Breastfeeding

Why do we recommend exclusively breastfeeding baby? There are many reasons, but the simplest is:

Time spent breastfeeding + no other foods = great milk supply for mom!

Breast milk is all supply and demand: If baby does not demand it, the body will not supply it. It really is that simple. If baby is taking formula, even if it is in addition to breastfeeding, he will not go to the breast as often.

Each time your baby breast feeds, hormones are released in your body telling the breasts to produce milk. The fewer times a baby breast feeds, the fewer hormones there are, resulting in less breast milk available for baby.

The Academy of Pediatrics recommends that you do not introduce artificial nipples, bottles or pacifiers until breastfeeding and milk supply is well established. This is usually after one month of exclusive breastfeeding.

• It’s all about the latch. If this is your first time breastfeeding, make sure you understand how to latch your baby. The difference between correct and incorrect latch can mean success or frustration in breastfeeding.
• Don’t worry about how much breast milk your baby is getting when breastfeeding. Newborn babies have small tummies and almost all mothers can produce the amount of colostrum and milk that they need. Instead, focus on breastfeeding often for as long as your baby will feed. Remember, a typical feeding of colostrum is about a teaspoon! It is packed with protein, vitamins and antibodies that start building your baby’s immune system. Baby’s tummy will get bigger as your milk supply starts to come in, around three to five days.
• Room in with your baby. Your baby will stay with you during your hospital stay so you can learn your baby’s cues and feed whenever he seems hungry. Babies typically feed eight to 12 times in 24 hours for the first several weeks.
• Avoid supplementary feedings. All your baby needs is you! Rarely is there a baby who needs more than the breast the first 24 hours. Offer the breast often and avoid bottle feeding. The fast flow and different feel of the bottle nipple can confuse babies and make subsequent breast feedings difficult and more work for you.
• Limit the use of pacifiers and swaddling. Anytime your baby seems hungry, offer the breast. In between, continue your skin-to-skin holding. Later your pediatrician may recommend a pacifier to reduce the risk of sudden infant death syndrome, but not until breastfeeding is well established. For now, pacifiers may keep babies from going to the breast as often as they need to. Frequent breast feeding in these early days assures that you will bring in an abundant milk supply and your baby will feed adequately.
• Ask for help. If things don’t seem to be going well or your breasts become sore, ask your nurse for assistance, or ask to see the lactation consultant. She can watch a feeding and give you tips on how to hold your baby at the breast. If you still have concerns when you get home, call our Lactation Consultant for guidance or to find one-on-one help.

Breastfeeding classes are a great way to learn and prepare to breastfeed your newborn. These classes gives first time moms, as well as current moms, an opportunity to ask questions and voice concerns regarding breastfeeding. Expectant mothers, new mommies and any other members of the support team are encouraged to attend since support is important with breastfeeding success. GRMC’s lactation consultant offers breastfeeding classes in both English and Spanish. See below for available class dates. All classes will be held in person unless otherwise notified. Please note the times for the English and Spanish breastfeeding classes.

Each breastfeeding class we will discuss:

• Breastfeeding basics: benefits, making breast milk (transitions, production cycle, etc.), and special situations
• Latching on/positioning (what effective and ineffective latch looks like) and feeding in the first weeks
• Feedings: when, hunger signs, feeding guidelines, tummy size, and feeding a sleepy baby
• How much is enough, satiety signs, and when to call your doctor
• Breast care (engorgement, nipple care, etc.)
• Breastfeeding lifestyle: taking care of yourself, proper time to introduce bottles and pacifiers if applicable, returning to work, expressing milk, milk storage guidelines, and where to find support

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Colostrum

Colostrum is the first stage of breast milk that develops during pregnancy. Once your baby is born, it is produced in small amounts for the first few days to match the size of your baby’s stomach. Colostrum is considered to be the “perfect” first food. Most babies do not need additional nutrition during this time. Two to five days after birth, colostrum changes to transitional milk.

• Commonly called “Liquid Gold”
• Yellow to clear in color
• Helps loosen mucous in baby
• Easily digested
• Acts as a laxative to help the baby clear his intestinal tract
• High in protein
• Contains antibodies and immunities

Transitional milk occurs after colostrum and just before mature milk. It has a thin and white appearance. This milk includes high levels of fat, lactose and water-soluble vitamins. Like colostrum, transitional milk is high in protein, but it has more calories than colostrum.

