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Breastfeeding Tips:

While you are in the hospital after delivery, feed your baby often every 1-3 hours.  Try to feed your baby within the first 2 hours after birth, since this when your baby will be awake and alert.  As much as possible keep your baby skin to skin on your chest.  Dad can enjoy bonding with skin-to-skin contact as well.

At home breastfeed your infant often, especially in the beginning, every 2-3 hours at least 8-12 times in 24 hours. Your baby may nurse anywhere from a total of 10-45 minutes per feeding.

Some signs your baby is getting enough milk

1-3 wet diapers and 1-2 stools in 24 hours in the first 3 days of life.

5-6 wet diapers and at least 1-2 stools in 24 hours after 3 days of life.

Audible swallowing sounds.

Baby taking 8-12 feedings in 24 hours.

Baby is gaining weight.

If you decide to pump your breast for expressed breast milk, use a hospital grade pump to get a good milk supply established, especially if you have multiples.

Engorgement while breastfeeding

Breast fullness is a normal part of lactation which nearly all women experience when their milk ‘comes in’ 2-5 days after birth. This feeling of fullness, which may be accompanied by a feeling of heaviness, tenderness, and warmth, is caused by swelling of the breast tissue as blood, lymphatic fluid, and milk collect in the ducts as the process of milk production begins. With this normal fullness, the breast tissue is compressible and you generally feel well (you rarely have pain or fever).

This normal breast fullness can develop into engorgement if the baby isn’t nursing often enough or vigorously enough, or if you are separated from your baby and don’t remove the milk frequently and effectively. When the normal breast fullness is not relieved, fluid builds up and swelling occurs. The breasts become hard and the skin is taut and shiny. They become extremely tender and painful, and you may run a low-grade fever and become achy. The swelling may extend into the area under the arms, and in very severe cases can cause numbness or tingling of your hands from pressure on your nerves. Because the breast is so full and swollen, the nipple and areola may flatten out (sort of like a water balloon) making the tissue difficult for the baby to grasp. If severe engorgement is not relieved, the alveoli (milk-producing cells at the end of the milk ducts) can become atrophied and may decrease milk production. If the buildup of milk and fluid is not removed, swelling can occur to the point where the milk ducts will actually swell shut, making it much more difficult to get the milk out. Unrelieved engorgement can also lead to plugged ducts and mastitis.

Use of drugs to “dry up the milk” is not recommended. These drugs not only are not very effective, but they can have serious side effects and may cause rebound engorgement after the medication is discontinued.

Suggestions for Preventing/Handling Engorgement:

  • Nurse frequently. Try to nurse at least 10-12 times in 24 hours – every 1 ½ – 2 hours during the day, with no more than a 3-hour stretch at night.
  • Try to nurse for at least 15 minutes on the first side before offering the second.
  • Don’t set time limits on time spent at the breast.
  • Nurse baby with only a diaper on (skin- to -skin contact will stimulate sucking).
  • Vary nursing positions to help promote drainage of the breast.
  • Wear breast shells (with holes for air circulation) for 20 minutes between feedings.
  • Wear a supportive bra (avoid under-wire), but don’t bind your breasts – this can lead to plugged ducts.
  • Lie flat on your back between feedings so that your breasts are elevated.

Apply cold compresses to your breasts and under your arms between feedings. Cold can help reduce swelling. Use a layer of fabric between the compress and the skin. Bags of frozen vegetables or a disposable diaper that you dampen and put in the freezer for 20 minutes work just as well as the ice packs that you purchase at the drugstore. Apply cold compresses for 15-20 minutes off and on for 1-2 hours.

The use of heat immediately before nursing can help the milk letdown. Taking a warm shower, leaning over a basin of warm water, soaking in a warm bath, or applying warm compresses or a heating pad may help. Moist heat is best. Gentle breast massage can also help the milk flow more readily.

If the nipple and areola are swollen, don’t try to nurse without softening them up first. Hand express or pump a little milk from your breast to soften the nipple and areola before trying to nurse. Gently massage the breast before nursing. If you use an electric pump, set it on MINIMUM and gradually increase the pressure after the milk begins to flow. You may not be able to turn it up to maximum, but try to increase the pressure as much as you comfortably can. Most pumps work better on the higher settings, but if the breast and nipple tissue is extremely tender, don’t try to increase the suction. Apply a few drops of olive oil to your nipple and areola before pumping to help prevent friction while pumping.

Be careful about the type of pump you use. Many of the small inexpensive electric pumps can damage your tissue since engorged breasts bruise easily due to increased blood volume. If you don’t have access to a high-quality pump, which cycles automatically, you may want to stick with manual expression. Even with manual expression or massage, be very, very gentle.

