When can I leave my baby unattended?

As a new parent it’s perfectly understandable that you want your newborn baby to be supervised at all times.
While that’s a wonderful thing, it can also be truly exhausting and sometimes difficult. After all, taking a bath, going to the washroom, cooking a meal or answering the doorbell can be a bit tricky with a baby in your arms.
If you are following post delivery confinement, you’ll probably have someone to look after you and your baby for the first forty days after birth. After your confinement is over, you can request a family member to watch over your baby if you stay in a joint family. If however, you live in a nuclear family you will need to find ways to manage every day chores with a baby in the house.
While the most obvious solution is to do as much as possible while your baby is asleep, as he gets older, his sleep time in the day reduces and you have just as many household chores, if not more, to tend to. You can start by prioritising your work. If something can wait for the weekend when your husband is home, don’t add it to your list of daily tasks. You can also try to get some of your chores done before your husband leaves for work or after he is back. This will also give your husband some time with your baby.
But even then, you will need to make time for your chores while your baby is awake. Here are a few ways you can go about the house knowing your little one is safe and happy:

• As long as your baby cannot sit, you can leave him for a few minutes in his cot. As a newborn, he will not be able to see very far so you can keep him entertained with wrist rattles or a contrast cot lining for him to gaze at. Once he starts seeing farther, he will not mind being alone for a while if he has an interesting mobile to gaze up at or a ceiling light that projects images onto the ceiling. Even a crystal that throws little rainbows onto the ceiling and walls when light passes through it or a wind chime can entertain your baby.
  Note: Never leave a stuffed toy or pillow around your baby if you leave him alone in his cot. Make sure the cot is clean of anything your baby can suffocate or choke on.


• You can bring him with you in a bouncy cradle or car seat. If you are cooking for example, your baby can lie in his seat and hear you move around the kitchen. If you speak or talk to him, he will feel reassured you are close even if he cannot see you. Many bouncy cradles come with toys hanging to keep your baby entertained while he is lying in it. He might enjoy those toys but might just be fascinated by how the chair rocks every time he kicks his feet.


• There are a host of play pens or play mats available in the market these days designed to help your baby develop his motor skills such as hand-eye coordination and keep him entertained. Make sure you choose one that is appropriate for your baby’s age. Play mats that your baby can lie on often have a mirror because small babies are fascinated by faces. Your baby will enjoy exploring the toys, colours and sounds that these play mats or play pens have.

Before leaving him alone, make sure that wherever you put him, even for a short time, he doesn’t get too cold or too hot and that all his basic needs such as a full stomach and clean nappy are met. You should never leave your baby alone in the house, even for very short periods of time. So gardening, stopping by the local market, going to your neighbour’s house for a chat or picking your older child from his bus-stop with your baby at home are all no-nos.

Also never leave your baby alone in a parked car even if it’s for a few minutes. Besides being unsafe, temperatures inside a parked car can rise frighteningly quickly even with the windows open.

If you still find it hard to get all your tasks done, you can hire a live-in maid to help look after your baby or part-time help for chores such as cleaning, ironing, cooking or washing clothes.

Bear in mind that as your baby starts crawling, leaving him alone will get more difficult as you will need to childproof your home first.

When can I let visitors hold my baby?

The arrival of a new baby is an exciting event for everyone, so you'll probably have friends and family keen to visit you both in the hospital and once you get home. It's not a problem if visitors hold your newborn, but you will need to take a few precautions.
Here are a few things to keep in mind:

• Traditionally, mums follow a 40-day confinement period to recover from the birth and to keep their newborn baby safe from infections. It may be a good idea to speak to your husband and let him or an elder such as your mum or mum-in-law, help you handle any visitors during the first few weeks.
• If possible, try to fix a set time for visitors. A constant stream of visitors all through the day may leave you tired and exhausted. Some mums find mid-mornings or evenings work best. This way they can have a late start to their day or fit in an afternoon nap.
• It is safest to request visitors to wash their hands before holding your baby. You may be worried about offending your guests, but, if you, your spouse or any other willing family member can lead by example, things should go just fine. Washing or using sterilised wipes or a hand sanitiser helps to limit the viruses or germs your baby is exposed to. You could say that you are following doctor's orders or taking precautions as there is the flu or viral going around.
• Try not to let too many people handle your baby for too long as he may get tired or over stimulated. Instead, settle your baby in his pram, palna or cradle in one place, and allow the guests to go and see him there. If your baby is sleeping, you could suggest visitors take a peek without touching or lifting him. You can tell your guests that they can hold your baby and play with him when he is awake.
• Young children, especially older siblings and cousins will be excited by the arrival of a new baby and may insist on holding your newborn. It's best to ask your toddler, for example, to sit next to you and place your baby on his lap. Keep a hand under your newborn's head to make sure it's supported. Place your other hand around your toddler (as if you're hugging him from the back) and hold your baby.
• Do make sure no one feeds any honey, mithai or herbal preparations to your baby. Your baby could pick up an infection from food, as his digestive system isn't mature enough. All your baby needs at this point is breastmilk or formula if you are bottle-feeding.
• If you are having a puja, naamkaran or chhatti celebration, try to limit the gathering to close family members and friends. Your baby may feel overwhelmed with too many people around, especially if every visitor wants to hold him..

Newborns are more susceptible than adults to whatever bugs might be going around because their immune systems aren't mature yet. Once they're more than a month or two old, you won't need to be so vigilant about protecting them from germs. It's advisable though, to keep your baby away from people who have recently recovered or are just recovering from infections and communicable illnesses.

We have a newborn. How will we know when to call the doctor?