Your milk will gradually change following transitional milk production. It may take longer depending on when you start breastfeeding and how often you breastfeed. The change in milk occurs a little earlier if you have breastfed before. Breast milk is made up of two stages of milk:

1. Fore-milk – Fore-milk is the first milk the baby receives upon latch and let-down. It is thin and watery with a light blue tinge. Fore-milk is largely water that is needed to satisfy your baby’s thirst.
2. Hind-milk – Hind-milk is released after several minutes of nursing. It is similar in texture to cream and has the highest concentration of fat. The hind-milk has a relaxing effect on your baby and helps him feel satisfied and gain weight. Allow your baby to finish feeding on the same breast to ensure he has access to this hind-milk. Feed until you see a sleepy, satisfied look on your baby’s face.

Both fore-milk and hind-milk are necessary when breastfeeding to ensure the baby is receiving adequate nutrition and will grow and develop properly.

At this early age, babies will not have a "schedule" for feeding. In fact, they may not have that for several months. Once they are a little older and their brain and nervous system mature, babies may be more predictable with their feeding patterns. Until then, every day may be different than the last.

It is recommended to feed "on demand," which means watching for your baby’s feeding cues and offering a feeding whenever she is willing to eat. This may be every two to three hours, but it can be sooner or later than that depending on your baby and the time of day. Generally, we say if your baby hasn’t fed in 2.5 to three hours, make sure to put her skin-to-skin with mom, which can help her come around to feeding sooner.

During the first feed, let your baby stay on the breast as long as he wants. He may want to nurse an hour or more: he is learning to latch and suckle. Later during the first 24 hours, offer baby the breast VERY frequently (every two to three hours). Watch for feeding/hunger cues: rooting, smacking lips, sticking tongue out or chewing fists. CRYING is a late hunger cue.

In the first day, your baby might not wake to feed every two to three hours, but if you offer very frequently, your baby will be able to eat when he’s hungry. Some babies are hard to wake up during the first day – you may need to take off his blanket and clothes to help him stay awake through a feed. This continued skin-to-skin contact helps him stay warm and promotes bonding.

In the second day of life (24-48 hours old), your baby should be waking more regularly and feeding a total of 8 to 12 times. Feeding frequently is normal for an exclusively breastfed baby. Exclusive breastfeeding means your baby only receives your breast milk with no formula, water or other foods given to him. Let your baby lead the feedings: he will let you know when and what he needs.

Breastfeed early and frequently. Frequent feedings encourage an abundant milk supply and minimize engorgement for you, increases weight gain and reduces jaundice and low blood sugar in baby. Remember to remove milk to make more milk! Expressing after a feed and giving colostrum to your baby in a spoon helps him and you! Milk expression is also a good option if baby won’t wake to latch or feed. Your milk production closely matches baby’s needs. The more baby nurses, the more milk you make.

• Baby is sleepy and his body relaxed at the end of a feed
• You may feel uterine contractions the first week during and after a feed
• Baby’s hand will start to relax and open when he’s getting full
• Your baby is meeting each day’s diaper goals

• 24 hours after your milk “comes in,” baby should begin having six to eight really wet (heavy) diapers and at least four bowel movements every day. If your baby is having less diaper change, nurse and express more and call your baby’s health care provider.
• Breast milk stool are mustard yellow liquid with or without solid in them. The solid may look like seeds or curds.

• Resolution of engorgement does not mean you are losing your milk.
• A totally breastfed newborn can be hungry 30 to 60 minutes after a feeding.

