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Feeding baby another mother's breast milk


Parents Think It's Safe to Share Breast Milk, Making Experts Nervous

By The Healthline Editorial Team on October 25, 2019

Share on PinterestSharing breastmilk without taking precautions can be dangerous, experts warn. Getty Images
  • In a survey on 650 mothers from the American Academy of Pediatrics found that more than 50 percent were not concerned about the safety of sharing breast milk.
  • But breast milk can expose infants to disease or drugs or other substances ingested by the donor.
  • Women who cannot produce enough breast milk can supplement with formula or use donor milk that comes from a milk bank.

Sharing breast milk informally is a potentially unsafe practice, but one that some parents resort to in an effort to give their infant the best nutrition possible.

With more parents interested in sharing breast milk, the American Academy of Pediatrics (AAP) is learning more about these shifting attitudes.

An AAP survey of 650 mothers found that more than 50 percent were not concerned about the safety of sharing breast milk. Nearly 80 percent did not screen donors because they “trusted them.” The mothers responded anonymously to a survey on Facebook.

Informally sharing breast milk refers to transferring breast milk—already expressed or via direct nursing — to an infant when the breast milk has not been screened or gone through milk bank protocols.

More than half of the respondents said they did not use a milk bank due to costs, as well as concerns about quality or the ability to obtain a prescription for breast milk.

The research was presented at the AAP’s national conference.

“Breast is best” has been the mantra for health officials for years, but there are several reasons why parents do not breastfeed their child. Many parents may be unable to breastfeed their child for medical reasons or they may not feel it is the right choice for them.

While health experts stress that formula can be a healthy option for infants, many parents may see donated breast milk as a better option.

Here’s why that can make experts nervous. The AAP does not encourage using informally shared breast milk, citing the risks of spreading disease.

It can also expose an infant to medications, alcohol, drugs, or other contaminants. According to the AAP, women who cannot produce enough breast milk can supplement with formula or use donor milk that comes from a milk bank.

“Informal milk sharing is becoming increasingly popular and widespread,” said Nikita Sood, a researcher at Cohen Children’s Medical Center/Northwell Health in New York. “It is therefore crucial that physicians become aware of this practice and the associated risks so that they can educate patients and address this growing concern.”

Dr. Ruth Milanaik, a physician at Cohen Children’s Medical Center/Northwell Health, said in a statement that people are not only unaware of the risks, they’re not talking to their physicians about it.

“In addition to educating patients, physicians must underscore the importance of discussing these habits with medical professionals so that we have the necessary information to make accurate diagnoses should a medical need arise,” Milanaik said.

Currently, formal breast milk sharing is conducted via human milk banks located all over the world. However, in most cases, donor breast milk is usually reserved for sick and/or premature babies who need to meet certain criteria for insurance coverage. While there are some cases where donor breast milk is available for babies who are not hospitalized, often times this can be cost prohibitive.

The Human Milk Banking Association of North America (HMBANA) has guidelines for screening and processing donated breast milk, which are guided by the Centers for Disease Control and Prevention and the Food and Drug Administration.

“These precautions are necessary as milk is screened, processed, pooled and cultured to make sure that recipient babies are not exposed to harmful bacteria,” added Dr. Natasha K. Sriraman, an associate professor of pediatrics at Eastern Virginia Medical School/Children’s Hospital of The King’s Daughters. She was not affiliated with the research.

“The milk donor screening guidelines the milk banks use are established to protect the most sick and fragile infants, so they are intentionally strict,” Sarah A. Keim, PhD, an associate professor at the Center for Biobehavioral Health at The Abigail Wexner Research Institute at Nationwide Children’s Hospital in Columbus, Ohio, told Healthline. “More research would help quantify some of the risks and may help inform future guidelines.”

Dr. Keim noted that women can transmit diseases via donated milk, even if they don’t feel sick. These can include HIV and cytomegalovirus, and others. If an infant receives that milk, their life could be at risk.

She advised women to talk with their doctors about procuring milk with their doctors.

That includes women who may want to share their milk.

“Because you have extra milk, you may want to help out someone who is seeking milk, but it’s important to know that your milk could be risky to someone else’s baby even if you feel healthy and were healthy during pregnancy,” she said.

