I think my baby has a breastfeeding aversion

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.

🤯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.

Breasts no longer feel full between feeding

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.

How many minutes should my breastfed baby feed for?

Not every baby needs 15 minutes per side. Some babies take a full feeding in only a few minutes, and from just one breast per feeding. Other babies may feed for a few minutes off each side. Older, more distractible  babies are efficient eaters with more important things to do than state at your chest. They may graze at the boob a few minutes at a time or want to go back and forth from side to side.

In general, you know baby is getting enough breast milk when you have a pain free latch where the nipple goes in and out of baby’s mouth the same shape. You can hear baby swallow and don’t need to keep them awake at the breast for them to continue feeding. Baby should be making lots of heavy wet diapers and pooping daily or every other day. They also gain weight to their own curve and are a similar size of your unique family genetics.

If your baby typically latches for you, and feeds well, and refuses to latch, they most likely are done. Follow your baby’s lead and get to know their feeding habits. Trust your baby and trust your body. If you’re concerned about how your baby is feeding, schedule and appointment with a breastfeeding expert: an IBCLC lactation consultant.

How often should my breastfed baby 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 or timed (waiting for every 3 hours, only feeding 15 minutes a side) or if baby is being sleep trained too early. Low milk supply can be caused by retained placenta, the impact of interventions during birth, medications, hormone based birth control, thyroid or hormone disorders, or when there is a breast surgical history like a reduction.

AFTER 6 weeks, it may be normal for SOME babies to poop less frequently. Baby should still make at least 6 wet diapers that have a mild smell. It can be normal for baby to have a massive yellow blow out every 1-7 days. As long as the poop is very soft or seedy/watery and they’re not in pain when passing

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 schedule should my baby breastfeed on?

I often get asked about strict schedules for new babies. Feed for 30 minutes. Play for 15 minutes. Wake window is 90 minutes. Sleep for 90 minutes. It hasn’t been 3 hours, wait to feed the baby. If baby cries or doesn’t settle, parents are disappointed or think something wrong is wrong with the baby. 

For some families, schedules go well. They fit into a pretty good model where baby follows a fairly consistent routine from early on. If that was you, GREAT! For the vast majority of us, though, we will start a schedule only to feel like it never lasts more than a few days before falling apart. This is for one simple reason: newborns have not read “the book”. They rely purely on instinct and reflex in the early months. Their basic human needs are nutrition, warmth, love, and sleep. Baby expects to be held 24/7 because that is how they survive and develop. They are born about 1-2 years too early! They are completely dependent on their parents for doing all of their cares: feeding, self care, cleaning, soothing, transitioning to sleep. Babies feed frequently. They have very small tummies and breast milk digests very quickly.

But you’re not just feeding for nutrition. They feed for thirst, comfort, pain relief, for growth, to help them poop! They want to be at the breast to soothe. They want to be at the breast if they’re cold. They want the breast for all of their range of new emotions. 

Babies cannot cognitively manipulate or control. They don’t cry or seek attention consciously. They do it for survival out of instinct and reflex. These instincts don’t always align with the clock. Putting a baby on a schedule doesn’t usually work. Their body may tell them it’s hungry again, even if it’s only been an hour. They may not be in a mood to play when the clock tells you they should. They may have gas and be uncomfortable on their belly when it’s Tummy Time time.

So why do we put so much pressure on ourselves to put a baby on a schedule? The short answer is: society. Society has deeply ingrained in us that a good baby is one that sleeps when we say they should sleep and for a long amount of time. Society says we should control what babies do and when they do it. That baby is only a good baby if they sleep for a designated amount of time. 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. We are supporting their physical, social, developmental and emotional needs and these needs shift and change as they age.

Does this mean we will never get into a schedule? NO! Most families find they naturally fall into a ROUTINE that works for them. Every routine will look different because every family is different. Usually as the weeks and months go by, a pattern naturally emerges that revolves around our unique family lifestyle. So how do you cope while waiting for a natural rhythm to be established? Sometimes just realizing that not having a set schedule in the early months is normal can take the stress off. Understanding that you’re not alone can be comforting to our structured adult mindset. 

What happens during a lactation consultation?

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

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?

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?

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?


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.