Tag: breastfeeding

Can I start collecting colostrum before baby is born?

- Julie Matheney
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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?

- Julie Matheney
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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

- Julie Matheney

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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Best Bottle for the Breastfed Baby

- Julie Matheney

Don’t fall for the marketing. There are so many bottle systems out there that are marketing themselves as “just like the breast” and even “shaped like the breast”. In truth the ones that look like a boob often function the least like it.  The good news is there are some really good bottles out there that even though they don’t work LIKE the breast, they can PROMOTE a latch similar to it to help baby go back and forth between the two.

There are many bottles marketed as “most like breast.” The bottle part may “look” like a breast, but the nipple typically has a wide neck and and short nipple, which is how some nipples look like at rest before a baby latches. I call these shoulder nipples. The baby tends to latch just to the short nipple in a straw-like latch because they can’t latch deeply to the wide base (breast tissue expands and fills baby’s mouth, but the rigid silicone of the bottle nipple doesn’t). If baby’s lips are super rounded and there’s dimpling in baby’s cheeks while they suck, they are in a shallow latch. They may still pull milk from the bottle, but this shallow latch back at the breast results in painful nipples and leas efficient feeding. 

 

Want to learn more? Take my Latched class to help find the right bottle for your breastfed baby.

CLICK HERE TO ENROLL

 

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Bottle nipples that have a more gradual slope from tip to base and a cylindrical shape are preferred for all babies, whether breastfeeding or not. Why cylindrical? We want your nipple to go in and out of baby’s mouth round. If your nipple is coming out pinched, creases, or flat, we’re talking about improving a shallow latch or releasing a tongue tie. Bottle nipples that are lipstick shaped, flat, creased, or pointed are going to promote incorrect sucking patterns which can transfer back to breast. Now hear me on this: while a round, tapered nipple are optimal, there are times when a different shape nipple is appropriate, especially if they’re the only shape baby will successfully take. We want all babies to have a wide latch to the bottle for more efficient feeding and better use of their facial muscles for skill development. I usually prefer the narrow neck to the wider versions for the majority of babies, as it helps promote better lip flanging, although some babies they will do just fine on the wider version. If your baby is struggling to take a round, tapered nipple, please seek the help of a qualified and specially trained IBCLC lactation consultant, occupational or speech therapist. CLICK HERE TO BOOK WITH ME NOW

 

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When a baby is at the breast, they create a vacuum in their mouth with negative pressure by making a seal with their tongue to the palate. They then use positive pressure by compressing the breast as their tongue moves in a wave like pattern from front to back called peristalsis. Positive and negative pressure are essential for a baby to efficiently feed from the breast. They need to maintain the tongue protruded over the bottom gun line and in that vacuum seal through the duration of the feeding, and the middle of the tongue needs to pump up and down to help compress out milk. This is why babies with tongue ties can struggle to feed both breast and/or bottle. Bottles work totally different than the breast and many only need the compression piece for baby to move milk. Some bottle nipples do a better job of approximating the breastfeeding latch and do require more suction in order to remove the milk. In general, bottles that require a combination of suction and compression to remove milk better promote breast feeding by using a more natural and functional sucking pattern. Those systems that use compression only promote a chomping sucking pattern or the baby squeezes the nipple harder to move milk, which can make it difficult (and painful) when transitioning back to breast.

What nipple “level” should my baby take? Nipple flow levels are not standardized across the bottle industry. Each company has their own set rate and it is completely different from company to company.  A level one will flow simple tell different across every brand of bottle. What is “slow” on one nipple can be very fast compared to “slow” on a different nipple. Britt Pados has done multiple research studies that measure flow rates. Turns out there are some brands “Slow” that are actually faster than other brands “Level 3” . Remember: don’t fall for the marketing. If your baby is coughing, choking, leaking milk or struggling to drinking from a nipple, try going to a slower flow nipple in the same brand and if that doesn’t work, switch brands. Do you ever need to go up a nipple level? No. They are marketing nipple levels by age like Carter’s does with onesies. If it fits, use it. No need to level up if your baby is content. Ever.

