Category: Breastfeeding Tips

Breastfeeding weaning

- Julie Matheney

There is no right or wrong age, it is completely up to you. Breast milk does not lose nutritional value (ever), so you get to decide how long you want to breastfeed. You also get to decide when you stop and all reasons for wanting to stop are valid. It is OK to wean for your emotional or mental well being and you do not have to justify your choices of how you feed your baby to anyone.

The age of your baby and how quickly you want to wean can play a role in how you wean.

Be prepared that some may experience mood changes and feelings of depression when weaning as your oxytocin and other hormones are dropping to stop milk production. If you need a specific plan to help you quickly wean, schedule a consultation with me to develop a plan that works for you.

Tips for gentle weaning:

✏️Start when your baby has already naturally started to wean, ex. only a quick snack before nap or waking up at 2am to pacify to sleep

✏️If transitioning from breast milk to formula, you can add formula to your breast milk bottles in slowly increasing amounts to make the transition easier on baby’s tummy (ex mix 2oz of breast milk with 1oz of prepared formula for several days, then mix 1.5oz each if breast milk and formula for a few days, then 2oz of formula with 1oz of breast milk)

✏️Don’t offer, don’t refuse

✏️Wear clothing that makes accessing the breast/chest more difficult.

✏️Distract child with favorite activities or offer alternatives like a favorite snack

✏️Change your routine

✏️Postpone: “After we play”

✏️Shortening the length of feeding or space feedings out

✏️Talk to your toddler about weaning. Older children (2 years and up) can be part of the process by talking to them about what is happening.

✏️Alternate between offering bottles and the breast

✏️Be consistent – this is a hard one but it can be even more confusing to your baby if you allow them to nurse one time and not the next.

✏️Lots of cuddles. Your breast/chest is more than just food but also a great source of comfort. Showing them you are still a source of that comfort despite not nursing is incredibly important

Ways to quickly wean:

⚓️Empty the breast only to comfort, trying not to stimulate the breast to make more milk

⚓️Breast gymnastics/“milk shakes” often to keep milk from sitting in the breast and clogging the ducts

⚓️Epsom salt soaks of the entire breast for soothing

⚓️Drinking 2-4 cups of sage or peppermint tea per day

⚓️Green cabbage leaves in the bra until they are soggy and then replacing the leaves

⚓️Cabocream (an alternative to the cabbage leaves

⚓️Cold packs on the breasts after feeding or pumping to reduce swelling

⚓️Starting on a hormone based birth control, especially The Pill (estrogen based) will drop supply

⚓️A last resort would be to take an antihistamine like Benadryl or Claritin-D as these are also notorious for dropping milk supply. This should be done with caution and under the direction of your primary care physician

True SELF-weaning by the baby before a year old is very uncommon. In fact, it is unusual for a baby to wean before 18-24 months unless something else going on (work, inefficient feeding, tongue tie, etc). A self weaning child is typically well over a year old (more commonly over 2 years) and getting most nutrition from solids, drinking well from a cup, and has been cutting back on nursing gradually.

Reasons a baby under a year may be perceived to self wean:

🔑Solids were introduced too soon

🔑Scheduled feedings/sleep training/pacifier use (all decrease time a baby would naturally want to be at the breast/chest)

🔑Lactating parent loses a lot of weight fast which can decrease milk supply

🔑Medications or hormonal birth control which will decrease supply

🔑Lactating parent is pregnant

🔑Baby taking lots of solids before one (human milk should be the primary nutrition source through one year of age)

Empty breasts make milk faster than full breasts

- Julie Matheney

FULL/EMPTY BREASTS

While it seems counterintuitive, the emptier your breasts are, the faster they make milk. A full bread has no place to store or hold the milk, so milk production slows to prevent plugged ducts and breast discomfort. Cluster feeding on an emptier breast actually tells the body to make more milk at a faster rate!! Some incorrectly assume you have to wait for the breast to “fill up” before feeding your baby or for pumping while at work. This will eventually lead to less milk, as a fuller breast tells your body baby isn’t eating very often and to slow milk production. The more frequent you empty the breast, the higher the fat content in that milk and the faster milk is made. The longer often you wait and the fuller the breast, the higher the water content in that milk and the slower your body will make milk overall.

