Click Here to Download this Document as a Printer Friendly PDF Document (832KB).

Breast is Best!

Contents:

• Three Different Stages of Breastmilk/ What's in the Breastmilk/Where Does the Milk Come From/What Happens When Your Baby Nurses
• Health Benefits of Breastfeeding
• It's All About the Latch – Hunger Cues/Positioning the Baby/ Signs of a Good Latch
• Is Your Baby Getting Enough Milk?/ Easy Steps to Increase Your Milk Supply
• Breastfeeding and Dads/ Returning to Work and Breastfeeding – Maintaining Your Milk Supply
• Breastfeeding Issues – Sore Nipples/ Engorgement/ Trouble Latching On/ Flat or Inverted Nipples
• Breastfeeding Issues Continue: Nipple Confusion/ Plugged Ducts/ Mastitis/ Nursing Strike
• Breastfeeding Issues Continue: Thrush/ Interruption of Breastfeeding

Three Different Stages of Breastmilk

Colostrum - is the first stage of breastmilk that occurs during pregnancy and lasts for several days after the birth of the baby. It is either yellowish or creamy in color. It is also much thicker than the milk that is produced later in breastfeeding. Colostrum is high in protein, fat-soluble vitamins, minerals, and immunoglobulins. Immunoglobulins are antibodies that pass from the mother to the baby and provide passive immunity for the baby. Passive immunity protects the baby from a wide variety of bacterial and viral illnesses. Two to four days after birth, colostrum will be replaced by transitional milk.

Transitional milk - occurs after colostrum and lasts for approximately two weeks. The content of transitional milk includes high levels of fat, lactose, water-soluble vitamins, and contains more calories than colostrum.

Mature milk - is the final milk that is produced. 90% is water, which is necessary to maintain hydration of the infant. The other 10% is comprised of carbohydrates, proteins, and fats, which are necessary for both growth and energy.

There are two types of mature milk: foremilk and hindmilk.

• Foremilk: This type of milk is found during the beginning of the feeding and contains water, vitamins, and protein.
• Hindmilk: This type of milk occurs after the initial release of milk and contains higher levels of fat, and it is necessary for weight gain.

Both foremilk and hindmilk is necessary when breastfeeding to ensure the baby is receiving adequate nutrition and will grow and develop properly.

What's in Breastmilk?

Proteins - Human milk contains two types of proteins: whey and casein. Approximately 60% is whey, while 40% is casein. This balance of the proteins allows for quick and easy digestion. If artificial milk, also called formula, has a greater percentage of casein, it will be more difficult for the baby to digest. Approximately 60-80% of all protein in human milk is whey protein. These proteins have great infection-protection properties.

Fats - Human milk also contains fats that are essential for the health of your baby. It is necessary for brain development, absorption of fat-soluble vitamins, and is a primary calorie source. Long chain fatty acids are needed for brain, retina, and nervous system development. They are deposited in the brain during the last trimester of pregnancy and are also found in breastmilk.

Vitamins - The amount and types of vitamins in breastmilk is directly related to the mother's vitamin intake. This is why it is essential that she gets adequate nutrition, including vitamins. Fat-soluble vitamins, including vitamins A, D, E, and K, are all vital to the infant's health. Water-soluble vitamins such as vitamin C, riboflavin, niacin, and panthothenic acid are also essential. Because of the need for these vitamins, many healthcare providers and lactation consultants will have nursing mothers continue on prenatal vitamins.

Carbohydrates - Lactose is the primary carbohydrate found in human milk. It accounts for approximately 40% of the total calories provided by breastmilk. Lactose helps to decrease the amount of unhealthy bacteria in the stomach, which improves the absorption of calcium, phosphorus, and magnesium. It helps to fight disease and promotes the growth of healthy bacteria in the stomach.

Where Does The Milk Come From?

Within your breasts, thousands of sacs lined with specialized cells absorb water, salts, sugar, and fat from your blood. From these constituents, you manufacture milk. Droplets of milk flow through ducts to reservoirs located behind your nipples. Milk collects in these reservoirs continuously between feedings. Milk reaches your baby's mouth through many tiny openings in your nipples.

