Breastfeeding FAQs: Some Common Concerns_KH_Parent

Breastfeeding FAQs: Some Common Concerns

Whether you're a new mom or a seasoned parenting pro, breastfeeding often comes with its fair share of questions. Here are answers to some common inquiries that mothers — new and veteran — may have.

Is it normal for my baby to spit up after feedings?

Sometimes, babies spit up when they:

  • have eaten too much
  • burp (the notorious "wet burp")
  • drool

Many infants will spit up a little after some — or even all — feedings or during burping because their digestive tracts are immature. That's perfectly normal.

As long as your baby is growing and gaining weight and doesn't seem uncomfortable with the spitting up, it's OK. The amount of spit up often looks more than it actually is. But spitting up isn't the same as vomiting all or most of a feeding.

If you're concerned your baby is forcefully vomiting, or much of a feeding is coming up more than once a day, call your doctor. In rare cases, there may be an allergy, digestive problem, or other problem that needs medical attention.

It also may help your doctor to properly diagnose the problem (if there is one) if you keep a record of exactly how often and how much your baby seems to be spitting up, then call your doctor. He or she should be able to tell you if it's normal or something that's cause for concern.

But again, it's important to remember that spitting up is usually perfectly OK. If the doctor says your baby's spitting up is normal, here are some things you can do to help alleviate it:

  • Burp your little one every 3 to 5 minutes during breast feedings, or after every 1 to 2 ounces during bottle feeds. Sometimes giving smaller, more frequent feeds can help rather than large volume feeds.
  • Keep your baby upright after feedings — holding the baby is best, since the position of the baby in a car seat may actually make spitting up more common.
  • Don't jiggle, bounce, or actively play with your baby right after feedings.
  • Keep your baby's head above his or her feet while feeding (in other words, don't hold your baby in a dipped-down position when feeding).
  • Raise the head of your baby's crib or bassinet. Roll up a few small hand towels or receiving blankets (or you can buy special "blocks") to place under (not on top of) the mattress. But don't use a pillow under your baby's head. Make sure the mattress doesn’t fold in the middle, and that the incline is gentle enough so the baby doesn’t slide down.

If your baby also gets bottles of breast milk or infant formula supplements:

  • Don't give the bottle while your little one is lying down.
  • Make sure the hole in the nipple is the right size and/or flow for your baby. For example, fast-flow nipples may cause babies to gag or may simply give them more than they can handle, whereas slower flows may be frustrating to some babies and may cause them to suck more vigorously and gulp too much air.

It's also important to keep in mind that this, too, shall pass. Many babies outgrow spitting up by the time they're sitting up.

I think I'm getting sick. Can I still breastfeed?

In most cases, yes — the majority of illnesses are not dangerous to a breastfeeding infant. In rare cases, though (such as HIV), a mother's health may interfere with her ability to breastfeed her baby.

If an illness in either you or your baby requires a brief interruption in nursing, you can pump and discard the breast milk until you're able to start nursing again. To maintain your milk production, it's important that you continue to pump your breast milk during this time. And if you're taking any medications for your illness, talk with your doctor to find out whether or not it's OK for you to breastfeed your baby.

My baby bites during breastfeeding. Can I stop it?

Babies will often play with their mothers' nipples with their gums, not meaning to cause any harm. But once their little chompers start coming in, the playfulness often isn't so amusing anymore. And babies who are teething may think mom's breasts seem like the ideal teething toy.

However, if your baby is positioned correctly on your breast (with not just the nipple, but much of your areola in the mouth) and latched on, your little one won't physically be able to bite you. Why? Because your nipple should be far back in your baby's mouth.

You often can tell when your baby's about ready to bite — usually when he or she is satisfied and starting to pull away from your breast. In this case, you can pull your potential little biter closer to you to make it more difficult for him or her to pull off easily, or break the suction by slipping your finger into the corner of your baby's mouth.

