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Breastfeeding basics: Advice for the first year

Dr. Ari Brown, co-author of "Baby 411," offers moms advice on breastfeeding for the first year. Read an excerpt from his book.

In part three of a special series on the "Today" show titled, "Today's Baby: Nursing Your Child," Dr. Ari Brown, co-author of "Baby 411:Clear Answers & Smart Advice for Your Baby's First Year," was invited to talk about some of the challenges new moms encounter when breastfeeding. Here's an excerpt from his book:

For the first six months of your baby’s life, you have only to make one decision about her nutrition: breast or bottle. Make that breast milk or formula. And you can guarantee that decision won’t occur in a vacuum: friends, neighbors, relatives and complete strangers at the grocery store will want to weigh in on what’s “best.” But you are the only one who can make that decision for your baby. If you decide to nurse, the first two weeks will be a critical time. To help, we’ve come up with a list of our Top 10 Breastfeeding Survival Tips. Then let’s look at the basic breastfeeding positions — that’s the kind of nuts and bolts issues we cover in "Baby 411." Finally, what happens if things go wrong? To help, we’ll discuss the Top 8 Breastfeeding Challenges and a month-by-month breakdown of how breastfeeding works for baby’s first year. So, let’s get rolling!

Top 10 Breastfeeding Survival Tips for The First Two Weeks    
  And now, from the home office here in Austin, TX:1. Make sure your baby is latched on to your areola and not just the tip of your nipple.2. If it hurts for more than a few seconds, take your baby off your breast and reposition him. Do not be a martyr.3. If the position you are using is not working, try another one. See below for more comments on positions.4. Have a spouse or willing volunteer get the baby's open mouth to your breast while you hold your breast. Have this person pull down your baby's chin gently with their finger.5. Ask for a nipple shield (a plastic covering with a hole) if your nipples are too tender or cracked to nurse comfortably. This is a controversial option because the volume of fluid coming to baby is reduced. But it may make the difference for some women if used for a day or two. If you choose this option, have a lactation consultant follow up with you.6. One word: LANOLIN. Various brands (such as Lansinoh) of this ointment are sold to provide comfort to healing nipples. It's also great for baby's bad diaper rashes.7. Use both breasts during each feeding to stimulate milk production. Once your milk supply is established at four weeks, it is fine to nurse on one breast per feeding. One exception: veteran moms may have plenty of milk to accomplish this sooner.8. Sleep when your baby sleeps. Your baby should not sleep more than a four-hour stretch in the first two weeks.9. Don't be afraid to ask for help. 10. Don't give up. The first two weeks can be rough, but then it will all be worth it!

Breastfeeding position

  • Cradle hold: Baby's head rests on mom's forearm with his belly next to mom's.
  • Football hold: Baby's head rests on mom's hand with his body coming underneath mom's armpit. (Good for after a C-section, large breasted moms, preemies, and twins.)
  • Side-lying: Baby and mom lie sideways and face each other. (This is popular at night feedings.)
  • Dancer hold: Baby lies in a sling, freeing up mom's hands to hold her breast and position Baby. (This is good for babies with a weak suck or poor seal.)

Trouble Shooting: The Top Eight Breastfeeding Challenges
When breastfeeding goes wrong, these are the usual suspects:1. Poor position. There are several positions that keep you and your baby comfortable. If one is not working, try another one. See list above.

2. Poor latch. You should hear your baby swallowing/gulping. Clicking is not a sound you should hear. Get your baby to open wide, with curled lips. Make sure his nose and chin are next to your breast. Don't let go of your breast until your baby is securely latched on. Poor latch leads to problem #6 (sore nipples).

