your guide to

BREASTFEEDING
Learning to Breastfeed:
Find the best
breastfeeding
holds for you and
your baby. Page 12

COMMON QUESTIONS: CAN I

TAKE MEDICINE WHILE
BREASTFEEDING? DO I NEED
BIRTH CONTROL? FIND OUT
THE ANSWERS TO THESE
QUESTIONS AND MORE.
Page 30

BREASTFEEDING IN PUBLIC:
FIND TIPS FOR MAKING
IT WORK. Page 40 LEARN ABOUT
THE HEALTH BENEFITS
COMMON CHALLENGES:
LEARN TIPS FOR SAYING FOR MOM AND BABY!
FAREWELL TO SORE Page 4
NIPPLES!
Page 22
YOUR GUIDE TO BREASTFEEDING

The U.S. Department of Health and Human Services

Office on Women’s Health (OWH) is raising awareness
of the importance of breastfeeding to help mothers
give their babies the best start possible in life. In
addition to this guide, OWH offers online content at
www.womenshealth.gov/breastfeeding and
www.womenshealth.gov/itsonlynatural.

Through its Supporting Nursing Moms at Work site,

OWH helps businesses support nursing mothers
with cost-effective tips and time and space solutions,
listed by industry. Learn more at https://www.
womenshealth.gov/supporting-nursing-moms-
work. OWH also partners with the Health Resources
and Services Administration’s Maternal and Child
Health Bureau to educate employers about the needs
of breastfeeding mothers via The Business Case for
Breastfeeding.

2
 There are so
many reasons to
breastfeed
• The joyful closeness and bonding with your baby
• Your breastmilk can help your baby as their
immune system develops
• The cost savings
• Health benefits for mother and baby

KEEP IN MIND THAT FEEDING YOUR BABY IS A LEARNED SKILL.

It takes patience and practice. For some women,
learning to breastfeed can be frustrating and
uncomfortable. It may also seem more difficult,
especially if your baby was born early or you have
certain health problems. The good news is that it can
get easier, and support for breastfeeding mothers is
available.

1
YOUR GUIDE TO BREASTFEEDING

CONTENTS

4 WHY BREASTFEEDING IS IMPORTANT

Healthy babies and mothers

7
FINDING SUPPORT AND INFORMATION
Health professionals who can help with
breastfeeding, and how to find support by phone

10
BREASTFEEDING MYTHS
Myths about breastfeeding are common.
Get the facts.

11 HOW YOUR MILK IS MADE

Describes how your body works

12
LEARNING TO BREASTFEED
Follow your baby’s lead from the first minute of
life for breastfeeding success

22 COMMON CHALLENGES
Tips for troubleshooting common problems

30
COMMON QUESTIONS
Find out whether your baby needs cereal, if you
can take medicine while breastfeeding, and more

2
34
BREASTFEEDING A BABY WITH A HEALTH PROBLEM
What to know if your baby has jaundice,
reflux, or colic

37
BREASTFEEDING AND SPECIAL SITUATIONS
Having twins or more? Information for moms of
multiples, mothers who are adopting, and more

40
BREASTFEEDING IN PUBLIC
Ways to feel comfortable feeding your
baby while out and about

41
PUMPING AND STORING YOUR MILK
Learn about the different types of breast pumps and
how to get them, plus tips on how to store your milk

46
GOING BACK TO WORK
Your rights and how to talk to your employer
about your breastfeeding needs

49 NUTRITION AND FITNESS

How to take care of yourself while breastfeeding

51 HANDLING STRESS
Coping tips to help keep stress at bay

52 WEANING YOUR BABY

Get tips for when and how to wean your baby

3
YOUR GUIDE TO BREASTFEEDING

WHY BREASTFEEDING
IS IMPORTANT

BREASTFEEDING PROTECTS BABIES

YOUR FIRST MILK IS LIQUID GOLD. YOUR MILK CHANGES AS YOUR BABY GROWS. BREASTMILK FIGHTS DISEASE.
Called liquid gold for its deep yellow Colostrum changes into mature milk The cells, hormones, and antibodies
color, colostrum is the thick first milk that by the third to fifth day after birth. This in breastmilk help protect babies from
you make during pregnancy and just after mature milk has just the right amount of illness. This protection is unique and
birth. This milk is very rich in nutrients fat, sugar, water, and protein to help your changes to meet your baby’s needs.
and includes antibodies to protect your baby continue to grow. It looks thinner Research suggests that breastfed babies
baby from infections. Colostrum also than colostrum, but it has nutrients and have lower risks of:
helps your newborn infant’s digestive antibodies your baby needs for healthy • Asthma
system to grow and function. Your baby growth. • Obesity
gets only a small amount of colostrum at • Type 1 diabetes
each feeding because the stomach of a FORMULA IS HARDER TO DIGEST. • Ear and respiratory infections
newborn infant is tiny and can hold only Breastmilk substitutes like formula may • Sudden infant death syndrome
a small amount. be harder to digest than breastmilk. (SIDS)
• Gastrointestinal infections
Talk to your baby’s doctor if you are (diarrhea/vomiting)
afraid the baby is not getting enough • Necrotizing enterocolitis (NEC),
milk, or to see if there is a medical need a disease that affects the
to supplement with formula. gastrointestinal tract in
preterm infants

Besides giving your baby nourishment and helping to keep your baby from
CAN BREASTFEEDING HELP ME becoming sick, breastfeeding may help you lose weight. Many women who breastfed
LOSE WEIGHT? their babies said it helped them get back to their pre-pregnancy weight more quickly,
but experts are still looking at the effects of breastfeeding on weight loss.

4
 BREASTFEEDING BENEFITS MOMS

Did you know that your baby can smell need to warm bottles in the middle of warm, and comforted. Breastfeeding
you and knows the unique scent of your the night! When you breastfeed, you can mothers also benefit from this closeness.
breastmilk? This is why your baby will satisfy your baby’s hunger right away. The skin-to-skin contact boosts your
turn his or her head to you when hungry. oxytocin levels. Oxytocin is a hormone
Your baby is born with an instinct to NOT BREASTFEEDING COSTS MONEY. that helps breastmilk flow and can calm
suckle at your breasts. Formula and feeding supplies can cost the breastfeeding mother.
more than $1,500 each year. Breastfed
LIFE CAN BE EASIER WHEN YOU BREASTFEED. babies may also be sick less often, which BREASTFEEDING IS GOOD FOR THE MOTHER’S
Breastfeeding may seem like it takes a can help keep your baby’s health care HEALTH, TOO.
little more effort than formula feeding costs lower. Breastfeeding is linked to a lower risk
at first. But breastfeeding can make your of Type 2 diabetes, high blood pressure,
life easier once you and your baby settle BREASTFEEDING KEEPS MOTHER AND BABY CLOSE. certain types of breast cancer, and
into a good routine. You do not have to Physical contact is important to ovarian cancer in mothers.1
buy, measure, and mix formula. You won’t newborns. It helps them feel more secure,

BREASTFEEDING GLOSSARY
Nutrients are any food substance (carbohydrates or sugar, fat,
protein, vitamins and minerals) that provides energy or helps
build tissue.

Antibodies are blood proteins made in response to germs or

other foreign substances that enter the body. Antibodies help
the body fight illness and disease by attaching to germs and
marking them for destruction.

The gastrointestinal system is made up of the stomach and the

small and large intestines. It breaks down and absorbs food.

The respiratory system includes the nose, throat, voice box,

windpipe, and lungs. Air is breathed in, delivering oxygen.
Waste gas is removed from the lungs when you breathe out.

1
https://effectivehealthcare.ahrq.gov/topics/breastfeeding/research
5
YOUR GUIDE TO BREASTFEEDING
YOUR GUIDE TO BREASTFEEDING

Breastfeeding protects your baby Your milk is always at the right

from the risks of an unsafe water temperature for your baby. The skin-to-
supply. skin contact of breastfeeding can help
DURING AN EMERGENCY, SUCH keep your baby’s body temperature from
AS A NATURAL DISASTER, Breastfeeding can help protect your dropping too low.2
BREASTFEEDING CAN SAVE YOUR baby against respiratory illnesses
BABY’S LIFE: and diarrhea.

Even if you aren’t able to eat regular

meals, your baby will still be able to
feed.

BREASTFEEDING IS GOOD FOR SOCIETY

Society benefits overall when mothers BREASTFEEDING SAVES MONEY. BREASTFEEDING IS BETTER FOR THE ENVIRONMENT.
breastfeed. Our health system would also save $3 Formula cans and bottle supplies create
billion per year.3 This is because medical more trash and plastic waste. Your milk
BREASTFEEDING SAVES LIVES. care costs are lower for mothers who is a renewable resource that comes
Recent research shows that if 90 percent exclusively breastfed than for those who packaged and warmed.
of families breastfed exclusively for 6 never breastfed. Medical costs are also
months, more than 700 deaths among lower for fully breastfed infants than for
infants could be prevented.3 never-breastfed infants.

2
Mori, R., Khanna, R., Pledge, D., Nakayama, T. (2010). Meta-analysis of physiological effects of skin-to-skin contact for newborns and mothers. Pediatr Int; 52(2):161-70.
3
Bartick, M.C., Schwarz, E.B., Green, B.D., Jegier, B.J., Reinhold, A.G., Colaizy, T.T., Bogen, D.L., Schaefer, A.J., Stuebe, A.M. (2017). Suboptimal breastfeeding in the United States: Maternal
and pediatric health outcomes and costs. Matern Child Nutr; 13 (1).
6
FINDING SUPPORT AND
INFORMATION
Although breastfeeding is a natural process, many moms need Don’t forget, friends who have successfully breastfed are great
help. Breastfeeding moms can seek help from different types sources of information and encouragement!
of breastfeeding professionals, organizations, and members of
their own families. Also, breastfeeding support and supplies
may be covered by insurance.

PROFESSIONALS WHO HELP WITH BREASTFEEDING

INTERNATIONAL BOARD CERTIFIED LACTATION CERTIFIED LACTATION COUNSELOR OR CERTIFIED DOULA.

CONSULTANT (IBCLC). BREASTFEEDING EDUCATOR. A doula is professionally trained to give
IBCLCs are certified breastfeeding A breastfeeding counselor or educator birthing families social support during
professionals with the highest level of teaches about breastfeeding and pregnancy, labor, and birth, as well as at
knowledge and skill in breastfeeding helps women with basic breastfeeding home during the first few days or weeks
support. IBCLCs help with a wide range challenges and questions. These after the baby is born. Doulas that are
of breastfeeding concerns. To earn counselors and educators have special trained in breastfeeding can help you
the IBCLC certification, candidates breastfeeding training, usually limited to learn to breastfeed.
must have a medical or health- a week-long course.
related educational background, have
breastfeeding-specific education and
clinical experience, and pass a rigorous
exam. Ask your obstetrician, pediatrician,
or midwife for the name of a lactation
consultant who can help you. You also
can go to www.uslca.org to find an
IBCLC in your area.

BABY-FRIENDLY® HOSPITAL INITIATIVE

Look for a hospital that is designated keeping mom and baby together to support after leaving the hospital. For
Baby-Friendly®. Baby-Friendly® throughout the hospital stay, teaching more information about Baby-Friendly®
Hospitals provide support for feeding cues and breastfeeding hospitals, visit www.babyfriendlyusa.org.
breastfeeding mothers, including techniques, and providing or linking

If you don’t have a Baby-Friendly® Hospital near you, you can still look for a
hospital with policies that support breastfeeding. Ask if your hospital encourages
skin-to-skin contact right after birth and rooming in with baby. You can also ask
if they have breastfeeding support professionals on staff and whether they limit
the use of formula, unless medically necessary.

7
YOUR GUIDE TO BREASTFEEDING

MOTHER-TO-MOTHER SUPPORT

Other breastfeeding mothers can be a counselor. “Peer” means that the • Find a local La Leche League support
great source of support. Mothers can counselor has breastfed her own group by visiting the organization’s
share tips and offer encouragement. You baby and can help other mothers website at www.llli.org.
can connect with other breastfeeding breastfeed. Many state Women, • Social media sites and message
mothers in many ways: Infants, and Children (WIC) boards can help you connect with
• Ask your doctor, nurse, midwife, or programs offer peer counselors. other moms. Don’t rely solely on
other breastfeeding expert to suggest • Search the Internet for a these resources for medical advice
a support group. Some pediatric breastfeeding center near you. These or clinical breastfeeding support
practices also have an IBCLC on staff centers may offer support groups. for challenges such as sore nipples
who leads regular support group Some resources include: or milk supply concerns. Talk with
meetings. – Nursing Mothers Advisory Council your doctor, nurse, midwife, or other
• Ask your doctor, nurse, midwife, – Nursing Mothers, Inc. breastfeeding expert instead.
or other breastfeeding expert for – BreastfeedingUSA.org
help finding a breastfeeding peer

WIC PROGRAM

The U.S. Department of Agriculture peer counselors and designated than non-breastfeeding mothers. WIC
(USDA) Special Supplemental Nutrition breastfeeding experts, who can assist has a website dedicated to supporting
Program for Women, Infants, and moms with normal breastfeeding and breastfeeding moms:
Children (commonly called WIC) offers challenges. Breastfeeding mothers www.wicbreastfeeding.fns.usda.gov.
food, nutrition counseling, and access to supported by WIC may also receive an
health services for low-income women, enhanced food package, breast pumps, To find contact information for your local
infants, and children. and other supplies. Breastfeeding WIC program, visit https://www.fns.
WIC has breastfeeding staff, including mothers can participate in WIC longer usda.gov/wic/wic-contacts.

