by Anne Smith, IBCLC
There may be times when, for a variety of reasons, nursing mothers need or want to leave their nursing baby with a caregiver. This may be a "once only" event, or a regular daily arrangement. The following information is intended as a guide for the caregiver of a breastfed baby, so she/he can better understand how to care for the baby and the expressed breastmilk (EBM) left for the baby's use.
Human milk does not look like formula or cow's milk. It may be a different color or consistency, and it is normal for it to be bluish, greenish, or even brownish in color. Frozen milk, or milk expressed during the early days of nursing (which still contains colostrum) may look yellowish. Human milk that is properly stored is not spoiled, unless it smells sour or tastes bad.
Because human milk is not homogenized, it will naturally separate into layers of milk and cream. This is normal, and does not mean the milk is spoiled. If the milk separates, heat and swirl it gently to mix.
Several batches of EBM expressed at different times may be mixed and/or stored together to make enough for one feeding. A mother's EBM should only be used for her baby. For health reasons, milk from different mothers should not be pooled.
Because a baby digests and uses human milk so completely, less breastmilk than formula may be needed at a feeding. There is no way to predict exactly how much milk a baby will need at each feeding, but you will soon learn how much milk the baby usually takes. As a rule of thumb, babies three months and under usually take between two and four ounces, and babies over three months will take from four to six ounces. It is a good idea to have some one or two- ounce portions available for snack feedings.
Until you get a feel for how much the baby will consistently take at each feeding, offer small amounts of EBM at a time. If the baby is not very hungry, you will not then have to waste large quantities of milk. If he needs more, prepare another smaller amount.
You should be aware that a breastfed baby may not be on the same feeding schedule as a formula fed baby. Breastmilk is digested quickly, and the baby may need to feed more frequently. Also, many nursing babies are used to nursing for comfort as well as nutrition, and my need extra cuddling and rocking, especially at naptime. Be flexible, and as you spend time with the baby you will get to know his own unique schedule, and you will be able to comfort him in your own way.
Breastfed baby's bowel movements are looser than formula fed infants, and may be more frequent (especially in the early weeks). It is not unusual for a newborn nursing baby to have a loose stool every time he feeds, but this is not diarrhea (unless accompanied by fever, lethargy, vomiting, or other symptoms of illness). In breastfed babies older than six weeks, it is not unusual for babies to go several days without stooling. In a totally breastfed infant, this is not considered constipation. Constipation consists of hard, dry stools that are painful to pass. An older nursing baby may not stool every day, but the stool will be loose and plentiful when he does pass it. Totally breastfed baby's stools are usually mustard yellow and seedy, but may also be yellow green or brownish. They are much milder smelling than a formula fed baby's stools.
To thaw frozen EBM, it is best to leave it in the refrigerator for about twelve hours. If you need to thaw it quickly, hold the container of milk under cool running water, and gradually add warmer water until the milk is thawed and heated to room temperature, gently swirling to mix in the fat.
To heat refrigerated EBM, put the container of milk in a pan of warm (not hot) water just until the chill is off. Many babies don't mind if the milk is cold, and serving it right out of the refrigerator is not harmful. Run the nipple under warm water, though, as most babies don't like the feel of a cold nipple.
NEVER thaw or heat EBM in a microwave. This can destroy valuable nutrients, and can also create dangerous "hot spots" that can burn the baby's mouth, even though the bottle may feel cool to the touch. For the same reasons, do not boil or overheat EBM.