According to the American Academy of Pediatrics and the World Health Organization, the following information has been deemed true when babies are breastfed:

• The risk of ear infections is reduced 50%
• The risk of serious colds as well as ear and throat infections are reduced by 63%
• The risk of SIDS is reduced by 36%
• The risk of clinical asthma and eczema are reduced by 27%
• The risk of inflammatory bowel disease is reduced by 31 %
• There is a 15%-30% reduction in obesity rates
• There is up to a 30% reduction in Type I Diabetes

According to the American Academy of Pediatrics and the World Health Organization, the following information has been deemed true with mothers who breastfeed:

• A decrease in blood loss and more rapid involution of the uterus
• Studies have found that breastfeeding helps mothers return to their pre-pregnancy weight sooner
• Mothers with a breastfeeding history of 12-23 months have a significant reduction in hypertension, hyperlipidemia, cardiovascular disease and diabetes
• A 28% reduction in risk for breast cancer and ovarian cancer with cumulative duration of 12 months of breastfeeding

There are now a multitude of studies that show that mothers and babies should be together, skin-to-skin (baby naked, not swaddled), immediately after birth, as well as later. Skin-to-skin contact, which should last for at least an hour a day, has the following positive effects on the baby:

• More likely to latch on and latch well
• Has more stable and normal skin temperatures
• Has more stable and normal heart rates and blood pressures
• Has higher blood sugars
• Is less likely to cry
• Is more likely to breastfeed exclusively longer

• Keep baby skin-to-skin as much as possible these first few weeks
• You cannot spoil a newborn. He needs the comfort and warmth of mom to feel secure and calm.
• Baby should be in a diaper and hat only, mom with no shirt and blanket over both of you

We encourage skin-to-skin contact as much as possible. By keeping baby with mom, it allows her to see and recognize her feeding cues. These cues are easily missed if your baby is wrapped up and away from Mom. If you are feeling sleepy, please ask Dad or someone else in the room to hold the baby. For safety reasons, we don’t recommend co-sleeping in the hospital or at home.

Hold your baby closely with his tummy turned toward you, and his nose at the level of your breast, opposite the nipple. Support the baby behind his shoulders and neck with the palm of your hand. Allow the baby’s head to tilt slightly back so that his jaw will open easily for latch.

• Your nipple will be directed toward the nose or roof of your baby’s mouth, not toward the back of the throat
• Stroke the baby’s lips to encourage a wide-open mouth
• When baby’s mouth is open wide (almost like a yawn), bring his lower lip and chin to the breast as the first point of contact on the areola
• Baby’s nose is slightly touching the breast
• Then bring the baby quickly and gently toward the breast using your hand to support the shoulders
• Your baby should be latched "asymmetrically," meaning more areola shows above the latch than below
• The baby will get a good mouthful of breast
• The lower lip will cover more of the areola than the upper lip (when you can see the lower lip, it will be flanged outward, like –– "fish lips")
• The baby’s chin is pressed well against your breast, with his nose relaxed and away from the breast. Both lips should be flanged out, similar to "fish lips".

Positioning

• Hold baby’s head behind the ears
• Position nose to nipple and belly to belly

Offer the breast

• Use the sandwich hold
• Stroke the nipple from nose to chin, rolling out baby’s lower lip
• Bring baby to the breast, not breast to your baby

Check the latch-on

• Baby’s lips are flanged and her mouth is 140 degrees
• There is no pain and no wedged or creased nipple
• Baby’s chin is touching the breast and she has an asymmetrical latch-on

Access milk transfer

• Baby shows a wide jaw excursion
• There is a consistent sucking
• You hear swallowing (after milk comes in)

General Helpful Tips

• Try to nurse him in a dimly lit and quiet room
• Make sure you are comfortable before you position him
• Use pillows to raise your baby to breast level
• Make sure your baby’s ear, shoulder and hip are in a straight line. Your baby should not have to turn his head to nurse.

Choose a comfortable chair or sofa with good support for your back. Use a footstool to bring your knees up so your lap is slightly inclined and the pressure is off the small of your back. Position pillows wherever needed to support your arms and relax your shoulders.

The cross cradle hold is one of the preferred positions for the first few weeks of breastfeeding. You will have good control of the position of your baby’s head when you place your hand behind your baby’s ears. Turn the baby to face you “belly to belly”.

The football hold (clutch hold) is good for mothers who have had a cesarean section delivery, because the weight of the baby is not on the abdomen. Tuck the baby under your arm with pillow support high enough to place the baby at breast height. You can tuck a pillow or rolled receiving blanket under your wrist for support if needed.

Side lying is great for getting a bit of rest while your baby nurses or if you want to avoid sitting because of soreness. Place a pillow support behind your back as well as baby’s. You can use pillows between your knees if that feels comfortable as well. Roll the baby towards you “belly to belly”.

