I know what you want me to say, but I can’t. You can have a glass of wine with dinner as long as it’s at least two hours before your baby’s next feeding—but only one. As for the doughnuts, an occasional treat is no problem. However, the evidence is increasing that if you eat too many sweet or starchy foods while nursing, you may affect your developing child’s metabolism for life, switching on genes responsible for appetite and blood-sugar control that can make him more vulnerable to obesity and diabetes later. So stick to a healthy, varied diet—it’s good practice for being a good role model once your child is old enough to notice what’s on your plate. More….
There were so many favorite foods I gave up while I was pregnant for the sake of my baby. Is it okay to indulge in a glass of wine or snack on some glazed doughnuts now?
I know what you want me to say, but I can’t. You can have a glass of wine with dinner as long as it’s at least two hours before your baby’s next feeding—but only one. As for the doughnuts, an occasional treat is no problem. However, the evidence is increasing that if you eat too many sweet or starchy foods while nursing, you may affect your developing child’s metabolism for life, switching on genes responsible for appetite and blood-sugar control that can make him more vulnerable to obesity and diabetes later. So stick to a healthy, varied diet—it’s good practice for being a good role model once your child is old enough to notice what’s on your plate. More….
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Does breast milk meet all my baby’s nutritional needs?
No. Breast milk provides most nutrients and additional protective factors, but it is low in vitamin D and iron. Be sure to give your breastfed baby liquid vitamins containing 400 IU vitamin D, 1,500 IU of vitamin A, and 10 mg of elemental iron daily. Most infant vitamins also contain additional vitamin C for optimal iron absorption. More….
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I’m a nursing mom, and I know I’m supposed to drink lots of water. What about my baby? Should I be giving her water in her bottle too to keep her hydrated?
Breast milk is 85% water. Adding water to a baby’s feedings is not necessary and on rare occasion can be dangerous. Breast milk is low in sodium (salt), so giving additional large amounts of water can dilute a baby’s delicate electrolyte balance. This low-salt state--known as hyponatremia--can cause a dangerous seizure in a very young baby. More…..
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Where’s the safest place to put a child in the car?
The very safest place for babies is in the center of the rear seat, facing backward. Older children can face forward in the center seat.
Have more than one child? Keep them all in the rear seat. The new child-restraint systems all provide good protection, even in the case of a side impact. That center seat is just the very safest one.
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Which over-the-counter hay fever remedies won’t put my child to sleep?
Today there are many kid-friendly and convenient preventive and symptom-relieving OTC drugs for allergies. The two nonsedating medications I prefer are:
- Loratadine (Claritin), a once-a-day syrup or tablet that can stave off or lessen an allergic reaction.
- Cetirizine (Zyrtec), a syrup or tablet that relieves allergy symptoms.
Diphenhydramine (brand name Benadryl) is a familiar older antihistamine that offers relief for hay-fever symptoms but since it is often accompanied by drowsiness and behavioral side effects, I don’t recommend it for seasonal allergies.
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How can I tell a cold from a seasonal allergy (hay fever)?
When you first start sneezing, blowing your nose, and rubbing at your eyes, it can be hard to tell if a cold virus or an allergen is to blame.
Colds come most often in the winter or fall.
They last about a week.
Muscle aches or a slight fever indicate a cold.
With a cold, mucus is clear at first and then turns white, yellow, or green.
Seasonal allergies hit most often in the spring or summer, depending on what your child is allergic to (a high pollen count at the same time is a major clue).
They can last for a day or two or a whole season.
Itchy eyes and/or skin indicate allergy.
With allergies, mucus is clear.
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What’s a neti pot and how do I use it?
One way to reduce allergic attacks is to flush pollen out the nasal passages with a saline rinse. This nasal rinse also eases congestion by regularly clearing out mucus and keeping nasal membranes moist.
There are several ways to do this:
- You can use an inexpensive squeeze-bottle saline spray from the drugstore or supermarket.
- With very young children you can also just mix a quarter-teaspoon of table salt in a cup of warm water and suck some up in a nasal aspirator bulb. Insert in a nostril and squeeze gently, then repeat on the other side.
- Older children can mix a little salt and water in a cupped palm, and gently closing one nostril, snort the warm salt water up the other, letting it slide down the throat. Repeat with the other nostril.
- Or they can try a remedy from India, rinsing with a little spouted neti pot filled with warm salt water. Have the child stand over the sink, head to one side while compressing the lower nostril, and pour the liquid from the neti pot into the upper nostril as she gives a short snort inward. Then have her release the lower nostril and let all the fluid (and associated gunk) drain out. Repeat on the other side.
