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Breastfeeding Information and Support

Breastfeeding is the normal way to feed infants and young children and is very important to the health of mothers, children and communities.

York Region recommends that children receive only breastmilk for the first six months of their lives. At six months, children can begin to eat healthy, age appropriate solid foods. Breastfeeding should continue, along with solid foods, for at least two years to give children the healthiest possible start in life. There are health risks to children and mothers who do not breastfeed.

Children who are fed formula instead of breastmilk are more likely to experience:

  • Sudden Infant Death Syndrome
  • Infections such as:
    • Ear
    • Lower respiratory tract
    • Urinary tract
    • Bacterial meningitis
  • Gastrointestinal illnesses such as infection and diarrhea
  • Inflammation of the stomach and intestines in premature infants
  • Crohn’s disease and ulcerative colitis
  • Chronic diseases such as:
    • Obesity
    • Type II diabetes
    • High blood pressure and heart diseases in adulthood
    • Higher cholesterol levels as adults
    • Certain childhood cancers such as lymphoblastic leukemia, Hodgkin’s disease and neuroblastoma
    • Lower IQ scores

Mothers who do not breastfeed are more likely to experience:

  • Breast and ovarian cancer
  • Chronic diseases such as:
    • Cardiovascular disease
    • Type 2 diabetes
    • Metabolic syndrome
  • Decreased postpartum weight loss

Breastfeeding results in healthier children and mothers. It is also free, protects the environment and is always available.

Mothers can get an early start by learning about breastfeeding from their doctor, midwife or public health nurse while they are pregnant. They can prepare for the arrival of their baby by learning where to get answers about breastfeeding and who in the community can help.


Breastfeeding Information and Support

The First 72 Hours

Mothers are encouraged to:

  • Lean back and put baby skin-to-skin on their chest
  • Allow and assist their baby to crawl toward their breast
  • Breastfeed their baby within the first hour after birth
  • Get help right away if baby is not showing interest in latching to the breast
  • Offer their breast every few hours or sooner when baby is showing signs of hunger

Skin-to-Skin Contact is Important

Mothers should cuddle skin-to-skin with their baby as soon as possible after birth and between feedings. Spending time skin-to-skin will help the baby:

  • Stay warm
  • Recover from birth
  • Follow the instinct to latch and feed at the breast

Getting a Good Latch at Every Feeding is Important

To encourage a good latch mothers can:

  • Wait until the baby moves toward the breast
  • Touch their nipple to the baby's upper lip and wait for the baby to latch
  • Support the breast while the baby latches and feeds
  • Make sure that the baby feels supported and comfortable

Some babies latch better when the breast is moulded into a “sandwich” shape. To do this, mothers can place their hand in a “U” shape under the breast and mould the breast to make it easier for baby to grasp.

When a baby is latched well:

  • The baby's chin and cheeks should be touching the breast and head tilted back slightly
  • Their nose will be tilted slightly away from the breast
  • Their mouth will be open wide and their lips are flared
  • Their chin and lower lip will touch the breast first
  • They will have more of the breast below the nipple in his mouth
  • They will have a strong and regular suck
  • There will be no pain and nipples will not look pinched or white
  • Mothers will often feel a “tugging” sensation but not pain
  • Mothers will hear their baby make the "kaa" sound of swallowing. These swallows become more frequent each day. By day three or four mothers will hear a swallow for every one or two sucks

Try Different Positions

It is important that both mother and baby feel supported and comfortable while breastfeeding. A public health nurse or breastfeeding clinic can help mothers find positions that work for them.

When in a good position for breastfeeding:

  • The mother should not experience pain or discomfort
  • The mother’s back should be well supported
  • The baby’s nose should be lined up with mother’s nipple to latch (nose to nipple)
  • The baby’s tummy should be facing the mother
  • The mother should be able to hold the baby close to her body
  • The baby’s neck, shoulders and bottom should be supported

For more information on learning to breastfeed, including positioning for a deep latch, see Best Start's Breastfeeding Matters booklet.

