When should baby start rice cereal? Never

Starting solid food Myth – Rice cereal is the best first food for practice and will help your child sleep.

FALSE!

Rice cereal is a highly processed food that when prepared as cereal is far from its natural state. There are very few calories in rice cereal and it serves no nutritional value to the body or the gut. The reason rice cereal is often recommended first is because in the processing it is iron fortified (iron is added to it). Most newborns have sufficient iron stored in their bodies for about the first 6 months of life (depending on gestational age, maternal iron status, and timing of umbilical cord clamping). By 6 months, however, babies require an external source of iron apart from breast milk. (Formula contains iron, so it’s less of a concern for formula-fed infants.) Babies need 11 mg of iron per day for normal growth and development, and iron is vital for brain health and red blood cell production. Though rice cereal is fortified with iron, it’s a kind that doesn’t absorb well.

There is also no evidence that rice cereal has a positive impact on baby’s sleep, as it doesn’t digest any slower than milk does. Adding cereal to the bottle is also a huge choking risk. 

Rice cereal is not the best first choice for baby food and may be something you want to avoid. Rice absorbs high levels of arsenic (which is poisonous) from the soil. Ingesting even small amounts can damage the brain, nerves, blood vessels, or skin. In 2012, the Consumer Products Safety Commission (CPSC) came out with a report that said babies who eat two servings of rice cereal a day could double their lifetime cancer risk.

There are other, better first food choices. Spinach and broccoli are naturally high in iron, as are legumes like peas, chickpeas, lentils and beans. Turkey and red meat are very good sources of iron. 

Tongue tie assessment

Assessing for tongue tie takes a true hands on assessment, not just a quick look under the tongue during a cry or looking at a picture. An assessment isn’t complete without the provider’s fingers sweeping under the tongue, lifting the tongue, and seeing how the tongue moves in all direction, and then more importantly, knowing the difference between a normal tongue frenulum and a tied or restricted frenulum. Just because a person is qualified to “assess“ for tongue-tie, does not mean they necessarily know how to do so. And just because a baby has a frenulum, that doesn’t mean it’s tied or restricted. And if your pediatrician told you there’s no tie just because baby can stick their tongue out, that wasn’t actually an assessment. 

As a speech therapist, I look at 3 things when doing an assessment on infants: what does the tongue look like, what can the tongue do, what symptoms is it causing. The tongue needs full range of motion (in and out, side to side, and up and down ) for feeding, dental hygiene and to some extent speech. Some babies with a frenulum can still have range of motion maintained. The frenulum does not impact function. Symptoms to watch out for are feeding difficulties (can not grasp and hold a nipple for breast or bottle feeding, fatigues easily from tension on the tongue and jaw, cannot create the vacuum needed to draw breast milk so weight gain is poor or milk supply suffers, chokes and gags during feeding)

When range of motion is restricted, or is causing symptoms, I will refer to a pediatric dentist who also looks at how the frenulum is impacting structure: is it pulling on the structures of the floor of the mouth and the jaw? Is it putting tension on the bone? In those cases, when function is restricted and it is currently causing symptoms, a revision is warranted.

How long does dairy protein take to clear my breast milk?

Trying to figure out if your breastfed baby is sensitive or allergic to the dairy or soy you’re eating? Cow’s milk protein intolerance (CMPI) is an abnormal response by the body’s immune system to protein found in cow’s milk, which damages the stomach and intestines. Cow’s milk protein intolerance is not lactose intolerance. If you were told it takes 2-3 weeks to clear the dairy from YOUR milk and you should switch to formula in that time, you were given extremely inaccurate (and potentially harmful) advice. 

From freetofeed.com: While more research is still needed, a small study showed lactating mothers who ingested milk prior to being dairy free, found cow’s milk protein peaked at 2 hours post-ingestion and were undetectable at 6 HOURS. While the study was small it was using mass spectrometer ion intensity testing which is incredibly accurate.

