Category Archives: Stage 2 Breastfeeding in Action

Before Returning to Work

• Speak to your employer about your plans to continue breastfeeding, and inform them that you intend to express milk at your
• Ask the lactation consultant, or healthcare provider whether you need a breast pump, and which kind is best for you.
• Practise pumping your breast milk during the morning or other times when your breasts feel fuller.
• Remember that pumping takes practice. Don’t be surprised if you only get a little the first few times. Babies are usually much better at removing milk.
• Store any milk you collect in small quantities (1-2 ounces). Baby may not take a large amount at one feeding, and your milk is too valuable to waste.

Preparing your baby

• About 2 weeks before you go back to work, start teaching baby to drink from a cup or bottle.
• Offer milk this way when baby is not hungry or upset.
• Ask someone else, like a caregiver or baby’s dad, to offer the cup/bottle.
• Don’t force baby to accept the cup/bottle. If baby refuses, take a break and try again later.
• Find a breastfeeding-friendly childcare provider.

Getting support from family

• Let your family members/caregivers know how important it is that they support you in your decision to breastfeed.

Pumping schedule

• Express your milk every 2 to 3 hours.
• If you’re using a double electric pump that expresses from both breasts at the same time, it may take around 20 to 30 minutes each time.
• Expressing by hand or with a manual pump will take longer.
• Be patient – you will get more efficient with practice.
• Use your regular breaks/lunchtime to express milk.

Useful Download(s)

1. Checklist for breastfeeding mum going back to work
2. How to express milk by hand/breast pump
3. Guide to storing and thawing expressed breast milk
4. Brochure for caregivers on how to take care of a breastfed baby

Facts about Separation Anxiety

• Once your infant realises you’re really gone, it may leave him unsettled.
• Some babies can display separation anxiety as early as 4 to 5 months of age, most develop more robust separation anxiety at around 9 months.
• The leave-taking can be worse if your infant is hungry, tired, or not feeling well.

How to Survive Separation Anxiety

• Create quick good-bye rituals. Keep good-byes short and sweet. If you linger, the transition time does too. So will the anxiety.
• Be consistent. Try to do the same drop-off with the same ritual at the same time each day you separate to avoid unexpected factors. A routine can diminish the heartache and will allow your child to simultaneously build trust in her independence and in you.
• Attention. When separating, give your child full attention, be loving, and provide affection. Then say good bye quickly despite her antics or cries for you to stay.
• Keep your promise. When you stick to your promise of return, you’ll build trust as your child gains self-confidence and independence.
• Be specific and use easy-to-understand terms. When you discuss your return, provide specifics that your child understands. If you know you’ll be back by 4 pm, tell it to your child on his terms. Define the time in ways he can understand. For example, instead of 4 pm, say “After your nap”; or, when referring to your return from a business trip, explain the time before he sees you again in terms of “sleeps”. So, instead of saying “I’ll be home in 3 days,” say, “I’ll be home after 3 sleeps.”
• Practice being apart. Leave baby with his grandparents, schedule playdates, and allow friends and family to provide child care for you (even for an hour) on weekends. Give your child a chance to prepare, experience, and thrive in your absence!

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For further information on infant and child nutrition, please refer to

1. MINISTRY OF HEALTH MALAYSIA (2013) Malaysian Dietary Guidelines for Children and Adolescents. Putrajaya: Technical Working Group on Nutritional Guidelines (for National Coordinating Committee on Food and Nutrition).
2. NUTRITION SOCIETY OF MALAYSIA (2011) Breastfeed with Confidence. Petaling Jaya: Mother’s Smart Choice.

Expect to be tired

• Looking after a baby is exhausting work, especially in the early days when you’re recovering from the delivery. Don’t feel bad if you feel tired and even irritable. You’re only human, after all.

Sleep

• Sleep is more important than doing dishes, laundry, and other chores, so grab some shut-eye every chance you get.
• Nap when baby naps.
• Try to sleep at least 1 ½ to 2 hours during the day for the first 2 to 3 weeks. Trust your husband, parents, or baby sitter with your baby for short periods of time, so that you have some time-out.

Night solution

• You may find it less tiring to nurse baby in bed during night feeds.

