Complementary Foods

- Julie Matheney

Breast milk or formula should be the primary source of nutrition for babies under 1 year old. The first foods we introduce to our babies are often called “complementary foods” because the idea is to introduce foods that complement breast milk/formula, not to simply replace milk.

Introducing solid/table/first foods should start when babys mouth and gut are ready to tolerate digesting them. Baby’s tongue thrust reflex should have disappeared, baby should be able to sit unsupported for at least the length of a meal, and baby should be using a pincher grasp to be able to bring their own food to their own mouth. This usually happens around 6 months, although for some it’s a little younger and others a little older. Food choices should be about exposing baby to a full palate of flavors and a wide variety of textures that add to baby’s feeding experience without taking away the nutrients and energy found in milk. The goal of complementary feeding is NOT to try to fill baby up with as much food as possible to cut back on giving breast milk or formula. It’s about baby gradually increasing the amount of foods eaten from your family’s unique diet across multiple months.

Cooked sweet potatoes, mashed avocado or banana, purée canned pears or peaches, and cooked carrots are wonderful first foods and simple to make. Next offer foods from your family table first (in the appropriate purée or cooked and cut form). Your baby has already been exposed to what you eat on a daily basis through your milk and they’ll have a higher likelihood of preferring those foods. Many foods marketed for babies, like rice cereal or oats, don’t actually add any nutritional value to baby’s diet. Read jarred food labels carefully for preservatives and sugar. There’s also a risk of filling your baby up with low calorie jarred foods which then decreases the amount of nutrient dense milk they will want to drink.

Remember: just as every family eats different foods and has their own unique way of doing meals, so does every tiny human. If you’re concerned about your littles eating habits, request feeding therapy with an occupational therapist at your next pediatrician appointment.

Remember:
⭐️ The World Health Organization recommends breastfeeding until 2 years of age
⭐️ Breast milk never loses its nutritional value and is good for children at any age
⭐️ From 7-9 months babies need about 250 calories from food a day
⭐️ From 10-12 months babies need around 450 calories from food a day

Should I wake up to pump if baby sleeps longer at night?

- Julie Matheney

💤 Prolactin, the major milk making hormone, is rises when we sleep, so it is naturally higher at night. Prolactin rises about 90 minutes after sleep begins and peaks around 4-5 hours later and stays high for about 2 hours after waking up. This helps you make more milk throughout the rest of the day

🛌 For most, milk removal in the middle of the night is essential for maintaining milk supply. If your exclusively breastfed baby under 12 months is waking at night, most likely they want to feed. If your baby is naturally sleeping longer on their own (with no sleep training or sleep devices to help baby sleep longer), they are telling you they are getting enough milk from you at other times to not need milk at night for growth.

Breast storage capacity has a LOT to do with whether or not you need to wake up to pump. If you have a large breast storage capacity you may be able to go longer between pump or feedings without dropping supply or feeling uncomfortable. You may be able to get a 4, 5, or even 6 hour stretch of sleep and not see your supply drop. Baby also has more milk available at other feedings and may take very large, less often feedings.

Those with low supply, small breast storage capacity, or baby struggling to feed efficiently may need to take advantage of higher night time prolactin levels made during REM. Even if you feel like you have a healthy supply in the first 4-6 weeks, a sudden drop in supply can happen if insufficient milk removals start too early into your breastfeeding journey when supply regulates around 3 months.

If you’re not sure what your storage capacity is, if baby is sleeping longer and you’re waking up engorged, or you’re waking up and pumping and then baby wants to feed and you have now pumped that milk, there are Lots of options:


✏️ Dream feed. If you’re waking up engorged and baby is still sleeping, some times you can sneak in a dream feed to relieve the breast and help baby sleep even longer. Bring sleeping baby to the breast to root and usually they will latch and feed while still sleeping. Lay them back down when you’re done. Don’t burp or change diapers as this will wake them up.
✏️ Pump 30-45 minutes after your last breastfeeding ends when you anticipate baby to take a longer sleep stretch. This will help you go a little longer before the next feeding without getting as engorged, seeing as drastic a supply dio, or pumping too close to the next feeding.
✏️ Pump when you feel uncomfortable but only pump enough to feel comfortable and not to empty the breast. If baby wakes up, you can always offer the breast and top off with what you pumped if they’re still hungry
✏️ Do nothing. If your baby is naturally sleeping longer at night on their own with no sleep training, your body will naturally regulate your supply.
✏️ If you are sleep training baby or using something like the Snoo to help baby sleep longer, you may need to still get up every few hours over night to maintain your milk supply.

