When’s the right time to stop breastfeeding?

It is recommended that you start offering solid foods when your baby is around 6 months old. The 4–6-month window is the most optimal to reduce the chances of your baby developing a food allergy. However, do look out for the following signs to indicate that your baby is ready to eat solids:

• Your baby can hold their head up
• They can sit up well in the support of their highchair
• Your child shows interest in mealtimes and food
• They can move food to the back of their tongue and swallow

If you’re unsure, please make sure to check with your doctor.

After you’ve introduced solids, you can start weaning them or continue to breastfeed you baby along with other foods until you’re ready to fully wean them.

How to stop breastfeeding

It is important that you do this gradually. Suddenly stopping breastfeeding might lead to engorgement which can be very uncomfortable. You are also at higher risk of developing mastitis or clogged ducts. Thus, you’ll still need to express your milk sometimes. Express just enough for comfort. If you express too much, it won’t reduce your milk supply and the weaning will take longer.

Some mums will go from one feed a day to one feed every few days to reduce the aforementioned symptoms, before stopping breastfeeding altogether.

Night weaning

When your kid is six months old, you can think about night weaning for breastfed babies or phasing out night feeds for bottle-fed babies. Most babies at this stage are getting enough food during the day for healthy growth and development.

However, if you’re comfortable with feeding your baby at night, there’s no hurry to phase out night feeds. It’s good to chat with your doctor prior to weaning to get individual advice.

If night wean, you baby will still get all the benefits of breastmilk if you continue breastfeeding during the day.

If your baby’s nighttime feed is short (less than 5 minutes) you can phase out night feeds by stopping the feed altogether and resettling your baby with your favourite settling technique. Note that it’ll take a few days for your baby to get used to the new routine.

If your feedings last for a longer period of time, you can gradually cut down the length of feeding over 5-7 nights, which will help your baby get used to the change.

Weaning for the baby

You can wean your baby to a cup or a bottle, it depends on your baby’s age. By 7-8 months old, babies can generally learn to drink from a cup.

The age of your baby also determines if you should replace breastmilk with formula or cow’s milk. If your baby is younger than 12 months, you should not offer them cow’s milk. They will need to be weaned onto formula.

Before you start weaning, you need to replace the breastfeed your baby seems the least keen on with expressed breastmilk, infant formula or cow’s milk, from a cup or bottle. Drop one feeding at a time and wait a few days before dropping the next one.

Stopping breastfeeding before six months

If you’re unable to continue breastfeeding until six months and want to try mother-led weaning, start by cutting out one breastfeed a day and replace it with formula.

Ideally, start with the mid-day feed. Be careful and mindful of good hygiene when preparing feeds. Your baby may take fewer feeds of expressed breast milk than from the breast during a 24-hour period. Don’t force them to take more milk than they want.

Once your body is used to this new volume, cut out another feed per day. Repeat until you’re no longer producing milk and your baby is fully weaned.

If you want to maintain the intimacy and health benefits of breastfeeding, but need to cut back, try partial weaning, where only some of the feeds are replaced with formula.

Stopping breastfeeding naturally over time

You can also choose to let your toddler decide when to stop breastfeeding (baby-led weaning or natural-term breastfeeding). The weaning process is likely to be slow and gradual. Over the months, her feeds will become shorter and less frequent, while they might also just lose interest one day.

Your body should have time to adapt, do you’re unlikely to experience any uncomfortable engorgement. You may find it tough emotionally however, so make time for plenty of cuddles and bonding moments.

Stopping breastfeeding quickly

Although this isn’t ideal, sometimes it’s necessary to stop breastfeeding suddenly for health reasons.

You’ll almost certainly need to express milk to avoid your breasts becoming uncomfortably engorged. Only express to easy any discomfort since you don’t want your body to produce more milk.

Your breasts may feel swollen and tender, but they will adapt. However, this may take days or even weeks.

Things to note about weaning

When weaning an older baby or toddler, it’s best to go slowly if you can.

It’s also normal to feed a bit down after your last feed, even if you were looking forward to it.

Your hormones may time some time to return to normal. Some women begin ovulating as soon as they reduce night feeds or begin to wean, while others find that ovulation and menstruation takes a few months.

