try two approaches:

a. Move the baby’s position a bit, to reduce pulling on your nipple.

b. Takethebabyoff.Breaksuctionbyeasingyourfingerinto the corner of the baby’s mouth. Start over.

PositionsUse as many different positions as you feel comfortable with. For all positions:

• Make sure you are comfortable and well supported. Use back support, pillows, feet up, etc.

• Hold baby close to your body (tummy to mummy)

• Baby’s nose is level with your nipple, and his head is tipped back a little (nose to nipple)

• Don’t lean over to the baby and make sure baby is not pull-ing on your nipple

Cross Cradle HoldThis is very helpful dur-ing the early days, since there is a little better control of baby’s head while you both are learning.

• Lay the baby with your arm along his back and your fingers gently supporting his head just behind the ears. Use a pillow if you need support. Tuck his arms out of the way (this can be tricky!)

• Position the baby so his nose is at the level of your nipple, and his body is facing you—tummy to mummy.

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• With your other hand cup the breast, and touch the nipple to the baby’s lips.

• Latch the baby. (See “A good latch…”)

• Once the baby is latched, slide the free hand under the baby to turn this into a cradle hold, lean back and relax.

Cradle HoldBaby is held across your lap, supported by one arm. The opposite hand cups the breast. When baby opens wide, bring him onto the breast. Once he settles you’ll have one hand free for something else (a glass of water, telephone, books, the remote…)

Football HoldEasier for moms who’ve had a Caesarean Section as there is no pressure on the incision. Baby can be placed on a pillow or two beside you. This will bring him up to the level of the breast. Mom’s arm supports his back. You may need another pillow once baby is pulled onto the breast. Be careful not to lean! This will last only while baby is short enough that his feet don’t reach the back of the chair.

Side-LyingHave baby lie beside mom, turned onto side, close to mom, with nose at level of nipple. This takes a little practice but is very help-ful when mom is tired or sore.

Laid Back breastfeedingThis position can promote self latching and maternal rest during nursing.

Signs Baby is Ready to Feed• Moving arms and legs• Bringing hand to mouth• Sucking motions with mouth• Rapid eye movements under lids

• Rooting (looking for nipple)• Tries to latch• Clenched hands

Signs Baby is Full• He spontaneously releases the nipple• He does not show interest if offered the breast again• Pushes away • Falls asleep• Baby has open, relaxed hands, arms

Signs Baby is Getting Milk• When baby first latches he will suck rapidly, called a flutter

suck. Then you should see a difference as the milk flows:

• Baby opens jaw (suck), pauses (mouth is filling), closes jaw (swallow and breath).

• You may not hear the sound of a swallow at first. You should hear a “click” with swallows from 3-4 days after the birth.

How Much, How Often, How Long• Babies’ tiny tummies need to be filled often in the early days,

at least 8 times in 24 hours. Feeding will be less often in a few weeks.

• Feedings won’t be evenly spaced. It may be ½ hour between feeds one time and 3 hours the next time. Some may last an hour and others five minutes. This is normal!

• Don’t go longer than 3 hours in the first week, and 4 hours in the second, especially if baby loses a lot of weight in hospital or isn’t gaining well.

• Feed the first breast until baby is no longer interested. Baby will get both foremilk (thirst-quenching) and hind milk (filling). Offer the second breast if baby still isn’t full. Between breasts is a good time to change baby’s diaper. In the first two weeks always offer both breast at a feeding.

• As baby gets the hang of breastfeeding, he’ll be easier to latch and feed. After two weeks, baby leads the way. Continue with demand feedings. You will probably be feeding about eight times a day, but some feeds will be quite short.

Pacifiers, Bottles and SupplementsFor breastfed babies we recommend avoiding any pacifiers or artificial teats. They are linked with early weaning and increased ear infections. If supplements are medically indicated, they should be given by cup or syringe. Ask your health care provider.

Growth SpurtsAround 4-6 weeks baby is liable to have a growth spurt and feed very frequently for about two days. This stimulates the breasts to make more milk. You may think that he’s just not satisfied. Wait a day or two for it to settle down. Expect growth spurts every month or two.

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Troubleshooting

Sleepy Baby Who Won’t FeedWake the baby by:

• Removing all clothes except for diaper. Baby will stay warm enough cuddled close to mom

• Rubbing his head, back, tummy, and feet.

• Changing position or talking to him

• Using a cool (not cold) cloth on his face

Once milk is flowing baby will wake up and be more interested, so expressing to get a let down may help.

Small Baby/Large NipplesSome babies have problems latching on to enough areola because they are small or mom is big. Baby only needs to take about 1 inch (2.5 cm) from the base of the nipple itself. If this is a problem try this:

Position baby as usual. Instead of cupping the breast, shape it so that it’s wide in the same direction as baby’s mouth. Think of how we compress a fat sandwich to take a bite. Using the C hold, gently compress the breast between the thumb and fingers. Using a teacup hold, compress tissue between the thumb and forefinger. Sometimes mom can wedge enough tissue to help baby latch. Baby should be able to take sufficient breast now.

