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Frequently Asked Questions
Breastfeeding Q. Can I involve my husband in the early breastfeeding process? A. He can be supportive and comforting when in the learning process. He can help support the baby during the feeding or position pillows to better support you and the baby while feeding. He may tickle the baby's foot or rub her back during a feeding to keep her stimulated when she starts to fall asleep. He can burp the baby for you while you are preparing to switch breast or when you are finished and need to get yourself back together. When your husband involves himself in such a way - the bonding will occur with both parents. A. By the third or fourth day of breastfeeding, your milk will change from colostrum to what looks more like skim milk. Your breasts will also go from feeling soft to firm. If your nipples leak, use a nursing pad or clean folded handkerchief squares inside your bra to catch the leaking milk. Be sure to change these often. Do not use plastic-lined pads because they will prevent air from circulating around your nipples.
Between feedings, gently pat your nipples dry. This helps prevent them from getting irritated. You may also want to apply a little expressed colostrum, human milk or medical grade modified lanolin on your nipples to prevent dryness. A. While some infants nurse for only 10 minutes on one breast, it is quite common for others to stay on one side for much longer. Some feedings may be longer than others depending on your baby's schedule and the time of day. Some babies may be nursing even though they appear to be sleeping. If your baby has fallen asleep at your breast, or if you need to stop a feeding before your baby is finished, gently break the suction with your finger. Do this by slipping a finger into your baby's mouth while he or she is still latched-on. Never pull the baby off the breast without releasing the suction.
When you breastfeed, alternate between which breast you offer first. (You may want to keep a safety pin or short ribbon on your bra strap to help you remember on which breast your baby last nursed.) While you should try to breastfeed evenly on both sides, your baby may prefer one side over the other and nurse much longer on that side. When this happens, the breast adapts its milk production to your baby's feedings. Remember, your baby's feedings control how much milk your breasts produce. It is important to let your baby nurse on both sides so that each breast gets stimulation over the course of a day.
You will soon get to know your baby's feeding patterns. Each baby has a particular style of eating, some slower, some faster. Learning your own baby's eating patterns makes it easier to determine when she is hungry, when she has had enough, how often she needs to eat, and how much time she needs for feedings.
For some mothers and babies, breastfeeding goes smoothly from the start. For others, it takes a little time and several attempts to get the process going effectively. Like anything new, breastfeeding takes some practice. This is perfectly normal. If you need help, ask the nurses while you are still in the hospital, your child's pediatrician, a lactation consultant or a breastfeeding support group. Remember, the most important keys to successful breastfeeding are proper positioning and correct latch-on.
Until you and your baby develop a feeding routine, stay positive and try not to get discouraged. Remember, your milk gives your baby more than just food. It also provides important antibodies to fight off infection and has medical and psychological benefits for both of you. Breastfeeding is the most natural gift that you can give your baby.
A. Breastfed babies tend to feed more often than formula-fed babies, usually eight to 12 times a day. The main reason for this is that their stomachs empty much more quickly because human milk is so easy to digest.
Initially, your newborn will probably nurse every couple of hours, regardless of whether it's day or night. By the end of the first month, your baby may start sleeping longer at night. Let your baby feed on demand — that is, whenever he is hungry. Watch for different signals from your baby, rather than the clock to decide when to nurse. When your baby is hungry, he may do any of the following:
- Nuzzle against your breast
- Show the rooting reflex
- Make sucking motions or put hand to mouth
- Cry
It is best not to wait until your baby is overly hungry before you breastfeed.
Some newborns can be sleepy and hard to wake. Do not let your baby sleep through feedings until your milk supply has been developed, usually about two to three weeks. If your baby is not demanding to be fed, wake her if three to four hours have passed since the last feeding. If this persists, call your pediatrician.
A. Wash your hands before expressing or handling your milk.
Be sure to use only clean containers to store expressed milk.
*Try to use screw-cap bottles, hard plastic cups with tight caps, or special heavy nursing bags that can be used to feed your baby. Do not use ordinary plastic storage bags or formula bottle bags, since these can easily split and leak. Do not store breastmilk in ice-cube trays.
Use sealed and chilled milk within twenty-four hours if possible. Discard all milk that has been refrigerated for more than seventy-two hours.
Freeze milk if you do not plan to use it within twenty-four hours. Frozen milk is good for at least one month in a freezer attached to a refrigerator or for three to six months if kept in a zero-degree deep freezer. Store it at the back of the freezer, where the temperature is coldest. Be sure to label the milk with the date and time that you expressed it. Use the oldest milk first. Keep in mind that the fats in human milk begin to break down with storage, so using frozen breastmilk within three months is desirable.
Freeze about two to four ounces of milk per container, to avoid wasting milk after you thaw it. You can always thaw an extra bag if needed.
Do not add fresh milk to already frozen milk in a storage container.
You may thaw milk in the refrigerator or by placing it in a bowl of warm water.
