Category: Breast Milk Supply

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.

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

Homesick feeling while breastfeeding: DMER

- Julie Matheney

Dysphoric Milk Ejection Reflex (D-MER) During Breastfeeding

Dysphoric Milk Ejection Reflex (D-MER) is a condition that affects some breastfeeding mothers, characterized by negative emotions that occur just before or during milk letdown. Unlike postpartum depression or anxiety, D-MER is specifically linked to the physiological process of milk release. Understanding D-MER is important for providing support and effective management for affected mothers.

What is D-MER?

D-MER is a sudden and brief wave of negative emotions, such as sadness, anxiety, irritability, or even a sense of dread, that occurs just before the milk ejection reflex. These feelings typically last only a few minutes and resolve once milk flow begins.

Symptoms of D-MER

Symptoms of D-MER vary in intensity and nature but are generally negative and unpleasant. They can include:
- **Sadness or Despair**: Feeling profoundly sad or hopeless.
- **Anxiety or Panic**: Experiencing a sense of anxiety, panic, or nervousness.
- **Irritability or Anger**: Sudden feelings of irritability or anger.
- **Dread or Guilt**: A sense of dread or guilt with no apparent cause.
- **Emotional Numbness**: Feeling emotionally detached or numb.

Causes of D-MER

The exact cause of D-MER is not fully understood, but it is believed to be related to the hormonal changes that occur during breastfeeding:
- **Dopamine Regulation**: D-MER is thought to involve a rapid drop in dopamine, a neurotransmitter that helps regulate mood, which occurs to allow prolactin (the hormone responsible for milk production) to rise.
- **Hormonal Imbalance**: The sudden shift in hormone levels during milk letdown can trigger the dysphoric response.

Distinguishing D-MER from Other Conditions

D-MER is distinct from other emotional or psychological conditions like postpartum depression (PPD) or postpartum anxiety (PPA):
- **Timing**: D-MER is closely linked to the act of breastfeeding and the letdown reflex, whereas PPD and PPA are more constant and pervasive.
- **Duration**: The negative emotions in D-MER are short-lived, lasting only a few minutes during milk letdown.
- **Specificity**: D-MER symptoms are specifically triggered by breastfeeding, not by other activities or events.

Managing D-MER

While D-MER can be distressing, several strategies can help manage the condition:

1. **Education and Awareness**: Understanding that D-MER is a physiological response and not a reflection of your emotional state can provide reassurance. Knowing that it is a temporary and normal reaction can reduce anxiety about the condition.

2. **Support System**: Talk to a healthcare provider, lactation consultant, or support group about your experiences. Support from others who understand D-MER can be invaluable.

3. **Stress Reduction**: Engage in stress-reducing activities such as deep breathing exercises, meditation, or gentle physical activities like walking or yoga to help manage overall stress levels.

4. **Hydration and Nutrition**: Maintain a healthy diet and stay well-hydrated to support overall well-being and potentially mitigate some of the symptoms.

5. **Monitor and Track**: Keep a journal to track when D-MER symptoms occur, their intensity, and any possible triggers. This information can be helpful for discussing with your healthcare provider.

6. **Medications**: In some cases, medications that help regulate dopamine levels may be considered. Always discuss with a healthcare provider before starting any medication.

When to Seek Help

If D-MER symptoms are severe, persistent, or interfere significantly with your ability to breastfeed or care for your baby, it is important to seek professional help. A healthcare provider or mental health professional can offer guidance and treatment options tailored to your needs.

Conclusion

D-MER is a challenging but manageable condition that affects some breastfeeding mothers. By recognizing the symptoms, understanding the causes, and implementing effective management strategies, mothers can continue to breastfeed while minimizing the impact of D-MER. Support from healthcare professionals, lactation consultants, and peer groups can make a significant difference in navigating this experience.

Do I need to fortify my preemie’s milk

- Julie Matheney

In the delicate world of premature babies, every ounce of care and nutrition matters profoundly. For mothers of preemies who choose to breastfeed, human milk fortification emerges as a vital intervention that can significantly impact the health and development of their fragile infants.

