La Leche League International
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Mammal Milk Composition and Mothering Styles
资料来源：
www.lllc.ca/mammal-milk-composition-and-mothering-styles
END
翻译：Lynn
审稿：传艳、楠楠
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母乳喂养 科普手册系列
#
当然，本手册只是提供资讯，无论妈妈选择哪种喂养方式，我们都尊重你们的选择。
即使母乳喂养几天也能减少产后问题，让妈妈产后恢复更快，瘦身更快，体内激素更均衡，并给宝宝的肾脏、肠道和肝脏一个更健康的开始。早期的乳汁充满了保护因子，宝宝在未来数月都会依赖这些保护。它具有任何配方奶都无法提供的特别定制的免疫因子。
研究表明，如果母乳喂养超过几个月，与配方奶喂养的母亲相比，妈妈会降低乳腺癌、子宫癌、宫颈癌、卵巢癌、糖尿病、骨质疏松症和泌尿道感染的发病率。
在出生后的头六个月纯母乳喂养有助于确保宝宝拥有正常的免疫系统，并保护他免受配方奶喂养可能引起的许多疾病。这意味着妈妈将拥有一个更健康快乐的宝宝，很少需要请假去照顾他。
母乳喂养不但是婴儿食物的来源，同样重要的这是他们舒适和安全感的来源。大多数母乳喂养的婴儿哭得少是因为他们被抱得多。
哺乳时间越长，宝宝的智商越高，身体越健康，降低包括癌症、心脏病、糖尿病和肥胖等长期健康风险。
纯母乳喂养的母亲排卵和月经的恢复可能会延迟至产后六个月或更长时间。
母乳喂养会消耗额外的热量，所以妈妈无需节食就能逐渐减轻体重。
与配方奶喂养相比，母乳喂养可以节省大量的时间、精力和金钱。
母乳喂养的婴儿往往拥有丝滑柔软的皮肤。配方奶喂养的婴儿更容易患湿疹，他们还更可能患哮喘和过敏。
END
撰稿 | Victoria
审阅 | Victoria, 晓璠
编辑 | 斯琦
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蛀牙这个锅，母乳该不该背？一文理清母乳喂养与牙齿健康 Breastfeeding and Dental Health
国际母乳会上面这篇母乳与牙齿健康的文章发表后，引起了广泛的讨论。
针对妈妈们关心的问题，我们特地采访了两位牙科医生：广州的mtk和武汉的乐乐妈，她们都是母乳妈妈。
以下是访谈详情：
1. 乳牙什么时候开始清洁，乳牙保健注意事项
刷牙的频率是每天早晚各一次，由父母来帮小朋友刷牙，直到至少六岁。小朋友牙缝容易嵌塞食物，父母亦应该每天帮小朋友使用牙线。定期的口腔检查也是十分重要，频率一般为每年两次。
2. 为什么换牙好多都长歪了，如果需要做正畸，几岁做比较好？
三岁的时候可以到正畸医生处就诊，若有骨性问题可及早干预，若非骨性问题可待替牙完成再进行干预。
3. 蛀牙和遗传有关吗？
4.孩子乳牙总是要换的，那护理与不护理有啥区别
5.门牙缝大 有必要去一下唇系带吗？
6.有必要定期带孩子涂氟吗？如果有必要的话是从几岁开始？
7. 夜奶会不会造成龋齿？
乐乐妈
END
审稿：Victoria、mtk、乐乐妈
编辑：斯琦
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正如我们的志愿者在内部会议中提到，投身公益事业后才知道做公益也是有成本的！你的支持和赞赏可以让更多的妈妈获益！
本篇文章来源于微信公众号: 国际母乳会LLL
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接下来我们将继续深入探讨关于母乳喂养期间饮酒的一系列问题，涵盖诸如“一杯酒”的定义以及一些至关重要的注意事项。包括在饮用酒精饮料后是否需要泵奶并丢弃乳汁，以及在发生醉酒情况时应该如何处理。还将详细讨论酒精依赖或利用酒精进行自我治疗对母乳喂养婴儿可能产生的影响，如何在权衡风险和收益时做出明智的选择。
Next, we will continue to delve into a series of issues regarding alcohol consumption during breastfeeding, covering topics such as the definition of “one drink” and some crucial considerations. This includes whether it is necessary to pump and discard breast milk after consuming alcoholic beverages and how to handle situations of intoxication. We will also discuss in detail the potential impact of alcohol dependence or using alcohol for self-treatment on infants during breastfeeding, as well as how to make informed decisions when balancing risks and benefits.
Par6
“一杯酒”是指多少？
欧洲
想要了解欧洲的标准杯衡量方法，请参阅欧洲标准饮酒准则 。在英国，国家医疗保健服务（NHS）建议使用以下这个酒精单位计算器：https://alcoholchange.org.uk/alcohol-facts/interactive-tools/unit-calculator
美国
在美国，国立卫生研究院（NIH）的定义如下：
一个“标准杯”的酒（或同等的酒精饮料）大约含14克纯酒精，相当于：
12盎司（约等于360ml）普通啤酒，其酒精含量通常约为5%
5盎司（约等于150ml）葡萄酒，其酒精含量通常约为12%
1.5盎司（约等于45ml）蒸馏酒，其酒精含量通常约为40%
中国（译者注）
《中国居民膳食指南2022》（https://www.cnsoc.org/notice/442220200.html）建议孕妇、乳母不应饮酒。成年人如饮酒，一天饮用的酒精量不超过15g。
15g酒精相当于
啤酒（4%计）：450ml
葡萄酒（12%计）：150ml
白酒（38%计）：50ml
高度白酒（52%计）：30ml
Part7
重要的注意事项
宝宝的年龄
酒精的量
了解什么叫“一个标准杯的酒精饮料”
酒精对婴儿的影响与饮酒量直接相关
饮酒越多，身体就需要越长的时间来清除酒精。
（CDC指出，“喝了1杯酒精饮料后大约2-3小时内可以在母乳中检测到酒精，喝了2杯酒精饮料后大约4-5小时内可以在母乳中检测到酒精，喝了3杯酒精饮料后大约6-8小时内可以在母乳中检测到酒精，依此类推。”）
Part8
喝了酒精饮料后我必须吸奶并丢弃乳汁吗？
Part9
如果我喝醉了怎么办？
Part10
酒精依赖/使用酒精来自我治疗会影响母乳喂养的婴儿吗？
Part11
权衡风险和获益
未雨绸缪
如果您选择喝酒，请尽可能好好计划，尽量减少宝宝接触酒精的机会；如果可能，提前挤出一些母乳并预存起来。
在饮用任何酒精饮料之前立即母乳喂养，然后等待大约三小时后再次哺乳，这样将有助于确保宝宝从母乳中喝到的酒精很少。
如果您在等待酒精从你体内清除的过程中开始涨奶，可以用手挤奶或者用吸奶器吸奶，并丢弃挤出的乳汁。
如果您打算大量喝酒，请确保找到一个负责任的看护人来代替您照顾好宝宝。
如果您真的不想去参加家庭或职场的社交活动，请与值得信赖的朋友或当地的国际母乳会哺乳辅导(获取
国际母乳会哺乳辅导联系方式)讨论去参加活动的利弊。
您可以坚持喝不含酒精的饮料。
在其他人都在喝酒的场合中，可以给值得信赖的朋友发消息或在线联系国际母乳会哺乳辅导。
A ‘standard drink’ is measured differently in different countries. It is important to understand what a ‘standard drink’ is if you choose to drink alcohol and breastfeed.
Please check with your Ministry of Health or other pertinent government resource for appropriate information in your country.
Thomas W. Hale, R.Ph. Ph.D, says this in his book Medications and Mothers’ Milk (17th ed., 2019):
“Alcohol transfers into human milk readily, with an average plasma/milk of about 1. This does not necessarily mean the dose of alcohol in milk is high, only that the levels in plasma correspond closely with those in milk. The absolute amount (dose) of alcohol transferred into milk is generally low and is a function of the maternal level. Older studies, some in animals, suggested that beer (or more likely barley) may stimulate prolactin levels. Significant amounts of alcohol are secreted into breastmilk although it is not considered harmful to the infant if the amount and duration are limited. The absolute amount of alcohol transferred into milk is generally low.
Excess levels may lead to drowsiness, deep sleep, weakness, and decreased linear growth in the infant. Maternal blood alcohol levels must attain 300 mg/dl before significant side effects are reported in the infant. Reduction of letdown is apparently dose-dependent and requires alcohol consumption of 1.5 to 1.9 gm/kg body weight. Other studies have suggested psychomotor delay in infants of moderate drinkers (2+ drinks daily). Avoid breastfeeding during and for 2–3 hours after drinking alcohol. Heavy drinkers should wait longer.
