Dr.Jayashree Jayakrishnan in Mangalore on Lactation workshop

Workshop on Lactation practices in KS Hegde, NITTE University Mangalore on March 2017 with MILC Team

Tongue tie specialist in tie with HappyMom Chennai

Prof Dr M S Saravanakumar

Dr M S Saravanakumar received his Masters in Pedodontics & Preventive Dentistry (MDS) from

College of Dental Sciences (CODS) Davangere, Karnataka. He is a Best Outgoing student (MDS) with a

University rank holder (RGUHS, Bangalore).He received Fellowship award 2014 from Indian Society

for Dental Research (ISDR chapter of IADR) and PEDO MASTER PROF MAARC SAADIA EXCELLENCE

AWARD 2015. National Dental Achievers Award 2015. Doctor’s choice city winner award 2015. He is

listed in global network as preferred INDIAN TONGUE TIE PROVIDER. He is a senior consultant in

Chennai Apollo hospitals. He has guest lectured extensively and conducted Laser Assisted Paediatric

Dentistry (LAP-D) ® National workshop in speciality conference (ISPPD). He is an Associate Editor in

journal of dental health, oral disorders and therapy (JDHODT). Published articles in various journals.

UNIVERSITAT DE LES VALLS EUROPE – ADJUNCT FACULTY.

Breast Abscess

The treatment of choice now for breast abscess is no longer surgery.We have had much better results with ultrasound to locate the abscess and a catheter inserted into the abscess to drain it.
Mothers going through this procedure do not stop breastfeeding even on the affected side, and complete healing occurs often within a week. This procedure is done by an intervention radiologist, not a surgeon. Ask your doctor to check out this study: Dieter Ulitzsch, MD, Margareta K. G. Nyman,MD, Richard A. Carlson, MD. Breast Abscess in Lactating Women: US-guided Treatment. Radiology 2004; 232:904–909
For small abscesses, aspiration with a needle and syringe plus antibiotics often is all that is necessary, though it may be necessary to repeat the aspiration more than once.

A lump that isn’t going away.
If you have a lump that is not going away or not getting smaller over more than a couple of weeks, you should be seen by a breastfeeding-friendly physician or surgeon. You don’t have to interrupt or stop breastfeeding to get a breast lump investigated (ultrasound, mammogram and even biopsy do not require you to stop breastfeeding even on the affected side). A breastfeeding friendly surgeon will not tell you that you have to stop breastfeeding before s/he can do tests to investigate a breast lump.

Lactation Consultants view about colic in Breastfed baby

Colic in the Breastfed Baby

Colic is one of the mysteries of nature. Nobody knows what it really is, but everyone has an opinion. In the typical situation, the baby starts to have crying spells about two to three weeks after birth.
These occur mainly in the evening, and finally stop when the baby is about three months old (occasionally older). When the baby cries, he is often inconsolable, though if he is walked, rocked or taken for a walk, he may settle temporarily. For a baby to be called colicky, it is necessary that he be gaining weight well and be otherwise healthy. However, even if the baby is gaining weight well, sometimes the baby is crying because he is still hungry. See below.
The notion of colic has been extended to include almost any fussiness or crying in the baby, and this is not surprising since we do not really know what colic is. There is no treatment for colic, though many medications and behaviour strategies have been tried, without any proven benefit. Of course, everyone knows someone whose baby was “cured” of colic by a particular treatment. Also, almost every treatment seems to work, at least for a short time, anyhow.
The Breastfeeding Baby with Colic
Aside from the colic that any baby may have, there are three known situations in the breastfed baby that may result in fussiness or colic. Once again, it is assumed that the baby is gaining adequately and that the baby is healthy.
Feeding both breasts at each feeding or feeding only one breast at each feeding
Human milk changes during a feeding. One of the ways in which it changes is that, in general, the amount of fat increases as the baby drains more milk from the breast. If the mother automatically switches the baby from one breast to the other during the feed, before the baby has “finished” the first side, the baby may get a relatively low amount of fat during the feeding. This may result in the baby getting fewer calories, and thus feeding more frequently. If the baby takes in a lot of milk (to make up for the reduced concentration of calories), he may spit up. Because of the relatively low fat content of the milk, the stomach empties quickly, and a large amount of milk sugar (lactose) arrives in the intestine all at once. The enzyme which digests the sugar (lactase) may not be able to handle so much milk sugar at one time and the baby will have the symptoms of lactose intolerance—crying, gas, explosive, watery, green bowel movements. This may occur even during the feeding. These babies are not lactose intolerant. They have problems with lactose because of the sort of information women get about breastfeeding. This is not a reason to switch to lactose-free formula.
It is also very important that you realize that a baby is not drinking milk from the breast just because the baby is making sucking movements on the breast. He may be “nibbling” not drinking and therefore the baby is not getting higher fat milk just because he is on the breast and sucking.

