Breastfeeding FAQs: Some Common Concerns

Whether you're a new mom or a seasoned parenting pro, breastfeeding often comes with its fair share of questions. Here are answers to some common queries that mothers — new and veteran — may have.

Is it normal for my baby to spit up after feedings?

Sometimes, babies spit up when they:

• have eaten too much
• burp (the notorious "wet burp")
• drool

Many infants will spit up a little after some — or even all — feedings or during burping because their digestive tracts are immature. That's perfectly normal.

As long as your baby is growing and gaining weight and doesn't seem uncomfortable with the spitting up, it's OK. The amount of spit up often looks more than it actually is. But spitting up isn't the same as forcefully vomiting all or most of a feeding.

If you're concerned that your baby is vomiting, call your doctor. Try to keep a record of exactly how often and how much your baby seems to be vomiting or spitting up. In rare cases, there may be an allergy, digestive problem, or other problem that needs medical attention. The doctor should be able to tell you if it's normal or something that's cause for concern.

If the doctor says your baby's spitting up is normal, here are some things you can do to help ease it:

• Burp your little one when he or she comes off of each breast, or after every 1 to 2 ounces during bottle feeds. Sometimes giving smaller, more frequent feeds can help rather than large volume feeds.
• Keep your baby upright after feedings — holding the baby is best, since the position of the baby in an infant seat may actually make spitting up more common.
• Don't jiggle, bounce, or actively play with your baby right after feedings.
• Keep your baby's head above his or her feet while feeding (in other words, don't hold your baby in a dipped-down position when feeding).
• Raise the head of your baby's crib or bassinet. Roll up a few small hand towels or receiving blankets (or you can buy special "blocks") to place under (not on top of) the mattress. But don't use a pillow under your baby's head. Make sure the mattress doesn’t fold in the middle, and that the incline is gentle enough so the baby doesn’t slide down.

If your baby also gets bottles of breast milk or infant formula supplements:

• Don't give the bottle while your little one is lying down.
• Make sure the hole in the nipple is the right size and/or flow for your baby. For example, fast-flow nipples may cause babies to gag or may simply give them more than they can handle. Many breastfed babies do well with the slow-flow nipple until they are 3 months old, or even older.

It's also important to keep in mind that this, too, shall pass. Many babies outgrow spitting up by the time they're sitting up.

I think I'm getting sick. Can I still breastfeed?

In most cases, yes — the majority of illnesses are not dangerous to a breastfeeding infant. If you aren’t feeling well, remember that as your body produces antibodies to fight an illness, those antibodies go to the baby through your breast milk. However, in rare cases (such as HIV), a mother's health may affect her ability to breastfeed her baby.

Contact a lactation consultant before you interrupt breastfeeding because of an illness or because of a medicine that you require. In most cases, interrupting breastfeeding is not necessary.

My baby bites during breastfeeding. Can I stop it?

Babies will often play with their mothers' nipples with their gums, not meaning to cause any harm. But once they start teething, a baby might bite, not knowing this is hurting mom. Giving the baby something hard and cold to chew on before the nursing will help the gums — then gums won't be as tender, which may reduce biting.

You often can tell when your baby's about ready to bite — usually when he or she is satisfied and starting to pull away from your breast.

Watch for your baby to switch from nutritive nursing to playing. When it's obvious it's playtime, take your baby off your breast before he or she has the chance to bite.

If there's still biting, pull your baby closer to you to make it more difficult for him or her to pull off easily.Or, break the suction by slipping your finger into the corner of his or her mouth. Try and react calmly and without raising your voice so the baby doesn't get scared.

In most cases, though, biting may be a sign that your baby is done with a nursing session, is distracted, or is just plain bored. The La Leche League International offers these tips to help reduce the biting potential:

• Say, "Mommy is not for biting. You can bite this," and offer your little one a teething toy or ring.
• Try starting a new activity if your baby seems distracted and is pulling off your breast a lot.
• Praise your baby — with a hug, kiss, or cuddle — whenever he or she nurses without biting or trying to bite.

Does my breastfed baby need extra vitamins?

Breast milk contains many vitamins as well as easily-absorbed iron. The iron from breast milk will be sufficient until your baby begins eating iron-rich foods (such as cereals or meats) around 6 months of age.

All babies need vitamin D supplementation. Vitamin D is added to formula and babies who are breastfed need to get their vitamin D as a daily supplement. The nutrient can be produced by the body when the skin is exposed to sunlight, but it is not safe for infants under 6 months to be in direct sunlight. After 6 months, infants should use sunscreen when in the sun, which blocks the body's ability to make vitamin D. So, babies who are primarily breastfed should be given daily vitamins.

Also, the American Academy of Pediatrics (AAP) states that infants — whether breastfed or formula-fed — do not need fluoride supplements during the first 6 months. From 6 months on, babies require fluoride supplements only if the water supply is severely lacking in fluoride. Well water and bottled water, for example, may not contain fluoride and the tap water in some communities does not have fluoride.

It can be dangerous to give a fluoride supplement to a child already getting enough fluoride, so it's important to find out the fluoride content in whatever water source your child is using. Again, ask your doctor about your baby's needs.

My baby doesn't want to nurse. What's going on?

Breastfeeding "strikes" are very normal and often last only a few days. Still, this can be worrisome, especially in a baby who usually breastfeeds with no problems at all.

So why might your child suddenly stop wanting to breastfeed? Here are some possible reasons:

• Teething has made the baby's gums sore.
• You've been stressed or have changed your nursing patterns lately.
• You smell "different" to your baby because you switched your soap, perfume, deodorant, or lotion.
• There is a different taste to your breast milk because of a change in your diet.
• Something is making breastfeeding painful or uncomfortable, such as an ear infection, a stuffed-up nose, a cut in your little one's mouth, or an oral infection called thrush.
• Your baby bit you and your reaction scared him or her.

As frustrating as nursing strikes can be, you and your little one can work through them. Here are some more tips La Leche League International offers breastfeeding moms that may help get you past the hump:

• Try to spend more time with your baby so you can devote some extra time to getting your breastfeeding back on track. Ask a family member, friend, or a babysitter to come over to help out with the chores and any of your other children.
• Make the experience as enjoyable for your baby as possible — hugging, caressing, and kissing your little one, and stopping to comfort whenever he or she gets upset or frustrated.
• Try nursing when your baby is sleepy and may be more willing to cooperate.
• Nurse while you're rocking your baby or walking around while carrying him or her in a sling.
• Breastfeed in a quiet room with few distractions.
• Try stimulating your milk let-down by pumping or hand expressing before starting to breastfeed so your baby gets the milk right away.

Until your nursing schedule is back to normal, you'll need to pump or hand express to keep your milk supply up and to make sure the baby is getting enough to eat. And if your child is really ready to stop breastfeeding (or wean), he or she will probably do it over a period of weeks or months.

In the meantime, both you and your baby can enjoy the special closeness and bonding that breastfeeding can offer.