Can you overfeed a breastfed baby?

- Julie Matheney
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Can you overfeed a baby? The answer is absolutely yes. You have a tiny human with a tiny human stomach. All of our stomachs can stretch to hold more capacity than what we actually need to take. The question is, is over eating a problem? We’ll take a look at this and strategies to understanding if whether your baby is over feeding and if it’s a problem or not.

Now we all know that it is very easy to overfeed from a bottle. Bottles have a hole in them that are instant and constant and absolutely yes, many bottle fed babies are over fed. Many times parents are watching the volume in the bottle instead of watching the baby for baby’s cues that they are ready stop. It also takes 20 minutes for the stomach to tell the brain that it’s full, so it is very easy for babies to take the large volume in a short amount of time and eat more than their stomach needs to, before the brain knows that it’s full. The mouth can still be hungry while the stomach is full so babies may show cues that they are still wanting to suck which parents interpret as cues that Baby wants to continue to feed, and because the stomach can stretch and hold more than it needs to, parents often overfeed from a bottle.

The big question is, can babies overfeed at the breast? The breast works different than a bottle. The breast needs to be stimulated to release milk and milk is released in multiple waves that take time to be triggered. Most young babies will take 15 to 30 minutes at the breast, which allows their tummy time to tell the brain that it’s full. As they age and become more efficient; they learn to listen to their stomach to help guide when to stop feeding.

It is still possible to overfeed at the breast. We usually see this for two reasons: either from the mother side or from the baby side.

On the mother side, the most common reason for overfeeding is the mother has an over supply of milk. There are several reasons for having an oversupply. First, it may be caused by using a Haakaa or a breast pump and overstimulating the breast to make more milk than it needs. This also drives up the letdown response, which makes milk flow faster than if the baby were just feeding at the breast without the over supply. In this case, baby takes too much milk too fast. Mother may also have an oversupply being driven by certain medications. The most common medication I see driving over supply is Zoloft. There are also different medical conditions that can be the reason for an oversupply such as a prolactinoma, which is a pituitary gland tumor, or uncontrolled thyroid disorders.  This would be diagnosed by a physician after bloodwork and other medical imaging. Lastly, some new parents who don’t have as much experience with babies may also interpret every cue as a hunger cue. Some babies are totally willing to keep eating even if they are full. If you offer me a cheesecake, I will totally eat the cheesecake even if I don’t need it. Some babies are also like this, they will always latch when offered the breast. Every time baby is put down to sleep in the crib, they cry. Or they sleep for 10 minutes and cry to be picked up. But these cues get misinterpreted as the baby is still hungry and the baby is put back to breast. Some babies are very willing to go back to breast and keep feeding.

Overfeeding  could also be on the baby side. Certain tongue ties will stimulate the breast into an over supply. These babies often use a quick suckle pattern which initiates the let down reflex from how the nipple is stimulated. These cases are complicated in that the tongue may be restricted in a way that the mother doesn’t have much nipple pain or damage, but her body is compensating for the baby not having full range of motion of the tongue. Babies with reflux may also over feed at the breast. They often want to nurse more to keep swallowing, which helps keep milk in the stomach. Breastmilk is a pain reliever and many babies with reflux learn that they would rather be swallowing milk down than bringing it back up as reflux. So frequently feeding helps them swallow more often, but it becomes a vicious cycle.

When does overfeeding actually become a problem? If baby is having a lot of negative symptoms related to feeding, and over feeding is determined to be part of the root, addressing the reason WHY there is overfeeding would be appropriate.

If the baby has digestive discomfort, and has a lot of reflux/excessive spit up/projectile vomiting with pain, severe gas or digestive pain, we would want to address over supply or other issues, causing this discomfort. If the baby is having green, frothy/foamy or watery poops, this is also a sign of too much milk too fast. These kinds of watery or green poops may be a sign of lactose overload, where baby is accessible too much foremilk due to an oversupply.

Another symptom to watch for that would lead us to believe overfeeding is a problem would be baby coughing, choking, or leaking milk during the feeding. If the baby just physically cannot keep up and is constantly struggling during the feeding, there would be a reason why we would want to reduce milk supply to help baby feel more comfortable at the breast. Although this may also be a symptom pointing back to a tongue tie driving the over supply, so just bringing supply down would not necessarily be the best answer in this case. We would want to determine if the oversupply is causing the coughing and choking or if an inefficient tongue is contributing to baby not being able to swallow efficiently.