“The nonprofit milk banks in the U.S. need more milk donors to have enough milk for hospitalized babies,” Keim said. Sometimes places that need milk may need to ship it in to meet demand.

“If there was greater awareness about donation and more opportunity, there could be less inefficiency,” she noted.

Additionally Sriraman endorses getting doctors involved even in informal situations because sharing breast milk will happen. This way doctors can play an important role in trying to ensure it is done as safely as possible and they can educate families about the risks and benefits.

Sriraman noted in a position paper for the Academy of Breastfeeding Medicine in 2017 what parents and potential breast milk donors should consider before sharing breast milk

Donors should not have any illness where breastfeeding could be harmful, nor should they be on any medication or herbal substance that is incompatible with breastfeeding. The donor should not have HIV, hepatitis B virus, or human T-cell leukemia virus type 1.

Sriraman’s paper lays out other protocols to assist mothers in finding appropriate donors. Flash pasteurization can also help guard against infection, but again the AAP does not recommend informal sharing and cites certified milk banks as the safe source for donated breast milk.

And there is one place never to use to source donated breast milk: the internet.

“First and foremost, do not acquire nor buy milk over the internet,” Sriraman said. “Numerous studies have shown breast milk purchased over the internet is not suitable for consumption and often contaminated with other substances. Any exchange of breast milk for money should be discouraged.”

What to Do if an Infant or Child Is Mistakenly Fed Another Woman's Expressed Breast Milk | Breastfeeding

  • Potential Concerns Related to Breast Milk Mix-Ups
  • Prevent Milk Mix-Ups

Despite significant efforts to prevent mix-ups, occasionally, expressed breast milk from a mother is given to another mother’s child in error. If a child is mistakenly fed another child’s bottle of expressed breast milk, such as in a childcare setting, sensitivity should be taken with both families to minimize fear and steps should be taken to appropriately manage the situation in a timely manner.

Few illnesses are transmitted via breast milk, and in fact, the unique properties of breast milk help protect infants from colds and other typical childhood viruses.  Nonetheless, both families need to be notified when there is a milk mix-up, and they should be informed that the risk of transmission of infectious diseases via breast milk is small.

CDC’s experts recommend health care and childcare providers take specific actions as soon as possible after this kind of error to prevent adverse health consequences. If a child is mistakenly fed another child’s bottle of expressed breast milk, follow these steps:

  • Inform the mother whose breast milk was given to another child, and ask her:
    • When was the breast milk expressed and how was it handled prior to being delivered to the caretaker or facility?
    • Would she be willing to share information about her current medication use, recent infectious disease history, and presence of cracked or bleeding nipples during milk expression with the other family or the child’s pediatrician?
  • Discuss the event with the parent(s) or guardian(s) of the child who was given another mother’s milk:
    • Inform them that their child was given another mother’s expressed breast milk.
    • Inform them that the risk of transmission of infectious diseases is small.
    • If possible, provide the family with information on when the milk was expressed and how the milk was handled prior to its being delivered to the caretaker.
    • Encourage the parent(s) or guardian(s) to notify the child’s physician of the situation and share any specific details known.

When a milk mix-up occurs, any decisions about medical management and diagnostic testing of the infant who received another mother’s milk should be based on the details of the individual situation and be determined collaboratively between the infant’s physician and parent(s) or guardian(s).

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Potential Concerns Related to Breast Milk Mix-Ups

Concerns about potential exposure to human immunodeficiency virus (HIV)

Routine prenatal care in the United States includes laboratory testing for sexually transmitted infections (STIs) and HIV. Most women living with HIV are identified prior to or during their maternity hospital stay. In the United States, women with HIV are advised not to breastfeed their infants. As such, it is unlikely that a mother living with HIV would be providing expressed milk for her own child at a child care center. In addition, the risk of mother-to-child transmission for whom a single bottle of another mother’s milk was fed is very low. The CDC is unaware of any evidence of transmission of HIV to a child via a single exposure to another mother’s milk.