W atch the baby, not the clock. Breasts may feel really full between feedings in the first few weeks after birth, but they’re also not supposed to stay engorged. There will come a time when they stay soft and don’t feel full between feedings or pumping, so waiting for that as a cue to feed will also sabotage your supply. Don’t be alarmed when your breasts no longer feel full between feeding. You’re entering a new stage where you’ll still make plenty of milk for your baby as long as you’re routinely emptying that milk. Trust your body. Trust your baby.

Nursing aversions and breastfeeding strikes

- Julie Matheney

NURSING AVERSION

My baby won’t take the breast and is completely refusing to eat. What do I do? I see cases like these occasionally and I feel like they’re some of my most challenging (and most rewarding) cases. If your infant under 6 months is displaying aversion to feeding, we need to figure out why. Aversion to feeding means screaming or crying when even offered the breast, taking very little from the breast, 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. A nursing strike that isn’t managed well can turn into a feeding aversion, though. The behaviors seen in baby are much more extreme for a true aversion. Here is my list of the most common culprits to a true breast aversion in order of most common cause in my experience.

👅Tongue tie/oral motor: Is there a visible tongue or lip tie? One of my biggest red flags for tongue tie is reflux and shutting down during breastfeeding (sleepy baby 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 as they’re compensating from a full milk supply. The aversion comes around 3-4 months when moms supply regulates and is dictated by the efficiency and responsibility of baby removing milk from the breast. If there is no tie, what’s the baby’s sucking pattern like? Do they have an immature or disorganized suck? How is their latch? Are they possibly taking in too much air with poor latch causing discomfort? Would a different bottle nipple shape or pacing be more appropriate? Do they struggle at the breast but take a bottle occasionally? Address the ties and do oral motor exercises to strengthen and coordinate the system and the refusal goes away.

🥛Intolerances/Allergy: This can look similar to reflux, but there is often a component of bowel issues involved as well (constipation with uncomfortable bowel movements, diarrhea, or mucousy/foamy poops). Look for patterns with formula changes- sometimes parents will say one formula works better than another, and if we look at the formula ingredients we might understand which ingredients baby is sensitive to. Babies who’s digestive tracts are uncomfortable don’t want to eat. They learn really quickly to associate feeding with pain, so they shut down on feeding. Finding the allergens clears the gut and makes feeding pleasant again.

🤮Reflux: Easiest culprit to blame and mask with medication. To be honest, putting baby on reflux meds rarely makes a difference. The medication may mask the pain but won’t actually take the reflux away. Don’t get me wrong, for some babies it can make a big difference, but let’s get to the root of the reflux. And medications should always be a last resort. Is the baby spitting up (doesn’t always happen with reflux)? Is there pain associated with the spit up? Is it projectile and frequent? Does the refusal stop once the bottle is removed or are there signs of discomfort even after the bottle is removed? Wanting small, frequent feedings is my classic tell tale of reflux. Continually swallowing helps keep acid in the stomach and reduces the pain. True reflux is usually caused by food allergy/intolerance, gut issues, or tongue tie. Address the issue, resolve the reflux.

🥵Aspiration: Milk going into the lungs instead of to the stomach. Is the baby stressed during feeding? Do their nostrils flare and their body get stiff or arch? Do the cough and choke throughout the feeding and not just during let down? Do they have noising breathing or feeding? Do you need to be super careful with position change/flow rate changes? Do they have a respiratory history (not just pneumonia- does the baby take long periods to get over any illness)? Further assessment by a speech pathologist is always needed.

🤯Behavioral: I’m not sure if “behavioral” is the correct word, but it’s the best way to describe it. The number one concern of parents is feeding the baby. When feeding isn’t going well, it causes extreme stress, which can cause us as 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 (or not being able to figure out the why in the first place). Occasionally the reason for the refusal is not longer there, but it was so stressful in the moment, the panic that it could happen again sets in and perpetuates the problem unnecessarily. 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. Are you just trying to push past baby’s stress signs due to your own stress with trying to get baby fed? Are you just trying a bunch of different things to see what works? Are you trying to feed based off of old information? You are just trying to do your best and are scared for baby, but sometimes the compensatory things we do can cause more problems or cause it to persist. Having an outside observer come in to help see what’s going on can help bring everyone back to baseline.

