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Baby on and off breast during feed


My baby fusses or cries when breastfeeding

By Kelly Bonyata, BS, IBCLC

© Lsantilli - Fotolia.com

Some babies will fuss, cry or pull off the breast during breastfeeding. There are a number of reasons why this might be happening. It’s pretty common to see this type of behavior at around 6-8 weeks, though it can occur at any time. If your baby is generally fussy (not just when nursing) see My baby is fussy! Is something wrong?

 

Determining the problem

Here are some of the problem-solving steps I go through when my baby is fussy at the breast or a mother asks me why her baby is fussing while breastfeeding:

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all their vitamin D
from their mothers’ milk;
no drops needed with
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by THERALOGIX. Use PRC code “KELLY” for a special discount!

How old is baby? Most babies go through growth spurts during the first few days at home and around 7-10 days, 2-3 weeks, 4-6 weeks, 3 months, 4 months, 6 months, 9 months, etc. Many babies are fussy during growth spurts.

Is baby working on anything new developmentally? Babies who are starting to notice the world around them can be notoriously distractible. Any kind of new developmental step that baby is working on can affect nursing temporarily, whether it be fussy nursing behavior or simply more frequent nursing.

When is baby fussing? To figure out the cause it’s helpful to pay attention to when the fussy behavior happens, both during the nursing session and during the day.

If baby is fussy right when your milk is letting down (or immediately after), there’s a good chance that the fussy nursing is related to a fast let-down. If baby is fussy before let-down, or a few minutes into nursing (and a while after let-down), then baby may be impatient for the fast flow of milk that comes with let-down. Fussing at the end of a nursing session (or what seems to be the end) may mean that baby needs to burp, or is ready to finish nursing, or just wants to suck (and doesn’t want to deal with a new let-down at this point), or wants to continue nursing on the other side or with a faster flow of milk.

If the fussy behavior is mainly in the mornings, it might be due to a faster than usual let-down if baby has just had a longer sleep period and mom’s breasts are fuller than usual. If baby is fussier during evening nursings, it may be due to the normal fussy time that most babies have during the evening. Although most babies don’t react to foods that mom eats, some do. If you eat a particular food at about the same time each day (or most days) and baby has a regular time where she fusses during nursing, try not eating that food for a week or two to see if things improve.

Does fussing occur on both sides equally or only on one side? Most moms have a faster let-down and/or a more abundant milk supply on one side than the other, so if your baby fusses more on one side, it may be due to these differences.

What else is going on with baby? Is she sick or teething? Is something new or different going on in her environment? Has she started solids or is she trying a new food? Is she exhibiting other symptoms besides the fussy nursing?

Below are discussions of some of the different things that can lead to fussy nursing behavior. Keep in mind that the problem may also be a combination of several things.

Does baby need to burp?

Many babies will cry, fuss, pull off the breast, etc. if they need to burp. Try to burp between breasts and after a feeding, but don’t worry if baby does not burp and is content. Breastfed babies overall don’t take in as much air during a feeding as bottle-fed babies do, so usually don’t need to burp as often. If baby has been crying before she nurses, or is so hungry that she nurses “frantically” or if mom has a fast let-down, baby could be taking in more air and may need to be burped more often.

Burping is usually only necessary during the first few months, though it may extend longer. Once your baby is moving more freely, she will be able to relieve the gastric gas herself. This usually will occur between the 4th and 6th month, but may be shorter in some children and longer in others.

If baby has a hard time burping, try burping more often during a feeding. The best burping position is one that applies firm pressure to the baby’s tummy. Placing baby over the shoulder way up so that there is pressure on baby’s abdomen often works well. Walking around while doing this might distract her long enough to get a good burp. You may even want to lie baby down on her stomach and burp her that way.

 

Growth spurt

Babies often pull off and fuss during growth spurts. Most babies go through growth spurts, sometimes called frequency days, during the first few days at home and around 7-10 days, 2-3 weeks, 4-6 weeks, 3 months, 4 months, 6 months and 9 months (more or less). More growth spurt information in this link.

 

Distractible baby

If baby seems to be pulling off the breast at any distraction (real or imaginary), then see The Distractible Baby.

 

Forceful let-down

Some babies will pull off the breast soon after let-down if mom has a forceful let-down. Baby may be frustrated by the too-fast flow of milk with let-down. A too-forceful let-down can also cause excessive gas or spitting up/vomiting. There is more information here on symptoms of and how to deal with a fast let-down reflex.

 

Slow let-down

Some babies get very impatient if mom has a slow let-down. There is more information here on speeding up a slow let-down reflex.

Baby wants a faster milk flow

Even very young babies can be quick to notice that pulling off, kneading the breast, etc. can cause an additional let-down, and can facilitate a faster, easier milk flow. Some babies become impatient with the slower milk flow following the initial fast flow at let-down. This may or may not be related to a slow let-down.

When a feeding begins at the breast there are drops of milk. Then when the initial let-down occurs (several seconds to a minute into the feeding), the milk flow speeds up quite a bit. At that time it may drip very quickly, squirt, or even spray. Some minutes later it slows again and the baby must continue to suck vigorously in order to elicit further let-downs. This pattern can continue through successive, multiple let-downs as long as the baby is continuing to nurse vigorously. Eventually, baby will learn that the flow will pick back up again if she’ll only continue to vigorously suck/swallow.

With bottle feeding, the flow is instant and continuous. The baby is required to work very little. Once a baby has had a bottle, especially a lot of bottles, she may begin to prefer the ease of bottle-feeding over the work of breastfeeding. She may become frustrated at the breast after the first let-down occurs and the flow of milk begins to slow.

If baby is getting bottles you might consider putting them away, at least for a while. When you must use a bottle, only use a newborn nipple for as long as baby will tolerate it so that she never gets a really fast flow of milk from the bottle, but has to work a little more to get the milk.

Sometimes babies of moms with oversupply or fast let-down will also get very used to the fast flow and object when it normally slows somewhere between 3 weeks to 3 months.

