The nurturing instinct of new parents often leads them to focus heavily on their baby’s feeding: is she getting enough? Too much? Are we doing it right? Generally, if she’s growing, has at least five heavy wet disposable nappies each day, soft bowel motions and settles well after most feeds, then everything is just fine.
Breastfeeding alone for the first six months and then continuing for at least two years is recommended by the World Health Organization (WHO). Not only does breastmilk provide the best possible nourishment for your baby, but breastfeeding helps you bond, allows your uterus to contract quicker and can help you to lose the extra weight gained during pregnancy.
Breastmilk is easily digested and helps protect babies from many infections, diarrhoea, earaches and fever, and can delay the development of some allergies (but not prevent them).
First six months: basic breastfeeding method
Step 1 Posture & positioning
Early on, it’s vital that you and your baby find a feeding posture that’s comfortable for you both, which doesn’t strain your back, neck or shoulders. A steep-backed chair and a firm cushion or feeding pillow will provide support.
Ensure your feet are flat on the floor and your elbows are supported, as baby’s head usually rests on your forearm. To ensure the nipple isn’t pulled away from your baby’s mouth, hold her diagonally (feet down, head up) across your body, and go chest-to-chest, keeping her head, neck and shoulders in a straight line.
Line up baby’s nose with your nipple so as her mouth opens towards the breast and her head tilts back slightly, her mouth will move into the right position to suckle.
Step 2 Encouragement
Most babies will seek out the nipple when hungry – this is called the rooting reflex. If she’s a bit slow, encourage her by rubbing the nipple over her cheek and she’ll instinctively turn to it. Don’t touch her face once she’s heading for the nipple, as this will only confuse her.
Step 3 Attachment
The medical term given to the way your baby takes to the breast is ‘attaching’. If she does this correctly it will stimulate your milk supply, making sure she gets enough and you don’t suffer cracked nipples.
When the breast is first offered to your baby, make sure she opens her mouth wide and closes it around the areola (the dark area around your nipple), taking in a good mouthful of breast. To avoid damaging your breast, bring your baby to the breast and aim the nipple towards the roof of her mouth.
Step 4 Checking
Make sure baby’s mouth is open wide, as both her tongue and jaw muscles need to work. Her chin will be touching your breast, but her nose will be clear, so she’ll still be able to breathe easily. A baby’s turned-up nose means her nostrils will be clear of the breast when she’s attached.
When your baby is attached properly, she’ll have more of the underneath part of the areola in her mouth than the top. If she’s using her jaw muscles correctly, her temples and ears will be moving.
Step 5 Changing position
Once your baby is feeding and you see a rhythmic suck and swallow pattern, think about how the breast is feeling: are you experiencing any pain? If so, take baby off by gently slipping your little finger into her mouth and between her jaws, breaking the suction. Then attach her again.
Step 6 Finishing the feed
Let your baby finish at the first breast before she is offered the other; when she’s had enough she’ll turn away from the breast or fall asleep. If you have a sleepy baby, you may be advised to wake her so she’ll feed for longer. In this case, follow the guidance of your health professionals.
Step 7 Burping
Give your baby the chance to burp after the feed by putting her over one shoulder or holding her on your lap with your hand under her chin. Gently rub her back for a few minutes using slow, circular movements. Don’t worry if she doesn’t burp each time – you can put her to bed without hearing a burp.
● Breastfeeding is the perfect time to bond with your baby, so make it a calm and enjoyable experience for you both.
● Her mouth must be open wide as you aim the nipple towards the roof of her mouth.
● Try to make sure your baby gets a big mouthful of nipple and breast every time.
● She will usually bring her tongue down and forward over her gums in readiness to attach.
● Allow your baby to finish at one breast before offering the other.
● If your baby falls asleep at the breast, don’t worry. As long as you’re confident she has fed well, it’s fine to put her to bed.
● Try holding your baby in different positions to find the one that’s most comfortable for you both. Mothers with larger breasts may find the cradle or ’football’ hold easier.
Some babies and breasts go well together right from the start, but there are many mums and bubs who need a helping hand. Professional advice and information can be accessed at mother-and-baby centres, from midwives, lactation consultants and counsellors.