It's normal for new parents (especially first timers) to worry about their newborn baby’s health, so you’re not alone. However, by taking a few simple precautions you can keep your baby healthy and you reassured:

• If you're breastfeeding, continue nursing for as long as you can (ideally throughout her first year).
• Place her on her back when she's sleeping to prevent Sudden Infant Death Sydrome (SIDS).
• Don't let anyone smoke around your baby.
• Avoid contact with people who are unwell.
• Wash your hands well after each nappy change.
• Make sure your baby is properly immunised.

Of course, even if you follow this advice, your daughter may still get ill. But you'll know when something is really wrong. Your knowledge of her usual patterns of feeding, sleeping, fussing and responding is invaluable when judging her overall state of health.

If you are unsure whether your baby is well or not, there are certain signs to look out for:

Unusual Behaviour:

• Temperament: If your baby is her usual self and feeding well, it’s unlikely that she’s seriously ill. This doesn't mean you shouldn't see your doctor if she has a fever or a cold. But a smiling baby with a runny nose is probably not as sick as a lethargic baby with a runny nose.
• Changes in crying: If your baby cries more than usual and can't be comforted, or if her cry is weak or high-pitched, she may be seriously ill.
• Lack of crying: If she seems unhappy but doesn't cry and is unusually inactive, call your doctor.
• Appetite: This will vary, but she should feed vigorously when hungry. A baby that tires easily from sucking, or loses interest in feeding, is probably sick. The same applies if she regurgitates food more than usual, and with more effort, or if the posset is green.
• Difficulty with breathing: If your baby's breathing is laboured in any way, get help immediately.

Stomach upsets:

• Abnormal bowel movements: Young babies, especially when breastfed, may have very soft or liquid stools. But if your baby has diarrhoea (watery poo), her tummy may be upset. Monitor this to see if the diarrhoea continues. If her poo is streaked with blood or mucus, or has the consistency of jelly, call your doctor. Look at our baby poo visual guide for more help.
• Dehydration: Make sure she’s drinking fluids or breastfeeding as often as usual. She should wet a minimum of six nappies a day. If she’s sleepy and has small, hard or dry stools or urate crystals (rusty orange stain or crystals) call your doctor.

High Temperature:

• Fever: A baby can have a high fever and only be mildly ill, or a slight fever and be seriously ill, but it is a sign of sickness. However, if a baby under three months of age has a fever higher than 100 degrees F or 37.7 degrees C, she should be examined. If an older baby has a fever but appears completely well otherwise, observe her for a day to see whether she develops other symptoms.

If you’re getting back to work and have a maid or family member taking care of your baby, make sure they have all of yours, your husband’s and your doctor’s contact information. It’ll be useful if you explain to your babysitter under which circumstances a doctor or you need to be called.

If you’re observing confinement, you may be advised traditional home remedies for any problems you and your baby may have. Babies with colic, for example, are traditionally offered carom seed (ajwain) water or just a hot compress of carom seeds to soothe them.

Even if you aren’t following confinement strictly, chances are that family and friends will share suggestions on all sorts of ways to handle a sick baby.

Although it’s tempting to try such remedies or follow well-meaning advice to comfort your colicky baby, it’s best to speak to your doctor first. There could be another (more serious) reason for your baby’s discomfort.

So trust your gut and if you’re in doubt don’t hesitate to call your doctor. After all, it's important for you to get peace of mind, and doctors expect to see tiny babies quite often. They know that they can become ill quite quickly. They also know they get better quickly too!

How to swaddle a baby

 

What does it mean to swaddle a baby?

Swaddling is the ancient art of snugly wrapping your baby to help him feel safe and secure.

Being wrapped up can stop your baby from being disturbed by his own startle reflex. You may have noticed your baby doing little jerks of his body when he's sleeping. These jerks are his startle reflex (hypnagogic startles) and are completely normal.

Swaddling can also help settle your baby down when he's overstimulated.

In many regions, babies are settled down in cradles (palnas) fashioned out of soft cotton cloths or sarees. These cradles hold the baby snugly and serve the purpose of swaddling the baby as well providing a rocking motion.

Check that your baby isn't hungry or wet, before you start. Keep his face and head uncovered, so he can breathe easily and doesn't overheat. If your baby is swaddled, he probably won't need another blanket on top.

How do I swaddle my baby?

Here is a step-by-step guide to swaddling your baby.

• Place a cotton cot sheet on a flat surface and fold down the top right corner about 15cm / 6 inches.
• Lay your baby on his back with his head on the fold.
• Pull the corner near your baby's left hand across his body. Tuck the leading edge under his right arm and around under his back.
• Pull the bottom corner up under your baby's chin.
• Bring the right-hand corner over and tuck it under his back on the left side. Some babies prefer to have their arms free, in which case you could just swaddle your baby under his arms.

You can swaddle your baby until he is about one month old. After that it may stop him moving around and hamper his development. When your baby begins to kick off covers, it's a sign he no longer appreciates being bundled so snugly!

What's the best way to store breastmilk?

You can store your breast milk to keep it fresh for your baby in a number of ways:

• At room temperature (maximum of 25 degrees C) for up to four hours.
• In a refrigerator (maximum of 4 degrees C) for 24 hours. In colder regions, breast milk kept in a fridge can stay fresh for three to five days. But in hotter parts of the country, fridge doors are opened and closed more frequently because there are many more fresh items that need to be kept cold. This is why it's best to store expressed breastmilk for no more than a day.
• In a freezer with a temperature of -18 degrees C, for three to six months (again, this takes into account the long hot summer months and more frequent use of the freezer). Always keep the milk in the back of the freezer away from the door, because items stored towards the front are more susceptible to changing temperatures when you open the freezer.
• In single-door refrigerators with a freezer compartment inside the fridge, for two weeks.
• In a cooler, Styrofoam or thermocol box filled with ice or ice packs for up to 24 hours.

You can place a thermometer in the fridge, freezer or cooler and keep track of the temperature during power cuts. Take special care in the summer or monsoon. The inside of the fridge could heat up faster at these times.

