Editing Maternal and Newborn Nursing (section)

=== Feeding ===

* '''Breastfeeding''': colostrum comes first (high in protein and immunoglobulin A, laxative effect that promotes meconium passage); mature milk typically comes in at about 2 to 5 days. Feed '''8 to 12 times per 24 hours''' on demand, watching for early hunger cues (rooting, hand to mouth, lip smacking) rather than waiting for crying, which is a late cue.
* '''Signs of an effective latch''': a wide open mouth taking in the nipple and a good portion of the areola, flanged lips, the chin touching the breast, audible swallowing, and comfort for the mother. '''Nipple pain and cracking usually mean a shallow latch, not too much feeding.''' Break suction with a clean finger in the corner of the mouth before removing the infant.
* '''Signs of adequate intake''': at least 6 wet diapers per day by about day 4 to 5, 3 or more stools per day in the early weeks, appropriate weight gain, and audible swallowing.
* '''Engorgement''' care differs by goal: for a breastfeeding mother, use warmth before feeding to promote letdown, feed or pump frequently, and use cold compresses after feeding for comfort. For a mother who is not breastfeeding, avoid all nipple stimulation, wear a supportive bra, use cold compresses, and do not pump.
* '''Formula feeding''': hold the infant semi-upright with the nipple full of formula, never prop the bottle, and never microwave formula. Prepared formula follows manufacturer dilution exactly; overdilution causes water intoxication and hyponatremia, and underdilution stresses immature kidneys. '''No cow's milk, honey (botulism risk), or solids before the recommended ages.'''
* Contraindications to breastfeeding are limited but include maternal HIV in settings where safe replacement feeding is available, active untreated tuberculosis (until treated, though expressed milk may be given), certain medications and chemotherapy, active herpes lesions on the breast, and infant galactosemia.