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.

Breast milk supply tips

- Julie Matheney

It's crucial to remember that every breastfeeding journey is unique, and breast milk pumping outputs can vary widely from person to person and even from day to day. Comparing your output to someone else's can create unnecessary stress and pressure.

Natural Variation: The amount of milk a person can pump varies based on factors like breast storage capacity, hormonal levels, baby's nursing habits, and more. Some people naturally produce more milk than others, and this doesn't reflect on their ability to nourish their baby

Frequency and Timing: Pumping output can fluctuate throughout the day and with different pumping sessions. It's normal for milk supply to be higher in the morning and lower in the evening. The timing and frequency of pumping sessions can also impact how much milk is expressed

Storage Capacity: Breast storage capacity differs among individuals. This affects how much milk can be stored in the breast at one time and consequently how much can be pumped in one sitting

Baby's Needs: Babies' needs vary, and not everyone needs the same amount of milk. Your baby's growth and development are better indicators of whether they're getting enough milk rather than the volume you pump

Typically, a newborn consumes around 1-3 ounces per feeding in the first few weeks. However, this can vary based on baby's age, appetite, and individual needs. Here are some general guidelines:

Early Days: In the first few days after birth, when your milk is transitioning from colostrum to mature milk, you might pump smaller amounts (e.g., 1/2 to 2 ounces per session)

Established Supply: As your milk supply regulates (around 4-6 weeks), you might pump around 2-4 ounces per session

Later Months: Pumping output can range from 2-5+ ounces or more per session as your milk supply adjusts to meet your baby's needs

Remember, the best indicator of successful breastfeeding is your baby's growth, diaper output, and general well-being. If you have concerns about milk supply or breastfeeding, it's always a good idea to reach out to an IBCLC for personalized support. And most importantly, be kind to yourself and focus on the special bond you're nurturing with your little one.

Nausea while breastfeeding

- Julie Matheney

The interplay between oxytocin and stress hormones is a fascinating aspect of our neuroendocrine system. Cortisol and oxytocin are both regulated by the hypothalamus, a critical part of the brain that helps maintain hormonal balance. The hypothalamus plays a pivotal role in maintaining the balance between these hormones.

Oxytocin is produced in the paraventricular nucleus inside the hypothalamus, a small but crucial part of the brain that regulates many autonomic functions. From the hypothalamus, oxytocin is transported to and released by the posterior pituitary gland into the bloodstream which then travels to the breast and causes the pulsatile contractions known as the Milk Ejection Reflex (let down).

In response to stress, the hypothalamus releases corticotropin-releasing hormone (CRH). CRH prompts the anterior pituitary gland to secrete adrenocorticotropic hormone (ACTH). ACTH then stimulates the adrenal glands to release cortisol and adrenaline into the bloodstream, preparing the body for a 'fight-or-flight' response. The hypothalamus coordinates the release of CRH and oxytocin, attempting to balance the stress response with mechanisms that promote recovery and resilience

These hormones counteract each other: cortisol increases alertness and stress, while oxytocin reduces anxiety and fosters calmness, helping to restore equilibrium in the body's stress response system

What Causes Let-Down Nausea?

The sudden surge of oxytocin, combined with fluctuating levels of other hormones released by the hypothalamus, can activate the parasympathetic nervous system, which can sometimes trigger nausea. This response is similar to the body's reaction to certain stressors or stimuli

Breastfeeding is both physically and emotionally demanding. Anxiety, lack of sleep, and overall stress can exacerbate nausea during let-down

Blood Sugar Levels: Low blood sugar, a common issue for new mothers who might skip meals or eat irregularly, can also cause or worsen nausea as hormones are fluctuating during breastfeeding

Managing breastfeeding nausea

Hydration and Nutrition: Ensure you're staying well-hydrated and eating balanced meals regularly. Small, frequent meals rich in protein and complex carbohydrates can help stabilize blood sugar levels and reduce nausea, especially when eaten a few minutes before moving milk

Relaxation Techniques: Practice deep breathing, meditation, or gentle yoga to reduce overall stress. Creating a calm and comfortable environment during breastfeeding or pumping  can help

Iron for breastfed babies

- Julie Matheney

At birth, babies have a natural reserve of iron accumulated during the last trimester of pregnancy. However, these iron reserves begin to deplete around 4-6 months of age due to baby's rapid growth and increasing blood volume. While breast milk contains relatively low levels of iron, it is highly bioavailable, meaning it is absorbed more efficiently by the infant's body compared to the iron in formula. But breast milk alone does not provide sufficient iron to meet the growing baby’s needs. This depletion necessitates the introduction of additional iron sources once baby starts solid foods at 6 months.

