Alcohol and breastfeeding

Current scientific research, including studies published in reputable journals such as 'Journal of Human Lactation,' supports the idea that moderate alcohol consumption is generally considered acceptable during breastfeeding. The key is understanding the timing of alcohol metabolism and its presence in breast milk. A study published in the "Journal of Pediatrics" found that alcohol concentrations in breast milk peaked around 30 to 60 minutes after consumption and gradually declined thereafter. If you’ve had one standard drink, that alcohol should be completely out of your milk 2-3 hours after you drank it. Research suggests that waiting a few hours after consuming alcohol before breastfeeding can significantly reduce the amount present in breast milk.

It is generally considered acceptable that breastfeeding mothers can typically enjoy up to one standard drink per day without compromising the well-being of their infants. A standard drink, equivalent to approximately 14 grams of pure alcohol,  would equal a 5-ounce glass of wine, a 12-ounce beer, or a 1.5-ounce shot of distilled spirits.

Understanding the timing of alcohol metabolism is crucial. Waiting a few hours after consuming alcohol before breastfeeding allows for a decline in alcohol concentrations in breast milk. If there's a need to breastfeed within this waiting period, pumping and storing milk in advance can be a practical solution.

Do be mindful of individual factors and how they impact alcohol consumption while breastfeeding—metabolism, body weight, and other personal characteristics. Mothers are encouraged to consider these factors when making choices about alcohol consumption during breastfeeding. If there are uncertainties or unique circumstances, our team is here to provide personalized guidance and support.

At LA Lactation, we believe in empowering mothers with knowledge to make informed decisions that prioritize the health and well-being of both mother and baby. For any questions or concerns, feel free to reach out. Your can email [email protected] 🌟🤱 #LALactation #BreastfeedingGuidance #EvidenceBasedSupport"

Postpartum Rage: It may also be grief

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Social media is filled with pictures of overflowing bottles and serene mothers cradling their content newborns to their breast. For many, though, the breastfeeding journey may not be what was planned for or expected, leading to intense emotions that go beyond frustration. Postpartum mood disorders, including postpartum rage, are on the rise. Postpartum rage, characterized by intense, often unexplained anger, can be heightened when breastfeeding expectations are unmet. It's crucial to recognize that this anger may, in fact, be a form of grieving as well. Whether hindered by physical challenges, birth trauma, societal pressures, or other unforeseen medical complications, the gap between expectations and reality can be a source of profound sorrow. Acknowledging breastfeeding rage as a potential facet of grief allows for a deeper understanding of these complex emotions. Seeking support, both emotionally and professionally, becomes paramount in navigating through these feelings.

#BreastfeedingRage #GrievingProcess #MotherhoodRealities #BreastfeedingGrief #MotherhoodJourney #SupportEachOther

Toddler Breastfeeding

Breastfeeding toddlers offers a range of benefits that extend beyond infancy, contributing to the overall health and well-being of the child. One notable advantage is the continued nutritional support provided by breast milk. As toddlers transition to a more varied diet, breast milk remains a valuable source of essential nutrients, offering a balance of proteins, fats, and antibodies tailored to the child's needs.

Moreover, breastfeeding fosters a strong emotional bond between the toddler and the mother. The act of nursing provides comfort, security, and a sense of connection, promoting the child's emotional development. This nurturing aspect of breastfeeding can be especially beneficial during times of stress, illness, or significant developmental milestones.

Breast milk adapts to meet the changing nutritional requirements of a growing toddler, offering a dynamic source of antibodies that help bolster the child's immune system. This immune support is particularly valuable as toddlers explore their environment, encountering new germs and pathogens.

The act of breastfeeding also promotes optimal oral and facial development in toddlers. The natural sucking motion required during breastfeeding contributes to the development of facial muscles, jaw alignment, and palate shape, potentially reducing the risk of orthodontic issues later in life.

Beyond the physical benefits, extended breastfeeding can support a smooth transition into more independent eating habits. Toddlers who breastfeed often exhibit a greater acceptance of a variety of flavors and textures in their diet. Breastfeeding can serve as a bridge between the comfort of nursing and the exploration of new foods.

In conclusion, breastfeeding toddlers offers a multitude of benefits encompassing nutritional, emotional, and developmental aspects. The continued provision of breast milk aligns with the evolving needs of the growing child, fostering a strong parent-child bond and contributing to the overall health and well-being of the toddler.

Can I take medications while breastfeeding?

Women are often told they need to stop breastfeeding because of medical testing or a medication. Or told that they cannot receive treatment until the child is weaned. The good news is that most medications (even many antidepressants and meds for ADHD) are compatible with breastfeeding, and for those few medications that are a safety issue there are usually acceptable substitutions.  If you do need to take a medication, there are reliable resources to help you make the decision for if it is safe to continue breastfeeding

According to Thomas Hale, RPh, PhD (Medications and Mothers’ Milk 2014, p. 7-12): “It is generally accepted that all medications transfer into human milk to some degree, although it is almost always quite low. Only rarely does the amount transferred into milk produce clinically relevant doses in the infant… Most importantly, it is seldom required that a breastfeeding mother discontinue breastfeeding just to take a medication. It is simply not acceptable for the clinician to stop lactation merely because of heightened anxiety or ignorance on their part. The risks of formula feeding are significant and should not be trivialized. Few drugs have documented side effects in breastfed infants, and we know most of these.”

