Palak Vyas

Some mothers&nbsp;produce more milk than their breasts can hold, which makes the breasts feel rock hard and uncomfortably full – a condition called engorgement.This condition might last temporarily for 24 to 48 hours. However it can be painful. What do engorged breasts feel like?The breasts feel large, hard and lumpy. The skin of your breasts look shiny and feel stretched, and your nipples becomes hard and flat. Breast engorgement can cause breastfeeding difficulties – which can, in turn, worsen the problem. Your baby might struggle to latch if your nipples are flatter and your breast tissue is harder,&nbsp;causing sore nipples. Causes of breast engorgement:<ul><li>Engorgement usually occurs because the baby is not feeding frequently enough (at least eight times in 24 hours).</li><li>Those women who doesn’t feed their babies or who can’t, due to any reason for example either they are working or too busy with chores due to large families, these women can develop breast engorgement. It can also cause when the woman produces more milk than her baby can have.</li><li>Engorgement can also happen if you suddenly cut on breastfeeds, maybe, because your baby is sick,&nbsp;either (s)he keeps sleeping longer, starting solid foods and other liquids, or going into childcare, which keeps him away from you for longer time.</li></ul> Treating engorged breasts:<ul><li>Breastfeed your baby for minimum 8 times in 24 hours.</li><li>Check that your baby has a good breastfeeding latch.</li><li>Try breastfeeding in different positions.</li><li>You can also massage your breasts gently while feeding to help the milk drain effectively.</li></ul>

New mothers might worry about breast engorgement but there is nothing to worry about much.

Understanding Breast Engorgement

<ul><li class="ql-align-justify">Breastfeed your baby as much as (s)he wants. In the early days and weeks, your baby will wake and feed frequently, day and night.</li><li class="ql-align-justify">When your baby is a newborn, their stomachs are tiny. Babies can physically take only small amounts of milk. They can digest breast milk easily and it soon gets absorbed it into their system. That's why babies might demand constant feeding.</li><li class="ql-align-justify">After the first few days, most young babies feed at least 8 to 10 times in 24 hours. This means your baby could be asking for a feed every 90 minutes to two hours.</li><li class="ql-align-justify">It's worth keeping an eye on the number of feeds the child has, and offering them your breast, even if the baby not asking. By breastfeeding often, you're building up your milk supply. The more your baby feeds, the more milk you will produce. This is called responsive feeding. And your baby will love snuggling into you, whether or not they are hungry.</li><li class="ql-align-justify">Do check that your baby is latched on well. Otherwise, (s)he may be nipple-feeding, rather than breastfeeding. This can make your nipples sore, and your baby may be unsettled, because they can't get a good amount of milk. Get advice from your elders or paediatrician if you're worried that your baby isn't feeding well.</li><li class="ql-align-justify">Your baby needs to open wide and take a good mouthful of your breast. Once they have latched on, the chin should be touching your breast, the nose should be clear and baby's lower lip should be evened.</li><li class="ql-align-justify">Your baby may want to feed more often, or for longer, at night. This is normal, because your body produces more prolactin, the hormone that makes milk, at night. By feeding often at night, your baby stimulates your body to make more milk.</li><li class="ql-align-justify">Over the next few months, your baby's feeding pattern may become more predictable. This can take a while to establish, though, so try not to be disheartened.</li><li class="ql-align-justify">Always keep the weight of the baby in check, to track their physical development. The track of baby’s weight will also help you to understand whether your baby is feeding enough or not.</li><li class="ql-align-justify">It is recommended to JUST breastfeed your baby until the age of twelve months and it can be continued till the age of four depending on mother's and child's comfort.</li></ul>Signs that your child is adequately breastfeeding:<ol><li class="ql-align-justify">Frequent urination up to 6-7 times a day.</li><li class="ql-align-justify">Adequate weight gain.</li><li class="ql-align-justify">A sleepy baby post breastfeeding.</li><li class="ql-align-justify">Let down reflex (Milk comes out from the other breast while baby feeds from one breast).</li></ol>

Worried about whether you are feeding the child enough? Look for the signs that your child gives.

Breastfeeding Schedule

Following are the guidelines to be followed regarding the milk intake of a child: <ul><li>Ideally the child should be compulsorily breastfed till the age of 1 year.</li><li>In case if the mother’s milk is not enough or if she’s a working mother and is unable to feed the child, external milk can be given.</li><li>As external milk, give formula milk. You can give formula milk based on your budget and child’s nutrition requirements. Formula milk is rich in proteins and DHA which help in brain development. There are several formulas for milk available - STANDARD formula like Lactogen and Dexolac. PREMIUM formula is also available in market which is very similar to the mother’s milk with DHA and ARA like Enfamil and Nan Excella pro.</li></ul> <ul><li>In any case, DO NOT give animal milk to your child before one year. The proteins in animal milk and human milk are completely different which can lead to consequences. A child can be given animal (cow/goat/buffalo) milk after 1 year.</li><li>A child can be given semi-skimmed milk after 2 years of age. However, do not give complete skim milk to a child under 5 years.</li></ul> <ul><li>There is no age limit for breastfeeding. A child can be breastfed till one or two years or even more than that as long as both the mother and child are comfortable. But sometimes it so happens that even after one year, the child considers mother’s milk as the sole source of food and does not intake any external food.</li><li>REMEMBER that after one year, the child’s nutrition need should be fulfilled 70% by outer food and 30% by mother’s milk.</li><li>When the child feeds on mother’s milk for a while, his/her hunger is satisfied but the child does not get enough nutrition. Hence, such a child can stay malnourished and can lose weight. In such cases, doctors can advise the mother to wean off the child at least during the daytime so that the child starts eating properly and gets proper nutrition.</li></ul>

It is important to breastfeed a child till 1 year. It is not advisable to give formula milk before the age of 1 year.