Introducing iron-rich foods, such as pureed meats, iron-fortified cereals, beans, and leafy green vegetables, helps prevent iron deficiency anemia, which can lead to developmental delays and impaired cognitive function. Starting iron-rich foods at 6 months ensures that babies receive adequate iron to support their developmental needs, complementing the high bioavailability of iron from continued breastfeeding. This approach helps maintain optimal iron levels during a critical period of growth and development.


Iron is crucial for:

📏Growth and Development: Iron is vital for the production of hemoglobin, the protein in red blood cells that carries oxygen throughout the body. Adequate oxygenation is essential for the rapid growth and development of infants, particularly for brain development

🤢Immune Function: Iron plays a significant role in the development and function of the immune system. Adequate iron levels help protect babies from infections and support overall immune health

🧠Cognitive Development: Iron is crucial for neurological development. It is involved in myelination, the process of forming the protective sheath around nerves, which is essential for efficient nerve transmission and brain function

Iron deficiency anemia can lead to:

- Developmental Delays: Iron deficiency can impair cognitive and motor development, leading to long-term developmental issues

- Behavioral Problems: Low iron levels can affect a baby's temperament and behavior, causing irritability and reduced attention span

- Weakened Immune System: Iron deficiency can compromise the immune system, making infants more susceptible to infections

Thus, maintaining adequate iron levels through a combination of continued breastfeeding and the introduction of iron-rich complementary foods is essential for ensuring healthy growth and development in infants.

Breast milk nutrition

- Julie Matheney

Breast milk is a complex and dynamic fluid that provides all the essential nutrients a baby needs for optimal growth and development. Its composition varies not only between different stages of lactation but also from one feeding session to another. Here’s an in-depth look at the key components and nutritional value of breast milk:

Macronutrients

- Proteins: Breast milk contains two primary types of proteins: whey and casein. Whey proteins, which are easier to digest, make up about 60-70% of the total protein content. Casein constitutes the remaining 30-40%. These proteins are crucial for the baby's growth and immune function.

- Fats: Fats are the most variable component of breast milk and provide the primary source of energy, comprising about 50% of the total calories. The fat content can range from 3-5 grams per 100 mL, depending on the time of day and how long since the last feeding or pump session. These fats include essential fatty acids, such as DHA and ARA, which are vital for brain development and vision.

- Carbohydrates: Lactose is the main carb in breast milk, providing about 40% of the total caloric content. It aids in the absorption of calcium and supports the growth of beneficial gut bacteria.

Micronutrients

- Vitamins: Breast milk contains a range of vitamins necessary for the baby's development. These include fat-soluble vitamins like A, D, E, and K, as well as water-soluble vitamins such as C, riboflavin, niacin, and B12.

- Minerals: Key minerals found in breast milk include calcium, phosphorus, magnesium, sodium, potassium, and trace elements like zinc and iron. These are essential for bone development, cellular function, and overall growth.

Immune-Boosting Components

- Antibodies: Immunoglobulin A (IgA) is the most abundant antibody in breast milk, playing a crucial role in protecting the infant from infections by forming a protective barrier on mucous membranes.

- White Blood Cells: Breast milk is rich in leukocytes, which help fight infections and bolster the infant’s developing immune system.

- Enzymes and Hormones: Enzymes such as lipase and amylase aid in digestion, while hormones like leptin and ghrelin help regulate the baby’s appetite and metabolism.

Caloric Content

- Calories: The caloric content of breast milk can vary significantly. On average, breast milk provides about 20 calories per ounce (approximately 67 calories per 100 mL). However, the caloric density can range from 15 to 30 calories per ounce (50 to 100 calories per 100 mL) based on factors such as the stage of lactation and the time of feeding. Colostrum, the first milk produced, is lower in calories but higher in proteins and antibodies, while mature milk produced later is higher in fat and overall caloric content.

Variability and Adaptability

One of the remarkable features of breast milk is its ability to adapt to the baby's changing needs. For example:

- **Foremilk and Hindmilk**: At the beginning of a feeding session, the milk (foremilk) is typically more watery and lower in fat, quenching the baby's thirst. As the feeding progresses, the milk (hindmilk) becomes richer in fat and calories, satisfying the baby's hunger and providing sustained energy.

