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Woman And Infants
Woman And Infants

Breastfeeding Tips

NICU Breastfeeding Guide
- (downloadable pdf) / Spanish - (downloadable pdf)

Benefits of Breastfeeding How to Rouse a Sleepy Baby
Breastfeeding Support Services How to Wean Baby
Engorgement/Plugged Milk Duct Leaking Breasts
Father/Family Involvement Medications & Breastfeeding
Feeding Assessment Nutrition while Breastfeeding
How to Breastfeed Discreetly Pumping & Storage
How to Calm a Fussy Baby Sore Nipples
How to Increase/Decrease Milk Supply

Benefits of Breastfeeding

  • The nutrient balance in a mother's milk is just right for her infant as he/she grows.
  • There are at least 12 anti-inflammatory agents in breast milk which promote healthy immune system.
  • Immunoglobulin-A in breast milk protects the baby against Coxsakie B virus, Staph and E coli bacteria by painting the intestinal tract and blocking the pathogen's adherence to the mucous membrane.
  • Lactoferrin prevents the growth of pathogenic organisms such as E coli, Salmonella and Candida Albican by blocking iron utilization necessary for their survival.
  • Breastfeeding decreases the risk of childhood cancers, asthma, bacterial infections, diarrhea, allergies, diabetes and SIDS.
  • Breastfeeding keeps babies' teeth clean and helps develop better speech.
  • Breastfeeding reduces the risk of breast, ovarian and endometrial cancer in mothers.
  • Breastfeeding mothers return to their pre-pregnancy weight sooner than their bottlefeeding counterparts.

Nutrition While Breastfeeding:

  • Eat a well-balanced, varied diet
  • Breastfeeding mothers burn 500+ calories daily
  • Check with your doctor about taking a multivitamin with iron
  • Drink eight glasses of fluid (eight ounces each) daily
  • Avoid or limit caffeinated drinks to one to two cups daily
  • Avoid alcohol or limit to one serving (six ounces of wine or 12 ounces of beer) on a special occasion
  • Call the Women & Infants' Warm Line with questions at 1-800-711-7011, weekdays 9:00 am to 9:00 pm and weekends 9:00 am to 5:00 pm
  • Call the Rhode Island Department of Health at 1-800-624-2700, Monday, Wednesday and Friday from 9:00 am to 1:00 pm

Prenatal and Breastfeeding Nutrition Guide:

  • The minimum recommended servings are based on a 2,200 calorie meal plan:
  • Bread, cereal, rice, pasta - nine to 11 servings
  • Vegetables - four to five servings
  • Fruits - three to four servings
  • Milk, yogurt, cheese - three to four servings of calcium-rich foods or a calcium supplement
  • Meat, poultry, fish, eggs, dry beans, nuts - three servings
  • Saturated and trans fats, oils and sweets - use in small amounts
  • Pregnant teenagers need four to five servings of dairy products and four servings from the meat group to support their growth as well as their baby's growth

How to Increase Your Milk Supply:

  • Increase frequency and duration of feedings
  • Encourage baby to take several feedings early in the day when milk quantity is greater
  • Apply warm, wet cloths to breasts
  • Massage breasts before a feeding
  • Rest! - when you nap, prolactin levels increase

How to Decrease Milk Supply:

  • Suggest that mother continue to drink eight glasses of fluid (eight ounces each) daily
  • Limit intake of salt
  • Wear a supportive, non-binding bra
  • Pump to comfort
  • Drink plenty of fluids, but don't force fluids
  • Avoid nipple or breast stimulation
  • If you become engorged, use cold compresses or ice packs

Medications and Breastfeeding:

  • When medications are necessary, mother needs to inform her healthcare provider that she is breastfeeding
  • Always check with your physicians before taking over-the-counter medications
  • You can call the Women & Infants Hospital Pharmacy at 401-274-1122, extension 1265 , 24 hours a day, Monday through Friday, and from 7:00 am to 10:00 pm on weekends and holidays.
  • Always ask to speak with a pharmacist if you have questions, or call the Women & Infants' Warm Line at 1-800-711-7011

Feeding Assessment

  • Feed every 2-3 hours or more frequently if needed. Infants are the best judge of their hunger. Listen to their feeding cues. 8-12 times a day is average.
  • Feeding cues to remember:
    • Wiggling in their sleep
    • Fluttering eyelids
    • Making sucking noise or motion with the mouth and bringing hands to the mouth
  • Infants may eat 10-20 minutes per side or more. If need be, let the baby nurse as long as he or she wants on the first side then offer the second.
  • Massage your breast to help remove more milk.
  • Don't force a sleepy baby to the breast. Give the baby a chance to show his or her hunger cues.
  • Don't give artificial milk unless no breast milk is available, and infant has a medical reason to be supplemented.
  • All infants may lose up to 7-8% of their birth weight per the American Academy of Pediatrics. Remember that excessive IV fluid prior to birth may artificially boost the birth weight.