Expressing and storing breastmilk is a great way for your baby to get the benefits of your milk, even when you're not around. This can come in especially useful if you plan on returning to work.

How you store your breastmilk also depends on how soon you want to use it. If you plan to use it within a day, refrigerating is better than freezing. This is because freezing destroys some of the substances in your milk that fight infection. Frozen breastmilk is still a healthier choice for your baby than formula, though.

Whether you choose to refrigerate or freeze your milk, you should:

• Use sterilised containers. The best choices are plastic bottles, or plastic breastmilk bags which are available at some chemist and baby shops. Glass containers aren't recommended. It's thought the infection-fighting white blood cells in breastmilk may cling to glass.
• Not store or freeze breastmilk uncovered, for example, in ice trays.
• Label and date your bottles and bags. Our lactation expert, Sonali Shivlani says it's a good idea to use the most recent milk first. The logic behind this is that breastmilk changes according to your baby's needs. So if you use the most recent milk, it is best suited to your baby's current needs. If you need more milk, you can work your way backward. But do keep a track on the dates and use older milk before it crosses the expiry time.
• Keep your breast pump clean. Wash the parts in hot, soapy water and rinse them thoroughly before sterilising.
• Freeze your milk as soon as possible after expressing. Leave a gap at the top of each bottle or bag, as your milk will expand during freezing.
• Watch out for tears, if you're storing your milk in bags. You may not notice any until you start to thaw the milk. Keep in mind, too, that plastic bags tend to fall over when thawing.

To make thawing easier and quicker, you could store breastmilk in smaller bags or bottles. This may also help to avoid wasting breastmilk that your baby can't finish. You can add freshly expressed milk to older breastmilk once that has been warmed to room temperature. But remember that you can only keep the mixed milk until the older milk is a day old in the fridge.

If your milk has been stored for some time, you may notice that it separates. This is normal. Just give it a gentle shake.

You can add freshly expressed milk to frozen milk as long as the fresh milk is chilled for at least an hour first. Make sure the amount you're freezing is smaller than the frozen portion.

Frozen breastmilk should be defrosted in the fridge, and can be stored there for 12 hours. Once it has defrosted, though, it mustn't be refrozen.

Don't be tempted to defrost or warm your breastmilk in a microwave. You should never put breastmilk on the gas or in a microwave. If you need the milk in a hurry, defrost it under cool, then warm, running water. Or you can place the closed bottle in a container with hot water. Dry the outside of the container before you open it.

How can I express my milk by hand?

Expressing by hand (hand expression) means that you use your hand to rhythmically press your breast so milk comes out.
There are probably as many ways of doing this as there are mums. The trick is to press the milk ducts behind your nipple. Many mums make the mistake of squeezing the nipple itself. You won't get any milk that way and it'll probably be painful.

• Wash your hands before you start. Find a suitable wide-rimmed container, such as a jug, for storing your milk. Either sterilise it in a steriliser or wash it well and scald it with boiling water.


• Sit comfortably, with your back straight.


• Place your little finger underneath your breast, against your ribs, and spread your other fingers slightly to support your breast. Your thumb needs to be on top, about 3cm or 4cm back from the base of your nipple. It should be just out of the areola.


• Adjust your fingers if you need to, so that your first finger and thumb are opposite each other, making a big C shape around your breast. If you visualise your breast as a clock you would have your thumb at 12 o'clock and your index finger at 6 o'clock.


• Your milk comes from deep within your breast, so your finger and thumb need to be well away from your nipple. Place them towards the edge the darker skin surrounding your nipple (areola). If you have a large areola, you may need to bring your fingers inside it.


• Gently squeeze your thumb and first finger together, hold the squeeze for a count of three, and release, but keep your finger and thumb in the same position.


• Repeat the squeezing and releasing until you see drops of your colostrum or breastmilk appearing at your nipple. Be patient, it may take a minute or two for milk to appear.


• Once you get the rhythm going keep pressing until the flow slows or stops. Then move your fingers around your breast and try a different section of your breast. Again, think of your breast as a clock and try 2 o'clock and 8 o'clock to get the ducts there, then 4 o'clock and 10 o'clock, and work your way around.


• Then go to the other breast and repeat. If your fingers feel tired, use your other hand.

Massage your breasts gently before you start expressing your milk and several times during the process to work your milk down to the nipple. Warm compressions or a warm shower may help you relax and prepare to express breastmilk.

Once you have had a bit of practice, you may find your milk sprays out. If this is the case try collecting your milk using a funnel inside your container. Scald the funnel first with boiling water.

It does take time to learn how to express by hand, but keep going. Many mums find that, once they become skilled at it, they can hand express a lot of milk in less time than it takes to use a manual or electric breast pump. Applying a warm compress on your breasts or having a warm shower just before expressing can help start the letdown reflex

Expressing breastmilk

 

What does expressing breast milk mean?

Expressing is simply a way of taking milk from your breast without your baby suckling. You can express breast milk:

• by hand
• with a manual pump
• with an electric pump

Once you've expressed your milk, you can store it in the fridge or freezer and offer it to your baby in a paladai, katori or bottle later.

Why should I express milk?

Expressing breast milk has many benefits:

• Whether you're just out for a few hours, or have gone to work, your baby can still have the benefits of breastmilk. This can be done even when she is cared for by someone else.
• You may choose to express breastmilk if you don't want to nurse your baby in public but wish to feed her breastmilk.
• It is also useful in cases of multiple births and you are unable to breastfeed more than one baby at a time.
• If you gave birth prematurely, your baby may have trouble latching on to your breast. You can help her by expressing your nutritious breastmilk.
• It is great way to increase your overall milk supply.
• It can help to relieve engorged breasts.
• It can help to prolong breastfeeding by keeping up your milk supply. If you are unable to breastfeed for some time because, for example, your nipples are sore or you're taking medication that can be harmful to your baby.

