Feeding your baby

Feeding your baby

Health Canada, the Canadian Paediatric Society, the World Health Organization, and many others agree that exclusive breastfeeding (or chestfeeding) for the first six months, and continued for up to two years or longer, (with the introduction of solid foods) is important for infants and toddlers:

  • Nutrition
  • Immunologic protection (helps your baby stay healthy and avoid getting sick)
  • Healthy growth and development

Learn about our free infant feeding clinic, offered by registered nurses and lactation consultants.

It is important to fully understand the difference between breastmilk (human milk) and formula to make the best decision for your family. However you feed your baby, we are here to support you.

It can be difficult to go back to breastfeeding once you start formula feeding.

Breastmilk (human milk)

Breastmilk (human milk) is:

  • Free and safe
  • Always the right temperature
  • Available anytime
  • Environmentally friendly

Breastmilk (human milk) helps protect your baby from:

  • Ear infections
  • Bowel disease
  • SIDS (Sudden Infant Death Syndrome)
  • Respiratory infections
  • Some childhood cancers
  • Diabetes
  • The effects of toxins in the environment

Breastfeeding helps prevent:

  • Breast cancer
  • Diabetes
  • Ovarian cancer
  • Mood disorders

Infant formula

  • Will provide your baby with necessary nutrients.
  • Will not protect your baby from infections and diarrhea.
  • Requires extra time to properly sterilize equipment.
  • Costs money.
  • Is not sterile in powdered form.
  • Is not recommended in the powdered form for babies who are premature, babies with a low birth weight (less than 2,500 grams or 5.5 pounds) and are under two months of age, or babies who have a weakened immune system.

In the first few months, most babies feed at least eight times in a 24-hour period. This does not mean they feed every three hours. Watch for your baby’s cues and respond to them. Your baby’s cues will help you know when they are ready to feed, if they need a break, and when they are finished feeding.

When your baby is hungry, they may

  • Open their mouth
  • Suck on their hands
  • Move their head back and forth
  • Stretch

Crying is a late sign of your baby’s hunger, and you may find that your baby is more difficult to latch when they are crying. Calm your baby by cuddling, holding them skin-to-skin, rocking, talking, or any other method that works for you.

When your baby is full, they may

  • Be still and relaxed
  • Fall asleep

Feed your baby as often and for as long as your baby wants, responding to their needs. Watch your baby, not the clock. Night-time feeds are normal and important, and will last for many months. Babies often cluster feed in the evening, which means they want to feed often for short periods.

Swaddling is tightly wrapping and restricting a baby’s movement. It is often promoted as a way to calm fussy babies, or a way to get babies to sleep longer. Some hospitals still routinely swaddle newborns or teach parents how to swaddle, which can make them think swaddling is important. However, research outlines many risk factors of swaddling which can affect breastfeeding, growth and development, and baby’s safety while sleeping. Swaddling risks include:

Interference with breastfeeding

Babies who are placed skin-to-skin immediately after birth will use their hands and arms to help them find the breast and successfully breastfeed for the first time. If they are swaddled, they are only about half as likely to breastfeed right away.

Babies who are swaddled show delayed feeding behaviours, and suckle less competently at their first feeding. This can lead to a reduction in milk supply.

Swaddled babies may gain weight more slowly because they are less able to signal hunger cues (ie. bringing their hands to their mouth), and are less aware that they are hungry. This results in missed feeding cues, delayed or missed feedings, and can lead to a reduction in the mother’s milk supply.

Decreased skin-to-skin contact

Babies who are exposed to skin-to-skin contact and not swaddled are calmer and cry less than babies who are swaddled. Skin-to-skin contact also promotes interaction and bonding. Babies are also more likely to breastfeed exclusively and longer if skin-to-skin is done. Research also shows that swaddled newborns have poorer circulation and lower body temperature than babies who are held skin-to-skin.

Increased risk of respiratory infections

Swaddling, especially tight swaddling, can restrict breathing and increase the risk of respiratory infections and pneumonia in babies.

Increased risk of Sudden Infant Death Syndrome (SIDS)

More frequent night wakings are actually protective against Sudden Infant Death Syndrome and are normal behaviours for infants. When compared to babies who are not swaddled, swaddling resulted in less arousal, less alert activity, more drowsiness and more sleep. Once a baby is able to roll over, it is very dangerous to swaddle them for sleep. A swaddled baby on their stomach has a 12.99 percent increased risk of Sudden Infant Death Syndrome.