Sleep Like A Baby

- Julie Matheney

BREASTFEEDING FACT: No one sleeps all night
The reality is, no one, including adults, sleeps all night all the time. Older infants and toddlers are no exception. They often wake multiple times a night, but as they mature, they learn to put themselves back to sleep. We all go through multiple sleep cycles in a night, and toddlers actually go through more of these sleep cycles than we do. Which means they have more opportunity to get woken up from a light sleep.

Generally, there are 2 sleep stages in newborn babies and 4 sleep stages in babies over 3 months old. Newborn sleep stages are rapid eye movement (REM) and non-rapid eye movement (NREM). Newborns spend close to equal amounts of time in REM and NREM while they sleep.

REM is an active sleep state and NREM is a quiet sleep state. During REM, a baby can be seen making small movements. The baby’s eyes move around (while closed), their arms, legs and fingers might twitch or jerk, their breathing might speed up, and they may move their mouths. During NREM, the baby is still and doesn’t move. Around 3 months, babies begin experiencing the same sleep stages as adults.

Adults go through 4 sleep stages. These sleep stages include three stages of NREM sleep (which happen first at night) and one of REM (which happens last). The first two are lighter stages of sleep, during which a person can be easily awakened. The third stage of sleep is the deepest stage, and it is very difficult to wake someone in this stage. The fourth is REM, where dreams happen. Although babies begin experiencing 4 stages of sleep around 3 months, it is not until closer to 5-years-old that children’s sleep actually begins to mirror that of adults. As babies, they experience a short REM stage almost immediately after falling asleep instead of last in the cycle. In contrast, adults do not experience REM until they have been asleep for around 90 minutes. As a baby’s sleep schedule changes, so do their sleep cycles. Baby REM sleep is one part of the sleep cycle that changes over time. However, there is no simple chart outlining sleep cycle length or REM by age. Know that it is normal for your baby and toddler to wake frequently at night, and as they age, they will get better and better at putting themselves back to sleep.

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sleeplikeababy #sleeplike #babysleeping #babysleep #babysleeptips #breastsleeping #nightnursing #nightbreastfeeding

Antidepressants and breastfeeding

- Julie Matheney

Put your oxygen mask on first. When there is an emergency on a plane, we are instructed to put our mask on first before helping others. This is also critical when caring for our children. Stress, depression, and anxiety can play major roles in how we care for our babies and for ourselves. Antidepressants are OK to take while breastfeeding. When maternal mental illness is not addressed, research shows this not only has a negative impact on the mother’s overall health, but can impact the baby as well.

The risks of not addressing maternal mental health include:
✏️Poor infant growth, language and cognitive development
✏️Poor gross and fine motor development
✏️Less efficient breastfeeding or weaning from breastfeeding earlier than desired
✏️Poor infant sleep and increased maternal stress.

When considering antidepressant use during lactation, while most medications are considered safe for mom and baby, there is no “zero risk” option. However, the benefits of using a medication to help decrease depression and anxiety usually outweigh the risks acostares with taking a medication. If a mother has been on a certain med prior to breastfeeding and it worked well for her, it would be reasonable to resume that medication while breastfeeding. Sertraline (Zoloft) is a first-line drug for breastfeeding, due to documented low levels of exposure in breastfeeding babies and the very low number of adverse events described in case reports. Prozac is generally considered safe to take while breastfeeding; however, research shows that the average amount of the drug in breastmilk is higher than with other SSRIs.

When taking any medication, you want to monitor for side effects both in you and the baby. Most common side effects when taking antidepressants are:
🥛 Changes in milk supply
🛌 Sedation/sleepiness in baby
Poor feeding or weight gain in baby

Antidepressants can work well to help you feel balanced again. Work closely with an IBCLC while starting antidepressants to help continue and feel supported in your breastfeeding journey

Is your baby’s tongue tie a tetherberg or a tether floe?

- Julie Matheney

There are two kinds of ice in the ocean: icebergs and ice floes. Both can look identical on the surface, but are completely distinct below the water. Icebergs have a portion of ice seen above the surface, and huge, extensive mountains of ice below the surface, anchoring what you can see above to the masses below. Ice floes are seen from above and are basically a sheet of floating ice.

Tongue ties can also be classified into two types: tetherbergs and tether floes.