How to Breastfeed Discreetly:

  • Many mothers find that with practice and in time, it is easier for you to position the baby discreetly
  • Wear a loose, comfortable shirt, sweater or jacket
  • Unbutton blouses from the bottom
  • Drape a shawl/blanket over your shoulder
  • Practice techniques with the baby at home in front of a mirror
  • Breastfeeding becomes easier as baby grows and has more muscle control.

Common Causes of Sore Nipples:

  • Improper positioning of the baby at the breast
  • Improper latch-on technique
  • Breaking suction improperly
  • Improper use of a breast pump
  • Use of plastic-backed nursing pads
  • Thrush - mother and baby should be treated by a physician

Comfort Measures for Sore Nipples:

  • Rub breast milk onto nipple after feeding, let air dry
  • Use warm, wet cloths on nipple
  • Air dry nipple after feedings
  • Apply Lansinoh or Pure Lan to nipple four times in a 24-hour period
  • Use breast shells if clothing is irritating already sore nipples
  • Ask for help with positioning - call Women & Infants' Warm Line at 1-800-711-7011 for an outpatient lactation consultation

Avoiding Sore Nipples:

  • Use proper positioning and latch-on techniques
  • Massage baby's jaw - gentle circles in front of baby's ears to relax baby's lower jaw
  • Draw down on baby's chin during latch-on
  • Use C-hold on breast tissue throughout the feeding
  • Tuck folded washcloths under larger breasts for support
  • Use a pillow for support for mother and baby
  • Mother could use a foot stool to help support the weight of the baby
  • Properly remove baby from breast - break suction with finger, don't just pull off
  • Use breast pumps properly
  • Avoid pushing in breast tissue to create an air pocket near baby's nose - inside-lying or cradle positions, bring baby's bottom closer to mother's body; in football hold, bring baby up slightly higher
  • Avoid plastic-backed nursing pads
  • If nursing pad sticks to sore nipples, pour warm water over pad for easy removal

What to do About Engorgement:

  • Breast fullness normally occurs around two to six days postpartum
  • When the breast is compressible, baby can latch on
  • If engorgement occurs, the breast may become hard, lumpy, painful, and difficult to compress, interfering with latch-on
  • Frequent breastfeeding can prevent engorgement
  • To treat engorgement, apply warm, wet cloths to breasts, shower, or immerse the breasts in a bowl of warm water
  • Very gently massage the breast tissue
  • Frequently remove milk from breast by feeding or pumping
  • Father or helper can massage mother's upper back and neck muscles during feeding or pumping sessions
  • Once breast tissue has softened, apply ice packs to breasts (plastic bags of frozen vegetables conform to the shape of the breast), place a layer of cloth between the ice pack and breast tissue
  • Wear a supportive, non-binding bra
  • Use a bra extender if your bra feels uncomfortably tight
  • Many times when breasts fill during engorgement, babies will have difficulty latching on - pump to soften the nipple and areola and then attempt to have the baby latch on.

What to do About a Plugged Milk Duct:
  • A tender spot, reddened area, or lump in the breast with no fever may be a plugged milk duct
  • Apply wet or dry heat to the affected area
  • Gently massage the area, beginning behind the plugged duct (near the chest)
    and work downward toward the nipple
  • Breastfeed baby on the affected side first
  • Increase frequency and duration of feedings
  • If possible, position the baby so the lower jaw is near the plugged duct
  • Use a pump or manually express to remove milk
  • Drink plenty of fluids - eight ounces, eight times in 24 hours!
  • Get lots of rest
  • Clogged milk ducts are often associated with fatigue - the body is telling mom to take it easy
  • Breast infection is signified by redness or extreme tenderness in one or both breasts, with fever, chills and fatigue; mother needs to contact her physician!
  • Infections often occur during the second or third week postpartum, but may occur at any time
  • It is important to take antibiotics according to your doctor's instructions
  • Breastfeeding can continue, milk needs to be removed from the breast frequently by feeding or pumping
  • Apply moist heat to the breast
  • Drink plenty of fluids
  • Rest! - Act as if you are sick with the flu - get help and go to bed
  • Wear a supportive, non-binding bra
  • Use a bra extender
  • Avoid constrictive clothing and heavy backpacks