Learn more about breastfeeding

basics and find other online
resources at
www.womenshealth.gov/
breastfeeding and
www.womenshealth.gov/
itsonlynatural.

8
 BUILDING A SUPPORT NETWORK

Talk to fathers, partners, and other family • Help the breastfeeding mother • Take care of any other children who
members about how they can help. during the night by getting the baby are at home
changed and ready to be fed • Give the baby love through playing
Breastfeeding is more than a way • Show their love and appreciation and cuddling
to feed a baby — it becomes a way for all of the work that goes into
of life. Fathers, partners, and other breastfeeding Fathers, partners, and other people in the
support persons can be involved in the • Be good listeners if you need to talk breastfeeding mother’s support system
breastfeeding experience, too. Partners about any breastfeeding concerns can benefit from breastfeeding, too. Not
and family members can: you might have only are there no bottles to prepare,
• Support your breastfeeding by being • Help make sure you have enough to but many people feel warmth, love, and
kind and encouraging drink and get enough rest relaxation just from sitting next to a
• Help around the house mother and baby during breastfeeding.

Your partner and family play a key role in supporting breastfeeding, right from
the start. You and your baby have many needs. There are many things your
partner can do to support you, your new baby, and the breastfeeding experience.

While you breastfeed, your partner can provide encouragement, comfort, and
WHAT YOUR PARTNER CAN DO support by helping you relax and positioning your baby at your breast. Your
partner can bring you water or snacks, take over household chores, and make
sure you rest as much as possible. Spending time with your baby is essential to
building a bond; your partner can cuddle, read to, burp, bathe, or just hold your
baby skin-to-skin. (see page 12 for more information about skin-to-skin contact)

9
YOUR
Y OGUURI DGEU ITDOE BTROE AB SR TE FA ESET DF IENEGD I N G

BREASTFEEDING
MYTHS
Moms-to-be and new moms get a lot of MYTH: IF YOUR BREASTS ARE SMALL, TUBULAR MYTH: BREASTFEEDING SPOILS A CHILD.
baby advice. Although people usually SHAPED, WIDELY SPACED, OR DIFFERENT SIZES, YOU After spending nine months growing
mean well, not all of it is based on fact. CAN’T BREASTFEED. inside you, it’s completely natural for a
Myths about breastfeeding are common. For most women, the size and shape of baby to be attached to his or her birth
The fact is that breastfeeding is a healthy their breasts does not affect their milk mother and vice versa. Despite what
way to feed your baby. The decision supply or the ability to breastfeed. This you’ve heard, newborns don’t need to
to breastfeed is a personal one, and it includes women with large areolas (the learn to fend for themselves at such
should also be an informed one. area around the nipple), flat nipples, and a young age. In reality, breastfeeding
even women who’ve had breast surgery. provides a unique bond with your
MYTH: EVERYONE USES FORMULA. (Note: If you’ve had extensive breast child that can last a lifetime. Research
More women breastfeed than you think. surgery, you may be able to partially or shows that breastfed children grow up
According to the Centers for Disease exclusively breastfeed. You should work to be confident and self-sufficient when
Control and Prevention, more than 83 with a breastfeeding professional before parents meet their needs.
percent of women in the United States and after your baby’s birth.) Tubular
start out breastfeeding.4 Research over shaped, widely spaced, or different size MYTH: BREASTFEEDING HURTS.
the past 40 years has proven that mother’s breasts do not always affect milk supply Breastfeeding is not supposed to be a
milk is an inexpensive and healthy choice and are best evaluated in a clinical setting painful experience. As with any new skill,
for babies. and should not be self-diagnosed. If you there is an adjustment period, so you may
are having breastfeeding challenges, you have some discomfort in the beginning.
MYTH: BREASTFEEDING MAKES YOUR BREASTS SAG. can get help from a doctor, nurse, IBCLC, But if you experience pain, it is usually
Actually, it’s pregnancy that stretches the or midwife. a red flag that something is wrong. See
ligaments of your breast tissue, whether pages 16 and 22 to learn more and find
you breastfeed or not. Age, genetics, and MYTH: YOU WON’T BE ABLE TO MAKE ENOUGH MILK. out when to seek help.
the number of pregnancies you’ve had Moms almost always make enough milk
also play a role. to feed their babies (see page 20 to know Learn more about the benefits of
if your baby is getting enough milk). The breastfeeding for both mom and baby
key to making plenty of milk is to nurse on page 4.
your baby often during the first 14 days
(8–12 times or more every 24 hours). It’s
also important to make sure your baby
is latched correctly and swallowing (for
signs of swallowing, see page 15).

4
https://www.cdc.gov/breastfeeding/data/reportcard.htm.

10
HOW YOUR MILK
IS MADE
Your breasts make milk in response to The breasts often become fuller and
your baby’s suckling. The more your tender during pregnancy. This is a sign
baby nurses, the more milk your breasts that the alveoli are getting ready to work.
will make. Knowing how your breast Some women do not feel these changes
makes milk can help you understand the in their breasts. Other women may sense
Lobes
breastfeeding process. The breast is an these changes after their baby is born.
organ that is made up of several parts: The alveoli make milk in response to the
hormone prolactin. Prolactin rises when
ALVEOLI CELLS: grape-like clusters of tissue the baby suckles. Another hormone, Areola
that make the milk oxytocin, also rises when the baby
suckles. This causes small muscles in
AREOLA: the dark area around the nipple the breast to contract and move the milk Nipple
through the milk ducts. This moving of
LOBES: the parts of the breast that make the milk is called the “let-down reflex.”
milk; each lobe contains alveoli cells and
Milk duct
milk ducts The release of prolactin and oxytocin
may make a breastfeeding mother feel
MILK DUCTS: tubes that carry milk through a strong sense of needing to be with Alveoli cells
the breast to the nipple/areola area her baby.

NIPPLE: the protruding point of the breast

The let-down reflex (also called just “let-down” or the milk ejection reflex)
happens when your baby begins to nurse. The nerves in your breast send
signals that release the milk into your milk ducts. This reflex makes it easier
for you to breastfeed your baby. Let-down happens a few seconds to several
minutes after you start breastfeeding your baby. It also can happen a few times
during a feeding. You may feel a tingle in your breast, or you may feel a little
uncomfortable. You also may not feel anything.

WHAT IS THE LET-DOWN Let-down can happen at other times, too, such as when you hear your baby cry
REFLEX? or when you’re just thinking about your baby. If your milk lets down as more of a
gush and it bothers your baby, try expressing some milk by hand before you start
breastfeeding.

Many factors affect let-down, including anxiety, pain, embarrassment, stress,

cold, excessive caffeine use, smoking, alcohol, and some medicines. Breastfeeding
mothers who have had breast surgery may have nerve damage that interferes
with let-down.

11
YOUR GUIDE TO BREASTFEEDING

LEARNING
TO BREASTFEED
Breastfeeding is a process that takes time The following steps can help you get off or formula, unless it is medically
and practice. When your baby drinks to a great start breastfeeding: necessary.
milk from your breasts, it is a signal to • Cuddle with your baby skin-to-skin • Let your baby stay in your hospital
your body to produce more milk for right away after giving birth. room all day and night so that you
the next feeding. All that time spent • Breastfeed as soon as possible after can breastfeed often.
breastfeeding in your baby’s first few days giving birth. • Try to avoid giving your baby any
prepares your body to make lots of milk, • Ask for an IBCLC to help you. pacifiers or artificial nipples until
whether you go on to breastfeed for three • Ask the hospital staff not to give he or she is skilled at latching onto
weeks or three years. your baby pacifiers, sugar water, your breast (usually around 3 to 4
weeks old).

PREPARE FOR BREASTFEEDING BEFORE YOU GIVE BIRTH

To prepare for breastfeeding, the most are called Baby-Friendly® Hospitals and with your doctor about treatments that
important thing expectant moms can Birth Centers. can work with breastfeeding.
do is to have confidence in themselves.
Committing to breastfeeding starts with TAKE A BREASTFEEDING CLASS. Pregnant women TELL YOUR DOCTOR THAT YOU WOULD LIKE TO
the belief that you can do it! who learn how to breastfeed are more BREASTFEED AS SOON AS POSSIBLE AFTER DELIVERY.
likely to be successful at breastfeeding The sucking instinct is very strong within
Other steps you can take to prepare for than those who do not. Breastfeeding the baby’s first hour of life.
breastfeeding are: classes offer pregnant women and their
partners the chance to prepare and ask TALK TO FRIENDS WHO HAVE BREASTFED, or
GET GOOD PRENATAL CARE, which can help you questions before the baby’s arrival. consider joining a breastfeeding
avoid early delivery. Babies born too early support group.
have more problems with breastfeeding. ASK YOUR DOCTOR TO RECOMMEND A LACTATION
CONSULTANT. You can establish a YOU DON’T NEED MANY SUPPLIES TO BREASTFEED,
TELL YOUR DOCTOR ABOUT YOUR PLANS TO relationship with a lactation consultant but there are some, including nursing
BREASTFEED, and ask whether the place before the baby comes so that you will bras and nursing pads, that can make
where you plan to deliver your baby has have support ready after the baby is born. it easier and more comfortable for you.
the staff and setup to support successful You may want to pack these supplies in
breastfeeding. Some hospitals and TALK TO YOUR DOCTOR ABOUT YOUR HEALTH. Discuss your bag so you have them at the hospital
birth centers have taken special steps to any breast surgery or injury you may when you deliver your baby.
create the best possible environment for have had. If you have depression or are
successful breastfeeding. These places taking supplements or medicines, talk

12
 FOLLOW YOUR BABY’S LEAD

Getting your baby to “latch” on properly HOLD YOUR BABY SKIN-TO-SKIN. Hold your opens his mouth, he should get a deep
takes some practice and can be a source baby, wearing only a diaper, against latch. Your baby can breathe at your
of frustration for you and your baby. One your bare chest. Hold the baby upright breast when positioned correctly. The
approach to learning to breastfeed is a between your breasts and just enjoy your nostrils will flare to allow air in. Check to
more relaxed, baby-led latch. This laid- baby for a while with no thoughts of make sure the nostrils are not blocked by
back, more natural breastfeeding style breastfeeding. your breast.
allows your baby to lead and follow his or
her instincts to suck. LET YOUR BABY LEAD. If your baby is not C HOLD
hungry, he or she will stay curled up
The following steps can help your against your chest. If your baby is hungry,
newborn latch onto the breast to start the baby will bob his or her head against
sucking when he or she is ready. Letting you, try to make eye contact, and squirm
your baby begin the process of searching around.
for the breast may take some of the
pressure off of you and keeps the baby SUPPORT YOUR BABY. HELP, BUT DON’T FORCE,
calm and relaxed. THE LATCH. Support your baby’s head and
shoulders as the baby searches for your
Keep in mind that there is no one way to breast. Your baby may need help latching U HOLD
start breastfeeding. As long as the baby is in the beginning. To help your baby latch,
latched on well, how you get there is up you can support your breast by using a C
to you. hold or U hold. When your baby’s chin
hits your breast, the firm pressure makes
CREATE A CALM ENVIRONMENT FIRST. Lie back him or her open his mouth wide and
on pillows or another comfortable area. reach up and over the nipple. As he or
Make sure you are relaxed and calm. she presses his chin into the breast and

Early and often! Newborns usually

need to nurse at least eight to 12
times every 24 hours. This also
helps make sure you will make
HOW OFTEN SHOULD plenty of milk.
I BREASTFEED?
Healthy babies develop their own
feeding patterns. Follow your baby’s
cues for when he or she is ready
to eat.

There is no set time for feedings.

They may be 15 to 20 minutes per
breast. They may be shorter or
HOW LONG SHOULD longer. Your baby will let you know
FEEDINGS BE? when he or she is finished feeding.
If you are worried your baby is not
getting enough milk, talk with your
doctor, nurse, IBCLC, or midwife.

13
YOUR GUIDE TO BREASTFEEDING

GETTING YOUR BABY TO LATCH

If your baby is still having problems latching on, try these tips:

Tickle the baby’s lips to encourage him Pull your baby close so that the chin and Watch the lower lip and aim it as far from
or her to open wide. lower jaw moves into your breast first. base of nipple as possible, so the baby
takes a large mouthful of breast.

When my son was born four years ago, we had a very difficult time breastfeeding
because he wasn’t latching correctly. He seemed almost lazy and disinterested
in eating. In the first two weeks, he lost quite a bit of weight and appeared gaunt
and fussy. Naturally, I was nearly frantic with worry. Luckily, I connected with
SOME BABIES LATCH ON RIGHT an amazing lactation consultant. She put me on a rigorous, week-long regimen,
AWAY, AND FOR SOME IT TAKES which consisted of nursing, then bottle feeding breastmilk, then pumping every
MORE TIME. three hours. I was completely dedicated to the regimen, and when I met with her
a week later, she was stunned by the results. My son had gained an entire pound,
and she said he had developed a perfect latch. She called us the miracle mom
and miracle baby! I was so proud of us. My determination paid off, and I enjoyed
breastfeeding for seven months. — Jill, Bridgewater, Massachusetts

14
 SIGNS OF A GOOD LATCH

• The latch feels comfortable to you size of your baby’s mouth. If areola • You hear or see your baby swallow.
and does not hurt or pinch. How it is showing, you will see more above Some babies swallow so quietly that
feels is more important than how it your baby’s lip and less below. a pause in their breathing may be the
looks. • When your baby is positioned well, only sign of swallowing.
• Your baby’s chest rests against your his or her mouth will be filled with • You see your baby’s ears “wiggle”
body. The baby does not have to turn breast. slightly.
his or her head while nursing. • Your baby’s tongue is cupped under • Your baby’s lips turn outward like
• You see little or no areola, depending the breast, although you might not fish lips, not inward.
on the size of your areola and the see it. • Your baby’s chin touches your breast.