In an interesting study of the effect of alcohol on milk ingestion by infants, the rate of milk consumption by infants during the 4 hours immediately after exposure to alcohol (0.3 g/kg) in 12 mothers was significantly less. Compensatory increases in intake were then observed during the 8–16 hours after exposure when mothers refrained from drinking.
Adult metabolism of alcohol is approximately 1 ounce in 3 hours, so mothers who ingest alcohol in moderate amounts can generally return to breastfeeding as soon as they feel neurologically normal. Chronic or heavy consumers of alcohol should not breastfeed.”
Your weight
A person’s size has an impact on how quickly they metabolize alcohol
A heavier person can metabolize alcohol more quickly than a lighter person
Amount of alcohol
Know what constitutes a “standard drink”
The more alcohol consumed, the longer it takes to clear the body. The CDC state “Alcohol from 1 drink can be detected in breast milk for about 2-3 hours, alcohol from 2 drinks can be detected for about 4-5 hours, and alcohol from 3 drinks can be detected for about 6-8 hours, and so on.”
As alcohol leaves your bloodstream, it leaves your breastmilk. Since alcohol is not “trapped” in breastmilk (it returns to the bloodstream as your blood alcohol level declines), pumping and dumping will not remove it. Pumping and dumping, drinking a lot of water, resting, or drinking coffee will not speed up the rate of the elimination of alcohol from your body.
If you are intoxicated, you should not breastfeed until you are completely sober, at which time most of the alcohol will have left your body. Drinking to the point of intoxication, or binge drinking, has been shown to impact the way infants sleep. The negative impact on sleep occurs when the infants are exposed to alcohol through milk containing alcohol at the level it would be found in human milk one hour after a mother consumed a significant amount of alcohol (0.3 grams per kilogram of their body weight).
CAN ALCOHOL DEPENDENCY/SELF-MEDICATING WITH ALCOHOL AFFECT A BREASTFED BABY?
Yes. Alcohol dependence or self-medicating with alcohol by the mother/lactating parent can result in slow weight gain or failure to thrive in their baby. As noted earlier, even a small to moderate amount of alcohol negatively affects the milk ejection reflex (let-down) and reduces the baby’s milk intake. The baby can suffer significant disruption to their sleep or may not suck effectively leading to decreased milk intake. The baby may even suffer from delayed motor development. If you are concerned that you or someone you know is self-medicating with alcohol excessively, contact your healthcare professional or a reputable organisation supporting people who are struggling with alcohol use.
WEIGHING THE RISKS AND BENEFITS
1.Centers for Disease Control (CDC).https://www.cdc.gov/alcohol/faqs.htm#excessivealcohol
END
翻译：许悦
审稿：Lynn、Marien
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正如我们的志愿者在内部会议中提到，投身公益事业后才知道做公益也是有成本的！你的支持和赞赏可以让更多的妈妈获益！
本篇文章来源于微信公众号: 国际母乳会LLL
点击上方国际母乳会LLL 设为星标，获取哺乳信息
°睡眠障碍，包括睡眠时间缩短，更频繁醒来，以及在饮酒后3小时内总的浅睡眠时间和快眼动睡眠时间减少
°哭吵增加
°惊跳增加
°觉醒增加
°暴露于酒精后3.5小时至24小时内，快眼动睡眠增加
°婴儿的乳汁摄入量减少
°生长迟缓
°免疫功能受损
°运动发育落后
°认知发育可能受损
°学龄期(6-7岁)抽象推理能力下降
Part4
在决定是否以及何时饮酒时，我还要考虑哪些其他影响？
Part5
在给宝宝喂奶期间，我可以偶尔喝点酒吗？
请注意，新生儿不能很好地代谢酒精；尽可能至少在宝宝8周龄大之前避免饮酒。
■如果可能的话，在喝任何酒精饮料之前立即母乳喂养宝宝，或者吸出并保存乳汁。
■酒精摄入量不要超过两杯葡萄酒（共8盎司，约相当于240ml）或一两杯啤酒，最好不要超过一杯。
■喝了一标准杯酒精饮料后，至少等2小时后再给宝宝喂奶。
■请注意，您喝得越多，清除酒精所需的时间就越长。
■如果您的宝宝等不及两个多小时就需要喂奶，请用您之前挤出的乳汁喂养宝宝。
■饮酒时喝点果汁。
■饮酒时吃点东西——它会减慢酒精进入血液的速度。
■仅在涨奶不舒服时才“吸奶并丢弃”。只要您的血液里有酒精，您的乳汁里就会含有酒精。
尽请期待
Can I drink alcohol and breastfeed? No harmful effects to babies have been from drinking no more than one drink a day. Our evidence-based article on Drinking Alcohol and Breastfeeding answers many questions you may have.
●Overview
●Can Drinking an Alcoholic Beverage Help Me Relax and Stimulate Milk Production?
●What are the Risks To My Baby?
●What Other Effects Should I Consider When Deciding Whether and When To Drink?
●Can I Nurse My Baby and Still Drink Occasionally?
●How Is One Drink Defined?
●Important Considerations
●Do I Have To Pump And Dump After Drinking an Alcoholic Beverage?
●What if I Get Drunk
●Can Alcohol Dependency/Self-medicating With Alcohol Affect A Breastfed Baby?
●Weighing The Risks And Benefits
●References
●Further resources
Breastfeeding mothers and lactating parents often receive conflicting advice about whether alcohol consumption can have an effect on their baby. While warnings are often given not to consume alcohol during pregnancy due to evidence that it could cause damage to an unborn child, the risks of consuming alcohol while breastfeeding have not received as much research attention. A number of studies have focused on the effects of alcohol on lactation and the infant, but long-term outcomes are still unknown.
Especially when it is consumed in large amounts, alcohol can cause drowsiness, deep sleep, weakness, and abnormal weight gain in the infant. There is also the possibility of decreased milk-ejection reflex in the mother. No harmful effects to babies have been found when breastfeeding mothers drink no more than one drink a day.
Depending on how much alcohol you consume before you nurse your baby, they may experience a number of effects from the alcohol in your milk. Even a small to moderate amount of alcohol may impair milk production and the milk ejection reflex. Some of the negative effects in the baby may be:
Potentially, depending on how much you drink and when you nurse your baby after drinking, there may be other, more severe effects on your baby as well. As a result, the guidance on drinking and nursing is changing. According to the CDC, “moderate alcohol consumption is defined as having up to 1 drink per day for women and up to 2 drinks per day for men”. We go into more detail below.
In brief, LactMed®, a database that contains information on drugs and other chemicals to which those who are breastfeeding may be exposed, offers the following information:
Another review, conducted by Nonacs, showed that motor development of infants who were exposed to alcohol in human milk regularly was decreased or delayed. The more alcohol the infants consumed through breast milk, the lower the infants scored on indices of motor development. Infants cannot metabolize alcohol as quickly as adults can; newborns can only metabolize alcohol at 25% to 50% of the rate at which adults can.
Concerns about negative effects on the infant’s developing brain are based on animal research. Oei notes that “robust animal data” indicate that “alcohol may be toxic to the developing brain, especially during periods of rapid brain development” such as occur in the first year after birth. Impairments to memory and inhibitory responses may also occur as a result of an infant’s consumption of alcohol.
Though research continues, Haastrup, Pottegård, and Damkier stated that “the possible long-term effects of alcohol in mother’s milk are unknown”.
Information about bed-sharing and alcohol here:Safer Sleep & the Breastfed Baby
In the upcoming article, we will continue to provide you with a series of questions regarding alcohol consumption during breastfeeding.
This includes addressing the question, “What does one drink mean?” We will also cover important considerations, such as whether it is necessary to pump and discard breast milk after consuming alcoholic beverages and how to handle situations where intoxication occurs. Additionally, we will delve into the impact of alcohol dependence or using alcohol as a form of self-treatment on infants during breastfeeding. Finally, we will explore how to make informed decisions by balancing risks and benefits.
These contents are designed to offer you comprehensive information on breastfeeding and alcohol-related concerns, aiding you in making well-informed decisions.
