Your Baby Week Fourteen

Breastfeeding Issues

Mother and child drinking juice in bed
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Kathleen Huggins, in her book The Nursing Mother's Companion, calls the time from a baby's second to sixth month as 'The Reward Period.' She describes it as being "exciting and rewarding," when "most mothers feel relaxed and confident."

Still, although breastfeeding is often going well when your baby is three months old, you may still run into some problems, such as:

  • making too much breastmilk - this is often a surprise to breastfeeding mothers who were initially concerned that they weren't making enough milk. Now, especially if their baby is sleeping all night, they may find that they have an overabundant supply of breastmilk and feel engorged while waiting for their baby to feed again in the morning. In this situation, it may help to breastfeed from just one breast at each feeding, alternating each time your nurse your baby. And then, if you feel full or engorged, manually express or pump some breastmilk from the other breast in between feedings.
  • nursing strikes - which is a baby who suddenly doesn't want to breastfeed anymore. This is much different from a baby who is ready to wean, which generally happens much more gradually.
  • poor weight gain - a three-month-old baby should be gaining at least half an ounce a day. If a breastfeeding baby is losing weight or is not gaining weight well, it may be because he is not nursing often enough or because his mother's breastmilk supply has decreased. Either way, his pediatrician and/or a lactation consultant can help get the baby to feed better or boost the mother's breastmilk supply.
  • going back to work - which can cause milk supply issues, especially if a nursing mother doesn't pump while she is at work.
  • nursing in public - as breastfeeding mothers begin taking their babies out in public as they get older, breastfeeding in public is something that can make these outings more convenient.

Baby Massage

Learning baby massage can be a fun way to calm your baby, soothe him to sleep, and play with him.
Learning baby massage can be a fun way to calm your baby, soothe him to sleep, and play with him.. Photo © Heiko Bennewitz

Baby massage is often viewed as a sophisticated technique or treatment to relieve gas or colic, but can also simply be a fun thing to do when you need to calm or play with your baby.

Some of the reported benefits of baby massage are that it can help your baby:

  • relax
  • bond with his caregivers
  • communicate well with his caregivers
  • sleep better
  • relieve pain

And of course, baby massage can simply be something that is fun for a parent to do with her baby.

Learning Baby Massage

One easy way to get started with baby massage is to read a book, such as the popular book - Infant Massage, A Handbook for Loving Parents by Vimala Schneider McClure or Baby Massage, Soothing Strokes For Healthy Growth by Suzanne Reese.

You can also learn baby massage from an instructor certified through the International Association of Infant Massage.



Baby massage and baby play: promoting touch and stimulation in early childhood. Moyse K - Paediatr Nurs - 01-JUN-2005; 17(5): 30-2.

Baby massage: a lasting touch. Pigeon-Owen K - Pract Midwife - 01-SEP-2007; 10(8): 27-9, 31.

Blocked Tear Duct

A blocked tear duct occurs when the nasolacrimal duct, which drains tears from the eye into the nose, gets blocked (because of incidents such as infection or trauma) or, more commonly, is blocked from birth (congenital nasolacrimal duct obstruction).

An infant with a blocked tear duct will often:

  • have teary eyes
  • have eyes that appear crusted and matted with discharge, because mucoid material that is normally produced in the lacrimal sac backs up onto the eye, instead of draining through the nasolacrimal duct to the nose
  • have some redness around his eyes because he rubs them a lot

Fortunately, most cases of blocked tear ducts go away on their own, but until then, treatments can include:

  • nasolacrimal massage, in which you massage the inside corner of your child's nose 2 to 3 times a day
  • cleaning any discharge or matter in the eyes with a warm washcloth
  • antibiotic eye drops when the discharge in the eyes becomes excessive, like if you are having to wipe it away more than 2 or 3 times a day
  • oral antibiotics if your child develops symptoms of dacryocystitis, an infection which can cause the tear duct to become swollen, red, and painful

If your child's blocked tear duct does not go away on its own, especially by the time he is 9 to 12 months old, additional treatment by nasolacrimal duct probing may be necessary. In this procedure, a pediatric ophthalmologist will insert a probe into the nasolacrimal duct, attempting to clear anything that is blocking the duct. Occasionally, a canalicular stent, a type of silicone tube, is placed into the nasolacrimal duct if it continues to get obstructed.



Evaluation and management of congenital nasolacrimal duct obstruction. Kapadia MK - Otolaryngol Clin North Am - 01-OCT-2006; 39(5): 959-77, vii.

Infant Care Tips - Cough

A chest x-ray is sometimes the only way to determine what is causing your child's cough.
A chest x-ray is sometimes the only way to determine what is causing your child's cough, including conditions such as pneumonia.. Photo © istockphoto

Your baby is likely to have a cough now and then.

Although parents often worry that their baby may have pneumonia when they have a cough, more common causes of coughs in young children include the common cold, croup, RSV, and allergies.