It can be helpful to do some breast compression when this fussiness starts or right before you expect it to. This will help speed up the milk flow again. Once compression stops helping, try switching baby to the other side when she begins to fuss and back and forth again (after using compression) as you need to.

 

Baby is done nursing for the moment

If baby is fussing after she’s been nursing for a while, and you’ve ruled out other causes, she may be in the process of changing her nursing pattern. Babies become very efficient at the breast with growth and maturity. They can milk the breast in a lot less time per feeding session than they required before. Baby’s frustration may just be a sign that she’s finished and wants to move on.

On a similar note, an occasional baby will just want to suck at the end of a nursing session and the flow of milk with let-down frustrates her. You might see if offering her a finger or pacifier (if baby is older than 4-6 weeks) to suck on during these times seems to help.

 

Baby prefers one side

Sometimes babies will refuse or fuss at a breast when the let-down is slower or too forceful, or the supply a bit lower. They in turn will prefer the side which lets down more/less quickly and in which the supply is more bountiful. See also: Lopsided! What can I do?

 

Fussy in the evening

Many young babies tend to pull off and fuss at the breast in the evening. See the article Cluster Feeding and Fussy Evenings.

 

Teething

Teething can cause fussy nursing behavior, as some babies experience gum discomfort with sucking. Baby might start to nurse, but then pull off and cry or fuss and not want to nurse anymore. See Teething for more information and tips.

 

Thrush

Frequent pulling off the breast can be a symptom of thrush.

 

Stuffy nose

A stuffy nose can cause fussy nursing behavior. If your baby has a stuffy nose and is having a hard time breathing and nursing at the same time, see colds & congestion.

 

Allergy or food sensitivity

Some babies with allergies or food sensitivities exhibit fussy nursing behavior. Often when there is a sensitivity to something in mom’s diet, baby will come to the breast hungry but when she tastes/smells something in the milk that will cause her GI distress, she pulls off, bats her head back and forth, etc. Sensitivities to foods in mom’s diet are rare. If this is the problem, you will most likely notice other symptoms, such as excessive spitting up or vomiting, colic, diarrhea, rash, persistent congestion or runny nose, or excessive gas. More information on food sensitivities in babies and links to more allergy information can be found in my article Dairy and other Food Sensitivities in Breastfed Babies.

 

Low milk supply

Low milk supply can cause baby to be fussy at the breast. If you feel that your milk supply may be low, see this page for more info: Increasing low milk supply.

 

Reflux

Reflux can result in baby being fussy at the breast. See Reflux and Breastfeeding for more information.

 

Tongue-Tie

Tongue-Tie can result in baby being fussy at the breast. See Breastfeeding a Baby with Tongue-Tie (Resources) for more information.

 

My baby is sick - should I continue to breastfeed? • KellyMom.com

By Kelly Bonyata, IBCLC

Absolutely! Anytime a sick baby is able to take anything by mouth, it should be his mother’s milk. Mom’s milk provides antibodies specifically tailored to fight baby’s illness, and is quickly and easily digested.

Temporary weaning, besides depriving baby of antibodies to fight the illness and the most easily digestible food source available, can make life miserable for both mother and baby. Nursing is extremely comforting to an ill baby and a major part of the healing process. Mom would have to pump to maintain milk supply and then there would still be some risk that supply would drop somewhat. Not pumping would put mom at risk for breast infection and extreme discomfort.

Now infants can get
all their vitamin D
from their mothers’ milk;
no drops needed with
our sponsor's
TheraNatal Lactation Complete
by THERALOGIX. Use PRC code “KELLY” for a special discount!

  • Colds and congestion
  • Baby refuses to nurse when sick
  • Vomiting and Diarrhea
  • Breastmilk vs. Pedialyte
  • Additional Information and References

Colds and congestion

If baby has a cold and is congested, it can make breastfeeding difficult. However, it is almost always easier for a sick baby to nurse than to take a bottle. If your baby has a stuffy nose and is having a hard time breathing and nursing at the same time, try the following:

  • Keep baby as upright as possible while nursing. At night, try propping up on lots of pillows and nursing/sleeping semi-upright. Also try the Australian position (mom is “down under”) – in this position, mom is lying on her back and baby is on top (facing down), tummy to tummy with mom.
  • The best thing you can do to help baby’s illness end quickly is to nurse often – that way she gets lots of the antibodies that your body is making to help her fight off the illness. Frequent nursing also helps to ensure that baby is getting plenty of milk (congested babies often nurse for shorter times since it’s hard to breathe and nurse at the same time).
  • Use saline drops (or breastmilk) & a rubber suction bulb to clear baby’s nose before nursing (if baby won’t tolerate the bulb syringe, then the saline drops/breastmilk alone should still help).
    • Put baby on your knees, face up and tilt your knees a little downhill (so baby’s head is angled away from you, toward the floor).
    • Put 2-3 drops of saline in each nostril and let it sit for a minute or so.
    • To suction the mucus out, squeeze the bulb part of the syringe first, gently stick the rubber tip into one nostril, then slowly release the bulb.
    • If baby is really congested, you may have to do this several times a day. Do it BEFORE baby nurses; if you do it afterwards your baby may spit up everything she’s eaten because syringing can stimulate the gag reflex.
    • To prepare saline drops at home, dissolve one teaspoon of salt in two cups of warm water.
  • Run a vaporizer or humidifier, preferably in a small closed room.
  • Boil a pot of water (some moms use small crock pots/potpourri pots), remove from the stove and add a few drops of essential oil (for example, eucalyptus, sage or balsam), and let the scent permeate the air. This may help relieve some head congestion.
  • Do NOT apply products containing peppermint oil, camphor or menthol on the face (especially in the nose) or chest of a baby or young child. There have been cases where the direct application of menthol or camphor products (for example, Vicks VapoRub™) to baby’s skin resulted in severe breathing difficulties or liver problems (see Camphor Hepatoxicity, Camphor Monograph and Menthol Toxicology).
  • Nurse in a steamy bathroom. To pump up the steam, run a really hot shower and set a chair outside the shower for nursing.
  • The US Food and Drug Administration recommends against giving over the counter cold and cough medicines to children under 2.
  • The Consumer Healthcare Products Association recommends over-the-counter cough and cold products not be used in children less than 4 years old due to the risk of serious and life-threatening side effects. There is also no evidence that over-the-counter cold meds actually benefit children younger than six years old. There are several well controlled studies where there has been no difference shown between children given medication and those who have not.

