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An infant breastfeeding
International Breastfeeding Symbol
Breastfeeding is the feeding of an infant or young child with milk from a woman\'s breasts. Babies have a sucking reflex that enables them to suck and swallow milk.
In most situations human breast milk is the best source of nourishment for human infants,Picciano M (2001). "Nutrient composition of human milk". Pediatr Clin North Am 48 (1): 53–67. PMID 11236733. preventing disease, promoting health and reducing health care costsRiordan JM (1997). "The cost of not breastfeeding: a commentary". J Hum Lact 13 (2): 93-97. PMID 9233193. (exceptions include if the mother is taking certain drugs or infected with tuberculosis or HIV). Experts disagree about how long to breastfeed to gain the greatest benefit, and the risks of using artificial formulas;Kramer M, Kakuma R (2002). "Optimal duration of exclusive breastfeeding". Cochrane Database Syst Rev: CD003517. Baker R (2003). "Human milk substitutes. An American perspective". Minerva Pediatr 55 (3): 195–207. PMID 12900706. Agostoni C, Haschke F (2003). "Infant formulas. Recent developments and new issues". Minerva Pediatr 55 (3): 181-94. PMID 12900705. in both developing and developed countries, artificial feeding is associated with more deaths from diarrhoea in infants.Horton S, Sanghvi T, Phillips M, et al (1996). "Breastfeeding promotion and priority setting in health". Health Policy Plan 11 (2): 156–68. doi:10.1093/heapol/11.2.156. PMID 10158457.
Breastfeeding is promoted as the best method of feeding infants in their first two years and beyond; the World Health Organization (WHO)Exclusive Breastfeeding. WHO: Child and Adolescent Health and Development. Retrieved on 2006-05-03. and American Academy of Pediatrics (AAP)Gartner LM, et al (2005). "Breastfeeding and the use of human milk". Pediatrics 115 (2): 496–506. doi:10.1542/peds.2004-2491. PMID 15687461. both stress the value of breastfeeding for mothers and children. While recognizing the superiority of breastfeeding, regulating authorities work to make artificial feeding safer when it is not used.
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The production, secretion and ejection of milk is called lactation. It is one of the defining features of being a mammal.
Not all the properties of breast milk are understood, but its nutrient content is relatively stable. Breast milk is made from the nutrients in the mother\'s bloodstream and bodily stores. Some studies estimate that a woman who breastfeeds her infant exclusively uses 400 - 600 extra calories a day in producing milk.Breastfeeding Guidelines. Rady Children\'s Hospital San Diego. Retrieved on 2007-03-04. The composition of breast milk depends on how long the baby nurses, the mother\'s food consumption and environment, but generally consists of a mix of water, fat, carbohydrates and other nutrients.
Himba woman and child.
Breastfeeding benefits mother and child both physically and psychologically. Nutrients and antibodies pass to the baby and beneficial hormones are released into the mother\'s body.Breastfeeding. Centers for Disease Control and Prevention. Retrieved on 2007-01-23. The maternal bond can also be strengthened during breastfeeding.Benefits of Breastfeeding. U.S. Department of Health and Human Services. Retrieved on 2007-01-23.
Research has demonstrated a variety of benefits to breastfeeding an infant.Ip S, Chung M, Raman G, et al (2007). "Breastfeeding and maternal and infant health outcomes in developed countries". Evid Rep Technol Assess (Full Rep) (153): 1–186. PMID 17764214. These include:
In children who are at risk (defined as at least one parent or sibling having atopy) atopic syndrome can be prevented or delayed through exclusive breastfeeding for four months, though these benefits may not be present after four months of ageGreer FR, Sicherer SH, Burks AW (2008). "Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas". Pediatrics 121 (1): 183–91. doi:10.1542/peds.2007-3022. PMID 18166574. though the key factor may be the age at which non-breastmilk is introduced rather than duration of breastfeeding.Oddy WH, Holt PG, Sly PD, et al (1999). "Association between breast feeding and asthma in 6 year old children: findings of a prospective birth cohort study". BMJ 319 (7213): 815–9. PMID 10496824. Atopic dermatitis, the most common form of eczema, can be reduced through exclusive breastfeeding beyond 12 weeks in individuals with a family history of atopy, but when breastfeeding beyond 12 weeks is combined with other foods incidents of eczema rise irrespective of family history.Pratt HF (1984). "Breastfeeding and eczema". Early Hum. Dev. 9 (3): 283–90. PMID 6734490.
