• Baby begins to gain weight (after initial birthweight loss).
• Breasts soften during the feeding.
• Baby awakens to feed.
• You can hear or see baby swallowing.
• Baby seems satisfied and content after feeding.
• Baby’s hands and feet are relaxed.
• Baby’s wet and dirty diapers are age appropriate; with pale yellow or nearly colorless urine. The urine should not be deep yellow or orange.
• A newborn breastfeeds at least 8 to 12 times every 24 hours, including at night.

Learn more about how much milk your baby needs. 

Hand Expression softens the nipple and areola so the baby can latch and relieves the fullness, so mom is more comfortable.

• Mom should place her thumb and fingers around the areola, approximately where her baby would normally be latching.
• Using a “C” shape, she can place her thumb on top of her breast, where the dark part of the areola meets the lighter part of her breast, or at the 12 o’clock position.
• Place the index finger directly opposite her thumb, below the breast where the dark part of her areola meets the lighter part of her breast, or the 6 o’clock position.
• Her remaining fingers are below her index finger.
• To begin moving the milk through the nipple, advise the mom to press her fingers back toward the chest wall without lifting her fingers from the breast
• She can then bring her thumb and index finger together and roll them toward the nipple.
• Repeat the process, pressing her fingers back toward the chest wall and then rolling them toward the nipple.
• The mom will eventually settle into a routine of rhythmic releasing of the milk.

Learn more about hand expression and pumping.

• May use a breast model to demonstrate massage to a mom.
• One technique is circular massage, in which the mom massages with fingertips or hands, applying gentle pressure in a circular motion and rotating around the breasts.
• Can gently tap breasts with fingertips, rotating around breast.

Learn more about how breast milk is made.

A good rule to remember: warmth before feedings, cool after feedings.

• Cold comfort: Cold pack can be placed on breasts for comfort, to help ease the pain and relieve swelling.
• Warm comfort: Apply heat (for example shower or hot pack) to the affected breast prior to a feeding to assist with let-down and milkflow. Direct pressure to the breast, pushing area of soreness toward the nipple (almost pushing it out) while the baby is feeding there or while manually or electronically expressing milk.

Learn more about sore nipples and engorgement.

• Check baby's positioning and latch.

Check out causes of nipple pain and solutions.

Ask mom if her breasts feel very hard and painful with signs of:

• Breast swelling (i.e., overfull)
• Breast tenderness
• Warmth
• Redness
• Throbbing
• Flattening of the nipple
• Low-grade fever

Engorgement can flatten the nipple and make it harder for the baby to latch. Engorgement can lead to plugged ducts and mastitis, so it is important to try to prevent it before this happens. Ask mom if she has tried massaging to focused areas to help move milk through blocked areas.

Learn more about engorgement and how to treat it.

Ask mom if she feels like there is a tender and sore lump in the breast. If mom has a fever or other symptoms then she probably has a breast infection rather than plugged ducts.

• A plugged duct happens when a milk duct does not drain properly. Pressure then builds up behind the plug, and surrounding tissue gets inflamed.
• A plugged duct usually happens in only one breast at a time.
• Plugged milk ducts that were not fully resolved can lead to an abscess and increase the risk of mastitis.
• The skin around the plug may or may not be reddened.
• She might also report a small white plug at the opening of a milk duct on her nipple, this is also referred to as a nipple bleb.

Ask mom if she has tried massaging to focused areas to help move milk through blocked areas. Gently massage the plugged area while the baby is feeding to help dislodge the plug.

Learn what causes plugged ducts and how to get relief.

An abscess is a pocket of pus that is confined in one area in the body. It is caused by an infection and can be very painful and warm to the touch.

An abscess can occur anywhere on a mother’s breast. The mother might report:

• A reddened area that is raised and swollen (though sometimes it can occur deep in the breast tissue and not be visible).
• The area is hot to the touch.
• The breast tissue around the affected area is swollen.
• She has a high fever.

Learn what causes abscesses and how to get relief.

Ask mom if she has tried to apply heat to the sore area with a warm, wet cloth. Or if she has tried massaging the area, starting behind the sore spot. Moving her fingers in a circular motion and massage toward the nipple.

• Mastitis is an inflammation of the breast; this inflammation may or may not involve a bacterial infection; causing redness, swelling, and pain.
• The mom might report fever and symptoms of the flu such as muscle aches, fatigue, or nausea.
• Mastitis can occur in one or both breasts.
• Occasionally, moms who experience mastitis have one or more episodes of mastitis which can occur in one or both breasts.

