Tag: breast feeding

Nursing aversions and breastfeeding strikes

- Julie Matheney

NURSING AVERSION

My baby won’t take the breast and is completely refusing to eat. What do I do? I see cases like these occasionally and I feel like they’re some of my most challenging (and most rewarding) cases. If your infant under 6 months is displaying aversion to feeding, we need to figure out why. Aversion to feeding means screaming or crying when even offered the breast, taking very little from the breast, refusing to eat, or needing to be fed while moving or while drowsy/asleep. This is not a temporary nursing strike where baby refuses the breast/bottle for a few days because of periods returning, mom going back to work, teething, or illness, etc. A nursing strike that isn’t managed well can turn into a feeding aversion, though. The behaviors seen in baby are much more extreme for a true aversion. Here is my list of the most common culprits to a true breast aversion in order of most common cause in my experience.

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

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

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

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

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

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

Does breast shape impact making milk?

- Julie Matheney

We come in all different shapes and sizes, and so do our breasts/chests. They can be large, petite, round, tubular, wide, narrow, symmetrical, uneven, teardrop shaped, or droopy. All of these types of breasts/chest are normal.

The size of your breasts/chest is based upon the amount of fatty tissue in it. Those with smaller breasts have less fatty tissue, and those with larger breasts have more fatty tissue. The fatty tissue doesn’t make breast milk. Glandular tissue inside the fatty tissue produces the breast milk.

Unlike fat, the amount of milk-making tissue in your breasts is not necessarily related to the size of your breasts. People with all different breast sizes are fully capable of producing a healthy supply of breast milk for their babies.

Smaller breasts does not necessarily mean smaller milk supply. As long as the small size is not related to hypoplastic breasts (not enough glandular tissue), there shouldn’t be an issue. While you may have to breastfeed more often due to the amount of breast milk that your breasts can hold, you can still successfully produce enough milk.

Breastfeeding with large breasts has its own unique challenges, usually related to position and how to hold or support the breast. Side lying or rolling a towel to put underneath the breast to lift it can be very helpful. Some worry that their breasts will block baby’s nose. Pulling baby in the opposite direction of the breast and compressing the breast from the back can help pop baby’s nose up off the breast. If your baby’s nose gets blocked while nursing, they will open their mouth and let go of the breast so they can breathe.

If you were told your breasts were too big or too small to breastfeed, I am so sorry. Your body is perfect just the way it is.

If you’re concerned that you’re not producing enough milk, pay attention to your baby’s wet diapers and bowel movements. Generally, small infrequent bowel movements or less than six wet diapers a day, are cause for concern. Contact a lactation consultant (🙋🏽‍♀️)right away.

Maternal vaccines and breastfeeding

- Julie Matheney

Did you know babies routinely get antibodies to anything you’ve been vaccinate against? Babies get temporary disease protection from you in this way. When you are vaccinated, your body has an immune response that makes antibodies to what you were vaccinated against. Antibodies are then secreted in breast milk to your baby. The type and quantity of these antibodies, and whether they provide any protection for baby after they are swallowed, are dependent on the vaccine received and maternal factors that influence immune system function such as genes, age and health.

Antibodies in breast milk have not been shown to reduce baby’s response to their own immunizations. However, some studies suggest that breast milk may improve baby’s immune response to some of the vaccines they receive.

If you do decide to be vaccinated while breastfeeding, there is no need to pump and dump your milk. Or to stop breastfeeding for any amount of time. When considering the vaccine, or any medication, most want to know whether a dangerous amount of a substance will be filtered into our milk and cause harm to our baby. For most drugs, so little gets to the baby that there’s really very little theoretical risk. Even if a drug or vaccine does end up in breastmilk, anything that goes through breastmilk also then has to go through baby’s gut before reaching baby’s bloodstream. The mRNA molecules in the Pfizer or Moderna vaccines, if they made it into your milk, would have to survive baby’s stomach acid first.

While breastfeeding, it is highly unlikely that an intact lipid from the vaccine would enter your blood stream and be passed directly into your milk. If it does, it is even less likely that either the intact nanoparticle or mRNA could be transferred into your milk. In the unlikely event that mRNA is present in your milk, it would first go through baby’s digestive system and would be unlikely to have any biological effects. The vaccine is supposed to trigger an immune response in your body. It helps your body recognize the virus when you’re exposed and fights the virus early, reducing the severity and length of illness. Once your immune system recognizes the SARS-CoV-2, the virus that causes Covid-19, antibodies are made to protect you and those antibodies may pass into the breastmilk. Researchers have already found Covid antibodies in the breastmilk of previously infected women, though they don’t know yet how much protection these antibodies give babies.