15
YOUR GUIDE TO BREASTFEEDING

HELP WITH LATCH PROBLEMS

ARE YOU IN PAIN? ARE YOU OR YOUR BABY FRUSTRATED? COULD YOUR BABY BE TONGUE-TIED?
Many moms say their breasts feel tender Take a short break and hold your baby Babies with a tight or short lingual
when they first start breastfeeding. in an upright position. Try holding your frenulum (the piece of tissue attaching
A breastfeeding mother and her baby between your breasts with your skin the tongue to the floor of the mouth)
baby need time to find comfortable touching his or her skin (called skin-to- are described as “tongue-tied.” The
breastfeeding positions and a good latch. skin). Talk or sing to your baby, or give medical term is ankyloglossia. Babies
If breastfeeding hurts, your baby may your baby one of your fingers to suck on who are tongue-tied often find it hard
be sucking on only the nipple. Gently for comfort. Try to breastfeed again in a to nurse. They may be unable to extend
break your baby’s suction to your breast little while. their tongue past their lower gum line
by placing a clean finger in the corner or properly cup the breast during a feed.
of your baby’s mouth. Then try again DOES YOUR BABY HAVE A WEAK SUCK OR MAKE ONLY This can cause slow weight gain in the
to get your baby to latch on. To find out TINY SUCKLING MOVEMENTS? baby and nipple pain in the mother. If
whether your baby is sucking only on Your baby may not have a deep enough you think your baby may be tongue-tied,
your nipple, check what your nipple latch to suck the milk from your breast. talk to your doctor.
looks like when it comes out of your Gently break your baby’s suction and try
baby’s mouth. Your nipple should not again. Talk with a lactation consultant or
look flat or compressed. It should look pediatrician if you are not sure whether
round and long or the same shape it was your baby is getting enough milk. See
before the feeding. page 15 for signs of swallowing.

A good latch is important for your baby to breastfeed effectively and for your
A GOOD LATCH comfort. During the early days of breastfeeding, it can take time and patience for
your baby to latch on well.

BREASTFEEDING HOLDS

Some moms find that the following pillows under your arms, elbows, neck, for one feeding may not work for the next
positions are helpful ways to get or back to give you added comfort and feeding.
comfortable and support their babies support. Keep trying different positions
while breastfeeding. You also can use until you are comfortable. What works

16
LAID-BACK HOLD (STRADDLE HOLD): a more CROSS-CRADLE OR TRANSITIONAL HOLD: useful for
relaxed, baby-led approach. Lie back premature babies or babies with a weak
on a pillow. Lay your baby against your suck because this hold gives extra head
body with your baby’s head just above support and may help the baby stay
and between your breasts. Gravity and latched. Hold your baby along the area
an instinct to nurse will guide your baby opposite from the breast you are using.
to your breast. As your baby searches for Support your baby’s head at the base of
your breast, support your baby’s head his or her neck with the palm of your
and shoulders but don’t force the latch. hand.

CRADLE HOLD: an easy, common hold that CLUTCH OR “FOOTBALL” HOLD: useful if you SIDE-LYING POSITION: useful if you have had
is comfortable for most mothers and have had a C-section, or if you have a C-section, but also allows you to rest
babies. Hold your baby with his or her large breasts, flat or inverted nipples, while the baby breastfeeds. Lie on your
head on your forearm and his or her or a strong let-down reflex. This hold is side with your baby facing you. Pull your
body facing yours. also helpful for babies who like to be in baby close so your baby faces your body.
a more upright position when they feed.
Hold your baby at your side with the
baby lying on his or her back and with
his or her head at the level of your nipple.
Support your baby’s head by placing the
palm of your hand at the base of his or
her head.

17
YOUR GUIDE TO BREASTFEEDING

Many leading health organizations recommend that most infants breastfeed for
at least 12 months, with exclusive breastfeeding for about the first six months.

HOW LONG SHOULD These recommendations are supported by organizations including the American
I BREASTFEED? Academy of Pediatrics, American Academy of Family Physicians, American
College of Obstetricians and Gynecologists, American College of Nurse-
Midwives, Academy of Nutrition and Dietetics, and American Public Health
Association.

TIPS FOR MAKING IT WORK

LEARN YOUR BABY’S HUNGER SIGNS. at each feeding. Other babies take only doctor has told you to use them because
When babies are hungry, they are more one breast at each feeding. Help your of a medical reason. If you need to use
alert and active. They may put their baby finish the first breast as long as he supplements, work with a doctor, nurse,
hands or fists to their mouths, make or she is still sucking and swallowing. IBCLC, or midwife. They can show you
sucking motions with their mouth, or Your baby will let go of your breast ways that are supportive of breastfeeding.
turn their heads looking for the breast. when he or she is finished. Offer your These include feeding your baby with
If anything touches their cheek, such as baby the other breast if he or she seems a syringe, a small, flexible cup, or a tiny
a hand, they may turn toward the hand, to want more. tube taped beside your nipple. Try to give
ready to eat. This sign of hunger is called your baby expressed milk first. Unless
rooting. Offer your breast when your KEEP YOUR BABY CLOSE TO YOU. your baby is unable to feed well, it’s best
baby shows rooting signs. Crying can be Remember that your baby is not used to feed at the breast.
a late sign of hunger. It may be harder to this new world and needs to be held
for the baby to latch if he or she is upset. close and comforted. Skin-to-skin MAKE SURE YOUR BABY SLEEPS SAFELY AND CLOSE BY.
Over time, you will be able to learn your contact between you and baby will Have your baby sleep in a crib or
baby’s cues for when to start feeding. sooth crying and help keep your baby’s bassinet in your bedroom so that you can
heart rate and breathing rates stable. A breastfeed more easily at night. Research
FOLLOW YOUR BABY’S LEAD. soft carrier, such as a wrap, has found that when a baby shares a
Make sure you and your baby are can help you “wear” your baby. bedroom with his parents, the baby has
comfortable and follow your baby’s lead a lower risk of SIDS. SIDS can also be
after he or she is latched on well to your AVOID NIPPLE CONFUSION. prevented by placing your baby on his
breast. Some babies will feed from (or Avoid using pacifiers and bottles for the back when he sleeps.
“take”) both breasts, one after the other, first few weeks after birth unless your

MAKING PLENTY OF MILK

The more often your baby breastfeeds, a lot: 8-12 times in a 24-hour period. Most breastfeeding mothers can make
the more milk your breasts will make. Feeding your baby that often helps plenty of milk for their baby. If you think
Babies’ tummies are small, so it doesn’t them grow. It also tells your body to keep you have a low milk supply, talk to a
take much to fill your baby up. That making milk. lactation consultant. See page 7 for other
means you’ll need to feed your newborn types of health professionals who can
help you.

18
 Babies need 400 International Units (IU) or 10 micrograms (mcg) of vitamin
D each day. The American Academy of Pediatrics recommends vitamin D
VITAMIN D supplementation for babies who do not get enough. Ask your baby’s doctor
about supplements in drop form. Learn more about vitamin D and your baby’s
needs on page 30.

WHAT WILL HAPPEN WITH YOUR MILK, YOUR BABY, AND YOU IN THE FIRST FEW WEEKS

TIME MILK BABY YOU (MOM)

BIRTH Your body makes Your baby will probably be awake in You will be tired and
colostrum (a rich, thick, the first hour after birth. This is a good excited. Be sure to rest
yellowish milk) in small time to breastfeed your baby. when possible.
amounts. It gives your
baby early protection
against diseases.

FIRST 12–24 Your baby will drink It is normal for your baby to sleep heavily. You will be tired, too.
HOURS about 1 to 2 teaspoons of Labor and delivery are hard work! Some Be sure to rest when
colostrum at each feeding. babies may be too sleepy to latch at first. possible.
You may not see the Within the first 24 hours after birth, babies
colostrum, but it has what should eat eight or more times. Some
your baby needs and in babies may need to be woken up to ensure
the right amount. they eat enough. When your baby wakes
up, look for signs that your baby is hungry
(see page 18). Feedings may be short and
all over the place — that’s OK!

NEXT 3–5 DAYS Your mature (white) Your baby will feed a lot, most likely 8 to Your breasts may feel
milk takes the place of 12 times or more in 24 hours. Very young full and leak. (You can
colostrum. It is normal breastfed babies do not eat on a schedule. use disposable or cloth
for mature milk to have It is okay if your baby eats every 2 to 3 pads in your bra to help
a yellow or golden tint at hours for several hours, then sleeps for with leaking.) Be sure
first. 3 to 4 hours. Feedings may take about 15 to rest when possible.
to 20 minutes on each breast. The baby’s If you are not noticing
sucking rhythm will be slow and long. The these changes in your
baby might make gulping sounds. breasts, contact a
doctor, nurse, IBCLC, or
midwife for support.

FIRST 4–6 WEEKS White breastmilk Your baby will now likely be better at Your body gets used
continues. breastfeeding and have a larger stomach to breastfeeding. Your
to hold more milk. Feedings may take less breasts may become
time and may be further apart. softer and the leaking
may slow down. Be sure
to rest when possible.

19
YOUR GUIDE TO BREASTFEEDING

HOW TO KNOW YOUR BABY IS GETTING ENOUGH MILK

Many babies, but not all, lose a small months, typical weight gain is two-thirds sleeping periods and wakeful, alert
amount of weight in the first days after to 1 ounce each day. periods.
birth. Your baby’s doctor will check your • Your baby is satisfied and content
baby’s weight at your first doctor visit. Other signs that your baby is getting after feedings.
Make sure to visit your baby’s doctor for plenty of milk: • Your breasts may feel softer after you
a checkup within 3 to 5 days after birth • Your baby passes enough clear or feed your baby.
and/or 2 to 3 days after discharge, and pale yellow urine. The urine is not • After your mature milk comes in, you
then again by one month of age. deep yellow or orange. will hear or see your baby swallow.
• Your baby has enough bowel
You can tell whether your baby is getting movements (see the chart on the next Talk to your baby’s doctor if you are
plenty of milk. He will be mostly content page). worried that he or she is not getting
and will gain weight steadily after the • Your baby switches between short enough milk.
first week of age. For the first 4 to 6

A newborn’s tummy is very small,

especially in the early days. In the
THE NEWBORN TUMMY first days and weeks, your baby
can only digest a small amount
of milk.

20
 Once breastfeeding is established,
exclusively breastfed babies who are
1 to 6 months old take in between
HOW MUCH DO BABIES 19 and 30 ounces of breastmilk
TYPICALLY EAT? each day. Every baby is different.
Typically, if you breastfeed your
baby eight times a day, your baby
will get around 3 ounces per feeding.

TYPICAL NUMBER OF WET DIAPERS AND BOWEL MOVEMENTS IN A BABY’S FIRST WEEK
(IT IS FINE IF YOUR BABY HAS MORE)
1 DAY = 24 HOURS

NUMBER OF NUMBER OF BOWEL COLOR AND TEXTURE OF

BABY’S AGE WET DIAPERS MOVEMENTS BOWEL MOVEMENTS

DAY 1 1 The first one usually occurs Thick, tarry, and black
(first 24 hours after birth) within 24 hours after birth.

DAY 2 2 3 Thick, tarry, and black

DAY 3 6 3 Looser greenish to yellow

(color may vary)

DAY 4 6 3 Yellow, soft, and watery

DAY 5 6 3 Loose and seedy, yellow color

DAY 6 6 3 Loose and seedy, yellow color

DAY 7 6 3 Loose and seedy, yellow color

21
YOUR GUIDE TO BREASTFEEDING

COMMON
CHALLENGES
Breastfeeding can be challenging at you and your baby. And while many baby that they don’t have with their other
times, especially in the early days. women are faced with one or more of babies. Read on for ways to troubleshoot
But remember that you are not alone. the challenges listed here, a lot of moms problems.
Lactation consultants can help you find do not struggle at all! Also, some women
ways to make breastfeeding work for may have certain problems with one

Ask a lactation consultant for help to improve your baby’s latch. Talk to your
doctor if your pain does not go away or if you suddenly get sore nipples after
several weeks of pain-free breastfeeding. Sore nipples may lead to a breast
infection, which needs to be treated by a doctor.

