Breastfeeding Questions and Answers

Breastfeeding Basics

While most parents and pediatricians understand that breastfeeding is best for both babies and their mothers, there is still a lot of things that get in the way of effective breastfeeding.

Get educated about breastfeeding and get help if you begin to have trouble.

1
Isn't breastfeeding supposed to be easy?

mother breastfeeding her baby
KidStock/Creative RF/Getty Images

While breastfeeding is natural, it is not always easy, especially in the first weeks after a baby is born.

If breastfeeding were easy:

  • We wouldn't have so many books and websites dedicated to helping breastfeeding mothers
  • We wouldn't need lactation consultants
  • More mothers that start breastfeeding would likely continue and reach their breastfeeding goals

Remember that "breastfeeding is a learned skill. It requires patience and practice. For some women, the learning stages can be frustrating and uncomfortable. And some situations make breastfeeding even harder, such as babies born early or health problems in the mother."

Breastfeeding does usually get easier though as time goes by.

2
How can I avoid colic while breastfeeding?

Learning to comfort their crying baby is an important skill for new parents.
Being fussy isn't always related to foods that you are eating while nursing. Photo © Anne Clark

Unfortunately, colic is not something that is easily avoided, even if you are breastfeeding.

It may be that your baby is intolerant or sensitive to something that you are eating and it is making him colicky, such cow's milk, broccoli, cabbage, cauliflower, chocolate, onions or spicy foods.

Does that mean that you should avoid these colicky foods?

Should you go so far as going on a very restrictive low-allergen diet and eat only lamb, pears, squash, and rice, avoiding cow's milk and soy and other 'allergy foods?'

While eliminating foods from your diet is typically not necessary, if you and your pediatrician think that it is, one way to go forward with an elimination diet while breastfeeding is to:

  • Eliminate specific foods and food groups from your diet, including cow’s milk (and other products made with milk and milk proteins, including butter, cheese, and ice cream, etc.), soy, citrus fruits, eggs, tree nuts, peanuts, wheat, corn, strawberries, and chocolate
  • Eliminate the foods one at a time, and wait to see if your baby's colicky symptoms (or other symptoms that you are targeting, like diarrhea or eczema, etc.) improve
  • If there is no change in your baby's symptoms after two or three days, you can then likely add that food back into your diet and eliminate another one. It is sometimes necessary to wait two to four weeks to see if your baby's symptoms will resolve though
  • If you do find a food that your baby is sensitive too, you might try it again, and if it continues to cause symptoms, then remove it from your diet until your baby is 9 to 12 months old and for at least 6 months.

In addition to your regular prenatal vitamins, be sure to take extra  calcium if you have eliminated milk products from your diet.

And keep in mind that in addition to your pediatrician and lactation consultant, a pediatric gastroenterologist can help if your baby is having severe GI symptoms while you are breastfeeding.

3
Is my baby getting enough breast milk?

A baby getting weighed at her first visit to her pediatrician.
A baby getting weighed at her first visit to her pediatrician. Photo © Vincent Iannelli, MD

The first week is a challenge for many breastfeeding mothers, as they wonder if their baby is getting enough breast milk, especially as they know their baby is losing weight (which is normal).

Signs that your baby is getting enough breast milk include that they are having:

  • At least 2 wet diapers and 3 bowel movements on day 2 that are likely still thick, tarry, and black
  • At least 5-6 wet diapers and 3 bowel movements on day 3, with the BMs becoming looser and greenish to yellow in color
  • At least 6 wet diapers and 3 yellow, soft and watery bowel movements on day 4
  • At least 6 wet diapers and 3 yellow, loose and seedy bowel movements on day 5
  • At least 6 wet diapers and 3 larger, yellow, loose and seedy bowel movements on day 7

After losing weight their first three to five days of life, you should also be able to tell that your baby is getting enough breast milk if they start to gain at least 2/3 to 1 ounce each day.

Feed your newborn baby at least 8 to 12 times a day and get help early if your baby isn't latching on or if you don't feel like your milk is coming in by the time your baby is 3 to 5 days old.

Your pediatrician will help monitor your baby's weight loss/gain at the first visit, which normally occurs by the time your baby is 3 to 5 days old. Keep in mind that an early checkup for your baby is especially important if your baby had an early discharge from the nursery and went home before she was 48 hours old. According to the American Academy of Pediatrics, these babies should be examined by a health professional within 48 hours of going home.

4
What can I do about sore nipples?

In addition to making sure that your baby is latching well if you have sore nipples, you can:

  • Change breastfeeding positions
  • Manually express some breastmilk and rub it on your sore nipples
  • Let your nipples air dry after nursing
  • Wear a soft cotton shirt and avoid tight-fitting shirts and bras
  • Frequently change your nursing pads

And see a lactation consultant if sore nipples are getting in the way of nursing your baby.