Concerns about potential exposure to hepatitis B and C viruses

Hepatitis B and C cannot be spread from a woman to a child through breastfeeding or close contact unless there is exposure to blood. It is very unlikely that a child would be at risk for hepatitis B or C by receiving another mother’s breast milk. Furthermore, with regard to hepatitis B (there is no vaccine for hepatitis C), most infants have already received at least one dose of the hepatitis B vaccine shortly after birth, the second dose between 1-2 months of age, and the third dose between 6-18 months of age. However, infants who have not been vaccinated, or infants whose vaccine schedule was interrupted, should be vaccinated according to the Advisory Committee on Immunization Practices’ hepatitis B vaccine recommendations as soon as possible.

There is no evidence that breastfeeding spreads hepatitis C virus.

Concerns about potential exposure to medications

Although many medications do pass into breast milk, most have little or no effect on infant well-being. Few medications are contraindicated while breastfeeding and risk of adverse effects from a single exposure to a medication through breast milk is very low.

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Prevent Milk Mix-Ups

To help prevent milk mix-ups, childcare facilities should review and update their policies and practices for storing and handling breast milk, as well as training (or retraining) all childcare facility staff in safe storage and handling of breast milk. In addition to clearly labeling expressed breast milk with the child’s name, some facilities use strategies such as putting different colored rubber bands around the bottles for different infants and using separate bins for each infant’s bottles of milk.

Breastfeeding and the mother-child bond | Newborn Care

You've been imagining meeting your baby for months, and finally it's happened. The first weeks of breastfeeding are a special time when you get to know each other and forge an emotional connection.

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After the birth of a baby, all-consuming love and the desire to protect him can literally overwhelm you. However, an emotional connection is an individual experience, so don't worry if it doesn't happen right away. It takes time to get to know a child well. The emotional bond between parents and baby develops and strengthens in the process of caring for him.

For both parents, the most important thing is to get used to caring for a child: to be near him, to talk, to take him in his arms, to cuddle him. This increases your confidence in your parenting abilities, creates the best emotional, physical and psychological conditions for your baby, and also contributes to successful breastfeeding.

Skin-to-skin contact with your baby

You've probably heard how important skin-to-skin contact is when you cuddle a diaper-only baby against your bare chest (if it's cool, you can put a sweater or light blanket over the top). Early skin-to-skin contact, preferably within the first hour after birth, releases hormones that encourage the baby to find the breast and start suckling. 1 One study found that newborns who spent more than 50 minutes in skin-to-skin contact were eight times more likely to suckle spontaneously. 2 However, skin-to-skin contact is not only important in the first hour of life. This is a great way to calm the baby in any situation. In addition, it stimulates milk production.

Skin to skin contact is good for the baby in many other ways. It normalizes heartbeat and breathing, helps maintain optimal body temperature and healthy blood sugar levels. 3 If, for any reason, you are unable to hold your baby immediately after birth, skin-to-skin contact can be provided by your partner so that the baby can experience all the benefits listed, feeling safe, loved and warm.

Oxytocin: a prerequisite for breastfeeding and forming an emotional bond

Adjusting to your new role as a mother can be difficult, but precious moments in direct contact with your baby have a beneficial effect not only on him, but also on you.

Skin-to-skin contact produces a powerful calming hormone cocktail in the mother's body, one of the main ingredients of which is oxytocin, the hormone of love and hugs. Oxytocin is produced with every contact with a newborn, and even when you just think about the baby or smell him. This smart hormone helps you adapt to motherhood. It stimulates "maternal behavior" - the desire to caress the child, look into his eyes and talk to him gently. 4

In addition, oxytocin fights feelings of anxiety and depression, thereby protecting you from postpartum depression. 5 It is also believed that the release of oxytocin shortly after birth prepares the brain for breastfeeding and stimulates milk production. 6

In addition, the mother produces beta-endorphin, a hormone that encourages her to respond to the needs of the child. Don't be surprised by the all-consuming desire to comfort a crying baby - this is a natural maternal instinct. In addition, beta-endorphin creates a feeling of pleasure and calmness. 3

What a newborn looks like

You will probably think your baby is the most beautiful creature in the world, but in fact, newborns usually look bruised and wrinkled, and sometimes even bruised or have a pointed skull, especially if forceps were used during birth or vacuum to extract the fetus.

