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Caregiver’s Guide to
the Breastfed Baby
By Anne Smith - IBCLC
There
may be times when, for a variety of reasons, nursing mothers need or want to
leave their nursing baby with a caregiver. This may be a ‘once only’ event,
or a regular daily arrangement.
The following
information is intended as a guide for the caregiver of a breastfed baby, so
she/he can better understand how to care for the baby and the expressed breastmilk
(EBM) left for the baby’s use.
General Information
Human milk does
not look like formula or cow’s milk. It may be a different color or consistency,
and it is normal for it to be bluish, greenish, or even brownish in color.
Frozen milk, or milk expressed during the early days of nursing (which still
contains colostrum) may look yellowish. Human milk that is properly stored
is not spoiled, unless it smells sour or tastes bad.
Because human
milk is not homogenized, it will naturally separate into layers of milk and
cream. This is normal, and does not mean the milk is spoiled. If the
milk separates, heat and swirl it gently to mix.
Several batches
of EBM expressed at different times may be mixed and/or stored together to make
enough for one feeding. A mother’s EBM should only be used for her baby.
For health reasons, milk from different mothers should not be pooled.
Because a
baby digests and uses human milk so completely, less breastmilk than formula
may be needed at a feeding. There is no way to predict exactly how much milk
a baby will need at each feeding, but you will soon learn how much milk the
baby usually takes. As a rule of thumb, babies three months and under usually
take between two and four ounces, and babies over three months will take from
four to six ounces. It is a good idea to have some one or two- ounce portions
available for snack feedings.
Until you
get a feel for how much the baby will consistently take at each feeding, offer
small amounts of EBM at a time. If the baby is not very hungry, you will
not then have to waste large quantities of milk. If he needs more, prepare another
smaller amount.
You should
be aware that a breastfed baby may not be on the same feeding schedule as a
formula fed baby. Breastmilk is digested quickly, and the baby may need
to feed more frequently. Also, many nursing babies are used to nursing
for comfort as well as nutrition, and my need extra cuddling and rocking, especially
at naptime. Be flexible, and as you spend time with the baby you will get
to know his own unique schedule, and you will be able to comfort him in your
own way.
Breastfed baby’s
bowel movements are looser than formula fed infants, and may be more frequent
(especially in the early weeks). It is not unusual for a newborn nursing
baby to have a loose stool every time he feeds, but this is not diarrhea (unless
accompanied by fever, lethargy, vomiting, or other symptoms of illness).
In breastfed babies older than six weeks, it is not unusual for babies to go
several days without stooling. In a totally breastfed infant, this is
not considered constipation. Constipation consists of hard, dry stools
that are painful to pass. An older nursing baby may not stool every day,
but the stool will be loose and plentiful when he does pass it. Totally breastfed
baby’s stools are usually mustard yellow and seedy, but may also be yellow green
or brownish. They are much milder smelling than a formula fed baby’s stools.
Thawing and Heating
To thaw frozen
EBM, it is best to leave it in the refrigerator for about twelve hours. If
you need to thaw it quickly, hold the container of milk under cool running water,
and gradually add warmer water until the milk is thawed and heated to room temperature,
gently swirling to mix in the fat.
To heat refrigerated
EBM, put the container of milk in a pan of warm (not hot) water just until the
chill is off. Many babies don’t mind if the milk is cold, and serving
it right out of the refrigerator is not harmful. Run the nipple under
warm water, though, as most babies don’t like the feel of a cold nipple.
NEVER thaw
or heat EBM in a microwave. This can destroy valuable nutrients, and can
also create dangerous ‘hot spots’ that can burn the baby’s mouth, even though
the bottle may feel cool to the touch. For the same reasons, do not boil
or overheat EBM.
Use thawed
EBM within twenty-four hours.
EBM that has been
refrigerated but not frozen will keep for up to eight days in a refrigerator.
Encouraging Baby to Feed
Many
breastfed babies are reluctant to take a bottle at first. A hard rubber
nipple feels and tastes very different from soft skin. Babies may refuse
to take a bottle from their mother since they associate her with nursing, but
will take it more readily from a caregiver, especially if the mother is not
in the room. Most babies adjust more easily if they get to know their
caregiver gradually, so it may be helpful to try a program of visits and short
stays (that include a feeding time) before baby is left for longer periods.
Tips to get
the baby to take a bottle include:
- Offer the bottle before the baby
gets frantically hungry.
- Offer the bottle in a position
other than the traditional cradle hold (many babies associate this position
with nursing). It sometimes works well to sit the baby in an infant seat or
prop him on your knees while offering the bottle.
- Wrap the baby in a piece of the
mother’s clothing while offering the bottle.
- Tickle the baby’s mouth gently
with the bottle nipple and let him draw it in himself, rather than pushing
it in.
- Run warm water over the nipple
before offering it.
- Try different types of nipples
to find a shape and flow rate that the baby will accept.
- Try moving rhythmically – rocking,
walking, or swaying from side to side while offering the bottle.
If the baby
will absolutely not take the bottle, he can be fed EBM by other methods, such
as cup, spoon, syringe, or dropper. With a little time and patience, he
will usually learn to accept the bottle.
When the Mother Will Be Returning
Soon
If
the baby becomes unsettled, try rocking and talking to him rather than feeding
him. Offer a pacifier if he is used to using it, and the mother approves. When
the mother returns, she will probably want to feed him as soon as possible for
practical reasons – her own comfort, closeness with her baby, and to stimulate
her milk supply. If you can’t get him settled, offer a small amount of
EBM. If no milk is available, offer a small amount of boiled water. The
mother should be consulted before any other liquids are offered to her baby. If
the baby is old enough to eat solid foods, you may be able to offer something
that has been tolerated previously. Always check this with the mother first.
Your Relationship With the Baby’s
Mother
You can be
an enormous help to the baby’s mother in supporting her efforts to provide breastmilk
for her baby. Mothers choose to provide EBM for their infants when they
have to be separated from them because they want the very best for their babies.
Making the decision to leave breastmilk rather than formula, and to continue
the nursing relationship even after returning to work or school requires a great
deal of commitment on the mother’s part. Your encouragement and support can
make all the difference, especially if the mother arranges to come to your home
or day care center to feed her baby.
There are
times when a baby may go through periods of appetite increase. These “growth
spurts” often occur at about six weeks, three months, and six months.
If you let the mother know, she will then try to express more milk. Sometimes
it takes a few days for her supply to catch up. If the mother knows you
support her efforts to provide breastmilk for her baby, you will be contributing
in a very positive way to helping her continue to nurse. Remember: BREASTMILK
IS THE PERFECT FOOD FOR BABIES! Your encouragement and support is very
important.
About the Author
Anne Smith, anne@breastfeeding-basics.com
http://www.breastfeeding-basics.com
Anne Smith is an IBCLC – International Board Certified Lactation Consultant
and La Leche Leader since 1978. More importantly, she is a mother to 6 breast
fed kids with twenty plus years experience of counseling nursing mothers. Her
site, www.BreastfeedingBasics.com
, provides expert advice and solutions to breast-feeding problems and gives
basic information on how to breast feed. Anne also features her recommended
breast feeding products and breast pumps.
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if you have any questions or comments!