becoming too full. If your breasts get too full, take a short, warm shower or put a warm, wet towel over your breasts and nipples for a minute or two and hand express a little milk before each feeding. Gently massage your breasts toward your nipples while your baby is breastfeeding. Cold packs can be used for up to 20 minutes between feedings if the fullness becomes uncomfortable. If your breasts become so full that you have trouble hand expressing, try the softening method found at http://www. breastmilkcounts.com/educational-activities.html. Do I have too little milk? Many babies will nurse very often at one time of the day. Many babies do this in the evening. This is normal. The more often you nurse your baby, the more milk you will make. Breastfeed often and do not give your baby formula. Exclusive breastfeeding for the first few weeks is very important for building a good milk supply. Sometime between your baby’s first and third week of life, he may want to nurse more often. About this same time your breasts will naturally soften and feel less full. This does not mean you don’t have enough milk. It means your baby is having his first growth spurt and your milk supply is changing to meet your baby’s needs. Try not to give your baby formula. Instead, set up a little area or “nest” by gathering plenty of supplies around you such as snacks, drinks, phone, remote controls, books, and magazines. Try to spend as much time as you can in your “nest” with your baby so you can get to know and enjoy your baby. Relax and nurse as often as your baby wants. Growth spurts usually happen around these times. • 1 to 3 weeks of age • 6 weeks of age • 3 months of age You should call your baby’s doctor if he: • Does not regain his birth weight by 2 weeks of age. • Has fewer than six wet diapers a day by day six. • Has fewer than three poops a day by day three. • Still has black poop on day four. • Will not wake up to nurse at least eight times a day. • Falls asleep or stops nursing right after attaching to your breast. How do I know when to call the doctor? How do I take care of myself ? Forget about housework and try to sleep when your baby sleeps. When you are tired, lie down for feedings. Have snacks and drinks beside you each time you sit down to nurse. Keep meals simple — like a sandwich, soup, and fruit. Limit drinks with caffeine to no more than three a day. Most medicines are safe to take when you are breastfeeding but check with your doctor to make sure. Or call the Infant Risk Center at 1-806-352-2519. Many women have mildly sore nipples the first few days of breastfeeding. If the discomfort only happens at the beginning of feedings and goes away when your milk starts to flow or within 30 seconds, this is probably normal. To soothe sore nipples, rub breastmilk into them or use a lanolin cream that is made for breastfeeding mothers. If the soreness lasts the entire feeding or is severe, see a breastfeeding counselor right away. If you have soreness at the beginning of feeding only and it does not go away within two weeks, see a breastfeeding counselor. Call your local WIC clinic for breastfeeding help. Most likely, you are sore because of the way the baby is positioned or the way the baby is latching on. Once this corrected, any soreness should go away. Hang in there. Breastfeeding gets easier. Take it one day at a time and be proud of what you are doing for your baby. You are giving your baby the best possible start in life. Optimal infant and young child feeding practices rank among the most effective interventions to improve child health. In 2006 an estimated 9.5 million children died before their fifth birthday, and two thirds of these deaths occurred in the first year of life. Under-nutrition is associated with at least 35% of child deaths. It is also a major disabler preventing children who survive from reaching their full developmental potential. Around 32% of children less than 5 years of age in developing countries are stunted and 10% are wasted. It is estimated that sub-optimal breastfeeding, especially non-exclusive breastfeeding in the first 6 months of life, results in 1.4 million deaths and 10% of the disease burden in children younger than 5 years. To improve this situation, mothers and families need support to initiate and sustain appropriate infant and young child feeding practices. Health care professionals can play a critical role in providing that support, through influencing decisions about feeding practices among mothers and families. Therefore, it is critical for health professionals to have basic knowledge and skills to give appropriate advice, counsel and help solve feeding difficulties, and know when and where to refer a mother who experiences more complex feeding problems. Child health in general, and infant and young child feeding more specifically, is often not well addressed in the basic training of doctors, nurses and other allied health professionals. Because of lack of adequate knowledge and skills, health professionals are often barriers to improved feeding practices. For example, they may not know how to assist a mother to initiate and sustain exclusive breastfeeding, they may recommend too-early introduction of supplements when there are feeding problems, and they may overtly or covertly promote breast-milk substitutes. This Model Chapter brings together essential knowledge about infant and young child feeding that health professionals should acquire as part of their basic education. It focuses on nutritional needs and feeding practices in children less than 2 years of age – the most critical period for child nutrition after which sub-optimal growth is hard to reverse. The Chapter does not impart skills, although it includes descriptions of essential skills that every health professional should master, such as positioning and attachment for breastfeeding. The Model Chapter is organized in nine sessions according to topic areas, with scientific references at the end of each section. These references include articles or WHO documents that provide evidence and further information about specific points. Useful resource materials are listed on the inside of the back cover. Training institutions may find it useful to have these resources