Sleep Like A Baby

BREASTFEEDING FACT: No one sleeps all night
The reality is, no one, including adults, sleeps all night all the time. Older infants and toddlers are no exception. They often wake multiple times a night, but as they mature, they learn to put themselves back to sleep. We all go through multiple sleep cycles in a night, and toddlers actually go through more of these sleep cycles than we do. Which means they have more opportunity to get woken up from a light sleep.

Generally, there are 2 sleep stages in newborn babies and 4 sleep stages in babies over 3 months old. Newborn sleep stages are rapid eye movement (REM) and non-rapid eye movement (NREM). Newborns spend close to equal amounts of time in REM and NREM while they sleep.

REM is an active sleep state and NREM is a quiet sleep state. During REM, a baby can be seen making small movements. The baby’s eyes move around (while closed), their arms, legs and fingers might twitch or jerk, their breathing might speed up, and they may move their mouths. During NREM, the baby is still and doesn’t move. Around 3 months, babies begin experiencing the same sleep stages as adults.

Adults go through 4 sleep stages. These sleep stages include three stages of NREM sleep (which happen first at night) and one of REM (which happens last). The first two are lighter stages of sleep, during which a person can be easily awakened. The third stage of sleep is the deepest stage, and it is very difficult to wake someone in this stage. The fourth is REM, where dreams happen. Although babies begin experiencing 4 stages of sleep around 3 months, it is not until closer to 5-years-old that children’s sleep actually begins to mirror that of adults. As babies, they experience a short REM stage almost immediately after falling asleep instead of last in the cycle. In contrast, adults do not experience REM until they have been asleep for around 90 minutes. As a baby’s sleep schedule changes, so do their sleep cycles. Baby REM sleep is one part of the sleep cycle that changes over time. However, there is no simple chart outlining sleep cycle length or REM by age. Know that it is normal for your baby and toddler to wake frequently at night, and as they age, they will get better and better at putting themselves back to sleep.

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Antidepressants and breastfeeding

Put your oxygen mask on first. When there is an emergency on a plane, we are instructed to put our mask on first before helping others. This is also critical when caring for our children. Stress, depression, and anxiety can play major roles in how we care for our babies and for ourselves. Antidepressants are OK to take while breastfeeding. When maternal mental illness is not addressed, research shows this not only has a negative impact on the mother’s overall health, but can impact the baby as well.

The risks of not addressing maternal mental health include:
✏️Poor infant growth, language and cognitive development
✏️Poor gross and fine motor development
✏️Less efficient breastfeeding or weaning from breastfeeding earlier than desired
✏️Poor infant sleep and increased maternal stress.

When considering antidepressant use during lactation, while most medications are considered safe for mom and baby, there is no “zero risk” option. However, the benefits of using a medication to help decrease depression and anxiety usually outweigh the risks acostares with taking a medication. If a mother has been on a certain med prior to breastfeeding and it worked well for her, it would be reasonable to resume that medication while breastfeeding. Sertraline (Zoloft) is a first-line drug for breastfeeding, due to documented low levels of exposure in breastfeeding babies and the very low number of adverse events described in case reports. Prozac is generally considered safe to take while breastfeeding; however, research shows that the average amount of the drug in breastmilk is higher than with other SSRIs.

When taking any medication, you want to monitor for side effects both in you and the baby. Most common side effects when taking antidepressants are:
🥛 Changes in milk supply
🛌 Sedation/sleepiness in baby
Poor feeding or weight gain in baby

Antidepressants can work well to help you feel balanced again. Work closely with an IBCLC while starting antidepressants to help continue and feel supported in your breastfeeding journey

Is your baby’s tongue tie a tetherberg or a tether floe?

There are two kinds of ice in the ocean: icebergs and ice floes. Both can look identical on the surface, but are completely distinct below the water. Icebergs have a portion of ice seen above the surface, and huge, extensive mountains of ice below the surface, anchoring what you can see above to the masses below. Ice floes are seen from above and are basically a sheet of floating ice.

Tongue ties can also be classified into two types: tetherbergs and tether floes.

Tetherbergs are tongue ties that look tied on the surface, but the breastfeeding issues and symptoms are connected to so much more than just the tongue. Baby usually has lots of tension in the body. There may be a sensitive nervous system. A traumatic birth. Baby may live in a state of fight or flight. There may be other asymmetries or structural differences in the body. There’s so much more below the surface than meets the eye. For these babies, doing a revision of the tie is literally only the tip of the ice berg. They usually need lots of pre and post release manual therapy such as chiropractic or craniosacral therapy, occupational therapy, and suck training. It may be weeks to months before what is below the surface is fully addressed.

