Vitamin D and the breastfed baby: Do I need to supplement the baby?

Vitamin and mineral supplements are usually not needed for the average healthy, full-term breastfed baby during the first year old life. One of the major exceptions to that is Vitamin D. Vitamin D is essential to babies in order to maintain healthy bone growth and development.  Recent research also tells us that vitamin D is key in the maintenance of our immune systems to help prevent and fight infections and inflammation. The American Academy of Pediatrics recommends that all babies receive routine vitamin D supplementation (400 IU per day) due to decreased sunlight exposure and an increase in rickets, which impacts leg growth and development. Practically everyone is at risk for vitamin D deficiency with, ironically, only formula-fed babies out of the danger zone because infant formula already contains 400 IU of vitamin D per quart of properly prepared formula.

If you are exclusively breastfeeding, your pediatrician should have educated you to supplement your baby with vitamin D, typically given as drops. But they may not have told you about how to supplement. There are two ways to supplement: to the baby or to you are the parent.

The primary source of vitamin D for babies, other than sunlight, is the stores that were laid down in baby’s body prior to birth. Because our vitamin D status during pregnancy directly affects baby’s vitamin D stores at birth and through the first 2-3 months of life, make sure to get enough vitamin D while pregnant! Human breastmilk is considered a very poor source of vitamin D, usually containing less than 50 IU per quart. This is why the AAP recommends all breastfed infants receive 400 IU per day vitamin D by supplement drops. This IS NOT A DEFECT IN BREAST MILK but a defect in the recommended amount of vitamin D the lactating parent should be taking. 

The best way to get vitamin D, the way that our bodies were designed to get the vast majority of our vitamin D, is from the sun. Depending upon where you live and how dark your skin is, going outside regularly may be all that is required for you or your baby to generate adequate amounts of vitamin D to need no further supplementation.  However, most health care professionals won’t tell you to get vitamin D from the sun because the risks of sun burn and skin cancer! One of the other problems with getting your vitamin D with sun exposure is simply that it’s hard to determine how much time outside is needed since it depends on so many factors (your unique skin tone, the latitude on the earth of where you live, the time of year, how much skin is exposed, amount of air pollution, etc.) There is a range of how much skin exposure to how long you need to be outside int the sun for your body to make adequate levels for your unique self. I cannot tell you through this video how much skin exposure or a length of time to be in the sun because of all of these factors, you would need to research these individual factors. 

So how else can you get vitamin D? Research shows that maternal vitamin D supplementation of 4000-6400 IU/d or a single monthly dosage of 150,000 IU) can adequately supply your breastmilk where no additional supplementation to your baby would be needed.  As long as you are not vitamin D deficient, your breastmilk will also have adequate amounts of vitamin D levels. For more information on the research behind this, check out  [Hollis et al 2015] and Hollis & Wagner 2004. In summary, yes, someone needs supplemented for vitamin D. In reality, vitamin D is just as essential for you as it is for the baby. If you have any concerns with vitamin D deficiency, both you AND the baby need to be supplemented. You can supplement the baby by drops, usually done on the nipple before latching or if you are giving breast milk bottles, you can add that to one of the bottles. You could also put the drop on a pacifier and have baby suck it that way. For you, taking 4000-6400 IU per day is adequate for most to prevent deficiencies and sun exposure is an option when done safely knowing your unique situation. 

Milk blebs

A milk bleb happens when the nipple pore gets blocked/clogged by a piece of skin or a small amount of hardened breast milk. It usually looks like a white dot on the nipple and the pain tends to be focused at that spot and just behind it. The clog might be a tiny, dry clump of hardened milk or a “string” of fattier, semi-solidified milk. 


Blebs are often caused by:

👉🏼Shallow latch

👉🏼Tongue tied baby

👉🏼Pumping with too large of a flange

👉🏼Often associated with recurrent mastitis


When the bleb is being caused by skin covering the nipple pore, the duct obstruction will often pop out from the pressure of nursing or manual expression. By changing baby’s position at the breast and focusing on a deep latch, breastfeeding alone will often pop the bleb.