1. Do not time feedings. Mothers all over the world have successfully breastfed babies without being able to tell time. Breastfeeding problems are greatest in societies where everyone has a watch and least where no one has a watch.
2. The mother should feed the baby on one breast, as long as the baby actually gets milk from the breast, until the baby comes off himself, or is asleep at the breast from being full or is nibbling even with compression. Use breast compressio to keep baby drinking and not just sucking. Please note that a baby may be on the breast for two hours, but may actually be drinking milk for only a few minutes. In that case the milk taken by the baby may still be relatively low in fat. This is the rationale for using compression. If, after “finishing” the first side, the baby still wants to feed, offer the other side. Do not prevent the baby from taking the other side if he is still hungry.
3. This is not a suggestion to feed only one breast at a feeding. You might be able to do it, and that’s fine, but not all mothers can manage it. You might find it possible in the morning when you have more milk (as most mothers do) but not in the evening when you have less milk (as most mothers do). If you insist on feeding on just one side, you may find your baby is “colicky” in the evening when he is, in fact, hungry.
4. At the next feeding, start the baby on the other breast and proceed in the same way.
5. Your body will adjust quickly to the new method and you will not become engorged or lop sided after a short while. But remember this: feeding on one side at a feeding, if you can manage it, will reduce the milk supply so that what may work now (breastfeeding on one breast at a feeding) may not work as the milk supply decreases. Therefore do not keep the baby to one breast, but “finish” one side and if the baby wants more, offer the other side.
6. It is not a good idea to feed the baby on just one side, to follow a rule. Yes, making sure the baby “finishes” the first side before offering the second can help treat poor weight gain or colic in the baby, but rules and breastfeeding do not go together well. If the baby is not drinking, actually getting milk, there is no point in just keeping the baby sucking without getting any milk for long periods of time. You should “finish” one side and if the baby wants more, offer the other.How do you know the baby is “finished” the first side? The baby is no longer drinking, even with compression. This does not mean you must take the baby off the breast as soon as the baby doesn’t drink at all for a minute or two (you may get another milk ejection reflex or letdown reflex, so give it a little time), but if it is obvious the baby is not drinking, take the baby off the breast and if the baby wants more, offer the other side. How do you know the baby is drinking or not?If the baby lets go of the breast on his own, does it mean that the baby has “finished” that side? Not necessarily. Babies often let go of the breast when the flow of milk slows, or sometimes when the mother gets a milk ejection reflex and the baby, surprised by the sudden rapid flow, pulls off. Try him again on that side if he wants more, but if the baby is obviously not drinking even with compression, switch sides.
7. In some cases, it may be helpful to feed the baby two or more feedings on one side before switching over to the other side for two or more feedings, as long as baby has come of the breast from drinking. Putting a baby back on a breast that was just “emptied” may cause baby to fuss or pull at the breast or fall asleep but not be full.
8. This problem is made worse if the baby is not well latched on to the breast. A good latch is the key to easy breastfeeding.

Overactive Letdown Reflex
A baby who gets too much milk very quickly, may become very fussy and irritable at the breast and may be considered “colicky”. Typically, the baby is gaining very well. Typically, also, the baby starts breastfeeding, and after a few seconds or minutes, starts to cough, choke or struggle at the breast. He may come off, and often, the mother’s milk will spray. After this, the baby frequently returns to the breast, but may be fussy and repeat the performance. He may be unhappy with the rapid flow and impatient when the flow slows. This can be a very trying time for everyone. On rare occasions, a baby may even start refusing to take the breast after several weeks, typically around three months of age. What can you do?

