Feeding & Eating

Do you sometimes feel that your kids might eat you out of house and home? It can feel like that at times, especially during the teen years. They grab a handful of cookies here, a bag of chips there, and finish last night’s leftovers in a flash. They’re growing like weeds, of course, so you figure all that eating is OK. And most of the time, it is.

But sometimes, heavy snacking isn’t what it seems to be. A kid who eats unusually large amounts of food — and feels guilty or secretive about it — could be struggling with a common eating disorder called binge eating disorder.

About Binge Eating Disorder

Lots of people find comfort in food. After all, it’s often at the heart of our happiest celebrations. Birthdays can mean cake with friends; Thanksgiving often means turkey and stuffing with family. Most people will sometimes eat much more than they normally do (or even want to) on special occasions.

But people with binge eating disorder have a different relationship with food — they feel like they’ve lost all control over how much they’re eating, like they can’t stop. They also binge more frequently — at least twice a week for several months.

For people with binge eating disorder, at first food may provide feelings of calm or comfort or stop them from feeling upset. But if bingeing continues, it can cause anxiety, guilt and distress. A binge usually involves eating unusually large amounts of food quickly. While bingeing, a person feels completely out of control. These behaviors can become a habit, which is often alternated with dieting.

Binge eating disorder is more common in people who are overweight or obese, but it affects people of healthy weight as well. However, there’s little information on how many kids and teens have it because the condition has only recently been recognized. Some people may be too embarrassed to seek help for it.

Also, because most binge eating is done alone, even if their kids may be gaining weight, parents might not be aware that it’s due to bingeing.

While other eating disorders (like anorexia and bulimia) are much more common in females, about a third of those with binge eating disorder are male. Adults in treatment (including 2% of adult Americans — roughly 1 million to 2 million people) often say their problems started in childhood or adolescence.

Signs and Symptoms

Kids and teens who sometimes eat a lot don’t necessarily have binge eating disorder. Kids can have huge appetites, especially during growth spurts, when they need more nutrients to fuel their growing bodies. So it can be difficult to determine whether a child has binge eating disorder. But several signs distinguish someone who binge eats from someone with a “healthy appetite.”

Parents and other family members may first suspect a problem when they notice large amounts of food missing from the pantry or the refrigerator, though it’s hard to imagine one child could have eaten so much.

Other signs include:

• a child eating a lot of food quickly
• a pattern of eating in response to emotional stress, such as family conflict, peer rejection, or poor academic performance
• a child feeling ashamed or disgusted by the amount they have eaten
• finding food containers or wrappers hidden in a child’s room
• an increasingly irregular eating pattern, such as skipping meals, eating lots of junk food, and eating at unusual times (like late at night)

People who binge might experience feelings that are common to many eating disorders, such as depression, anxiety, guilt, or shame. They may avoid school, work, or socializing with friends because they’re ashamed of their binge eating problem or changes in their body shape and weight.

Causes

The causes of binge eating disorder aren’t clear, although the National Institutes of Health (NIH) report that up to half of all people who have it also have a history of depression. It’s not known, though, if binge eating brings on depression or if people with depression are prone to the disorder.

Many people who binge eat say that episodes can be triggered by feelings of stress, anger, sadness, boredom, or anxiety. However, even if someone feels better temporarily while eating, it’s usually associated with feelings of distress. Most commonly, after a binge a person will feel anxious, guilty, and upset about losing control.

How It Differs From Other Eating Disorders

Binge eating disorder is slightly different from other eating disorders.

People with bulimia nervosa (sometimes called binge-purge syndrome) binge on food and then purge (vomiting or using laxatives) to avoid gaining weight. They may also fast (stop eating for a while) or compulsively exercise after an eating binge. Like people who suffer from binge eating disorder, those with bulimia nervosa repeatedly eat very large amounts of food and feel guilty or ashamed about it. Unlike bulimia, however, those with binge eating disorder do not or are unable to purge and are, therefore, frequently overweight.

Anorexia nervosa also involves feelings of guilt about eating. Whereas people with binge eating disorder consistently overeat, people with anorexia starve themselves, causing potentially life-threatening damage to their bodies. They also may compulsively exercise to achieve weight loss, a condition known as anorexia athletica.

Diagnosis

If the doctor thinks your child might have an eating disorder, he or she will take a thorough medical history. The doctor will also discuss the family history, patterns of eating in the family, and emotional issues. In addition, a complete physical will be done and lab tests may be ordered. Blood tests can look for medical issues (like high cholesterol or thyroid problems) that may be related to having an unhealthy weight.

Doctors and mental health professionals use the criteria in the Diagnostic and Statistical Manual IV (DSM-IV) when they identify binge eating disorder. These include:

• binge eating more food than most people could consume in short periods of time
• a sense of lack of control over eating
• feelings of distress about eating behaviors
• binge eating that happens, on average, at least 1 days a week for 3 months
• the binges are not associated with regular purging with laxatives or by vomiting or excessive exercise
• binge episodes associated with:
  • eating more rapidly than usual
  • eating until uncomfortably full
  • eating when not hungry
  • eating alone or in secret
  • feelings of disgust, depression, or guilt

Treatment

As with any eating disorder, it’s also important for a child to have psychological therapy for support and to help change unhealthy behaviors.

Different types of therapy can help treat binge eating disorder. For example, family therapy and cognitive-behavioral therapy teach people techniques to monitor and change their eating habits and the way they respond to stress. Family therapy includes the whole family in the process of helping the individual.

Cognitive-behavioral therapy combines the approach of helping people change self-defeating thoughts along with changing their behavior. Counseling also helps patients look at relationships they have with others and helps them work on areas that cause them anxiety. In some cases, doctors may prescribe medication to be used with therapy.

But there’s no quick fix for any eating disorder. Treatment can take several months or longer while the person learns how to have a healthier approach to food. Although weight-control programs are helpful for some people affected by binge eating disorder, kids and teens should not begin a diet or weight-control program without the advice and supervision of a doctor.

For some parents and family members, the long road to recovery can be frustrating and expensive. Get support for yourself through parents groups or by reading about the disorder so you can help your child and your family get through this.

Risks and Complications

Many children and teens with binge eating disorder become overweight after months of overeating. Their most common health risks are the same ones that accompany obesity, including diabetes, high blood pressure, high cholesterol levels, gallbladder disease, heart disease, some kinds of cancer, and depression and anxiety.

Helping Your Child

If you suspect your child has a problem with binge eating, call your doctor for advice and referrals to qualified mental health professionals who have experience treating eating disorders in kids.

Reassure your child that you’re there to help or just to listen. Having an eating disorder can be difficult to admit, and your child may not be ready to acknowledge having a problem. You also can encourage healthier eating habits by modeling your own positive relationship with food and exercise and by not using food as a reward.

With the help of your family, friends, and supportive professionals, your child can start eating healthy amounts of food and learn to manage stress in healthier ways.

Whether you’re a new mom or a seasoned parenting pro, breastfeeding often comes with its fair share of questions. Here are some answers to common queries that mothers — new and veteran — may have.

When will my milk come in?

For the first few days after your baby’s birth, your body will produce colostrum, a nutrient-rich “pre-milk” or “practice milk.” Colostrum contains many protective properties, including antibacterial and immune-system-boosting substances that aren’t available in infant formula.

For some women, colostrum is thick and yellowish. For others, it is thin and watery. The flow of colostrum is slow so that a baby can learn to nurse — a process that involves coordination to suck, breathe, and swallow.

After about 3 to 4 days of producing colostrum, your breasts will start to feel firmer. This is a sign that your milk supply is increasing and changing from colostrum to breast milk, which resembles skim (cow’s) milk.