Tether floes are the babies I dream of in my practice. The tongue tie is the root cause of the breastfeeding problems and symptoms. A simple release is an overnight, miracle cure to nipple pain and damage, weight gain, milk supply or reflux. These babies usually need minimal additional interventions to restore the breastfeeding relationship and have all of their symptoms melt away.

Being aware of the tetherbergs vs the tether floes is the beginning to understanding your journey with a tied baby. Many families have their baby’s tie revised only to find they still have persistent symptoms. For them, the mass of ice below the surface must still be addressed before relief is gained. If you’re in the middle of your journey, keep going. Keep asking questions. Keep finding the highly trained health care providers who specialize in ties who can help.

For more information, see the original post by Michele Chatham

https://www.michalechatham.com/blog/tether-berg-or-tether-floe?fbclid=IwAR0q5o8NP_iwFkA5XijLMymDPyxcsLwvTq3cS8V4kxyRZ1jOjk3x8g5sdZE

Breastfeeding is a medical and Heath issue. It should be treated as such

Breastfeeding issues are medical problems. I wish health care providers would understand this. When a parent wants to breast/chestfeed, but is running into challenges, those challenges need to be taken seriously, just as if they were complaining about any other health or medical issue.

Feeding your baby from your body should not be painful. Our bodies are designed to feed our babies, so when there is pain there is always a reason. Pain tells us that something needs fixed. It may be as simple as the position and latch or as complex as a tongue tie. At no point should healthcare providers accept tissue damage as normal. If they are telling you it’s fine and part of the process, please get a second opinion.

When everything is going well, our bodies are designed to provide plenty of milk for our babies. If you are not making enough milk for your baby while seemingly doing all the right things, we should find the root (IGT? Wrong pump flange? Not pumping enough? Medications? Hemorrhage at birth?).

Baby unable to latch? Popping on and off? Babies are born to feed. All of their reflexes and instincts are designed to get them to latch and feed. If baby is struggling at the breast, there is always a reason. Rarely will we not find the root if we dig deep and long enough.

When there is pain, damage, low milk supply or a non-latching baby, interventions are often needed. These are medical interventions that should be overseen by an IBCLC who has lactation specific training to make sure the correct tool for the correct cause of the issue is being used. And getting the best, most accurate information for that individual family. If a family chooses not to breastfeed because of these issues, that is their choice and should be supported to the fullest. If your health care providers are not taking your concerns seriously, find another health care provider

Human milk fat


The fat in your milk accounts for 50% of the calories your baby takes in each feeding. While protein and lactose remain relatively stable throughout the day, milk fat concentration can vary by 47% in a 24 hour period!

Factors that influence milk fat in breast milk:
🤱🏽 In the lactation parent (some of these you can change and control and some of these you can’t):
Lifestyle
Diet
Body size
Health or disease/inflammation
Number of children
Type of birth
Overall milk volume produced daily

👶🏼 In the baby (the lactating parents body responds to make specific milk to accommodate the baby):
Gender
Gestational age
Birth weight

🍫 Other factors that influence fat in human milk:
⏰ Time of day (highest fat is in the afternoon/evening)
👶🏼 👧🏽 Stage of lactation (colostrum has the lowest amount of fat. Extended milk for toddlers 12+ months has the highest amount of fat!)
🗓 Time postpartum (milk fat increases with time!) mm
Ways to help increase milk fat:
🤱🏽 Feed more frequently. An emptier breast has higher fat and lower water concentrations. Pump
⭐️ Shake your breasts prior to feeding. This gets the fat at the back of the breast to be activated more quickly to flow sooner in the feeding
🐠 Add in healthy fats to your diet: salmon, herring, sardines, flax and chia seeds, and walnuts are high in healthy fats that can boost your milk fat.
🍦 Manage diabetes/blood sugars
🏋🏽‍♀️ Make sure you’re not anemic or iron deficient
♨️Reduce inflammation in the body (can often be done with diet and lifestyle changes and/or with the help of a naturopathic practitioner)

Fluid dynamics

Milk is a liquid. And it obviously flows like a liquid. Have you ever sprayed your baby in the face from milk that flows too fast during let down? Have you ever been concerned with how fast or slow your milk seems to flow in any given feeding or pump session?

Did you know the breast is like a tree inside? With lots of lobes at the back of the breast that funnel down through milk ducts to fewer nipple pores at the front? The flow of your milk is impacted by multiple things. One of the biggest things to impact how your milk flows is your unique breast anatomy.

🌳Everyone has a different number of milk making lobes, also known as alveoli. These lobes are connected to your blood steam, because milk is made from nutrients in your blood. Oxytocin triggers contractions of the lobes to release milk down your milk ducts

🌴The length and diameter of the ducts play a role in how quickly milk goes from where it is made to the baby.

🌲The viscosity, or thickness, of your milk can slow down or speed up milk flow. This viscosity can change from feeding to feeding depending on many factors. Many will take sunflower lethicin to thin their milk (keep the fat from sticking) to help speed up milk flow and reduce the risk of the milk fat sticking in the ducts and causing plugged ducts

🎄How dense or elastic your breast tissue is contributes to flow rate.

Your body and your anatomy is unique. Milk production or how milk is made in the breast is not the same for every person. If you’re struggling with making or releasing milk to your baby, schedule a consultation to figure out why and develop an individualized plan that works for your anatomy.

COLORS OF MILK

Your milk can be a variety of colors which can be caused by a variety of things.

💛Diets high in yellow-orange vegetables (yams, squash, carrots, etc) can lead to high levels of carotene in your milk, which can turn it yellow or orange.

💛Frozen milk may look more yellowish when thawed.

🧡Food dyes used in carbonated sodas, fruit drinks, and gelatin desserts have been associated with milk that is pink or pinkish orange.

💙Blueish milk is often just a higher water content in the milk. It could also be caused by food dyes.

💚Greenish milk has been linked to consuming green sports beverages, seaweed, certain herbs, or large amounts of green vegetables (such as kale or spinach). I had mine turn green from a plant based multivitamin!!

💗Pink milk, some times called “strawberry milk” be a sign of blood in your milk. This can occur with or without cracked nipples. Seeing blood in your milk may be alarming at first, but it is not harmful to babies. If you have any concerns or other symptoms associated, such as pain or mastitis, set up a lactation consultation right away.

💔Occasionally blood in breastmilk is caused by things other than nipple or breast trauma. Papillomas are small growths in the milk ducts which are not harmful but can cause blood to enter your milk. In the vast majority of cases, blood in human milk is not a concern. However, some forms of breast cancer can cause blood to leak from the nipples. Breast milk can also turn pink if a bacteria called Serratia marcescens is present, although rare this bacteria can be extremely harmful to young babies. If you’re experiencing pink milk without noticeable nipple damage, please reach out to a health care provider immediately.

🤎Brown milk may be caused by what is known as rusty pipe syndrome. During pregnancy and in the first few days after birth the ducts and milk making cells in your breasts grow and stretch. As blood flows to your breasts it can sometimes leak into your milk ducts, making your milk look brown or rust-colored. It usually clears within a few days as more milk flows through your breasts. Continue feeding your baby your milk.

FIL: How breast milk is actually made

Milk production is controlled by how often milk is being emptied from the breast. An empty breast makes milk faster than a full breast. The more you empty, the more you make. This is because milk production is being controlled in the breast by a substance called the feedback inhibitor of lactation, or FIL (a polypeptide), which is present in the milk itself. Sometimes one breast stops making milk while the other breast continues (in some cases of slacker boob), for example if a baby nurses on only one side. This is because of the local control of milk production independently within each breast. If milk is not removed, the FIL builds up in the milk and stops the cells from making any more milk. This protects the breast from things like clogged ducts and mastitis. If breast milk is emptied from the breast, the inhibitor is also removed, and making milk resumes. Milk removal can be done by the baby or a pump
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The amount of milk that is produced is determined by the amount of FIL in the milk, which is driven by how much and how often the baby or a pump removes milk from the breast. Emptier breasts have less FIL and make milk faster. Full breasts have more FIL and make milk slower. This mechanism is especially important for continuing to make milk after 11-14 weeks when hormones shift and milk making is completely determined by how much milk is being emptied from the breast.