- **Circadian Rhythms**: The composition of breast milk can also change based on the time of day. For instance, evening and nighttime milk often contain higher levels of melatonin, which can help the baby sleep better.

Breast milk is a highly specialized and ever-changing nutritional source that supports infants' growth, development, and immune function. Its unique composition, tailored to meet the specific needs of human infants, underscores the benefits of breastfeeding for both mother and child. The dynamic nature of breast milk, with its varying caloric content and nutrient composition, ensures that babies receive optimal nourishment during the critical early stages of life.

Pump Flanges: Size Matters

- Julie Matheney

The history of the 24mm pump flange is closely linked to the evolution of breast pump technology. Breast pumps have been around for over a century, but significant advancements began in the 20th century. Early breast pumps were manual, cumbersome, and often inefficient.

In the mid-20th century, electric breast pumps were introduced, revolutionizing breastfeeding by making it easier and more efficient to express milk. However, these early models were still quite rudimentary in design.

The 1980s and 1990s saw significant improvements in breast pump technology, with companies like Medela and Ameda leading the way. During this period, a range of flange sizes was developed to accommodate different nipple and breast sizes. The 24mm flange size became a standard option, as it was thought to fit a significant portion of women effectively. However, over time, it has become evident that the 24mm size is often too large for many women. Research and user feedback have shown that the majority of women actually require smaller flange sizes for a proper fit and comfort.

The predominance of the 24mm flange as a default size reflects an initial lack of understanding and support for the anatomical diversity among breastfeeding mothers. Many women experience discomfort and inefficient milk expression due to using flanges that are too large. This mismatch can lead to reduced milk supply and a negative breastfeeding experience.

Today, there is a growing awareness of the need for a wider variety of flange sizes that truly support the diverse needs of breastfeeding mothers. Companies are increasingly offering smaller flange sizes and more customizable options to ensure a proper fit for all users. This shift towards inclusivity and better support for all anatomical variations marks a significant improvement in the breast pump industry, aiming to enhance the breastfeeding experience through better technology and design.

Cluster Feeding

- Julie Matheney

Cluster feeding is a normal and common behavior in newborns, where they nurse frequently and irregularly over a period of several hours, often in the evening. This behavior helps stimulate milk supply and can also provide comfort to the baby, who may be going through a growth spurt or developmental leap. Despite its normalcy, cluster feeding can be particularly challenging and frustrating for new parents, especially if they are unprepared for its intensity and duration.

New parents may find cluster feeding overwhelming for several reasons. First, the frequent and seemingly incessant nursing sessions can lead to physical exhaustion and a sense of being constantly tethered to the baby. The lack of predictability in feeding patterns can also make it difficult for parents to find time for their own basic needs, such as eating, sleeping, and showering. This can contribute to feelings of frustration and stress, as the demands of cluster feeding can seem relentless.

Additionally, new parents might worry that their baby is not getting enough milk or that there is something wrong with their breastfeeding technique. This anxiety can be exacerbated if they are not aware that cluster feeding is a typical behavior that helps regulate and increase milk supply. The emotional toll of seeing their baby seemingly insatiable and unsettled can add to their frustration.

Education and support are key in helping new parents navigate cluster feeding. Knowing that cluster feeding is a normal part of newborn development can alleviate some of the stress and help parents manage their expectations. Seeking support from lactation consultants, pediatricians, or breastfeeding support groups can provide reassurance and practical advice. Understanding that this phase is temporary and that it plays an important role in establishing a healthy milk supply can also help parents cope with the challenges of cluster feeding.

Super Weaners: Toddler Breastfeeding

- Julie Matheney
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Breastfeeding toddlers offers a unique set of challenges for mothers, primarily due to the frequency of nursing, the use of nursing for comfort and emotional regulation, and the phenomenon of feeling "touched out." Toddlers, who are typically more active and aware of their surroundings, may still desire to nurse frequently. They’re like hummingbirds and barnacles. Popping on and off and on and off and then staying suctioned for long periods of time. This can be due to nutritional needs, comfort, or as a means of seeking closeness with mommy. Unlike babies whose primary source of nutrition is breastfeeding, toddler breast milk fills in nutritional gaps from a table food diet. They don’t need as much milk to be considered exclusively breast fed.

Using nursing for emotional regulation is common in toddlers. They often use it for soothing themselves when they are upset, tired, or seeking reassurance or feeling overwhelmed, anxious, or in need of emotional support. This can result in more frequent nursing sessions that are less about hunger and more about the need for comfort and connection.