Sometimes a mother’s milk may take longer than a few days to come in. This is perfectly normal and is usually no cause for concern, but make sure to let your doctor know. While babies don’t need much more than colostrum for the first few days, the doctor may need to make sure the baby is getting enough to eat. It can help to breastfeed often to stimulate milk production.

When should I begin breastfeeding?

If possible, try to start nursing within an hour of your baby’s birth. This timing takes advantage of the natural wakefulness of a newborn immediately after birth. After the initial period of being alert, a newborn will spend much of the next 24 hours sleeping. So it may be more difficult to get your baby to latch on after those first few hours.

A newborn baby placed on the mother’s chest after birth will naturally “root” (squirm toward the breast, turn the head toward it, and make sucking motions with the mouth). To breastfeed, the baby will latch onto the breast by forming a tight seal with the mouth around the nipple and areola. Even if your baby doesn’t actually latch on at this time and just “practices,” it’s still good for your baby (and you!) to get used to the idea of breastfeeding.

In the first few days of life, your baby will want to feed on demand, usually about every 1-3 hours day and night. As babies get older and their bellies grow to accommodate more milk, they will go longer between feedings.

Are bottles or pacifiers OK?

If you plan to exclusively breastfeed, it’s best to allow your baby time to practice breastfeeding without being confused by a bottle or a pacifier. Sucking on a bottle or a pacifier requires a different set of skills than breastfeeding. So until breastfeeding is well established (sometime within the first month or so), experts suggest not introducing a bottle or pacifier to avoid “nipple confusion.” (But while some babies experience this confusion, others have no problem moving between a bottle and the breast.)

There’s also a chance that breastfed babies who are given a bottle early on may prefer it. Since drawing milk from a bottle requires less effort and the milk flows much quicker than at the breast, sometimes babies stop breastfeeding altogether and will only take bottles.

Experts also worry that giving a pacifier early on and often will prevent parents from recognizing a baby’s hunger cues, causing a baby to miss necessary feedings. Giving a pacifier occasionally (such as during a circumcision, when baby boys may be given pacifiers with sugar water) is OK and usually won’t undermine breastfeeding efforts.

In certain situations, doctors may recommend supplementing your breast milk with formula. If this happens, it’s still possible to simulate breastfeeding by feeding your baby through a nursing system that lets formula be delivered through a small tube attached to your nipple.

How do I know that my baby is hungry?

Despite what you might think, crying is a late sign of hunger. Try to nurse your baby before he or she is upset from hunger and is difficult to calm down.

Other signs that babies are hungry include:

• moving their heads from side to side
• opening their mouths
• placing their hands and fists to their mouths
• puckering their lips as if to suck
• nuzzling again their mothers’ breasts
• stretching
• showing the rooting reflex (when a baby moves its mouth in the direction of something that’s stroking or touching its cheek)

What is “let-down”?

During the first few days to weeks after delivery, you may feel a pins-and-needles or tingling sensation in your breasts just after your baby starts to suckle. Milk may seep from the other breast. This is called the let-down reflex, or milk-ejection reflex.

The let-down reflex happens when your baby’s sucking (or a machine pumping) triggers nerves in the nipple. The nerves send a message to your brain telling it to release milk. The brain releases a hormone called oxytocin that causes tiny muscles in the breast to tighten and squeeze the milk out, or “let it down.” Oxytocin also can make you feel cramps in your uterus when your milk lets down. This is helpful in returning your uterus back to its original size.

Let-down also can happen if a feeding is overdue or before you start nursing (some women have let-down from simply seeing their baby or hearing a baby cry). Or it can happen after your baby is latched on and has sucked a few times. Some women have multiple let-downs during a single feeding.

Some women, however, never have a feeling of let-down, which is OK, too. Even if you don’t feel it, you should still see milk coming from your nipple and hear and see your baby swallowing.

How do I latch my baby on correctly?

Many new mothers have trouble getting their baby to latch correctly. An incorrect latch can be frustrating for babies and very painful for mothers.

Here’s how you can make sure your baby gets a good latch every time:

1. Make sure your baby’s mouth is opened wide and his or her tongue is down when latching on.
2. Support your breast with your hand, positioning your thumb on top and your fingers at the bottom, keeping your thumb and fingers back far enough so that your baby has enough of the nipple and areola (the darker circle of skin around the nipple) to latch onto.
3. Gently glide your nipple from the middle of your baby’s bottom lip down to his or her chin to help prompt your baby to open his or her mouth.
4. When your baby opens his or her mouth wide and the tongue comes down, quickly bring your baby to your breast (not your breast to your baby). Your baby should take as much of your areola into his or her mouth as possible.
5. Make sure your baby’s nose is almost touching your breast (not pressed against it), his or her lips are turned out (or flanged), and you see and hear your baby swallowing. (You should be able to tell by seeing movement along your baby’s lower jaw and even in your baby’s ear and temple. Some babies may also make small noises when they swallow that sound like little clicks.)
6. Have a nursing session observed by someone knowledgeable about breastfeeding.

When your baby is properly latched on, you may have 30 to 60 seconds of latch-on pain (this is caused by the nipple and areola being pulled into the baby’s mouth). Then the pain should ease. It will then feel like a tug when your baby is sucking.

If you continue to feel pain, stop feeding momentarily and reposition your baby on your breast. If you still feel pain during feeds even after repositioning, talk to your doctor or lactation consultant to make sure something else isn’t going on, such as an infection.

How can I tell if my baby is latched on wrong?

If your baby tends to suck on the tip of your nipple, without getting much of your areola, he or she is latched on incorrectly. Babies who tend to latch on wrong also fall sleep at the breast more often and may not seem satisfied because they may not be getting enough. If this happens, break the suction and reposition your baby onto your breast to include the nipple and areola.

Call your doctor or a lactation consultant if:

• you’re unable to nurse your baby without pain (you may just need help getting your baby to latch on correctly, or it could be a sign of a nipple injury or breast infection)
• your baby consistently sleeps at the breast
• your baby is nursing but doesn’t seem satisfied when feedings are over
• your baby does not gain weight as expected or does not produce the usual numbers of wet and soiled diapers (about 6 wet and 4 soiled each day at first)

How can I tell if my baby is getting the milk?

Once a baby is latched onto the breast, he or she usually takes four to five sucks, followed by a 5- to 10-second pause. Your baby’s sucks will increase in number as the quantity of your milk increases. As the milk flow slows, your baby’s pattern will probably change to three or four sucks and pauses that last longer than 10 seconds.

Most babies will release the breast on their own. If your baby doesn’t release your breast but the sucks now seem limited to the front of his or her mouth, slip your finger in the side of your baby’s mouth (between the gums) and then turn your finger a quarter turn to break the suction. Then, try to burp your baby and switch him or her to the other breast.

Newborns will often fall asleep while breastfeeding. If this happens, try to wake your baby by tickling the feet, rubbing the back, or taking off some clothing. Sometimes burping your baby or changing the diaper also can be helpful.

Is there more than one way to hold my baby?

Yes. You can try several different nursing positions (or holds) to figure out which one is the most comfortable for you and your baby.

They include the:

• Cradle Hold: This is the traditional hold many mothers will try from the get-go, holding the baby across the chest and using the arm on the same side as the nursing breast to support the baby.
• Clutch (or Football) Hold: This position holds the baby at your side, under your arm, and is good for the mom who’s had a C-section (because the baby doesn’t put pressure on the mother’s belly), as well as for mothers with large breasts or those who had twins.
• Cross-Cradle (or Crossover) Hold: Similar to the cradle hold, this position involves using the arm on the opposite side as the nursing breast to support the baby. Some mothers find that this hold makes it easier to control how their babies latch on.
• Side-Lying Position: This position, in which mom lies on her side facing the baby, allows moms to get some rest during feedings and is also a common choice for mothers who’ve had C-sections.

