37-33 SHOULD CLEAR FEEDS BE GIVEN DURING THE FIRST FEW DAYS?

Sterile water or dextrose water should not be given before starting breast or formula feeds on day 1. A breast fed infant does not need additional clear feeds. If the mother wants to breast feed, no bottle feeds should be given to the infant as a teat can confuse the infant and cause it to reject the nipple.

Unlike a bottle fed infant, that sucks the milk out of the teat, a breast fed infant holds the nipple against the hard palate and compresses the milk ducts in the areola with the gums. The breast fed infant, therefore, makes a chewing movement while feeding (suckling).

ROUTINE CLEAR FEEDS ARE NOT NEEDED ON DAY 1

37-34 WHAT IS THE BEST POSITION TO HOLD AN INFANT WHILE FEEDING?

The correct position of the infant while feeding is important. The mother should be warm and comfortable. Usually she sits up and holds her infant across her body in front of her. The infant is held in one arm, and should lie on its side with its mouth facing the nipple. The breast is held in the other hand to offer the nipple to the infant.

Mothers should be encouraged to try different feeding positions in order to find which is most comfortable. Some mothers prefer to lie down while they feed. Other mothers prefer to tuck the infant under an arm like a rugby ball.

37-35 HOW SHOULD AN INFANT FIX AT THE BREAST?

One of the commonest mistakes made when breast feeding is that the infant is not held and fixed correctly (latched) at the breast. The infant must take the whole nipple and most of the pigmented areola into the mouth. Sucking or chewing on the nipple causes pain and damages the nipple. The mother should let her nipple touch the infant's cheek, so that the infant will turn towards the breast with an open mouth to take the nipple. Make sure that the infant's nose is not covered by the breast.

THE INFANT MUST TAKE THE WHOLE NIPPLE AND MOST OF THE AREOLA INTO THE MOUTH WHEN FIXING AT THE MOTHER'S BREAST

37-36 SHOULD INFANTS BE DEMAND FED?

Yes. Whenever possible infants should be demand fed. This means that the infant is put to the breast whenever hungry. A normal breast fed infant will usually feed every 2 to 4 hours during the day for the first few weeks. Demand feeding prevents engorged breasts.

37-37 WHAT IS THE LET DOWN REFLEX?

When an infant is put to the breast, the pituitary gland in the mother's brain responds by producing the hormones prolactin and oxytocin. Prolactin stimulates the breast to secrete milk while oxytocin produces the "let down reflex". This reflex produces a tingling feeling in the breast, and results in milk being pumped into the infant's mouth by the contraction of muscle cells that surround the milk ducts under the areola. Milk may leak from the other nipple during feeds. The release of oxytocin helps the uterus to involute by causing the uterus to contract. It may also produce abdominal pain during feeding for the first few days after delivery. Tension, anxiety and a lack of sleep may inhibit the let down reflex.

37-38 HOW DO YOU MANAGE LEAKING BREASTS?

Milk leaking from the breasts is common in the first few weeks of feeding. Leaking of the opposite breast during feeding can be stopped by pressing on that nipple. Cotton handkerchiefs or pads can be used for leaking between feeds. They should be changed frequently as dampness may cause sore nipples.

37-39 CAN A MOTHER'S MILK BE TOO STRONG OR TOO WEAK?

No, but the appearance of breast milk varies. There are 3 different types of breast milk:

1. COLOSTRUM. This is a milky fluid produced in small quantities for the first few days after delivery. However, it contains a lot of protein and provides all the infant's nutritional needs. After 3 to 5 days the milk supply suddenly increases and the breasts feel full. This is due to the production of mature milk, which consists of foremilk and hind milk.
2. FOREMILK. This is produced at the start of each feed. It appears very weak and thin as it consists mainly of water with little fat. On a hot day a thirsty infant will take frequent, small feeds of foremilk.
3. HINDMILK. This is only produced towards the end of a feed. It looks thick and rich, and contains a lot of fat. A hungry infant will empty the breast to obtain the hindmilk

37-40 DO ALL MOTHERS PRODUCE ENOUGH BREAST MILK?

Most mothers produce enough milk for their infant if breast feeding is managed correctly. Unfortunately many mothers stop breast feeding during the first 5 days because they are incorrectly advised that they do not have enough milk or because the infant is losing weight. Milk supply is normally best in the morning and poorest in the late afternoon and early evening.

The mother is probably not producing enough milk if:

1. Her breasts do not feel full before feeds after day 5.
2. The infant continues to lose weight after day 5.
3. The infant loses more than 10% of its birth weight.
4. The infant is not gaining weight by 2 weeks.
5. The infant does not wet 6 or more nappies in 24 hours (after day 5), is very restless and appears hungry.

If you are worried that an infant is not getting enough milk, then the infant can be test weighed before and after a feed. After the first week of life, most term infants will gain about 25 g per day. Weight gain is best determined over a few days.

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