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Signs of Hunger

Babies should be fed at least eight times every 24 hours. Mothers will know it is time to feed when their baby shows these signs of hunger:

  • Wiggling, tossing and turning or restlessness while sleeping
  • Moving their hand towards the mouth and sucking on their fists
  • Licking their lips
  • Making sucking motions or sounds
  • Rooting (opening their mouth, searching to suck and sucking on contact)
  • Turning their head back and forth
  • Sticking out their tongue
  • Making soft cooing or sighing sounds
  • Moving their arms and legs

Parents should try to feed their baby when they see the above signs. Crying is a late sign of hunger. If the baby is too upset to breastfeed well or latch, mothers can try:

  • Sitting the baby upright on her chest, skin-to-skin
  • Talking, rocking or gently stroking her baby in a calming way

Babies Should Breastfeed Frequently

Breastfed babies need to eat at least eight times every 24 hours. It is normal for babies to breastfeed 12 or even more times in a 24 hour period. Babies will often cluster some feedings together and then leave longer periods between other feedings.

During the first several weeks of life, babies will want to feed many times during the night. It may seem that the baby has “night and day mixed up”. This is normal for newborn babies and will help them grow and gain weight and will also help build the mother’s milk supply.

If the baby is not waking up to feed at least eight times in 24 hours, mothers should see their healthcare provider.

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Wet and Dirty Diapers

Diapers are the best way to tell if a baby is getting enough milk.

Mothers should talk to their health care provider, public health nurse or lactation consultant if their baby is not having enough wet and dirty diapers.

Day One

  • One wet diaper
  • One black stool

Day Two

  • Two wet diapers
  • One or two black or brown stools

Day Three

  • Three wet diapers
  • Two to three lighter brown stools

Day Four

  • Four heavy wet diapers
  • At least two yellow stools

Day Five

  • Five heavy wet diapers
  • At least two yellow stools

Day Six and On

  • Six heavy wet diapers
  • At least two yellow stools which may be runny and seedy
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Day Three Onwards

Breastmilk production works by supply and demand. The more often a baby breastfeeds and successfully removes milk from the breast, the more breastmilk is made. Mothers should feed their baby at least eight times every 24 hours to make sure they have enough breastmilk to feed their baby.

A mother’s breastmilk will start to change after 72 hours:

  • Breastmilk supply should start to increase – breasts may feel full and warm
  • Breastmilk gradually changes from sticky yellow colostrum to white, mature breastmilk over the first two weeks

Mothers should remove breastmilk frequently if their baby is not able to breastfeed. This can be done by hand or using a double electric breast pump. A Public Health Nurse can answer questions about removing milk by hand or by pump.

Babies Should Soften the First Breast Before Switching Sides

Mothers should make sure that the first breast is well drained before switching to the second. To do this, they can:

  • Keep the baby on the first breast as long as the baby is swallowing milk
  • When the breast feels softer and there are less swallows, the baby can be offered the second breast
  • If the baby is still showing signs of hunger after both breasts, both breasts can be offered again
  • By the end of the feed, at least one breast should feel soft and the baby should no longer be showing signs of hunger

Breasts Should not be Sore and Hard

A mother’s breasts should not become sore or hard if their baby is breastfeeding well. This happens when the breasts are full of milk that is not being removed. Hard, sore breasts can be treated with a cold compress or ice pack to reduce swelling between feedings.

If the baby cannot latch because breasts are too full and hard, mothers can remove some milk by hand or with a pump. This will soften the nipple/areola area to allow the baby to latch.

Tips for Mothers Whose Baby is not Latching Well

Mothers whose baby is not latching well can:

  • Be patient and don’t give up; it may take days or weeks for the effects of birth to wear off
  • Hold the baby wearing only a diaper to their naked chest (this helps the baby recover from birth and encourages feeding)
  • Feed their baby another way while baby continues to work on breastfeeding
  • Continue to remove milk from their breasts by hand or with a breast pump
  • Breastfeed or remove breastmilk about eight times every 24 hours to keep breastmilk production up
  • Get help; a health care professional or breastfeeding clinic can support mothers through this time and provide expert breastfeeding help
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Breastmilk Alternatives

Formula should not be used unless necessary. Mothers should talk to a health care provider, public health nurse or breastfeeding expert about how and when to give extra milk also known as supplementing. Most breastfed babies do not need supplements. Babies may need supplements if:

  • They are not having enough wet and dirty diapers for their age
  • A health professional is worried that the baby is not growing well
  • They cannot latch at the breast or do not drink well at the breast
  • A health professional has assessed that breast milk supply is truly low
  • They have been separated from their mother for medical or other reasons

In all of these cases, mothers should see a health care professional as soon as possible and get help from a breastfeeding expert. Breastfeeding support will help mother and baby establish breastfeeding, and often avoid the need for a supplement, or limit the amount that is necessary.