1.Centers for Disease Control (CDC).https://www.cdc.gov/alcohol/faqs.htm#excessivealcohol
END
翻译：许悦
审稿：Lynn、Marien
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正如我们的志愿者在内部会议中提到，投身公益事业后才知道做公益也是有成本的！你的支持和赞赏可以让更多的妈妈获益！
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点击上方国际母乳会LLL 设为星标，获取哺乳信息
什么是正常的婴儿黄疸 ？
黄疸
即皮肤、巩膜(俗称“眼白”）、牙龈和嘴唇内侧发黄，在母乳宝宝中很常见也很正常。
发黄：是由于婴儿血液中的胆红素过多引起的。
而胆红素是由红细胞破坏时产生的。在子宫里，胎儿需要有较多的红细胞，才能把氧气从胎盘输送到全身。
婴儿一出生，就开始用肺呼吸来获得氧气，不再需要体内这些多余的红细胞了。它们分解后在婴儿体内循环，其中一个代谢产物是一种黄色色素，叫做胆红素，它可以通过粪便自然地从婴儿体内清除。
第一次的排便（即胎便）含有大量胆红素，所以它是黑色的。出生后的头几天婴儿吃得越多，胆红素从婴儿体内排出的速度就越快。大部分胆红素(98%)会通过婴儿早期的排便清除掉。肤色较深的婴儿可能不会显现黄疸引起的发黄，所以更应该仔细观察。
胆红素值上升缓慢，通常在出生后第3~5天达到峰值，不超过12毫克/分升 (你的奶量通常也会在产后第3~5天急剧增加。如果婴儿吃奶很好，就会更频繁、大量地排便)。
除了频繁有效地哺乳之外，轻度黄疸通常不需要治疗，可自行消退。摄入足够奶量就有助于婴儿清除体内的胆红素。胆红素水平的轻度升高，在有些婴儿中可能会持续15周或更长时间。
喂养不足型黄疸：
当婴儿没有吃到足够的初乳/母乳来清除胆红素时，就会产生喂养不足型黄疸。
胆红素就无法尽快被清除掉，它会被婴儿的肠道吸收，重新回到血液中，使它达到更高的水平。这会导致婴儿的皮肤和眼睛更黄。
皮肤颜色较深的婴儿可能无法识别出发黄的加重。检查牙龈和嘴唇内侧有助于识别。
婴儿可能会越来越嗜睡，使得喂奶变得更难。 医护人员会监测婴儿的胆红素水平。让婴儿多吃奶至关重要！黄疸较重时，通常需要照蓝光来辅助解决问题。
有时黄疸会一直持续到出生两周以后。这通常被称为延迟性、迟发性或母乳性黄疸。
表征：
中度升高的胆红素水平有时会在婴儿体内维持数周时间。这在出生后早期胆红素水平较高的婴儿中更为常见。迟发性黄疸的婴儿通常反应和吃奶都很好、体重增长和发育也正常。
只要胆红素水平不超过20毫克/分升，延迟性黄疸无需任何治疗就会在12~15周左右消退。
一些医疗保健人员会建议暂停母乳，但这既没有好处，也没有必要。(请参阅下列关于黄疸管理的母乳喂养医学会第22号临床指南，这是可以分享给医疗保健人员的相关信息)。
英文版本：www.bfmed.org/assets/DOCUMENTS/PROTOCOLS/22-jaundice-protocol-english.pdf
中文（繁体字）版本：www.bfmed.org/assets/DOCUMENTS/PROTOCOLS/22-Jaundice-17-1.pdf
有时是。但轻中度的黄疸并不危险。胆红素是一种强效抗氧化剂，在保护新生儿健康方面起着重要而有益的作用。
然而如果胆红素水平过高，就会损伤婴儿的大脑（译者注：Kernicterus或核黄疸）。安全的胆红素水平要根据胎龄、体重以及婴儿整体的健康状况来综合确定。较小的婴儿或早产儿所能耐受的胆红素水平比足月儿还低，所以更有脑损伤的风险。
如果足月儿在出生后的第一个24小时内就出现黄疸、快速上升，并超过17毫克/分升，说明存在更严重的问题。有时这被称为病理性黄疸，这通常不是母乳不足的缘故，而是由其它因素引起的。需要在不中断母乳喂养的情况下及时进行评估和治疗。
新生儿黄疸的危险因素：
产后泌乳延迟。
母乳喂养启动很慢有很多原因。剖宫产和初产是两种常见的情形，这时需要额外的照护来帮助建立起母乳喂养。
早产
38周之前分娩
小于胎龄儿
婴儿出生时出现头部淤伤
母亲患有糖尿病
Rh血型不合引起的溶血
有婴儿黄疸的家族史
男孩比女孩更容易发生黄疸。亚洲婴儿出现黄疸的可能性最大，其次是北美土著婴儿、白种人婴儿、最后是美籍非裔婴儿。O型血和RH阴性血母亲的婴儿更可能有黄疸。
*尽早、频繁地母乳喂养。
分娩后尽快开始母乳喂养。良好的含乳对于有效排出乳汁非常重要。请参阅哺乳姿势和含乳姿势这两篇文章。尽早哺乳可以帮助婴儿早点排出胎便（也就是第一次大便）。
*用舒服的半躺姿势。
垫好你的腰背，抱着婴儿皮肤贴着皮肤、胸贴着胸。半躺式哺乳姿势可以让婴儿用他天生的反射找到乳房并含乳，这也解放了你的双手，便于你在需要时帮助他。你和宝宝可以用这种姿势哺喂很多日子，这有助于你们彼此了解，并学会如何含好乳房。产后初期要持续频繁地把婴儿抱到你的胸前，并对所有的哺乳信号做出回应。
*避免给婴儿喝水或葡萄糖水。
这不仅不会预防黄疸或降低胆红素水平，反而会妨碍婴儿吃到足够的母乳。
*婴儿出院后的两天内，安排一次医疗保健人员的家访。
*如果婴儿出现以下情况，请咨询医护人员：
– 嗜睡
– 吃奶不好
– 排便少于预期
PS：嗜睡和吃奶不好是黄疸值增高的征兆。
胆红素水平可通过验血测得。如果婴儿存在下列情况，医护人员可能会要求验血：
婴儿嗜睡，并且吃奶不好
婴儿身体的很多部位看起来很黄
婴儿的皮肤和眼睛在出生后24小时内就开始发黄
治疗严重的黄疸可能需要婴儿照一段时间蓝光。这种特殊的光有助于分解胆红素，然后通过婴儿的尿液和大便排出体外。
照蓝光时，需要遮住婴儿的眼睛。治疗过程中母婴分离会令人不安。你可以和婴儿待在一起，大多数情况下，也可以把婴儿从蓝光箱中抱出来哺乳（译者注：目前国内也有一些开展蓝光治疗而不需要母婴分离的医疗机构）。喂奶时和婴儿做肌肤接触可以激发出他本能的哺乳行为，也能让你自己平静下来。
婴儿也可能需要添加挤出的母乳、捐赠的母乳或配方奶。如果他嗜睡且吃奶不好，补充喂养就很有必要。如果你的泌乳量增长缓慢，也有必要补充喂养。婴儿得靠进食才能清除胆红素。如果婴儿在乳房上吃不到足够的母乳，就需要添加奶以清除体内的胆红素。你可以用杯子、勺子、乳旁加奶或奶瓶来添加。
高胆红素血症的治疗通常需要几天时间。重要的是在这段时间里要挤奶，这样你才能为婴儿提供自己的母乳，并建立起充足的奶量。请参阅建立奶量和如何挤奶。胆红素水平一旦下降，婴儿就会变得更机警、哺乳也会改善。
Jaundice and Breastfeeding
What is normal infant jaundice?
Jaundice, yellowing of the skin, eyes, gums and inner lips, is common and normal in breastfeeding infants. The yellow colour is caused by extra bilirubin in the baby’s blood. Bilirubin is produced when red blood cells break down. In the womb, your baby has extra red blood cells to bring oxygen from the placenta. Once your baby is born, he uses his lungs to get oxygen. These extra blood cells are no longer needed.
They break down to be recycled in your baby’s body. One byproduct is a yellow pigment called bilirubin. It is removed naturally from your baby’s body in the stools (poops). The first stool, meconium, has a large amount of bilirubin. This is why it is black in colour. The more your baby feeds in the early days, the quicker the bilirubin leaves your baby’s body. Most of the bilirubin (98%) will be eliminated in your baby’s early stools. Babies with darker skin tones may not show the yellowing effect of jaundice, so they should be observed carefully.
Normal, mild jaundice generally takes a few days to appear. The level rises slowly, usually peaking between days 3 and 5 at less than 12 mg/dl. (Between days 3 and 5 is also when your milk production should increase dramatically. When your baby is feeding well, this results in more frequent and larger poops.) Mild jaundice usually resolves without treatment other than frequent and effective feeding. Adequate milk intake is what helps your baby clear the bilirubin from his body. Some babies will have mildly elevated bilirubin levels for as long as 15 weeks or longer.
What is suboptimal intake jaundice?
Suboptimal intake jaundice occurs when a baby is not getting enough colostrum/milk to eliminate the bilirubin. When there is not enough milk intake, bilirubin is not eliminated as quickly as it should be. If the bilirubin is not eliminated quickly, it is absorbed from your baby’s gut back into the blood at higher levels. This causes more yellowing of your baby’s skin and eyes. This increase in yellowing may not be recognized in a baby with darker skin colour. It’s helpful to check the gums and inner lips. Your baby may become more and more sleepy, making feeding even more challenging. Your baby’s bilirubin levels will be monitored by your healthcare provider. It is essential that your baby gets more to eat. Phototherapy treatment is often required to help settle things down.
What is prolonged (late-onset) jaundice?