Sometimes moms are advised to limit or discontinue breastfeeding because milk increases mucus production. This is not good advice for two reasons:

  1. You are not a cow and your milk is not a dairy product. So even if dairy is a problem, your milk would not be.
  2. In addition, there is no scientific evidence that cow’s milk results in the production of more mucus unless you are allergic to dairy products.

Baby refuses to nurse when sick

Some babies may refuse to nurse when sick (particularly if something like a sore throat or pressure from an ear infection makes nursing painful for baby). If this happens, try different nursing positions – particularly those where baby is upright – and keep offering to nurse at least every hour or so. See also: What to do about a nursing strike. Rest assured that your baby will return to nursing when he feels better. Here are some things to try if baby is too uncomfortable to nurse:

  • feed baby expressed milk from a cup, dropper, spoon or syringe
  • try momsicles, or freeze your milk until it’s slushy and let baby eat it with a spoon
  • for older babies (over six months) who are eating solids: if baby will take solids but not nurse, add lots of breastmilk to the solids. You might also try making yogurt from breastmilk.

Vomiting and Diarrhea

Another time when moms can be unsure about whether to continue nursing is when baby has diarrhea or is vomiting. Frequent and loose stools in a breastfed baby is not necessarily diarrhea. Here is more information on normal stooling patterns for breastfed babies: What Are Baby’s Stools Supposed to Look Like? Diarrhea in a breastfed baby is diagnosed when a baby has 12-16 stools per day (or more often than the baby’s regular stool frequency), watery stools, and an offensive odor to the stools. Just one of these symptoms does not in itself mean the baby has diarrhea.

The current recommendations when vomiting or diarrhea is present in the breastfed child are as follows:

  • Breastfeeding should be the FIRST choice if your child can take anything by mouth. Because of the ease and rapidity with which breastmilk is digested, even if your child vomits or stools shortly after nursing, he will still have retained some of the nutrients. Other foods that are often suggested (such as Pedialyte, sports drinks, gelatins and sodas) offer little nutritional value and none of the antibodies that human milk contains.
  • When your breastfed child is ill you’ll want to offer more frequent feedings — this can limit the volume taken in at one time and helps to comfort and soothe a sick child. If your child is vomiting often and not keeping the milk down for long, it may be helpful to breastfeed frequently but limit the length of each nursing session (so your child takes in less milk at once). Another option is for Mom to express some milk before breastfeeding so that the milk flow is slower. RARELY does the baby who is allowed to breastfeed at will during a vomiting or diarrhea illness become dehydrated.

The use of an oral rehydration therapy such as Pedialyte is a sound recommendation for a formula-fed infant who is vomiting or who has diarrhea, but using this in place of breastmilk offers no benefit to the breastfed baby. Human milk is a natural fluid, unlike formula and other milk products, that again is easily and rapidly digested.

Forego the Pedialyte as long as baby continues to nurse well and as long as there are no signs of dehydration. If baby is showing signs of dehydration, talk to your doctor. Following are signs of dehydration:

  • fewer than 2 wet diapers in a 24-hour period
  • baby not behaving normally (more irritable, less active, sleeping more)
  • lethargy
  • listlessness
  • weak cry
  • no tears (in an infant older than 3 months)
  • dry mouth
  • skin that stays wrinkly-looking when pinched (pull up the skin on the front of the hand; it should pop easily back into place – not stay pinched or wrinkly-looking)
  • eyes that look sunken
  • cool, clammy extremities, especially the fingers and toes
  • fast breathing, or a heart that is beating faster than usual
  • fever

Babies who are allowed to continue breastfeeding through an illness such as this are less likely to become dehydrated than those who are taken off the breast. Continued nursing also provides your child with precious antibodies that will prevent the illness from worsening and speed healing. Nursing is also very comforting to your child, which is healing in itself.

Breastfed babies sometimes need oral rehydration therapy (Pedialyte, etc), though far less often than artificially fed infants. The World Health Organization recommends continuing to breastfeed during and after oral rehydration therapy. Research shows that babies lose more weight and actually have more stools during diarrhea when they are deprived of breastmilk.

Sometimes moms are recommended to withhold breastmilk “because it is a dairy product.” Breastmilk is NOT considered a dairy or milk product (mom is not a cow!).

Anytime there is diarrhea (in adults as well as babies) it can take a while for the bowel to heal and the stools to get back to normal. So even if you identify the problem and take corrective action, you may not see favorable results for a few weeks. This is because if the bowel gets irritated it is harder for the bowel to digest lactose – the undigested lactose then actually creates more irritation and runny stools… it can be tough to turn around at times. There is usually an inflammatory response with diarrhea – that is the part that takes time to heal. When the cause of the problem is removed (when baby recovers from the illness), the gut will heal even if the baby is still fed breastmilk. More here on secondary lactose intolerance.

Breastmilk vs. Pedialyte

When baby is sick, moms are sometimes told to discontinue or restrict breastfeeding and substitute an oral rehydration therapy such as Pedialyte. This outdated practice has been shown to offer no benefits to the breastfed baby, and can even delay healing.

