What to Feed the Baby when the Mother is Working Outside the Home

This is not an information sheet on all the ins and outs of working outside the home and breastfeeding. This sheet provides information on how your baby can be fed when you are not with him. It is addressed in particular to the mother who is returning to paid work when the baby is about 6 months of age or older. Mothers in Canada have the right to 52 weeks maternity leave. You should take full advantage of this time if it is at all possible. Remember that there are costs to returning to outside work (transportation, clothes, daycare) that may cancel any benefit of increased income. If you cannot take a full year, take at least 6 months, better 7 months (from the point of view of ease of continuing breastfeeding while away from your baby). Your baby will never be this age again.

Some Myths:

Babies must learn to take a bottle so that they can be fed when the mother is not there

Not true

Why not an open cup? It is true that some exclusively breastfed babies will not take a bottle by 2 or 3 months of age. Most, who have not taken a bottle, and even some who once did accept a bottle will not take one by the time they are 4 or 5 months of age. This is no tragedy, and there is no reason to give a bottle early so that the baby knows how. If your baby is refusing to take a bottle, do not try to force him; you and he may become very frustrated and there is just no need to go through all this. If the baby is at least 6 months of age when you start back at outside work, the baby quite simply does not need to take a bottle. If he is even 3 or 4 months, he does not need to take a bottle. He can be fed liquids or solids off a spoon and by 6 months of age he can be taking enough so that he will not be hungry during the day. Furthermore, he can start learning to drink from a cup even by 1 day of age. The cup can be an open cup and is best not to have a spout (a “sippy” cup is, essentially, a bottle). If, however, he has not got the hang of the cup by the time you must leave him, do not worry, he can take fluids off a spoon, or his solid foods can be mixed with more liquid (expressed milk, water). Obviously, if the baby is to be taking a fair amount of a variety of foods by 6 months of age, he may need to be started on solids by 5 months of age. However, some babies prefer to wait for their mother in order to drink something. This is fine; many babies sleep 12 hours at night without drinking or eating at all.

But getting the baby to take a bottle surely won’t hurt

Not necessarily true

Some babies do fine with both. The occasional bottle, when breastfeeding is going well, may not hurt. But if the baby is getting several bottles a day on a regular basis, and, in addition, your milk supply decreases because the baby is breastfeeding less, it is quite possible that the baby will start refusing the breast, even if he is older than 6 months of age.

Babies need to drink milk when the mother is not at home

Not true

Three or four good breastfeedings during a 24-hour period plus a variety of solid foods in goodly amounts gives the baby all he needs nutritionally, and thus he does not need any other type of milk when you are at your outside job. Of course, solid foods can be mixed with expressed milk or other milk, but this is not necessary.

If the baby is to get milk other than breastmilk, it needs to be artificial baby milk (infant formula) until the baby is at least 9 months of age

Not true

If the baby is breastfeeding a few times a day and getting fair quantities of a variety of solid foods, infant formula is neither necessary nor desirable. Indeed, babies who have not had infant formula before 5 or 6 months of age often refuse to drink it because it tastes pretty bad. (If you want to convince yourself of how little we know about breastmilk, ask yourself why it is that, although breastmilk and infant formulas have the same amount of sugar, breastmilk is so much sweeter). If you want to give the baby some other sort of milk, homogenized milk is acceptable at 6 months of age, as long as it is not the baby’s only food. In fact, if the baby is taking good quantities of a wide variety of foods, breastfeeding 3 or 4 times a day, and growing well, homogenized milk or 2% milk is good enough, but also not necessary. The “need” for formula to 9 months to 12 months of age is basically formula company marketing and very successful at that. Statements by the Canadian Paediatric Society and the American Academy of Pediatrics urging formula to a year surely did not take into consideration the baby who is continuing to breastfeed after 6 months.