If Supplements are Needed

Mothers should still try to give as much breastmilk as possible if supplements are needed. Breastmilk can be removed by hand or using a double electric breast pump.  This milk can then be fed to the baby. Pasteurized human milk from an accredited milk bank would be the best second choice to a mother’s own milk, however, in Ontario this is only available for hospitalized babies. 

For a step-by-step guide to hand expression of breastmilk, please see Hand Expression

To watch a video which demonstrates hand expression, please visit:
Hand Expression Video - Stanford University

For information on how to safely store and use expressed breastmilk, please see Storing expressed breastmilk factsheet.

Infant formula (commercial cow milk-based) can be used if a mother does not produce enough breastmilk to feed her baby. Read our infant formula factsheet for information and safe preparation and storage instructions.

Bottle Nipples and Pacifiers Should be Avoided

Offering a bottle or a pacifier/soother may make learning how to breastfeed difficult for some babies. If babies need extra milk, mothers can try the following alternative feeding devices before using a bottle:

  • Tube at the breast
  • Finger-feeding tube
  • Cup
  • Spoon

For information about the use of any of the above feeding methods, please see the When your breastfed baby needs extra milk booklet.

Pacifier/soother use can interfere with a baby’s breastfeeding success.  Instead of using a pacifier, parents can try to calm their baby with cuddling, rocking and placing skin-to-skin.

Just Breastmilk for six Months

Babies do not need any foods or drinks other than breastmilk until six months of age. They can then be given solid foods, along with breastmilk. It is recommended babies continue to breastfeed with solid foods for two years and beyond. Breastmilk continues to provide older babies and toddlers with protection against illness and disease and continues to be an excellent source of nutrients for young children.

There is no need to give babies water in the first six months of life — breastmilk has all the water babies need.

All babies need extra Vitamin D. Vitamin D has already been added to infant formula, however, breastfed babies and babies receiving breastmilk will need a Vitamin D supplement.  Talk to your health care professional about giving Vitamin D to your baby.

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Mothers Who Need Help With Breastfeeding

Mothers can get support:

Mothers should seek help if:

  • Their baby is not having enough wet or dirty diapers
  • Their baby is not able to latch or cannot latch well
  • Their baby still seems hungry after breastfeeding and they have to feed their baby supplements
  • Their baby does not regain their birth weight after 14 days
  • A health professional is worried about their baby’s growth
  • They have sore nipples or breasts
  • They have questions or want information or advice about feeding their baby
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How to Express Your Breast Milk by Hand

Hand expression in the first hour after birth and continuing after each feeding helps to establish a good milk supply, even when breastfeeding is going well.

Hand expression can:

  • Provide baby with a taste of milk to get them interested in feeding
  • Soften the area of the breast surrounding the nipple (areola) to help baby to latch
  • Lessen the discomfort of overfull breasts
  • Help maintain milk supply if separated from baby or unable to feed baby directly from the breast
  • Save the cost of a breast pump

It is normal to get very little or no milk at first. You may only get a few drops or a teaspoon initially. This is the perfect amount for your new baby’s small tummy in those first few days. The more you hand express over time, the easier it will become and the more milk you will get.

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Breastfeeding and Returning to Work or School

Continued breastfeeding after returning to work or school is possible and can often be easily incorporated into a family’s daily routine. Continued breastfeeding is important to the health of both mother and baby, and is a protected right covered under The Ontario Human Rights Commission.

Why keep breastfeeding?

Health Canada, the World Health Organization and the Canadian Paediatric Society recommend that babies be fed only breastmilk for the first six months of life (called exclusive breastfeeding), then be fed solid foods with continued breastfeeding for two years and beyond. 

Breastfeeding protects both maternal and child health. Many of the protective effects of breastfeeding increase over time. The longer a child is breastfed or receives human milk, the greater the protective effect against disease, for both mother and child.