Blankets can also pose a danger as they can become loose, posing a risk for infant safety and possible increased risk of Sudden Infant Death Syndrome.

Increased risk of hip dysplasia

Developmental dysplasia of the hip (DDH) is a disorder that can improve or worsen as a baby develops, depending on how it is managed in the first months of life. Swaddling a baby with their legs extended can increase the risk of developmental dysplasia of the hip, especially when the legs are not free to bend and flex. For this reason, any clothing or wrapping on the lower half of a baby’s body should be loose enough to allow the baby free movement.

Increased risk of overheating

A swaddled baby can also be at risk for overheating, especially if their head is covered. Skin-to-skin contact has been shown to help babies regulate temperature better than swaddling.

How to decrease the risks

If you choose to swaddle your baby:

  • Keep your baby’s hands up and out of the swaddle so that they can signal hunger cues.
  • Use sparingly. Spend plenty of time skin-to-skin and use other comfort measures such as back-patting, or a warm bath.
  • Swaddle your baby to help settle them when crying, but avoid swaddling for sleep.
  • Stop swaddling when your baby is able to roll over, and always position babies on their backs when swaddled.
  • Always ensure the swaddle is loose enough so that your baby has full movement of their hips and legs.
  • Keep the wrapping lightweight and off your baby’s head, and check your baby for signs of overheating such as sweating, flushed skin, or a hot chest or back.
  • When latching your baby, make sure you and your baby are both comfortable.
  • Hold your baby close to your body. Bring your baby to your breast or chest—not your breast or chest to the baby.
  • Support your baby with your hand behind your baby’s shoulders, supporting the neck and not the head.
    • Hold your baby so their nose is near your nipple. As your baby’s chin touches the skin, it will trigger an open-mouth reflex.
    • When latched well, your baby’s chin will be pressed into you, their head will be tipped back, and their nose will not be pressed into you.
  • Attaching your baby at the breast video

Best Start’s Infant formula: What You Need To Know is available in 18 languages. The booklet provides information on:

  • How to prepare, store, and transport formula
  • How to sterilize water and equipment
  • When and how to feed your baby according to their cues
  • Supplementing a breastfed baby

For information on how to safely prepare infant formula follow these tips sheets (available in 18 languages). The six tip sheets cover the following topics:

  • Informed decision making.
  • Getting ready to make formula.
  • How to prepare ready-to-feed liquid formula for healthy babies.
  • How to prepare concentrated liquid formula for healthy babies.
  • How to prepare powdered formula for healthy babies.
  • How to bottle feed your baby and transport formula.

Watch Best Start’s video on how to safely preparing infant formula for your baby.

Caution: Commercial milk formula making machines

Recently, the infant commercial milk formula industry introduced machines on the market that prepare commercial milk formula, claiming to be at the right temperature and thickness. Some machines simply heat water to the appropriate temperature and pour it into bottles so parents can add powdered or concentrated commercial milk formula. Other machines heat and mix commercial milk formula powder automatically before it is poured into a bottle.

Parents should be careful about using these machines as there are questions about the quality of the commercial milk formula these machines make. Is the temperature right? Is there enough commercial milk formula powder in the mix? Is the thickness of the commercial milk formula good for babies at different stages?

Potential problems

  • Health Canada recommends using sterilized water to prepare concentrated or powdered commercial milk formula. Sterilized water is water boiled for two minutes in order to destroy any pathogens in the water.
  • Powdered commercial milk formula is NOT sterile. There could be bacteria that can make babies seriously sick. The World Health Organization (WHO) recommends that powdered commercial milk formula not be fed to babies who are under two months of age, born prematurely, with low birth weight, or with immune system issues.
  • The powdered commercial milk formula will sometimes clump in the machine and the moisture can cause harmful bacteria to grow, which can make your baby sick.
  • It is recommended that ALL equipment used for feeding and/or preparing food for your baby be cleaned and sanitized to remove harmful bacteria. However, it is not possible to clean and sterilize ALL the parts in these machines.

Although many families will find these machines a great help, infant commercial milk formula should be prepared by hand, one feed at a time to reduce the risk of bacteria growing in the milk.

Signs your baby is getting enough milk include:

  • Your baby feeds at least eight times in 24 hours.
  • Your baby is sucking strongly, slowly, steadily, and swallowing often.
  • Your baby has a loud cry and moves actively.
  • Your baby wakes easily and is alert for feeds.
  • Your baby comes off looking relaxed and sleepy.
  • Your breasts (chest) feel softer after feeding.
  • Your baby has enough wet and dirty diapers according to their age.