A review of the association between breastfeeding and celiac disease (CD) concluded that breast feeding while introducing gluten to the diet reduced the risk of CD. The study was unable to determine if breastfeeding merely delayed symptoms or offerred life-long protection.Akobeng AK, Ramanan AV, Buchan I, Heller RF (2006). "Effect of breast feeding on risk of coeliac disease: a systematic review and meta-analysis of observational studies". Arch. Dis. Child. 91 (1): 39–43. doi:10.1136/adc.2005.082016. PMID 16287899.
Infants exclusively breastfed have less chance of developing diabetes mellitus type 1 than peers with a shorter duration of breastfeeding and an earlier exposure to cow milk and solid foods.Perez-Bravo F, Carrasco E, Gutierrez-Lopez MD, Martinez MT, Lopez G, de los Rios MG (1996). "Genetic predisposition and environmental factors leading to the development of insulin-dependent diabetes mellitus in Chilean children". J. Mol. Med. 74 (2): 105–9. PMID 8820406. Breastfeeding also appears to protect against diabetes mellitus type 2,Owen CG, Martin RM, Whincup PH, Smith GD, Cook DG (2006). "Does breastfeeding influence risk of type 2 diabetes in later life? A quantitative analysis of published evidence". Am. J. Clin. Nutr. 84 (5): 1043–54. PMID 17093156. Mayer-Davis EJ, Dabelea D, Lamichhane AP, et al (2008). "Breast-feeding and type 2 diabetes in the youth of three ethnic groups: the SEARCh for diabetes in youth case-control study". Diabetes Care 31 (3): 470–5. doi:10.2337/dc07-1321. PMID 18071004. at least in part due to its effects on the child\'s weight.
Breastfeeding protects infants against diarrhea as compared to formula-fed peers;Dewey KG, Heinig MJ, Nommsen-Rivers LA (1995). "Differences in morbidity between breast-fed and formula-fed infants". J. Pediatr. 126 (5 Pt 1): 696–702. PMID 7751991. compared to formula-fed peers, death rates due to diarrhea in breastfed infants are lower irrespective of development level of country.
Breastmilk include several anti-infective factors such as bile salt stimulated lipase (protecting against amoebic infections), lactoferrin (which binds to iron and inhibits the growth of intestinal bacteria)Kunz C, Rodriguez-Palmero M, Koletzko B, Jensen R (1999). "Nutritional and biochemical properties of human milk, Part I: General aspects, proteins, and carbohydrates". Clin Perinatol 26 (2): 307–33. PMID 10394490. Rodriguez-Palmero M, Koletzko B, Kunz C, Jensen R (1999). "Nutritional and biochemical properties of human milk: II. Lipids, micronutrients, and bioactive factors". Clin Perinatol 26 (2): 335–59. PMID 10394491. and immunoglobulin A protecting against microorganisms.Glass RI, Svennerholm AM, Stoll BJ, et al (1983). "Protection against cholera in breast-fed children by antibodies in breast milk". N. Engl. J. Med. 308 (23): 1389–92. PMID 6843632.
Despite also being a factor in the transmission of HIV from mother to child, some constituents in breastmilk may be protective of infection. In particular, high levels of certain polyunsaturated fatty acids in breastmilk (including eicosadienoic, arachidonic and gamma-Linolenic acids) are associated with a reduced risk of child infection when nursed by HIV-positive mothers. Arachidonic acid and gamma-linolenic acid may also reduce viral shedding of the HIV virus in breastmilk.Villamor E, Koulinska IN, Furtado J, et al (2007). "Long-chain n-6 polyunsaturated fatty acids in breast milk decrease the risk of HIV transmission through breastfeeding". Am. J. Clin. Nutr. 86 (3): 682–9. PMID 17823433.