Always figure out the root of why you have one and address that first. Other remedies:

❤️‍🩹Keeping olive or coconut oil on the top to soften the bleb

❤️‍🩹Hand expressing behind the bleb to move milk through

❤️‍🩹Switch nursing positions

❤️‍🩹Taking sunflower lecithin  

❤️‍🩹Ice after feeding to reduce inflammation

❤️‍🩹Epsom salt or saline soaks

❤️‍🩹Triamcinolone 0.1% spot applied for 1-3 weeks under direction of an IBCLC

❤️‍🩹If they do not resolve on their own in a few days, seeing a breast specialist for further work up and management


A milk bleb happens when the nipple pore gets blocked/clogged by a piece of skin or a small amount of hardened breast milk. It usually looks like a white dot on the nipple and the pain tends to be focused at that spot and just behind it. The clog might be a tiny, dry clump of hardened milk or a “string” of fattier, semi-solidified milk. 


Blebs are often caused by:

👉🏼Shallow latch

👉🏼Tongue tied baby

👉🏼Pumping with too large of a flange

👉🏼Often associated with recurrent mastitis


When the bleb is being caused by skin covering the nipple pore, the duct obstruction will often pop out from the pressure of nursing or manual expression. By changing baby’s position at the breast and focusing on a deep latch, breastfeeding alone will often pop the bleb.


Always figure out the root of why you have one and address that first. Other remedies:

❤️‍🩹Keeping olive or coconut oil on the top to soften the bleb

❤️‍🩹Hand expressing behind the bleb to move milk through

❤️‍🩹Switch nursing positions

❤️‍🩹Taking sunflower lecithin 

❤️‍🩹Ice after feeding to reduce inflammation

❤️‍🩹Epsom salt or saline soaks

❤️‍🩹Triamcinolone 0.1% spot applied for 1-3 weeks under direction of an IBCLC

❤️‍🩹If they do not resolve on their own in a few days, seeing a breast specialist for further work up and management


#milkbleb #milkblebtreatment #milkblebhack #milkblister #breastfeedingproblems #pumpingproblems #pumpingprotips #pumpingmom #lactation #ibclclife #ibclc #breastfeed


Postpartum chin and nipple hair

Sprouting chin hairs? Random nipple/areola/boob hairs? Blame those darn hormones again. Immediately after delivery, a sudden increase in estrogen may have you noticing thicker, darker hair in strange and unwanted places. The body uses an enzyme to change the estrogen to testosterone which can lead to a “beard.” The hair will most likely return to its normal state within a few months. There are lots of options for removing your chin hair: wait it out and see if hair growth stops or slows as hormones settle. Or you can pluck, wax, or even shave it. If you’re considering making an appointment for laser hair removal, you’ll want to make sure you visit an actual dermatologist, as not all center or clinic practitioners have the correct training or even the correct laser tools. There is no evidence that electrolysis or laser hair removal would affect breastfeeding, breast milk, or your breastfed baby.

What about those pesky nipple hairs? Trust me, more people have them than just you. If you can’t resist the urge, trimming them with scissors is a safe way to keep them at bay. Tweezing nipple hair can be an effective way to get rid of unwanted nipple/areolar/breast hair. However, this can be painful as breast and nipple skin can be particularly sensitive while breastfeeding. Honestly the best thing to do is leave it alone. You wouldn’t want to increase the risk of infection and ingrown hairs by plucking or tweezing. Cracked nipples from a shallow latch and mastitis from the wrong size pump flange are enough to deal with without having to tell your lactation consultant you were overly zealous plucking the tablecloth.

#postpartumhair #postpartumhairgrowth #postpartumchanges #healthyhormones #pregnancyhormones #lactationsupport #lactationspecialist

Freeze Dried Breast Milk: What's the hype about?

Freeze drying milk is not a new concept. Powdered milk, sometimes called dried milk, milk powder, or dry milk, is a made by evaporating milk to dryness which can then later be reconstituted to the liquid form by adding water later. The first modern attempts at drying milk started as early as 1802 with specific processes for drying milk being created by 1837. Powdered milk is frequently used in the manufacturing of infant formula, confectionery such as chocolate and caramel candies, and in recipes for baked goods where adding liquid milk would make the final product too thin or runny. During the 1960s, commercial infant formulas became popular, and by the mid-1970s they had all but replaced evaporated milk formulas as the "standard" for infant nutrition.