Your baby should be having at least the number of wet and dirty diapers listed in the chart. If there is poop and pee in one diaper, you can count it as both.

Signs your baby is feeding well

Day 1: At least one wet diaper and one dark green or black poop.

Day 2: At least two wet diapers and one dark green or black poop.

Day 3: At least three wet diapers and three brown, green, or yellow poops.

Day 4: At least four wet diapers and three brown, green, or yellow poops.

Day 5 to 3 weeks old: At least six heavy pale, or clear wet diapers and three large, soft, yellow or brown poops.

Only count poops that are the size of a toonie, or bigger.

Get help if your baby:

  • Is feeding less than eight times in 24 hours
  • Has dark urine
  • Has fewer wet diapers or stools than in the chart (see Know your baby is getting enough milk above)
  • Is very sleepy and is hard to wake up to feed
  • Has yellow skin and eyes, and is not feeding well
  • Has a dry, sticky mouth
  • Seems unwell
  • Develops a fever
  • Other signs something is wrong when breastfeeding or chestfeeding:
    • Your baby is not latching or drinking well at the breast.
    • Your nipples hurt.
    • Your breasts feel hard and painful.
    • You feel like you have the flu.
  • If you need medical help contact your health-care provider, midwife or Health811 (dial 811), or your local emergency department.

Get help if your baby:

  • Is feeding less than eight times in 24 hours
  • Has dark urine
  • Has fewer wet diapers or stools than in the chart
  • Is very sleepy and is hard to wake up to feed
  • Has yellow skin and eyes, and is not feeding well
  • Has a dry, sticky mouth
  • Seems unwell
  • Develops a fever

Other signs something is wrong when breastfeeding or chestfeeding:

  • Your baby is not latching or drinking well at the breast.
  • Your nipples hurt.
  • Your breasts feel hard and painful.
  • You feel like you have the flu.

If you need medical help contact your health-care provider, midwife or Health811 (dial 811).

If it is urgent visit:

If you have any infant feeding concerns or questions, the following supports are available:

Hand expressing milk allows you to:

  • Provide your baby with a taste of milk to get them interested in feeding.
  • Help your baby latch more easily.
  • Lessen the discomfort of overfull breasts.
  • Help maintain milk supply.
  • Save your money by not needing to buy a pump.

How to express milk:

  1. Wash your hands.
  2. Sit up and lean slightly forward.
  3. Gently massage your breast, or use a warm towel to help get the milk flowing. Seeing or hearing your baby also helps.
  4. Place your fingers and thumb behind the areola in a « C » shape (nipple in the centre).
  5. Press back towards your chest. Gently compress your thumb and fingers together and towards the nipple, then release.
  6. Collect drops of milk in a clean cup, spoon, or syringe to feed your baby, or store for later.
  7. Repeat (press back, compress, relax) and move fingers around your breast.
  8. Switch sides and repeat. Continue until milk stops flowing.

It is normal to not get any milk at first. You may only get a few drops to a teaspoon. This is the perfect amount for your new baby’s small tummy size in those first few days. The more you hand express, the easier it will become, and the more milk you will get.

View Best Start’s guidelines for storing breastmilk.

View Global Health Media for a video that shows you how to express milk with your hands.

View Stanford Medicine’s How to Use Your Hands When You Pump video that demonstrates some ways that pumping mothers can increase production.

If your baby is fed breastmilk (human milk)

  • If your baby is getting any amount of breastmilk (human milk), give your baby a vitamin D supplement of 10 µg (400 IU) every day. Keep giving vitamin D until your baby is two years of age.

If your baby is fed formula

  • Infant formula has vitamin D added so you do not have to give a supplement.

In Ontario, all pregnant and breastfeeding parents are protected under the Ontario Human Rights Code. Part of this code gives breastfeeding, or chestfeeding parents the right to feed anytime, anywhere without being disturbed, asked to stop, move, or cover up. This includes public areas. Services must also be provided free from discrimination.

You can take birth control when breastfeeding. Talk to your health-care provider to choose a method that is right for you.

Breastfeeding itself can be a form of birth control. This method is called Lactational Amenorrhea Method (LAM) and can reduce the chance of pregnancy by 98 percent, but only if the following statements are true:

  • Your baby is less than six months old.
  • Your monthly periods have not returned.
  • Your baby is fully or nearly fully breastfed. Fully breastfed means that your baby gets all food from suckling at the breast. Nearly fully breastfed means that your baby is receiving vitamin D and or one or two mouthfuls once or twice a day of any other fluids or solids.
  • Your baby breastfeeds at least every four hours during the day and no longer than six hours between feedings at night.