1. Get the best latch possible. This problem is made worse if the baby is not well latched on to the breast. A good latch is the key to easy breastfeeding. No matter what you are told about how good the latch looks, try to improve on it. Think of it this way: if your chin is tucked into your chest while you are trying to drink you would become overwhelmed by the fast flow very easily. If you want to drink quickly you will throw your head back, chin in the air, and be able to handle the fast flow. This is the kind of position baby’s head should be in while breastfeeding—his chin deep into your breast, his head in a slightly tipped-back position, his nose away from your breast, and his chin far from his own chest. This position will help him to handle the faster flow of the let down.
2. If you have not already done so, try feeding the baby one breast per feed. In some situations, feeding even two or three feedings on one breast before changing to the other breast may be helpful. If you experience engorgement on the unused breast, express just enough to feel comfortable. Remember, if the baby wants the second breast, the mother should offer it.
3. Feed the baby before he is ravenous. Do not hold off the feeding by giving water (a breastfed baby does not need water even in very hot weather) or a pacifier. A ravenous baby will “attack” the breast and may cause a very active letdown reflex. Feed the baby as soon as he shows any sign of hunger. If he is still half asleep when you put him to the breast, all the better.
4. Feed the baby in a calm, relaxed atmosphere, if possible. Loud music, bright lights are not conducive to a good feeding. Older babies tend to become very distracted as the flow slows down. Using compressions gently at first, and then more firmly as necessary to keep the speed of flow consistent, will often keep baby interested in staying on the breast longer, because he is drinking better.
5. Lying down to breastfeed sometimes works very well. If lying sideways to feed does not help, try lying flat, or almost flat, on your back with the baby lying on top of you to breastfeed, or try leaning back in a chair. Gravity helps decrease the flow rate. Remember, the baby may be frustrated at the inconsistent flow, so it may be necessary to lie down at the beginning when the flow is fast, and sit back up as the milk slows. Babies like the lying down position; they tend not to fuss with slower flow but tend to sleep.
6. The baby may dislike the rapid flow, but also become fussy when the flow slows too much. If you think the baby is fussy because the flow is too slow, it will help to compress the breast to keep up the flow,If all else has not made things better:
7. As a last resort, rather than switching to formula, give the baby your expressed milk by cup or by bottle if baby won’t take a cup.

Foreign Proteins in the Mother’s Milk
Sometimes, proteins present in the mother’s diet may appear in her milk and may affect the baby. The most common of these is cow’s milk protein. Other proteins have also been shown to be excreted into some mothers’ milk. The fact that these proteins and other substances appear in the mother’s milk is not usually a bad thing. Indeed, it is usually good, helping to desensitize your baby to these proteins. Ask about this if you have any questions.
Thus, in the treatment of the colicky breastfed baby, one step would be for the mother to stop taking dairy products or other foods, but only one type of food at a time. Dairy products include milk, cheese, yoghurt, ice cream and anything else that may contain milk, such as salad dressings with whey protein or casein. Check labels on prepared foods to see if they include milk or milk solids. When the milk protein has been changed (denatured), as in cooking for example, there should be no problem. Ask if you have any questions.
If eliminating certain foods from the mother’s diet does not work, the mother can take pancreatic enzymes (Cotazyme, Pancrease 4, for example), starting with 1 capsule at each meal, to break down proteins in her intestines so that they are less likely to be absorbed into her body as whole protein and appear in the milk. Of course, your chances of not being able to produce enough of your own enzymes from your pancreas are very low (unless you have cystic fibrosis, for example), but it has been shown that whole protein does get absorbed into the breastfeeding mother’s body and into her milk and adding the enzymes may decrease the amounts of whole protein entering your body and getting into the milk.