Help from husband

• Delegate some tasks to your husband, for example lulling your baby to sleep after each night fee

“Me” time

• Even if it’s just for 10 minutes, make it a point to do something purely for yourself. This private time will make you feel good and keep you from getting burnt out or overwhelmed.
• Do not put your hobbies and interests completely on the back-burner. You really should not feel guilty for spending a time away from baby, as this “me” time helps recharge your batteries, and be a good parent.

At least 95% of mothers can make plenty of milk for their babies, but many are concerned about not having enough. Checking your baby’s weight and growth is the best way to know if he’s getting enough milk.

Often, although mums think that their milk supply is low, it’s actually just fine.

What you can do:

• Eat a well-balanced diet and drink enough fluids.
• Make sure your baby is latched on and positioned well
• Breastfeed often and let your baby decide when to end the feeding
• Offer both breasts at each feeding. Have your baby stay at the first breast as long as he is still sucking and swallowing. Offer the second breast when the baby slows down or stops
• Avoid giving your baby formula or cereal as it may lead to less interest in breast milk. Your baby doesn’t need solid foods until he has reached 6 months old.
• Limit or stop pacifier use as your baby may fall asleep while sucking on this even when he is hungry.
• Let your doctor know if you think your baby isn’t getting enough milk.

Is Galactagogue necessary?

• Galactagogues are foods, herbs or medications that are thought to enhance milk supply.
• Taking these foods may only work if accompanied by sufficiently stimulating breast milk production, either through frequent feeds or expressing milk.
• While there are many substances that mothers claim to help them make more breast milk, there is limited scientific evidence to prove their effectiveness.
• Many cultures have special foods that are thought to enhance milk production. These vary and may contain active ingredients to fulfil this purpose. However, they have not been formally studied.
• Prolactin is the main hormone responsible for the production of breastmilk. Most medications that act as galactagogues work by increasing prolactin levels.
• The most common galactagogues are Fenugreek seed, Domperidone and Metoclopramide.
• Always speak to your doctor or lactation consultant if you plan to take any galactagogues.

The main cause of sore and cracked nipples is poor attachment by baby when feeding. This may be due to baby pulling the nipple in and out as he suckles, and rubbing the skin against his mouth. It may also be due to the strong pressure on the nipple from incorrect suckling.

Improving breastfeeding positions and latch-on is usually all it takes to solve this problem. Often, as soon as the baby is well attached, the pain will lessen and the baby can continue breastfeeding normally.

There is no need to rest the breast as the nipple will heal quickly when it’s no longer being damaged.

Symptoms

• Inverted nipples do not protrude from the level of the areola but are retracted inwards instead. Sometimes, an inverted nipple is non-protractile and does not stretch out when pulled; instead the tip goes in. This makes it difficult for baby to latch on. Protractility often improves during pregnancy and in the first week or so after baby is born.

Causes

• Different nipple shapes are a natural physical feature of the breast. An inverted nipple is held by tight connective tissue that may loosen after a baby suckles from it for a time.

Management

• Talk to your doctor or lactation consultant if you are concerned about your nipples.
• Continue breastfeeding, remember that baby has to latch on to both nipple and breast, so even inverted nipples can work just fine. Baby is more likely to attach and feed well if he becomes used to breastfeeding very early on. It is best to avoid bottles and teats this time, as these are very different in shape compared to the inverted nipple.
• Often, inverted nipples will protrude over time, as the baby sucks more. Trying different breastfeeding positions may also help baby to attach.
• If baby cannot attach in the first week or two, mother can express her breast milk and feed it by cup.
• Mothers can gently stimulate her nipple using a breast pump or another mild suction device such as a syringe.
• There is also a special device designed to pull out inverted nipples. It is a non-surgical method for inverted nipples that uses suction to stretch the lactiferous ducts gently in a manner similar to tissue expansion.

Symptoms

• The breasts are swollen, and the skin looks shiny and red.
• Usually the whole of both breasts are affected, and are painful.
• You may have a fever that usually subsides in 24 hours.
• The nipples may become stretched tight and flat, which makes it difficult for the baby to attach and remove the milk.
• The milk does not flow well.

