Breastfeeding Your Baby (booklet)

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  • Benefits of Breastfeeding

  • How Breastfeeding Works

  • Getting Started

  • Beyond the First Feedings

  • The Fussy Breastfed Baby

  • Caring for Your Breasts

  • Special Concerns

  • Breastfeeding After You Return to Work

  • Breast Milk Expression and Storage

  • Weaning Your Baby

  • Breastfeeding: A Natural Gift

This tile also is available in preprinted, 2-color booklet format (8.5" x 5.375") sold in packs of 50. Orders can be placed online at http://shop.aap.org/Breastfeeding-Your-Baby-Brochure-50pk-Brochure.

Getting ready for the birth of your baby is an exciting and busy time. One of the most important decisions you will make is how to feed your baby. Deciding to breastfeed can give your baby the best possible start in life.

Breastfeeding benefits you and your baby in many ways. It also is a proud tradition of many cultures. This booklet was written by the American Academy of Pediatrics (AAP) to answer common questions about breastfeeding.

Benefits of Breastfeeding

In general, the longer you breastfeed, the greater the ≠benefits you and your baby will get and the longer these benefits will last.

Why is breastfeeding so good for my baby?

Breastfeeding is good for your baby because

  • Breastfeeding provides warmth and closeness. The ≠physical contact helps create a special bond between you and your baby.

  • Human milk has many benefits.

    • It's easier for your baby to digest.

    • It doesn't need to be prepared.

    • It's always available.

    • It has all the nutrients, calories, and fluids your baby needs to be healthy.

    • It has growth factors that ensure the best development of your baby's organs.

    • It has many substances that formulas don't have that help protect your baby from many diseases and infections. In fact, breastfed babies are less likely to have

      • Ear infections

      • Diarrhea

      • Pneumonia, wheezing, and bronchiolitis

      • Other bacterial and viral infections, such as meningitis

Research also suggests that breastfeeding may help protect against obesity, diabetes, sudden infant death syndrome (SIDS), asthma, eczema, colitis, and some cancers.

Who can help me?

Before your baby is born, learn as much as you can. There are many resources about breastfeeding, including books, videos, and classes. Talk with your doctor about cultural customs and beliefs that are important to you. For more information about breastfeeding, visit the AAP Web site at www.aap.org/breastfeeding.

Getting support from family and friends is very important too. Father and baby can share many special and personal moments. Older siblings can be great playmates and help with changing diapers. Besides providing another set of helping hands, grandparents can offer wisdom and experience.

Why is breastfeeding good for me?

Breastfeeding is good for your health because it helps

  • Release hormones in your body that promote mothering ≠behaviors.

  • Return your uterus to the size it was before pregnancy more quickly.

  • Burn more calories, which may help you lose the weight you gained during pregnancy.

  • Delay the return of your menstrual period to help keep iron in your body.

  • Provide contraception, but only if these 3 conditions are met: (1) you are exclusively breastfeeding at daytime and nighttime and not giving your baby any other supplements, (2) it is within the first 6 months after birth, and (3) your period has not returned.

  • Reduce the risk of ovarian cancer and breast cancer.

  • Keep bones strong, which helps protect against bone ≠fractures in older age.

How Breastfeeding Works

When you become pregnant, your body begins to prepare for breastfeeding. Your breasts become larger and, after your fourth or fifth month of pregnancy, your body is able to produce milk.

What is colostrum?

Colostrum is the first milk your body makes. It's thick with a yellow or orange tint. Colostrum is filled with all the nutrients your newborn needs. It also contains many substances to ≠protect your baby against diseases and infections. It's very important for your baby's health to get this early milk, though it may seem like a small amount. Your baby only needs less than 1 tablespoon per feeding on the first day and about 2 tablespoons per feeding on the second day.

What's the difference between milk coming in (increase in milk production) and let-down?

Milk coming in and let-down mean different things, but both are important.

  • Milk comes in 2 to 5 days after your baby is born. This is when colostrum increases quickly in volume and ≠becomes milky-white transitional milk. Signs that your milk is ≠coming in include

    • Full and tender breasts

    • Leaking of milk

    • Seeing milk around your baby's mouth

    • Hearing your baby swallow when fed

    Breast milk changes daily and will adjust to your baby's needs for the rest of the time you breastfeed. Because the color or creaminess of the milk can change daily, don't worry about how your milk looks.

  • Let-down is the reflex that creates the flow of milk from the back of the breast to the nipple. Let-down occurs each time the baby suckles. It is triggered when you are relaxed and your baby is latched on to your breast properly. Let-down may also happen between feedings, such as when the breasts are somewhat full or when you hear a baby's cry. The first few times you breastfeed, the let-down reflex may take a few minutes. Afterward, let-down occurs faster, usually within a few seconds. Let-down occurs in both breasts at the same time. It may occur several times during each feeding.