The cradle hold is great for the older baby that is nursing well and whose latch-on is easy. It is the most common position and you will often see this in pictures of breastfeeding mothers. Please wait to use this position until your baby latches easily on their own.

• To start milk flow, use warm, moist heat on the breasts for a few minutes, or take a brief warm shower before breastfeeding. (Note: Using heat for extended periods of time, over five minutes, may make swelling worse.)
• Hand expression or brief use of a breast pump will soften the nipple and areolar tissue, making it easier for your baby to latch well and deeply.
• Pumping once to completely drain the breasts after baby nurses can resolve engorgement for some women. Then return to frequent breastfeeding to manage breast fullness.
• Gently massage and compress the breast when your baby pauses between sucks. This helps drain the breast, leaving less milk behind.
• A bag of frozen vegetables wrapped in a thin towel, or a sports pack works well as a cold compress after feedings. This can be done for 15 minutes at a time, every hour as needed.
• A well-fitted but not too tight supportive nursing bra makes some women feel better.
• Get enough rest, proper nutrition and fluids.
• A fever higher than 100.4 degrees F (38 degrees C) or severe pain may signal a breast infection. Call your healthcare provider if this occurs.
• Talk with your healthcare provider about medications, such as ibuprofen, which may help to reduce pain and inflammation.

According to research, the main cause of nipple soreness is nipple trauma due to incorrect positioning of the baby on the breast. However, even with proper positioning, some women may experience short-term latch-on soreness. This should be resolved in seven to 10 days. Continued soreness is due to improper positioning and latch, which can usually be corrected relatively easily.

• Make sure your baby’s mouth is wide open with head tilted back for good latch-on. You should be very cautious as cracks can lead to infection. It is recommended to expose nipples to sunlight a couple times a day, and make sure they stay clean and dry between feedings. This will help to heal them and reduce the chance of infection.
• Start with your nipple opposite your baby’s nose.
• If you feel pain that lasts throughout a feeding, break the suction, remove your baby, reposition and try again.
• Ensure a proper release by inserting a finger between your baby’s jaws to break the suction before removing your baby from your breast.
• Make sure your baby’s lips are not turned inward and that your baby is not chewing on your nipple or sucking her tongue. Baby’s lips should be turned outward like “fish lips.” Gently adjust baby’s lips if necessary.
• If your baby is sucking her tongue, you may hear a smacking sound and see your baby’s cheeks dimpling. Take your baby off the breast, reposition, and try again.
• Try different positions until you and your baby find a comfortable routine.
• Express some breast milk onto your nipples after a feeding and then allow your nipples to air dry completely.
• Some moms may want to apply hypoallergenic purified lanolin to their nipples if they are dry and sore. (Make sure to check with your healthcare provider if you have allergies).
• If nipples are damaged, then gently rinse and apply expressed breast milk onto the damaged or sore nipple.

Sometimes milk ducts may become clogged due to incomplete emptying or continued pressure on one or more ducts. If this happens, you may feel a hard, lumpy, painful area on your breast.

Suggestions

• Apply warm, moist towels to your breasts before feeding
• Massage your breasts down toward the nipple, paying special attention to the painful area
• Nurse your baby more often, as often as every 1 or 1½ hours if possible
• Breastfeed in different positions, placing your baby’s chin in the direction of the plugged duct
• Breastfeed on the side with the plugged duct first. (Babies suck hardest on the first breast.)
• Use a little lotion on your thumb and apply gentle, steady rolling pressure from behind the outer lump toward the nipple while your baby breast feeds
• Get plenty of rest and enough fluids
• Avoid tight clothing. Look to see if your baby carrier or bra is rubbing the painful area.
• Avoid sleeping on your stomach or the side with the plugged duct

Mastitis is breast infection and inflammation. Sometimes a plugged duct will become infected, or bacteria will enter the breast through another route, such as an open sore or nipple.

It is NOT the breast milk that is infected. A red, hard and very painful area will usually be present on the breast. There may be red streaking from the affected area or breast tissue that may look pink over a large area. You may also have a fever, body aches and feel as if you have the flu.