From a lactation perspective, we generally want breastfed babies to use a nipple that matches the flow of their mothers milk back at that breast. This is USUALLY the slowest flowing nipple (remember, this will vary from brand to brand). We want them to take a bottle slowly since breastfeeding is usually a slow process, and we want them to actively suck to get milk out. Although for those with a fast let down or over supply of milk, it’s totally fine to use a faster flow nipple that matches the speed at which your baby takes the breast.

 

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Babies are masters at compensating to feed. They learn very quickly what works and what doesn’t to get milk. But sometimes this comes at the cost of them compensating with their muscles which can lead to symptoms like lip blisters, two tone lips, lots of gassiness and reflux. Clicking while swallowing, leaking milk, coughing and eating too fast are all symptoms that something isn’t right: either with the nipple shape, flow level or their latch OR something else may be going on in their mouth like a tongue and lip tie. If baby is doing well with their bottle and you have no concerns, keep doing what you’re doing! No need to start fresh and buy new. Some babies do a really nice job of going back and forth from breast to bottle, despite requiring different mechanics. If you are seeing any red flags and something doesn’t feel right about your baby’s  bottle feeding skills, either breast or bottle, schedule a consultation. There is help and guidance for you to get things back on track.

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What medicine can I take while being sick and still breastfeeding?

- Julie Matheney

There is nothing worse than being sick. It’s even harder when you still need to breastfeed when all you want to do is sleep and there’s nothing that sounds good to eat or drink. So what can you take get help feel better fast? There are still safe medications and herbs/supplements. Thomas Hale wrote the textbook on medications and breast milk and categorized medications as follows:
L1 Safest
L2 Safer
L3 Probably safe
L4 Possibly hazardous
L5 Hazardous

🤒Pain and fever
👍🏼Ibuprofen (Motrin/advil), acetaminophen (Tylenol), and paracetamol (L1) are safe to take while breastfeeding.
👎🏻Aspirin (L2) can pass into human milk and cause a serious condition called Reye’s syndrome in baby. Reye’s syndrome is associated with brain and liver damage.
👎🏻Use of codeine is not recommended while breastfeeding. If essential, and only where there is no alternative, it should be at the lowest effective dose, for the shortest possible duration and you should stop taking it and seek medical advice, if you notices side effects in baby such as:

  • Breathing Problems
  • Lethargy
  • Poor Feeding
  • Drowsiness
  • Bradycardia (slow heart beat)

🤧Sinus congestion
👍🏼Saline rinse L1
👍🏼Afrin and Nasacort L3 Because these medicines are not absorbed well from the nasal passages, they don’t have the same effect on milk supply that decongestants taken by mouth can have.
👎🏻Pseudoephedrine L3
Medications containing pseudoephedrine (Sudafed, Zyrtec D) — use with caution because they can decrease milk supply

😮‍💨Cough/chest congestion
👍🏼Guaifenesin (Robitussin/Mucinex) L2
👍🏼Dextromethorphan (Robitussin DM/Delsym) L3 The amounts of dextromethorphan and its active metabolite in breastmilk are very low and are not expected to affect the nursing infant. It is best to avoid the use of products with a high alcohol content while nursing.

Not sure if the medications you want to take is safe? Call Infant Risk at 806-352-2519

Kellymom.com also is a phenomenal resource for safe things you can take and do while sick and breastfeeding

Breast milk is made from your blood

- Julie Matheney

The food you eat and the water you drink do not magically go directly to your breast milk. What you eat and drink goes first to your stomach to be broken down and then into your intestines to be absorbed and processed. Your digestive system breaks nutrients into parts small enough for your body to absorb and use for energy, growth, and cell repair. The muscles of the small intestine mix food with digestive juices from the pancreas, liver, and intestine. Special cells in the walls of the small intestine absorb water and the digested nutrients into your bloodstream. Your blood carries molecule-sized components such as simple sugars (carbohydrates), amino acids, white blood cells, enzymes, water, fat, and proteins throughout your body. As blood passes by the breasts, milk glands pull out these nutrients for milk production and pass some of them to your baby. Not all molecules are small enough to pass through into milk. (That’s why some medications are safe to take while breastfeeding and some are not. Molecules that are too big can’t get into the milk while really small molecules can.) 

Nuts, seeds, beans, and grains all have plant based proteins. Meat and dairy are animal based proteins. Both plant and animal proteins carried in your blood can make it into your milk. Sometimes these proteins can affect baby’s digestive system, causing symptoms like reflux, gas, colic, and blood or mucus in the poops from iritations to baby’s intestinal lining. Diary proteins are the most common cause of upset in the stomach, however research suggests that the proportion of exclusively breastfed infants who are actually allergic to something in their mother’s milk is very small. Fussiness and gas alone are not  enough to diagnose a cow milk protein allergy. 

In general, there are NO foods that need to be avoided because you’re breastfeeding. Every baby is different in the foods they are sensitive to. IF your baby always seems to have a reaction when you eat a certain food or a large amount of a certain type of food, cutting back on it or cutting it out temporarily may be helpful. 

Hunger cues for baby

- Julie Matheney

How do I know my baby is hunger and not just fussy, has a wet diaper, or is lonely and wants to be picked up? Babies have a limited communication repertoire when they are first born. Every cue can look the same. It does get better with time as you learn your baby and your baby grows and matures. In general, young babies go through stereotypical phases of hunger cues. Some times we can miss these cues when the baby is swaddled or in a crib or bassinet away from where we are. 

Early

  • Licking or smacking their lips
  • Opening and closing their mouth
  • Sucking on their lips, tongue, hands, fingers, or anything within reach
  • Time to get your breastfeeding pillow and grab a snack and some water!

Active

  • Rooting around and attempting to latch on anything nearby their mouth
  • Hitting you on the arm or chest repeatedly and/or grabbing at your clothing
  • Trying to get into a nursing position 
  • Fidgeting/squirming
  • Becoming fussy
  • Breathing fast: get ready for them to start crying!
  • This is the best time to latch!

Late

  • Crying
  • Moving their head frantically from side to side
  • You’ll need to calm the baby before attempting to latch!

Many newborns are very sleepy after birth and may actually need to eat more often than they exhibit hunger cues. Newborns should be offered the breast anytime they cue hunger, which can be between 1-3 hours since the beginning of the last feeding. Watch the baby and not the clock. Don’t make the baby “wait” until some mythical hour to be fed. Feed the baby when the baby is hungry. 

Hand sucking is not as reliable an indicator of hunger as baby ages. Starting at around 6-8 weeks, baby will begin to gain more control over their hands and will begin to explore their mouth and everything else in their environment with their hands. Babies also suck on their hands during teething. Symptoms of teething can sometimes occur weeks and even months before the first tooth erupts.

Breastfeeding and Weight Loss

- Julie Matheney

You were probably told breastfeeding would be this incredible biological postpartum weight loss plan. While that may be true for about 1/3 of people, most of us hold on to our weight regardless of how much boob juice we make. When you breastfeed, fat cells stored in your body during pregnancy and calories from your diet fuel milk production. Your body burns about 20 calories for each ounce of milk you make. Which is why you need an extra 300-500 calories a day. After an immediate postpartum weight loss of about 15#, it tends to be gradual — about 1–2 pounds a month for the first six months after childbirth and more slowly after that point. It often takes 6-9 months to lose pregnancy weight.

Why are you not losing the baby weight?

🧁 I don’t know about you, but I was hungrier breastfeeding than pregnant. You’re still eating for two only your second party is bigger now than when they were in your belly. Breastfeeding cravings are real. 

🧁 Lactation cookies? Let’s be honest, a cookie is still a cookie whether or not it helps with your supply. Eating lots of bars, cookies, power drinks and teas with sugar or honey are not going to help with weight. 