Tandem breastfeeding and how to make it work

Breastfeeding can be stressful, but after months of trying to make it work, you finally get the hang of it. You and your baby are both happy and healthy, and suddenly you realise you are pregnant. You’ll probably have a lot of questions. Should you continue nursing? Do you have to wean your baby? Is your milk safe for your baby to consume? In this article, we’ll talk about tandem breastfeeding, why breastfeeding while pregnant is safe, its benefits and some tips on how to make it work! Do remember to check with your doctor regardless of what your decision is.

What is tandem breastfeeding?

Tandem breastfeeding or nursing is breastfeeding more than one child at the same time. For instance, a toddler and a newborn at once.

It’s a common misconception that once you get pregnant, you must stop breastfeeding for the health of you and your baby. However, this isn’t the case. Let’s talk about what breastfeeding while pregnant is actually safer than you think.

Why breastfeeding while pregnant is safe

Development of the unborn baby

Many mummies think that breastfeeding during pregnancy deprives your foetus of its nutrients. This isn’t true if you eat enough! During your second and third trimester, you need to eat an additional 350-450 calories per day, on top of what you need to consume for breastfeeding. This means breastfeeding while pregnant means you need an additional 500 to 650 calories per day. You’ll also need sufficient protein and calcium intake while taking in enough fluids!

Uterine contractions

You’ve probably heard that breastfeeding while pregnant causes contractions and premature labour. The reasoning behind this is that oxytocin, produced and released during breastfeeding stimulates labour.

However, it should be noted that the amount of oxytocin released while pregnant and breastfeeding is a lot less than the amount released when you are breastfeeding but not pregnant. This means that the amount of oxytocin released is not enough to cause your cervix to prematurely dilate or cause contractions.

Miscarriage fears

You may have heard that breastfeeding while pregnant causes miscarriages. But there’s no evidence to support this claim.

Miscarriages can occur due to many factors and oftentimes there is no explanation for one.

Milk compatibility for a nursing child

While it is true that pregnancy hormones pass into your milk, it is not true that they make the milk unsafe for your nursing child. Only a small amount of these hormones pass into your milk and they pose no harm to the child you are breastfeeding while pregnant.

However, your child may decide to wean on their own. In the second trimester, the taste of your milk may change and your nursing child may not like the taste. Your supply will also dip during pregnancy, causing some children to wean themselves.

When you might have to wean

You may have to wean for your and your unborn’s safety. Let your doctor know you are intending on breastfeeding while pregnant so they can best advise you.

• Pregnancy complications/ high-risk pregnancy
• Pregnant with twins or multiples
• Bleeding, contractions or uterine
• The foetus is not growing well

Now that we’ve established that tandem breastfeeding is safe, let’s talk about some of its benefits!

Benefits of tandem nursing

Increased milk supply

Since breastmilk works on a demand and supply basis, two mouths to feed can cause your milk supply to double! This is to accommodate feeding two children and triggers more milk production.

Connects toddler and baby

Tandem breastfeeding can help to provide a smooth transition for the older child. Sometimes, for the older child, it is hard to adjust to a new baby in the family. Tandem nursing can help to ease the transition and promote sibling bonding with an activity they can do together.

Sometimes, a toddler that has been weaned may want to nurse again after seeing their mum breastfeed the new baby. If you are comfortable with this, it can be a great bonding experience.

Tips for tandem breastfeeding

Drink lots of water and consume lots of calories

As discussed earlier, breastfeeding while pregnant requires lots of extra calories! Tandem breastfeeding is demanding as well, and you will have to continue consuming extra calories. You’ll have to eat well and drink lots of water to keep up with the demands of pregnancy and breastfeeding.

Let your newborn nurse first

During your newborn’s first week of life, you will be producing colostrum, which contains antibodies and is great for the newborn. Let your baby nurse from the fullest breast first and offer your toddler the same breast later. After your milk properly comes in, you don’t have to do that anymore.

However, letting your newborn nurse first is important to make sure they’re getting enough milk to grow well since it’s their only food!

Take care of yourself

Tandem breastfeeding is draining, both emotionally and physically! Your hormones are also going crazy and it takes some time before your hormones balance again. Tandem nursing won’t be the peaceful experience you might imagine.

You’ll need to tend to yourself well, prioritising your sleep, nutrition and hydration. Take breaks from your kids, and lean on your partner if you need support.

