Infants In Specialized Care
Some situations require specialized expertise and care. Mothers at high risk of preterm or medically complicated births require information tailored to their specific needs. If a baby is anticipated to require specialized care, families need additional information about:
- The importance of skin-to-skin care in the NICU
- Establishing milk production, pumping or hand expressing, if babies cannot breastfeed effectively
- The vital role of families as part of the infants care team.
If a mother is unsure or is choosing not to breastfeed her infant in specialized care, sensitively providing information about the value of breastmilk for their sick or preterm infant can be beneficial. For example, breastmilk is effective in preventing necrotizing enterocolitis, leading to fewer severe infections, reducing colonization by pathogenic organisms, improving neural development, and leading to a shorter hospital stay.Footnote 66 Given this information, some mothers will choose to express milk for their preterm infant even if they do not plan to breastfeed.
Avoid Alcohol And Smoking And Limit Certain Foods
The following tips are reminders that as long as youâre breastfeeding, youâre passing on what you eat and drink to your baby, which means certain things need to be avoided or limited to ensure your baby isnât affected in a negative way:
Limit your coffees to no more than 3 cups per day, because caffeine can irritate your baby and affect his sleep
Limit seafood thatâs high in mercury like swordfish, king mackerel, and tilefish
Avoid smoking since nicotine can interfere with your babyâs sleep and health. Secondhand smoke also increases the risk of Sudden Infant Death Syndrome and respiratory illnesses in your baby.
Avoid alcohol as itâs not safe for your baby. If you do happen to have the occasional drink, wait two to three hours for it to leave your system before breastfeeding. âPumping and dumpingâ your milk wonât speed up the removal of alcohol from your breast milk.
Is My Baby Latching On Correctly
Good attachment is crucial for getting breastfeeding off to a good start,6 as your babys latch affects how well he drinks the milk and consequently how he grows and develops. A poor latch can cause sore or damaged nipples, so never worry about asking a healthcare professional to check your attachment, even if youve been told the latch is fine and you dont notice an obvious problem especially while youre still at your birth facility.
Every time I fed in hospital, I buzzed a midwife to check the latch, says Emma, mum of two, Australia. There were a few times I thought I had it right but it was painful and the midwife helped take my baby off and do it properly. It meant I had the confidence to do that at home.
When your baby is latching on, aim your nipple towards the roof of his mouth. This way he will latch on to the nipple, as well as some of the areola beneath it. This means he can draw both the nipple and some breast tissue into his mouth and feed well.6
The latch should feel pretty comfortable and like a tugging sensation rather than a pain, says Cathy. Your baby will have his mouth wide open. His bottom lip may be flanged outwards, but his top lip will rest comfortably on your breast. His body language will show he is comfortable. Theres not going to be a large volume of milk at this early stage, so you wont see much swallowing, although your baby will be sucking a lot and feeding lots of times.
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Supporting Families Who Are Not Breastfeeding
WHO uses the acronym AFASS to describe the process of assisting families who are not breastfeeding to choose breastmilk substitutes. The Nutrition for Healthy Term Infants: Recommendations from Birth to Six Months joint statement provides guidance on the use of breastmilk substitutes including safe preparation and storage.Footnote 2
It is important to provide families with information on responsive, cue-based feeding signs of satiation and the importance of skin-to-skin contact as well as information on professional and peer support regardless of feeding method.
Provide non-judgmental and supportive care for families who choose not to breastfeed, whether for medical, personal, or social reasons. Families may feel guilt or shame for not breastfeeding and may require individualized support to deal with these emotions as well as information to optimize their infants nutritional well-being.
If women do not breastfeed, lactogenesis still occurs. Research on lactation suppression has primarily focused on pharmacological measures. It is important that HCPs provide women with information on comfort measures for sore breasts, including analgesics, cold compresses, supportive bras, and limited hand expression.Footnote 89 Breast binding and restricting fluids are not recommended.
Supporting Sustained Breastfeeding Of The Older Infant And Young Child
Breastfeeding is also an important source of nutrition for the older infant and young child. Breastfeeding can provide 50% or more of the energy needs of the infant aged 6 months to 1 year, with other foods supplying the remainder.Footnote 187Footnote 188 One-third of the 12- to 24-month-old toddlers energy needs can come from breastmilk.Footnote 188Footnote 189 In addition, the act of breastfeeding is comforting to the child.
Many mothers continue to breastfeed because they believe it enhances their relationship with their child.Footnote 190 Breastfeeding beyond infancy and well into toddlerhood is common in many cultures.