Is jaundice dangerous?
Sometimes it is. But mild to moderate jaundice is not dangerous. Bilirubin is a powerful antioxidant and can play an important and beneficial role in protecting newborn health.
However, if bilirubin reaches too high a level, it can cause injury to a baby’s brain. Safe bilirubin levels are determined individually based on gestational age, weight and your baby’s overall health. Small or premature babies are at risk of brain injury from a lower level of bilirubin than can be tolerated by a full-term baby.
Jaundice that appears within the first 24 hours, rises quickly, and reaches higher than 17 mg/dl in a full term baby is indicative of a more serious problem. This is sometimes called pathological jaundice. This is often caused by other factors, not a lack of milk. It needs to be assessed and treated promptly without interrupting breastfeeding.
Risk factors for jaundice in newborns
· Delayed milk production. There are many reasons why breastfeeding might get off to a slow start. Cesarean section birth and first time pregnancy are two common situations where it helps to take extra care with getting breastfeeding established.
· Premature birth.
· Birth earlier than 38 weeks.
· Small for the baby’s gestational age.
· Bruises in the baby’s head from the birth.
· Maternal diabetes.
· Rh sensitization.
· Family history of jaundiced infants.
Boys are more likely to be jaundiced than girls. Asian babies are most likely to be jaundiced, followed by Indigenous North American babies, Caucasian babies and finally African American babies. O blood type and RH negative mothers are also more likely to have jaundiced babies.
Preventing high jaundice levels
· Breastfeed early and frequently. Start as soon after birth as possible. A good latch is important for effective milk removal. See Positioning and Latching. Early feedings help your baby pass the meconium or first stool quickly.
· Lie-back in a comfortable, reclined position that supports your back. Hold your baby skin to skin and chest to chest. The laid-back position allows your baby to use her inborn reflexes to find the breast and latch. It also frees your hands so you can help, as needed. You and your baby can feed like this for many days. It will help you get to know each other and learn how to get a good latch. Continue putting your baby to breast frequently in the early days. Respond to all feeding cues.
· Avoid giving your baby water or glucose. This will not prevent jaundice or bring down bilirubin levels. It will interfere with your baby getting enough milk.
· Arrange a visit with your baby’s healthcare provider within two days of discharge from a hospital birth.
· Consult your baby’s healthcare provider if your baby is:
Ø sleepy.
Ø not feeding well.
Ø not pooping as expected.
Sleepiness and poor feeding are signs of high jaundice levels.
Treatment for jaundice
Bilirubin levels are checked by a blood test. Your baby’s healthcare provider may order a blood test if:
· your baby is sleepy and not feeding well.
· much of your baby’s body looks yellow.
· your baby’s skin and eyes started turning yellow within the first 24 hours.
Treatment of severe jaundice may require your baby to spend time under phototherapy lights. These special lights help break down the bilirubin so it can be removed in your baby’s urine as well as the stool. Your baby’s eyes are covered while under these lights. Separation during this treatment can be upsetting. You can stay with your baby, and in most cases, take your baby out from under the lights to feed. Placing your baby skin to skin during these feedings encourages instinctive feeding behaviours. Holding your baby skin to skin also calms you.
Your baby may also require supplementation with expressed milk, donor milk or formula. This may be necessary if your baby is sleepy and not feeding well. It may also be necessary if your milk production is slow to increase. Your baby needs food to eliminate the bilirubin. If your baby is not getting enough milk at breast, supplementation is needed to remove the bilirubin from your baby’s body. You could supplement with a cup, spoon, at-breast supplementer or bottle. See How to Protect Breastfeeding while Supplementing (https://www.lllc.ca/how-protect-breastfeeding-while-supplementing) .
Treatment of high bilirubin levels usually takes a few days. It is important to express your milk during this time so that you can provide your own milk for your baby and establish a plentiful milk supply. See Establishing Your Milk Supply and Expressing Your Milk. Once your baby’s bilirubin levels are dropping, your baby will be more alert and will feed better.
If you have any breastfeeding questions or concerns, contact your local La Leche League China Leader who can provide you with support and information.
Updated 2022
参考文献References
Flaherman, V.J., Maisels, M.J. and the Academy of Breastfeeding Medicine. (2017). ABM Clinical Protocol #22: Guidelines for Management of Jaundice in the Breastfeeding Infant 35 Weeks or More of Gestation—Revised 2017, Volume 12, Number 5, 2017. DOI: 10.1089/bfm.2017.29042.vjf
Mohrbacher, Nancy. (2020). Breastfeeding Answers: A Guide for Helping Families, Second Edition. Nancy Mohrbacher Solutions, Inc., 245-246.
资料来源Source
https://www.lllc.ca/jaundice-and-breastfeeding
作者：加拿大母乳会
翻译：传艳
审核： Lynn 、Marien、楠楠
编辑：沐凡
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正如我们的志愿者在内部会议中提到，投身公益事业后才知道做公益也是有成本的！你的支持和赞赏可以让更多的妈妈获益！
本篇文章来源于微信公众号: 国际母乳会LLL
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我的大女儿今年12岁了，脸上有时候会长几粒无伤大雅的青春痘。看到她这样，就想到她出生在月子里，手指上脸上起的湿疹。那时的表现真是太有画面感了。
初为人母的我，看到这些皮肤上的丘疹，就会打一圈电话问其他的妈妈。就是一颗小痘痘就能联想到红斑狼疮这种可怕的事情。还会经常看看孩子有没有呼吸。现在的我看到新手妈妈们惶惶不安的情况特别感同身受。
敏感是一个新手母亲最宝贵的品质之一，敏感多疑的行为会帮助女性快速进入母亲的角色当中。
发现宝宝的各种问题：拉了、尿了、渴了、饿了、发烧了、生病了，母亲往往第一个知道。
但其实这样女性是非常需要帮助的，缓解紧张敏感的情绪。
面对身边陷入困境的妈妈，国际母乳会的哺乳辅导（Leader）会共情会帮助，当被帮助的妈妈成功母乳喂养我们欢呼雀跃，当妈妈不得不放弃母乳喂养我们遗憾不已。
可以说国际母乳会的志愿者（哺乳辅导）陪笑陪哭，妈妈们甘之如饴。可是面对一些棘手的问题，那种无力感会经常伴随我们。
尤其是难缠的湿疹，不是要命的病却是累心的麻烦。尤其是很多妈妈忌口之后还不能见效，这对一个母乳妈妈的打击是致命的，不仅是孩子的痛痒难耐，还有周围亲人们的质疑。
都是为了孩子，引来的常常是家庭大问题。作为志愿者的我们更加难受，因为大多数哺乳辅导都不是医生或药师，不能给予任何医疗建议，否则就是对妈妈们极其不负责任。
国际母乳会希望在各个方面帮助妈妈。今年8月世界母乳喂养周恰逢国际母乳会举办母乳艺术照征集活动，我们欣喜地发现和奇维生物在母乳育儿方面有着志同道合的想法。
为了帮助更多的皮肤问题宝宝，9月我们诚邀了40位妈妈带着自己的孩子，在安全的情况下，进行了近一个月的奇维生物奇异佳天然弱酸性修护霜使用体验，效果良好。
图片来源：参与体验的家庭提供
图片来源：参与体验的家庭提供
国际母乳会感谢参与体验的妈妈们！我们和奇维生物的共同目标是让所有的宝宝免于皮肤困扰，不止于红屁屁和湿疹，让所有的妈妈们安心。
下面是这次公益测评的用户反馈数据，可以看到很多宝宝不只是湿疹，还有口水疹、红屁屁等一系列皮肤问题都得到很大缓解。
使用奇异佳修护霜后明显改善的皮肤问题
奇异佳修护霜优势，妈妈关心的问题都在这
对于月龄小的宝宝，沟通是很大的问题。小月龄只会哭和笑，哭起来对于新手妈妈来说是很可怕的。
日常护理及时且有效更加能让妈妈体会育儿的快乐与幸福，进一步减轻女性产后心理和生理的不适。
国际母乳会中国希望通过这次公益测评，能为妈妈们解决经常困扰母婴的问题。
奇异佳弱酸修护霜目前仅在线上有售，有需要的妈妈可以直接扫码进入小程序购买。
作者：宋薇
编辑：沐凡
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母乳喂养的建立并不会总是一帆风顺，产后最初的几周内，那些断奶的女性中有80%在做出断奶的决定前就已经停止了母乳喂养。然而，一旦母乳喂养进展顺利，往往就会成为母亲育儿过程中非常重要又令人愉悦的一部分。
母乳喂养、与婴儿同床睡眠、用背巾把宝宝紧紧抱在怀里，都是自然又正常的育儿方式，婴儿也本能地期待吃母乳、靠近母亲。这不是可选择的一种生活方式，也不仅仅是母亲给婴儿喂食物的方式，而是整个母婴关系的一部分。
母乳喂养会自始至终持续地给母亲和儿童提供身体健康和精神情感上的益处。有时人们认为母乳终有不再提供任何益处的时候，但这是不对的。
母乳既具有营养价值，又有情感上的益处，世界卫生组织和英国卫生部建议母乳喂养应持续两年或以上，并适当添加辅食。
母乳喂养自然持续的时长
公认的母乳喂养的好处
渐进式离乳的重要性
自然离乳
母乳喂养远超乎食品的定义
母乳喂养自然持续的时长