    The signs of let-down are different for each woman. Some women feel nothing, even though breastfeeding is going fine. Other women feel

    • Cramping in the uterus. This can be strong for the first few days after delivery but often goes away after breastfeeding is well established.

    • A brief prickle, tingle, or even slight pain in the breast.

    • A sudden feeling that breasts are heavier.

    • Milk dripping from the breast that's not being used.

    • Their baby swallowing or gulping when fed.

What is demand and supply?

The more milk your baby takes from your breast, the more milk you make. This is called demand and supply because the more milk your baby demands, the more you will supply. Many women with small breasts worry that they won't be able to make enough milk. However, because of demand and supply, there's no relationship between breast size and how much milk is produced.

Getting Started

Babies are very alert after they are born and ready to find the breast! The more relaxed and confident you feel, the faster your milk will flow to your baby. Getting comfortable will help you and your baby get started toward a better latch-on.

How soon can I breastfeed?

You can and should breastfeed within the first hour after birth if you and your baby are physically able to do so. After delivery, your baby should be placed on your chest or stomach, skin to skin. The early smell and taste of your milk helps your baby learn to breastfeed, or nurse. Your breast milk is all your baby needs if your baby is healthy. Other liquids, including water, sugar water, and formula, will only lessen the benefits your baby receives from the early breast milk. Try to stay with your baby as much as you can. Rooming in with your baby day and night during your hospital stay has been shown to help start breastfeeding and keep it going longer.

What are different breastfeeding positions?

Always take time to get comfortable. Don't be shy about asking for help during the first feedings. It may take a few tries, but with a little patience, you and your baby will succeed.

Here are 4 breastfeeding positions.

  • Cradle hold. This is the traditional breastfeeding position. Firmly support your baby's back and bottom. When feeding this way, make sure your baby's entire body is facing your body, not the ceiling.

  • Clutch hold or football hold. This hold may be more comfortable if you've had a cesarean delivery because it keeps the baby's weight off of the stitches.

  • Reclining. Feeding your baby while ≠lying down lets you relax and can be helpful if you've had a cesarean ≠delivery or are tired.

  • Laid-back. In this position lie back slightly with your head, shoulders, and back supported by pillows. With your baby on your stomach, let baby's head rest near your breast. Be patient while your baby crawls to the breast, latches on, and breast≠feeds. Help as little or as much as your baby needs.

Important reminder: It's important that you stay awake while you are ≠breastfeeding. For instance, babies who sleep in the same bed as their parents are at risk of SIDS, suffocation, or ≠strangulation. Parents can roll onto babies during sleep, or babies can get tangled in the sheets or blankets. And remember to place your baby on her back for every sleep. Also, place your baby to sleep in the same room where you sleep but not the same bed. Keep the crib or bassinet within an arm's reach of your bed. You can easily watch or breastfeed your baby by having your baby nearby.

How can I get comfortable while breastfeeding?

A few simple things can help you feel comfortable and relaxed.

  • Sit on a comfortable chair with good back and arm support.

  • Lie on your side in bed with your baby facing you. Place pillows to support your back and neck.

  • Take deep breaths and picture yourself in a peaceful place.

  • Listen to soothing music while sipping a healthy drink.

  • Apply moist heat (such as warm, wet washcloths) to your breast several minutes before each feeding.

  • If your home is very busy, find a quiet place where you won't be disturbed during feedings.

  • If you had a cesarean delivery, use extra pillows to help position your baby.

  • Try different breastfeeding positions.

  • Make sure your baby is latched on correctly. (See the next question about latch-on.)

What if I have inverted nipples?

Although rare, a few women have nipples that are drawn inward, or are inverted. When nipples are inverted, a baby may not be able to grasp the areola (dark area around the nipple) properly to get milk.

The problem of inverted nipples often clears up on its own during pregnancy, as breasts get larger. Often a baby's suckling will pull the nipple out. If this doesn't happen, you may need some special help with breastfeeding after your baby is born.

Why is latch-on so important, and how is it done?

A good latch-on means that your baby has opened his mouth wide and is well back on the breast, taking both the areola and nipple far back into his mouth.

Correct latch-on is very important because it

  • Makes milk flow better

  • Prevents sore nipples

  • Keeps your baby satisfied

  • Stimulates a good milk supply for baby's weight gain

  • Helps prevent engorged (overly full) breasts

You can help your baby latch on by holding your breast with your free hand. Place your fingers under your breast and with your thumb on top. Move your fingers well back from the areola so they don't get in the way. Position your baby with his entire body facing you.

Touch your nipple to the center of your baby's lower lip. This will cause your baby to open his mouth widely. This is called the rooting reflex. As this occurs, pull your baby onto the nipple and areola. Keep in mind that when your baby is correctly positioned, or latched on, your nipple and much of the areola are pulled well into his mouth. Your baby's lips and gums should be around the areola and not just on the nipple. Your baby's chin should be touching your breast and his nose should be close to the breast.