How do I express breastmilk?

Expressing by hand is the cheapest way to do it, because you don't need to buy equipment. It does take a bit of getting used to. The trick is to put pressure on the milk ducts behind your nipple, rather than squeezing the nipple itself. It's a useful knack to have and can help you to relieve your breasts if they're too full. Find out more about expressing by hand.

You may find it easier to use a manual or electric pump. To use an electric pump, you put a suction cup over your breast, turn the machine on, and let it do the work. It'll extract your milk, depositing it in an attached container. Manual pumps also use a suction cup, but you'll have to repeatedly squeeze a handle to extract your milk.

It takes anywhere between 15 minutes and 45 minutes to pump both your breasts. Don't use time to guide you, though. Just pump for as long as your milk is flowing well. Change breasts when the flow slows down, and pump each breast twice. Good breast pumps try to mimic the sucking action of your baby, stimulating your milk to come in (letdown reflex). Expressing shouldn't be painful.

Knowing which breast pump is right for you depends on:

• how often you plan to use a pump
• how much time you can spare for feeding

If you only need to express the odd feed, expressing by hand or using a cheaper manual pump may do. But if you work full-time and have to pump during a busy day, you might want to choose an ultrafast hospital-grade electric pump. These are expensive to buy, so find out if you can test or hire one first to try it out.

How do I use a breast pump to express milk?

If you're using a breast pump, try these tips:

• Sit comfortably with your back straight.
• Support your breast from underneath. Place your fingers flat on your ribs with your first finger between your breast and your ribs.
• Ease your nipple into the funnel. Make sure your nipple is in the centre of the funnel.
• Keep the funnel close enough to maintain a seal with your skin, without forcing it onto your breast.
• Be patient. It often takes a minute or two for your milk to flow well.
• Pump until the milk flow slows down, and then switch to the second breast. When the flow slows on the second breast, go back to the first. Finally, finish on the second when the flow slows for the second time.
• If you are pumping both breasts at the same time (double pumping), turn the pump off for 30 seconds or so when the flow slows. Then turn it back on and carry on until it slows again. Using a double pump can be tricky at first - you only have two hands! But keep practising and it will get easier.

If you are not producing as much milk as you would like, read our tips on increasing the amount of breastmilk you express.

How do I store breastmilk?

It is best to put breastmilk in plastic feeding bottles with secure tops to seal in freshness. You can also use plastic bags made especially for storing milk, or disposable baby bottle liners. Remember to write the date on the bottle or bag before putting it in the fridge or freezer. It'll make it easy for you to work out in which order to use batches.

To keep your milk safe in the fridge, you need to know how cold your fridge is. If your fridge doesn't have a built-in thermometer, you can buy one from a chemist shop. Also, don't store too much breast milk if you have frequent power cuts and no provision for back-up electricity. Fluctuations in temperature can spoil your precious breastmilk.

Freshly expressed milk can be stored for:

• up to five days in the main part of a fridge, at 4 degrees C or lower
• up to two weeks in the freezer compartment of a fridge
• up to six months in a freezer, at minus 18 degrees C or lower

If you plan to store expressed breastmilk for fewer than five days, keeping it in the fridge is the best way to maintain all its goodness.

As well as a breast pump and containers for milk storage, you may need a portable ice box to carry expressed milk home from work. Read our article about work and breastfeeding to find out more.

How do I thaw frozen expressed breastmilk?

Freezing milk destroys some of its antibodies. Antibodies are chemicals our bodies make to fight infections. So it's best not to freeze any that you plan to use within the time limits. Frozen breastmilk is still healthier for your baby than formula milk.

You can thaw frozen milk in any of the following ways:

• place the bottle or bag in a bowl of warm water
• place the sealed bottle or bag under a tap with running warm water
• defrost it in the fridge overnight

It's tempting to speed up the thawing or warming process, especially when you're busy. But using a microwave or gas stove to do the job will kill the nutrients in your breastmilk. Once the milk is thawed, use it straight away. Throw away partially drunk portions of milk. The milk will have mixed with your baby's saliva and may not be hygienic for her next time.

Expressing and the working mum

What are the advantages of expressing at work?

Expressing milk at work can be time-consuming, and doing such a personal thing in a work environment can feel strange. But many mothers find that it is worth the effort. You are still able to give your baby the benefits of breastmilk. And expressing can help you to feel close to your baby while you're away from her.

Expressing is also a great way of keeping up your supply of breastmilk, which will prove useful on weekends when you are home with your baby. It will also ensure that your breasts don't feel painful or leak when they are full.

There is another benefit. Mums who give their babies breastmilk take less time off work than mums of formula-fed babies. That's because breastfed babies are ill less often.

You'll also be coming home to a baby who still wants to breastfeed. You get to snuggle with her straight away, re-establish your bond, and nurture her in a way that nobody else can. To make the most of this special moment, ask your baby's carer to feed her as little as possible in the hour before you get home. Then you and your baby can have a satisfying reunion.

How do I go about expressing breastmilk at work?

It's a good idea to start at home before returning to work. Then you'll know what to expect and can set up a routine. Express after as many daytime feeds as you can, and start to build a supply in the freezer. Your baby will then have milk for your first day back at work. Read more about how to store breastmilk properly.

You will get less milk expressing after a feed than if you express a full feed. But if you express in between feeds and breastfeed as well, you may over-produce milk and feel uncomfortable. You will probably collect very little milk at first, but soon you'll have a useful amount after every expressing session.

Going back to work may be physically and emotionally exhausting for you. It may be a good idea to return to work on a Thursday or a Friday, so that you get a break soon after you join. If possible you may want to consider starting with half days at work or working from home for a few hours every day. Slowly returning to full working days may make the transition easier for you and your baby.

