Engorgment

What is engorgement? 

Engorgement is when your body begins to increase the amount of milk you are producing.

What does it feel like?

Your breasts may feel hard, heavy, warm to the touch, uncomfortable (to painful), breast tissue may feel tight.  One may also get a low grade fever.

When does it happen?

Anywhere from day 3 to 5.

How long does it last?

It should be resolved within 24 to 48hrs. with proper treatment.  Without proper treatment it could last up to 7 – 10 days.

How do I reduce the effects of engorgement?

o      staying ahead of engorgement is the easiest way to avoid it...nurse/pump breasts as often as possible (minimum every 3 hours with no more than one 5 hour stretch in 24 hours.). 

o      If feeling breasts "filling" up, try to nurse/pump to comfort.

o      If having difficulty removing milk, try to ice the breasts (both upper and lower parts of breast) for 20 minutes.  Using frozen peas/corn work great for icing the breasts.  Nurse/pump after.

o      Talk to your doctor about taking ibuprofen for reducing inflammation (swelling) and pain.

o      If baby is having a hard time latching w/ full breasts, try "Reverse Pressure Softening"...place finger tips around nipple on areola...finger tips form a circle around nipple.  Now press your fingers back and hold it there for a count of 50.  Release and latch baby.  The idea is to push fluid back so baby can latch more easily...this won't last long, so do this when you are ready to nurse and can latch baby quickly

o       Avoid using warm compresses during engorgement…it may make it worse.

Feeding Cues

What are feeding cues?

Feeding cues are signs that baby gives to tell us that they are hungry.

What are some feeding cues baby gives when hungry?

1.    REM (Rapid Eye Movement) while sleeping, baby's eyes will move back and forth...this cue is letting you know that baby is getting ready for a feed.  You could get a drink, comfortable position, sit down, un-latch bra flaps and get ready to feed baby.

2.    baby centers him/herself…baby while resting will cross legs, bring hands/arms in to center.

3.    baby will start making sucking movements w/ mouth, licking lips, etc.

4.    Tight fist. 

5.    Rooting.  This is when you touch baby on the cheek...baby opens mouth and turns in that direction that was touched.

6.    Hand to mouth.  Baby puts his/her hand to his/her mouth.

7.    Crying.  Ok...this is really not a feeding cue, this is baby getting ticked off and giving up…if baby gets to the crying stage, it may take a few minutes to calm him/her down to be able to nurse well.  Some skin to skin always helps in this situation. 

Introducing the bottle

So it is time to introduce the bottle.  Some babies take to the botttle right away, others not so much.  Here are some suggestions

When is it ok to start a bottle?

We suggest families wait until at least 2 weeks old before introducing a bottle (or pacifier).

What are some suggestions for introducing the bottle?

Bottle intro.  Some suggestions:

1.     Have someone besides you give the bottle...some babies won't take a bottle if you are even in the room.

2.     When giving the bottle, try w/ expressed breast milk (formula may put baby off...not as tasty) heated a bit or cold.  

3.     Try different positions...sit on floor w/ knees bent w/ baby laying on legs looking at you for an example.

4.     Try walking/moving around while trying to give the bottle.

5.     Many times a baby that is too hungry won't take the bottle, while others do better when they are more hungry.

6.     A sleepy baby may have better success than a wide eyed baby (that is a MAY).

7.     Try nipples that somewhat resemble your nipples

8.     Try to get a nipple that resembles your milk flow...if you have an active letdown, a baby w/ a bottle will be expecting to get a mouthful of milk.  On the other end, if you have a slower letdown a bottle nipple that flows faster will overwhelm him/her.

9.     You could try warming nipple under water before giving it to him/her

10.Have baby open wide for bottle instead of trying to shove it in his/her mouth

11.Carrying him/her in a sling while trying to give a bottle may also help.

12.Caregiver could try to wear a shirt that you have worn while trying to give a bottle...ok now I have tried this one and on one occasion it backfired..baby got mad because he could smell me but the breast wasn't there.  Might be worth a try though.

13.Give baby lots of smiles and praises when taking bottle

14. If baby gets upset, stop and try again later