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Don’t worry that there is no milk at first. Colostrum is there and that is just what your baby needs for a good start. Expect your milk to come in within 36-72 hours after delivery. You will usually be aware the milk is there and you may be sore. This will pass with nursing, warm showers, and compresses. Remember, when the milk arrives, your baby’s nursing is what stimulates breast milk production. Interrupting nursing with supplements and pacifiers will delay breast milk production. Take care of yourself. Eat well, drink plenty of fluids, and stay rested. Open the baby’s mouth to ensure contact with the whole areola, not just the nipple. Ask for help from the staff, doctors, and your family. Feeding and preparation for feeding will occupy a lot of time with your baby over the first month. Once you have begun breastfeeding, it is helpful to establish a routine for getting ready to nurse. Prior to nursing, wash your hands, gather whatever you need during nursing (a beverage, burp cloth, reading material), and consider turning off your phone so you can nurse undisturbed.

It is important that you alternate the position used for nursing so you drain all the milk sinuses regularly. Properly distribute pressure on the areola and nipple to avoid soreness. The following are three of the more common positions for breastfeeding: The Madonna: Traditional sitting position. Sit with the baby’s body across your abdomen, supporting her with the same arm as your breast. Cross-Cradle: Holding your baby across your lap, using the opposite arm to the breast she is feeding from to support her. Football Hold: With pillows positioned along the side of your body, hold your baby under your arm; much in the same way a football player holds the football. Lying Down: Lie on your side with knees bent. Lay baby on his/her side facing you, bringing his/her face toward your breast. Use pillows for comfort or support, if needed. Laid-back: Semi-reclined, with your baby lying across your stomach or shoulder. Improper positioning of the baby at the breast is a major cause of nipple soreness. The baby should be held closely enough so the tip of the nose touches the breast. The chin should press against the breast as well. The mouth should be opened widely and positioned slightly below the center of the breast. This will result in the lower lip covering more of the areola than the upper lip. The baby’s mouth should cover much of the areola, not just attach to the nipple.

During the first few weeks, it is important to provide some support for the breasts during feeding. The preferred method of supporting the breast is the C-hold. You cup your free hand to form the letter C with your thumb on top and your fingers curved below the breast. You can then gently guide the breast so that the nipple is centered in the baby’s mouth. This technique helps keep the breasts from obstructing the baby’s breathing, and is especially useful for large breasted women.

If the baby is allowed to determine the length of the feeding, his/her mouth will gently release the nipple when he/she is finished. If you wish to remove your baby from the nipple before this occurs, you will need to break the suction. Insert your finger gently into the corner of your infant’s mouth and press your finger against your breast near the corner of your baby’s mouth. The nipple should then slip easily out of the baby’s mouth.

In order for you to produce equal amounts of milk in each breast, you want to ensure that both breasts receive the same amount of stimulation. They must also be emptied regularly in order to avoid problems with plugged ducts, engorgement, or breast infections. Routinely offer both breasts at every nursing. Alternate the breast you begin with at each feeding. Encourage your baby to take the second breast. Burp him/her and stimulate him/her after he/she has finished nursing on the first side. He/she can then have unlimited nursing time on the second breast. If you end with the left breast at a nursing, you will begin the next nursing with the left breast.

After nursing, let your nipples air-dry. Moisture can lead to tender and sore nipples. You can pat the nipples dry with a soft cloth or leave the bra flap down a few minutes. Air-drying is especially important if you plan to apply a lubricant, such as lanolin, to the nipples since this lubricant can trap moisture.

The supply of breast milk is determined by the amount of nipple stimulation that you receive from your baby. When the baby nurses frequently, there is greater nipple stimulation and greater milk production. Nursing makes milk. To ensure that you have enough breast milk, nurse your baby frequently offering both breasts at each feeding. This will ensure that more milk will be produced.

