My let down doesn’t feel as strong. Am I losing my milk supply?

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It is normal for you not to feel your let-down as strong as your baby gets older. Some never feel let-down, and some stop feeling the let-down sensation as time goes by. This does not necessarily indicate that let-down is not taking place.

Reliable signs of a healthy, functioning let-down include:
* In the first week or so, feeling uterine cramping during letdown.
* Baby changes sucking pattern from short and quick (like a pacifier suck) at the beginning of the feeding to more long, rhythmic suck a minute or so into the feeding. You’ll start to hear consistent swallowing that sounds like a “uh” or small puff of air. Baby’s jaw will drop lower with the swallow than with sucking
* A feeling of calm, relaxation, sleepiness or drowsiness
* Strong thirst when breastfeeding.
* Occasionally people can experience itching, nausea, headaches, or negative emotions during let down
.
It’s quite normal to have a harder time letting down to a pump than to baby. The milk may be in the breast, but the stimulation from the pump may not be enough to trigger the release needed for the milk to flow. Although rare, this can occasionally happen when directly breastfeeding as well.

Many things can be the cause of a slow or inhibited let-down: anxiety, pain, embarrassment, stress, cold, excessive caffeine, smoking, use of alcohol, or certain medications. People with breast surgery or nipple piercing history may have nerve damage that can interfere with let-down. In extreme situations of stress or crisis, the release of extra adrenaline (the “fight or flight” response) can reduce or block the hormones which affect let-down.

Let down can be a conditioned response. Sometimes a cycle is created, where baby fusses and pulls off because the let-down is slow, which makes mom tense up, which makes the let-down even slower, etc. You can use relaxation techniques and let-down cues to break this cycle.

#letdown #letdownreflex #letdownmilk #milkstash #treeoflifebreastfeeding #treeoflifeart #breastfedbaby #breastfeedingbabies #breastfeedingbaby #breastfeedingart

Constantly feeding breastfed baby: Is it normal for them to want to feed all the time?

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CONSTANT FEEDING
Do you some time feel like baby is constantly feeding? As long as breastfeeding is pain free, baby is making 6+ wet and consistent poops and gaining weight over time, everything is going as it should!! The more baby removes milk from the breast, the higher your supply actually is!!

Myth: If baby wants to feed more frequently than normal, and is super fussy, it means I don’t have enough milk or my milk is drying up.
Fact: babies want to be at the breast for all kinds of reasons: hunger, thirst, boredom, comfort, pain relief, for sickness/feeling unwell, when they’re grumpy, soothing, sleep, because they’re a baby. Babies are constantly going through growth spurts and requires more food. By the time they go through multiple growth spurts it’s time to teethe. By feeding more frequently they are meeting their caloric needs while helping you increase your supply while being comforted and getting some sleep. Make sure you’re getting enough rest, sleep, hydration and food to meet this increased demand.

If breastfeeding is established and going well (you’re past 2-3 weeks and you have an established milk supply), don’t be so quick to always blame the breast for baby’s fussiness. And don’t withhold the breast because of the clock or some other “schedule” baby “needs to follow” because “the book said...” trust your body. Trust your baby. When in doubt, boob out.

Conversely, do you feel your older baby doesn’t nurse enough? Like they used to feed every 2-3 hours for 20-30 minutes and now they feed for only a few minutes? Babies 3+ months are more efficient at breastfeeding. How quickly can you drink a glass of water? Normally we don’t chug it quickly, but we can. As babies learn there’s an exciting world out there, they can some times feed really quickly to get back to what they were doing. Don’t be surprised if your older baby has quick feeds.
Myth: my baby needs to eat 15 minutes on each side
Fact: every baby feeds in their own unique way. Some can take a full feeding in just a few minutes and others like to hang out at the breast.
Learn your baby. If they’re making good wet and dirty diapers and happy, let them feed in their own way

When should my baby sleep through the night?

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There are many reasons why your baby would wake more often to feed at night. Regardless of what you find online or from well meaning family and friends, there is no specific, developmental weight or age when a child no longer needs to feed overnight. There is no scientific or medical standard or recommendations for when a baby no longer needs nutrition at night. Society also says babies shouldn’t need tended to at night time and that we should teach them, often from a ridiculously early age, not to need us at night. In reality, we are not in control and neither are our babies. We’re in a mutual relationship where we are learning what our babies need and when they need it. Reasons why babies wake to feed over night:
💡Growth spurts
💡Developmental leap
💡You were gone at work and they missed you, they want breast milk straight from the breast, they didn’t take as much from the bottle while you were gone
💡Teething
💡They were distracted during the day because the world is an amazing place to learn in and they’re making up for calories over night
💡Sickness
💡They had a bad dream or are scared without you
💡Because they’re human

Per current research, 78% of babies wake up at least once a night and 60% of waking to feed until 1 year (Brown, 2015). That’s NORMAL. Between 12-18 months your toddler may still occasionally wake to feed. Or they may just need an adult to help them transition back to sleep. It’s not until 24 months that the human baby has matured enough to not consistently need an adult to help them transition back to sleep over night (Paavonen, 2020).

It’s normal for your child to wake to feed, but if at any time it starts to wear on your physical, emotional, or mental health, don’t hesitate to reach out for a consultation. There are strategies to help with routines to find the balance between biology and sanity.

#sleeplikeababy #growthspurt #developmentalleap #wonderweeks #nightfeeds #nightfeeding #toddlerbreastfeeding #momhood #motherhoodjourney #sleeptraining #sleeptips

Will breastfeeding make my breasts saggy?

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SAGGY BOOBS
True or false: Pumping or breastfeeding makes your boobs sag. False. Neither pumping nor breastfeeding makes droopy boobies. A study done in 2008 concluded that the risk of breast ptosis, aka sagging, increases with each pregnancy, but has no correlation to breastfeeding (https://www.ncbi.nlm.nih.gov/m/pubmed/19083576/)

Many things can cause drooping:
* Gravity: can’t fight it. While pulling your breasts down, it strains and stretches the ligaments that support your breasts
* Breast Size and Shape: Smaller breasts with a rounder bottom tend to hold their shape better than larger or narrow breasts. Larger breasts lose the battle to gravity more
* Body Mass Index: a higher BMI tends to equal larger breasts
* Weight Loss or Gain: Gaining or losing a lot of weight, especially quickly like in pregnancy, can change the shape of breasts and stretch/shrink the skin surrounding them.
* Smoking: causes skin to lose elasticity
* Genetics: family genes play a part in size and shape or breasts, the strength of the ligaments supporting breasts, and body weight
* Number of Pregnancies: The more babes you have, the more stretched out your breasts will be
* Exercise Without Support: puts extra strain on the breast ligaments, leading to stretching of the ligaments and sagging of the breasts
* Age: it’s just a normal part of life

With many factors that contribute to sagging, you can't completely prevent it. Some things you can do to try to keep your breasts from sinking south as long as possible:
* Good posture. When you slouch and have poor posture, gravity wins
* Healthy weight. Eat a well-balanced diet, get some exercise, and try not to gain/lose weight too quickly
* Hydrate. Keep your skin healthy and hydrated to try to preserve its elasticity
* Don't smoke

#saggyboobsmatter #saggyboobs #saggybreast #mombod #mombody #postpartumbody

Vitamin D and the breastfed baby: Do I need to supplement the baby?

 

Vitamin and mineral supplements are usually not needed for the average healthy, full-term breastfed baby during the first year old life. One of the major exceptions to that is Vitamin D. Vitamin D is essential to babies in order to maintain healthy bone growth and development.  Recent research also tells us that vitamin D is key in the maintenance of our immune systems to help prevent and fight infections and inflammation. The American Academy of Pediatrics recommends that all babies receive routine vitamin D supplementation (400 IU per day) due to decreased sunlight exposure and an increase in rickets, which impacts leg growth and development. Practically everyone is at risk for vitamin D deficiency with, ironically, only formula-fed babies out of the danger zone because infant formula already contains 400 IU of vitamin D per quart of properly prepared formula.

If you are exclusively breastfeeding, your pediatrician should have educated you to supplement your baby with vitamin D, typically given as drops. But they may not have told you about how to supplement. There are two ways to supplement: to the baby or to you are the parent.

The primary source of vitamin D for babies, other than sunlight, is the stores that were laid down in baby’s body prior to birth. Because our vitamin D status during pregnancy directly affects baby’s vitamin D stores at birth and through the first 2-3 months of life, make sure to get enough vitamin D while pregnant! Human breastmilk is considered a very poor source of vitamin D, usually containing less than 50 IU per quart. This is why the AAP recommends all breastfed infants receive 400 IU per day vitamin D by supplement drops. This IS NOT A DEFECT IN BREAST MILK but a defect in the recommended amount of vitamin D the lactating parent should be taking. 

The best way to get vitamin D, the way that our bodies were designed to get the vast majority of our vitamin D, is from the sun. Depending upon where you live and how dark your skin is, going outside regularly may be all that is required for you or your baby to generate adequate amounts of vitamin D to need no further supplementation.  However, most health care professionals won’t tell you to get vitamin D from the sun because the risks of sun burn and skin cancer! One of the other problems with getting your vitamin D with sun exposure is simply that it’s hard to determine how much time outside is needed since it depends on so many factors (your unique skin tone, the latitude on the earth of where you live, the time of year, how much skin is exposed, amount of air pollution, etc.) There is a range of how much skin exposure to how long you need to be outside int the sun for your body to make adequate levels for your unique self. I cannot tell you through this video how much skin exposure or a length of time to be in the sun because of all of these factors, you would need to research these individual factors. 

So how else can you get vitamin D? Research shows that maternal vitamin D supplementation of 4000-6400 IU/d or a single monthly dosage of 150,000 IU) can adequately supply your breastmilk where no additional supplementation to your baby would be needed.  As long as you are not vitamin D deficient, your breastmilk will also have adequate amounts of vitamin D levels. For more information on the research behind this, check out  [Hollis et al 2015] and Hollis & Wagner 2004. In summary, yes, someone needs supplemented for vitamin D. In reality, vitamin D is just as essential for you as it is for the baby. If you have any concerns with vitamin D deficiency, both you AND the baby need to be supplemented. You can supplement the baby by drops, usually done on the nipple before latching or if you are giving breast milk bottles, you can add that to one of the bottles. You could also put the drop on a pacifier and have baby suck it that way. For you, taking 4000-6400 IU per day is adequate for most to prevent deficiencies and sun exposure is an option when done safely knowing your unique situation. 

 

Want to know more about picking the right bottle or pacifier for your breastfed baby? Take my Latched class where we discuss all things latching! CLICK HERE TO ENROLL TODAY

Milk blebs

A milk bleb happens when the nipple pore gets blocked/clogged by a piece of skin or a small amount of hardened breast milk. It usually looks like a white dot on the nipple and the pain tends to be focused at that spot and just behind it. The clog might be a tiny, dry clump of hardened milk or a “string” of fattier, semi-solidified milk. 

 

Blebs are often caused by:

  • 👉🏼Shallow latch
  • 👉🏼Tongue tied baby
  • 👉🏼Pumping with too large of a flange
  • 👉🏼Often associated with recurrent mastitis

 

When the bleb is being caused by skin covering the nipple pore, the duct obstruction will often pop out from the pressure of nursing or manual expression. By changing baby’s position at the breast and focusing on a deep latch, breastfeeding alone will often pop the bleb.

 

Always figure out the root of why you have one and address that first. Other remedies:

  • ❤️‍🩹Keeping olive or coconut oil on the top to soften the bleb
  • ❤️‍🩹Hand expressing behind the bleb to move milk through
  • ❤️‍🩹Switch nursing positions
  • ❤️‍🩹Taking sunflower lecithin  
  • ❤️‍🩹Ice after feeding to reduce inflammation
  • ❤️‍🩹Epsom salt or saline soaks
  • ❤️‍🩹Triamcinolone 0.1% spot applied for 1-3 weeks under direction of an IBCLC
  • ❤️‍🩹If they do not resolve on their own in a few days, seeing a breast specialist for further work up and management

 

A milk bleb happens when the nipple pore gets blocked/clogged by a piece of skin or a small amount of hardened breast milk. It usually looks like a white dot on the nipple and the pain tends to be focused at that spot and just behind it. The clog might be a tiny, dry clump of hardened milk or a “string” of fattier, semi-solidified milk. 

 

Blebs are often caused by:

  • 👉🏼Shallow latch
  • 👉🏼Tongue tied baby
  • 👉🏼Pumping with too large of a flange
  • 👉🏼Often associated with recurrent mastitis

 

When the bleb is being caused by skin covering the nipple pore, the duct obstruction will often pop out from the pressure of nursing or manual expression. By changing baby’s position at the breast and focusing on a deep latch, breastfeeding alone will often pop the bleb.

 

Always figure out the root of why you have one and address that first. Other remedies:

  • ❤️‍🩹Keeping olive or coconut oil on the top to soften the bleb
  • ❤️‍🩹Hand expressing behind the bleb to move milk through
  • ❤️‍🩹Switch nursing positions
  • ❤️‍🩹Taking sunflower lecithin 
  • ❤️‍🩹Ice after feeding to reduce inflammation
  • ❤️‍🩹Epsom salt or saline soaks
  • ❤️‍🩹Triamcinolone 0.1% spot applied for 1-3 weeks under direction of an IBCLC
  • ❤️‍🩹If they do not resolve on their own in a few days, seeing a breast specialist for further work up and management

 

CLICK HERE FOR MORE INFORMATION

 

#milkbleb #milkblebtreatment #milkblebhack #milkblister #breastfeedingproblems #pumpingproblems #pumpingprotips #pumpingmom #lactation #ibclclife #ibclc #breastfeed

 

Postpartum chin and nipple hair

Sprouting chin hairs? Random nipple/areola/boob hairs? Blame those darn hormones again. Immediately after delivery, a sudden increase in estrogen may have you noticing thicker, darker hair in strange and unwanted places. The body uses an enzyme to change the estrogen to testosterone which can lead to a “beard.” The hair will most likely return to its normal state within a few months. There are lots of options for removing your chin hair: wait it out and see if hair growth stops or slows as hormones settle. Or you can pluck, wax, or even shave it. If you’re considering making an appointment for laser hair removal, you’ll want to make sure you visit an actual dermatologist, as not all center or clinic practitioners have the correct training or even the correct laser tools. There is no evidence that electrolysis or laser hair removal would affect breastfeeding, breast milk, or your breastfed baby.

What about those pesky nipple hairs? Trust me, more people have them than just you. If you can’t resist the urge, trimming them with scissors is a safe way to keep them at bay. Tweezing nipple hair can be an effective way to get rid of unwanted nipple/areolar/breast hair. However, this can be painful as breast and nipple skin can be particularly sensitive while breastfeeding. Honestly the best thing to do is leave it alone. You wouldn’t want to increase the risk of infection and ingrown hairs by plucking or tweezing. Cracked nipples from a shallow latch and mastitis from the wrong size pump flange are enough to deal with without having to tell your lactation consultant you were overly zealous plucking the tablecloth.

#postpartumhair #postpartumhairgrowth #postpartumchanges #healthyhormones #pregnancyhormones #lactationsupport #lactationspecialist

Freeze Dried Breast Milk

Freeze Dried Breast Milk: What's the hype about?

Freeze drying milk is not a new concept. Powdered milk, sometimes called dried milk, milk powder, or dry milk, is a 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 candies, and in recipes for baked goods where adding liquid milk would make the final product too thin or runny. 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

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. 

THE COST
Freeze drying breast milk is still a new science. 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.

How to safely prepare formula for your baby

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Being pro breastfeeding does not mean being anti formula. As an IBCLC lactation consultant, my job actually includes education on feeding infant formula. This includes helping families choose an infant formula that is right for them based on solid evidence based research, bottle selection and techniques for bottle feeding. It also includes how to safely prepare formula. 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 feeling more confident in the process. Let’s talk about safely preparing formula.

Formula-to-water ratio:  Follow the directions on your particular can of formula. For most powdered formula, the recommendation is 1 level scoop of formula (not packed down) per 2 fl oz of water. Be careful not to add too much water as this dilutes essential nutrients and can affect baby’s nutrition. Too little water may cause baby’s kidneys and digestive system to work too hard and may cause baby to become dehydrated. You also do not want to use breast milk to make formula unless under the direct supervision of a pediatrician or pediatric dietician as this hyper concentrates certain nutrients and can lead to medical complications.

Reminder: Powdered infant formula is NOT sterile and should not be fed to premature babies or babies with compromised immunity unless directed and supervised by your doctor. Typically most pediatricians will recommend ready-to-feed formula (already a liquid) for babies under 2 months. When preparing baby’s powdered infant formula, it is important to know that recommendations can differ based on several factors including  baby’s age and the safety of the water. Your pediatrician should be guiding you on formula preparation based on your unique baby’s health. For infants under 2-4 months of age, those who were born prematurely and those who have a weakened immune system, hot water should be used to prepare formula to kill any microbes. To do this, boil the water and let it cool for about 5 minutes, and then wait for the mixed formula to cool down before giving it to baby. After 2-4 months, it’s safe to prepare powdered infant formula by mixing it with tap water (filtered or unfiltered) and following the manufacturer’s instructions on the container.

Preparing formula with boiled water:

Ask your baby’s doctor if you need to use cooled, boiled water for mixing and if you need to boil (sterilize) bottles, nipples, and rings before use. If you choose to boil, follow these steps:

1. Bring water to a rolling boil for 1 minute, then turn off the heat.

2. Let the water cool for about 5 minutes before adding the powdered formula. Making formula with boiling water can cause clumping and decrease the nutritional value. The hot water, though, is what kills harmful bacteria in the formula.

3. Once the formula is mixed, run it under cold water or leave it on the counter for a few minutes to cool down to the right temperature for baby. Before feeding, put a few drops on the inside of your wrist to make sure it is not too hot. Do not offer the bottle immediately after mixing.

4. Feed or refrigerate the prepared formula.

Note: If you are concerned about lead or other harmful substances in your water, talk to your healthcare professional before making formula with tap water. Bottled or filtered water can contain bacteria and should still be boiled.

Mixing Tips for Powdered Formula

Single bottle instructions

1. Wash your hands thoroughly with soap and warm water.

2. Measure and pour desired amount of water into the baby bottle. Make sure to measure the water FIRST.

3. Add unpacked, level scoop(s) of powder formula to the bottle as directed. Return dry scoop to can. (1 scoop of formula per 2 fl oz of water is a typical recipe.)

4. Put the cap on the bottle and gently swirl or shake. Stirring often causes less bubbles to be formed which if swallowed can make baby gassy.

Tip: Moving your wrist in a twisting motion helps powder formula mix more quickly and more thoroughly.

5. Feed or store immediately in refrigerator. You can mix 24 hours worth of formula in a pitcher and keep it in the fridge to pour out and feed to baby. Pour the correct amount from the pitcher into a clean bottle and either feed cold or reheat.

The can of powdered formula can be used for one month after it has been opened. Manufacturers don't recommend using the formula after the 30 days of opening because the nutrients start to degrade. Store powdered formula with the lid tightly shut in a cool, dry place – but NOT in the refrigerator.

How to pick a baby formula: Reading the label and picking the carb source

How to pick an infant formula: The sugar source, what do the ingredients mean?

Being pro breastfeeding does not mean being anti formula

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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.