Nursing changes as your baby grows. Here's how to adapt.

By Dana Sullivan
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The first days and weeks of breastfeeding often boil down to sheer survival: getting your baby to latch onto (and stay on!) your breast; functioning on what often feels like mere minutes of sleep; and willing yourself to keep going if you're having problems. Yet at some point down the road, when you and your baby have made it through the getting-to-know-each-other period, you're likely to have different questions and concerns.

Here's a look at some of the breastfeeding issues you're likely to face throughout the first year.

Month 1: Getting a Good Latch

Without a proper latch, your baby may not get enough milk, and you could develop sore and cracked nipples, says Corky Harvey, R.N., M.S., I.B.C.L.C., co-owner of The Pump Station stores in Southern California. Here’s how to get it right:

        • Position your baby so he is lying on his side, his belly flush against yours.

        • Prop up the baby with a pillow and hold him up to your breast; don't lean over toward him.

        • Using your free hand, place your thumb and fingers around your areola (the dark area surrounding the nipple).

        • Tilt your baby's head back slightly and gently touch him with your nipple just above his upper lip.

        • When his mouth is open wide, scoop your breast into his mouth. Place his lower jaw on first, well behind the nipple.

        • Tilt his head forward, placing his upper jaw deeply on the breast. Make sure he takes the entire nipple and at least 1½ inches of the areola in his mouth.

Month 2: Understanding Your Milk Supply

Milk supply is one of the most common concerns among breastfeeding moms, because unlike with a bottle, you just can't tell how much milk your baby is getting. To make sure you're both on the right track, your pediatrician will monitor his weight closely, especially for the first several weeks.

In the meantime, pay attention to his diapers: He should have six to eight wet ones and at least two "seedy," mustard-colored stools daily by the time he's seven days old. Also keep this in mind: "As long as your baby is gaining weight consistently and his diapers show that he is eating enough, you can assume that he's getting plenty of milk," says Jeanette Panchula, R.N., P.H.N., I.B.C.L.C., a lactation consultant at the Solano County Department of Public Health and the California Department of Public Health's Maternal, Child and Adolescent Health division. If you're still concerned, schedule a weight check with your pediatrician.

Month 3: Mastering Your Pumping Routine

Many new moms head back to work at this time. If you’re planning to keep breastfeeding and will need to pump at work, let your employer about your plans so that you can work together to find the best place for you to pump. "It will help things go more smoothly if you can figure out where and when you will pump before you actually get back to work," Panchula says. You should have begun pumping when your baby was 3 weeks or 4 weeks old, both to get him used to taking a bottle and so you'll have a supply of breast milk stored in the freezer. If you haven't started, get going!

Since you'll be returning to work full time, you'll probably want to rent or buy a double electric pump because it expresses both breasts at once and therefore cuts down on pumping time. When you return to work, try to pump as often—and at about the same times—as your baby normally nurses.

Month 4: Keeping Your Breast Milk Safe

You might enjoy a glass of wine—but your baby shouldn’t. To make sure your breast milk is safe, keep in mind that the alcohol from one drink—8 ounces of beer, 6 ounces of wine or one shot of hard alcohol—tends to be metabolized (and thus absent from your milk) within two to three hours, at which time it's safe to nurse your baby. But a better guideline is this: As long as you're feeling any effects from the alcohol, even if you are just a bit tipsy or giddy, don't put your baby to the breast. Want to be even more sure? Try MilkScreen, a home test for alcohol in breast milk (milkscreen.com).

Month 5: Balancing Breastfeeding and Sleep

By month five you may be feeling exhausted, and counting down the days until your baby sleeps through the night. But you need to keep in mind that "sleeping through the night" at this age actually means five or six hours, not eight or nine. "Babies sleep through the night when they're ready, whether or not they're breastfed," Panchula says.

That said, because breast milk is digested so completely and more quickly than formula, breastfed babies do tend to eat—and therefore wake—more frequently than formula-fed babies. (Tip: Don't look at the clock! Feed the baby whenever he's hungry, day or night.)

Month 6: Introducing Solids

While your baby is ready to try solid foods, that doesn’t mean that you should give up breastfeeding. “Breast milk still is the most important part of your baby's diet at this age, so breastfeed right before you offer cereal or other foods," says Debi Page Ferrarello, R.N., M.S., I.B.C.L.C., director of family education and lactation at Penn Medicine at the University of Pennsylvania Health System.

When you do offer solids, start with rice cereal and gradually add a cooked or mashed fruit or vegetable. (Many pediatricians believe it's fine to start with a finely puréed fruit or vegetable, or even meat; check with your doc to see what she recommends.) Be sure to wait three to five days before introducing a different food so you can trace the cause of any allergic reaction.

Month 7: Breastfeeding and Birth Control

Not ready for another little one yet? “Opt for a progestin-only 'mini-pill,' since pills containing estrogen can decrease milk supply," Ferrarello says. Depo-Provera—an injection given every three months— is another progestin-only contraceptive that is safe to use while breastfeeding; wait six weeks after childbirth before beginning use.

 

Month 8: Dealing With Clogged Milk Ducts

Clogged milk ducts can be a painful—and all-too-common—breastfeeding issue. “One of the risk factors for clogged ducts is a change in a baby's feeding pattern," Ferrarello says. "If your baby is nursing less frequently because he's eating more solids, milk 'stasis'— when milk sits in the breast—can occur and cause the ducts to clog." The best way to treat clogged ducts is by nursing or pumping often from the affected breast, applying warm compresses, and getting plenty of fluids and rest. If you have a fever or flulike symptoms, see your doctor; you may have mastitis, an infection that often requires antibiotics.

Month 9: Controlling the Biting

Those little baby teeth can be sharp! If your baby clamps down, take him off the breast immediately, say, "No biting!" and keep him off the breast until the next feeding. Also be alert: Biting usually happens toward the end of a feeding, so if you can tell that your baby is almost finished nursing, remove him from the breast before he bites.

Month 10: Losing Interest in Nursing

Your budding toddler may be distracted by every noise he hears, which causes him to pull away from the breast; or he may be crawling, in which case he really wants to explore. "This is completely normal at this age," Harvey says. "Babies are curious about their world and really start to explore now." While this might be a frustrating time for you, it should pass; it typically doesn't mean that the baby is ready to wean.

Month 11: Balancing Breast Milk and Solids

Now that your baby is exploring all kinds of new foods, it can be hard to determine how often he should nurse. ”A minimum of four times a day is what we expect," Harvey says. "A baby this age should be getting about 16 to 20 ounces of breast milk daily." At the end of the first year, half of a baby's calories should be coming from breast milk.

Month 12: Determining When to Wean

Not ready to wean? There’s no need—and there are many reasons to continue nursing. One of the best is your baby's health: Breast milk continues not only to protect him from many illnesses, but it also will help him recover more quickly if he does get sick. "As long as your baby is drinking breast milk, he's getting all the immunological benefits nursing provides," Harvey says.

But there's more. "A nursing mother and her infant have a special bond, and there is no reason any woman should be in a hurry to give it up," Harvey adds. "As long as she and the baby are happy, there is no reason to wean."

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