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When Should I Introduce a Bottle to my Breast Fed Baby?

Introducing a bottle too soon could cause a baby to begin to refuse the breast. Waiting too long could result in a baby who refuses to take a bottle. I would suggest beginning when the baby is 3 weeks old. A bottle should be offered at least 2 times per week (so the baby will not forget how to bottle feed) but not more than once per day until mom returns to the work place. Begin to 2-3 ounces per feed. Don’t forget that mom needs to pump within an hour (before or after) the bottle is given or she will become engorged.

What is the Best Bottle to Use for a Breast Fed Baby?

A “slow flow” nipple is probably your best choice. Most bottle manufactures make a so-called slow flow nipple. The issue is that the range of actual flow among slow flow nipples is significant. The slowest flowing nipples are Dr. Brown preemie nipple or the Munchkin Latch. “In the middle” would be Born Free, Avent, Comotomo, or Tommie Tippee. The fastest so-called slow flow nipple is the Medela 0-4 month nipple.

Is it Possible for the Nipple to be Too Slow?

Yes it is. The baby should be able to ingest 2-3 ounces in 15 -20 minutes. If it is taking the baby longer, you run the risk of the baby exerting more calories than the baby is ingesting. If you find the baby is taking 30 minutes or longer to finish 2-3 ounces, move to Avent, Born Free, Comotomo, or Tommie Tippee.


When Can I Give My Baby a Pacifier?

The Academy of Pediatrics and many lactation consultants suggest that you wait at least a month before introducing a pacifier. The current thinking is that if introduced too soon, the baby’s latch could be adversely affected. While I don’t necessarily disagree, I find that many babies do very well moving between the breast and a pacifier with no adverse effects. Many babies have a very strong suck and require many hours of sucking. This can be very hard on a new mother, especially if her nipples are sore/damaged. I take each mother/baby as an individual case. If I find that the baby is feeding well, gaining weight and just appears to need “extra” sucking time, I believe a pacifier is a good choice for the family.


How do I know if I Have Thrush?

Many new mothers are led to believe after reading internet postings that painful, burning nipples means mom has thrush. While this is a common symptom it is more likely that the source of the burning is in fact nipple trauma. Any breastfeeding mother experiencing burning nipples should see their obstetrician. A lactation consultant can also be helpful. If the mother actually has a yeast infection on her nipples, her baby often has oral thrush and should be seen by the pediatrician.


How Can I tell if My Baby is getting enough to Eat at the Breast?

In the first month the easiest way to measure milk intake is to “measure” output. You count pees and poops.  By 5-6 days from birth, a breastfed baby should have at least 6-8 wet diapers and at least 3 (larger than a quarter) mustard stools.  For most feedings the baby should appear to swallow intermittently at the breast for up to 10-15 minutes and the come of the breast appearing content. Lastly a thriving breastfed baby will lose weight initially but should be back to birth weight by 10-14 days. Babies should then gain .75 to 1 ounce (20-30 gm) per day until they are about 4 months old.

Should I BE Concerned if My Baby Will Only Feed From One Breast at a Feeding?

Probably not. If the mother has an ample milk supply, the baby will often be completed satiated on one breast. Simple allow the baby to feed completely on one breast. If the baby comes off the breast looking content or is asleep, the baby is likely full. Simply feed from the opposite breast at the next feeding.


Should I Be Concerned If My Baby Will Only Feed for 5 Minutes and Then Falls Asleep?

Assuming your baby has plenty of wet/dirty diapers and is gaining the proper amount of weight, you have nothing to worry about. In this situation the baby is generally a very efficient feeder and mom usually has a copious milk supply.


What does it Mean If My Baby has Green Stools?

The internet has made a HUGE deal about green stools. The only color pediatricians are concerned about would be white, black or red. Otherwise you can relax. Green stool is thought to be an imbalance of foremilk and hind milk. Foremilk is the milk the baby ingests initially and then the longer the baby suckles the more hind milk the baby takes. The ONLY difference between fore and hind milk is fat. Foremilk is good! It is common for a baby to appear extra gassy and fussy when they have green stools. Otherwise they are just fine. Foremilk hind milk imbalance is often the result of a copious milk supply. For suggestions on how to remedy this imbalance please see handout on abundant milk supply.

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