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Do I have to give up all foods with a high glycemic index?
No, because the other foods on your plate can help balance a high-GI food like rice or white potato. Salad and cooking greens, for instance, have a GI of zero. Just try to eat at least one low-GI food at every meal.
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How do I figure out the glycemic index of a food?
Some nice research scientists have done all the work for you. You can go to www.glycemicindex.com/ to look up the score for any food containing carbohydrate.
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What is the glycemic index?
The glycemic index (GI) uses a score of 1 to 100 to measure the quality of the carbohydrates in a food. The more processed the carbohydrate (fluffy white bread instead of chewy whole-grain bread, for example), the higher the glycemic index (GI). The higher the glycemic index, the worse the health effects.
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What’s the difference between a night terror and a nightmare?
Two things—when they occur and how well your child remembers them.
1. Night terrors tend to happen during non-REM (non-dreaming) sleep in the first few hours of sleep. Nightmares are bad dreams that tend to occur in the early morning hours during REM (dreaming) sleep.
2. A child has no later memory of a night terror, but can usually describe what happened in a nightmare.
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My child's constipation has been persistent for almost 5 days now, what should I do?
Alpha, 0
Age matters when dealing with constipation issues. I will assume this discussion is about a three year old but take into account that the advice will differ with the age of the child. Most children have several factors which can affect stool quantity and quality. Cows milk can be a factor as kids who drink lots of milk can get constipated. Remember that milk is a carbohydrate and can bind stools.
Children (and adults) rarely drink enough water. Hydration is key to maintaining good quality stools. Fiber is also an issue as most kids eat processed foods that have been depleted of natural fiber. The general rule is the more processed , the less fiber content. Fruits and vegetables are chock full of fiber as are items like bran and bran muffins. Flaxseed oil is a great adjunct to the diet. Make sure it is refrigerated and fresh (it should smell nutty not rancid).
Dr. D Omega Three supplements can also be helpful. Probiotics are critical to normal stool habits as western diets and antibiotics in the food chain can deplete the healthy bacteria that live in the gut. I frequently advise probiotics for kids with constipation. The Dr. D probiotics are actually very sophisticated symbiotics which contain prebiotics and healthy probiotics. They work very well in my experience.
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Help! My 6 year old has had three cases of pinworms in the last 6 months! What can I do?
Susan, NY
This is a very common scenario in young school age children. The mechanism of transmission is actually the fecal-oral route by way of the eggs. When the child scratches or touches the itchy anal area the eggs become embedded under the fingernails. When the child puts her hands in the mouth, the eggs are ingested and hatch in the intestines.
There are several critical steps that you must take. First, trim the child's fingernails carefully. Clean under the nails gently with a blunt object as best you can. Wash all the sheets and pajamas in hot water cycle in your washing machine. I generally treat with Vermox chewable tabs for two doses one week apart.
Pinworms strongly dislike garlic. I advise getting fresh garlic into your child in any way feasible. Kyolic garlic extract is one way. Give it with chocolate syrup as this will disguise the flavor. My kids like fresh roasted garlic. Take an entire garlic head and roast it. Squeeze out the soft yummy pieces when cooked. The taste is sweet and delicious. Keep on giving the garlic as often as possible.
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If everyone else gets vaccinated, then my child is protected without having to have any shots himself, right?
Absolutely not. Let me explain the concept of herd immunity. If everyone who can be immunized is immunized, than those who cannot be (pregnant women, people with immune disorders) are protected by the fact that they aren’t ever exposed to this disease. This is the strategy used to protect pregnant women from German measles (rubella), which can cause great harm to a fetus. If everyone else is vaccinated against rubella through the MMR shots, the infection can’t gain a toehold in the herd.
Preventing an epidemic depends on getting everyone immunized and keeping them immunized. Vaccine effectiveness is rarely 100% and generally wanes with time without booster shots.
When an infection does get loose in a population, it seeks out susceptible individuals. The most susceptible are those who have not been immunized. There was a case a number of years ago where diphtheria broke out in a California community—the only child to die was the only one in the class who had not been vaccinated.
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I keep hearing that the serious side effects of vaccines are very rare, but I don’t know what the serious side effects are, the specific vaccines they’re associated with, and how often they occur, so I can’t assess the danger myself. Can you help?
