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    Breastfeeding Problem Solving Guide

    The following recommendations are general guidelines. If, after trying some of these suggestions, you find that you are still having problems, call a lactation consultant or your healthcare provider.

    • If your baby is gaining weight, then your milk supply is fine.

    • If your baby is having at least six to eight wet diapers and frequent stools per 24 hour day, he/she is getting enough milk.

    • Burp your baby whenever suckling slows down. This will encourage him/her to wake up and complete the feeding on the other breast.

    My baby wants to nurse all the time. It seems as if my milk does not hold him for four hours. Is this normal?

    Human milk (as compared to formula) is digested quickly. Normal time between feedings is 1-1/2 to 3 hours. Your baby may also need burping; if burped, he can drink more milk.

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    After 10 to 15 minutes of nursing, he cries as though he is still hungry. Is he getting enough?

    Although babies get most of the milk in the first 10 to 15 minutes, some take 15 to 45 minutes to finish nursing on both breasts depending on the strength of their suck.

    • Let your baby nurse longer on both breasts (until asleep or quits) as he gets the "hind-milk" at the end of the feeding which helps induce sleep and provides the most calories.

    • Try to listen for swallows during the feeding as an indicator that your baby is still actively nursing.

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    When I give him a bottle after a feeding, he takes one to two ounces and finally goes to sleep. Isn't he getting enough milk from me?

    Are you offering both breasts at each feeding? Are you nursing for fewer than 10 minutes per breast? Using both breasts stimulates a second and third let-down and creates more volume for your baby to drink. Your baby's primary motivation is to suck and is not always out of hunger. He will usually suck if a nipple is put in his mouth.

    • Use both breasts at each feeding. Consider switching the baby back to the first breast when the baby is done nursing on the second breast.

    • Give longer feedings at the breast until he falls asleep.

    • Feed more frequently.

    • Drink adequate fluids, eat a healthy diet and get enough rest.

    • Avoid bottle supplementation. This will decrease your milk supply as your baby will not nurse as often.

    • A baby will usually take from a bottle after nursing, as you eat dessert, even though you may be full. Therefore, just because your baby takes the bottle doesn't mean he is still hungry.

    • Contact a lactation consultant or your physician if these steps do not increase your milk supply within 48-72 hours.

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    When I try to squeeze milk from my breasts and when I first start pumping, I get very little milk - does this mean I don't have enough milk?

    Hand expression and pumping are learned techniques and not as efficient as your baby's suck. What you obtain when you first start pumping or hand expression does not necessarily reflect your milk supply.

    • Hand expression and pumping take practice.

    • Take a shower or apply warm, wet cloths to your breasts for 10 minutes before hand expressing.

    • Massage your breast down and out toward your nipple while expressing and pumping your milk.

    • Use a high-quality breast pump.

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    I've been giving a bottle and breastfeeding and now my baby fusses at the breast and doesn't want it. What's wrong?

    Bottle nipples allow milk to flow faster with less effort by your baby, and your baby may prefer the easier way. In addition, by giving bottles, you may have diminished your milk supply.

    • Discontinue the bottle and increase the number of times you breastfeed to re-establish your milk supply.

    • Eliminate the use of all artificial nipples such as pacifiers.
    Your baby should suckle better with time. Be patient.

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    My nipples are sore all the way through the feeding. What can I do?

    Nipple-chewing caused by improper positioning of the baby can cause nipple pain for the duration of the feeding.

    • Reposition your baby.

    • Make sure your baby is facing your breast, with his/her tummy facing your tummy with the initial latch-on. Bring your baby close to you very quickly before their mouth closes.

    • Be certain you are holding your breast behind the areola.

    • Wait for your baby to open his/her mouth wide, then quickly pull him in close.

    • If the pain continues, remove your baby from your breast and reposition.

    • Consult a lactation consultant or your physician for support and advice.

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    Why are my nipples sore only when the baby first latches-on?

    Is your baby grabbing the nipple and using it to work himself into proper position on the breast?

    • Be certain the baby has his/her mouth wide open with the initial latch-on.

    • Position your baby so that your nipple is pointing down during latch-on.

    • This situation will spontaneously resolve itself as your baby learnes he receives more milk in the proper position.

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    I'm feeding less often to give my nipples a rest. Is this going to create a problem?

    Your baby may become so hungry that he grabs the breast and sucks more vigorously causing more nipple soreness. Your breasts may become engorged, making it more difficult for your baby to latch-on properly.

    • Return to your normal schedule of feeding about every 1 to 3 hours per 24 hours (8-12 times per 24 hours).

    • Sore nipples are usually caused by improper latch-on.

    • Be sure you break the suction when removing your baby from your breast.

    • Make an appointment with a lactation specialist or your physician to determine why your nipples are sore.

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    Should I wash my breasts before each nursing?

    • No, a daily shower is adequate, but avoid using soap on your breasts.

    • Always wash your hands before feeding or expressing your milk, whether by hand or with a breast pump.

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    No one in my family has ever had enough milk; is it hereditary?

    Very few women truly do not have enough milk. Family members may have had dietary deficiencies, misinformation and/or lack of support. You can be the first to succeed!

    • Get plenty of rest and nurse your baby on demand.
      Refer to the "How long should each feeding take?" section regarding increasing your milk supply.

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    Why doesn't my 3-week old baby sleep through the night?

    This is an unrealistic expectation for a newborn. Most babies do not sleep a six-hour stretch until they are at least six to eight weeks old.

    • This is normal.

    • Try to nap when the baby naps during the day.

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    He was doing fine, but all of a sudden he started nursing all the time. Is something wrong?

    Growth spurts occur typically at seven to 10 days, three weeks, six weeks and 12 weeks, increasing your baby's appetite. His frequent suckling increases your milk supply to meet his new needs.

    • The increase in nursing will typically last three to five days.

    • He/she will return to a reasonable schedule.

    • Try to rest and drink liquids.

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    I am going back to work. Does that mean I need to wean?

    No! Working mothers have many options. New battery-operated and electric breast pumps allow for fast and efficient breast milk expression. Many mothers continue to breastfeed after returning to work. Refer to the section on expressing milk, milk storage and transport guidelines.

    For more information consider attending class before you return to work. Another helpful source for suggestions about breastfeeding and returning to work is the book, Nursing Mother, Working Mother by Gale Pryor.

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    Other Breastfeeding Resources

    From Healthwise Knowledgebase

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