Babies need to drink milk to get calcium

Not true

If you are worried about the baby’s intake of calcium, he can eat cheese or yogurt. There is no need to drink the calcium. Besides, if the baby is also breastfeeding, breastmilk still contains calcium.

Follow-up formulas (artificial milk for infants over 6 months of age) are specially adapted to the needs of infants 6 to 12 months of age

Not true

They are completely unnecessary and are specially adapted to the needs of the formula companies’ profit margins. They also are part of a marketing strategy that tries to get around restrictions on the advertising of artificial baby milks directly to the public (widely disregarded in any case). In Europe now, there are special formulas available for the toddler (1-3 years of age). In Singapore, they have formulas for children up to 7 years of age. Some people will buy anything, it seems. But these toddler formulas will soon be here in North America and soon nobody will consider it unusual to feed formula to a 3 year old. In fact, just as some paediatricians in France now push formula to 3 years, some paediatricians in North America will too. You can bet on it. Bottom line über alles. We will all soon be on formula from birth to death.

The breastfed baby 4 months of age needs to be getting more iron than can be provided by breastmilk alone

Not true

For the baby born at term who is breastfeeding exclusively, all the iron required is provided by breastmilk. However, by 6 months of age, more or less, it is prudent for the baby to begin getting more iron than that provided by breastmilk alone. The best way for your baby to get iron is through his food, and the best source of iron is meat, not formula, and not infant cereals.

The best way to assure the baby’s getting enough iron is to give him infant cereals

Not true

Infant cereals do contain a lot of iron, but most of it is not absorbed, and this amount of iron seems to cause constipation in some babies. Furthermore, some breastfed babies who have had only breastmilk to 5 or 6 months of age do not like cereal. There is nothing wrong with infant cereal, but pushing this food on reluctant babies may result in later feeding problems. The best way to ensure the baby is getting enough iron is to continue breastfeeding, and introduce solid foods in a relaxed, enjoyable way at the appropriate time (See the information sheet Starting solid foods). The appropriate time is when the baby is showing interest in eating by reaching out for and trying to eat food the parents or other members of the family are eating. This occurs usually about 4 ½ to 5 ½ months of age. A baby this age can eat what the parents eat, with few exceptions. There is no need to be obsessive about the order in which foods are introduced, or trying to keep the baby eating only one food/week. The easiest way to give extra iron for the 6 to 12 month old baby is meat, the iron of which is very well absorbed. Start feeding the baby solids in a way that makes eating enjoyable and the baby will eat iron-containing foods just fine.

What to Feed the Baby when the Mother is Working Outside the Home, February 2009© 
Written and revised (under other names) by Jack Newman, MD, FRCPC, © 1995-2016 
Revised by Jack Newman MD, FRCPC, IBCLC and Edith Kernerman, IBCLC, 2008, 2009© 
This handout may be copied and distributed without further permission, on the condition that it is not used in any context in which the WHO code on the marketing of breastmilk substitutes is violated

Starting Solid Foods

Health Canada, the Canadian Pediatric Society, the American Academy of Pediatrics, IBFAN, UNICEF, the WHO Global Strategies on Infant Feeding and most paediatric societies around the world recommend exclusive breastfeeding to about six months. Many health professionals suggest starting solid foods at four months of age; many now say you must not start before six months of age. However, most babies do fine with exclusive breastfeeding to six months of age or even a little longer. You should start your baby on solids when s/he shows signs of being ready for solids, not by the calendar. See below.

Why start solid foods?

• Because there comes a time when breastmilk no longer supplies all your baby’s nutritional needs. (This does not mean, as some uninformed people say, that there is no nutritional value in breastmilk after the baby is six months old.) A full term baby will start requiring iron from other sources by 6 to 9 months of age. The calories supplied by breastmilk may become inadequate by 8 to 9 months of age, although some babies can continue to grow well on breastmilk alone well past a year. But just because they can grow well on breastfeeding alone is not a reason to delay introduction of solids when the baby is obviously ready for them. See below about the baby’s cues that he is ready to eat.
• Because some babies not started on solids by a certain age (9-12 months) may have great difficulty accepting solid foods.
• Because it is a developmental milestone that your child passes when he starts solid foods. He is growing up. Usually, he will want to eat solids just as you do. He is ready to participate with the rest of the family in this family activity. Why stop him?

