What You Need to Know About Breastfeeding: Q&A with a Pediatrician

According to the Centers for Disease Control, breastfeeding is the best source of nutrients for infants and may reduce the risk of certain health conditions for both infants and mothers. Dr. Danielle Dunetz, DO, FAAP, is a pediatrician at Partners in Pediatrics committed to providing comprehensive care for children and their families. Dr. Dunetz emphasizes the critical benefits of breastfeeding for both mother and baby. Her insights offer valuable guidance for new mothers navigating the challenges of breastfeeding.  

Question: Why is it important to breastfeed? 

 
Dr. Dunetz: Breastfeeding is the healthiest thing for both the mom and the baby, both short-term and long-term. When a baby gets sick or is exposed to germs, the mom will produce antibodies against those germs, keeping the baby healthy. For the mom, it decreases the risk of breast cancer, ovarian cancer, type 2 diabetes, hypertension, and coronary vascular disease. 

 
Question: What should nursing mothers consider about their diet?  

 
Dr. Dunetz: It’s recommended that the mom continue taking prenatal vitamins. She should also be sure to get enough nutrients. For calcium, she needs between 1000 and 1300 mg a day, which is about three servings of milk. It is better to get enough calcium through your diet rather than from a supplement.  

She also needs extra vitamin D. Babies are typically prescribed 400 units of vitamin D a day. The mom can get the vitamin D through her prenatal vitamins, or she can go on over 5000 units of vitamin D a day and opt not to give the baby the 400 units. That way, she makes sure that enough vitamin D is passed through the breastmilk.  

For protein, a nursing mother needs about six to six and a half ounces a day. They should also be aware of iron and folic acid, but prenatal vitamins should cover that. 
 

Question: Should nursing mothers worry about alcohol consumption? 

 
Dr. Dunetz: That’s controversial. They can consume a small amount of alcohol, though there is an old pumping and dumping technique that is not recommended anymore. But if a mother feels the effect of alcohol, they should not nurse the baby and wait a couple of hours after having the drink until they no longer feel it before nursing or pumping. It’s best to not drink alcohol at all. Alcohol, in general, can decrease the milk supply by about 20% over the next 24 hours, even after just one drink.  
 

Question: Speaking of milk supply, how often should a mother breastfeed? 

 
Dr. Dunetz: As a rule, I recommend that she feed on demand and go by the baby’s cues. At first, it will be every two to three hours. Try not to go more than four hours until the baby is back at its original birth weight. 
 

Question: What can a mother do if she is experiencing discomfort while breastfeeding? 

 
Dr. Dunetz: There are many reasons why a woman might experience discomfort while breastfeeding. Often, the baby’s latch is the issue. In this case, either the pediatrician or a lactation consultant can check how the baby is nursing. It might just be the positioning of the baby. Sometimes, a baby could have a tongue tie or lip tie, and that’s something a pediatrician could address. She could have cracked nipples or an infection like mastitis. That’s something to ask a pediatrician or lactation consultant about. 
 

Question: How does a mother know if the baby is getting enough milk? 

 
Dr. Dunetz: The biggest indicator is the baby’s weight. In the first couple of days after birth, the baby shouldn’t lose more than seven percent of their birth weight. After that, it’s really based on peeing and pooping. By one week of age, the baby should be peeing at least six times in 24 hours. It can take two to three weeks for a breastfed baby to get back to birth weight. But that’s one of a mom’s biggest worries. It’s hard because we can’t physically see how much the baby is drinking. So, the big thing is getting back to birth weight and the number of wet diapers. 

 
Question: Can you help dispel some common myths about breastfeeding?  

 
Dr. Dunetz: One common myth is that breastfeeding is a great form of contraception, and you can’t get pregnant while breastfeeding. Many women will not get their period while breastfeeding, but you can definitely still get pregnant while breastfeeding. This is especially true after six months when the baby starts eating solid foods and sleeping more.  
Another myth is that women with smaller breasts can’t make enough milk. Milk production has nothing to do with the size of the breasts; it has to do with the number of mammillary glands. So, whether you are small or big-chested, it really doesn’t matter. 
 

Question: What else should a woman know about breastfeeding? 

 
Dr. Dunetz: I think it’s best to be relaxed. Women who are more stressed out about their milk end up making less. Another thing to know is that you don’t have to wean at twelve months. The recommendation is to nurse as long as it is mutually desired. So, if you are nursing your baby, that doesn’t mean you have to switch to whole milk at a year of age. You just have to make sure that the baby is getting enough calcium, whether through nursing or yogurt and cheese.  

New moms should strive to maintain open communication with their healthcare providers and their baby’s pediatrician. With proper support, breastfeeding can have tremendous nutritional, immunological, and emotional benefits for both mother and baby. 

Southern New Hampshire Medical Center (SNHMC) has received the Hospital-Based IBCLC Care Award given by the International Board of Lactation Consultant Examiners and the International Lactation Consultant Association. This global recognition celebrates our commitment to providing exceptional lactation support at SNHMC. Learn more here. 

Dr. Danielle Dunetz is a fellow of the American Academy of Pediatrics and a member of the American Osteopathic Association, practicing at Partners in Pediatrics in Nashua, New Hampshire.