ladyg2_WebMD: How long should you wait if the baby will not drink?

Payne-Orton: Could you clarify your question for me?

Moderator: As we are waiting for a response, we will go move on

saralg_WebMD: What kind of lotion is safe to use on your breasts when you are breastfeeding?

Payne-Orton: Lanolin can be used if you have irritation of the skin around the nipple. It's pesticide free lanolin. Unfortunately, I think it's been seven years ago, there was a scare because they'd found some insecticide in the lanolin, so insecticide free lanolin. Also, if you do a little manual expression, and express some breast milk and rub it around the breast, it has white blood cells in it and can help prevent infection. Other than that, a moisturizer that's hypoallergenic, like Lubriderm, it doesn't have any scent. But they do want to try not to put it around the aereola in the nipple area, because infants love smells, but not the kind of smells we like. They like the smell of mom, the smell and taste of breast milk, the smell of amniotic fluid. That's one of our problems in our society. We want to get everyone cleaned up after birth, and that may confuse the infant, so the infant may not as readily go to the breast.

ladyg2_WebMD: How long should you try to breast feed - a few days after birth? Longer? And if the baby doesn't drink the milk when should you decide to move to formula?

Payne-Orton: AS you are well aware, I'm a big proponent of breastfeeding. However, I'll quote my mentor, Amy Spangler, who is the past president of the ILA (ILA = International Lactation Association). And she says, " When you are talking about breastfeeding, rule number one is feed the baby. And rule number two is see rule number one. So, the infant's survival is above all our main goal, and a starving infant isn't going to breastfeed well, either. They have to have caloric reserves to be able to nurse. Sometimes, if one of the problems I mentioned is interfering with breastfeeding, or the baby has been given a bottle early on and they have nipple confusion, breastfeeding may not be going as well as we'd like. And in these instances, the mother should begin pumping, and it's pumping fairly frequently, five or six times a day. This will hopefully continue to stimulate her nipples and promote breast milk production. If an infant has lost more than ten percent of their birth weight, and not gained it back within ten days, that is, is not back to birth weight, we should be watching that infant closely and intervening, and pumping should be considered. If an infant is two to three days old and is not having four poopy diapers, or not showing urine output, then we need to intervene. There are a variety of things we can do. Hopefully we have got the mother pumping, and we can give pumped breast milk and/or formula via a variety of methods.

LadyG2 didn't say whether it was a problem with an infant taking the milk, or the mother producing it, so I can't give all the information I'd like. But we can try a supplemental nurser, and you can buy an S&S nurser. And that's where they hang a bag with either pumped breast milk or formula, and there's a tube that is taped to the breast, and the baby stimulates and suckles the breast, and at the same time the baby gets nutrition as well as positive reinforcement that they can get food from the breast. The problem to watch with that is sometimes they are smart little creatures, and they'll grab the tube and suckle the tube. You want to discourage that. Another alternative is finger feeding where you use a little syringe with a tube connected. The tube is taped to your finger, and you put your finger in their mouth with your nail side down to help them learn to suckle. Sometimes this can help them learn to open their mouth like they're supposed to, and their tongue down. Then another method is cup feeding, and you use a tiny cup, and can also do this with a teaspoon. You hold the infant upright, and help teach the infant to keep their mouth open wide and tongue down. The key is to use a variety of methods, so that they don't decide, for example, that they just want to be fed from the finger. You're still giving the infant the nutrition they need, and teaching them, hopefully with the help of a lactation consultant how to properly open their mouth, and you avoid confusing them with a nipple which has a totally different type of suck than suckling from the breast.

Moderator: In your opinion, at what age should a child be weaned?

Payne-Orton: Great question. I knew someone would ask that. Although there is no magic number for weaning age, I will tell you that internationally, the average age is two to four. Of course, that helps with child spacing. In cultures where children are weaned later, they tend to have smaller families, and it's seen as an economic benefit. In our culture, we don't necessarily want to rely on breastfeeding for child spacing.. So, what are the reasons for nursing for a longer period of time? There are several. The infant continues to receive passes of antibodies from the mother for as long as they're nursing. They also continue to have that wonderful bonding time with mom, that special time. And up until the age of two, they continue to have tremendous brain growth. So most importantly, you're feeding that brain with human specific fat that will result in myelinization of the nervous tissue. So I encourage people, if they're comfortable, to nurse until two, or a little older. But it's not a sexual act, it's not psychologically harmful to the infant, and may continue to be a nice bonding experience for mother and baby. But many people aren't culturally comfortable with it, and that's okay. If you're not, try to nurse until one. There's a lactation consultant I know, who is a big proponent of breastfeeding, and is wonderful. She has two grown children. She tells the story that her daughter breastfed until two, and her son breastfed until 15 months. The reason for this "early weaning" on the part of her son was because of his behavior. Her daughter was very polite breastfeeder, and would quietly request to nurse, and it was nice quiet time for her and her daughter. Whereas her son would usually choose a crowded party to run across the room after her, and cry out, "Boobie, boobie," so, she weaned him a little earlier.