Does breastmilk cause cavities? Do I need to night wean?

Were you told by your dentist to night wean your breastfed baby for concerns of it causing cavities? Extensive research has proven that there is no link between breastfeeding (nighttime or otherwise) and cavities. Breastfed babies can get cavities, though, so good dental hygiene is still needed.

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What can cause cavities are nighttime bottles and not brushing teeth before bed once baby is eating solid foods. Bottles allow liquids to pool in baby’s mouth and sit on baby’s teeth for long periods of time. Breastmilk doesn’t pool in the same way because milk only flows when baby is actively sucking. When baby is latched appropriately to actually express breastmilk, it enters the baby’s mouth behind the teeth. If the baby is actively sucking then he is also swallowing, so breast milk doesn’t sit in baby’s mouth like it can with bottles. Sugars from table foods can sit on the teeth and bacteria in saliva uses these sugars to produce acid, which in turn causes tooth decay. Actively brushing baby’s teeth twice a day helps reduce these sugars from sitting on the teeth.

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One Finnish study could not find any correlation between cavities and breastfeeding among children who were breastfed for up to 34 months (Alaluusua 1990). In 2013, Lavigne found, “that there was no conclusive evidence that prolonged breastfeeding increased the risk of early childhood cavities.” Valaitis et al stated, “In a systematic review of the research on early childhood caries, methodology, variables, definitions, and risk factors have not been consistently evaluated. There is not a constant or strong relationship between breastfeeding and the development of dental caries. There is no right time to stop breastfeeding, and mothers should be encouraged to breastfeed as long as they wish.” (Valaitis 2000).

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So no need to night wean for cavities… but if you need the sleep I completely understand.

Nipple Damage

Nipples and penises have a lot in common. From an anatomical, cellular level, they are both made of the same elastic, erectile tissue. They erect and evert with stimulation. They can crack, bleed, and blister, but they can never toughen up or callous. And neither one should ever crack or bleed.

Babies mouths have two areas: the hard, bony palate up front and the soft palate at the back, just in front of where that little hangy downy uvula is. One of the reasons a nipple erects, everts, and stretches is to help to get it in the safe zone where the palate is soft.

When a baby is latched correctly, the nipple tip stretches back to where the palate is soft, then the tongue massages the nipple to express milk. If baby has a shallow latch, the tongue pinches the nipple tip against the hard roof of the mouth and causes damage. This also happens when there is a tongue tie where the tongue is restricted in its movement. Instead of the middle of the tongue massaging the nipple, the the tongue is anchored to the floor of the mouth and it flicks the nipple, or the middle of the tongue where the restriction is pinches the nipple against the bony palate.

Nipples are perfectly designed to withstand breastfeeding. Other than temporary tenderness in the first few days, there should be no pain or damage. If you do get damage, they should heal quickly (within 24-48 hours) if you can get a consistent deep latch.

Moist wound healing is most effective to heal a nipple. Tips to heal a damaged nipple:

💡Keep breast milk on the nipple. Using a washable breast pad can help keep milk on the nipple

💡Nipple balms/butters, coconut oil and lanolin can help keep the nipple from sticking to clothing and feel soothing

💡Breast gels

💡A 20 second saline rinse once or twice a day

💡Soak the nipple in an Epsom salt bath, either in a bowl or Haakaa filled with warm water

💡A prescription for Dr Jack Newman’s All Purpose Nipple Ointment for severely damaged nipples

💡Silverette cups for persistent damage

💡Temporarily use a nipple

💡Schedule a lactation consultation time get to the root of the damage

Silverette Cups to heal moderate to severe nipple damage

Where did my milk go?

What can cause a late onset decreased milk supply?

1.The mother is pregnant again. Milk supply decreases during pregnancy. Domperidone will not work when the mother is pregnant.

