Mayo Clinic Expert Answers: Infant and Toddler Health

The Mayo Clinic’s website offers advice on infant health, newborn health and toddler health.On the website, in response to the question “I’ve heard that breast-feeding promotes weight loss. Is that true?”, Dr. Roger W. Harms writes, “When you breast-feed, you use fat cells stored in your body during pregnancy—along with calories from your diet—to fuel your milk production and feed your baby. Weight loss during breast-feeding can occur even when you follow the recommendations to eat an additional 400 to 500 calories a day to keep up your energy.”

He points out, however, that after an immediate postpartum weight loss of about 15 pounds, weight loss tends to happen gradually, at a rate of about 1 or 2 pounds a month for the first six month and more slowly after that.  He recommends focusing on making healthy food choices while breastfeeding, opting for a variety of whole grains as well as fruits and vegetables and making sure you remain hydrated. Incorporate moderate physical activity and avoid sources of empty calories, such as soft drinks, desserts, fried foods, etc. He recommends that a mother should wait until six months, by which time your baby will be beginning to eat more solid foods, before more carefully restricting your own calories.

Responding to the question: “What causes a low milk supply during breastfeeding?” Elizabeth LaFleur, RN, writes that, “Various factors can cause a low milk supply during breastfeeding, such as waiting too long to start breastfeeding, not breastfeeding often enough, and use of certain medications. Sometimes previous breast surgery affects milk production. Factors such as premature birth, maternal obesity and insulin-dependent diabetes can also affect milk production. But take heart. Although many women worry about low milk supply, insufficient breast milk production is rare. In fact, most women make one-third more breast milk than their babies typically drink.”

She offers the following recommendation to boost milk supply:

• Breastfeed as soon as possible. If you are able to “hold your baby skin to skin right after birth, … your baby will likely breastfeed within the first hour after delivery.”
• Breastfeed often. “For the first few weeks, breastfeed your baby at least every two to three hours round-the-clock” to maintain your milk supply.
• Be alert to feeding problems. “It’s okay for your baby to nurse on only one breast at a feeding – but if this happens regularly, your milk supply will decrease. Pump the other breast to relieve pressure and protect your milk supply until your baby begins taking more at each feeding.”
• Hold off on the pacifier. “If you choose to give your baby a pacifier, consider waiting until four to six weeks after birth…to settle into a regular nursing routine and establish your milk supply.”
• Use medications with caution. “Certain medications decrease milk supply, including medications containing pseudoephedrine (Sudafd, Zyrtec D, others). “ She recommends consulting with your health care provider about the advisability of certain types of hormonal contraception until breastfeeding is firmly established.
• Avoid alcohol and nicotine. Apart from other areas of concern, she points out that both moderate to heavy use of alcohol, or smoking nicotine-based products, can decrease milk production.

In answer to the question: “Should I wake my newborn for feedings?” Elizabeth Lafleur notes that “Most newborns lose weight in the first few days after birth. Until your newborn regains this lost weight – usually within one to two weeks after birth – it’s important to feed him or her frequently. This might mean occasionally waking your baby for a feeding, especially if he or she sleeps for a stretch of more than four hours.” Once a pattern of weight gain is established and your baby reaches the birth-weight milestone, she advises that it is generally okay to wait for your baby to wake naturally for feeding.

She points out that newborns need 8 – 12 feeding a day, once every two to three hours. Frequent feedings are important because:

• Crying is a late sign of hunger. “The sooner you begin each feeding, the less likely you’ll need to soothe a frantic baby.” She recommends looking for early signs of hunger such as stirring, restlessness, sucking motions and lip movements.
• Frequent feedings support early breastfeeding.

She notes that these recommendations apply to full term babies. If your baby was born prematurely or you are concerned about your baby’s feeding patterns or weight gain, you should consult with your doctor for specific recommendations.