Author: Julie Matheney

Feeding babies has been my passion since I was ten years old. Almost twenty years ago, I pursued becoming a speech therapist to work with babies in the Neonatal Intensive Care Unit. In working in that setting, I realized I wanted a more intimate approach to working alongside families as they struggled to feed their babies. I became a board certified lactation consultant and have really fallen in love with what I do. There’s nothing better than empowering families to reach their feeding goals, wherever they are in their journey, whether it’s exclusive breastfeeding, combo feeding, pumping or bottle feeding. I offer prenatal breastfeeding classes, virtual, office and home consultations. I can assess for tongue or lip ties, educate on pumps to maximize pumping sessions, transition baby to bottle in preparation for parents going back to work, help increase or decrease milk supply, and assist with all breastfeeding challenges.

What happens during a lactation consultation?

- Julie Matheney

Did you work with a lactation consultant when you baby was born? I love working with families at all ages and stages in their feeding journey. But what actually happens in an appointment?
📖We start with a full medical history, both for you and the baby. I want to know about any medications you’re taking, any surgeries or procedures you’ve had done on your breasts, any thyroid or hormone disorders you have. I want to know how the baby has been feeding and what their sleep is like. I want to know what symptoms both of you are experiencing. And most importantly I want to hear what your personal goals are. Because they will be different than every other patient I work with because your family and lifestyle are unique to you
⚖️Next we weigh the baby in a dry diaper before feeding. This is so after the baby feeds we weigh them again and can know exactly how much milk they transferred during that feeding. This is a snapshot in time but gives us lots of information about how baby is feeding
👩🏽‍⚕️I do a full head to toe assessment on the baby. Their feet, hips, neck, shoulders, head, and everything in between tells a story. Some times a baby will need routines like tummy time and some times they will need interventions like craniosacral therapy or occupational therapy. What they need will be unique and individual to them
👅Every baby gets a full oral motor assessment to make sure there are no tongue or lip ties
🤱🏾Time to latch. We may try different positions and latching techniques. Nipple shield may or may not be used
👩🏻‍🍼Depending on the baby we also look at bottle feeding
🍼I always want to see people’s pump and make sure they know how to use it and have the correct size flange. Usually we have enough time to do this at the first appointment but sometimes we do that in a follow up
📝We create a care plan based on your personal goals. I send resources, videos, and give handouts so you know the next steps and have a specific plan that will work for you. We may also schedule a follow up to make sure the plan is going as intended and we can tweak or pivot as needed

If you’re having difficulty breastfeeding, find a local IBCLC lactation consultant to help

How to get my baby to suck on a bottle. They’re just chewing the nipple

- Julie Matheney

Reflexes are neurological blueprints that help us do movements for survival and to learn skills. Reflexes are triggered by certain movements, touch or sound. Sucking and swallowing are primitive reflexes present at birth to help us learn how to feed. These reflexes are triggered by touching baby’s lips, tongue, and palate. If you put anything in baby’s mouth, they will suck on it and if there is any kind of liquid in their mouth, they reflexively need to swallow it. These reflexes are there for the first 3-4 months while babies are learning how to suck and swallow on their own. Around 3 to 4 months they have practiced sucking and swallowing so many times that these reflexes integrate into the brain and they can suck and swallow by choice. They now move to a more mature oral motor pattern of chewing. If you are going to introduce a pacifier or bottle, do so around 3-10 weeks while baby is reflexively sucking. After 3 months babies now have more volitional control of their tongue and get to choose what they suck on. From 3-4 months babies now reflexively like to practice chewing. If you touch their gums, the reflex is to chew which helps them practice the next essential skill of getting ready for solid foods. Babies start putting everything in their mouth at this age including hands and toys. Hands in the mouth is no longer a hunger cue, but a way to trigger the bite reflex to help practice chewing. If you introduce a pacifier or bottle at this age, you may find that the baby will prefer to chew on it. This is the next stage of development and is normal. If you try multiple bottles, and they refused to take them, you could move to spoon or cup feeding that milk instead. This toy is one of my favorites to practice chewing at this age. It’s called a Wrinkel Rattle & Sensory Teether Toy. I also love O balls this kind of practice.

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

My breasts don’t feel full any more. Am I losing my milk?

- Julie Matheney

The breast changes as much as the baby. Your body is amazing. And it’s constantly changing in the early weeks to months postpartum. For the first three months your body is making milk, and when all is going well will usually make more than it needs. Baby will only take about 65-85% at any given feeding. This is because baby is going to go through many cluster feedings and needs to gain weight the fastest in this period of time. Your breasts may feel engorged or full between feedings because of extra blood and fluid that help support changes in the structures of the breast to help you make milk. This engorgement is supposed to go away, usually around 6-8 weeks, as that blood and fluid reabsorb into your body and your breasts will go back toward pre-pregnancy size (or stay larger for some). Then as you milk supply regulates around 3-4 months, the leaking may slow or stop (or not for some) and you may not feel your let down as strong. Your body moves from milk being hormone driven, because you had a baby, to baby driven, you’ll make the milk that is being routinely emptied. If you leaked or collected milk in a haakaa or passive collector, you may start to see less of this milk. This is NORMAL. Your body is becoming more efficient. Softer breasts, not being able to tell which side baby fed on last, leaking less and not feeling let down as strong is all part of your body becoming more efficient with making milk. This process has a wide range of normal. It can be earlier or later depending on your unique body.