How can I make breastfeeding more comfortable?

Again, it’s mostly about finding a comfortable nursing position and proper latch-on — once you’ve gotten those down, it can make for a truly rewarding bonding experience.

Here are some other things that might help you to relax and enjoy the experience:

• Keep a breastfeeding goodie bag or basket near all of your regular nursing areas at home (next to the bed, on the couch, etc.). Fill it with bottled water, some healthy snacks, a few magazines, your portable home phone or cellphone (so you don’t have to get up to answer or make calls), plenty of burp cloths or cotton diapers for dribbles and spit-up, and the remote controls if you want to use a TV, DVD player, or stereo nearby.
• Find the most comfortable seating arrangement and stick to it so that your baby gets comfortable with — and looks forward to — the routine. Many mothers like to sit in a glider or in a cozy chair with armrests.
• Give your feet and back a break. Footstools and pillows can give extra support. Pillows that some women find helpful are the wraparound nursing pillows or the “husband” back pillows with arms on each side for nursing in bed.

How long should I plan to breastfeed my baby?

That’s a personal choice. Experts do recommend that babies be breastfed exclusively (without offering formula, water, juice, non-breast-milk, or food) for the first 6 months, and that breastfeeding continue until 12 months (and beyond) if it’s working for both mother and baby.

Studies on infants show that breastfeeding can lower the occurrence or severity of diarrhea, ear infections, and bacterial meningitis. Breastfeeding also may protect children against sudden infant death syndrome (SIDS), diabetes, obesity, and asthma.

Breastfeeding also burns calories and helps shrink the uterus, so nursing moms might be able to return to their pre-pregnancy shape and weight quicker. And studies show that breastfeeding helps lower a woman’s risk of breast cancer, high blood pressure, diabetes, and cardiovascular disease, and also may help decrease the risk of uterine and ovarian cancer.

I’m having a hard time. What can I do?

Nursing comes easily for some moms, but takes time and practice for others. In fact, it can be one of the most challenging and rewarding things you do as a mother.

While you’re in the hospital, seek help from a lactation consultant, who can help you through most of your breastfeeding challenges. If your hospital doesn’t provide a lactation consultant, the nursing staff, your baby’s pediatrician, or your OB-GYN can be very helpful in guiding you through the dos and don’ts of breastfeeding.

Doctors usually want to weigh infants and evaluate breastfeeding within 24 to 48 hours after a mother and newborn leave the hospital. But if you have any concerns or difficulties before then, make sure to talk to your doctor.

Whatever you do, try not to become too discouraged. With a little patience and some practice, it will likely become easier for both you and your baby in the coming weeks. Like the old saying goes, practice makes perfect.

Whether you’re a new mom or a seasoned parenting pro, breastfeeding often comes with its fair share of questions. Here are answers to some common queries that mothers — new and veteran — may have.

How often should I breastfeed?

Your newborn should be nursing 8-12 times per day for about the first month. If you feel like you’re feeding your little one more often than a friend whose baby is formula fed, you might be. Why? Because breast milk digests easier than formula, which means it moves through your baby’s digestive system faster and, therefore, your baby is hungry more often.

Frequent feedings also will help stimulate your milk production during the first few weeks. By 1 to 2 months of age, a breastfed baby will probably nurse 7-9 times a day.

Before your milk supply is established, breastfeeding should be “on demand” (when your baby is hungry), which is generally every 1½ to 3 hours. As newborns get older, they’ll nurse less often, and may develop a more reliable schedule. Some might feed every 90 minutes, whereas others might go 2 or 3 hours between feedings. Newborns should not go more than about 4 hours without feeding, even overnight.

Are feeding intervals counted from the time my baby starts or stops nursing?

You count the length between feedings from the time when your baby begins to nurse — rather than when he or she ends — to when your little one starts nursing again. In other words, when your doctor asks how often your baby is feeding, you can say “about every 2 hours” if your first feeding started at 6 a.m. and the next feeding was at around 8 a.m., then 10 a.m., and so on.

This means that, especially at first, you may feel like you’re nursing around the clock, which is completely normal. Soon enough, you’ll both be on a more routine, predictable schedule.

How can I tell when my baby’s ready to eat?

It’s usually recommended that moms feed a newborn whenever the baby seems hungry. But crying is a late sign of hunger. So try to feed before your baby gets so hungry that he or she gets really upset and becomes difficult to calm down.

It’s also important, however, to realize that every time your baby cries it is not necessarily because of hunger. Sometimes babies just need to be cuddled or changed. Or they could be overstimulated, bored, or too hot or too cold.

Signs that babies are hungry include:

• moving their heads from side to side
• opening their mouths
• sticking out their tongues
• placing their hands and fists to their mouths
• puckering their lips as if to suck
• nuzzling again their mothers’ breasts
• showing the rooting reflex (when a baby moves its mouth in the direction of something that’s stroking or touching its cheek)

Watch for signs that your baby is full (slow, uninterested sucking; turning away from the breast or bottle) and stop the feeding when you see them.

How long does it take to nurse?

That depends on both you and your baby and many other factors, such as whether:

• your milk supply has come in completely
• your let-down reflex (which causes milk to flow from the nipple) is immediate or takes a few minutes into the feeding to start
• your milk flow is slow or fast
• you’re positioning your baby correctly on your breast
• your baby tends to get right down to business or dawdles a bit
• your baby is sleepy or easily distracted (which can be the case in older babies, especially)

How long babies nurse also depends on their age. As babies get older, they become more efficient, so they may take about 5-10 minutes on each side, whereas newborns may feed for up to 20 minutes on each breast.

Make sure your baby is latched on correctly from the beginning to ensure the most productive feeding possible. It’s important that your baby nurses with a wide-open mouth and takes as much as possible of your areola in his or her mouth (not just the tip of the nipple).

But be sure to call your doctor if you’re concerned about the length of your baby’s feedings — whether they seem too short or too long.

How often should I alternate breasts?

To keep up your milk supply in both breasts — and prevent painful engorgement in one — it’s important to alternate breasts and try to give each one the same amount of nursing time throughout the day. Again, that amount of time differs for every baby and every woman — some babies may be satisfied after 5 minutes on each breast, others may need 10 or 15 minutes on each side.

Some experts recommend switching breasts in the middle of each feeding and alternating which breast you offer first for each feeding. Can’t remember on which breast your baby last nursed? Some women find it helpful to attach a subtle reminder — a safety pin or small ribbon — to their bra straps indicating which breast they last nursed on so they’ll know to start with that breast at the next feeding. Or, keep a notebook handy to keep track of how your baby feeds.

Your baby may seem to prefer both breasts with each feeding and may be doing well. Or, your little one may like to nurse on just one breast with each feeding. Whichever way you choose, it’s important for you to do whatever works and is the most comfortable for you and your baby.

How often should I burp my baby during feedings?

Let your baby breastfeed at one breast then switch to the other side. Try burping your baby when switching breasts and at the end of the feed. Often, the movement alone can be enough to cause a baby to burp.

As your milk comes in and your baby has established good latch-on, you can try burping as often as you think helps your baby. Some infants need more burping, others less, and it can vary from feeding to feeding depending on what the mother has been eating.

If your baby spits up a lot, you may need to try burping more frequently. While it’s normal for infants to “spit up” a small amount after eating or during burping, a baby should not vomit after feeding. Vomiting after every feeding may be a problem that needs medical attention. If you have concerns that your baby is spitting up too much, call your doctor.