The structure of a nursing mother's breast is like a collection of streams that flow into a reservoir. The reservoir has a limited amount of space to store milk. Your body compensates for the limited storage by replenishing its supply of milk when the milk is needed. In other words, lactating breasts are a manufacturing site: They are never empty, and they are always capable of producing more milk.

What Happens When Your Baby Nurses?

Foremilk collects in your breasts between feedings. It is the first milk to enter your baby's mouth at each breastfeeding session. Foremilk accounts for about one third of your baby's intake at a feeding. Once you baby has drunk your foremilk, the hindmilk, higher up in the duct system, flows to the nipple.

• Quick feedings and scheduled feedings transfer mostly foremilk and little hindmilk to your baby, leaving her hungry and dissatisfied when she is removed from the breast. If you ensure that your baby drinks both foremilk and hindmilk, she is more apt to be full and sated by both fat and total liquid content.
• You can help her get both kinds of milk by breastfeeding her at her request, nursing her until she decides she is finished, and allowing frequent feedings. Let your baby drink from one breast until she is satisfied; do not switch her to the second breast until she has drawn hindmilk from the first.

Your baby controls the amount of milk your body makes. His strong sucking action stimulates nerves in your nipple. Impulses from these nerves travel to your brain, causing several hormones, including prolactin and oxytocin, to enter your bloodstream. Prolactin speeds to your breasts, directing them to make milk. The more frequently and effectively your baby sucks, the more prolactin your brain releases and the more milk your breasts produce.

• If your baby sucks less often and for shorter episodes, your prolactin level falls and milk production decreases.
• A drop in milk production can also occur if your baby is incorrectly positioned at the breast, resulting in poor "latch-on," which fails to stimulate the flow of milk.

Your baby takes milk from your breast by sucking, but you also give milk by letting it down. Letdown of your milk is important to your baby's nutrition.

Team players: hormones

• With birth — and the delivery of the placenta milk-making gets under way. The hormone prolactin swings into action, your milk supply increases rapidly ("comes in"), and your breasts feel full.
• Oxytocin, the milk-ejection hormone, squeezes the sacs where milk is made and sends milk through ducts to the tip of your nipple. This squeeze and sudden release of milk is your letdown reflex. Some mothers experience it as a tingling sensation in their breasts. Let-down might feel peculiar at first, but after a few weeks the sensation will lessen and you'll equate it with a feeling of relaxation and the sight of contented baby.

The Letdown Reflex

Seeing a baby's open mouth, hearing his cry, or simply thinking about breastfeeding can begin the process that ends in the release of your milk.

Conversely, your scare of mind can also hamper letdown by inhibiting the release of oxytocin. For example, anxiety or stress can impair your letdown reflex.

To encourage letdown, include plenty of water in your diet, get adequate rest, and relax into nursing sessions with your baby, enjoying his smell and feel.

Back to Top

Health Benefits of Breastfeeding

Calming effect - Breastfeeding has a soothing effect on nursing mothers. The breastfeeding hormones are involved in the production of endorphins, chemicals that bring about a sense of peace and increase affectionate, maternal behavior while suppressing hostility, anxiety, and irritability. In addition, breastfeeding requires you to sit or lie down with your infant eight or more times a day, a practice that is in itself quieting.

Shaping up - The hormone oxytocin stimulates your uterus to contract, helping to control blood loss and return your uterus to its pre-pregnancy size.

Aid in child spacing - Prolactin, secreted when your nipples are adequately stimulated, suppresses ovulation. If you don't ovulate, you cannot become pregnant.

• Lactational amenorrhea is very sensitive to your breastfeeding style. The key to a contraceptive effect is consistent, relatively continuous breastfeeding that occurs at night as well as during the day.
• Ovulation — and fertility — is likely to resume if you do any of the following:
  • Breastfeed intermittently
  • Give your baby a pacifier
  • Encourage long intervals between feedings
  • Breastfeed only during the daytime
  • Put your baby on a feeding schedule
  • Supplement with any amount of formula or solid food

Decreased risk of iron deficiency - Your body uses some of its iron in the manufacture of breastmilk. But that loss is offset by the delayed resumption of you menstrual periods. When the effect of delayed menses is combined with improved iron absorption by your digestive tract, the net result is decreased risk for iron deficiency (anemia).

