By Dr Ananya Mandal, MD
There are several common questions and worries related to breastfeeding that affect new and first time mothers. Some of these include:-
Is there a need for supplementation?
Breast milk, if given adequately and properly, is sufficient for the baby’s needs to the first six months of his or her life. It has been shown that more the baby takes off the mother’s breasts, more milk is produced by the mother in response.
Supplementing breast milk with artificial baby formula may reduce the baby’s need for the mother’s milk. A baby’s stomach is usually very small and needs are thus low. Most newborns can take in only an ounce or two of milk at first.
If the baby is given formula, he or she may skip one feed all together. This may mean a reduced milk supply of the mother. However, if the baby is not taking adequate breast milk, or if he or she is not gaining weight, supplementation with formula may be needed. In these cases the baby’s doctor may be consulted.
Is there a need to introduce cereals and water?
For the first six months of life, nothing other than breast milk is needed. Breast milk alone meets all the nutritional and fluid needs of the baby.
Early introduction of cereals may decrease the need for breast milk in the baby. This may decrease the milk supply in the mother. Even when very hot, there is no need for water for the baby. The initial part of each feed contains thinner milk called fore milk. This is designed to quench the baby’s thirst. Once the baby is ready for solids, they should be rich in iron.
Should a pacifier be given to calm the baby?
Pacifiers should be introduced after the baby has learnt to latch on well to the breast and has mastered breastfeeding. This prevents onset of nipple confusion that may hamper breastfeeding. This learning usually takes 4 to 6 weeks.
When to wean the baby?
According to the American Academy of Pediatrics (AAP) breastfeeding should be continued for at least 12 months. Thereafter it may be continued for as long as mother and baby desire. The World Health Organization recommends continued breastfeeding up to 2 years of age or beyond.
Up to six months of age the baby should be given only breast milk and nothing else. These babies do not require water, juice, and other foods.
Beyond this period solids may be slowly introduced. Up to one year of age these foods act as supplement to breast milk.
After one year completion there is a gradual increase in the volume of solid foods and breast milk becomes a useful addition to the child's diet. Weaning is a gentle process and not all babies are same in this respect.
Which birth control method to use while breastfeeding?
Breastfeeding protects from pregnancy to a certain extent by bringing periods a few of months later. However, this is not fool proof. Most mothers are advised to adopt a safe method of contraception while breastfeeding.
This includes barrier methods like condoms and diaphragms and Intrauterine devices (IUDs). Birth control pills are generally not recommended for breastfeeding mothers.
Does breast feeding hurt?
If the baby is latched on correctly, there should be no pain. Initially learning to feed and the baby to learn how to latch on may seem like a challenge but most mothers and babies eventually make it and develop their own preferred position and strategy.
It may hurt once the baby starts to grow teeth and bite. However, if the baby is actively feeding there is no biting. Once the baby begins to bite, the mother must know that he or she is full and is treating the mother’s nipple as a teether.
To prevent the baby biting, a gentle “no” helps. The mother should prise his or her mouth open and remove the nipple gently. She should not shout or yell as this may frighten the baby.
Stopping feeding, offering a teether or a snack (for a baby over 6 months) or a sipper helps. Putting down the baby for a while also helps to teach the baby that there would be a negative reaction to his or her biting.
Why is the baby crying?
There are several reasons for the baby to be crying. While some may be simple like colic, cold, hunger, bright lights or noise etc., some may be more difficult to diagnose.
If the baby is not comforted by breastfeeding or other soothing measures, his or her doctor needs to be consulted.
Will there be a problem breastfeeding in public?
While many mothers feel uncomfortable breastfeeding in public, with adequate community and family support this can be overcome. Young and new mothers often feel embarrassed to feed in public.
Many organizations support breastfeeding and have developed guidelines to foster breastfeeding even when in public.
The mother needs to remember that this is nothing inappropriate or embarrassing. Wearing appropriate clothes that reveal little while feeding, using a special breastfeeding blanket around the shoulders or a sling to breastfeed works for most mothers.
What can happen if someone else's breast milk is given to another child?
Some viral infections may be transmitted through breast milk. One of the most dreaded is HIV. The risk from a single feed of breast milk however is low. Breast milk from healthy mothers is not a risk.
Reviewed by April Cashin-Garbutt, BA Hons (Cantab)