Your Guide to Successful Breastfeeding 01-2018 - Virtua Health
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Your Guide to Successful Breastfeeding 2018
VirtuaBaby
Breastfeeding Resources & Support Systems
Virtua Voorhees Hospital Breastfeeding / Lactation Line
856-247-2793
Virtua Memorial Hospital Breastfeeding / Lactation Line
609-914-7258
Virtua Breastfeeding Support
Private Breastfeeding Sessions – 60 minutes
Meet one-on-one with an International Board Certified Lactation Consultant with extensive
experience in helping moms overcome any problems they may be experiencing.
Fees apply
Breastfeeding eVisits – 15 minutes
Virtua eVisits are a convenient way for breastfeeding moms to privately talk via video with an
Internationally Board Certified Lactation Consultant in the comfort of their own home.
Fees apply
Support Groups
Support groups are held at Virtua Memorial and Voorhees. They are informal gatherings of mothers
& nursing babies led by a Certified Lactation Consultant to help answer your individual questions.
Free
Memorial: Every Wednesday 11am-12:30pm
Mt. Holly Conference Center - 175 Madison Avenue, Mt Holly, NJ 08060
Voorhees: Every Wednesday 2pm-3:30pm
Garden Level Conference Center, Lobby B Entrance, 100 Bowman Drive, Voorhees, NJ 08043
Register for any of these services at Virtua.org/services/breastfeeding or call 1-888-VIRTUA-3
La Leche League ZipMilk.Org
Community Breastfeeding Support Breastfeeding resources
www.lalecheleaguenj.org in your area
La Leche League International searchable by zipcode
1-800-La Leche (1-800-525-3243) www.zipmilk.org
WIC Offices
WIC is for low- or no-income mothers and children at risk for nutrition or health problems.
Burlington County: Camden County: Gloucester County:
609-267-4304 Atco: 856-809-2111 Paulsboro: 856-423-7160
Blackwood: 856-302-1405 Sewell: 856-218-4116
Camden: 856-225-5050
Table of Contents
Breastfeeding Resources and Support Systems............1
Why Breastfeeding is Important........................................3
Changes in Your Breasts and Milk Production..............5
Getting to Know Your Baby.................................................7
Learning to Breastfeed..........................................................8
Getting Started
- Positioning........................................................................9
- Bringing Your Baby to the Breast............................10
- Signs of A Good Latch/
Help with Latch Problems..........................................11
- Tips for Making it Work..............................................12
- Making Plenty of Milk.................................................13
- How to Know Your Baby is
Getting Enough Milk....................................................14
How to Soothe Your Baby....................................................15
Common Challenges.............................................................16
Common Questions................................................................23
Pumping and Milk Storage...................................................26
Introducing Bottles & Supplemental Feedings..............29
Going Back to Work...............................................................30
Nutrition and Fitness.............................................................32
FAQs: A Recap.........................................................................33
Breastfeeding Log...................................................................35
Ten Steps to Successful Breastfeeding..........................39
Tips for Breastfeeding Success .......................................41
VirtuaBaby
Why Breastfeeding 4. Breast milk fights disease.
The cells, hormones, and antibodies in breast milk protect
is Important babies from illness. This protection is unique; formula cannot
match the chemical makeup of human breast milk.
In fact, among formula fed babies, ear infections and diarrhea
Breastfeeding Protects Babies are more common. Formula fed babies also have higher
risks of:
1. Early breast milk is liquid gold.
• Necrotizing (nek-roh-TEYE-zing) enterocolitis (en-TUR-oh-
Known as liquid gold, colostrum (coh-LOSS-trum) is the thick
coh-lyt-iss), a disease that affects the gastrointestinal tract
yellow first breast milk that you make during pregnancy and
in pre-term infants
just after birth. This milk is very rich in nutrients and anti-
bodies to protect your baby. Although your baby only gets a • Lower respiratory infections
small amount of colostrum at each feeding, it matches the • Atopic dermatitis, a type of skin rash
amount his or her tiny stomach can hold. (See page 14 to see
• Asthma
just how small your newborn’s tummy is!)
• Obesity
2. Your breast milk changes as your baby • Type 1 and Type 2 diabetes
grows.
• Childhood leukemia
Colostrum changes into what is called mature milk. By the
Breastfeeding has also been shown to lower the risk
third to fifth day after birth, this mature breast milk has just
of SIDS (sudden infant death syndrome).
the right amount of fat, sugar, water, and protein to help
your baby continue to grow. It is a thinner type of milk than
colostrum, but it provides all of the nutrients and antibodies Formula feeding can raise health risks in babies,
your baby needs. but there are rare cases in which formula may be
a necessary alternative. Very rarely, babies are born
3. Breast milk is easier to digest. unable to tolerate milk of any kind. These babies
For most babies – especially premature babies – breast milk must have soy or another type of special formula.
is easier to digest than formula. The proteins in formula are Formula may also be needed if the mother has
made from cow’s milk, and it takes time for babies’ stomachs certain health conditions and she does not have
to adjust to digesting them. access to donor breast milk.
Content from this booklet comes from Your Guide to Breastfeeding from the Office on Women’s Health, U.S. Department
of Health and Human Services. The content of this booklet is for informational purposes only and should never
replace the advice of your healthcare provider.
3 | VirtuaBaby.Org
Breastfeeding Guide
Mothers Benefit from
Breastfeeding
Breastfeeding During
1. Breastfeeding can make your life easier.
Breastfeeding may take a little more effort than formula
an Emergency
feeding at first, but it can make life easier once you and your
When an emergency occurs, breastfeeding can
baby settle into a good routine. When you breastfeed, there
save lives:
are no bottles and nipples to sterilize. You do not have to buy,
• Breastfeeding protects babies from the risks
measure, and mix formula. And there are no bottles to warm
of a contaminated water supply.
in the middle of the night.
• Breastfeeding can help protect against
2. Breastfeeding can save money. respiratory illnesses and diarrhea. These
Formula and feeding supplies can cost well over $1,500 each diseases can be fatal in populations displaced
year, depending on how much your baby eats. Breastfed by disaster.
babies are also sick less often, which can lower health care • Breast milk is the right temperature for babies
costs. and helps to prevent hypothermia when the
body temperature drops too low.