2.The mother is taking some hormonal birth control method (pill including progestin only pill, IUD, etc)

3.The mother is breastfeeding on only one side at a feeding or “block feeding” (several feedings in a row on the same breast, used to treat “overabundant milk ejection, “overabundant milk supply”). I have posted on “block feeding” previously.

4.Some medications other than hormones can decrease the milk supply (antihistamines for example).

5.Can an emotional shock decrease the milk supply? Possible but unusual in our experience.

6.Blocked ducts/mastitis as well as any febrile illness may decrease the milk supply.

7.The use of bottles more than occasionally can very much decrease the milk supply.

8.”Overdoing it”. It’s time that others do most of the usual chores that fall on women’s shoulders.

9.An “abundant milk supply” associated with a less than “ideal” latch. In this situation, the milk flows into the baby’s mouth with little participation of the baby. The baby may often choke while breastfeeding, especially when the mother has a milk ejection reflex. A tongue tie is a common cause of a baby having a less than “ideal” latch and can be a significant cause of late onset decreased milk supply even if neither the mother or the baby had problems early on.

This problem of late onset decreased milk supply and accompanying symptoms is typically the problem of the mother who once had an abundant milk supply and milk supply may still be quite good, but less than it once was.

Breastfeeding and lactose, dairy, food intolerances and allergies

Lactose is the number one sugar in breastmilk. It is the protein in cow’s milk that is difficult to digest for some babies. Human milk has human protein. It is easily digested by the stomach and absorbed in the intestines. The protein of cow’s milk is shaped different and not easily absorbed by the stomach and intestines as it’s designed to be absorbed by calves. It can sometimes make babies gassy or have poops that have bloody or mucous in them. Cow’s milk sensitivity or allergy can cause colic-like symptoms, eczema, wheezing, vomiting, diarrhea (including bloody diarrhea), constipation, hives, and/or a stuffy, itchy nose. Which can also be signs of other things. You could always try decreasing your dairy intake. Baby’s symptoms will usually begin to improve within 5-7 days of eliminating a problem food. Baby may not improve immediately, however, especially if the reaction is to a food that has been a regular part of your diet. Sometimes symptoms get worse before they begin to improve. It usually takes 2-3 weeks to see an improvement.

If baby is sensitive to dairy, it will not help to switch to lactose-free dairy products or put your baby in formula, which is cow protein based.

While culture may dictate what you can and cannot eat while breastfeeding, science does not. Most babies have no problems with anything that you eat. It’s generally recommended that you eat whatever you like, whenever you like, in the amounts that you like and continue to do this unless you notice an obvious reaction in your baby.

There is no list of “foods that every nursing person should avoid” because most of us can eat anything we want, and because the babies who are sensitive to certain foods are each unique – what bothers one may not bother another.

Babies’ guts are also constantly developing. So what bothers them as a newborn may not bother them the closer they get to a year.

Unless there are known food allergies in your family history or your baby is having severe reactions to what you think you may be eating, there’s no need to restrict what you eat. Remember: fussiness and gas is normal for a young baby, and is not usually related to foods you eat. If your baby is sensitive to something you are eating, you will most likely notice other symptoms in addition to fussiness, such as EXCESSIVE spitting up or vomiting, colic, rash or persistent congestion, crying inconsolably for long periods, or sleep little and wake suddenly with obvious discomfort. Other signs of a true food allergy may include: rash, hives, eczema, sore bottom, dry skin; wheezing or asthma; congestion or cold-like symptoms; red, itchy eyes; ear infections; irritability, fussiness, colic; intestinal upsets, vomiting, constipation and/or diarrhea, or green stools with mucus or blood. Fussiness that is not accompanied by these other symptoms and calms with more frequent nursing is probably not food-related.