To express breastmilk at work, it may be a good idea to first speak to your supervisor or your HR manager. It is important to let them know that you'll need to take two or three breaks in the day to express breastmilk. Also you may want to talk about a comfortable and safe environment in which you can express. This is vital if you don't have privacy at your work space or if the staff restrooms are not clean.

Ideally, you should have access to a private room at work, such as an unused office or conference room. Or even a large, clean storeroom with a chair, a table, and a power point. Ask the human resources staff for suggestions, and try to enlist the support of a colleague or manager. If there's some demand (even two mothers is enough), you could lobby to create a nursing mothers' area in the office.

You will need to bring some equipment to work with you:

• A breastpump. Double electric pumps are most efficient, but they are expensive. Many mums find that hand pumps work just as well for them.
• A coolbag or coolbox lined with frozen ice packs.
• Breast pads.
• Bottles.

You'll need access to a fridge to store your milk during work hours. Milk bags are available that are lined with gel packs. These maintain the right temperature for up to 12 hours. They can be practical if you do not have access to a fridge at work.

Should I tell my colleagues that I'm expressing?

You don't have to tell your colleagues what you're doing during your breaks if you feel uncomfortable. But you should tell your supervisor and your HR manager. They need to know that expressing milk won't interfere with your work.

Reassure them that by feeding your baby in this way, you will have much more peace of mind that your baby is only getting the best. This will leave you free to concentrate exclusively on your office work. You may also want to discuss how breastfeeding affects your baby and keeps her healthy, reducing the number of leave days you'd take.

At Breastfeeding Promotion Network of India you may find useful information about breastfeeding and returning to work for employees and employers.

How can I maximize my milk flow?

While you're expressing at work, try to relax and think about your baby. You could take a photo of your baby, or a little item of her clothing, to work with you. Thinking about your baby can help you to produce plenty of milk. Read our tips on how to express more milk for other tips.

When should I express?

It's up to you how often you express, but try to do it at the same time every day. Pumping once or twice a day is probably realistic, and it will be enough to keep up your milk supply.

What do I do with my breast milk after I express it at work?

This takes a bit of organisation, but once you're in the routine, it should become easier:

• Pump and store milk either in sturdy plastic bottles or plastic bags made for the purpose. Glass bottles aren't a good idea as they can break, and the white cells in milk tend to cling to glass. The downside of plastic bags is that they can tear and fall over.
• Label and date the bottles and bags, and use the oldest ones first. Leave room at the top of each bottle or bag for expansion during freezing.
• Store freshly expressed milk, well-labelled as yours, in the office fridge or a cooler while at work. Bring it home in a cooler with an ice pack if your journey is longer than 30 minutes. Freshly expressed milk is fine at room temperature (no warmer than 25 degrees C) for six hours.
• If you refrigerate or chill freshly pumped milk, you can add it to a bottle of already frozen milk.
• If you refrigerate the milk you pump on Monday, whoever is looking after your baby can give it to her on Tuesday, and so on. After your first day back at work, you might not need to use frozen milk again.
• Thaw milk by holding the bottle or bag under warm running water or by placing it in a bowl of warm water. Heating it up in the microwave or on the gas will destroy some of the nutrients. Dry the container with a clean wash cloth before you open it. The milk will have separated, so you will need to shake it gently before giving it to your baby.

Tips for expressing breast milk at work

• If you find that colleagues are critical of expressing breast milk at work, it's best not to let their attitude or comments bother you. It may be more useful to focus on the positive aspects of being back at work and on the fact that you are making a decision that is great for you and your baby.
• You would need to wash the pumping equipment after you are done. If clean and safe water is unavailable it may be a good idea to carry a bottle of drinking water along to wash the pump.
• Try to ensure that you don't go more than three hours without expressing breast-milk or your breasts may get full and painful.
• Using breast pads may be useful to deal with drips and leaks which are common in the first few months of breastfeeding and when your breasts are full.
• You may like to leave a set of clothing such as a shirt or a salwar suit at your workspace. This may be useful in case you have an accident while expressing or have leaked onto the top or kurta.
• It may be useful to invest in a pump that makes minimum noise.
• An electric pump with batteries is useful if you can't find a convenient power point or during a power cut.
• Your supervisor may ask questions such as how often and how much time you would need to express breast milk, and what resources you may require from the office. It may help to think about these questions and have the answers prepared.
• If you are storing your expressed breast milk in the office refrigerator, it may be a good idea to place the container in a packet or bottle cover and mark it with your name. Read our article on breastfeeding and working for more help.

Do mothers have to breastfeed? What if I don't want to?

