Definition

• Breastfeeding questions about feeding, milk and supply

Health Information

Topics Covered

Go to the topic that relates to your question for advice:

1. How often to feed to bring in your milk supply
2. Length of feedings to bring in your milk supply
3. Length of feedings after your milk supply is in
4. Signs of a good milk supply (Do I have enough milk?)
5. How to increase your milk supply
6. Supplemental bottles of expressed milk or formula
7. When to introduce a bottle
8. Extra water
9. Cereals and other solid foods
10. Storage of pumped milk

Care Advice

1. How Often to Feed to Bring in Your Milk Supply:
   • Every 1½ to 3 hours for the first month (8 to 12 times/day).
   • During the day, wake your baby up if more than 3 hours have passed since the last feeding.
   • During the night, wake your baby if more than 4 hours pass without a feeding.
   • After 1 month of age, allow your baby to sleep longer. If your baby is gaining weight well, feed on demand and do not awaken for feedings.
2. Length of Feedings to Bring in Your Milk Supply:
   • Offer both breasts with each feeding
   • Nurse 10 minutes on the first breast. Then, nurse up to 15 minutes on second breast if your baby is actively sucking.
   • For each feeding, switch which breast you start on.
   • Needing to stimulate your baby to take the second breast is normal.
3. Length of Feedings After Your Milk Supply is in: (by day 8 at the latest)
   • On the first breast, allow your baby to nurse up to 20 minutes. (Reason: To get the high-fat, calorie-rich hind milk.)
   • You can tell your baby has finished when the sucking slows down. Your breast should feel soft. Then offer the 2nd breast if she’s interested.
   • For each feeding, switch which breast you start on.
   • To keep your baby actively sucking for the entire nursing session, rub or raise the hand. You can also tickle under the arm. If that doesn't work, feed your baby undressed wearing only a diaper.
4. Signs of a Good Milk Supply: (Is your baby getting enough breast milk?)
   • It is very important that your baby is latched on right. This way she can get enough milk.
   • Wait for your baby’s mouth to open wide. Then have your baby take nipple and part of areola. Lips must be wide open (like a fish) to get a good latch.
   • Look and listen for regular swallowing. This shows that your milk has letdown. Letdown is the release of breastmilk into the milk ducts just before a feeding. It starts after 2 to 3 weeks of nursing. At first, milk letdown may take 60 to 90 seconds of sucking before it starts.
   • As your milk volume increases and is established (usually by day 4 of life), you should see the following:
   • Urine: Expect a steady increase in the number of wet diapers for each day of life. Three wet diapers per day can be normal while milk is coming in. By day 5 of life, your baby should have 6 or more wet diapers per day. Note: If you aren’t sure about the diaper being wet, place a tissue in the diaper.
   • Stools: Stools should increase in quantity and change from black to green to yellow-mustard in color. They should be yellow-colored by day 5. The number of stools is the best marker for how much breastmilk the baby is getting. On day 2 and 3, the baby should pass 1 or 2 stools per day. By day 4 or 5, the baby should be passing 3 or more normal breastmilk stools per day. Once breast-feeding is established, babies normally pass 4 stools per day to 1 after each feeding during the first month of life.
   • Caution: Once the milk is in, infrequent stools are not normal for the first month of life. However, it can become normal after 4 weeks of age.
   • Your baby should be satisfied (not hungry) after feedings.
   • Your breasts should feel full before feedings and soft after feedings.
5. How to Increase Your Milk Supply:
   • Enough sleep (extra naps), reduced stress (ask for help), relaxed environment, good fluid intake
   • Drink enough fluids to keep your urine pale yellow in color.
   • Usually that means drinking at least 2 quarts (2 liters) of fluid per day.
   • Increase how often you nurse. Limit the use of the pacifier.
   • Pump the breasts for 10 minutes after each feeding. Do this only for a few days (see lactation consultant as this is tiring). Electric breast pumps that are double-sided give the best results.
   • Mother-baby skin-to-skin contact may also help increase the milk supply.