Remember to check with your doctor for final advice. Let them know your intention of breastfeeding while pregnant and tandem breastfeeding so they can give good advice and information to you.

 

Breastfeeding premature babies

You might be preparing yourself for the probability of your baby being born prematurely, but did you know what you can breastfeed your premature baby?

Most pregnancies last 40 weeks. A premature or pre-term baby is a baby born before the 37th week. Fortunately, thanks to modern medicine, 90% of premature babies survive and go on to live normal lives. Very premature babies are at a higher risk of developmental problems, being born at 23 to 24 weeks. Babies born before 32 weeks may need to spend time in the neonatal intensive care unit (NICU) until they have developed enough to survive on their own.

Importance of breastmilk for premature babies

Breastmilk is extremely beneficial for newborns. DHA (a fatty acid vital for healthy brain and eye development) and immunoglobulin G (an antibody) are transported from mummy to foetus via the placenta throughout pregnancy. But since premature babies arrive early, they may not have received these important factors. However, the milk from the mums of premature babies contains more fats and immunoglobulin than milk from full-term babies.

Premature babies also have immature gastrointestinal tracts, so they need foods that are easy for them to digest. Breastmilk contains enzymes that help your baby with digestion and helps their intestines mature.

Breastmilk is extremely important for premature babies. You might want to consider donor milk from the milk bank if it is available to you to help to bridge the gap, rather than using formula.

Will I have milk

After the placenta is delivered after the baby is born, your pregnancy hormones drop, triggering colostrum production. Usually, a mum’s milk supply will be triggered by her newborn baby latching onto her breast and sucking, but if your baby comes early, he might not be able to feed at first.

You can reproduce the sensations by stimulating your breast and nipples with your hands or by using a pump, to collect colostrum to give your baby.

What if my preemie can’t feed from the breast?

Many babies born before 34 weeks struggle to coordinate their sucking, swallowing, and breathing. Until they have developed enough to do this, nurses will place a tube into their tummy to feed them. In this case, continue to pump and express milk until you can feed them. Talk to your healthcare professionals to find out how you can give your child breastmilk.

Hospital policy on breastfeeding preemies

Breastmilk is important for the best growth and development for your newborn, and especially so for premature babies. However, there are a few reasons why hospitals don’t encourage it.

Breastfeeding may not be a priority for hospital staff who are focused on other aspects of care;  premature babies often have significant medical problems and needs.

Hospital routines also make it difficult for mothers to establish milk production and get the baby latching well. It’s also a difficult time for mothers, who will be worrying about the baby. Hence, they might not be able to build a good milk supply.

Kangaroo care

Kangaroo care is when parents keep their newborn skin-to-skin against their bare chests for extended periods, as it helps to calm and regulate the baby’s breathing and heartbeat. Preemies with kangaroo care often have better health. If possible, you can even breastfeed your premature baby during kangaroo care.

Looking after yourself

Recovery from pregnancy and birth is not easy, but the added stress from your baby being in the NICU can really make it difficult. It’s important to remember to look after yourself. The more smoothly you recover, the more strength and energy you must be involved in your baby’s care. This is the best time to say yes to as many offers of help as you can. It’ll make things easier for you and keep you going at a difficult time.

Here are the 8 most common questions for new mothers we get — these are some of the answers from our in-house lactation consultant, Joanna

If you’re a new mummy, this won’t be a comprehensive guide, but will hopefully give you some guidance into this brand-new world! And of course, if you have any other questions, feel free to contact your healthcare provider!

Is it normal to only have a small amount of colostrum, the first milk that comes out of the breast?

Yes! Most mums start with just a few drops of colostrum that helps fight infection, which is very important for newborns. This milk can be bright yellow, as it is rich in beta carotene. Mums will produce a few drops of this, to a few teaspoons in the first few days. Over the next few days, as breastfeeding and pumping increase, this milk will turn into transitional milk and change colour.

By week 2, the milk will turn cloudy white as the body introduces water. Breastmilk is 87% water, so your baby gets enough water to stay hydrated.

You may continue seeing elements of colostrum for the first 2 weeks of breastfeeding, but this will go away as the breast milk evolves to produce the carbohydrates and other nutrients the baby needs.