In 2011/12, the rate of breastfeeding beyond the babys first year of life was 19%.Footnote 3 Although the reasons for earlier weaning are multifactorial, lack of knowledge about the value of prolonged breastfeeding and the lack of support for mothers breastfeeding older infants and toddlers are contributing factors. Mothers who continue to breastfeed into toddlerhood may face negative attitudes and criticism, and be reluctant to say they are still breastfeeding, a practice called closet nursing.Footnote 2Footnote 128Footnote 191Footnote 192
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How Many Breastfeeds Your Baby Will Need
Each child is different, but a young baby usually needs to feed 8 to 12 times in 24 hours. Your milk supply adjusts to your babys needs, so it helps to feed whenever your child is ready. You will know that youre providing enough milk if your baby:
- has 6 to 8 really wet cloth nappies or 4 to 5 heavy disposable nappies in 24 hours
- has soft bowel motions
- generally settles after most feeds
- has bright eyes and good skin tone
- is gaining weight appropriate to their age.
Some signs your baby is feeding well are:
- After some initial short frequent sucks to stimulate milk flow, your baby begins to swallow. Sucking becomes slower, deeper and more rhythmic with rest periods between each sucking burst. As the feed progresses the sucking bursts become shorter and the rest periods longer
- You can hear or see your baby swallowing.
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The Following Things Are Normal:
- Frequent and/or long feedings.
- Varying nursing pattern from day to day.
- Cluster nursing for several hoursusually eveningseach day. This may coincide with the normal fussy time that most babies have in the early months.
- Growth spurts, where baby nurses more often than usual for several days and may act very fussy. Common growth spurt times in the early weeks are the first few days at home, 7 10 days, 2 3 weeks and 4 6 weeks.
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Breastfeeding Positions: How To Hold Your Baby While Breastfeeding
When learning how to breastfeed a newborn, the positioning plays an important role. There are many ways you can hold your baby in while breastfeeding as long as both you and your baby find the process comfortable. Some of the most loved positions by feeding mothers are:
How Soon Do Baby Goats Need Colostrum
As time ticks by following birth, so does the antibody concentration in does colostrum. Baby goats should begin to nurse naturally within hours of birth, says Olson. If they do not nurse within 4 hours or receive an adequate amount of colostrum, youll need to step in by feeding a colostrum replacer.
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How Often Should I Burp My Baby During Feedings
After your baby finishes on one side, try burping before switching breasts. Sometimes, the movement alone can be enough to cause a baby to burp.
Some infants need more burping, others less, and it can vary from feeding to feeding.
If your baby spits up a lot, try burping more often. While it’s normal for infants to “spit up” a small amount after eating or during burping, a baby should not vomit after feeding. If your baby throws up all or most of a feeding, there could be a problem that needs medical care. If you’re worried that your baby is spitting up too much, call your doctor.
What Am I Going To Learn
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Limit Caffeine And Alcohol
Don’t overdo your caffeine consumption, because you’ll pass the caffeine along to your baby in your breast milk, and it can accumulate in their system.
You’ll also want to limit drinking alcohol while you’re breastfeeding, because the same amount of alcohol that enters your bloodstream makes it into your breast milk and your baby can’t process the alcohol as well as you can. Learn how alcohol can affect your breastfeeding baby.
Support For The Mother Who Is Not Yet Breastfeeding
If the mother or baby is ill or the baby is too small to suckle you need to give extra support and help. First teach the mother how to express milk and feed the baby by cup. If you have not been trained to do this, you should refer to an infant feeding counsellor where possible. If the mother and baby are separated for any reason then reassure the mother about the baby’s progress whenever she asks. Encourage the mother to start breastfeeding the baby as soon as she or the baby is able.
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What Are Some Common Breastfeeding Latch Problems
Below are some common latch problems and how to deal with them.
Youre in pain. Many moms say their breasts feel tender when they first start breastfeeding. A mother and her baby need time to find comfortable breastfeeding positions and a good latch. If breastfeeding hurts, your baby may be sucking on only the nipple, and not also on the areola .
Gently break your babys suction to your breast by placing a clean finger in the corner of your babys mouth. Then try again to get your baby to latch on. To find out if your baby is sucking only on your nipple, check what your nipple looks like when it comes out of your babys mouth. Your nipple should not look flat or compressed. It should look round and long or the same shape as it was before the feeding.