At first you will feel a tugging sensation. You also may feel a brief period of pain. If breastfeeding continues to hurt, pinch, or burn, your baby may not be latched on properly. You may need to try different ways to break suction. Also, it can take ≠several tries before the seal is broken. Never pull the baby off the breast without releasing the suction.

Option 1: Slip your finger into the ≠corner of your baby's mouth.

Option 2: Press one finger gently but ≠firmly on the baby's cheek, close to his mouth.

Option 3: Gently pull the corner of your baby's mouth.

Hospital staff should watch a feeding and make suggestions. If breastfeeding continues to hurt, you may need the help of a lactation specialist. Let your pediatrician know if there's a problem.

Beyond the First Feedings

How often should I breastfeed?

Newborns feed often and will give cues or signs when they are ready to feed. The length of each feeding varies and your baby will show signs when she is finished. Newborns are hungry at different times, with a long cluster of feedings in the late ≠afternoon or night. Most breastfed newborns feed 8 to 12 or more times per 24 hours (once the milk has come in). If your baby isn't waking on her own during the first few weeks, wake her if more than 2 hours during the day and 4 hours during the night have passed since the last feeding. If you are having a hard time waking up your baby for feedings, let your pediatrician know.

What's the best feeding schedule for a breastfed baby?

Feeding schedules are different for every baby, but it's best to start breastfeeding your baby before crying starts. Crying is a late sign of hunger. Whenever possible, use your baby's cues instead of the clock to decide when to breastfeed. It can be less frustrating for you and your baby if you learn your baby's early hunger cues. Frequent feedings help stimulate the breasts to produce milk more efficiently. (See Early Signs of Hunger.)

Some days, babies will want to nurse much more frequently, sometimes every hour. Many mothers worry that they are not making enough milk for their baby. This is your baby's way of telling your breasts that they need to make more milk because the baby is growing. This is called a growth spurt. Remember, this is normal and temporary, usually lasting about 4 to 5 days. Keep on breastfeeding, and don't give any other liquids or foods.

How long does breastfeeding take?

Each baby feeds differently: some slower, some faster. Some feedings may be longer than others depending on your baby's appetite and the time of day. Some babies may be nursing even though they appear to be sleeping. While some babies nurse for only 10 minutes on one breast, it's quite common for others to stay on one side for much longer. It's generally good to allow your baby to decide when the feeding is over—he will let go and pull back when he is done.

If your baby has fallen asleep at your breast, or if you need to stop a feeding before your baby is done, gently break the suction. (See Why is latch-on so important, and how is it done? for information on how to break the suction.)

To stimulate both breasts, alternate which breast you offer first. Some women like to keep a safety pin on their bra strap to help remember. While you should try to breastfeed evenly on both sides, many babies seem to prefer one side over the other and nurse longer on that side. When this happens, the breast adapts its milk production to your baby's feedings.

Why is it important to feed only breast milk in the early months?

The AAP recommends breastfeeding as the sole source of nutrition for your baby for about 6 months. This is important for many reasons, including

  • Colostrum is the "first immunization." It provides early protection from harmful infections and helps to prevent allergies.

  • Colostrum and mature breast milk contain the perfect balance of nutrients and immunities for your baby for about the first 6 months.

  • Breast milk is more easily digested and less likely to cause ≠allergies than other liquids or foods.

  • Other liquids or foods interfere with the nutrients and immune properties of human milk. (Note: Follow advice from your doctor if he or she has recommended a special feeding plan for your premature or previously sick baby.)

  • Other liquids and foods interfere with the "feedback loop" between baby and mother that is demand and supply. Filling up the baby with other nutrients results in less hormonal stimulation for the mother, lower milk supply, and fewer benefits to the mother and baby's overall health.

Note: When you add solid foods to your baby's diet, continue breastfeeding until at least 12 months. You can continue to breastfeed after 12 months if you and your baby desire. Check with your baby's doctor about vitamin D and iron supplements during the first year.

How can I tell if my baby is hungry?

You will soon get to know your baby's feeding patterns. In addition, babies may want to breastfeed for reasons other than hunger. It's OK for you to offer these "comfort feedings" as another way of meeting your baby's needs.

Nearly all newborns are alert for about 2 hours after delivery and show interest in feeding right away. Let the hospital staff know that you plan to take advantage of this opportunity—it's very important to the breastfeeding process. After 2 hours, many newborns are sleepy and hard to wake for the next day or so.

Keeping your baby with you skin to skin while in the hospital will make it easier for you to recognize hunger cues and easier for your baby to be alert and feed often. Watch for the early signs of hunger. This is the time to pick your baby up, gently awaken her, check her diaper, and try to feed her. (See Early Signs of Hunger.)