It is not always easy to tell the difference between a breast infection and a plugged duct, because both have similar symptoms and can get better within 24 to 48 hours. Some breast infections that do not get better on their own need to be treated with prescription medicine from a healthcare provider.

Learning from the mom that she feels a lump, feels feverish, and her breast is reddened and warm to touch may indicate mastitis, which requires referral to her healthcare provider.

Learn about the signs of Mastitis and how to treat it.

Thrush is a fungal infection that is also sometimes called a yeast infection. Thrush may have these signs:

• Pain described as burning or stinging.
• Itching sensation.
• Skin discoloration, including redness, a shiny appearance, or tiny satellite lesions around the red areas.
• Thrush in the baby’s mouth (White spots on inside of baby's cheeks, tongue, or gums.).
• Vaginal yeast infection in the mom or fungal diaper rash in the baby.

If mom has concern of a fungal infection, mom should call both her healthcare provider and baby's healthcare provider. That way, they both can be correctly diagnosed and treated at the same time. This will help keep mom from passing the infection back and forth.

Learn more about the signs of thrush and when to call your healthcare provider.

Hungry babies will show signs of hunger before they begin to cry. Once baby is crying, it can be harder to latch.

Watch for these signs that baby is hungry, and then feed baby right away:

• Fists moving to mouth.
• Head turning to look for the breast.
• Becoming more alert and active.
• Sucking on hands or lip smacking.
• Opening and closing mouth.

Learn how to tell if your baby is hungry or full.

It's important to let baby nurse until they're full. Some signs that babies are done eating are:

• The baby’s hands slowly begin to relax.
• The baby’s toes begin to relax.
• Baby stops drinking and drifts off to sleep.
• Baby releases the nipple and unlatches.

Learn how to tell if your baby is hungry or full.

• It’s not uncommon for a baby to lose some weight immediately after birth. By the time the baby is 14 days old, the birth weight should be exceeded.
• A baby usually gains about 1 ounce per day during the first six months.
• In general, most babies double their birth weight by 6 months of age and triple their birth weight by 1 year.

Learn more about how much milk your baby needs.

• Sometimes the baby may want to nurse more often. When feedings are bunched together, especially in the evening, it's called cluster feeding. While it may seem like a lot, it is normal.
• Many babies are fussier during growth spurts and will want to nurse longer and more often, as much as every 30 minutes.

Learn more about cluster feedings and growth spurts.

Positioning -  No Single “Right” Way 

• Baby entirely faces the mom’s body.
• Baby is held close to the mom. There should be no gaps between mom and the baby’s body. If the baby’s hands are in the way, baby is not close enough.
• Baby’s head faces the breast and is not turned to the side.
• Baby’s body, head, shoulders and hips are in a straight line. The neck is not bent.
• Mom should not lean over the baby.

Learn more about position.

Good if:

• You had a C-section.
• You are breastfeeding twins.
• You have large breasts.
• Your nipples are flat or inverted.
• Your milk let-down is strong.
• Your baby likes to feed upright. This position may help babies with reflux.

Learn when to use the football hold and how to do it.

Good if:

• Your baby needs extra head support.
• Your baby is premature.
• Your baby's suck is weak. This hold may help your baby stay latched.

Learn when to use the cross-cradle hold and how to do it.

Good if:

This is how you and your baby are comfortable breastfeeding. This hold is very common because

• it's easy and comfortable for a lot of moms and babies.
• Your baby has difficulty latching. This hold can help guide baby's mouth to your breast.

Learn when to use the cradle hold and how to do it.

Good if:

• You’d like a relaxed, baby-led approach.

Learn when to use the laid-back hold and how to do it.

Good if:

• You had a C-section.

Learn when to use the side-lying position and how to do it.

• In all positions, all of the areola below the nipple will be in the baby’s mouth and baby’s tongue will be well below the areola. Some of the top part of the areola might be visible.
• Baby’s chin should indent the breast.
• Baby’s nose should barely touch the breast.
• Baby’s mouth should be open wide.  
• Baby’s lips should be flared out, like fish lips.

No matter what position is used feed the baby, it's important to get a good latch.

See the steps and signs of a good latch.

• When the baby is latched well, breastfeeding should not be painful.
• It is normal for the latch to be tender at first. Mom should feel a tugging sensation.
• Pain is not normal. This is her telling mom something is not right.
• If the mom is in pain while breastfeeding, she can gently break the latch by inserting a clean finger into the corner of the baby’s mouth. Then try again.
• If you're having trouble getting a good latch, try: moving to a quiet place; holding your baby skin-to-skin, or letting your baby lead (i.e., Support your baby's neck, shoulders, and hips with your hands, and offer your breast but let your baby find your nipple on their own.).