Your milk has four things that your baby needs even more than usual when he’s sick:

  1. Antibodies to fight this illness – you want baby to get as much of these as possible. Encourage *more* nursing rather than less. Pedialyte has no antibodies.
  2. Liquids to keep baby hydrated. Your baby may not be eating as much because he doesn’t feel well. Sick babies are more likely to nurse than to take anything else by mouth, so nursing is important to keep baby hydrated. Keeping baby well hydrated also helps keep the mucus secretions thinned out if baby has a cold or other congestion. So again, you want to nurse *more*. Pedialyte will keep baby hydrated, but so will breastmilk.
  3. Concentrated nutrients. Breastmilk is easily and quickly digested, so baby gets more nutrients and absorbs them faster. Pedialyte will keep baby hydrated but has little nutritional value. Again, it’s best to nurse *more* since baby may not be eating as much if he feels bad.
  4. Comfort. Sick babies need more comforting – what better way to do this than at the breast?

See the section above for more information on the use of Pedialyte in breastfed babies – Breastfed babies sometimes do need oral rehydration therapy (Pedialyte, etc), though far less often than artificially fed infants. The World Health Organization recommends continuing to breastfeed during and after oral rehydration therapy.

Additional Information and References

@

  • Baby’s health issues: Links
  • Surgery – Mom or Baby
  • Should breastfeeding continue when mom is sick?
  • Will lying down to nurse cause ear infections?

@ other websites

  • Withdrawal of Cold Medicines: Addressing Parent Concerns from the AAP
  • The AAP Practice Parameter on The Management of Acute Gastroenteritis in Young Children states that “Infants fed human milk can be nursed safely during episodes of diarrhea.”
  •  Runny Nose (with green or yellow mucus) parent info sheet from the US Centers for Disease Control
  • Childhood Illness Index from AskDrSears.com
  • Baby Health: Colds from Babycenter.com (general health information)
  • Working with Your Child’s Doctor by Janice Berry, from New Beginnings, Vol. 16 No. 6, November-December 1999, pp. 196-199.

References

Bhattacharya SK, et al. Risk factors for development of dehydration in young children with acute watery diarrhoea: a case-control study. Acta Paediatr 1995 Feb;84(2):160-4.

Brown, K “Dietary Management of acute childhood diarrhea: optimal timing of feeding and appropriate use of milks and mixed diets.” J. of Ped. 1991;118(4) pt 2: S92.

Clemens, J. et al. Discontinuation of bf during episodes of diarrhoea in rural Bangladesh children. Trans Royal Soc Trop Med Hygiene 1998; 82:779.

Ewer, A. et al. Gastric emptying in preterm infants. Arch Dis Child 1994; 71: F24-F27.

Faruque AS, Mahalanabis D, Islam A, Hoque SS, Hasnat A. Breast feeding and oral rehydration at home during diarrhoea to prevent dehydration. Arch Dis Child 1992 Aug;67(8):1027-9. “…withdrawal of breast feeding during diarrhoea was associated with a five times higher risk of dehydration compared with continuation of breast feeding during diarrhoea at home.”

Huffman SL, Combest C. Role of breast-feeding in the prevention and treatment of diarrhoea. J Diarrhoeal Dis Res 1990 Sep; 8(3):68-81.

Khin MU, Nyunt-Nyunt W, Myokhin AJ, et al. Effect of clinical outcome of breast feeding during acute diarrhoea. Br Med J. 1985;290:587-589.

Lawrence R. Breastfeeding: A Guide for the Medical Profession, 4th ed. St. Louis: Mosby, 1994, pp. 371, 438, 459-60.

Mahalanabis D, et al. Prognostic indicators and risk factors for increased duration of acute diarrhoea and for persistent diarrhoea in children. Int J Epidemiol 1991; 20: 1064.

Mauer et al. “American Academy of Pediatrics Committee on Nutrition: Use of ORT and Post-treatment feeding following enteritis in children in a developed country. Pediatrics 1985; 75: 359.

Mohrbacher N. Breastfeeding Answers Made Simple. Amarillo, Texas: Hale Publishing, 2010, pp. 281-282, 314-317.

Riordan J and Auerbach K. Breastfeeding and Human Lactation, 2nd ed. Boston and London: Jones and Bartlett, 1999, pp. 637-642.

Wan C, Phillips MR, Dibley MJ, Liu Z. Randomised trial of different rates of feeding in acute diarrhoea. Arch Dis Child 1999 Dec; 81(6):487-91.

World Health Organization. The Treatment of Diarrhoea. A manual for physicians and other senior health workers. WHO/CDR/95.3 (10/95). Division of Diarrhoeal and Acute Respiratory Disease Control.

Solutions to six breastfeeding problems in the first week

Are you having difficulty breastfeeding your newborn baby? Read on for expert advice on tackling the main challenges of the first week of breastfeeding.

Share this information

Cathy Garbin, child health nurse, midwife and lactation consultant:
Cathy, a mother of two, was a research fellow at the renowned Human Lactation Research Institute, founded by Peter Hartmann, for seven years, providing support to breastfeeding mothers in clinics and at home. Today, she still works as a family counselor, and also conducts seminars for attending physicians and speaks at international conferences.

Breastfeeding is not always easy, so if
you are having difficulty, know that you are not alone. A US study found that out of 500 new mothers surveyed, 92% experienced breastfeeding problems by the third day. 1 Fortunately, most early breastfeeding problems are easy to resolve. Below you can read recommendations for solving the main problems that mothers often face in the first week of feeding.

Problem #1. Breastfeeding hurts!

Pain during feeding is usually associated with tenderness or inflammation of the nipples, especially when milk "comes" on the second to fourth day after birth. 2 The baby will beg for a breast every couple of hours, and this can quickly aggravate the problem: some mothers' nipples crack, bleed, or blister. This is, of course, very annoying.