CHALLENGE: SORE NIPPLES

Many moms say that their nipples feel IBCLC can watch you breastfeed Some women should not use these
tender when they first start breastfeeding. to find out why you are in pain products. Your doctor will help you
Breastfeeding should be comfortable and suggest ways to help. Delaying make the choice that is best for you
once you and your baby have found a feedings can cause more pain and and your baby.
good latch and some positions that work. harm your milk supply. • Don’t wear bras or clothes that are
• Try changing positions each time too tight and put pressure on your
WHAT YOU CAN DO you breastfeed. nipples.
• A good latch is key, so see page 14 for • After breastfeeding, express a few • Change nursing pads (washable or
detailed instructions. If your baby drops of milk and gently rub it on disposable pads you can place in
sucks only on the nipple, gently your nipples with clean hands. your bra to absorb leaks) often to
break your baby’s suction to your Human milk has natural healing avoid trapping in moisture.
breast by placing a clean finger in the properties and oils that soothe. Also, • Avoid harsh soaps or ointments that
corner of your baby’s mouth and try try letting your nipples air-dry after contain astringents (like a toner) on
again. (Your nipple should not look feeding or wear a soft cotton shirt. your nipples.
flat or compressed when it comes out • Get help from your doctor, nurse, • If your nipples are cracked, use soap
of your baby’s mouth. It should look midwife, or other breastfeeding and water to clean them.
round and long, or the same shape as expert before using creams, hydrogel • If the steps above don’t help, check
it was before the feeding.) pads (a moist covering for the nipple with your doctor to make sure there
• If you find yourself wanting to delay to help ease soreness), or a nipple aren’t any medical issues that could
feedings because of pain, get help shield (a plastic device that covers be causing sore nipples.
from a lactation consultant. An the nipple while breastfeeding).

22
 CHALLENGE: LOW MILK SUPPLY

Most breastfeeding mothers can make WHAT YOU CAN DO • Try to avoid giving your baby
plenty of milk for their babies. But many • Make sure your baby is latched on formula or cereal in addition to your
mothers worry about having enough and positioned well. breastmilk. Otherwise, your baby
milk. Let your doctor, nurse, IBCLC, or • Gently massage or compress your may lose interest in your breastmilk,
midwife know if you are concerned. breasts while your baby is latched to and as a result, your milk supply
help release more milk. could decrease.
HOW TO TELL IF YOU ARE MAKING ENOUGH MILK • Breastfeed often and let your baby • Limit or stop your baby’s use of a
• Checking your baby’s weight and decide when to end the feeding. If pacifier while trying the above tips.
growth is the best way to make sure your baby does not empty the breast, • If the steps above don’t help, check
he is getting enough milk. try pumping afterward. The more with your healthcare provider to
• Keep track of your baby’s wet and often you empty your breasts, the make sure there aren’t any medical
dirty diapers. more milk your breasts will make. issues that could be decreasing your
• Babies may want to nurse more often • Offer both breasts at each feeding. milk supply.
and longer during growth spurts Have your baby stay at the first breast
(see page 29). This is common and as long as he or she is still sucking
does not mean you are not making and swallowing. Offer the second
enough milk. breast when the baby slows down
• Your breasts no longer feeling full or stops.
and baby only nursing for a few • Use breast compressions or massage
minutes at a time are NOT signs of your breasts while your baby is
low milk supply. latched to help release more milk.
• Review page 20 for more ways to tell
if your baby is getting enough milk.

Talk to your baby’s doctor if you

think your baby is not getting
enough milk.

23
YOUR GUIDE TO BREASTFEEDING

CHALLENGE: OVERSUPPLY OF MILK

Some breastfeeding mothers worry about increasing the length of time • You also can use a cold compress or
an oversupply of milk. An over-full breast per feeding. washcloth to reduce discomfort and
can make breastfeeding stressful and • If the other breast feels too full swelling.
uncomfortable for you and your baby. before you are ready to breastfeed on • Feed your baby before he or she
it, hand express for a few moments becomes overly hungry to prevent
WHAT YOU CAN DO to relieve some of the pressure (avoid aggressive sucking. (Learn more
• Breastfeed on one side for each pumping or hand expressing too about hunger signs on page 18.)
feeding. Continue to offer that same much because it can lead to further • Burp your baby often if he or she
breast for at least two hours until oversupply). is gassy.
the next full feeding, gradually

Ask a lactation consultant for help

if you are unable to manage an
oversupply of milk on your own.

CHALLENGE: STRONG LET-DOWN REFLEX

Some women have a strong milk ejection WHAT YOU CAN DO and let the excess milk spray into a
reflex or let-down, which can cause a • Hold your nipple between your first towel or cloth.
rush of milk. This can happen along with and middle fingers or with the side • Allow your baby to come on and off
an oversupply of milk. of your hand. Lightly compress your the breast at will.
milk ducts to reduce the force of the • Hold your baby in the laid-back
milk ejection. position during feedings. This allows
• If your baby chokes or sputters when your baby to nurse against gravity
breastfeeding, gently break the latch and better manage the flow of milk.

FIVE ENGORGEMENT HOLDS*

1. One-handed “flower hold.” Works best 2. Two-handed, one-step method. Works

if your fingernails are short. Curve your best if your fingernails are short. Curve
fingertips in toward your body and place your fingertips in toward your body and
them where baby’s tongue will go. place them on each side of the nipple.

Illustrations adapted from Reverse Pressure Softening by K. Jean Cotterman© 2008.

*

24
 CHALLENGE: ENGORGEMENT

Women can experience engorgement at Engorgement can lead to plugged ducts • Use cold compresses on your breast
any time during breastfeeding. It usually or a breast infection (see page 26), so it is in between feedings to help ease the
happens during the third to fifth day important to try to prevent it before this pain.
after giving birth. Your breasts might happens. • If you are away from your baby (e.g.,
become large, heavy, and a little tender. work, school, travel), try to pump
This is normal and should go away as you WHAT YOU CAN DO your milk as often as your baby
continue to breastfeed and your supply • Breastfeed often after giving birth. normally breastfeeds when the baby
adjusts to your baby’s needs. However, As long as your baby is latched on is with you.
engorgement can become problematic. If and sucking well, allow your baby to • Get enough rest, proper nutrition,
your breasts remain full after your milk nurse for as long as he or she likes. and fluids.
comes in and you are experiencing pain, • Work with a lactation consultant to • Wear a well-fitting, supportive bra
swelling, tenderness, warmth, redness, improve your baby’s latch. that is not too tight.
throbbing, hardness, or flattening of the • Breastfeed often on the affected side • Try reverse pressure softening to
nipple, talk to your doctor, nurse, IBCLC, to remove the milk, keep the milk make the areola soft around the base
or midwife. moving freely, and prevent your of the nipple and help your baby
breast from becoming overly full. latch. Try one of the holds in the
Engorgement sometimes also causes a • Avoid using pacifiers or bottles to illustrations on the left and below.
low-grade fever and can be confused with supplement feedings. Press inward toward the chest wall
a breast infection. Engorgement is the • Hand express or pump a little milk and count slowly to 50. Use steady
result of the milk building up. This may to first soften the breast, areola, and and firm pressure, but gentle enough
be more likely if you are not feeding your nipple before breastfeeding. to avoid pain. You may need to repeat
baby or expressing your milk often. • Gently massage the breast. each time you breastfeed for a few
days.

3. Use the two-handed, one-step method. 4. Two-handed, two-step method. Using 5. Two-handed, two-step method. Using
You may ask someone to help press by two or three fingers on each side, place straight thumbs, place your thumbnails
placing fingers or thumbs on top of yours. your first knuckles on either side of the evenly on either side of the nipple.
nipple and move them 1/4 turn. Repeat Move 1/4 turn and repeat above and below
above and below the nipple. the nipple.

25
YOUR GUIDE TO BREASTFEEDING

CHALLENGE: PLUGGED DUCT

Plugged ducts are common in WHAT YOU CAN DO • Use a warm compress on the
breastfeeding mothers. A plugged milk • Breastfeed on the affected side as sore area.
duct feels like a tender and sore lump in often as every two hours. This will • Get extra sleep, or relax with your
the breast. You should not have a fever or help loosen the plug and keep your feet up to help speed healing.
other symptoms. milk moving freely. • Wear a well-fitting supportive bra
• Aim your baby’s chin at the plug. that is not too tight, since this can
A plugged duct happens when a milk This will focus the baby’s suck on the constrict milk ducts. Consider trying
duct does not drain properly. Pressure duct that is affected. a bra without underwire.
then builds up behind the plug, and • Gently massage the area, starting • If you have plugged ducts that keep
surrounding tissue gets inflamed. A behind the sore spot. Move your coming back, seek help from an
plugged duct usually happens in one fingers in a circular motion and IBCLC.
breast at a time. massage toward the nipple.

If your plugged duct doesn’t loosen up, ask for help from a lactation consultant.
Plugged ducts can lead to a breast infection.

CHALLENGE: BREAST INFECTION (MASTITIS)

Mastitis is painful inflammation or an • Yellowish discharge from the nipple WHAT YOU CAN DO
infection of the breast. Your breast may that looks like colostrum • Breastfeed on the affected side every
feel tender or sore, or you may feel a • Breasts that feel warm or hot to the two hours or more often. This will
hardened lump. It is not always easy to touch keep the milk moving freely and your
tell the difference between mastitis and a • Skin on the breasts that appears red breast from becoming overly full.
plugged duct because they have similar and streaky • Gently massage the area, starting
symptoms. However, with mastitis, behind the sore spot. Move your
you will feel very ill and can have the If you are not feeling better 12–24 hours fingers in a circular motion and
following symptoms: after symptoms start, contact your massage toward the nipple.
• Fever or flu-like symptoms, such as doctor. You may need to be treated with • Apply heat to the sore area with a
feeling run down or very achy medicine. (Learn more about medicines warm compress.
• Nausea and breastfeeding on page 31.) • Wear a well-fitting supportive bra
• Vomiting that is not too tight, since this can
constrict milk ducts.

Ask your doctor for help if you do not feel better within 24 hours of trying these
tips, if you have a fever, or if your symptoms worsen. You might need medicine.

SEE YOUR DOCTOR RIGHT AWAY IF:

• You have a breast infection in which both breasts look affected.
• There is pus or blood in your breastmilk.
• You have red streaks near the affected area of the breast.
• Your symptoms came on severely and suddenly.

Also, talk with your doctor about any medicines you take or plan to take.

26
 CHALLENGE: FUNGAL INFECTIONS

A fungal infection, also called a yeast • Deep pink and blistered nipples very hot water (above 122°F).
infection or thrush, can form on your • Achy breasts • Wear a clean bra every day.
nipples or in your breast. This type of • Shooting pains deep in the breast • Wash your hands often.
infection thrives on milk and forms from during or after feedings • Wash your baby’s hands often,
an overgrowth of the Candida organism. • White patches in your baby’s mouth especially if he sucks on his fingers.
Candida lives in our bodies and is kept or a white coating on your baby’s • If there are safety concerns, talk
healthy by the natural bacteria in our tongue to your baby’s doctor. Refer to the
bodies. When the natural balance of product guidelines and instructions
bacteria is upset, Candida can overgrow, WHAT YOU CAN DO on cleaning, safety and use for
causing an infection. Fungal infections may take several pacifiers, nipples, and toys that your
weeks to clear up, so it is important to baby puts in his or her mouth.
Signs of a fungal infection include: follow these tips to avoid spreading the • Boil all breast pump parts that touch
• Nipple soreness that lasts more than infection: your milk every day.
a few days, even after your baby has a • Change disposable nursing pads • Make sure other family members
good latch often. are free of thrush or other fungal
• Pink, flaky, shiny, itchy, or cracked • Wash any towels or clothing that infections. If they have symptoms,
nipples come in contact with the yeast in make sure they get treated.

If you or your baby has symptoms

of a fungal infection, call both your
doctor and your baby’s doctor so
you can be correctly diagnosed and
treated at the same time. This will
help prevent passing the infection to
each other.

I had a terrible time learning to

nurse my son. My nipples were
terribly sore, and it felt like it wasn’t
getting any better. After visiting my
doctor, the lactation consultant, and
the pediatrician, it became clear that
a horrible case of thrush had been
the source of my pain. I honestly
did not think I would make it, but I
was too stubborn to quit, and I am
grateful I stuck with it. I am proud
to say that I breastfed my son until
he was 16 months old! – Jessica,
Edmonton, Alberta, Canada

27
YOUR GUIDE TO BREASTFEEDING

CHALLENGE: NURSING STRIKE

A nursing “strike” is when your baby has • Being upset about a long separation WHAT YOU CAN DO
breastfed well for months and suddenly from the breastfeeding mother or a • Try to express your milk as often as
begins to refuse the breast. A nursing major change in routine. the baby used to breastfeed to avoid
strike can mean that your baby is trying • Being distracted while breastfeeding, engorgement and plugged ducts.
to let you know that something is wrong. such as becoming interested in other • Try another feeding method
A nursing strike is usually temporary things going on around the baby. temporarily to give your baby your
and typically does not mean your baby is • Having a cold or stuffy nose that breastmilk, such as using a cup,
ready to wean. makes breathing while breastfeeding dropper, or spoon.
difficult. • Keep track of your baby’s wet and
Not all babies will react the same way • Getting less milk from the dirty diapers to make sure he or she
to the different things that can cause a breastfeeding mother after gets enough milk.
nursing strike. Some babies will continue supplementing breastmilk with • Keep offering your breast to your
to breastfeed without a problem. Other bottles or overuse of a pacifier. baby. If your baby is frustrated, stop
babies may just become fussy at the • Responding to the mother’s strong and try again later. You can also offer
breast. And other babies will refuse the reaction if the baby has bitten her your breast when your baby is very
breast entirely. while breastfeeding. sleepy or is sleeping.
• Reacting to changes in soap or other • Try different breastfeeding positions,
Some of the major causes of a nursing cosmetics that smell unfamiliar. with your bare skin next to your
strike include: • Responding to changes in the baby’s bare skin.
• Having mouth pain from teething, a taste of milk because of an illness, • Focus on and comfort your baby
fungal infection like thrush, or a cold medication, or diet. with extra touching and cuddling.
sore. • Breastfeed your baby in a quiet room
• Having an ear infection, which If your baby is on a nursing strike, it with few distractions.
causes pain while sucking or is normal to feel frustrated and upset,
pressure while lying on one side. especially if your baby is unhappy. Be
• Feeling pain from a certain patient with your baby and keep trying to
breastfeeding position, perhaps from offer your breasts.
an injury on the baby’s body or from
soreness from an immunization.