How can I tell if my baby’s eating enough?

New mothers, especially breastfeeding moms, are often concerned that their infants may not be getting enough to eat. You can be assured that your baby is getting enough to eat if he or she:

• seems satisfied and content after eating
• produces about 4-6 wet diapers a day
• has regular bowel movements
• sleeps well
• is alert when awake
• is gaining weight

Your baby may not be getting enough to eat if he or she:

• does not appear to be satisfied after feeding
• seems hungry often
• isn’t making several wet and soiled diapers a day
• is fussy or cries a lot
• isn’t gaining weight

If you’re concerned that your baby isn’t getting enough to eat, call your doctor. Breastfed infants should also be seen by their doctor 24 to 48 hours after a mother and newborn leave the hospital. During this visit, the baby will be weighed and examined, and the mother’s breastfeeding technique can be evaluated. It’s also an opportunity for nursing mothers to ask questions.

Even if a breastfed baby is doing well, the doctor probably will schedule another visit for when the baby is around 2 weeks old. These postnatal checkups can help you be sure that your baby is gaining weight and getting enough nutrients.

For your own peace of mind, it can help to keep a notebook or first-week breastfeeding log to write down each time your baby feeds, how long the baby fed on each breast, and each time the baby stools (poops) or makes a wet diaper.

If you’re concerned or notice any signs that your infant isn’t getting enough nutrients, call your baby’s doctor.

What should my newborn’s diapers look like?

Your baby’s diapers are excellent indicators of whether your breastfed baby is getting what he or she needs. Because colostrum (the first milk your newborn gets) is concentrated, your baby may have only one or two wet diapers in the first 24 hours.

Your newborn’s stools (or poop) will be thick and tarry at first and become more greenish-yellow as your milk comes in, which is usually about 3 or 4 days after birth. The more your baby nurses, the more dirty (or “soiled”) diapers he or she will have; but it may be just one a day in the first days after birth.

After 3 to 4 days, here are some signs you should look for:

• six or more wet diapers per day, with clear or very pale urine. Fewer diapers or darker urine may mean your baby’s not getting enough to drink. If you see orange crystals in a wet diaper, contact your baby’s doctor. They’re common in healthy, well-fed babies and usually not a cause for concern, but sometimes can be a sign that a baby isn’t getting enough fluids.
• four or more yellow, seedy bowel movements per day, usually one after each feeding. After about a month, though, breastfed babies usually have fewer bowel movements and many may go a few days without pooping.

My baby wants to nurse for comfort. Is this OK?

If your baby seems to be getting enough milk, but continues to suck longer than usual, he or she might be nursing for comfort rather than for nourishment. So, how do you know? Once your baby has fed vigorously, he or she may stay on your breast but show these signs of non-nutritive sucking:

• seems satisfied
• moves the jaws but stops sucking and swallowing
• plays with your nipple

Early on, it’s OK to let your baby nurse for comfort, but it can become a problem as your little one gets older because he or she may need to nurse to take a nap or go to bed at night. So, at some point you may want to wean your baby off of sucking for comfort and make breastfeeding sessions only about nourishment.

Instead of nursing, you might offer your baby his or her thumb or hand to suck on. You also could give your little one a pacifier if your child doesn’t seem to be hungry. Because pacifiers are associated with a lower risk of sudden infant death syndrome (SIDS), experts now recommend letting babies go to sleep with a pacifier. But only do this after breastfeeding is well established (usually after 1 month).

If possible, also hold off on introducing a bottle until breastfeeding is well established. Some babies have “nipple confusion,” though the likelihood of this happening is much less after 4 to 6 weeks.

My baby is hungrier than usual. Is this normal?

As babies gain weight, they should begin to eat more at each feeding and go longer between feedings. Still, there may be times when your little one seems hungrier than usual.

Your baby may be going through a period of rapid growth (called a growth spurt). These can happen at any time, but in the early months growth spurts often occur at around:

• 7 to 14 days old
• 2 months
• 4 months
• 6 months

During these times and whenever your baby seems especially hungry, follow his or her hunger cues. You may need to temporarily increase the frequency of feedings.

Whether you’re a new mom or a seasoned parenting pro, breastfeeding often comes with its fair share of questions. Here are answers to some common queries that mothers — new and veteran — may have.

How can I be discreet when nursing in public?

Nursing in front of others can be downright intimidating and even embarrassing, especially at first. But with a little confidence, the right place, and the appropriate clothes, it can seem like no big deal in no time.

Some women prefer to drape a small blanket or shawl over their shoulder and their breast to make the public process a little more private. Others may opt to simply pull up their shirts or sweaters then cover the baby’s head with a blanket. You can also use a baby sling, in the cradle position, to nurse your baby. Whether you use a blanket, shawl, or sling, just make sure that your baby’s mouth and nose aren’t blocked and that the baby has room to breathe.

When out and about, you may want to ask for an isolated booth when dining in restaurants so you have a sort of privacy barrier and can face away from other patrons. If you’re shopping at the local mall, ask if they have a “lactation room” or “lactation lounge.” You’d be surprised how quick many people are to accommodate a nursing mom. Moms who want more privacy often nurse in dressing rooms or even in the car.

What clothes are best for “easy access”?

As with breastfeeding anywhere, it’s important to wear clothes that make nursing simple. The less fuss, the better — especially when you’re having to hold a hungry baby with one hand and adjust your bra and shirt with the other.

A variety of nursing bras are available — with snaps, clasps, and flaps that open and are attached in either the middle (between the breasts) or on the bra straps. Which kind of bra you end up using is up to you and what you find most comfortable. You may want to buy (or register for) a few types of each just to figure out what’s best for you. If you buy them before you deliver, just remember that your breast size will likely increase as your breasts fill with milk, and then change again as your body adjusts to breastfeeding.

You also can invest in special nursing wear or simply sport button-down shirts (although these can be cumbersome if the buttons are finicky), a zip-front sweatshirt, or a comfortable shirt or sweater (V-necks are good) that you can simply pull down or pull up to allow your baby to feed.

Here’s a helpful tip from the breastfeeding advocacy organization La Leche League International: Cut slits in an old T-shirt and wear it underneath an oversized shirt or sweater. That way, your midriff and most of your breast won’t be exposed when you pull up the shirt or sweater on top to nurse.

Keep in mind that whatever type of clothes you decide to wear, they’ll probably need to be slightly larger than your pre-pregnancy size since your breasts are likely to be bigger than usual while you’re nursing.

Is it normal to leak?

Absolutely. As breastfeeding women everywhere can attest, milk leakage always seems to happen at the most inopportune times — during a staff meeting, as you’re talking to your boss, while you’re out shopping, when you’re hugging an old friend. Wherever it happens, it is normal.

Leaking may happen when you see a baby, see a picture of your own baby, hear a baby cry, or even so much as think of your baby. It’s your maternal instinct to feed your child kicking in.

One breast also may leak while you’re nursing on the other. In that case, it may help to put a towel, burp cloth, or cotton diaper over the other one.

You can buy disposable or washable cotton nursing pads to wear in your bra to help combat embarrassing messes and protect your wardrobe. Some women wear pads all the time while nursing, others wear them only when out in public. If needed, it’s a good idea to keep extras with you, just in case.

If you don’t want to spend money on tons of nursing pads, you can use clean folded handkerchief squares inside your bra. It’s better to avoid using plastic-lined pads, which can make it hard for your nipples to get enough air.

If you’re caught in a leakage situation and aren’t wearing or carrying any nursing pads, try discreetly crossing your arms over your chest and applying a little pressure. Wearing patterned tops also can help reduce the embarrassment of sudden leaks.

