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The saying "breast is best" aptly describes how breast milk is nutritionally the ideal food for your baby.

It is gentle on your baby's digestive system, but beyond that, the breastfeeding relationship between mother and baby also provides nurturing intimacy as the two of you bond in this shared activity.

The American Academy of Pediatrics (AAP) recommends exclusive breastfeeding (meaning it is the only food your baby consumes) for at least 6 months. This includes offering breast milk either from your breasts or from bottles.

Learning How to Breastfeed

While breastfeeding is natural, it is still a learned process for both mother and baby. Both your milk and how you breastfeed will change as your baby develops. The nutrients in your milk change according to your baby's needs, such as the increase of anti-infective properties should your baby be exposed to a new bacteria or virus. Your baby's feeding routine will also change over time.

Below are some tips for beginning breastfeeding:

Early Breastfeeding

It may take some time for both you and your baby to become comfortable with breastfeeding, so be patient in the first few weeks. You will be recovering from delivery and your newborn will be getting used to his or her new surroundings. Allow this to be a time of learning for both of you as you develop a daily routine by keeping track of each feeding. Additionally, wet diapers can help your baby's pediatrician assess how feedings are going.

Day 1
The AAP recommends skin to skin contact immediately after birth. Skin to skin means laying a naked baby against your bare skin, typically on your chest. This encourages your baby to breastfeed for the first time while also keeping your baby warm and his or her blood sugar up. It is best to keep babies skin to skin for at least one hour.

The majority of full-term, healthy babies are ready to breastfeed within the first half hour to two hours after birth. But after the first few hours of being awake, babies can become sleepy or drowsy, and they may become more interested in sleeping than eating. It is typical to change only a couple diapers during the first 24 hours.

Days 2 to 4
Similar to the first day, your baby will likely only have a few wet and dirty diapers on the second and third days. Your baby may also lose weight during this time. Your baby's weight and the number of diaper changes will increase as your milk comes in.

During the first few days of breastfeeding, it is normal to have uterine cramps. This means your uterus is contracting, which lessens bleeding. It also is a positive sign that your baby's sucking has initiated milk let-down. With milk let-down, some mothers initially feel a flush of warmth or cooling through the breasts accompanied by a tingling, pins and needles sensation. To alleviate discomfort from cramping, a nurse can give you medicine before feeding your baby.

Most babies need practice with latching on and sucking at the breasts. By the second day, your baby should have a total of 8 to 12 feedings over 24 hours, which is a feeding about every 1 ½ to 3 hours. These frequent and early feedings tell your breasts to produce more milk and provide your baby with colostrum (antibody-rich first milk).

Since your baby is still learning to suck, your nipples may be sore when your baby latches on. Nipple tenderness is influenced by many factors, but it usually is mild and goes away within the first week. Consult your nurse if your nipples become cracked or if tenderness becomes worse. You may be referred to a lactation consultant.

Days 3 to 5
Your milk "comes in" 3 to 4 days after birth, which means that you will have more milk in your breasts for each feeding. Since your baby is drinking more milk, he or she may act more satisfied or fall asleep after a feeding.

Within 24 hours of your milk coming in, you will likely be changing more wet diapers. The texture of your baby's stools will also change in this first week.

The rate of your baby's weight gain will also increase during this time, typically to ½ an ounce gain a day. After your milk has come in, your breasts may feel heavier, fuller and warmer. The best thing to do during this time is to feed your baby frequently, which empties your breasts often, leading to the production of more milk.

Breast Engorgement
After your milk has come in, your breasts may become swollen and painful from too much milk. This is a temporary engorgement, as your body will regulate to match your milk production to your baby's feeding needs. During this time your baby may have trouble latching on to your breasts. Feeding your baby frequently may prevent this. If not, these tips may help alleviate discomfort:

  • Continue to breastfeed or express milk by hand or pump every 1 to 2 hours. Your breasts should feel softer after emptying them.
  • Express a small amount of milk by hand and then let your baby latch on. A warm compress or a warm shower before or during expressing may also encourage let-down.
  • After nursing, leave an ice pack on your breasts for 15 to 20 minutes if the pain is severe.

Days 5 to 28
As the first month continues, you and your baby will be getting better at breastfeeding together. Feed your baby about 8 to 12 times in 24 hours and let your baby decide when he or she is finished eating.

As you continue breastfeeding, your baby should:

  • Have six or more wet diapers a day, with pale yellow or clear urine.
  • Have three or more loose, yellow stools every day.
  • Gain two-thirds to one ounce of weight every day for the first three months.

If you are concerned that your baby is not eating enough, consult your baby's healthcare provider.

Pacifier Use

To decrease the risk of sudden infant death syndrome (SIDS), the AAP recommends introducing pacifiers. For breastfeeding mothers, the AAP recommends waiting until breastfeeding is well established so pacifier use doesn't interfere with the early stages of breastfeeding. Milestones of an established breastfeeding relationship are typically reached after three to four weeks and include:

  • Your baby is heavier than his or her original birth weight.
  • You feel comfortable breastfeeding your baby.
  • Your baby easily latches on your nipple.

Tips for Breastfeeding

Every baby nurses in a slightly different way. Some like to take frequent breaks during a feeding and others like to drink milk quickly without interruption. Allow your baby to lead the feeding and set the pace.

Ways to let your baby lead the feeding include:

  • Letting your baby decide when he or she is finished nursing by allowing him or her to self-detach from the nipple. Self-detachment increases the amount of higher calorie and higher fat milk (hind milk) that your baby will drink.
  • Once your baby has self-detached from the nipple, you may offer your other breast. Often, babies will breastfeed for a shorter time on the second breast. Also, some babies feed better if they are burped between breasts or have their diaper changed between breasts. Some babies will be full from the first breast and will not need to drink from the second. In this case, offer the second breast first at the next feeding.

Your baby may want to keep sucking on your breast as a way to self-soothe, even after your breast is empty. With practice, you will be able to recognize sucking for nutrition from sucking for self-soothing. If your baby sucks for comfort and it becomes painful, gently detach your baby and offer a pacifier instead. If you think your baby may still be hungry, offer your other breast.

Paying attention to your baby's feeding cues will help you be sensitive to your baby's needs. Feeding cues include the following:

  • Your baby turns his or her head toward your breast
  • Your baby smacks or licks his or her lips
  • Crying (late sign of hunger)

Your baby may go through several growth spurts that last two to four days. During growth spurts, your baby may want to eat around the clock. Babies can have growth spurts between two to three weeks, four to six weeks, and again around three months. Allow your baby to eat more frequently during these growth spurts. Your baby's feedings will return to a regular pattern within a few days.

The breastfeeding relationship between mother and baby is unique for everyone. Every mother's milk storage capacity and production are different and every baby's needs and feeding times are also different. Trying to make your breastfeeding adhere to a strict schedule can result in poor weight gain for your baby. Instead, allow this relationship to develop and change naturally over time.

Amanda Votruba, MD

Methodist Physicians Clinic 192 Dodge Pediatrics

Dr. Votruba answers your questions about child health and parenting. As a pediatrician, Dr. Votruba feels that seeing the kids every day is the best part of her job. With four children, including one set of twins, she enjoys sharing her experience and assisting parents through all phases of their child's life. She feels that by knowing the child's health history she can help parents and patients feel more comfortable and trust that she will take this into account. She has college students ...

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