Breastfeeding does not appear to offer protection against allergies.Kramer MS, Matush L, Vanilovich I, et al (2007). "Effect of prolonged and exclusive breast feeding on risk of allergy and asthma: cluster randomised trial". BMJ 335 (7624): 815. doi:10.1136/bmj.39304.464016.AE. PMID 17855282.
Babies with a specific variant of the FADS2 gene (approximately 90% of all babies) demonstrate an average of 7 points higher IQ if breastfed.Caspi A, Williams B, Kim-Cohen J, et al (2007). "Moderation of breastfeeding effects on the IQ by genetic variation in fatty acid metabolism". Proc. Natl. Acad. Sci. U.S.A. 104 (47): 18860–5. doi:10.1073/pnas.0704292104. PMID 17984066. ; lay-summary
Necrotizing enterocolitis (NC), found mainly in premature births, is six to ten times more common in infants fed formula exclusively, and three times more commin in infants fed a mixture of breast milk and formula, as compared to exclusive breastfeeding. In infants born at more than 30 weeks, NC was twenty times more common in infants fed exclusively on formula.Lucas A, Cole TJ (1990). "Breast milk and neonatal necrotising enterocolitis". Lancet 336 (8730): 1519–23. PMID 1979363.
Breast milk contains the ideal ratio of the amino acids cystine, methionine, and taurine to support development of the central and peripheral nervous system. Children aged seven and eight years old who were of low birthweight who were breastfed for more than eight months demonstrated significantly higher intelligence quotient scores than comparable children breastfed for less time, suggesting breastfeeding offers long-term cognitive benefits in some populations.Horwood LJ, Darlow BA, Mogridge N (2001). "Breast milk feeding and cognitive ability at 7-8 years". Arch. Dis. Child. Fetal Neonatal Ed. 84 (1): F23–7. PMID 11124919.
Breastfeeding appears to reduce the risk of extreme obesity in children aged 39 to 42 months.Armstrong J, Reilly JJ (2002). "Breastfeeding and lowering the risk of childhood obesity". Lancet 359 (9322): 2003–4. doi:10.1016/S0140-6736(02)08837-2. PMID 12076560. The protective effect of breastfeeding against obesity is consistent, though small, across many studies, and appears to increase with the duration of breastfeeding.Arenz S, Rückerl R, Koletzko B, von Kries R (2004). "Breast-feeding and childhood obesity--a systematic review". Int. J. Obes. Relat. Metab. Disord. 28 (10): 1247–56. doi:10.1038/sj.ijo.0802758. PMID 15314625.
The duration of certain types of inner ear infections (otitis media with effusion, OME) in the first two years of life, is associated with a shorter period of breastfeeding in addition to cigarette smoking and feeding while lying down.Owen MJ, Baldwin CD, Swank PR, Pannu AK, Johnson DL, Howie VM (1993). "Relation of infant feeding practices, cigarette smoke exposure, and group child care to the onset and duration of otitis media with effusion in the first two years of life". J. Pediatr. 123 (5): 702–11. PMID 8229477. A reduced proportion and duration of any otitis media infection was associated with breastfeeding rather than formula feeding for the first twelve months of life.
Breastfeeding appears to reduce symptoms of upper respiratory tract infections in premature infants up to seven months after release from hospital.Blaymore Bier JA, Oliver T, Ferguson A, Vohr BR (2002). "Human milk reduces outpatient upper respiratory symptoms in premature infants during their first year of life". J Perinatol 22 (5): 354–9. doi:10.1038/sj.jp.7210742. PMID 12082468.
Breastfed babies have improved arousal from sleep, which may reduce the risk of sudden infant death syndrome.Horne RS, Parslow PM, Ferens D, Watts AM, Adamson TM (2004). "Comparison of evoked arousability in breast and formula fed infants". Arch. Dis. Child. 89 (1): 22–5. PMID 14709496.