If you have concerns about supply or changes in your body, please work with an IBCLC lactation consultant to make sure what you’re experiencing is part of this very normal process

How do I prevent baby’s tongue tie from reattaching?

- Julie Matheney

TONGUE TIE REATTACHMENT

How can I prevent reattachment after baby has a tongue tie release? If you’ve had to go down the tongue tie path, you’ve probably heard about reattachment. This is where the frenulum under the tongue regrows, which is normal, but the frenulum can grow back shorter, thicker, or tighter than the original frenulum. This can cause the same or worse symptoms that were experienced prior to the original release. Many release providers will have families do “stretches” under the tongue to help prevent the new frenulum from forming too soon or too tight. Providers should also be recommending manual therapy (like chiropractic, CST, or OT) as well as continued lactation support.

I’ve seen babies, though, who have done bodywork and the tie still reattached. We need to look at the whole infant structure and not just think of manual therapy as a box to check off in the tongue tie process. Manual therapy , but instead a method to help to restore mobility and range of motion to the whole body. I’m an IBCLC, so I only see babies, but I see a lot of babies who don’t have a full range of motion of the head and neck, and tension in a the lower back, that prevents them from moving their spine through the range of motion too. In reality, this tension needed to be addressed BEFORE the release to optimize the body’s function and prepare for the new range of motion the release gives.

None of these things happen in isolation. Tension anywhere causes tension everywhere. If you have tension in you neck and shoulders, your tongue isn’t free to move EITHER. You can try that on yourself....tense up your neck and shoulders and see what happens to how your resting tongue posture feels.

Bodywork isn’t a magic step that prevents reattachment. It’s an critical step that allows for mobility and strength and THAT allows a change in a frenulum as it grows.

Just like not all oral function providers or dentists are equally skilled, not all manual therapy workers are as equally skilled. And, in my experience, the bigger piece of the puzzle is what the parents are doing BETWEEN visits that also has a massive impact on the outcome. If a family sees a chiropractor or osteopath once, and then goes back to using the Snoo for 10 hours a day, mobility can not be restored, because a body has to go through the range of motion to develop the connection to their brain that allows them to continue to go through the full range of motion with ease.

So, a body worker to help with movement is really important, but is not a magician that it seems like some people are hoping for.....that they can prevent reattachment with a cell phone and a credit card, if they get CST one time done before a release. I think *that* is the misunderstanding.

Reflux baby

- Julie Matheney

One of the biggest culprits of reflux, colic and gassiness (which are symptoms not a diagnosis), are actually undiagnosed tongue and lip ties.  True milk allergies are rare (they do exist!!) but so many moms are told to just cut whole food groups out of their diets instead of exploring for ties. The restrictions in the mouth from the ties cause baby to lose the latch and swallow more air (called aerophagia) which contribute to the symptoms (Kotlow, 2011)

Remember ...

Breast milk is NOT made directly from your stomach contents but within the breast itself from your blood. The foods you eat are broken down in your digestive system. Proteins, carbohydrates, nutrients, white blood cells, enzymes, pre- and probiotics, water, fat, and chemicals (alcohol, caffeine, medications) are pulled from your intestines into the blood stream. Blood delivers these nutrients to the milk making glands at the back of the breast. Every nutrient you consume gets used or stored and each type gets cleared from your blood in a certain amount of time. Cow protein, for example, is completely cleared from your blood steam within 8-12 HOURS of absorption. Caffeine clears your blood in 4-7 hours and alcohol within 2. Medications have longer or shorter half lives, which is how long they stay in your body, and larger or smaller molecules. Some can pass into breast milk and some can’t.

🪫MYTH: If the baby is fussy or has colic, don’t eat dairy.

💡FACT: Cow milk protein allergy is only in 2-7% of the population. Fussiness is not a symptom for diagnosing cow milk protein allergy.

🪫MYTH: Spicy food makes spicy breastmilk which will upset the baby’s tummy.

💡FACT: While the foods you eat can change the flavor of your milk, there is no evidence that capsaicin (the compound that makes foods spicy) is ever present in breast milk. Breast milk is actually quite sweet and palatable for babies.

🪫MYTH: Beans, cabbage, broccoli, and cucumber give the baby gas.

💡FACT: The insolvable fiber found in vegetables mixes with your gut bacteria and makes you gassy. Insoluble fiber does not leave the GI tract and cannot reach your milk.

🪫MYTH: Baby will refuse your milk if you eat garlic, onions, and other potent flavors

💡FACT: Research studies have found babies actually  prefer the flavor of garlic in breastmilk and will spent more time at the breast and drink more milk. (Mennella, 1993

🪫MYTH: Carbonated beverages will make the baby gassy

💡FACT: Carbonated drinks don’t carbonate the blood. The bubbles don’t get into your milk.