Often, more important than the simple presence of a cough, is whether or not your child has any other symptoms. These other symptoms can help determine if your child has a serious condition causing the cough, and can include:

  • fast or hard breathing
  • fussiness
  • fever
  • decreased appetite

Treatments for Cough

Unfortunately, with all of the restrictions and warnings on infant cold medicines, there aren't really any cough suppressants for younger children. That will likely leave you with other symptomatic home remedies when your infant has a cough, such as:

  • using a cool mist humidifier.
  • taking your child into the bathroom, closing the door and turning on all of the hot water to create a steam bath, and letting your child breathe in the warm, moist vapor. This can be especially helpful when your child wakes up in the middle of the night with the bark-like cough of croup.
  • giving him cool things to drink, like juice, in addition to his routine diet of breast milk or an iron-fortified infant formula
  • reviewing your child's asthma action plan and giving his reliever medicine if he has asthma and you think it is causing his cough

And since a child's cough can often be caused by a runny nose and post-nasal drip, it can also help to place a few drops of saline nasal drops in your child's nostrils, which can help thin the mucus in his nose. Wait a minute or two, and then suction it out with a nasal aspirator designed for babies.

Week Fourteen Q&A - Preventing Ear Infections

It is usually not a good idea to prop your baby's bottles - a risk factor for ear infections.
In general, it is usually not a good idea to prop your baby's bottles, especially since it can be a risk factor for getting ear infections.. Photo © Amit Erez

Q. My first child had a lot of ear infections and ended up needing tubes. Is there anything I can do to help avoid the same issues with my second child?

Ear infections in kids are a common and frustrating problem for parents.

Fortunately, you can take some steps to help reduce your child's chances of getting a lot of ear infections. According to the American Academy of Pediatrics, one way to reduce your child's risk of getting an ear infection is to simply reduce how many colds and upper respiratory tract infections he gets. That makes sense since ear infections usually accompany or follow colds. The only way to really reduce your child's risk of getting a cold is to keep him away from other sick kids though, which isn't always practical, especially if your child is in daycare.

Other things that may help decrease the number of ear infections your child has that you likely do have more control over includes:

  • breastfeeding your child for at least six months
  • not propping your baby's bottle when he drinks
  • taking away or reducing how much your baby uses a pacifier once he is six months old
  • not smoking around your child, keeping in mind that even smoking outside your house when your child is not around may increase his risk of ear infections
  • making sure your child gets the pneumococcal conjugate vaccine (Prevnar), which can help to decrease ear infections
  • getting your child a flu shot each year during flu season

The AAP does state that ear infections can run in the family, so it would be a good idea to do as much as you can to reduce your child's risk of ear infections since your other child had so many and needed ear tubes.



AAP Clinical Practice Guideline. Diagnosis and Management of Acute Otitis Media. PEDIATRICS Vol. 113 No. 5 May 2004, pp. 1451-1465.

Baby's First Tooth

Baby's First Tooth
Baby's First Tooth. Mary Gascho

Surprisingly, the timing of when your baby's first tooth comes in can vary quite a bit.

Although the average age for getting a first baby tooth is 6 months, some infants don't get their first tooth until they are 14 or 15 months old. Others can begin teething and get an early baby tooth at 3 months.

The lower, middle two teeth (central incisors) usually come in first, followed by the upper, middle two teeth. The lateral incisors, canine teeth, first, and then second molars all follow, until all 20 baby teeth are in by the time your child is about 2 to 3 years old.

Keep in mind that many children don't follow this typical pattern and their teeth may come in randomly.


Parents often think that their babies are teething when they begin drooling and putting their fingers in their mouth when they are around 3 or 4 months old.

However, this is often simply a normal developmental milestone and has nothing to do with actual teething. Often, even when infants have these classic 'teething symptoms,' they will not get their first tooth for a few more months or sometimes not until they are more than a year old. So until you see swollen gums or that first tooth coming in, any other symptoms may just be a coincidence.

Health Alert - Failure to Thrive

Pediatricians and parents often use growth charts at a baby's well child checkups can help to determine how well they are gaining weight.

Failure to Thrive

While most babies gain weight well, even if they are moving up or down on their growth chart a little bit, some babies lose weight or who aren't gaining weight well enough. These babies have what is termed failure to thrive (FTT) and according to the Nelson Textbook of Pediatrics will usually be found to have growth that is "growth below the 3rd or 5th percentile or a change in growth that has crossed two major growth percentiles."

If you think that your baby isn't gaining weight well, be sure to talk to your pediatrician, who can look for an underlying cause. If you pediatrician suspects that your baby has failure to thrive, among the conditions that your baby may be tested for may include, but are not limited to:

  • gastrointestinal problems - reflux, celiac disease, food intolerances and allergies, malabsorption, liver diseases
  • endocrine problems - hypothyroidism, diabetes, growth hormone deficiency, and adrenal disorders
  • infections - tuberculosis, AIDS, gastrointestinal parasistic and bacterial infections
  • heart and lung disorders - asthma, congestive heart failure, cystic fibrosis, obstructive sleep apnea
  • miscellaneous conditions - metabolic disorders, chromosomal abnormalities, congenital syndromes, lead poisoning, cancer, chronic kidney problems

In addition to these medical conditions that can lead to failure to thrive, children can also have weight loss or poor weight gain when they are simply not given enough to eat (psychosocial failure to thrive).



Failure to Thrive. Behrman: Nelson Textbook of Pediatrics, 17th ed.

Failure to thrive. Krugman SD - Am Fam Physician - 1-SEP-2003; 68(5): 879-84.

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