Breastfeeding reduced the risk of acquiring urinary tract infections in infants up to seven months post-partum. The protection was strongest immediately after birth, and was ineffective past seven monthsMårild S, Hansson S, Jodal U, Odén A, Svedberg K (2004). "Protective effect of breastfeeding against urinary tract infection". Acta Paediatr. 93 (2): 164–8. PMID 15046267.
Zanzibari woman breastfeeding
Breastfeeding is a cost effective way of feeding an infant, and provides the best nourishment for a child at a small nutrient cost to the mother. Frequent and exclusive breastfeeding can delay the return fertility through lactational amenorrhea, though breastfeeding is at best an imperfect means of birth control. Breastfeeding is possible throughout pregnancy, but generally milk production will be reduced at some point.Feldman S (July-August 2000). "Nursing Through Pregnancy". New Beginnings 17 (4): pp. 116-118, 145. La Leche League International. Retrieved on 2007-03-15.
Breastfeeding mothers have less risk of endometrial,Rosenblatt K, Thomas D (1995). "Prolonged lactation and endometrial cancer. WHO Collaborative Study of Neoplasia and Steroid Contraceptives". Int J Epidemiol 24 (3): 499–503. PMID 7672888. Newcomb P, Trentham-Dietz A (2000). "Breast feeding practices in relation to endometrial cancer risk, USA". Cancer Causes Control 11 (7): 663-7. PMID 10977111. breast and ovarian cancer, and osteoporosis. Mothers who breastfeed longer than eight months also benefit from bone re-mineralisation Melton III L; Bryant S, Wahner H, O\'Fallon W, Malkasian G, Judd H, Riggs B (March 1993). "Influence of breastfeeding and other reproductive factors on bone mass later in life". Osteoporosis International 3 (2): pp. 76-83. London: Springer. doi:10.1007/BF01623377. PMID 8453194. and breastfeeding diabetic mothers require less insulin.Rayburn W, Piehl E, Lewis E, Schork A, Sereika S, Zabrensky K (1985). "Changes in insulin therapy during pregnancy". Am J Perinatol 2 (4): 271-5. PMID 3902039. Breastfeeding helps stabilize maternal endometriosis, reduces the risk of post-partum bleeding and benefits the insulin levels for mothers with polycystic ovary syndrome.Sir-Petermann T, Devoto L, Maliqueo M, Peirano P, Recabarren S, Wildt L (2001). "Resumption of ovarian function during lactational amenorrhoea in breastfeeding women with polycystic ovarian syndrome: endocrine aspects". Hum Reprod 16 (8): 1603–10. PMID 11473950.
Some breastfeeding women have pain from candidiasisor staphylococcus infections of the nippleAmir L; Garland S, Dennerstein L, Farish S (1996). "Candida albicans: is it associated with nipple pain in lactating women?". Gynecol Obstet Invest 41 (1): pp. 30-34. Karger. PMID 8821881. though these can be managed with medical attention with little concern for mother and child.
The hormones released during breastfeeding strengthen the maternal bond. Teaching partners how to manage common difficulties is associated with higher breastfeeding rates.Pisacane A, Continisio GI, Aldinucci M, D\'Amora S, Continisio P (2005). "A controlled trial of the father\'s role in breastfeeding promotion". Pediatrics 116 (4): e494–8. doi:10.1542/peds.2005-0479. PMID 16199676. Support for a mother while breastfeeding can assist in familial bonds and help build a paternal bond between father and child.Van Willigen, John; John van Willigen (2002). Applied anthropology: an introduction. New York: Bergin & Garvey. ISBN 0897898338.
If the mother is away, an alternative caregiver may be able to feed the baby with expressed breast milk. The various breast pumps available for sale and rent help working mothers to feed their babies breast milk for as long as they want. To be successful, the mother must produce and store enough milk to feed the child for the time she is away, and the feeding caregiver must be comfortable in handling breast milk.