Lower incidence of certain cancers - Mothers who breastfeed for at least six months in their lifetime show a decrease risk of contracting breast cancer. Similar reduced rates have been shown for ovarian and uterine cancers.

Protection against fragile bones - Women who breastfeed are 75% less likely to develop osteoporosis than women who feed their babies formula. Most mothers lose a small amount of their bone mass during the time they breastfeed. But within months of weaning, their bodies have replaced it with new, denser, and stronger bone.

Nature's easiest diet - A well-documented benefit of breastfeeding is relatively rapid and sustained weight loss. Nursing an infant burns 200 to 500 calories a day. A formula-feeding mother would need to swim 30 laps or ride a bicycle for more than an hour to burn an equivalent number of calories.

Back to Top

It's All About The Latch

The most important part of successful breastfeeding is the latch. If your baby is not properly latched on to your breast, feedings could be painful. There are specific techniques that can be used when latching the baby to the breast.

The position in which you hold your baby is also crucial. When a good position and latch is obtained, breastfeeding can be a wonderful experience between mother and baby.

Hunger cues

Your baby may first display some hunger cues, signaling that he/she is ready to feed. He might suck on his lip, tongue, finger, or fist. Fidgeting and fussing at this time are also indicators that your baby is hungry. Crying is a late hunger cue and may make it more difficult to begin breastfeeding. Try to pay attention and learn those earlier hunger cues. Keep in mind that swaddling, pacifiers, and mittens can inhibit the hunger cues, as the baby's mouth and hands are restricted.

Positioning your baby to feed

The following technique will help ensure a proper latch:

• The baby's nose should be opposite the nipple
• You might need to hold your breast to help guide the nipple to your baby's mouth. Grasp the breast on the sides, not the top and bottom. If your hand is under your nipple, it will be in the way of the baby's mouth.
• Aim the nipple toward the baby's upper lip, not the middle of the mouth. You might need to rub the nipple across the top lip to get your baby to open his mouth.
• The baby's head should be tilted slightly back. You do not want his chin to his chest.
• When he opens his mouth wide with the chin dropped and tongue down, he should latch on to the nipple.
• Try to get as much of the lower portion of the areola (the area around the nipple) in the baby's mouth.
• The baby's chin should indent the lower portion of your breast.

Signs that confirm a good latch:

• Tongue is seen when the bottom lip is pulled down
• Ears wiggle
• There is circular movement of the jaw rather than rapid chin movement
• Cheeks are rounded
• You do not hear clicking or smacking noises
• You can hear swallowing
• Chin is touching your breast
• Your baby ends the feeding with signs of satiety/satisfaction. These signs include: the baby looks relaxed, "falls" off the breast, has open hands, and/or falls asleep.

Back to Top

Is Your Baby Getting Enough Milk?

Breastfeeding works by the concept of supply and demand. In general, if your baby is nursing frequently, has six to eight wet diapers a day, is gaining weight, appears healthy, and receives no supplementation, she is probably getting plenty of milk. If you suspect that your milk production is tapering off, simply increase the number of times you put your baby to the breast each day and night. The more your baby stimulates and empties your breasts by nursing (or the more you express or pump your milk), the more milk you will produce. Remember, even if your breast feels empty, it will produce milk as your child nurses.

Easy Steps to Increase Your Milk Supply

• Feed your baby nothing but your own milk. If you have been supplementing with formula, cut back gradually
• Encourage your baby to nurse as often and as long as she wants. Don't give her a pacifier, which would replace sucking at the breast.
• Check positioning to be sure your baby is nursing efficiently
• Encourage your baby to drain both breasts at each feeding. - It's fine to switch back and forth a few times during feedings to keep him interested.
• Drink plenty of fluids, especially water, and eat a nutritious diet. You may want to eat smaller, more frequent meals.
• Rest, relax, and enjoy the closeness of your nursing time.

If you are still concerned about your milk supply, contact a La Leche League leader or a lactation consultant for advice. In most cases, a few simple steps will remedy the problem. It your baby is not gaining weight by the time he is two weeks old, keep his doctor informed.

