Breastfeeding: Getting Started

Breastfeeding your child

Breastmilk is the perfect food for your baby. It gives your baby many advantages compared with formula. Your milk contains just the right amount of nutrients. It is gentle on your baby's developing stomach, intestines, and other body systems. 

The American Academy of Pediatrics (AAP) strongly advises exclusive breastfeeding for at least 6 months. Exclusive breastfeeding means that your baby has only breastmilk for 6 months. That means giving your baby breastmilk from your breasts or from bottles. Don’t give your baby water, sugar water, or formula.

Pacifier use

The AAP advises using pacifiers to decrease the risk of sudden infant death syndrome. For breastfeeding mothers, the AAP advises waiting until breastfeeding is well established. Then the pacifier isn't replacing the feedings babies need to grow. Well-established breastfeeding means that:

• Your baby can easily put their mouth around the nipple and latches on

• Breastfeeding is comfortable for you

• Your baby weighs more than their original birth weight

These milestones are often reached after the first 3 or 4 weeks.

Getting started with breastfeeding

Your milk and how you breastfeed change as your baby grows and develops. A newborn's feeding routine is different than that of a breastfeeding 6-month-old. As your baby grows, the nutrients in your milk change to meet your growing baby's needs. The anti-infective properties also increase if you or your baby is exposed to some new bacteria or virus. Here's how to get started:

Early breastfeeding

The first few weeks of breastfeeding are a learning period for both you and your baby. It takes time for you both to work as a team. Be patient as you recover from your delivery, create a daily routine, and become comfortable with breastfeeding. Keep track of feedings and wet diapers. This can help your child's healthcare provider assess how your feedings are going.

Day 1

Most full-term, healthy babies are ready and eager to begin breastfeeding within the first half hour to 2 hours after birth. This first hour or 2 is an important time for babies to nurse and be with their mothers. The AAP advises that babies be placed skin to skin with their mother right after birth (or when both you and your baby are able). Skin to skin means placing your naked baby stomach-down on your bare chest. This keeps the baby warm, helps keep the baby's blood sugar up, and helps the baby breastfeed for the first time. It's advised that babies be kept skin to skin at least 1 hour. Or they can be kept this way longer if the baby hasn't breastfed yet.

After these first few hours of being awake, babies will often act sleepy or drowsy. Some babies are more interested in sleeping than eating on their birthdays. You can expect to change only a couple of diapers during the first 24 hours.

Days 2 to 4

Your baby may need practice with latching on and sucking. But by the second day, your baby should begin to wake and show readiness for feedings every 1 1/2 to 3 hours, for a total of 8 to 12 feedings over 24 hours. These frequent feedings provide your baby with antibody-rich first milk (colostrum). And they tell your breasts to make more milk. Let your baby nurse on one breast until finished. You can then change and burp your baby before you offer the other breast. If the baby isn't interested in breastfeeding, start with the second breast at the next feeding.

As with day 1, you likely will change only a few wet and dirty diapers on baby's second and third days. Don't be surprised if your baby loses weight during the first few days. The number of diaper changes and your baby's weight will increase when your milk comes in. 

It's normal to have uterine cramping during the first few days of breastfeeding. This is a positive sign that the baby's sucking has triggered a milk let-down. It also means your uterus is contracting, which helps lessen your bleeding. A nurse can give you medicine before feeding if needed for the discomfort. Some mothers briefly feel a tingling, pins and needles, or flushing of warmth or coolness through the breasts with milk let-down. Others don't notice anything different, except the rhythm of the baby's sucking.

Your baby is still learning how to latch on and breastfeed. Your nipples may be sore when your baby latches on or while you are breastfeeding in the beginning. But often it is mild and goes away by the end of the first week. Other factors may lead to this soreness. Tell your nurse if soreness continues or gets worse. Or if your nipples are cracked or damaged. Your nurse or healthcare provider may advise seeing a lactation consultant. This is someone who specializes in breastfeeding.

