Breastfeeding Your Baby

Latching

Helping your baby latch

It’s important that your baby takes a large amount of the darker area around your nipple (the areola) into their mouth and not just the nipple. Your baby’s mouth will probably cover more of the areola with the lower jaw.

This allows your baby to “milk” the breast and not hurt your nipple.

Tips to help baby latch:

• Baby facing you: Your baby’s chest and body is turned towards you.
• Face to breast: Support your baby so that their head is level to your breast.
• Nose to nipple: Your baby’s nose should be at the same level as your nipple.
• Baby’s chin and lower lip should touch your breast first.
• Wait for your baby to open their mouth wide over your nipple.
• More of the breast below the nipple (not above the nipple) should be in baby’s mouth.
• Your baby’s chin should be against your breast and their nose should be slightly back from the breast.

Baby-led latching (Laid back breastfeeding)

Babies are born with a natural instinct to latch and feed at the breast. Baby-led latching is a good way for your baby to learn breastfeeding.

It’s also helpful if breastfeeding is not going well or if you have sore nipples.

How to do baby-led latching:

• Position yourself in a laid back position, propped up with pillows.
• Place your baby skin-to-skin with their belly and chest facing you, and their head at the level of your breasts.
• Your baby will start rooting (looking for the nipple) by bobbing their head up and down.
• Help to support your baby’s bottom and back while they are rooting. This allows your baby to tilt their head back a little, which makes it easier to latch.
• Your baby will eventually find your nipple, though they may find it with their hands first.
• Your baby will open their mouth wide, pushing their chin into your breast, and latch on.
• When your baby has latched on, you can adjust their position and provide support to keep them in place. Keeping their bottom tucked in helps to keep them latched well.

Keep the following tips in mind when positioning your baby:

• Make sure you’re comfortable before you start feeding your baby.
• Lay back supported by pillows or sit upright and bring baby to the breast without bending down to baby. This will help prevent you from having a sore neck and shoulders.
• If you need to protect sore areas after a C-section or episiotomy, experiment to find the most comfortable position: baby-led latching (laid-back breastfeeding), sitting or lying down.

Baby-led latching

See 'Latching' section above for more detail.

Sitting or lying down

You may prefer to feed your baby while you are sitting or lying down. As you learn to breastfeed, you will likely find other positions that work well for you.

Whatever position you choose, remember:

• Good back support can help keep you comfortable.
• Your baby’s ear, shoulder and hip should be in a straight line.
• Your baby’s head should be tilted back slightly, so they can latch deeply and swallow easily.
• Tuck your baby’s bottom in so that it is against your body.

Vitamin D for breastfeeding babies

Babies and toddlers who are breastfed or receive breastmilk should continue to have a daily vitamin D supplement of 10 ug (400 IU) until two years of age.

Why is vitamin D important for babies?

Vitamin D is an essential nutrient to help build and maintain strong bones and teeth. A daily vitamin D supplement will help prevent against vitamin D deficiency rickets (a condition where the bones are soft and weak), which can lead to:

• skeletal deformities (e.g. bowed legs)
• increased risk of fractures
• dental problems

When should I start giving my baby a vitamin D supplement?

A vitamin D supplement of 10 ug (400 IU) should be given to your baby within the first few days after birth.

What should I look for when buying a vitamin D supplement?

A single vitamin D3 supplement (without other vitamins) is recommended.

Some liquid supplements require you to place a drop of vitamin D on the breast and others need you to use a dropper filled to 400 IU. Follow the manufacturer’s instructions carefully and only use the dropper that comes with the vitamin D supplement purchased.

For older children, chewable vitamin D tablets are available.

Does my baby get enough vitamin D from sunlight?

Although sunshine (ultraviolet light) allows skin cells to convert vitamin D into an active state, there are several reasons this alone is not sufficient for babies:

• Halton Region is in the northern part of the world, so we don’t get enough sunshine throughout the year for babies to make the vitamin D they need through their skin.
• Clothing acts as a sun barrier.
• We keep babies out of direct sunlight because of their sensitive skin and to prevent skin cancer.

When can I stop giving my baby a vitamin D supplement?

After two years of age, a vitamin D supplement is no longer recommended. Your child’s eating patterns should follow Canada’s Food Guide (external link).

What foods contain vitamin D?

Some foods naturally offer vitamin D, including:

• eggs (yolk)
• liver
• fatty fish (tuna, salmon, trout, halibut, mackerel, sardines and herring)
• cod liver oil

In Canada, vitamin D is added to:

• cow’s milk, tofu and margarine
• some orange and apple juices
• some soy milk, almond milk, rice milk, goat’s milk and yogurt

Read food labels to see how much vitamin D a product provides.

In the first six months, breastfeeding can be an effective method of birth control. You might hear this referred to as Lactational Amenorrhea Method (LAM).

