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Guidelines for Successful Breastfeeding by the American Academy of Pediatrics
The following is an excerpt from a statement from the American Academy of Pediatrics about breastfeeding. 1. Human milk, with very few exceptions, is the preferred food for all infants, including prematurely born and weak babies. The final decision on feeding the baby belongs to the mother. Pediatricians must provide parents with complete and reliable information about the benefits and methods of breastfeeding so that the decision made on breastfeeding is fully justified. When direct breastfeeding is not possible, fresh human milk should be provided for premature babies, fortified if necessary. Before discouraging breastfeeding or advising its early termination, the practitioner should carefully consider the benefits of breastfeeding and the risk of not getting human milk. 2. Breastfeeding is best started as soon as possible after childbirth, usually within the first hour. Except in special circumstances, the newborn infant must be with the mother for the entire recovery period. Procedures that may affect breastfeeding or injure the baby should be avoided or minimized. 3. Newborns should be fed as soon as they show signs of hunger, such as increased anxiety or activity, grimacing, or seeking behavior. Crying is a late sign of hunger. Newborns should have approximately eight to twelve feedings before satiety every twenty-four hours, usually ten to fifteen minutes per breast. In the first weeks after the birth of undemanding children, it is necessary to wake up if four hours have passed since the last feeding. Appropriate initiation of feedings is facilitated by continuous co-residence. A formal assessment of the performance of feedings should be performed by an experienced and documented observer during the first twenty-four to forty-eight hours after delivery and again on the next visit, which should occur from the forty-eighth to seventy-fourth hours after birth. Recording by the mother of the time of each feeding and its duration, as well as the emptying of the bladder and stool, every day during breastfeeding in the hospital and at home, greatly facilitates the evaluation process. 4. No additives (water, water with glucose, artificial nutrition, etc.) should be given to breast-fed infants unless there is a medical indication for this. Based on in-depth knowledge of breastfeeding and practice, supplements are rarely needed. Supplements and dummies should be avoided, if possible, and if given, only after breastfeeding is well established. 5. If discharge occurs earlier than forty-eight hours after delivery, all nursing mothers and their babies should be examined by a pediatrician or other healthcare practitioner when the baby is two to four days old. In addition, in order to determine the weight of the baby and its general state of health, breastfeeding should be monitored and evaluated so that there is evidence of safe feeding. The infant should be tested for jaundice, adequate hydration and age-appropriate excretory functions (at least six emptying of the bladder per day and three to four bowel movements per day) at the age of five to seven days. All newborns should be examined at the age of one month. 6. Only breastfeeding is an ideal diet and is sufficient to maintain optimal growth and development for approximately the first six months after birth. Infants weaned earlier than twelve months should not receive cow's milk, but artificial nutrition for babies that is saturated with iron. Gradual administration of iron-fortified solid foods can supplement breast milk in the baby’s diet. It is recommended that breastfeeding be continued for at least twelve months or more, as long as mutual desire persists. 7. In the first six months, water, juices, and other foods are especially undesirable for infants. Vitamin D and iron may be needed before the sixth month only for a select group of babies (vitamin D for babies whose mothers lack it, or for babies who do not receive adequate sunlight; iron for those who have low iron or anemia). Fluorides should not be delivered to the baby in the first six months, regardless of whether they are breastfeeding or using an artificial mixture. Over a period of six months to three years, breast-fed infants (and artificially fed) need fluoride supplements only if their water is severely deficient (less than 0.3 ppm). 8. If hospitalization of the mother or baby is required, everything possible must be done to continue breastfeeding, better than usual, but if necessary, feeding of expressed fresh breast milk is also possible.
When normal breast filling turns into painful engorgement
If the breast is not freed by effective feeding of the baby, this indicates an early stage in which the normal fullness of the breast turns into pathological (abnormal) engorgement, in which the mother’s breast becomes painfully heavy and sensitive, and all this can be accompanied by mild fever. Swelling of the breast makes the nipple flat, preventing the baby from taking the breast properly. When this happens, the baby can only suck on the tip of the nipple and cannot take enough tissue from the nasal mug to press on the exits of the milk ducts. Lactation hormones continue to produce milk, but the child can not take it from the chest, while the engorgement intensifies, and the child remains hungry. Since a hungry baby sucks harder, but not more correctly, the nipple is injured. Microbes can enter through tears of the skin, infecting the mother with an infection, and mastitis occurs.
Prevention and fight against engorgement
Fortunately, you can prevent normal physiological engorgement from developing into a problem. Since puffiness becomes stronger due to the fact that the breast is filling faster than it is emptying, you can prevent this problem by emptying the breast.