Another great source of information is the Australian Breastfeeding Association (ABA), which is a group that supports breastfeeding women. Trained counsellors offer a phone or email advisory service, as well as meetings, activities and publications.
When your milk first comes in, or when your baby starts to sleep longer and feed less, your breasts may start to become engorged, feeling hard, hot and painful. This occurs because there’s more milk in the breast than your baby can consume in one feed.
The best way to prevent engorgement in the early weeks is to feed your baby frequently (eight to 12 times in 24 hours). Consistently offering the first breast twice before the second will settle the breasts’ supply to meet your baby’s needs and give you relief.
For pain relief, try a cold compress for short periods on the breast. Taking paracetamol is also effective and safe for your baby.
Too much milk
You may find that you have so much milk it causes initial difficulties, but while over-supply can be inconvenient, it’s usually resolved in the first six weeks of your baby’s life. She may splutter at times when the milk ’lets down’ (you may feel the ’let down’ as a tingling sensation), but as the flow settles over time, she will feed without spluttering. In the meantime, try hand-expressing a little milk before feeding.
You may also find that your breasts leak between feeds, but there’s no need to do anything if you and your baby are coping. Cloth breast pads designed to keep the skin’s surface dry can help with leakage.
If there is soreness due to poor attachment (the most common cause), your nipple will look pinched or misshapen when your baby comes off the breast. Sore nipples usually heal on their own, but if pain persists beyond the first month, seek advice from a breastfeeding counsellor or lactation consultant.
When your baby’s first tooth comes through, she may try to gnaw or bite the nipple for comfort. If she does this, gently take her off the breast and firmly tell her, “No”.
If one of the tiny tubes that carries the breast-milk becomes blocked, the milk can’t flow well, which can cause a painful lump. It may be the result of a tight bra or an area not draining properly, or it might be caused by the breast being held too tightly while feeding. If the lump doesn't disappear after a breastfeed, try one of the following self-treatment methods.
● Have a hot shower or apply a hot pack to the top of the breast.
● Firmly but gently massage the lump, first in circles, then down towards the nipple.
● Feed your baby again or express a little milk by hand or pump.
To avoid developing an infection called mastitis, it’s important to get the milk moving again. If you feel unwell, have a temperature of more than 38°C, have muscle aches and a hard, reddened area on your breast, see your doctor.
Antibiotics may be prescribed to treat the infection, but it’s important to continue breastfeeding. Your baby is unlikely to be upset by this, but ask your GP for advice. If you’re prone to thrush, you may want to increase the acidophilus – an ingredient found in some yoghurts – in your diet.
It’s also a good idea to reduce sugars and yeast-based foods until the antibiotics are finished.
Feeding in public
Breastfeeding in public is a perfectly acceptable thing to do, after all, you’re doing what’s best for your baby. If anyone objects, politely and calmly tell them that you’re legally entitled to feed your child anywhere you like.
Is bub getting enough milk?
Many women worry about their ability to supply enough breastmilk for their baby. Since you can’t see how much she’s getting, it’s natural to wonder.
The following points are a guide to knowing if she is getting the right amount of milk:
● She is attaching correctly to the breast, suckling strongly and swallowing.
● She’s feeding eight or more times in 24 hours.
● Your baby is producing at least six to eight heavy wet cloth or five disposable nappies in 24 hours.
● Your breasts are softer after a feed.
● She settles after most feeds.
● Most feeds are finished within an hour of starting.
● Your baby is gaining weight and developing appropriately for her age.
During the first few months, your baby will have growth spurts and require more milk. To increase your milk production, feed her more frequently. You may feel this extra demand means your baby isn’t receiving enough milk, but once your supply increases her feeding patterns are likely to revert to normal.
Breastfeeding as contraception
The Lactational Amenorrhoea Method (LAM) is a natural form of contraception, whereby fertility is reduced while breastfeeding. It’s an unreliable form of family planning, but may be effective for a few months after childbirth. Your baby’s sucking motion activates LAM by stimulating the production of a natural chemical called prolactin. This cuts off the production of the follicle-stimulating hormone (FSH) and the luteinising hormone (LH) that a woman’s
body produces to ovulate.