Choosing to be vaccinated is a personal risk/benefit decision to be made between you and your health care providers. If you do chose to be vaccinated with the COVID vaccines, there is no need to pump and dump for concerns of your milk harming your baby.

The Second Night

- Julie Matheney

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

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

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

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

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

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

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

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

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

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

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

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

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

Why can’t I put my baby down to sleep?

- Julie Matheney

SLEEP IN THE FOURTH TRIMESTER

I was going back through pictures when peach was a tiny baby. I have so many pictures of her sleeping on me. Babies don’t like to be put down, especially in the first 3-4 months. All their instincts and reflexes are designed to get them on a body. Their neurological system is immature at birth and still needs time to develop. Being on your body:

🧠 Accelerates Brain Development: Holding baby on your body increases the development of essential neural pathways, which accelerates brain maturation

🧘🏽‍♀️ Calms, Soothes & Reduces Stress: Having your baby on your body soothes baby so much that babies’ cortisol levels (stress hormone) are measurably lowered after only 20 minutes of being held skin to skin. Babies who are held cry less

🛌 Improves Quality of Sleep: Development of mature brain function in infants depends on the quality of their sleep cycling. During skin to skin, most infants fall asleep easier and achieve “Quiet Sleep” for longer

⚖️Stimulates Digestion & Weight Gain: Reduces cortisol and somatostatin in babies, allowing for better absorption and digestion of nutrients. With a reduction of these hormones, baby’s bodies preserve brown fat (the healthy fat baby was born with), helping to maintain birth weight and maintain body temperature. As a result, baby’s body does not have to burn its own fat stores to stay warm, leading to in better weight gain

💪🏻 Enhances Immune System: Your mature immune system passes antibodies through your skin to baby. Being on your skin also increases baby’s skin hydration

❤️Synchronizes Heart Rate + Breathing: You are a pace maker and a respirator. Your body sets the pace for baby’s body

🔑Promotes Psychological Well-Being: As our babies touch our skin, oxytocin levels rise and stress hormones fall, causing us adults to relax

🥛Milk production: Placing baby in skin to skin on your body for 1 hour a day will show an immediate increase in milk supply

🔥Regulation of Body Temperature: Woman’s breast tissue regulates a baby’s temperature, and can either cool OR heat, a man’s breast tissue only heats baby. Female is thermostat and male is radiator

My baby’s weight gain is slowing

- Julie Matheney

WEIGHT GAIN

While your young baby is supposed to gain on average an ounce a day (30gm), weight gain slows as baby ages. From 4-6 months babies should only gain 3-4 ounces per week (90-120gm) and from 6-12 months babies should only gain 1-2 ounces per week (30-60gm). If you have been tracking baby’s weight gain and see the scale slowing down, don’t be alarmed if your baby is older. Continue to watch for lots of wet diapers and consistent pooping. Trust your baby and trust your body.

Where has my breast milk gone?

- Julie Matheney

Some times we can sabotage our own milk supply from little things that we don’t understand will make a difference. Here are the top ways to accidentally drop your milk supply:

😳Putting baby on a feeding schedule in the first 3-4 months

😳Watching the clock instead of feeding baby on demand

😳Sleep training in the first 3-4 months after birth

😳Waiting for your breasts/chest to feel full to pump or feed

😳Not pumping when baby is getting a bottle

😳Letting partner feed a bottle in the middle of the night to get more sleep (and not getting up to pump)

😳”Topping off baby” after feeding, especially during the witching hour phase. (I’m not talking about when supplementing is necessary or if you’re on a triple feeding plan because of true low supply or baby weight gain. Supplementing after breastfeeding can be needed, but you would also be pumping at that time)

😳 Not pumping enough when returning to work

😳Using the wrong size pump flanges

😳Using a poor quality pump (insurance companies have to provide you with one, but that doesn’t mean they’ll give you one of quality)

😳Going back on hormonal birth control at your 6 week postpartum checkup

😳Taking nasal decongestants or allergy medications

While these seem like normal recommendations from many parent groups or even your health care providers, these subtle things can sabotage milk supply. Your body works on a demand and supply basis. The more you empty or demand from the breast/chest, the more milk it will make. Want to increase supply? Increase the number of milk removals, give young infants free access to feed on demand, and watch out for medications, hormones, of pumping traps that can sabotage your success.