Breastfeeding releases the hormones oxytocin and prolactin which relax the mother and make her feel more nurturing toward her baby.Dettwyler K; Stuart-Macadam P (1995). Breastfeeding: Biocultural Perspectives. Aldine Transaction, p. 131. ISBN 978-0-202-01192-9. Breastfeeding soon after giving birth increases the mother\'s oxytocin levels, making her uterus contract more quickly and reducing bleeding. Oxytocin is similar to pitocin, a synthetic hormone used to make the uterus contract.Chua S, Arulkumaran S, Lim I, Selamat N, Ratnam S (1994). "Influence of breastfeeding and nipple stimulation on postpartum uterine activity". Br J Obstet Gynaecol 101 (9): 804-5. PMID 7947531.
As fat accumulated during pregnancy is used to produce milk, breastfeeding can help mothers lose weight.Dewey K, Heinig M, Nommsen L (1993). "Maternal weight-loss patterns during prolonged lactation". Am J Clin Nutr 58 (2): 162-6. PMID 8338042. Lovelady C, Garner K, Moreno K, Williams J (2000). "The effect of weight loss in overweight, lactating women on the growth of their infants". N Engl J Med 342 (7): 449-53. PMID 10675424.
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Despite being a natural human activity, breastfeeding difficulties are not uncommon. Putting the baby to the breast as soon as possible after birth helps to avoid many problems. The AAP breastfeeding policy says: Delay weighing, measuring, bathing, needle-sticks, and eye prophylaxis until after the first feeding is completed. Many breastfeeding difficulties can be resolved with proper hospital procedures, properly trained midwives, doctors and hospital staff, and lactation consultants.Newman J; Pitman T (2000). Dr. Jack Newman\'s guide to breastfeeding. HarperCollins Publishers. ISBN 0006385680. There are some situations in which breastfeeding may be harmful to the infant, including infection with tuberculosis or HIV, some medications and some legal and illegal drugs.
Breastfed infants generally gain weight according to the following guidelines:
The average breastfed baby doubles birth weight in 5–6 months. By one year, the typical breastfed baby will weigh about 2½ times birth weight. At one year, breastfed babies tend to be leaner than bottle fed babies.Weight gain (Growth patterns). AskDrSears.com. By two years, differences in weight gain and growth between breastfed and formula-fed babies are no longer evident.Mohrbacher, Nancy (2003). The Breastfeeding Answer Book, 3rd ed. (revised), La Leche League International. ISBN 0-912500-92-1.
There are many books and videos to advise mothers about breastfeeding. Lactation consultants in hospitals or private practice, and volunteer organizations of breastfeeding mothers such as La Leche League also provide advice and support.
In the half hour after birth, the baby\'s suckling reflex is strongest, and the baby is more alert, so it is the ideal time to start breastfeeding. Widstrom AM, Wahlberg V, Matthiesen AS, Eneroth P, Uvnas-Moberg K, Werner S, et al. Short-term effects of early suckling and touch of the nipple on maternal behavior. Early Hum Dev 1990; 21:153-63. . Early breast-feeding is associated with fewer nighttime feeding problems Renfrew MJ, Lang S. Early versus delayed initiation of breastfeeding. In: The Cochrane Library [on CD-ROM]. Oxford: Update Software;1998.
Breastfeeding at least once every two to three hours helps to maintain milk production. For most women, eight breastfeeding or pumping sessions every 24 hours keeps their milk production high. Newborn babies may feed more often than this: 10 to 12 breastfeeding sessions every 24 hours is common, and some may even feed 18 times a day.Infant feeding – Breast or bottle and how to breast feed. Retrieved on 2007-05-26. Feeding a baby on demand (sometimes referred to as "on cue"), may mean breastfeeding much more than the recommended minimum. Feeding when the baby shows early signs of hunger, is the best way to maintain milk production and ensure the baby\'s needs for milk and comfort are being met. However, it may be important to recognize whether a baby is truly hungry, as breastfeeding too frequently may mean the child receives a disproportionately high amount of foremilk, and not enough hindmilk, potentially creating problems.V Livingstone. The Art of Successful Breastfeeding [VHS]. Vancouver, BC, Canada: New Vision Media Ltd...