Many mums choose to breastfeed. It's a lovely way to care for your baby, and has many health benefits for you both. When it's going well, breastfeeding can help you to build a close bond with your baby.
However, breastfeeding isn't the only way to care for your baby. There's no evidence to say that babies who are formula-fed are less well-loved than breastfed babies. Though breastmilk is good for your baby, you don't have to breastfeed, or feel that you are a second-class mum, if you choose to feed your baby with formula milk.
Some women cannot breastfeed for medical reasons while others really don't like the idea of breastfeeding. Or they try it and find it just doesn't feel right for them. There may be all sorts of reasons why you feel this way, and you may not even be able to explain some of them.
Perhaps you are worried that you won't be able to breastfeed successfully. Or maybe your mum or sister didn't breastfeed, so you think you won't be able to either (which isn't true!). Maybe you're a second-time mum, and because you found breastfeeding difficult with your first baby, you don’t want to go through it all again.
It’s a good idea to get plenty of information about breastfeeding before you make up your mind. Talk things over with your doctor or speak to a breastfeeding specialist, while you're pregnant. You could take antenatal classes, as breastfeeding is one of the topics discussed. Read tips from other breastfeeding mums for more help.
No one should try to make you feel you 'ought' to breastfeed. But medical experts are likely to point out the benefits of breastfeeding, while supporting your right to not do it.
Like some mums, you can leave the decision until your baby arrives. Although, it's not easy to switch from formula feeding to breastfeeding, it can be done. If you start formula feeding and later decide want to give breastfeeding a try, talk to your doctor to get help in building up your milk supply.
If you aren't sure one way or the other, you could try breastfeeding first. Breastfeeding for the first three or so days means your baby will get the benefit of your first milk (colostrum), which is full of antibodies. These help to strengthen your baby's immune system and fight infection. Any amount of breastfeeding has a positive effect, but the longer you breastfeed, the greater the benefits.
Some mums start breastfeeding and then make the switch to formula. This most often happens because they didn't get the help and support they needed to tackle breastfeeding problems, or because they lost confidence. They can feel angry, depressed and disappointed, and sometimes regret how things worked out.
Some mums prefer to express milk, put it in a bottle and feed their baby. They find it easier than breastfeeding and their baby still gets the benefits of breastmilk. Read more about how to store expressed breastmilk.
Whatever your reason for not breastfeeding, or for stopping breastfeeding, there's no reason for you to feel guilty. If breastfeeding didn't work out for you, talk through your feelings with your doctor, a breastfeeding specialist or a family member. It may help you to hear an explanation, to learn it wasn't your fault, and that you don't have to breastfeed to be a great mum.

How can I make sure my husband doesn't feel excluded when I breastfeed?

With public awareness messages promoting breastfeeding, talks with your doctor and family members, chances are your husband is well informed about the importance of breastfeeding. So he’s likely to be supportive when you breastfeed.
If your husband wants to know more, you could spend time together reading up on the benefits of breastmilk. This way, he’ll understand your reasons for breastfeeding and have a better idea of what to expect.
However, it’s possible your husband may feel left out because all of your attention is now focused on your baby.
Also, in many households having a baby is an affair for the entire family, and dads aren’t usually as involved with taking care of the baby. And, if you observe confinement a family member or dai will probably help out with your baby’s daily routine instead of your husband.
But with a growth in nuclear families, more and more new dads want to play a greater role in taking care of their babies.
Just supporting you, and encouraging you, is a wonderful thing for your husband to do. Research shows a spouse's support can make a big difference, especially in the initial days, when both your baby and you are getting used to breastfeeding.
Happily, your husband can be involved even when you breastfeed your baby, such as burping her after a feed. There are so many other ways for your husband to bond with your baby:

• reading or singing a lullaby
• giving her a massage
• soothing and talking to her when she’s upset
• dressing and changing nappies
• bathing

You can, if you want, express breastmilk for your husband to give in a paladai or bottle. But don't feel you have to do this in order for him to get close to the baby.

All these things are important times for interacting with your baby, and they can be done by either of you, or both of you together. You could get your husband to take care of your baby by himself for short periods of time initially.

You may get resistance from relatives who consider child care to be only a woman’s domain. Talking to your husband about such criticism may help you both figure out how you want to tackle the situation.

Extended breastfeeding: is it for you?

 

What is extended breastfeeding?

Extended, or long-term breastfeeding is when you continue to breastfeed your baby beyond his first year.

If you decide this is right for you and your baby, you're in good company with mums around the world. The average length of time mums breastfeed their children across the globe is about four years.

The World Health Organization and the Ministry of Health recommends you continue to breastfeed till your baby is two years old. Despite this advice, and the global trend for extended feeding, you may feel uncomfortable about breastfeeding your toddler or preschooler. Extended breastfeeding or breastfeeding beyond the first year is a matter of personal choice. And as a mum you would be able to decide what works best for you and your baby.

The hardest part of extended breastfeeding can be putting up with unwanted comments and stares from friends, family, and strangers.

But don't let others pressure you to stop. There are plenty of good reasons, emotional and physical, for continuing to breastfeed your child. It's up to you to decide what's right for you both.

Why is breastfeeding my toddler a good idea?

Here are the benefits of extended breastfeeding:

• Even though your child is now getting most of his nutrition from solid food, breast milk still provides valuable vitamins and enzymes.
• If your child is ill, breast milk may be the only thing he can keep down. You'll feel better too, knowing that you're helping him fight off the illness.
• Breastfed toddlers usually get sick less frequently than their peers do. If your child is prone to allergies and infection, breast milk can provide immunity to reduce the effect of the infection as well.
• Toddlers are always on the go, and you will be too, just to keep up! Breastfeeding gives you both a chance to take time out for each other.
• As your child matures, breastfeeding can be an important way to comfort and feel close to him. The strong attachment your child feels with you while feeding will actually help him to be independent, rather than clingy. Forcing a child to stop breastfeeding before he is ready will not necessarily create a more confident child. So, it's best not use tactics such as applying neem or bitter gourd (karela) juice to your nipples.
• Breastfeeding your baby beyond his first year also means you won't have to bother with formula feeding at all.
• If you travel a lot, breastfeeding is a lot easier than carrying around milk or worrying about having to buy supplies when you reach. And when you're staying overnight in a strange place, the comfort of your breast may be the best way to soothe your child's fears.

What are the challenges with extended breastfeeding?

You may find yourself in some uncomfortable situations at times. It may help to keep the following in mind:

• You may get comments and criticisms from people who think breastfeeding an older child is strange.
• You may feel inhibited about breastfeeding in public, especially if you've already experienced people making comments. This can be difficult if your toddler lifts up your shirt in the market and demands a quick snack.
• Your child may start to rely on your breast when he's really just bored or it's the only way to get your attention. However, it is easy to distract your child and interest him in other ways. Toddlers are eager to explore the world and need stimulation to fuel their rapid development.
• Breastfeeding a toddler when you're pregnant is possible. But you may find it physically demanding. Unless you plan to continue breastfeeding your older child after your baby is born, you may want to think about weaning him before the birth. You may find your toddler is happy to wean himself. The taste, and sometimes amount, of your milk changes during pregnancy.

