I was blessed with a baby girl yesterday. I notice that I am secreting only a few drops of breast milk. I’m worried this may not be sufficient to feed my infant whose birth-weight is below normal.
— Shereen Vijay, Chennai
Soon after delivery, progesterone levels dip, causing stimulation and secretion of prolactin hormone by the anterior pituitary gland. Also, once placenta is expelled, there is a surge in oxytocin hormone from the posterior pituitary gland. These two hormones are responsible for colostrum secretion. Colostrum is yellowish milk that is secreted in the first three-four days after delivery and is rich in antibodies, vitamins, and has anti-fungal, anti-tumor properties.

A new-born’s stomach size is as big as a marble on day 1 and as big as a lemon on day 2 and 3. Hence your infant requires only 5-7 ml of colostrum per feed — about a teaspoon in volume. Most new mothers believe that they should have flowing milk of about 20-30 ml per feed. Please note this happens after day 4. So don’t worry. Your new-born will be satisfied with her first few feeds.

I am breastfeeding my seven-day-old infant and have developed a cracked nipple on my left breast. It’s very painful. Please advise.
— Masha Thomas, Mumbaii
Cracked nipples occur due to improper positioning and attachment while breastfeeding in the initial few days because the myoepithelial cells in your nipples aren’t yet elastic. As time passes (two-three weeks), they become more elastic. When there is shallow latch due to nipple feeding rather than complete areola, a crack surfaces in the junction of the nipple-areola complex. This is a major problem for new moms since it’s painful and with the infant feeding round the clock, there isn’t enough time to allow the wound to heal. I advise proper positioning and attachment such as deep latch during feed time. You could also apply healing creams such as lanolin and use nipple shields.

My five-month-old daughter has been breastfed since birth. Till what age should I breastfeed her? When can I start feeding her cow milk?
— Shivi Sinha, Delhi
The World Health Organization (WHO) recommends the following:
• Exclusively breastfeed your infant until six months are completed
• After six months, continue to breastfeed until two years, while starting supplementary foods
• Avoid non-human milk until one year of age
Starting your infant on cow milk early might cause anemia. There is also the risk of milk protein allergy, asthma and atopy.

(Dr. Amritha Rao Kordcal is consultant paediatrician at Shishu Clinic and Brindavan Hospital and lactation consultant at Motherhood Hospital, Mysore)