When you are taking medications and breastfeeding, the age of the baby, the dose of the medication, whether the medication is immediate or extended release, etc are all considerations for the timing of when to take the medication. Always double check your particular medication for drug interactions (for example: if you’re on a thyroid medication you need to avoid fenugreek because it can cause a drug interaction. Fenugreek is one of the most common herbal supplements used in “milk boosting” products). If you’re concerned about the medication you’re being prescribed or are being told you need to pump and dump or wean, please consult with an IBCLC to confirm. 

Breastfeeding with nipple piercings

Will nipple piercings impact breastfeeding? In my experience, the majority of people who’ve had a piercing will have absolutely ZERO issues with breastfeeding. But every body is different in how it reacts to taking out the jewelry out prior to breastfeeding. Just like with pierced ears,  occasionally the hole left by jewelry will scar closed, or partially closed, which can inhibit milk from coming out certain nipple pores. Often, the longer the time since the piercings were initially placed the better the outcome as the nipple has had time to properly heal. Other concerns may include nerve damage (the piercing happened to go through right at the nerve and damages it) that impacts milk let down or extra holes created by the piercings that lead to milk coming out of unexpected places! I have (rarely) seen mastitis and abscesses from previous nipple piercings, but that is NOT common.

Breastfeeding with the nipple jewelry in place is never recommended as it can make it difficult for the infant to latch-on correctly, increases the risk of choking on loose or dislodged jewelry, and can damage the inside of the baby’s mouth. If you are going to take your jewelry in and out every feeding, make sure you are being extremely careful with hand washing and jewelry sanitizing to reduce the risk of infection. Best practice says take the piercings out for the entirety of your breastfeeding journey. Laid back breastfeeding positions and extra nursing pads to catch the excess milk can help. You may also need to find which direction your baby needs to face if you notice leaking milk from additional holes created by the piercing if they are not in baby’s mouth. Many women go on to breastfeed successfully with a history of pierced nipples, but if you’re having any problems or have concerns, see an IBCLC lactation consultant. 

 

Baby cheek dimples

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If a baby's cheeks are dimpled or they makes a clicking sound when breast or bottle feeding, they is not latched well. It can be a sign of a shallow latch, wrong shape bottle nipple, issues from a small/retracted jaw, signs of a cleft palate, or baby may have a tongue tie. If baby feeds without dimpling or clicking at the breast but has these symptoms on a bottle, consider a different bottle system. If baby has dimpling and clicking on both bottle AND breast, it’s worth further investigating with the help of an IBCLC lactation consultant to figure out why.

#dimples #dimplegirl #breastfeedingmama #breastfedbaby #breastfeedingsupport #breastfeedingproblems

Can I start collecting colostrum before baby is born?

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Hand expression is the most effective tool for emptying colostrum from the breast when baby is sleepy or not efficient at the breast in the first 3-5 days after delivery. When baby isn’t latching immediately after birth, many hospital lactation consultants will have the mom start  pumping. This is a great way to stimulate the breast, but many get discouraged from not seeing much colostrum come out with those first few pumps. 

Colostrum is a thick, nutrient dense first milk. It starts in a small amount and moves slow to help baby learn how to practice sucking, swallowing and breathing  without getting overwhelmed by a faster flow. Colostrum has been in the breast since 10-14 weeks gestation so it is ready for whenever baby is born, even if baby is born premature. 

You can actually start practicing hand expression while you’re still pregnant. It is a phenomenal skill to practice in case you need to hand express after baby is born. It will also give you the confidence that you have milk and do not need to wait for “milk to come in” To start, you’ll want to gently prime the breast. Using your fingers like combs or in gentle strokes, massage the breast from back to front. The colostrum is made at the back. These gentle strokes and massages encourages the milk to move from the back of the breast, down the breast ductal system to the nipple at the front. You can also gently shake the breast to help stimulate the movement of milk. After a less than a minute of massage you’re ready to express your milk. There are multiple ways to hand express, and I will show you several different ways. You’ll want to practice different techniques until you find what works for you and your body. Some people can hand express with either hand, and some will find they need to use their dominant hand. There is no one right or wrong way, it is what works for you and your body.  To start, take your hand in a C or U position. The breast is a circle, so either position is fine, and you’ll want to experiment with both until you find the sweet spot on your own breast that works for you to start seeing your colostrum come. You want your finger and thumb opposite of each other on the areola not too close to the nipple. You’ll bring your hand back into the breast and compress your fingers together, trying to make them meet behind the areola and nipple area. Compress and release. You may have to do this gentle compresss and release for a minute or two before you start to see the glistening drops of colostrum from the nipple. If you don’t see anything after a few compresses, go back to gentle massage. You can switch breasts often.  Be mindful to bring your fingers together  from equal points cross from each other on the circle of the areola. If you are asymmetrical, you won’t see any movement.  

Usually the first time you try, you may see only a drop or two from each side. You cannot run out of colostrum or have colostrum change to mature milk until your placenta is birthed. As long as you are a low risk pregnancy and not on bed or pelvic rest, it is considered safe to hand express. This should not hurt. If you feel any pain or discomfort, stop and find a local IBCLC lactation consultant to help you practice. If you have questions about antenatal hand expression, make sure to ask your IBCLC lactation consultant during your prenatal breastfeeding consultation. 

HERE'S HOW TO COLLECT COLOSTRUM BEFORE BABY ARRIVES

Breast pumps only use suction, so if you use some compressions on the breast with your hands to start moving the milk to fill the ducts, it might flow easier when pumping. Using the pump to stimulate your hormones and then ending with lots of hand expression will actually help you see milk move. Don’t get discouraged if you don’t see any colostrum the first few times you pump after birth. Pumps are not as efficient as your hands or your baby once they’re awake and alert.

Which formula is best for the breastfed baby?

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FORMULA

Being pro breastfeeding does not mean being anti formula. As an IBCLC lactation consultant, my job actually includes education on safely preparing, handling and feeding infant formula. This includes helping families choose an infant formula that is right for them based on solid evidence based research. If there was more education and less demonizing of formula, families would feel less guilt and stigma around just trying to feed their babies. 

So let’s break down how to choose an infant formula. Here’s the disclaimer: what works for one baby won’t work for all babies. So always speak with your pediatrician or personal health care provider if your baby is struggling to tolerate any infant formula you are using. 

There are three main ingredients that are essential and needed in all infant formulas. The carbohydrate, or sugar source, the protein and the fat. In this video we will just be concentrating on the carbohydrate. Carbohydrates are an important source of energy for growing babies, as they account for 35 to 42% of their daily energy or caloric intake. The number one sugar or carb in breastmilk is lactose. Lactose is not only a good source of energy, it also aids in the absorption of the minerals magnesium, calcium, zinc and iron. It’s also lowest on the glycemic index scale – meaning that it won’t increase blood sugar levels nearly as fast as glucose or sugar will. Lactose is healthier for babies to metabolize, and can help maintain stable blood sugar (and therefore insulin) levels. All human babies have an enzyme called lactase which breaks down the lactose and make sit easily digestible. After about 5 years of age, most people (about 75% of the world's population) stop producing the lactase enzyme. Without lactase, they can no longer digest milk, and they become lactose intolerant. This is actually the age of biological weaning, as in if children were left to self wean, they would do so some time between 2.5-7 years old, meaning the weaning age coincides with no longer being able to break down the sugar. Because of this it is EXTREMELY RARE for a human baby to be lactose intolerant. That disorder is called galactosemia and is an inherited genetic condition This hereditary condition is passed from parent to child as an autosomal recessive disease. This means that a child needs to inherit two copies of the defective gene (one from each parent) in order to have the disease and occurs in only 1 of every 30-40K babies born. 

To replicate the sugar in breast milk, most cow's milk-based formulas will also have lactose as the main source of carbohydrates. When possible, I typically recommend a lactose based formula for most babies because most of the time if an infant is having a reaction to a formula, they are reacting to the protein and not the sugar source. More on protein in a different blog/video. But more on carbs. 

So again, I typically recommend looking for a lactose based formula first. Human babies are designed to break down lactose and it is the most easily digested by the human gut. If you are using a lactose based formula and baby doesn’t seem to be tolerating it, consider a lactose based formula with an alternative protein source first before going to a lactose free formula. 

Because formulas without lactose will use other sources of carbohydrates. Both the FDA and the European Commission require that infant formulas provide 40% of their calories from carbohydrates. However, the source of those carbs is up to the manufacturer of the formula. In the US, carbs can come from five main sources: Lactose, Maltodextrin, Glucose, Sugar, or Corn syrup. Not all of these sugars are created equal! 

Glucose and corn syrup are the sugar source in over half of the formulas produced in the USA. WHY? Because they’re widely available and very cheap to produce. The problem with corn syrup (and all glucose/sugar in general) is that it’s a fast-acting carbohydrate. This means that it’s high on the glycemic index, and quickly increases blood sugar. The EU has some limits and guidance on how much corn syrup can be used, and bans the use of corn syrup solids in organic baby formula, but the US does not. Which means that infant formula in the US can contain 100% of its carb source from corn syrup! Now before you get all fired up, corn syrup is NOT the same as high fructose corn syrup, which is what we are told as adults we need to stay away from. High-fructose corn syrup is corn syrup that has been further treated with enzymes to break down some of the glucose into another common sugar, fructose to make foods taste sweeter. Infant formulas are nutritionally complete and need a source of carbohydrate to provide energy. 

Maltodextrin is a type of sugar that is made up of glucose. Maltodextrin will become syrup if it is broken down further, so it’s essentially the same thing as added sugar.

Glucose syrup is the same thing as corn syrup! It just means that the syrup was extracted from a different plant – but it’s still the same as sugar.Sucrose is table sugar, and has a lower glycemic index than glucose, but higher than lactose.

Corn syrup, sucrose, maltodextrin are most used in “sensitive” formulas. That’s due to the fact that these formulas are designed for babies who are lactose intolerant, and so formula manufacturers are trying to replace lactose with an alternative carbohydrate.

Sometimes some corn syrup or glucose syrup is necessary in hypoallergenic formulas, because those formulas use hydrolyzed milk proteins, which are essentially partially digested milk proteins – and they taste/smell bad! So the corn syrup is used to try to mask the taste of the hydrolyzed milk protein.

But there are hypoallergenic formulas that do not overuse glucose and use healthier forms of carbs. 

There are a few reasons why formula manufacturers choose corn syrup over lactose in baby formula:

  • It’s a carbohydrate that babies can digest
  • It’s cheap to produce
  • Some sugars like maltodextrin also provide the function of thickening and emulsifying the formula for a better “mouth feel”
  • Corn syrup is sweet! And babies like sweet things – which might make formula more palatable to babies.
  • In hypoallergenic formulas, corn syrup might be used to make the formula taste better and mask the hydrolyzed milk protein taste.

So to recap, when choosing a baby formula, lactose is the preferred sugar or carb source for human babies. Prior to switching to a lactose free version, which will have the sugar source coming from another carb product, we should be switching to a formula with lactose with a different protein source which we will be discussing next. 

Formulas: Protein source 

Infant formulas come in powder, liquid concentrate, and ready-to-feed forms. They are designed to be prepared by the parent or caregiver in small batches and fed to baby, usually with either a cup or a bottle. 

There are an overwhelming number of infant formulas on the market and it can be difficult to determine which one is best to give to your baby. As an IBCLC lactation consultant, my job actually includes education on safely preparing, handling and feeding infant formula. Which includes helping families choose an infant formula that is right for them based on solid evidence based research. If there was more education and less demonizing of formula, families would feel less guilt and stigma around just trying to feed their babies while also feeling supported in the medical and nutritional care of their babies. 

So let’s break down how to choose an infant formula. Here’s the disclaimer: what works for one baby won’t work for all babies. So always speak with your pediatrician or personal health care provider if your baby is struggling to tolerate any infant formula you are using. 

There are three main ingredients that are essential and needed in all infant formulas. The carbohydrate, or sugar source, the protein and the fat. In this video we will be talking about the protein source. In my experience, if an infant is going to have difficulty tolerating an infant formula, it’s usually the protein piece that they are struggling to digest and changes to the formula can make a drastic difference in baby’s gut. 

So what is protein? Protein is the building block of all things. Excluding water and fat, the human body is made up almost entirely of protein. Protein is the main component of muscles, bones, organs, skin, and nails. For example, your muscles are composed of about 80% protein. There are at least 10,000 different proteins that make up and maintain different functions throughout your body. Protein is made from over 20 different basic building blocks called amino acids. Because we don’t store amino acids, our bodies make them in two different ways: either from scratch within our own cells, or by modifying others from the foods that we consume. There are 9 amino acids—histidine, isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan, and valine—known as the essential amino acids, which we can only get for our bodies from the food that we eat. The body breaks down consumed protein into these amino acids, and absorbs it for use. It is used to build muscles and organs, to make hormones and antibodies, to be stored as fat, and to be burned as energy. 

Human milk is made up of protein from the foods we consume and is designed for feeding human babies. When you eat your food, proteins and nutrients go from your mouth to your stomach where they are broken down and passed to your intestine. These nutrients are absorbed in your intestines to your blood stream where it goes to the back of your breast to little sack like cells called alveoli. The alveoli pull nutrients, including protein, from your blood as well as water and milk is made. This milk then goes to your baby’s mouth, their stomach to be broken down and then absorbed in their intestines for their body to use.  Baby’s intensities have human protein receptors to accept and use the protein from human milk, which makes it easily digestible for baby. Protein levels in human breast milk are constantly changing based on the stage of lactation, frequency of nursing, and other biological factors of the mother. Human milk protein concentration, how much protein is in each ounce, is not affected by maternal diet, but increases with maternal body weight for height, and decreases in those producing higher amounts of milk. 

There are actually many types of proteins in human milk, but can be generally divided into two kinds of protein classes: whey and casein. These two kinds can also be further subdivided by a remarkable array of multiple other specific proteins and peptides. So protein is like saying letters, numbers or colors. It’s a general category that can be further broken down into many types of proteins. 

Whey and casein are two different classes of protein found in both breast milk and cow’s milk, as well as the milk of any other mammals. What are whey and casein? Have you heard the nursery rhyme about little miss muffet who sat on her tuffet eating her curds and whey? The curds are the casein and the whey is the liquid. The ratio of curds to whey, as well as then adding additional ingredients, is how we make dairy products like cheese and butter.  This is why they’re the protein sources in routine infant formulas. As we explore these two protein types, there’s one key concept to keep in mind: although both human and cow’s milk contain whey and casein protein, the actual whey and casein proteins in each type of milk are significantly different. In human milk, the ratio between whey and casein is dynamic, and it shifts throughout the course of lactation. In the very early days of milk production, breast milk will have more whey than casein, with a whey:casein ratio of 80:20. After the first few weeks of life, the concentration of whey declines and casein increases until the proteins reach the concentration seen in “mature” breast milk with roughly equal amounts of each protein type, about 60% whey and 40% casein. On the other hand, casein is the dominant protein in cow’s milk, contributing roughly 80% of the protein, while whey makes up about 20%. These differences in proportions relate to different developmental needs of human and cow newborns. Whey proteins are easier to digest, and as a result, provide a more rapid source of amino acids. In contrast, the unique structure of casein proteins—called the casein micelle—makes them harder to break apart and requires a longer digestion time. Such gut muscle activity is referred to as gut motility and its rate is measured as gastrointestinal transit time. Baby cows digest differently than baby humans as a species. Cows’ milk and its proteins are known to delay gastrointestinal transit time. In some people, this may manifest as constipation. In others, delayed transit time in the gut may allow more time for fermentation of fermentable carbohydrates and which leads to intestinal fluid resorption, resulting in softer stools. This is what makes the gassiness and constipation symptoms in babies when consuming milks other than human breast milk. There is much discussion on the digestibility of whey vs. casein. Overall, whey remains a liquid during the course of digestion, while casein forms curds or clots. The pH (or acid level) of the stomach influences how these different proteins behave in the GI tract. The high proportion of casein in unmodified cow’s milk is one of the reasons why regular milk is not an appropriate to feed to young babies. Even after birth, the GI tract still has a lot of maturing to do, and a feeding that provides primarily casein can cause issues for many babies. While it makes some sense for infant formulas to mimic the whey and casein ratio of breast milk, protein is more complex than just ratios! The finer details of the composition of different types of whey and casein, as well as how they function in the body, are also considered when infant formulas are designed. Both whey and casein are considered high-quality proteins and provide all nine essential amino acids we know are required to support growth and development.

Now let’s jump in to the nitty gritty of the different kinds of proteins found in infant formulas so you understand what to look for when you’re staring at the ingredient list on the side of the can. There are many sources of protein used in baby formulas. Animal-based (dairy-based) sources of protein used in baby formulas include cow’s milk, goat’s milk, whey protein, organic milk protein concentrate, milk protein isolate, and casein hydrolysate. Plant-based sources of protein used in baby formulas include soy protein, pea protein, and some times almond butter protein

  • Cow's milk formula is the most commonly used type. An alternative to cow protein would be goat milk protein. 
  • Soy protein based formulas are frequently used for infants allergic to cow's milk or lactose and for those who are avoiding animal products like vegetarians or vegans. 
  • Protein hydrolysate formulas contain protein that's been broken down into smaller sizes than are those in cow's milk and soy-based formulas. Protein hydrolysate formulas are meant for babies who do not tolerate cow's milk or soy-based formulas.
  • Specialized formulas are also available for premature infants and those with specific medical conditions where the protein has been broken down even further. 

Those are the options for protein sources, but let’s break it further down to understand those food labels better. Also, research has shown that baby formulas with high casein may be more difficult to digest. For this reason, baby formula manufacturers often add whey protein, resulting in an adapted whey to casein ratio. Adding whey protein to baby formula may help to reduce tummy troubles in little ones. Remember the whey remains a liquid while digesting but the casein protein stays a solid and is harder to digest. A formula with at least 50, ideally 60% whey is ideal. Each manufacturer determines for their own brand this ratio but the trick thing is they don’t have to list the ratio. Some manufacturers will only list the ratio it there is 100% whey with no casein, (like Gerber Gentle Soothe Pro or Burt’s Bees Ultra Gentle). Most of the time you’ll have to call the manufacturer how much their particular ratio is or you can sometimes deduce how much is in there based on the position of “whey protein” in the ingredients list. For more whey in the ratio, you want it in the top 3-4 ingredients of the list on the label. Now if your baby is already drinking formula and they are tolerating it well, I will always say there is no one size fits all approach to feeding. If your baby seems to be drinking their formula fine with no digestion upsets, meaning constipation or fermented gas, if it ain’t broke, don’t fix it. But if you feel like your baby is struggling in their current formula, this is the ingredient to change first. So when we’re talking about picking formula by protein, first we want to look at the percentage of whey to casein. We usually want 50-60% of whey or possibly more depending on your baby. 

Now let’s break down the casein portion. There are subtypes of casein called “beta-casein” proteins there are a couple of different types, but we will focus on this. It comes in a 1 beta-casein or a  2 beat-casein formula. This is A1 versus A2 beta-casein formulas. The majority of mammal milks, including human milk, produce predominantly or exclusively A2 beta casein. That’s what we as humans are designed to digest. But the majority of our cows in the US produce both A1 and A2 beta proteins. Because we as humans weren’t really designed to digest A1 beta casein, some times we see digestive issues with both adults and babies. Sometimes we see symptoms that are less severe than a true milk allergy but are indicative of a milk protein sensitivity. These babies may benefit from an A2 formula that doesn’t have these beta-casein proteins. These symptoms can include eczema, raspiness, congested-sounding breathing, occasional mucous in the stools, and digestive discomfort. But without the extreme symptoms that we see with CMPA, like widespread rash, projectile vomiting, blood in the stool, poor growth or weight gain and feeding aversion or refusal. So if your baby has trouble with milk protein but testing negative in their stool test for milk allergy, switching to an A2 formula can be a good place to start before jumping to a hypoallergenic milk if there’s no diagnosed CMPA. 

Another option for a gentle formula is to pay attention to whether or not your formula is hydrolyzed. This means they have taken the intact milk proteins and broken them down into smaller pieces which can be easier to digest and have a lesser risk of an allergenic response. A partially hydrolyzed formula means they have some of their proteins broken down. A hypoallergenic formula means it has been extensively hydrolyzed where above 90% of the proteins are significantly broken down. 

Some babies may need an elemental or amino acid formula where there’s no detectable protein at all but instead the amino acid components of protein so there is no protein to react to. Unfortunately many pediatricians will jump to this type of formula when baby is reacting to other formulas instead of systematically working through other formula options first. If you read my other blog on the carbohydrate, one of the biggest concerns with the hydrolyzed and elemental formulas is the sugar source. They are most often using sugars other than lactose, which is the number one sugar in breast milk, to mask the flavor of these formulas. For more information on that see my other video. 

So here’s the summary:

IF your baby is having trouble with their formula, I suggest the following order to try to find a more digestible formula, unless there is obvious evidence there is an allergy:

  1. A formula with more whey protein in the ratio
  2. A formula with A2 protein (even better if it’s an A2 with added whey
  3. A formula that’s partially hydrolyzed (but remember you’re often sacrificing the lactose)
  4. An extensively hydrolyzed formula
  5. An elemental formula 

The other protein options for infant formulas are those the are plant based. Eating plants in the form of fruits and vegetables is good for babies (when they are developmentally read for them of course!). However, there is no nutritional advantage to plant-based infant formulas. For many health care providers, the use of soy-based formulas is often recommended for only those infants who cannot not have dairy-based products because of health, cultural or religious reasons, such as a vegan lifestyle or due to galactosemia. Soy formula is made from soy protein isolate, a product that comes from whole soybeans that have had fat removed (defatted). However, plant based protein is nutritionally deficient compared to animal based protein formula sources as soy is an incomplete protein, which has been a concern with soy formulas. Since infant formula is the only source of nutrition for many babies, it must contain all the nutrients that infants need to grow and thrive. So current soy formulas have added 3 amino acids which are naturally deficient in soy protein including methionine, taurine, and carnitine. 

The other concern with soy protein based infant formulas used to be higher amounts of aluminum found in soy, up to 50% more aluminum in soy than human breast milk. However, 95% of the ingested aluminum is not absorbed in the gut, and the kidney excretes the absorbed 5%, so there are no differences in plasma aluminum levels in children fed with different formulas  

Two potential issues remain for the use of soy formulas: One is the concern about possible hormonal effects on the reproductive system caused by phytoestrogens found in soy protein. Although at present there is no definitive evidence that phytoestrogens have toxic effects in human babies who are fed soy formula, concern has been raised from research carried out in vitro and in animal studies. Phytoestrogens are plant-derived substances with estrogenic activity. There is concern that these isoflavones may mimic the actions of estradiol or alter estradiol metabolism, and consequently modify the processes influenced by estradiol in the body. Estradiol is the primary form of estrogen found in the body during reproductive years that plays a significant role in initiating and maintaining postpubescent female secondary sex characteristics including breast development, changes in body shape, and affecting bones and fat deposition. Despite this theoretical possibility, practical experience has shown that the millions of babies who have consumed these products since the 1960s appear to have grown and matured as expected. Although no overt toxicity is associated with the consumption of soy-based formula in healthy babies, clinical research has shown that babies with congenital hypothyroidism should be cautious when consuming soy based formulas and have their thyroxine levels routinely monitored. 

A recent retrospective human study showed that adults who consumed soy-based formulas as babies showed no difference in rates of reproductive maturity, cancer development and general health as adults who had been fed cow’s milk-based formulas. Additionally, soy formulas appear to be safe from a neurodevelopmental perspective, as shown in a nationwide study of infants born in Korea. Soy formula intake did not increase the risk for developing epilepsy, attention-deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), or decreased developmental status. Currently available soy-based formulas support normal growth and nutritional status for the first year of life, with no overt toxicities observed in healthy babies. However, soy-based infant formulas may not adequately promote growth in babies who were born premature, and it is not recommended for these babies. 

The other problem to take into consideration is the use of transgenic soy in formulas. The US Department of Agriculture records that up to 93% of soybean crops are transgenic. Due to these nutritional disadvantages, higher allergenicity and less tolerance, the European Academy of Allergy and Clinical Immunology (EAACI) and the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) recommend not giving soy to babies with CMPA during the first 6 months of life or to children who have experienced gastrointestinal symptoms like constipation or foul smelling gas. Rarely, a soy-based formula is necessary to treat a metabolic disease. In this case, formula is used as a clinical intervention, much like medicine is used. These are exceptional cases and parents are encouraged to follow recommendations of their medical team.

Some families turn to soy-based formulas because of suspected cow’s milk protein allergy. Soy proteins can cross react with cow’s milk proteins; therefore, soy is not an appropriate formula for infants with a cow’s milk allergy. In fact, up to one half of infants with a cow’s milk allergy who are fed a soy formula are also sensitive or allergic to soy proteins (this is called cross reactivity). Both the American Academy of Pediatrics and the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) Committee on Nutrition recently produced papers on soy protein infant formulas (38,49). They recommend extensively hydrolyzed protein (or amino acid-based formulas if hydrolyzed formulas not tolerated) for the treatment of infants with CMPA. A 2020 review article from Europe recommends avoiding soy formula for infants with cow’s milk allergy who are under 6 months of age. (Concerns for the use of soy-based formulas in infant nutrition. Paediatr Child Health. 2009 Feb;14(2):109-18. PMID: 19436562; PMCID: PMC2661347.)

Rice is one of the less allergenic foods, reacting in less than 1% of allergic children. It has no lactose and no phytoestrogens. For this reason, hypo-allergenic formulae that uses hydrolyzed rice proteins have been developed as another plant based protein alternative for infant formulas. These formulae have now been in use for more than a decade in several westernized countries. Rice protein composition is naturally different from cow proteins: although they are rich in essential amino acids, three of these do not reach the respective value contained in breastmilk.

For this reason, to guarantee nutritional safety to infants allergic to cows milk or soy, partially hydrolyzed rice proteins formulas (HRF) are supplemented with multiple amino acids as several key nutrients like, iron and zinc. Although several studies have shown the hydrolyzed rice protein formulas to be nutritional and allergy safe, they are still recommended as a second choice to elemental or amino acid formulas. 

The BEST formula for you is the one that works best for your baby. This is NOT one size fits all and what works for your baby may not work for other babies. As always, please consult with your child’s health care provider or pediatrician for questions and concerns about your baby’s nutrition growth, and digestive system. This is not medical advice, this is the most current education on the choices available to you and how to interpret the labels on the containers of infant formula.  Manufacturers do not have to disclose their whey to casein ratio on the side of the can, but remember: human milk has a higher whey to casein ratio. If your baby is struggling with a whey based formula, switching to one with a higher amount of whey may help baby digest the formula quicker resulting in less constipation or fermenting gas. 

  • Breast milk has 400+ different proteins.
  • These proteins fit in two categories: i) casein and ii) whey.
  • Protein itself is a nutrient, but also helps absorb other nutrients.
  • Proteins also have antimicrobial and immune-supporting functions.
  • Amino acids are the building blocks of proteins, and each has a unique combination.
  • Therefore, the amino acid profile of whey and casein proteins are distinct.
  • From colostrum to mature milk, the ratio and amounts of whey/casein protein changes.
  • Between the two, whey protein is predominant. It makes up 50-80% of protein content in breast milk.
  • Suffice to say that the protein composition of breast milk is dynamic!
  • Nucleotides are also found in breast milk. They are the building blocks of our DNA.
  • Nucleotides are conditionally essential nutrients during the early stages of life.
  • In infants, they help the immune system and the gastrointestinal tract.

Freeze Dried Breast Milk

Freeze drying milk is not a new concept. Powdered milk, also called milk powder, dried milk, or dry milk, is a manufactured dairy product made by evaporating milk to dryness which can then later be reconstituted to the liquid form by adding water later. The first modern attempts at drying milk started as early as 1802 with specific processes for drying milk being created by 1837. Powdered milk is frequently used in the manufacturing of infant formula, confectionery such as chocolate and caramel candy, and in recipes for baked goods where adding liquid milk would make the final product too thin. During the 1960s, commercial infant formulas became popular, and by the mid-1970s they had all but replaced evaporated milk formulas as the "standard" for infant nutrition.

Typically when we think of breast milk storage, freezing in either a standard freezer or a deeper freezer have been the go-to for years. Milk that has been frozen correctly and stored in a deep freezer is optimal for about 6-9 months before the flavor begins to change. Newer guidelines are saying that frozen milk may still be good about a year in the freezer. But freeze-dried milk which can last from 3 to 20 years on the shelf! So the while the idea and concept of freeze dried breast milk isn’t new, it’s taking the market by storm with many new companies popping up in recent months. So let’s do a deep dive into the world of freeze dried breast milk, the pros and cons, and the expense. 

HOW IT WORKS

Sublimation is the fancy term for the freeze-drying process which basically means all the water has been removed from the breast milk and turns it into powder. Low temperatures are used for a long time in the drying process to ensure the nutrients in the milk are protected. Freeze drying is different than dehydrating, which uses very high heat and is relatively faster. With freeze drying, 'low and slow' is the name of the game to protect precious nutrients.

Here is the basics of a freeze-drying process:

  • Deep freezing: Milk is deep frozen in a chamber at temps below -40 degrees Fahrenheit.
  • Pressure dropping: Air inside the chamber is removed via a pump, which drops the pressure to create a vacuum. The low pressure turns the solid to gas. The vacuum pumps out the water particles.
  • Drying: Ice crystals inside the frozen breastmilk is vaporized by drying the milk with alternating warm and cold air (without thawing the breast milk) leaving behind a breastmilk powder
  • Packaging: The powder is sealed in special airtight bags or packages that protect against air, light, oxygen, and moisture. 
  • Since everyone’s breast milk is unique, the company will send you specific directions for reconstituting your milk for baby to drink. This is NOT like standard formula where 1 scoop gets 2oz of water. Each bag of powdered breast milk will need specific amounts of water unique to your milk. 
  • You should expect that however much milk you send will equal however much you receive back. If you send in 200oz of your breast milk, your powdered milk will make 200oz of breast milk when you’re ready to use it. 

Breast milk powder should be stored and prepared properly in order to prevent contamination with Cronobacter and other bacteria that can cause serious illness if safe handling guidelines are not followed.

THE PROS TO TRY IT:

  • To preserve milk for longer than it would last in the freezer, especially if it is going to expire soon
  • For the convenience factor
    • It’s easy to travel with or to ship to someone else
  • Can help with high lipase
    • While freeze-drying doesn’t reduce the amount of lipase in the milk, by removing the water it reduces the enzyme activity that breaks down breast milk which can make the taste and smell much milder. For some whose baby rejected pumped milk in bottles because of high lipase may have a higher chance of taking it freeze dried
  • For those who are doing elimination diets, this may preserve the milk longer for when your baby outgrows the allergy or intolerance so you can offer your milk later in your feeding journey
  • In cases where breast cancer has been identified and a mastectomy would be life saving, freeze drying milk can ensure future children conceived after mastectomy could still receive mother’s own milk
  • Can add some nutritional value to your older child’s meals by sprinkling it in purees or on solid foods, or even baking with it for the whole family
  • Could be an option for surrogates or donor milk
  • Saves space 

THE CONS AND THE COST

The big concern medical professionals have is that freeze-dried milk has not been widely studied. Yet. Most current health care providers will stick with AAP guidelines, CDC guidelines, FDA guidelines, and they have not released a formal statement on the safety and the efficacy of freeze-dried breast milk. But I would anticipate as it gains popularity and traction that eventually studies will be down on it. Without sufficient studies, it’s unclear if freeze-dried milk has the right protein, fat, carb ratio that infants need. We don’t know exactly how freeze-drying impacts the nutritional composition of breast milk. Some research suggests that breast milk's natural carbohydrate and protein content remains intact for up to six months after freeze-drying. But other studies report that freeze-drying may lower the amount of key antioxidants, like vitamin C, that are naturally present in breast milk. There really is a lack of evidence in terms of the nutritional safety of freeze-dried human milk at this current moment in time. Another concern is that freeze-dried milk does not undergo a pasteurization process which kills harmful bacteria. Pasteurization is avoided on purpose, in order to preserve the vital probiotics that are present in breast milk, and which would be destroyed with pasteurization. Just as bacteria can grow in freshly expressed milk if it is left at the right temperature for extended lengths of time, the same can happen with rehydrated breast milk powder. And there is room for error when making up bottles of freeze-dried milk. Each bag may require different amounts of water for rehydration, which means parents need to pay close attention to how they are preparing each bottle. Too much or too little water too often can lead to adverse effects in baby, like low sodium levels or not enough calories per feeding. 

Freeze drying breast milk is still a relatively new science when we are talking about using it for breast milk. Even though there are multiple new companies specializing in this, no matter what company you choose, it is going to be an investment. The cost to freeze dry your milk will vary based on the company you choose as well as the quantity of milk that you have.

Several companies will wait until they have your milk in hand before charging you. This way they know exactly how many ounces of milk there are! This is because we often aren’t accurate in our measurements of what we collect. The bag or the bottle lines can be inaccurate or we can tilt the bottle to see a different number than what’s actually there. Companies are very particular in measuring so that they can ensure proper ratios at the end too. They want to make sure they aren’t over or under charging you. Other companies may charge a flat rate or give you an estimate. Do your research but expect to pay several hundred dollars for your batch of milk!!

Freeze-drying human milk may still be an appealing option depending on your circumstances. If you are adamant about freeze-drying your milk, make sure to use a legitimate company with lots of reviews. And DON’T try it at home yourself as you're risking contamination.

 

References:

  • Basics of Breastfeeding Support for the NICU or PICU Dyad. IABLE- Institute for the Advancement of Breastfeeding and Lactation Education
  • Blackshaw, K., Wu, J., Valtchev, P., Lau, E., Banati, R. B., Dehghani, F., & Schindeler, A. (2021). The Effects of Thermal Pasteurisation, Freeze-Drying, and Gamma-Irradiation on the Antibacterial Properties of Donor Human Milk. Foods (Basel, Switzerland), 10(9), 2077. https://doi.org/10.3390/foods10092077
  • de Halleux, V., Pieltain, C., Senterre, T., Studzinski, F., Kessen, C., Rigo, V., & Rigo, J. (2019). Growth Benefits of Own Mother’s Milk in Preterm Infants Fed Daily Individualized Fortified Human Milk. Nutrients, 11(4), 772. https://doi.org/10.3390/nu11040772
  • Ginglen JG, Butki N. Necrotizing Enterocolitis. [Updated 2022 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513357/
  • Jarzynka, S., Strom, K., Barbarska, O., Pawlikowska, E., Minkiewicz-Zochniak, A., Rosiak, E., Oledzka, G., & Wesolowska, A. (2021). Combination of High-Pressure Processing and Freeze-Drying as the Most Effective Techniques in Maintaining Biological Values and Microbiological Safety of Donor Milk. International journal of environmental research and public health, 18(4), 2147. https://doi.org/10.3390/ijerph18042147
  • Lima, H. K., Wagner-Gillespie, M., Perrin, M. T., & Fogleman, A. D. (2017, August 2). Bacteria and bioactivity in holder pasteurized and shelf-stable human milk products. OUP Academic. https://academic.oup.com/cdn/article/1/8/e001438/4735239
  • Meredith-Dennis, L., Xu, G., Goonatilleke, E., Lebrilla, C. B., Underwood, M. A., & Smilowitz, J. T. (2018). Composition and Variation of Macronutrients, Immune Proteins, and Human Milk Oligosaccharides in Human Milk From Nonprofit and Commercial Milk Banks. Journal of human lactation : official journal of International Lactation Consultant Association, 34(1), 120–129. https://doi.org/10.1177/0890334417710635
  • Putting Evidence Into Practice: Freeze Dried Human Milk
  • Salcedo, J., Gormaz, M., López-Mendoza, M. C., Nogarotto, E., & Silvestre, D. (2015). Human milk bactericidal properties: effect of lyophilization and relation to maternal factors and milk components. Journal of pediatric gastroenterology and nutrition, 60(4), 527–532. https://doi.org/10.1097/MPG.0000000000000641

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Weaning from a Nipple Shield

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Nipple shields are a commonly used tool in the lactation world. They may help a premature baby latch to give the baby time to mature and learn how to suck, prevent nipple damage from a tied baby, or be used when a nipple is flat/inverted (either from normal anatomical variations or because the breast is fluid overloaded from interventions during birth).  While there are many benefits to using a shield, are also risks, like the potential for decreased milk supply. Hopefully if you were given a shield, you were also given an exit strategy for weaning off of it. With any tool, make sure the reason you were given one has been addressed (giving a premature baby time to grow, doing oral motor exercises and a tie release, education that fluids during labor and delivery can temporarily make breast tissue swell and make nipples look shorter or flatter than they naturally are, etc). When you are ready to wean from one there are multiple strategies to help:

  • 💡Start with the shield on and take it off after the first let down once baby is not as hungry/use it on the first side and not on the second side
  • 💡Try without the shield once a day during daylight hours when baby is happy and not too hungry. Catching early hunger cues is imperative. If they’re crying, try a different time 
  • 💡Start in skin to skin. Taking a bath together can help. Try to be as relaxed as possible
  • 💡Try to erect and evert your nipple. Use reverse pressure softening (RPS, see highlight reel), a pump or stimulate your nipples with your hands before attempting to latch
  • 💡Help baby latch with laid back nursing, supporting the breast in a “C” or sandwich hold, or the flipple. Make sure baby’s chin and cheeks are physically touching the breast as much as possible
  • 💡Hand express to get milk flowing to keep baby interested 
  • 💡Relax and be patient. Babies can feel your energy. The more you can see it as fun practice, the less pressure you’ll put on yourself and your baby
  • 💡Try a different shield like the Lovi or Dr Brown’s which are thinner and give you more stimulation 

How to properly place a nipple shield: CLICK HERE