Immune boosting power of breast milk

🍀Doctors have long known that infants who are breast-fed get fewer infections because babies gain extra protection from antibodies and live immune cells found in human milk.
🍀Research shows every tsp of breastmilk has 3,000,000 germ killing cells in it. Even one teaspoon a day is giving baby some immune protection!
🍀Once ingested, live molecules and cells in the milk help to prevent microorganisms from penetrating the baby’s body tissues.
🍀Some of the immune molecules bind to viruses/bacteria/germs in the digestive tract, preventing them from getting into the rest of the body.
🍀Certain immune cells in human milk attack viruses and bacteria directly. Another set produces chemicals that stimulate baby’s own immune response.
🍀The most impressive amount of immune cells are found in colostrum.
🍀Several studies suggest human milk may induce an infant’s immune system to mature more quickly than with formula
🍀Some of the immune factors in breastmilk increase in concentration as baby gets older and nurses less, so older babies continue to benefit from breast milk
🍀Remember, freezing kills some of the live immune factors of breastmilk even though the nutrition (vitamins, protein, fat) is maintained. Offer fresh breast milk whenever possible.
🍀Research is showing that if you’ve had COVID or the COVID vaccine, your milk will pass antibodies to your baby to protect them from getting it!

Vasospasm: pins and needles in the nipple

Has your nipple looked waxy or dull white after feeding or pumping? That’s because the blood vessels have gone into spasm and are not letting blood through. Vasospasm occurs when there is exposure to cold, an abrupt temperature drop, vibration, or repetitive motion in the affected area. The arteries go into spasm and stop letting blood through. There is a disorder called Reynauds that make peoples experience this in their fingers and toes on a more routine basis. When it happens in the nipple it really HURTS. Some say it feels like fire or ice. Others describe it as a pinchy, slicing feeling, or pins and needles. The nipple often turns pale and become painful right after the baby unlatches. It often gets misdiagnosed as thrush but will not respond to medications. So if you’ve been on multiple rounds of medications for thrush and it’s not working, you may actually be having vasospasm.

It can simply be caused by a bad latch, but can have several other culprits. For people prone to vasospasm, the repetitive action of feeding or pumping in combination with the abrupt drop in temperature when baby unlatches or the pump stops is enough to trigger the spasm.

The two main ways to help: massage and heat.

🤲🏼Gently massaging, rubbing, or pinching the nipple helps. Immediately cover your nipples with your shirt/bra/nursing pad, then gently rub or massage them through the fabric.

🌞Heat is important because of science: evaporation is a cooling process. When liquid turns to gas, it uses heat energy from its surroundings to transition. When milk and saliva evaporate off your nipple, the skin and surface tissue cool rapidly, causing the vasospasm.

🌞To slow evaporation, place heat on your nipple as soon as baby unlatches. Use dry heat like a lavender pillow, microwaveable rice/barley/flax pack, hand warmer/Hot Hands (like you use in snowy climates for skiing), or a heating pad can help. Leave heat on for a few minutes until the pain subsides.
🌚Avoid anything wet on the nipple as this promotes evaporation.
🌝Wear wool nursing pads between feedings

Unfortunately, there isn’t a lot of good quality research about treating breastfeeding nipple vasospasm no. Much of what we know is taken from other vasospasm research, or applied from anecdotal evidence. You should always consult your primary health care provider before making any changes to your health, such as adding a supplement, taking medications, or making big lifestyle changes. At a basic level:
🌻Watch for a deep latch every time
🌻Have baby assessed for tongue tie
🌻Check your flange size. If you’re maxing our the suction on the pump, your flange is too big. When too much areola is drawn into the tunnel, the areola swells shut around the nipple and causes the spasm. Using too small a flange does the same: cuts off blood flow to the nipple tip.

Other tips to reducing vasospasm:
🌸Avoid nicotine and medications that cause vasoconstriction (such as pseudoephedrine, beta blockers).
🌸Limit or avoid caffeine
🌸Some research indicates hormonal birth control pills increase the risk of vasospasm.
🌸The main supplement that seems to help with vasospasm is vitamin B6. Dr Jack Newman suggests 100 mg of B6 twice day, as part of a B vitamin complex. If your B vitamin contains 50 mg of B6, you’d take two of them, twice a day. If it contains 25 mg of B6, you’d take four of them twice a day.
🌸Calcium plays an important role in blood vessel dilation. Magnesium helps in calcium regulation. Supplementing with cal/mag often helps with vasospasm.
🌸Being active helps prevent their vasospasm. An active lifestyle can keeps blood circulating through your body.
🌸The internet is full of conflicting opinions on if ibuprofen is a vasoconstrictor or vasodilator. Regardless, it sometimes turns up to treat/prevent vasospasm. If you have regular vasospasm, the risks of longterm ibuprofen use most likely outweigh the potential decrease in vasospasm. It may be OK for occasional vasospasm. Discuss regular ibuprofen use with a healthcare provider.
🌸For chronic, painful vasospasm that does not respond to breast-feeding help, some doctors may prescribe a short course of a blood medication called Nifedipine.