Milk for babies - Mother's milk, Formula milk or Animal milk

Samiksha Choithani

Cleft is a split in the lip that can be immediately identified during the birth of a baby. A cleft lip is a split in the lip. Cleft lip and cleft palate can affect one or both sides of the mouth. Cleft lip and cleft palate can occur independently of each other or can occur together. A cleft lip is caused due to many reasons - it can be hereditary, exposure to substances like cigarettes, alcohol or medications, diabetes or obesity during pregnancy. Babies having cleft lip can breastfeed comfortably, however babies with a cleft palate may have difficulty in sucking.&nbsp;Consider this while feeding a baby with cleft lip (Without cleft palate):<ul><li>The baby may find it difficult to seal nipple with the mouth. If there is a hissing sound, it indicates that air is entering in the mouth.</li><li>Try to reposition the breast and baby’s mouth to form a vacuum.</li><li>The nipple should be behind the tongue; this will help the baby to hold the nipple in its mouth.</li><li>You can adjust and change positions to identify the one that works the best for your baby</li></ul> A cleft palate is a split or opening in the roof of the mouth. A cleft palate can involve the hard palate (the bony front portion of the roof of the mouth), and/or the soft palate. Consider this while breastfeeding a baby with cleft palate:<ul><li>Hold your breast in such a way that baby can get a good grip and latch properly.</li><li>The cleft can be repaired with surgery after 6-12 months but before that do not stop breastfeeding your child.</li><li>Breast milk is very helpful as it does not cause irritation on delicate tissues of the nose and throat and can help to reduce ear problems. Try to avoid formula milk.</li><li>Take help from nurses or specialists to feed the baby with a cleft palate. There are alternate methods like bowl and spoon-feeding, use a breast pump to get the milk in a bowl and feed the child with a spoon.</li></ul>

A cleft occurs because the tissues of the baby’s face and mouth don’t fuse (link) properly.

Breastfeeding a child with cleft lip/palate

Ravina Sewani

Breastfeeding after having a C-section delivery can be difficult due to the painful wound. Your healthcare provider will guide you about the positions that are most comfortable for you. Breastfeeding positions which you can try are the under-arm hold where your baby lies on your side under your arm. In this position, support your back and the side with cushions. Another position which you can try is side-lying hold, where you lie on one side, support your head and back with pillows with your baby closely tucked to you and facing you. You can read about these positions in detail in our Breastfeeding positions article. While breastfeeding, use a pillow over the wound to protect it and then ask someone to pass the baby to you. Make the best use of your hospital stay to get the needed guidance to breastfeed your baby effectively.

Breastfeeding after having a C-section delivery can be difficult due to the painful wound.

Breastfeeding after a C-section

Reduced milk production can be due to pain through breast pump, infection, or poor latching, any breast surgeries you’ve had, stress, high blood pressure, insulin dependent diabetes, obesity, or thyroid. If your baby was born prematurely, it might be a while before your little one gets the knack of proper feeding. And because your baby takes a while to adjust to breastfeeding it too impacts your milk supply. Do not feel guilty about low milk supply as most of the factors are out of your control. Following are the ways which will help you to increase your breast milk production: <ul><li>Evaluate Your Baby’s Latch: Make sure the baby is latching on your breasts correctly.</li><li>Continue to Breastfeed: Your body works on the principle of demand and supply. As you keep feeding, it will produce enough milk. If your milk supply is low, try to express at least 8 times in 24 hours and at least once overnight. Milk producing hormones are secreted the highest at night, so do not skip the night-time expressing.</li><li>Stimulate Your Breasts: Use a breast pump or a hand expression technique to stimulate your breasts after you finish breastfeeding your baby. The extra stimulation will tell your body that you need more breast milk.</li><li>Use a formula supplement: When the milk flow is low or slow, the child may refuse to suck so you can use a formula supplement.</li><li>Make Healthy Lifestyle Changes: Smoking, taking a combination of birth pills, stress and fatigue can also adversely affect milk production.</li><li>Breastfeed Longer at Each Feeding: Your newborn should be breastfeeding for at least 10 minutes on each side. If (s)he falls asleep, try to wake him/her up gently to continue nursing. The more time your baby spends at the breast, the more stimulation you're getting.</li><li>Breastfeed From Both Breasts at Each Feeding: During the first few weeks, breastfeeding from both sides during each feeding will help to build up a stronger supply of breast milk.</li><li>Try to Keep Your Baby Awake During Feedings: Yes! When you are feeding your baby try to keep your child awake and actively sucking so that there is stimulation which helps in milk production.</li><li>Spend Some Time in Direct Skin-to-Skin Contact: The&nbsp;kangaroo care technique that is skin to skin connection between the newborn and mother stimulates their bodies and has a very positive impact on the baby and the mother.</li><li>Eat Well: Eat some milk boosting food such as oatmeal (porridge or upma), spinach, fenugreek, garlic, apricot.</li><li>Drink Plenty of Fluids: Breast milk is made up of about 90 percent water. Drinking about 6 to 8 glasses of water or other healthy liquids such as milk, juice, or tea proves beneficial.</li><li>Try to Get Some Rest: Exhaustion and stress can have a negative effect on your milk supply. Try to take a nap when the baby is sleeping, and know that it's OK to ask for help.</li></ul>

It is very rare that mothers have to deal with less breastmilk production. Nevertheless, there are always ways to deal with it.

Low Breastmilk Supply

If the infant is feeding at least 6 times a day and stays healthy, understand that your baby is having enough breast milk.