When trying to figure out which of these culprits is the cause of the aversion, know that you don’t have to figure it out alone. Finding a trained lactation consultant (🙋🏽‍♀️) can help ask the right questions to get to the root of the issue and get feeding back on track.

The Second Night

- Julie Matheney

Second Night Syndrome : What absolutely every parent should be warned about in pregnancy.

Second night syndrome. I hate the word syndrome. It implies something is wrong. For nine months your baby has been in your belly. Heard your voice. Felt your body move. Listened to the rush of your blood flow past and heard the gurgle of food digesting. Their existence controlled by the cycles of your body. Then the intensity of labor and delivery propels them into a new world that sounds, smells, and moves differently. The sheer exertion of being born often makes babies as tired as their mothers. It is typical for babies to have a deep recovery sleep about 2 hours after birth (after their 1st breastfeed).

On the second night, however, most babies will want to frequently nurse. This helps with two transitions: meconium to soft, seedy yellow poops and colostrum to mature milk. This cluster feeding catches many parents by surprise and leaves them wondering if baby is starving. Unless baby is not latched well or efficiently feeding, this is normal and the cluster feeding will help transition your milk.

Many babies, though, don’t want to be put down during this process. Each time you put them on the breast they nurses for a little bit, go back to sleep and then cry when placed in the crib. A lot of moms are convinced it is because their milk isn’t “in” yet, and baby is starving. It isn’t that, baby’s awareness that the most comforting place is at the breast. It’s the closest to “home”. This is pretty universal among babies. When baby drifts off to sleep at the breast after a good feed, break the suction and take your nipple gently out of their mouth.

This is also protective of SIDS. You’re exhausted from labor and delivery and just want to sleep. But night time is when newborns are most vulnerable to respiratory complications and SIDS. By waking you frequently at night, you are waking frequently to check on the well being of your baby when they’re at their greatest risk of infant death. Waking regularly at night for the first few months to feed also helps babies from getting into too deep of a sleep state which can cause them to stop breathing. Instead of seeing the loss of sleep as a negative for you, consider the positive reason it has for baby.

Don’t try to burp baby, just snuggle baby until they fall into a deep sleep where they won’t be disturbed by being moved. Babies go into a light sleep state (REM) first, and then cycle in and out of REM and deep sleep about every ½ hour or so. If they start to root and act as though they want to go back to breast, that’s fine… this is their way of comforting. During deep sleep, baby’s breathing is very quiet and regular, and there is no movement beneath the eyelids. That is the time to put them down.

Second night syndrome. As described above, when all is going well it is normal for baby’s to cluster feed on the second night to help milk transition and poop out meconium. Some babies do not efficiently feed, though, and intervention may be necessary.

🩺Medical interventions and pain relief during labor and delivery, maternal health complications like PCOS, uncontrolled diabetes or hypothyroidism, or large blood loss during delivery may delay the transition of your milk.

🧸If your baby not latched well, has a tongue tie, or hasn’t figured out how to coordinate sucking to actually transfer milk from the breast, intervention may also be necessary.

🖐🏽The first line of defense is hand expressing your milk frequently. Hands are better at expressing colostrum than a pump, although a pump is a great way to stimulate milk to be made.

🥄Dripping your milk into baby’s mouth from a spoon or small syringe can help jump start the feeding process.

❓If you have any doubt about either your milk supply or your baby’s ability to breastfeed well, reach out to a qualified IBCLC ASAP to get to the root issue and get you back on track.

♥️There is no shame in supplementing your baby if needed during this time of learning. Remember, you can always use your milk first by using your hands or a pump if baby hasn’t figured it out yet.