When to start solid foods.

The best time to start solids is when the baby is showing interest in starting. Some babies will become very interested in the food on their parents’ plates as early as four months of age. By five or six months of age, most babies will be reaching and trying to grab food that parents have on their plates. When the baby is starting to reach for food, grabs it and tries to put it into his mouth, this seems a reasonable time to start letting him eat. There really is no reason to start on a specific date (four months, or six months). Go by the baby’s cues.

In some cases, it may be better to start food earlier. When a baby seems to be hungry, or when weight gain is not continuing at the desired rate, it may be reasonable to start solids as early as three months of age. Starting at three months of age when things are going well, however, is not recommended (see above). But, it may be possible, with help, to continue breastfeeding alone without any addition of solids and have the baby less hungry and/or growing more rapidly. See the information sheet Increase intake of breastmilk. See also the information sheet Slow weight gain for reasons your milk supply may be down and what you can do about the decrease. Check the videos at ibconline.ca so that you can use the Protocol better. But if the techniques described here, which nevertheless will increase your baby’s intake of breastmilk, do not deal with the problem, adding solids can help also. Increasing the baby’s intake while breastfeeding is the first step and best step. There is no advantage to giving artificial baby milk (formula) and there definitely are some disadvantages, especially if it is given by bottle. The baby who is not satisfied completely at the breast may start to take more and more from the bottle, and end up refusing to take the breast completely.

The breastfed baby digests solid foods better and earlier than the artificially fed baby because breastmilk contains enzymes that help digest fats, proteins, and starch. As well, breastfed babies have received a wide variety of tastes in their lives in the breastmilk, since the flavours of many foods the mother eats will pass into her milk. Breastfed babies thus accept solids more readily than artificially fed babies. Breastfeeding is amazing, eh?

How should solids be introduced?

When the baby is starting to take solids at about six months of age, there is little difference what he starts with or the order foods are introduced. It is prudent to avoid highly spiced or highly allergenic foods at first (e.g. egg white, strawberries), but if the baby reaches for the potato on your plate, make sure it is not too hot, and let him have the potato. There is no need to go in any specific order, and there is no need for the baby to eat only one food for a certain period of time. Some exclusively breastfed babies of 6 months of age or so, dislike infant cereal. There is no need for concern and no need to persist if the baby doesn’t want the cereal. There is nothing magic or necessary about infant cereal. Offer your baby the foods that he is interested in. Allow the baby to enjoy food and do not worry exactly how much he actually takes at first. Much of it may end up in his hair and on the floor anyhow. There is no need either that foods be pureed if the baby is six months of age or older. Simple mashing with a fork is all that is necessary at first. You also do not have to be exceedingly careful about how much the baby takes. Why limit the baby to one teaspoon if he wants more? You also do not need to waste your money on commercial baby foods.

• Be relaxed, feed the baby at your mealtimes, and as he becomes a more accomplished eater of solid foods, offer a greater variety of foods at any one time.
• The easiest way to get extra iron for your baby five or six months of age is by giving him meat. Infant cereal has iron, but it is poorly absorbed and may cause the baby to be constipated. If you wish your baby to be vegetarian, it would be best to speak with an experienced pediatric nutritionist about how to get iron into the baby’s diet.
• There is no reason to introduce vegetables before fruit. Breastmilk is far sweeter than fruit, so there is no reason to believe that the baby will take vegetables better by delaying the introduction of fruit.
• Respect your baby’s likes and dislikes. There is no essential food (except breastmilk). If your baby does not like a certain food, do not push it on him. If you think it important for him, wait a few weeks and offer it again.
• At about eight months of age, babies become somewhat assertive in displaying their individuality. Your baby may not want you to put a spoon into his mouth. He may want to take the spoon out of your hand and put it into his mouth himself, often upside down, so that the food falls on his lap. Respect his attempts at self-sufficiency and encourage his learning.

