Breastfeeding Support

What is breastfeeding support?

Breastfeeding support is a clinical consultation in which mother and baby are assessed together, a feed is actually observed and a plan specific to the problem is made. It is different from general advice like "rest more, drink plenty of water": how the baby latches on, the sucking–swallowing pattern, the weight gain curve, the number of diapers, the mother's breast examination and, if present, the cause of pain are each looked at one by one.

What do the guidelines recommend?

The World Health Organization (WHO) and UNICEF recommend that babies receive only breast milk for the first 6 months, and that breastfeeding continues together with suitable complementary foods from 6 months up to 2 years and beyond. The American Academy of Pediatrics (AAP) also supports, in its 2022 policy statement, continuing breastfeeding up to 2 years and beyond for as long as mother and baby wish.

This is not a bar to reach but a description of a direction. Every breastfeeding story is unique; the aim of support is not to push the mother toward a standard but to remove the obstacles that stand between the mother and her own goal.

When should you seek support?

• Pain, cracks or bleeding in the nipple while breastfeeding
• The baby cannot latch on, lets go right after latching, or feeds restlessly
• The baby does not return to birth weight within the expected time, or weight gain slows down
• Fewer wet diapers per day
• Worry that "my milk is not enough" and thoughts of starting formula because of it
• Hardness, redness and pain in the breast together with fever (suspected blocked milk duct / mastitis, a breast infection)
• Breastfeeding routine disrupted because of jaundice
• Breastfeeding babies born early (premature) or twins
• A plan for pumping, storing milk and getting the baby used to it before returning to work

What is looked at during the assessment?

The consultation covers the following, in order:

1. Observing a feed. How the baby is positioned at the breast and latches on is watched live. The most common cause of nipple pain is a shallow latch, and it is usually solved by correcting the position.
2. Examining the baby. Checking inside the mouth (tongue movements, shape of the palate), weight tracking, jaundice and general condition.
3. Measurable signs that feeding is adequate. The weight curve, the number of wet and dirty diapers, and swallowing that can be heard during feeds. These answer the question "is it enough?" based on measurable data, not feelings.
4. Assessing the mother. Breast examination, pain, previous breast surgery, medicines being taken, and conditions such as thyroid problems that can affect milk production.
5. The plan. How often to breastfeed, a pumping schedule if needed, practical suggestions for pain and when the next check-up will be.

"My milk is not enough" — is it really not enough?

The most common reason for stopping breastfeeding early is the perception of low milk supply. A baby wanting to feed often, being fussy in the evenings, or the breast not "feeling full" is not, on its own, a sign of low milk. The real signs of insufficient milk are weight gain and the number of diapers. If the assessment shows that support is truly needed, a plan that increases how often the breast is emptied is made first; if extra feeding is needed, it is planned in a way that keeps breastfeeding going.

Pumping and storing breast milk

The breast milk storage recommendations of the US Centers for Disease Control and Prevention (CDC) for healthy babies born at term are as follows:

• At room temperature (≤25 °C): up to 4 hours
• In the refrigerator (4 °C): up to 4 days
• In the deep freezer (−18 °C): 6 months for best quality, 12 months at most
• Thawed milk: should be used within 1–2 hours in the refrigerator and must not be frozen again

Warming milk in the microwave is not recommended; because it heats unevenly, it can burn the baby's mouth.

Taking medicines while breastfeeding

The range of medicines breastfeeding mothers can use is wider than commonly believed. Most pain relievers, antibiotics and medicines for long-term conditions are safe during breastfeeding. Still, every medicine should be used after asking a doctor; rather than stopping breastfeeding on your own because of a medicine, a suitable alternative should be considered.

When should you seek help without delay?

• If the baby is still clearly below birth weight at 5–7 days old
• If there are fewer than 6 wet diapers a day (after the first week)
• If the baby is hard to wake up or unwilling to feed
• If the mother has a fever above 38 °C, redness in the breast and severe pain