Key Skills For Health Care Providers
Fundamental skills for HCPs include breastfeeding assessment and knowing the key skills for mothers described above and how to teach those skills. Effective teaching/counselling helps mothers become increasingly confident in their ability to understand their infants cues, feed their baby, and recognize the signs that their infant is feeding well.
1. Feeding assessment
Feeding assessments require knowing the normal changes that mothers and infants go through and the feeding relationship and how each of these parameters changes with time. Perinatal Services BC Breastfeeding Healthy Term Infants guideline has recommendations on breastfeeding assessment and discharge criteria.Footnote 54
As the length of hospital stay for mothers and infants varies from just a few hours to 72 hours or more, appropriate follow-up after discharge, including breastfeeding assessment by a skilled HCP, is essential. The Society of Obstetricians and Gynaecologists of Canada recommends that all mothers and infants be assessed by an HCP within 48 hours of discharge from a hospital or birthing centre.Footnote 136 The CPS gives recommendations on newborn surveillance related to breastfeeding and jaundice in their Guidelines for Detection, Management and Prevention of Hyperbilirubinemia in Term and Late Preterm Newborn Infants.Footnote 137
Increasing Milk Production
Medications to increase milk production
Traditional foods as galactagogues
2. Infant weight loss and expected gain
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How To Hold Your Nursing Baby
There’s more than one way to nurse a baby, but the best way is the one most comfortable for both of you. Here are three simple ways to cradle baby.
- The Cradle Hold: Lay baby lengthwise across your abdomen, using one hand to support their head and the other their bottom.
- The Football Hold: Place baby beside you face up and lengthwise. Lay them along your arm and guide their head to your breast. If you’ve had a C-section, you may find this hold more comfortable.
- The Lying-Down: Lay down in bed with your little one, with you on your right side and baby on their left. With your free hand, move baby’s mouth toward the nipple closest to the bed and circle your other arm around him. Note: Your baby’s mouth should be at the same height or slightly lower than your nipples.
Breastfeeding pillows and carefully folded blankets and towels can also help you prop baby in a comfortable position.
Are There Any Foods Or Drinks That I Should Avoid While Breastfeeding
Similarly to when you were pregnant, you should pay attention to what you eat and drink when youre breastfeeding. There arent as many restrictions when youre breastfeeding as there are when you are pregnant, but a few things to keep in mind include:
- Cutting back on your caffeine. You can drink caffeine when youre breastfeeding, but try to limit it to about 200 milligrams each day. You might also want to time your cup of coffee so that youre not drinking caffeine before your childs nap or bedtime feeding. The caffeine could pass through your milk and to your baby.
- Limiting your alcohol intake. You can also drink a limited amount of alcohol when youre breastfeeding. However, you should wait a few hours after a drink before you feed your baby. Over time, the alcohol will leave your system. Its safest for your baby if you wait after drinking to breastfeed because it can pass through your milk and could possibly cause harm.
Its also good to quit smoking if you havent already. Secondhand smoke is dangerous to children. Smoking is not only harmful to your children and your own health, but it can also decrease your milk supply. You shouldnt smoke or use any other type of drug around your baby.
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How To Breastfeed A Baby
Breastfeeding, its one of the most natural things in the world. But how do you do it? Heres our step by step breastfeeding guide including information on breastfeeding latch, positions and burping.
Theres loads of local support available. Make the most of it, if you can
Try to get yourself comfortable and check if baby is latched correctly
How Often Should Baby Be Nursing
Frequent nursing encourages good milk supply and reduces engorgement. Aim for nursing at least 10 12 times per day . You CANT nurse too oftenyou CAN nurse too little.
Nurse at the first signs of hunger dont wait until baby is crying. Allow baby unlimited time at the breast when sucking actively, then offer the second breast. Some newborns are excessively sleepy at firstwake baby to nurse if 2 hours or 4 hours have passed without nursing.
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Consider Different Ways To Latch
To breastfeed, your baby needs to âlatch on.â This is when your baby is properly attached to your breast with his mouth wide open over your nipple, covering most of your areola, and his nose, lips, and chin close to your breast.
Here are two ways to get your baby to latch on when breastfeeding:
After getting into a comfortable breastfeeding position, cup your breast with your hand and guide the nipple to stroke your babyâs lip. This action stimulates your babyâs natural rooting reflex to open his mouth wide and suckle. Make sure to bring your baby close to your breast and aim your nipple toward the roof of his mouth.
âBaby-ledâ latching or âlaid-backâ breastfeeding involves you lying on your back and placing your baby on your chest with your babyâs cheek close to your breast. Your baby will naturally explore his surroundings, find your nipple, and latch on.