人类学家凯西·德特威勒的研究表明，现代人类母乳喂养正常且自然的持续时长至少为2.5岁，最长可达7岁左右。直到大约100年前，自然的长期母乳喂养还是一种文化常态。
德特威勒还说: “许多灵长类动物在幼崽萌出第一颗恒牙时才会给其断奶。这相当于是在现代人5岁半到6岁时断奶，这时儿童差不多已获得了成年人的免疫能力，说明在我们最近的进化过程中，母乳提供的主动免疫通常一直到这个年龄都是对儿童有效的。”
公认的母乳喂养的好处
联合国儿童基金会于
儿童的免疫系统需要花二到六年才能完全发育成熟。只要一直给孩子喂母乳，母乳就会持续补充和增强他的免疫系统。
对母乳喂养或断奶的幼儿疾病发病率的研究反映了这些机理。对认知成就(智商分数，学校成绩)和母乳喂养之间关系的广泛研究表明，母乳喂养时间最长的孩子获益最大。
渐进式离乳的重要性
孩子长大后自己就不再吃母乳是一个很自然的过程，让他们按照自己的节奏成长吧！在孩子们准备好独立之前，是没法强迫他们独立的。独立性、而非依赖性，是自我离乳的母乳喂养儿童一个共同的显著特点。
自然离乳
自然离乳允许孩子各有不同。一个逐渐离乳的孩子能够保持他对母亲的情感依恋，而不会被迫转向一个无生命之物，如一个玩偶或一条毯子。
快速断奶可能会造成乳房涨奶，让妈妈感到不舒服；因为母亲的身体只会对逐渐减少奶量的信号做出反应。
突然断奶可能会让孩子觉得妈妈不仅收回了乳房，还收回了她的爱。荷尔蒙的突然转换可能导致母亲变得抑郁沮丧，她也可能患上乳腺炎或乳房脓肿。
离了乳的孩子更容易被感染，因为他失去了具有抗感染和保护特性的母乳。
离乳的生理过程很复杂，涉及微生物、生化、营养、免疫和母婴的心理调节。在离乳过程中，母乳的成分会进行调整以满足儿童成长的需求，因此，尽管母乳的量在减少，但仍然含有适当水平的营养物质，并且其免疫保护性不会削弱。
母乳喂养远超乎食物的定义
诺玛·布姆加纳在她的Mothering Your Nursing Toddler一书中解释了母乳喂养对学步儿来说不仅仅是食物。
她说: “母乳喂养可以提供爱、舒适和保护的感觉。如果母亲能在孩子还无法独立行事的时候给他哺乳，这样的孩子长大后可能会更独立，因为他相信母亲总会在那里帮助他。允许学步儿按照自己的节奏吃奶(或离乳)是一种信任的展现，这有助于增强他的自尊” 。
母乳妈妈从亲近孩子中获益，孩子也喜欢这种舒适和安全感。强行阻止这种关系会造成不必要的、持续的精神上的痛苦，双方都失去了其带来的健康益处，还剥夺了婴儿享有母乳喂养的人权。
如果对您有帮助，请拉到文章底部。
每一分都是爱，您的支持和赞赏可以让更多的妈妈获益！
作者: 安娜·伯比奇
版权为国际母乳会英国分会2016所有，文章最初发表在本网站上标题为《母乳喂养二合体》
DECEMBER
Breastfeeding Beyond a Year
Establishing breastfeeding is not always easy and in the first few weeks eight out of ten women who stop do so before they had intended to. However once breastfeeding is going well it usually becomes a very important and enjoyable part of mothering.
Breastfeeding, co-sleeping with a baby and carrying them close in a sling can be natural and normal ways of mothering, and babies instinctively expect to breastfeed and to be near to their mother. This is not a lifestyle choice and it is not just about the way a mother gives her baby food; it is part of the whole mother/baby relationship.
Breastfeeding continues to offer benefits to mother and child, both to their health and mental and emotional well being, for as long as it continues. It is sometimes thought that there is a point where breastmilk no long offers any benefits but this is not accurate.
Breastmilk maintains nutritional value as well as emotional benefits and the World Health Organisation and the Department of Health recommend that breastfeeding continues, with the appropriate additional of complementary foods, for two years and beyond.
Natural duration of breastfeeding
Established benefits of breastfeeding
The importance of gradual weaning
Natural Weaning
Breastfeeding is much more than food
Natural duration of breastfeeding
Anthropologist Kathy Dettwyler’s research suggests that the normal and natural duration of breastfeeding for modern humans falls between 2.5 years at a minimum and about 7 years at a maximum. Until around the last 100 years natural term breastfeeding was a cultural norm.
Dettwyler also says “Many primates wean their offspring when they are erupting their first permanent molars. This occurs around five-and-a-half to six years in modern humans around the same time as achievement of adult immune competence suggesting that throughout our recent evolutionary past the active immunities provided by breastmilk were normally available to the child until about this age.”
Established benefits of breastfeeding
The UNICEF report, entitled Preventing Disease and Saving Resources, published 18 October 2012, sets out the ways in which the longer a baby is breastfed the greater the health benefits for both mother and child. It takes between two and six years for a child’s immune system to fully mature. Human milk continues to complement and boost the immune system for as long as it is offered.
Research on the incidence of illness in breastfed or weaned toddlers reflects these dynamics. Extensive research on the relationship between cognitive achievement (IQ scores, grades in school) and breastfeeding has shown the greatest gains for those children breastfed the longest.
The importance of gradual weaning
It’s a natural process for children to outgrow breastfeeding on their own, letting them grow at their own pace.
Natural Weaning
Natural weaning allows for differences in children. A child who weans gradually is able to maintain his emotional attachment to his mother, rather than being forced to switch to an inanimate object such as a cuddly toy or blanket. Rapid weaning may cause the breasts to become uncomfortably full; a mother’s body responds to signals to reduce milk production only gradually.
Abrupt weaning may leave the child feeling his mother has withdrawn her love as well as her breast. The sudden shift in hormones may cause the mother to become depressed and she may also risk developing mastitis or a breast abscess. A weaned child is more susceptible to infections because of the loss of the anti-infective and protective properties of human milk.
The physiological process of weaning is complex and involves microbiological, biochemical, nutritional, immunological, and psychological adjustments for both mother and child. During the weaning process the composition of human milk adjusts to meet the needs of the growing child so that, although the volume is decreasing, an appropriate level of nutrients remains present and immunological protection is not compromised.
Breastfeeding is much more than food
In her book Mothering Your Nursing Toddler, Norma Bumgarner explains how breastfeeding is so much more than food to toddler. She says, “Breastfeeding can provide feelings of love, comfort, and protection.
When a mother makes herself available to nurse her child through a situation that he can’t handle alone, he will likely develop independence based on faith that mother will be there to help. Allowing a toddler to nurse (or wean) at his own pace is an expression of trust that contributes to his self-esteem”.
Breastfeeding mothers benefit from being near to their children and children love the comfort and security. To have this relationship involuntarily stopped is something which will cause unnecessary and ongoing emotional distress and loss of health benefits to both, and is taking away the human right of a baby to be breastfed.
Written by Anna Burbidge
reference resources
参考资源
https://www.laleche.org.uk/breastfeeding-beyond-a-year/
1、Dettwyler, K. A Natural Age of Weaning. http://whale.to/a/dettwyler.html (accessed 8 February 2018)
2、https://www.unicef.org.uk/wp-content/uploads/sites/2/2012/11/Preventing_disease_saving_resources.pdf
3、Mohrbacher, N., Stock, J. The Breastfeeding Answer Book. Schaumburg, Illinois: LLLI, 2003AP 1997; Goldman, A. Immunologic components in human milk during the second year of lactation. Acta Paediatr Scand 1983; 72:461-62; Gulick, E. The effects of breastfeeding on toddler health. Ped Nursing 1986; 12:51-54.; Saarinen, U. Prolonged breastfeeding as prophylaxis for recurrent Otitis media. Acta Paediatr Scand 1982; 71:567-71.
4、van den Bogaard, C. et al. The relationship between breast feeding and early childhood morbidity in a general population. Family Med 1991; 23:510-15.
5、Ferguson, D.M. et al. Breastfeeding and subsequent social adjustment in six- to eight-year-old children. J Child Psychol Psychiatr Allied Discip 1987; 28:378-86.