Solutions 3

  • Check how the baby latch on. An incorrect latch is one of the most common causes of pain during breastfeeding. A newborn baby should take most of the lower half of the areola (dark skin around the nipple) into his mouth, and your nipple should rest against his palate, supported from below by the tongue.
  • Contact a lactation consultant or healthcare professional to make sure your baby's mouth and torso are properly positioned during feeding and there are no other latch-on problems. The doctor may also examine the baby's mouth for physical abnormalities.
  • Try other feeding positions. Reclining, cross cradle, underarm, or lying positions can relieve pressure on the most painful areas of your breasts.
  • Gently wipe soaked nipples with water-soaked cotton swabs after each feed to remove milk residues that can cause infection.
  • Air dry nipples or blot with a clean, soft muslin or flannel cloth to prevent bacterial growth in a humid environment. Use disposable or reusable bra pads to absorb leaking milk and remember to change them regularly.
  • Soften your nipples. An ultra-pure lanolin treatment will help relieve inflammation and dry skin. You can also apply a few drops of your own breast milk to your nipples. In both cases, you do not have to wash your breasts before the next feeding. You can also apply refrigerated hydrogel pads* to your nipples. They soothe the nipples and help relieve pain during feeding, as well as speed up healing.
  • Protect your nipples. Nipple shields* protect the sore area from rubbing against clothing.
  • Be patient. The inflammation usually resolves after a few days as your body adjusts to breastfeeding and your baby learns to suckle.
  • Seek medical attention, if pain during feeding does not go away after a few days. Constant inflammation of the nipples may indicate an infection that requires prompt treatment.

Problem #2. Baby doesn't latch on properly

Some newborns do not latch on properly right away. Maybe both of you just need more time to learn how to breastfeed, or maybe the baby was born prematurely, feels unwell after a difficult birth, or mom has flat or inverted nipples.

Solutions

  • Contact a lactation consultant or healthcare professional who can help identify the cause of the problem and suggest solutions.
  • Flat or inverted nipples must be pulled out. Nipple formers* fit comfortably in the bra and apply gentle pressure to the nipples to help them come out for easier feeding.
  • Try different positions and ways to support your newborn. The baby needs to feel supported. He must be comfortable and breathe freely in order to suckle properly. Do not hold the child by the head and do not put pressure on it. Lean back and let your child take the lead. This stimulates his natural reflexes and helps him find and latch on to his breasts. 4
  • When feeding, try to find the optimal position. Instead of putting your baby on and off, stressing both of you, try to position him in a way that is easy and comfortable for him. Hold the torso and legs of the baby close to you, support him by the shoulders and hold him firmly so that he feels safe. Let the baby's head rest freely on your arm so that he can tilt it back slightly and breathe freely. The chin should be pressed against your chest. If these small adjustments don't make feeding more comfortable for your baby, seek help from a lactation consultant or healthcare professional.
  • Use nursing pads. If your baby is having difficulty latch-on, a lactation consultant or healthcare professional may suggest trying nursing pads*. A nipple with an overlay is more convenient to take in the mouth, so it is larger and more rigid. Do not use nursing pads for a long time.

Problem #3. Not enough breast milk

You will produce little breast milk at the very beginning, as the hormonal changes that trigger milk production occur slowly and do not end until the second or fourth day after birth. 2 You may be worried that your baby is not getting enough milk, but in the early days his stomach is still too small and feedings are frequent, so don't worry. The only things to worry about these days are excessive weight loss, too few wet and soiled diapers, or signs of dehydration in the baby. For more information on how often a newborn should urinate and void, see Breastfeeding Newborns: What to Expect in the First Week.

Solutions

  • Contact a Lactation Consultant or your healthcare provider who can determine if you have problems with milk production. The sooner you do this, the better.
  • Feed your baby on demand, not on a schedule. In the first week after birth, your baby will ask to breastfeed every two to three hours (or more often!), both day and night. Such frequent feeding helps to establish the production of breast milk.
  • Take care of yourself. It's not always easy with a newborn, but try to rest whenever you can, eat right, and accept any help around the house or with older children that your loved ones can give you to fully focus on breastfeeding.
  • Try expressing milk. If a baby is feeding frequently but not gaining any weight, a lactation consultant or doctor may recommend pumping to increase breast milk production. If milk is not coming out at all, you can try the Medela Symphony Dual Electric Clinical Breast Pump**. It features an Initiate program that mimics a baby's natural sucking rhythm for the first few days.

Problem #4. Breast full and heavy

Your breasts will become fuller and heavier as milk comes in.
If the baby suckles well and often, this should not cause any problems. However, in some women, the breasts become so full that they become hard and painful. This condition, called breast swelling, can cause discomfort. The swollen chest seems to be “burning”, now all the activity of your body is concentrated in it, resembling a busy traffic at rush hour. Fortunately, this condition usually resolves within 24 to 48 hours. However, due to the swelling of the mammary glands, the nipples can become flat and the baby may have difficulty latch-on. 5

Solutions

  • Feed your baby often. Try to breastfeed at least 8-12 times a day. This is the main way to alleviate this condition. For more tips and tricks, see the article on Breast Swelling. 6.7
  • Call your healthcare provider, if symptoms persist for more than 48 hours, you have a fever, or your baby is unable to breastfeed due to swelling.

Problem #5. Milk is leaking

Breast leakage is very common in the early days of breastfeeding when milk production begins. Milk may leak from one breast while you are feeding the other, when you sleep on your stomach, or when something accidentally triggers the milk flow reflex, such as when you hear a baby crying in a store. The leakage usually stops after about six weeks.

Solutions

  • Protect clothes from stains will help disposable or reusable bra pads to be used day and night.
  • Don't waste precious drops! Breast milk collection pads* fit inside the bra and allow you to collect any leaking milk. This is a very useful thing when there is too much milk and the pads are not absorbing well, or when one breast is leaking while you are feeding the other. If you want to save the collected milk, use only the milk collected at the feeding. Place it in a sterile container and refrigerate immediately if you are not supplementing with it right away. Collected milk must be used within 24 hours. The breast milk collection sleeves should not be worn for more than two to three hours at a time.