If you’re interested in using LAM as contraception, talk to your GP. In order for it to have any chance of success, the following points must apply.
● Your baby must be younger than six months old.
● You must be fully breastfeeding – once you start introducing other foods, your normal fertility may return.
● Feed at intervals of no more than four hours. If you’re away from your baby for more than four hours, you need to express milk, as nipple stimulation is the key to ensuring LAM works.
● Your menstrual cycle has not resumed. If it has, then you must use another form of birth control.
It’s possible to continue breastfeeding after you’ve returned to work by making a few small adjustments.
● If your baby is cared for at or near to your workplace, talk to your boss to arrange breaks so that you can leave to breastfeed at normal feed times.
● You can express breastmilk at work, where you’ll need a quiet area (not the toilets) with a comfortable chair, and a clean refrigerator in which to store the milk. You’ll also need a small insulated bag to transport the milk between work and home.
Feeding two babies gets easier with practice. Initially you might want to feed them one at a time before cradling both babies at your breasts in a double ’football hold’.
If your arms start to ache or you need a free hand, try supporting them with a V-shaped pillow that straddles your body or cushions on either side. These won’t be needed as their head control improves.
Your milk supply will increase to meet the ’additional’ demand of feeding two bubs, but it’s important to remember they are likely to feed at different speeds and times.
If your breasts are very heavy, causing your baby breathing problems while feeding, you may need to hold your breast up using the flat of your hand. But avoid pressing on the areola, as that can block the milk ducts.
If you can’t be with your baby at mealtimes you can still feed her by planning ahead and expressing milk manually or with a breast pump.
You can safely store expressed breastmilk in the fridge for three to five days (at the back on a shelf, not in the door) and also freeze it for up to three months, depending on your freezer.
MUM'S FOOD NEEDS
There are no special foods for a breastfeeding mum to include in her diet, unless there’s a family history of an allergy (in which case, speak to your GP). Follow a well-balanced diet and drink to quench your thirst.
All in all, the healthy diet adopted during pregnancy will form a good basis for the diet required after your baby is born. If you’re worried about getting the right vitamins, a supplement designed for breastfeeding women may help (consult your doctor).
Contact the Australian Breastfeeding Association for more information on nutrition
Six to 12 months
Breastmilk remains your baby’s most important source of nutrition for the first six months, although she may be starting to hanker for new flavours and textures in her food as she gets older.
According to Australian National Health and Medical Research guidelines, feeding her solids is not recommended until she is at least six months old – and then only if she has gained sufficient head control to swallow safely. You baby’s tongue extrusion reflex (where the tongue pushes forward when touched) must also be disappearing.
By then, your baby’s iron and zinc stores will be starting to drop, and her digestive system will probably be sufficiently matured for you to introduce solids.
After this, a tell tale sign of her willingness to try is when she takes an interest as you eat – for instance, she watches when you take food from the plate to your mouth.
Make her introduction very gradual, both in terms of quantity and speed of feeding, and ensure it consists of very basic, natural foods, such as fruit and vegetables, that can be managed by her still-sensitive digestive system.
However, encouraging her to accept a wide variety of healthy foods in her early life will have benefits later, when she begins to express her personal eating preferences.
If you have a family history of allergies you need to be more cautious when introducing new foods. Talk to your GP first if you have any concerns.
From six months
Make the first food your baby eats plain, without artificial additives or any added flavouring. A great first food is commercial baby rice cereal, which can be mixed with breastmilk. Enriched with vitamins and iron, it’s bland, easy to digest and makes a good thickener for purees.
Fruit and vegetables provide interesting tastes and textures, and are easily digestible for babies, helping to avoid constipation.
Start your baby on one type of food, then work up to combining flavours. Pureeing is not necessary after six months, and many babies prefer to eat chunks of food that they can pick up and feed to themselves.
On the other hand, a puree is a good way to provide variety. Try steaming, boiling or microwaving potato, pumpkin, squash, parsnip, pear or apple, which can then be pureed with a little boiled water or expressed breastmilk.
