What if I get sick?
The mother should continue to nurse her baby even if she is ill..
Once the signs of a viral infection begin, the baby has already
been exposed to the virus for several days before her symptoms
started. The antibodies that her body is making against the viral
illness, will go into the breastmilk and help the baby get over
the illness faster. If the mother is too ill to nurse, instruct
her to pump her breasts. Remind the breastfeeding mother to check
with her doctor before using any over the counter remedies. Antihistamines
will lower the milk supply if she doesn't keep well hydrated.
The mother should drink plenty of fluids and get lots of rest.
What if my baby gets sick?
Contact the baby's medical provider if he has a fever over 101°F,
an exceptionally stuffy nose, is vomiting and/or has diarrhea.
A stuffy nose will make it difficult for baby to nurse. If the
baby has an ear infection, he may refuse to nurse because suckling
may worsen ear pain. The mother can feed breastmilk from an eye
dropper, sipper cup or spoon. The baby may demand to nurse more
if he is sick. The medical provider may recommend that the baby
receive only liquids for a while. It is O.K. to breastfeed. If
the baby must be hospitalized, make arrangements with the staff
for the mother to stay with the baby while he is hospitalized.
If this is not possible, the mother needs to pump her breasts
on a regular basis to maintain a good milk supply.
What is colic?
Colic is a catch-all term used by parents for a fussy baby. Infants
cry for a variety of reasons. Sometimes it may be boredom or loneliness.
Parents need to be told that crying is normal. Lengthy bouts of
infant fussiness are always labeled as "colic" by the parents.
It is normal for every baby to have a daily, predictable, fussy
period; usually between 4:00 p.m. and 11:00 p.m. The baby may
be reacting to the increased level of activity in the household.
Dad and other siblings are home, mom is busy getting supper ready
etc. The mother should prepare for the fussy time by getting any
possible household duties out of the way, before the baby gets
fussy. She should use calming measures such as a warm bath, rocking
the baby in the direction of his ears, soft music, going for a
walk out of doors, swaddling or a baby carrier.
In the medical profession, colic is defined as inconsolable crying
accompanied by apparent intestinal discomfort. If the baby cannot
be comforted, the mother should seek assistance from the baby's
doctor. Don't advise the parents to let the baby "cry it out."
This is very dangerous. If the baby is crying, something is bothering
him.
A diagnosis of colic is made using a rule of threes:
1. Crying for more that three hours a day
2. More than three times per week
3. For more than three weeks (Cynamon 3).
Colic is believed to be caused from a variety of reasons: an immature
digestive or nervous system, excess torsion of the head and neck
at birth or sensitivity to the environment. All may be correct.
I believe however, that true colic is the result of a reaction
to foreign proteins, a type of allergy, especially to formula.
From my experience, if there are no identifiable allergens in
the mother's diet (e.g., cow's milk, eggs, peanut butter), colic
symptoms are often the result of an overactive let-down reflex
or overfeeding syndrome. In the entirely breastfed infant, colic
like symptoms are the result of overfeeding in 95 % of the colic
cases I see. The infants of mothers with an overabundant milk
supply will often gain up to one pound per week. Less than 2-3
% of infants said to have colic have true colic. The remaining
percentage can be attributed to other causes.
If the infant is exceptionally gassy, is gulping and choking at
the breast, the baby may be getting too much milk too fast or
swallowing large amounts of air. She should be instructed to burp
the baby more often. If burping more frequently doesn't help with
the fussiness, the baby should be examined by a pediatrician for
any signs of illness. If illness has been ruled out, the mother
should be referred to a lactation consultant before the baby is
placed on any medication for colic. In most cases, reaction to
an overactive let-down is quite simple to correct by changing
the baby's feeding pattern. A baseline infant weight is critical
before mother changes the feeding pattern. Once a change is made,
the baby should have several weight checks, one week apart, to
determine if the baby is continuing to gain well.
See information on oversupply syndrome
What if my baby has a slow weight gain?
Seek assistance from a lactation consultant at once! The consultant
will try to identify if there is a problem with the breastfeeding.
Together with the baby's physician a lactation consultant can
suggest a method of treatment to assist with the lack of weight
gain. The mother should always continue to see the baby's doctor
for follow-up care and any testing that may be needed to determine
or eliminate a medical cause while under the care of a lactation
consultant.
Is my baby getting all the vitamins he needs?
Breastmilk contains everything that the original designer intended
for the baby. Vitamins, including fat soluble A, D, E, and K,
are present in highly usable forms in breastmilk. The use of vitamins
and fluoride supplements is no longer recommended by the American
Academy of Pediatrics for the healthy, term infant. The Committee
on Nutrition recommends fluoride supplementation where local water
supplies do not contain adequate concentrations of fluoride. (Lawrence
and Lawrence 813-815) The use of vitamin drops should be discussed
between the parents and the baby's physician.
Should I give my baby extra water or juice?
Breastmilk is about 90 % water. Studies done in the arid regions
of Africa have proven that a baby gets all the water he needs
from breastmilk. Even on the hottest days, breastmilk will provide
all the liquid the baby needs. To ensure an adequate supply of
breastmilk, the mother should drink to thirst.
I will be returning to work. How can I best introduce my baby
to a bottle?
If the baby will need to take a bottle later because the mother
is returning work, the first bottle should be introduced between
three and six weeks of age. An occasional bottle after three or
four weeks will not usually interfere with the milk supply or
cause "nipple confusion." If the mother waits too long to introduce
the first bottle, the infant may not accept the bottle.
Bottles should be given by someone other than baby's mother. A
baby will not understand why his mother is giving him this hard,
rubber thing instead of her soft, warm breast. It is best if the
mother is away from the house. Often the mother worries that the
baby will not take a bottle, only to find that the sitter has
no problem.
The first bottle feedings should be given at a time when the baby
is not overly hungry. The care giver should not to hold the baby
in the "nursing position." The baby should not be upset by the
experience, so the care giver should not insist that the baby
take the bottle. If the baby does become upset, he should be soothed
first and then the bottle tried again. Bottles of expressed breastmilk
or formula should be continued once or twice a week.
There is the occasional baby who will absolutely not take a bottle.
(My own son was like this from birth) I have often heard that
baby should be left hungry to "starve him into submission." This
attitude defies logic and is dangerous. An eye dropper, spoon
or a small cup (shot glass) can be tried, when the baby will not
accept the bottle Infants who refuse to take anything other than
the breast will often choose to sleep while his mother is away
and "stack up" or frequency feed when she is home. This refusal
is the ultimate compliment, (although it may not seem like it
at first), because the baby truly prefers his mother's breast.
What if I lose my milk?
This is highly unlikely. After about six weeks the breasts become
more efficient at making milk and no longer need to over produce.
For the first few weeks, mother's body isn't aware that she didn't
have twins. Supply has finally caught up with demand. The firmness
once felt as engorgement is expected to disappear. Production
of milk is now entirely dependent on the infant nursing at regular
intervals. When the baby suddenly seems hungrier than usual one
thing to consider is that the baby may be having a "growing day."
Baby is trying to bring mother's milk supply up to his new needs.
These growth spurts usually occur around three weeks, six weeks,
three months and six months of age. The baby should be back on
his normal schedule within 24 to 48 hours. The mother should be
instructed to count wet diapers for an estimate of infant intake.
The baby should have a minimum of six to eight wet diapers per
day.
What if I feel like my milk supply is low?
The mother should be advised to improve her nutritional status,
(three meals and two small snacks per day) 2200-2500 calories
per day, of well balanced foods.
Some other things that may help are:
1. Drink to thirst.
2. Use both breasts at each feeding.
3. Nurse more frequently.
4. Lengthen feedings.
5. Avoid supplemental bottles of water, formula or juice. Avoid
using a pacifier. Remember, a baby shouldn't get cereal until
four-six months of age. Cereal WILL NOT make the baby sleep through
the night. Seek assistance from a lactation consultant if she
suspects a low milk supply.