In addition, the body of a newborn may be covered with so-called "stork bites" or "angel kisses" - red spots that disappear after a few months. The hands and feet of a newborn may have a bluish tint. All this is absolutely normal.

After a few days, the skin will smooth out, the head will become more round, and the primordial lubrication (cheesy white substance that protected the baby's skin in the womb) will disappear. There is no need to rinse off the lubricant - it is a natural moisturizer.

For the first few days, only the baby's head, buttocks and genitals should be washed (unless, of course, he has been soiled from head to toe with the contents of the diaper!). Bathing the whole baby is not required.

Washing your baby can be a great way for your partner to bond emotionally with the baby and take part in the care of the baby if the baby is fully breastfed. The rest of the baby's umbilical cord usually falls off within a couple of weeks. It does not look very pretty, but the main thing is to keep it clean and dry - then everything will be in order.

Making eye contact with the baby

Newborns can only see black, white and gray
(the color spectrum expands by about three months), 7 and their eyes can focus on objects no further than 25 cm (9.8 inches). This is enough for the baby to see your face while feeding. He may even briefly make eye contact with you. In the early days, you will have to feed the baby very often, so you will have the opportunity to enjoy this visual intimacy several times a day.

Forming an emotional connection with the voice

Full-term babies have good hearing. The fetus reacts to sounds as early as the 19th week of pregnancy. 8 It has been proven that newborns prefer the voice of their mother 9 to all others and even recognize the melodies they heard while they were in the womb. 10

Talking quietly to your baby creates two-way communication, which is important for your child's social development in the future. 11 You can talk about guests, about the view from the window - about anything. Newborns are very grateful listeners.

“Walking with Iris in the early days, I told her what I saw — trees, flowers, children playing,” recalls Anna, a mother from the UK.

Singing is another great way to form an emotional connection, 12 it doesn't matter if you have a voice. “While my daughter Leni was very young, I sang songs to her when I changed diapers,” says Charlotte, a mother from the UK, “Now she is 18 months old, and I still sing the same songs to her, usually at night. She loves it very much - familiar melodies calm her down.

The power of touch

Touch is very important for a child. Hugs, petting, rocking, and other caresses are a great way to soothe your baby and make him feel safe, 13 and stimulate the release of oxytocin. By the way, did you know that the baby has already developed a grasping reflex? Try touching his palms or stroking his feet and see what happens.

“While Vivienne and Marcus were babies, they liked having their feet massaged. Now I continue to do this before bed. I tried to take them in my arms as often as possible - it was a great way to establish an emotional connection with them, ”says Rachel, a mother from Australia.

Dee, a mother from South Africa, loved wearing her baby in a scarf sling. In her opinion, this not only allows you to establish an emotional connection with the child: “It helped us a lot to establish breastfeeding. Now my daughter is 17 months old, but she still loves it when I wear her in a sling.”

Attractive mother's scent

Newborns have a well-developed sense of smell, which plays a key role in establishing an emotional bond between mother and child. The newborn is attracted by the smell of the mother's breast. Scientists explain this by saying that Montgomery's glands (small bumps on the areola - dark areas of the skin around the nipples) secrete a secret that smells like amniotic fluid. 14

In addition, the baby recognizes the smell of the mother and can even smell her breast milk from that of another woman. 15 And when mother and baby hug and smell each other, oxytocin is released, which, as already mentioned, helps to establish an emotional connection and establish breastfeeding.

It is important to understand that all mothers and babies are different and it may take time for you to get used to each other. If you have any questions or concerns, please contact your healthcare provider for advice and assistance.

Literature

1 Klaus M. Mother and infant: early emotional ties. Pediatrics. 1998;102( E 1):1244-1246. - Klaus M., "Mother and child: the origin of emotional bonds". Pediatrix (Pediatrics). 1998;102(E1):1244-1246.

2 Gomez AP et al. Kangaroo method in delivery room for full-term babies. An Esp Pediatr. 1998;48(6):631-633. - Gomez A.P. et al., "Application of the Kangaroo Technique to Term Babies in the Delivery Room". An Esp Pediatr. 1998;48(6):631-633.