6、Mothering Your Nursing Toddler Bumgarner NJ Schaumburg, IL, LLLI,
2000
7、https://www.laleche.org.uk/supporting-womens-right-to-breastfeed/
END
译者 | 传艳
审阅 | Lynn、张楠
编辑 | 李热爱
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欢迎大家访问“国际母乳会LLL”官网：
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新手父母听到婴儿吃母乳时发出的声音，往往会很惊讶。母乳喂养和育儿的书里通常不会提到这些声音。图片是无声的，而许多准父母也从来没有和母乳宝宝相处过。那么，哺育之音是什么样的呢，它又告诉了我们什么？
产后第三到五天，你的母乳量虽少，但正好匹配婴儿的小胃口。婴儿可能要吸吮好几次，你才会听到一次吞咽声。随着母乳量的增加，婴儿会在每次开始吃奶时快速地吸吮以刺激奶阵（即喷乳反射）。
一旦乳汁开始流出，婴儿一般会每吸吮一两次，就吞咽一次。每次吸吮都能喝到一大口奶的婴儿，会随着每次的吞咽发出轻微的吸气声。有时声音太轻了很难听到。吞咽后，婴儿会呼出一口气，听起来像“咔”声。呼气后，婴儿会再次吸气和吞咽，如此循环往复。
当喷乳反射很强时，婴儿会以规律地吞咽或发出“咔”声的方式来吸吮–吞咽–呼吸、吸吮–吞咽–呼吸。
有时你会听到“咔哒”声。随着每次吸吮婴儿脸颊上可能还会出现明显的酒窝，也可能没有。你的乳头也可能疼痛。
这些迹象，无论是一同还是单独出现，都可能表明你的婴儿含乳不够深。“咔哒”声说明婴儿破坏了在乳房上形成的密闭性，这会导致乳头在他嘴里滑动，往往就造成了乳头疼痛。
如果你听到了“咔哒”声，就试着将婴儿的下巴紧贴到乳房上来改善含乳。婴儿的头向后仰时，鼻子应该上仰离开乳房。鼻子往往会碰触乳房，但不应埋进去。你不应该觉得必须得向后按住乳房，婴儿才能够呼吸。
母乳喂养中的常见声音：
感谢提供母乳喂养音频的妈妈们！
下巴紧贴住、鼻子向上仰、头往后仰，这就和你喝水时的姿势一样。（现在就来试试，假装喝水。看看你的下巴是如何往前伸，头是如何向后仰的？）
当你觉得婴儿含乳不佳时，立即纠正非常重要。如果感觉疼痛，你就得让婴儿松开乳房，可以把一根手指塞入他的嘴角来中断吸吮，然后试着重新含乳。也可以在婴儿含着乳头的同时调整含乳姿势，如果婴儿的下巴缩到她胸前，是无法用嘴含住乳房的，吞咽也很困难。（现在就试试吧，你把下巴缩到胸口然后吞咽，很难吧！）
你可以试着调整婴儿的姿势，让她的下巴紧贴着你的乳房，头向后仰。用这种姿势，婴儿就可以舒服地吃奶了，就像你喝水一样。
如果“咔哒”声、婴儿脸颊上的酒窝或你的乳头疼痛一直存在，请联系国际母乳会哺乳辅导或国际认证哺乳顾问（IBCLC），检查一下含乳是否有问题。
大多数情况下，调整适合你和婴儿的哺乳体位就能很快解决问题。如果有持续的乳头疼痛或含乳不佳，可能需要进一步检查，以确保婴儿没有舌系带/唇系带过紧或其它问题。
你可能听到一些声音像是乳汁喷到婴儿喉咙后方，或像是喷乳反射时婴儿来不及喝奶。有些母亲的喷乳反射很强烈，这就是说婴儿每次吸吮都能吃到大量的奶。新生儿可能很难对付这么大量的乳汁，会让他在乳汁流速最快时松开乳房。
你可以调整一下姿势，向后斜躺着，让婴儿趴在乳房上，就能帮助控制乳汁的流速。如果遇到这种情况，国际母乳会哺乳辅导也可以帮你和婴儿找到最佳的哺乳姿势。
有时婴儿会发出呼噜声，或是刺耳吱吱作响的呼吸声。这些声音可能没有问题，但你应和医护人员或国际认证哺乳顾问（IBCLC）讨论一下。
最重要的是要记住，母乳喂养是不应该痛的。如果你感到乳头疼痛，肯定有什么地方不对，不管外表看起来含乳有多好。
接下来要考虑的是，婴儿大小便的尿布数量是否在他这个月龄是够的，还有体重增长得是否合适。更多的相关信息，请参阅《如何知道婴儿是否吃到了足够的母乳》。
如果你乳头不痛，婴儿也长得很好，那么哺乳时的声音就只是一些有趣之音，试着享受其中吧。
更新于2022年
你可能也感兴趣的相关信息:
DECEMBER
The Sounds of Breastfeeding
First time parents are often surprised by the feeding noises that come with breastfeeding a baby. Breastfeeding and parenting books don’t usually mention these sounds. Photos are silent and many expectant parents have never spent time with a breastfeed baby. So, what are the sounds of breastfeeding and what do they tell us?
In the first three to five days your milk volume is small to match your baby’s small tummy size. Your baby may suck several times before you hear a swallowing sound. As the milk volume increases your baby will suck rapidly at the beginning of each feeding to trigger the letdown of your milk (milk ejection reflex). Once your milk starts flowing, your baby will usually suck once or twice for each swallow. A baby who is getting a good mouthful of milk with each suck makes a small gulping noise with each swallow. This is sometimes too quiet to hear. After swallowing, your baby will breathe out with a puff of air that sounds like a “k-ah” sound. After breathing out (exhaling) your baby will breathe in and swallow again, repeating the cycle. When your milk is letting down strongly, your baby will suck, swallow, breath, suck, swallow, breathe in a rhythmic gulp/”k-ah” pattern.
Sometimes you may hear a “clicking” sound. Your baby may or may not also have noticeable dimples in the cheeks with each suck. And you may have sore nipples. These signs, together or individually, may suggest that your baby has not achieved a deep latch. A “click” indicates that your baby is breaking the seal on the breast. This causes your nipple to slip in your baby’s mouth and often creates a sore nipple. If you are hearing clicking, try improving the latch by bringing your baby’s chin deeply onto your breast. Your baby’s nose should tilt away from the breast as your baby’s head tips back. The nose often touches the breast but it shouldn’t be poking into it. You shouldn’t feel like you have to hold your breast back so your baby can breathe. Chin in, nose tilting away, head back is the same position you take when you drink something. (Try it now, pretend to take a drink of water. See how your chin goes forward and your head tips back?)
When you feel that your baby is not latched well, it is important to deal with it right away. If it feels painful you may have to unlatch your baby from the breast by slipping a finger in the corner of her mouth to break the suction. Then you can try latching again. However, usually the latch can be adjusted while your baby is still latched. If your baby’s chin is tucked into her chest, she will not be able to hold onto the breast with her mouth. She will have difficulty swallowing. (Try it now. Tuck your chin into your chest and swallow. It is very hard.) You can try adjusting your baby so that her chin presses into your breast and her head tips back. In this position your baby can drink comfortably, just like you do.
If the clicking, dimpling or sore nipples persist, contact a La Leche League Leader or an International Board Certified Lactation Consultant (IBCLC) to review your latch. In most cases, an adjustment to the positioning fit between you and your baby quickly resolves the problem. Persistent soreness or poor latch may need further investigation to ensure that your baby does not have a tongue or lip tie or some other issue.
You may hear something that sounds like your milk is hitting the back of your baby’s throat, or like your baby is drowning when your milk lets down. Some mothers have a strong milk ejection reflex. This means that your baby can get a lot of milk with each suck. Your newborn may find this amount of milk hard to handle. This may make your baby pull away from the breast when the flow is strongest. Adjusting your position so you are laying back with your baby on top of your breast can help manage the milk flow. This is another situation in which a La Leche League Leader can help you work out the best positioning for you and your baby.
Sometimes babies make grunting noises or have raspy or squeaky breathing. These sounds may be fine but you should discuss with your healthcare provider or International Board Certified Lactation Consultant (IBCLC).
The most important thing to remember is that breastfeeding should not be painful. If you are experiencing nipple pain something is not right, no matter how good the latch looks from the outside. The next thing to consider is whether or not your baby is producing adequate wet and poopy diapers for his age and is gaining weight appropriately. See How to Know Your Baby is Getting Enough Milk for more information.
If you are pain free and your baby is growing well then the noises of breastfeeding are just funny noises and you will probably learn to love them.