Breast milk is undoubtedly the gold standard for infant nutrition, offering a unique blend of nutrients, antibodies, and growth factors that promote optimal growth and immunity. However, many families with preterm infants typically 31-33 weekers) may be told their breast milk isn’t nutritionally adequate and they either need to supplement baby with formula or a human milk fortifier. It’s not that your milk is inadequate, it’s that babies born early miss out on a surge of nutrient absorption that normally would have occurred during the third trimester. Preemies have higher nutrient requirements, especially for protein, minerals like calcium and phosphorus, and certain vitamins like vitamin D. They should have been getting these nutrients from your placenta which takes these nutrients from your blood and bones. A preemie’s gastrointestinal tract is also very immature, less efficient at processing nutrients and more prone to distress. Preemies who experience medical complications including infection, respiratory disorders, surgeries, and stress, experience an increase in metabolism and increased caloric demand. So babies born prematurely have multiple reasons for needing more nutrients than an otherwise healthy full-term baby. Human milk fortifiers are designed to supplement breast milk with these essential nutrients to match the specific needs of premature infants, supporting their growth and development, that they missed.

Currently there are two main types of human milk fortifier available. The first is made using cow-based protein. It comes as either a powder or liquid which get added to pumped breast milk. The second fortifier is actually made of donated human milk from other pumping mothers. The only manufacturer of human based fortifier in the US currently is Prolacta Bioscience, and is only available to hospitals. Donated milk is modified into a frozen liquid concentrate which is added to pumped milk in the NICU.

Premature infants often struggle with catching up to the growth milestones of full-term babies. Fortifying breast milk helps enhance calorie intake and nutrient absorption, aiding in weight gain and promoting more rapid growth without increasing the volume of milk intake.

Preterm infants are at increased risk of various health complications, including necrotizing enterocolitis (NEC) and developmental delays. Fortified breast milk has been shown to lower the incidence of NEC and other serious conditions by providing a more robust nutritional profile.

Adequate nutrition during the neonatal period is critical for preventing long-term health problems such as neurodevelopmental impairments and metabolic disorders. Fortifying breast milk ensures that preemies receive the essential nutrients necessary for optimal brain and organ development.

Human milk fortification enables mothers to continue breastfeeding while meeting their preemie's unique nutritional needs. This approach supports the emotional and physiological benefits of breastfeeding while addressing the challenges posed by premature birth.

How long after birth they need to be supplemented depends upon many factors, including baby’s gestational age at birth, medical condition, nutritional status, and the individual practices of the NICU team your baby worked with. It’s very common for NICU graduates to require special nutrients for weeks to months after going home. This might be as simple as adding small amounts of over-the-counter preemie formula to pumped milk, adding in a few bottles of preemie formula each day, or as complex as using specialized prescription formulas. 

Ultimately, human milk fortification represents a critical component of neonatal care for premature infants. It empowers mothers to provide the best nutrition possible for their preemies, supporting their babies' health and development during this vulnerable stage of life. Healthcare providers play a pivotal role in guiding mothers through the process of human milk fortification, offering education and support to optimize outcomes for these tiny fighters.

By recognizing the importance of fortifying breast milk for preemie babies, we can enhance the quality of care and improve the long-term health prospects of these resilient little ones. Every drop of fortified breast milk signifies a step forward in nurturing and protecting the smallest members of our communities.

The composition of breast milk undergoes significant changes to meet the evolving nutritional needs of infants as they grow. The differences between preterm (colostrum and transitional milk) and mature breast milk are particularly important for understanding how mothers can support the unique requirements of preterm babies. Here's a breakdown of these differences:

**1. Protein Content:**

   - Preterm Breast Milk: Higher in protein, specifically whey protein, which is easier for preterm infants to digest.

   - Mature Breast Milk: Lower in total protein compared to preterm milk, with a higher proportion of casein protein.

**2. Fat Composition:**

   - Preterm Breast Milk: Contains more medium-chain fatty acids and higher levels of essential fatty acids like DHA (docosahexaenoic acid) and ARA (arachidonic acid), which are crucial for brain and visual development.

   - Mature Breast Milk: Higher in long-chain fatty acids, reflecting the changing needs of the growing infant.

