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Infant Feeding

Deciding how to feed your baby is a very important decision and there are many things to consider. 

Breastfeeding is important.

  • Breastfeeding supports a baby’s growth and development.
  • Breast milk changes according to a baby’s nutritional needs.
  • Breast milk is the only food babies need for the first six months of life.
  • Breastfeeding decreases a baby’s response to pain (e.g., during immunizations).
  • Breastfeeding provides an additional way to connect emotionally.
  • Breastfeeding up to two years and beyond provides the older baby with important nutrients and some immune protection.
  • Breast milk is different than infant formula
  • There are risks to using formula and to bottle feeding.
  • Not breastfeeding is associated with an increased risk of diarrhea, ear infections, chest infections, obesity, diabetes, and SIDS for babies.
  • For mothers, not breastfeeding is associated with an increased risk of health concerns such as postpartum bleeding, type 2 diabetes, breast cancer, and ovarian cancer.
  • Speak to you healthcare provider about other risks, and how to minimize these risks if you make an informed decision to formula feed
  • Infant formula is a commercial product, usually cow-milk based. 
  • Powdered formula is not a sterile product. 

We encourage you to learn the facts about breastfeeding and infant formula so that your decision is informed. We also encourage you to discuss your thoughts, feelings, concerns and questions with your family and your health care provider.

The Mount Sinai team seeks to make sure you have access to infant feeding information that is up-to-date, accurate and evidence-based. We will also support your decision by educating you and assisting you as much as possible when your baby arrives and while you are in hospital. 

The infant feeding timeline was created to help you navigate feeding in the first 48 hours after birth. This timeline is used for education and it serves as a reminder about what is considered normal infant feeding behaviours and patterns. We hope it helps you recognize your infant’s cues and that it gives you tips for what to do to support your infant’s feeding during each segment of time after the birth of your infant. Your nurse will help you navigate your infant’s feeding behaviours and patterns during your hospital stay, but it is also helpful to have some understanding of these things before your baby is born. 

Skin to Skin involves the placement of your baby in an upright position, on you or your partner’s chest with no clothing or blankets placed between the infant and the parent.

The following two videos provide more guidance:

General Feeding Information

Mount Sinai seeks to support you in your infant feeding goals. The evidence tells us that there are certain steps that we can take to support your success. Our Promise is made up of these steps.

Once you go home with your baby, you may require additional breastfeeding support. Our Postnatal Ambulatory Clinic (PNAC) is staffed by a team of registered nurse/lactation consultants who provide breastfeeding support services free of charge to Mount Sinai patients with identified needs.

Learn more about Postnatal Ambulatory Clinic (PNAC).

Hand expression of breast milk is a technique that is valuable for every new breastfeeding mother to learn. In addition to feeding your baby at the breast, hand expression of breast milk has been shown to increase milk production. It can also be very helpful when a breast is very full.  A small amount of hand expression from a full breast can assist a baby to latch more successfully.

Learning the skill of hand expression early in your breastfeeding experience can allow for better availability of colostrum in the first days because the breast pump may not easily collect this thicker, stickier version of breast milk. Colostrum is low in fat, and high in carbohydrates, protein, and antibodies to help keep your baby healthy. Colostrum is extremely easy to digest, it is low in volume (measurable in teaspoons rather than ounces), but high in concentrated nutrition for the newborn. Colostrum has a laxative effect on the baby, helping him pass his early stools, which aids in the excretion of excess bilirubin and helps prevent jaundice.

Your expressed breast milk offers many important benefits and is especially important if your baby is born prematurely or is sick.  If you are separated from your infant, and you plan to breastfeed, we encourage early hand expression of breast milk.

The research tells us that hand expression should begin within 1 hour of the birth and continue regularly, every 3 hours or so, for the first 24 hours.  You will also be encouraged to do regular breast pumping at intervals similar to the timing a baby may feed if going to the breast.  It is also okay to hand express or pump as well as feed your baby at the breast with the goal of increasing milk supply. It is usually advised that you breastfeed first and then pump or hand express, collecting your expressed breast milk to supplement the feed at the breast. Hand expression is an effective means of expressing milk, boosting milk supply and collecting milk for an infant. Ask your labour and delivery and your postpartum nurse to help you with hand expression. 

Expressed breast milk is the optimum choice for supplementation of the breastfeeding infant. Your expressed breast milk should always be refrigerated and given to your infant when they are ready to begin feeds.  If there is not enough breast milk, your team will discuss with you what options might be available.

Baby-led latching is natural and simple and can be encouraged immediately after the baby is born. It can also be useful as your baby learns to breastfeed, if your baby is not breastfeeding well and if your nipples are sore or painful. 

To encourage ‘Baby-led latching’:

  • Start with a calm baby who is placed vertically with their tummy on your upper chest, between your breasts
  • Be comfortable, lean back a little
  • Your baby will begin to bob or peck while looking for your breast
  • Support your baby’s head and neck, shoulders and bottom as they move to find the nipple
  • In time, your baby will find the nipple, push their chin into the breast and reach up to the nipple with an open mouth
  • It will help to continue to support the baby’s bottom, back and shoulders while this happens
  • Once baby is latched, you and your baby can settle into a more comfortable position.

This video shows you how baby-led latching happens in the first moments after birth.

Learning to position and latch your infant takes time, for you and your baby.

The following tips might be helpful: 

  • Have your baby skin to skin, close to your body.
  • Position your baby so the nose is at the nipple.
  • Allow your baby to reach up towards the nipple with an open mouth, so the head is slightly extended or tilted back.
  • Use the base of your hand behind the shoulders to direct the baby up to the breast.
  • Support the head with your fingers.
  • Make sure your baby’s ear, shoulder and hip are in a straight line.
  • Baby’s mouth will be wide open with lips flanged.