For this method to be effective, you must answer “yes” to all of the following:

• Is your baby less than 6 months old?
• Has your period not yet returned?
• Is your baby fully or nearly fully breastfed?
  • “Fully breastfed” means that your baby gets all their food from drinking at your breast.
  • “Nearly fully breastfed” means that your baby does not take more than one to two mouthfuls per day of other fluids or solids.
• Does your baby breastfeed at least every four hours during the day and at least every six hours during the night?

There are many other types of birth control that can be used while breastfeeding (external PDF).

Breastfeeding is a human right in Ontario. According to the Ontario Human Rights Code (external link), an employer should accommodate any needs related to an employee breastfeeding or expressing milk for their child.

Supporting breastfeeding makes good business sense too! Breastfed babies are less likely to get sick and therefore parents should require less time away from work to care for an ill child.

Breastfeeding options

Breastfeeding parents have plenty of options as they plan for returning to work or school. It’s not as hard as you might think!

Options for continuing breastfeeding:

• Pump or hand express to keep the same number of breastmilk feeds per day. Expressed breastmilk may be stored in a refrigerator or a cooler bag with ice packs.
• Plan for your baby to take breastmilk in other ways:
  • Open cups (for babies older than 6 months) or bottles.
  • Mixed into baby’s food, such as infant cereal.
• If your baby doesn't like to drink breastmilk in a cup or bottle, they can drink water (if older than 6 months) or homogenized milk (if older than 9 months) instead.
• Consider visiting your child during the day to breastfeed or have your care provider bring your child to you.
• Wean your baby from the breastfeeds you will miss during the work or school day. Many parents find that they and their babies can easily adapt to less breastfeeds on working days and more when home together.

Breastfeeding is a great way to reconnect with your child at the end of the work or school day.

Tips to help you transition back to work or school

The return to work or school will go more smoothly if you take some time to plan ahead.

• Discuss your plans with your employer ahead of time.
• Talk to your employer about being a baby-friendly organization (external link).
• Speak with other parents who have continued breastfeeding when returning to work or school.
• Begin to store breastmilk before returning to work or school.

For strategies to help you adjust to the return to work, review the Returning to Work After Baby booklet (external link) from Ontario’s Best Start program.

Your baby will show feeding cues when they are ready to eat. View this information about signs of hunger (external link) to learn what feeding cues look like.

If you see "late feeding cues", calm your baby before feeding by trying:

• skin-to-skin holding
• cuddling
• talking
• rocking

For the first several weeks:

• most babies will feed at least eight times in 24 hours.
• feedings should last as long as your baby is actively sucking.

While some babies feed regularly, many have short, frequent feedings. This often happens in the evening or at night. It is called cluster feeding and is very common in the early weeks.

As your baby grows, it is important to remember that:

• your baby will often feed faster.
• some babies will consume all the milk they need in 5 minutes, while others will take 20 minutes or longer.
• some babies will only want one breast at each feeding.

Watch your baby, not the clock or an app.

Always follow your baby’s feeding cues (external link). Your baby knows when and for how long they need to eat. When your baby comes off the first breast, burp them and offer the second breast.

Offer whichever breast is fuller. This is usually either the breast that your baby did not take at the last feed, or if you fed from both sides, the breast that your baby took last.

To help you remember which side to start with, wear a bracelet, or tie a ribbon on your bra.

Yes. At birth, your baby’s stomach is only the size of a cherry. (external link) By the end of the first week, it is still just the size of an egg. This means they need to eat very frequently. Always offer your breast if your baby is stirring and showing feeding cues.

In the beginning, some newborn babies are sleepy and do not wake up to feed at least eight times in 24 hours. Until you know that your baby is gaining weight steadily, you may need to wake your baby to feed.

These tips may help:

• Keeping your baby close by can help you notice hunger cues (babies wake to feed better when they are skin-to-skin).
• Try undressing your baby and rubbing their back to help wake them up.
• Express a little breastmilk so your baby is tempted to feed.

If you keep your baby skin-to-skin, they are more likely to wake up on their own for feedings.

Some babies want to feed more often at night and less often during the day. This is sometimes referred to as “reverse cycling”. There are some things you can try to encourage more daytime feeding:

• Keep normal house lighting and noises during the day.
• Talk to and play with your baby when they are awake during the day.
• Wake your baby to feed at least every two to three hours.
• During night wakings, keep things dark and quiet. Feed your baby with minimal talking.

Every baby is different. In the early weeks, night feedings are needed:

• because your baby’s tummy is small
• to increase or maintain your milk supply

Gradually, as your baby grows, they will not need to feed as often.

Many babies wake up more often when:

• they are having a growth spurt
• they are sick
• they are learning a new skill
• their mother has recently returned to work or school

Every baby is unique and so are their sleep patterns. Understand normal and safe sleep for babies. 

Some newborn babies fall asleep at the breast before they have finished feeding. If your baby has stopped actively sucking and swallowing, you can help them to start sucking again by using breast compressions. To do this:

• make a C-shape with your hand; and
• gently compress your breast behind the areola to squeeze a little milk into your baby’s mouth.

Sometimes your baby will want to suck more for comfort than to feed. Babies are born with a strong need to suck, which ensures their survival. In the early days, when your baby is fussy, try offering the breast. It may calm them enough to help them fall asleep.