If your breasts remain full, knotty, and tender after nursing, you may want to pump for 5-10 minutes to remove all the milk that comes out quickly and easily. Don’t be afraid that nursing or pumping will increase your milk supply and make the engorgement worse. At this early stage, when your milk is just coming in, remember that the fullness is a build up of other fluids (blood and lymph) as well as milk. Removing the milk will relieve the pressure and reduce the swelling, softening the areola and making it easier for the baby to latch on.

You may want to use cabbage leaf compresses if the above suggestions don’t bring you enough relief. This sounds really strange, but this is a remedy that has been used for over a hundred years with much success. No one is exactly sure why it works, but since it is inexpensive, safe, and effective, you may want to give it a try.

Here’s what to do:

  • Buy plain green cabbage.
  • Rinse and dry leaves. Put them in the refrigerator.
  • Remove the base of the hard-core vein and gently pound leaves.
  • Wrap around breast and areola, leaving the nipple exposed. The leaves fit nicely around the breast, and the cold feels good.
  • Cover entire breast, and if needed the area under your arms.
  • Change every 30 minutes or sooner if they become wilted.

Check your breasts often and as soon as you feel the milk beginning to drip, or if your breasts feel ‘different’, remove leaves and try to nurse or pump.

Re-apply as needed (up to 3 times between feedings). Check OFTEN, as overuse can cause a decrease in your milk supply.

If pain and swelling persist, using OTC medication may help.  Acetaminophen, the main ingredient in Tylenol, helps relieve pain, but ibuprofen, the main ingredient in Motrin and Advil, provides pain relief and also reduces inflammation.  Both ibuprofen and acetaminophen are considered safe for nursing mothers, but ibuprofen is usually more effective than acetaminophen when treating engorgement, due to its anti-inflammatory properties.

Sage tea (available at health food stores) is a powerful herb that contains a natural form of estrogen and may decrease your milk supply. Drinking a cup at bedtime for a night or two may help in cases of severe engorgement. As with cabbage leaves, monitor breast changes often as overuse can decrease your supply.

Call your doctor if your temperature rises over 101, or if you develop localized pain or flu-like symptoms. Even if you develop a breast infection, breastfeeding can and should continue.

Remember that engorgement usually subsides within 24-48 hours, so hang in there. Severe engorgement that is not treated promptly may take up to a week to resolve, and there is a greater risk of developing an infection. During this uncomfortable period, take comfort in the fact that most mothers who experience engorgement usually have more than adequate milk supplies once the initial period of discomfort is over. Lactation Consultants worry much more about mothers who don’t experience some degree of breast fullness during the postpartum period than those who do.

It is also important to note that the uncomfortable fullness you experience in the first few days after your baby’s birth is due to a hormonal rush that will never again be duplicated. You may experience some degree of engorgement later on if your baby sleeps a long stretch for the first time, or if you are separated from your infant, but you will never again have the same hormonal response that you will have immediately after his birth.

 Breast Milk Storage Guidelines

Breast milk is the most preferable way to feed a baby as the nutrients in it best fit the baby’s needs. Therefore, if it is available, it should always be offered before formula.

Breast milk can remain out at room temperature 3-4 hrs. best, 6- 8 hrs. okay.

Remain in a cooler w/ frozen gel packs up to 24 hrs.

Remain in the refrigerator 3 days best, 5-8 days okay.

Must be frozen within 72 hours of the time it was pumped if planning to freeze. Remain in the freezer (kept solidly frozen)

6 months ideal, 12 months okay.

Frozen Breast milk:

Previously frozen and thawed breast milk can remain out at room temperature 1-2 hours best, 3-4 hours okay.

Remain in a cooler w/ frozen gel packs for up to 24 hrs.

Remain in the refrigerator for up to 24 hrs.

Can never be re-frozen.

Reference: Human Milk Banking Association of North America, 2005

To increase milk supply, ask OB doctor about Lactate support Gala Herbs from Whole foods.

Drink plenty of water, have water bottles all over the house for easy access.

Infant formulas

Bottle-feeding; Formula feeding

Definition

Infant formulas are food products designed to provide for the nutritional needs of infants under 1 year old. They include powders, concentrated liquids, or ready-to-use formula

Food Sources

A variety of formulas are available for infants younger than 12 months old who are not drinking breast milk. Infant formulas vary in nutrients, calorie count, taste, and ability to be digested, and cost.

Guidelines for infant formulas and normal infant feeding based on human breast milk are available from the American Academy of Pediatrics (AAP).

Specific Types of Formula

Standard milk-based formulas:

Almost all babies and infants do well on these formulas. Fussiness and colic are common problems. Most of the time, cow’s milk formulas are not the cause of these symptoms and parents do not need to switch to a different formula.

These formulas are made with cow’s milk protein that has been changed to be more like breast milk. Lactose and minerals from the cow’s milk, as well as vegetable oils, minerals, and vitamins are also in the formula.

