14. How can I tell for sure that my breastfed baby is getting enough to eat?
ANSWER: If the baby is growing adequately, the baby is getting enough to eat.
There are a few clues that are helpful for very young infants (under 4 weeks
of age). The baby should be satisfied for at least some period after most
feedings. The baby should have at least six soaking diapers a day and one or
more dirty diapers with over a tablespoon of stool. Usually babies this age
will have several additional dirty diapers with just a little stool (up to 12
a day). Older babies should also have six soaking diapers a day, if they are
getting enough to eat, but they will have fewer dirty diapers.
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15. What are the nutritional differences between formula and breast milk?
ANSWER: There are several nutritional differences between formula and human
milk. For example, the types of fats in human milk are more easily digested
than those in formula and may contribute to better neurological development.
There is less iron in human milk than in formula. However, the iron in human
milk is better absorbed than iron from formula, so the baby gets all he or
she needs. Human milk proteins form fluffy curds smaller in size than
proteins in formula, and they are more readily absorbed and pass through the
digestive tract more quickly than do the proteins in formula.
16. Is it true that formula-fed babies will sleep through the night better
than breastfed ones because the formula stays with them longer?
ANSWER: Yes, they will sleep a little longer. Formula-fed babies may average
about 3 to 4 hours between feedings while breastfed babies may average 2 to 3
hours.
17. Can I supplement breastfeedings with formula to delay frequent feedings?
ANSWER: When you start giving formula to a breastfed baby, you actually
disturb the normal mechanism for regulating your milk supply. This means that
you have to take the responsibility of seeing that your breasts get adequate
stimulation and regular emptying so that your supply does not drop if you do
not want it to. If the baby is nursing well, then the mother can safely add
formula as long as she empties her breasts often enough to maintain her milk
production. For most women, six thorough breast emptyings during every
24-hour period will be enough to maintain milk production. Some women may
need more, some less. If a breastfed baby is feeding too often, you need to
find out why. For example, some babies who want to nurse every hour are not
emptying the breast when they nurse because they are not nursing properly.
They are hungry within a short time because they have not taken much milk,
and the mother's milk supply is low because the baby is not emptying her
breasts. Giving formula in this case can cause the mother to lose her milk
supply completely. The answer is that sometimes you can supplement to delay
frequent breastfeeding safely and sometimes you can't. A good lactation
consultant can be a great help if you have questions.
18. I am breastfeeding. At what stage is it recommended to start a
supplemental bottle?
ANSWER: Supplemental feeding is an option, not a recommendation. Supplemental
feeding should not begin before two to three weeks after birth. If you know
that you will be giving a bottle later on, you can start giving one at about
this time and keep it up on a regular basis so that the baby will not refuse
to take a bottle when you go back to work or when you get ready to leave him
or her for a while. The best option is to put expressed breast milk in the
bottle and avoid giving formula until you decide to reduce your milk supply.
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19. Is it okay to use goat's milk?
ANSWER: Goat's milk is not suitable as a sole or even primary source of
nutrition. It is lacking in folate (a B vitamin) and a deficiency may result.
Goat's milk is also low in iron and in carbohydrates, and has a high renal
solute load, which means it can stress the kidneys.
20. What kind of formula do you recommend as a supplement to nursing?
ANSWER: Generally, any regular cow's- milk-based formula is suitable. Your
doctor or health care professional can help you to select a formula, and it
is important to have good advice when making this decision.
21. What formula is closest to breast milk?
ANSWER: All regular commercial infant formulas are manufactured to be as
close to human milk as possible. Manufacturers go to great lengths to produce
nutrients that will match those found in human milk. Some formulas are closer
in one way, and others are closer in other ways. But being close is not the
same as being identical. Human milk is so elegantly designed that it delivers
a higher percentage of its nutrients to the baby than formula can. A formula
that had the same amount of iron as that of breast milk could lead to iron
deficiency in the formula-fed baby, but the same amount of iron in breast
milk is enough! So you see, this is not as simple a question as it seems.
Rather than looking at the composition of the formula, it is better to look
at the effect of the formula on the baby. From this perspective, the formula
that makes your baby happiest and healthiest is the closest to your breast
milk. Your doctor or health care professional can assist you in choosing a
commercial formula preparation that meets your infant's particular needs.
22. How long does my baby need formula before switching to cow's milk?
ANSWER: The American Academy of Pediatrics and other authoritative bodies
worldwide recommend that cow's milk, full cream milks, and evaporated milk
not be introduced until the infant is at least 12 months of age. Cow's milk
contains little iron and can strain a young baby's kidneys.
23. There are some days that my son doesn't eat well; what can I do?
ANSWER: Be patient. Even babies have days when they don't have much appetite.
Sometimes breastfed babies have "nursing strikes" when they refuse to eat
much of anything for 24 hours or more. Check your baby's mouth to see if
something is hurting him. He may be cutting a tooth or he may have a sore in
his mouth which makes it difficult for him to eat. Watch his behavior. If he
acts sick, call his doctor.
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24. What if I want to go back to work and still want to breastfeed my child?
How can I resolve this dilemma?
ANSWER: It is not as hard as it may seem. You can
Pump at work and leave expressed milk for the baby.
Leave formula while you are at work and nurse when you are with the baby.
Nurse during your lunch hour or on breaks.
Your choice may depend on your work situation
Is there a private place for you to pump?