Suggestions

Do not wait for the mastitis to go away by itself. Contact your doctor immediately for treatment with antibiotics that are safe for you and your baby. It is very important that you continue nursing often during this time. Your milk is not infected and will not harm your baby. It is the tissue surrounding the blockage that is infected and not the breast milk. Also, complete the entire treatment of antibiotics (seven to ten days) so the infection does not come back. Consider contacting a lactation consultant to teach you how to prevent mastitis from happening again.

1. Beforehand expression, wash your hands thoroughly.
2. Apply moist heat, massage the breast in a circular motion around the breast, working toward the areola.
3. Position fingers behind the areola.
4. Press back toward the chest.
5. Squeeze your breast gently by bringing your thumb and fingers together. Avoid pulling or sliding on the breast surface.
6. Compress your breast several times in this position.
7. Rhythmically repeat compressions, moving your thumb and fingers all the way around the breast, including areas near your chest and armpits.
8. Repeat steps 4 and 5.
9. Repeat procedure with the other breast.
10. Stop when the milk slows down.
11. Complete cycle takes 20 to 30 minutes.

A balanced and healthy diet is always important throughout your life. However, when you breastfeed, your body will change to make you feel both hungrier and thirstier. While breastfeeding, you need to eat about 500 extra calories each day. You can get these extra calories by choosing nutrient-rich foods. Choose from the six food groups, and follow these guidelines for a healthy, balanced diet while you are breastfeeding. And remember to take your prenatal vitamin!

Caffeine does pass into breast milk. However, 1 to 2 cups a day probably won’t bother your baby. Caffeine is found in tea, coffee, chocolate and sodas (including some that are light in color).

While you are nursing, stay away from restrictive weight-loss plans. Cutting your calories too much may reduce your milk supply and affect your health. However, a gradual weight loss of 2 to 4 pounds each month is healthy and should not affect milk supply.

A vegetarian mom who eats dairy products and/or eggs can get enough nutrients. Those eating vegan diets may need to be more aware of zinc, vitamin B12, calcium, vitamin D, iron and minerals.

Many convenience food items are high in fat, sugar and calories and do not provide important nutrients such as protein, vitamins and minerals. These foods include fried foods, high-fat chips, butter, margarine, oil, salad dressing, carbonated beverages, juice drinks, candy, cake, pie, cookies and other high-calorie desserts.

Alcohol also fits in the category of foods to avoid. A safe level of alcohol consumption while breastfeeding has not been determined. Limit alcohol to only an occasional drink while you are breastfeeding. If you do drink, do so after breastfeeding, or wait at least one hour for each drink you have.

To ensure a good breast milk supply, drink enough fluids to satisfy your thirst and prevent dehydration. You need at least 8 to 12 cups of fluids daily — more if you feel thirsty. Sip on a glass of water, milk or juice while you are nursing your baby. Milk and juice also supply some of the extra nutrients needed for breastfeeding. Limit the amount of caffeine beverages such as colas, teas and coffees to two servings or less each day. Too much caffeine may cause your baby to become active and lose sleep.

You need to eat 6 to 10 ounces of grains daily, and at least half of these should be whole grain. These foods supply B-vitamins, iron and energy. A one-ounce serving is:

• 1 cup ready-to eat cereal
• 1 slice bread or roll
• ½ cup cooked cereal (oatmeal)
• ½ cup cooked rice
• ½ cup cooked pasta
• ½ hot dog or hamburger bun

Include fresh fruits and vegetables in your diet as much as possible. About 2½ to 3½ cups of vegetables and 2 to 2½ cups of fruits daily are important for breastfeeding women. Make sure to include a vitamin C source in your
daily menu and a good source of vitamin A several times each week.

• Oranges
• Orange, grapefruit or WIC-approved juice
• Strawberries
• Green peppers
• Broccoli
• Butternut squash
• Greens
• Carrots
• Sweet potatoes
• Cantaloupe

Eating 5 to 7 ounces each day of foods high in proteins important. A 1-ounce serving is:

• 1 ounce of lean beef, pork, chicken, turkey or fish.
• 1 egg
• 2 tablespoons peanut butter
• ¼ cup cooked beans, dry peas or lentils
• 1 tablespoon nuts or seeds

Dairy foods provide calcium for women of all ages. Try to consume 3 to 4 calcium-rich foods daily. The following provides 300 mg. of calcium:

• 8 ounces yogurt
• 1½ ounces natural cheese
• 2 ounces processed cheese
• 8 ounces milk

• ¼ cup whole almonds (164mg.)
• ½ cup turnip greens (74 mg.)
• ½ cup calcium fortified fruit juice (300 mg.)
• 1 to 3 ounces canned fish with edible bones such as salmon and sardines (91 to 212 mg.)