Natural Weaning from the Breast

NATURAL WEANING

Natural weaning is the biological process of gradually decreasing milk supply as baby gets older. This process starts around 7-9 months as baby takes more solid foods and progresses toward sleeping longer stretches at night. It ends when baby finally weans (which may not be until 2-3 years old!!). Natural weaning doesn’t mean that you need to wean baby from the breast. Decreasing milk supply doesn’t mean you’re at risk of losing your supply, either. Your breast is designed to match the stage of development your baby is in. 

Milk supply iss highest from month 1-6 when baby is going through multiple growth spurts. They need to double their birth weight by 6 months. Milk is also the only food in their diet.  Therefore, your milk supply is supposed to be at its highest to meet their nutritional needs. From 6-12 months, weight gain slows but their need for milk volume needs remain stable. It is natural as baby transitions from a full milk diet to a milk+solids diet to then a solids+milk diet that breast milk supply will shift along with it. Your milk supply varies compared to baby’s solids intake and there is a wide range of normal based on your individual baby. Some babies love solids and eat them in large quantities many times a day. Other babies continue on a mostly milk diet until almost 1 year.  At 12 months, milk finally takes a back seat to solids, but still fills in nutritional gaps and acts like medicine against illness. From 12 months on there continues to be a wide range of normal for milk supply depending on your child’s eating and feeding habits. Some babies continue to nurse occasionally over night while others seem to become boob barnacles again and would happily stay on the breast all day, every day.

So what does this mean? If you’re exclusively breastfeeding you may not notice anything.  You can continue to bring baby to breast for as long and often as baby wants. You may notice baby spacing out feedings or not nursing as long. They may want the breast more when teething or going through growth spurts or developmental leaps. They have days with little interest in the breast. 

Moms who pump (either exclusively or because of work) report overflowing milk in the early weeks, often able to pump 4-6 or even 8-10 ounces in a morning pump session. By 4 months supply regulates and mom gets about 3-5 ounces per pump in place of a feeding. By 9 or 10 months it can feel like your trying to wring out a wet rag to get even 2-4 ounces a pump session. As long as baby has unrestricted access to the breast when your not working and you still have a regular pump routine in place no intervention is usually needed. Every journey is supposed to look different because it is your unique journey.

Photo Credit Jermaine Love
@jermainelove44

One Breast or Two?

SHOULD I OFFER ONE BREAST OR TWO WHEN BREASTFEEDING?

Just as no rule says you must eat the same amount at every meal, there’s no rule that says your baby must eat from both sides every feeding.

  • Factors that play a role in offering one side or two include your individual breast storage capacity, and milk supply, when your last feeding was, and your unique baby’s volume needs.
  • Storage capacity is not indicated by breast size, but by glandular tissue in the breast. People with lots of glandular tissue have a higher storage capacity in each breast regardless of the actual breast size. Their babies may only want one side per feeding as each side makes plenty of milk. Some people have smaller storage capacities and their babies will want to feed off of both sides (maybe even multiple times!) to get what they want.
  • You will get to know your breast storage capacity and how quickly your breasts make milk as you get to know your body and your baby.  Every feeding can also be different. There’s no right or wrong. Sometimes a baby will want both breasts if they’re really hungry and sometimes they’ll want only one when they just want to comfort nurse to sleep. Some times you may feel like you’re offering each breast 5 or 6 times in a feeding, rotating constantly!! NORMAL!!! Trust your baby and your body. You can always offer the second breast/side but don’t feel stressed if your baby doesn’t always want it. 

BREASTS ARE SISTER, NOT TWINS

You may also feel like baby always prefers one side or even does better feeding on one side!! That’s because breasts are sisters and not twins!!!! One side can be bigger, one side can make more. Nipples can even be different shapes and sizes, making one side easier to latch to from purely an anatomical perspective.