Please note: Intolerance to milk protein has nothing to do with lactose intolerance, a completely different issue. Also, a mother who is lactose intolerant herself should still breastfeed her baby.
Suggested method:

• Eliminate all milk products for 7-10 days.
• If there has been no change for the better in the baby, the mother can reintroduce milk products.
• If there has been a change for the better, you can then slowly reintroduce milk products into her diet, if these are normally part of your diet. (There is no need to drink milk in order to make milk, for example, so if you don’t drink milk normally, don’t while you are breastfeeding). Some babies will tolerate absolutely no milk products in the mother’s diet. Most tolerate some. You will learn what amount of dairy products you can take without the baby reacting.
• If you are concerned about your calcium intake, calcium can be obtained without taking dairy products. Speak with your doctor or a dietician. But, 7-10 days off milk products will not cause you any nutritional problems. Actually, evidence suggests that breastfeeding may protect the woman against the development of osteoporosis even if she does not take extra calcium. The baby will get all he needs.
• Be careful about eliminating too many things from your diet all at once. Everyone will know someone whose baby got better when the mother stopped broccoli, beef, bananas, bread, etc. You may find that you are eating white rice only. Our diets are too complex to be sure exactly what, if anything, is affecting the baby.

One more piece of information. Some babies are hungry even if they are gaining weight really well. This may occur for several reasons, some mentioned earlier in this information sheet. One more way a baby can be hungry and nevertheless gain weight well is that you are limiting the feedings; for example, you feed the baby 10 or 20 minutes a side. If you have a lot of milk, the baby may gain weight well and still be hungry. So don’t limit feedings.
Be patient, the problem usually gets better no matter what. Formula is not the answer, but, because of the more regular flow, some babies do improve on it. But formula is not breastmilk and breastfeeding is much more than breastmilk. In fact, the baby would also improve on breastmilk from the bottle because of the regularity of the flow. Even if nothing works, time usually helps. The days and nights may seem eternal, but the weeks will fly by.

Cause, symptons and Treatment for Blocked Ducts & Mastitis

Blocked Ducts & Mastitis

Mastitis is due to an infection (almost always due to bacteria rather than other types of germs) that usually occurs in breastfeeding mothers. However it can occur in any woman, even if she is not breastfeeding and can even occur in newborn babies of either sex.
Nobody knows exactly why some women get mastitis and others do not. Bacteria may enter the breast through a crack or sore in the nipple but women without sore nipples also get mastitis and most women with cracks or sores do not.
Mastitis is different from a blocked duct because a blocked duct is not thought to be an infection and thus does not need to be treated with antibiotics. With a blocked duct, a mother has a painful, swollen, firm mass in the breast. The skin overlying the blocked duct is often red, but less intensely red than the redness of mastitis. Unlike mastitis, a blocked duct is not usually associated with fever, though it can be. Mastitis is usually more painful than a blocked duct, but both can be quite painful. Thus seeing the difference between a “mild” mastitis and a “severe” blocked duct may not be easy. It is also possible that a blocked duct goes on to become mastitis, so things become even more complicated. However, without a lump in the breast, there is no mastitis or blocked duct for that matter. In France, physicians recognize something they call lymphangite when the mother has a painful, hot redness of the skin of the breast, associated with fever, but there is no painful lump in the breast. Apparently, most do not believe this lymphangite requires treatment with antibiotics. I have seen a few cases that fit this description and yes, in fact, the problem goes away without the mother taking antibiotics. But then, often a full-blown mastitis also goes away without the mother taking antibiotics.
As with almost all breastfeeding problems, a poor latch, and thus, poor emptying of the breast sets the mother up for blocked ducts and mastitis.

Blocked ducts

Blocked ducts will almost always resolve without special treatment within 24 to 48 hours after starting. During the time the block is present, the baby may be fussy when breastfeeding on that side because the milk flow will be slower than usual. This is probably due to pressure from the lump collapsing other ducts. A blocked duct can be made to resolve more quickly if you:

1. Continue breastfeeding on that side and draining the breast better. This can be done by:
   • Getting the best latch possible (see the information sheet When Latching as well as the video clips on how to latch a baby on at the website nbci.ca).
   • Using compression to keep the milk flowing (see the information sheet Breast Compression as the video clips on how to latch a baby on at the website nbci.ca). Get your hand around the blocked duct and compress it as the baby is breastfeeding if it is not too painful to do so.
   • Feeds the baby in such a position that the baby’s chin “points” to the blocked duct. Thus, if the blocked duct is in the bottom outside area of the breast (7 o’clock), then feeding the baby in the football position may be helpful.
2. Apply heat to the affected area. You can do this with a heating pad or hot water bottle, but be careful not to burn your skin by using too much heat for too long a period of time.
3. Try to rest. Of course, with a new baby it is not always easy to rest. Try going to bed. Take your baby with you into bed and breastfeed him there.