3. Breastfeeding can feel great. • Breast milk is readily available without the
Physical contact is important to newborns. It can help them need for other supplies.
feel more secure, warm, and comforted. Mothers can benefit
from this closeness, as well. Breastfeeding requires a mother
to take some quiet relaxed time to bond. The skin-to-skin
contact can boost the mother’s oxytocin (OKS-ee-TOH-suhn)
levels. Oxytocin is a hormone that helps milk flow and can Breastfeeding Benefits
calm the mother. The nation benefits overall when mothers breastfeed.
Recent research shows that if 90 percent of families
4. Breastfeeding can be good for the mother’s breastfed exclusively for 6 months, nearly 1,000 deaths
health.
among infants could be prevented. The United States
Breastfeeding is linked to a lower risk of some health would also save $13 billion per year – health care costs are
problems in women: lower for fully breastfed infants than for never-breastfed
• Type 2 diabetes infants. Breastfed infants typically need fewer sick visits,
prescriptions, and hospitalizations.
• Breast cancer
Breastfeeding also contributes to a more productive
• Ovarian cancer workforce because mothers miss less work to care for sick
• Postpartum depression infants. Employer medical costs are also lower.
Experts are still looking at the effects of breastfeeding on Breastfeeding is also better for the environment. There is
osteoporosis and weight loss after birth. Many studies have less trash and plastic waste compared to that produced
reported greater weight loss for breastfeeding mothers by formula containers and bottle supplies.
than for those who don’t. But more research is needed to
understand if a strong link exists.
5. Nursing mothers miss less work.
Breastfeeding mothers miss fewer days from work because
their infants are sick less often.
1-888-VIRTUA-3 | 4
VirtuaBaby
Changes in Your called prolactin from the anterior pituitary gland. Prolactin
stimulates the milk secreting cells in the breast to produce
Breasts and Milk milk. The levels of prolactin begin to drop about three hours
after breastfeeding. When you breastfeed frequently, it keeps
Production the hormone levels high, ensuring you have plenty of milk for
your baby.
During Pregnancy
Breast changes
Stages of Human Milk Production
Breasts become larger and tender with darkening of the
areola (the dark area around the nipple) due to increased • Colostrum (Days 1-2) Colostrum is the initial milk that is
levels of the hormones estrogen and progesterone. Women readily available (thick, sticky, and clear or creamy yellow
who have darker complexions may notice more pronounced in color), and small in volume, but very rich in protein,
pigmentation. fat-soluble vitamins, minerals, and antibodies. The rich
composition helps to keep your baby satisfied during the
Milk production first few days after delivery. It is always available at birth
and gradually converts to mature milk.
Milk-producing glands become larger and greater in number
during pregnancy, and begin producing colostrum (first milk) • Transitional Milk (Days 2-5) As the breasts continue to
early in pregnancy. You may experience some leaking in the be stimulated, milk production increases. Transitional milk
third trimester. may be light yellow in color, and contains plenty of fat,
water-soluble vitamins, and calories.
• Mature Milk (Day 6+) Mature milk is lighter in color and
After Delivery greater in volume. Your breasts become fuller and heavier,
and baby will be gulping and swallowing frequently. Mature
Breast changes milk consists of foremilk and hindmilk. Milk production will
At first, you probably will not notice any changes in your continue to increase slowly during the first month.
breasts, but don’t worry; you are making all the milk your
• Foremilk: Milk that flows at the start of a feeding is
baby needs. After a few days, your breasts will feel fuller
called foremilk. Watery, high in protein and lactose
and heavier, a sure sign that you are making more milk.
(milk sugar), and low in fat, it quenches your baby’s
thirst.
Milk production
• Hindmilk: As you continue to feed, the milk that flows
Milk production is directly related to the frequency of
as your breast empties is called hindmilk. Hindmilk is
nursing. In other words, the more you nurse your baby,
richer in fat, high in calories, and satisfies the baby’s
the more milk you produce. Stimulation of the breast
hunger.
during breastfeeding or pumping releases a hormone
5 | VirtuaBaby.Org
Breastfeeding Guide
What is a
let-down reflex?
A let-down or milk ejection reflex is a
conditioned reflex that ejects milk from
the alveoli, through the ducts, to the
sinuses of the breasts and the nipple.
This reflex makes it easier to breastfeed
your baby. Let-down happens a few
seconds to several minutes after you
start breastfeeding your baby. It can
also happen a few times during a
feeding. You may feel a tingle or slight
discomfort in your breast, but some
women don’t feel anything.
If your milk lets down as a gush and
it bothers your baby, try expressing
some milk by hand before you start
breastfeeding.
Let-down can happen at other times,
too, such as when you hear your baby
cry or when you are thinking about
your baby.
Special cells inside your breasts make milk. These small muscles around the cells to contract and move the
cells are called alveoli (al-VEE-uh-leye). When your breasts milk through a series of small tubes called milk ducts. This
become fuller and tender during pregnancy, this is a sign that moving of the milk is called the let-down reflex.
the alveoli are getting ready to work. Some women do not Oxytocin also causes the muscles of the uterus to contract
feel these changes in their breasts. Others may sense these during and after birth. This helps the uterus to get back to its
changes after their baby is born. original size. It also lessens any bleeding a woman may have
The alveoli make milk in response to the hormone prolactin after giving birth. The release of both prolactin and oxytocin
(proh-LAK-tin). Prolactin rises when the baby suckles. may be responsible in part for a mother’s intense feeling of
Another hormone, oxytocin (oks-ee-TOH-suhn), causes needing to be with her baby.
Another hormone, CCK (which stands for cholecystokinin), is released in both mother and baby during
suckling, which causes both of you to feel sleepy. This is nature’s way of helping you get additional rest,
and helping your baby to be content until your milk volume increases.
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VirtuaBaby
Getting to Know Your Baby Waking for Feedings
Babies are often very sleepy during the first few days after
Infant States birth, and may need to be awakened for feedings. Watch your
baby for signs of an active sleep state, which can be a good
Quiet sleep: A deep sleep; only very intense stimuli will time to wake him or her. If you see that your baby is starting
arouse the baby. Care giving should be limited during this to stir, it is probably a good time to pick him or her up.
time. The average length of a sleep cycle is 50-80 minutes. Cuddling your baby skin-to-skin is also a nice way to begin
Active sleep: Usually precedes waking. The baby may make to wake your baby.
brief fussy or crying noises, but he or she is not necessarily
ready to breastfeed.
Quiet alert: Quietly alert babies are attentive to their Tips to awaken a sleepy baby:
environment. During the first few hours after birth, infants
• Dim the lights and unwrap the baby’s blanket. You
are in this state before going into a long period of sleep.
may need to undress the baby down to just a diaper.