Breastmilk:

  • Helps to protect a child from common childhood illnesses, such as ear and lower respiratory tract infections, as well as diarrhea
  • Decreases a child’s risk of diabetes, childhood cancers and obesity later in life. Children who are not breastfeed are at greater risk for these chronic diseases
  • Supports a child’s immune system. Some of the illness-fighting cells present in breastmilk increase during the second year of lactation. This makes breastfeeding two years and beyond very important to a toddler’s health
  • Continues to be a valuable source of nutrition for children, well beyond one year of age. Necessary vitamins, minerals and energy continue to be supportive of healthy growth and development
  • Is very important to maternal health. Women who are breastfeeding or expressing milk have a decreased risk of breast and ovarian cancers, as well as depression, cardiovascular disease and type 2 diabetes

Did you know?

Mothers who breastfeed after returning to work take less time off work to care for ill children. This is because breastfed children get sick less often!

What are the options for continued breastfeeding?

There are several ways to continue breastfeeding or providing expressed breastmilk after returning to work or school. 

Options include:

  • Having someone bring your child to work or school to be breastfed. Employers and schools will accommodate this as breastfeeding is a protected human right
  • Expressing breastmilk at work or school and storing it in a fridge, or insulated cooler with ice pack. Expressed breastmilk can then be fed to your child in your absence
  • Breastfeeding while you are with your child at home, but not expressing breastmilk or breastfeeding while at work or school. Milk supply will adjust to meet the needs of your child. However, once breastmilk supply has decreased, it may be difficult to increase again at a later time

What are my rights?

The Ontario Human Rights Commission states that you have the right to breastfeed your child, or to express your breastmilk, while at work or school. To learn more about this human right, please visit www.ohrc.on.ca

What must an employer do?

  • Protect and support your right to breastfeed and/or express breastmilk
  • Give you enough time to breastfeed or express your breastmilk
  • Give you an appropriate place that is clean and private, to breastfeed or express your breastmilk

Tips for returning to work:

Before you return:

  • Talk to your employer about your plans to breastfeed or express your breastmilk
  • Talk to other breastfeeding mothers who spend time away from their children
  • Practice expressing breastmilk by hand or pump
  • Buy an insulated cooler bag to store breastmilk, or ensure there is a fridge at work or school that you can use to store your expressed milk
  • Review Storing Expressed Breastmilk

  While you are at work or school:

  • Wear a supportive and comfortable bra
  • Express your milk when you feel full or uncomfortable, about every three to five hours depending upon the age of your child
  • Expect that it may take days or weeks for your breastmilk supply to adjust to the amount of milk being removed

What will be helpful for my child?

  • Breastfeed right before you leave the house and when you are reunited with your child again. Your child may wish to breastfeed frequently during the evening as well
  • Understand that it is not unusual for children to want to breastfeed more often at night once separated from their mothers in the day. This may be short term, as your child adjusts to a new routine.
  • Breastfeed on demand when you are with your child
  • If you will not be directly breastfeeding your child at school or in the workplace, have your child practice drinking in another way. A sippy cup is an option if your child is under 18 months of age, or a cup without a lid once they are able to do so without excessive spillage
  • If you decide to feed expressed breastmilk from a bottle, remember that artificial nipples may lead to earlier weaning from direct breastfeeding.
  • By 18 months, children should be breastfeeding and/or drinking from a cup without a lid. Using a bottle or sippy cup should stop by eighteen months, as prolonged use may lead to dental problems

How can my childcare provider support breastfeeding?

Choose a childcare provider who:

  • Understands that breastfeeding is important to health
  • Will support your breastfeeding goals, and welcome you to breastfeed during dropoff and pickup
  • Accepts expressed breast milk to feed your child in your absence
  • Has a policy about how to store and offer expressed breastmilk

Remember, breastfeeding and expressing breastmilk at work, school or in public is a human right in Ontario. You have the right to breastfeeding anywhere, anytime!

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More Information

To speak with a public health nurse about breastfeeding and to find out where to get help in York Region, contact:

Health Connection
Telephone: 1-800-361-5653
Email:  AccessYork@york.ca



Related Resources

External Resources

To learn more about The Baby-Friendly Initiative (BFI), please visit the Breastfeeding Committee of Canada website.

For information about medication during breastfeeding, contact Motherisk – The Hospital for Sick Children at 416-813-6780.

For information on the rights of a breastfeeding mother, visit the Ontario Human Rights Commission website.

For more information on nutrition and healthy eating, visit the Health Canada website.

For more information about breastfeeding, see Best Start's Breastfeeding Matters guide.


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