Decreased Milk Supply? - consider these questions:

• Are you supplementing with juice, formula, milk, or water? If your baby skips a nursing, your breasts produce less milk.
• Is your baby nursing efficiently? Perhaps he is not draining your breast, which causes your milk supply to decrease.
• Are you feeding on a schedule? The best schedule is determined by your baby. Let her choose when and how long to nurse. This will ensure that you meet her nutritional needs.
• Do you smoke: eat chocolate: or drink coffee, tea, or cola? Caffeine can slow weight gain, and nicotine can reduce your milk supply. Both can make babies fussy.
• Do your breasts no longer seem full? This is normal once your production has adjusted to your baby's needs.
• Do your breasts no longer leak? Leakage has nothing to do with milk supply. Many women experience leaking only during the first few months.
• Do you no longer feel the let-down reflex, or has its intensity subsided? This is normal. Some mothers never feel let-down, and for most, it becomes less noticeable over time.
• Does your baby want to nurse frequently? Babies need comfort as well as food. Frequent nursing assures your baby of plenty of milk and cuddles.
• Has your baby suddenly changed the duration or frequency of nursing. She may have become a more efficient nurser or be more interested in exploring, A growth spurt can make her nurse more, or she may need more time with you,
• Is your baby fussy? There are innumerable reasons for a baby to fuss. If nursing doesn't help, try a walk, a massage, a bath, wrapping him, or rocking him. If fussiness is almost constant, your baby may have an allergy thrush, or an ear infection. Check with your baby's healthcare provider.
• Are your baby's weight gain and routines different from those of your friends' babies? There is a wide variation within the norms. Every baby grows at a different rate, and healthy babies come in a variety of shapes, sizes, and behaviors.

Back to Top

Breastfeeding and Dads

As a father, you have and important role in the life of a breastfeeding mother. Becoming involved in your partner's breastfeeding education can help to alleviate her fears and reservations, as well as your own.

How Can I be More Supportive of my Breastfeeding Partner or Family Member?

The most important thing that you con do to help your partner is to support her in to breastfeed and help her avoid outside negative influences from extended family or when nursing in public.

• Offer your partner comfort measures such as a drink, a footstool or a pillow nursing
• Burp baby after a feeding
• Change baby's diaper or bathe baby
• Care for baby while your partner naps or showers
• Help your partner feel positive by affirming her mothering, her beauty and her; offer a massage and show plenty of affection
• Be realistic in your expectations, acknowledging that adjusting to parenthood overwhelming
• Assist with or take over household responsibilities such as cooking, cleaning grocery shopping, or washing dishes.
• Sterilize breast pumps and bottles
• When baby awakens for middle of the night feedings, bring baby to your partner

Performing daily activities with your baby that are reserved for you alone will produce a special bond between you and your child. Take a walk or spend some time alone with your baby. Try making it a habit to be the one to burp your baby after your partner nurses. Your baby will become accustomed to being comforted by your body. Showering or bathing with baby (after the umbilical cord has fallen off) is also a great way to form a closeness between the two of you. Should your baby need to learn to take breastmilk from a bottle, you are the best person to offer the first bottle.

How will breastfeeding affect our sex life?

Parenthood affects your sex life-regardless of whether your partner breastfeeds. Exhaustion and lack of free time may have a dampening affect on your intimacy. Planned get-togethers are helpful; romantic words and gestures go a long way to create an amorous mood.

There is no harm in handling your partner's breasts during sex. As they are functioning to produce milk, they may occasionally be somewhat tender and can leak or spray milk when stimulated. Realize, however, that some women seem to get their "daily touching quota through nursing and may wish to avoid excessive touching of the breasts during sex. Some fathers feel uncomfortable, too, because they perceive that the role of the breasts has changed. Talk about your feelings with your partner, and avoid activity that makes either of you uncomfortable. The shape of a woman's breasts may change, but this is due to pregnancy, not breastfeeding.