In my 25 years of experience in pediatric medicine, I have only seen one case that I strongly suspected was vaccine-related. This was many years ago--a case of a Guillain-Barré Syndrome following a flu vaccine. The child was referred to me when I was attending at a local hospital and recovered fully after hospitalization.
All vaccines—like all prescription medicines and medical procedures-- carry some element of risk. There is often a small group of people who for genetic or other reasons will be affected differently.
Vaccine side effects are usually very minor—pain at the injection site, maybe some localized swelling, or a low-grade fever.
While serious side effects like Guillain-Barré are very rare in children, if your child is the one rare victim, rarity is of no consolation. However, an unimmunized child is at even greater risk for all of the diseases vaccines are designed to prevent
It is well worth your time to read the informative and thorough vaccine information sheets at the CDC website www.cdc.gov/vaccines/ to put this risk in perspective.
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My 12-year-old daughter’s pediatrician is pushing for her to have the cervical cancer vaccine. She won’t even be exposed until she’s an adult and sexually active, so can’t I let her wait to make that decision for herself then?
I can think of quite a few reasons why you should not wait much longer to have your daughter vaccinated:
- Teens rarely share with their parents when they become sexually active, and may even have different definitions of what “sex” is.
- Teens are harder to get into the doctor’s office for an immunization.
- Gardasil requires three shots within a six-month period to be effective. A teen or young adult might not follow up properly on her own.
- This is a vaccine against a common cancer that causes a lot of pain and suffering.
Talking to your daughter about this vaccine for cervical cancer offers a golden opportunity to have an open conversation with her about topics that may otherwise be difficult to broach.
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Why does my child have to get shots for Hep A and Hep B before he’s two when he won’t be a tattooed intravenous drug user having lots of risky sex until he’s at least 18?
It’s true adults are more likely to get either of these forms of liver disease than children. Unfortunately, adults and their doctors don’t always pay much attention to the recommended adult immunization schedule. What’s more, vaccines are less effective due to the more battered nature of their immune systems.
A young child’s immune system is quite impressionable and flexible, so vaccines are both better tolerated and more effective if given to infants and toddlers. The two hepatitis vaccines are especially well-tolerated by children. That’s why experts decided that childhood, which already has a full slate of required and recommended vaccines, is the best time for protection from hepatitis as well.
Young children are also vaccinated for Hepatitis A and B because you never know when or where they may be exposed. Babies born to women who test positive for Hep B can suffer liver damage at a very young age. Hep A can be introduced through simple hand-to-mouth contact, and Hep B is not just caught from sexual contact or i.v. drug use—there are also cases of unknown origin. Protection from these two liver-damaging diseases can only be a good thing.
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My pediatrician insists on giving all the shots as scheduled, and I’d like to space them out a bit more. Should I find another pediatrician?
Parents occasionally ask me to modify the vaccine schedule in ways they consider safer. In reality, by ignoring the expert advice and adding more immunization visits, these modifications increase the pain and decrease the safety for your child. As an aside, they also raise the cost to you.
As I’ve said elsewhere, vaccine schedules are not created willy-nilly, and they should not be used like some kind of Chinese menu where you pick one from Column A and two from Column B. They’ve been developed by experts who have the benefit of data from years of research and clinical experience, and there are solid reasons behind these decisions.
I strongly discourage deviations from the recommended schedules, as other timings have not been proven to be as safe or effective. Today’s combined vaccines are the safest ever, and have fewer side effects. By asking to space out shots more than recommended, you are asking your pediatrician to use non-combined vaccines that require your child to have more total shots—and more pain—than necessary.
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I’m worried that giving my child so many shots so young will overwhelm her immature immune system. Can I hold off on some?
Because the immune system is still immature, infancy is the time when children are the very most susceptible to dangerous infections. Furthermore, infants are far more likely to sustain serious neurological damage from a disease, because the brain and nervous system are still developing. For example, bacterial meningitis can cause irreversible damage such as deafness, blindness, and mental retardation in a young baby. I saw all of these complications as a young intern/resident--before the introduction of the Hemophillus influenzae vaccine. (Thankfully today’s young doctors rarely even see this horrific disease.) So it makes no sense to me not to give shots at the time when they most protect your baby from danger.
As I’ve said elsewhere, vaccine schedules are not created willy-nilly, and they should not be used like some kind of Chinese menu where you pick one from Column A and two from Column B. They’ve been developed by experts who have the benefit of data from years of research and clinical experience, and there are solid reasons behind these decisions.
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Why can’t I just forget about the varicella vaccine and expose my kids to a child with active chicken pox like my mother did?