How can I make extended breastfeeding work for me?

Try these tips to make extended breastfeeding a little easier:

• If you can, find like-minded mums. Then you'll have a support network of long-term breastfeeding friends around you. Our community is a great place to meet mums who may be in the same stage as you.
• You may feel more comfortable breastfeeding your child only while you're in your own home. If that's the case, feed your child before heading out. You could breastfeed once in the morning and once at night and teach your toddler to drink from a cup during the day.
• If you don't care what people think or say, then have some responses ready when someone asks you the inevitable question: "Is he still feeding?" Sometimes a simple "yes" is the best conversation stopper.
  Or, the next time you're feeding in public and someone asks, "Are you ever going to stop breastfeeding?" say, "Yes, in about 10 minutes."
• You can teach your child a code word for your breasts, so that when he starts demanding "numnum" or "mama" in the middle of a restaurant, no one will pay any attention.
• If you're coming under pressure about extended breastfeeding, remind yourself and others of what a wonderful job you are doing, helping your child to grow.

With the right support, and a certain amount of determination, you and your baby can look forward to many more months, and possibly years, of happy feeding.

Breast feeding problems and solutions : thrush

What is thrush?

Thrush is a fungal infection (candida albicans) which can affect your breasts and your baby's mouth when he is breastfeeding.

What causes thrush?

All of us carry the candida albicans fungus in our bodies. It's a normal part of our digestive system, and good bacteria usually keep it in check. But now and then it gets a chance to grow and spread, which can lead to an infection.

Breastfeeding creates the perfect environment for thrush. Thrush thrives in warm, moist, sugary places, which is exactly what your baby's mouth is like during breastfeeding. The thrush infection can then pass to your nipples.

Thrush may take hold more easily if your nipples are already sore or cracked, perhaps because your baby isn't latching on properly. Unless it's treated, thrush can pass back and forth between you and your baby.

You can also get thrush on your breasts if you do not change your breast pads frequently enough.

Some experts say that thrush is becoming more common. This may be because we often use antibiotics to tackle all kinds of infections. Antibiotics kill off the friendly bacteria in our gut that can help to keep thrush in check. Antibiotics are given at every delivery in India. At times, thrush can be the result of medications used during labour and delivery especially if you have had a caesarean section.

How will I know if I have thrush?

Here are the common signs of thrush in breastfeeding mums:

• Cracked nipples which don't heal, even though your baby is latching on well.
• Nipples that are pink, or red and shiny, perhaps with white areas.
• Nipples that become sore after a period of pain-free breastfeeding. The pain often becomes more intense as your baby feeds, and can last for up to an hour after a feed.
• Itchy nipples, which may be extremely sensitive to any touch, even to loose clothing.
• A burning sensation in your nipples.

However, if your nipples are sore, painful or cracked, it could be some other problem besides thrush. It's more likely that your baby is not latching on to your breast well when he feeds. Take a look at the pictures in our article on how to breastfeed and read our expert advice on how to know if your baby is latched on correctly, if you're not sure.

Occasionally, thrush on your nipples can enter your milk ducts, the channels along which your milk flows to your nipple. This can cause shooting or burning breast pain deep in your breasts, and is called ductal thrush.

Unlike letdown pain, which doesn't last long, thrush pain lasts while your baby is feeding and usually gets worse after feeds. It's unusual to get ductal thrush, and some experts even doubt that ductal thrush exists.

How will I know if my baby has thrush?

If your baby has thrush, white patches that look like milk curds will usually appear on his tongue, gums and on the inside or roof of his mouth. If you touch these gently with a clean finger, you'll find the base is raw and may bleed. Your baby may be unsettled, or only feed for a short time. He may pull away from your breast while feeding because his mouth is sore.

Thrush can pass through your baby's digestive system to his bottom and cause nappy rash. The rash is usually sore with red spots, and may take a while to heal.

How is thrush treated?

If you suspect thrush, speak to your doctor for treatment. She will probably prescribe an antifungal medication. If you have an infection on your nipples, the chances are that your breastfed baby has it, too, even if you can't see any white spots. He needs treatment just as much as you do at the same time. Or you may pass the infection back and forth.

If your nipples are very red and sore your doctor may prescribe a mild steroid cream to help with healing.

Your nipples and your baby's mouth, and possibly bottom, should be treated at the same time. If you have resumed sexual intercourse, it might be a good idea to get your husband checked as well.

Thrush can take up to a few weeks to cure completely, though the pain should ease after a few days. If it doesn't, go back to your doctor.

As well as taking medicine, there are other things you can do to keep thrush at bay:

• Sterilise pacifiers, bottles, teats and breast pump parts, or clean them in boiling water after each use, to avoid re-infecting yourself or your baby.
• Wash toys in hot, soapy water.
• Wash your and your baby's clothes in hot water, to kill off the fungus. Some mums also add disinfectant liquid or vinegar.
• Use only plain water to wash your nipples.
• Try to keep your nipples as dry as possible, as thrush flourishes in damp conditions.
• Use a separate towel for everyone in the family, and change it daily.
• Some mums find that cutting down on sugary foods and foods that contain yeast (such as bread) helps.
• To ease deep breast pain, you can take a mild painkiller, prescribed by your doctor. This will help until the worst is over and your treatment begins working.
• Garlic is found to be effective against thrush and other fungal infections. You could try whole, peeled cloves of garlic in your cooking.

You could add probiotics in the form of pills or natural live curd to your daily diet. This helps the friendly bacteria to suppress thrush to grow again in your digestive tract. But don't rely on them to fight your thrush infection. You'll need treatment as well.