Babies like to suck, some more than others. Before introducing a pacifier, here are some things that are helpful to know:

• Many babies do not use a pacifier.
• Babies suck differently on the pacifier than on the breast. Your baby may not suck as well on the breast if they use a pacifier.
• Your baby might want to breastfeed less often after sucking on a pacifier. This can result in you not making enough milk for your baby.
• There are many other ways to comfort a crying baby.
• If you decide to try a pacifier, wait until your milk supply is well established and only use it for a short time after feedings.

Here is some important safety information about using a pacifier:

• Do not dip it in honey, sugar or sweet liquid. This can cause tooth decay.
• Do not hang it around your baby’s neck with a string. Your baby could be accidentally strangled.
• Do not clean a pacifier in your own mouth to avoid spreading bacteria.

Signs that your newborn baby is getting enough milk:

• They feed at least eight times in 24 hours.
• They have enough wet and dirty diapers for their age (external PDF).
• They are active and have a strong cry.
• The inside of their mouth is wet and pink.

Signs that your older baby is getting enough milk:

• They are growing well and meeting their developmental milestones.
• They have enough wet and dirty diapers (See How do I know if my baby is getting enough milk below)

It is common for breastfeeding parents to worry that they do not have enough milk when their baby is around three to six months old.  This worry can be caused by several factors:

• It is common for your breasts to feel less full around this time as your milk production regulates to your baby’s needs. You may also notice that you are leaking less or not at all. This does not mean that you do not have enough milk to feed your baby.
• Your baby may want to feed more often.  Many babies have a growth spurt around this time and may want to feed more often.  Feeding your baby whenever they show signs of hunger (external link), and not giving any other supplements, will help your body make the milk to meet your baby’s growing needs.

Get help from a breastfeeding professional (external link) right away if your baby does not have enough wet and dirty diapers.

Are you thinking of giving your baby formula? Call 311 to speak to a public health nurse.

• Watching how your baby feeds (video) can help you gage how much milk your baby is drinking.
• When your baby is feeding at the breast you should notice a pause of the bottom tip of their chin after their jaw is fully open. This pause is when their mouth is filling up with milk. A longer pause means your baby is taking in more milk with each suck.
• Watch this video to see what good feeding looks like:

For babies less than six weeks old:

• Expect at least one wet diaper on day one, increasing to at least six wet diapers in 24 hours with pale yellow or clear urine by day four or five. The pee should be pale yellow or clear in colour.
• During the first few days your baby should have one to two dark green or black poops as they pass the meconium.  By day three they should have at least three brown, green or yellow poops a day.  
• After day five your baby should have at least six very wet diapers and at least three large yellow and seedy poops in 24 hours.
• At around one month old, your baby might have one to two poops per day, or might only have one large poop every few days. This is normal as long as your baby is feeding well, is reasonably content, and has soft yellow-brown poops.

For babies over six weeks old:

• Once your baby is six weeks old they should continue to have at least six very wet diapers in 24 hours with pale and mild smelling urine. The number of poops can range from a few poops per day, to as little as one poop every two to seven days. This is normal as long as your baby is gaining weight well and their poops and tummy are soft.
• Other signs that your baby is getting enough milk are that your breasts feel softer after feeding, and that your baby seems reasonably content immediately after feeding. 
• Usually babies will double their birth weight by around three or four months.

Consider the following:

• It is normal for your baby to lose about seven to 10 per cent of their birth weight in the first few days after birth.
• From day four onward, they should begin to gain weight.
• They should be back to birth weight by around two weeks.
• The World Health Organization growth charts (external link) are recommended for tracking your baby’s growth. Older growth charts were based on the feeding patterns of babies being fed on a schedule rather than cue-based and should not be used for breastfed or bottle-fed babies who are fed according to their hunger cues.  
• Follow up with your healthcare provider to monitor your baby’s weight gain.

Even though babies feeding at the breast do not take in much air, it’s a good idea to burp your baby after feeding.

• Your baby may fuss or come off the breast if they need to burp.
• In the beginning, try burping after each breast.

By watching your baby, you will see how often they need to be burped. Some babies will not need to burp every time.

Hold your baby in an upright position against your shoulder or sitting on your lap. This helps the air bubble to come up more easily. Gently rub or pat baby’s back.

Sometimes a burp brings up some milk as well. Some babies spit up after feedings. This is nothing to worry about as long as your baby is gaining weight.

A healthy full-term baby gets all the fluid they need for the first six months from breastmilk. They do not need any other fluids (including water) until around 6 months old.

Even from six to twelve months of age, your baby’s main source of fluid and nutrition is still breastmilk.

Visit Feeding Your Baby Solid Food for more information.

After six months of age, you can start offering your baby water in a cup with meals and snacks.

Offer small amounts of water (1/4 of a cup at a time and no more than half a cup per day) so babies can get used to the taste.

Breastmilk will still provide your baby’s main source of nutrition and fluids from six to twelve months. Water should not replace your baby’s feed.