If you are worried your baby is not getting enough milk, talk to your baby’s doctor.
The doctor can check your baby’s weight gain.

28
 CHALLENGE: INVERTED, FLAT, OR VERY LARGE NIPPLES

Some women have nipples that turn Very large nipples can make it hard for with very large nipples will improve
inward instead of pointing outward, the baby to get enough of the areola into with time as the baby grows. It might
or that are flat and do not protrude. his or her mouth to compress the milk take several weeks to get the baby to
Nipples also can sometimes flatten for ducts and get enough milk. latch well. If you have a good milk
a short time because of engorgement or supply, your baby will get enough
swelling from breastfeeding. Inverted WHAT YOU CAN DO milk even with a poor latch.
or flat nipples can sometimes make it • Talk to your doctor, nurse, midwife,
harder to breastfeed. But remember, or other breastfeeding expert if you
for breastfeeding to work, your baby are concerned about your nipples.
must latch on to both the nipple and the • A lactation consultant can give you
breast, so even inverted nipples can work advice for safely and comfortably
just fine. Often, flat and inverted nipples pulling your nipples out.
will protrude more over time as the baby • The latch for babies of mothers
sucks more.

Ask for help if you have questions about your nipple shape or type, especially if
your baby is having trouble latching well.

CHALLENGE: GROWTH SPURTS

Growth spurts can cause your baby to

want to nurse longer and more often.
These growth spurts can happen when
your baby is around two to three weeks,
six weeks, and three months old. Growth
spurts can also happen at any time. Don’t
be worried that your milk supply is too
low to satisfy your baby (see page 23 for
more information on low milk supply).

WHAT YOU CAN DO

Follow your baby’s lead. Nursing more
often will help build up your milk supply.
Once your supply increases, you will
likely be back to your usual routine.

29
YOUR GUIDE TO BREASTFEEDING

COMMON
QUESTIONS
SHOULD I SUPPLEMENT WITH FORMULA? with an adequate amount of vitamin help protect your baby from respiratory
Giving your baby formula may cause him D. To avoid developing a vitamin D problems and SIDS. Be sure to smoke
or her to not want as much breastmilk. deficiency, the American Academy of away from your baby and change your
This will decrease your milk supply. Talk Pediatrics recommends that you give your clothes to keep your baby away from the
to your baby’s doctor if you are afraid the baby a vitamin D supplement of 400 IU chemicals smoking leaves behind. Ask
baby is not getting enough milk or to see (10 mcg) each day. This should start in your doctor or nurse for help quitting
if there is a medical need to supplement the first few days of life. Ask your baby’s smoking or go to https://women.
with formula. doctor about supplements in drop form. smokefree.gov/.

DOES MY BABY NEED INFANT CEREAL OR WATER? Even though sunlight on the skin enables Not drinking alcohol is the safest option
Giving the baby infant cereal may the body to make vitamin D, exposing for breastfeeding mothers. However,
cause your baby to not want as much your baby’s skin to the sun can be drinking up to 1 standard drink per day
breastmilk. This will decrease your milk harmful. is not known to be harmful to your baby,
supply. When your baby is ready for solid especially if you wait at least 2 hours after
foods, the food or infant cereal should Once your baby is weaned from a single drink before nursing. You can
be rich in iron. Talk to your baby’s doctor breastmilk, talk to your baby’s doctor also pump milk before you drink to feed
about when to feed your baby solid foods about whether your baby still needs your baby later.
and which foods are best. Your baby does vitamin D supplements. Some children
not need water in the first 6 months do not get enough vitamin D from the The CDC has more information
of life. food they eat. on this website https://www.cdc.
gov/breastfeeding/breastfeeding-
IS IT OKAY FOR MY BABY TO USE A PACIFIER? DOES MY BABY NEED IRON? special-circumstances/vaccinations-
Pacifiers can reduce the risk of SIDS, Babies are born with stores of iron they medications-drugs/alcohol.html.
so it is ok to use one. If you want to try get from their mother during pregnancy.
it, it is best to wait until your baby is When babies are about 4 months old, It is not safe for you to use an illicit
comfortable breastfeeding. This allows they need an additional source of iron. If drug. Drugs such as cocaine, marijuana,
your baby time to learn how to latch well your baby was premature, they may need heroin, and PCP can harm your baby.
on the breast and get enough milk. extra iron. Talk with your baby’s doctor Some reported side effects in babies
about how much iron your baby needs. include seizures, vomiting, poor feeding,
DOES MY BABY NEED VITAMIN D? and tremors.
Vitamin D is needed to build strong IS IT SAFE TO SMOKE, DRINK, OR USE DRUGS?
bones. All infants should get at least If you smoke, it is best for you to quit as Talk to your doctor about whether
400 IU (10 mcg) of vitamin D each day. soon as possible. If you can’t quit, it is you can breastfeed if you are taking
Breastmilk alone does not provide infants still better to breastfeed because it can medication to treat an opioid use
disorder.

30
CAN I TAKE MEDICINES IF I AM BREASTFEEDING? help protect your baby from getting the should temporarily refrain from
You can take certain medicines while same sickness. (See page 5 to learn about breastfeeding your infant or feeding
breastfeeding, but not all. Many antibodies.) your baby expressed breastmilk
medicines pass into breastmilk in from the affected breast. You may
small amounts, but most have no effect If you are sick with the flu, you can still breastfeed your infant and express
on the baby and can be used while breastfeed. It is important to take steps to milk from the unaffected breast but
breastfeeding. Always talk to your doctor keep your baby from getting sick. Wash should ensure that the lesions on
and pharmacist about medicines you are your hands with soap and water before the affected breast are completely
using and ask before you start using new touching your baby or any item that covered to avoid transmission.
medicines. This includes prescription your baby will touch. You should also • Have active varicella (chicken pox)
and over-the-counter drugs, vitamins, wash your hands anytime you sneeze infection that developed within 5
and dietary or herbal supplements. or cough on them. If you don’t feel well days before delivery or 2 days after
For some women with chronic health enough to breastfeed your baby, have delivery.
problems, stopping a medicine can be someone who is not sick give your baby
more dangerous than the effects it will expressed breastmilk. When you express You should not breastfeed if you:
have on the breastfed baby. your milk, you should wash your hands • Are infected with human T-cell
and, if you’re using a pump, follow lymphotropic virus type I or type II.
The National Library of Medicine offers recommendations for cleaning your • Take prescribed cancer
an online tool to learn about the effects pump parts. chemotherapy agents, such as
of medicines on breastfed babies. The antimetabolites.
website address is https://toxnet.nlm. Talk with your doctor, nurse, IBCLC, or • Are undergoing radiation therapy —
nih.gov/newtoxnet/lactmed.htm, and midwife about breastfeeding or feeding but talk to your doctor, nurse, IBCLC,
the LactMed app is available through your baby expressed breastmilk if you: or midwife because some nuclear
the Apple Store and Google Play. You • Have HIV or AIDS. You can also medicine therapies require only a
can discuss the information you find on contact a human milk bank if temporary break from breastfeeding.
LactMed with your doctor, nurse, IBCLC, you want to give your baby donor • Are infected with HIV
midwife, or pharmacist. breastmilk (see page 39 for more You can contact a human milk bank
information). if you want to give your baby donor
CAN I BREASTFEED IF I AM SICK? • Have untreated, active tuberculosis. breastmilk (see page 39 for more
Some women think that they should not You may be able to feed your information).
breastfeed when they are sick. But most baby expressed milk or resume
common illnesses, such as colds, seasonal breastfeeding after treatment.
flu, or diarrhea, can’t be passed through • Have active herpes lesions on
breastmilk. In fact, your breastmilk has your breast. If you have an
antibodies in it. These antibodies will active lesion on your breast you

31
YOUR GUIDE TO BREASTFEEDING

COMMON
QUESTIONS
WILL MY PARTNER BE JEALOUS IF I BREASTFEED? estrogen levels are lower during I HEARD THAT BREASTMILK CAN HAVE TOXINS IN IT
You can help prevent jealousy by these times. If you have vaginal FROM THE ENVIRONMENT. IS IT STILL SAFE FOR MY
preparing your partner before birth. dryness, you can try more foreplay BABY?
Explain that you need his or her support. and water-based lubricants. Although certain chemicals can appear
Discuss the important and lasting health • Leaking breasts. You can feed your in breastmilk, breastfeeding is still the
reasons to breastfeed. Remind your baby or express some milk before best way to feed and nurture young
partner that the baby will need to be fed lovemaking so your breasts will be infants and children. The known risks
somehow. Any method will take time, but more comfortable and less likely of not breastfeeding far outweigh any
once breastfeeding is going smoothly, it to leak. It is common for a woman’s possible risks from environmental
is convenient and comfortable. Be sure breasts to leak or even spray milk pollutants. Remember that your baby
to emphasize that not breastfeeding during sex, especially during her was once inside your body and was
can cost you money. Your partner can orgasm. If this happens, put pressure exposed to the same things you were
help by changing and bathing the baby, on your nipples or have a towel exposed to during pregnancy.
sharing household chores, and simply handy to catch the milk.
sitting with you and the baby to enjoy the The concern over environmental toxins
special mood that breastfeeding creates. DO I STILL NEED BIRTH CONTROL IF I AM is a reason to breastfeed, not avoid it.
BREASTFEEDING? Infant formula, the water it is mixed
DO I HAVE TO RESTRICT MY SEX LIFE WHILE Yes. Your doctor will likely discuss with, or the bottles or nipples used to
BREASTFEEDING? birth control with you before you give give it to the baby can be contaminated
No, but you may need to make some birth. Breastfeeding is not a sure way to with bacteria or chemicals. Good
adjustments to make sex more prevent pregnancy, even though exclusive hygiene and sources of clean water are
comfortable for you and your partner if breastfeeding can delay the return of very important if formula is used.
you have the following: normal ovulation and menstrual cycles.
• Vaginal dryness. Some women Some hormonal birth control may affect
experience vaginal dryness milk supply. Discuss with your doctor
right after childbirth and during birth control choices that you can use
breastfeeding. This is because while breastfeeding.

32
DOES MY BREASTFED BABY NEED VACCINES? IS IT SAFE WHAT SHOULD I DO IF MY BABY BITES ME? WHAT DO I DO IF MY BABY KEEPS CRYING?
FOR ME TO GET A VACCINE WHEN I’M BREASTFEEDING? If your baby starts to clamp down, you If your baby does not seem comforted
Yes. Vaccines are very important to your can put your finger in your baby’s mouth by breastfeeding or other soothing
baby’s health. Breastfeeding may also and take them off your breast with a firm measures, talk to your baby’s doctor. The
help your baby respond better to certain “no.” Try not to yell, as it may scare the doctor and a lactation consultant can
immunizations that protect your baby. baby. If your baby continues to bite you, help you find ways to help your baby eat
Follow the schedule your baby’s doctor you can: well.
gives you and, if you miss any vaccines, • Gently press your baby to your
check with the doctor about getting your breast. This will cause your baby to
baby back on track as soon as possible. open her mouth more to breathe.
Breastfeeding while the vaccine is given • Stop the feeding right away so your
to your baby, or immediately afterward, baby is not tempted to get another
can help relieve pain and soothe an upset reaction from you. Don’t laugh. This
baby. is part of your baby’s learning of
limits.
Nursing mothers may also receive most • Offer a cold teething toy or frozen
vaccines. Breastfeeding does not affect wet washcloth before breastfeeding
the vaccine, and most vaccines will so your baby’s gums are soothed
not harm your baby because they do already.
not enter your breastmilk. However, • Put your baby down for a moment
vaccines for smallpox and yellow fever to show that biting brings a negative
can be passed through breastmilk. Avoid consequence. You can then pick your
these vaccinations if possible while baby up again to give comfort.
breastfeeding and talk to your doctor.

33
YOUR GUIDE TO BREASTFEEDING

BREASTFEEDING A BABY
WITH A HEALTH PROBLEM
Some health problems in babies can you, you can express or pump your milk
make it harder for them to breastfeed. and give it to your baby with a dropper,
But breastmilk provides the healthy start spoon, or cup.
your baby needs — even more so if your
baby is premature or sick. Even if your Some common health problems in
baby cannot breastfeed directly from babies are listed below.