Whether you’re a new mom or a seasoned parenting pro, breastfeeding often comes with its fair share of questions. Here are answers to some common queries that mothers — new and veteran — may have.

Is it normal to have cramps while nursing?

Yes. During the first few days to weeks after delivery, you may feel strong, menstrual-like cramps in your uterus when your milk lets down. This is your uterus shrinking back to a smaller size.

Is it normal to feel pain during or after nursing?

If your baby is latched on properly, you may have 30 to 60 seconds of pain (from the nipple and areola being pulled into your baby’s mouth), then the pain should ease. But if you continue to feel pain, stop feeding momentarily and reposition your baby on your breast. If the pain persists, something else might be going on.

If your baby consistently latches on wrong, sucking on your nipple without getting much of your areola in the mouth, you’ll probably feel discomfort throughout each feeding. Some moms say it’s painful or feels like a pinch as their babies nurse. And you’ll probably have sore, cracked nipples in no time. Consulting with your doctor or lactation consultant can help with these situations.

What else can cause breast pain?

If your breasts are sore and you have flu-like symptoms, fever, chills, a hard or red area of the breast, or red streaks on your breast, you may have an infection in your milk ducts called mastitis. If you have any of these symptoms, call your doctor. If he or she finds that you have mastitis, the infection can be easily treated with antibiotics.

You may also have a yeast (or thrush) infection of your breast. It’s important that you call your doctor if you have any of these symptoms:

• shooting or burning breast pain either during or after feedings
• pain deep within your breast
• strong pain in the breasts or nipples that doesn’t get better after properly latching on and positioning your baby
• nipples that are cracked, itchy, burning, or are pink, red, shiny, flaky, or have a rash with little blisters

Babies with oral thrush may have cracked skin in the corners of the mouth, and whitish or yellowish patches on the lips, tongue, or inside the cheeks.

Sore breasts with a lump also may be a sign of a plugged milk duct, in which a particular duct gets clogged. To help unclog the duct and ease your pain:

• Take warm showers or use warm compresses on the area, massaging the area, several times a day. Then, breastfeed your baby immediately.
• When breastfeeding, position the baby so the nose is pointed toward the clogged area.
• If that doesn’t work, try using a manual (hand) or electric pump for a few minutes to help draw out the clogged milk.
• If the lump doesn’t go away within a couple of days, or if you have any fever, chills, aches, or red streaking, call the doctor.

Women who have inverted nipples (that turn inward rather than protrude out) or flat nipples (that don’t become erect as they should when your baby is nursing) also may have trouble breastfeeding and may have frequent nipple pain. If either is the case, talk to your doctor or a lactation consultant about ways to make nursing easier and reduce any pain.

Can I still breastfeed if I have a breast infection?

Yes. Contrary to what many people think, you can continue to nurse your baby while treating your breast infection. In fact, continuing to breastfeed can help clear up the infection.

How can I ease my breast or nipple pain?

When dealing with sore breasts or nipples, here are some pointers for avoiding pain in the future as well as making yourself more comfortable while your breasts heal:

• Make sure your baby latches onto your breasts correctly every time.
• Ask your doctor or lactation consultant to recommend a cream to put on your nipples in between feedings to help sore nipples heal.
• At the end of a feeding, massage some breast milk on your nipples, and then allow them to air dry.
• Consider wearing breast shields in between feedings (not to be confused with nipple shields, which are used during breastfeeding) to protect sore nipples. Breast shields are dome-shaped covers that prevent nipples from rubbing against clothing and help them heal faster.
• Ask your health care provider if a nipple shield is a good idea to use while nursing. These shields are placed over the areola and nipple during a feeding to protect sore or cracked nipples. Nipple shields may interfere with a mother’s milk supply, so it’s important to only use them under the supervision of a doctor or lactation consultant.
• Some women find it helpful to nurse more often but for shorter periods of time, rather than nurse for extended periods.
• Try to nurse first on the side that’s less sore.
• Gently break suction when removing your baby from your breast. (Slip your finger in the side of your baby’s mouth, between the gums, and then turn your finger a quarter turn to break the suction.)
• Vary breastfeeding positions to help drain all areas of your breast.
• Use wet or dry heat on your breasts (a warm water bottle, heating pad, washcloth, or warm shower) right before feeding. (However, if you have a yeast infection in your breast, you’ll need to keep your nipples dry because the yeast thrives on moisture.)
• Put ice packs or cool compresses on engorged breasts after feedings.
• Gently massage the sore area before nursing.
• Get plenty of rest and fluids.
• Some mothers with cracked or sore nipples find that pumping for 2 to 3 days allows their nipples to heal.

If you find that you’re consistently unable to nurse your baby without pain, be sure to call your doctor or a lactation consultant.

Is it normal for my breasts to become engorged?

No. If the breasts are emptied frequently, engorgement (when the breasts become overfilled with milk) won’t happen. Engorgement can lead to mastitis and should be avoided.

But the longer you wait to breastfeed or pump — both initially and throughout your time nursing — the more uncomfortable and engorged your breasts may become.

If you can’t feed your baby right away, use warm compresses and try to pump or manually express your milk. One way you can express your milk is by holding onto your breast with your fingers underneath your breast and your thumb on top. Gently but firmly press your thumb and fingers back against the chest wall, then roll your thumb and fingers toward your areola over and over to help push the milk down the milk ducts.

Also, nursing often (approximately every 2 to 3 hours) and trying to empty your breasts can help with the initial discomfort and prevent engorgement.

Whether you’re a new mom or a seasoned parenting pro, breastfeeding often comes with its fair share of questions. Here are answers to some common queries that mothers — new and veteran — may have.

When can I start pumping my breast milk?

Some women who breastfeed start pumping soon after their baby is born to build up their milk supply if they’re not producing enough milk. This also can be helpful if a mom wants to store milk in the freezer for when she returns to work.

But it’s a good idea to wait to introduce a bottle to your baby. Some experts feel that pumping and giving bottles too early — before a baby is used to breastfeeding —  might cause “nipple confusion,” leading a baby to decide that the bottle is the quicker, better option than the breast. While some babies have this confusion, others have no problem moving between a bottle and the breast.

If you’re returning to work after maternity leave, try to start pumping a couple of weeks beforehand. If you wait until the day before you go back to work, you may be frustrated to find that your body doesn’t respond to the pump, which isn’t nearly as cute and cuddly as your baby. In fact, it may take some practice and patience before you’re able to produce enough milk without your baby’s help. It also may take time for your baby to get used to taking a bottle.

Depending on how heavy their milk flow is, some women can fill a bottle in one pumping session, while others may need to pump two or three times (and sometimes more) to get a full bottle.

Though pumping might be frustrating at first, it can help you get some much-needed rest and let your partner and other family members bond with and feed the baby. It also allows you to continue to provide breast milk for your baby when you return to work or are away.

What type of pump is best?

You can buy or rent a breast pump from lactation consultants, hospitals, retail stores, and online. A lactation consultant will give you detailed instructions and be there for you if you have difficulty.

Which kind of breast pump to use is up to you. Here’s what’s available:

• Manual pumps. Manual (or hand-operated) pumps are smaller than electric pumps and more discreet. They are cheaper than electric pumps (manuals are usually under $50, whereas electric models can cost hundreds of dollars). A manual pump is fine for occasional pumping, but usually not for returning to work because many moms find that the effort required for manual pumps is too much and it takes too long to draw out milk.
• Electric pumps. Despite their expense, electric (or automatic) pumps can be easier to use than manual ones because they don’t require much physical effort. And many models let you pump both breasts at once, which is a real time-saver and may increase your milk supply.

