Breastfeeding: Answers to New Moms' Common Questions

Breast milk is the most nutritional food we can give our infants; it builds up immunities and reduces the number of inner-ear, urinary tract and respiratory infections a baby may have down the road. We’ve tapped the experts at Boston’s Brigham & Women’s Hospital to offer this list of frequently asked questions – and answers – about breastfeeding. If you need more information or have additional questions, talk with your nurse, obstetrics provider, pediatrician or lactation consultant:

Breastfeeding1 Will my baby show any cues that she or he is hungry?

Yes. Hunger signs may include awakening, fluttering eyes, lip smacking noises, bringing hands to the mouth, thrusting his or her tongue, rooting or trying to suck.

2 How often should I feed my baby?

By 3 to 4 days old, your baby should feed eight to 12 times in 24 hours or on demand. Some babies will feed every one-and-a-half to two hours; others feed every three to four hours.

3 How long should I breastfeed during each feeding?

Initially, your baby may actively suck for only five to 10 minutes. After the first few days, breastfeed at least 10 minutes or longer until your breasts feel softer and your baby seems content. This will allow for the baby to get the richer hindmilk. Sometimes your baby may breastfeed on only one breast. If this happens, start on the opposite breast at the next feeding.

4 When will my breast milk come in?

Roughly two to five days after giving birth, your breasts will begin to fill with milk, feeling firmer and warmer. As your milk changes from colostrum (thin, initial breast milk) to a transitional milk, its color will change from yellow to light yellow or whitish yellow. Your mature milk, which comes in about two weeks after the birth of your baby, will also be thin and may have a bluish-white color.

5 What is a normal feeding pattern?

Babies suck in bursts, and every baby has his or her own unique style and rhythm. You want to feel about six to 10 rhythmic sucks followed by an audible swallow, then a pause. Your baby’s suck and swallow pattern will slow as she or he swallows the richer milk at the end of each feeding. (see What's Your Baby's Feeding Style?)

6 How do I know if my baby is getting enough (or if I’m producing enough) milk?

As your milk supply increases within two to five days after the birth, you should notice:

• a sense of fullness in your breast before feeding;

• that your baby is swallowing while breastfeeding;

• that your breasts are softer after a feeding;

• a tightening or tingling in the breast as your milk “lets down” or releases (you may also feel relaxed and sleepy);

• possible leaking from one breast while the baby is feeding from the other;

• possible uterine cramps the first few weeks while breastfeeding.

In the first 24 hours after your baby’s birth, he or she should have one wet diaper and one with stool (bowel movement). By day 2, two wet diapers and one to two stools; by day 3, three wet diapers and one to three stools; and by day 4, four wet diapers and one to four stools.

When your milk supply has increased or by six days of age, your baby should have:

• eight to 12 feedings in 24 hours;

• at least six to eight wet diapers every 24 hours. Urine will be pale yellow, not dark tea-colored. If you use disposable diapers and are unsure if the diaper is wet, place a tissue in the diaper;

• At least two to three soft, yellow, seedy stools every 24 hours. During the first weeks the baby may have a bowel movement with most feedings;

• Quiet, contented periods after breastfeeding.

7 My baby seems to want to breastfeed all of the time! Is this normal?

This is normal due to “growth spurts,” which are predictable periods when the breastfed baby will want to feed more frequently than before. Growth spurts occur at two to three weeks, six weeks, three months and six months. This frequent feeding may last for 24-72 hours. During these times, it is important to feed your baby on demand – as much as she or he wants. Breastfeeding on demand will meet your baby’s needs; water or formula supplements are not necessary. As your baby feeds more frequently, your body will respond by producing more milk. When growth spurts end, your baby will want to feed less often.

8 How much should I eat while breastfeeding?

While breastfeeding, you should consume at least 1,800 calories each day, which is the minimum amount you will need to produce an adequate supply of milk and meet your nutritional needs. As a rule, it is recommended that you consume 300-500 calories more than you would if you were not breastfeeding. Be sure to maintain a well-balanced diet that includes protein, carbohydrates, fruits and vegetables.

9 What should I do if my baby seems sleepy and does not regularly awaken for feedings, loses interest easily or does not vigorously breastfeed?

Watch for cues that your baby is hungry as described above, especially the eyes fluttering. This rapid eye movement indicates that the baby is in a light sleep state and may awaken more easily to breastfeed. During the day, be alert to your baby’s feeding cues or wake your baby every two-and-a-half to three hours to encourage at least eight to 12 feedings in 24 hours. Try waking your baby by unwrapping blankets, stimulating rooting by stroking the baby’s mouth or encouraging baby to suck on a clean finger before bringing your baby to your breast. It may be helpful to change your baby’s diaper or try burping your baby.
At night, it’s not necessary to awaken your baby for feeding – unless your pediatric care provider recommends it or your baby is not feeding eight to 12 times in 24 hours.

10 Can I have caffeine while I am nursing?

Because caffeine is passed on to babies through breast milk, you should limit the amount of caffeine you consume to one or two eight-ounce servings per day. In addition to helping you stay hydrated and sleep better, avoiding caffeine will prevent the irritability and poor sleep habits that it can cause in babies. The caffeine in your breast milk will reach its highest level one hour after you ingest it – try to time your baby’s feedings so that they occur before you drink a caffeinated beverage.

11 Can I drink alcohol?

You should abstain from drinking alcohol while you are breastfeeding your baby. Alcohol can be passed on to babies through breast milk and can negatively affect your ability to let down or release milk.

12 Can I use aspartame?

 Studies show that aspartame products (e.g., NutraSweet® and Equal®) are safe to use while breastfeeding. However, sugar-free drinks offer no nutrients and often include caffeine, so they should be consumed in moderation. For a tasty, low-calorie drink, mix four ounces of your favorite juice with seltzer water and ice.

13 Are there foods I should avoid eating?

Most women who are breastfeeding can eat a wide variety of foods without any problems. However, some babies are more sensitive to certain food proteins, spices or dairy products. If your baby seems fussy after you have eaten a different type of food, try to avoid that food until your baby’s digestive system has developed a bit more.

Published with permission from Brigham & Women’s Hospital in Boston, MA.