Journal of Pediatric Gastroenterology and Nutrition reports “for an immediate reaction the maternal elimination diet needs to be maintained for only 3 to 6 days. If delayed reactions are suspected (eg, allergic proctocolitis), then the diet should be continued for up to 14 days. If there is no improvement, then it is likely that diagnoses other than CMPA are the cause of the symptoms and the child should be further evaluated.”

So while the protein is cleared from your milk in less than a day, the REACTION and damage in your baby’s GI system can absolutely last longer than the protein is in your or baby’s system. It’s the residual inflammation from the protein exposure, not continual exposure from your milk after 12-24 hours that causes the reaction to last for days to weeks. 

If you’re trying ro figure out if baby is sensitive to dairy or soy, eliminate these from your diet but it is SAFE to CONTINUE to breastfeed through the elimination. That protein has cleared from your milk within hours, not weeks. 

Breastfeeding and Weight Loss

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. 

Feeding Aversion: My Baby is refusing to eat

Aversion to feeding means screaming or crying when offered the breast or bottle, refusing to eat, or needing to be fed while moving or while drowsy/asleep. This is not a temporary nursing strike where baby refuses the breast/bottle for a few days because of periods returning, mom going back to work, teething, or illness, etc. The behaviors seen in baby are much more extreme for a true aversion. Most common causes: 

👅Tongue tie: One of my biggest red flags for tongue tie is reflux and shutting down during breastfeeding (sleepy on the breast, popping on and off, refusing the breast and preferring the bottle but then shutting down on the bottle). Some babies with tongue or lip tie do fine for the first few months by compensating on a full milk supply. The aversion comes around 3-4 months when supply regulates. Address the ties and do oral motor exercises to strengthen the system and the refusal can go away. 

🥛Intolerances/Allergy: This looks similar to reflux, but often with bowel issues as well (constipation, diarrhea, or mucousy/foamy poops). Babies who’s digestive tracts are uncomfortable don’t want to eat. They learn quickly to associate feeding with pain, so they shut down on feeding.

🤮Reflux: Easiest culprit to blame and mask with medication. The medication may mask the pain but won’t actually take the reflux away. Reflux is usually caused by food allergy/intolerance, gut issues, or tongue tie. Address the issue, resolve the reflux. 

🥵Silent aspiration: Milk going into the lungs instead of to the stomach. If baby is having recurring chest infections, they should be seen by a speech pathologist right away for a swallow study to see if they actually are aspirating

🤯Behavioral: The number one concern of parents is feeding the baby. When feeding isn’t going well, it causes extreme stress, which can causes parents to do extreme things to try to fix the problem. It’s easy to spiral out when you’ve tried everything and it’s not working out of stress and desperation. Occasionally the reason for the refusal is no longer there, but it was so stressful in the moment, the panic that it could happen again sets in and perpetuates the problem. Some times the root issue is still there, but you’ve compensated and it’s causing a behavioral manifestation in both you and the baby. 

Baby poop: Should my baby be pooping daily?

While some things we hear about babies are common, that doesn’t mean they are normal. The idea that breastfed babies don’t need to poop daily has been normalized, but in reality, isn’t true!! The idea that there’s very little waste produced from breast milk is not based on scientific evidence and can actually prevent finding the true reason for baby’s lack of poop. 

In the newborn stage, prior to 6 weeks, pooping tells us if baby is getting the appropriate volumes of milk from the breast. Many times when a newborn isn’t pooping, it’s a sign they’re not getting enough breast milk. As you increase milk volumes, baby starts to poop! Decreased milk intake can happen when baby has a tongue tie and can’t efficiently move milk from the breast, if feedings are scheduled (waiting for every 3 hours) or if baby is being sleep trained too early. Low milk supply can be caused by retained placenta, thyroid or hormone disorders or when there is a breast surgical history like a reduction. 

Constipation can have other root causes. 

🧬For some, it may be that their digestive biome is not ideal… things like antibiotics given to mom during pregnancy/birth or antibiotics given to baby shortly after birth shift the biome where it doesn’t ideally absorb and process milk. Introduction of formula also changes the gut microbiome. Some babies may have difficulty digesting certain formulas and may struggle with pooping until the right one is found. 