How can I tell if my baby is getting enough milk?

Here are several ways you can tell whether your baby is getting enough milk.

  • Your baby has frequent wet and dirty diapers.

  • Your baby appears satisfied after feeding.

  • Milk is visible during feedings (leaking or dripping).

  • Your baby is gaining weight after the first 4 to 5 days of life.

Your baby should have several wet or dirty diapers each day for the first few days after delivery. Beginning around the fifth day of life, the wet diapers should increase to 6 or more per day. At the same time, stools should start turning green, then yellow. There should be 3 or more stools per 24 hours. Typically, once breastfeeding is going well, breastfed babies have a yellow stool during or after each feeding. As your baby gets older, stools may occur less often and, after a month, may even skip a number of days. If stools are soft and your baby is feeding and acting well, this is quite normal.

Your baby's feeding patterns are an important sign that he is feeding enough. If you add up all the feedings over the course of the day, your baby should feed at least 8 to 12 times a day.

Remember, newborns feed often and will give cues or signs when they are ready to feed. The length of each feeding varies, and your baby will show signs when he is finished.

When feeding well with good latch-on, the newborn will suckle deeply, you will hear some swallowing, and the feeding won't be painful. The baby should appear satisfied and/or sleep until time for the next feeding. If your baby sleeps for stretches of longer than 2 hours during the day or 4 hours during the night in the first 2 weeks, wake him for a feeding. If your baby will not wake enough to eat at least 8 times per day, call your pediatrician.

Your baby will be weighed at each doctor's visit. This is one of the best ways to tell how much milk your baby is getting. The AAP recommends that babies be seen for an office visit (or home visit) between 3 to 5 days of age to check on breastfeeding and baby's weight. During the first week, most newborns lose several ounces of weight, but they should be back up to their birth weight by the end of the second week. Once your milk supply is established and after the fourth or fifth day, your baby should gain between ½ and 1 ounce per day during the first 3 months.

Early Signs of Hunger

Your baby starts to let you know when she's hungry by the following early signs or cues:

  • Small movements as she starts to awaken

  • Whimpering or lip-smacking

  • Pulling up her arms or legs toward her middle

  • Stretching or yawning

  • Waking and looking alert

  • Putting her hands toward her mouth

  • Making sucking motions

  • Moving her fists to her mouth

  • Becoming more active

  • Nuzzling against your breast

  • Rooting or turning her head and opening her mouth

Does my baby need anything else in addition to breast milk?

Breastfeeding babies don't need any water or other milk supplements for the first 6 months. However, vitamin D drops (400 IU per day) should be given beginning in the first few days of life. Iron-containing foods should be given beginning at about 6 months of age.

The AAP and the American Academy of Pediatric Dentistry ≠recommend that breastfed infants (as well as bottle-fed infants) not receive fluoride supplements during the first 6 months of life. After 6 months of age, check with your pediatrician to see if your baby needs fluoride. Begin to clean your baby's teeth as soon as they come through the gums.

Is it OK to use a pacifier?

Pacifiers should not be given until after breastfeeding is well established, which is usually 3 to 4 weeks after birth. Babies who are sucking on pacifiers are not breastfeeding and thus not stimulating the mother's milk supply. After about 3 to 4 weeks, pacifiers may help reduce the risk of SIDS when used to put babies to sleep during naps and at bedtime. However, babies who do not like pacifiers should not be forced to use one. All babies should sleep on their backs regardless of pacifier use. A pacifier may be used in the newborn period for specific medical reasons (such as pain relief) and for premature newborns in the newborn intensive care unit.

Is it OK for the baby's father to give a bottle to the baby?

Most experts recommend that you avoid giving bottles until breastfeeding has become well established. In general, bottles are introduced usually by about 3 to 6 weeks. If you decide to use them on occasion, it should be possible for the baby to switch from one method to another. Plan ahead so that you can have some expressed milk on hand for times when the baby will be getting a bottle. (See Breast Milk Expression and Storage.)

Should I be worried about my baby spitting up?

It's common for babies to spit up during or after feeding. Some babies spit up more easily than others. There's usually no serious problem, but if you are concerned, discuss it with your pediatrician.

Do I need to change my diet?

The mother's diet has only minor effects on her milk, and these are usually not cause for any concern. Your body does require extra calories, nutrients, and fluids during breastfeeding, similar to the needs of pregnancy. Your diet mainly affects your nutrition, so a healthy diet is still important.

Many cultures recommend that women who breastfeed should eat certain foods while avoiding others. Most experts agree that women should continue to eat any foods that they normally eat. If you have a restricted diet (such as vegetarianism) for health, religious, or cultural reasons, you should discuss this with your doctor or a nutritionist.