Returning to Work And Breastfeeding - Maintaining Your Milk Supply

Frequency is the key. Nurse unrestrictedly throughout your evenings, nights, weekends, and days off. As long as you continue breastfeeding, even part time, you will produce milk, although your supply might diminish if you do not express for missed feedings. Remember that milk production is based on supply and demand. If you and your baby spend time apart during the day, it is common for your baby to want to breastfeed more when you are together, to compensate. Expect an upswing in the frequency of nursings.

Returning to work

Choose the expression method that best meets your needs. If you purchase a pump, practice assembling and cleaning it. In time, you will become accustomed to the sensation of holding a plastic flange against your breast. If you opt for hand-expression of your milk, learn the technique well in advance of your return to work. Begin expressing and freezing milk about two weeks prior to resuming your work routine. The assurance you gain will make it easier for you to continue after you return to work. Try breastfeeding and expressing milk in various locations.

Delay introducing a bottle until your baby has become expert at nursing and your milk supply is well established — at least four, preferably six weeks. About two weeks before you return to work, have your baby's caregiver offer your baby a bottle. Many babies will refuse a bottle if their mother is nearby. Infants older than three months who resist the notion of drinking from a bottle might accept milk from a cup or a spoon.

Expressing milk at home

To build up an initial milk supply, try expressing in the morning (before your baby breastfeeds), between feedings, or immediately after feedings. Many mothers get good results by expressing milk from one breast while their baby sucks on the other. Allow your baby to nurse from the side first offered until he unlatches of his own accord. If he is still interested in nursing, you can switch sides, allowing him to breastfeed on the pumped breast. You need not worry that he will be nursing on an empty breast. You produce milk as your baby nurses.

Storing your milk

Store your milk in clean glass or plastic bottles or specially designed, disposable plastic bags. Save it in quantities of 2, 3, and 4 ounces so the caregiver can choose the amount appropriate to your baby's hunger or feeding pattern. Leave fresh rather than frozen, milk for your baby whenever possible.

• You can safely keep your milk for up to 10 hours at room temperature (66°F - 72°F)
• For eight days in the back of your refrigerator
• Up to two weeks in the freezer compartment of your refrigerator
• Three to four months in a separate door freezer that is opened often
• Six months or longer in a separate freezer that stays a constant 0°F.

Label each container of frozen milk with the date and the quantity. Use the oldest milk first. To thaw breastmilk, place the container under cool running water, gradually increasing the water temperature until the milk is warm. Never refreeze thawed breastmilk. The antibodies in breastmilk can survive freezing if the milk is properly stored, but they cannot survive intense heating, such as that from a microwave oven.

Use a separate container to store the milk each time you pump. You can later combine cooled batches for a feeding or for frozen storage. You can add refrigerated milk to frozen milk provided the amount you add is less than the amount already frozen.

Back to Top

Breastfeeding Issues

Sore Nipples

There may be times during breastfeeding when your nipples hurt as your baby latches on, especially in the first few weeks. This is normal and does not mean that breastfeeding won't work for you.

After the initial weeks of nursing, nipple soreness is often caused by improper positioning. Your nipple should be positioned far enough in your baby's mouth that there is no friction as she sucks. A position that is too high, too low, or pulling to one side, perhaps caused by insufficient support of the baby's weight, can cause your nipples to chap, crack, or bleed.

Remove your baby from the breast by inserting your finger between your baby's mouth and your nipple to gently break the suction. Change nursing positions throughout the day to prevent continual friction on any one part of the nipple. Don't cease nursing while your nipples heal. If you do, your breasts may become engorged, which will make it more difficult for your baby to latch on. You can try putting a little of your milk on your nipples; breastmilk fights infection and is high in soothing fats.

If nipples are exposed to air and sunlight, they heal quickly. Change nursing pads often, if you wear them, and keep your nipples well ventilated with natural-fiber bras and clothing. Very tender nipples can be protected with plastic breast shells (not to be confused with nipple shields).