A bleb or blister

Sometimes, but not always by any means, a blocked duct is associated with a bleb or blister on the end of the nipple. A flat patch of white on the nipple is not a bleb or blister. If there is no painful lump in the breast, it is confusing to call a bleb or blister on the nipple a blocked duct. A bleb or blister is, usually, painful and is one cause of nipple pain that comes on later than the first few days. Some mothers get blisters in the first few days due to a poor latch. Nobody knows why a mother would suddenly get a bleb or blister out of the blue several weeks after the baby is born.
A blister is often present without the mother having a blocked duct.
If the blister is quite painful (it usually is), it is helpful to open it, as this should give you some relief from the pain. You can open it yourself, but do this one time only. However, if you need to repeat the process, or if you cannot bring yourself to do it yourself, it is best to go to see your doctor or come to our clinic.

• Flame a sewing needle or pin, let it cool off, and puncture the blister.
• Do not dig around; just pop the top or side of the blister.
• Try squeezing just behind the blister; you might be able to squeeze out some toothpaste-like material through the now opened blister. If you have a blocked duct at the same time as the blister, this might result in the duct unblocking. Putting the baby to the breast may also result in the baby unblocking the duct.

Ultrasound for blocked ducts

Most blocked ducts will be gone within about 48 hours. If your blocked duct has not gone by 48 hours or so, therapeutic ultrasound often works. Most local physiotherapy or sports medicine clinics can do this for you. However, very few are aware of this use of ultrasound to treat blocked ducts. An ultrasound therapist with experience in this technique has more successful results.
Some mothers have used the flat end of an electric toothbrush to give themselves “ultrasound” treatment. And apparently have had good results.
If two treatments on two consecutive days have not helped resolve the blocked duct, there is no point in getting more treatments. Your blocked duct should be re-evaluated by your doctor or at our clinic. Usually, however, one treatment is all that is necessary. Ultrasound may also prevent recurrent blocked ducts that occur always in the same part of the breast.
The dose of ultrasound is 2 watts/cm² continuous for five minutes to the affected area, once daily for up to two treatments.
Lecithin is a food supplement that seems to help some mothers prevent blocked ducts. It may do this by decreasing the viscosity (stickiness) of the milk by increasing the percentage of polyunsaturated fatty acids in the milk. It is safe to take, relatively inexpensive, and seems to work in at least some mothers. The dose is 1200 mg four times a day.

Mastitis

If you start getting symptoms of mastitis (painful lump in the breast, redness and pain of the breast, fever), try to get some rest. Go to bed and take the baby with you so you can continue breastfeeding while remaining in bed. Rest is good to help fight off infection.
Continue breastfeeding on the affected side. It should go without saying that you should continue on the other breast as well. Of course, if you are in so much pain that you cannot put the baby to the affected breast, continue on the other side and as soon as your breast is less painful put the baby to the breast with the mastitis. Sometimes expressing your milk may be less painful, but not always, so if you can, continue breastfeeding on the affected side. Mothers and babies share all their germs.
Heat helps fight off infection. It also may help with draining of the breast. Use a hot water bottle or heating pad but be careful not to burn the skin.
Fever helps fight off infection. Adults usually feel terrible when they have a fever and you may want to bring down the fever for this reason. But you don’t need to bring down the fever just because it’s there. Fever does not cause the milk to go bad!
Potatoes (adapted from Bridget Lynch, RM, Community Midwives of Toronto). Within the first 24 hours of your symptoms beginning, you may find that applying slices of raw potato to the breast will reduce the pain, swelling, and redness of mastitis.

• Cut 6 to 8 washed raw potatoes lengthwise into thin slices.
• Place in a large bowl of water at room temperature and leave for 15 to 20 minutes.
• Apply the wet potato slices to the affected area of the breast and leave for 15 to 20 minutes.
• Remove and discard after 15 to 20 minutes and apply new slices from the bowl.
• Repeat this process two more times so that you have applied potato slices 3 times in an hour.
• Take a break for 20 or 30 minutes and then repeat the procedure.