Babies gaining weight too quickly or faster than expected can also be a symptom that baby is being overfed, however, this is my symptom of least concerned. If the baby is gaining happily with no digestive discomfort, poops are a normal color and consistency, and is not leaking, coughing, or choking during feedings, fast weight gain alone would not be a concern. Many typically feeding babies with mothers with a normal supply can gain weight quicker than anticipated and then level off in weight once they become more active or distracted.

Yes, it is occasionally possible for breastfed babies to overfeed. If there there are symptoms happening (recurrent plugged ducts and mastitis for mother from an over supply, nipple pain and damage, coughing/choking baby, digestive discomfort or concerns with poop), working with an IBCLC lactation consultant can help determine what the root is (excessive pumping, medications, tongue tie, reflux, etc) to help balance the dyad for happier feeding.

How much breast milk does a newborn need?

- Julie Matheney

For the first few months after delivery, when hormones are balanced and the breast is well stimulated, the breast makes lots of milk. Research shows at any given feeding, breastfed babies take 65-80% of the available milk in the breast. When feeding is well established, most babies eat until they are full, not until the breast is “emptied”. In fact, the breast is constantly making milk and can never truly be emptied. Your body knows a young baby is growing quickly and frequently cluster feeding, so your body has milk available all the time. This is why people can create a stash. They are pumping the extra milk that baby leaves behind.

Efficient and frequent milk removals helps to produce more milk quickly. The extent to which the breast is drained during a feed is what research has shown to drive milk production. The more often a breast has milk moved from it, the faster milk is made to replace that milk. The longer you go between feedings, the slower milk is eventually is made. Breastmilk fat/calorie content is also driven by a similar mechanism. The fuller the breast, the lower the fat content of the milk; the body thinks baby is dehydrated and focuses on hydration. The more often milk is moved, the higher the fat content of the milk; your body knows baby is in a growth spurt or needs higher fat to help sleep. If you go multiple days with fuller breasts where less milk is being moved, supply will drop to protect the breast from sitting milk which has a higher risk of inflammation that causes plugs and mastitis.

As baby ages, this extra milk goes away and your body makes what baby is routinely taking. Because your body AND your baby become more efficient. If you think baby isn’t moving milk well, and supply is suffering for it, it is important to address it as early as possible.

Research: https://publications.aap.org/pediatrics/article-abstract/117/3/e387/68590/Volume-and-Frequency-of-Breastfeedings-and-Fat?redirectedFrom=PDF

#breastfeeding #breastfeedingsupport  #lactationconsultant #lactation #milkproduction #pregnancy #postpartum

Why does my breast pump hurt? Can my breast pump cause plugged ducts and mastitis?

- Julie Matheney

You would think that the stronger a breast pump can suction, the better. But before you crank that pump to the highest setting, make sure you know the benefits (and risks) of doing that. Breast pump suction power is measured in mmHG (millimeters of mercury), the standard unit of measuring vacuum pressure. Studies were done on babies sucking at the breast and breasts pump suction levels are based off what we know of how babies remove milk from the breast. The suction level, or vacuum, is different than the cycle speed, which is how fast it pumps. This is why breast pumps should have two settings: cycle (speed) and vacuum (strength). Most pumps will cycle at 40-70 cycles per minute. This is based off of the average number of sucks a baby does at the breast in that same amount of time. Every baby sucks are their own pace and with their own vacuum strength.

Every pump has its own max suction strength that it can reach. “Hospital grade” pumps generally have maximum suction levels in the 300+ mmHg range while personal grade pumps are generally in the 200+ mmHg range. This doesn’t necessarily make a pump better or worse. The highest suction level on most pumps are actually above the comfort zone of the majority of pumpers. Most people feel comfortable expressing in the range of 150 – 200 mmHg regardless of whether the pump can reach 250 or 350 mmHg at its max. Using the suction too high, especially in combination of the wrong size flanges, can hinder milk flow and be the root cause of plugged ductsmastitis, dropping milk supply and breast/nipple damage!

Think of it like drinking from a milkshake with a narrow straw. When you suck too hard, the straw starts to collapse on itself and the shake is really hard to drink. Milkshakes move better with gentle, consistent sucking that doesn’t collapse the straw. Milk ducts are like compressible straws inside the breast that move milk from the milk-making glands called alveoli to your nipple pores in your nipple to your baby. Not only does everyone have a different number of these ducts, but the diameter of the ducts also varies from person to person. Too much breast pump suction compresses the areolar tissues which pinches off the ducts and actually decreases the flow of milk to the pump. With time this can cause milk to back up in the breast, increasing the risk of plugged ducts. This can also foster inflammation and risk damage. This also leaves milk behind which eventually can drop your overall milk supply. Having the right size flange AND using enough suction to move milk but not compress the ducts is essential to a happy pumping journey.