In the first few days, nursing times are generally short, about 10 to 15 minutes. Your baby may nurse only on one breast each feeding and then drift off to sleep. The second breast should be offered each time. As the days pass and your baby becomes more alert, nursing times usually increase. In general, feeding length should be determined by your baby’s needs. When the flow of milk diminishes from your first breast and the rich hind milk has been extracted, the baby will release the nipple and it will slide out of his/her mouth. You can then offer the second breast and again permit sufficient nursing time for the baby to receive the hind milk. This hind milk is rich in fat and is important for your baby to receive. Unlimited suckling time, beginning directly after birth, improves breastfeeding. There is no reason to restrict feeding frequency or duration when you first begin breastfeeding. Unlimited nursing time has been shown to help decrease breast engorgement for moms and jaundice in babies. Some initial nipple discomfort is to be expected on about the third postpartum day. Prevention of sore nipples through use of proper positioning and correct feeding techniques is the most effective. Decreasing the time or frequency of feedings will only serve to delay nipple soreness by a day or two.

During the first month, nursing frequency for your healthy baby may range from 8 to 14 feedings per day, with most babies requiring 10 to 12. Some breastfed babies nurse as often as every two hours for part of the day with some other feedings spaced four to five hours apart. Generally, you should nurse your baby around every two to three hours during the day. Try not to allow more than three hours to lapse between feedings during the day. You do not need to wake your baby at night for feedings unless your baby has not nursed enough during the day or unless he/she has poor weight gain. Don’t be alarmed if your baby wants to nurse as often as every hour or hour-and a half during the day and several times during the night. Every baby’s needs are different and you should remain flexible to meet your baby’s requirements. By about six weeks of age, your baby usually will have developed a pattern of nursing every two to three hours with a longer stretch at night. As your baby matures and becomes a more efficient nurser, he/she will obtain more milk in a shorter period of time and will begin to space his/her feedings further apart.

Almost all medications taken by a breastfeeding mother are passed to the baby through the milk. Check with your physician before taking any medications. Avoid cigarette smoking. Nicotine is excreted in breast milk and has been found to decrease breast milk supply. Remember that breastfeeding is the best way to feed your baby. It works best if you remain relaxed and let nature take its course. Knowing what to do can help prevent problems. Please call our office or the hospital lactation consultant if you have any questions about breastfeeding.

Infant formulas are sold in three forms: ready-to-use, concentrated liquid, and powder. There are differences in cost and convenience between the different types of formula. The ready-to-use is most expensive. Powder is least expensive. Keep bottles and nipples clean. Wash in a dishwasher or scrub bottles. Wash nipples and caps with hot, soapy water and a bottle brush, squeezing water through holes in nipples. Rinse, dry, and place in a protected location until time for use. We do not recommend one brand of nipple or bottle over another. Nipple holes should be the correct size. Milk should drop at a rate of 1-2 drops per second. If holes are too large, discard the nipple. Formula may be mixed as you go or mixed in advance and stored for up to 48 hours in the refrigerator. Offer formula at room temperature. We do not recommend using a microwave to heat formula as the milk can get very hot in places and scald the baby’s mouth. Warming a bottle from the refrigerator can be done under warm running water or a bottle warmer. Seated comfortably and holding your baby with his/her head slightly elevated, hold the bottle so that the neck of the bottle and nipple are always filled with formula. Never prop the bottle.

Burping helps to remove swallowed air. Both breast and bottle-fed babies swallow air. Sit him/her in your lap with his/her head supported, hold him/her upright over your shoulder, or place him/her face down over your lap, and pat his/her back. Burp your baby frequently during the feeding as well as at the end.

Feed on demand – that is, whenever your baby seems hungry. This usually is between 2-4 hours. In general, the baby will have more knowledge as to his/her hunger than anyone else. Begin by placing 2-3 oz. of formula in the bottle. If this is not finished, discard remainder immediately. When your baby finishes the amount of milk offered, begin to increase the amount placed in the bottle by ½ to 1 oz. In general, have a little more milk in the bottle than is ordinarily taken. Remember, if the baby is sucking his/her fingers and smacking, and it has not been 2 hours since the last feeding, he/she may be suckling for comfort and a pacifier may be tried.

Sucking comforts babies. Even when not hungry, babies often suckle the fingers and thumb for comfort. You will learn the difference in your baby’s hungry behavior and “I need comfort” behavior in time. For formula-fed babies, a pacifier is fine. Breastfeeding moms may want to limit pacifiers until your milk supply is well established, as mentioned earlier. Allowing frequent nursing will meet your baby’s comfort needs.

