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Newborn Feeding/Weight Gain

How often should I breastfeed?

The frequency of breastfeeding is di erent for every newborn and your baby will determine his/her own feeding schedule. Most newborns end up feeding about every 2-3 hours (and it can be more frequent than that!). In the first two weeks of life, the baby should not go any more than 4 hours without feeding (at least until the baby regains his or her birthweight), and should feed at least 8-12 times in 24 hours. If your baby is sleepy, you may have to undress him or her, tickle the feet or rub the back to wake him or her for feeds. With time, you will find that your baby will fall into his or her own schedule during the day and night. Babies may have periods in the day when they cluster their feeds, feeding every hour, and this is normal.

How long will it take for my milk to come in? Is there anything I can do to make my milk come in faster?

Mature human breastmilk usually comes in about 72 hours after delivery. The breasts swell and become engorged with milk. With second and third pregnancies, milk can come in slightly earlier. Until the mature milk comes in, mothers produce an early milk called “colostrum” which provides for all of the baby’s nutritional needs. The best thing for you to do to “help” the mature milk come in is to allow your baby to suckle on the breast. The sensation of suckling at the breast produces release of a hormone in the brain which tells the glands in the breast to initiate milk production. Although there are a number of other remedies, such as Fenugreek and Mother’s Milk Tea, these are typically used to stimulate breastmilk production once the milk has already come in, not to hasten its arrival.

Is it okay to supplement with formula or sugar water until my milk comes in? What do you recommend?

It is not necessary to supplement with formula or sugar water from a nutritional standpoint. However, some parents find that their babies are more fussy and irritable until the mature milk comes in and are soothed by a few ounces of formula to “tide them over.” We would recommend not introducing formula until breastfeeding has become well established, but we support parents who decide to supplement while in the hospital. We would recommend that if the baby is going to be receiving significant amounts of supplementation (more than 2 ounces per day), that this should be formula and not sugar water. It is also important to remember to always put the baby to the breast first in order to stimulate milk production before supplementing with formula. If you give your baby formula, always follow package directions when preparing it. You do not need to boil water before preparing formula.

My baby has lost 10 ounces since he/she was born. Is this okay?

Babies normally lose up to 10 percent of their birth weight in the first week of life and regain it in the second. We will be monitoring the baby’s weight both in the hospital and in our o ce. Our goal is for your baby to have regained his/ her birth weight by the 2 week o ce visit.

How much spit up is normal?

Many babies spit up when they feed, and it is usually normal. If your baby spits up often, keep his or her head raised for at least 30 minutes after feeding. Spitting up small amounts is harmless as long as your baby is gaining weight and is not in pain. Spitting up usually ends by age six to nine months. If the spit up becomes projectile and is associated with every feed, that would be abnormal and might require some tests to work up the problem. Other symptoms that may indicate that your baby has reflux are: irritability after feeding and arching of the back. Make sure you are burping with each feed as this will help to expel some of the air the baby may have swallowed. After feeds, gently burp the baby by holding the baby on your chest, upright and gently patting or stroking the back. Do this for 2 to 5 minutes. Your baby may not burp after every feeding.

Who should I contact if I am having a difficult time with breastfeeding?

During your hospital stay, you should take advantage of the nurses and the lactation consultants provided by the hospital. Once you are home, you are always free to bring breastfeeding questions to our o ce, but for issues that require more time and expertise, we wholeheartedly recommend the lactation consultants at the Pump Station. Our patients with difficult breastfeeding issues have had an incredible response to the assistance given by their consultants and the various services provided by the Pump Station: We also have names of lactation consultants that make house calls. Please call our o ce for more information.

What are the advantages to breastfeeding over formula feeding?

Breastfeeding has many distinct advantages over formula feeding for the baby, including but not limited to enhanced immune system, decreased incidence of food allergies and eczema, lower obesity rates, and fewer ear infections. The American Academy of Pediatrics recommends breastfeeding for the first year of life. This being said, we understand that breastfeeding is not the best decision for every family and we support parents that decide to opt for formula instead.

Are there any contraindications to breastfeeding?

There are very few contraindications to breastfeeding. If you are taking a medication, please let us know before breastfeeding, so that we can verify that is safe for lactation. Of note, Tylenol and Advil (which is not recommended during pregnancy) are both safe medications to take while breastfeeding. Real contraindications to breastfeeding include: active herpes lesions on the breast, mother positive for HIV, and certain antibiotics.

Are there any foods that I need to avoid while breastfeeding?

A breastfeeding mother has a great deal more freedom than a pregnant woman. Many of the foods that are o -limits in pregnancy are okay while breastfeeding, if eaten in moderation: alcohol, ca eine, and mercury-containing fish included. If a large amount is consumed, it may be wise to “pump and dump” the expressed breast milk from when the next feed is due, and give the baby some stored breastmilk for that particular feed. A breastfeeding woman should focus on eating a well balanced diet, drinking lots of fluids, and remaining on her prenatal vitamins. We are currently recommending that breastfeeding mothers take a DHA/ARA containing fatty acid supplement, which has shown thus far to have a positive benefit on neurologic development.

If I decide not to breastfeed, what formula is best?

Choosing a formula can be overwhelming for a new mom as there are literally hundreds to choose from. Most babies will do just fine with the basic, modified cow’s milk formulas: Enfamil, Similac, or Good Start. The AAP recommends that any formula you use be iron-fortified. If your baby develops symptoms of a dairy protein allergy, your pediatrician may recommend a hypoallergenic formula such as Nutramigen or Alimentum. These formulas should also be given to newborns when there is a family history of significant allergies in the parents or siblings. Some babies may show signs of gassiness, and it may be recommended to try a sensitive formula, such as Similac Sensitive, Enfamil Gentlease, or Good Start Soothe. Again, it is best to speak with your pediatrician prior to switching formulas as they can help guide you in your decision.