This state is the optimal time to begin breastfeeding.
• Change the baby’s diaper.
Active alert: Variable activity level; the baby may become
fussy or increasingly sensitive to stimuli. • Massage gently, but with firm pressure, on the spine
and feet.
• Lightly stroke or tap the baby’s lips with your
finger, or with your baby’s hand, to stimulate
the rooting reflex.
• Express a small amount of colostrum and rub it
onto your baby’s lips.
• Wipe the baby’s forehead with a cool cloth.
7 | VirtuaBaby.Org
Breastfeeding Guide
Learning to Breastfeed
Breastfeeding is a process that takes time to master. Babies
and mothers need to practice. Keep in mind that you make
milk in response to your baby sucking at the breast. The
more milk your baby removes from the breasts, the more
milk you will make.
After you have the baby, these steps can help you get off to
a great start:
• Breastfeed as soon as possible after birth.
• Ask for a nurse or lactation consultant to help you,
if needed.
• Try not to give your baby other food or formula, unless it
is medically necessary.
• We encourage your baby to stay with you in your hospital
room day and night so that you can breastfeed often.
Keeping your baby close helps you to learn your baby’s
feeding cues.
• Try to avoid giving your baby any pacifiers or artificial
nipples so that he or she gets used to latching onto just
your breast. (See pages 10-11 to learn about latching.)
How often should I breastfeed?
Early and often! Breastfeed as soon as possible after birth. Then breastfeed at least 8 to 12 times every 24 hours to
make plenty of milk for your baby. In the first few days after birth, you may need to wake your baby for feedings about
every three hours, even during the night, but follow your baby’s cues if your baby is waking more frequently and showing
you signs that he or she is ready to eat. After the first few sleepy days, your baby will wake more often for feedings.
Healthy babies will develop their own feeding schedules. Follow your baby’s cues for when he or she is ready to eat.
How long should feedings be?
Feedings may be 15 to 20 minutes or longer per breast. But there is no set time. Your baby will let you know when
he or she is finished. If you are worried that your baby is not eating enough, talk to your baby’s doctor. See the
breastfeeding log on pages 36-39 to keep track of your baby’s feedings and diapers.
1-888-VIRTUA-3 | 8
Getting Started
Positioning
Proper positioning is important for effective breastfeeding, as it allows the baby to have a deep latch. Using good positioning is
the best way to avoid sore nipples, and it may even help prevent engorgement. Basic principles to remember include keeping
the baby at breast level, turned in toward you (chest-to-chest), with the chin and nose touching the breast.
Cradle hold: Hold the baby in the crook of your arm, close to the breast, facing
you, chest-to-chest. Your baby should be up high on your chest, legs even with
your other breast. When the baby opens his or her mouth wide, bring the baby to
your breast with your forearm. Your baby should not be in your lap or turned onto
his or her back, as this can cause an improper latch that will damage your nipple.
Although this may feel like the most natural way to hold your baby for breastfeeding,
it may be harder to use this hold when you are just starting out, as you may not be
as easily able to guide the baby onto the breast for a deep latch. Once you and your
baby have some practice, this hold will become much easier.
Football or clutch hold: Tuck the baby along your side with her feet up against
the back of the chair or bed, with pillows underneath the baby to bring him or her
up to the level of your breast. Support the baby’s neck with your hand, and use
your forearm to support his or her upper body. Be sure to tuck the baby far enough
back along your side so that you are not leaning forward over the baby; you should
be sitting comfortably upright when you guide the baby to your breast. This is a
good position to use after a c-section, when you don’t want the baby to touch your
abdomen. It is also good if your breasts are large, or you are nursing a small or
premature baby.
Cross-cradle hold: Support the baby’s neck and back as in the football hold, and
hold the baby across your chest to the opposite breast. Support your breast with
your other hand. This position, like the football hold, gives you more control in
guiding the baby to the breast for a deeper latch.
Side-lying: As with the cradle hold, your baby should be facing you. Lay the baby
along your side, and nurse from the side on which you are lying. You may need to
use a pillow to bring the baby up to breast level. The side-lying position is especially
good if you are uncomfortable sitting, or for nursing at night.Breastfeeding Guide
Bringing Your Baby to the Breast
When awake, your baby will move his or her head back and Getting your baby
forth, looking and feeling for the breast with his or her mouth
and lips. The steps below can help you get your baby to latch
to latch:
on to the breast. Keep in mind that there is no one way to
start breastfeeding. As long as the baby is latched on well,
Tickle the baby’s lips to
how you get there is up to you.
encourage him or her to
• Hold your baby, wearing only a diaper, against your bare open wide.
chest, with his or her head under your chin. Your baby will
be comfortable in that cozy valley between your breasts.
You can ask your partner or a nurse to place a blanket
across your baby’s back, or bring your bedcovers over you
Pull your baby close so
both. Your skin temperature will rise to warm your baby.
that the chin and lower jaw
• Support his or her neck and shoulders with one hand and moves into your breast first.
hips with the other. He or she may move in an effort to find
your breast.
• Your baby’s head should be tilted back slightly to make it
easy to suck and swallow. With his or her head back and Watch the lower lip and aim
mouth open, the tongue is naturally down and ready for the it as far from the base of the
breast to go on top of it. nipple as possible, so the
baby takes a large mouthful
• At first, your baby’s nose will be lined up opposite your of breast.
nipple. As his or her chin presses into your breast, his or her
wide open mouth will get a large mouthful of breast for a
deep latch. Keep in mind that your baby can breathe at the
breast. The nostrils flare to allow air in and out. Some babies latch on right
• Tilt your baby back, supporting your baby’s head, upper away, and for some it takes
back, and shoulders with the palm of your hand, and pull more time.
your baby in close.
Hand Expression of Colostrum/Milk
How to Hand Express
• Massage your breasts before expressing. Place your fingers and thumb as shown in picture a.
a 1 2 3
press inward squeeze release
Steps of hand expressing:
• Repeat steps 1–3 without loosening your grip, until breast milk/colostrum comes out. You may need to push your
fingers forward, toward the nipple, to push the colostrum out until the milk flow increases.
• Collect the breast milk into a clean spoon, medicine cup, or container. You can express directly into the pump flange
if you are also pumping.