Tetherbergs are tongue ties that look tied on the surface, but the breastfeeding issues and symptoms are connected to so much more than just the tongue. Baby usually has lots of tension in the body. There may be a sensitive nervous system. A traumatic birth. Baby may live in a state of fight or flight. There may be other asymmetries or structural differences in the body. There’s so much more below the surface than meets the eye. For these babies, doing a revision of the tie is literally only the tip of the ice berg. They usually need lots of pre and post release manual therapy such as chiropractic or craniosacral therapy, occupational therapy, and suck training. It may be weeks to months before what is below the surface is fully addressed.

Tether floes are the babies I dream of in my practice. The tongue tie is the root cause of the breastfeeding problems and symptoms. A simple release is an overnight, miracle cure to nipple pain and damage, weight gain, milk supply or reflux. These babies usually need minimal additional interventions to restore the breastfeeding relationship and have all of their symptoms melt away.

Being aware of the tetherbergs vs the tether floes is the beginning to understanding your journey with a tied baby. Many families have their baby’s tie revised only to find they still have persistent symptoms. For them, the mass of ice below the surface must still be addressed before relief is gained. If you’re in the middle of your journey, keep going. Keep asking questions. Keep finding the highly trained health care providers who specialize in ties who can help.

For more information, see the original post by Michele Chatham

https://www.michalechatham.com/blog/tether-berg-or-tether-floe?fbclid=IwAR0q5o8NP_iwFkA5XijLMymDPyxcsLwvTq3cS8V4kxyRZ1jOjk3x8g5sdZE

Breastfeeding is a medical and Heath issue. It should be treated as such

- Julie Matheney

Breastfeeding issues are medical problems. I wish health care providers would understand this. When a parent wants to breast/chestfeed, but is running into challenges, those challenges need to be taken seriously, just as if they were complaining about any other health or medical issue.

Feeding your baby from your body should not be painful. Our bodies are designed to feed our babies, so when there is pain there is always a reason. Pain tells us that something needs fixed. It may be as simple as the position and latch or as complex as a tongue tie. At no point should healthcare providers accept tissue damage as normal. If they are telling you it’s fine and part of the process, please get a second opinion.

When everything is going well, our bodies are designed to provide plenty of milk for our babies. If you are not making enough milk for your baby while seemingly doing all the right things, we should find the root (IGT? Wrong pump flange? Not pumping enough? Medications? Hemorrhage at birth?).

Baby unable to latch? Popping on and off? Babies are born to feed. All of their reflexes and instincts are designed to get them to latch and feed. If baby is struggling at the breast, there is always a reason. Rarely will we not find the root if we dig deep and long enough.

When there is pain, damage, low milk supply or a non-latching baby, interventions are often needed. These are medical interventions that should be overseen by an IBCLC who has lactation specific training to make sure the correct tool for the correct cause of the issue is being used. And getting the best, most accurate information for that individual family. If a family chooses not to breastfeed because of these issues, that is their choice and should be supported to the fullest. If your health care providers are not taking your concerns seriously, find another health care provider

Human milk fat

- Julie Matheney


The fat in your milk accounts for 50% of the calories your baby takes in each feeding. While protein and lactose remain relatively stable throughout the day, milk fat concentration can vary by 47% in a 24 hour period!

Factors that influence milk fat in breast milk:
🤱🏽 In the lactation parent (some of these you can change and control and some of these you can’t):
Lifestyle
Diet
Body size
Health or disease/inflammation
Number of children
Type of birth
Overall milk volume produced daily

👶🏼 In the baby (the lactating parents body responds to make specific milk to accommodate the baby):
Gender
Gestational age
Birth weight

🍫 Other factors that influence fat in human milk:
⏰ Time of day (highest fat is in the afternoon/evening)
👶🏼 👧🏽 Stage of lactation (colostrum has the lowest amount of fat. Extended milk for toddlers 12+ months has the highest amount of fat!)
🗓 Time postpartum (milk fat increases with time!) mm
Ways to help increase milk fat:
🤱🏽 Feed more frequently. An emptier breast has higher fat and lower water concentrations. Pump
⭐️ Shake your breasts prior to feeding. This gets the fat at the back of the breast to be activated more quickly to flow sooner in the feeding
🐠 Add in healthy fats to your diet: salmon, herring, sardines, flax and chia seeds, and walnuts are high in healthy fats that can boost your milk fat.
🍦 Manage diabetes/blood sugars
🏋🏽‍♀️ Make sure you’re not anemic or iron deficient
♨️Reduce inflammation in the body (can often be done with diet and lifestyle changes and/or with the help of a naturopathic practitioner)

Fluid dynamics

- Julie Matheney

Milk is a liquid. And it obviously flows like a liquid. Have you ever sprayed your baby in the face from milk that flows too fast during let down? Have you ever been concerned with how fast or slow your milk seems to flow in any given feeding or pump session?