What if I am starting solids at 3 months?

At this age, it may be prudent to go a little more slowly. Start with ripe avocado or easily mashed foods such as banana, or homemade oatmeal. Sometimes a baby will eat better from your finger (or his!) than off a spoon. Go a little more slowly with quantities as well. But as the baby tolerates solids, both quantity and variety of foods can be increased, as the baby desires. Incidentally, why are you starting solids at three months? Many grandmothers are keen that the baby start “real food”, but if there is not a good reason to start at 3 months, don’t. (The most common legitimate reason to start earlier than five or six months of age is poor weight gain not corrected by correcting latch, using compression, switching back and forth, using domperidone).

What If I Am Already Supplementing With Formula?

Starting solids early is a way to prevent supplementing the baby with formula by bottle. Formula may be added to solids so that baby consumes the extra calories (from the formula) by spoon instead of by bottle.

Solids or breast first?

There seems to be considerable worry when a child is starting solids about whether to give the breast first or give solid food first. If breastfeeding and the introduction of solid foods both are going well, it probably does not matter much. Indeed, there is no reason that a baby needs both breast and solids every time he eats.

Starting Solid Foods, 2009© 
Written and revised (under other names) by Jack Newman, MD, FRCPC, © 1995-2016 
Revised by Jack Newman MD, FRCPC, IBCLC and Edith Kernerman, IBCLC, 2008, 2009© 
This handout may be copied and distributed without further permission, on the condition that it is not used in any context in which the WHO code on the marketing of breastmilk substitutes is violated.

Toxins and Infant Feeding

The question of toxins in breastmilk is being addressed in a patient information sheet because the issue comes up every few months in the media, as regular as clockwork. It frightens many pregnant women out of breastfeeding their babies and many women who are already breastfeeding into stopping. Journalists do not seem to know how to handle this question very well. Some may have an ulterior motive (“my baby wasn’t breastfed and he’s okay”) thus finding a way of getting back at breastfeeding advocates and justifying their “choice of infant feeding”. It is, of course, unprofessional to do this, but that doesn’t stop them. Others are merely trying to get out the news but often without understanding what they are doing. They don’t understand, for example, that by talking about toxins in breastmilk and considering formula as an almost as good alternative, they are striking a blow against breastfeeding.

Why are there all these studies that look at toxins in breastmilk? One gets the impression that there is panic about the state of breastmilk in the modern world, that it is so polluted that everyone is trying to study it. But the reason that breastmilk is being studied so often is that it is easily available, and gives us an easily obtained sample of human fluid. That’s the reason, not because scientists are worried about breastmilk in particular. We need to be worried about all our bodily fluids given the levels of pollution we have created in the world.

Is Formula Almost The Same As Breastmilk?

This question needs to be considered in trying to understand the issue of toxins in breastmilk and the answer is no, formula is not almost like breastmilk, not by a long shot. Just because every few years the formula manufacturers add something to their formulas that we knew was in breastmilk for years but the manufacturers denied were of any importance, doesn’t mean that the “new and improved” formula is just like breastmilk. In some cases, the formula is improved, but remember, they were telling us that the formula before the “new and improved” version was also “almost like breastmilk”. This is true, for example, of the long chained polyunsaturated fatty acids (DHA and AA) that are supposed to make your baby smarter (one company even calls their formula A+, but it deserves a C- at best). We’ve known how important these fats are for many years, but for many years (before they were added to formula, of course), the manufacturers, echoed by many health professionals, just kept saying that it didn’t matter, and that there was no proof that these fats were of any importance at all (this is still in the Canadian Paediatric Society’s 1995 statement on the nutrient needs of premature babies). This cycle of “our milk is just like breastmilk” followed by “we have now added x to our milk so that it is even more like breastmilk” has been going on since the 19th century.