Problem #6. There seems to be too much milk

Sometimes when milk comes in, too much is produced! In the first few weeks there may be an overabundance of milk, but usually everything returns to normal soon. 7 Up to this point, the breasts may be heavy and sore almost all the time, even immediately after a feed, and a lot of milk may leak. A strong flush can cause a baby to cough or choke, vomit immediately after a feed, have tummy discomfort, or have hard, frothy, greenish stools. These are all signs that you are having too much milk, but the problem may resolve itself as your breasts get used to the new function.

Solutions

  • Express some milk by hand at the beginning of each feed to ease the force of the flush.
  • Try to feed while leaning back: this will help your baby control the flow of milk. The "cradle" position is also good: hold the baby obliquely by the shoulders so that the head can lean back slightly while on your arm. The torso of the baby will be located diagonally on you.
  • Be kind and patient. Let your baby rest and absorb milk both during and after feeding. Don't move your baby too much or too fast, as this can make him nauseous. As the baby grows, he will learn to better cope with the rush of milk, which is likely to weaken anyway.
  • Use the towel or swaddle to soak up spilled milk if the baby can't handle the flush, and place the breast milk collection pad on the other breast to catch any spilled milk.
  • Contact a lactation consultant or doctor if problems persist after a few weeks . He will examine you and may suggest one-sided feedings or hourly breast changes (“breast duty”) to reduce your milk supply.

Related materials: Difficulties in breastfeeding in the next few weeks and problems with breastfeeding after the first month

Literature

1 Wagner EA et al. Breastfeeding concerns at 3 and 7 days postpartum and feeding status at 2 months. Pediatrics . 2013: peds -2013. - Wagner I.A. et al., "Breastfeeding Problems at Days 3 and 7 of a Child's Life and Type of Feeding at 2 Months". Pediatrix (Pediatrics). 2013:e865–e875.

2 Pang WW, Hartmann PE. Initiation of human lactation: secretory differentiation and secretory activation. J Mammary Gland Biol Neoplasia 2007;12(4):211-221. - Pang, W.W., Hartmann, P.I., "Lactation initiation in the lactating mother: secretory differentiation and secretory activation." G Mammary Gland Biol Neoplasia. 2007;12(4):211-221.

3 Cadwell K. Latching - On and Suckling of the Healthy Term Neonate: Breastfeeding Assessment. J Midwifery & Women ’ s 2007;52(6):638-642. — Cadwell, K., "Latching and sucking in healthy newborns: evaluation of breastfeeding." F Midwifery Women Health. 2007;52(6):638-642.

4 Colson SD et al. Optimal positions for the release of primitive neonatal reflexes stimulating breastfeeding. Early Hum Dev . 2008;84(7):441-449. - Colson S.D. et al., "Optimal Positions for Provoking Primitive Innate Reflexes to Induce Breastfeeding." Airlie Hume Dev. 2008;84(7):441-449.

5 Jacobs A et al. S3-guidelines for the treatment of inflammatory breast disease during the lactation period. Geburtshilfe Frauenheilkd. 2013;73(12):1202-1208. - Jacobs A. et al., "Recommendations S -3 for the treatment of inflammatory diseases of the breast during breastfeeding. Geburtskhilfe und Frauenheilkünde. . ABM Clinical Protocol# 4: Mastitis , Revised MARCH 2014. Breastfeed - 9020: 5): 5) H., Academy of Breastfeeding Protocol Committee, AVM Clinical Protocol #4: Mastitis, March 2014 edition of Brestfeed Med (Breastfeeding Medicine). 2014;9(5):239-243.

7 Academy of Breastfeeding Medicine Protocol Committee. ABM clinical protocol # 20: Engorgement. Breastfeed Med . 2009;4(2):111-113. - Protocol Committee of the Academy of Breastfeeding Medicine, "AVM Clinical Protocol No. 20: Engorgement, Revision 2016". Brestfeed Med (Breastfeeding Medicine). 2009;4(2):111-113.

Read instructions before use. Consult a specialist about possible contraindications.

* RU No. ФСЗ 2010/07352 of 07/19/10

** RU No. ФСЗ 2010/06525 of 03/17/2021

and increase milk production? If you need help, support, or just want to know what to expect, read our first month breastfeeding advice

Share this information

The first few weeks of breastfeeding are stressful. If at times you feel like you can't handle it, know that you are not alone. Feeding your baby all day long is completely natural and helps produce breast milk, but can be quite tiring at times. Be patient, think about yourself and remember: after the first month, when milk production stabilizes, it will become easier.

How often should a baby be breastfed?

Babies are born with a small stomach that grows rapidly as milk production increases: in the first week it is no larger than an apricot, and after two weeks it is already the size of a large hen's egg. 1.2 Let the child eat as much as he wants and when he wants. This will help him quickly regain the weight lost after birth and grow and develop further.

“Be prepared to feed every two to three hours throughout the day. At night, the intervals between feedings can be longer: three to four or even five hours, says Cathy Garbin, a recognized international expert on breastfeeding. Some eat quickly and are satiated in 15 minutes, while others take an entire hour to feed. Do not compare your breastfeeding regimen with that of other mothers - it is very likely that there will be nothing in common between them.

At each feed, give your baby a full meal from one breast and then offer a second one, but don't worry if the baby doesn't take it. When the baby is full, he lets go of his chest and at the same time looks relaxed and satisfied - so much so that he can immediately fall asleep. The next time you feed, start on the other breast. You can monitor the order of the mammary glands during feeding using a special application.

Why does the child always ask for a breast?

The first month is usually the hardest time to breastfeed. But do not think that because the baby is constantly hungry and asks for a breast almost every 45 minutes, then you do not have enough milk.

In the first month, the baby needs to eat frequently to start and stimulate the mother's milk production. It lays the foundation for a stable milk supply in the future. 3

In addition, we must not forget that the child needs almost constant contact with the mother. The bright light and noise of the surrounding world at first frighten the baby, and only by clinging to his mother, he can calm down.