Will I have enough milk for my baby?

A common worry for mothers, and a justified one. Most mothers do have enough milk to exclusively breastfeed their baby for however long they wish. In Singapore, mothers are recommended to breastfeed for at least six months if you are able to. However, in many parts of the world, mothers may breastfeed for as long as 3-5 years.

Starting breastfeeding immediately after delivery leads to success and the increased production of breast milk. In the first week, the volume of breast milk will increase to satisfy the baby’s hunger.

However, if you are concerned about your supply there are many other methods you can try to increase your milk supply.

Is breastfeeding painful?

Breastfeeding should not be painful, but there might be some discomfort while both you and your infant are getting used to it. When there is a proper latch, the baby’s tongue and gums will massage the milk ducts on the areola which will lead to proper breastfeeding and milk production. On the other hand, if your baby has an improper latch, on the nipple, for example, it will cause low milk production and pain.

If breastfeeding is painful for you, be sure to check with a lactation consultant or your doctor.

If I use a breast pump, how long can I store my breast milk?

Generally:

• fridge: 5 days
• standard freezer: 3-6 months
• deep freezer: 6-12 months

When thawed, it is good for 24 hours. Most mums store the breast milk in storage bags, which are typically provided with the breast pump and have a place to write the time and date you pumped it.

How long should I breastfeed?

You should breastfeed as long as they feel comfortable with it. The recommendation is to breastfeed for at least 6 months, and if possible to continue until the baby is 2 years old.

You can introduce appropriate forms of solids to infants any time after 4 completed months, and before 6 months. This helps to introduce infants to new tastes, textures and the development of feeding skills. Milk should be the main source of nutrition for infants in the first year of life.

By 1 to 2 years of age, toddlers should be getting more and more of their calories from food rather than milk.

What do I need for breastfeeding?

You may wish to get some of the following items:

Nursing bra: the cups come with clips so you can breastfeed your baby without having to remove your bra. For a better fit, get the bra in your last trimester.

Breast pads: these are placed inside your bra to absorb leakage from your breasts, especially when they are full, or if you are expressing only from one side.

Nursing wear: these are designed with cleverly hidden openings to make it easier for you to breastfeed in public

Breast pump: they are available in single and double pumps which can be either hand-operated or electric. This is a good investment as you can express and freeze your excess milk and reheat it later. This is a necessity for mums returning to work.

Breast milk containers or bags: lets you store and freeze your milk

How does breastfeeding work while I’m at work?

You don’t have to stop breastfeeding just because you are returning to work! Your baby can be fully breastfed even while you’re at the office.

• Two weeks before your maternity leave ends, start expressing and storing your milk
• Feed your baby just before you go to work, and as soon as you return home.
• While at work, express and store your breast milk in the fridge (usually at lunch break and just before leaving)

Is it normal to not get my period while breastfeeding?

Having a baby causes many hormonal changes in your body, so it’s common to not have a menstrual cycle while breastfeeding. Over time, your body will return to a normal cycle. Everyone’s body is different, so there’s no set period of time which you’ll get your period again. However, a lot of mums get their period again around the same time they start introducing solids to their babies and sleeping more.

 

 

Why is my baby not gaining weight? And should I be worried?

If you exclusively breastfeed your baby, usually your baby will gain weight consistently if they latch well and feed often. However, if you’re breastfeeding and your baby is not gaining weight or is gaining weight slowly, they might not be getting enough milk.

Newborn babies should take in about 44-60ml of breast milk every 3 hours. Premature babies need more milk than term babies. Generally, your newborn can lose up to 10% of their body weight during the first 5 days of life. By the time they are 10 days to 2 weeks old, they should regain the weight they lost. After that, they should be gaining about 30g per day.

It is important to understand that every baby is different, and some babies just grow more slowly than others. If you are bringing your baby for regular checkups to the pediatrician and they don’t see an issue, then your baby’s weight is likely not a cause of concern. However, if this is a concern for you, always make sure to check with your pediatrician so they can advise your or provide you with ease of mind.

There are some reasons for a slow weight gain. If your baby is not getting enough milk to gain weight consistently, your pediatrician or a certified lactation consultant can help you find the problem and fix it.