Learn more about breastfeeding with confidence.

• Encourage mom to feed the baby directly right before and after separation.
• Ask the childcare provider to avoid full feedings if mom expects to arrive within an hour or so.
• Begin getting baby used to supplemental feedings by offering small practice feedings of one ounce (i.e. expressed milk) or so shortly before she plans to return to work or school.
• It is normal for babies to adopt a “reverse cycle feeding” pattern when they are away from mom. This means they sleep more and feed less when with the caregiver and breastfeed more often when they are with mom.

Learn more about how to transition back to work or school.

• Encourage mom to breastfeed exclusively at the breast, if possible, during the first 3-4 weeks, to build good milk production.
• Frequent milk removal with baby at the breast or expression is the most effective way to increase or maintain milk supply. Remind them to pump at night, too.
• If mom will be away for longer than 2-3 hours, suggest that she express her milk by hand or with a breast pump to keep her breasts from becoming too full and to help maintain milk production.
• Women who exclusively pump sometimes face issues maintaining milk production long-term.

Learn more about making milk expression work for you.

• Recommend begin expressing (hand expression or pumping) milk during mom’s maternity leave.
• Expressing/pumping milk during the morning, or another time of day when mom seem to have the most amount of milk, can be a good time to start practicing expression.
• The number of times you need to express/pump milk at work should be equal to the number of feedings your baby will need while you are away. As the baby gets older, the number of feeding times may decrease. When babies are around 6 months old and begin solid foods, they often need to feed less often.
• Express/pump milk for 10-15 minutes approximately 2-3 times during a typical 8-hour work period.

Hand expression can be an effective way to express milk for short separations.

Learn more about hand expression.

• Remind moms that thawed milk should be used within one hour after it has thawed or place it in the refrigerator.
• If the milk was thawed in the refrigerator, it should be used within one day (24 hours) after it is thawed.
• Any unused milk left in the bottle should be discarded within 1-2 hours after the baby is finished feeding.
• Milk that has been thawed should never be refrozen, even if it has been refrigerated.

Learn more about milk storage and how to thaw milk.

When baby leads the way, babies gradually discontinue feedings on their own.

• When baby is ready to wean, baby may start to skip feedings or nurse for only a few minutes at a time. Note: This may be a nursing strike, so best to express until baby resumes nursing again.
• Over several weeks, baby will drop one breastfeeding session at a time.
• As they grow, babies typically rely less and less on breast milk once complementary foods begin. They may continue to seek the breast for comfort, before bedtime, or when they are upset. Infant formula may need to be introduced if the weaning occurs before 1 year of age.
• “Don’t offer, don’t refuse” can encourage babies beyond a year to lead the weaning process.

Learn more about baby-led and mom-led weaning and why baby may suddenly refuse the breast.

Some parents may decide to actively wean before their baby shows signs of wanting to wean.

• With mom-led weaning, the mom makes the decision to discontinue breastfeeding.
• Weaning gradually will make it easier for both the mom and baby to adjust. It helps the mom to be more comfortable by allowing her breasts time to adjust to the dropped feedings.

Learn more about weaning your baby.

To make the process easier for mom and her child, wean over several weeks or more. As mom slowly stop breastfeeding, her body will start producing less breast milk and eventually her body will no longer make breast milk.

If a mom wants to wean from formula and return to full breastfeeding, the CPA will use critical thinking skills to determine appropriate recommends based on the baby’s age and the amount of formula the baby has been receiving.

• If the baby is very young (e.g., 4-5 days old) or the mom is supplementing only a very small amount each day and the baby’s weight is good, it might be safe to discontinue formula more quickly.
• If the baby is several weeks old, if the mom has been supplementing larger amounts, or if the baby is underweight or gaining slowly, a more gradual approach to discontinuing formula will be needed.
• Generally, a safe reduction in formula when a mom has been supplementing for a while is about 1 or 2 ounces over a 24-hour period every other day or so. Reducing supplements slowly helps the mom build her production capacity so it can catch up to what her baby needs.

Learn more about weaning your baby.

Begin decreasing supplemental formula at times when the mom tends to have more milk, such as in the mornings.

• Decrease supplemental formula at times when the baby tends to be less interested in feedings.
• Decrease small amounts of supplemental formula spaced out over several feedings throughout the day rather than an entire bottle (e.g., ½ ounce at 4 feedings throughout the day instead of eliminating a full 2 ounces at one feeding).

Learn more about weaning your baby.