Do you have access to a refrigerator or a place to store a cooler?
Is there a good day-care facility on site or nearby?
Whatever you decide to do, it is a good idea to discuss your plans with your
employer before you return. If you can, make arrangements to go back to work
half a week early. Start work on a Thursday or Friday and take off on
Wednesdays for a few weeks. This will allow you and your baby time to adjust
gradually.
Here is an important pointer:
Frequency: If you want to breastfeed without giving formula, be sure to nurse
and/or pump at least six times every day. You can nurse several times in the
evening, and nurse once and pump once in the morning before you leave. If
your milk supply seems to be dropping, nurse very frequently (10 to 12
times/day) on the weekend to stimulate your supply. Many working mothers find
that their volumes are high on Monday and low by Friday.
25. How do I store my breast milk at work?
ANSWER: The best way is to keep it cold, but not frozen. Freezing reduces
some of the value because it kills most of the living cells in the milk. You
can put it in a refrigerator or in a small cooler with an ice pack. Your baby
can drink it in the next day or so. If you want to store milk for later use,
for example, if you plan to take a business trip without your baby, then you
can freeze a little at a time until you have enough. This is what you will
need to do before you go back to work.
26. What kind of container should I use? I've heard that it is not good to
use glass bottles.
ANSWER: Oh no, glass is fine-in fact, it is excellent. At one time there was
some concern that the live cells in the milk stuck to the glass, but now we
know that it happens only temporarily. You can use glass or hard plastic or
even baggie bottles. The baggie bottles have a couple of disadvantages: some
of the immunoglobins stick to them- but not all or even most; and they can be
punctured, so you might contaminate the milk accidentally or lose some. The
advantage of baggie bottles is that they are presterilized and compact.
Glass bottles can break and they take up a lot of space, otherwise they are
great. Hard plastic bottles won't break, but they do scratch. This means they
become harder to clean properly when they get old, so it is important to
replace them periodically. If I were choosing for myself, I would use glass,
but it is really up to you.
Pumps and equipment: There are many different kinds of pumps available. Some
come with attractive carrying cases and coolers specifically designed for
working mothers. You don't have to buy a pump, of course. Hand expression is
the easiest and cleanest way to express milk, but it takes practice.
Wash your hands thoroughly and rinse your breasts with clean water before
pumping or hand expressing. All equipment should be thoroughly clean. When
you hand express, remember to compress just behind the milk sinuses and roll
the fingers forward to force the milk out of the nipple. If you have trouble,
a lactation consultant can show you how to hand express efficiently.
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27. What should I look for in a breast pump?
ANSWER: Find one that is easy to use and to clean. Several good hand pumps
are available, including double-cylinder pumps and pumps that can be operated
with one hand. The old-fashioned "bicycle horn" pumps should be avoided. They
are hard to clean and may hurt the breast because they produce too much
suction. Battery-operated pumps are easier to use than hand pumps, but
replacing batteries can be both inconvenient and costly.
If you select an electric breast pump, one with alternating positive and
negative suction will give you the best results. These high-quality electric
pumps are very expensive, however, and usually are leased or rented by
mothers of hospitalized infants.
28. Does the amount and type of liquid I drink affect my milk production?
ANSWER: Contrary to popular misconception, you cannot increase your milk
supply by drinking a lot of liquids. It may be that your milk supply will
decrease if you become dehydrated, however. You should drink something
whenever you are thirsty, and you will probably be thirsty often. After all,
you will be producing about 25 ounces of milk every day, and even people who
are not nursing need to drink six 8-ounce glasses of water a day.
The type of liquid can be important to your health and can affect the
composition of your milk to some extent. If you drink caffeinated drinks, you
will have caffeine in your milk. Water, milk, and juices are excellent
choices for most nursing mothers.
29. Does the type of food I eat affect my milk, for example, chocolate or
hot, spicy foods?
ANSWER: Most nursing mothers can eat any food they want without causing their
babies discomfort. This includes chocolate, spicy foods, cabbage, onions,
broccoli, and all the foods usually included on the "don't eat" lists so
often distributed. Occasionally, some babies have problems with certain foods
that the mother eats. After your baby is born, if you suspect such a problem,
discuss it with your doctor. In the meantime, enjoy all the kinds of healthy
foods that you normally like.
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30. Can I drink alcohol if I breastfeed?
ANSWER: It is best to avoid alcohol when you breastfeed. If you do drink on
occasion, remember to wait a few hours before nursing your baby.
Alcohol will get into your breast milk, and it is toxic to your baby's brain
cells just as it is to yours. The difference here is that your baby is not
able to break down the alcohol as easily as you do, and your baby's brain
cells are more sensitive because they are still developing. Fortunately, your
system removes the alcohol from your milk whether you empty your breasts or
not. So if you take a single drink and wait for a few hours before you nurse,
almost all the alcohol in your milk will be removed and broken down just as
it has been removed from your blood stream.
31. Can I breastfeed if I smoke cigarettes?
ANSWER: Yes, you can. The choice is yours to make. You will have nicotine in
your milk and you will be exposing your baby to nicotine. This is probably
not good, but at the same time you will be giving your baby many protective
components that he or she could not get from formula. Babies exposed to
cigarette smoke, he will be more likely to become ill, and may need all the
protection he can get.
Please talk to your doctor about programs to help you stop smoking, and NEVER
allow yourself or anyone else to smoke in the same room with your child.
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