Complementary Foods

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

Sleep Like A Baby

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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Antidepressants and breastfeeding

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

Human milk fat


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)

COLORS OF MILK

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.

Vasospasm: pins and needles in the nipple

Has your nipple looked waxy or dull white after feeding or pumping? That’s because the blood vessels have gone into spasm and are not letting blood through. Vasospasm occurs when there is exposure to cold, an abrupt temperature drop, vibration, or repetitive motion in the affected area. The arteries go into spasm and stop letting blood through. There is a disorder called Reynauds that make peoples experience this in their fingers and toes on a more routine basis. When it happens in the nipple it really HURTS. Some say it feels like fire or ice. Others describe it as a pinchy, slicing feeling, or pins and needles. The nipple often turns pale and become painful right after the baby unlatches. It often gets misdiagnosed as thrush but will not respond to medications. So if you’ve been on multiple rounds of medications for thrush and it’s not working, you may actually be having vasospasm.

It can simply be caused by a bad latch, but can have several other culprits. For people prone to vasospasm, the repetitive action of feeding or pumping in combination with the abrupt drop in temperature when baby unlatches or the pump stops is enough to trigger the spasm.

The two main ways to help: massage and heat.

🤲🏼Gently massaging, rubbing, or pinching the nipple helps. Immediately cover your nipples with your shirt/bra/nursing pad, then gently rub or massage them through the fabric.

🌞Heat is important because of science: evaporation is a cooling process. When liquid turns to gas, it uses heat energy from its surroundings to transition. When milk and saliva evaporate off your nipple, the skin and surface tissue cool rapidly, causing the vasospasm.

🌞To slow evaporation, place heat on your nipple as soon as baby unlatches. Use dry heat like a lavender pillow, microwaveable rice/barley/flax pack, hand warmer/Hot Hands (like you use in snowy climates for skiing), or a heating pad can help. Leave heat on for a few minutes until the pain subsides.
🌚Avoid anything wet on the nipple as this promotes evaporation.
🌝Wear wool nursing pads between feedings

Unfortunately, there isn’t a lot of good quality research about treating breastfeeding nipple vasospasm no. Much of what we know is taken from other vasospasm research, or applied from anecdotal evidence. You should always consult your primary health care provider before making any changes to your health, such as adding a supplement, taking medications, or making big lifestyle changes. At a basic level:
🌻Watch for a deep latch every time
🌻Have baby assessed for tongue tie
🌻Check your flange size. If you’re maxing our the suction on the pump, your flange is too big. When too much areola is drawn into the tunnel, the areola swells shut around the nipple and causes the spasm. Using too small a flange does the same: cuts off blood flow to the nipple tip.

Other tips to reducing vasospasm:
🌸Avoid nicotine and medications that cause vasoconstriction (such as pseudoephedrine, beta blockers).
🌸Limit or avoid caffeine
🌸Some research indicates hormonal birth control pills increase the risk of vasospasm.
🌸The main supplement that seems to help with vasospasm is vitamin B6. Dr Jack Newman suggests 100 mg of B6 twice day, as part of a B vitamin complex. If your B vitamin contains 50 mg of B6, you’d take two of them, twice a day. If it contains 25 mg of B6, you’d take four of them twice a day.
🌸Calcium plays an important role in blood vessel dilation. Magnesium helps in calcium regulation. Supplementing with cal/mag often helps with vasospasm.
🌸Being active helps prevent their vasospasm. An active lifestyle can keeps blood circulating through your body.
🌸The internet is full of conflicting opinions on if ibuprofen is a vasoconstrictor or vasodilator. Regardless, it sometimes turns up to treat/prevent vasospasm. If you have regular vasospasm, the risks of longterm ibuprofen use most likely outweigh the potential decrease in vasospasm. It may be OK for occasional vasospasm. Discuss regular ibuprofen use with a healthcare provider.
🌸For chronic, painful vasospasm that does not respond to breast-feeding help, some doctors may prescribe a short course of a blood medication called Nifedipine.

Lip Tie vs Normal Lip Frenulum: An SLP/IBCLC Perspective

Lip ties (and their pictures on social media) drive me clinically nuts, because is so much confusion and misinformation about who actually has one. Too often medical professionals and lactation consultants say:

“All babies have lip ties”
“All babies have a band under there, there’s no such thing as a lip tie”
“That tissue will stretch with time/migrate up as they get older”
“They’ll eventually fall and break it on their own. No need to intervene”
“It doesn’t cause any problems, so just leave it alone”

On the flip side, some providers (and other random parents on social media forums) will say:

“See how the band of tissue is really low on the gums? That’s a lip tie”
“See how thick that band is? That lip is definitely tied”
“Lip ties are causing of all your nursing issues, cut it ASAP”
“Lip ties will cause all kinds of issues in the future, even if you don’t have symptoms now, better to cut it sooner rather than later”
“Where there’s a lip tie, there’s a tongue tie, your baby must be tied if they have any symptoms if a frenulum is visible”

Lip tie

I am the first to refer to the appropriate health care provider (ENT or pediatric dentist) when a true lip tie is not allowing proper function of the lips and is impacting the success of digestion or breastfeeding. But let’s understand a few things:

✏️According to a 1994 study by Flinck, who looked at >1000 babies, 77% of them had a frenulum that inserted “low” on to the gumline. A further 17% had a frenulum that inserted into the palate. So 94% of babies have a really low gum insertion – that is NOT the definition of a lip tie. Having a low set frenulum cannot be the only criteria used for release.