5
What are some treatments for blocked ducts and mastitis?

Blocked or plugged ducts are a common source of pain when breastfeeding. When a milk duct becomes blocked or plugged, it can become tender and inflamed. Unlike mastitis, plugged ducts are not associated with fever and often get better if you breastfeed more often. Other treatments might include massaging your breast and applying warm compresses to the area.

Mastitis causes similar symptoms to a blocked duct, but you will likely also have a fever and other flu-like symptoms. While a plugged duct is caused by inflammation, mastitis is actually an infection of the breasts. Treatments are similar, though, including breastfeeding more on the side that is affected, although you may need to take an antibiotic if you aren't quickly feeling better.

A lactation consultant can help you with these common breastfeeding problems.

6
When would I use a nipple shield?

Nipple shields are worn over your nipple and areolar area while you are nursing.

Why use a nipple shield?

Some situations when they might be helpful temporarily include:

  • Sore nipples
  • Engorgement
  • Flat nipples

Just remember that they are not supposed to be used long-term and should likely be used under the supervision of a lactation consultant so that you can be sure that you are using your nipple shield properly, are fixing your underlying breastfeeding problem, and can stop using the nipple shield as soon as possible.

7
What can I do about engorgement?

A breastfeeding newborn baby.
Frequent feedings can help with engorgement. Photo © Tari Faris

Symptoms of engorgement can include having:

  • Hard and painful breasts
  • Swollen breasts
  • Nipple flattening
  • A low-grade fever

Common treatments for engorgement, which typically occurs as your breast milk comes in when your baby is two to five days old, include continuing to feed on demand at least 8 to 12 times a day, warm compresses, gentle breast massage, cool compresses or ice packs, and even cabbage leave compresses.

See a lactation consultant if sore nipples are getting in the way of nursing your baby.

8
What are some benefits of using a lactation aid?

A lactation aid can help prevent nipple confusion and stimulate your breasts to produce milk. They are a good alternative to simply giving your baby a bottle to supplement with expressed breast milk or formula.

The lactation aid is basically a feeding tube that you attach to a bottle and to your nipple so that when your baby latches on and attempts to nurse, he is able to get a supplement from the bottle.

A lactation aid is also included in supplemental nursing systems (SNS), along with a disposable feeding tube device.

9
Is Gentian violet a good treatment for thrush?

Thrush is an oral infection that is caused by the Candida albicans yeast.

Common treatments for infants with thrush include the prescription medications Nystatin oral suspension and Fluconazole oral suspension.

What about Gentian violet?

While some breastfeeding mothers prefer gentian violet as it is available without a prescription (ask the pharmacist, as it is likely behind the counter), often works as a one-time treatment, and can also be used to treat her own infection, it does have some downsides.

Gentian violet is very messy. It will stain clothing and skin (not permanently though).

It is important to note that gentian violet is not made from any part of the gentian plant. It is a dye derived from coal tar that is simply the same purple color as one variety of gentian flowers.

Gentian violet is also known by its chemical names, hexamethyl pararosaniline chloride and methyl violet 10B.

10
What is breastfeeding jaundice?

A baby being checked for jaundice.
A baby being checked for jaundice. Photo © Vincent Iannelli, MD

Most parents are aware that newborn babies can become jaundiced - getting a yellow discoloration to their skin and eyes from high levels of bilirubin (hyperbilirubinemia).

They are often surprised to learn that there are different types of jaundice, including:

  • Breastfeeding jaundice - jaundice that worsens because of poor breastmilk supply or inadequate nursing in a baby's first week, which can lead to dehydration and excessive weight loss. This is also sometimes called not-enough breast milk jaundice. This is a type of physiologic jaundice that also occurs in formula-fed infants, but may be exaggerated if a baby is also not nursing well and has lost a lot of weight.
  • Breast milk jaundice - unlike breastfeeding jaundice, these babies are nursing well and have mild levels of jaundice that may linger for two or three months.

Whatever the cause, jaundice is not a reason to stop breastfeeding. Instead, work with your pediatrician and/or a lactation consultant to get your baby breastfeeding more effectively and improve your breast milk supply. If it becomes necessary to supplement, talk to your pediatrician about using a lactation aid instead of a bottle.

And although some people do state that breast milk jaundice will go away if you stop breastfeeding for a day or two, there is no good reason to do so. This form of jaundice doesn't cause any problems and will resolve on its own.

11
What is finger feeding?

Finger feeding is another technique that can help to avoid nipple confusion when your baby doesn't want to latch on and nurse. It is another alternative to using a bottle.

Similar to using a supplemental nursing system, with finger feeding, you simply insert a lactation aid and your finger into your baby's mouth so that your baby sucks on your finger and gets a supplement through the lactation aid. A syringe attached to the other end of the lactation aid can help to push the supplement into your baby's mouth.