Typically when we think of breast milk storage, freezing in either a standard freezer or a deeper freezer have been the go-to for years. Milk that has been frozen correctly and stored in a deep freezer is optimal for about 6-9 months before the flavor begins to change. Newer guidelines are saying that frozen milk may still be good about a year in the freezer. But freeze-dried milk which can last from 3 to 20 years on the shelf! So the while the idea and concept of freeze dried breast milk isn’t new, it’s taking the market by storm with many new companies popping up in recent months. So let’s do a deep dive into the world of freeze dried breast milk, the pros and cons, and the expense. 


Sublimation is the fancy term for the freeze-drying process which basically means all the water has been removed from the breast milk and turns it into powder. Low temperatures are used for a long time in the drying process to ensure the nutrients in the milk are protected. Freeze drying is different than dehydrating, which uses very high heat and is relatively faster. With freeze drying, 'low and slow' is the name of the game to protect precious nutrients.

Here is the basics of a freeze-drying process:

  • Deep freezing: Milk is deep frozen in a chamber at temps below -40 degrees Fahrenheit.
  • Pressure dropping: Air inside the chamber is removed via a pump, which drops the pressure to create a vacuum. The low pressure turns the solid to gas. The vacuum pumps out the water particles.
  • Drying: Ice crystals inside the frozen breastmilk is vaporized by drying the milk with alternating warm and cold air (without thawing the breast milk) leaving behind a breastmilk powder
  • Packaging: The powder is sealed in special airtight bags or packages that protect against air, light, oxygen, and moisture. 
  • Since everyone’s breast milk is unique, the company will send you specific directions for reconstituting your milk for baby to drink. This is NOT like standard formula where 1 scoop gets 2oz of water. Each bag of powdered breast milk will need specific amounts of water unique to your milk. 
  • You should expect that however much milk you send will equal however much you receive back. If you send in 200oz of your breast milk, your powdered milk will make 200oz of breast milk when you’re ready to use it. 

Breast milk powder should be stored and prepared properly in order to prevent contamination with Cronobacter and other bacteria that can cause serious illness if safe handling guidelines are not followed.


  • To preserve milk for longer than it would last in the freezer, especially if it is going to expire soon
  • For the convenience factor
    • It’s easy to travel with or to ship to someone else
  • Can help with high lipase
    • While freeze-drying doesn’t reduce the amount of lipase in the milk, by removing the water it reduces the enzyme activity that breaks down breast milk which can make the taste and smell much milder. For some whose baby rejected pumped milk in bottles because of high lipase may have a higher chance of taking it freeze dried
  • For those who are doing elimination diets, this may preserve the milk longer for when your baby outgrows the allergy or intolerance so you can offer your milk later in your feeding journey
  • In cases where breast cancer has been identified and a mastectomy would be life saving, freeze drying milk can ensure future children conceived after mastectomy could still receive mother’s own milk
  • Can add some nutritional value to your older child’s meals by sprinkling it in purees or on solid foods, or even baking with it for the whole family
  • Could be an option for surrogates or donor milk
  • Saves space 


The big concern medical professionals have is that freeze-dried milk has not been widely studied. Yet. Most current health care providers will stick with AAP guidelines, CDC guidelines, FDA guidelines, and they have not released a formal statement on the safety and the efficacy of freeze-dried breast milk. But I would anticipate as it gains popularity and traction that eventually studies will be down on it. Without sufficient studies, it’s unclear if freeze-dried milk has the right protein, fat, carb ratio that infants need. We don’t know exactly how freeze-drying impacts the nutritional composition of breast milk. Some research suggests that breast milk's natural carbohydrate and protein content remains intact for up to six months after freeze-drying. But other studies report that freeze-drying may lower the amount of key antioxidants, like vitamin C, that are naturally present in breast milk. There really is a lack of evidence in terms of the nutritional safety of freeze-dried human milk at this current moment in time. Another concern is that freeze-dried milk does not undergo a pasteurization process which kills harmful bacteria. Pasteurization is avoided on purpose, in order to preserve the vital probiotics that are present in breast milk, and which would be destroyed with pasteurization. Just as bacteria can grow in freshly expressed milk if it is left at the right temperature for extended lengths of time, the same can happen with rehydrated breast milk powder. And there is room for error when making up bottles of freeze-dried milk. Each bag may require different amounts of water for rehydration, which means parents need to pay close attention to how they are preparing each bottle. Too much or too little water too often can lead to adverse effects in baby, like low sodium levels or not enough calories per feeding. 

