Proper nipple care, positioning, appropriate nursing frequency, and other measures can prevent many common breastfeeding problems.

Most women's breasts have nipples that protrude slightly at rest and become erect when stimulated, as with cold. During pregnancy, the nipple and the pigmented area around it (areola) thicken in preparation for breastfeeding. Little glands (Montgomery glands) on the areola become more noticeable. They contain a lubricant to keep the nipple and areola from drying, cracking, or becoming infected.

Soaps and harsh washing or drying of the breasts and nipples can cause extreme dryness and cracking and should be avoided. Some experts recommend leaving milk on the nipple after feeding and allowing it to dry and protect the nipple. Keeping the nipples dry is important to prevent cracking and infection. For cracked nipples, apply 100% lanolin after feedings.

ENGORGEMENT

Many times the breasts will become swollen and painful 2-3 days after birth. The best treatment for this is to nurse the baby more frequently. Also, it may be helpful to pump your breasts should you have to miss a feeding, or if a feeding does not relieve the pain. See your health care provider if there is no improvement after 1 day.

BABY'S POSITION

Comfortable nursing requires correct positioning of the baby at the breast. Some guidelines are given to help you develop your own technique. Observing someone else breastfeed or practicing with an experienced nursing mother or a lactation consultant may also help.

Cradle Hold:

Sit in a comfortable chair, with arm rests if possible. Place your baby on your abdomen, tummy-to-tummy. The baby's head is cradled in the crook of your arm and the face to your breast. The baby's knees are underneath your other breast. The infant's head, back, and legs should all be in a straight line. This position can be held for the entire duration of the feeding. If you feel your nipple starting to hurt half-way into the feeding, check to see if your baby has slipped down and if the knees are starting to face the ceiling instead of being tucked in next to your side.

Football hold:

Cradle the back of your baby's head in your hand, with the body under your breast and toward the elbow. Place a pillow under your elbow to help you support your baby's bottom. Use your other hand to support your breast. This position allows you to control the baby's head and assures good positioning to latch on.

Side lying:

Lie on your side with one arm supporting your head. Your baby can lie beside you with the head facing your breast. Pull the baby in snugly and place a pillow behind to support the infant.

Rarely, a baby may have a sucking disorder which will need to be observed by a health care provider. A certified lactation consultant can be of tremendous help in teaching a baby to breast-feed.

NURSING FREQUENCY

Most babies normally breastfeed every 1 1/2 to 2 1/2 hours during the first month. Breast milk is digested more quickly than formula so breastfeeding is needed more frequently. Even if you cannot measure the amount of milk your baby drinks, you can tell that the baby has had enough if: baby nurses every 2 to 3 hours, has 6 to 8 really wet diapers per day, and is gaining weight appropriately (1 pound each month). The frequency of feeding does decrease with age as the baby can eat more at each feeding. So, don't get discouraged; you will eventually be able to do more than sleep and nurse!

NIGHTTIME FEEDING

While you were pregnant, your baby was continuously fed and didn't know hunger. After birth, babies need to be fed frequently. During the first few weeks, your baby will want to breastfeed around the clock. This is perfectly normal. Some mothers find that bringing the baby in bed at night or placing a bassinet within reach, allows them to meet the child's needs while losing minimal rest. Other mothers prefer to keep the baby in a separate bedroom, and have a comfortable chair there. The American Academy of Pediatrics recommends you should not sleep with your infant. While nursing an infant in bed is acceptable, you should return the infant to their crib or bassinet when the feeding is done. Avoid bringing an infant into bed if you are very tired or taking medications that cause drowsiness.

If you return to work, don't be surprised if your baby wants to nurse more frequently at night. If you do not sleep well with your baby in your bed, you may find that keeping them in the same room or a room close enough to hear them is just fine.

You may have heard that night nursing can lead to what used to be called baby bottle tooth decay. Breast milk by itself is the healthiest food for babies??? teeth, day or night. It tends to slow bacterial growth and acid production. However, when breast milk is alternated with sugary foods or drinks, the rate of tooth decay can be faster than with sugar alone. Night nursing can be wonderful, but avoid sugary snacks and drinks for your baby or toddler throughout the day ??? and especially close to sleep time.