3. Nipple problem. Large areola (the pigmented part of the breast) and inverted nipples pose a challenge. The football hold may help get baby latched on to large areola. Stimulating inverted nipples to stand out prior to nursing may help. Breast shells also help inverted nipples.4. Mouth problem. Babies with tongue thrusting and tongue tie can have poor technique. Babies who thrust their tongues forward while nursing can be taught how to suck correctly (with a lot of patience and professional help).5. Poor milk supply. Remember, milk supply is based on demand. If your baby is not stimulating you enough, use a breast pump to help rev up the supply. Pump for a few minutes after each feeding session.6. Sore nipples.7. Engorgement.8. Plugged ducts. Equate this to a clogged  pipe. The milk backs up and causes a hard, lumpy, tender area. Massage these areas while you nurse. Use a heating pad. Nurse or pump frequently (at least every three hours). Beware of any redness on the skin or fever. Plugged ducts are the precursor for a breast infection called mastitis.The Big Picture: Breastfeeding for the First Year
Okay, let's sum up this breastfeeding section with an overview of nursing for your baby's first year:Birth to two weeks: (18-24 ounces/day)
Breast fed newborns tend to eat every two or three hours. That adds up to eight to 12 times in a 24-hour day. They may cluster feed as frequently as every 1 1/2 hours (that's from the beginning of one feeding to the beginning of the next). If you are expressing breast milk and feeding via a bottle, your baby will probably take two or three ounces at a feeding.

Babies who try to nurse more frequently than every 90 minutes are nursing for comfort —beware of being the human pacifier. Babies have no other way of consoling themselves. They can't just pull it together and settle down. Sucking is extremely soothing. So, if it has been less than 90 minutes since the beginning of the last feeding, try using your finger to let him suck. Your breasts will thank you. Note: If your baby is truly nursing non-stop, go get your baby weighed. Make sure you have enough milk supply.

On the flip side, your baby may take a four-hour stretch before feeding again. In the first two weeks of life, do not let your baby go more than four hours without feeding. Why?

  • Breast milk is a supply and demand phenomenon. To get your supply established, the demand must be there.
  • Your breasts will feel like they are going to explode. If that four-hour stretch is during daylight hours, you are in for a long night of cluster feedings.

Two weeks to two months: (20-32 ounces/day)
Once your baby is two weeks old, you can relax a bit. Your milk supply will be better established and your baby will have regained his birth weight. If he sleeps through the night, let him! You may need to pump to get comfortable during the night, but don't wake a sleeping baby. By the way, this is unlikely to happen. If it does, don't tell your friends about it. They will hate you.

This feeding "pattern" goes on for at least the first two months of life. While this seems a bit erratic, it is normal for a newborn to be irregular with her feeding (and sleep patterns).Two to four months: (30-40 ounces/day)
Your baby will start to have some regularity! He will have more predictable wakeful periods and sleep periods. Hopefully, you will be down to one or two night feedings. If you are returning to work and pumping, plan on four ounces per feeding at two months of age and up to eight ounces per feeding at four months. Babies usually max out at 40 ounces per day at four months of age.Four to six months: (36-40 ounces/day)
You can look forward to five or six breast feedings a day. You should be able to get an evening stretch of six hours without nursing. Six hours is considered "sleeping through the night", although this is probably not your definition.

You may be introducing solid food at this point. Solid food is dessert. Your baby needs the same volume of breast milk for a while.Six to nine months: (28-36 ounces/day)
Your baby will nurse four or five times per day. You should be done with night feedings. If you are not, do some problem solving with your doctor. You may enjoy those cuddly moments nursing in the middle of the night, but these are not a necessity. Your baby is comforted and used to feeding at night. Frequently, so is Mommy. If both of you are enjoying this situation, keep doing it. If one of you (Mom) is not enjoying it and wants more sleep, read Chapter 9, "Sleep."

Nine to 12 months: (20-30 ounces/day)
Babies are well into solid foods and start to wean — that is, their volume and frequency of nursing decline. Your baby may nurse three or four times per day.

By one year of age, babies wean to 16 to 24 oz per day. At this point, you deserve a gold medal of honor. If you and baby are ready, you can stop breastfeeding.

We recommend switching to whole milk with Vitamin D added at one year of age. The goal is two cups of milk per day (or dairy serving equivalents). Remember, breast milk is low in Vitamin D and iron. So, if you want to go beyond a year of nursing, find other nutritional sources for these nutrients.Reprinted with permission from "Baby 411:Clear Answers & Smart Advice for Your Baby's First Year" by Dr. Ari Brown and Denise Fields (Windsor Peak Press, $11.95). Copyright 2004. "Baby 411" is available in bookstores nationwide or online at