Q1. This is my first baby. She keeps on crying. How do I know that my baby is crying for a feed?
Babies cry for various reasons besides hunger-like discomfort due to a soiled diaper or feeling hot or cold or simply they want to be picked up and cuddled. Mothers slowly learn to pick up early feeding cues indicating that baby is hungry; for example, bringing her hands to mouth, turning her head towards breast when picked up, lip licking and sucking movements, or generalized fussiness. If these feeding cues are missed, she may start crying vigorously due to hunger. So when your baby cries, check whether the diaper is soiled and change it, ensure that nothing else is bothering the baby and This is my first baby. She keeps on crying. How do I know that my baby is crying for a feed? Q1 then put the baby to the breast. If she is hungry, she will feed. Let her feed for as long as she wants to at one breast so that she gets both the thin watery milk, at the beginning of the feed to quench her thirst, followed by the thicker and fatcontaining milk, that satisfies her hunger. Once satiated, she will fall asleep and come off the breast by herself. If she continues to cry after coming off one breast, feed on the other. Otherwise feed on the other side at the next feed to maintain milk output from both breasts.
Q2. My mother says that if I breastfeed lying down, then milk will enter in the baby’s ears. Is that true?
Well, breastmilk is unlikely to enter baby’s ears through the tube that connects baby’s middle ear to the throat during breastfeeding. When mother lies down and breastfeeds then milk does not pool in the baby’s mouth due to the mechanics involved in breastfeeding. It is far more likely to occur with bottle feeding. Moreover, breastmilk contains lot of anti-infective and immunity boosting factors which actually protect baby from developing middle ear infection. Hence mother can safely breastfeed baby in the lying down position.
Feeding in sitting position
When you sit and feed, then sit with your back straight and well supported. You need to hold your baby close to you, at the level of your breast and turned towards you in such a way that her tummy touches yours and her face is towards your breast with her nose opposite the nipple so that she can take both the nipple and surrounding black part (called areola) into her mouth to latch on to the breast and effectively draw out the milk.
Feeding in lying down position
When you lie down and feed, ensure that you are lying on your side and your baby is facing you the same way as in the sitting position. This correct positioning of yourself and your baby for effective suckling at the breast is the key to successful breastfeeding. So, go ahead and continue to feed your baby in the correct lying down or sitting position!
Q3. My sister-in-law has been diagnosed with tuberculosis (TB) chest few weeks before delivery. Can she breastfeed?
We understand that this must be a cause for concern for the family. Be assured that TB is not transmitted through breastmilk. Transmission from mother to baby most commonly occurs after birth due to exposure to TB bacteria in respiratory droplets, which are generated when a mother with active lung TB talks, coughs, or sneezes. The transmission of TB from mother to the baby can rarely occur in the womb for which doctors do certain tests on the infant such as an X-ray chest, abdominal ultrasonography, and stomach aspirates for TB bacteria to rule out this possibility.
How to protect the child?
If your sister-in-law has been taking anti-TB medications regularly for at least 2 weeks or more before delivery, she is less likely to transmit the infection to the baby and she can safely breastfeed. She should maintain cough hygiene by placing tissue or cloth over the mouth while coughing and sneezing, and wear mask, wash hands, and dispose tissue or cloth properly after soiling. She should also take antitubercular medicines regularly under doctor’s supervision. Her doctor will help protect the baby by prescribing some anti-TB medicine which may be given once a day to the baby for 6 months under supervision and prescription. The Bacillus Calmette–Guérin (BCG) vaccine is also given at birth as is usual for all babies.
When not to breastfeed?
Only if a mother is noncompliant with her medications or is suffering from multidrug-resistant TB, then she should not directly breastfeed or be in direct contact with her baby until appropriate drug treatment is administered and she is no longer infectious. Meanwhile her expressed breastmilk (EBM), collected with all hygienic procedures including respiratory (wearing a mask) and hand hygiene could be fed to the baby by cup or wati or katori and spoon by a noninfected caretaker.
Q4.The current evidence shows that corona virus is not transmitted by the breastmilk
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, causing coronavirus disease 2019 (COVID-19), has taken pandemic proportions. All ages are vulnerable to get infected by this highly infectious virus. The coronavirus spreads through droplets, released during coughing and sneezing, and aerosols. The virus enters in the body through eyes, nose, and mouth directly when a person is very close to the patient or through contaminated hands and wipes coming in contact with the face. World Health Organization recommends exclusive breastfeeding for infants born to COVID-positive mothers without significant risk to the infants. The mother must maintain respiratory hygiene, wear mask, and wash hands frequently with soap and water or sanitize hands with alcohol-based sanitizer (having more than 70% alcohol), especially before and after breastfeeding. New studies claim that breastfeeding even protects baby against coronavirus infection by secreting antibodies produced by the mother against coronavirus. Breastfeeding keeps baby healthy, develops good immunity in them against several serious infections, and helps in achieving adequate growth and development.
Q5. It is summer. Can I give water to my baby between breastfeeds?
Breastmilk contains enough water. The breastmilk composition is such that milk flowing in the first few minutes contains more water. This is called foremilk. Milk secreted towards the end of the breastfeeding is rich in fat and is called hindmilk. It is said that foremilk quenches thirst and hindmilk fills the belly. Water content of the breastmilk is regulated by the dryness of the infant’s oral mucosa. If baby needs more water, then breasts will secrete higher amount of water during breastfeeding and vice versa. This kind of dynamic water regulation for the infant is not possible with the formula/powder milk. The formula milk feed is always prepared with a fixed amount of water whereas breastfeeding provides exact amount of water required by the infant.
Q6.I have fever, cold, and cough since yesterday, should I stop breastfeeding?
I see that you are concerned about breastfeeding your baby. Fever, cold, and cough, which are quite common, are generally caused by viral infections. Such viruses are not transmitted through breastmilk and breastfeeding is quite safe. The viral infection is transmitted through droplets generated during coughing and sneezing. You may take medicines for fever (tablet paracetamol) and other medicines as advised by the doctor, along with warm saline gargles and cough lozenges. These medicines do not harm the baby. You must, however, wash your hands with soap and water before handling the baby and use a face mask to prevent transmission of respiratory droplets. So, you can continue breastfeeding that will also help in preventing infection to the baby as antibodies produced by the mother are secreted in the breastmilk.
It is good to know that you want to continue breastfeeding. Ideally an infant should be exclusively breastfed (nothing else to be given, not even water) for 6 months followed by continued breastfeeding for at least 2 years along with semisolid family foods. Breastfeeding makes a baby to grow healthy and strong. Several organizations, both government and private, support mothers by granting full pay maternity leave for 6 months. You may check with your employer about your entitlement for the same. Even if you have to rejoin work after 2–3 months, you can continue to breastfeed your baby by any of the following methods: