A pediatrician's guide to breastfeeding

How long should you breastfeed?

How long a parent decides to breast feed is a personal decision that is reliant on both physiologic, lifestyle, and cultural reasons. According to the American Academy of Pediatrics (AAP), breast milk alone is sufficient to sustain growth and development for the first six months of life.

The AAP also recommends nursing until the baby is at least one year and to continue as long as it is beneficial to both mother and baby.

Going back to work, ability to pump while on the job and personal preference all factor into the decision making process of how long to breastfeed.  Most pediatricians advise that solids be introduced after six months of age, as most babies are ready to handle the motor component of swallowing food.  Waiting until this age has also been shown to reduce the risk of obesity in the future.

It’s important to note that all exclusively breastfed babies should be on a supplement containing vitamin D, because breast milk alone does not provide a sufficient amount.

How do you know if you are breastfeeding successfully?

Many mothers become stressed at the thought that they are inadequately breastfeeding.

Seeking out your pediatrician is a great way to discuss these concerns and receive helpful feedback. We recommend that infants have 8-12 feedings per day.  Don’t be surprised if your baby wants to cluster feed, meaning feed every hour for several consecutive hours – it’s completely normal.

The importance of a good latch cannot be emphasized enough.  The mouth should surround a majority of the areola, not just the tip of the nipple. After a mother's milk comes in, she will have the sensation that her breasts are engorged before feeds, and then empty afterwards.

If the baby falls asleep at the breast, try simple mechanisms to wake him up, as excessively long feeds are exhausting and may cause you to be fatigued. Undressing your baby, softly blowing on his face or using a cool washcloth to rub his back can help him stay stimulated and engaged.

Breastfeeding on a regular basis helps stimulate prolactin and oxytocin which are hormones necessary for milk production and let-down.  Two of the most important means of measuring whether or not you are breastfeeding sufficiently is if your baby is having an adequate amount of wet diapers, and if she is gaining appropriate weight during your pediatrician’s well child check-ups.

Don’t be discouraged if breastfeeding is unsuccessful the first few tries. If you are having difficulty breast feeding ask your physician to refer you to a lactation consultant.

Is it supposed to be this painful?

It’s normal for breastfeeding to be painful and tricky at first while trying to figure out the mechanics. However, nursing should feel more comfortable and not be painful when the baby has a correct latch.

The baby’s mouth should be opened wide, and the nipple should be aimed towards the palate. Both the chin and nose should be pressed against the breast.

There are several simple ways to help alleviate the discomfort that is associated with breastfeeding.  Lanolin cream can be applied to ease sore, cracked nipples. Applying some breast milk to the nipple can also be soothing and healing. Nipple shields help to prevent chaffing against your clothing in between feeds as well as protect the skin of your nipple from becoming broken down by breastfeeding.

It’s important to recognize the signs and symptoms of an infection if one does arise. Inflammation, redness, irritation and hardening of the breast tissue in addition to generalized fever and malaise is known as mastitis – an infection that occurs in up to 10 percent of women who breastfeed.

If you develop any of these symptoms, you should see your doctor, because you may require antibiotics to clear the infection.  It is generally encouraged to continue breastfeeding in cases of mastitis that are not disabling. Emptying of the breasts helps with symptomatic relief for the mother and will not interfere with loss of milk production in the future.

Can women get pregnant while breastfeeding?

A popular myth is that it is impossible to get pregnant while breastfeeding - which is simply not true!  Breastfeeding has been linked to a decreasing the chance of getting pregnant, especially during the first 6 months after childbirth – but it doesn’t eliminate it altogether!

The reason some women do not get pregnant while nursing is related to the same hormone that enables milk production; prolactin.  Prolactin is responsible for suppressing ovulation, and when high enough levels are in the blood, a new egg will not be released for fertilization.

The level of prolactin necessary to prevent pregnancy cannot be accurately and reliably gauged for each woman. So if you’re not ready for another baby, you should talk to your doctor about contraception.

Having an open dialogue about breastfeeding with your pediatrician can help with both the emotional and physical components of nursing. It can also help to have your pediatrician observe a feed to offer helpful tips and reassurance.  And remember, every mother is different, so you should feel empowered with the decision you make and receive proper support from your physician.

Dr. Ayala Miller is a Resident Pediatrician at New York Presbyterian Hospital- Weill Cornell Medical College located on the Upper East Side of Manhattan.  She attended the Johns Hopkins University and graduated with Honors receiving a B.A.in Writing Seminars and then went on to attend the University of Maryland School of Medicine, where she was the recipient of the J. Edmund and Kathryn Bradley award for Excellence in Pediatrics.