Updated 2022
reference resources
参考资源
www.lllc.ca/sounds-breastfeeding
END
译者 | Lynn
审阅 | 传艳、张楠、Victoria
视频 | 黄明珠
编辑 | 李热爱
更多阅读资料，
欢迎大家访问“国际母乳会LLL”官网：
https://www.muruhui.org/
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你和宝宝各自的需求，随着时间的推移每天都会变
母爱就是建立关系、滋养爱意和信任，使婴幼儿茁壮成长。通过母乳喂养展现的母爱是一种正常、自然和有效的育儿方式。母乳喂养有助于你培养和婴儿的关系，并满足他们的个人需求。它是一种满足婴儿对食物、爱、舒适和亲情连结需求的自然方式。
要花时间才能了解婴儿需要什么。一些育儿专家提倡对婴幼儿实行严格的生活规律。他们声称，如果一位母亲遵循他们的生活规律手册，她的宝宝就会非常满足。但每一个婴儿都是不同的。虽然我们一整天都遵循着一个可以预料的模式会感到很安心，但严格的喂养和睡眠规则往往无法满足每一个婴儿的需求。
常见情况
遵循生活规律的困难
充盈的乳房降低了产奶速度，可能会导致的问题
挤奶引起的问题
母乳: 均衡的膳食、饮料、零食
母乳喂养: 舒适同时联结感情
频繁的母乳喂养: 昼夜不停
吃一边还是两边乳房？
母乳喂养模式的调整
找到自己的节奏: 自由的感觉
把母乳喂养当成小事
期待意外
建立有用的模式
小婴儿的时光稍纵即逝
遵循生活规律的困难
一些婴儿会强烈反对硬加给他们的、不满足他们需求的生活规律。另一些孩子则很容易顺从，就算某个特定的生活规律不适合，他们也只是略微的表示不悦。
较早的喂奶信号包括吸吮手，舔嘴唇，把头转向你，或是烦躁。不要等到他们绝望了——哭泣是饥饿较晚的信号。试图“拉长”喂奶之间的间隔对你和宝宝来说都很难也会有压力，还会减少婴儿总的母乳摄入量。
排奶顺畅的乳房比充盈的乳房产奶更快。要鼓励婴儿频繁地哺乳，让你的乳房保持又软又舒适的状态。
充盈的乳房降低了产奶速度，可能会导致的问题：
婴儿体重增加缓慢或需要补充配方奶来维持适当的体重增加。
婴儿嗜睡，需要被唤醒并鼓励他们积极地哺乳以获得他们所需的食物。
哺乳时间过长
婴儿烦躁
乳房肿胀、乳管堵塞或乳腺炎
挤奶引起的问题
一些育儿专家建议吸奶来维持奶量以满足婴儿的需要。然而，如果婴儿和你的身体彼此协调，挤奶就会破坏这种微妙的平衡。
产奶量超出婴儿的需求会增加患乳腺炎的风险。你可能会经历乳汁流速过快或奶量过多，造成婴儿吐奶、呛奶或不停地含上吐出乳房。婴儿也可能肠绞痛或者烦躁。
母乳: 均衡的膳食、饮料、零食
就像成人一样，婴儿的进食也不规律——没人会每顿饭吃的量都一样，也不会总按定好的时间表吃饭喝水。如果随时能从乳房吃到奶的话，婴儿会平衡地摄入液体、卡路里、蛋白质、脂肪和其它营养素，所得皆所需。通常我们需要的只是让婴儿主导的信心。
母乳喂养：舒适又连结了情感
母乳喂养不仅仅是提供食物和饮料，还有助于你和婴儿彼此保持情感的连结和亲密。所以当婴儿感到疲倦、不开心或者不安时，他们会本能地要吃奶，因为这会帮助他们重新获得对周遭正确的感受。
许多母乳妈妈说，仅仅通过喂奶就能安抚宝宝，让他平静下来，是她们坚持母乳喂养的主要原因之一。它让每个人的生活都变得更加轻松、平和。
频繁的母乳喂养：昼夜不停
婴儿需要频繁地哺乳，以建立和维持你的产奶量，特别是在出生后最初的几周。母乳喂养在早上可能会间隔稍长，但婴儿到了晚上频繁地哺乳(或叫做“密集哺乳”)特别常见。
婴儿在更频繁地哺乳时，会得到富含脂肪的母乳。婴儿是在为晚上储粮，还在为第二天预订食物！(点击这里查看更多关于如何应对新生儿烦躁的夜晚的内容)
吃一边还是两边乳房？
有时婴儿想吃一边乳房，有时又想吃两边。你的宝宝知道他们需要什么——让他们先在第一边乳房上积极地吃奶，直到他们看起来吃满足了或者困了松口，再喂第二边乳房。
经过最初的几个月后，婴儿往往会成为真正高效的干饭人——所以如果他们十来分钟就吃完了奶，也不要惊讶哦！他们的尿布量和持续的体重增长会让你放心，他们确实吃饱了。(如何知道婴儿是否吃到了足够的母乳)
母乳喂养模式的调整
婴儿的生长速度和母亲的乳房存储容量将影响他们的哺乳模式。甚至天气也能造成差异——口渴的婴儿在炎热的天气里可能会吃更多次的奶。碰到婴儿猛长期、面对似乎特别饿的婴儿时，大多数母亲发现没必要挤奶来维持产奶量——更频繁地喂奶就能奏效。产奶量很快适应了婴儿的需求，喂养模式也在几天内稳定下来。
找到自己的节奏：自由的感觉
可预测性结合上一些灵活性，就能给你一种自由感，让你不再觉得束手束脚。起初，有了新生儿的生活似乎相当混乱，但是如果你放松并观察宝宝，会发现和缓的生活模式正在显现。你可以在此基础上，创建出适合你们两人的日常生活节奏。
严格的生活规律并不一定带给你更轻松的生活。局限于特定的规则、午睡时间和睡觉地点，会使外出活动、拜访朋友或度假变得异常复杂。
你和婴儿各自的需求，随着时间的推移每天都会变。当婴儿经历猛长期或生病时，跟随他们的节奏有助于你满足他们的需求。这也会给你信心在必要时去调整适应，比如应对预约就医或者假期的旅行安排时。
当婴儿依附于你而不是被捆绑在强加给他们的规则时，就不太可能出现问题，你会对安排一天的日程感到游刃有余。
把母乳喂养当成小事
就像你自己工作之余喝茶休息一样，可以试着把喂奶当成日常生活中灵活、随意的小事，而不是需要计划的大事件。
期待意外
不管你的宝宝平常的生活模式是什么，他们总有让你惊讶的时候。他们可能会在异于平常的时间里睡觉、睡得更久、或者根本不睡。他们两次吃奶间隔的时间可能更长了，或者突然想要更频繁地吃奶。
但是没必要惊慌——婴儿就是这样！我们可能永远也不知道这些变化的原因。生活要么回归到原有模式，要么自行建立一个新模式。婴儿将会在随后几年里继续成长，并不断给你带来惊喜。
建立有用的模式
早上——有一个合理、规律的起床、穿衣时间和模式会成为你一天的动力。
外出——外出可以帮助你规划一天的生活，让宝宝也娱乐一下，还带给你一种特意的目标感。你可以让这成为一个常规，让每个人都吃饱、准备好、然后走出家门。如果你要一早出门，前一天晚上就准备好所需的物品。
下午——婴儿通常会在中午左右准备睡觉。他们随着成长发育而各不相同，生活方式也随之变化。试着了解你的宝宝喂奶、清醒和睡眠的自然节奏，调整你的活动以适应他们。你自己也可以小睡或者休息一会儿，能帮助你在剩下的一天里充满能量。
晚上——和缓的睡前流程，如洗澡、哄睡、唱歌和哺乳都可帮助疲惫的婴儿放松下来并入睡。观察到婴儿烦躁、打哈欠和揉眼睛了，你就立即开始这个放松流程。有些婴儿天生是“夜猫子”，傍晚小睡一会儿，晚上就一直很精神。
家务——培养“可被打断”的能力会很有帮助。碎片化完成家务同时准备随时停下来照顾孩子，是满足每个人需求的成功之道。透过婴儿的眼睛看世界可以帮你放慢脚步、享受当下，而不是匆忙行事。养育婴幼儿是一项全职工作——期待集清洁工、厨师和园丁于一身这过于雄心勃勃了。要把有限的精力放在必要的事上。做那些孩子在身边你也能做的事，把特别棘手的事留在有人帮忙时做。几年之后当你回首往事，你不太可能希望那时自己做了更多的家务！
小婴儿的时光稍纵即逝
婴儿不会被你的爱和关怀宠坏的。照顾婴儿最简单的方法就是接受并满足他们对亲近的需求。记住，你最了解自己的孩子，接受对你有用的信息、建议和想法，忽略那些感觉不对的建议。你可以把生活的节奏和规律调整成吻合你自己、宝宝和家人各自需求的模式。
如果需要如何满足婴儿需求方面的支持，请联系我们的哺乳辅导或访问我们的网站。参加国际母乳会月度聚会与其他人分享经验、交流实用技巧也很有帮助。
该文献给所有的国际母乳会哺乳辅导，她们在过去六十年中慷慨地付出时间支持母乳喂养的母亲和家庭，并将持之以恒。
作者: 凯伦·巴特勒、苏·阿普斯通以及国际母乳会英国分会的母亲们
版权所有：国际母乳会英国分会 2020
更新于2022年6月
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Mothering is about building relationships and nurturing the love and trust that enables babies and children to thrive. And mothering through breastfeeding is a normal, natural and effective way of doing this. Breastfeeding helps you nurture your relationship with your baby and meet their individual needs. It’s nature’s way of satisfying a baby’s need for food, love, comfort and connection.
