Other Breastfeeding and Breast Milk FAQs

Healthy infants will develop their own feeding schedules, and you should follow your infant's cues for when he or she is ready to eat.¹ Feedings may last 15 to 20 minutes or longer per breast. There is no set length of feeding—your infant will let you know when he or she is finished.

The number of times that you breastfeed your infant per day and the time of day depend on your infant's age and the infant's preference. A newborn will need to be fed eight to 12 times per day.² This means that your infant will likely need to breastfeed about every hour or two in the daytime and a couple of times at night during the first few days after birth.¹

Breast milk is the optimal source of nutrition for infants. The American Academy of Pediatrics (AAP) recommends iron-fortified infant formula as an appropriate alternative during the first year after birth, when breast milk is not available.³

A variety of formulas are sold for infants who are not breastfed or who are partially breastfed.

Formulas include:⁴

• Cow's milk–based formulas and soy-based formulas, which are fortified with iron
• Hypoallergenic formulas for those with or at risk for allergic conditions
• Other formulas designed to meet certain dietary needs, such as galactose-free formulas

Infants who drink enough formula and are gaining weight appropriately usually do not need extra vitamins or minerals, as long as the formula is fortified with vitamin D and iron. Your health care provider may prescribe extra fluoride if the infant formula is mixed with non-fluoridated water.⁵

Infant formulas can be purchased in the following forms:⁵

• Ready to use: Do not need to be mixed with water
• Powdered: Must be mixed with water
• Concentrated liquid: Must be mixed with water

The U.S. Food and Drug Administration (FDA) closely monitors infant formulas to make sure they meet certain standards of nutrition for infants.³

Visit the FDA's webpage FDA 101: Infant Formula Guidance Documents & Regulatory Information to learn more about infant formulas, nutritional specifications, and safety: http://www.fda.gov/Food/GuidanceRegulation/
GuidanceDocumentsRegulatoryInformation/InfantFormula/default.htm

Visit the AAP's policy on breastfeeding to learn more about infant formula recommendations:
http://pediatrics.aappublications.org/content/129/3/e827.full 

You should always speak with your infant's health care provider before traveling for additional guidance on breastfeeding your infant while you are traveling.

You may find that breastfeeding is easier than bottle-feeding during traveling. Some things to keep in mind while traveling with your infant include the following:⁶

• In extremely hot environments, you do not need to supplement a breastfed infant with water. Breast milk contains the right balance of water as long as you are feeding at regularly spaced intervals that are consistent with your normal feedings.
• Consider taking along a sling or other soft infant carrier to make nursing or carrying your infant easier, particularly if you need to stand for extended periods.
• If you are planning to be away from your child for an extended period, you should express and store a supply of breast milk.
• If you have a flexible schedule while traveling, take regular breaks to express breast milk to ensure an adequate supply during the trip.
• Expressed breast milk should be stored in clean, tightly sealed containers. Breast milk may be stored and transported under refrigeration, frozen, or on dry ice.
• Freshly expressed breast milk is safe for infant consumption for 6 to 8 hours when stored at room temperature.
• Fresh breast milk can be safely stored in a cooler bag with frozen ice packs for up to 24 hours.
• Refrigerated breast milk can be stored for up to 5 days.

For more information on traveling with your breastfeeding infant, visit the Centers for Disease Control and Prevention Travel Recommendations for the Nursing Mother webpage.

La Leche League International  also provides information and tips on breastfeeding while traveling .

Breast milk banks supply fresh breast milk to those who need it. There are many reasons that a mother may need to use banked milk. For example, she may not produce enough milk to satisfy the nutritional needs of her infant. Or she may have an illness or other condition that prevents her from feeding her infant.

If you are considering feeding your infant milk from a milk bank, you should be aware of the possible health and safety risks to your infant. If a donating mother has not been properly screened, risks to an infant receiving the milk include exposure to infectious diseases, including HIV, and chemical contaminants such as illegal and prescription drugs.⁷ Discuss your choices with your infant's health care provider.

The Food and Drug Administration (FDA) recommends against feeding your infant breast milk acquired directly from another person or through the Internet. Milk purchased through the Internet is likely to be contaminated with potentially harmful bacteria.⁷ The FDA recommends that if you decide to feed an infant with human milk from a source other than the mother, such as from a milk bank, you ensure that the source has screened its milk donors and taken safety precautions, such as proper handling to prevent contamination.⁸

For more information on milk banking and how to contact a milk bank, visit the Human Milk Banking Association of North America's website: https://www.hmbana.org .