• Don’t bind your breasts. This is an old-fashioned idea that is no longer recommended. Binding breasts can make you very uncomfortable and cause plugged ducts and mastitis. Wear a supportive sports bra instead.
• Using drugs to "dry up" the milk is also not recommended because they are not very effective and may cause serious side effects
• Wear a supportive (but not tight) bra for support. Choose clothing that is less likely to show wet spots if you leak, and wear nursing pads to absorb leaking milk.
• Drink plenty of fluids. Restricting fluids doesn’t help.
• Cut down on salt intake. Salt causes your body to retain fluids.
• Sage tea contains a natural form of estrogen and can decrease your supply and help dry up your milk. You can buy it at the health food store, or use the spice from your kitchen. Take 1 teaspoon of rubbed sage with 1 cup of hot water, [steeped for about 15 minutes]. You will want to add some milk or honey to it as it is very bitter. One full cup every six hours will usually dry the milk up quickly. Sage works best if you use it along with cabbage leaf compresses.
• Cabbage leaf compresses are a home remedy that has been used for over 100 years to reduce engorgement and dry up milk. Here’s how to use them: Buy plain green cabbage. Rinse and dry leaves. Put them in the refrigerator. Remove base of hard-core vein and gently pound leaves. Wrap around breast and areola, leaving nipple exposed. The leaves fit nicely around the breast and the cold feels good. Cover entire breast and, if needed, the area under your arms. Change every 30 minutes or sooner if the leaves become wilted.
• Don’t be afraid to relieve your discomfort by expressing some milk. Express just enough to keep them from feeling as if they are "bursting" or are swollen, overfilled and lumpy. Allow most of the milk to stay in the breast, which signals the body to stop milk production. If you remove a large amount of milk or do it consistently, you are telling the body to produce more.
• Do not use heat on swollen breasts. Instead, use cold packs or compresses to reduce swelling around the milk glands and ducts.

The first few days in the hospital, moms are encouraged to directly breastfeed as much as possible. This is the easiest for mom and baby and avoids the need for giving baby a bottle, which may make breastfeeding more difficult. In addition, colostrum is very thick and far back in the breast, and the baby is more efficient at expressing it than a pump.

Occasionally, mom may need to start pumping. Some of those reasons can include:

• Baby is not latching or is unable to breastfeed
• Baby has a doctor’s order to increase intake (for jaundice, weight loss or low blood sugar)
• Mom has flat or inverted nipples

In these circumstances, mom will start pumping with a hospital-grade double electric pump. Your nurse or lactation consultant will set it up and show you how and when to use it.

When you are ready to buy your own pump for use at home, choose a good, quality model.

Going back to work can be overwhelming. Start slowly, if possible, by returning to work for a half day or in the middle of the week. To protect your milk supply, ideally you should pump on the same schedule that your baby is feeding. Avoid having your breasts become overly full, as engorgement sends a signal to your body to slow down milk production. Likewise, decreasing the amount of times the breast is stimulated in a day may also decrease milk supply.

The milk you pump at work one day can be used the next day to feed your baby. After pumping, cool your milk in a refrigerator or cooler.

Working mothers or others who are pumping breast milk for their infants should store the milk in the cleanest and safest way. It can be stored in any clean container: plastic, glass or breast milk storage bags. Recommendations for storage temperatures and times vary greatly from one authority to another. We are recommending guidelines based on research and common sense.

Freshly pumped breast milk can be kept at room temperature for four hours. If it will need to be kept longer, please refrigerate. Milk that has been previously chilled should be kept at room temperature for no longer than an hour or so.

Breast milk may be stored in a refrigerator up to five days. If you think that you may not use it within that time, freeze it. If you find you have milk that has almost reached its expiration date in the refrigerator, you may freeze it for later use.

