Changes and Challenges in Breastfeeding Your Baby

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Preference for One Breast
Sometimes, after months of nursing, a mother will notice that her baby has developed a preference for one breast. The preferred breast usually produces more milk and releases it more rapidly. It's hard to tell which comes first. Does the baby prefer one side because it has the better supply? Or does the preferred breast produce more milk because it is suckled more often? Sometimes, the preference develops because the mother has unintentionally nursed more often on one breast-usually the left side if she is right-handed. The discrepancy between the two breasts is easily perpetuated because the baby naturally prefers to nurse on the better-producing side.

When your baby has a strong preference for one breast, you should make three important evaluations:

• Is your baby gaining adequate weight? Often the infant will be gaining fine despite getting most of his milk from one breast. Sometimes, however, low milk production on one side results in inadequate milk intake, causing your baby to stop gaining weight appropriately.
• How great is the discrepancy in milk production between the two sides? If the unfavored breast produces much less milk-say only a fourth of the preferred side-you might be anxious to try to increase production in that breast by using it more often or stimulating it with a breast pump. You may be able to get the baby to take the least favored side by offering it when your baby is drowsy or offering it first. If your baby insists, you can start on the favored breast and then slide him across your lap to the less-preferred side without changing his position.
• I must caution you, however, about decreasing use of the preferred breast as you try to focus on the unfavored side. You certainly don't want to risk jeopardizing your high milk production on the preferred side. In my experience, when a marked discrepancy in milk production exists, it is usually easier to boost milk supply even further on the "good" side than to achieve much increase on the very low side. You actually might be better off following your baby's lead by letting him nurse as often as he wants on the high-producing breast.

Is there any abnormality involving the unfavored breast? For example, cases have been reported where blood in the milk made the baby reject a breast. Also, milk tastes salty when a mother has mastitis. If you have a painful area in your breast, detect a lump, or note an abnormal appearance to your milk, notify your doctor and schedule a breast exam. Many older babies thrive just fine using one breast more than the other. As long as your baby is gaining well, you generally can let him be the judge of which breast to use when. He may prefer the side with faster flow when he's most hungry and use the other breast for comfort nursings.

Continued Night Waking in Older Babies
Many breastfed babies continue to awaken at night in the second half of the first year and even beyond. Often the baby will nurse just a short while before falling back to sleep. A common cause of night waking in an older baby is that the infant hasn't learned to fall asleep on his own. Parents' reactions vary widely concerning continued night waking in older babies and toddlers. For many parents, nighttime nursings beyond the first six months represent an important aspect of their parenting style. Many mothers are comfortable nursing an older baby or toddler multiple times each night. Often such mothers allow their children to sleep with them and find the night nursings to be minimally disruptive. It's not important to these parents whether their baby is waking because of true hunger or because he needs his mom to help him get back to sleep. Other parents are highly motivated to get their baby to sleep through the night. They acknowledge that getting adequate rest at night makes them a better parent and better partner the whole next day. They may resent their baby's frequent wakings and eagerly seek strategies for getting their child to sleep through the night. The following explanation may be very helpful to such parents.

Babies awaken at night, even after they no longer require nighttime nutrition, simply because everyone awakens multiple times each night. However, you and I immediately recognize our familiar bedroom surroundings and peacefully roll over and return to sleep. If a baby has always fallen asleep while nursing and being rocked and sung to, he simply may not be able to go back to sleep on his own after a middle-of-the-night awakening. Instead, the baby needs to call forth all his "bedtime props"-breast, mother, rocker-in order to re-create the environment in which he is used to falling asleep.

If your baby is over six months old and is still waking and needing you several times each night, it could be that he doesn't know how to fall asleep on his own. You can help him by starting to put him in his crib just before he dozes off. Let his last waking memory be the crib environment, instead of your breast. That way, when he awakens, he will likely be able to get himself back to sleep without needing to come out of the crib. You'll probably have more success beginning this training during daytime naps. At night, we have fewer reserves and, thus, tend to continue using short-term solutions instead of trying new strategies. At first, when your baby cries, you may have to stand nearby and pat his back for a while. Reassure him with your presence, but try not to succumb to the temptation to take him out of his crib. Once your baby learns to go down for daytime naps on his own, he probably will go back to sleep uneventfully in the middle of the night too.