A lactation consultant can help you with this technique.

12
When should a mother stop breastfeeding if she is sick?

Believe it or not, breastfeeding mothers rarely need to stop breastfeeding when they are sick.

Some situations when it would be a good idea to stop might include:

  • Certain infections, like HIV; untreated, active tuberculosis (ok to pump); untreated brucellosis; active herpes lesions on her breast (ok to pump); and mothers who are positive for the human T-cell lymphotropic virus type I or II
  • Taking illicit drugs

  • Getting chemotherapy for cancer
  • Taking medications that are deemed too dangerous for a breastfeeding baby, although you should make sure that there aren't alternative drugs that you could take instead

It is much more common to have to stop breastfeeding temporarily because a mother is sick and has to take a medication that is deemed too dangerous for a breastfeeding baby, although again, you should make sure there aren't alternative drugs that you could take instead.

Simply have a cold, a fever, and most other illnesses is not a reason to stop breastfeeding your baby.

13
When should a baby not breastfeed if he is sick?

There are very few contraindications to breastfeeding.

The main one that exists is having a baby that is diagnosed with classic galactosemia.

While breastfeeding is usually encouraged when kids have a stomach virus, even if they are vomiting, there may be times when your child is hospitalized and is so ill that he won't be able to breastfeed. Pump during these times to keep up your milk supply and once your child is no longer getting intravenous fluids, you should be able to start breastfeeding again.

14
What is breast compression and how can it help my milk supply?

Breast compression is a technique that can help your baby get more  milk if he is latched on, but not getting enough breast milk.

Is your baby not gaining weight well or falling asleep while eating?

Than breast compression might be a good technique to try.

Make sure that your baby is latched on well and once it seems that your baby isn't sucking or nursing as well, gently, but firmly squeeze your breast and see if he starts drinking again.

Stop squeezing when he stops sucking, wait a little bit, and then do it again.

A lactation consultant can help you with this technique and with getting a better latch.

15
What are some challenges for working mothers who breastfeed their kids?

A Medela Pump In Style Breast Pump and Supplies
A Medela Pump In Style Breast Pump and Supplies. Photo © Vincent Iannelli, MD

In addition to being away from their baby, some challenges for working mothers who breastfeed their kids include:

  • Getting a good breast pump, preferably a good quality double electric pump.
  • Finding a private and secure area to pump while at work
  • Finding time to pump 2 or 3 times while at work
  • Storing pumped breast milk while at work

To help talk to your human resources department and review the supports provided by the Affordable Care Act for working mothers who breastfeed before going back to work.

16
What can you do about people who are unsupportive of breastfeeding?

While you might be able to educate those around you who are unsupportive of breastfeeding, you might need to find others who will be more supportive, including:

  • A breastfeeding support group
  • A lactation consultant if you need breastfeeding help
  • A pediatrician
  • Peer counselor support and other resources at WIC (if you are eligible)
  • The National Breastfeeding Helpline (800-994-9662)

You might also need to get educated about federal breastfeeding laws and breastfeeding laws in your state.

17
Should I try Domperidone to increase my milk supply?

Historically, domperidone has been thought to work well to boost or increase a mother's breast milk supply has decreased:

  • While taking birth control pills
  • While pumping for a sick or premature baby
  • When her baby is about three to four months old

It is important to be aware that the World Health Organization (WHO) and the Food and Drug Administration (FDA) are warning against the use of domperidone. In response to reports that women may be using this unapproved drug, to increase milk production (lactation), the WHO and FDA are warning breastfeeding women of safety concerns as "there have been several published reports and case studies of cardiac arrhythmias, cardiac arrest and sudden death in patients receiving an intravenous form of domperidone that has been withdrawn from the market in a number of countries."

Also, the FDA warns that "domperidone is excreted in breast milk, exposing a breastfeeding infant to unknown risks."

While many drugs are used off-label for other indications, it is important to note that domperidone is not approved for any indication in the United States.

So no, you likely should not take domperidone to help increase your milk supply.

18
What do you think about breastfeeding a toddler?

A mother with her breastfeeding toddler.
A mother with her breastfeeding toddler. Photo by Thinkstock Images / Getty Images

Why would someone breastfeed a toddler?

Why not?

The current guidelines from the American Academy of Pediatrics state that "breastfeeding continue for at least 12 months, and thereafter for as long as mutually desired."

19
Any tips for breastfeeding an adopted baby?

There are actually a few ways to breastfeed an adopted baby, including:

  • Getting some or all of your breastmilk from a donor milk bank
  • Work with a lactation consultant to try and induce lactation by pumping regularly, even before you adopt your baby

It is also sometimes possible to induce relactation - getting a mother who has stopped breastfeeding to build up her milk supply again.