Freeze drying breast milk is still a new science. Even though there are multiple new companies specializing in this, no matter what company you choose, it is going to be an investment. The cost to freeze dry your milk will vary based on the company you choose as well as the quantity of milk that you have.

Several companies will wait until they have your milk in hand before charging you. This way they know exactly how many ounces of milk there are! This is because we often aren’t accurate in our measurements of what we collect. The bag or the bottle lines can be inaccurate or we can tilt the bottle to see a different number than what’s actually there. Companies are very particular in measuring so that they can ensure proper ratios at the end too. They want to make sure they aren’t over or under charging you. Other companies may charge a flat rate or give you an estimate. Do your research but expect to pay several hundred dollars for your batch of milk!!



Freeze-drying human milk may still be an appealing option depending on your circumstances. If you are adamant about freeze-drying your milk, make sure to use a legitimate company with lots of reviews. And DON’T try it at home yourself as you're risking contamination.

How to safely prepare formula for your baby


Being pro breastfeeding does not mean being anti formula. As an IBCLC lactation consultant, my job actually includes education on feeding infant formula. This includes helping families choose an infant formula that is right for them based on solid evidence based research, bottle selection and techniques for bottle feeding. It also includes how to safely prepare formula. If there was more education and less demonizing of formula, families would feel less guilt and stigma around just trying to feed their babies while feeling more confident in the process. Let’s talk about safely preparing formula.

Formula-to-water ratio:  Follow the directions on your particular can of formula. For most powdered formula, the recommendation is 1 level scoop of formula (not packed down) per 2 fl oz of water. Be careful not to add too much water as this dilutes essential nutrients and can affect baby’s nutrition. Too little water may cause baby’s kidneys and digestive system to work too hard and may cause baby to become dehydrated. You also do not want to use breast milk to make formula unless under the direct supervision of a pediatrician or pediatric dietician as this hyper concentrates certain nutrients and can lead to medical complications.

Reminder: Powdered infant formula is NOT sterile and should not be fed to premature babies or babies with compromised immunity unless directed and supervised by your doctor. Typically most pediatricians will recommend ready-to-feed formula (already a liquid) for babies under 2 months. When preparing baby’s powdered infant formula, it is important to know that recommendations can differ based on several factors including  baby’s age and the safety of the water. Your pediatrician should be guiding you on formula preparation based on your unique baby’s health. For infants under 2-4 months of age, those who were born prematurely and those who have a weakened immune system, hot water should be used to prepare formula to kill any microbes. To do this, boil the water and let it cool for about 5 minutes, and then wait for the mixed formula to cool down before giving it to baby. After 2-4 months, it’s safe to prepare powdered infant formula by mixing it with tap water (filtered or unfiltered) and following the manufacturer’s instructions on the container.

Preparing formula with boiled water:

Ask your baby’s doctor if you need to use cooled, boiled water for mixing and if you need to boil (sterilize) bottles, nipples, and rings before use. If you choose to boil, follow these steps:

1. Bring water to a rolling boil for 1 minute, then turn off the heat.

2. Let the water cool for about 5 minutes before adding the powdered formula. Making formula with boiling water can cause clumping and decrease the nutritional value. The hot water, though, is what kills harmful bacteria in the formula.

3. Once the formula is mixed, run it under cold water or leave it on the counter for a few minutes to cool down to the right temperature for baby. Before feeding, put a few drops on the inside of your wrist to make sure it is not too hot. Do not offer the bottle immediately after mixing.

4. Feed or refrigerate the prepared formula.

Note: If you are concerned about lead or other harmful substances in your water, talk to your healthcare professional before making formula with tap water. Bottled or filtered water can contain bacteria and should still be boiled.

Mixing Tips for Powdered Formula

Single bottle instructions

1. Wash your hands thoroughly with soap and warm water.

2. Measure and pour desired amount of water into the baby bottle. Make sure to measure the water FIRST.

3. Add unpacked, level scoop(s) of powder formula to the bottle as directed. Return dry scoop to can. (1 scoop of formula per 2 fl oz of water is a typical recipe.)

4. Put the cap on the bottle and gently swirl or shake. Stirring often causes less bubbles to be formed which if swallowed can make baby gassy.

Tip: Moving your wrist in a twisting motion helps powder formula mix more quickly and more thoroughly.

5. Feed or store immediately in refrigerator. You can mix 24 hours worth of formula in a pitcher and keep it in the fridge to pour out and feed to baby. Pour the correct amount from the pitcher into a clean bottle and either feed cold or reheat.

The can of powdered formula can be used for one month after it has been opened. Manufacturers don't recommend using the formula after the 30 days of opening because the nutrients start to degrade. Store powdered formula with the lid tightly shut in a cool, dry place – but NOT in the refrigerator.

How to pick a baby formula: Reading the label and picking the carb source

How to pick an infant formula: The sugar source, what do the ingredients mean?

Being pro breastfeeding does not mean being anti formula


Being pro breastfeeding does not mean being anti formula. As an IBCLC lactation consultant, my job actually includes education on safely preparing, handling and feeding infant formula. This includes helping families choose an infant formula that is right for them based on solid evidence based research. If there was more education and less demonizing of formula, families would feel less guilt and stigma around just trying to feed their babies. 

So let’s break down how to choose an infant formula. Here’s the disclaimer: what works for one baby won’t work for all babies. So always speak with your pediatrician or personal health care provider if your baby is struggling to tolerate any infant formula you are using. 

There are three main ingredients that are essential and needed in all infant formulas. The carbohydrate, or sugar source, the protein and the fat. In this video we will just be concentrating on the carbohydrate. Carbohydrates are an important source of energy for growing babies, as they account for 35 to 42% of their daily energy or caloric intake. The number one sugar or carb in breastmilk is lactose. Lactose is not only a good source of energy, it also aids in the absorption of the minerals magnesium, calcium, zinc and iron. It’s also lowest on the glycemic index scale – meaning that it won’t increase blood sugar levels nearly as fast as glucose or sugar will. Lactose is healthier for babies to metabolize, and can help maintain stable blood sugar (and therefore insulin) levels. All human babies have an enzyme called lactase which breaks down the lactose and make sit easily digestible. After about 5 years of age, most people (about 75% of the world's population) stop producing the lactase enzyme. Without lactase, they can no longer digest milk, and they become lactose intolerant. This is actually the age of biological weaning, as in if children were left to self wean, they would do so some time between 2.5-7 years old, meaning the weaning age coincides with no longer being able to break down the sugar. Because of this it is EXTREMELY RARE for a human baby to be lactose intolerant. That disorder is called galactosemia and is an inherited genetic condition This hereditary condition is passed from parent to child as an autosomal recessive disease. This means that a child needs to inherit two copies of the defective gene (one from each parent) in order to have the disease and occurs in only 1 of every 30-40K babies born. 

To replicate the sugar in breast milk, most cow's milk-based formulas will also have lactose as the main source of carbohydrates. When possible, I typically recommend a lactose based formula for most babies because most of the time if an infant is having a reaction to a formula, they are reacting to the protein and not the sugar source. More on protein in a different blog/video. But more on carbs. 

So again, I typically recommend looking for a lactose based formula first. Human babies are designed to break down lactose and it is the most easily digested by the human gut. If you are using a lactose based formula and baby doesn’t seem to be tolerating it, consider a lactose based formula with an alternative protein source first before going to a lactose free formula. 

Because formulas without lactose will use other sources of carbohydrates. Both the FDA and the European Commission require that infant formulas provide 40% of their calories from carbohydrates. However, the source of those carbs is up to the manufacturer of the formula. In the US, carbs can come from five main sources: Lactose, Maltodextrin, Glucose, Sugar, or Corn syrup. Not all of these sugars are created equal! 

Glucose and corn syrup are the sugar source in over half of the formulas produced in the USA. WHY? Because they’re widely available and very cheap to produce. The problem with corn syrup (and all glucose/sugar in general) is that it’s a fast-acting carbohydrate. This means that it’s high on the glycemic index, and quickly increases blood sugar. The EU has some limits and guidance on how much corn syrup can be used, and bans the use of corn syrup solids in organic baby formula, but the US does not. Which means that infant formula in the US can contain 100% of its carb source from corn syrup! Now before you get all fired up, corn syrup is NOT the same as high fructose corn syrup, which is what we are told as adults we need to stay away from. High-fructose corn syrup is corn syrup that has been further treated with enzymes to break down some of the glucose into another common sugar, fructose to make foods taste sweeter. Infant formulas are nutritionally complete and need a source of carbohydrate to provide energy. 

Maltodextrin is a type of sugar that is made up of glucose. Maltodextrin will become syrup if it is broken down further, so it’s essentially the same thing as added sugar.

Glucose syrup is the same thing as corn syrup! It just means that the syrup was extracted from a different plant – but it’s still the same as sugar.Sucrose is table sugar, and has a lower glycemic index than glucose, but higher than lactose.

Corn syrup, sucrose, maltodextrin are most used in “sensitive” formulas. That’s due to the fact that these formulas are designed for babies who are lactose intolerant, and so formula manufacturers are trying to replace lactose with an alternative carbohydrate.

Sometimes some corn syrup or glucose syrup is necessary in hypoallergenic formulas, because those formulas use hydrolyzed milk proteins, which are essentially partially digested milk proteins – and they taste/smell bad! So the corn syrup is used to try to mask the taste of the hydrolyzed milk protein.

But there are hypoallergenic formulas that do not overuse glucose and use healthier forms of carbs. 

There are a few reasons why formula manufacturers choose corn syrup over lactose in baby formula:

  • It’s a carbohydrate that babies can digest
  • It’s cheap to produce
  • Some sugars like maltodextrin also provide the function of thickening and emulsifying the formula for a better “mouth feel”
  • Corn syrup is sweet! And babies like sweet things – which might make formula more palatable to babies.
  • In hypoallergenic formulas, corn syrup might be used to make the formula taste better and mask the hydrolyzed milk protein taste.

So to recap, when choosing a baby formula, lactose is the preferred sugar or carb source for human babies. Prior to switching to a lactose free version, which will have the sugar source coming from another carb product, we should be switching to a formula with lactose with a different protein source.

My baby is refusing the breast: breastfeeding aversion

Aversion to feeding means screaming or crying when offered the breast or bottle, 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. The behaviors seen in baby are much more extreme for a true aversion. Most common causes: 

👅Tongue tie: One of my biggest red flags for tongue tie is reflux and shutting down during breastfeeding (sleepy 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 by compensating on a full milk supply. The aversion comes around 3-4 months when supply regulates. Address the ties and do oral motor exercises to strengthen the system and the refusal can go away. 

🥛Intolerances/Allergy: This looks similar to reflux, but often with bowel issues as well (constipation, diarrhea, or mucousy/foamy poops). Babies who’s digestive tracts are uncomfortable don’t want to eat. They learn quickly to associate feeding with pain, so they shut down on feeding.

🤮Reflux: Easiest culprit to blame and mask with medication. The medication may mask the pain but won’t actually take the reflux away. Reflux is usually caused by food allergy/intolerance, gut issues, or tongue tie. Address the issue, resolve the reflux. 

🥵Silent aspiration: Milk going into the lungs instead of to the stomach.

🤯Behavioral: The number one concern of parents is feeding the baby. When feeding isn’t going well, it causes extreme stress, which can causes 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. Occasionally the reason for the refusal is no longer there, but it was so stressful in the moment, the panic that it could happen again sets in and perpetuates the problem. 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. 

I don’t like breastfeeding, it makes me feel sad or angry.

Ready to find out more?

You’re not alone if you’re experiencing some kind of breastfeeding aversion. Click here to learn more.

Breastfeeding is not all snuggles and cuddles. Some may actually experience an aversion to the act of breastfeeding. There are 3 types of aversions:

Sensory Aversion

Breastfeeding is a complex sensory experience full of touch, sound, smell, and movement. This is an aversion to the actual act of breastfeeding. While the baby is latched, mothers experience creepy crawling or tingling sensations in various parts of the body (especially legs), feeling overwhelmed, have an intense desire to unlatch, itching accompanied by intrusive thoughts. As soon as baby unlatches the sensations go away, but often leave a feeling of guilt or sadness for having felt that way. Some of those who identify as neurodiverse or who have ADHD may have higher sensitivities and become more easily overstimulated or overwhelmed by the process of breastfeeding than others. While other people may actually find that it calms and relaxes their sensory system.