JAUNDICE

Jaundice is caused by an excess of more frequent breastfeeding or feeding

bilirubin. Bilirubin is found in the blood of expressed breastmilk or after the
but usually only in very small amounts. mother’s milk comes in.
In the newborn period, bilirubin can
build up faster than it can be removed Your baby’s doctor may monitor your
from the intestinal tract. Jaundice can baby’s bilirubin level. Some babies with
appear as a yellowing of the skin and jaundice may need treatment with a
eyes. It affects most newborns to some special light (called phototherapy). This
degree, appearing between the second light helps break down bilirubin into a
and fifth day of life. Jaundice usually form that can be removed from the
clears up by 2 weeks of age and is body easily.
typically not harmful.
Keep in mind that breastfeeding is best
Some breastfed babies develop jaundice for your baby. Even if your baby gets
when they do not get enough breastmilk, jaundice, this is not something that you
either because of breastfeeding caused. Your doctor can help you make
challenges or because the mother’s milk sure that your baby eats well and that the
hasn’t come in. This type of breastfeeding jaundice goes away.
jaundice usually clears up quickly with

If your baby develops jaundice, let

your baby’s doctor know. Discuss
treatment options and let the
doctor know that you do not want
to interrupt breastfeeding if at all
possible.

34
 REFLUX DISEASE

Some babies have a condition called • Irritability and inconsolable crying Many healthy babies might have some
gastroesophageal reflux disease (GERD). as if in discomfort of these symptoms and not have GERD.
GERD happens when the muscle at the • Arching of the back as if in severe Also, some babies with only a few of
opening of the stomach opens at the pain these symptoms have a severe case of
wrong times. This allows milk and food • Refusal to eat or pulling away from GERD. Not all babies with GERD spit
to come back up into the esophagus, the the breast during feeding up or vomit. Talk to your baby’s doctor if
tube in the throat. Some symptoms of • Waking up often at night your baby has symptoms of GERD. More
GERD include: • Slow weight gain severe cases of GERD may need to be
• Severe spitting up or spitting up after • Gagging or choking or having treated with medicine.
every feeding or hours after eating problems swallowing
• Vomiting (the milk shoots out of • Respiratory/breathing problems
the mouth) (e.g., wheezing cough)

See your baby’s doctor if your baby spits up after every feeding and has any
of the other symptoms listed in this section. If your baby has GERD, it is
important to continue breastfeeding. Breastmilk is usually easier to tolerate
than formula for babies with GERD.

COLIC

Many infants are fussy in the evenings, Colic usually starts between 2 and 4 If your infant shows signs of colic, talk to
but if the crying happens for long periods weeks from birth. It will likely improve your doctor. Sometimes changing what
of time for no clear reason, it may be or disappear by 3 or 4 months after birth. you eat can help. Some infants seem to
colic. Colic is when a baby cries for more Doctors don’t know why some babies be soothed by being held, “worn” with a
than three hours a day and three times a get colic. Some breastfed babies may be baby wrap or sling, rocked, or swaddled
week without a clear cause. A baby may sensitive to a food their breastfeeding (wrapped snugly in a blanket). When
cry inconsolably or scream, extend or mother eats, such as caffeine, chocolate, your baby shows signs of trying to roll,
pull up his or her legs, and pass gas. The dairy, or nuts. Colic could be a sign of swaddling should no longer be used
baby’s stomach may be enlarged. Crying a medical problem, such as a hernia or because it is not safe.
can happen anytime, although it often some type of illness.
gets worse in the early evening.

35
YOUR GUIDE TO BREASTFEEDING

PREMATURE OR LOW BIRTH WEIGHT

Premature birth is when a baby is born SOME BABIES CAN BREASTFEED RIGHT AWAY. renting an electric pump. Call your
before 37 weeks. Prematurity often will This may be true if your baby was born insurance company or local WIC
mean that the baby is born at a low birth at a low birth weight but after 37 weeks. office to find out whether you are
weight, defined as less than 5½ pounds. These babies will need more skin-to-skin eligible for a breast pump.
When a baby is born early or is small contact to help keep warm. These smaller • Pump milk as often as you would
at birth, the mother and baby will face babies may also need feedings more normally breastfeed — about eight
added challenges with breastfeeding and often, and they may get sleepier during times in a 24-hour period.
may need to adjust, especially if the baby those feedings. • Give your baby skin-to-skin contact
has to stay in the hospital for extra care. once your baby is ready to breastfeed
Keep in mind that breastmilk has been EVEN IF YOUR BABY IS BORN PREMATURELY AND YOU directly. This can be very calming
shown to help premature babies grow ARE NOT ABLE TO BREASTFEED AT FIRST, YOUR BABY and a great start to your first feeding.
and stay healthy. CAN STILL BENEFIT FROM YOUR MILK. YOU CAN: Be sure to work with a lactation
• Use hand expression to express consultant on proper latch and
colostrum in the hospital as soon positioning. It may take some time
as you can. for you and your baby to get into a
• Talk to the hospital staff about good routine.

If you leave the hospital There are some health conditions that don’t allow you to
before your baby, you can breastfeed your baby at all. For example, babies that have
express milk for the hospital classic galactosemia, a rare genetic metabolic disorder,
staff to give the baby. cannot have breastmilk and need lactose-free formula. If
you or your baby have a health condition, talk with your
doctor about whether you can breastfeed.

36
BREASTFEEDING AND
SPECIAL SITUATIONS
TWINS OR MULTIPLES

The benefits of breastfeeding for mothers SEEKING SUPPORT – La Leche League Great Britain
of multiples and their babies are the Reach out to other moms of multiples lalecheleague.org.uk/twins
same as for all mothers and babies — and get help and information by: – Mothering Multiples: Breastfeeding
possibly greater, since many multiples • Finding a lactation consultant who and Caring for Twins or More!
are born early. The idea of breastfeeding has experience with multiples. Ask • Joining a support group for parents
more than one baby may seem the lactation consultant where you of multiples through your doctor,
overwhelming at first! Many moms of can rent a breast pump if the babies hospital, local breastfeeding center,
multiples find breastfeeding easier than are born early. or La Leche League International.
other feeding methods because there • Finding Internet and print resources
is nothing to prepare. Many mothers for parents of multiples. Some good
successfully breastfeed more than one resources include:
baby even after going back to work.

Even if your babies need to spend time in the neonatal intensive care unit,
DID YOU KNOW? breastfeeding is still possible with some adjustments.

37
YOUR GUIDE TO BREASTFEEDING

MAKING ENOUGH MILK • If your babies are born early, using • It helps to have each baby feed
Most breastfeeding mothers can make an electric double breast pump in from both breasts. You can “assign”
plenty of milk for twins. Many mothers between nursing sessions will help a breast to each baby for a feeding
exclusively breastfeed or express their you make more milk. and switch at the next feeding. Or
milk for triplets or quadruplets. Keep • The doctor’s weight checks can you can assign a breast to each baby
these tips in mind: tell you whether your babies are for a day and switch the next day.
• Breastfeeding soon and often after getting enough breastmilk. You can Switching sides helps keep milk
birth is helpful for multiples the also track wet diaper and bowel production up if one baby isn’t
same way it is for one baby. The movements to tell whether your eating as well as the other baby. It
more milk that is removed from babies are getting enough milk. also gives babies a different view to
your breasts, the more milk your For other signs that your babies are stimulate their eyes.
body will make. getting enough milk, see page 20.

Many breastfeeding basics are the When they were first born, it was too overwhelming for me to care for them at
same for twins or multiples as they the same time. I fed them one at a time, which was nice, because I was able to
are for one baby. Learn more about bond with each individually. But then I realized that I was pretty much feeding
these important topics: one of them every one to two hours, and in order to get more sleep, I started
• How to know your babies are feeding them at the same time. Once I got the hang of feeding both at once, I
getting enough milk (page 20) was able to free up so much more time! They started to get on the same eating/
• How to troubleshoot common sleeping schedule, and while both were sleeping, I would find myself having a
challenges (page 22) solid two to three hours to catch up on some sleep, relax, and clean up around
• Ways to keep milk supply the house. It was so liberating and much needed! I’m so glad I figured out
up (page 23) something that worked for all of us.
– Jen, Charleston, South Carolina

BREASTFEEDING AFTER BREAST SURGERY

How much milk you can make depends than people who had incisions around If you have had surgery on your breasts
on how your surgery was done, where or across the areola, which can cut into for any reason, talk with a lactation
your incisions are, and the reasons for milk ducts and nerves. People who have consultant. If you are planning to have
your surgery. People who have had had breast implants usually breastfeed breast surgery, talk with your surgeon
incisions in the fold under the breast are successfully. about ways he or she can preserve as
less likely to have problems making milk much of the breast tissue and milk ducts
as possible.

38
 ADOPTION AND INDUCING LACTATION

Many mothers who adopt want to will make. Some mothers won’t be able supply for your new baby. You might
breastfeed their babies and can do it to breastfeed exclusively and may need be able to prepare by pumping every
successfully with some help. In fact, to supplement their breastmilk with three hours around the clock for two to
many adoptive mothers can breastfeed donated breastmilk from a milk bank or three weeks before your baby arrives, or
exclusively, and those who have been with infant formula. you can wait until the baby arrives and
pregnant in the past may have an easier start to breastfeed then. You can also
time. Lactation is a hormonal response If you plan to adopt and want to try a supplemental nursing system or a
to a physical action. The stimulation of breastfeed, talk with both your doctor, lactation aid to ensure your baby gets
the baby nursing causes the body to see a nurse, midwife, or other breastfeeding enough nutrition and that your breasts
need for and make milk. The more your expert. They can help you decide the are stimulated to make milk at the
baby nurses, the more milk your body best way to try to establish a milk same time.

USING MILK FROM DONOR BANKS

If you can’t breastfeed and still want to – You have a specific illness (like HIV directly from other women or through
give your baby human milk, you may want or active tuberculosis). the Internet.
to consider a human milk bank. Some – You get radiation therapy, though
human milk banks can dispense donor some therapies may mean only a The Human Milk Bank Association of
human milk if you have a prescription brief pause in breastfeeding. North America (https://www.hmbana.
from your doctor. Many steps are taken to • Your baby isn’t thriving on formula org/) follows voluntary guidelines
ensure the milk is safe. because of allergies or intolerance. for safety, but are not regulated by
• You want to give your baby the federal government. They collect,
Some reasons you may want or need a breastmilk, but made the choice not process, and provide human milk
human milk bank include: to breastfeed or pump. donated by nursing mothers.
• You are unable to breastfeed because:
– Your baby was born premature. Some breastfeeding mothers give their To find out if your insurance will cover
– Your baby has other health milk directly to parents of babies in need. the cost of the milk, call your insurance
problems. This is called “casual sharing.” This milk company or ask your doctor. If your
– You take certain medicines that are has not been tested in a lab such as a insurance company does not cover the
dangerous for babies and can be human milk bank. The Food and Drug cost of the milk, talk with the milk bank
passed to your baby in your breastmilk. Administration recommends against about payment options.
feeding your baby breastmilk that you get

WHEN MOM OR BABY HAVE A HEALTH CONDITION

• In some situations, alternatives to condition that impacts your ability to besides your breastmilk. Learn
breastmilk may be necessary. You breastfeed. Speak with your doctor, more about the health conditions
or your baby may have a health nurse, IBCLC, or midwife before you that could prevent you from
decide to feed your baby anything breastfeeding your baby on page 31.

39
YOUR GUIDE TO BREASTFEEDING

BREASTFEEDING
IN PUBLIC
Some mothers feel uncomfortable keep your baby comforted and close
breastfeeding in public. You are feeding to you. Check with the Consumer
your baby and not doing anything wrong. Product Safety Commission for
Even though it may seem taboo in some warnings before buying a sling.
places, awareness of the support new • Breastfeed in a women’s lounge or
breastfeeding mothers need is building. dressing room in stores.
• Practice breastfeeding at home so
The federal government and many that you can make sure you are
states have laws that protect nursing revealing only as much as you feel
women. These laws are based on the comfortable with.
recognition of organizations such as • Face the wall at a restaurant or sit
the American Academy of Pediatrics, in a booth.
the American College of Obstetricians
and Gynecologists, the World Health It helps to breastfeed your baby before
Organization, and many others that he or she becomes fussy so that you have
breastfeeding is the best choice for the time to get into a comfortable place or
health of a mother and her baby. You can position to feed. (Over time, you will
see the laws in your state at the National learn your baby’s early hunger cues.)
Conference of State Legislatures website When you get to your destination, find a
at www.ncsl.org/research/health/ place you can breastfeed where you will
breastfeeding-state-laws.aspx. feel most comfortable.
It is important to believe in yourself and
your choice to breastfeed your baby. If someone criticizes you for
Remind yourself that you can succeed, breastfeeding in public, know the laws
and wear your confidence! where you are and don’t be afraid to
respond. Most of all, it is important to
Some tips for breastfeeding in public remember that you are meeting your
include: baby’s needs. It isn’t possible to stay
• Wear clothes that allow easy access home all the time, and you should (and
to your breasts, such as tops that pull can) feel free to feed your baby while
up from the waist or button down. you are out and about. You should be
• Use a special breastfeeding blanket proud of your commitment! Plus, no
around your shoulders. bottles mean fewer supplies to pack and
• Breastfeed your baby in a sling. Be no worries about getting the milk to the
aware that some slings may be risky right temperature.
for newborns. Slings or other soft
infant carriers are especially helpful
for traveling — it makes it easier to

40
PUMPING AND STORING
YOUR MILK
PUMPING YOUR BREASTMILK

If you are unable to breastfeed your baby contains at least 60 percent alcohol. Make • Apply a warm, moist compress to
directly, it is important to remove milk sure the area where you are expressing your breasts.
during the times your baby normally and your pump parts and bottles are • Gently massage your breasts.
would feed. This will help you to clean. • Visualize the milk flowing down.
continue making milk. • Sit quietly and think of a relaxing
If you need help to get your milk to start setting.
Before you express breastmilk, be sure flowing, you can:
to wash your hands with soap and water. • Think about your baby. Bring a
If soap and water are unavailable, use photo or a blanket or item of clothing
an alcohol-based hand sanitizer that that has your baby’s scent on it.