Engorgement

Your breasts are full, swollen, sore, and perhaps a little shiny. You can't figure out why your baby has such a hard time latching on. She opens her mouth wide (crying, usually), but when she tries to suck, her mouth slides off your breast and onto your nipple. Engorgement is caused by a large supply of milk in combination with extra blood and fluids supplied to your breasts in preparation for feeding. Consider full breasts your body's way of telling you it is time to nurse. Engorgement can return any time there is an unusually long interval between feedings or when your baby is not draining accumulated milk sufficiently. This can occur if nursing sessions are cut short or if your baby is not positioned properly. Engorgement is easy to treat. To ease discomfort of engorgement, try pumping, hand-expressing, a hot shower, or a warm washcloth applied to the breast. Be sure to express only enough milk to relieve your discomfort and soften the areola enough to nurse. Too much pumping or expressing can increase milk production, aggravating the problem. Cabbage leaves: place several fresh in your bra (replacing every three hours)

• Green cabbage is preferred
• Wash thoroughly & crush
• Use a rolling pin to flatten
• Place in bra or directly to breast

Trouble Latching On

There are several reasons for latching-on difficulties, especially in the early days of breastfeeding. Each time you bring your baby to your breast, give her about 10 minutes to latch on. If she's unsuccessful, take a break and try again later. Don't get discouraged. Contact someone in your support network for encouragement and ideas. Practice and patience will pay off.

Flat or Inverted Nipples

It is not uncommon for a woman to have one or two flat or inverted nipples. This can make breastfeeding a little more difficult at the start, but patience and guidance can quickly alleviate the problem. Encourage your baby to take adequate amounts of your nipple and breast into his mouth. As he feeds, he may draw out the nipple. You can also try pulling on and rolling the nipple with your fingers or using a breast pump very briefly before feeding. Many women find that wearing breast shells helps to draw nipples outward. If you can't get your baby to latch on, your lactation consultant might advise you to express milk and feed it to your child with a spoon or a cup in the early weeks; in time, breastfeeding will become easier.

Nipple Confusion

If your baby receives a bottle or a pacifier at the hospital or at home during the early weeks, you might experience difficulty getting him back on the breast. Remember all the advantages of breastfeeding, and avoid the bottle and pacifier whenever possible, especially during the early weeks.

Plugged Duct

A sore or tender spot on your breast is usually a plugged milk duct. If you have a plugged duct, a part of the breast may still feel firm and full after nursing. If left untreated, a plugged duct can lead to mastitis, a painful inflammation of the breast. A plugged duct is usually the result of milk improperly or incompletely drained from your breast during a feeding. The best solution is prevention. Proper positioning of your nursing baby is important in the prevention of plugged ducts.

Watch your baby nurse. He should take long, deep swallows. Quick, shallow swallowing is an indication that he doesn't have enough breast tissue in his mouth or that his position is inhibiting the strong sucking that drains the breast. The breast should be emptied fully and evenly of accumulated milk at each nursing.

Vary your nursing position throughout the day so you expose different parts of the breast to your baby's most vigorous sucking. Try the football hold or lying down with your baby to feed him. Be sure your bra and clothing do not constrict your breasts. Wear a proper nursing bra rather than sliding up a regular bra to nurse. Rest, eat well, and drink ample fluids. Try to get plenty of sleep so you aren't run down. When you are breastfeeding, you need extra rest and nutrition. Structure your life in a way that makes you feel good and keeps you healthy. A plugged duct is often the first signal that you are doing too much. Get more help, or let some housework and activities slide. Relax and enjoy your baby!

To Release a Plugged Duct

• Nurse on the affected breast first and more frequently.
• Position yourself so you can nurse with your baby's chin pointing toward the plugged duct. Her tongue action will stimulate the milk to flow.
• While you are nursing on the affected breast, apply massage and heat, such as a warm, wet washcloth, to encourage proper drainage.
• Between nursings, use moist heat and massage to encourage the duct to clear.
• Gently rub the plug toward the nipple while you are showering.
• Use plain warm water to cleanse any dried secretions that may be blocking your nipple's pores.

Mastitis

Prompt treatment of plugged ducts will usually prevent mastitis and its symptoms: fever, fatigue, and nausea. If you begin to feel flu like symptoms, or if your breast becomes hot and tender, you might have a breast infection. Breast infections are particularly common in the first weeks after birth and during times when a mother doesn't get the rest and nutrition she needs.

Most often, mastitis is preceded by a plugged duct. It can also result from an infection entering the breast through a cracked nipple.