The Fussy Breastfed Baby

Many women assume that their diet is causing their breastfed baby to be unusually fussy. Actually, other reasons are more ≠likely. Here are some general causes of excess crying. Your pediatrician can help pinpoint and treat the exact problem (if possible). You may be referred to a lactation specialist to assist you.

  • Hunger. If your newborn feeds constantly but is never satisfied after coming off of the breast, talk with a health care professional who is knowledgeable in breastfeeding ≠management.

  • Growth spurt. A rapid growth phase often happens at 2 to 3 weeks of age, again around 6 weeks, and around 3 months. During a growth spurt, your baby will seem fine but want to nurse constantly. Remember, this is normal and only temporary, usually lasting about 4 to 5 days. Many women are tempted to give their babies formula during this time, but formula is not needed. Continue to breastfeed very often to increase your milk supply.

  • Hyperalert or "high-needs" babies. Some babies require more of everything, except sleep. They cry all day long. They are not very regular in their eating, sleeping, or reactions to others. They usually need a lot of holding, carrying, and ≠motion. Slings or other baby carriers may help calm these babies while parents are moving around.

  • Colic. Colic begins around 2 to 3 weeks of age. Babies with colic generally have one period each day when they appear to be in pain with legs drawn up, crying hard, and turning red. They may act hungry during these times but then pull back and refuse the breast. Your pediatrician can offer advice.

  • Oversupply or overactive let-down of breast milk. This may begin almost any time in the first month. The mother has very full breasts or a lot of leaking or may see milk spraying. The baby will be gulping down the milk very fast, sometimes pulling off to catch his breath. The rapid drinking causes the baby to get a lot of air and milk and, later, gas bubbles. Your doctor can suggest certain breastfeeding positions and techniques to help your baby deal with this.

  • Excessively spitting up (also called reflux). Most newborns spit up after feeding. When spitting up results in problems for the baby (such as pain or weight loss), it requires an evaluation by your pediatrician.

  • Food sensitivities. The foods you eat will flavor your breast milk. Occasionally, a particular food (eaten by the mother) may cause problems in a baby. If you think this might be the case, avoid that food for one week to see if symptoms go away. Try the food again to see if symptoms return. Many cultural groups eat foods that could be considered spicy, and babies handle them just fine. Generally, your baby may be most likely to enjoy the flavors of foods you enjoyed while pregnant.

  • Allergies. Although baby crying is often blamed on food allergies, allergies are less common than some of the other reasons for fussiness. True food allergies can be very serious and require the attention of your pediatrician.

  • Serious illness. Crying, fussiness, restlessness, and increased or decreased feeding, when your baby acts ≠inconsolable, can be symptoms of illness—you should ≠contact your pediatrician.

Caring for Your Breasts

How do I take care of my breasts?

During pregnancy, the oil glands around the nipple become more active, moisturizing and protecting the skin. When you take a bath or shower, wash your breasts with warm water only. Don't use soaps or lotions because they aren't necessary and may be irritating.

If you wear bras, you will probably have to purchase new ones as your breasts grow during pregnancy. Nursing bras have fasteners in the front to allow easy access for feeding.

Deciding to wear a bra is a personal choice. Some women choose not to wear a bra during pregnancy or breastfeeding. There's no research to say that wearing a bra affects breast size or shape in later life.

When your milk comes in, your breasts will go from feeling soft to firm. If your nipples leak, use an absorbent pad to catch the leaking milk. Don't use plastic-lined pads because they prevent air from circulating around your nipples.

Your obstetrician or family doctor should examine your breasts and nipples during pregnancy and at your yearly checkups. You should learn how to do a breast self-exam. Self-exams should be done monthly during and after pregnancy. If you plan to prepare your breasts or nipples in any special way based on ≠cultural practices, discuss this with your doctor. Remember to ask any questions you have about breastfeeding or other health concerns.

What is engorgement?

It's normal for your breasts to get bigger and for your breasts and nipples to feel tender when you first start breastfeeding. Engorgement occurs when your breasts become too full. This often occurs if you haven't been breastfeeding often enough or not draining your breasts adequately. Feeding on demand ensures that your baby's hunger is satisfied and helps prevent engorgement.

If your breasts become engorged, try

  • Breastfeeding frequently.

  • Soaking a cloth in warm water and putting it on your breasts or taking a warm shower before feeding your baby.

  • Using cool compresses or ice packs after feedings to relieve your discomfort and reduce swelling.

  • Gently massaging your breasts from under the arm and down toward the nipple.

  • Different positions during feeding, such as lying down or using the football hold.

  • Expressing some milk before you breastfeed, either manually or with a breast pump. This may be needed to allow the baby to latch on properly. (See Breast Milk Expression and Storage.)

  • Pain medicines such as ibuprofen or acetaminophen. If you received prescription medicines for pain after delivery, these can be used as well, but only for a few days.