Mastitis and Antibiotics

Generally, it is better to avoid antibiotics if possible since mastitis may improve all on its own and antibiotics may result in your getting a Candida (yeast, thrush) infection of the nipples and/or breast. Our approach is as follows:
If you have had symptoms consistent with mastitis for less than 24 hours, we would give you a prescription for an antibiotic, but suggest you wait before starting to take the medication.

• • If, over the next 8 to 12 hours, your symptoms are worsening (more pain, more spreading of the redness or enlarging of the painful lump), start the antibiotics.
• • If over the next 24 hours, your symptoms are not worse but not better, start the antibiotics.
• • If over the next 24 hours, your symptoms are lessening, then they will almost always continue to lessen and disappear without your needing to take the antibiotics. In this case, the symptoms will continue to lessen and will have disappeared over the next 2 to 7 days. Fever is often gone by 24 hours, the pain within 24 to 72 hours and the breast lump disappears over the next 5 to 7 days. Occasionally the lump takes longer than 7 days to disappear completely, but as long as it’s getting small, this is a good thing.

If you have had symptoms consistent with mastitis for more 24 hours and the symptoms have not improved, you should start the antibiotics straight away.
If you are going to take an antibiotic, you need to take the right one. Amoxicillin, plain penicillin and some other antibiotics used frequently for mastitis do not kill the bacterium that almost always causes mastitis (Staphylococcus aureus). Some antibiotics which kill Staphylococcus aureus include: cephalexin (our usual choice), cloxacillin, dicloxacillin, flucloxacillin, amoxicillin combined with clavulinic acid, clindamycin and ciprofloxacin. Antibiotics that can be used for community acquired methicillin-resistant Staphylococcus aureus (CA-MRSA): cotrimoxazole and tetracycline.
All these antibiotics can be used when mothers are breastfeeding and do not require her to interrupt breastfeeding.
You should not interrupt breastfeeding if you are infected with MRSA! Indeed, breastfeeding decreases the risk of the baby getting infection.
Medication for pain/fever (ibuprofen, acetaminophen, and others) can be helpful to get you through this. The amount that gets into the milk, as with almost all medications, is tiny. Acetaminophen is probably less useful than those drugs (e.g. ibuprofen) that have an anti-inflammatory affect.

Lactation Consultation in Chennai

Dr.Mehta Hospitals Pvt Ltd (Monday to Friday)
Address: No.2, McNichols Rd, 3rd Lane, Harrington Road, Chetpet, Chennai, Tamil Nadu 600031
Phone:044 4227 1001

Prashanth Hospital(Monday to Friday)
Address: 77, Harrington Road, Chetpet, Chennai, Tamil Nadu 600031
Phone:044 4227 7777

Madras Medical Mission(Monday & Wednesday & Friday)
Address: 4-A, Dr J Jayalalitha Nagar, Mogappair, Chennai, Tamil Nadu 600037
Phone:044 2656 5991

Fortis Malar Hospital (Saturday)
Address: 52, 1st Main Rd, Gandhi Nagar, Adyar, Chennai, Tamil Nadu 600020
Phone:044 4289 2222

KM Speciality/Bloom Hospital (Sunday)
Address: Shanmugam Salai, KK Nagar, Chennai, Tamil Nadu
Phone:044 4353 0555

Motherhood Hospital (only on appointments)
Address: # 542, ., TTKrishnamachari Rd, Sri Ram Nagar, Alwarpet, Chennai, Tamil Nadu 600018
Phone:044 4915 4444

Is My Baby Getting Enough Milk?

Breastfeeding mothers frequently ask how to know their babies are getting enough milk.The breast is not the bottly , and it is not possible to hold the breast up to the light to see how many ounces or millilitres of milk the baby drank.And this is a good thing!!
We are not supposed to know how much the baby is getting but rather is baby getting enough. Our number-obsessed society makes it difficult for some mothers to accept not seeing exactly how much milk the baby receives. However, there are ways of knowing that the baby is getting enough. In the long run, weight gain is the best indication whether the baby is getting enough, but rules about weight gain appropriate for bottle fed babies may not be appropriate for breastfed babies. In the short term, there are ways to know if baby is satisfied by looking at how well the baby feeds, and even just looking at the baby after a feeding – is the baby content, satisfied, is he rooting or sucking his hand?
Ways of Knowing