1-888-VIRTUA-3 | 10VirtuaBaby
Signs of a Good Latch Help with Latch Problems
• The latch feels comfortable to you, without hurting or Are you in pain? Many moms report that their breasts
pinching. How it feels is more important than how it looks. can be tender at first until both they and their baby find
• Your baby’s chest is against your body and he or she does comfortable breastfeeding positions and a good latch. Once
not have to turn his or her head while drinking. you have done this, breastfeeding should be comfortable. If
it hurts, your baby may be sucking on only the nipple. Gently
• You see little or no areola, depending on the size of your
break your baby’s suction to your breast by placing a clean
areola and the size of your baby’s mouth. If areola is
finger in the corner of your baby’s mouth and try again.
showing, you will see more above your baby’s lip and less
Also, your nipple should not look flat or compressed when
below.
it comes out of your baby’s mouth. It should look round and
• When your baby is positioned well, his or her mouth will be long, or the same shape as it was before the feeding.
filled with breast.
• The tongue is cupped under the breast, although you might
Are you or your baby frustrated? Take a short break and
not see it.
hold your baby in an upright position. Try holding him or her
• You hear or see your baby swallow. Some babies swallow between your breasts, skin-to-skin. Talk, sing, or provide your
so quietly, a pause in their breathing may be the only sign finger to suck for comfort. Try to breastfeed again in a little
of swallowing. while. Or, the baby may start moving to the breast on his or
• You see the baby’s ears “wiggle” slightly. her own from this position.
• Your baby’s lips turn out like fish lips, not in. You may not
even be able to see the bottom lip. Does your baby have a weak suck or make only tiny
• Your baby’s chin touches your breast. suckling movements? Break your baby’s suction and
try again. He or she may not have a deep enough latch
to remove the milk from your breast. Talk with a lactation
consultant or pediatrician if your baby’s suck feels weak or
if you are not sure he or she is getting enough milk. Rarely, a
health problem can cause a weak suck.
A Good Latch
A good latch is important
for your baby to breastfeed
effectively and for your
comfort. During the early
days of breastfeeding, it can
take time and patience for
your baby to latch on well.
11 | VirtuaBaby.OrgBreastfeeding Guide
Tips for Making It Work
1. Learn your baby’s hunger signs. When babies are Vitamin D
hungry, they become more alert and active. They may put
their hands or fists to their mouths, make sucking motions Babies need 400 International Units (IU) of
with their mouth, or turn their heads looking for the breast. vitamin D each day. Ask your baby’s doctor about
If anything touches the baby’s cheek – such as a hand supplements in drop form.
– the baby may turn toward the hand, ready to eat. This
sign of hunger is called rooting. Offer your breast when
your baby shows rooting signs. Crying can be a late sign
few weeks unless there is a medical reason to do so. If
of hunger, and it may be harder to latch once the baby is
supplementation is needed, try to give expressed breast
upset. Over time, you will be able to learn your baby’s cues
milk first. But it’s best just to feed at the breast. This will
for when to start feeding.
help you make milk and keep your baby from getting
2. Follow your baby’s lead. Make sure you are both confused while learning to breastfeed.
comfortable and follow your baby’s lead after he or she
5. Sleep safely and close by. Have your baby sleep in a
is latched on well. Some babies take both breasts at each
crib or bassinet in your room, so that you can breastfeed
feeding. Other babies only take one breast at a feeding.
more easily at night. Sharing a room with parents is linked
Help your baby finish the first breast, as long as he or
to a lower risk of SIDS (sudden infant death syndrome).
she is still sucking and swallowing. This will ensure the
baby gets the “hind” milk – the fattier milk at the end of a 6. Know when to wake the baby. In the early weeks after
feeding. Your baby will let go of the breast when he or she birth, you should wake your baby to feed if 4 hours have
is finished and often falls asleep. Offer the other breast if passed since the beginning of the last feeding. Some tips
he or she seems to want more. for waking the baby include:
3. Keep your baby close to you. Remember that your • Changing your baby’s diaper
baby is not used to this new world and needs to be • Placing your baby skin-to-skin
held very close to his or her mother. Being skin-to-skin • Massaging your baby’s back, abdomen, and legs
helps babies cry less and stabilizes the baby’s heart and
If your baby is falling asleep at the breast during most
breathing rates.
feedings, talk to the baby’s doctor about a weight check.
4. Avoid nipple confusion. Avoid using pacifiers, Also, see a lactation consultant to make sure the baby is
bottles, and supplements of infant formula in the first latching on well.
How long should I breastfeed?
Many leading health organizations recommend that most infants breastfeed for at least 12 months,
with exclusive breastfeeding for the first 6 months. This means that babies are not given any foods or liquids
other than breast milk for the first 6 months. These recommendations are supported by organizations including the
American Academy of Pediatrics, American Academy of Family Physicians, American College of Obstetricians
and Gynecologists, American College of Nurse-Midwives, American Dietetic Association, and American Public
Health Association.
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Making Plenty of Milk
Your breasts will easily make and supply milk directly in response to your baby’s needs. The more often and effectively a baby
breastfeeds, the more milk will be made. Babies are trying to double their weight in a few short months, and their tummies are
small, so they need many feedings to grow and to be healthy. Most mothers can make plenty of milk for their baby. If you think
you have a low milk supply, talk to a lactation consultant.
What Will Happen with You, Your Baby, and Your Milk
in the First Few Weeks
Time Milk The Baby You (Mom)
Birth Your body makes Will probably be awake in the first hour after birth. This is You will be tired and
colostrum (a rich, thick, a good time to breastfeed your baby. excited.
yellowish milk) in small
amounts. It gives your
baby a healthy dose of
early protection against
diseases.
First Your baby will drink It is normal for the baby to sleep heavily. Labor and You will be tired, too.
12-24 about 1 teaspoon of delivery are hard work! Some babies like to nuzzle and Be sure to rest.
hours colostrum at each may be too sleepy to latch well at first. Feedings may
feeding. You may be short and disorganized. As your baby wakes up, take
or may not see the advantage of your baby’s strong instinct to suck and feed
colostrum, but it has every 1-2 hours. Many babies like to eat or lick, pause,
what the baby needs savor, doze, then eat again.
and in the right amount.
