The Ins and Outs of Breastfeeding

Breastfeeding is a wonderful decision for both baby and you. It can help protect both infant and mother from a variety of illnesses and diseases including asthma, obesity, diabetes, and SIDS for infants; and certain cancers, diabetes, and high blood pressure for mothers. In addition, breastmilk is constantly changing to best meet the nutritional needs of your baby as they grow. However, while breastfeeding comes naturally to some, it can be a very trying and stressful time for others and is often accompanied by many questions. Here is a rundown of some of the most common questions and concerns.

How often should my baby feed and for how long?

On average breast milk comes in between days 3-5. During the first few weeks after birth, infants feed quite frequently: about every 2-3 hours, equal to 8-12 feedings per day! In the first few days, however, you may notice your infant feeding even more frequently. This is called “cluster feeding”. Cluster feeding helps stimulate your body to begin producing milk.

When it comes to feeding your infant, it is very important that you pay close attention to hunger cues. Common hunger cues include sucking on a fist, making smacking sounds with their lips, and rooting (a newborn reflex where the infant turns his/her face when their cheek is stroked and makes sucking motions with their mouth).

Many infants, however, can be particularly sleepy during the first few days. If this is the case for your baby, whether they sleep through a feeding or fall asleep mid-feed, it will be important to wake them up for feedings, particularly while you are waiting for your breastmilk to come in and until they regain their birth weight. You can stimulate them to wake up by undressing them, changing their diaper, stroking their cheek, or playing with their feet. Once they have regained their birth weight, it is usually safe to feed on demand if they are gaining weight at an appropriate rate.

Are they getting enough?

One of the most common concerns of breastfeeding moms is whether their baby is getting enough milk. Some key indicators to look for include:

• Breastfeeding at least 8 times in a 24-hour period
• Breastfeeding for 10 minutes or more in a rhythmic suck/swallow/pause/suck pattern
• Not displaying hunger cues
• Gaining appropriate weight. (Note: it is normal for infants to lose up to 10% of their birth weight in the first few days and regain that weight by about 2 weeks of age).
• Making an appropriate number of wet diapers and stools. If your infant is not stooling by day 5, you should notify your child’s primary care provider.

How long should you breastfeed?

While it is ultimately up to the mother how long she decides to breastfeed, the American Academy of Pediatrics (AAP) and the World Health Organization (WHO) recommend exclusive breastfeeding up to 6 months of age with continued breastfeeding along with the introduction of appropriate complementary foods up to 2 years of age or longer. The longer the infant is breastfed, the greater the protection the infant has from certain illnesses and long-term diseases. Of note, the AAP recommends children be introduced to foods other than breastmilk or formula at about 6 months old.

Returning to work and/or school

Transitioning back to school and work after maternity leave can be very difficult both mentally and physically, so it is imperative that mothers understand their rights. The Patient Protection and Affordable Care Act requires employers to support breastfeeding mothers to express breast milk for 1 year after each child’s birth by providing mothers with reasonable break time and a private, non-bathroom space to express their breastmilk. Ideally, to keep up breastmilk supply it is important to pump or hand express breast milk on the same schedule that the infant typically feeds when mom is at home. While this may not always be feasible, trying to stick to a schedule as best as possible will be important. Talk to your employer to develop a plan prior to returning to work.

What is proper breastmilk storage?

For those returning to work and even for those occasional date nights, it is important that we address proper breastmilk storage. Freshly expressed or pumped milk can be stored:

• At room temperature for up to 4 hours
• In the refrigerator for up to 4 days
• In the freezer for about 6 months (although up to 12 months is acceptable)

Thawed, previously frozen breastmilk can be stored:

• At room temperature for 1-2 hours
• In the refrigerator for up to 1 day
• It is not recommended to refreeze thawed breastmilk once it has been previously frozen

Finally, if you have any leftover milk from a feeding, the remaining milk should be used within 2 hours.

Are there situations where breastfeeding is not recommended?

While breastfeeding is considered to be the best nutrition for most infants, there are some rare exceptions to consider when breast milk or breastfeeding is not recommended. Infants should not be breastfed or offered expressed (pumped) breast milk if:

• The infant is diagnosed with galactosemia, a rare genetic metabolic disorder
• Mother is diagnosed with HIV
• Mother is infected with human T-cell lymphotropic virus type I or II
• Mother is using an illicit street drug
• Mother has suspected or confirmed Ebola virus

The infant should only temporarily avoid breastfeeding or expressed break milk if:

• Mother is infected with untreated brucellosis
• Mother is taking certain medications (check with your PCP, OBGYN, or lactation counselor before starting any new medications)
• The mother is undergoing diagnostic imaging with radiopharmaceuticals
• Mother has an active herpes simplex virus (HSV) infection with lesions present on the breast. (Note: Mother can still breastfeed on the unaffected breast if lesions on the affected breast are covered completely).

Infant should not breastfeed but can have expressed breast milk if:

• Mother has untreated tuberculosis
• Mother has an active varicella infection (chicken pox) that developed within 5 days before delivery to 2 days after delivery