You can puree small amounts with a spoon and sieve, but you will need a blender for larger quantities. Excess puree can be frozen in ice-cube trays.
Up to nine months
Introducing lumpier food will encourage your baby to put her new teeth into action. To minimise the risk of choking, make sure the lumps are either smaller than a pea, so they can be easily swallowed whole, or larger than a paperclip, in which case she will instinctively chew them. It’s best to offer food with texture that she can hold and explore. You can try the following:
● wholemeal (not wholegrain) toast cut into fingers
● cheddar cheese sticks
● chunks of peeled and seeded soft fruit, such as melon or banana, and thinly sliced apple and pear
● cooked carrot sticks
● cooked florets of broccoli or cauliflower.
Nine to 12 months
Your baby will find it fun to feed herself by this age. With encouragement, she can learn to use her own spoon. Start feeding her at the same time as the rest of the family, as it’s understood that babies who join family mealtimes and who are offered a range of foods are less fussy as they get older.
From 12 months
Around this time your baby will be able to eat most meals, as long as they’re cut up into small pieces for her. It’s important to give her a good variety of food and drink.
Encourage her to have breastmilk as her main drink, supplemented with fluids such as water.
She can also have starchy foods, such as pasta or rice, a variety of different fruits and vegetables, as well as fish and meat with the fat and skin removed.
It’s important to be aware of hygiene. Always wash your hands before preparing food and make sure all food preparation areas, cooking and eating utensils, and surfaces such as high chair trays and placemats are kept clean.
Also keep in mind that choking remains a hazard, even when your baby can feed herself, so make sure she’s never left unsupervised. If she’s mobile, don’t let her run around with food in her mouth and don’t leave food where she can grab it then run out of your sight. Avoid giving her foods such as hot dogs, which are a common cause of choking.
It is also not considered safe to give honey to babies under 18 months old, as there is a risk that they may contract botulism.
Around one in 15 babies will show an allergic reaction or intolerance to some foods when they start eating solids, so keep your eyes open for any unusual symptoms after meals.
Foods most likely to cause allergic reactions are nuts, eggs, wheat, shellfish and soy, so introduce her to these with caution, one at a time, and monitor her reaction.
Mild allergic reactions may cause rashes, slight wheezing or a runny nose. Severe allergies are rare, but would occur soon after a child has eaten, with vomiting or diarrhoea, hives (reddened, itching skin), or swelling around the mouth – seek urgent medical help. If her face is swelling up, she seems faint or has trouble breathing, call an ambulance.
● Exclusively breastfed babies don’t need other foods or fluids during the first six months of life. After the six months, offer a cup of water with each meal.
● Introduce your baby to solids gradually and make sure meals consist of simple, unprocessed foods, such as fruit and vegetables.
● Avoid giving her non-fat or low-fat foods – your baby needs fat for energy and development.
● Don’t add salt to her food, and keep her intake of salty food to a minimum.
● Encourage her to eat savoury food over sweet.
● Wait until your baby is six months old before giving her wheat and 12 months before offering eggs or ground nut products.
● If there is a family history of allergies present, discuss with your doctor whether to avoid certain food in your baby’s first year.
The Prep Rules
● Wash and remove the peel, pips, stalks and husks from fruit or vegetables. Then cut into evenly sized pieces, so they will all cook through in the same amount of time.
● Allow food to cool before pureeing – it needs to be fairly sloppy in the early
days. To thin it, you can mix in a little breastmilk or use the water in which the vegetables have cooked.
● Commercial rice cereals may cause constipation, so mix them with plenty of fruit and vegetables.
● Always test the temperature of the food before offering it to your baby.
● Never reheat food in a microwave as it heats unevenly.
● As your baby’s appetite increases, use a food processor or blender to puree larger quantities.
● Baby spoon, with rounded, soft edges and a long handle.
● Unbreakable plastic bowl.
● Fork, sieve or blender for blending/pureeing.
● Bibs – and lots of them.
● High chair (though you may prefer to hold your baby on your lap at first).
● A mat to protect the floor from splats and spills.
● Containers with lids for freezing extra portions.