These resources might be helpful to review before baby is born, and then again after baby is born.

Clusterfeeding is part of the normal pattern a baby has in the first days after birth. Following the initial quiet alert stage in the first two or three hours after birth, baby goes into a deep sleep to help recover from labor. This period of deep sleep is followed by increased wakefulness and increased nursing demands. This is called "clusterfeeding." Clusterfeeding is often interpreted as an indication "that baby is not getting any milk or is getting an insufficient amount" of milk. Research has shown that this is a time in the early postpartum period, when mothers will resort to using supplemental formula. Clusterfeeding is not a medical indication for formula supplementation.

Some important points to remember:

  • Cluster feeding usually occurs 24 to 48 hour after birth
  • This is a normal reaction to reduction of colostrum and brown fat reserves baby has made during pregnancy.
  • The neurological system of a healthy, full term newborn is immature at birth and is somewhat disorganized in its behaviours. Baby seeks comfort and familiarity and breastfeeding offers this.
  • Prolactin is the hormone responsible for making milk. It is at its highest levels at night and increases with more frequent feeding. Night feeds are particularly important to establish the milk supply and to increase milk volumes.

Allowing baby to feed as much as possible at the breast during this time period of clusterfeeding will help the more mature milk to come in, will comfort baby and will positively influence future milk production.  If parents become exhausted in this period of time, feeding mom’s own expressed milk is the first line of defense.

One of the reasons parents feel they need to introduce formula when they are breastfeeding is because they think they do not have enough milk for their growing infant.

The Best Start “Breastfeeding Your Baby Poster” is a guide that outlines the signs that feeding is going well, and can be a source of reassurance when you are feeling uncertain. 

Watch the following videos to hear more about how you know you have enough milk, or how you can increase your supply.

How do you safely supplement a breastfeeding baby?

If a baby requires supplementing, our first advice is to use mom’s own milk to do so. Hand expression and /or pumping can assist you in collecting your own milk to supplement your baby. Using formula when you are breastfeeding your baby can be a very difficult decision. These resources may also be helpful in making this decision:

The use of formula is sometimes medically indicated when your milk is not enough in volume for your baby. Extra breast milk or formula may also be indicated for medical reasons such as: 

  • Low blood sugar (glucose) levels
  • Jaundice treatments (if the baby is too sleepy to feed well at the breast)
  • Meconium stools continue after the fourth day
  • Late preterm baby who is not feeding well at the breast
  • Excessive weight loss (despite frequent, effective feeds)
  • Mother’s milk has not increased by the fourth day
  • Dehydration (not enough wet diapers)

Ask your nurse or lactation consultant about supplementing your infant. Above all, your infant must be fed. We want you to be informed so that you can make the best decisions for your infant, but you may also find it helpful to get the opinion and support of experts. 

Recommended volumes for supplementing

The chart below is a guide for supplementing your infant’s feed:

Age

Per feed ml

The first 24 hours

2-10 ml

24 to 48 hours    

5-15 ml

48 to 72 hours   

15-30 ml

72 to 96 hours   

30-60 ml

More information about a baby’s stomach capacity in the early days can be found here.

When is a bottle needed?

Paced bottle feeding is a method of feeding your baby that mimics breastfeeding. It is also known as ‘Baby-led bottle feeding’ and is a method of feeding that can help minimize the negative impact bottle feeding may have on the baby who is also breastfeeding or trying to breastfeed. It is an acceptable method of supplementing breastfeeding when volumes of expressed milk or formula that are recommended exceed what might be reasonable to feed by cup or spoon. 

Paced bottle feeding is also the recommended method of feeding if you choose to exclusively formula feed by bottle.

The following video can help you learn how to pace bottle feed your baby:

Using Formula

It is important to know how to safely prepare and store formula as well as how to sterilize bottles and equipment. It is important to note that powdered formulas are not considered sterile, and can be subject to contamination recalls. We encourage our patients to consider using the premixed liquid formula or the concentrated liquid formula in the first two months of life. In addition to good hand hygiene and proper sterilizing of equipment when preparing formula, we encourage parents to always follow the package directions for reconstituting formula.

These resources are helpful for any parent who is considering formula for full feeds or as a supplement:

The evidence tells us that there are certain steps that we can take to support your success. Our Promise, made up of these steps, has been modified to acknowledge the very specific challenges that a parent might have when feeding a baby in the NICU. You can find that information in the document below.

If you are feeding a baby in the NICU the link below includes additional helpful information. You will have access to a Lactation Consultant with specialized knowledge in developing a milk supply and encouraging a preterm baby to the breast when they are ready.

The Postnatal Ambulatory Clinic offers the following free services for Mount Sinai Hospital postpartum patients within the first seven days after birth:

  • Breastfeeding support
  • Postpartum follow-up for patients experiencing any maternal concerns, and who cannot get an appointment with their primary health care provider
  • Newborn follow up as directed by a health-care provider
  • Telephone advise during clinic hours
  • Other consultations - for patients who are unable to access their primary care provider, the clinic can provide: follow-up for jaundice, newborn assessment, maternal postpartum assessment and staple removal after caesarean birth

 Referral for an appointment is usually made while you are still in the hospital.

Location: 

17th floor at 600 University Ave

Hours of operation:

7 days a week (including holidays) from 9 a.m. to 4 p.m., by appointment only

Contact information:

Call 416-586-4800 ext. 7409 for an appointment

In-Patient Education

Helpful breastfeeding education class to guide you