Breastfeeding: Getting Started
Breastfeeding your child
Nature designed breast milk especially for human babies. Your milk contains just the right balance of nutrients. Breast milk is the easiest food for your baby to digest, and it protects against illness.
The American Academy of Pediatrics (AAP) strongly recommends exclusive breastfeeding for at least 6 months. Exclusive breastfeeding means that your baby consumes only breast milk for 6 months. Babies who are exclusively breastfed have a lower risk for sudden infant death syndrome (SIDS), ear infections, respiratory illnesses, and diarrhea.
The AAP recommends using pacifiers to decrease the risk of SIDS. For breastfeeding mothers, the AAP recommends waiting until breastfeeding is well established. For most mothers, this is when the baby can easily put his or her mouth around the nipple and begins to nurse ("latches on"), breastfeeding is comfortable, and the baby has returned to his or her original birth weight.
Getting started with breastfeeding
Your milk and how you breastfeed change as your baby grows and develops. A newborn's feeding routine may be different than that of a breastfeeding 6 month old. As the baby grows, the nutrients in your milk adapt to your growing baby's needs. The anti-infective properties also increase if you or your baby is exposed to some new bacteria or virus. Here's how to get started:
The first few weeks of breastfeeding are a learning period for both you and your baby. It takes time for you both to work as a coordinated team. Be patient as you recover from your delivery, develop a daily routine, and become comfortable with breastfeeding. Keep track of feedings and wet diapers. This can help your child's health care provider assess how your feedings are going.
Most full-term, healthy babies are ready and eager to begin breastfeeding within the first half hour to 2 hours after birth. This first hour or 2 is an important time for babies to nurse and be with their mothers. The AAP recommends that babies be placed skin to skin with their mother immediately after birth (or when both the mother and baby are able). Skin to skin is placing a naked baby on a mother's bare chest. This keeps the baby warm, helps keep the baby's blood sugar up, and helps the baby breastfeed for the first time. It is recommended that babies be kept skin to skin at least 1 hour -- longer if the baby hasn't breastfed yet.
After these first few hours of being awake, babies will often act sleepy or drowsy. Some babies are more interested in sleeping than eating on their birthdays. You can expect to change only a couple diapers during the first 24 hours.
Days 2 to 4
Although he or she may need practice with latching on and sucking, by the second day, your baby should begin to wake and show readiness for feedings every 1.5 to 3 hours for a total of 8 to 12 breastfeedings over 24 hours. These frequent feedings provide your baby with antibody-rich first milk, called colostrum, and tell your breasts to make more milk. Allow your baby to nurse on one breast until finished. You can then change and burp your baby before you offer the other breast. If the baby is not interested in breastfeeding, start with the second breast at the next feeding.
As with day 1, you probably will change only a few wet and dirty diapers on baby's second and third days. Don't be surprised if your baby loses weight during the first couple of days. The number of diaper changes and baby's weight will increase when your milk "comes in."
It is normal to experience uterine cramping during the first few days of breastfeeding. This is a positive sign that the baby's sucking has triggered a milk let-down. It also means your uterus is contracting, which helps lessen bleeding. A nurse can give you medication before feeding if needed for the discomfort. Some mothers briefly feel a tingling, "pins and needles," or flushing of warmth or coolness through the breasts with milk let-down. Others don't notice anything different, except the rhythm of the baby's sucking.
Because your baby still is learning, your nipples may be tender when he or she latches on or during a feeding. Other factors also may contribute to this tenderness, but usually it is mild and disappears by the end of the first week. If tenderness continues, or gets worse, or if your nipples are cracked, tell your nurse. Your nurse or health care provider may recommend a lactation consultant. This is someone who specializes in breastfeeding.
Days 3 to 5
You will have a lot more breast milk 3 or 4 days after birth. When the amount of milk increases, the milk is said to have "come in." Since your baby is drinking more at each feeding, he or she may drift off after a feeding and act more satisfied. Within 12 to 24 hours, you should be changing a lot more wet diapers. The number of dirty diapers also increases, and the stools should be changing. They will change from meconium, the baby's first bowel movements, which are sticky and dark, to a mustard-yellow, loose and seedy stool.
Weight gain should also pick up within 24 hours of this increase in milk production, so your baby begins to gain at least half an ounce (15 g) a day. You may notice that your breasts feel fuller, heavier, or warmer when your milk comes in. The most important thing to do when your milk first comes in is to feed your baby frequently — emptying your breasts often and completely.
Your breasts may become overfilled with milk ("engorged") causing them to be swollen and painful. Your baby may have trouble latching on if your breasts are engorged. If this happens:
Express some milk, this means squeezing a small amount out of your breasts, and then let baby latch on.
Breastfeed or express milk by hand or breast pump frequently (every 1 to 2 hours). Your breasts should feel noticeably softer after breastfeeding or pumping.
a cold pack, a sandwich bag filled with ice, or a bag of frozen vegetables, covered in a thin towel, on your breasts. Keep it on your breasts for 15 to 20 minutes after nursing or pumping.
Days 5 to 28
Your baby will become more proficient at breastfeeding as the first month progresses. Expect to feed your baby about eight to 12 times in 24 hours. Let your baby tell you when he or she is finished eating. When the baby self-detaches from the nipple, you can offer the other breast. Some babies feed better between breasts if you change their diapers and burp them. Usually, a baby will breastfeed for a shorter period at the second breast, and sometimes he or she may not want to feed on the second breast at all. Simply offer the second breast first at the next feeding.
Your baby should continue to:
Soak 6 or more diapers a day with clear or pale yellow urine.
Pass 3 or more loose, seedy or curd-like yellow stools.
Begin to gain weight. Babies typically gain two-thirds to 1 ounce each day up to 3 months of age.
Talk to your baby's care provider if you think that your baby is not eating enough.
Every baby is different. Some will eat quickly, some will take longer to savor each drop, and others will take frequent breaks during each feeding. It is important to let your baby lead each feeding. This self-detachment will increase the amount of higher-fat/higher calorie milk (hindmilk) that your baby will get. However, once the breast is empty, some babies will continue to want to suck as a means of self-soothing. This can increase nipple soreness. If your baby continues to suck in this case, gently detach your baby. If breastfeeding is well established, you can off a pacifier instead.
Your baby probably will go through several two to four day "growth spurt" periods when he or she seems to want to eat almost around the clock. Babies commonly experience a growth spurt between 2 to 3 weeks, 4 to 6 weeks, and again at about 3 months. It is important to let a baby feed more often during these spurts. Within a few days, your baby will have returned to a more typical pattern.
Let your baby set the pace for breastfeeding. Pay attention to his or her feeding cues. Here are some examples of feeding cues:
The number of feedings each baby needs and the length of time each feeding lasts will vary from baby to baby. Trying to force a breastfed baby to wait longer between feedings, or to fit a particular feeding schedule, can result in poor weight gain.
- Holloway, Beth, RN, M.Ed.
- MMI board-certified, academically affiliated clinician