A. It is rarely necessary to switch to formula because a woman is unable to produce enough milk for her baby. Nearly all women can breastfeed successfully, assuming they receive enough support and information. The women you know who didn't have enough milk probably did not breastfeed frequently or long enough or did not manage to get their babies latched on to the breast properly. If their babies were given supplemental feedings or a pacifier, their infants' subsequent nursing efforts may not have been strong enough to stimulate enough milk production. The volume of breastmilk naturally fluctuates quite a bit during the first two or three weeks. The best initial solution when a newborn cries for a feeding or wakes frequently in the night to breastfeed is to continue nursing as often as possible to stimulate milk production. By using good breastfeeding techniques and focusing will increase your breastmilk supply. The early days and weeks are crucial in terms of getting breastfeeding off to a good start.
Joan Younger Meek, MD, MS, RD, FAAP with Sherill Tippins
Common Concerns Q. Can head lice hop or jump from person to person? A. The legs of the human louse are adapted for grasping a person’s hair. They are unable to hop, jump, fly or leap tall buildings with a single bound. A. Unfortunately, many medications for children have an unpleasant taste or texture. We will always try to prescribe a medicine that tastes o.k., but many times the best medication for a particular condition may still taste terrible. There are many things you can try to help your child tolerate their medication better.
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Ask your pharmacist to add a flavored syrup to the medication. Many local pharmacies can add FlavoRx to your prescription. They have more than 30 flavors available; check their website at www.flavorx.com for locations and flavors. -
Give your child some chocolate syrup before and after the medication.
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If the medicine has a gritty texture, give the child graham crackers after taking the medicine to remove any bitter particles from the tongue.
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Mix the medication with some jelly.
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Offer a popsicle after giving the medicine to remove the taste and “numb” the tastebuds.
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Use positive reinforcement as a reward for taking medicines well. (The chocolate syrup and the popsicles may work for this reason, too!)
Always follow the advice of your pharmacist about proper preparation and storage of medications; when in doubt, follow the instructions of your pharmacist. There are no official guidelines from drug manufacturers, but the suggestions above should not change the effectiveness of the medication. Please call us for any questions or problems. You should always store medications in a safe place and be careful not to tell the child that a medication is candy. Children may accidentally get into medications, potentially leading to a harmful overdose. A. Until the umbilical cord falls off (a week or two after birth), it is important not to immerse the baby in water, but instead to give the child a delicate sponge bath. Wipe the base of the cord (where it joins the skin) with alcohol at every diaper change. It takes about ten days to two weeks for the umbilical cord to fall off. Frequently, as the cord stump moves around, there may be a little bleeding from the area. This is normal. Generally, the cord falls off without complication, but in cases in which there is a redness, swelling or discharge, the pediatrician should be contacted. A. Most healthy newborns experience hiccups. For many infants, hiccups seem to occur after every feeding and may be so violent that they cause the infant's entire body to shake. Hiccups are probably due to pressure on the diaphragm from a full stomach. Perhaps extra swallowed air may contribute to the problem. The best treatment of hiccups is to let them run their course. Sometimes a few sips of water helps, but hiccups probably bother us more than they concern the baby. General PediatricsQ. CircumcisionA. Some parents wonder whether circumcision is a necessary procedure for their child. While scientific studies show some medical benefits of circumcision, these benefits are not sufficient for the American Academy of Pediatrics (AAP) to recommend that all infant boys be circumcised. However, parents may want their sons circumcised for religious, social and cultural reasons. Parents considering circumcision for their sons often have similar questions about this procedure. Here are a few of the more common concerns parents may have.
Is Circumcision Painful?When done without pain medicine, circumcision is painful. There are pain medicines available that are safe and effective. The American Academy of Pediatrics recommends that they be used to reduce pain from circumcision. Local anesthetics can be injected into the penis to lower pain and stress in infants. There are also topical creams that can help. Talk to your pediatrician about which pain medicine is best for your son. Problems with using pain medicine are rare and usually not serious.
What Should I Expect for my Son After Circumcision?After the circumcision, the tip of the penis may seem raw or yellowish. If there is a bandage, it should be changed with each diapering to reduce the risk of the penis becoming infected. Petroleum jelly should be used to keep the bandage from sticking. Sometimes a plastic ring is used instead of a bandage. The plastic ring that is left on the tip of the penis usually drops off within five to eight days. It takes about seven to 10 days for the penis to fully heal after circumcision.
Are There Any Problems That Can Happen After Circumcision?Problems after a circumcision are very rare. However, call your pediatrician right away if
- Your baby does not urinate normally within six to eight hours after the circumcision.
- There is persistent bleeding.
- There is redness around the tip of the penis that gets worse after three to five days.
It is normal to have a little yellow discharge or coating around the head of the penis, but this should not last longer than a week. See your pediatrician if you notice any signs of infection such as redness, swelling or foul-smelling drainage.