• It's more important than ever to continue nursing frequently. Your baby won't get an infection from your breast.
• Apply warm, moist compresses to the sore part of your breast before and during nursing.
• Rest. Go to bed and stay there for two or three days. Get help with all tasks.
• Contact your healthcare provider, who might prescribe an antibiotic. Request a type that allows you to continue breastfeeding.
• Be sure to complete the entire course of treatment, even if the infection seems to clear quickly.
• Consider going without a bra while you recover.
• Drink plenty of liquids.
• Enjoy a little extra time with your baby.

Nursing Strike

Your baby suddenly refuses to nurse, or she stops nursing after a few swallows and begins to cry. She abruptly seems to have lost interest in breastfeeding. A typical strike lasts a few days, but it can continue for as long as two weeks. There are many possible reasons for a nursing strike. Among the most common are teething, a cold or ear infection, an unpleasant taste, a sore mouth, and discomfort from an injury or immunization. Emotional causes are also common: separation from you, a change in your baby's routine, a change in your behavior, too many distractions during nursing, and insufficient attention to your baby's needs. An emotional reason for a strike is just as important to consider as a physical one. Returning to nursing may take some gentle coaxing and extra attention, especially if the strike was set off in part by something you did, such as yelling when you were bitten. Almost all children will resume nursing, given the chance. In the meantime, you can try feeding your child your milk by cup or spoon or increasing the solid food available to a toddler. Pump or express your milk to keep up your supply.

• Make offers to nurse as relaxed and pleasant as you can.
• Devote yourself to your child as much as possible. Try cuddling, stroking, or singing at nursing time. Keep in mind that a sleepy baby may be more willing to nurse.
• Many mothers are upset to think that nursing is over. True weaning occurs gradually over weeks or months as a toddler loses interest. Some parents interpret a nursing strike as the ideal time for early weaning, but this is usually not the best choice for either of you. The nursing relationship is a bond of love and understanding as well as a food source. It usually works best to end nursing gradually, by mutual agreement.

Thrush

Thrush is a yeast infection that thrives on milk. In an infant, it appears as white spots inside the mouth and as a diaper rash resembling a mild burn or a patch of red does. The rash may be accompanied by peeling skin, and it doesn't respond to air exposure or other ordinary treatments.

A baby with thrush may also show signs of tiredness: inefficient nursing with eyes closed, often followed by long bouts of sleep. When the yeast moves to the intestinal tract, the baby may experience gas and discomfort.

Thrush is passed to a nursing mother from her baby's mouth.

• Mother's symptoms include red, swollen, or cracked nipples accompanied be itching, flaking, or burning.
• White spots are occasionally apparent.

Thrush is caused by Candida, a yeast always present in the body. Prolonged sucking (sometimes caused by sleeping with a bottle or a pacifier) can injure the lining of the mouth and allow the yeast to grow out of control, causing an infection. Babies sometimes acquire the infection as they pass through the birth canal. This is particularly true when maternal diabetes is involved. A thrush infection may follow a cesarean birth because the antibiotics given to the mother kill the natural yeast stabilizers in her system. Antibiotics administered to an infant can also cause the infection.

Both mother and baby need treatment, but there is no need to stop nursing, even temporarily.

• Expose your nipples to air and sun, and exercise careful hygiene with everything that touches your breasts and your baby's mouth, such as nursing shells and baby's toys.
• Keep your bras clean, and change your nursing pads, if you use them, after each feeding.
• Your healthcare provider can prescribe a safe medication to treat thrush, such as nystatin. Because it is swallowed, nystatin eliminates the intestinal yeast.
• It is also recommended that mothers supplement their diet with Lactobacillus acidophilus (found in yogurt that contains live cultures), especially after taking antibiotics." This beneficial bacterium is present in normal human digestive tracts, where it usually keeps thrush-causing yeast in check.

Interruptions in Breastfeeding

If breastfeeding is interrupted due to illness or temporary separation, you will want to express milk to keep up production. By pumping your breasts and getting your milk to your baby, you'll ensure the continuation of milk production and the best nutrition for your child.

Next Page: Newborn Care »