✏️There is currently no published criteria defining a normal frenulum vs a lip tie. That does not mean a lip shouldn’t be addressed when function is being impacted by anatomy. But that band between lip and gums is supposed to be there to some extent to help anchor your lips to your face for proper movement and facial development.

✏️Lip tie, when it is present, can certainly get in the way of a normal latch. A lip tie may cause increased air intake (contributing to reflux and gas), breast pain from the lips gripping too tightly to the breast, contribute to lip blisters muscle compensations, or not allow the baby to be able to maintain the latch through the whole feeding. While the lips are important for feeding, I’m more concerned about the tongue for obtaining a normal latch. Many compensations baby does to overcome a tongue tie may be mimicking issues seen with lip tie. Baby needs assessed for both.

✏️ It is rare for there to only be a lip tie. In the vast majority of cases, where there is a true lip tie there is also a tongue tie. The tongue is usually the reason for the symptoms as the tongue plays the major active role in breastfeeding. If the lip tie is released and symptoms persist, it is worth further evaluation of the tongue. I have had a few cases where a lip tie release only has resolved the breastfeeding issue, usually areola pain or popping on and off the breast from not being able to make a tight seal with the lips.

No lip tie

True diagnosis of lip tie is all about anatomy (what does it look like), physiology (what does it do), and symptoms (what is it causing). A lip tie will always impact function of the lip by restricting its expected movement. The upper lip should be soft and move to spread and pucker the lips without difficulty. The upper lip should play a passive role when breastfeeding, gently rounding to maintain the seal at the breast so milk doesn’t leak out and not gripping the breast.

An evaluation by an IBCLC should be mandatory before any baby is sent for oral surgery. Are the symptoms and behaviors at the breast being caused by poor position and latch? By tension in the body from birth trauma? Is tongue tie the actual culprit to the issues going on?

👄 The movement of the lip must be physically challenged to determine its full range of motion. If the lip is lifted up toward the nose, the center of the lip should move up toward the nose with the rest of the lip. If the center of the lip stays down against the gum line, it is most likely a tie. If no one physically flipped the lip up toward the nose, lip tie was not assessed.

👄 When you lift the lip, if the gums where the frenulum inserts turns white (blanches) OR the lip skin/frenulum turns white (blanches ) when you lift the lip up with reasonable amounts of pressure, the lip is tied.

👄 A notch in the bone of the gums where the frenulum attaches means the lip is tied. It indicates the tissue is so tight it’s now impacting the bone. This kind of lip tie needs immediately assessed and addressed as it most likely will impact dentition and dental hygiene.

👄 My baby has lip blisters. Does that mean they have a lip tie? Not necessarily. They may have a tongue tie and the lips are compensating for it. They may be constantly in a shallow latch at the breast or bottle and be using their lips to hang on. Lip blisters are a sign of shallow or dysfunctional latch and feeding should be observed to maximize latch.

👄 My baby always tucks their upper lip when nursing. Does that mean they have a lip tie? If the lip is still soft and can easily be flanges out, no, it’s not tied. Some babies like to tuck the upper lip or it gets accidentally tucked when latching and it’s not a problem. Tucking the upper lip can also happen when the tongue is tied- if the tongue can’t hold the seal (which is its job), then the lips have to. If the lips hold the seal, the lips have to be tucked in or milk will leak.

👄 The upper lip frenulum is one that can stretch and migrate up with time. As more teeth come in, the teeth may naturally help close the gap caused by some frenulum. If that is normal, why should it be released? An upper lip frenulum can migrate up over years, but if the restriction of the lip is affecting baby and mom NOW, then it should be treated NOW. Nipple pain and damage may have been normalized by the general public, but that does not mean it is normal. If you’re having symptoms associated with lip tie, have the lip and tongue assessed by someone who can properly evaluate and manage it.

A lot of emphasis is being put on lip ties right now, especially by well meaning parents on social media. Remember: you usually cannot tell if a lip is tied from a picture alone. A full, dynamic assessment is needed. If a health care provider looked at the lip without actually completing a full inner mouth assessment in the lips, cheeks and tongue, and observing a feeding, a full assessment wasn’t made. While a lip tie alone can get in the way of feeding and cause some pretty intense symptoms in some babies, the main focus should be on good position and deep latch with normal tongue mobility.

Normal frenulum. No blanching and lip flips without difficulty

If you’re struggling with breastfeeding, seek out a qualified IBCLC or schedule your consultation with me ASAP to determine your next steps.