Will a breastfed baby become constipated?
For the entirely breastfed infant, constipation is rare. Because
formula has more waste products, constipation is a common problem
with formula use. Constipation means the passage of dry, hard
stools, not the frequency of stools. After six weeks of age it
is not uncommon for the baby to go two or three days without a
stool. Near six weeks of age, the bowel matures and the stool
pattern becomes more regular. It is important to teach the mother
that her baby will develop his own stooling pattern. If any formula
is used, the infant should have a stool at least once a day.
What if my baby suddenly refuses to nurse?
An ear infection can make it painful for the baby to nurse. A
stuffy nose can also make nursing difficult. If the baby is ill,
has a fever or is pulling at his ears, call the baby's doctor.
When a baby weans himself from the breast it is a gradual process
and does not happen suddenly. Provided there are no signs of illness,
this may be a "nursing strike." The mother will need to do some
detective work. Has nursing become stressful? Is the household
overly busy? Has the baby been frightened at the breast? Has he
injured his mouth? Is he teething? Did the mother change bath
soap, deodorant or perfume? Has the baby been getting a bottle
or pacifier frequently? Is the baby learning how to crawl? (Pre
crawling boredom can make a baby too restless to settle down to
nurse). There are several things to try. Nurse the baby when he
is asleep or almost asleep. Take him into a darkened room. Offer
the breast frequently but don't insist. If the problem continues
for longer than 24 hours seek assistance, first from the baby's
doctor to be sure that the baby isn't ill and then refer to a
lactation consultant.
What if my baby only takes one breast and won't take the other?
Babies occasionally develop a preference for one breast over the
other. Ask the mother: Is there any difference in the shape of
the nipple or the entire breast? Have her offer the breast that
the baby won't take between feedings or when he's almost asleep.
Also she can try to hold him in the same position that he is in
when nursing from the other breast. The problem should resolve
itself in one or two days. If the baby won't take the other breast
at all, mother should pump the breast that the baby has not nursed
on to prevent plugged ducts and mastitis and to help keep the
milk supply even. If the problem doesn't resolve quickly refer
to a lactation consultant for assistance.
What can I do when my baby bites?
Newborns do not bite: they clamp. Biting occurs more often in
the baby four six months or older. If the baby bites, the mother
should immediately break the latch and gently tell the baby, "Don't
bite." Place the baby on the floor and walk away. This feeding
is now over. The baby will soon understand that if he bites, he
doesn't get to finish the feeding. The mother should take care
not to frighten the baby or raise her voice. If she frightens
the baby he may refuse to nurse again. Secondly, tell the mother
to begin to pay close attention to the baby's nursing pattern
- a baby will not bite his own tongue. She will be able to feel
the tongue pull back just before he bites. The mother should be
instructed to quickly insert a finger into his mouth and stop
the feeding. ALWAYS end the feeding with the same words "Don't
bite" Babies usually bite when they are teething, so mother should
check the mouth for swollen gums or the beginning tips of the
teeth poking through the gum. The pressure feels good on his sore
gums. Babies are most likely to bite at the beginning of a feeding
or as they fall asleep.
What if my baby won't sleep unless he nurses?
Most infants under the age of three years cannot go to sleep without
assistance of some kind. Nursing helps them relax and doze peacefully
off. Sometimes a baby will get so over-tired that it will take
quite a bit of effort to get him settled down enough to sleep.
If the baby begins to wake again during the night, the mother
may need to nurse him back to sleep. Night waking usually resumes
during teething. Have mother try calling out to him first. Go
to the crib and pat him. She should pick him up when nothing else
calms him.
Questions after the first 4 weeks
Storage of EMM (Expressed Mother's Milk)
Copyright Marie Davis, RN, IBCLC 1999
Last reviewed: