Many infants are fussy in the evenings, but if the crying does not stop and gets worse throughout the day or night, it may be caused by colic (KOL-ik). Colic usually starts between 2 and 4 weeks of age. A baby may cry inconsolably or scream, extend or pull up his or her legs, and pass gas. The baby's stomach may be enlarged. Crying can happen at any time, although it often gets worse in the early evening.

Colic will probably get better or disappear by the age of 3 or 4 months. Doctors don't know why some babies get colic. Some breastfed babies may be sensitive to certain foods their mother eats, like caffeine, chocolate, dairy, or nuts. Colic could be a sign of a medical problem, such as a hernia or some type of illness.

If your infant shows signs of colic, talk to your doctor. Sometimes changing what you eat can help. Some infants seem to be soothed by being held, "worn" with a baby wrap or sling, rocked, or swaddled (wrapped snugly in a blanket).

Jaundice is caused by an excess of bilirubin, which is found in the blood but usually only in very small amounts. In the newborn period, bilirubin can build up faster than it can be removed from the intestinal tract. Jaundice can appear as a yellowing of the skin and eyes. The jaundice usually clears up by 2 weeks of age and usually is not harmful.

Some breastfed babies develop jaundice when they do not get enough breastmilk, either because of breastfeeding challenges or because the mother's milk hasn't come in. This type of jaundice usually clears up quickly by breastfeeding more often or feeding of expressed breastmilk or after the mother's milk comes in.

Your baby's doctor may monitor his or her bilirubin level with blood tests. Some babies with jaundice may need treatment with a special light (called phototherapy). This light helps break down bilirubin into a form that can be removed from the body easily.

Breastfeeding is best for your baby. Even if your baby gets jaundice, this is not something that you caused. Your doctor can help you make sure that your baby is eating well and that the jaundice goes away.

Some babies develop gastroesophageal (GASS-troh-uh-SOF-uh-JEE-uhl) reflux disease (GERD). GERD happens when the muscle at the opening of the stomach opens at the wrong times. This allows milk and food to come back up into the esophagus, the tube in the throat.

Some symptoms of GERD include:

• Severe spitting up or spitting up after every feeding or hours after eating
• Projectile vomiting, where the milk shoots out of the mouth
• Inconsolable crying, as if in discomfort
• Arching of the back, as if in severe pain
• Refusal to eat or pulling away from the breast during feeding
• Waking up often at night
• Slow weight gain
• Gagging or choking or having problems swallowing

Many healthy babies might have some of these symptoms and not have GERD. Also, some babies with only a few of these symptoms have a severe case of GERD. Not all babies with GERD spit up or vomit. GERD may need to be treated with medicine if the baby refuses to nurse, gains only a small amount of weight or is losing weight, or has periods of gagging or choking.

See your baby's doctor if your baby spits up after every feeding and has any of the other symptoms listed in this section. If your baby has GERD, continue breastfeeding. Infant formula is harder to digest than breastmilk.

Premature birth (also called preterm birth) is when a baby is born before 37 weeks. Premature babies often have a low birth weight (less than 5½ pounds). Both of these can make it challenging to breastfeed, especially if the baby has to stay in the hospital for extra care. But breastmilk helps premature babies grow and stay healthy.

Some babies can breastfeed right away. This may be true if your baby was born at a low birth weight but after 37 weeks. These babies will need more skin-to-skin contact to help keep warm. These smaller babies may also need to be fed more often because their stomachs are smaller, and they may get sleepier during those feedings.

If your baby is born prematurely and you are not able to breastfeed at first, you can:

• Hand express or pump colostrum in the hospital as soon as you are able
• Talk to the hospital staff about renting an electric pump. Call your insurance company or the local Women, Infants and Children (WIC) office to find out whether insurance will pay for rental of this type of pump. Most insurance plans must cover the cost of a breast pump, but different insurance plans will cover different types of pumps.
• Pump milk as often as you would normally breastfeed — about eight times in a 24-hour period (every 3 hours).
• Give your baby skin-to-skin contact once your baby is ready to breastfeed directly. This can be very calming and a great start to your first feeding. Be sure to work with a lactation consultant on proper latch and positioning. It may take some time for you and your baby to get into a good routine.

Your baby will begin teething sometime between 4-7 months. Some moms may find it hard to breastfeed when baby's teeth are coming in. That's because babies can experience discomfort when teething and will change their position or latch to avoid hitting their sore gums. Babies may also try to relieve soreness by biting. When either of these things happen, it can cause nipple pain or discomfort.

Here are a few examples of things you can try:

Before Nursing

• Give your baby a cold, wet washcloth or cold teething toy to soothe sore gums.
• Massage your baby's gums with a clean finger.

During Nursing

• Try different breastfeeding positions to ensure that your baby's weight is well supported when baby is latched on.
• Make sure your baby is properly latched.
• Before babies can bite, they must move their tongue to avoid biting themselves. If you notice your baby's tongue moving, stick your finger in the corner of baby's mouth. That way, baby will bite your finger and not your breast.

If your baby bites you, try not to react in a way that may startle or scare your baby. You can tell your baby firmly, "no bite." Then turn baby on your lap, facing away from you for a moment. Babies learn quickly not to bite down if the feeding is stopped.

Planning to be apart from baby? Find tips for feeding baby with expressed milk.

Nursing your baby at the breast is the easiest way to feed when you are together. But when you're separated, one common way to feed your baby is with a bottle of breast milk you've expressed.

Using a bottle to feed your baby is different than feeding your baby at your breast.

Here are some tips for using bottles with breastfed babies. Be sure to share these tips with your partner, your mom, or other child care provider so they can help you continue your breastfeeding journey.

• Hold your baby snugly and fairly upright. This will give baby comfort and control.
• Hold the bottle at an angle. This will limit the amount of air baby swallows. Burp your baby at regular intervals.
• Switch sides. If your baby takes a break or needs to burp, use this pause to switch baby to the other side to continue baby's bottle. This also gives your baby a new view!
• Let someone else offer your baby breast milk from a bottle. Your baby may be more likely to accept breast milk in a bottle from your partner, your mom, or other loved one at first, since baby is used to nursing from your breast.
• Give your baby time to adjust. If you're going back to work or school, in the week or two before you go back, try giving your baby one or two feedings a day from a bottle. This will get baby used to bottle feeding. It may take your baby several days to adjust. Once they're used to it, most babies do great going back and forth between breast and bottle.

KNOWING WHEN BABY IS FULL

Look for signs that your baby is full, such as turning away from the bottle or keeping lips closed. Don't force your baby to finish a bottle.

Make sure your caregiver knows the signs for when your baby is full and doesn't overfeed your baby. When your baby is not overfed, you can better keep up with your baby's breast milk needs while you are pumping or hand expressing.