Slacker boob

Did you know? Around 70% of women produce more milk in the right breast. Which means 30% make more in the left. It is VERY common for one side to produce more than the other. Some times double on one side. We don’t know why. This is not a reason to neglect one side. You want to make sure you rotate which breast you offer first. Babies may prefer one side over the other for various reasons:

👶🏽They like to lay with their head in a certain direction or their body is uncomfortable in the opposite position

👶🏿They prefer the flow (one side may flow faster or slower than the other)

👶🏼They may prefer the flavor (YES!! Milk can taste different form each breast during the same feeding!!)

If you want to help balance out a slacker boob:

🔆Offer the slacker first more often. 

🔆End on the slacker can also help, especially if baby just wants to use you like a pacifier. 

🔆Pump the slacker side during or after feedings can also help stimulate more milk production

🔆Make sure you have the correct sized pump flange on the slacker side. Our nipples can often be different sizes and using the wrong sized flange can drop supply on that side

🔆Hand expression on that side at random times of the day even for a few minutes will jump start increased production. 

🔆If it’s positional from your baby (they only want to lay cross cradle to the right and not the left, experiment with other positions like football or side lying to help baby compensate for their body. If your baby prefers one side of the other from a positional perspective, consider taking your baby for some infant bodywork like chiropractic or craniosacral therapy.

What’s up with my baby biting, gumming, chomping, hitting, pulling and pinching the nipple/breast while breastfeeding?

Babies are masters at breastfeeding. They will exhibit all kinds of behaviors at the breast that will make you question if you have any milk and wonder what’s wrong with the baby. Most babies discover they have power and control over the breast and that different behaviors get different things. Biting, tugging, gumming, pulling, patting, chomping, shaking the nipple and breast are normal infant behaviors. Repeatedly latching on and off can also be normal when it doesn’t happen all the time. They happen during growth spurts, cluster feeding and teething. And may increase when baby discovers they can get a reaction from you for them. These behaviors increase or decrease the flow rate of milk and help stimulate supply and let down during growth spurts and teething.

What can you do? Stay calm. Most likely it’s normal and will change with time. Lots of skin to skin time between feedings can help keep baby calm and will naturally increase your supply during growth spurts. Using breast compressions while feeding can help increase flow and help trigger let downs. If baby is teething, give plenty of opportunity to chew and bite on appropriate toys and food items outside of nursing times. If baby is biting to slow flow, try a laid back position and make sure you’re not promoting an oversupply from over use of the Haakaa or pumping at sporadic times. Continue to watch for wet and dirty diapers and know that usually these behaviors are normal and don’t last.

If baby is having these behaviors all the time and isn’t making the amount of wet and dirty diapers you would expect, schedule a lactation consultation immediately.

Low Milk Supply

There are people that will struggle to or never make a full milk supply. From 1 month to 1 year, exclusively breastfed babies average 25oz of breast milk per day. True low supply means making less than this when the breasts are stimulated at least 8 times in 24 hours. Chronic low milk supply is linked to either a greater health concern or something out of your control which you cannot change or fix with cookies, teas or even medications and pumping. 

🗝Low milk supply that can be increased with time and support:

  • 💡Taking certain prescription medications with a side effect of dropping milk (Sudafed, Benadryl, antibiotics)
  • 💡Baby not feeding efficiently from lack of oral motor skill or tongue tie
  • 💡Taking certain prescription medications with a side effect of dropping milk (Sudafed, Benadryl, antibiotics)
  • 💡Not feeding or pumping enough, especially over night
  • 💡Scheduled feedings or over use of a pacifier
  • 💡Birth. Many medications designed to help you labor and deliver actually inhibit baby from latching and feeding effectively for hours to days after birth. Hemorrhage or birth trauma can also cause low supply in the beginning
  • 💡Supplementing, especially in the two weeks after birth

🗝Reasons for chronic low milk supply that may NOT increase even with maximal support:

  • 💡Breast or nipple surgery, augmentation, reduction, trauma
  • 💡Insufficient glandular tissue (IGT). Breasts never developed during puberty and look tubular or widely spaced. Signs of IGT include breasts did not grow in puberty, or increase in size during pregnancy. No engorgement in the week after birth
  • 💡Uncontrolled or undiagnosed thyroid disorder
  • 💡Uncontrolled diabetes
  • 💡Hormone or endocrine disorders, including severe PCOS
  • 💡Hormonal birth control placed/used too soon after delivery
  • 💡Nipple piercing that scars shut instead of staying open

There is a mistaken belief that prescription galactagogues, teas, or herbs can cure ANY chronic low milk supply. Before self-prescribing or taking Domperidone, Reglan, fenugreek, or any other lactation supplement, consider having your serum prolactin levels tested and a full evaluation by a skilled lactation consultant. Continue to follow @lalactation in Instagram or see my videos on YouTube for strategies of breastfeeding with chronic low milk supply.