1. Baby’s breastfeeding is characteristic. A baby who is obtaining good amounts of milk at the breast sucks in a very characteristic way. When a baby is getting milk (he is not getting milk just because he has the breast in his mouth and is making sucking movements), you will see a pause at the point of his chin after he opens to the maximum and before he closes his mouth, so that one suck is (open mouth wide > pause > close mouth type of sucking). If you wish to demonstrate this to yourself, put your index or other finger in your mouth and suck as if you were sucking on a straw. As you draw in, your chin drops and stays down as long as you are drawing in. When you stop drawing in, your chin comes back up. This same pause that is visible at the baby’s chin represents a mouthful of milk when the baby does it at the breast. The longer the pause, the more the baby got. Once you can recognize this pause you will realize that so much of what women are told about timing the baby on the breast is meaningless. For example, it is meaningless to suggest to mothers to feed the baby twenty minutes on each side. Twenty minutes of what? Sucking without drinking? Sucking and drinking (some pausing in the movement of the chin)? All long pause-types of sucks? A baby who does this type of sucking (with the pauses) for twenty minutes straight might not even take the second side. A baby who nibbles (doesn’t drink) for 20 hours will come off the breast hungry. Our website nbci.ca shows video clips of drinking at the breast. If the baby comes off the breast while doing this kind of drinking with long pauses, then baby is probably saying, I have had enough. If baby is continually just sucking without drinking (therefore little or no pausing) baby will still be hungry. Play detective, what is baby’s chin doing as he seems to “finish”? If the milk is flowing well the baby can either choose to drink it or take a little break (in fact the baby does not need to suck continuously and most babies do not). If the milk is not flowing well, then baby will be ‘forced’ to just suck without drinking. If this is the case, use compression to help more milk to flow .
2. Baby’s bowel movements (stools, poops). For the first few days after birth, the baby passes meconium, a dark green, almost black, substance which has collected in his intestines during pregnancy. It is passed during the first few days, and by the third day, the bowel movements start becoming lighter, as the baby drinks more milk. Usually by the fourth day, the bowel movements have taken on the appearance of the normal breastmilk stool. The normal breastmilk stool is pasty to watery, mustard coloured, and usually has little odour. However, bowel movements may vary considerably from this description. They may be green or orange, may contain curds or mucus, or may resemble shaving cream in consistency (full of air bubbles). The variations in colour do not mean something is wrong. A baby who is getting only breastmilk, and is starting to have bowel movements that are becoming lighter by day 3 of life, is doing well.Without becoming obsessive about it, monitoring the frequency and quantity of bowel movements is one of the best ways, next to observing the baby’s drinking (see above, and videos at nbci.ca to see if the baby is getting enough milk). After the first three to four days, the baby should have increasing bowel movements so that by the end of the first week he should be passing at least two to three substantial yellow stools each day. In addition, many infants have a stained diaper with almost each feeding. A baby who is still passing meconium on the fourth or fifth day of life should be seen at the clinic the same day. A baby who is passing only brown bowel movements is probably not getting enough, but this is not a very reliable sign.Some breastfed babies, after the first three to four weeks of life, may suddenly change their stool pattern from many each day, to one every three days or even less. Some babies have gone as long as 20 days or more without a bowel movement. As long as the baby is otherwise well, and the stool is the usual pasty or soft, yellow movement, this is not constipation and is of no concern. No treatment is necessary or desirable, because no treatment is necessary or desirable for something that is normal.Any baby between five and 21 days of age who does not pass at least one substantial bowel movement within a 24 hour period should be seen at the breastfeeding clinic the same day if possible, but certainly within a couple of days. If this same baby is soaking at least 6 heavy wet diapers (see #3, Urination), then baby is most likely fine and getting enough. Generally, and only as a general rule, small, infrequent bowel movements during this time period mean insufficient intake. There are definitely some exceptions and everything may be fine, but it is better to check.
3. Urination (pees). If, after about 4 or 5 days of age, the baby is soaking six diapers in a 24 hour period, (the diapers should be soaking, not just damp or just wet) you can be reasonably sure that the baby is getting a lot of milk (if he is breastfeeding only). Unfortunately, the new super dry “disposable” diapers often do indeed feel dry even when full of urine, but when soaked with urine they are heavy. It should be obvious that this indication of milk intake does not apply if you are giving the baby extra water (which, in any case, is unnecessary for breastfed babies, and if given by bottle, may interfere with breastfeeding). The baby’s urine should be almost colourless after the first few days, though occasional darker urine is not of concern.During the first two to three days of life, some babies pass pink or red urine. This is not a reason to panic and does not mean the baby is dehydrated. No one knows what it means, or even if it is abnormal. It is undoubtedly associated with the lesser intake of the breastfed baby compared with the bottle fed baby during this time, but the bottle feeding baby is not the standard on which to judge breastfeeding. However, the appearance of this colour urine should result in attention to getting the baby well latched on and making sure the baby is drinking at the breast. During the first few days of life, only if the baby is well latched on can he get his mother’s milk. Giving water by bottle or cup or finger feeding at this point does not fix the problem. It only gets the baby out of hospital with urine that is not red. Fixing the latch and using compression will usually fix the problem. If fixing the latch and breast compression do not result in better intake, there are ways of giving extra fluid without giving a bottle directly. Limiting the duration or frequency of feedings can also contribute to decreased intake of milk.