Twenty years ago parents routinely exposed their kids to chicken pox so that a mild childhood case would prevent a more serious reaction in adulthood. There were even—if you can imagine—“pox parties” at the homes of spotty kids. However, thanks to the varicella vaccine, it’s a lot harder these days to find a kid with active chicken pox to catch it from.
A case of chicken pox is now more risky than it once was, too. The disease itself is usually mild, but the danger of serious infection through scratched pox has become greater with the rise of antibiotic-resistant “superbugs” such as MRSA (methicillin-resistant Staphylococcus aureus). Our overuse of antibiotics has created germs that are harder to control and kill than they were 20 years ago. Each scratched lesion offers a direct pathway to your child’s blood stream for any opportunistic infection, and in some children these infections turn serious, and even deadly.
The varicella vaccine provides excellent lifelong full or partial (you only get a mild case) immunity to chicken pox. Since its introduction, hospitalizations and deaths from complications of chicken pox have thankfully dropped dramatically.
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What if I can't make enough milk?
Michelle, NJ
Nature has this wonderful balance in place—the more your baby sucks the more milk you produce. If baby is latching on and sucking well, consider a few other possible causes of a weak milk supply—stress, fatigue, too few calories (making milk is work!), and too few liquids. Get enough rest, try yoga or breathing exercises to relax, drink more fluids than you ever have before, and eat enough high-quality food for two—or at least one and a half.
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Are there any herbal remedies out there that really work?
Actually, there are a few herbal remedies that I rely on in my practice. My favorite is elderberry extract, a herbal product containing the leaves and flowers of the plant Sambucus nigra that can shorten the duration of the flu. The most studied product on the market is Sambucol®, a product manufactured in Israel. The extract is considered safe for both adults and children.
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Should I put my child on a diet?
I’m generally opposed to putting children on diets because, in my experience, singling them out as the only person in the family who needs to be “fixed,” doesn’t produce very good results. I’m also wary of cutting back on calories so much that a child doesn’t get all the nutrients he or she needs. I find it far more effective to ask the whole family to switch to healthier eating patterns and more exercise and to work with the child to stay at the same weight as he or she grows. If the entire family won’t go along then mom or dad should join with the child as a partner in making the changes needed.
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What is the Mediterranean Diet and is it safe for a child?
The so-called Mediterranean Diet is not actually a weight-loss diet at all, but simply a healthy pattern of eating after study has found that eating the traditional diet of the Mediterranean countries—Italy, Provence, Morocco, Turkey, Crete—reduces the risk for many chronic diseases. Key foods in the Mediterranean eating pattern are vegetables, fruits, whole grains, nuts, olive oil, beans, cheese, yogurt, and minimal amounts of poultry and fish.
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How can I tell if my toddler's limp is serious?
The two main causes of limp in a child aged one to three are trauma and infection. Swelling, bruising, or severe pain should call for a visit to the doctor after a trauma. Kids without trauma who look sick, have very limited painful movement of the joint, and an intermittent fever should see a doctor immediately as bacterial infections of the bone or joint require antibiotics, sometimes intravenously.
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When should I call the pediatrician for a limp?
Call your pediatrician if a limp has persisted for more than a few days or causes severe pain.
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How do the symptoms of colic differ from the symptoms of GERD?
Sometimes babies are diagnosed with colic who actually have a problem with gastroesophageal reflux (GER).
- Babies with colic feed well, and their crying spells occur at the same time of day and last for hours at as time.
- Babies with GER usually cry during or after feedings, and their problem will last many weeks or months longer than colic’s typical one-to-three-month duration.
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How do you soothe a baby with colic?
One of the best ways to soothe both crying babies and their frustrated parents is infant massage. Using a little natural moisturizing cream, massage your baby in a calm and gentle manner using only light pressure for five or ten minutes (no more) once or twice a day. It’ll make you both feel better.
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What causes colic?
It’s not clear exactly what causes colic, and it may have different causes in different infants. Some babies just seem to be hypersensitive to sound and touch and less easy to soothe. It could be that their nervous systems are slower to mature. Some experts suggest that these babies may just need to cry every day as a form of emotional release.
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What are the symptoms of colic?
A colicky baby cries apparently without cause for one to three hours at the same general time of day (or night). These crying jags last for about three months, when they suddenly disappear.
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What are the most important things to remember when starting a baby on solids?
My two cardinal rules are:
- Start slowly with very small amounts of food.
- Introduce only one new food at a time so you can easily identify any foods that may cause allergy, sensitivity, or intolerance.
