Breastfeeding Tips for the First Year

Becoming a parent is very exciting and full of new experiences. Among the many decisions parents make is how they choose to feed their newborn. Friends, family and complete strangers will be eager to weigh in, but only you and your baby’s pediatrician will know what’s best. For those families who breastfeed, the experts at Johns Hopkins All Children’s Hospital provide helpful tips and advice for the first year.

What to expect in the early weeks

Successful breastfeeding comes from understanding the different stages of breast milk and your baby’s evolving nutritional needs. Many new moms wonder whether or not baby is getting enough breast milk. Signs of good breastfeeding include alertness at feeding time and hearing your baby swallow. You can also be sure baby is getting enough milk by counting wet and dirty diapers. Your breastfed baby should regain his or her birthweight by two weeks of life. Learning what to expect in the days after your infant’s birth can be helpful.

• Baby’s first milk. The mother first produces colostrum, the early, concentrated milk that is packed with nutrients and antibodies. Although colostrum comes out in small amounts, it provides your baby with everything he or she needs in the days after birth. Your milk should start to come in between days two and five.
• How to start breastfeeding baby. It’s best to start breastfeeding in the first hours after your baby is born, preferably with a nurse or lactation consultant nearby to help. Although your baby will instinctively know how to suck, getting your baby in the right position and helping your baby latch may take some practice. Deborah Locicero, lactation consultant at Johns Hopkins All Children’s Hospital, encourages moms to hold their infants skin to skin soon after birth. “Babies are born to breastfeed, but they have to be in the right place to receive their needed sensory cues,” Locicero says. “That right place is close to their mother, where they can smell her colostrum, hear her heartbeat and breathing, and feel her touch.” Some babies will latch deeper if they find their own way to the breast. To help baby find his or her way, moms can try leaning back and resting baby on the chest.
• Learning the signs of a hungry baby. Long before baby is crying, he or she shows signs of hunger: rooting, stirring and hands in the mouth. Baby may even start to stretch. Instead of waiting for baby to cry, you should nurse at the first signs of hunger. Babies who have been crying for some time might refuse the breast even if they are extremely hungry.
• Feeding patterns. During the day and night, newborns should be awakened for feedings every two to three hours if they have not roused on their own, with feedings lasting 15 to 45 minutes. Newborns should not go longer than four hours from the beginning of one feeding to the beginning of the next before eating again. When it comes to feeding, not every infant is the same. Some infants will feed on only one side each time while others will feed on both sides. Both patterns are completely normal.
• Amount of breastmilk to feed baby. Your infant’s demand will determine the milk supply you have in your breasts. If your baby appears to be eating all of the time, do not be concerned unless you are experiencing pain with feedings or diaper counts decrease. Breastfed babies are in control of their feeding volumes and frequently eat 10 to 12 times in 24 hours. If you are pumping breast milk and feeding by bottle, your baby’s pediatrician or health care provider is the best reference to help parents determine the amount to feed the baby.
• Wet and dirty diapers. Once mom’s milk is in, baby should have six to eight wet diapers a day and three to four (or more) yellow, seedy stools a day. The stools should be the size of a quarter or larger by day five. Learn more about what’s normal, what’s not and when to call the doctor.
• Vitamin D supplementation. The American Academy of Pediatrics (AAP) recommends all infants receive 400 international units of vitamin D a day. Parents of newborns should ask their pediatrician about adding vitamin D drops.

Months 1-3

In the first three months, feeding and sleeping patterns begin to change. Between six and 12 weeks is also when some moms return to work. In many cases, working moms will pump their breast milk, which can lead to a whole new list of questions. It’s important to note that in all stages, the amount of breast milk given by bottle will be determined by the baby’s weight and weight gain and their output, under the direction of baby’s pediatrician. When it comes to breastfeeding alone (without any bottle feeding), the amount of milk mom produces may vary. “Mothers who breastfeed their babies on demand–as often as they want–generally produce what their baby needs (supply and demand),” Locicero says.

• Feeding patterns. As your infant grows, feeding patterns may start to change. Baby may continue to feed frequently or may eat on more of a routine, with fewer feeding sessions but taking a larger amount each time.
• Sleeping patterns. Some babies will begin to sleep longer at night, while others continue to wake frequently. Babies like a routine, so try to stick to the same series of events each night, such as bath time, feeding, reading and then down for the night.
• Supplementing breastmilk with formula. The AAP recommends feeding your baby breast milk exclusively for the first six months of life. If mother produces enough milk, baby’s feedings should not be supplemented with formula. However, if mom’s supply is not meeting infant’s demand, the mother should work with a lactation consultant to help her find ways to increase her milk supply. Formula supplementation may be started on the advice of your pediatrician if your baby’s weight gain is not adequate in the first few months of life.

Months 4-6 and beyond

For the first six months of life, exclusive breastfeeding is recommended by the AAP, with the addition of nutritious foods added at six months of age. Breastfeeding should continue between months six to 12 or as long as mother and baby mutually desire. Solid foods are not meant to replace breastfeeding, but should be in addition. Breast milk should still be baby’s primary source of nutrition until the baby is 12 months old.

• Feeding patterns. Don’t be alarmed if breastfeeding sessions become shorter. Baby will continue to eat every two to four hours throughout the day but go for a longer stretch at night before eating again. If babies are taking bottles, they might eat between four to six ounces per feeding.
• Sleeping patterns. Many babies begin to “sleep through the night” at this stage. This usually means sleeping one five- to six-hour stretch, possibly longer.
• Introducing solids. Solids should complement breast milk at this stage, not replace it. The AAP recommends introducing solids at six months of age, and that first foods are single-ingredient foods such as infant cereals (rice, barley or oats) or pureed meats. These foods provide iron and zinc, which are key nutrients infants require at this stage. To maintain milk supply, mom should try nursing baby before the solid food is given, rather than after, to ensure baby gets the amount of breast milk needed. Breast milk can be used as needed to thin foods to make it easier for baby to swallow. Some parents might think about skipping infant cereals. The experts at Johns Hopkins All Children’s advise otherwise. “For a breastfed infant, fruits and vegetables won’t provide iron and zinc, two key nutrients that require a source in the diet at four to six months of age,” says Melanie Newkirk, nutritional services clinical manager at Johns Hopkins All Children’s. “Infant formulas are fortified, but infants who are exclusively breastfed need iron and zinc at this point. Fruits and vegetables alone will not suffice.”
• Signs baby is ready for solids. Parents should consult baby’s pediatrician on when he or she should start eating solids. Generally, baby is ready to start solids when he or she can sit with support, has good head and neck control, pushes up with straight elbows when lying face down and leans forward with an open mouth when interested in food.
• Feeding timeline for solids. When baby is four to six months old, offer him or her solids one to two times a day, increasing to three times a day by seven to eight months. Parents should introduce single-ingredient foods every few days to make sure baby shows no signs of allergic reaction. The actual amount of solids a baby will eat may vary greatly based on weight and size of the infant as well as intake of the liquid source of nutrition, either breast milk or formula.