Dysphoric Milk Ejection Reflex (DMER)

This only occurs during the actual let down and is a physiological response to the release of the hormone oxytocin. An intense, transient dysphoria results in feelings of dread, anxiety, sadness or irritability, felt for 30 seconds to 2 minutes while the hormone is released. the rest of the breastfeeding or pumping session is totally fine. 

Breastfeeding Aversion and Agitation (BAA)

In further contrast to D-MER, this aversion occurs unexpectedly for some who have previously breastfed for some time. It varies in onset, severity and duration. Those who experience this describe it as involuntary, overwhelming sensation of aversion in response to the act of breastfeeding or pumping lasting the majority of feeding, not just during let down. They experience negative emotions including anger, rage, agitation and irritability. There is a strong urge to run away due to feeling trapped by feeding. (Yate, 2017).

While most people who have BAA describe the feelings and thoughts in a similar way, BAA happens in varying degrees and durations and the onset and severity are unpredictable. This is different then D-MER where the feelings are only during let down. And the feelings during BAA are different than D-MER: anger and agitation are not the same as dread, despair or sadness.

We don’t know what causes it. Hormones, lack of sleep, unrealistic expectations and not enough self care may play a role? There is not enough research on BAA to know how many breastfeeding people it affects, why it happens, and what can be done to treat it. But if you experience this, you are not alone.  Distraction for the breast feeder, taking certain supplements, and peer-to-peer support may help.

Up to 85 percent of us will experience the some severity of the baby blues.  It is normal to not be happy all the time, especially when transitioning to such a drastic life stage where a tiny human is completely dependent on you for all cares on top of a lack of sleep. You may feel happy one minute and overwhelmed and crying the next. If symptoms are severe or last for more than two weeks, a new mom should be concerned about a postpartum mood disorder, such as postpartum depression. Women who had anxiety or depression before giving birth are at higher risk. The signs and symptoms of postpartum depression include:

* Anxiety

* Sadness

* Anger and irritability

* Difficulty sleeping

* Intrusive thoughts (which may include thoughts of harming the baby)

Next steps:

💡 Know that what you’re experiencing is real and not just made up. You’re not alone in your aversion and there is support!

🍎 Nutrition and hydration are critically. Breastmilk is high in water, which is taken from your blood. Staying well hydrated is essential for not only making milk but also reducing feeling of depletion and aversion while feeding. Drink a glass of water 10-15 minutes before breastfeeding/pumping.

Be mindful of any nutritional deficits you may have, as this can make symptoms worse. Having lab work to determine if there are iron, vitamin d or b deficiencies can help. Many find taking A magnesium supplement may also reduce symptoms. Magnesium glycerinate is the preferred type of magnesium. Magnesium citrate is more common for constipation.

🛌 Sleep is the hardest to get,  but many find their aversion is worse without good sleep. Take any opportunity for a quick snooze

📺 Distract yourself. Watching Tv, using noise reducing or Loop headphones, listening to music or talking on the phone works because your brain can't process both the activity and attending to the emotions/thoughts

🧬Hormonal shifts caused by pregnancy, bf, and periods can throw even the most mindful person off. A blood test can check for abnormal hormone levels of LH, FSH, prolactin, estrogen, and progesterone. Diet changes, specific supplements, or medications can help under the guidance of a trained health care professional.

🛑 Time to wean. It’s absolutely OK to stop if you’re experiencing aversions. As long as you’ve reached your goals and are feeling well supported in your journey

Why does my newborn feel like they’re biting me?


When a baby latches to the breast, the baby needs to cup the tongue around the niple, keep the tongue out over the gum line, and shape/form the nipple in the mouth while using the lips to seal the cavity to prevent milk from spilling out. This whole progress creates negative pressure, or a vacuum, in the mouth. The tongue then pumps to compress the breast to remove milk. In reality it’s quite the complicated process!

It’s the up and down pump action of the middle of the tongue that is essential for creating a vacuum (negative pressure) inside the mouth for baby to efficiently move milk from the breast. Babies need to be able to protrude the tongue out past the lower gum line AND MAINTAIN IT protruded for the duration of the feeding.