Engorgement is a temporary condition. Once the engorgement passes, your breasts will become soft again. This is normal and exactly what should happen.

What should I do for sore nipples?

Get help right away if your nipples are sore. Breastfeeding shouldn't make your nipples sore. Most often soreness is caused by incorrect latch-on. Many women think they have to wait and "tough it out," but this only makes it harder to treat the problem. If you have nipple pain that continues after the latch-on, pain all through the feeding, open cracks, or bleeding, you need to be seen by your doctor or a ≠lactation specialist.

What are blocked or plugged ducts?

Sometimes an area of the breast becomes blocked or plugged. The area is firm and painful and may be slightly red, but the mother is otherwise healthy. Treatments for blocked ducts are moist heat applied to the area, massaging the area before and during feeding, and frequent draining of the breast by feeding or milk expression. If the blockage doesn't clear within 48 hours, call your doctor. Sometimes a blocked or plugged duct will lead to a breast infection.

How do I know if I have a breast infection, and how is it treated?

Mastitis is an infection of the breast. The infection is in the tissues, not in the milk. It causes swelling, burning, redness, and pain in the breast, along with flu-like symptoms such as fever, body aches, and low energy. Mastitis usually occurs in just one breast. If you have any of these symptoms, let your doctor know right away so that you can start treatment. Treatment usually includes continued breastfeeding or pumping, a lot of rest and fluids, warm compresses, antibiotics, and pain relievers.

Special Concerns

What about drugs and medicines?

  • Medicines. Most medicines are safe, but check with your doctor before taking any medicines to make sure. Birth control pills may affect your milk production, but this varies from woman to woman and with the type of pill or contraception you are using. If you are exclusively breastfeeding during the first 6 months and have not had your period return, then you are somewhat protected from pregnancy by a method called lactational amenorrhea method, or LAM. However, if you don't want to become pregnant, check with your doctor about more effective forms of birth control.

  • Alcohol. While you are nursing, avoid drinking alcohol because it can pass through your milk to your baby. If you drink alcohol occasionally, drink it just after you breastfeed rather than just before. Drinking alcohol with a meal will decrease the amount that gets to your baby. If you decide to drink heavily, you should refrain from breastfeeding until the alcohol has cleared your system. If you need to pump for comfort during this time, you should discard this milk.

  • Tobacco. Don't smoke while you are breastfeeding or around children. Secondhand smoke is dangerous to all children but especially to newborns. It increases the risk of SIDS. Try to cut down or quit smoking for your own health as well as your baby's. Using a nicotine patch is compatible with breastfeeding and passes less nicotine and its by-products to your baby than smoking does.

  • Caffeine. Caffeine tends to build up in babies' systems because their bodies can't get rid of it very easily. Caffeine can make some babies irritable and sleep poorly. Try to avoid excessive intake of caffeine or at least reduce your intake while you are breastfeeding.

  • Herbal medicines. If you take any herbal medicines or complementary therapies (such as special teas), tell your doctor; many of them would not be recommended while breastfeeding.

  • Illegal drugs. Illegal drugs are dangerous to you and your baby. If you decide to use street drugs, pump your milk and throw it away until you can safely breastfeed again.

What if I have a fever or other symptoms of being sick?

Breastfeeding can and should continue during most illnesses, including colds, flu, bacterial infections, and even surgical ≠conditions. Mother and baby benefit if it does.

By the time you show symptoms of an illness, your baby has already been exposed to it. The best thing to do is to keep breastfeeding; that way, your baby gets protective antibodies against the germs causing your infection. If you stop breast≠feeding suddenly, you will likely have uncomfortable symptoms of engorgement and possibly a low-grade fever.

If you can't breastfeed your baby while you are ill, keep up your milk supply by expressing your milk. (See Breast Milk Expression and Storage.) If you must remain in the hospital, arrange to have your baby stay with you or visit if a family member is there to be responsible for your baby between ≠feedings.

There are a few infections that can be transmitted through human milk to your baby, including HIV. Mothers in the United States with HIV are advised not to breastfeed. Your ≠obstetrician and pediatrician can advise you on how to ≠manage other types of infections.

Will I be able to breastfeed if I have had breast surgery?

The effects of breast surgery are different for each woman and depend on the exact surgical procedure that was done. Breast augmentation can be compatible with breastfeeding, but breastfeeding may require special care and help. Breastfeeding may not be possible after breast reduction, and professional help from a lactation specialist may be needed. Make sure you share all your concerns with your doctor. Your pediatrician needs to be aware of any previous breast surgery that you've had so your baby can be followed closely.

Will I have enough milk for twins or triplets?

Remember the phrase demand and supply? Two babies will demand more milk than one! Most women are able to produce enough milk to breastfeed multiple babies. With practice, it's possible to breastfeed 2 babies at the same time, a baby at each breast. You can hold one baby on each side using the football hold. Or you can cradle them both in front of you with their bodies crossing each other, as they would have been in your womb.

