4)) When to breast feed??

Breastfeeding on demand is key to ensuring baby gets enough milk and the goodness that comes with it. Breast milk is also what baby needs to keep hydrated. Newborns should be woken up and fed every 3 to 4 hours for at least the first two weeks, or until their weight gain stabilises; and breastfeeding should continue even if baby is ill. Take note of what baby is depositing in his nappy, as well as his growth to determine if he’s getting the milk he needs.

As a start, feed newborn baby every 2 hours (8 to 12 times in 24 hours) during the first 3 months. Some babies may eat several times in a short period, especially during growth spurts. As baby gets older, the number of feeding times per day may decrease or increase.

Every baby is different. Breastfeed baby on demand and pay attention to baby’s hunger cues (eg. increased eye movement, opening his mouth and stretching out his tongue while turning his head around to look for breast, making soft whimpering sounds and sucking on hands, fingers or any nearby objects). Nurse him immediately whenever is needed. Don』t wait until baby cries to put him to the breast as crying is a late sign of hunger.

When baby is sick, continue breastfeeding baby. Breast milk contains antibodies specifically tailored to help baby to fight against illness and keeps baby hydrated.

Is night feeding important?

Night feeding is important because your hormones that stimulate milk production work better at night. In addition, newborn babies sleep for 16 or more hours a day and should be woken up every 3 to 4 hours to breastfeed until their weight gain is established – usually within the first couple of weeks. After that, it’s OK for baby to sleep for longer periods of time.

Most breastfed infants won』t snooze for extended periods. This is because breast milk is more easily digested than formula, and baby will feel hungry again soon after a feed.

A newborn baby’s longest sleep period is generally between 4 and 5 hours. If newborns do sleep for longer, they』ll probably be extra hungry during the day and may want to nurse more frequently.

After 3 months, a baby averages a total of 5 hours of daytime napping, and 10 hours sleep at night, usually with an interruption or two. Babies may sleep 「through the night」, meaning 6 to 8 hours in a row. However, bear in mind that this varies greatly among babies.

What are the signs that may baby is getting enough breast milk?

These are some signs that baby is getting enough breast milk:

Regular wet diapers

After baby’s first few days, he should have at least 6 wet nappies a day and the urine should be odourless and clear, or a very pale colour. Strong, dark urine suggests that baby needs more breast milk and you should seek medical advice.

Regular bowel movements

Baby’s poo should start turning green and then yellow. Your baby should have 3 or more bowel movements a day, although he may do this less frequently after he is a month or older. Normal poo should be yellowish and soft.

Healthy growth

During the first week, most infants lose several grams of weight but should be back up to their birth weight by the end of the second week. After this, your baby should be gaining weight regularly. Speak to the doctor at each visit about whether your baby is growing normally. Your baby should sleep well and have good muscle tone and healthy skin.

5)) BREAST FEEDING PROBLEMS AND SOLUTIONS

Mums who are new to breastfeeding might encounter some minor problems. However, with the right guidance, these problems can be easily resolved.

5a) Expect to be tired

Looking after a baby is exhausting work, especially in the early days when you』re recovering from the delivery. Don』t feel bad if you feel tired and even irritable. You』re only human, after all.

5b) Sleep

Sleep is more important than doing dishes, laundry, and other chores, so grab some shut-eye every chance you get. Nap when baby naps. Try to sleep at least 1 ½ to 2 hours during the day for the first 2 to 3 weeks. Trust your husband, parents, or baby sitter with your baby for short periods of time, so that you have some time-out.

5c) Night solution

You may find it less tiring to nurse baby in bed during night feeds.

5d) Help from husband

Delegate some tasks to your husband, for example lulling your baby to sleep after each night fee

5e) 「Me」 time

Even if it’s just for 10 minutes, make it a point to do something purely for yourself. This private time will make you feel good and keep you from getting burnt out or overwhelmed. Do not put your hobbies and interests completely on the back-burner. You really should not feel guilty for spending a time away from baby, as this 「me」 time helps recharge your batteries, and be a good parent.

5f) Inadequate milk supply

At least 95% of mothers can make plenty of milk for their babies, but many are concerned about not having enough. Checking your baby’s weight and growth is the best way to know if he’s getting enough milk.

Often, although mums think that their milk supply is low, it’s actually just fine.