At bedtime and naptime, prepare your baby by being sure he/she is warm, dry, and not hungry. It is fine to rock for comfort, and then place him/her in his/her bed to go to sleep. Babies should sleep on their backs with no pillows or soft bedding. Babies who are put in bed awake, sleepy and satisfied, and allowed to go to sleep on their own are better sleepers in the long run.

Items needed: A warm room Table or countertop of comfortable height A soft washcloth No-tears shampoo Rubbing alcohol Cotton balls and Q-tips Full-sized towel Your baby may be washed in a dishpan or in the sink. Always check water temperature. He/she may not be placed in water before the cord is off. Daily baths are fine, but are not necessary. Wash his/her face and head first, and his/her diaper area last. After bathing, rinse and dry. If the skin is too dry, you may use baby lotion or hand cream. We don’t recommend baby oil/powder.

The umbilical cord should dry and fall off in 1-3 weeks. After bathing, clean the cord with alcohol using cotton balls or Q-tips. Lift up the cord so that the base of the cord can be cleaned and dried. When the cord drops off, clean the base with alcohol until this area completely heals. Position diaper below cord and leave cord uncovered. Some bleeding, green, or yellow discharge, or odor is common as the cord separates. If the skin around the cord is warm or red, call our office.

Gently wash the penis with a cotton ball and mild soap, rinse, and pat dry. Apply Vaseline until healed.

Don’t try to pull the foreskin back over the head of the penis. As your child grows, the foreskin will gradually loosen and they will be able to gradually retract it more and more.

Babies need very basic clothing for the first month of life. They should be dressed comfortably for their environment. A cotton gown and diaper will be sufficient for several weeks. A light blanket for sleeping will be needed. Do not overdress. Either cloth or disposable diapers may be used.

When taking a rectal temperature, first shake down the thermometer below the 96 degree mark. Lubricate the tip with Vaseline or other lubricant for easy insertion. Lay the baby on his/her stomach in your lap (with a diaper underneath for protection), holding the baby firmly. Spread the buttocks with one hand. Carefully insert the thermometer into the rectum ½ to ¾ of an inch. Do not let go of the baby or the thermometer. Hold the thermometer in place for 2-3 minutes. Remove the thermometer and read results where the mercury stops. Cleanse the bulb with soap and cool water. Rectal temperature records the baby’s internal temperature. A normal rectal temperature can be 97.0 to 100.0 degrees. If the temperature is above 100.5 degrees, do not give fever-reducing medication and please call your pediatrician.

If, during the first three months of life, the baby’s rectal temperature is over 100.5 degrees, he/she is extremely fussy or lethargic, has difficulty breathing, or has excessive vomiting or diarrhea, notify your physician. In this age group, we don’t recommend giving Tylenol without talking to a doctor. Your pediatrician will instruct you further with any special care or treatment.

Squeeze the bulb syringe. Insert into each nostril or the sides of his/her mouth. Release syringe compression and suction mucous out of the baby’s nose or mouth. Cleanse bulb often with soap and water.

Newborn screening for hearing loss, PKU, congenital heart disease, congenital hypothyroidism, low thyroid hormone, congenital adrenal hyperplasia, galactosemia, Sickle Cell disease and related red blood cell disorder, biotinidase deficiency, amino acid disorders, fatty acid oxidation disorders, organic acid disorders and cystic fibrosis are routine in Alabama. Testing starts in the hospital and results are usually available at the two week checkup. Newborn screening tests and abnormal hearing tests are repeated at the two week checkup. An abnormal screen DOES NOT MEAN something is wrong with your baby, only that follow-up is important to make sure that the test is normal. All of these conditions can be treated if detected early, giving babies the best outcomes. That is why we screen! If you do not see the physicians at Fort Payne Pediatrics for your two week checkup, please ensure that your baby’s doctor follows up on these screenings and gives your baby a Hepatitis B vaccination at two weeks of age, if they did not receive it while in the hospital. You should be notified of your infant’s hearing screen results before leaving the hospital. These screens are often abnormal because infants have fluid in the middle ear space. This does not mean your child has hearing problems. Follow-up is very important.