**3. Carbohydrates:**

   - Preterm Breast Milk: Contains higher levels of lactose and oligosaccharides, providing readily available energy for the developing preterm baby.

   - Mature Breast Milk: Still rich in lactose but with a slightly lower concentration compared to preterm milk.

**4. Minerals and Vitamins:**

   - Preterm Breast Milk: Generally higher concentrations of certain minerals like calcium, phosphorus, and zinc to support bone and overall growth.

   - Mature Breast Milk: Adequate levels of minerals and vitamins tailored to the needs of a growing infant.

**5. Immunological Factors:**

   - Preterm Breast Milk: Richer in immunoglobulins (especially secretory IgA) and other immune factors to bolster the preterm baby's immature immune system and protect against infections.

   - Mature Breast Milk: Continues to provide valuable immunological support but at levels adjusted for the older infant's immune needs.

**6. Growth Factors:**

   - Preterm Breast Milk: Higher levels of growth factors like insulin-like growth factor (IGF) to support rapid growth and development.

   - Mature Breast Milk: Contains growth factors in appropriate proportions to sustain healthy growth without promoting excessive weight gain.

**7. Micronutrients:**

   - Preterm Breast Milk: Often supplemented with higher levels of vitamins and minerals to meet the increased requirements of preterm infants.

   - Mature Breast Milk: Provides sufficient micronutrients for the needs of older infants, although additional supplementation may be necessary depending on the infant's diet.

Understanding these differences underscores the importance of tailored nutrition for preterm infants. While human milk is always beneficial, preterm breast milk offers a specialized blend of nutrients and bioactive components uniquely suited to support the growth and development of premature babies during the critical early stages of life. As preterm infants transition to mature breast milk, the composition adjusts to meet their changing nutritional demands, ensuring optimal health and development as they continue to thrive on mother's milk.

 

Exclusively pumping is like having unexpected twins

- Julie Matheney

The Double Duty of Exclusive Pumping:

🧑🏽‍🍼Time and Effort: Exclusively pumping requires significant time and dedication. You're not just feeding one baby directly; you're also spending extra hours feeding your pump. Not to mention all the set up and clean up that involves

🎛️Logistics:Managing the logistics of pumping and feeding your baby involves intricate planning and organization—keeping track of pumping schedules, milk storage, sterilization, and bottle preparation

🎢Physical and Emotional Demands: Exclusive pumping can be physically and emotionally demanding. It requires resilience and perseverance to maintain a steady milk supply while

Remember, You Are Incredible:

- Your dedication is extraordinary. Unlesss they’ve done it before, people don’t understand that exclusive pumping (or triple feeding) is like having twins. It’s not **just pumping**, it’s feeding two babies, one is just electronic

- It's okay to feel overwhelmed or exhausted at times. Stay hydrated. Make sure you have plenty of snacks. Naming your pump can help some feel more connected to the process. Find support to make sure you have a quality pump and the right size flanges as well as help with pump schedules to make sure you reach your goals

- Celebrate your achievements. Every ounce of milk pumped is a testament to your determination to reach your feeding goals

This message is a reminder of the incredible dedication and love that goes into exclusive pumping. It's important to acknowledge the challenges while also celebrating the immense strength and resilience of parents who undertake this journey

Weaning toddler from breastfeeding

- Julie Matheney

When and how you wean from breastfeeding is a personal decision, and there is no right or wrong way to go about it. Weaning a toddler from breastfeeding is a gradual process that requires patience and sensitivity.

🗝️Introduce Alternative Milk or Drinks. Start offering cow's milk or a suitable alternative if they are over 1 year old. Gradually replace breastfeeds with milk in a cup. Cow’s milk is a good source of fat and calcium, but never needed if your toddler eats a well balanced diet with other foods rich in fat and calcium

🗝️Gradually reduce the number of breastfeeding sessions. Start by dropping one feed at a time, perhaps beginning with daytime feeds before tackling bedtime or morning feeds

🗝️Don’t offer, don’t refuse. Don’t offer the breast at routine times, but it’s ok to offer it when asked. Eventually this will turn into distract, delay, and don’t sit down!