  Some women find the noise of the electric pumps to be a little much (especially if you’re pumping at work or away from home). And though they often come in easy-to-carry bags (such as backpacks or arm bags), the weight and bulk can be a bit cumbersome.

  Also keep in mind where you might be using the pump. Some electric pumps can be plugged in or battery-operated; others can’t. So, unless you want to have to find a comfortable spot and an electrical outlet every time, you might want one that offers both options. It’s also important to consider a back-up method, such as a battery-operated or manual pump, in case of a power outage.

Find out which type of pump (if any) your insurance will help pay for. If you don’t have the money to buy a pump or don’t receive one as a gift, contact the governmental organization Women, Infants, and Children (WIC) to find out about their pump program and to see if you qualify.

Are used pumps OK?

Doctors, lactation consultants, and pump manufacturers will tell you that it’s not a good idea to borrow or buy someone else’s used pump. This is because bacteria and viruses from the previous owner can get trapped inside the pump. They are potentially hazardous to your baby’s health, even with thorough and repeated sterilization and cleaning.

Some pumps, though, are designed to decrease the risk of contamination between users and are meant for multiple users, each with their own accessory kit.

How can I make pumping easier?

As with nursing, it’s important to be comfortable when pumping (which doesn’t always seem possible while you’re attached to a machine). It can be hard, especially at first, for your body (and your mind) to get used to producing milk without your baby’s help.

Often, women’s milk will “let down” (or start to be released) when they see or hear their babies cry. So, when faced with an object instead of the welcoming face of your little one, you may find it hard to pump.

If you’re having trouble with let-down, it could be helpful to hold something that reminds you of your baby or has your baby’s scent, like a picture, video on your phone, blanket, or piece of clothing. Your let-down also can be affected if you’re frustrated, embarrassed, or rushed. Try relaxing in a comfortable chair or couch and don’t stress out too much about producing enough milk.

If your breast just doesn’t seem to fit the pump correctly, the pump may come with different sized flanges or you can buy a smaller or larger flange to place over your breast. (The flange is the plastic cup that goes over the nipple and areola when you pump.)

Also, just like when you’re nursing, it’s important to place the breast shield of the pump correctly over your breast, covering your nipple and areola (not just the tip of your nipple), and getting a good seal. If you place the pump incorrectly, it can be uncomfortable and you’ll be much less likely to get the milk you need. And if you’re using an electric breast pump, make sure to adjust the speed and suction to the level that’s comfortable for you to help prevent unnecessary discomfort.

Where can I pump at work?

If you’re pumping at work, try to find a discreet and comfortable place to do it.

Many companies offer their employees pumping and nursing areas. If yours doesn’t, ask your supervisor or the human resources department about an office or other private area that might be suitable. Employers are required by law to provide an appropriate area (that’s not a bathroom) for employees to pump breast milk and reasonable time to do so.

As a last resort, if you have to pump in a bathroom, find a large one with a comfortable chair and some type of privacy barrier.

Whether you’re a new mom or a seasoned parenting pro, breastfeeding often comes with its fair share of questions. Here are answers to some common queries that mothers — new and veteran — may have.

How do I store my breast milk?

You can freeze and/or refrigerate your pumped (or expressed) breast milk. Store it in clean bottles with screw caps, hard plastic cups that have tight caps, or nursing bags (pre-sterilized bags meant for breast milk).

It’s helpful to label each container with the date when the milk was pumped (and your baby’s name if the milk is going to childcare providers). You can add fresh cooled milk to milk that is already frozen, but add no more than is already in the container. For example, if you have 2 ounces of frozen milk, then you can add up to 2 more ounces of cooled milk.

How long, exactly, can I store my breast milk?

For healthy full-term infants:

• You can store it at room temperature:
  
  • for 6 to 8 hours (at no warmer than 77°F, or 25°C)
• You can store it in the refrigerator:
  • for up to 5 days at 32°–39°F (0°–3.9°C)
• You can store it in the freezer (be sure to leave about an inch of space at the top of the container or bottle to allow for expansion of the milk when it freezes):
  • for up to 2 weeks in a freezer compartment located inside the refrigerator
  • for 3 to 6 months in a freezer that’s self-contained and connected on top of or on the side of the refrigerator and is kept at 0°F (–18°C). Store the milk in the back of the freezer, not in the door.
  • for 6 to 12 months in a deep freezer that’s always -4°F (–20°C)

To thaw frozen milk, you can move it to the refrigerator (it takes 24 hours to thaw), then warm by running warm water over the bag or bottle of milk and use it within the next 24 hours. If you need it immediately, then remove it from the freezer and run warm water over it until it’s at room temperature. Do not refreeze it. Once your baby has started to drink from the bottle, you should use it within 1 hour.

You may find that different resources provide different variations on the amount of time you can store breast milk at room temperature, in the refrigerator, and in the freezer. Talk to your doctor if you have any concerns or questions.

How much of my milk should I store in the freezer?

Although some women may choose to pump large volumes to be frozen, it’s a good idea to actually store the breast milk in 2- to 4-ounce (59.1 to 118.2 milliliters) portions so as not to waste any. Label the bottles, cups, or bags with the date, then freeze them.

You also could pour the milk into ice cube trays that have been thoroughly cleaned in hot water, let them freeze until hard, store them in freezer bags, then count up the amount of cubes needed to make a full bottle.

My frozen breast milk changed color. Is this OK?

Breast milk that’s been frozen or refrigerated may look a little different from fresh breast milk, but that doesn’t mean it’s gone bad. It’s normal for early breast milk to look kind of orange and the mature milk to look slightly blue, yellow, or brown when refrigerated or frozen. And it may separate into a creamy looking layer and a lighter, more milk-like layer. If this happens, just swirl it gently to mix it up again.

Thawed milk may smell or taste soapy due to the breakdown of fats in the milk. The milk is still safe to drink, and most babies won’t have a problem with it. If your baby doesn’t like it, the milk can be heated to scalding (bubbles around the edges) right after it is pumped or expressed and then quickly cooled and frozen. This switches off the enzyme that breaks down the milk fats.

How do I clean bottles and pump parts?

Before their first use, wash and then sterilize the nipples, bottles, and washable breast pump supplies (for example, the breast shields and any other part that touches your breasts or your milk) by boiling them for 5 to 10 minutes. Check the manufacturer’s recommendations for the length of time to boil the parts.

You also can sterilize the parts with a countertop or microwaveable sterilizer, but boiling works just as well and costs nothing. After that, wash the bottles, nipples, and pump supplies in hot, soapy water (or run them through the dishwasher) after every use. They can transmit bacteria if not cleaned properly.

Is it safe to microwave my baby’s bottles?

The microwave can create dangerous “hot spots” in bottles of formula or breast milk, so you should never microwave them. Instead, you can run the bottle or freezer bag under warm water for a little bit, swirl the bag or bottle around in a bowl of warm water, or thaw the milk in the refrigerator.

You also can put your baby’s bottles in a pan of warm water (away from the heat of the stove) and then test the temperature by squirting a drop or two on the inside of your wrist before feeding your baby. And bottle warmers are available for use at home or in the car.

Whether you’re a new mom or a seasoned parenting pro, breastfeeding often comes with its fair share of questions. Here are some answers to common queries that mothers — new and veteran — may have.

Where should my baby sleep?

There are many options for where your baby can sleep, but in your bed is not one of them. Putting your baby in bed with you, or bed-sharing, is hazardous and increases the risk of sudden infant death syndrome (SIDS).

Never let your baby sleep on a soft surface or in the same room with people who are smoking. Babies should always be put on their backs to sleep to help reduce the risk of SIDS.

To make nursing in bed more comfortable for yourself, it may help to keep a donut-type nursing pillow on or near your bed or to use a “husband” back pillow with arms on each side.