Some mums find homeopathic medicine helpful, but it is essential to consult a qualified, registered practitioner for treatment. It's also a good idea to speak to your doctor before trying herbal or home remedies.

Can I still breastfeed if I have thrush?

Yes. Thrush shouldn't prevent you from breastfeeding your baby, though it can make it painful. You can carry on breastfeeding while you're both being treated. If you expressed milk when your baby had thrush, throw it away and don't freeze it. This will prevent your baby from becoming re-infected.

Breastfeeding Problems and Solutions : Leaking breasts

It’s normal for your breasts to leak or even spurt milk during the first few weeks after you have your baby.
Milk leaks can be inconvenient and sometimes embarrassing. But it’s actually a good sign that your body is capable of making lots of milk for your baby.

Why are my breasts leaking?

Your breasts will leak when they become so full of milk that they overflow, or when something triggers your let-down reflex. You might find you leak when you’re feeding your baby from your other breast. Sometimes, hearing your baby cry, or just thinking about your baby, can cause your breasts to release a little milk.

How long will my breasts leak for?

Although everyone is different, you’ll probably find you leak the most during your first few weeks of breastfeeding. It takes a little while for your body to adjust to your baby’s feeding needs. Many mums find the leaks stop over the first six to 10 weeks of breastfeeding.

How can I stop my breasts from leaking?

There’s no guaranteed way of stopping your breasts from leaking. However, breastfeeding or expressing before your breasts become too full does seem to help.

If leaking is becoming a real issue for you, feed your baby as often as possible. The more you breastfeed, the less likely your breasts are to overflow. Experiment with different positions until you find one where he can latch on really well. Once you find a breastfeeding rhythm that’s best for both of you, the problem should settle down.

You may not be able to control your milk overflow, but you can plan for it:

• Wear breasts pads inside your bra. Remember to change them when they become damp though, otherwise your nipples could become sore. If you’re out and about, carry plenty of breast pads with you.
• Try using washable plastic breast shells. If you sterilise them first, you can store and freeze the milk that collects in them.
• If one breast always leaks when you’re feeding on the other side, place a cloth or breast pad inside your bra.
• Wear tops that camouflage milk stains. Prints and patterns work well. If you're out for the day, take a spare top. The pallu of your sari or the dupatta of your salwar kameez can also work well to hide any stains.
• If you feel a let-down tingle at an unexpected moment, cross your arms and press gently against your breasts. This might stop the unwanted flow.

My breasts never leak. Do I have enough milk?

You're sure to have enough milk. Leaking breasts don’t relate to the amount of milk you have. Many mums never leak at all. It all depends on how the tiny muscles at the opening of the nipple pores work. These muscles squeeze open and shut, controlling how much milk flows out. If your muscles are very efficient, your breasts probably won’t leak at all.

Breast feeding problems and solutions : Sore nipples

Is it normal that my nipples pain when my baby feeds?

Painful nipples are so common to new nursing mums that many think they are part and parcel of breastfeeding. But there is a lot you can do to help or prevent sore nipples. It's normal to feel some tenderness at the beginning of a feed during the first few days of breastfeeding. But severe or lasting pain is not normal. Breastfeeding should be enjoyable for you and your baby. If it isn't, it's a sure sign that you need to make some changes.

What causes painful nipples and what can I do about them?

A variety of things may be making your nipples hurt, but it's most likely to be the way your baby is breastfeeding. If the technique's not right, and your baby is not latching on well, the result could be pain for you. One or several of the following problems could be giving you painful nipples:

Cause	Problem	Solution
Difficulty latching on	If your baby has to suck or pull your nipple into her mouth it can become painful for you.	Check that your baby is latching on properly by seeing our illustrated guide on how to breastfeed. If your nipples are very painful and cracked or bleeding, you can use a purified lanolin ointment or cream on them.
Tongue-tie	This means that your baby's tongue is attached to the bottom of her mouth. This will stop her from latching on well.	Ask your doctor to check your baby's tongue. Tongue-tie can be easily treated in young babies by a simple procedure called a frenulotomy.
Thrush	If your nipples are painful after a spell of pain-free feeding, you might have thrush.	Your doctor can prescribe an antifungal treatment for you and your baby. If you have thrush on your nipples, it will also be in your baby's mouth.
Dermatitis	Inflamed and itchy nipples could be the sign of dermatitis. This can be caused by creams, lotions or soaps that irritate your skin.	Wash your breasts with clean water only.
Teething	When your baby is teething, she might bite or chew on your nipples leaving them sore	If your baby is latched on well, the nipple will be too far into her mouth to bite on. So make sure your baby latches on properly. You can do this by touching her lips to your nipple and then moving her quickly onto your breast as she responds.
Breastfeeding during pregnancy	Your nipples are tender because you're pregnant again and this might make breastfeeding painful.	You'll have to be patient! Your nipples should only be tender in the early days of your new pregnancy. If your nipples get really sore, you can use a purified lanolin ointment or cream to soothe them.
Soreness from your bra or breastpads	A badly fitting bra can put pressure on your nipples. Some breast pads and plastic linings in bras may also be culprits. They don't let your skin breathe, making the problem worse by trapping too much moisture.	Buy a bigger or more comfortable bra. Use breastpads made from natural materials. If your nipples are cracked you could also try healing pads.

Will my sore nipples affect my baby?

If your nipples are sore your baby is unlikely to be latched on well at the breast. This may mean that your baby doesn't get enough of the calorie-rich hindmilk at the end of a feed. If this is the case, she may not put on enough weight and is unsettled after feeds.

Can I breastfeed my baby even if I have sore nipples?

Yes. But if you're still feeling very sore even after trying the above tips, consult your doctor.