Soy-based formulas:

These formulas are made using soy proteins. They do not contain lactose. The American Academy of Pediatrics recommends soy formulas for parents who do not want their child to eat animal protein, and for infants with galactosemia or congenital lactase deficiency.

Soy-based formulas have not been proven to help with milk allergies or colic. Babies who are allergic to cows’ milk may also be allergic to soymilk.

Hypoallergenic formulas (protein hydrolysate formulas):

This type of formula may be helpful for infants who have true allergies to milk protein, and for those with skin rashes or wheezing caused by allergies.

Hypoallergenic formulas are generally much more expensive than regular formulas. 

Lactose-free formulas:

These formulas are used for galactosemia, congenital lactase deficiency, and primary lactase deficiency. Lactase deficiency most often begins after a child is 12 months old. The condition is diagnosed using special tests.

A child who has an illness with diarrhea usually will not need lactose-free formula.

Special formulas that should be used only under a health care provider’s supervision:

Reflux formulas are pre-thickened with rice starch. They are usually needed only for infants with reflux who are not gaining weight or who are very uncomfortable.

Formulas for premature and low-birth-weight infants have extra calories and minerals to meet the needs of these infants.

Special formulas may be used for infants with heart disease, malabsorption syndromes, and problems digesting fat or processing certain amino acids.

Newer formulas with no clear role

Formulas with long-chain polyunsaturated fats (such as arachidonic acid [AA] and docosahexaenoic acid [DHA] claim to improve eye and brain development. However, these claims are not well proven.

Toddler formulas are offered as added nutrition for toddlers who are picky eaters. To date, they have not been shown to be better than whole milk and multivitamins. They are also expensive.

Most formulas can be purchased in the following forms:

Ready-to-use — do not need to be prepared with water

Powdered formulas — must be mixed with water, but are the least expensive form.

Concentrated liquid formulas — also need to be mixed with water.

Recommendations The AAP recommends that all infants be fed breast milk or iron-fortified formula for at least 12 months.

Standard formulas contain 20 Kcal/ounce and 0.45 grams of protein/ounce. Formulas based on cow’s milk are appropriate for most full-term and preterm infants.

Infants who drink enough formula and are gaining weight usually do not need extra vitamins or minerals. Your doctor or nurse may prescribe extra fluoride if the formula is being made with water that has not been fluorinated.

Infant formula can be used until a child is 1 year old. The American Academy of Pediatrics does not recommend cow’s milk for children under 1-year-old. After 1 year, the child should only get whole milk, not skim or reduced-fat milk.

Preparing, feeding with, cleaning, and storing formula

Clean bottles and nipples with soap and then boil them in a covered pan for 10 minutes. They should cool while still covered.

Can also use microwave sterilizers, read all directions.

Parents can make enough formula to last for up to 24 hours.

Make formula as directed. DO NOT water it down or make it stronger than recommended. This can cause your child to have pain, not grow well, or rarely, to have more severe problems. DO NOT add sugar to formula.

Store cans of powdered formula in a cool, dry place with a plastic lid on top. Always wash your hands and the top of the container before handling.

Once it is made, store formula in the refrigerator in individual bottles or a pitcher that has a closed lid. During the first month, your baby may need at least eight bottles of formula per day.

Feeding:

Warm the formula slowly by placing it in hot water. DO NOT boil the water and DO NOT use a microwave. Always test the temperature of the formula on yourself before feeding your baby.

Hold your child close to you and make eye contact. Hold the bottle so the nipple and the neck of the bottle are always filled with formula. This will help prevent your child from swallowing air.

Throw away leftover formula after feeding. Do not keep it and use again. The formula can remain out at room temperature for 1 hour.

Can remain in the refrigerator for 48 hours after opening.

Average breast milk/formula intake
AgeBreast Milk/FormulaSolid Food
0-2week18-24oznone
2 weeks to 2 month20-32oznone
2 to 4 month30-40oznone
4 to 6 month32-40oz0-4oz
6 to 9 month28-36oz6-14oz
9 to 12 month20-30oz10-18oz

TALK WITH YOUR PEDIATRICIAN BEFORE STARTING YOUR BABY ON ANY SOLID FOODS.
Average Baby Growth

Birth to four days old: a weight LOSS of 5-10% is normal.

Four days to three months: A weight GAIN of 2/3 to one ounce a day (1/2 lb. a week) Newborns should be back to their birth weight by their second-week doctor visit.

Three months to six months: A weight gain of about 1/2 to 2/3 ounce a day (1/2 lb. every 2 weeks).

Six months to 12 months: A weight gain of about 1/4 to 1/2 ounce a day (3/4 to 1 lb. per month)

Reference: Baby 411 4th editions. Denise Fields and Ari Brown, M.D.

Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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Sweet Dreams Infant Care Inc.