The truth of the matter is this:

1. Just adding something to formula, even if it is in the same amounts as in breastmilk, does not mean that the baby will get the amount he needs or the best sort of this something that he needs. The example of iron helps us understand this. Breastmilk contains enough iron (with the stores the baby has during pregnancy), to keep the baby iron sufficient for at least 6 months. To maintain iron sufficiency in formula fed babies, formula needs to contain at least 6 times more iron than breastmilk, just because iron does not get absorbed from the baby’s gut as well from formula as it does from breastmilk.
2. There are still hundreds of components of breastmilk that are still not added to formulas.
3. Breastmilk varies in what it contains, from morning to evening, from day to day, from beginning of the feeding to the end, from day 1 to day 4 to day 10 to day 100, so there is no way we can know what breastmilk really contains. This means that there is no way to duplicate breastmilk because there is no such thing as a standardbreastmilk. In fact, since every woman produces somewhat different breastmilk, the notion of a standard breastmilk becomes an absurdity. Breastmilk is a living, dynamic fluid. Formula is a chemical soup.

So What Does This Mean?

This means that we should consider formula a drug, which, if one thinks about it, is exactly what it is. It replaces a normal fluid (breastmilk). It is only very superficially like that fluid it replaces. There are known side effects of formula, in the short term, medium term and long term, some quite serious and irreversible. Formula may occasionally be necessary, but so are drugs. In rare cases, formula can be lifesaving, but so can some other drugs.

A drug is, as my pharmacology professor said to us in medical school, a poison or toxin with beneficial side effects. There is much wisdom in that statement. So when a mother decides to feed her baby artificial milk instead of breastfeeding, she is not avoiding the problem of giving toxins to her baby.

In fact, it is amazing how indulgent we are towards formulas. In none of the articles or television programmes that bring us the news of toxins in breastmilk, do they ever, in any I have read or heard, talk about toxins in formula. There are toxins in formula. Why would everything on earth be polluted, even the far reaches of the Arctic, but not formula? Formula is full of heavy metals, including lead, for example, in quantities much higher than breastmilk. And why would pesticides not be present in formula? After all, the cows do eat the grass in the countryside where the fields are sprayed. And soybeans grow there too. Interesting you never read about this in the newspapers.

But Toxins Are Not Good Are They?

No they are not and breastfeeding helps to diminish their bad effects.

Here are some facts:

1. Toxins increase the risk of developing some cancers. 
   True, and the evidence shows that breastfeeding babies have a lower risk of some cancers than artificially fed babies.
2. Toxins may interfere with neurological function and learning abilities. 
   True, and the evidence shows that children who were breastfed do better on neurological and intelligence tests than artificially fed children, and the longer they are breastfed, the better they do.
3. Toxins may interfere with immunity. 
   True, and the evidence shows that infants who are breastfed have better and more mature immunity than artificially fed infants, and that this better immunity carries on much longer than the length of time the infant or child is breastfed.

What Should You Do?

If you breastfeed your baby, you are doing the best for your baby, and for the world, for that matter. Breastfeeding is very environmentally friendly. Formula feeding pollutes the environment. The fact that there are pollutants in breastmilk can be likened to the situation of the canary in the coal mine. We should be worried about what we are doing to our planet, but this should not lead us to encourage mothers to feed their babies artificially.