🗝️Distract and delay. Engage your toddler in other activities or offer comfort in different ways when they ask to breastfeed. Substitute breastfeeding with a favorite toy, book, or snack

🗝️Gradual Shortening of Feeds. Try shortening the duration of each feed over time. Set a timer and when it dings, it’s time to stop. Start the timer at your usual nursing length and shorten the time each day

🗝️Discuss this with your toddler! They understand more than you think. Have a discussion with them about why you’re stopping in language they can understand. This is a good chance to introduce the concept of bodily autonomy and consent. Read a book that talks about weaning, like The Booby Moon, and talk about it together

🗝️Cover your nipples and reduce access. Wearing clothing like sports bras and high neck shirts and dresses can help reduce access. For older toddlers or preschoolers, some moms will cover their nipples with bandaids and say either their nipples hurt or their boobies are broken, whichever language resonantes best with your child

🗝️Understand that weaning can be an emotional process for both you and your toddler. Offer extra cuddles, reassurance, and comfort during this transition

🗝️Be Consistent and Patient: Create a plan you feel you can carry out and stick to it. Once you establish a rule about breastfeeding, don’t change it. Especially for tantrums. If you give in, this only reinforces that your toddler just has to escalate the tantrum and you’ll give in to their demands. If you don’t want to cold turkey wean, come up with a plan with gradual steps that you fell comfortable enforcing

### Night Weaning:

- Night weaning can be a separate process. Gradually reduce nighttime feeds or comfort your toddler in other ways if they wake up seeking breastfeeding.

### Celebrate Milestones:

- Celebrate each step achieved towards weaning. Praise your toddler for being a big boy or girl and trying new ways of getting comfort.

### Seek Support:

- Talk to other moms, friends, or a healthcare professional if you need guidance or emotional support during the weaning process.

### Final Transition:

- Once breastfeeding is fully phased out, celebrate this milestone together and focus on the new ways you can bond with your toddler.

Remember, weaning is a personal journey that varies for every child and parent. The key is to approach it with love, patience, and understanding.

Fortifying breast milk for preemie baby

- Julie Matheney

Title: The Importance of Human Milk Fortification for Breastfed Preemie Babies

In the delicate world of premature babies, every ounce of care and nutrition matters profoundly. For mothers of preemies who choose to breastfeed, human milk fortification emerges as a vital intervention that can significantly impact the health and development of their fragile infants.

Breast milk is undoubtedly the gold standard for infant nutrition, offering a unique blend of nutrients, antibodies, and growth factors that promote optimal growth and immunity. However, many families with preterm infants typically 31-33 weekers) may be told their breast milk isn’t nutritionally adequate and they either need to supplement baby with formula or a human milk fortifier. It’s not that your milk is inadequate, it’s that babies born early miss out on a surge of nutrient absorption that normally would have occurred during the third trimester. Preemies have higher nutrient requirements, especially for protein, minerals like calcium and phosphorus, and certain vitamins like vitamin D. They should have been getting these nutrients from your placenta which takes these nutrients from your blood and bones. A preemie’s gastrointestinal tract is also very immature, less efficient at processing nutrients and more prone to distress. Preemies who experience medical complications including infection, respiratory disorders, surgeries, and stress, experience an increase in metabolism and increased caloric demand. So babies born prematurely have multiple reasons for needing more nutrients than an otherwise healthy full-term baby. Human milk fortifiers are designed to supplement breast milk with these essential nutrients to match the specific needs of premature infants, supporting their growth and development, that they missed.

Currently there are two main types of human milk fortifier available. The first is made using cow-based protein. It comes as either a powder or liquid which get added to pumped breast milk. The second fortifier is actually made of donated human milk from other pumping mothers. The only manufacturer of human based fortifier in the US currently is Prolacta Bioscience, and is only available to hospitals. Donated milk is modified into a frozen liquid concentrate which is added to pumped milk in the NICU.

Premature infants often struggle with catching up to the growth milestones of full-term babies. Fortifying breast milk helps enhance calorie intake and nutrient absorption, aiding in weight gain and promoting more rapid growth without increasing the volume of milk intake.

Preterm infants are at increased risk of various health complications, including necrotizing enterocolitis (NEC) and developmental delays. Fortified breast milk has been shown to lower the incidence of NEC and other serious conditions by providing a more robust nutritional profile.