Cause

• Failure to remove breast milk may cause congestion, especially in the first few days after delivery when milk comes in filling the breast and at the same time, blood flow to the breasts increases.
• The common reasons why milk is not removed adequately are delayed initiation of breastfeeding, infrequent feeds, poor attachment and ineffective suckling.

Management

• You must remove the breast milk. If the baby can attach well and suckle, then you should breastfeed as frequently as the baby is willing.
• If the baby is not able to attach and suckle effectively, you should express milk by hand or with a pump until the breasts are softer, so that the baby can attach better. Once this is achieved, get baby to breastfeed frequently.
• You can apply warm compresses to the breast or take a warm shower before expressing. This will help the milk to flow.
• You can also use cold compresses after feeding or expressing, as this will help to reduce swelling or fluid retention

Mastitis is an infection of the breast tissue.

Symptoms

• There is a hard swelling in the breast, with redness of the overlying skin and severe pain.
• Usually only a part of one breast is affected, which is different from engorgement, when the whole of both breasts are affected.
• You may have fever and feel ill.
• Mastitis is most common in the first 2 to 3 weeks after delivery, but can occur at any time.

Causes

• Usually due to long gaps between feeds.
• Other causes include poor attachment, with incomplete removal of milk.
• Unrelieved engorgement.
• Frequent pressure on one part of the breast from fingers or tight clothing, and trauma.

• Management
• Improve the removal of milk and try to correct any specific cause that is identified.
• Rest and breastfeed the baby frequently and avoid leaving long gaps between feeds. If working, take sick leave to rest in bed and feed the baby. (Mums with mastitis should not stop breastfeeding)
• Apply warm compresses.
• Start breastfeeding the baby with the unaffected breast, to stimulate the oxytocin reflex and milk flow.
• Vary the position of the baby.
• If symptoms are severe, if there is an infected nipple crack, or if no improvement is seen after 24 hours of improved milk removal, the treatment should then include some antibiotics. However, antibiotics will not be effective without improved removal of milk. Always speak to your doctor if this happens.

For further information on infant and child nutrition, please refer to

1. MINISTRY OF HEALTH MALAYSIA (2013) Malaysian Dietary Guidelines for Children and Adolescents. Putrajaya: Technical Working Group on Nutritional Guidelines (for National Coordinating Committee on Food and Nutrition).
2. NUTRITION SOCIETY OF MALAYSIA (2011) Breastfeed with Confidence. Petaling Jaya: Mother’s Smart Choice.

As a start, feed newborn baby every 2 hours (8 to 12 times in 24 hours) during the first 3 months. Some babies may eat several times in a short period, especially during growth spurts. As baby gets older, the number of feeding times per day may decrease or increase.

Every baby is different. Breastfeed baby on demand and pay attention to baby’s hunger cues (eg. increased eye movement, opening his mouth and stretching out his tongue while turning his head around to look for breast, making soft whimpering sounds and sucking on hands, fingers or any nearby objects). Nurse him immediately whenever is needed. Don’t wait until baby cries to put him to the breast as crying is a late sign of hunger.

When baby is sick, continue breastfeeding baby. Breast milk contains antibodies specifically tailored to help baby to fight against illness and keeps baby hydrated.

Night feeding is important because your hormones that stimulate milk production work better at night. In addition, newborn babies sleep for 16 or more hours a day and should be woken up every 3 to 4 hours to breastfeed until their weight gain is established – usually within the first couple of weeks. After that, it’s OK for baby to sleep for longer periods of time.

Most breastfed infants won’t snooze for extended periods. This is because breast milk is more easily digested than formula, and baby will feel hungry again soon after a feed.

A newborn baby’s longest sleep period is generally between 4 and 5 hours. If newborns do sleep for longer, they’ll probably be extra hungry during the day and may want to nurse more frequently.

After 3 months, a baby averages a total of 5 hours of daytime napping, and 10 hours sleep at night, usually with an interruption or two.  Babies may sleep “through the night”, meaning 6 to 8 hours in a row. However, bear in mind that this varies greatly among babies.

These are some signs that baby is getting enough breast milk:

Regular wet diapers

• After baby’s first few days, he should have at least 6 wet nappies a day and the urine should be odourless and clear, or a very pale colour. Strong, dark urine suggests that baby needs more breast milk and you should seek medical advice.