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What solid foods are best to start with?
Always start with cereal, mixed to a soupy consistency with expressed breast milk, formula, or water. Rice cereal is the blandest, followed by barley cereal and oatmeal. Gradually make the cereal thicker as baby gets used to the feeling of solids. I generally recommend organic cereals, because children this young are exquisitively sensitive to the influences of agricultural chemicals and other pollutants.
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When should I start feeding my baby solids?
My usual recommendation is not to add solids to the diet of a breastfed baby until at least six to eight months of nursing, the later the better. I advise starting solids with formula-fed babies starting at about five or six months of age.
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What's the key to successful nursing?
I’m a strong believer in the power of a lactation expert, someone who can show you the techniques and answer all your questions, especially in the first weeks. This person can be a pro, or just a friend who’s already nursed a baby or two successfully (a “bosom buddy”, so to speak).
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How long should I nurse my baby?
The longer a woman nurses, the greater the benefits to both her and her baby. I advise my patients to nurse exclusively for at least six to eight months, and to continue nursing even after solid foods are being added for as long as possible.
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Why breastfeed?
Study after study has found that nursing benefits baby and mother in both the long- and short-term. Most seasoned physicians know this too. Best of all, there are no disadvantages to breastfeeding.
Babies who are breastfed get the ideal combination of nutrients and growth factors. Breastfeeding reduces their risk for many early-life diseases and conditions, including ear infections, respiratory tract infections, atopic dermatitis, type 2 diabetes, diarrhea, sudden infant death syndrome, and some childhood cancers, as well as more adult conditions such as obesity and high blood pressure. Breastfed babies also benefit from improved immunity as antibodies are passed from mom to baby and better digestion as immune-promoting beneficial bacteria like Lactobacillus and Bifidus are transferred in breast milk to populate the baby gut.
Mothers who breastfeed have a decreased risk for type 2 diabetes, ovarian cancer, and premenopausal breast cancer. And they lose those pregnancy pounds faster!
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I've been thinking about breastfeeding but I read that mothers transfer toxins to their babies in their milk. Is this true?
It’s true that heavy metals, pesticides and other chemicals such as PCBs can get into breast milk, and thereby into baby. That by itself is a good reason to reduce your family’s exposure to these pollutants in as many ways as you can. Still, all the studies have confirmed that the benefits of nursing far outweigh the risks of these small chemical exposures. Many researchers think that the immune-boosting compounds in breast milk may even help negate the effects of any toxins in the milk.
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My milk doesn't seem to be coming in very well. Should I supplement with formula?
You should first address the underlying causes of low milk production--fatigue, stress, poor nutrition, and poor hydration. Slow recovery from a difficult delivery can also affect milk flow. Talk to a lactation expert or friend who has successfully nursed for guidance and reassurance. Remember, no one is born knowing how to breastfeed.
Babies lose up to 10% of their body weight after birth, and need 7-10 days to get it back. If baby is back to birth weight after that time, things are going well. If not, use your baby’s weight and disposition to assess whether or not you need to supplement with formula--a hungry baby is usually an irritable baby.
I reserve supplemental formula for short-term use when a baby is not recovering its initial weight loss or mom is too run down to produce enough milk yet. Once baby has returned to his initial weight or mom is finally healed and rested, baby can slowly be weaned off the supplemental formula and go back to exclusively breastfeeding. Don’t remove formula too quickly, because your baby is now used to a certain amount of calories and you’ll need a little time to get full milk production going.
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How do I know if my baby is getting enough milk?
The proof is in the pudding and your baby is the pudding! If your baby is gaining 1 ½ to 2 ½ pounds a month in her first three months (after that, weight gain slows), she’s doing fine. You can also look at stool frequency. In the first few weeks well-fed babies should be passing stools frequently, perhaps even after every feeding, The stools will gradually become seedy, loose, and the color of mustard. A baby who is pooping regularly in these early weeks is getting plenty of breast milk. After about two months, stool frequency will change in breastfed babies. They may poop seven times a day or once in seven days, and either is fine.
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How long should I let my baby feed? And should I switch sides with each feeding or let him nurse a little on each side with each feeding session?
Opinions vary, but I usually advise nursing 10-15 minutes on each side. Some babies will only nurse on one side, and that works too. I do advise new mothers not to leave baby at the breast for hours at a time. You need time to rest, and allowing a baby to use you as a pacifier will lead to irritated nipples in no time. Remember, nursing is a partnership and both partners need some downtime.
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