What you can do:

Eat a well-balanced diet and drink enough fluids. Make sure your baby is latched on and positioned well Breastfeed often and let your baby decide when to end the feeding Offer both breasts at each feeding. Have your baby stay at the first breast as long as he is still sucking and swallowing. Offer the second breast when the baby slows down or stops Avoid giving your baby formula or cereal as it may lead to less interest in breast milk. Your baby doesn』t need solid foods until he has reached 6 months old. Limit or stop pacifier use as your baby may fall asleep while sucking on this even when he is hungry. Let your doctor know if you think your baby isn』t getting enough milk.

5g) Sore or cracked nipples

The main cause of sore and cracked nipples is poor attachment by baby when feeding. This may be due to baby pulling the nipple in and out as he suckles, and rubbing the skin against his mouth. It may also be due to the strong pressure on the nipple from incorrect suckling.

Improving breastfeeding positions and latch-on is usually all it takes to solve this problem. Often, as soon as the baby is well attached, the pain will lessen and the baby can continue breastfeeding normally.

There is no need to rest the breast as the nipple will heal quickly when it’s no longer being damaged.

5h) Inverted nipples

Symptoms

Inverted nipples do not protrude from the level of the areola but are retracted inwards instead. Sometimes, an inverted nipple is non-protractile and does not stretch out when pulled; instead the tip goes in. This makes it difficult for baby to latch on. Protractility often improves during pregnancy and in the first week or so after baby is born.

Causes

Different nipple shapes are a natural physical feature of the breast. An inverted nipple is held by tight connective tissue that may loosen after a baby suckles from it for a time.

Management

Talk to your doctor or lactation consultant if you are concerned about your nipples. Continue breastfeeding, remember that baby has to latch on to both nipple and breast, so even inverted nipples can work just fine. Baby is more likely to attach and feed well if he becomes used to breastfeeding very early on. It is best to avoid bottles and teats this time, as these are very different in shape compared to the inverted nipple. Often, inverted nipples will protrude over time, as the baby sucks more. Trying different breastfeeding positions may also help baby to attach. If baby cannot attach in the first week or two, mother can express her breast milk and feed it by cup. Mothers can gently stimulate her nipple using a breast pump or another mild suction device such as a syringe. There is also a special device designed to pull out inverted nipples. It is a non-surgical method for inverted nipples that uses suction to stretch the lactiferous ducts gently in a manner similar to tissue expansion.

5i) Breast engorgement

Cause

Failure to remove breast milk may cause congestion, especially in the first few days after delivery when milk comes in filling the breast and at the same time, blood flow to the breasts increases. The common reasons why milk is not removed adequately are delayed initiation of breastfeeding, infrequent feeds, poor attachment and ineffective suckling.

Management

You must remove the breast milk. If the baby can attach well and suckle, then you should breastfeed as frequently as the baby is willing. If the baby is not able to attach and suckle effectively, you should express milk by hand or with a pump until the breasts are softer, so that the baby can attach better. Once this is achieved, get baby to breastfeed frequently. You can apply warm compresses to the breast or take a warm shower before expressing. This will help the milk to flow. You can also use cold compresses after feeding or expressing, as this will help to reduce swelling or fluid retention

5j) Mastitis

Mastitis is an infection of the breast tissue.

Symptoms

There is a hard swelling in the breast, with redness of the overlying skin and severe pain. Usually only a part of one breast is affected, which is different from engorgement, when the whole of both breasts are affected. You may have fever and feel ill. Mastitis is most common in the first 2 to 3 weeks after delivery, but can occur at any time.

Causes

Usually due to long gaps between feeds. Other causes include poor attachment, with incomplete removal of milk. Unrelieved engorgement. Frequent pressure on one part of the breast from fingers or tight clothing, and trauma.

Management Improve the removal of milk and try to correct any specific cause that is identified. Rest and breastfeed the baby frequently and avoid leaving long gaps between feeds. If working, take sick leave to rest in bed and feed the baby. (Mums with mastitis should not stop breastfeeding) Apply warm compresses. Start breastfeeding the baby with the unaffected breast, to stimulate the oxytocin reflex and milk flow. Vary the position of the baby. If symptoms are severe, if there is an infected nipple crack, or if no improvement is seen after 24 hours of improved milk removal, the treatment should then include some antibiotics. However, antibiotics will not be effective without improved removal of milk. Always speak to your doctor if this happens.

For further information on infant and child nutrition, please refer to

MINISTRY OF HEALTH MALAYSIA (2013) Malaysian Dietary Guidelines for Children and Adolescents. Putrajaya: Technical Working Group on Nutritional Guidelines (for National Coordinating Committee on Food and Nutrition). NUTRITION SOCIETY OF MALAYSIA (2011) Breastfeed with Confidence. Petaling Jaya: Mother’s Smart Choice.

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