Next Your mature (white) milk Your baby will feed a lot (this helps your breasts make Your breasts may feel
3-5 comes in. It is normal plenty of milk), at least 8-12 times or more in 24 hours. full and leak. (You
days for it to have a yellow or Very young breastfed babies don’t eat on a schedule. can use disposable or
golden tint first. Talk to Because breast milk is more easily digested than formula, cloth pads in your bra
a doctor and lactation breastfed babies eat more often than formula-fed babies. to help with leaking.)
consultant if your milk It’s ok if your baby eats every 1-2 hours for several
is not yet in. hours, then sleeps for a while, maybe up to 4 hours. This
is referred to as “cluster feeding”. Feedings may take
about 15-20 minutes on each side. The baby’s sucking
rhythm will be slow and long. You might hear gulping.
The Mature (white) breast Your baby will likely be better at breastfeeding and have Your body gets used
first milk continues. a larger stomach to hold more milk. Feedings may take to breastfeeding so
4-6 less time and will be farther apart. your breasts will be
weeks softer and the leaking
may slow down.
13 | VirtuaBaby.OrgBreastfeeding Guide
How to Know Your Baby is Getting Other signs that your baby is getting plenty of milk:
• He or she is passing enough clear or pale yellow urine, and
Enough Milk
it’s not deep yellow or orange (see the breastfeeding log on
Many babies, but not all, lose a small amount of weight in page 36).
the first days after birth. Your baby’s doctor will check his
• He or she has enough bowel movements (see the
or her weight at your first visit after you leave the hospital.
breastfeeding log on page 36).
Make sure to visit your baby’s doctor within three to five days
after birth and then again at two to three weeks of age for • He or she switches between short sleeping periods and
checkups. wakeful, alert periods.
You can tell if your baby is getting plenty of milk if he or she • He or she is satisfied and content after feedings.
is mostly content and gaining weight steadily after the first • Your breasts feel softer after you feed your baby.
week of age. From birth to three months, typical weight gain
Talk to your baby’s doctor if you are worried that your baby
is 2/3 to 1 ounce each day.
is not eating enough.
Bowel movements How Much Do Babies
It is not unusual for the frequency of your baby’s
Typically Eat?
bowel movements to change at around 4-6 weeks of
age. At that time, the baby may go 3 or more days A newborn’s tummy is very small, especially in
without a bowel movement. As your baby gets older, the early days. Once breastfeeding is established,
the digestive system gets more efficient, so there is exclusively breastfed babies from 1 to 6 months of
less waste. In addition, the gastrocolic reflex begins age take in between 19 and 30 ounces per day. If
to lessen. As long as your baby’s stools appear soft you breastfeed 8 times per day, the baby would
and loose, your baby is not constipated. If you are eat around 3 ounces per feeding. Older babies will
concerned about constipation, please speak with take less breastmilk as other food is introduced.
your health care provider. Every baby is different, though. At birth, the baby’s
stomach can comfortably digest what would fit in a
hazelnut (about 1-2 teaspoons). In the first week,
the baby’s stomach grows to hold about 2 ounces or
what would fit in a walnut.
Growth spurts
At times, it may seem like your baby wants to eat
The Newborn Tummy
constantly. Your baby will probably have feeding
frequency days known as “growth spurts.” They
usually occur around 2-3 weeks, 6 weeks, 3 months,
and 6 months. During these times, your baby may
feed more frequently for 2-3 days until your breasts
have time to respond to the increased stimulation.
The increased feeding will increase the volume
of milk and change the composition of your
milk to better meet your baby’s needs. Avoiding
supplementation during this time will help your body Hazelnut Walnut
meet the demands of your growing baby.
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How to Soothe Your Baby Supplementation
All babies cry, often because they have a difficult time getting
used to all the new stimuli present in life outside of mom’s The American Academy of Pediatrics recommends
body. The Happiest Baby on the Block method developed
exclusively breastfeeding (that is, giving no other
by Dr. Harvey Karp has been known to help turn on a
baby’s calming reflex during the first few months of life by food, beverage, or formula) for the first 6 months.
mimicking experiences in the uterus. There are five simple Many of the health benefits of breastfeeding come
steps to this method that are known as the 5 ‘S’s.
during these first few months from the protective
1. Swaddling: Tight swaddling or wrapping provides the
continuous touch and support that your baby experienced antibodies found in breast milk. There may be times,
while in the womb. however, when it is medically necessary to
2. Side/stomach position: Place your baby, while holding supplement with expressed breastmilk, donor milk,
him or her, either on his or her left side to aid in digestion,
or formula if needed. For example, if the baby has
or on his or her stomach to provide support. Once your
baby is asleep, you can place the baby in the crib, on his or low blood sugar, jaundice, significant dehydration,
her back.
has a low birth weight, or is premature, supplements
3. Shushing sounds: “Shhhhhh” triggers your baby’s
may be necessary. Administer supplemental
calming reflex by imitating the continual whooshing sound
made by the blood flowing through the arteries near the feedings using a cup, syringe, or teaspoon instead of
womb. You have to say it as loud as your baby’s crying a bottle so as to not interfere with your baby’s
and close to his or her ear or he or she may not notice.
ability to breastfeed. As with pacifiers, it is best to
A white noise machine or a recording of your hair dryer
or vacuum cleaner can also mimic the noise. wait until your baby is 3-4 weeks old before
4. Swinging: Newborns are used to the swinging motions introducing bottles and pumping for supplemental
they felt when they were still in their mother’s womb.
feedings. It takes time for your milk supply to
Rhythmic movements imitate the sensations your baby
felt inside your uterus, and activate the calming reflex. become well established and for your baby to learn
Rocking, car rides, and other swinging movements can how to nurse well. Additionally, some babies have
all help.
difficulty going back and forth between breast and
5. Sucking: Your breast, your finger, or, later
bottle, especially in the early weeks.
(ideally after 3-4 weeks), a pacifier can be used.
Use of pacifiers
The American Academy of Pediatrics (AAP) advises waiting 3-4 weeks until breastfeeding is well established before
using a pacifier. Studies indicate that the quantity of milk a mother makes in the long term is largely determined
by how well the baby drains the breasts in the first weeks. According to the AAP, pacifier use can break the milk
production cycle and result in chronically low milk production. In addition, some babies find it difficult to adjust
to the differences between the breast and a pacifier. If you need to use a pacifier in the early days and weeks of
breastfeeding, try to limit it to short periods of time and infrequent occasions.
15 | VirtuaBaby.OrgBreastfeeding Guide
Common Challenges
Breastfeeding can be challenging at times, especially in the
early days. But it is important to remember that you are not
alone. Lactation consultants are trained to help you find
ways to make breastfeeding work for you. And while many
women face one or more of the challenges listed here,
many women do not struggle at all! Also, many women have
certain problems with one baby that they don’t have with
their second or third babies. Read on for ways to troubleshoot
problems.
