Breast feeding - Expressing breast milk

When direct breastfeeding is not possible a baby can still be fed breast milk. By expressing (artificially removing and storing) her milk, a mother can enable her child to be fed with her milk while she is away. With manual massage or the use of a breast pump a woman can express her milk and keep it in freezer storage bags, a supplemental nursing system, or a bottle ready for use. This container may be kept at room temperature for up to ten hours, refrigerated for up to eight days or frozen for up to four to six months. Research suggests that antioxidant activity in expressed breast milk decreases over time but it still remains in higher levels than in infant formula.

Expressing breast milk can keep up a mother's milk supply when she and her child are apart for long. If a sick baby is unable to feed, expressed milk can be fed through a nasogastric tube.

Expressed milk can also be used when a mother is having trouble breastfeeding, such as when a newborn causes grazing and bruising. When an older baby grows teeth and bites the nipple, the mother's reaction - a jump and a cry of pain - is usually enough to discourage the child from biting again. Babies or toddler that are truly feeding cannot physically bite the nipple, if they are, they arent' feeding but playing.

It is generally advised to delay using a bottle in feeding expressed breast milk until the baby is about 4-6 weeks old and is good at sucking directly from the breast. This is to avoid nipple confusion and nursing strike, when the baby prefers to suck from bottle, which takes less effort, and so loses its desire to suck from the breast. If feeding expressed breast milk (EBM) must be done before 4-6 weeks of age, it is recommended that it be given by other means such as feeding spoons or feeding cups. Also, EBM should be given by someone other than the breastfeeding mother (or wet nurse), so that the baby can learn to associate direct feeding with the mother (or wet nurse) and associate bottle with other people.[citation needed]

Some women donate their expressed breast milk (EBM) to others, either directly or through a milk bank. Though some dislike the idea of feeding their own child with another woman's milk, others appreciate being able to give their baby the benefits of breast milk. Feeding expressed breast milk—either from donors or the baby's own mother—is the feeding method of choice for premature babies.

Breastfeeding - Exclusive breastfeeding

Exclusive breastfeeding is when an infant receives no other food or drink, or even water, besides breast milk (whether expressed or through breastfeeding).

International guidelines recommend that all infants be breastfed exclusively for the first six months of life. While each country has its own policy regarding infant feeding, it is generally accepted that newborns should be exclusively breastfed for around 6 months, and that breastfeeding should continue with the addition of appropriate foods, for two years or more. The practice of exclusive breastfeeding has dramatically reduced infant mortality in developing countries due to a reduction in diarrhea and infectious diseases.

Exclusively breastfed infants feed, anywhere from 6 to 14 times a day. Their requirements vary greatly. Newborns consume from 30 to 90 ml (1 to 3 US fluid ounces). After the age of four weeks, babies consume about 120ml (4 US fluid ounces) per feed. Each baby is different, and as it grows the amount will increase. It is important to recognise the baby's hunger signs and it is advised that the baby should dictate the number, frequency, and length of each feed, based on the assumption that it knows how much milk it needs. The supply of milk in the breast is determined by the frequency and length of these feeds or the amount of milk expressed. The birth weight of the baby may affect its feeding habits, and mothers may be influenced by what they perceive its requirements to be. For example, a baby born small for gestational age may lead a mother to believe that her child needs to feed more than if it larger; they should, however, go by the demands of the baby rather than what they feel is necessary.

It can be hard to accurately measure the amount of food a breastfed baby consumes, but babies normally feed to meet their own requirements. Babies that fail to eat enough may exhibit symptoms of failure to thrive. If necessary, it is possible to estimate output from wet and soiled nappies (diapers): 8 wet cloth or 5–6 wet disposable, and 2–5 soiled per 24 hours suggests an acceptable amount of input for newborns older than 5–6 days old. After 2–3 months, stool frequency is a less accurate measure of adequate input as some normal infants may go up to 10 days between stools. Babies can also be weighed before and after feeds.