Did you know the breast is like a tree inside? With lots of lobes at the back of the breast that funnel down through milk ducts to fewer nipple pores at the front? The flow of your milk is impacted by multiple things. One of the biggest things to impact how your milk flows is your unique breast anatomy.

🌳Everyone has a different number of milk making lobes, also known as alveoli. These lobes are connected to your blood steam, because milk is made from nutrients in your blood. Oxytocin triggers contractions of the lobes to release milk down your milk ducts

🌴The length and diameter of the ducts play a role in how quickly milk goes from where it is made to the baby.

🌲The viscosity, or thickness, of your milk can slow down or speed up milk flow. This viscosity can change from feeding to feeding depending on many factors. Many will take sunflower lethicin to thin their milk (keep the fat from sticking) to help speed up milk flow and reduce the risk of the milk fat sticking in the ducts and causing plugged ducts

🎄How dense or elastic your breast tissue is contributes to flow rate.

Your body and your anatomy is unique. Milk production or how milk is made in the breast is not the same for every person. If you’re struggling with making or releasing milk to your baby, schedule a consultation to figure out why and develop an individualized plan that works for your anatomy.

COLORS OF MILK

- Julie Matheney

Your milk can be a variety of colors which can be caused by a variety of things.

💛Diets high in yellow-orange vegetables (yams, squash, carrots, etc) can lead to high levels of carotene in your milk, which can turn it yellow or orange.

💛Frozen milk may look more yellowish when thawed.

🧡Food dyes used in carbonated sodas, fruit drinks, and gelatin desserts have been associated with milk that is pink or pinkish orange.

💙Blueish milk is often just a higher water content in the milk. It could also be caused by food dyes.

💚Greenish milk has been linked to consuming green sports beverages, seaweed, certain herbs, or large amounts of green vegetables (such as kale or spinach). I had mine turn green from a plant based multivitamin!!

💗Pink milk, some times called “strawberry milk” be a sign of blood in your milk. This can occur with or without cracked nipples. Seeing blood in your milk may be alarming at first, but it is not harmful to babies. If you have any concerns or other symptoms associated, such as pain or mastitis, set up a lactation consultation right away.

💔Occasionally blood in breastmilk is caused by things other than nipple or breast trauma. Papillomas are small growths in the milk ducts which are not harmful but can cause blood to enter your milk. In the vast majority of cases, blood in human milk is not a concern. However, some forms of breast cancer can cause blood to leak from the nipples. Breast milk can also turn pink if a bacteria called Serratia marcescens is present, although rare this bacteria can be extremely harmful to young babies. If you’re experiencing pink milk without noticeable nipple damage, please reach out to a health care provider immediately.

🤎Brown milk may be caused by what is known as rusty pipe syndrome. During pregnancy and in the first few days after birth the ducts and milk making cells in your breasts grow and stretch. As blood flows to your breasts it can sometimes leak into your milk ducts, making your milk look brown or rust-colored. It usually clears within a few days as more milk flows through your breasts. Continue feeding your baby your milk.

FIL: How breast milk is actually made

- Julie Matheney

Milk production is controlled by how often milk is being emptied from the breast. An empty breast makes milk faster than a full breast. The more you empty, the more you make. This is because milk production is being controlled in the breast by a substance called the feedback inhibitor of lactation, or FIL (a polypeptide), which is present in the milk itself. Sometimes one breast stops making milk while the other breast continues (in some cases of slacker boob), for example if a baby nurses on only one side. This is because of the local control of milk production independently within each breast. If milk is not removed, the FIL builds up in the milk and stops the cells from making any more milk. This protects the breast from things like clogged ducts and mastitis. If breast milk is emptied from the breast, the inhibitor is also removed, and making milk resumes. Milk removal can be done by the baby or a pump
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The amount of milk that is produced is determined by the amount of FIL in the milk, which is driven by how much and how often the baby or a pump removes milk from the breast. Emptier breasts have less FIL and make milk faster. Full breasts have more FIL and make milk slower. This mechanism is especially important for continuing to make milk after 11-14 weeks when hormones shift and milk making is completely determined by how much milk is being emptied from the breast.