Breastfeeding Basics

Breastfeeding is a pretty tricky business for most new moms. How do you get that small squirming creature to behave? Plus, you can't "see" what's going in. I found reassurance in taking constant notes: what time my son ate, for how long, from which side, and how many wet diapers he had.

Looking for reassurances? Dr. Hank Bernstein, a top pediatrician at Boston's Children's Hospital, answers basic questions about breastfeeding below.

Does it really matter if I breastfeed or not?
How can I tell if my baby is getting enough to eat?
When can I introduce a bottle?
When can I stop breastfeeding?
What do I do when I'm ready to stop breastfeeding?
How do I switch from nursing to bottle-feeding?
When can I introduce my baby to solids?

Does it really matter if I breastfeed or not?
Human milk is definitely superior to any other milk for infant feeding. The American Academy of Pediatrics (APA) clearly emphasizes that breastfeeding is the ideal method that will help children achieve optimal health, growth, and development. Pediatricians promote and support your efforts to breastfeed. Plus, new moms can enjoy the "special" bond that develops when breastfeeding.

I generally recommend breastfeeding for at least the first year of life, or for as long as possible in the first year, since breastfeeding has so many health benefits for you and your infant. I would encourage a discussion with your infant's doctor, if you haven't had one already. Perhaps an effective solution exists that will allow you to continue to breastfeed comfortably for at least some of the time.

How can I tell if my baby is getting enough to eat?
In the first couple of months of life, a newborn generally feeds every two hours. If you're breastfeeding, offer as much as 15 minutes on each breast; for formula feeding, offer about 2-3 ounces at each feeding. As your newborn gets older, she will tend to eat more at each feeding. If your infant produces six wet diapers a day and is gaining weight regularly, then she probably is getting enough food calories. Discuss your infant's feeding and growth with her pediatrician at each check-up.

When can I introduce a bottle?
So that everything is just right for breastfeeding, I don't routinely recommend using bottles in the first few weeks of your baby's life. I feel "nipple confusion" is really more of a problem in the first few days or week of life. This is when your baby is learning to suck and swallow. A different suck is needed for the baby to empty a bottle as opposed to a breast. Once he's mastered the technique with your guidance, it is much less of an issue. I also want to maximize the amount of milk you produce. The more often you put the baby to the breast, the more breast milk you'll make. (The milk is produced on a demand-and-supply system.) This is related to the hormones in your body.

When can I stop breastfeeding?
The right time to stop breastfeeding is a decision that you and your child will make. Either you or your baby can initiate the weaning process. Some mothers are ready to stop breastfeeding because of work and other scheduling issues. Other times, the infant is ready to stop and begins to bite and refuse the nipple.

When children are over one year of age, they can move right to whole milk. (Breast milk is very beneficial in terms of the nutrients it provides compared with whole milk, so the longer he drinks your milk, the better.)

What do I do when I'm ready to stop breastfeeding?
If you're ready to begin weaning, then you may want to wean directly to a cup. This avoids having to wean your son from breast to bottle, then from bottle to cup. The weaning process could be gradual and may take months. For a smooth transition, replace one feeding a day with a cup of breast milk and gradually work your way up. Start by replacing his midday feedings, since morning and evening feedings tend to be a relaxing and comforting time for a mother and child. It may be a bit more difficult to drop his overnight feed. Also, avoid trying to use a cup when your son is very hungry, because he may become frustrated with the new object.

Early on in the breast-to-cup weaning process, your son may see the cup as a toy and will likely throw it and examine it before he actually starts to drink from it. Use either a trainer cup equipped with a snap lid, or a small plastic cup. Initially putting only a small amount in the cup will prevent large spills. The trainer cup may hold more liquid, but it will only be a short time until your son learns how to open the lid and dump out the contents.

During the weaning process, your breasts are likely to feel engorged. To relieve engorged breasts, it is recommended you use a breast pump to collect the milk. You can then give it to your child in a bottle or a cup.

When children are over one year of age, they can move right to whole milk. (Breast milk is very beneficial in terms of the nutrients it provides compared with whole milk, so the longer he drinks your milk, the better.)

I'd like to switch from nursing to bottle-feeding. How do I do this?
Whether you're breastfeeding or bottle feeding, your baby truly enjoys the close bonding experienced with you at each feeding! Assuming your decision to switch to formula has been fully explored, weaning an infant from the breast to the bottle can be favorably accomplished even at a young age, such as six weeks. Although it can be done abruptly, many mothers will often transition more slowly over time. It's very important to be flexible. The choice is up to you, given your specific circumstances.

The more you put the baby to the breast, the more breast milk you make. This has to do with your body's hormonal response to the nippling. Thus, if you begin to decrease the number of times you breastfeed, you naturally will begin to make less breast milk. The initial introduction of a bottle can also result in your infant being a bit fussier. Your infant may not want a bottle as often; part of the time you may simply be comforting the baby. Therefore, some mothers will alternate the type of feeding each day or drop a breastfeeding session or two every few days over several weeks, until their infant has fully accepted the bottle. This slower transition may also help make the feeling of engorgement in each of your breasts more bearable.

When can I introduce my baby to solids?
Although many grandmothers and neighbors may swear that a little cereal in their newborn's bottle helped him sleep better, the American Academy of Pediatrics doesn't recommend introducing cereal and other solid foods until four to six months of age. Before that age, young infants need only breastmilk or formula.

Once your infant is between four and six months of age, she may start showing signs of readiness for solid foods. These signs include being able to support her own head, having good tongue thrust (can push food out of her mouth) and showing interest in the foods you are eating. When you feel your baby is ready and your pediatrician gives the go ahead, you can then start feeding her rice cereal, by mixing the cereal flakes with her breastmilk or formula. The familiar taste will help her accept the new food. Rice cereal tends to be less allergy-provoking than some other foods.

Infants are just beginning to experience new tastes and textures, so do not be surprised if she initially rejects them. Be sure to try again in a few minutes. Once she gets used to the rice cereal, increase the quantity slowly. After rice cereal is accepted, you can then introduce oat or barley cereal, followed by vegetables, fruit, and then finally meat. Introduce new foods one at a time in order to watch for any food allergies. Always wait a few days before introducing another new food. By doing so, you can watch for any diarrhea, bloating, rashes, or other signs or symptoms that may occur because of an allergic reaction to a food.

Soon enough you will be cleaning up pureed peas and carrots from the kitchen floor. In the meantime, enjoy breastfeeding or giving your child formula from a bottle until she is ready for solid foods.

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