|
Chapter 1 Index
A. General Information
about the well child examination B. Nutrition Issues
--Breastfeeding – Advantages and Disadvantages
|
|
Breastfeeding: Resources and Frequently Asked Questions
Introduction: Parents often ask pediatricians for resources
that they can utilize in preparing for breastfeeding. Only a few resources
are listed here:
Internet:
Books:
- A Woman’s Guide to Breastfeeding: an AAP publication
- Breastfeeding: A Guide for the Medical Profession" Ruth Lawrence
5th edition.
Local numbers: Teresa – lactation consultant 1-0190; LaLeche:
736-1893; 800-992-9708
Some Frequently Asked Questions:
- Why should I breastfeed? The AAP has been quite
forthright in indicating that our job as pediatricians should be to
encourage breastfeeding. Most practitioners do not have access to
lactation consultants, so they need to learn a lot about breastfeeding.
- When should expectant mothers start preparations?
Particularly if she has retracted or inverted nipples, daily manual
stimulation should be started in 3rd trimester.
- What are the 3 phases of breastfeeding and when do
they occur?
- Phase One: Colostrum present from delivery
to 5 days of age. More protein, less carbohydrate and fat than mature
milk.
- Phase Two: Transitional milk: lasts up to
15 days of age: increased fat, cho.
- Phase Three: Mature milk: day 15 on:
foremilk has low fat; hindmilk high.
- When should I start supplementing? Not for several
weeks; preferably not at all.
- What are relief bottles and when can I give them?
Same as supplemental; urge parents to wait until breastfeeding well
established.
- Why do the nurses in the hospital advise me to give
formula then? They are looking at weight gain short-term, not long-term.
- How often should I nurse? Every 2 to 2½ hours to
start; work towards 2½ to 3 hours. LaLeche feels that no time period
should be recommended, however, if nurse more often than every 2 hours,
prolactin secretion is inhibited.
- How long should I nurse with each feeding? Answers
vary, but it is known that 50% of the milk goes in the first 2 minutes,
and 80-90% in the first 4 minutes. Some recommend longer feeds, because
the higher fat and caloric milk comes at the end of the feeding (hind
milk). Average time: 10-15 minutes/side.
- What if I get problems with my nipples? Do I
continue to nurse?
- Mastitis? Depends on amount of pain; needs
antibiotic RX for mother.
- Cracked nipples: uncertain benefit of creams,
ointments.
- Engorgement: warm showers, washcloths.
- What foods should I avoid when nursing? Varies, but
milk products are definitely associated with colic. Others implicate
chocolate, onions, broccoli, cauliflower
- Can I combine breast and bottle feedings when I go
back to work? Absolutely, but must wean off nursings at certain times of
day and give bottles at those times: one weaning over 7-10 days minimizes
pain. Others pump at work; all don’t have the time or the facilities to
be able to do this. The fewest number of nursings in 24 hours should
remain above 3 nursings.
- How long should I wait to start solid foods in my
baby? No need for most babies nursed exclusively to start before 6 months
of age. Bottle fed: more at 4 mos of age.
- Should I supplement my baby with vitamins? See
discussion of rickets above. Since so many dark-skinned babies do not get
enough sunlight, AAP may come out with a recommendation that all babies be
supplemented with Vitamins A, C, D
- When and how should I wean my baby from nursing?
- When: most people wean between 6 and 12 months of
age, although we pediatricians recommend waiting until after a year of
age.
- How: Similar to combination feedings (see #11
above). Wean off one feeding at a particular time of day e.g. 10 AM,
give bottle then; 7-10 days later drop the alternative feeding e.g. 6 PM
while continue to nurse at 2 PM. If weaning occurs over a number of
weeks, then much fewer difficulties.
NB. Pediatricians are often asked to give talks to Lamaze groups,
prenatal gatherings and to young parents. If you have a good knowledge base
about breastfeeding and are prepared to answer the above questions, and
others, young families will greatly appreciate your expertise.
Written 10/2001
Next Page |