Moms on Call's Breastfeeding Basics

Feeding a baby can be one of the sweetest parts of those early days. It can also be one of the parts parents have the most questions about. We get it. Between the two of us, we have eight children. We have exclusively breastfed, breastfed and bottle-fed, pumped, supplemented and bottle-fed. And through more than 20 years as pediatric nurses and Moms on Call, we have helped thousands of families figure out feeding in real life.

Here is what we want you to know from the beginning: There is more than one way to feed a baby well. You may nurse. You may pump and offer breast milk in a bottle. You may use formula. You may do a combination of all three. Our goal at Moms on Call is not to tell you what your feeding journey has to look like. It is to give you practical information so you can confidently decide what works for your baby, your body and your family. A fed baby is a happy baby, and a supported parent matters too.

Before Baby Arrives

It is great to prepare. Read the books. Take the class. Talk with your pediatrician, OB or midwife. Find a lactation consultant if breastfeeding is something you hope to do. But also leave some room for your actual baby. You can make the most beautiful feeding plan in the world and then meet a tiny human who has plans of their own. Your recovery matters. Your milk supply matters. Baby's latch matters. Baby's weight and growth matter. Your mental and physical well-being matter. Plans can change. Changing the plan isn't failing. It is parenting. Think Through Your Feeding Goals

Ask yourself:

• Do I hope to breastfeed exclusively?

• Do I want my baby comfortable taking a bottle too?

• Will I pump?

• Am I planning to return to work?

• Who else will regularly feed the baby?

• What kind of support will I have at home?

Then share those goals with the people supporting you. And remember, those answers can change once baby arrives.

Gather the Breastfeeding Basics

You don't need to turn your house into a lactation supply store.

A few helpful things to have available include:

• A breast pump if you plan to pump

• Properly fitted pump flanges

• Nursing bras or comfortable tops

• Breast pads

• Milk storage bags or containers

• Burp cloths

• A supportive nursing pillow if you like one

• A large water bottle

• Easy snacks

• A long phone charger, because somehow it is always six inches too short

You may also hear about nipple shields, milk collectors and other breastfeeding tools. Some can be very helpful in the right situation, but we prefer using them intentionally rather than assuming every breastfeeding parent needs them. Your lactation consultant or healthcare provider can help you determine what is useful for you.

Your Support System Matters

One of the best things your partner, family or friends can do is help make feeding easier without making feeding their entire job.

They can:

• Bring you water or food

• Change baby before or after a feeding

• Burp baby

• Wash bottles and pump parts

• Take over a bottle feeding when appropriate

• Hold baby while you shower, eat or rest

• Help with siblings, meals, laundry and everything else that still somehow needs to happen

Feeding the baby may be your job in that moment. Taking care of you can be theirs.

The First Days and Weeks

Those first couple of weeks are about learning. Baby is learning how to eat. You are learning your baby. If you are breastfeeding, your body is establishing milk production. Newborns commonly breastfeed frequently, often 8–12 times in 24 hours, and sometimes as often as every 2-3 hours in those earliest days. That is normal. Before baby has regained birth weight, follow the feeding plan provided by your pediatrician or healthcare team. Some babies will need to be awakened to eat. Once baby is around 2 weeks old, has regained birth weight and is growing well, that is when we typically begin moving toward the Moms on Call routine.

What About Sore Nipples?

Some tenderness while you and baby are learning can happen. But breastfeeding should not continue to be significantly painful. Pain that is severe, nipples that are cracked or bleeding, or pain that is not improving deserves attention. A lactation consultant or healthcare provider can watch a feeding and evaluate baby's latch, positioning and milk transfer. Don't spend weeks thinking you simply have to "tough it out." Sometimes a small positioning or latch adjustment can make a big difference.

Getting a Sleepy Newborn to Eat

Newborns can be very sleepy, especially in those first days.

If it is time for baby to eat and they would rather snooze:

• Unswaddle them

• Take baby down to a diaper

• Change the diaper

• Rub their back or feet

• Sit them upright for a moment

• Burp and reposition

• Switch breastfeeding positions or sides

If your newborn is consistently difficult to wake for feedings, isn't feeding effectively or you are concerned about intake, contact your pediatrician.

Focus on an Effective Feeding

Rather than watching the clock and deciding baby must nurse a certain number of minutes on each side, look at the quality of the feeding. We want to see a deep, comfortable latch and active sucking and swallowing. Let baby feed effectively on the first breast, then burp and offer the second. Some babies take both. Some don't. And some feedings will look different from others. That is okay.

When Can We Start the Moms on Call Routine?

This is one of our most common questions. Typically, once baby is around 2 weeks old, has regained birth weight and your pediatrician is happy with baby's growth, you can begin working toward the Moms on Call routine. During the day, our routines generally move toward feedings about 2 hours and 45 minutes to 3 hours apart. At night, we allow baby to wake us for feeding unless your pediatrician has given you differen instructions. That distinction is important. The first days of breastfeeding are about establishing feeding, milk production and healthy weight gain. The Moms on Call routine comes after that foundation is established. And remember our 15-minute grace period. This is a routine, not a stopwatch. Predictability and flexibility can exist together.

What If My Breastfed Baby Wants to Eat Every 1½–2 Hours?

First, look at baby's age. Frequent feeding is expected in the early newborn period, and cluster feeding can happen too. But once baby is past those first couple of weeks, has regained birth weight and you are trying to establish your daytime routine, consistently feeding every 1½–2 hours is a reason to take a closer look at the whole picture.