National laws in the United States require employers to provide a reasonable break time for an employee to express breast milk for her nursing child for one year after the child's birth. There is no set limit for the number of times that an employee can express breast milk during a given day.

Employers are also required to provide a place other than a bathroom, that is shielded from view and free from intrusion from coworkers and the public, to be used by an employee to express breast milk.⁹ Special rooms provided by employers for mothers to express their breast milk during work hours are called lactation rooms.

For more information on specific breastfeeding laws in your state, including employer requirements, visit http://www.ncsl.org/issues-research/
health/breastfeeding-state-laws.aspx .

Also visit https://www.womenshealth.gov/breastfeeding/breastfeeding-home-work-and-public/breastfeeding-and-going-back-work for information on breastfeeding and returning to work.

Common myths about breastfeeding can lead to confusion and uncertainty about the right way to breastfeed.¹⁰

• Myth 1: Frequent nursing leads to poor milk production, weak let-down of milk, and unsuccessful nursing.
• Fact: Milk supply is best when a healthy infant is breastfed as often as he or she indicates the need. The body's response to hormones that help push milk out of the breast is strongest in the presence of a good supply of milk, which usually occurs when a mother feeds based on an infant's cue.
• Myth 2:Infants get all the milk they need in the first 5 to 10 minutes of breastfeeding.
• Fact: While many older infants can take in the majority of their milk in the first 5 to 10 minutes, this is not true for all infants. Newborns are not always efficient at nursing and may need longer to feed. An infant's ability to take in milk is also subject to the quality of the milk ejection. Some nursing mothers may eject their milk in small batches several times during a nursing session. Rather than guessing, it is best to allow the infant to nurse until he or she shows signs of fullness and satiety, such as self-detachment from the breast and relaxed hands and arms.
• Myth 3: A breastfeeding mother should space her feedings so that her breasts will have time to refill.
• Fact: Every infant-mother pair is unique. A nursing mother's body is always making milk. A mother's breasts hold an amount that is unique to her, some holding more, some less. The emptier the breast, the faster the body makes milk to replace what has been consumed or removed; the fuller the breast, the more the production of milk slows down. If a mother consistently waits until she thinks her breasts have "filled up" before she nurses, her body may get the message that it is making too much milk and may respond by reducing total milk production.
• Myth 4: Colostrum (the first milk) is bad for the baby.
• Fact: Colostrum actually is very helpful in promoting a newborn's health. It contains essential nutrients, provides immune factors, and supports the development of a newborn's digestive system.¹¹

For more information, visit the Common Breastfeeding Myths   page of the La Leche League International website.

Breastfeeding is extremely important for a preterm infant. If your child is born preterm, your milk will be higher in protein and other nutrients than the milk produced by the mother of an infant born at full term. A preterm infant is an infant who is born before 37 weeks of pregnancy.

Because a preterm infant is generally smaller than a term infant, it may be difficult to position your child correctly for feeding. Certain positions, such as the "cross-cradle hold," are recommended for positioning preterm infants at the breast for feeding. Visit the La Leche League website  for more information on this hold and positioning your preterm infant.

Some infants who are born preterm may not be able to breastfeed at first, but they do benefit from expressed breast milk. A new mother's breast milk contains colostrum, which has certain nutrients and immune factors. To make sure that your newborn receives your colostrum, even if he or she is too small to breastfeed, you should express your colostrum by hand or pump as soon as you can in the hospital. Ask a nurse or other health care specialist to provide you with a clean container for your expressed breast milk to feed to your newborn as soon as possible after birth.¹²

If you give birth to twins or triplets, the benefits of breastfeeding to you and your children are the same as for all mothers and infants.^13,14 Some women think that breastfeeding more than one infant will be overwhelming; however, it can be done with special planning and preparation.

Most mothers are able to make plenty of milk for twins. Many mothers of triplets (three infants) or quadruplets (four infants) are able to provide enough milk to breastfeed their infants completely or partially. When a mother breastfeeds partially, she supplements her breast milk with human milk from another source or with an infant formula.¹⁴

For more information on breastfeeding multiple infants, visit the HHS Office of Women's Health resources on breastfeeding and special situations.