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What to expect after tongue tie release

- Julie Matheney
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My baby has a tongue tie and we’re going to have it released. What should I expect?

First, having a tongue tie clipped isn’t always a magic fix to breastfeeding issues. While 80% of mothers report a significant decrease in nipple pain after the procedure, there is still a recovery and healing proceess that needs to take place. That tissue under the tongue has been there since 8 weeks gestation and depending on how baby has learned to use their tongue, some unlearning and relearning is necessary. Bodywork, suck training and lactation support are still crucial for the few days to weeks after the procedure is done. But what should you expect as a parent.

Day 1-3 your baby will feel sore and tender. They may be fussier than usual. A white patch will form where the surgery was done. Baby may have difficulty latching to bottle or breast, so have an alternative feeding plan ready such as cup or finger feeding. Reflux and gas often get worse before they get better. For the first week, baby is relearning how to use their tongue. Your provider should talk to you about stretches to do several times a day to help prevent the tongue from reattching. Our bodies like to heal together, so this is very important. Some minor bleeding may occur, but if you see lots of blood notify your provier right away. Pain management is often needed for the first few days, but many babies can taper off of this.

From week 2-4, the white patch will shrink and may turn yellow as it heals. Eventually a new frenulum will form. This anatomical structure helps anchor the tongue to the floor of the mouth, but the new frenulum should allow the tongue to move freely in and out, side to side and up and down. Everyone sees progress differently, but symptoms should be improving at this point. Many babies will still need bodywork or lactation support.

Why is my baby a lazy feeder?

- Julie Matheney

We are a survivalist species. Our babies are born with instincts to survive. They cry when they are put down because they know they are vulnerable to temperature and can’t feed themselves. They use their senses to find their food source and are familiar with their parents over strangers by sound and smell. They have reflexes to help them learn critical motor patterns for development.

When a baby isn’t feeding well, it isn’t because they are lazy. Lazy is a character trait for someone who volitionally doesn’t want to do something. If a baby didn’t feed well, historically that baby may not survive. We need to find the reason why they aren’t feeding well and address that.

Reasons a baby may not feed well at birth may include:
⏱️Prematurity. When a baby is born before 36 weeks, there is often a lot of support and expectation set that baby may need time to learn to feed. But 37 and 38 weekers are the great pretenders. They look like full term babies but often don’t feed like them. They may need 4-6 additional weeks to figure out how to feed because they really needed those extra few weeks to practice sucking and swallowing in utero without the expectation to coordinate swallowing as well
💊Medications. Medications cross the placenta to baby, and while most are safe, babies can have withdrawal symptoms from certain meds after birth, making them sleepy. These could be medications given during labor and delivery or even medications mother was taking during pregnancy. As these medications clear from baby’s system, they will perk up. Other medications, like SSRIs, can continue to make babies sleepy
👅Tongue and lip tie. The tongue needs to move in and out, side to side, and up and down. Babies need to protrude the tongue over the gums and keep it out while pumping the tongue up and down to effectively move milk from the breast. Ties can restrict this movement and make it challenging to feed.

If your baby isn’t feeding well and you’re being told they’re lazy, ask why. That isn’t a valid reason. If you’re struggling to feed your baby, work with a baby feeding expert: the IBCLC lactation consultant. #newmom #newborncaretips #prematurityawareness #prematurity

Will peppermint drop my milk supply?

- Julie Matheney
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Peppermint is a popular flavor during the festive Christmas season, and it's often found in candies, teas, and other treats. While peppermint is generally considered safe for consumption, there is a traditional belief that it may have an impact on milk supply.

Some people claim that peppermint, particularly in the form of peppermint tea, might potentially decrease milk supply. However, scientific evidence is limited and has yet to support this as true. A 2020 study found that Menthol did suppress milk production in mice. Menthol is a chemical naturally found in peppermint and other mint plants, but it can also be made in a lab. It's essential to note that individual responses can vary, and not every breastfeeder will experience a noticeable effect on milk supply when consuming peppermint.

