Some useful ways to overcome problems in breast-feeding
Dear Dr. Donya,
I am feeding my baby with my breast milk by pumping it into a feeding bottle and also giving him formula milk. As my nipples are flat my baby finds it is difficult to feed. Sometimes my baby sucks for a while but he is not feeding continuously and cries a lot. When I see him crying I get frightened and immediately give him milk in a bottle.
How can I succeed in giving my breast milk directly to him? Every day, my milk secretion is around 450 ml to 500 ml. He also likes breast milk rather than formula milk. Every day my baby drinks around 450 ml to 500 ml (250 ml to 300 ml breast milk and 100 ml to 150 ml formula milk). When he was born in October his weight was 2,650 grams and now he is 3,350 grams. For the last three days in the evening, his milk intake is every half an hour and he drinks 30 ml to 40 ml then sleeps immediately. If we put him on the bed he only sleeps for a few minutes (around 10 minutes) and then he is awake crying for milk. If I feed him, it takes a long time for him to drink it and sometimes he refuses it.
Doctor, please advise me if I should increase his milk intake and how can I stop him from frequently waking up. During the daytime he is not sleeping much and most of the time he is playing. During the night he wakes up every three hours and drinks milk. Please let me know how long a newborn should sleep each day. Also will they only cry when they feel hungry or their diaper is wet.
Yours sincerely,
-- A reader
Dear reader,
The flat, retracted or blind nipple is the nipple that is drawn back into the breast by the supporting tissue. This nipple does not prevent nursing but it makes it more difficult to nurse.
You can try massaging the nipple lightly with your fingers first, it sometimes makes a nipple stand out. Before feeding him, squeeze some milk out first. To make sure the nipple is softer and easier, compress then press the areola into the more protruding shape between the thumbs and forefinger and put into his mouth. If he starts crying, stop right away and comfort him, try again later. Remember "take your time". Or, you can use a nipple pump to retract your nipple, ask your doctor about it.
Your milk is a fair amount for the baby. In the first month, the milk production is around 600 milliliters, so you have around 250-300 milliliters. As I always recommend, the more the baby sucks the more milk you produce. In your condition it takes time and patience so do not jump to bottle-feeding if you want to succeed at breast-feeding.
Generally, babies sleep approximately 16 hours a day in the first few months. But all babies are different, some sleep all the time except for feeding time, others sleep less. But as long as the baby is active, eats well and gains weight he is definitely getting enough sleep. Your son plays a lot in daytime so in early evening he is already sleeping after one ounce of milk. I think he is waking up frequently for two reasons. One, he still needs more milk but he is tired so you should increase his intake, or two, he may have gas in his stomach. All you need to do is burp him after feeding. A baby waking up every three hours at night is quite normal in the first few months. So try these few tips and please let me know how things progress.
-- Dr. Donya
Dear Dr. Donya,
Please could you tell me about the various immunization shots that should be given at different age intervals, the sequence and what to do if we miss giving one.
Hoping to hear back from you,
Regards,
-- Vidya
Dear Vidya
Glad to hear from you again.
The immunization program is as follows:
Birth -- BCG (tuberculosis), HBV 1 (hepatitis B_
1 month -- HBV 2
2 months -- DPT 1, OPV 1(diphtheria, tetanus, pertussis and polio); HbCV 1 (Hemophilus influenzae type b)
4 months -- DPT 2, OPV 2, (HbCV 2)
6 months -- DPT 3, OPV 3, (HbCV 3) and HBV 3
12-15 months -- MMR 1 (mumps, measles, rubella)
18 months -- DPT 4, OPV 4
5 years -- DPT 5, OPV 5
10-14 years -- dT, MMR 2
There are a few other vaccines that are provided and recommended to give to older children, such as the hepatitis A vaccine which can be given in adolescence or to adults less than 40 years, and varicella vaccine (chicken pox) which can be given to children between 10 years to 12 years old.
If you forgot your child's shot you can take her to the doctor and continue the vaccine program without restarting the schedule from the beginning again.
Take care,
-- Dr. Donya