For moms, this frequent and comfort-based nursing can lead to feelings of being "touched out." This term describes the exhaustion and irritation some feel when they experience constant physical contact from their child. The near-constant demand for breastfeeding, especially when coupled with other physical caregiving activities, can leave moms feeling overwhelmed and in need of personal space. This sensation of being "touched out" is a common and valid experience.

Balancing the needs of both sides of the dyad is crucial. Setting boundaries for nursing sessions, finding alternative comfort measures for the toddler, and ensuring the mom has opportunities for self-care and personal time can help manage the challenges associated with a human super weaner.

Milk supply at night

- Julie Matheney

Infant sleep patterns, especially during the early months, are characterized by frequent waking, often every 2-3 hours, which is largely driven by their need for regular feeding. Night feedings play a crucial role in maintaining and boosting breast milk supply due to the hormonal mechanisms involved. Prolactin, a hormone essential for milk production, tends to be at its highest levels during nighttime. When an infant breastfeeds at night, the mother's body receives signals to produce more milk, ensuring an adequate supply for the baby's needs. Frequent night feedings help to maintain high prolactin levels and stimulate continuous milk production. Consequently, consistent night feeding is vital for establishing and sustaining a robust breast milk supply, particularly during the early weeks postpartum when the milk supply is being established. Skipping night feedings can lead to decreased milk production as the demand decreases, sending signals to the body to reduce milk output. Therefore, understanding and supporting infant sleep patterns that include night feedings are essential for successful breastfeeding.

Research indicates that newborns typically wake every 2-3 hours during the night for feeding. This frequent waking is due to their small stomach capacity and high metabolic rate, requiring regular intake of nutrients. Studies show that by the age of three months, many infants may start to sleep for longer stretches, though it is common for them to still wake at least once or twice during the night for feeding. On average, these night wakings can last anywhere from 20 minutes to an hour, depending on how quickly the baby feeds and settles back to sleep.

A study published in *Sleep Medicine Reviews* highlighted that infants between the ages of 0-6 months wake up approximately 2-3 times per night. Another research in the *Journal of Clinical Sleep Medicine* found that these night wakings typically decrease in frequency as the infant grows older, but individual patterns can vary widely. Some infants may continue to wake frequently throughout the first year, especially if they are breastfed, as breast milk is more quickly digested than formula, necessitating more frequent feedings.

Night feedings are crucial for maintaining breast milk supply due to the elevated levels of prolactin during nighttime. Consistent night feeding supports ongoing milk production by keeping prolactin levels high and ensuring that the body continues to respond to the infant's nutritional demands. Thus, understanding typical infant sleep patterns and their need for night feedings is essential for breastfeeding success and ensuring adequate milk supply.

What you weren’t told about breastfeeding a preemie

- Julie Matheney
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Babies born under 38 weeks gestation are considered premature, with those born between 34-36.6 weeks gestation, known as late preterm infants. While those born in the 37th week are considered term, lactation consultants call them the Great Pretenders, because they can look like full term babies, but still act like late preterm babies. All of these babies exhibit distinct feeding habits compared to full-term infants (those born at 38+ weeks). Here are the primary differences:

Feeding Efficiency:

   -Late Preterm Infants: Often have less developed oral motor skills, which can lead to less efficient suck-swallow-breathe coordination. This can make feeding slower and more labor-intensive for both the infant and the caregiver.

   - Full-Term Infants: Typically have more mature feeding skills, allowing them to feed more effectively and efficiently from the breast or bottle.

Energy Levels and Fatigue:

   - Late Preterm Infants: These babies tend to tire more quickly during feeding due to lower energy reserves. This can result in shorter, more frequent feedings and a need for longer feeding sessions.

   -Full-Term Infants: Generally have higher energy levels and stamina, enabling them to complete feedings more quickly and efficiently.

Latching and Milk Transfer:

   -Late Preterm Infants: May struggle with latching onto the breast properly, leading to inefficient milk transfer. This can necessitate additional support, such as the use of nipple shields or supplementary feeding devices.

   -Full-Term Infants: Usually latch more easily and effectively, facilitating better milk transfer during breastfeeding.

Feeding Frequency:

   -Late Preterm Infants: Often require more frequent feedings due to their limited ability to consume large volumes of milk in a single feeding session.

   -Full-Term Infants: Can typically consume larger amounts of milk per feeding, allowing for longer intervals between feedings.

Supplementation Needs:

   -Late Preterm Infants: More likely to need supplementation with expressed breast milk or formula to ensure they meet their nutritional needs and support adequate growth and weight gain.