Challenge: Sore Nipples
Many moms report that nipples can be tender at first.
Breastfeeding should be comfortable once you have found
some positions that work and a good latch is established. Yet
it is possible to still have pain from an abrasion you already 6. Avoid wearing tight bras that put pressure on your nipples.
have. You may also have pain if your baby is sucking on only 7. Change nursing pads often to avoid trapping in moisture.
the nipple. 8. Avoid using soap or ointments that contain astringents or
other chemicals on your nipples, as well as products that
What you can do
must be removed before breastfeeding. Washing with clean
1. A good latch is key, so see pages 10-11 for detailed water is all that is needed to keep
instructions. If your baby is sucking only on the nipple, your nipples and breasts clean.
gently break your baby’s suction to your breast by placing
9. If you have very sore nipples, you can ask your doctor
a clean finger in the corner of your baby’s mouth and try
about using non-aspirin pain relievers.
again. (Your nipple should not look flat or compressed
when it comes out of your baby’s mouth. It should look
round and long, or the same shape as it was before the
feeding.)
2. If you find yourself wanting to delay feedings because Ask a lactation consultant for help
of pain, get help from a lactation consultant. Delaying
feedings can cause more pain and affect your supply.
to improve your baby’s latch. Talk
3. Try changing positions each time you breastfeed. This puts
to your doctor if your pain does not
the pressure on a different part of the breast. go away or if you suddenly get sore
4. After breastfeeding, express a few drops of milk and gently nipples after several weeks of pain-
rub it on your nipples with clean hands. Human milk has free breastfeeding. Sore nipples may
natural healing properties and emollients that soothe. Also
lead to a breast infection, which
try letting your nipples air-dry after feeding, or wear a soft
cotton shirt. needs to be treated by a doctor.
5. If you are thinking about using creams, hydrogel pads, or
a nipple shield, get help from a healthcare provider first.
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Challenge: Low Milk Supply Challenge: Oversupply of Milk
Most mothers can make plenty of milk for their babies. But Some mothers are concerned about having an oversupply of
many mothers are concerned about having enough. milk. Having an overfull breast can make feedings stressful
Checking your baby’s weight and growth is the best way to and uncomfortable for both mother and baby.
make sure he or she is getting enough milk. Let the doctor
know if you are concerned. For more ways to tell if your What you can do
baby is getting enough milk, see page 14. 1. Breastfeed on one side for each feeding. Continue to
There may be times when you think your supply is offer that same side for at least two hours until the next
low, but it is actually just fine: full feeding, gradually increasing the length of time per
feeding.
• When your baby is around six weeks to two months old,
your breasts may no longer feel full. This is normal. At the 2. If the other breast feels unbearably full before you are
same time, your baby may nurse for only five minutes at a ready to breastfeed on it, hand express for a few moments
time. This can mean that you and baby are just adjusting to to relieve some of the pressure. You can also use a cold
the breastfeeding process – and getting good at it! compress or washcloth to reduce discomfort and swelling.
• Growth spurts can cause your baby to want to nurse longer 3. Feed your baby before he or she becomes overly hungry to
and more often. These growth spurts can happen around prevent aggressive sucking. (Learn about hunger signs on
two to three weeks, six weeks, and three months of age. page 12.)
They can also happen at any time. Don’t be alarmed that 4. Try positions that don’t allow the force of gravity to help
your supply is too low to satisfy your baby. Follow your as much with milk ejection, such as the side-lying position
baby’s lead – nursing more and more often will help build or the football hold. (see page 9 for illustrations of these
up your milk supply. Once your supply increases, you will positions.)
likely be back to your usual routine. 5. Burp your baby frequently if he or she is gassy.
Some women have a strong milk ejection reflex or let-down
What you can do
(see page 6). This can happen along with an oversupply of
1. Make sure your baby is latched on and positioned well. milk. If you have a rush of milk, try the following:
2. Breastfeed often and let your baby decide when to end the 1. Hold your nipple between your forefinger and middle
feeding. finger or with the side of your hand to lightly compress
3. Offer both breasts at each feeding. Have your baby stay milk ducts to reduce the force of the milk ejection.
at the first breast as long as he or she is still sucking and 2. If baby chokes or sputters, unlatch him or her and let the
swallowing. Offer the second breast when the baby slows excess milk spray into a towel or cloth.
down or stops.
3. Allow your baby to come on and off the breast at will.
4. Avoid giving your baby formula or cereal as it may lead
to less interest in breast milk. This will decrease your milk
supply. Your baby doesn’t need solid foods until he or she Ask a lactation consultant for help if you are unable
is at least six months old. If you need to supplement the to manage an oversupply of milk on your own.
baby’s feedings, try using a spoon, cup, or a dropper.
5. Limit or stop pacifier use while trying the above tips.
Let your baby’s doctor know if you think the baby is
not getting enough milk.
17 | VirtuaBaby.OrgBreastfeeding Guide
Challenge: Engorgement
It is normal for your breasts to become larger, heavier, and a Ask your lactation consultant or doctor for help if the
little tender when they begin making more milk. Sometimes engorgement lasts for two days or more.
this fullness may turn into engorgement, when your breasts
feel very hard and painful. You also may have breast swelling,
tenderness, warmth, redness, throbbing, and flattening of
the nipple. Engorgement sometimes also causes a low-
grade fever and can be confused with a breast infection.
Engorgement is the result of the milk building up. It usually
happens during the third to fifth day after birth, but it can
happen at any time.
Engorgement can lead to plugged ducts or a breast infection
(see page 19), so it is important to try to prevent it before this
happens. If treated properly, engorgement should resolve.
What you can do
1. Breastfeed often after birth, allowing the baby to feed as
long as he or she likes, as long as he or she is latched on
well and sucking effectively. In the early weeks after birth,
wake your baby to feed if four hours have passed since the
beginning of the last feeding.
2. Work with a lactation consultant to improve the baby’s
latch, if needed.
3. Breastfeed often on the affected side to remove the
milk, keep it moving freely, and prevent the breast from
becoming overly full.
4. Avoid overusing pacifiers and using bottles to supplement
feedings.
5. Hand express or pump a little milk to first soften the
breast, areola, and nipple before breastfeeding.