If you're breastfeeding, enjoy your peppermint mocha during the holiday season. Pay attention to your body's response, and if you have concerns about your milk supply, consult with an IBCLC lactation consultant for personalized advice.

I believe the REAL reason why we see supply drop at the holidays isn’t the peppermint consumption, but being off normal schedules and routines, traveling, and having the baby be passed from grandma to aunt to friend where hunger cues are being missed and feedings delayed. In general, maintaining a well-balanced diet, staying hydrated, and responding to your baby's feeding cues are crucial factors in supporting a healthy breast milk supply. Enjoying holiday treats in moderation, including those with peppermint.

High Lipase: My breast milk tastes soapy

- Julie Matheney
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Have you heard of high lipase in breast milk? Lipase is an enzyme that helps break down fat in breast milk. The breakdown of the fat in breastmilk by lipase is normal but not noticeable when the baby is feeding directly at the breast. When lipase occurs in excess, this process happens much more rapidly and can make the milk taste off or soapy after a period of time. Milk with excess lipase is safe to drink, but some babies dislike the taste and refuse it.

 

How do you know if you have high lipase?

  • Test prior to freezing – Before freezing large amounts of breast milk, you can test it for odor and taste changes due to lipase. Collect and freeze 1-2 bags or small containers of breast milk for at least 5 days and then evaluate the odor to see if your baby will drink it.

What can you do if you have high lipase?

  • Freeze milk as soon as you pump it whenever possible
  • Reduce intake of polyunsaturated fatty acids
  • Scald you’re milk prior to freezing 
  • To scald fresh milk: Heat it in a pot until tiny bubbles form around the edges of the pan (approximately 180° F) but don’t boil it. Remove the milk from the stove and allow it to cool before freezing.

Scalding fresh milk will stop the enzymes from breaking down the fat, preventing that soapy smell and taste. Scalding milk does reduce some of the beneficial components in breast milk, however, so give your infant fresh breast milk whenever possible.

To scald milk:

  • Heat milk to about 180 F (82 C), or until you see little bubbles around the edge of the pan (not to a full, rolling boil with bubbles in the middle of the milk).
  • Quickly cool and store the milk.

Scalding the milk will destroy some of the immune properties of the milk and may lower some nutrient levels, but this is not likely to be an issue unless all of the milk that baby is receiving has been heat-treated.

Per Lawrence & Lawrence, bile salt-stimulated lipase can also be destroyed by heating the milk at 144.5 F (62.5 C) for one minute (p. 205), or at 163 F (72 C) for up to 15 seconds (p. 771).

Lawrence R, Lawrence R. Breastfeeding: A Guide for the Medical Profession, 6th ed. Philadelphia, Pennsylvania: Mosby, 2005: 156-158, 203-205, 771, 781.

Lawrence RA. Storage of human milk and the influence of procedures on immunological components of human milk. Acta Paediatr Suppl. 1999 Aug;88(430):14-8.

Have a ton of freezer milk with high lipase? Some babies don’t mind the flavor and will drink it anyway. If you’re won’t, Before pitching it, consider trying the following:

  • Mix frozen milk with fresh milk to make it more appetizing to baby
  • Some moms find adding a few drops of alcohol free vanilla extract can mask the lipase flavor. 
  • Use it for a milk bath which can help with dry skin

Milk taste rancid or metallic? That's not lipase, the cause may be chemical oxidation (Mohrbacher, p. 461). Reducing intake of polyunsaturated fats may help. Certain minerals or metals in drinking water may also be to blame like copper or iron ions. When this happens, Mohrbacher has a few suggestions to try:

  • Avoid your usual drinking water (either drinking it or having milk come into contact with it) by using bottled or reverse osmosis filtered water instead
  • Avoid fish-oil and flaxseed supplements, and foods like anchovies that contain rancid fats
  • Increase antioxidant intake (including beta carotene and vitamin E like berries, spinach, beets, and beans).

Mohrbacher N. Breastfeeding Answers Made Simple. Amarillo, Texas: Hale Publishing, 2010: 460-461.

Do I need to pump overnight to maintain milk supply?

- Julie Matheney
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There is a science in how breast milk is made and maintained. The MOTN is when hormones are highest for making milk. Milk removals overnight drives a fuller supply all day long. Strong sucking at the breast overnight also plays a role in delaying periods from returning. Periods have their own cyclical impact on milk supply. The biological body is expecting to directly feed the baby. It doesn’t know we live in a modern era with pumps and freezers. When milk is not being moved, your body correctly assumes the baby is being fed by some other source and drops milk supply to protect the breast from plugs and infection. 