Days 3 to 5

You will have a lot more milk 3 to 5 days after birth. When the amount of milk increases, the milk is said to have come in. Your baby is drinking more at each feeding, so they may drift off to sleep after a feeding and act more satisfied. Within 12 to 24 hours, you should be changing a lot more wet diapers. The number of dirty diapers also increases, and the stools should be changing. The baby's first bowel movements (meconium) are sticky and dark. They will become a mustard-yellow, loose, and seedy stool after the first few days.

Weight gain should also pick up within 24 hours of this increase in milk production. So your baby will begin to gain at least 1/2 an ounce (15 g) a day. You may notice that your breasts feel fuller, heavier, or warmer when your milk comes in. The most important thing to do when your milk first comes in is to feed your baby frequently. This empties your breasts often and completely.

Breast engorgement

Your breasts may become overfilled with milk (engorged) when the milk comes in. Engorgement can make them swollen and painful. Your baby may have trouble latching on if your breasts are engorged. Feeding frequently and on demand will help prevent this. But if it happens:

• Express some milk. This means hand expressing a small amount out of your breasts to help soften the area, then let your baby latch on. A warm shower or warm compresses right before or during expressing may help.

• Breastfeed or express milk by hand or breast pump often (every 1 to 2 hours). Your breasts should feel noticeably softer after breastfeeding or pumping.

• If the pain is severe, you may put an ice pack on your breasts. Keep it on your breasts for 15 to 20 minutes before or after nursing or pumping. To make an ice pack, put ice cubes in a plastic bag that seals at the top. Wrap the bag in a clean, thin towel or cloth. Never put ice or an ice pack directly on your skin.

Days 5 to 28

Your baby will get better at breastfeeding as the first month progresses. Expect to feed your baby about 8 to 12 times in 24 hours. Let your baby tell you when they are finished eating. When the baby self-detaches from the nipple, you can offer the other breast. Some babies feed better between breasts if you change their diapers and burp them. Often a baby will breastfeed for a shorter period at the second breast. Sometimes they may not want to feed on the second breast at all. Simply offer the second breast first at the next feeding.

Your baby should continue to:

• Soak 6 or more diapers a day with clear or pale yellow urine

• Pass 3 or more loose, seedy, or curdlike yellow stools every day. The stools should be larger than a tablespoon in volume.

• Gain weight. Babies typically gain 2/3 of an ounce to 1 ounce each day, up to 3 months old.

Talk with your baby's healthcare provider if you think your baby isn't eating enough.

General tips beyond the first few weeks

Every baby is different. Some will eat quickly and some will take longer to enjoy each drop. Others will take frequent breaks during each feeding. It's important to let your baby lead each feeding. This self-detachment will increase the amount of higher fat and higher calorie milk (hindmilk) that your baby will get. But once the breast is mostly empty, some babies will keep wanting to suck as a way of self-soothing. Over time you will be able to tell when your baby is switching to this self-soothing sucking. If your baby keeps sucking in this way and it’s painful, gently detach your baby. If breastfeeding is well established, you can offer a pacifier instead. If you aren't sure if your baby is full, try offering the other breast.

Your baby likely will go through a few 2- to 4-day growth spurt periods. During this time, they will seem to want to eat almost around the clock. Babies often have a growth spurt between 2 to 3 weeks, 4 to 6 weeks, and again at about 3 months. It’s important to let a baby feed more often during these spurts. Within a few days, your baby will go back to a more typical pattern.

Let your baby set the pace for breastfeeding. Watch their feeding cues. Here are some examples of feeding cues:

• Turning the head toward the breast

• Licking the lips

• Smacking the lips

• Being awake

• Crying (this is a late sign of hunger)

The number of feedings each baby needs and the length of time each feeding lasts will vary from baby to baby. Also, every mother's milk production and storage capacity is different. Trying to force a breastfed baby to wait longer between feedings, or to fit a certain feeding schedule, can result in poor weight gain.