Sarah, mother of three from the UK, confirms: “Crying is not always a sign of hunger. Sometimes my kids just wanted me to be around and begged for breasts to calm them down. Use a sling. Place the cradle next to the bed. Don't look at the clock. Take advantage of every opportunity to relax. Forget about cleaning. Let those around you take care of you. And not three days, but six weeks at least! Hug your baby, enjoy the comfort - and trust your body."

Do I need to feed my baby on a schedule?

Your baby is still too young for a strict daily routine, so
forget about breastfeeding schedules and focus on his needs.

“Volumes have been written about how to feed a baby on a schedule, but babies don't read or understand books,” Cathy says. - All children are different. Some people can eat on a schedule, but most can't. Most often, over time, the child develops his own schedule.

Some mothers report that their babies are fine with scheduled feedings, but they are probably just the few babies who would eat every four hours anyway. Adults rarely eat and drink the same foods at the same time of day - so why do we expect this from toddlers?

Offer your baby the breast at the first sign of hunger. Crying is already the last stage, so be attentive to early signs: the baby licks his lips, opens his mouth, sucks his fist, turns his head with his mouth open - looking for the breast. 4

What is a "milk flush"?

At the beginning of each feed, a hungry baby actively sucks on the nipple,
thereby stimulating the milk flow reflex - the movement of milk through the milk ducts. 5

“Nipple stimulation triggers the release of the hormone oxytocin,” explains Cathy. “Oxytocin is distributed throughout the body and causes the muscles around the milk-producing glands to contract and the milk ducts to dilate. This stimulates the flow of milk.

If the flushing reflex fails, milk will not come out. This is a hormonal response, and under stress it may not work at all or work poorly. Therefore, it is so important that you feel comfortable and calm when feeding.

“Studies show that each mother has a different rhythm of hot flashes during one feed,” Kathy continues, “Oxytocin is a short-acting hormone, it breaks down in just 30-40 seconds after formation. Milk begins to flow, the baby eats, the effect of oxytocin ends, but then a new rush of milk occurs, the baby continues to suckle the breast, and this process is repeated cyclically. That is why, during feeding, the child periodically stops and rests - this is how nature intended.

The flow of milk may be accompanied by a strong sensation of movement or tingling in the chest, although 21% of mothers, according to surveys, do not feel anything at all. 5 Cathy explains: “Many women only feel the first rush of milk. If you do not feel hot flashes, do not worry: since the child eats normally, most likely, you simply do not understand that they are.

How do you know if a baby is getting enough milk?

Since it is impossible to track how much milk a baby eats while breastfeeding, mothers sometimes worry that the baby is malnourished. Trust your child and your body.

After a rush of milk, the baby usually begins to suckle more slowly. Some mothers clearly hear how the baby swallows, others do not notice it. But one way or another, the child himself will show when he is full - just watch carefully. Many babies make two or three approaches to the breast at one feeding. 6

“When a child has had enough, it is noticeable almost immediately: a kind of “milk intoxication” sets in. The baby is relaxed and makes it clear with his whole body that he is completely full, says Katie, “Diapers are another great way to assess whether the baby is getting enough milk. During this period, a breastfed baby should have at least five wet diapers a day and at least two portions of soft yellow stool, and often more.”

From one month until weaning at six months of age, a baby's stool (if exclusively breastfed) should look the same every day: yellow, grainy, loose, and watery.

When is the child's birth weight restored?

Most newborns lose weight in the first few days of life. This is normal and should not be cause for concern. As a rule, weight is reduced by 5-7%, although some may lose up to 10%. One way or another, by 10–14 days, almost all newborns regain their birth weight. In the first three to four months, the minimum expected weight gain is an average of 150 grams per week. But one week the child may gain weight faster, and the next slower, so it is necessary that the attending physician monitor the health and growth of the baby constantly. 7.8

At the slightest doubt or signs of dehydration, such as
dark urine, no stool for more than 24 hours, retraction of the fontanel (soft spot on the head), yellowing of the skin, drowsiness, lethargy, lack of appetite (ability to four to six hours without feeding), you should immediately consult a doctor. 7

What is "cluster feeding"?

When a baby asks for a breast very often for several hours, this is called cluster feeding. 6 The peak often occurs in the evening between 18:00 and 22:00, just when many babies are especially restless and need close contact with their mother. Most often, mothers complain about this in the period from two to nine weeks after childbirth. This is perfectly normal and common behavior as long as the baby is otherwise healthy, eating well, gaining weight normally, and appears content throughout the day. 9

Cluster feeding can be caused by a sharp jump in the development of the body - during this period the baby especially needs love, comfort and a sense of security. The growing brain of a child is so excited that it can be difficult for him to turn off, or it just scares the baby. 9 If a child is overworked, it is often difficult for him or her to calm down on his own, and adult help is needed. And breastfeeding is the best way to calm the baby, because breast milk is not only food, but also pain reliever and a source of happiness hormones. 10

“Nobody told me about cluster feeding, so for the first 10 days I just went crazy with worry - I was sure that my milk was not enough for the baby,” recalls Camille, a mother from Australia, “It was a very difficult period . I was advised to pump and supplement until I finally contacted the Australian Breastfeeding Association. There they explained to me what was happening: it turned out that it was not about milk at all.

Remember, this is temporary. Try to prepare dinner for yourself in the afternoon, when the baby is fast asleep, so that in the evening, when he begins to often breastfeed, you have the opportunity to quickly warm up the food and have a snack. If you are not alone, arrange to carry and rock the baby in turns so that you have the opportunity to rest. If you have no one to turn to for help and you feel that your strength is leaving you, put the baby in the crib and rest for a few minutes, and then pick it up again.

Ask your partner, family and friends to help you with household chores, cooking and caring for older children if you have any. If possible, hire an au pair. Get as much rest as possible, eat well and drink plenty of water.

“My daughter slept a lot during the day, but from 23:00 to 5:00 the cluster feeding period began, which was very tiring,” recalls Jenal, a mother from the USA, “My husband tried his best to make life easier for me - washed, cleaned, cooked, changed diapers, let me sleep at every opportunity and never tired of assuring me that we were doing well.