Reasons for poor weight gain

Generally, there are 3 reasons as to why your baby is not gaining weight: not taking in enough calories, not absorbing calories or burning too many calories. This could be a result of intestinal issues, which means that they are unable to absorb calories well. Some kids also use a lot of calories due to certain health issues or being born prematurely.

Poor latch

A good latch allows your child to take in breast milk from your breast without getting tired or frustrated. If there is poor latch, or latching on to just your nipple, they won’t be feed very well or easily.

Infrequent breastfeeding

Breastfeed your newborn at least every 2-4 hours throughout the day and night for the first six to eight weeks. If they want to breastfeed more often, put them back to the breast.

Short nursing sessions

Newborns should breastfeed about 8-10 minutes on each side. As they grow older, they won’t need to breastfeed as long to get the breast milk out. However, during the first few weeks, try to keep your baby awake and actively sucking for as long as you can.

Pain or discomfort

If your baby is not comfortable because of a birth injury or an infection in their mouth, they may not breastfeed well, which causes poor weight gain.

Low or delayed milk supply

Some mothers have their milk come in quite late. Other mothers may experience low milk supply, which causes the child to have less milk when they breastfeed.

Learning curve

Some babies take a little longer than others to learn how to coordinate sucking, breathing and swallowing.

Sleepy baby

Newborns can be sleepy and not want to finish the whole nursing session, meaning that they don’t take in enough calories.

Risk factors

Some babies are more likely to face difficulties while breastfeeding. When a child is at risk for breastfeeding difficulties, the chances of growing and gaining weight at a slower pace are higher. Here are some of the risk factors that may affect your baby’s weight gain.

Being born premature or near term

Babies that are born before 37 weeks may not have the strength or energy to breastfeed for a long enough time to get all the breastmilk they need. They are also more likely to be sleepy and experience medical issues.

Oral challenges

It may be difficult for babies to latch on if their mother has hard, engorged breasts/ large nipples. However, infants with small mouths or physical issues like a tongue-tie or a cleft lip can have latching troubles regardless.

Jaundice

Babies with this medical condition makes them very sleepy and not interested in breastfeeding.

Reflux

Infants with reflux spit up or vomit after feedings. This causes them to lose milk from feeding and the acid from the reflux can irritate their throat and esophagus, which makes it painful to breastfeed.

Illness

Infants with an illness or an infection may not breastfeed well. They may not gain weight, or they might even lose weight.

Neurological issues

Neurological issues can impede their ability to latch and nurse properly.

Failure to thrive

Sometimes, if a child shows continued growth deficiency, they may become undernourished, which may be then diagnosed as failure to thrive. This could lead to developmental issues if left untreated. Children with this medical issue need continued medical supervision to address it. If you think your child may have this issue, do seek medical attention asap.

What to do

If you are concerned about your baby’s poor weight gain, it is important to seek medical help as soon as possible. Your pediatrician might suggest:

Checking your baby’s latch: make sure that your baby is latching on correctly. You can try asking your doctor, a lactation consultant, or a local breastfeeding group for help.

Breastfeeding often: Breastfed babies need to be fed every 2-3 hours and whenever they show signs of hunger. Unlike formula-fed babies, who need to be fed every 3-4 hours instead, breast milk is more easily digested and hence need to eat more often.

Keep your baby awake: Try to keep your baby awake and actively breastfeeding for about 20 minutes per feeding. To keep them awake, you can try tickling their feet, changing your feeding position, changing their diaper or burping them.

Address supply issues: If the problem is your low supply of milk, try to take steps to increase it. You can try breastfeeding more often, pumping between feedings, or try our lactation bakes and nursing tea.

Consider supplementing: if your pediatrician thinks it’s necessary, you may have to supplement your baby with additional feedings of either pumped breast milk or infant formula.

However, if all else fails, and your doctor advises it, you may decide to stop exclusively breastfeeding. You can exclusively pump, switch to formula, or do a combination of the two. Infant formula is a safe and healthy alternative and can ensure that your baby gains weight well. If you need to change your breastfeeding plan, try not to feel too down and remember that you’re doing what you need to do for yourself and your child.

Please refer to the infographics for information regarding the covid-19 vaccine safety for breastfeeding mothers. If you have any other questions or concerns, just call MOH at 1800-333-9999 or consult with your healthcare provider.