Breastfeeding

Breast milk is the best food you can offer your new baby. The Canadian Paediatric Society recommends exclusive breastfeeding for the first 6 months of life. At about 6 months, your baby will be ready for other foods, but you can continue breastfeeding as long as it is comfortable for you and your baby, even well into the toddler years.

Breast milk:

• Is naturally and uniquely produced—by each mother for her own baby. So your baby is less likely to be exposed to foreign allergenic material.
• Contains antibodies and other immune factors that help prevent illness.
• Has the right amount and quality of nutrients to meet your baby’s first food needs.
• Is easy on your baby’s digestive system, so there is less chance of constipation or diarrhea.

Breastfeeding offers your baby the best start, but it’s not always easy. Problems are common. Don’t be afraid to ask for help and support—it’s out there (see “Who should I ask if I have questions about breastfeeding?).

What should breastfeeding mothers eat?

Breastfeeding burns calories, so it is important that you eat a variety of nutritious foods and drink plenty of fluids. You don’t need to avoid milk, egg, peanut or other foods while breastfeeding. There is no evidence that avoiding certain foods will prevent allergy in your child.

You should avoid dieting while you are breastfeeding.

What is colostrum?

Colostrum is the first milk produced in the early days after your baby is born. It is sometimes thick and yellowish, but it can also be thin and watery. Colostrum is very rich in proteins, vitamins, minerals and infection-fighting antibodies that are found only in breast milk.

You will know that your colostrum is changing into breast milk when it becomes milky white in colour. Your breasts may also feel full. This is known as your milk “coming in”. The amount of time it takes for milk to “come in” varies from mother to mother. If your milk hasn’t come in within 72 hours of your baby’s birth, it is a good idea to talk to your doctor.

How do I know when it’s time for a feeding?

You should always feed a baby on demand, which means feeding her whenever she’s hungry. However, in the first few days of life, it is not uncommon for babies to need to be woken up for a feed. If this behavior persists into the second week of life, talk to your doctor. In the first few weeks, babies need to be breastfed 8 to 12 times over a 24-hour period. Let your baby set the pace.

Sometimes babies ask to feed for short periods of time but more frequently. This is called “cluster feeding” and often happens in the evening. “Cluster feeding” is normal and might mean your baby is going through a growth spurt. This is your baby’s way of stimulating your milk production.

How will I know if my baby is feeding well?

Feed your baby from each breast for as long as she wants and alternate the breast you begin with at each feeding.

Your baby is feeding well when:

• You hear short swallowing sounds (making a “K” sound) which gradually become longer and deeper as your milk is released.
• He is content after feeding.
• The nursing process isn’t painful.
• Six or more wet diapers in a 24-hour period.
• Stools that are yellow, soft and seedy. Early on, these may come after every feeding. After the first month, stools may not be as frequent (1 bowel movement every 2 to 7 days), but they should be soft and yellow.
• Your baby is gaining weight.

How will I know if my baby isn’t feeding well?

Your baby isn’t feeding well when:

• She isn’t content after a feeding.
• The nursing process is painful.
• Your baby is not gaining weight.

What else should I know about breastfeeding?

• Wash your hands before breastfeeding.
• If you experience cracked or sore nipples, try exposing them to the air after each feeding, allowing them to dry naturally. You can also apply lanolin cream. You can buy a lanolin product at your local pharmacy. Cracked or sore nipples are often a sign that a baby’s latch is not optimal. Talk to your doctor or a lactation specialist about this.
• Avoid using soap on your nipples. Soap will wash away your breasts’ natural lubricants.
• Some women get mastitis, a serious bacterial infection which causes painful swelling of the breasts, and sometimes fever. If you have these symptoms, see your doctor. Mastitis is treated with antibiotics. It is advised to keep breastfeeding during treatment.

When should I express breast milk?

If your breasts are engorged (large, sore, and feeling extremely full), your newborn may have difficulty latching on. Express some milk by gently massaging or pushing on your breast with your hand. This may help your baby latch on.

If you will be away from your baby during feeding time, you can express your breast milk. This will allow your baby to drink breast milk from a cup or a bottle when you are not available.

Expressed breast milk is also a way to keep breastfeeding while your baby is in child care. Make sure the centre or home has a refrigerator. Breast milk has to be kept chilled until feeding time.

How should expressed breast milk be stored?