😵‍💫Stress: Research has also found that elevated cortisol levels (the stress hormone) have been associated with weight retention in the first 12 months postpartum

😴 Lack of sleep:  Research shows when we don’t get consistent sleep, our hunger hormone (ghrelin) gets triggered and our satiety hormone (leptin) dips, increasing appetite. Scientists at the University of California also found that sleep-deprived people tend to reach for higher-calories foods compared to those who are well-rested.

🩸Hormones: Prolactin, your milk making hormone, is also sometimes called the “fat-storing hormone”. High levels of prolactin can result in weight gain. And they are at their highest while breastfeeding. While more research on prolactin is needed, we hypothesize that our bodies undergo metabolic adaptations to hold onto excess fat as “insurance” for baby. Meaning, if you were to find yourself in a famine, you body has what it needs for baby.

🔑Remember: there is waaaay too much pressure to “bounce back” after having a baby. Your body is epic and lovely and just pushed a tiny human being out. Your body is going through so many changes and there are physiological things at play that can be beyond your control. Trust your body. Trust your baby. Love your body. 

Why is my breastfed baby losing weight?

- Julie Matheney

While maternal nipple pain and damage are classic signs of tongue tie in baby, I have seen many cases where the mother reports absolutely no pain with breast-feeding. These babies tend to have very high palates and some times a weak suck (not always). The actual nipple in most cases is large and long and goes up into the palate where the tongue tends not to be able to pinch it as much. There may be creasing of the nipple, but usually not the classic damage seen with other presentations of tongue tie. These mother‘s bodies often compensate with a fast let down and over supply of milk. These babies trigger let down easily and the mothers body responds with freely flowing milk. Baby drinks from the fountain without learning how to stimulate the breast and empty it on their or or learning how to trigger new let downs. These babies often gain weight well or even faster than expected until around 3-4 months when they unexpectedly drop off the growth curve and mom feels like her supply suddenly drops. Symptoms often include clicking at the breast (caused by that high palate and the fast flow of milk) which in turn increases the risk of reflux, colic and gassiness. Moms also complain that they need to constantly hold or shape the breast or baby loses the latch. These ties often go undiagnosed and many of these babies are switched to bottles and formula as the supply continues to decrease from the baby inefficiently moving milk from the breast which can also coincide with mother going back to work. If she is using a poor quality pump or the wrong size flanges and not moving milk well with the pump, she’ll often blame herself for the low supply.

Breast changes

- Julie Matheney

Breasts are made of a network of ducts, covered by a layer of fatty tissue. During pregnancy, estrogen and progesterone enlarge the milk ducts and multiply the glandular tissue that produces milk. After birth, estrogen and progesterone drop and prolactin and oxytocin rise. Prolactin makes milk production and oxytocin releases it into the ducts. Extra blood and fluid fill the breast just after birth to supoort your body adding hormone receptors in the breast to make milk. The blood and fluid surrounds the ducts and this extra pressure is what makes your breasts feel full between feeding. This blood and fluid reabsorb around 6-8 weeks once supply is established and you won’t feel that full/soft feeling except when you go a really long time between feeding or pumping. Breasts go back to prepregnancy size when supply regulates around 11-14 weeks but continue to make milk. When you wean from breastfeeding, it can take several months for prolactin levels to return to baseline (which is why you may still see milk for months after weaning). Once you stop breastfeeding, the milk making structures actually self-destruct – a process that involves massive cellular suicide, and the removal of the debris. Around 6 months after weaning, the milk-producing tissue is replaced with fatty tissue. If you return to your pre-pregnancy weight, your breasts most likely will return to the same size. They may not be as “perky” because the skin is a bit more stretched and the connective and fatty tissues in the breasts often shifts during pregnancy and breastfeeding. While they may look smaller after weaning most of us can expect that our breasts will return to a similar size as they were pre-pregnancy. They’re just a little more lived in and well loved.