Tiny babies have tiny bellies that need to be fed day and night. As baby grows, so does the size of their stomach. There is no magic weight or age when a baby should stop feeding overnight. There is no scientific evidence to back that up. What we do know is the majority of breastfed babies are nursing at least once a night, if not 2-4 times, until after the first birthday. 

Producing breast milk is about demand and supply. What you move is what you’ll make. If you stop moving milk, your body thinks that milk is no longer needed, and decreases milk production. If your supply is constantly being moved, your body keeps producing more milk. While there is a science behind making milk, your body is art and your anatomy is unique to you. Some breasts have a large storage capacity and can hold more milk before seeing a drop in supply while others hold need milk moved more often to maintain supply. There are some people who can go 6-8  or even 10 hours and still maintain a full supply while others will see a drop when going more than 3-4 hours between feeding and pumping.

Feeding (or pumping) over night and milk supply are linked. If you’re making adequate milk during the day while sleeping long stretches at night, AWESOME!! If you’re going long stretches at night and day supply is dipping, that may be contributing. 

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Sudden Breast Milk Supply Drop

- Julie Matheney
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Occasionally I’ll hear of moms who had a well established milk supply and all of a sudden their supply drops. What can cause a late onset decreased milk supply?

🤰🏽Pregnancy. Milk supply drops during pregnancy because of hormone shifts to protect and grow the fetus. Domperidone or other milk making herbs/medications and more pumping or feeding will not work to increase supply

💊Hormonal birth control (pill including progestin only pill, IUD, etc)

🤱🏽Breastfeeding on only one side at a feeding or “block feeding” to correct an oversupply if done too long or with a small storage capacity

💊Some medications can decrease the milk supply (antihistamines, decongestants). Certain herbs in excess or as essential oils can, too (too much peppermint or sage)

🛌 Sleep training. Babies are supposed to wake often at night for the first 3 months and continue to frequently wake through 6 months and occasionally wake there after to feed. Night nursing keeps milk hormones high for making supply and sleep training prior to 3 months can sabotage milk supply

😷Blocked ducts/mastitis as well as any illness with a fever may decrease the milk supply

🍼Giving bottles can very much decrease the milk supply if you’re not pumping to replace those feeds. When at all possible, pump whenever baby is getting a bottle, regardless of if it is formula or breast milk being given

🎡”Overdoing it”. Anything that interrupts feeding baby on demand, including too many visitors, too many errands, or making baby wait to feed by the clock

🚿An “abundant milk supply” associated with a less than “ideal” latch. The milk flows into baby’s mouth with little participation of baby. Baby may often choke while breastfeeding, especially during a strong let down. A tongue tie is a common cause of a baby having a less than “ideal” latch and can be a significant cause of late onset decreased milk supply even there were no feeding problems early on. Baby was riding an over abundant supply instead of stimulating milk supply
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#milksupply #milksupplybooster #breastmilkbooster #breastmilksupply #breastmilkmagic

Breastsleeping

- Julie Matheney
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Let’s talk about co-sleeping and bed sharing. The recommendations from the American Academy of Pediatrics and the Safe to Sleep program for a safe sleep environment include:
💡Baby on his/her back
💡Use a firm sleep surface
💡Room-sharing without bed-sharing
💡Avoid soft bedding
💡Avoid overheating.
Additional recommendations from the AAP to reduce SIDS include:
💡Avoid exposure to smoke, alcohol, marijuana, and illicit drugs
💡Breastfeed your baby
💡Immunize
💡Use a pacifier

The Academy of Breastfeeding Medicine had a protocol for safe sleep and co-sleeping/bedsharing which is highly protective of SIDS called “breastsleeping”; baby feeds at the breast during the night. When mom and a full term, healthy baby share a firm mattress (not a couch or water bed) with no blankets or pillows that could possibly cover baby’s head or face and mom’s body forms a “C” shape around baby’s body, this position is safe and protective of baby and allows for optimal breastfeeding over night.

This allows baby to sleep on their back next to mom when not directly breastfeeding. This is for healthy babies. Babies should be unswaddled to avoid overheating and moms with long hair should be tied up. Older siblings or children should not sleep with babies under a year. Any smoking, nicotine or marijuana, is a high risk factor for SIDS.
Ever single aspect needs to be followed or it negates safe sleep.
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#cosleeping #bedsharing #safesleep
#breastsleeping #breastsleep