It can take time to learn what a baby needs. Some childcare experts promote strict routines for babies and young children. They claim that if a mother follows their rulebook, her baby will be perfectly content. But every baby is different. While we may feel reassured if our day follows a predictablepattern, strict routines for feeding and sleeping often fail to meet the needs of individual babies.
Difficulties with routines
Full breasts slow down their rate of milk production, which may lead to:
Problems caused by expressing
Breastmilk: a balanced meal, a drink, a snack
Breastfeeding: comfort and connection too
Frequent breastfeeds: day and night
One breast or two
Breastfeeding patterns adjust
Finding your own rhythms: a sense of freedom
Think of breastfeeds as minor events
Expect the unexpected
Establishing helpful patterns
Babies are little for such a short time
Difficulties with routines
Some babies will object strongly to an imposed routine that doesn’t meet their needs. Others are easy going, and give only subtle signals that a particular routine isn’t right for them. Early feeding cues include hand sucking, lip smacking, turning their head towards you, or fussing. Don’t wait until they are desperate—crying is a late sign of hunger. Trying to ‘stretch’ the gaps between feeds is hard work and stressful for you both and can reduce your baby’s overall intake of milk.
A well-drained breast makes milk faster than a full one. Encourage your baby to nurse frequently enough to keep your breasts soft and comfortable.
Full breasts slow down their rate of milk production, which may lead to:
A baby gaining weight slowly or needing supplements to maintain adequate weight gain.
A sleepy baby who needs to be roused and encouraged to breastfeed actively to get the food they need.
Lengthy feeds.
A fussy baby.
Engorgement,blocked ducts or mastitis.
Expressing milk (pumping) can cause problems
Some childcare experts advise pumping to keep milk supply one step ahead of a baby’s needs. However, expressing can interfere with the delicate balance that happens when your baby and body are in tune with each other. Making more milk than your baby needs increases your risk of mastitis. You may experience fast flow and/or oversupply causing your baby to gag, splutter or come on and off the breast. Your baby might also have colic or be fussy.
Breastmilk: a balanced meal, a drink, a snack
Just like adults, babies feed irregularly—none of us eats the same amount at every meal, nor do we always follow a set timetable for eating and drinking. With easy access to the breast, babies will balance their intake of fluids, calories, proteins, fats and other nutrients so they receive exactly what they need. All that is usually needed is the confidence to let your baby take the lead.
Breastfeeding: comfort and connection too
Breastfeeding isn’t just food and drink. It also helps you and your baby maintain that connection and closeness with each other. So when your baby is tired or unhappy or upset, they instinctively ask to nurse because it helps them regain a sense of rightness with the world. Many breastfeeding mothers say that the ability to calm and comfort a baby just by nursing is one of the main reasons for carrying on. It makes life easier and more peaceful for everyone.
Frequent breastfeeds: day and night
Your baby needs to nurse frequently to establish and maintain your milk production, especially in the early weeks. While breastfeeds may be further apart in the morning, it’s very common for babies to nurse frequently (or ‘cluster feed’) in the evening. Babies receive fattier milk when they nurse more often. Your baby is stocking up for the night and putting in their order for tomorrow! (See here for more on coping with Fussy evenings with a newborn.)
One breast or two
Sometimes your baby will want one breast, at other times both. Your baby knows what they need—let them nurse actively from the first breast until they come off looking satisfied or sleepy. Then offer the second breast. After the first few months babies often become really efficient feeders—so don’t be surprised if they’ve finished in 10 minutes or so! Their nappy output and continuing weight gain will reassure you they are getting enough. (Is my baby getting enough milk?)
Breastfeeding patterns adjust
A baby’s growth rate and mother’s breast storage capacity will affect their nursing pattern. Even the weather can make a difference—a thirsty baby will probably nurse more in hot weather. When babies have growth spurts and seem extra hungry, most mothers find there’s no need to pump to keep up milk production—more frequent feeds will do the trick. Milk production quickly adapts to meet your baby’s needs and feeding patterns settle down within a few days.
Finding your own rhythms: a sense of freedom
Combining some predictability with flexibility can give you a sense of freedom and stop you feeling tied down. At first, life with a new baby can seem quite chaotic, but if you relax and observe your baby you will find gentle patterns emerging. You can build on these patterns, creating a daily rhythm to suit you both.
Strict routines don’t necessarily make life easier for you. Being tied to particular routines, nap-times and sleep places canmake getting out and about, visiting friends or taking holidays more complicated.
Your needs and those of your baby will change with time and from day to day. Following your baby’s rhythms will help you meet their needs when they have has growth spurts or are ill. It will also give you confidence to adapt when necessary, for example for a doctor’s appointment or holiday travel arrangements. When your baby is attached to you, rather than their routine, problems are less likely and you may feel more relaxed about managing the day.
Think of breastfeeds as minor events
Just as with your own tea-breaks, try thinking of feeds as minor and flexible events that fit in with everyday life rather than major events which have to be planned for.
Expect the unexpected
Whatever your baby’s usual pattern is, there will always be times when they surprise you. They might sleep at a different time, sleep longer, or not at all. They might go longer between feeds, or suddenly want to feed more frequently. But there’s no need to panic—this is how babies are! We may never know the reason for such changes. Life will either settle back into the original pattern or a new one will establish itself. Your baby will continue to grow and surprise you over the coming years.
Establishing helpful patterns
Morning – Having a reasonably regular time and pattern for getting up and dressed can be a springboard for your day.
Going out – Going out can help structure your day, entertain your baby and give you a sense of purpose. You can develop a routine for getting everyone fed, ready, and out of the house. Prepare what you’ll need the evening before if you need to get out early.
Afternoon – Babies are often ready to have a sleep somewhere around the middle of the day. Babies are all different and patterns change as they grow and develop. Try to tune in to your own baby’s natural rhythms of feeding, alertness and sleep and adjust your activities to match them. A nap or a rest for yourself, too, can help boost your energy for the rest of the day.
Night-time – A gentle evening routine, eg bath, rocking, singing and nursing can help a tired baby wind down to sleep. Watch for fussing, yawning and rubbing of eyes and start your wind down pattern promptly. Some babies are natural ‘night owls’, taking a late afternoon nap and being alert during the evening.
Household tasks – Developing the ability to be ‘interruptible’ is a real help. Completing housework in small ‘bites’ while being prepared to pause and attend to children can be a successful way to meet everyone’s needs. Seeing the world through your baby’s eyes can help you slow down and enjoy the present rather than rushing to get things done. Mothering babies and young children is a full-time job—it’s ambitious to expect to be a cleaner, cook and gardener at the same time. Concentrate on essentials. Do those things you can do with a baby around and save really tricky jobs for times when you have help. It’s unlikely you’ll look back in years to come and wish you had done more housework!
Babies are little for such a short time
You can’t spoil a baby with love and attention. The easiest way to care for a baby is to accept and meet their need for closeness. Remember, you know your baby best; take the information, advice and the ideas that are helpful to you and ignore those suggestions that don’t feel right. You can develop rhythms and routines that are in tune with your needs, and those of your baby and family.
For support in meeting your baby’s needs contact our LLL Leader or visiting our website. It can be helpful to share experiences with others at our monthly meetings where you can exchange practical tips.
Written by Karen Butler, Sue Upstone and mothers of LLLGB.
Pages you might also be interested in：
Adjusting to Motherhood
Breastfeeding Basics
Safe Sleep and the Breastfed Baby
Further Reading
The Womanly Art of Breastfeeding. LLLI. London: Pinter & Martin, 2010.
How Mothers Love and How Relationships Are Born. Stadlen, N. London: Piatkus Books, 2011.
What Mothers Do, Especially When It Looks Like Nothing. Stadlen, N. London: Piatkus Books, 2005.
Why Love Matters: How affection shapes a baby’s brain. Gerhardt, S. London: Routledge, 2004.
Kiss me! How to raise your children with love. Carlos Gonzalez. London: Pinter & March 2020
Rhythms & Routines is dedicated to all LLL Leaders who have given their time generously to support breastfeeding mothers and families over the past sixty years and continue to do so.
reference resources
参考资源
https://www.laleche.org.uk/rhythms-and-routines/
END
译者 | 传艳
审阅 | Lynn、张楠、Victoria
编辑 | 李热爱
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