41
YOUR GUIDE TO BREASTFEEDING

WAYS TO EXPRESS YOUR MILK BY HAND OR PUMP

TYPE HOW IT WORKS WHAT’S INVOLVED AVERAGE COST

HAND You use your • Requires practice, skill, and coordination. Free
EXPRESSION hand to gently • Gets easier with practice, and can be as fast as pumping.
massage and • Good if you are seldom away from your baby or you need an
compress your option that is always with you. All moms should know how to
breast to remove hand express, in case they need to do it unexpectedly. Watch
milk. a video at http://med.stanford.edu/newborns/professional-
education/breastfeeding/hand-expressing-milk.html.

MANUAL You use your • Requires practice, skill, and coordination. $30 to $50
PUMP hand and wrist • Useful for occasional pumping if you are away from your baby (may be
to operate a only once in a while. covered by
hand-held • May put you at higher risk of breast infection. insurance).
device to pump
the milk.

ELECTRIC Runs on battery • Can be easier for some moms. $150 to

BREAST or plugs into an • Can pump one breast at a time or both breasts at the same time. more than
PUMP electrical outlet. • Double pumping may collect more milk in less time, which is $250 (often
helpful if you are going back to work or school full-time. covered by
• Need a place to clean and store the equipment between uses. insurance).

You can rent an electric pump from a Your health insurance plan may cover Learn more about your breastfeeding
lactation consultant at a local hospital or the cost of a breast pump. You may be benefits at Healthcare.gov/coverage/
from a breastfeeding organization. This offered a rental or a new pump you can breast-feeding-benefits/ and talk to your
type of pump works well for creating a keep. Your plan may provide guidance insurance company to learn their specific
milk supply when a new baby can’t feed on whether you will receive a manual or policies on breast pumps.
at the breast. Mothers who struggled with electric pump, how long the coverage of
other expression methods may find that a rented pump lasts, and when they’ll
these pumps work well for them. provide the pump. Talk to your insurance
company to learn more.

42
 STORING YOUR BREASTMILK

Breastmilk can be stored in clean glass provider, label the container with • Store milk in the back of the freezer
or hard BPA-free plastic bottles with your child’s name and talk with — not on the shelf in the freezer
tight-fitting lids. You also can use milk your childcare provider about other door.
storage bags, which are made for requirements they might have for
freezing human milk. Never store labeling and storing breastmilk. TIPS FOR THAWING AND WARMING MILK
breastmilk in disposable bottle liners • Refrigerate or chill milk right after it • Use the oldest stored milk first.
or plastic bags that are not intended is expressed. Do not store breastmilk • Thaw frozen milk in the refrigerator
for storing breastmilk. in the door of the refrigerator. overnight, or you can hold the frozen
• Freeze expressed breastmilk right bag of milk under warm running
Storage bottles or bags to refrigerate or away if you do not think you will use water or setting it in a container of
freeze your breastmilk may qualify as tax- it within four days. warm water. Test the temperature
deductible breastfeeding gear. • Use any leftover breastmilk your by dropping some on your wrist. It
baby doesn’t finish during a feeding should be comfortably warm.
BEFORE EXPRESSING OR HANDLING BREASTMILK within two hours. After two hours, • Find the right breastmilk
• Wash your hands well with soap leftover breastmilk should be temperature for your baby.
and water. If soap and water are not discarded. Breastmilk does not necessarily need
available, use an alcohol-based hand • Store breastmilk in an insulated to be warmed. Some moms prefer to
sanitizer that contains at least 60 cooler bag with a frozen ice pack take the chill off and serve at room
percent alcohol. for up to 24 hours when traveling. temperature.
• Express breastmilk by hand or with a Use milk right away, store it in a • Do not put a bottle or bag of
manual or electric pump. refrigerator, or freeze it once you breastmilk directly on the stove or
• If using a pump, inspect the pump arrive at your destination. in the microwave. Microwaving milk
kit and tubing to make sure it is creates hot spots that could burn
clean. Discard and replace moldy TIPS FOR FREEZING MILK your baby and damage the milk.
tubing immediately. • Freeze breastmilk in small amounts • Swirl the breastmilk to mix
• If using a shared pump, clean pump of 2 to 4 ounces (or the amount that the fat. Shaking the milk is not
dials, power switch, and countertop will be offered at one feeding) to recommended — this can cause
with a disinfectant wipe. Pump kits avoid wasting breastmilk that might some of the milk’s valuable parts to
should not be shared. not be finished. Freezing small break down.
amounts of breastmilk also allows • Use thawed breastmilk within 24
AFTER EACH PUMPING you to thaw milk faster. hours (this means from the time it
• Label the storage container with • Try to leave an inch or so between is no longer frozen or completely
the date. If you will be delivering the milk and the top of the container thawed, not from the time when you
breastmilk to your childcare because milk will expand when took it out of the freezer). Do not
freezing. refreeze thawed breastmilk.

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YOUR GUIDE TO BREASTFEEDING

SAFELY CLEAN PUMP EQUIPMENT germs in the sink could contaminate with a sanitize setting. Sanitizing is
Clean, sanitize, and store your items. especially important if your baby
pump equipment properly. This will • Air dry the items on a clean is less than 3 months old, was born
help protect your breastmilk from dishtowel or paper towel. prematurely, or has a weakened immune
contamination. • Using clean hands, store the parts in system due to illness or medical
• Take apart breast pump tubing a clean, protected area. treatment.
and separate all parts that • Discard and replace moldy tubing
come in contact with your immediately. Make sure you also clean, sanitize,
breast and breastmilk. • If using a shared pump, clean pump and store your baby’s bottles and other
• Rinse the breast pump parts by dials, power switch, and countertop feeding items properly.
holding them under running water with a disinfectant wipe. Pump kits
to remove remaining milk. Do not should not be shared. For more information, visit
place parts in sink to rinse. https://www.cdc.gov/healthywater/
• Clean pump parts in a dishwasher For extra germ removal, sanitize pump hygiene/healthychildcare/
or by hand in a clean basin with parts, wash basin, and bottle brush at infantfeeding.html.
soap and water. Do not wash the least once daily after they have been
parts directly in the sink because the cleaned. Items can be sanitized using
steam, boiling water, or a dishwasher

I was committed to breastfeeding, but learning to nurse while learning to take care of
a newborn was tough. My baby hated taking the entire nipple, and slipping off as she
nursed was painful. And when it’s 3 a.m. and your baby is fussing and you are sore,
those bottles are incredibly tempting.

At the same time, most of the health professionals I came in contact with — as
well as many of my family members and friends — seemed to be undermining my
breastfeeding relationship. My day care providers seemed afraid of my breastmilk, my
workplace didn’t offer me a place to pump, and other mothers would act as though my
breastfeeding was condemning their choice not to.

But I remembered that my nurse, Charlene, asked me to give it at least 8 weeks. I

remembered that advice and decided to wait a little longer. I went back to Charlene
for help, and she showed me how to combat my daughter’s slipping latch. She also put
me in touch with a local support group and helped me find professionals who really
knew how to help. They got me through the most critical period, but it was only my
willingness to seek out their guidance that allowed me to keep nursing. Don’t be afraid
to ask for help whenever you need it!
– Lin, Lock Haven, Pennsylvania

44
 GUIDE TO STORING FRESH BREASTMILK FOR USE WITH HEALTHY FULL-TERM INFANTS

TYPE OF BREAST MILK STORAGE LOCATION AND TEMPERATURES

COUNTERTOP REFRIGERATOR FREEZER

77°F (25°C) or colder 40°F (4°C) 0°F (-18°C) or colder
(room temperature)

FRESHLY EXPRESSED OR Up to 4 Hours Up to 4 Days Within 6 months is best

PUMPED Up to 12 months is acceptable

THAWED, PREVIOUSLY 1–2 Hours Up to 1 Day NEVER refreeze human milk

FROZEN (24 hours) after it has been thawed

LEFTOVER FROM A FEEDING Use within 2 hours after the

(BABY DID NOT FINISH THE baby is finished feeding
BOTTLE)

You can keep germs from getting

into the milk by washing your
pumping equipment with soap
and water and letting it air dry.
For more information, visit: https://
www.cdc.gov/healthywater/hygiene/
healthychildcare/infantfeeding.html.

Source: https://www.cdc.gov/breastfeeding/recommendations/handling_breastmilk.htm

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YOUR GUIDE TO BREASTFEEDING

GOING BACK TO
WORK OR SCHOOL
Taking time off after you give birth can help you become more comfortable with
breastfeeding and pumping and settle into a good breastfeeding routine. It also helps
your body recover. Take as much time off as you can. Find more information about
returning to work here https://www.fns.usda.gov/tn/breastfed-babies-welcome-here.

BEFORE YOUR BABY IS BORN

Planning ahead for your return to work • Discuss different types of schedules company or school. Ask the lactation
or school can help ease the transition. with your boss or academic advisor, program director, your supervisor,
Learn as much as you can ahead of time such as going back part-time at first, your academic advisor, your school
and talk with your employer or academic registering for morning or evening health center, the wellness program
advisor about your options. This can help classes, or taking split shifts. director, the employee human
you continue to enjoy breastfeeding your • Find out if your company or school resources office, or other coworkers
baby long after you return from taking offers a lactation support program or classmates if they know of other
time off.5 for employees or students. women who breastfed after returning
• Talk to other women at your to work or school.

DURING YOUR TIME OFF

• Take as many weeks off as you can. • Help your baby adjust to taking • Work with your doctor, nurse, IBCLC,
At least six weeks of leave can help breastmilk from a bottle (or cup, or midwife to find the best way to
you recover from childbirth and syringe, or dropper). Babies used to feed your baby breastmilk when you
settle into a good breastfeeding nursing might prefer to take milk a return to work.
routine. Twelve weeks is even better. different way when someone else • Talk with your family and your child
• A breast pump may be the best gives it.” care provider about your desire to
method for efficiently removing milk • If possible, wait at least a month breastfeed. Let them know you will
during the workday or school day. before introducing a bottle (cup, need their support.
syringe, or dropper) to your infant.

5
Ogbuanu, C., Glover, S., Probst, J., Liu, J., Hussey, J. (2011). The effect of maternity leave length and time of return to work on breastfeeding. Pediatrics; 127(6):e1414-27)

46
 BACK AT WORK OR SCHOOL

• Keep talking with your supervisor more time to adjust. baby from child care, take time
or academic advisor about your • If your child care is close by, find out to breastfeed first. This will give
schedule and what is or isn’t working whether you can visit to breastfeed you both time to reconnect before
for you. Keep in mind that returning over lunch. traveling home and returning to
to work or school gradually gives you • When you arrive to pick up your other family responsibilities.

GET A QUALITY BREAST PUMP

A good-quality electric breast pump Electric pumps that allow you to express more information on types of breast
may be your best strategy for efficiently milk from both breasts at the same time pumps and how to work with your
removing milk during the workday. reduce pumping time. See page 42 for insurance company to get them.

FIND A PRIVATE PLACE TO EXPRESS MILK

Work with your supervisor or school to use an office with a door, a conference Explain to your supervisor that it is
administrator to find a private place to room, or a little-used storage area. best not to express milk in a restroom.
express your milk. Restrooms are unsanitary, and there are
The room should be private and secure usually no electrical outlets. It can also
If your company does not provide a from intruders when in use. The room be difficult to manage a pump in a
private lactation room, find another should also have an electrical outlet if toilet stall.
private area you can use. You may be able you are using an electric breast pump.

WHEN TO EXPRESS MILK

At work or school, you will need to Expressing milk can take about 10 to 15
express and store milk during the times minutes. Sometimes it may take longer.
you would normally feed your baby. Many women use their regular breaks
(In the first few months of life, babies and lunch break to pump.
need to breastfeed eight to 12 times in 24
hours.) This turns out to be about two to
three times during a typical eight-hour
work period. As the baby gets older, the
number of feeding times may go down.

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YOUR GUIDE TO BREASTFEEDING

You may need to pump two to three times each day to make enough milk for your
baby while he or she is with a caregiver. Research shows that breastfed babies
between 1 and 6 months old take in an average of two to four ounces per feeding.
HOW MUCH MILK SHOULD
I SEND WITH MY BABY Some babies eat less during the day when they are away from their breastfeeding
DURING THE DAY? mothers and then nurse more often at night. This is called “reverse-cycling.” Babies
may eat during the day and still nurse more often at night. This may be more for the
closeness with you that your baby craves. If your baby reverse-cycles, you may find
that you do not need to pump as much milk for your baby during the day. Track your
baby’s weight and diapers to make sure your baby gets enough milk.
(See page 20 for more ways to tell whether your baby is getting enough milk.)

PUMPING TIPS

It may take time to adjust to pumping down from the milk ducts: • Think about your baby. Bring a
breastmilk in a work or school • Relax as much as you can. photo of your baby or a blanket or
environment. For easier pumping, try • Gently massage your breasts. item of clothing that smells like
these tips for getting your milk to let • Visualize the milk flowing down. your baby.