6. Supplemental Bottle Feedings:
   • You should be nursing your baby every 2 hours (start to start) for the first week after birth. Reason: to get the colostrum and to establish a good milk supply.
   • In general, don’t offer your baby any bottles of formula before 3 to 4 weeks old. Reason: It will interfere with creating a good milk supply.
   • There are some exceptions. Medical indications to prevent dehydration or severe jaundice include the following:
   • The milk is not in (day 2 - 4) AND your baby is very hungry (especially preterms)
   • Not enough wet or poopy diapers OR
   • Your baby is quite jaundiced. Reason: Prevents dehydration.
   • After every breastfeeding for 1 or 2 days, give expressed breastmilk or formula. Give 1 ounce (30 ml) at a time. Some babies may only take ½ ounce (15 ml).
   • See your child’s doctor within 24 hours for a weight check and a feeding assessment. Reason: More than 2 formula feedings in 24 hours can lead to a decrease in milk production.
   • Triple feedings (nursing, pumping and bottle feeding) are tiring. A lactation specialist can help. Call your local hospital for a referral.
   • Gradually stop the supplements as your milk supply increases.
   • Call Your Doctor If:
   • You think your baby needs an extra bottle feeding
7. When to Introduce a Bottle:
   • When your baby is 4 weeks old, if your baby is nursing well, offer a bottle. Use pumped breastmilk or 1 ounce (30 ml) of formula. This allows him to get used to a bottle and the nipple.
   • Frequency: Start with a bottle feeding once per day. After your baby accepts bottle feedings, continue them once every 3 days or so. This insures that he will continue to accept them.
   • If you wait too long (such as 8 weeks), some babies will reject bottle feedings.
   • Bottle acceptance allows you to leave your baby with a sitter or other family member. It’s also essential if you plan on going back to work outside the home.
   • You can use pumped breast milk that has been refrigerated or frozen or formula.
8. Extra Water Not Needed:
   • Never give extra water to infants younger than 6 months. Reason: Too much water can cause a seizure.
   • It’s not needed. (Reason: Breast milk contains 88% water.)
   • If your baby gets enough breast milk, extra fluids are not needed. They may decrease your baby’s interest and ability to breastfeed.
9. Cereals and Other Solid Foods:
   • Breast-fed infants should be started on baby foods at 6 months. First baby foods can be cereals and/or fruit.
   • Starting before 6 months is not needed. Starting before 6 months makes feedings messier and longer. Early use of solids can also cause gagging.
   • Solids don’t increase sleeping through the night for breast-fed infants.
   • Caution: Delaying solids past 9 months of age is not advised. The delay runs the risk that your infant will refuse solids.
10. Storage of Breast Milk:
    • Freshly pumped breast milk can be stored for 5 days in a refrigerator.
    • Frozen breast milk can be kept 6 months in a refrigerator freezer. Put the milk inside the freezer, not on side shelves. It can be kept 12 months in a deep freezer. If your ice cream is solidly frozen, the temperature is fine.
    • To thaw frozen milk, put the bag of breast milk in the refrigerator. It will take a few hours to thaw.
    • For quicker thawing, place it in a pan of warm water. Do this until it has warmed up to the temperature your baby likes. Never warm it up in a microwave or boiling water. This would destroy the antibodies that protect your baby from getting sick.
    • After thawing, breast milk can be kept safely in the refrigerator for 24 hours. Do not refreeze. After feeding your baby, toss any unused breast milk in a bottle after 1 hour.

Call Your Doctor If

• Your baby’s suck becomes weak
• Your baby starts looking or acting sick
• Your baby starts looking or acting abnormal in any way
• Your baby is always hungry
• You think your baby needs to be seen

Author: Barton Schmitt MD, FAAP

Copyright 2000-2020 Schmitt Pediatric Guidelines LLC

Disclaimer: This health information is for educational purposes only. You the reader assume full responsibility for how you choose to use it. The information contained in this handout should not be used as a substitute for the medical care and advice of your pediatrician. Listing of any resources does not imply an endorsement.

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