6. Massage the breast.
7. Use cold compresses in between feedings to help ease
pain. Ice packs help relieve swelling.
8. If you are returning to work, try to pump your milk on the
same schedule that the baby breastfed at home. Or, you
can pump at least every four hours.
9. Get enough rest, proper nutrition, and fluids.
10. Wear a well-fitting, supportive bra that is not too tight.
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Challenge: Plugged Duct easy to tell the difference between a breast infection and a
plugged duct because both have similar symptoms and can
It is common for women to have a plugged duct at some improve within 24 to 48 hours. Most breast infections that do
point when breastfeeding. A plugged milk duct feels like a not improve on their own within this time period need to be
tender and sore lump in the breast. It is not accompanied by treated with medicine given by a doctor. (Learn more about
a fever or other symptoms. It happens when a milk duct does medicines and breastfeeding on page 24.)
not properly drain and becomes inflamed. Then, pressure
builds up behind the plug, and surrounding tissue becomes What you can do
inflamed. A plugged duct usually only occurs in one breast 1. Breastfeed often on the affected side, as often as every two
at a time. hours. This keeps the milk moving freely and keeps the
breast from becoming overly full.
What you can do
2. Massage the area, starting behind the sore spot. Use your
1. Breastfeed often on the affected side, as often as every
fingers in a circular motion and massage toward the nipple.
two hours. This helps loosen the plug, and keeps the milk
moving freely. 3. Apply heat to the sore area with a warm compress. Ice
may also help relieve swelling.
2. Massage the area, starting behind the sore spot. Use your
fingers in a circular motion and massage toward the nipple. 4. Get extra sleep or relax with your feet up to help speed
healing. Often a breast infection is the first sign that a
3. Use a cold compress on the sore area.
mother is doing too much and becoming overly tired.
4. Get extra sleep or relax with your feet up to help speed
5. Wear a well-fitting supportive bra that is not too tight
healing. Often a plugged duct is the first sign that a mother
because this can constrict milk ducts.
is doing too much.
5. Wear a well-fitting supportive bra that is not too tight
because this can constrict milk ducts. Consider trying a
Ask your doctor for help if you do not feel better within
bra without underwire.
24 hours of trying these tips, if you have a fever, or if
your symptoms worsen. You might need medicine.
If your plugged duct doesn’t loosen up, ask for help See your doctor right away if:
from a lactation consultant. Plugged ducts can lead to
• You have a breast infection in which both breasts
a breast infection.
look affected.
• There is pus or blood in the milk.
• You have red streaks near the area.
Challenge: Breast Infection • Your symptoms came on severely and suddenly.
(Mastitis) Even if you are taking medicine, continue to breastfeed
during treatment. This is best for both you and your
Mastitis (mast-EYE-tiss) is soreness or a lump in the
baby. Ask a lactation consultant for help if needed.
breast that can be accompanied by a fever and/or flu-
like symptoms, such as feeling run down or very achy.
Some women with a breast infection also have nausea and
vomiting. You also may have yellowish discharge from the
nipple that looks like colostrum. Or, the breasts may feel
warm or hot to the touch and appear pink or red. A breast
infection can occur when other family members have a cold
or the flu. It usually only occurs in one breast. It is not always
19 | VirtuaBaby.OrgBreastfeeding Guide
Challenge: Fungal Infections
(Thrush) Signs of thrush in mothers:
Thrush is a common problem among breastfeeding mothers • Painful, burning, or sore nipples between, during,
and babies that can range from an annoying nuisance to and after feedings
an extremely painful experience. Thrush is an infection
• Nipple pain that develops when breastfeeding was
caused by the overgrowth of yeast, which are one-celled
previously going well
organisms that normally live in and on our bodies. It is
only when yeast overgrows that it becomes a problem. As • Burning or shooting pain in the breast during or
pregnancy progresses, a woman is more likely to have an after a feeding
overgrowth of yeast. At birth, a vaginal overgrowth of yeast • Red nipples or areola
can be transferred to the baby, and the baby can end up with
• Itchy nipples or shiny, peeling skin
oral thrush (a yeast infection in the baby’s mouth). A yeast
infection on your nipples can also be transferred to your baby • Sore nipples that do not respond to treatment
during breastfeeding. • Nipple pain that occurs while using a breastpump
Predisposing factors (causes) of thrush include: correctly
• Pregnancy • Cracked nipples that do not heal
• Infancy
• Repeated breast infections
• A history of vaginal yeast infections
• Recent antibiotic use
• Nipple damage Signs of thrush in babies:
• White spots in the mouth, on the tongue, or inside
Probiotics the lips that look like pearls, curds, or streaks of
milk that won’t wipe away
Women who have recently given birth may have • Red, irritated rash in the diaper area
been treated with antibiotics for a c-section or for
• Gassiness and crankiness
GBS (Group B Streptococcal infection). Treatment
with antibiotics destroys some of the body’s • Baby repeatedly pulls off the breast during a
helpful bacteria, as well as the harmful bacteria. feeding
One function of the good bacteria is to keep yeast
from overgrowing. If you have been on antibiotics
recently, or were administered antibiotics during If you suspect that you or your baby has
your delivery, we recommend that you take a
probiotic (acidophilus, lactobacillus, or bifidus), a yeast infection, call both of your health-
which is an oral nutritional supplement that helps re- care providers. Treatment for mother and
establish the good bacteria in your body. Probiotics
baby must occur at the same time, even if
can be found in your local pharmacy, grocery store,
health food store, or natural food store. The label only one of you has symptoms. If you are
will state how often to take the probiotic to help
not treated simultaneously, you and your
avoid yeast overgrowth. The recommended dose
is at least 1-2 billion units or more. If you have a baby can re-infect each other.
thrush infection, you may need to take higher doses.
Discuss this with your lactation consultant.
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What you can do (treatment for mom): 9. Take supplements that prevent the growth of yeast:
1. Call your health care provider/obstetrician for medicine • Probiotics (acidophilus, lactobacillus, or bifidus)
for your nipples. Most often an antifungal cream will be • Garlic
prescribed, or perhaps an over-the-counter antifungal
• B-complex vitamins
cream will be recommended.
10. It is best not to use breast pads. If you do use them,
2. After each feeding, you may rinse your nipples with water
replace them as soon as they get wet.
or a solution of one tablespoon cider vinegar in one cup
of water. Allow your nipples to air dry. 11. Boil items that come into contact with your breast
(breast shells, pump parts) for 20 minutes every day.