  • Around 70% of us produce more milk on the right. Which means 30% make more on the left. 
  • It is VERY common for one side to produce more than the other, often double. This is not a reason to neglect one side. You want to make sure you rotate which side you offer first. This can also cause one breast to be significantly larger than the other especially if you continue to only feed from one side.
  • Babies may prefer one side over the other for various reasons
    • They like to lay with their head in a certain direction
    • They prefer the flow (one side may flow faster or slower than the other)
    • They may prefer the flavor (YES!! Milk can taste different from each side during the same feeding!!)
    • They may have tension in their body from positioning during pregnancy or from trauma during birth.
  • If you want to help balance out a slacker boob, you can try offering the slacker first more often.
  • Ending on the slacker can also help, especially if baby just wants to use you like a pacifier.
  • Pumping the slacker side after feedings can also help stimulate more milk production.

Don’t stress too much about a slacker boob if it’s not an issue. If baby is happy, there’s really no need to fret over differences between your breasts. If you start to notice one side is increasing in cup sizes significantly from the other, schedule a consultation and we can get to the root of why baby only wants one side and we can work on it together.

How Much Breast Milk Does Baby Need?

HOW MUCH BREAST MILK DOES MY BABY NEED IN A DAY?

How many ounces of breast milk should my exclusively breastfed baby be eating at a feeding? This is usually on the top five questions from families. The answer is: that depends.

  • Some babies are grazers. They like smaller, more frequent feedings to keep their tummy from being too full or uncomfortable. Their feedings can range from 1-3 ounces of breast milk and they may feed 10 or more times a day.
  • Other babies are bingers. They like a big, full tummy and may take 3-5 or even occasionally 6 ounces of breast milk but not as often. They may feed only 6-8 times a day and have longer sleep stretches. Their tummy doesn’t mind being stretched fuller and their bodies tell them it’s ok to go longer between feedings.
  • A helpful question to always be asking is: how many times a day is baby feeding? From one month to one year, babies take between 19-32 ounces of breast milk a day. The average is 25 ounces in 24 hours. There’s a range because, just like us as adults, some days we want to eat more than other days depending on the activities of the day, growth spurts, cravings, and even babies emotionally eat sometimes. Trust your baby to know their stomach better than you do. 
  • Babies get hungry frequently: 8-12 or more times a day. They drink so much breast milk because they grow so rapidly. They will double their birth weight by six months and triple their weight by a year. Imagine how much you would need to eat to double your weight in six months! You may feel like you feed your baby all the time, and you are. Every 1-3 hours in the first few months is normal!! Every feeding is different and breast milk volumes taken vary throughout the day. Sometimes you want a snack and sometimes you want a buffet. 
  • How is pumping going for you and can you keep up with his volume needs? Pumping is never an indication of your breast milk supply, it just indicates what your pump can empty from you. So many people have their breast milk supply sabotaged by baby being overfed from a quick flowing bottle, not enough time spent during the feeding, or interpreting baby’s cues wrong.
  • If your milk supply is keeping up with their demand there’s no problem. If you’re concerned about your baby’s feeding habits, definitely schedule a consultation with me.

Oxytocin

Positioning tools and devices

Oxytocin is a hormone produced by the pituitary gland in the brain. It increases relaxation, lowers stress and anxiety, lowers blood pressure, and causes muscle contractions. Oxytocin, also called the mothering, cuddle or love hormone, is involved in social relationships, bonding, trust, and love. Breastfeeding stimulates the release of oxytocin from your brain.  When your baby latches on to breastfeed, the nerve cells in your breasts send a signal to your brain to release oxytocin. The oxytocin causes the muscles around the milk-making glands in your breast to contract, squeezing the breast milk into the milk ducts. The milk ducts then contract to push the breast milk through your breast, out of the nipple to your baby. This is called the let-down reflex. As baby continues to breastfeed, more oxytocin is released and milk continues to flow. You may experience 2-14 let-downs in one breastfeeding session! The release of oxytocin while you're breastfeeding may make you feel sleepy and relaxed. It can raise your body temperature and is one of the reasons you may feel so hot while nursing. It might also make you feel thirsty or even give you a headache!