If you are concerned about the frequency of breastfeeding, it is worth contacting a specialist. “Check with a lactation consultant or doctor to see if this is indicative of any problems,” recommends Cathy. “Resist the temptation to supplement your baby with formula (unless recommended by your doctor) until you find the cause. It may not be a matter of limited milk production at all - it may be that the child is inefficiently sucking it.

When will breastfeeding become easier?

This early stage is very special and does not last long. Although sometimes it seems that there will be no end to it, rest assured: it will get easier soon! By the end of the first month, breast milk production will stabilize, and the baby will become stronger and learn to suckle better. 2.3 Any problems with latch on by this time will most likely be resolved and the body will be able to produce milk more efficiently so inflammation and leakage of milk will begin to subside.

“The first four to six weeks are the hardest, but then things start to get better,” Cathy assures. It just needs to be experienced!”

The longer breastfeeding continues, the more benefits it brings, from saving on formula and improving sleep quality 11–13 to boosting your baby's immune system 14 and reducing your risk of certain cancers. 15

“When you feel like you're pushing yourself, try to go from feed to feed and day to day,” says Hannah, a UK mom. “I was sure I wouldn’t make it to eight weeks. And now I have been breastfeeding for almost 17 weeks, and I dare say it is very easy.”

Read the resource Breastfeeding After the First Month: What to Expect

Literature

1 Naveed M et al. An autopsy study of relationship between perinatal stomach capacity and birth weight. Indian J Gastroenterol .1992;11(4):156-158. - Navid M. et al., Association between prenatal gastric volume and birth weight. Autopsy. Indian J Gastroenterol. 1992;11(4):156-158.

2 Neville MC et al. Studies in human lactation: milk volumes in lactating women during the onset of lactation and full lactation .Am J Clinl Nutr . 1988;48(6):1375-1386. at the beginning and at the peak of lactation." Am F Clean Nutr. 1988;48(6):1375-1386.

3 Kent JC et al. Principles for maintaining or increasing breast milk production. 2012;41(1):114-121. - Kent J.S. et al., "Principles for Maintaining and Increasing Milk Production". J Obstet Ginecol Neoneutal Nurs. 2012;41(1):114-121.

4 Australian Breastfeeding Feeding cues ; 2017 Sep [ cited 2018 Feb ]. - Australian Breastfeeding Association [Internet], Feed Ready Signals; September 2017 [cited February 2018]

5 Kent JC et al. Response of breasts to different stimulation patterns of an electric breast pump. J Human Lact . 2003;19(2):179-186. - Kent J.S. et al., Breast Response to Different Types of Electric Breast Pump Stimulation. J Human Lact (Journal of the International Association of Lactation Consultants). 2003;19(2):179-186.

6) Kent JC et al . Volume and frequency of breastfeedings and fat content of breast milk throughout the day. Pediatrics. 2006;117(3): e 387-395. - Kent J.S. et al., "Amount and frequency of breastfeeding and fat content of breast milk during the day." Pediatrix (Pediatrics). 2006;117(3):e387-95.

7 Lawrence RA, Lawrence RM. Breastfeeding: A guide for the medical profession. 7th ed. Maryland Heights MO, USA: Elsevier Mosby; 2010. 1128 p . - Lawrence R.A., Lawrence R.M., "Breastfeeding: A guide for healthcare professionals." Seventh edition. Publisher Maryland Heights , Missouri, USA: Elsevier Mosby; 2010. P. 1128.

8 World Health Organization. [Internet]. Child growth standards; 2018 [cited 2018 Feb] - World Health Organization. [Internet]. Child Growth Standards 2018 [cited February 2018].

9 Australian Breastfeeding Association . [ Internet ]. Cluster feeding and fussing babies ; Dec 2017 [ cited 2018 Feb ] - Australian Breastfeeding Association [Internet], Cluster Feeding and Screaming Babies; December 2017 [cited February 2018].

10 Moberg KU, Prime DK. Oxytocin effects in mothers and infants during breastfeeding. Infant . 2013;9(6):201-206.- Moberg K, Prime DK, "Oxytocin effects on mother and child during breastfeeding". Infant. 2013;9(6):201-206.

11 U.S. Department of Health & Human Services [Internet]. Surgeon General Breastfeeding factsheet; 2011 Jan 20 [cited 2017 Feb] - Department of Health and Human Services [Internet], "Breastfeeding Facts from the Chief Medical Officer", Jan 20, 2011 [cited Feb 2017]

12 Kendall-Tackett K et al. The effect of feeding method on sleep duration, maternal well-being, and postpartum depression. clinical lactation. 2011;1;2(2):22-26. - Kendall-Tuckett, K. et al., "Influence of feeding pattern on sleep duration, maternal well-being and the development of postpartum depression." Clinical Lactation. 2011;2(2):22-26.

13 Brown A, Harries V. Infant sleep and night feeding patterns during later infancy: Association with breastfeeding frequency, daytime complementary food intake, and infant weight. Breast Med . 2015;10(5):246-252. - Brown A., Harris W., "Night feedings and infant sleep in the first year of life and their association with feeding frequency, daytime supplementation, and infant weight." Brest Med (Breastfeeding Medicine). 2015;10(5):246-252.

14 Hassiotou F et al. Maternal and infant infections stimulate a rapid leukocyte response in breastmilk. Clin Transl immunology. 2013;2(4). - Hassiot F. et al., "Infectious diseases of the mother and child stimulate a rapid leukocyte reaction in breast milk." Clean Transl Immunology. 2013;2(4):e3.

15 Li DP et al. Breastfeeding and ovarian cancer risk: a systematic review and meta-analysis of 40 epidemiological studies. Asian Pac J Cancer Prev . 2014;15(12):4829-4837. - Lee D.P. et al., "Breastfeeding and the risk of ovarian cancer: a systematic review and meta-analysis of 40 epidemiological studies.

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