Many parents who have a tongue tied baby will describe breastfeeding with words like “pinch, chomp, bite, and gum”. OUCH. That is because a tongue without full range of motion can’t do these two actions: up and down and SUSTAINED out. If a health care provider told you your baby doesn’t have a tongue tie because baby could stick their tongue out, that single action is not enough. A full assessment makes sure the tongue can stay protruded to cup the nipple and not flick back after every few sucks. This flicking back is what causes the “chomp” or “gumming” sensation. If the middle of the tongue is restricted, that is where baby cannot generate and maintain the negative pressure in the mouth to be efficient at expressing milk. That is why many of those babies fatigue and are sleepy at the breast, feed for a really long time and then are still hungry. They often doing better on a bottle where they only have to compress the nipple to get milk (you don’t need the vacuum seal in the mouth on the bottle to still express milk and when you can’t maintain the seal that’s where the milk leaks out of the mouth).

Think your baby has a tie but you’re not sure what to do next? Consider taking my Tied & Untied class. Click here to enroll

Need some exercises NOW to help your baby’s tongue? Hop over to my YouTube channel for many videos on helping your baby learn to use their tongue. This VIDEO helps baby’s tongue move in all the right directions and can help get your baby ready for a tongue tie release.

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There are many informational videos on my YouTube channel to help on the next stage of your journey.

My postpartum breasts don’t feel as full, am I losing my breast milk supply?


Breasts are made of a network of ducts, covered by a layer of fatty tissue. During pregnancy, estrogen and progesterone enlarge the milk ducts and multiply the glandular tissue that produces milk. After birth, estrogen and progesterone drop and prolactin and oxytocin rise. Prolactin makes milk production and oxytocin releases it into the ducts. Extra blood and fluid fill the breast just after birth to supoort your body adding hormone receptors in the breast to make milk. The blood and fluid surrounds the ducts and this extra pressure is what makes your breasts feel full between feeding. This blood and fluid reabsorb around 6-8 weeks once supply is established and you won’t feel that full/soft feeling except when you go a really long time between feeding or pumping. Breasts go back to prepregnancy size when supply regulates around 11-14 weeks but continue to make milk. When you wean from breastfeeding, it can take several months for prolactin levels to return to baseline (which is why you may still see milk for months after weaning). Once you stop breastfeeding, the milk making structures actually self-destruct – a process that involves massive cellular suicide, and the removal of the debris. Around 6 months after weaning, the milk-producing tissue is replaced with fatty tissue. If you return to your pre-pregnancy weight, your breasts most likely will return to the same size. They may not be as “perky” because the skin is a bit more stretched and the connective and fatty tissues in the breasts often shifts during pregnancy and breastfeeding. While they may look smaller after weaning most of us can expect that our breasts will return to a similar size as they were pre-pregnancy. They’re just a little more lived in and well loved.


There are two types of engorgement during breastfeeding.
🌞Primary engorgement occurs in the first week after birth. Hormones shift from pregnancy driven to breastfeeding driven.
🔆Breasts may feel lumpy/bumpy or hard as rocks.
🔆They may feel hot to the touch and you’ll often see visible veins on the surface of the skin.
🔆They can increase up to two cup sizes (or more!!).
🔆Breastfeeding or pumping makes the breasts soften.
🔆This marks the transition from colostrum to mature milk and typically lasts 12-48 hours if baby is frequently, efficiently breastfeeding
🔆Heat, massage, hot showers, hand expression and frequent, efficient feeding are the best to help with this transition
⏰Once your milk supply starts to regulate, around 6-8 weeks, you’ll no longer feel as full between feedings and the veining and huge breast size will go away. Around 10-12 weeks your breasts will transition back to prepregnancy size and you’ll no longer feel engorged between feedings at all.

🌚Secondary engorgement can happen at any time during your breastfeeding journey but usually when:
🌐Poor latch or inefficient feeding
🌐Change in feeding schedule
🌐Mom unable to pump frequently enough while away from baby
🌐Sleeping longer than normal
⏰Cool compresses before to help reduce swelling, hand expression, reverse pressure softening, gentle lymphatic drainage massage, emptying the breasts regularly and temporarily using cabbage leaf compresses can be helpful. If you can reduce the engorgement, schedule an appointment with an IBCLC to help.