Toxins and Infant Feeding, 2009© 
Written and revised (under other names) by Jack Newman, MD, FRCPC, © 1995-2016 
Revised Jack Newman MD, FRCPC, IBCLC and Edith Kernerman, IBCLC, 2008, 2009©

Slow Weight Gain Following Early Good Weight Gain

Introduction

Sometimes, babies who were doing very well and gaining weight very well with exclusive breastfeeding start to gain more slowly and even not at all after two to four months. Exclusively breastfed babies do tend to gain more slowly after three or four months compared to artificially (formula) fed babies but this is normal. The more rapid weight gain of the artificially fed baby is not the standard. Breastfeeding is the normal, natural, physiologic way of feeding infants and young children. Using the artificially fed baby as the model of normal is not rational and leads us to make errors in advising mothers about feeding and growth.

In some cases, however, an illness in the baby may result in slower than expected weight gain. Supplementing with formula does not cure the illness and may rob the baby of the beneficial effects of exclusive breastfeeding.

You can tell when a baby is getting milk and when he is not (see below and the video clips at the website ibconline.ca). If the baby is sucking at the breast and not getting milk, well, this explains why he is not gaining weight and it is most likely the mother’s milk supply is down. The mother’s milk having decreased is the most common reason that the baby fusses and pulls at the breast and/or no longer gains weight well enough.

Why would your milk supply decrease?

1. You have gone on the birth control pill, the Mirena IUD, have received Depo Provera or are taking estrogens and/or progesterones in another way. It should be noted that breastfeeding itself has a significant contraceptive effect, especially if you are breastfeeding exclusively.
2. You are pregnant. Pregnancy definitely decreases the milk supply.
3. You have been trying to stretch out the feedings or “train” the baby to sleep through the night. If this is the case, feed the baby when he is hungry or sucking his hand. Consider safe co-sleeping so the baby feeds at night and you don’t have to get up to feed him.
4. You are using bottles more than occasionally. It is better to avoid bottles altogether, but the occasional bottle is not usually going to influence your milk supply. However, regular, frequent bottle use results in the baby latching on less well and thus getting milk less well from the breast. Often the baby will pull off before he has “emptied” the breast, and the milk supply decreases. See below under “This reason requires more explanation”. If you must have the baby fed by someone other than you, then a cup (not a sippy cup as that is the same as a bottle) would be better than a bottle. See the video clips at the website ibconline.ca.
5. An emotional shock can, occasionally, decrease the milk supply.
6. Sometimes an illness in the mother, particularly if the illness is associated with fever, can decrease the milk supply. Mastitis and blocked ducts can also decrease milk supply. Fortunately this doesn’t happen most of the time.
7. Could you be doing too much? It is easy to get caught up in trying to conform to others’ ideas of what you should be doing. Let the housework go. Sleep when your baby sleeps. If you are tired, lie down with the baby to breastfeed and let yourself fall asleep. Make sure co-sleeping is done safely according to theguidelines set out by UNICEF and UK Baby Friendly .
8. Some drugs may decrease your milk supply. It is possible antihistamines do, especially the older ones such as Benadryl; pseudoephedrine (Sudafed) can also decrease the milk supply. Note that these two drugs (or similar ones) are found in cold and allergy medicines.
9. You are feeding one side only at each feeding. It is not a good idea to feed the baby on just one side, to follow a rule. Yes, making sure the baby “finishes” the first side before offering the second can help treat poor weight gain or colic in the baby, but rules and breastfeeding do not go together well. If the baby is not drinking, actually getting milk, there is no point in just keeping the baby sucking without getting any milk for long periods of time. You should “finish” one side and if the baby wants more, offer the other.

   How do you know the baby is “finished” the first side? Because the baby is no longer drinking, even with compression (see the video clip and information sheet on compression) This does not mean you must take the baby off the breast as soon as the baby doesn't drink at all for a minute or two (you may get another milk ejection reflex or letdown reflex, so give it a little time), but if it is obvious the baby is not drinking, take the baby off the breast and if the baby wants more, offer the other side. How do you know the baby is drinking or not? See the video clips at the above website.