Oxytocin can cause your milk to let-down when you're not breastfeeding. Hearing a baby cry, thinking about your baby or even smelling something that reminds you of your baby can trigger oxytocin flow and make you leak!! While oxytocin is responsible for the let-down reflex and the release of breast milk from your body, it has nothing to do with the amount of breast milk that you will make. Prolactin is the hormone that does that. 

Some people feel the oxytocin release (aka Let-Down) and others don’t. Both are totally normal!

Signs of let down include:

  • Tingling or a pins-and-needles sensation in your breasts. It could be a light sensation or even an electrical shock feeling.
  • Hearing baby swallow while at the breast.
  • Leaking milk from the other breast
  • Uterine cramps when breastfeeding, especially the first week.
  • Feeling happy and relaxed after you feed your baby.

Factors that inhibit oxytocin release and let down include: pain, breast surgery or trauma, stress, illness, fatigue, fear, embarrassment, drinking or smoking. 

Some mothers may breastfeed and let-down milk just fine to baby but struggle to release milk to an electric pump. A quality double electric breast pump will have two modes: a quick cycle/light suction or "stimulation" mode, and a slow cycle, hard suction of "expression" mode. By alternating several times between these modes in a pump session, you can trick your body into thinking baby is feeding to stimulate more let-downs of milk. When pumping, you can also help stimulate your body to let-down more often by:

  • Watching videos or looking at pictures of your baby
  • Smelling something that reminds you of your baby (a onesie, your baby shampoo or soap, lavender)
  • Listening to calming music
  • Using heat before and during pumping
  • Massaging your breasts before and during pumping
  • Eating a snack or drinking water while pumping

 

Foremilk/Hindmilk and Making Fattier Milk

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How can I make fattier milk? I get this question a lot. Fat in breast milk changes constantly both throughout the day and as baby ages. It is predominantly influenced by how full/empty the breast is which tells your body how old your baby is. Newborns nurse around the clock and have a higher milk fat content than toddlers who may only nurse a handful of times a day and are getting their fats from table foods. Your diet does not usually have an effect on the quantity of fat present in breast milk but it can change the type- saturated, trans, monounsaturated, polyunsaturated.

I often get questions about foremilk/hindmilk as related to making a fattier milk. But what is fore milk/hindmilk? Is that even a thing? The breast only makes one type of milk, however, because of the way milk is released during a feeding, the fat content can change. Fats make up about 3-5% of the nutrients of breast milk and each ounce of contains about 1.2 grams of fat. Milk is made in the alveoli, which are grape-like clusters of cells at the back of the breast. Once the milk is made, it is squeezed out through the alveoli into the milk ducts, which resemble highways and carry the milk through the breast to the nipple. As milk is produced, fat globules in the milk stick to each other and to the walls of the milk ducts. As time passes, milk gradually moves toward the nipple as the breasts fill, pushing the thin watery milk forward while leaving the denser and fattier hindmilk behind (because the fat is sticking to the walls of the ducts). Shorter time between feedings or pumping a help keep the hind milk at the front of the breast. Think of it like turning on a faucet in the sink. 

At first, the water comes out cold and then gradually gets warmer until it is hot. If you come back a minute later and turn the faucet on again, it will still be relatively warm. However, if wait an hour, the water will be cold. You’ll have to wait for it to warm up again. Breast milk fat is similar.

When the baby first latches on, the higher-water content foremilk is released. Little by little the milk becomes fattier as fat globules are pulled down from the ducts. Frequent feedings or pumping mean the milk doesn’t have time to “get cold.” There is no switch that gets flipped – the change from foremilk to hindmilk is gradual. There is less foremilk for your baby to go through before they get to the fattier milk. Basically, the less time in between feedings, the higher the fat content at the beginning of that particular feeding.