If any of the statements are not current, the chance of pregnancy increases greatly, and you will need to use another form of birth control.

The effectiveness of Lactational Amenorrhea Method in exclusively pumping mothers may not be equivalent to direct breastfeeding.

Non-hormonal birth control choices

The following birth control choices have no effect on breastfeeding and can generally be started soon after childbirth or the postpartum checkup:

  • Condoms and spermicides
  • Copper Intrauterine Device (IUD)
  • Vasectomy (permanent for male)
  • Tubal ligation (permanent for female)

Hormonal birth control choices

Hormone-based birth control choices can also be compatible with breastfeeding. Current research suggests that estrogens and progestins in birth control are not harmful to infants, but it is known that estrogen can reduce milk supply. For this reason, progestin-only birth control is recommended when breastfeeding, starting no sooner than six weeks after childbirth. There have been some reports of low milk supply with some progestin-only choices.

Progestin-only birth control:

  • Mini pill
  • Depo-Provera
  • Hormone-releasing IUDs
  • Emergency contraceptive (Plan B)

Estrogen and progestin birth control:

  • Birth control pill
  • Birth control patch
  • Vaginal contraceptive ring
  • Emergency contraception (Ella)

If you are thinking of starting (or resuming) birth control, talk to your health-care provider.

Your health-care provider may suggest starting with a short-acting progestin—only contraceptive such as the mini pill before beginning a longer-acting form such as Depo-Provera, as it lasts three months and cannot be reversed once administered.

Sex and U has additional information on birth control options and effectiveness.

Visit the Infant Risk Center for additional information on Safe Use of Birth Control While Breastfeeding.

The Society of Obstetricians and Gynaecologists of Canada also have additional information on Medications and Drugs While Breastfeeding.

Smoking

Smoking can expose you and your child to harmful chemicals. Smoking can cause your baby to be fussy and can decrease the amount of milk you make. Babies and children are especially vulnerable to the effects of smoke; if you can, try to cut down on smoking or quit. If you or someone else in your home smokes, decrease your baby’s exposure to second-hand smoke. Here are a few ideas to consider to reduce the risks:

  • Feed your baby before you smoke.
  • Smoke outside.
  • If you have smoked, wash your hands and change your clothing before holding your baby.
  • Ask people not to smoke around you and your baby.

Cannabis

No amount of cannabis (marijuana) has been proven to be safe during pregnancy, or while breastfeeding or chestfeeding.

Stopping all cannabis product use while breastfeeding or chestfeeding is the safest option for your baby.

No matter how cannabis is used, cannabis compounds are stored in body fat and can be passed to your baby through your milk. These chemicals are slowly released over time (up to 30 days) which means that « pumping and dumping » does not work.

Some research reports that babies exposed to cannabis have slower motor development, reduced muscular tone, and poor sucking.

If you consume cannabis and need help to reduce your consumption, or would like help quitting, please speak to your health-care provider.

Alcohol

Alcohol passes into your milk. Alcohol is not stored in milk; instead it enters and exits according to your blood alcohol levels. Once alcohol is out of your blood, it will be out of your milk. Generally, it takes two hours for an average woman to clear the alcohol from one standard alcoholic drink.

The safest choice is not to drink any alcohol while breastfeeding.

If you are thinking about drinking alcohol occasionally while breastfeeding or chestfeeding, follow these tips to reduce risks to your baby:

  • Limit the amount you drink to one to two standard drinks per occasion, with no more than two standard drinks per week.
  • Measure your drinks to be sure how much you are drinking.
  • Drink alcohol after feeding, not before.
  • Before feeding, wait at least two hours after drinking a single serving of alcohol.
  • Occasional drinking is not a reason to stop breastfeeding or chestfeeding.

Heavy alcohol consumption can put you and your baby at risk by:

  • Disrupting your baby’s sleep patterns.
  • Decreasing the letdown reflex and the amount of milk being produced.
  • Affecting your baby’s weight gain, growth, and risk of developmental delays.
  • Making it hard for you to recognize and respond to your baby’s needs.

Visit La Leche League International’s Drinking alcohol and Breastfeeding webpage for common questions about alcohol and breastfeeding, and recommendations supported by the evidence.