   If the baby lets go of the breast on his own, does it mean that the baby has “finished” that side? Not necessarily. Babies often let go of the breast when the flow of milk slows, or sometimes when the mother gets a milk ejection reflex and the baby, surprised by the sudden rapid flow, pulls off. Try him again on that side if he wants more, but if the baby is obviously not drinking even with compression, switch sides.

10. A combination of the above.
11. Sometimes, the milk supply decreases for no obvious reason.Well, maybe the reason is not so difficult to figure out as that once you consider the information in the following paragraph and know how to know a baby is getting milk from the breast (or not).

    This reason (number 11) requires more explanation.

    In the first few weeks, babies tend to fall asleep at the breast when the flow of milk slows down. This slowing of the flow occurs earlier in the feeding if the baby is not latched on well. A baby who has a less-than-good latch but whose mother has an abundant supply can gain well, but he really depends on the milk ejection (letdown) reflex in order to get milk. The baby will suck and sleep and suck, without getting large quantities once the initial rapid flow diminishes but if the mother has more milk ejection reflexes, he will drink some more, even half asleep. Once the baby is older, however, some may pull away from the breast when the flow slows down, often within minutes of starting the feeding (Actually some do this from very early on, some never do this, and some do a combination of sleeping and pulling away from the breast depending probably on how hungry they are or their mood). This is more likely to occur when babies have received bottles from early on, but can also occur even without the baby’s having received bottles. When this pulling occurs, most mothers will probably put the baby over to the other side but then the same thing happens. The baby may still be hungry and may refuse to take the breast again, preferring to suck his hand. He won’t get those extra milk ejection reflexes (letdown reflexes) that he would have gotten if he had stayed longer at the breast. So, the baby drinks less and the supply also decreases because he drinks less and the flow slows even earlier in the feeding (because there is less milk) and a vicious circle has started. It doesn’t always happen this way and many babies may gain weight well even if they do spend only a short period of time on the breast. They may still pull off the breast and suck their hands because they want more sucking (which is pleasurable for them) but if their weight gain is good, there is no need for concern. Still, it’s nice to have a baby breastfeed without pulling at the breast.

    The way to prevent this all is to get a good latch from the beginning. Many mothers are told the latch is perfect when, in fact, it is far from perfect. The latch can still be improved even in the older baby, but it’s not always easy. But sometimes it is. See the Increase intake of breastmilk and the video clips at the website ibconline.ca.

    Often, domperidone will increase the milk supply significantly and we use it often. However, you should not use it if you are pregnant. In the first place it won’t work if you are pregnant and although there is no evidence that it is worrisome to use during pregnancy, the absence of studies showing concern does not mean it is safe during pregnancy.

How Do You Know The Baby Actually Drinks At The Breast?

When a baby is getting milk (he is not getting milk just because he has the breast in his mouth and is making sucking movements), you will see a pause at the point of his chin after he opens to the maximum and before he closes his mouth, so that one suck is (open mouth wide - pause - close mouth type of suck). If you wish to demonstrate this to yourself, put your index or other finger in your mouth and suck as if you were sucking on a straw. As you draw in, your chin drops and stays down as long as you are drawing in. When you stop drawing in, your chin comes back up. This pause that is visible at the baby’s chin represents a mouthful of milk when the baby does it at the breast. The longer the pause, the more the baby got. Once you know about the pause you can cut through so much of the nonsense breastfeeding mothers are being told. Such as: Feed the baby twenty minutes on each side. A baby who does this type of sucking (with the pause) for twenty minutes straight might not even take the second side. A baby who nibbles (doesn’t drink) for 20 hours will come off the breast hungry. See the video clips at the website ibconline.ca which show when a baby is getting milk (or not) and also how to latch a baby on and how to use compression.

Slow Weight Gain After Early Good Weight Gain, 2009© 
Written and revised (under other names) by Jack Newman, MD, FRCPC, © 1995-2016 
Revised by Jack Newman MD, FRCPC, IBCLC and Edith Kernerman IBCLC, 2008, 2009©