With twins or triplets, it's very helpful to get advice from a lactation specialist. Twins and triplets are commonly born somewhat early; see the next question about feeding premature ≠newborns.

What if my baby is premature or ill?

Many premature and seriously ill babies are able to breastfeed eventually. Human milk is very beneficial to premature and sick newborns by helping growth and preventing many diseases. If your baby isn't able to breastfeed at first, you can begin to collect your milk within the first few hours after birth for your hospital staff to give by feeding tube. Express your milk at the times when your baby would usually feed so that your body becomes used to the schedule, usually about 8 times per day by electric breast pump. Continue expressing milk until your baby can breastfeed. Depending on the specific situation, full breast≠feeding is usually a very gradual process. Many hospitals have lactation specialists to help you.

Breastfeeding After You Return to Work

Human milk has the same benefits for older babies as it does for newborns. You can continue to breastfeed while working away from home. There are different options if you plan ahead. Many women are proud to continue to provide their milk while they are away, knowing that this can't be replaced by anyone else.

With the US health care law (Patient Protection and Affordable Care Act of 2010), your workplace is required to provide reasonable break time and a place for you to express your milk at work. Your company will also benefit: for every $1 invested making a breastfeeding program, there is a $2 to $3 return.

Here are different ways working women manage breastfeeding.

  • Extend maternity leave to have more time to get breastfeeding established—at least 3 to 4 weeks if possible. After breastfeeding is established and before you return to work, introduce bottle-feeding so your baby can get used to receiving breast milk from a bottle.

  • Explore different work options, such as working part time, working at home, or starting back part time. (Your employer may be aware that recent studies show that breastfed infants don't get as sick as often as formula-fed infants and their parents miss fewer days of work to care for a sick baby, which saves the company money.)

  • Breastfeed your baby once or more during the workday if she is in child care at your workplace or nearby.

  • Feed your baby before going to work and on return home. More frequent breastfeeding after returning home will help maintain your milk supply.

  • Express and store milk (usually every 3 to 4 hours while you are at work).

  • Breastfeed when you are with your baby; breastfeed completely on days off.

  • Keep it up. Remember that some breastfeeding (or some breast milk) is better than none.

Share your feeding plans with your child care provider and give him or her information about handling breast milk. Before returning to work, find out if there's a place for breastfeeding or pumping. Human resources staff or occupational nurses often handle these questions. Try to find a coworker who has successfully breastfed after returning to work.

You will need 10 to 15 minutes each time you express milk ≠(usually 2 or 3 times during the workday). You will need access to soap and water to wash your hands before expressing. You will also need a refrigerator or a small cooler and ice packs where you can keep milk cold until you get home.

After mothers return to work and their babies are getting bottles regularly, some babies may get frustrated with breastfeeding. The milk flows differently from the breast than it does from the ≠bottle. The following tips may help:

  • Select a bottle nipple with a slow flow.

  • Offer the breast before your baby gets very hungry, when she is just beginning to show hunger cues.

  • Pump for 1 to 2 minutes before you breastfeed.

  • Massage the breast as you nurse to encourage milk flow.

  • Do something that will help you relax (such as taking deep breaths) during feeding to enhance milk flow.

  • Try to increase your milk supply by pumping more often.

Breast Milk Expression and Storage

There are several ways to express your milk. You can express milk manually with your hands or with a breast pump. Pumping allows you to continue to breastfeed by keeping your milk production stimulated. If milk isn't drained from the breast regularly, it sends a message to your body to stop making milk.

How do I express breast milk by hand?

  • Make sure your hands are clean. Wash them well with soap and water.

  • Put a clean cup or container under your breast.

  • Massage the breasts gently toward the nipples.

  • Place your thumb about 1 inch back from the base of the nipple and your first finger opposite.

  • Press back toward your chest, then gently compress the areola between the thumb and finger, and release with a rhythmic motion until the milk flows or squirts out.

  • Rotate your thumb and finger around the areola to get milk from several positions.

Transfer the milk into clean, covered containers for storage in the refrigerator or freezer. Always label and date the containers. (See How should I store breast milk?.)

How do I express breast milk using a breast pump?

Some women prefer expressing breast milk by hand because it can be done quietly without special equipment. Other women find it easier and faster to express milk with a breast pump.

Many types of breast pumps are available with different features, costs, and effectiveness. Before you buy a breast pump, research which breast pump is best for your situation. It may be helpful to get advice from a lactation specialist or a prenatal instructor. Some of the breast pumps available in department stores or pharmacies are not very effective for women who must be away from their baby regularly (such as for work or school). If your breast pump doesn't work well for you, you will waste your effort and may lose your milk supply.

