Breastfeeding Questions New Parents Ask

Breastfeeding is natural, but that does not mean it comes easily. Most new parents have questions, and many hit a rough patch or two in the early weeks. That is normal, and help is available. Here are answers to the questions we hear most often from families, in plain language. Every baby is different, so bring your own questions to your baby's checkups too.

How often should my baby breastfeed?

In the first weeks, most newborns breastfeed about 8 to 12 times in 24 hours. That works out to roughly every 2 to 3 hours, counting from the start of one feeding to the start of the next, day and night. Some feedings will be closer together and some a bit further apart.

Watch your baby more than the clock. Early hunger signs include rooting (turning the head and opening the mouth), sucking on hands, smacking lips, and stirring. Crying is a late sign, and a very upset baby can have a harder time latching. Early on, if your baby sleeps longer than your pediatrician advises, wake them to feed.

How can I tell if my baby is getting enough milk?

You can't see how much a breastfed baby drinks, which worries a lot of parents. These signs help:

• Wet diapers. The number goes up over the first several days. By about day 5 or 6, expect around six or more wet diapers a day, with pale yellow urine.
• Dirty diapers. Stools change from dark, sticky meconium to green, then to loose, seedy, mustard yellow by the end of the first week.
• Swallowing. You hear or see your baby swallow during feeds, and your breasts feel softer afterward.
• Contentment. Your baby seems satisfied for a while after most feedings.
• Weight checks. Most babies lose a little weight in the first few days, then start gaining. Your pediatrician will weigh your baby at early visits to make sure they are back on track, usually back to birth weight by around two weeks.

If you are unsure, ask for a weight check. It is a quick, simple way to know.

What does a good latch look like, and is soreness normal?

A good latch means your baby takes in a large mouthful of breast, not just the nipple. Signs of a good latch:

• Your baby's mouth is open wide, with lips turned out like a fish.
• Their chin touches the breast, and their nose is free or lightly touching.
• You hear swallowing, not clicking or smacking.
• After the first few seconds, you feel a tug, not sharp pain.

Some tenderness in the first days is common. Pain that lasts through the feeding, cracked or bleeding nipples, or a nipple that looks flattened or pinched after feeding usually means the latch needs work. To unlatch, slide a clean finger into the corner of your baby's mouth to break the suction, then try again. Bring your baby to you, belly to belly, instead of leaning down over them.

Why does my baby want to eat all evening?

This is called cluster feeding. Many babies feed again and again over a few hours, often in the evening, and then may sleep a longer stretch. It does not mean you are out of milk. It is a normal way for babies to fill up and to tell your body to make more. It can be exhausting. Set up a comfy spot with water and a snack, and let a partner or helper handle other tasks during that time.

What are growth spurts?

Every so often your baby may suddenly seem hungry all the time for a few days. These growth spurts often happen around 2 to 3 weeks, 6 weeks, and 3 months, though every baby has their own timing. Feeding more often during these days helps your supply catch up. After a few days, things usually settle back down.

Does my breastfed baby need vitamin D?

Yes. Breast milk is the ideal food for babies, but it usually does not have enough vitamin D, which babies need for strong bones. The AAP recommends vitamin D drops for breastfed babies starting in the first days of life. Give the drops as your pediatrician recommends, and ask which product and amount to use.

How should I pump and store breast milk?

Wash your hands before pumping, and keep pump parts clean. Store milk in clean containers or breast milk storage bags, and label each with the date. The CDC gives these guidelines for freshly expressed milk:

• Room temperature (77°F or cooler): up to 4 hours.
• Refrigerator: up to 4 days.
• Freezer: about 6 months is best, and up to 12 months is acceptable.

Thaw frozen milk in the refrigerator overnight, or by placing the container in warm water. Never microwave breast milk, because it can heat unevenly and burn your baby's mouth. Once thawed in the fridge, use it within 24 hours and do not refreeze it. If your baby does not finish a bottle, use the leftover milk within 2 hours, then throw it out. Store milk in small amounts to cut down on waste. On a hot San Antonio day, a warm room or car can easily pass 77°F, so use a cooler with ice packs when you are on the go. See the CDC's full guide to breast milk storage and preparation.

How do I keep breastfeeding when I go back to work?

Many parents do, with a little planning:

• Start pumping and building a small stash of frozen milk a few weeks before your return date.
• Let someone else offer a bottle once breastfeeding is going well, so your baby gets used to it.
• Talk with your employer before you go back about when and where you can pump. Many workers have legal rights to break time and a private space that is not a bathroom. Your HR office can tell you what applies to you.
• Pump about as often as your baby would eat while you are apart.
• Breastfeed when you are together, such as before work, after work, and at night.

When should I see a lactation consultant?

A lactation consultant is trained to help with breastfeeding problems. Ask for help early, ideally in the first week, if:

• Feeding hurts, or your nipples are cracked or bleeding.
• Your baby has trouble latching or falls asleep within minutes every time.
• You are worried your milk supply is low.
• Your baby is not gaining weight well.
• You are going back to work and want a pumping plan.

Your pediatrician, OB, or hospital can help you find one. Many health plans cover lactation support, and WIC also offers breastfeeding help to families who qualify.

What if my baby needs formula?

Sometimes a baby needs more than breast milk alone, for example if weight gain is slow, your supply is low, or you need to be apart from your baby. Supplementing does not have to mean the end of breastfeeding. Your pediatrician can help you decide how much extra milk your baby needs and whether to use pumped milk, donor milk, or formula. To protect your supply, keep breastfeeding or pumping regularly while you supplement. Use only infant formula made for babies. Never water it down or make homemade formula. And remember: a fed, growing baby is the goal. Any amount of breast milk is a gift, and you are a good parent however your baby is fed.

For more answers, see the AAP's breastfeeding articles for parents and MedlinePlus on breastfeeding.

When to call us

Call your A thru Z Pediatrics office if your baby:

• Has fewer wet diapers than expected, dark urine, or a dry mouth.
• Is not back to birth weight by about two weeks, or seems too sleepy to feed.
• Looks more yellow (jaundice), especially if the yellow spreads or your baby is feeding poorly.
• Seems hungry all the time and never satisfied, or vomits forcefully after feeds.
• Has a temperature of 100.4°F or higher and is younger than 3 months. Call right away.

Also call your own doctor if you have a painful, red, warm area on your breast with fever or chills. Call 911 or go to the ER if your baby has trouble breathing, turns blue or gray, is very hard to wake, or is limp.

Questions about feeding or weight? Request a visit.