3. Apply a small amount of the antifungal cream to your
nipples, areola, and any part of the breast that comes in 12. If your nipple pain does not improve after five days of
contact with your baby’s mouth. Do this after each feeding treatment, contact your health care provider. You may
until two weeks after all signs of thrush are gone. Gently need a different antifungal cream or ointment. If you
wash away any obvious residue of medicine that has not experience shooting or burning pain in your breasts, you
been absorbed before breastfeeding. may need to be treated with an oral antifungal medication
for two weeks or more. This medicine can be used safely
4. Wash your hands thoroughly before and after feedings,
by most breastfeeding mothers and babies.
and also after you apply medicine to your nipples.
5. If your nipples are too painful for you to nurse your baby,
pump or express your milk until your nipples feel better. What you can do (treatment for baby):
Ibuprofen or acetaminophen may help reduce pain. 1. Call the baby’s health care provider/pediatrician for
6. Breast shells may provide relief if nipple pain makes it medicine, usually an oral antifungal solution.
uncomfortable to wear clothing. 2. Put the measured amount of medicine into a medicine cup
7. If you are pumping your milk, feed it to your baby the or small paper cup. Swab the medicine onto the inside of
same day. If you save it for a later time, you may re-infect the baby’s mouth with a cotton swab or your finger. Do not
your baby. Freezing does not kill yeast. Discard previously use the medicine dropper that comes with the medication,
stored milk. as you could contaminate the medicine. Apply the
medicine to all surfaces of the baby’s mouth after feedings,
8. Avoid foods that encourage yeast to grow: at least 4-6 times each day. This medication works best by
• Sugar (including artificial sweeteners) direct contact with the yeast. Have your baby drink what is
• Yeast breads left in the cup.
• Milk and dairy products 3. Boil things that go into your baby’s mouth (pacifiers,
teething toys, bottle nipples) for 20 minutes each day, and
• Fermented beverages (wine, beer)
replace them after 1 week of treatment.
• Peanuts and peanut butter
4. Wash your hands before and after putting medicine in your
• Mushrooms baby’s mouth, and after diaper changes.
5. If your baby has a diaper rash, antifungal cream should be
applied after each diaper change.
For yeast infections that are difficult to eliminate, Gentian Violet can be very effective, and can be used at the same time as
other antifungals. Talk with your health care provider or lactation consultant for instructions on using Gentian Violet or for
any additional concerns about treating yeast infections.
21 | VirtuaBaby.OrgBreastfeeding Guide
Challenge: Inverted, Flat, or Very
Large Nipples
Some women have nipples that turn inward instead of
protruding or that are flat and do not protrude. Nipples can
also sometimes be flattened temporarily due to engorgement
or swelling while breastfeeding. Inverted or flat nipples can
sometimes make it harder to breastfeed. But remember that
for breastfeeding to work, your baby has to latch on to both
the nipple and the breast, so even inverted nipples can work
just fine. Often, flat and inverted nipples will protrude more
over time, as the baby sucks more.
Very large nipples can make it hard for the baby to get
enough of the areola into his or her mouth to compress the
milk ducts and get enough milk.
What you can do
1. Talk to your doctor or a lactation consultant if you are
concerned about your nipples.
2. You can use your fingers to try and pull your nipples
out. There are also special devices designed to pull out
inverted or temporarily flattened nipples.
3. The latch for babies of mothers with very large nipples
will improve with time as the baby grows. In some cases,
it might take several weeks to get the baby to latch well.
But if a mother has a good milk supply, her baby will get
enough milk even with a poor latch.
Ask for help if you have questions about your nipple
shape or type, especially if your baby is having trouble
latching well.
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Common Questions Is my baby getting enough
Vitamin D?
Should I supplement with formula? Vitamin D is needed to build strong bones. All infants and
Giving your baby formula may cause him or her to not want children should get at least 400 International Units (IU) of
as much breast milk. This will decrease your milk supply. If Vitamin D each day. To meet this need, all breastfed infants
you are worried that your baby is not eating enough, talk to (including those supplemented with formula) should be given
your baby’s doctor. a Vitamin D supplement of 400 IU each day. This should start
in the first few days of life. You can buy Vitamin D
supplements for infants at a drug store or grocery store.
Sunlight is a major source of Vitamin D, but it is hard to
Does my baby need cereal or measure how much sunlight your baby gets, and too much
water? sun can be harmful. Once your baby is weaned from breast
milk, talk to your baby’s doctor about whether your baby still
Your baby only needs breast milk for the first six months
needs Vitamin D supplements. Some children do not get
of life. Breast milk alone will provide all the nutrition your
enough Vitamin D through diet alone.
baby needs. Giving the baby cereal may cause your baby to
not want as much breast milk. This will decrease your milk
supply. Even in hot climates, breastfed infants do not need
water or juice. When your baby is ready for other foods, the
food should be iron rich.
Is it safe to smoke, drink, or use
drugs?
If you smoke, it is best for you and your baby to quit as soon
Is it okay for my baby to use a as possible. If you can’t quit, it is still better to breastfeed
pacifier? because it can help protect your baby from respiratory
problems and sudden infant death syndrome. Be sure to
If you want to try it, it is best to wait until the baby is 3-4 smoke away from your baby and change your clothes to keep
weeks old to introduce a pacifier. This allows the baby to your baby away from the chemicals smoking leaves behind.
learn how to latch well on the breast and get enough to eat. Ask a health care provider for help quitting smoking!
You should avoid alcohol, especially in large amounts. An
occasional small drink is okay, but avoid breastfeeding for two
When should I wean my baby? hours after the drink.
The American Academy of Pediatrics recommends
It is not safe for you to use or be dependent on an illicit drug.
breastfeeding beyond the baby’s first birthday, and for as
Drugs, such as cocaine, marijuana, heroine, and PCP, harm
long as both the mother and baby would like. The easiest
your baby. Some reported side effects in babies include seizures,
and most natural time to wean is when your child leads
vomiting, poor feeding, and tremors.
the process. But how the mother feels is very important
in deciding when to wean. If you are breastfeeding, do not use marijuana. You may pass the
chemicals from marijuana through the breast milk. According to
the American Academy of Pediatrics, a mother’s ability to care
for an infant may be impaired while using marijuana. Also,
studies show that infants are exposed to marijuana by inhaling it
when the drug is smoked near them.
23 | VirtuaBaby.OrgYou can also read