   -Full-Term Infants: Generally able to meet their nutritional requirements solely through breastfeeding or standard bottle feeding.

Risk of Jaundice:

   -Late Preterm Infants: Higher risk of developing jaundice, which can affect feeding patterns and overall health. Effective and frequent feeding is critical in managing this condition.

   -Full-Term Infants: While jaundice can occur in full-term infants, it is typically less severe and easier to manage through regular feedings.

Growth Monitoring:

   -Late Preterm Infants: Require closer monitoring of their growth and development to ensure they are meeting milestones and gaining weight appropriately.

   -Full-Term Infants: While growth and development are monitored, they generally follow a more predictable growth pattern.

Understanding these differences is essential for caregivers and healthcare providers to offer the appropriate support and interventions to ensure that both late preterm and full-term infants thrive.

 

This means your expectation is you may have to triple feed or do lots of pumping until baby becomes efficient, which is usually 2-3 weeks PAST their due date. They need extra time to figure out how to efficiently feed. Many parents who had babies born at 37 weeks were not told their baby may struggle to breastfeed for the next 4-6 weeks, so they give up on breastfeeding just a few weeks in  don’t give up!!! Your baby just needs time to figure it all out  

#preemie #preemiestrong #preemiepower #preemiemom #preemieawareness #preemielife

Alternatives to bottle feeding a baby: Cup feeding

- Julie Matheney

Cup feeding involves using a small, open cup to feed a baby. The baby sips or laps the milk from the cup, much like how an adult would drink. This method is often recommended for newborns, especially preterm infants, or when direct breastfeeding is not possible.

When is Cup Feeding Used?

Cup feeding can be an appropriate option in several scenarios:

- **Premature Babies**: For babies born prematurely who may have difficulty latching onto the breast.

- **Transitioning from Tube Feeding**: To help babies transition from nasogastric tube feeding to oral feeding.

- **Temporary Separation**: When the mother is temporarily unable to breastfeed due to medical reasons or separation.

- **Avoiding Nipple Confusion**: To prevent nipple confusion in breastfed babies who need supplementation.

Benefits of Cup Feeding

  1. Preserves Breastfeeding Skills: Unlike bottle feeding, which can cause nipple confusion, cup feeding allows babies to maintain their breastfeeding suckling patterns. This makes it easier for them to transition back to the breast.

2. **Encourages Natural Feeding Behaviors**: Babies can control the pace of their feeding, similar to breastfeeding. This can reduce the risk of overfeeding and helps babies develop their feeding cues.

3. **Avoids Nipple Confusion**: Since cup feeding doesn’t involve artificial nipples, it helps avoid nipple confusion, making it easier for the baby to switch between breast and cup.

4. **Promotes Oral Development**: The use of cup feeding supports the development of the baby's oral muscles, which are important for speech and eating solid foods later on.

5. **Simple and Accessible**: Cup feeding requires minimal equipment – just a small cup. It’s easy to clean and sterilize, making it a hygienic option.

How to Cup Feed a Baby

Cup feeding requires patience and proper technique to ensure the baby feeds safely and effectively. Here’s how to do it:

1. **Prepare the Cup**: Use a small, clean cup. A medicine cup or a small shot glass works well. Fill the cup with a small amount of breast milk or formula.

2. **Hold the Baby Upright**: Position the baby in an upright, seated position. Support their head and neck with one hand.

3. **Offer the Cup**: Hold the cup at the baby’s lips, tilting it just enough so that the milk touches their lips. Allow the baby to lap or sip the milk at their own pace. Do not pour the milk into the baby’s mouth, as this can cause choking.

4. **Take Breaks**: Give the baby time to swallow and breathe. Watch for their cues to know when they need a break or are full.

5. **Burp the Baby**: After feeding, gently burp the baby to release any swallowed air.

#### Safety Considerations

- **Supervision**: Always supervise your baby closely during cup feeding to prevent choking.

- **Hygiene**: Ensure the cup is thoroughly cleaned and sterilized before each use.

- **Small Amounts**: Start with small amounts of milk to avoid spillage and waste.

Cup feeding can be an excellent alternative to bottle feeding, offering numerous benefits for both the baby and the mother. It supports breastfeeding efforts, promotes natural feeding behaviors, and aids in the baby's oral development. With proper technique and patience, cup feeding can be a successful and rewarding feeding method. If you’re considering cup feeding, consulting with a lactation consultant or pediatrician can provide additional guidance and support.