Babies usually show they are hungry by waking up (newborns), mouthing their fists, moaning or fussing. Crying is a late indicator of hunger. When a baby\'s cheeks are stroked, the rooting instinct makes it move its face towards the stroking and open its mouth.
Breastfeeding can make mothers thirsty, especially at first, when both mother and baby are inexperienced and when feeding sessions can last for an hour or more (there is no time limit for breastfeeding). Having water readily available helps mothers maintain proper hydration.
Rooming-in bassinet
Most US states now have breastfeeding laws which allow a mother to breastfeed her baby anywhere she is allowed to be. In hospitals, rooming-in care is used for breastfeeding. There are breastfeeding rooms in some places, including hypermarkets.
When the nipple strokes the baby\'s cheek the baby will open its mouth and turn towards the nipple. To help the baby latch on well, tickle the baby\'s top lip with the nipple, wait until the baby\'s mouth opens wide, then bring the baby up towards the nipple quickly, so that the baby has a mouthful of nipple and areola. The nipple should be at the back of the baby\'s throat, with the baby\'s tongue lying flat in its mouth. Inverted or flat nipples can be massaged so that the baby will have more to latch onto. Resist the temptation to move towards the baby, as this can lead to poor attachment.
Many women wear nursing brassieres for easier access to the breast, but these are not always necessary and certainly not required. In the very early days, wearing a nursing bra can make breastfeeding complicated and uncomfortable. Wearing a bra at any time after birth will not affect how the breast changes with pregnancy and breastfeeding. Many women find that the size of their breasts change dramatically and so fitting a bra is better done after childbirth rather than before. An ill-fitting bra, whether designed for nursing or otherwise, can cause plugged ducts or mastitis.
Pain in the nipple or breast is linked to incorrect breastfeeding techniques. Failure to latch on is one of the main reasons for ineffective feeding and can lead to infant health concerns. A 2006 study found that inadequate parental education, incorrect breastfeeding techniques, or both were associated with higher rates of preventable hospital admissions in newborns.Paul I, Lehman E, Hollenbeak C, Maisels M (2006). "Preventable newborn readmissions since passage of the Newborns\' and Mothers\' Health Protection Act". Pediatrics 118 (6): 2349–58. PMID 17142518.
The baby may pull away from the nipple after a few minutes or after a much longer period of time. Normal feeds at the breast can last a few sucks (newborns), from 10 to 20 minutes or even longer (on demand). Sometimes, after the finishing of a breast, the mother may offer the other breast.
The length of feeds varies a lot. Regardless of the time taken, the breastfeeding mother should be comfortable.
While most women breastfeed their child in the cradling position, there are many ways to hold the feeding baby. It depends on the mother and child\'s comfort and the feeding preference of the baby. Some babies prefer one breast to the other, but the mother should offer both breasts at every nursing with her newborn.
When tandem breastfeeding, the mother is unable to move the baby from one breast to another and comfort can be more of an issue. As tandem breastfeeding brings extra strain to the arms, especially as the babies grow, many mothers of twins recommend the use of more supporting pillows. Favored positions include:
Exclusive breastfeeding is when an infant receives no other food or drink, or even water, besides breast milk. National and international guidelines recommend that all infants be breastfed exclusively for the first six months of life. It is generally accepted that newborns should be exclusively breastfed for around 6 months. Breastfeeding may continue with the addition of appropriate foods, for two years or more. Exclusive breastfeeding has dramatically reduced infant deaths in developing countries by reducing diarrhea and infectious diseases.
Exclusively breastfed infants feed anywhere from 6 to 14 times a day. Newborns consume from 30 to 90 ml (1 to 3 US fluid ounces). After the age of four weeks, babies consume about 120ml (4 US fluid ounces) per feed. Each baby is different, but as it grows the amount will increase. It is important to recognize the baby\'s hunger signs. It is assumed that the baby knows how much milk it needs and it is therefore advised that the baby should dictate the number, frequency, and length of each feed. The supply of milk from the breast is determined by the number and length of these feeds or the amount of milk expressed. The birth weight of the baby may affect its feeding habits, and mothers may be influenced by what they perceive its requirements to be. For example, a baby born small for gestational age may lead a mother to believe that her child needs to feed more than if it larger; they should, however, go by the demands of the baby rather than what they feel is necessary.