Regular bowel movements

• Baby’s poo should start turning green and then yellow. Your baby should have 3 or more bowel movements a day, although he may do this less frequently after he is a month or older. Normal poo should be yellowish and soft.

Healthy growth

• During the first week, most infants lose several grams of weight but should be back up to their birth weight by the end of the second week. After this, your baby should be gaining weight regularly. Speak to the doctor at each visit about whether your baby is growing normally.
• Your baby should sleep well and have good muscle tone and healthy skin.

For further information on infant and child nutrition, please refer to

1. MINISTRY OF HEALTH MALAYSIA (2013) Malaysian Dietary Guidelines for Children and Adolescents. Putrajaya: Technical Working Group on Nutritional Guidelines (for National Coordinating Committee on Food and Nutrition).
2. NUTRITION SOCIETY OF MALAYSIA (2011) Breastfeed with Confidence. Petaling Jaya: Mother’s Smart Choice.

A proper latch is the key to prevent many breastfeeding problems. The following are some ways to check if baby is latched on properly:-

• Observe your baby while he is feeding. If he has latched on well, you will notice the following:
• Baby’s mouth is wide open
• Baby’s lips is turned outward
• Chin is touching the breast (or nearly so)
• More areola is visible above the baby’s mouth than below
• Baby suckles slowly and deeply with pauses
• Cheeks appear full and round during suckling
• You can hear swallowing
• Baby releases breast when full
• Not feeling pain although you may experience an initial discomfort due to the pulling of nipple and areola by your baby

If baby isn’t latched on well, start over. To break the suction, insert a clean finger between your breast and your baby’s gums.

<Insert video: Expert “Breastfeeding technique and positions”>

It will take time for mum and baby to learn to breastfeed. It can take up to 6 weeks to establish breastfeeding. It’s mostly about finding a comfortable nursing position and ensuring baby is properly latched on, but here are some other ways you can do to make breastfeeding as fuss free as possible:

Nurse in a calm and relaxing environment

• Nursing baby in a relaxing environment and staying as calm as possible before and during nursing can help your milk let down and flow more easily. That, in turn, can help calm and relax your infant.
• Before you begin breastfeeding, you can do things such as take deep calming breaths or play soothing music in the background to put you in the right state of mind. Dimming the lights in the room may also help.

Breastfeeding goodie bag/basket

• Keep one at all the spots where you usually breastfeed at home – next to the bed, on the couch, etc. Fill it with bottled water, some healthy snacks, a few magazines, your portable home phone or cell phone, plenty of burp cloths or cotton diapers for dribbles and spit-ups.

Comfy chair

• Find the best seating arrangement and stick to it so you don’t waste time and energy trying to be feel comfortable while breastfeeding.

Extra support

• Footstools and pillows can provide extra support. Pillows that some women find helpful are the wraparound nursing pillows or the “husband” back pillows with arms on each side for nursing in bed.

Causes of colic

• There are many reasons why your baby cries. The pattern of crying may suggest the cause.
• About one-fifth of all babies develop colic, usually between the second and fourth weeks.
• They cry inconsolably, often screaming, extending or pulling up their legs, and passing gas. Their stomachs may be enlarged or distended with gas.
• The crying spells can occur around the clock, although they often become worse in the early evening.
• The cause is not clear. Babies with colic usually grow well, and the crying decreases after 3 to 4 months. However, it can last up to 6 months of age.
• Sometimes, in breastfeeding babies, colic is a sign of sensitivity to a food in the mother’s diet.
• Colicky behaviour may also signal a medical problem, such as a hernia or some type of illness.

What to do:

• First, consult your doctor to make sure that the crying is not related to any serious medical condition that may need treatment.
• For nursing mum, try to stop taking milk products, caffeine, onions, cabbage, and any other potentially irritating foods. If food sensitivity is causing the discomfort, the colic should decrease within a few days of these changes.
• Carry your baby more and rock him, applying gentle pressure on his abdomen with your hand. Alternatively, hold him against your shoulder.
• Swaddle baby in a large, thin blanket so that he feels secure and warm, but not too hot.
• When you’re feeling tense and anxious, have a family member or a friend look after baby so that you can leave the house. Even an hour or two away will help you relax and maintain a positive attitude. No matter how impatient or angry you become, a baby should never be shaken. Shaking an infant hard can cause blindness, brain damage, and even death. Let your own doctor know if you are depressed or having trouble dealing with your emotions, so she can recommend ways to help.