Paced bottle feeding

- Julie Matheney

Paced bottle feeding (meaning you’re setting the pace for how fast/slow baby drinks) helps prevent over feeding baby: it takes 20 minutes for the stomach to tell the brain that it’s full. If a baby takes a bottle too quickly, the mouth can still be “hungry” and wanting to suck when the stomach is actually full. Like going to an all you can eat buffet and eating a lot of food quickly and then realizing half hour later you ate way too much. A baby that happily sucks down too much milk from a bottle can make you think you don’t have enough breast milk even if you make a normal amount. It can also make baby frustrated by the flow of milk from the breast and inadvertently sabotage breastfeeding

These pictures are the same baby in two different positions for paced feeding: semi upright and side lying. Side lying is my favorite position to use as it puts baby in the same position as breastfeeding. Many parents feel baby is more supported in this position. Baby is supported by your leg or breastfeeding pillow.

Tips:

🍼Never feed baby on their back

🍼Keep the bottle parallel with the floor with about half the nipple filled with milk

🍼Use the slowest flow nipple baby will tolerate

🍼Rub the nipple gently on baby’s lips, allow baby to latch at their own pace, don’t force it into their mouth

🍼It should take 15-20 minutes to finish the bottle

🍼Watch the baby and not the bottle, stop when they show signs of being full

🍼Resist the urge to finish the bottle, even if there is only a little left, when baby is showing signs their tummy is full

🍼Take short breaks to burp and give the tummy time to fill naturally

🍼If baby is gulping or chugging, slow down

🍼If baby has taken a good volume of milk (2-4oz) in a short amount of time and is still acting hungry, offer a pacifier for a few minutes to help them digest and give the tummy to to tell the brain it’s full. If they’re still hungry, slowly offer more in 1/2oz increments

Yoga Increases Breast Milk

- Julie Matheney

A study in 2011 by Caldwell & Maffei found that mothers who did yoga six consecutive days in a row boosted their breast milk supply by an average of 3.5 ounces per breastfeeding. They studied 30 mothers who had babies 1-6 months old and found the increase in milk supply across the board. They hypothesize that this happens because Yoga can affect the mind, soul and spirit of the mothers, in which Yoga gives peace of mind, relaxation and a sense of comfort as well as increasing mothers’ confidence. This in turn affects the release of prolactin and oxytocin hormones for optimal breast milk production. Yoga promoted increased blood flow to the muscles around the breast, strengthening the muscles of respiration, stimulating the hormonal glands associated with milk supply and release, and relaxation with increased self-awareness. Yet another way our bodies are magical and when we include self care into our routine, not only do we benefit, but so does our milk supply.

Forever milk

- Julie Matheney

Did you know that you will ALWAYS be able to make milk? You’ve had the milk making glands in your breasts since puberty. They’re like little empty clusters of balloons at the back of the breast. Pregnancy activates your milk making hormones, allowing the glands to expand and start filling with milk between 16-20 weeks gestation. In the early days after birth, the more stimulation the breast has (from feeding or pumping), the more the milk making glands and their corresponding hormone receptors multiply. The milk balloons fill and empty milk multiple times per feeding.

After at least 40 days of not expressing any milk, once you completely wean, your milk making balloons deflate and become dormant, like before pregnancy. But they aren’t dead. Pregnancy and breastfeeding hormones caused a permanent change in your body. Your milk making glands will FOREVER remember how to make milk. They can ALWAYS make milk again, no matter how long it has been. They just need enough of the right stimulation to turn on and start filling again. Some times years after breastfeeding a mother may feel the tingle of let down if she hears a baby cry. Or she may leak if her partner does enough nipple stimulation. There are grandmothers in other cultures who bring back milk to breastfeed their grandchildren! Our bodies are AMAZING!! Now you know!

Nipple shields

- Julie Matheney

Not all nipple shields are created equal. Nipple shields are a great tool that can be used to help baby latch and stay latched, help you heal from nipple damage or trauma, or transition baby back to breast from using a bottle. Nipple shields are a great tool and can be used as long as needed. There are risks to long term use, the biggest one is a decrease in milk supply if baby isn’t able to trigger let downs or remove milk efficiently. If you weren’t given a plan for transitioning off the shield, a qualified lactation consultant can help!