The following are NOT good ways of judging

1. Your breasts do not feel full. After the first few days or weeks, it is usual for most mothers not to feel full. Your body adjusts to your baby’s requirements. This change may occur quite suddenly. Some mothers who are breastfeeding perfectly well never feel engorged or full.
2. The baby sleeps through the night. Not necessarily. A baby who is sleeping through the night at 10 days of age, for example, may, in fact, not be getting enough milk. A baby who is too sleepy and has to be woken for feeds or who is “too good” may not be getting enough milk. There are many exceptions, but get help quickly.
3. The baby cries after feeding. Although babies sometimes cry after feedings because of hunger, there are also other reasons for crying. See also the information sheet Colic in the Breastfeeding Baby. Do not limit feeding times. “Finish” the first side before offering the other. Remember, play detective and watch baby’s chin—this will tell you if baby has been actually feeding or just going through the motions!
4. The baby feeds often and/or for a long time. For one mother feeding every three hours or so may be often; for another, three hours or so may be a long period between feeds. For one, a feeding that lasts for 30 minutes is a long feeding; for another, it is a short one. There are no rules how often or for how long a baby should breastfeed. It is not true that the baby gets 90% of the feed in the first 10 minutes. Let the baby determine when he is ready for feeding and things usually come right, if the baby is sucking and drinking at the breast and having at least two to three substantial yellow bowel movements each day. Remember, a baby may be on the breast for two hours, but if he is actually feeding or drinking (open wide > pause > close mouth type of sucking) for only two minutes, he will likely come off the breast hungry. If the baby falls asleep quickly at the breast, you can compress the breast to continue the flow of milk. Contact the breastfeeding clinic with any concerns, but wait to start supplementing.
5. “I can express only half an ounce of milk”. This means nothing and should not influence you. Therefore, you should not pump your breasts “just to know”. Most mothers have plenty of milk. The problem usually is that the baby is not getting the milk that is available, and this is usually because he is latched on poorly, and/or the milk is not flowing well. Breast Compressions might need to be used. These problems can often be fixed easily.
6. The baby will take a bottle after feeding. This does not necessarily mean that the baby is still hungry, and using this ‘test’ is not a good idea, as bottles may interfere with breastfeeding. Babies will often take more liquid from a bottle even if they are already full.
7. The five week old is suddenly pulling away from the breast but still seems hungry. This does not mean your milk has “dried up” or decreased. During the first few weeks of life, babies often fall asleep at the breast when the flow of milk slows down even if they have not had their fill. When they are older (four to six weeks of age), they may no longer fall asleep but rather start to pull away or get upset. The milk supply has not changed; the baby has changed. Get the best latch possible and use compression to help you increase flow to the baby Notes on scales and weights

1. Scales are all different. We have documented significant differences from one scale to another. Weights have often been written down wrong. A soaked cloth diaper may weigh 250 grams (half a pound) or more, so babies should be weighed naked.
2. Many rules about weight gain are taken from observations of growth of formula feeding babies. They do not necessarily apply to breastfeeding babies. A slow start may be compensated for later by fixing the breastfeeding. Growth charts are guidelines only.