Sore NipplesAlmost all women report some nipple tenderness very early in breastfeeding. It is common for some pain just as baby latches. Any breakdown of skin (cracks, scabs, etc) suggests that there is a problem. Most often this is caused by a position and latch that

pull on the nipple. Small corrections can make a big difference, but you may need help in figuring out just what to change. For short term use, nipple shields can be helpful. Pure lanolin oint-ment is soothing and helps healing.

EngorgementThis is best prevented by frequent baby-lead feeds from birth. This occurs when breasts move into full production mode, about 3-5 days after birth. Simple treatment with ice and fre-quent feeding will reduce swelling and discomfort. Using cold green cabbage leaves inside the bra (20 min) also helps (wash them first!). Engorgement is best prevented by frequent small feeds right from birth.

Trouble LatchingBabies don’t need to take the entire areola, just about 2 cm/1 inch from the base of the nipple. For mothers with larger breasts that baby finds hard to latch onto, compress the areola a little between your fingers. For mothers with very full breasts that stretch out the areola (making it hard to grasp), express a little milk before a feed, to make the nipple easier to grasp.

Why aren’t my breasts full anymore?At the same time, breasts have adapted to full production and may be softer. The milk hasn’t gone; your body is just more effi-cient at making it.

Will the baby ever sleep through?Babies will not sleep through for several months. At around 3 to 4 months or at 12-13 lbs (6 kg) they may start having a longer sleep at night (5-6 hours). That’s sleeping through.

Would cereal help?It would help make baby have an upset tummy. Both the research and experienced moms say cereal is no help at all.

So when do I start solids?All the latest recommendations are to give nothing but breast-milk until baby is 6 months old.

Continued on next page.

Age 1 day 2 day 3 day 4 day 5 day 6 day 7 day 2 wk 3 wk 4 wk 5 wk 6 wk

Tummy Size Chickpea Cherry or Teaspoon Walnut or Tablespoon

Wet Diapers in 24 hrs

1 wet 2 wet 3 wet 4 wet 5 wet 6 heavy wet

Soiled Diapers

1-2 per day black or

dark green

2-3 per day brown, green or yellow

1-3 per day yellow, may have white flecks

1+ large yellow, every 1-7 days

Adapted from Best Start

Teacup HoldC Hold

Guidelines for Breastfeeding

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Hand Expressing/Pumping and Storing BreastmilkThese guidelines are for full-term, healthy babies.

• Store breastmilk in containers with tightly sealing lids:

Ì Glass containers

Ì Clear rigid BPA free plastic

Ì Cloudy (or opaque) rigid BPA free plastic

Ì Heavy breastmilk storage bags

• Do not use bags from bag and bottle system. They can leak.

• Containers should be washed in very hot water.

• Wash hands before pumping or expressing milk.

• Store in portions of 2-4 ounces (60-120 ml) to minimize waste.

• Pump or express several times through the day

• Chill newly expressed milk before adding it to existing container.

• When desired amount is reached, label, mark date and freeze for use later on.

• Thaw breastmilk by placing container in the refrigerator for several hours. or put container into warm running water.

• Breastmilk can be fed cold, cool or warm. Warm in a bowl of warm water.

• Swirl to mix in fats which separate.

• Discard milk remaining after feed.

Storage Guidelines for BreastmilkRoom Temperature

Cooler with Ice Packs

Refrigerator Freezer in Refrigerator

Deep Freezer, eg, chest freezer

3-4 hours (temperature < 25°C)

24 hours 3-5 days 3-6 months 6-12 months

Thawed, not warmed: 24 hours

Do not refreeze.

Do not refreeze.

Getting HelpSeek help from someone experienced in breastfeeding if you have questions about . . .

position sore nipples feeding problems

latch engorgement fussy baby

expressing milk not enough milk storing milk

. . . Call us!

Public Health Nurses provide telephone and home visits. We also have a dietitian to answer mother and baby nutrition questions.

D E L H I Every second Thursday of the month 10 to 11 a.m. Ontario Early Years Centre 393 James St. (in Delhi Secondary School)

S I M C O E Wednesdays 9:30 to 11:30 a.m. Ontario Early Years Centre 12 Colborne St. North

C A L E D O N I A Tuesdays 9:30 to 11:30 a.m. Ontario Early Years Centre Notre Dame School 35 Braemar ave.

D U N N V I L L E Thursdays 9:30 to 11:30 a.m. Ontario Early Years Centre Fairview Ave. Public School223 Fairview Ave W,

Well Baby and Breastfeeding Drop-In Have baby weighed

Meet other moms

Talk with the Public Health Nurse

Lots of information

Toddlers, dads, and grandparents welcome too!

Updated May 2016

www.hnhu.orginfo@hnhu.org

Simcoe:P.O. Box 247,12 Gilbertson Dr.,Simcoe, ON N3Y 4L1519-426-6170 or 905.318.6623

Caledonia:282 Argyle St. Sl,Caledonia, ON N3W 1K7905.318.6623