20
What is a nursing strike?

It is important to know about nursing strikes, as some breastfeeding mothers misinterpret them as a sign that their baby is ready to wean or stop breastfeeding.

Instead, a nursing strike happens when your infant temporarily stops nursing and refusing to breastfeed, typically for just a few days. It might occur when your baby is teething, has a cold, or simply has had a change in his routine.

21
Can my baby be allergic to my breast milk?

Almost certainly not.

If a baby has an allergic reaction while drinking breast milk, it could be a reaction to something you have eaten that has passed into your milk.

For example, if your baby has bloody stools, which is often a sign of allergic colitis, a milk protein allergy, it is to the cow's milk proteins you are eating and drinking. These proteins pass enter your breast milk and to your baby, causing the reaction. The solution is usually to stop eating milk and milk products and to continue breastfeeding.

Infants can also have allergic reactions to peanuts and other foods a breastfeeding mother eats, but you would expect the reaction to occur fairly quickly after nursing - typically within minutes to a few hours.

22
Can I make too much breast milk?

Some breastfeeding mothers would say no, as they would be happy to make as much as they possibly can, especially if they aren't making enough or are trying to build up a supply for when they have to go back to work.

Having an oversupply of breast milk isn't a good thing if your breasts become too full and painful, though.

An oversupply of milk can also lead to an overactive let-down reflex.

With an overactive let-down, your baby might have a hard time latching, might pull off the breast, or might choke or gag while nursing. Mothers sometimes complain to their pediatrician that they think their baby has reflux when they actually just have a forceful or overactive let-down.

If your overactive let-down is causing any symptoms, it can help to pump for a minute or two and then breastfeed your baby.

23
What are some common breastfeeding myths?

Breastfeeding using a
Breastfeeding both babies at the same time using a "football hold" is one common way that mothers breastfeed twins. Photo: Bryan Mullennix / Getty Images

Common breastfeeding myths include that:

  • You can't breastfeed if you have inverted nipples - you usually can
  • You should nurse your baby for 10 minutes on each side - you actually shouldn't time your feedings, instead nursing until your baby is done and then switching sides. Timed feedings can lead to a foremilk/hindmilk imbalance and a gassy baby.
  • You can't breastfeed if you have had breast surgery - you often can, although you might want to talk to a lactation consultant before your baby is even born, and to your surgeon if possible to make sure that he or she understands that you plan on breastfeeding in the future
  • You can't breastfeed twins or triplets - you can
  • You shouldn't breastfeed in public - you can and should if it is time to nurse your baby
  • You can't breastfeed if you are pregnant again - you can
  • You can't get pregnant if you are breastfeeding - you can
  • Dads can't help feed if you are breastfeeding - they can and that doesn't have to just mean giving a supplemental bottle of pumped milk or formula.
  • You have to eliminate a lot of foods from your diet while you are breastfeeding - you don't
  • You can't drink coffee or other caffeinated drinks while nursing - you can, but do it in moderation, limiting yourself to just two or three cups a day
  • You can't drink alcohol while nursing - you certainly can't and shouldn't drink any alcohol while you are pregnant, but an occasional drink (not every day) at least two hours before you are going to nurse is probably okay
  • Breastfeeding at night won't lead to cavities - it will once your baby's teeth come in and you should be sure to stop nursing once your baby falls asleep so that no breast milk remains in your baby's mouth, especially after he turns a year old
  • Getting a baby's tongue tie clipped will fix all or most breastfeeding problems - it probably won't is likely an overdone procedure these days
  • You will have to stop breastfeeding once your baby gets teeth or bites you - you don't
  • You can't get a flu shot while breastfeeding - you can

A new myth is that breastfeeding is expensive. It's not and is certainly not more expensive than buying baby formula for a year. The idea comes from a writer who states that while exclusively breastfeeding her baby for six months, she "spent approximately $2,000 on products and services to make nursing and pumping breast milk easier and less uncomfortable."

Of course, her expenses included getting her baby's tongue tie clipped. She also rented a hospital grade breast pump and had numerous visits to a doctor who specializes in lactation problems. These are not expenses that the average breastfeeding mother will have. Nor are all of the "medications and supplements; plus creams, nipple shields and special cooling packs to ease and treat said pain and infections." Many of her other expenses probably seem a little more reasonable though, including "nursing bras and tops that flip down or pull aside for easier access; a nursing smock for modesty in public; reusable and disposable pads to keep milk from leaking at inopportune times; hands-free bras so I could work while pumping milk."

But of course, if you are going to compare the expenses of a breastfeeding baby with complications, it should be to a formula-feeding baby with complications. One who has had to switch formula multiple times has had several visits to the ER because of bloody diarrhea and vomiting. One who has to see a pediatric gastroenterologist and ends up on Elecare or Neocate.

At about $50 a can, let's see how the comparison of breastfeeding vs formula works out now...

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