While it can be hard to measure how much food a breastfed baby consumes, babies normally feed to meet their own requirements.Iwinski S (2006), "Is Weighing Baby to Measure Milk Intake a Good Idea?", LEAVEN 42 (3): 51-3, <http://www.lalecheleague.org/llleaderweb/LV/LVJulAugSep06p51.html>. Retrieved on 8 April 2007 Babies that fail to eat enough may exhibit symptoms of failure to thrive. If necessary, it is possible to estimate feeding from wet and soiled nappies (diapers): 8 wet cloth or 5–6 wet disposable, and 2–5 soiled per 24 hours suggests an acceptable amount of input for newborns older than 5–6 days old. After 2–3 months, stool frequency is a less accurate measure of adequate input as some normal infants may go up to 10 days between stools. Babies can also be weighed before and after feeds.
When direct breastfeeding is not possible, a mother can express (artificially remove and store) her milk. With manual massage or using a breast pump, a woman can express her milk and keep it in freezer storage bags, a supplemental nursing system, or a bottle ready for use. Breast milk may be kept at room temperature for up to ten hours, refrigerated for up to eight days or frozen for up to four to six months. Research suggests that the antioxidant activity in expressed breast milk decreases over time but it still remains at higher levels than in infant formula.Hanna N (November 2004). "Effect of storage on breast milk antioxidant activity". Arch Dis Child Fetal Neonatal Ed 89 (6): pp. F518-20. BMJ Publishing Group Ltd. PMID 15499145.
Expressing breast milk can maintain a mother\'s milk supply when she and her child are apart. If a sick baby is unable to feed, expressed milk can be fed through a nasogastric tube.
Expressed milk can also be used when a mother is having trouble breastfeeding, such as when a newborn causes grazing and bruising. If an older baby bites the nipple, the mother\'s reaction - a jump and a cry of pain - is usually enough to discourage the child from biting again. (Another possibility is responding to the bite by drawing the baby so close that his nose is covered and he cannot breathe without releasing.[1]) Babies or toddlers that are truly feeding cannot physically bite the nipple.
"Exclusively Expressing", "Exclusively pumping" and "EPing" are terms for a mother who feeds her baby exclusively on her breastmilk while not physically breastfeeding. This may arise because her baby is unable or unwilling to latch on to the breast. With good pumping habits, particularly in the first 12 weeks when the milk supply is being established, it is possible to produce enough milk to feed the baby for as long as the mother wishes. Kellymom [2] has a page of links relating to exclusive pumping.
It is generally advised to delay using a bottle to feed expressed breast milk until the baby is 4-6 weeks old and is good at sucking directly from the breast.Arlene Eisenberg (1989). What to Expect the First Year. Workman Publishing Company. ISBN 0894805770. Because It takes less effort to suck from a bottle, a baby might lose its desire to suck from the breast. This is called nursing strike or nipple confusion. To avoid this when feeding expressed breast milk (EBM) before 4-6 weeks of age, it is recommended that breast milk be given by other means such as feeding spoons or feeding cups. Also, EBM should be given by someone other than the breastfeeding mother (or wet nurse), so that the baby can learn to associate direct feeding with the mother (or wet nurse) and associate bottle feeding with other people.[citation needed]
Some women donate their expressed breast milk (EBM) to others, either directly or through a milk bank. Though some dislike the idea of feeding their own child with another woman\'s milk, others appreciate being able to give their baby the benefits of breast milk. Feeding expressed breast milk—either from donors or the baby\'s own mother—is the feeding method of choice for premature babies.Spatz D (2006). "State of the science: use of human milk and breast-feeding for vulnerable infants". J Perinat Neonatal Nurs 20 (1): 51-5. PMID 16508463.