Using a breast pump takes practice. You must have let-down to get milk out of the breast, even with a pump. Call a knowledgeable person for help if you are having trouble using your pump.

Follow the instructions that come with your pump for use and cleaning. Wash pump parts after each use with hot, soapy water and rinse well to prevent contamination of your milk. (Do not buy pumps that look like a bicycle horn because they can't be cleaned properly and milk may become contaminated.)

How should I store breast milk?

Here are storage and preparation tips for a healthy baby at home. (The hospital may have different guidelines for you to follow if your baby needs to have expressed milk.)

  • Always wash your hands before expressing or handling your milk.

  • Use only clean containers to store your milk. Try to use ≠screw-cap bottles, hard plastic cups with tight caps, or special heavy nursing bags that can be used to feed your baby. Don't use ordinary plastic storage bags or formula bottle bags for storing expressed milk because of the potential risk of polychlorinated biphenyl (PCB) exposure contained in certain plastics. In addition, regular plastic storage bags are more likely to break open during handling or storage.

  • Freshly expressed milk can remain at room temperature for up to 4 hours.

  • Use sealed and chilled milk within 24 hours if ≠possible. Discard all milk that has been refrigerated for more than 4 days. For babies who are hospitalized, check with the hospital.

  • Freeze milk if you will not be using it within 24 hours. Frozen milk is good for at least 1 month in a freezer attached to a refrigerator or for 3 to 6 months if kept in a deep freezer at 0įF (32įC) or below.

  • Store it at the back of the freezer—never in the door section.

  • Make sure to label the milk with the date that you collect it. Use the oldest milk first.

  • Freeze 2 to 4 ounces of milk at a time, depending on the ≠average amount of a single feeding for your baby; however, you may want some smaller amounts for some occasions.

  • You can thaw milk in the refrigerator or more quickly by swirling it in a bowl of warm water.

  • Don't use microwave ovens to heat bottles because they don't heat them evenly. Uneven heating can easily scald your baby or damage the milk. Bottles can explode if left in the microwave too long. Excess heat can destroy important proteins and vitamins in the milk.

  • Previously frozen milk that has been thawed in the refrigerator must be used within 24 hours.

  • Don't refreeze your milk.

  • Don't save milk from a used bottle for use at another feeding.

Weaning Your Baby

Families and cultures have different views about weaning. In the English language, weaning has several different meanings.

  • The natural weaning process begins when solid foods (sometimes called weaning foods) are added to a baby's diet. This usually occurs around 6 months of age when babies may show an interest in food, are able to sit up for feeding, and are ready to digest other foods. Parents can start to offer some mashed foods with a spoon, and the baby should continue to breastfeed. Very gradually, other foods begin to replace breast milk. The mother's milk supply decreases very slowly. It's perfectly normal to continue breastfeeding your toddler if mutually desired. Some children, if allowed to gradually decrease feedings on their own, will nurse at "quiet times," some up until 4 to 6 years of age.

  • Weaning the child from the breast generally indicates a process in which the mother has decided to stop breastfeeding. This type of weaning can be sudden or gradual, depending on the circumstances or the mother's preference. If you decide to wean from the breast before 1 year of age, start a cup or bottle gradually over several days. Use the cup or bottle for one feeding and work your way up to more. It helps if your baby isn't too hungry because then he may be more patient trying the new feeding method. It helps if your spouse or a caregiver gives your baby the cup or bottle when you are not around. Your baby will need time to get used to the new method. This type of weaning results in some temporary engorgement. As the engorgement fades, the milk supply decreases.

  • Complete weaning is when breastfeeding stops. According to current recommendations, this would happen anytime after 1 year of age. (If your baby is weaned completely from milk before 1 year of age, feed your baby infant formula instead of regular cow's milk.) After complete weaning, your milk will gradually dry up. You may feel sad, guilty, lonely, or depressed about giving up the closeness that comes from breastfeeding. These feelings are natural. Cuddle and interact with your baby even more. Remember that weaning is a natural step in helping your child grow up.

Breastfeeding: A Natural Gift

Breast milk gives your baby more than just good nutrition. It also provides important substances to fight infection. Breastfeeding has medical and psychological benefits for both of you. For many mothers and babies, breastfeeding goes smoothly from the start. For others, it takes a little time and ≠several attempts to get the process going effectively. Like anything new, breastfeeding takes some practice. This is perfectly normal. If you need help, ask the doctors and nurses while you are still in the hospital, your pediatrician, a lactation specialist, or a breastfeeding support group.

For more information about breastfeeding, read the AAP book New Mother's Guide to Breastfeeding.

Listing of resources does not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of external resources. Information was current at the time of publication.

Products are mentioned for informational purposes only and do not imply an endorsement by the American Academy of Pediatrics.

The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

Illustrations by Anthony Alex LeTourneau