3 Crenshaw JT. Healthy birth practice #6: Keep mother and baby together—It’s best for mother, baby, and breastfeeding. J Perinat Educ . 2014;23(4):211-217. — Crenshaw, JT, "Physiological Birthing Practices #6: Mother and Baby Should Be Together - Better for Mother, Baby, and Breastfeeding. " J Perinat Eduk (Perinatal education). 2014;23(4):211-217.

4 Britton JR et al. Breastfeeding, sensitivity, and attachment. Pediatrics. 2006;118(5): e 1436-1443. - Britton J.R. et al., Breastfeeding, Sensitivity and Attachment. Pediatrix (Pediatrics). 2006;118(5):e1436-1443.

5 Kim S et al. Oxytocin and postpartum depression: delivering on what's known and what's not. Brain Res . 2014;1580:219-232. - Kim S. et al., "Oxytocin and postpartum depression: what we know and what we don't know." Brain Res. 2014;1580:219-232.

6 Uvänas-Moberg K, Prime DK. Oxytocin effects in mothers and infants during breastfeeding. Infant . 2013;9(6):201-206.- Uvenas-Moberg K., Prime D.K., "The effects of oxytocin on mother and child during breastfeeding." Infant. 2013;9(6):201-206.

7 Franklin A , Davies New evidence for infant color categories. Br J Dev Psychol. 2004;22(3):349-377. http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.456.5409&rep=rep1&type=pdf - Franklin, A., Davis, I.R., "New Evidence for Color Perception in Infants ". Br J Dev Saikol. 2004;22(3):349-377.

8 Hepper PG The development of fetal hearing. Arch DisChild. 1994;6(3): F 81-87. - Hepper P.J., Shahidullah B.S., "The Development of Hearing in the Prenatal Period". Arch Dis Child. 1994;6(3):F81-87.

9 Lee GY, Kisilevsky BS. Fetuses respond to father's voice but prefer mother's voice after birth. DevPsychobiol. 2014;56(1):1-11. — Lee JI, Kisilewski BS, "Fetus responds to paternal voice but prefers mother's voice after birth. " Dev Psychobiol. 2014;56(1):1-11.

10 Partanen E et al. Prenatal music exposure induces long-term neural effects. PLoS One . 2013;8(10): e 78946. - Partanen, I. et al., Prenatal music listening has long-term effects on the brain. PLOS One. 2013;8(10):e78946.

11 Kirk E et al. A longitudinal investigation of the relationship between maternal mind - mindedness and theory of mind. Br J Dev Psychol. 2015;33(4):434-445. — Kirk, I. et al., "Longitudinal study of the relationship between mother's orientation towards intelligence development and child's mental state model." Br Zh Dev Psychol. 2015;33(4):434-445.

12 de l'Etoile SK. Infant behavioral responses to infant-directed singing and other maternal interactions. Infant Behav Dev . 2006;29(3):456-470. - de l'Etoile SK, "Infant behavioral response to singing and other interactions with the mother." Infante Behave Dev. 2006;29(3):456-470.

13 Moore ER et al. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database Syst Rev . 2012;5(3). - Mur I.R. et al., "Early skin-to-skin contact and its impact on mothers and healthy newborns". Cochrane Database Syst Rev. Rev. 2012;5(3).

14 Doucet S et al. The secretion of areolar (Montgomery's) glands from lactating women elicits selective, unconditional responses in neonates.PLoS One . 2009;4(10): e 7579. - Doucet S. et al., "Papillary circle gland secretion (Montgomery's glands) in lactating women induces a selective unconditioned response in the newborn." PLOS One. 2009;4(10):e7579.

15 Vaglio S. Chemical communication and mother-infant recognition. 2009;2(3):279-281. - Vaglio S., "Chemical Communication and Recognition in the Mother-Child Pair". Commune Integral Biol. 009;2(3):279-281.

Breastfeeding in the first month: what to expect

Not sure how to establish lactation and increase milk production? If you need help, support, or just want to know what to expect, read our first month breastfeeding advice

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The first weeks of breastfeeding are a very stressful period. 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 feeding, 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,” Cathy explains. “Oxytocin circulates 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 can you tell if your 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 assistance 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 — he 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 suck better at the breast. 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 developing certain types of cancer. 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 Beyond the First Month: What to Expect

Readings

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. J 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 .

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