Expressed breast milk (EBM) or infant formula can be fed to an infant by bottle
Predominant or mixed breastfeeding means feeding breast milk along with infant formula, baby food and even water, depending on the age of the child. Babies feed differently with artificial teats than from a breast. When feeding from the breast, the tongue massages the milk out rather than sucking, and the nipple does not go as far into the mouth; when feeding from a bottle, an infant will suck harder and the milk may come in more rapidly. Therefore, mixing breastfeeding and bottle-feeding (or using a pacifier) before the baby is used to feeding from its mother can induce the infant to prefer the bottle to the breast. Orthodontic teats, which are generally slightly longer, are closer to the nipple. Some mothers supplement feed with a small syringe or flexible cup to reduce the risk of artificial nipple preference.
Feeding two children at the same time is called tandem breastfeeding The most common reason for tandem breastfeeding is the birth of twins, although women with closely spaced children can and do continue to nurse the older as well as the younger. As the appetite and feeding habits of each baby may not be the same, this could mean feeding each according to their own individual needs, and can also include breastfeeding them together, one on each breast.
In cases of triplets or more, it is a challenge for a mother to organize feeding around the appetites of all the babies. While breasts can respond to the demand and produce large quantities of milk, it is common for women to use alternatives. However, some mothers have been able to breastfeed triplets successfully Grunberg R (1992). "Breastfeeding multiples: Breastfeeding triplets". New Beginnings 9 (5): 135-6. Australian Breast Feeding Association: Breastfeeding triplets, quads and higher Association of Radical Midwives: Breastfeeding triplets.
Tandem breastfeeding may also occur when a woman has a baby while breastfeeding an older child. During the late stages of pregnancy the milk will change to colostrum, and some older nurslings will continue to feed even with this change, while others may wean due to the change in taste or drop in supply. Feeding a child while being pregnant with another can also be considered a form of tandem feeding for the nursing mother, as she also provides the nutrition for two.Flower H (2003). Adventures in Tandem Nursing: Breastfeeding During Pregnancy and Beyond. La Leche League International. ISBN 978-0912500973.
Breastfeeding past two years is called extended breastfeeding or "sustained breastfeeding" by supporters and those outside the U.S.La Leche League International. Report from the Board: Update from the LLLI Board of Directors. LLL. Retrieved on 2007-08-02.) Some women breastfeed a child until the age of 3 or more. Supporters of extended breastfeeding believe that all the benefits of human milk, nutritional, immunological and emotional, continue for as long as a child nurses. Often the older child will nurse infrequently or sporadically as a way of bonding with the mother.[citation needed]
In developing nations in Africa, it is sometimes common for more than one woman to breastfeed a child. Shared breastfeeding is a risk factor for HIV infection in infants.Alcorn K. "Shared breastfeeding identified as new risk factor for HIV", Aidsmap, 2004-08-24. Retrieved on 2007-04-10. A woman who is engaged to breastfeed another\'s baby is known as a wet nurse. Islam has codified the relationship between this woman and the infants she nurses, and also between the infants when they grow up, so that milk siblings are considered as blood siblings and cannot marry.
Weaning is the process of introducing the infant to ordinary food and reducing the supply of breast milk. The infant is fully weaned once it relies on ordinary food for all its nutrition and it no longer receives any breast milk. Most mammals stop producing the enzyme lactase at the end of weaning, and become lactose intolerant. Many humans have a mutation that allows the production of lactase throughout life and can drink milk - usually cow or goat milk - well beyond the age of weaning.http://www.aafp.org/afp/20020501/1845.html Aapf.org
In the past, bromocriptine was sometimes used to reduce the engorgement experienced by many women during weaning. However, it was discovered that when used for this purpose, this medication posed serious health risks to women, such as stroke, and the U.S. FDA withdrew this indication for the drug in 1994.http://www.fda.gov/bbs/topics/ANSWERS/ANS00594.html FDA.gov
Famille d’un Chef Camacan se préparant pour une Fête ("Family of a Chef Camacan preparing for a Day") by Jean-Baptiste Debret shows a woman breastfeeding a child in the background.