For further information on infant and child nutrition, please refer to

1. MINISTRY OF HEALTH MALAYSIA (2013) Malaysian Dietary Guidelines for Children and Adolescents. Putrajaya: Technical Working Group on Nutritional Guidelines (for National Coordinating Committee on Food and Nutrition).
2. NUTRITION SOCIETY OF MALAYSIA (2011) Breastfeed with Confidence. Petaling Jaya: Mother’s Smart Choice.

How much you need to eat when you’re breastfeeding depends on your pre-pregnancy weight, and how much weight you gained during pregnancy, as well as how active you are.

In general, most breastfeeding women need about 500 calories more than women who are not – that is a total of 2,500 kilocalories (kcal) per day. 

When breastfeeding, a healthy and well-balanced diet is as important as always. It should include a variety of foods from all the food groups in the Malaysian Food Pyramid.

In addition, an extra 2 servings of protein, for example one medium-sized fish (eg ikan kembong) and one egg, should be included to a breastfeeding mum’s existing diet.

Your calcium requirement increases by 25% during the lactation period. This means you need to eat more calcium-rich foods such as dairy products (milk, yoghurt), calcium fortified products (breakfast cereals), fish (sardines, ikan bilis), beans and bean products (taufu, tempeh), and green leafy vegetables.

Eating a variety of foods while breastfeeding will change the flavour of your breast milk. In fact, some experts believe that babies enjoy a variety of flavours in their breast milk, and this may help them accept different foods once they start eating solids.

Drink whenever you feel thirsty. Clear or pale yellow urine is a good sign that you are well hydrated.

Useful Download(s)

Chart of daily food group servings and sample meal plan for breastfeeding mothers

Do NOT try to lose weight by dieting until at least two months after your baby is born. A low-calorie diet in the first few months could make you feel weak and lessen your milk flow.

Avoid drastic weight loss. Instead, lose weight at a slow and steady rate of ½ to 1kg a week to avoid changes in the amount and quality of your milk. It is recommended that you speak to your doctor/dietitian /nutritionist before starting on any diet or exercise plans.

Breastfeeding burns 500 calories. Breastfeed exclusively for 6 months (and continue for up to 2 years while introducing your baby to other foods), stick to a healthy and balanced diet, and add some gentle exercise (you can increase the intensity 6 to 8 weeks after giving birth). These will help you to get back to your pre-pregnancy weight healthily.

There are NO foods you should avoid simply because you’re breastfeeding unless you notice an obvious reaction in your baby to a particular food. Moderation is the key.

However, if you suspect that something in your diet might be making your baby a little fussier than usual, avoid the food or drink for up to a week to see if it makes a difference in your baby’s behaviour. If removing a certain food or drink from your diet has no impact on your baby’s fussiness, add it back to your diet and consider other possible causes. If you’re concerned about your baby’s behaviour, consult your doctor.

Coffee and Caffeine

• If you consume excessive amounts of caffeine (more than 5 caffeinated beverages per day), your baby may be more fussy or irritable. It may even keep him awake.
• Breastfeeding mums are advised to limit their intake of coffee and caffeinated drinks, such as tea, chocolates and cola, to no more than 2 cups per day.

Alcohol

• Alcohol passes through your milk to your baby, so it’s best to avoid habitual use while breastfeeding.
• If you choose to have an alcoholic drink, have it after you have breastfed your baby or express your milk prior to the drink, and allow at least 2 hours to pass before you breastfeed or express milk again.

For further information on infant and child nutrition, please refer to

1. MINISTRY OF HEALTH MALAYSIA (2013) Malaysian Dietary Guidelines for Children and Adolescents. Putrajaya: Technical Working Group on Nutritional Guidelines (for National Coordinating Committee on Food and Nutrition).
2. NUTRITION SOCIETY OF MALAYSIA (2011) Breastfeed with Confidence. Petaling Jaya: Mother’s Smart Choice