MILK SUPPLY

Some mothers stop nursing during the first few days or weeks because they feel they aren't producing enough milk. It may seem like your baby is always hungry. You can't measure the amount of milk your baby is drinking so you may worry that you aren't producing enough milk. In reality, your baby's increased need to nurse signals your body to produce more milk. This is a natural way your body determines the amount of milk needed and provides an adequate milk supply.

The first weeks may be difficult and frustrating for you but don't give up. If you can resist supplementing your baby's diet with formula feedings for the first four to six weeks, your body will respond appropriately and produce an adequate supply of milk. Supplementing your baby's diet with formula feeding will only trick your body into believing the current supply of breast milk is adequate.

GROWTH SPURT

Around the 2nd week, and the 2nd, 4th, and 6th months, it may seem that your baby wants to nurse all the time. Your baby may want to nurse every 30 or 60 minutes, and stay at the breast for longer periods. It may seem that the only thing you are doing all day is nursing. This increase in nursing is normal and signals your body to produce more milk as your baby enters a growth spurt. Within a few days, your milk supply will have increased to provide enough milk at each feeding and the baby will start eating less frequently and for shorter periods of time.

Many nursing mothers have trouble finding the time to devote to their baby's increased feeding needs during this adjustment period. Often, understanding how and why this happens and that it is only temporary can help. Slow down and enjoy the job of feeding your baby; a job that only you can do. Ask for and accept help with other responsibilities to free your time for feeding.

THE 6 O'CLOCK SYNDROME

Babies frequently seem fussy and want to nurse more frequently late in the afternoon and into the evening, when everyone else (especially you) is tired. You may feel too tired to nurse again or assume that you just don't have any more milk to give. It may be tempting to give your baby a bottle of formula while you attend to other responsibilities.

But remember, bottle feeding your baby formula when you are tired or your milk supply seems low will signal your body to produce less milk which will result in more fatigue and frustration for you and your baby. breastfeeding a baby on demand is full-time and exhausting work. Your body needs energy to produce enough milk. Be sure you get adequate nutrition, rest, and sleep. Taking good care of yourself is necessary if you're going to take good care of your baby.

BABY'S STOOLS

Your baby's bowel movements (stools) during the first two days will be black and tar-like (sticky and soft). Early and frequent breastfeeding during the first 48 hours will flush this sticky stool (meconium) from the infant's bowels. The stools will become yellow-colored and seedy. This is the normal stool consistency for a breastfed baby and should not be confused with diarrhea.

During the first month, your baby may have a bowel movement after each breastfeeding. This frequency decreases with age. Don't worry if bowel movements occur after every feeding or every three days, as long as the pattern of bowel movements is regular and your baby is growing well (gaining weight).

NIPPLE CONFUSION

The human breast and nipple are very different from a bottle and nipple. A baby has to learn to adapt to the type of nipple used. Exposure to a rubber nipple can create nipple confusion for your baby and make breastfeeding more difficult, especially during the first two weeks. After that, your milk supply will be well established, you both will be comfortable with the technique and routine of breastfeeding, and occasional use of a rubber nipple will cause less nipple confusion.

American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome. The changing concept of sudden infant death syndrome: diagnostic coding shifts, controversies regarding the sleep environment, and new variables to consider in reducing risk. Pediatrics. 2005;116:1245-1255.

American Dental Association. ADA statement on early childhood caries. Chicago, IL. Position Statement 2000:454.

Azevedo TD. Feeding habits and severe early childhood caries in Brazilian preschool children. Pediatr Dent. 2005;27(1): 28-33.

Ribeiro NM, Ribeiro MA. Breastfeeding and early childhood caries: a critical review. J Pediatr (Rio J). 2004 Nov;80(5 Suppl):S199-210.

Rosenblatt A, Zarzar P. Breast-feeding and early childhood caries: an assessment among Brazilian infants. Int J Paediatr Dent. 2004 Nov;14(6):439-45.