Ask:

How is the latch?

Is baby actively swallowing and getting a full feeding?

Is baby falling asleep shortly after beginning?

How is weight gain?

How is baby sleeping between feeds?

Sometimes families unintentionally get caught in what we call a snack cycle. Baby fusses. We feed. Baby eats a little and falls asleep. An hour later baby wakes hungry, but now baby is tired too. So baby eats a little again and falls asleep. And around we go. That can be exhausting for everybody. When baby is ready, we want to work toward full, effective daytime feedings and then give baby the opportunity to eat well again around the next scheduled feeding. The routine isn't about ignoring hunger. It is about looking at the whole pattern instead of responding to every fuss with another small feeding.

What About Night Feedings?

Once baby has regained birth weight and your pediatrician is comfortable with growth, we generally let baby determine when they need to eat overnight. Keep nighttime simple. Low lights. Quiet voices. Feed. Burp. Change the diaper if needed. Back to bed. In Moms on Call language, we keep the environment strictly business. We aren't trying to entertain baby at 2 a.m. We want baby's body to begin recognizing: Daytime is for eating, interacting and living. Nighttime is for sleeping.

When Will My Breastfed Baby Sleep Through the Night?

There isn't one magic age. Babies gradually consolidate nighttime sleep as they grow, become more efficient feeders and take in more of their nutrition during the day. With Moms on Call, we are creating the conditions that support that progression: consistent daytime feeding opportunities, an age-appropriate routine, a supportive sleep environment and allowing baby to gradually lengthen nighttime sleep when growth and development allow. Some babies get there earlier. Some take longer. And occasionally everybody has a rough night. That doesn't mean your routine isn't working. We look for progress, not perfection.

Will Longer Nighttime Sleep Hurt My Milk Supply?

Milk production works largely through supply and demand, particularly while your supply is becoming established. That is one reason we are careful about those earliest weeks. Once breastfeeding is established, baby has regained birth weight, growth is appropriate and nighttime stretches gradually lengthen, your body can often adjust along with your baby's changing feeding pattern. If you are exclusively pumping, have supply concerns, have had difficulty establishing milk production or your baby is not gaining as expected, your needs may be different. Work with your pediatrician, OB/midwife or lactation professional to create a plan specific to you.

Engorgement, Breast Inflammation and Mastitis

This is one area where recommendations have changed over the years. We used to hear a lot about aggressively massaging a "clogged duct," applying lots of heat and trying to completely empty the breast. Current guidance has moved away from that approach. A painful, firm or swollen area can be part of breast inflammation and narrowing around the milk ducts rather than a literal "plug" that needs to be forced out. Aggressive massage and repeatedly pumping to empty the breast can actually increase inflammation or stimulate more milk production.

Instead:

• Continue feeding your baby normally

• Avoid repeatedly pumping simply to "empty" the breast

• Use cold packs for comfort and swelling

• Wear a comfortable, supportive bra

• Avoid deep or aggressive breast massage

• Gentle touch or light sweeping is preferable

• Talk with your healthcare provider about appropriate anti-inflammatory or pain medication for you

If you develop fever, chills, worsening redness, significant breast pain, flu-like symptoms or symptoms that are getting worse instead of better, contact your healthcare provider. Mastitis sometimes requires medical treatment.

What About Thrush?

Breast or nipple pain isn't automatically thrush. Latch problems, nipple trauma, dermatitis, inflammation, vasospasm and infection can cause similar symptoms. If you develop new burning or persistent nipple/breast pain, shiny or irritated nipples, or your baby develops white patches inside the mouth that don't easily wipe away, contact your healthcare provider or lactation professional. Rather than trying home remedies first, we recommend getting the cause identified so you and baby can receive the right treatment if treatment is needed.

How Do I Know Baby Is Getting Enough?

This matters far more than whether your feeding looks exactly like someone else's.

We look at the whole baby:

• Effective feeding and swallowing

• Appropriate wet and dirty diapers for age

• Baby's behavior after feeds

• Weight gain and growth

• What your pediatrician sees at baby's visits

If you are ever worried about baby's intake, don't wait and wonder. Call your pediatrician.

Nursing, Pumping, Formula or Combination Feeding

We want to say this clearly because feeding conversations can carry way too much pressure. Moms on Call supports families. Breastfeeding is wonderful. Pumped breast milk is wonderful. Formula is wonderful and is a safe and nutritionally complete way to feed an infant. Combination feeding can be a wonderful option too. Sometimes the feeding plan you imagined before baby arrives is exactly what happens. Sometimes it isn't even close. Your feeding method is not a measure of how much you love your baby or how good of a parent you are. Babies need adequate nutrition, growth, connection and parents who have the support and confidence to care for them. That is what matters.

Give Yourself Grace

You will hear us say this over and over at Moms on Call: Parent out of truth, not fear. Don't let someone else's feeding journey determine what yours should look like. Don't let one difficult feeding convince you that the entire day is ruined. And don't be afraid to change the plan when your baby or your family needs something different. There is predictability. There is flexibility. And there is a whole lot of grace in between. That is parenting simplified.

As always, your baby's pediatrician and your healthcare provider should guide you when there are concerns about feeding, weight gain, milk supply, breast pain, illness or anything specific to your or your baby's health.