Adequate nutrition during the neonatal period is critical for preventing long-term health problems such as neurodevelopmental impairments and metabolic disorders. Fortifying breast milk ensures that preemies receive the essential nutrients necessary for optimal brain and organ development.

Human milk fortification enables mothers to continue breastfeeding while meeting their preemie's unique nutritional needs. This approach supports the emotional and physiological benefits of breastfeeding while addressing the challenges posed by premature birth.

How long after birth they need to be supplemented depends upon many factors, including baby’s gestational age at birth, medical condition, nutritional status, and the individual practices of the NICU team your baby worked with. It’s very common for NICU graduates to require special nutrients for weeks to months after going home. This might be as simple as adding small amounts of over-the-counter preemie formula to pumped milk, adding in a few bottles of preemie formula each day, or as complex as using specialized prescription formulas. 

Ultimately, human milk fortification represents a critical component of neonatal care for premature infants. It empowers mothers to provide the best nutrition possible for their preemies, supporting their babies' health and development during this vulnerable stage of life. Healthcare providers play a pivotal role in guiding mothers through the process of human milk fortification, offering education and support to optimize outcomes for these tiny fighters.

By recognizing the importance of fortifying breast milk for preemie babies, we can enhance the quality of care and improve the long-term health prospects of these resilient little ones. Every drop of fortified breast milk signifies a step forward in nurturing and protecting the smallest members of our communities.

The composition of breast milk undergoes significant changes to meet the evolving nutritional needs of infants as they grow. The differences between preterm (colostrum and transitional milk) and mature breast milk are particularly important for understanding how mothers can support the unique requirements of preterm babies. Here's a breakdown of these differences:

**1. Protein Content:**

   - Preterm Breast Milk: Higher in protein, specifically whey protein, which is easier for preterm infants to digest.

   - Mature Breast Milk: Lower in total protein compared to preterm milk, with a higher proportion of casein protein.

**2. Fat Composition:**

   - Preterm Breast Milk: Contains more medium-chain fatty acids and higher levels of essential fatty acids like DHA (docosahexaenoic acid) and ARA (arachidonic acid), which are crucial for brain and visual development.

   - Mature Breast Milk: Higher in long-chain fatty acids, reflecting the changing needs of the growing infant.

**3. Carbohydrates:**

   - Preterm Breast Milk: Contains higher levels of lactose and oligosaccharides, providing readily available energy for the developing preterm baby.

   - Mature Breast Milk: Still rich in lactose but with a slightly lower concentration compared to preterm milk.

**4. Minerals and Vitamins:**

   - Preterm Breast Milk: Generally higher concentrations of certain minerals like calcium, phosphorus, and zinc to support bone and overall growth.

   - Mature Breast Milk: Adequate levels of minerals and vitamins tailored to the needs of a growing infant.

**5. Immunological Factors:**

   - Preterm Breast Milk: Richer in immunoglobulins (especially secretory IgA) and other immune factors to bolster the preterm baby's immature immune system and protect against infections.

   - Mature Breast Milk: Continues to provide valuable immunological support but at levels adjusted for the older infant's immune needs.

**6. Growth Factors:**

   - Preterm Breast Milk: Higher levels of growth factors like insulin-like growth factor (IGF) to support rapid growth and development.

   - Mature Breast Milk: Contains growth factors in appropriate proportions to sustain healthy growth without promoting excessive weight gain.

**7. Micronutrients:**

   - Preterm Breast Milk: Often supplemented with higher levels of vitamins and minerals to meet the increased requirements of preterm infants.

   - Mature Breast Milk: Provides sufficient micronutrients for the needs of older infants, although additional supplementation may be necessary depending on the infant's diet.

Understanding these differences underscores the importance of tailored nutrition for preterm infants. While human milk is always beneficial, preterm breast milk offers a specialized blend of nutrients and bioactive components uniquely suited to support the growth and development of premature babies during the critical early stages of life. As preterm infants transition to mature breast milk, the composition adjusts to meet their changing nutritional demands, ensuring optimal health and development as they continue to thrive on mother's milk.

 

High Lipase: My breast milk tastes soapy

- Julie Matheney

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.

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