💃🏻Not getting enough movement, tummy time or being in one position for too long (sitting in positioning devices like a dockatot for hours a day) decreases movement through the gut. Allergies and intolerances are another culprit. 🦷Babies who are teething may have a temporary change and miss a day or two and then return to daily stooling. 

🤢Illness, change of environment (maybe a holiday/ move of house), change of daily rhythm etc can all play a role, and temporary changes are to be expected.

Every person is unique and so there isn’t any “one size fits all” reason why an infant may be struggling with constipation/infrequent stooling. If you baby isn’t pooping regularly, an IBCLC can help figure out what may be going on and refer you to the right specialist as needed. 

What can I eat to make breast milk?

Prolactin is hormone responsible for making breast milk. We know that when you’re breastfeeding, you need about 300-500 extra calories to supoort making nutrition for your baby. You’re still eating for two!! There are foods with phytoestrogens which help boost and support your natural prolactin levels.

There are several main classes of phytoestrogens. Lignans are part of plant cell walls and found in fiber-rich foods like berries, seeds (flaxseeds), grains, nuts, and fruits. Two other phytoestrogen classes are isoflavones and coumestans. Isoflavones are present in berries, grains, and nuts, but are most abundant in soybeans and other legumes. Coumestans are found in legumes like split peas, lima and pinto beans. Eating these will naturally increase prolactin which in turn helps support making milk
🌾We all know oats are the go-to for increasing supply. They are rich in plant estrogens and beta-glucan. But other grains like brown rice, barley, and quinoa work as well!
🧄Garlic! It will definitely flavor you milk, but research shows babies love the flavor and often suck more in response and it’s been shown to increase milk supply
🌱Fennel: Raw or cooked, fennel seeds can be added to a recipe, or drunk as a tea. There are also many lactation specific supplements that include fennel in pill form for a more concentrated dose
🥬Dark Leafy greens like spinach, kale, collard greens, and broccoli. And yes, you can eat broccoli while breastfeeding. 🥦
🌻Seeds: Sesame seeds, flax seeds, and chia seeds are all super boosters of making milk and can be added to baked goods and smoothies very easily
🍓Berries: Get a phytoestrogen boost with fruits like strawberries, cranberries, and raspberries.
🌰Nuts: Almonds are high in linoleic acid and known to be the most lactogenic nut. Packed with healthy fats and antioxidants, Vitamin E and omega-3, walnuts, cashews, and pistachios are all good choices. Snack on raw or roasted nuts, add them to cookies, smoothies, and salads.
🍏🍇🍍🥥🥑🥦🥒🫑🥕🧄🧅🍠🍞🧀🍳🥩🍔🥗🍪🥛

Why is my breastfed baby losing weight?

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.

Do I have thrush?

Has your nipple looked white after feeding or pumping? The blood vessels have gone into spasm and are not letting blood through. When the nipple gets pinched, the arteries spasm and stop letting blood through. As the pinch is released, blood starts to flow, and it results in pain. Some say it feels like fire or ice. Others describe it as a burning, slicing, or pins and needles. It often gets misdiagnosed as thrush but will not respond to medications.

It can be caused by a bad latch, but also from undiagnosed tongue tie and using a pump flange that’s too big. For people prone to vasospasm, the repetitive act of feeding or pumping in combination with the abrupt drop in temperature when baby unlatches or the pump stops is enough to trigger a spasm.

🌻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.

Other tips:
🤲🏼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.
🔥 Use dry heat like a lavender pillow, microwaveable rice/barley/flax pack, hand warmer/Hot Hands immediately after baby unlatches or you stop pumping. Leave heat on for a few minutes until the pain subsides.
🌸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.
🌸Calcium plays an important role in blood vessel dilation. Magnesium helps in calcium regulation. Taking cal/mag often helps with vasospasm.
🌸For chronic, painful vasospasm that does not respond to other strategies, some doctors may prescribe a short course of the rx Nifedipine.

Breast changes

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.