What if I Choose Not to Have my Son Circumcised?If you choose not to have your son circumcised, talk to your pediatrician about how to keep your son's penis clean. When your son is old enough, he can learn how to keep his penis clean just as he will learn to keep other parts of his body clean.
The foreskin usually does not fully retract for several years and should never be forced. The uncircumcised penis is easy to keep clean by gently washing the genital area while bathing. You do not need to do any special cleansing, such as with cotton swabs or antiseptics.
Later, when the foreskin fully retracts, boys should be taught how to wash underneath the foreskin every day. Teach your son to clean his foreskin by:
- Gently pulling it back away from the head of the penis
- Rinsing the head of the penis and inside fold of the foreskin with soap and warm water
- Pulling the foreskin back over the head of the penis
© Copyright 2001 American Academy of Pediatrics A.
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Q: What is jaundice?
A: Jaundice is the yellow color seen in the skin of many newborns. It happens when a chemical called bilirubin builds up in the baby’s blood. Jaundice can occur in babies of any race or color.
Q: Why is jaundice common in newborns?
A: Everyone’s blood contains bilirubin, which is removed by the liver. Before birth, the mother’s liver does this for the baby. Most babies develop jaundice in the first few days after birth because it takes a few days for the baby’s liver to get better at removing bilirubin.
Q: How can I tell if my baby is jaundiced?
A: The skin of a baby with jaundice usually appears yellow. The best way to see jaundice is in good light, such as daylight or under fluorescent lights. Jaundice usually appears first in the face and then moves to the chest, abdomen, arms, and legs as the bilirubin level increases. The whites of the eyes may also be yellow. Jaundice may be harder to see in babies with darker skin color.
Q: Can jaundice hurt my baby?
A: Most infants have mild jaundice that is harmless, but in unusual situations the bilirubin level can get very high and might cause brain damage. This is why newborns should be checked carefully for jaundice and treated to prevent a high bilirubin level.
Q: How should my baby be checked for jaundice?
A: If your baby looks jaundiced in the first few days after birth, your baby’s doctor or nurse may use a skin test or blood test to check your baby’s bilirubin level. A bilirubin level is always needed if jaundice develops before the baby is 24 hours old. Whether a test is needed after that depends on the baby’s age, the amount of jaundice, and whether the baby has other factors that make jaundice more likely or harder to see.
Q: Does breastfeeding affect jaundice?
A: Jaundice is more common in babies who are breastfed than babies who are formula-fed, but this occurs mainly in infants who are not nursing well. If you are breastfeeding, you should nurse your baby at least 8 to 12 times a day for the first few days. This will help you produce enough milk and will help to keep the baby’s bilirubin level down. If you are having trouble breastfeeding, ask your baby’s doctor or nurse or a lactation specialist for help. Breast milk is the ideal food for your baby.
Q: When should my newborn get checked after leaving the hospital?
A: It is important for your baby to be seen by a nurse or doctor when the baby is between 3 and 5 days old, because this is usually when a baby’s bilirubin level is highest. The timing of this visit may vary depending on your baby’s age when released from the hospital and other factors.
Q: Which babies require more attention for jaundice?
A: Some babies have a greater risk for high levels of bilirubin and may need to be seen sooner after discharge from the hospital. Ask your doctor about an early follow-up visit if your baby has any of the following:
- A high bilirubin level before leaving the hospital
- Early birth (more than 2 weeks before the due date)
- Jaundice in the first 24 hours after birth
- Breastfeeding that is not going well
- A lot of bruising or bleeding under the scalp related to labor and delivery
- A parent or brother or sister who had high bilirubin and received light therapy
Q: When should I call my baby’s doctor?
A: Call your baby’s doctor if:
- Your baby’s skin turns more yellow.
- Your baby’s abdomen, arms, or legs are yellow.
- The whites of your baby’s eyes are yellow.
- Your baby is jaundiced and is hard to wake, fussy, or not nursing or taking formula well.
Q: How is harmful jaundice prevented?>
A: Most jaundice requires no treatment. When treatment is necessary, placing your baby under special lights while he or she is undressed will lower the bilirubin level. Depending on your baby’s bilirubin level, this can be done in the hospital or at home. Jaundice is treated at levels that are much lower than those at which brain damage is a concern. Treatment can prevent the harmful effects of jaundice.
Putting your baby in sunlight is not recommended as a safe way of treating jaundice. Exposing your baby to sunlight might help lower the bilirubin level, but this will only work if the baby is completely undressed. This cannot be done safely inside your home because your baby will get cold, and newborns should never be put in direct sunlight outside because they might get sunburned.
Q: When does jaundice go away?
A: In breastfed infants, jaundice often lasts for more than 2 to 3 weeks. In formula-fed infants, most jaundice goes away by 2 weeks. If your baby is jaundiced for more | |