In some cases, though, biting may be a sign that your baby is done a nursing session, is distracted, or is just plain bored. The breastfeeding advocacy organization La Leche League offers these tips to help reduce the biting potential:

  • Say, "Mommy is not for biting. You can bite this," and offer your little one a teething toy or ring.
  • Try initiating a new activity if your baby seems distracted and is pulling off your breast a lot.
  • Praise your baby — with a hug, kiss, or cuddle — whenever he or she nurses without biting or trying to bite.

Does my breastfed baby need extra vitamins?

Breast milk contains many vitamins as well as easily-absorbed iron. The iron from breast milk will be sufficient until your baby begins eating iron-rich cereals around 4 to 6 months of age.

However, vitamin D isn't found in high enough concentrations in breast milk. The nutrient can be produced by the body when the skin is exposed to sunlight, but it is not safe for infants under 6 months to be in direct sunlight. After 6 months, infants should use sunscreen when in the sun, which blocks the body’s ability to make vitamin D. So, babies who are primarily breastfed should be given daily vitamins.

Also, the American Academy of Pediatrics (AAP) states that infants — whether breastfed or formula-fed — do not need fluoride supplements during the first 6 months. From 6 months on, babies require fluoride supplements only if the water supply is severely lacking in fluoride. Well water and bottled water, for example, may not contain fluoride and the tap water in some communities does not have fluoride. It can be dangerous to give a fluoride supplement to a child already getting enough fluoride, so it’s important to find out the fluoride content in whatever water source your child is using. Again, ask your doctor about your baby's needs.

My baby doesn't want to nurse. What's going on?

Breastfeeding "strikes" are very normal and often last only a few days. Still, this can be worrisome, especially in a baby who usually breastfeeds with no problems at all.

So why might your child suddenly stop wanting to breastfeed? Here are some possible reasons:

  • Teething has made your baby's gums sore.
  • You've been stressed or have changed your nursing patterns lately.
  • You smell "different" to your baby because you switched your soap, perfume, deodorant, or lotion.
  • A different taste to your breast milk because of a change in your diet.
  • Something is making breastfeeding painful or uncomfortable, such as an ear infection, a stuffed-up nose, a cut in your little one's mouth, or an oral infection called thrush.
  • Your baby bit you and your reaction scared him or her.

As frustrating as nursing strikes can be, you and your little one can work through them. Here are some more tips La Leche League offers breastfeeding moms that may help get you past the hump:

  • Try to spend more time with your baby so you can devote some extra time to getting your breastfeeding back on track. Ask a family member, friend, or a babysitter to come over to help out with the chores and any of your other children.
  • Make the experience as enjoyable for your baby as possible — hugging, caressing, and kissing your little one, and stopping to comfort whenever he or she gets upset or frustrated.
  • Try nursing when your baby is sleepy and may be more willing to cooperate.
  • Nurse while you're rocking your baby or walking around while carrying him or her in a sling.
  • Breastfeed in a quiet room with few distractions.
  • Try stimulating your milk let-down by pumping or hand expressing before starting to breastfeed so that your baby gets the milk right away.

Until your nursing schedule is back to normal, you'll need to pump or hand express to keep your milk supply up and to make sure the baby is getting enough to eat. To express your milk, hold onto your breast with your fingers clasped underneath and around your breast and your thumb on top. Gently but firmly push your thumb from the top of your breast down to your areola over and over to help push the milk down the milk ducts.

And if your child is really ready to stop breastfeeding (or wean), he or she will probably do it over a period of weeks or months. In the meantime, both you and your baby can enjoy the special closeness and bonding that breastfeeding can offer.

Reviewed by: Larissa Hirsch, MD
Date reviewed: May 2008

Related Sites

American Dietetic Association
Women, Infants, and Children (WIC)
American Academy of Pediatrics (AAP)
La Leche League

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Nursing Positions
Weaning Your Child
Breastfeeding FAQs: Getting Started
Breastfeeding vs. Formula Feeding
Burping Your Baby