Keep the room dimly lit for nighttime feedings and also keep stimulation (talking, singing, etc.) to a minimum. This will help your baby to realize that nighttime is for sleeping — not playing — and will encourage your little one to return to sleep sooner.

My baby falls asleep while nursing. What can I do?

Newborns often fall asleep at the breast, especially after feeling satisfied from a good feeding. (You’ll know if your baby isn’t nursing if you don’t hear swallowing sounds, like little clicks, or see the jawbones moving.)

If you think your baby is asleep and hasn’t finished nursing, here are some tips to try:

• undress your baby and rub the back
• tickle the feet
• burp your baby
• try changing your baby’s diaper or switching to the other breast

Babies who latch on incorrectly may fall asleep at the breast. If this happens, break the suction and reposition your baby onto your breast to include both your nipple and areola. You can break the suction by slipping your finger in the side of your baby’s mouth (between the gums) and then turning your finger a quarter turn to break the suction. (If you just pull your baby off your breast, it will likely startle your little one and hurt your breasts as well.)

After you’ve broken the suction, try to burp your baby and switch your little one to the other breast. A lactation consultant can show you the right latch method and help you with any questions or concerns you might have.

Is it OK to nurse my baby to sleep?

In the first few months of life, it’s practically impossible to keep a nursing baby awake who is satisfied with a full belly. Once babies get older, however, most doctors advise against nursing a baby solely for the purpose of getting him or her to sleep. Doing this regularly may prevent your baby from learning how to fall asleep on his or her own.

At nap times and bedtime, try to put your baby down slightly awake so that he or she will get used to falling asleep without having to nurse. Make breastfeeding sessions more about nourishment and less about pacifying.

If your baby is sick or has been separated from you, you may want to nurse for comfort, but try not to make it a habit.

If your baby has trouble falling asleep, consider giving him or her a pacifier. Experts recommend giving babies under 1 year old pacifiers at nap time and bedtime to reduce the risk of SIDS — but only after breastfeeding has become established, so no sooner than 3 weeks of age. But if your little one doesn’t want a pacifier, don’t push it.

Try to encourage your baby’s sleep by establishing a bedtime routine that will be familiar and relaxing. Bathing, reading, and singing can soothe babies and signal an end to the day. Be consistent and your baby will soon associate these steps with sleeping.

When will my baby sleep through the night?

Newborns should be woken up every 3 to 4 hours until their weight gain is established, which typically happens within the first couple of weeks. After that, it’s OK if a baby sleeps for longer periods of time.

But don’t get your slumber hopes up just yet — most breastfed infants won’t snooze for extended periods of time because they get hungry. Remember, breast milk is much more easily digested than formula, so it passes through babies’ systems faster and, therefore, makes them hungry more often.

Newborns’ longest sleep periods are generally 4 or 5 hours — this is about how long their small bellies can go between feedings. If newborns do sleep for a while, they’ll probably be extra-hungry during the day and may want to nurse more frequently.

And just when parents think that sleeping through the night seems like a far-off dream, things start to get a little easier. At 3 months, a baby averages a total of 5 hours of sleep during daytime naps and 10 hours at night, usually with an interruption or two. Most babies this age sleep “through the night,” meaning 6 to 8 hours in a row.

It can help to stimulate your baby during the day, keep things calm at night, and have a regular bedtime routine. But every baby is different, so don’t be surprised if your baby sleeps more or less than others.

Will it hurt my milk supply to let my baby sleep?

Letting your baby sleep through the night (usually at around 3 months of age) isn’t going to hurt your breastfeeding efforts. Your body readjusts your milk supply based on when you nurse and how much your baby needs. Some babies will sleep through the night early but will make up for it during the day, so your breasts will accommodate that.

As your baby matures and starts taking solid foods, the need for breast milk will decrease and your body will adjust for that too.

Whether you’re a new mom or a seasoned parenting pro, breastfeeding often comes with its fair share of questions. Here are answers to some common queries that mothers — new and veteran — may have.

Is it OK to give my baby breast milk and formula?

Although breast milk is the best nutritional choice for infants, in some cases, breastfeeding (or exclusive breastfeeding) may not be possible or an option. Your baby’s health and happiness is, in large part, determined by what works for you as a family. So if you need to supplement, your baby will be fine and healthy, especially if it means less stress for you.

Babies who need supplementation may do well with a supplemental nursing system in which pumped milk or formula goes through a small tube that attaches to the mother’s nipple. They also can be fed pumped milk or formula by bottle.

Some experts feel that giving bottles too early can create “nipple confusion,” leading a baby to decide that the bottle is a quicker, better option than the breast. To avoid this, be sure that your little one has gotten used to and is good at breastfeeding before you introduce a bottle. Lactation professionals recommend waiting until a baby is about 3 weeks old before offering artificial nipples of any kind (including pacifiers).

If I need to give my baby formula, how do I start?

If you’re using formula because you’re not producing the amount of milk your baby needs, nurse first. Then, give any pumped milk you have and make up the difference with formula as needed.

If you’re stopping a breastfeeding session or weaning from breastfeeding altogether, you can begin to replace breastfeeding with bottle feeds. As you do this, pump to reduce uncomfortable engorgement so you will not have problems with plugged ducts or mastitis. As you eliminate nursing sessions, your milk supply will decrease and your body will begin to adapt to produce enough milk to accommodate your new feeding schedule.

Starting your breastfed baby on formula can cause some change in the frequency, color, and consistency of the stools (poop). Be sure to talk your doctor, though, if your baby is having trouble pooping.

If your baby refuses formula alone, you can try mixing some of your pumped breast milk with formula to help the baby get used to the new taste.

Is it OK for me to give my baby the first bottle?

If possible, you should have someone else give your little one the bottle at first. This is because babies can smell their mothers and they’re used to receiving breast milk from mom, not a bottle. So try to have someone else — such as a caregiver or partner — give a breastfed baby the first bottle.

Also consider either being out of the house or out of sight when your baby takes that first bottle, since your little one will wonder why you’re not doing the feeding as usual. Depending on how your baby takes to the bottle, this arrangement may be necessary until he or she gets used to bottle feeding.

If your baby has a hard time adjusting to this new form of feeding, just be patient and keep trying.

When should I introduce solid foods and juice?

For babies who are exclusively breastfed, doctors recommend waiting until a baby is about 6 months old. But some infants may be ready sooner.

How will you know if your baby is ready? Babies who are ready to eat solids foods:

• are interested in foods (for example, they may watch others eat, reach for food, and open their mouths when food approaches)
• hold up their heads well, and sit up with little or no help
• have the oral motor skills needed to eat (meaning that they don’t push food of the mouth but move it to the throat and swallow it)
• usually weigh twice their birth weight, or close to it

Wait until your baby is at least 4 months old and shows these signs of readiness before introducing solids. Babies who start solid foods before 4 months are at a higher risk of becoming obese.

When the time is right, start with a single-grain, iron-fortified cereal for babies (rice cereal has traditionally been the first food for babies, but you can start with any you prefer). Start with one or two tablespoons of cereal mixed with formula to achieve the right consistency. (As an alternative, you can give an iron-rich puréed meat.) Feed your baby with a small baby spoon, and never add cereal to a baby’s bottle unless your doctor instructs you to do so.

At this stage, solids should be fed after a nursing session, not before. That way, your baby fills up on breast milk, which should be your baby’s main source of nutrition until age 1.

Once your baby gets the hang of eating cereal, introduce a variety of puréed fruits, vegetables, and meats. Wait a few days between introducing a new food to make sure your baby doesn’t have an allergic reaction.