Expressed breast milk should be kept in a clean container, such as a glass bottle or milk bags for breast milk, with the date marked on it. Plastic polyethylene bags, such as commercial bottle liners, and containers made of bisphenol A (BPA) are not recommended because they can affect the quality of your milk.  

Breast milk can be stored for:

• 6 to 8 hours at room temperature (no warmer than 25°C [77°F]),
• up to 5 days in the refrigerator (at a temperature of below 4°C [<39°F]),
• 2 weeks in your refrigerator freezer (not in the door),
• 3-6 months in the freezer compartment of a refrigerator with separate doors, or
• 6-12 months in a separate chest-type freezer (at a temperature below -20°C [-4°F]).

Never mix fresh breast milk with chilled or frozen breast milk because it can cause bacteria to grow and lead to food poisoning.

How do I prepare expressed breast milk for a feeding?

• Thaw frozen milk in the refrigerator and keep it there until you’re ready for it. Do not use a microwave to thaw or warm frozen expressed milk because it can affect the quality of the milk.
• Prepare clean bottles and nipples.
• Put the thawed milk into a feeding bottle or cup. You can warm the milk by placing the bottle of expressed milk into a container of warm water before the feeding.
• Shake the bottle of breast milk well to mix any separated layers.
• After each feeding, throw away any leftover milk.
• Do not refreeze breast milk once it has been thawed or partially thawed.

Does my baby need anything else besides breast milk?

Because of our northern latitude, Canadian infants are at risk of vitamin D deficiency. Since breast milk has only small amounts of vitamin D, babies who are breastfed should receive a daily supplement, which is available as drops.

Are there ever reasons not to breastfeed?

Rarely are there reasons not to breastfeed.

If you are receiving chemotherapy (especially cyclosporine, methotrexate, bromocriptine, cyclophosphamide, doxorubicin), have HIV disease, or take street drugs (especially PCP), talk to your doctor. You may be advised not to breastfeed.

If you have a medical condition or take prescription medications, always talk to your doctor before nursing your baby. Breastfeeding is safe to continue with most prescription medications because only small amounts will pass through your breast milk.

Can I use cannabis if I am breastfeeding?

There is no known safe amount of cannabis use during breastfeeding. The safest approach is to not use cannabis during breastfeeding. This includes all modes of use: smoking, vaping, and ingesting. If you are using cannabis and breastfeeding, talk to your healthcare provider about ways to reduce possible harms.

What do I feed my baby when I cannot breastfeed?

If breastfeeding is not an option, use a store-bought iron-fortified infant formula for the first 12 months.

• Formula should be cow milk-based.
• Homemade formulas made from canned, evaporated, whole milk (cow or goat) are not recommended as a breast milk substitute. 
• Rice or other plant-based beverages, even when fortified, are not appropriate as a breast milk substitute as they are nutritionally incomplete for infants. There is no evidence that soy-based formula will prevent your child from developing an allergy. 
• Soy-based infant formulas should only be used as an alternative to cow milk-based formula if your baby has galactosemia (a rare disorder that will affect how your baby’s body processes simple sugar) or if your baby cannot consume dairy-based products for cultural or religious reasons. 
• Talk to your doctor if you are unsure which formula is best for your child.

Since vitamin D is already added to infant formula, most full-term babies who are formula-fed don’t need a supplement. However, formula-fed babies in northern communities should receive a supplement of 400 IU/day from October to April to ensure they have enough vitamin D.

At about 6 months, you can begin to introduce solids to your baby’s diet.

Can I use donor breast milk?

Pasteurized donor breast milk in Canada is currently used for sick and hospitalized newborns whose mothers cannot breastfeed. Informal milk sharing of unpasteurized donor human milk (without going through a human milk bank) is not recommended. There is potential risk for contamination of the milk with bacteria or viruses, a lack of control over proper collection and storage of the milk, and often a lack of knowledge of the donor’s health history. Infant formula, when mother’s own milk is not available, is considered the safer breast milk substitute.

Who should I ask if I have questions about breastfeeding?

Although breastfeeding is the natural way to feed your baby, you may find it hard in the beginning. This is normal and like most aspects of motherhood, you’ll learn through experience. Don’t be afraid to ask for help or advice from health professionals or experienced friends and relatives.

Your doctor or midwife can counsel you about the principles and practice of breastfeeding. Many community-based programs also support breastfeeding families, such as La Leche League Canada. Call their toll-free breastfeeding line for a referral to someone in your community: 1-800-665-4324.

You may also contact a lactation consultant, public health nurse, and/or breastfeeding coordinator.