Breast milk may be stored in a freezer for up to three months and in a deep freeze for up to 12 months. The freezer is cold enough if it keeps your ice cream solid. That will be about 0° degrees F (-20°degrees C). It should be placed in a part of the freezer that will not be subject to changes in temperature as the door is opened and closed. If plastic breast milk storage bags are used, they should be doubled or protected from being bumped and torn in the freezer.

You may add “new” milk to previously chilled or frozen milk. Chill the new milk prior to adding it to the container of milk. The expiration date of that container of milk will be from the date of the original milk.

It is best to freeze milk in feeding-size quantities. If you are just starting to pump, you may not yet have an idea of what will be the right size for your baby. Freeze in 2- to 3-ounce quantities to start. You don’t want to thaw out more milk than your baby will take in 24 hours. You can always get more if necessary, but you will be dismayed if you have to discard pumped breast milk. After you have some experience with how much your baby takes from a bottle, you can freeze milk in that quantity.

Feeding is a special time for bonding. When you’re bottle-feeding your baby, look into his eyes, talk or sing quietly, and smile. This helps make it a nurturing experience. Start feeding him with small amounts at first. He’ll be able to take in more as he gets used to eating from a bottle.

Making the formula:

• Clean the area where you will prepare the bottles
• Wash your hands well with soap and warm water, then dry
• Place water that is safe for drinking in a clean pot or kettle on the stove. Bring the water to a bubbly boil and keep it boiling for one minute. Read the instructions on the formula can to find out how much water and formula you need to mix. Adding more or less formula than what is written can make babies sick.

For powdered formula:

• Powdered formula is not sterile so you need very hot water to kill bacteria that may be in the formula. Being careful to avoid burns, pour the correct amount of boiled water into a clean and sterile bottle within five minutes after boiling. Add the correct amount of formula right away, attach nipple and ring to the bottle, and shake well to mix.

For liquid concentrate formula:

• Allow boiled water to cool to room temperature, then mix equal amounts of water and formula. Attach nipple and ring to the bottle and shake well to mix.

Very important: Quickly cool hot formula by holding the bottle under cold, running water or by placing it into a container of cold water. This will bring it to a safe temperature for your baby to drink. To warm a cold bottle of formula, place it in warm water for several minutes. Never microwave your baby’s formula.

• Hold your baby with his head in the crook of your arm and his bottom on your lap. Baby should be in a semi-upright position, with the bottle almost level with the floor.
• Lower the bottle periodically to stop milk flow and allow your baby to rest
• Baby should never be lying flat while feeding since formula can flow into the middle ear and cause an infection
• Switch arms halfway through the feeding, and alternate sides with every feeding
• When switching sides, burp him and watch his hunger signs. If he’s not rooting or smacking his lips, loses interest in sucking or turns away from the bottle, then he’s done eating.

• See if your baby prefers his bottle warmed up, at room temperature or cool from the refrigerator
• Never use a microwave or boiling water to warm the bottle
• Bottles can be warmed by submerging them in a bowl of warm tap water, under warm, running water or by using a bottle warmer
• Test the temperature of the liquid on the inside of your forearm — if it feels too hot, it’s too hot for your baby

• Wash new bottles and nipples in hot, soapy water before using them
• After a feeding, wash bottles and nipples in hot, soapy water or put them through a dishwasher cycle
• Use a nipple and bottle brush to clean hard-to-reach areas
• If you use well water, you can sterilize bottles, rings and nipples by putting them in boiling water for five minutes
• Dry items on a clean drying rack or paper towel

Propping a bottle for your baby instead of holding it can:

• Cause your baby to choke
• Can cause tooth decay
• Give your baby a higher risk of ear infections
• Cause your baby to miss out on bonding time with you

• Keep powdered formula lids and scoops on clean areas
• Close containers of powdered infant formula as soon as possible
• If you do not plan to use the prepared formula right away, put it in the refrigerator immediately and use within 24 hours
• When in doubt, throw it out. If you can’t remember how long you have kept formula in the refrigerator, it is safer to throw it out than to feed it to your baby.

• Allergies
• Ear infections
• Asthma
• Diabetes
• Acute respiratory disease
• Side effects of environmental contaminants
• Gastrointestinal infections
• Mortality
• Childhood cancers
• Obesity
• Chronic diseases
• Reduced cognitive development
• Infection from contaminated formula
• Cardiovascular disease