I know many will not always agree but there are plenty of studies and research if you are interested when it comes to allergies and lactose / dairy intolerance . I feel so many are not educated ates correctly as it is more complex that what meets the eye.

My 2 day old won’t stop crying

- Julie Matheney

Second night syndrome. The word syndrome. It implies something is wrong when in reality everything is going as expected. For nine months your baby has been in your belly and connected in every way. Their existence controlled by the cycles of your body. Then the intensity of labor and delivery propels them into a new world that sounds, smells, and moves differently. The sheer exertion of being born often makes babies as tired as their mothers. On the second night, however, most babies will want to frequently nurse. This helps with two transitions:  meconium to soft, seedy yellow poops and colostrum to mature milk. This cluster feeding catches many parents by surprise and leaves them wondering if baby is starving. Unless baby is not latched well or efficiently feeding, this is normal. It takes 22-24 good latches and feedings to stimulate the breast for making milk. Many babies, though, don’t want to be put down during this process. Each time you put them on the breast they nurses for a little bit, go back to sleep and then cry when placed in the crib.  Many are convinced it is because their milk isn’t “in” yet, and baby is starving.  It isn’t that, baby’s awareness that the most comforting place is at the breast where you body regulates their temperature, heart rate, respiratory rate and blood sugar.  This is pretty universal among babies. When baby drifts off to sleep at the breast after a good feed, break the suction and take your nipple gently out of their mouth.  Don’t try to burp baby, just snuggle baby until they fall into a deep sleep where they won’t be disturbed by being moved. Keep baby in skin to skin contact as much as possible in this transition and trust your body in the process.

Why can’t I lose the baby weight while breastfeeding?

- 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.

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

🩸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 making milk

🔑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.

Breastfeeding truths

- Julie Matheney

What’s true for most is never true for all. There is a bell curve to human anatomy and physiology. What you are taught is the middle of the curve: what most people do. But there is such a wide variety of normal, the people at either end of the spectrum often are lead to believe that what they experience isn’t normal, when it fact it’s just a variation of normal. Breastfeeding is the same. There is a wide variation of normal. For example:

💦It’s normal to leak milk. It’s also normal to not leak milk at all. Many leak for the first 3-4 months and see the leaking slow when supply regulates around 11-14 weeks. Some stop leaking right away and other leak the whole time the breastfeed

🤱🏾Most breastfed babies (once they’re no longer newborns) want to feed every 2-3 hours and average 8-12 feedings in 24 hours. Some breastfed babies will only do 5-6 feedings and others will seem like boob barnacles who are latched all day. As long as your baby is making enough wet and dirty diapers and gaining weight as expected, let them feed how they want

👼🏼Most breast feeders cannot go more than 6 hours without feeding or pumping and maintain their milk supply. The breast needs emptied frequently to get the signal that more milk needs made. But some can go 8-12 hours and not lose supply. While others can’t go more than 2-3 without the same risk. Breast storage capacity is unique in every breast and what’s true for you won’t be true for someone else

If someone tells you “All breastfeeding does/looks like/should be….”, don’t believe them. While there are general guidelines to how breastfeeding works, there is still such a wide variety of normal. And what works for you won’t necessarily work for someone else. If something is working for you, don’t let comparison to someone else’s journey sabotage your own.

Why do I smell so bad postpartum?

- Julie Matheney

SWEATY AND STICKY

Do you feel hot, sticky, sweaty, sopping wet and a little stinky? Welcome to motherhood. It does get better. There is an actual biological point to leaking from every pore and that weird stench that accompanies it. Not all of our senses are developed at birth. It would overwhelm our littles too much to go from a dark, wet environment to such a bright, crazy world to actually have every sense developed like ours. Their vision isn’t great and they have no depth perception. But they have a fully developed sense of smell. They have been getting to know your odors since their womb days. Your amniotic fluid was constantly changing in its scent based on what you ate and drank and your unique hormone combination. All that leaking you’re doing postpartum has a similar scent which serves to orient your baby back to you. Your body odors are familiar to your baby and it makes them feel safe and secure that they are with their birth person and not someone else. Your leaking smells also stimulate their hunger, which is why baby may constantly root when on your body even if they aren’t hungry. Did you know that the breast secretes an oil from those little bumps on your areolas that smells just like amniotic fluid? This helps baby locate dinner when they are ready to eat. Showering is normal, but avoiding the use of scented products can actually be very helpful and calming for your baby. While you may find your body odor unbecoming, know that to your baby it makes you feel like home.

You may also feel more thirsty than usual, especially during let down. The oxytocin that releases your milk to baby also triggers your thirst. It's your body's way of reminding you to get enough water to produce breast milk. Remember, with breastfeeding, you are losing up to 30 ounces of fluid a day to breast milk. So your body is reminding you to take care of yourself and not just the baby.