Here are the best strategies to help increase the fat in your milk:

📌Nurse or pump more frequently. The fullness of the breast makes the most difference with the amount of fat in your milk. The fuller the breast, the more water content is in your milk because your body thinks baby is dehydrated from going a long time without feeding or that you have an older baby that is getting fats from table foods. The shorter amount of time you go between feeding or pumping, the higher the fat content in your milk. You will see a smaller volume, but a higher fat content.

📌Drain the breast. Let your baby completely finish on one side before switching to the other side. Emptier breast’s have higher milk fat content. 

📌Use your hands. Compressing and massaging the breast from the chest wall down toward the nipple while feeding and/or pumping helps push fat (made at the back of the breast in the ducts) down toward the nipple faster. 

📌Eat more healthy, unsaturated fats, such as nuts, wild caught salmon, avocados, seeds, eggs, and olive oil. 

📌 Increase your protein intake. This helps increase overall milk supply, which = more  fat for your baby. Lean meats, chicken, fish, eggs, dairy, nuts, and seeds are the best dietary sources of protein. Vegetarians if you do not get enough protein from your food alone, consider adding a protein supplement in your routine.

📌Sunflower lethicin. Often used to relieve frequently blocked ducts, this supplement works by decreasing the stickiness of breast milk by mixing the fatty parts of breast milk with the watery parts to make it “slide out” easier. Some people believe that this helps increase the fatty acids in milk at the beginnings of feedings, too. 

Switching baby too quickly from breast to breast while they are still actively sucking means that they aren’t getting enough time to let the fattier hindmilk unstick from the milk ducts.

 

TAKE AWAY:

Depending on your nursing pattern, it’s possible for fat content to be higher at the beginning of a particular feeding than it is at the end of other feedings. The longer the time between feedings, the lower the fat content at the beginning of the next feeding. If feedings are closer together, you’re starting off with a higher fat content. 

Because every baby varies in the amount of time it takes him to receive his fill of the higher-fat milk at the end of the feeding, it’s important not to switch breasts while baby is actively nursing.

 

Pumping for a toddler

The number one complaint I get my mothers going back to work is a drop in supply when they start to pump. They go from seeing tons of milk to very little. Pumping at work is a PITA. You have to be very committed to it and depending on your job it can be stressful or difficult to get away to pump. What most women don’t seem to understand about Breastfeeding is that the more milk you remove the more milk you will make. You can’t just will your body to make the same amount of milk whether you pump once or six times. The science doesn’t work that way.

Through the first year of life, I recommend mothers pump three times on an 8 hour shift and four times on a 12 hour shift. Remember, I recommend leaving the same number of ounces as number of hours you will be gone. If you’re gone 8 hours, you only need to leave 8 ounces. Make sure your caregivers are doing paced bottle feedings and not accidentally sabotaging your milk supply. Mothers can add in additional pump sessions by pumping in the car with the battery operated pump. Once your baby turns a year, and his or her milk needs decrease; as long as they are taking a healthy amount of solid foods mom can drop down to pumping twice or three times a shift.

As your Toddler continues to grow, you can make the decision to add in another milk/milk substitute, continue to pump, or just breastfeed when you are home and have caregivers give water depending on how much you are gone from your older toddler.

My last pump session at work. cheers.

Breastfeeding will working is a large commitment. I know this full well. These are the guidelines I followed with my own daughter. Up until she was 12 months, I pumped 3 times on my 8 hour shift. I had decided at 17 months to stop pumping while at work and just feed my daughter when I was home. However she had other plans 🙂 she constantly asks for May May, which is her word for my milk, while I am gone. So I was back to pumping just once a day and mixing my small amount of breastmilk with flax milk. She eats off of me like a barracuda when I walk in the door. (I think she just wants the snuggles). At 18 months I am now no longer pumping at work. She will nurse when she wakes up, when I come home, around bed time at 6:30, and every once in a while she’ll still wake up around 4am for an early morning snack. This is what my tiny human does. You have to figure out what works best for your tiny human, your family, and your health. Happy pumping!