Note: There is no benefit to offering fruit juice, even to older babies. Juice can fill them up and leave little room for more nutritious foods, promote obesity, cause diarrhea, and even put a baby at an increased risk for cavities when teeth start coming in.

When can I give my baby water?

In their first few months, babies usually don’t need extra water. On very hot days, most babies do well with additional feedings. But you may want to offer your infant water, especially if your baby’s pee is dark or your baby urinates less frequently than usual.

Once your baby is eating solid foods, you can offer a few ounces of water between feedings, but don’t force it. Water that is fortified with fluoride will help your baby develop healthy teeth and gums. If you live in an area with nonfluoridated water, your doctor or dentist may prescribe fluoride drops.

Whether you’re a new mom or a seasoned parenting pro, breastfeeding often comes with its fair share of questions. Here are answers to some common queries that mothers — new and veteran — may have.

Is it normal for my baby to spit up after feedings?

Sometimes, babies spit up when they:

• have eaten too much
• burp (the notorious “wet burp”)
• drool

Many infants will spit up a little after some — or even all — feedings or during burping because their digestive tracts are immature. That’s perfectly normal.

As long as your baby is growing and gaining weight and doesn’t seem uncomfortable with the spitting up, it’s OK. The amount of spit up often looks more than it actually is. But spitting up isn’t the same as forcefully vomiting all or most of a feeding.

If you’re concerned that your baby is vomiting, call your doctor. Try to keep a record of exactly how often and how much your baby seems to be vomiting or spitting up. In rare cases, there may be an allergy, digestive problem, or other problem that needs medical attention. The doctor should be able to tell you if it’s normal or something that’s cause for concern.

If the doctor says your baby’s spitting up is normal, here are some things you can do to help ease it:

• Burp your little one when he or she comes off of each breast, or after every 1 to 2 ounces during bottle feeds. Sometimes giving smaller, more frequent feeds can help rather than large volume feeds.
• Keep your baby upright after feedings — holding the baby is best, since the position of the baby in an infant seat may actually make spitting up more common.
• Don’t jiggle, bounce, or actively play with your baby right after feedings.
• Keep your baby’s head above his or her feet while feeding (in other words, don’t hold your baby in a dipped-down position when feeding).
• Raise the head of your baby’s crib or bassinet. Roll up a few small hand towels or receiving blankets (or you can buy special “blocks”) to place under (not on top of) the mattress. But don’t use a pillow under your baby’s head. Make sure the mattress doesn’t fold in the middle, and that the incline is gentle enough so the baby doesn’t slide down.

If your baby also gets bottles of breast milk or infant formula supplements:

• Don’t give the bottle while your little one is lying down.
• Make sure the hole in the nipple is the right size and/or flow for your baby. For example, fast-flow nipples may cause babies to gag or may simply give them more than they can handle. Many breastfed babies do well with the slow-flow nipple until they are 3 months old, or even older.

It’s also important to keep in mind that this, too, shall pass. Many babies outgrow spitting up by the time they’re sitting up.

I think I’m getting sick. Can I still breastfeed?

In most cases, yes — the majority of illnesses are not dangerous to a breastfeeding infant. If you aren’t feeling well, remember that as your body produces antibodies to fight an illness, those antibodies go to the baby through your breast milk. However, in rare cases (such as HIV), a mother’s health may affect her ability to breastfeed her baby.

Contact a lactation consultant before you interrupt breastfeeding because of an illness or because of a medicine that you require. In most cases, interrupting breastfeeding is not necessary.

My baby bites during breastfeeding. Can I stop it?

Babies will often play with their mothers’ nipples with their gums, not meaning to cause any harm. But once they start teething, a baby might bite, not knowing this is hurting mom. Giving the baby something hard and cold to chew on before the nursing will help the gums — then gums won’t be as tender, which may reduce biting.

You often can tell when your baby’s about ready to bite — usually when he or she is satisfied and starting to pull away from your breast.

Watch for your baby to switch from nutritive nursing to playing. When it’s obvious it’s playtime, take your baby off your breast before he or she has the chance to bite.

If there’s still biting, pull your baby closer to you to make it more difficult for him or her to pull off easily.Or, break the suction by slipping your finger into the corner of his or her mouth. Try and react calmly and without raising your voice so the baby doesn’t get scared.

In most cases, though, biting may be a sign that your baby is done with a nursing session, is distracted, or is just plain bored. The La Leche League International offers these tips to help reduce the biting potential:

• Say, “Mommy is not for biting. You can bite this,” and offer your little one a teething toy or ring.
• Try starting a new activity if your baby seems distracted and is pulling off your breast a lot.
• Praise your baby — with a hug, kiss, or cuddle — whenever he or she nurses without biting or trying to bite.

Does my breastfed baby need extra vitamins?

Breast milk contains many vitamins as well as easily-absorbed iron. The iron from breast milk will be sufficient until your baby begins eating iron-rich foods (such as cereals or meats) around 6 months of age.

All babies need vitamin D supplementation. Vitamin D is added to formula and babies who are breastfed need to get their vitamin D as a daily supplement. The nutrient can be produced by the body when the skin is exposed to sunlight, but it is not safe for infants under 6 months to be in direct sunlight. After 6 months, infants should use sunscreen when in the sun, which blocks the body’s ability to make vitamin D. So, babies who are primarily breastfed should be given daily vitamins.

Also, the American Academy of Pediatrics (AAP) states that infants — whether breastfed or formula-fed — do not need fluoride supplements during the first 6 months. From 6 months on, babies require fluoride supplements only if the water supply is severely lacking in fluoride. Well water and bottled water, for example, may not contain fluoride and the tap water in some communities does not have fluoride.

It can be dangerous to give a fluoride supplement to a child already getting enough fluoride, so it’s important to find out the fluoride content in whatever water source your child is using. Again, ask your doctor about your baby’s needs.

My baby doesn’t want to nurse. What’s going on?

Breastfeeding “strikes” are very normal and often last only a few days. Still, this can be worrisome, especially in a baby who usually breastfeeds with no problems at all.

So why might your child suddenly stop wanting to breastfeed? Here are some possible reasons:

• Teething has made the baby’s gums sore.
• You’ve been stressed or have changed your nursing patterns lately.
• You smell “different” to your baby because you switched your soap, perfume, deodorant, or lotion.
• There is a different taste to your breast milk because of a change in your diet.
• Something is making breastfeeding painful or uncomfortable, such as an ear infection, a stuffed-up nose, a cut in your little one’s mouth, or an oral infection called thrush.
• Your baby bit you and your reaction scared him or her.

As frustrating as nursing strikes can be, you and your little one can work through them. Here are some more tips La Leche League International offers breastfeeding moms that may help get you past the hump:

• Try to spend more time with your baby so you can devote some extra time to getting your breastfeeding back on track. Ask a family member, friend, or a babysitter to come over to help out with the chores and any of your other children.
• Make the experience as enjoyable for your baby as possible — hugging, caressing, and kissing your little one, and stopping to comfort whenever he or she gets upset or frustrated.
• Try nursing when your baby is sleepy and may be more willing to cooperate.
• Nurse while you’re rocking your baby or walking around while carrying him or her in a sling.
• Breastfeed in a quiet room with few distractions.
• Try stimulating your milk let-down by pumping or hand expressing before starting to breastfeed so your baby gets the milk right away.

Until your nursing schedule is back to normal, you’ll need to pump or hand express to keep your milk supply up and to make sure the baby is getting enough to eat. And if your child is really ready to stop breastfeeding (or wean), he or she will probably do it over a period of weeks or months.

In the meantime, both you and your baby can enjoy the special closeness and bonding that breastfeeding can offer.