STORING YOUR MILK

Breastmilk is food, so it is safe to keep it If you work in a medical department, do Be sure to label the milk container with
in any clean refrigerator used for food not store milk in the same refrigerators your name and the date you expressed
storage or a cooler with ice packs. Talk to where medical specimens are kept. the milk.
your supervisor or school administrator
about the best place to store your milk.

SUPPORTING NURSING MOMS AT WORK

The Office on Women’s Health has resources to help businesses support nursing
mothers at work at this website https://www.womenshealth.gov/supporting-
nursing-moms-work. This site offers cost-effective tips and time and space
YOUR BUSINESS CAN TAKE solutions listed by industry.
EASY STEPS TO SUPPORT
BREASTFEEDING! THE BUSINESS CASE FOR BREASTFEEDING
The Office on Women’s Health partnered with the Health Resources and
Services Administration to create a toolkit that encourages business owners to
support breastfeeding. The program points out the benefits of breastfeeding
to businesses and gives them easy steps to make a breastfeeding-friendly work
environment. Share this site with your employer: https://www.womenshealth.
gov/breastfeeding/breastfeeding-home-work-and-public/breastfeeding-and-
going-back-work/business-case.

48
NUTRITION
AND FITNESS
HEALTHY EATING

A healthy diet is important for moms Keep these important nutrition tips in • Talk to your doctor about taking
who are breastfeeding babies, but many mind: a supplement. Vitamin and
new moms wonder whether they should • Drink plenty of fluids to stay mineral supplements should not
be on a special diet while breastfeeding. hydrated. Drink when you are thirsty, replace healthy eating, but in
The answer is no. In fact, you can and drink more fluids if your urine is addition to healthy food choices,
continue to enjoy the foods that are dark yellow. some breastfeeding women may
important to your family, including the • Limit drinks with added sugars, such need a multivitamin and mineral
special meals you know and love. as sodas and fruit drinks. supplement.
• Limit the amount of caffeine you • Talk to your doctor or nutritionist
As for how your eating habits affect your get each day. Drinking a moderate to ensure you are consuming the
baby, there are no special foods that amount (one or two cups a day) of right amount of calories and a well-
will help you make more milk. You may coffee or other caffeinated beverages balanced, nutrient-rich diet.
find that some foods you eat can cause does not cause a problem for most • See page 30 for information on
stomach upset in your baby. You can try breastfeeding babies. Too much drinking alcohol and breastfeeding.
avoiding those foods to see if your baby caffeine can cause the baby to be
feels better and ask your baby’s doctor fussy or not sleep well.
for help.

Fish and other protein-rich foods have

nutrients that can help your child’s
growth and development. This chart
ADVICE ABOUT EATING FISH can help you choose which fish to eat,
and how often to eat them, based on
their mercury levels. https://www.fda.
gov/media/102331/download.

If you follow a diet that does not include any forms of animal protein (meat,
fish, milk and milk products, and eggs), you or your baby might not get enough
vitamin B-12. In a baby, B-12 deficiency can cause symptoms such as loss of
VEGAN DIETS appetite, slow motor development, being very tired, weak muscles, vomiting,
and blood problems. You can help protect your and your baby’s health by taking
vitamin B-12 supplements while breastfeeding. Talk to your doctor about your
supplement needs.

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YOUR GUIDE TO BREASTFEEDING

GET A DAILY PLAN FOR MOMS DESIGNED JUST FOR YOU.

The USDA’s online, interactive tool can help you choose foods based on your
CHOOSEMYPLATE FOR MOMS baby’s nursing habits and your energy needs. Visit choosemyplate.gov/browse-
by-audience/view-all-audiences/adults/moms-pregnancy-breastfeeding to
figure out how much you need to eat, choose healthy foods, and get the vitamins
and minerals you need.

CAN THE FOOD I EAT AFFECT MY BREASTMILK?

Sometimes a baby may be sensitive to • Fussiness during or after feedings Talk with your baby’s doctor if you notice
something the breastfeeding mother • Inconsolable crying for long periods your baby having any of the symptoms
eats such as eggs or dairy products like • Sudden waking with discomfort listed above. If your baby ever has
milk and cheese. Watch your baby for • Wheezing or coughing problems breathing, call 911 or go to your
the symptoms listed below, which could nearest emergency room.
indicate that your baby has an allergy or These signs do not mean your baby is
sensitivity to something you eat: allergic to your milk, only to something
• Diarrhea, vomiting, green stools with that you ate. You may need to stop eating
mucus or blood whatever is bothering your baby or eat
• Rash, eczema, dermatitis, hives, less of it. You may find that after a few
dry skin months you can eat the food again with
better results.

FITNESS

Being active helps you stay healthy, feel

better, and have more energy. It does
not affect the quality or quantity of your
breastmilk or your baby’s growth. It
may help to wear a comfortable support
bra or sports bra and pads in case you
leak during physical activity. It is also
important to drink plenty of fluids. Be
sure to talk to your doctor about how
and when to slowly begin exercising
following your baby’s birth.

50
HANDLING
STRESS
Both short- and long-term stress can SURROUND YOURSELF WITH SUPPORTIVE PEOPLE.
affect your body. In fact, stress can make It really does take a village to raise a
you more likely to get sick. It can also child. Let family and friends help you
make problems you already have worse. with housework or hold your baby while
It can play a part in a range of issues, you rest or take a bath.
including trouble sleeping, stomach
problems, headaches, and mental health GET MOVING.
conditions. Physical activity improves your mood.
Your body makes certain chemicals,
Having a new baby and learning called endorphins, before and after you
to breastfeed may be stressful. It is exercise. These relieve stress and improve
important for new mothers to take care of your mood. If you are a new mother,
themselves. Try to listen to your body so ask your doctor when it is okay to start
that you can tell when stress is affecting exercising.
your health.
DON’T DEAL WITH STRESS IN UNHEALTHY WAYS.
Take these steps to help ease stress while This includes drinking too much alcohol,
breastfeeding: using drugs, or smoking, all of which
can harm you and your baby. It is also
RELAX. unhealthy to overeat in response to stress.
Try and find a quiet, comfortable,
relaxing place to nurse. This will help GET HELP FROM A PROFESSIONAL IF YOU NEED IT.
make breastfeeding more enjoyable for A therapist can help you work through
you and your baby. Use this time to bond stress and find better ways to deal with
with your baby, listen to soothing music, problems. Medicines can help ease
meditate, or read a book. symptoms of depression and anxiety
and help promote sleep. Talk to your
SLEEP. doctor or pharmacist before taking
Your stress could get worse if you don’t any medicine. See page 31 for more
get enough sleep. With enough sleep, it information.
is easier to cope with challenges and stay
healthy. Try to sleep whenever possible.

Breastfeeding may help mothers

relax and handle stress better.
DID YOU KNOW? Skin-to-skin contact with your
baby has a soothing effect.

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YOUR GUIDE TO BREASTFEEDING

WEANING
YOUR BABY
Are you ready to wean? Do you think your child is ready In the normal course of breastfeeding, weaning happens
to wean? gradually and without any conscious effort or action. However,
you may have a desire or reason to wean before your child
From the first time you feed your baby something other would have naturally stopped nursing or receiving your milk.
than your milk, the process of weaning begins. Weaning is
the journey between when your child is fully breastfed (or If you need or want to actively wean before it happens on its
breastmilk-fed, if you feed expressed milk) and when your child own, it is best for you and your child to go slowly. Weaning
stops nursing for comfort and nutrition. suddenly can be physically painful for you and emotionally
hard on you and your baby.

WHEN TO WEAN YOUR BABY

In cultures where there is no social the toddler years and beyond. If you have been advised to stop
pressure to wean, children usually stop Breastfeeding is good for mother and breastfeeding because you need surgery
breastfeeding or receiving their mother’s child at any age, and no evidence has or you take a certain medicine, be sure
milk between 2½ and 7 years old.6 been found of developmental harm to get a second opinion. There are very
from breastfeeding an older child. few reasons that complete weaning is
In families that let it happen on its own, absolutely necessary. In most cases, you
weaning happens very gradually, often You may also want to consider delaying can still breastfeed after surgery, and
without any fuss, process, or effort. weaning if: many medicines are safe for both baby
• Your child is teething or sick. Your and the breastfeeding mother.
The American Academy of Pediatrics baby will need extra comfort during
recommends: these times. Also, the antibodies in Talk to an IBCLC who can help you
• Breastfeed exclusively (no other your breastmilk help your baby fight decide whether you truly need to wean or
foods or drinks) for the first 6 months off illness and germs. just need some help getting you and your
of your baby’s life. • Your family is going through a baby through a difficult time.
• After 6 months of age, continue to major change, like moving or if you
breastfeed and begin to add solid recently went back to work and your Also, try not to make the decision to wean
foods (this is when weaning begins). baby is now in child care. on a day when breastfeeding is difficult.
• After your baby’s first birthday, • Your baby is struggling. If your
continue to breastfeed for as long baby is resisting all your attempts
as both you and your baby are to wean, it may just not be the right
comfortable. Some mothers and time. If you can, wait and try again in
babies continue to nurse into another month or two.

6
Dettwyler, K. A., Stuart-Macadam, P. (Eds.). (1995). Breastfeeding: Biocultural Perspectives. Piscataway, NJ: Aldine Transaction. Accessed on August 4, 2014, from Rogoff, B. (2003).
The Cultural Nature of Human Development. Oxford University Press. pp. 64–65.

52
 HOW TO TELL WHEN YOUR CHILD IS READY TO WEAN

Children who wean themselves rarely do You can watch for these signs, but they HE OR SHE LOSES INTEREST IN NURSING.
so suddenly and without warning. The may be so gradual you may not notice: Young children (younger than a
process is generally slow and gradual, year) who seem to lose interest in
even for babies who wean from the breast NURSING SESSIONS HAPPEN LESS OFTEN. breastfeeding may do so because they
earlier than is normal due to separation As children age, they naturally become get the comfort they need from sucking
from their breastfeeding mother, pacifier more occupied with playing, exploring, on pacifiers or their thumbs. These
use, or bottle-feeding. and using their new skills like walking, comforting behaviors may be more
talking, and eating interesting foods. familiar to them than nursing. For these
If your baby suddenly rejects your breast, Nursing sessions get further apart, even babies, weaning from the breast may
it is more likely a nursing strike, not a to the point of happening once a day, or, not be difficult, but their nutritional and
readiness to wean. Read more about as time goes on, once every few days or a emotional needs will remain.
nursing strikes on page 28. few times a month.

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YOUR GUIDE TO BREASTFEEDING

It depends on the age of your child, and whether they are able to get enough
nutrition from other foods and beverages.

IF YOUR BABY IS YOUNGER THAN 1 YEAR, it depends on how much breastmilk your baby
DOES MY CHILD NEED is still getting. Talk to your baby’s doctor to determine if your baby needs formula
FORMULA WHEN I WEAN? and how much.

IF YOUR BABY IS OLDER THAN 1 YEAR, they do not need formula.

HOW TO WEAN YOUR BABY

Weaning works best when it happens • You will need to substitute your milk • Remember, even if you and your
slowly, in its own time. However, there with formula if your baby is younger child are ready to wean, it can be
are some reasons you may have to stop than 1 year. If your baby is older hard emotionally on both of you.
breastfeeding before your baby is ready than 1 year, you can stop offering the Give your baby lots of extra love and
and even perhaps before you planned to breast and drop one feeding a time, attention during this time.
stop breastfeeding. over several weeks. • Talk to your child about weaning.
• Start by taking away his or her Even young children can understand
Weaning your child suddenly — going least favorite feeding first. Nursing what you are saying and offer their
“cold turkey” — may cause your breasts to sessions that come before falling opinions and ideas for how best to
become painfully engorged. asleep or after waking are often the stop breastfeeding.
ones to go last. Wait a few days to
• If your baby is still very young, you drop another feeding. Even when you wean slowly and
may need to express some milk from • Avoid sitting in your special nursing gradually, it may still be uncomfortable
your breasts or pump a tiny amount if chair, but do offer extra cuddles or for you. Try these tips to ease discomfort.
your breasts become uncomfortable. babywearing during this transition • Hand-express or pump just enough
Do not express or pump the amount so your child can still enjoy being milk to take the pressure off.
you normally would for a feeding. close to you. • Do not bind your breasts. This
When you pump or nurse, your • Distract your child with an activity can cause plugged ducts or a breast
breasts make more milk in response. or outing during the times when you infection.
By removing less milk than normal, would normally nurse. • Talk to your doctor about whether
your breasts will make less milk. • If your baby likes to nurse to sleep, a pain reliever, such as ibuprofen,
Contact an IBCLC if you have overly try a car ride or let your partner do might be helpful for you.
full breasts while weaning. the bedtime routine.

54
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YOUR GUIDE TO BREASTFEEDING

56
HEALTH INFORMATION FROM THE OFFICE ON WOMEN’S HEALTH

The Office on Women’s Health (OWH) offers a wide range of

health information for women and girls through our website
womenshealth.gov.

Follow us on Facebook (www.facebook.com/HHSOWH) or

Twitter (www.twitter.com/womenshealth) to get the latest on
breastfeeding and other women’s health topics.

www.womenshealth.gov
Empowering women to live healthier lives

www.womenshealth.gov/itsonlynatural
Sharing benefits of breastfeeding with African-American women

www.girlshealth.gov
Helping girls learn about health and growing up

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YOUR GUIDE TO BREASTFEEDING

www.womenshealth.gov

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