Here are some tips to prevent breast overflow:
- Teach your baby the right way to breastfeed in the first days after birth, especially the wide opening of the mouth and clicking with the lower lip described in chapter 2. It is easier for the baby to learn how to properly breastfeed on the first or second day when you have not received milk.
- Be in the same room with the baby immediately after birth and offer him frequent and unlimited feedings. Ignore the advice of those who recommend that you limit your feedings to 510 minutes to protect your nipples. Studies show that actually limiting the duration of feedings can lead to inflammation of the nipples and increase engorgement, as the baby does not completely empty the breast.
- Feed at night as often as during the day, especially the first weeks. Trying to get your baby to sleep too long quickly will lead to a problem with engorgement. A child sleeping all night is a dubious advantage: the mother wakes up rested, but with edema.
- If you have an uncomfortable engorgement before the baby learns to take the breast properly, use a hospital-grade electric breast pump to pump out a little milk. This will make the nipple circle softer and help the baby better take the chest and, therefore, empty the chest.
- If your breast is too full and the baby cannot take it correctly, and you don’t have a breast pump ready for use, pump out a little milk by hand right before feeding to sufficiently soften the nipple circle for the baby to take it correctly (see illustrations in chapter 7). Then use the breast sandwich technique (see chapter 2). Hold the breast after the baby has taken it, or everything may happen again.
- When you express milk to facilitate engorgement, express as much as you want to feel comfortable. Pumping more milk can cause it to form even more.
- If your chest is painfully swollen, be careful when manually pumping or using a breast pump. Excessive pumping can damage your internal breast tissue and cause mastitis.
- Wet your breasts with a warm shower just before pumping or feeding. Simply spraying from the shower from the top of the chest to the nipples is a massage for the chest. The feeling of warmth will trigger a milk-reflex that will make milk flow faster when you start pumping or feeding your baby. Other ways to provide your breasts with warmth and moisture are to dip your breasts in a container of warm salt water (gravitational force will help to separate the milk in this position) or warm compresses on the chest.
“Essentially, do anything to extract milk from your chest.” If your child is not able to eat well, you should pump out the milk on a regular schedule to prevent problems with engorgement and to develop a milk secretion reflex. Frequent breast emptying in the early stages of lactation will help you to have good milk secretion in the future.
- Moreover, do not stop breastfeeding. The chest should be empty. If the baby is not eating, use a breast pump or express milk manually. If you do not get rid of engorgement, then breast infection may occur.
- Apply a cold compress to the chest between feedings to relieve pain and reduce swelling. Try wrapping ice or frozen vegetables in a light dishcloth. Although the warmth of a hot towel or hot shower reduces pain, it can actually increase blood flow to the chest and make the situation worse. Use heat only to stimulate the milk secretion just before feeding or pumping.
- Increase the duration of each feeding so that there is confidence that the baby has emptied the breast and it has become soft after feeding.
- Use ibuprofen to reduce pain and as an anti-inflammatory.
- To prevent nipple inflammation when breast engorgement occurs, decant a few drops of milk several times a day and gently rub this healthy natural emollient into your nipples.
- Avoid bras that are too narrow or push the lower part of your chest to the body, which leads to stagnation of milk and causes engorgement and mastitis. (For help choosing your own design for your nursing bra, see Chapter 7.)
- Rest, rest, rest! There is something magical about the effect of rest on reducing engorgement. Double the frequency and duration of your sleep.
- You may hear about the use of chilled or heated well-washed cabbage leaves to treat engorgement. Even though controlled studies have not shown any advantage of this method of treatment over those described above, many mothers prefer it. Undoubtedly, it is easier to wear cabbage leaves in a bra (softening them before with a rolling pin) than to pack ice, with which you should lie flat. Wrap one or two sheets around each breast for 20-30 minutes, two or three times a day, only until coarsening decreases.
Breast engorgement after the first weeks
If you were content with weeks of carefree feedings, and then engorgement suddenly occurred, take it as a signal that something had an effect on the balance between milk production and the baby’s need: the baby began to take too long breaks between feedings or became worse to eat, or stress affected your ability to feed or to milk secretion. Experienced nursing mothers relate to the appearance of engorgement, as a hint to relieve several days of extraneous duties and devote them to restoring communication with the child. They increase the frequency and duration of feedings and soon restore a convenient feeding schedule.
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Guidelines for Successful Breastfeeding by the American Academy of Pediatrics
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