What to do About Leaking Breasts:

  • It is normal for milk to leak in the early weeks, but soon mother's body will adjust to baby's needs.
  • Breastfeed frequently
  • Use nursing pads and cotton cloths
  • To temporarily stop the flow of milk, place palm of hand over nipple and press into chest wall or cross arms over chest at nipple level and press into chest
  • Wear loose-fitting clothing with a print design, wear blazers, sweaters, bring an extra shirt

How to Rouse a Sleepy Baby:

  • Dim the room
  • Speak softly
  • Unwrap the baby and change his/her diaper, leave baby in just diaper to feed
  • Massage gently
  • Support baby's head and neck, sit baby upright, rub baby's back, gently walking fingertips up the sides of baby's spine
  • Let baby fuss a little to become more awake

How to Calm a Fussy Baby:

  • Dim the room
  • Skin-to-skin contact
  • Talk in a soft, soothing voice
  • Gentle massage
  • Change baby's clothing/diaper
  • White noise (vacuum cleaner, shower, clothes dryer, etc.)
  • Soft music
  • Warm bath

Involvement of Father/Family Members:

  • Give baby a bath
  • Change the baby's diaper
  • Massage the baby
  • Jaw massage - gentle circles in front of baby's ears before feedings to relax the lower jaw
  • Gentle circles around the crown of baby's head to stimulate suckling at the breast
  • Gentle, pulsating touch to palm of baby's hand or sole of baby's foot to stimulate suckling
  • Massage mother's upper back and neck muscles during a feeding or pumping session
  • Get or prepare healthy snacks for mom to eat or drink
  • Offer to run errands, hold baby while mom showers or takes care of other self care needs
  • Do laundry, housekeeping and take care of meals - mom needs to rest and recover and concentrate on feeding the baby
  • Offer to take the baby for a walk in the yard in the evening - this gives mom a little break
  • Keep visitors and phone calls to a minimum so mom and baby have plenty of free, unpressured time to practice
  • Dads can practice soothing techniques to use when baby is unable to breastfeed
  • Dads should try to have some time every day to be alone with the baby

How to Pump:

  • If baby is unable to go to the breast, mother may begin pumping any time after delivery
  • Usually it is best to pump every two to three hours during the day and once or twice at night
  • For extra stimulation to milk supply or to obtain milk for a later feeding, pump an hour after a feeding
  • Before pumping, apply warm, wet cloths over breasts (warm water in a disposable diaper works well instead of a cloth)
  • Massage breasts using the same circular motion used for breast self examinations
  • Moisten flange on breast pump for a tight seal with breast tissue
  • Apply warm, wet cloths over breasts and pump flange while pumping
  • Sit in a comfortable position with good back support and a footstool
  • When using a manual pump, keep elbows close to your body
  • Start on the lowest setting and increase according to comfort level
  • Place a pillow on your lap to support bottles
  • When separated from baby, a picture of the baby or article of clothing with baby's scent can help milk to flow
  • Practice deep breathing exercises, close your eyes and relax while pumping

Single Pumping Schedule:

Pump one breast, then the other, three times each, following this schedule:

First breast
5 to 7 minutes

Second breast
5 to 7 minutes

First breast
3 to 5 minutes

Second breast
3 to 5 minutes

First breast
2 to 3 minutes

Second breast
2 to 3 minutes

Double pumping schedule:
Pump both breasts at the same time

  • Double pumping increases the hormone prolactin to help increase milk supply
  • Double pumping cuts pumping time in half, 10 to 15 minutes is usually sufficient

Breast Milk Storage/Thawing:

  • Unless being used immediately, refrigerate it within 1 hour.
  • Thaw/warm the milk in container of lukewarm water or running water.
  • Once milk is thawed, it should be used within 24 hours.
  • Once milk is warmed and not used for the feeding, it should be discarded.

Fresh Refrigerated Frozen
CCN refrigerate within 1 hour use within 48 hrs then freeze up to 3 months
TERM/NNN same as above use within 72 hrs then freeze up to 6 months

How to Wean Baby:

  • Gradually eliminate feeding sessions (one per week)
  • Offer baby other feeding devices (cup, straw, spoon, bottle)
  • Engage in enjoyable activities and focus attention on baby/child - reading, bathing, walking, car rides, playing
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