One of the biggest decisions that a new mother must make is whether to breastfeed their infant or not. Breastfeeding is an excellent choice, but it also requires a lot of patience and determination. It is not for all moms, but those who choose to do it need to heed the advice and support of their pediatrician and lactation specialists in the hospital.

It takes an average of about 4-7 days for a mother’s full breast milk to come in, and all infants lose some weight initially, which is normal. Being patient, persistent and trying to avoid bottle feeding, if possible, in the first few days is critical to being successful. Once the full breast milk does come in, the mother-infant experience improves tremendously. There are some medical situations in which it is necessary to supplement right away, but, in most cases, the initial colostrum is enough to support the baby until full breast milk arrives. Remaining patient is key. Below, is some great advice from one affiliated TopLine MD Alliance Lactation Consultant and Nurse Practitioner, Jamie Lenis.

How often should babies be breastfed?

These generalized guidelines are for babies that are born full term or close to full term. They may change depending on health of the newborn as well as if the baby was born prematurely or is in the NICU.

Babies are fed roughly every 2-3 hours which is approximately 8-12 times in 24 hours. Skin to skin contact is recommended directly after birth – within the first hour of life if possible. It not only helps stabilize the mother’s vital signs but also the baby’s vital signs (heart rate, breathing, and temperature). Skin to skin contact initiates bonding by stimulating hormones needed to support breastfeeding and mothering. In addition, it prepares baby for the feeding.

Initial feeding will consist of colostrum 24-36 hours after delivery, yielding approximately 7-14 ml per feed. Colostrum is the “first milk” that a breastfeeding mother produces in the weeks before delivery and in the early days of breastfeeding. It is high in antibodies and nutrition. After the colostrum, the breast milk production increases and babies ingest more – approximately 3-5 oz. by the first month.

How do you know if your baby is getting enough breast milk?

Stools and wet diapers are a great indicator of the baby’s intake within the first 4-6 weeks of life. Beyond that, it is a combination of diapers, weight gain, and developmental milestones that indicate adequate intake. The general rule of thumb is on day 1 a baby should have a minimum of 1 wet diaper and 1 stool. On days 2 and 3, there should be a minimum of 2-3 wet diapers and 2-3 stools. Then, on days 5 and 6, the baby should have at least 2 pale yellow stools and 5 or more wet diapers.

When should you begin pumping?

There are many reasons why mothers start to use their breast pump. Some use it to initiate and maintain lactation. For example, when a mother’s baby is in the NICU and she wants to breastfeed, the mother will use the breast pump for breast stimulation until the baby is able to latch onto the breast. Others use the breast pump when they must be apart from the baby or if they want a partner to help with feeding. On the other hand, some mothers choose to exclusively pump. It depends on the mother’s breastfeeding goals. If a mother is exclusively breastfeeding, she may only need to use the pump if she misses a feed. Mothers may also begin to use the breast pump once they return to work.

When should moms switch to formula?

Switching to formula depends on the mother’s breastfeeding goals. Formula may also be medically indicated if the pediatrician recommends it for a variety of reasons. Some mothers also use a combination of formula and breast milk to feed their baby. Most lactation consultants are cheerleaders for mothers and will help facilitate mothers’ choices in the safest way possible. Remember, breastfeeding is not an all-or-nothing process!

Until when should moms breastfeed their children?

According the World Health Organization and the American Academy of Pediatrics, the recommendation is to exclusively breastfeed (meaning give only breast milk) for the first 6 months of life. After 6 months, parents should introduce solid foods to complement the breastfeeding. The mother and child can continue to breastfeed until two years or beyond, as desired.

What are the guidelines for toddlers if moms decide to breastfeed? Or the guidelines for dairy milk for toddlers?

After 6 months of age, a variety of foods that are safe to eat should be introduced. Breastfeeding can complement a nutritious healthy diet in toddlers. Toddlers should eat 2-3 meals a day and 2-3 snacks per day. If a mother chooses to continue breastfeeding, it can be done on an on-demand basis. Be sure to speak to your pediatrician regarding dairy milk in the toddler’s diet.

Guidance on advancing from breastfeeding or formula to adding foods

During the first year of your baby’s life, you will receive important information from your pediatrician during well visits. When solely breastfeeding, adding rice cereal is not recommended until 5-6 months of age due to fact that the bioavailability of iron in breast milk is very high. With formula-fed babies, pediatricians recommend adding rice cereal with a spoon at 4 months of age and then advancing to oatmeal cereal. Also, at 6 months of age, along with the addition of fruits and vegetables to a babies’ diet (who are both breast-fed and formula-fed), can be increased to three solid food meals a day with breast milk or formula in between.

Always begin the meal with solid foods accompanied with either breast milk or formula with subsequent and in-between feedings of either breast milk or formula. The goal is to decrease breast milk and formula intake as solid food increases. Also, do not forget to only start 1 new food at a time, and wait 3-5 days before starting another new food. This allows for ensuring that babies tolerate foods well without an allergic reaction. Starting to introduce meats and chicken, as well as table foods, should be around 8-9 months of age. Highly allergic foods like eggs, dairy, peanut butter, fish, and shellfish should be avoided until 1 year of age. However, some pediatricians now recommend to start earlier at about 9 months of age – be sure to follow your pediatrician’s guidance. Switching from formula to dairy milk should happen after 1 year of age, which is also a great time to transition from bottle to cups.

These are just a few basic guidelines, but be sure to follow the recommendations of your pediatrician. If you do not have one for your child, you can always find a TopLine MD Alliance affiliated provider here.

Dr. Michael L. Bruck is a proud member of the TopLine MD Alliance practicing Pediatrics in Palm Beach County.

Jamie Lenis, a Nurse Practitioner, is a proud members of the TopLine MD Alliance at the For Women Only, Ob/Gyn Specialists of Fort Lauderdale.

The TopLine MD Alliance is an association of independent physicians and medical practice groups who are committed to providing a higher standard of healthcare services. The members of the TopLine MD Alliance have no legal or financial relationship with one another. The TopLine MD Alliance brand has no formal corporate, financial or legal ties to any of the affiliated physicians or practice groups.