Vitamin D supplements and breast milk

- Julie Matheney

VITAMIN D

Were you told by your pediatrician to give your baby vitamin D drops? Vitamin D is absolutely critical strong bones, because it helps the body use calcium from the diet. Traditionally, vitamin D deficiency has been associated with rickets, a disease where the bone tissue doesn’t mineralize properly, leading to soft bones and skeletal deformities. Recent research also tells us that vitamin D is key in maintaining our immune systems for regulating both infection and inflammatory pathways. If you shun the sun, have a milk allergy, or follow a strict vegan diet, you may be at risk for vitamin D deficiency. Known as the sunshine vitamin, vitamin D is produced by the body in response to skin being exposed to sunlight. It is also occurs naturally in a few foods like certain fish, fish liver oils, egg yolks, and fortified dairy and grain products.

Our bodies are designed to make very large amounts of vitamin D through exposure to the sun (10,000—20,000 IU in 24 hours, after 15—20 minutes of summer-sun exposure in a bathing suit/45—60 minutes of exposure for those with darker skin tones). However, in an effort to decrease our risk of skin cancer from over exposure to the sun, we’ve limited our ability to keep our vitamin D status at a normal level from absorbing it directly from the best source. That said, those living where clouds often cover the sky or in cities with polluted air quality will have a hard time getting sun exposure for natural vitamin D. People with darker skin tones are more likely to have low levels of vitamin D, as well, due to the increased pigment in their skin. They require nearly four times the length of sun exposure in order to penetrate the skin to manufacture vitamin D.

Vitamin D is essential for babies. Your pediatrician cannot tell you to put your baby in the sun, even though that is the best source of vitamin D, because of the risks of skin cancer. So they should have advised you to give your baby 400 IU of vitamin D each day, usually given by drops in the mouth.

All formulas sold in the United States have at least 400 IU/L of vitamin D; so if your baby is drinking 32 ounces of formula, vitamin D supplementation is not needed.

But what about from breast milk? Human milk is a very poor source of vitamin D, usually containing less than 50 IU per quart. This is why the AAP recommends all breastfed infants be supplemented. This does not mean there is anything wrong with the milk, but an issue in the recommended amount of vitamin D the lactating parent should be taking. This goes back to the sunlight recommendation. If you were getting 15-45 minutes of sunlight (depending on how dark your skin tone is) 3-4 times per week, your body would have plenty of natural vitamin D to pass through your milk to your baby. Many who live in the US either don’t live in a location where that’s possible year round (hi, Chicago in January) or maybe can’t get out in the sun because of needing to work. The Academy of Breastfeeding Medicine (a global organisation) recommends that “The breastfeeding infant should receive vitamin D supplementation for a year, beginning shortly after birth in doses of 10–20 lg/day (400–800 IU/day) (LOE IB). This supplement should be cholecalciferol, vitamin D3, because of superior absorption unless a vegetable source such as ergocaliferol vitamin D2, is desired. … Vitamin D also may be delivered adequately through human milk.” Research has shown that as long as you as the lactating parent is taking 6,400 IU of vitamin D daily, there is no need to supplement the baby as your milk will have adequate amounts.

Breast milk supply drop at six months

- Julie Matheney

SIX MONTH DROP

For the first six months after birth, baby is supposed to be on an exclusive breast milk diet. At six months and beyond your breast milk goes through a major change. The volume of milk slowly drops because baby is eating and drinking other foods. They may also be sleeping longer at night and are more active during the day. Your milk is super smart and shifts with this drop to have more antibodies and a higher fat content. The breast makes milk based on how it is emptied and what your hormones are doing based on how old baby is. Your hormones are also shifting and you may start your monthly cycle again. Many experience a further dip in supply around the time with their period. If you’re exclusively breastfeeding, you may notice baby pulling or tugging on your nipple or using their hands to beat your chest while feeding. If you’re pumping, you may slowly start to see less milk each pump session. Usually months 5-7 are the hardest from a baby behavior perspective and it settles out again as baby eats more table food and your hormones adjust. If breastfeeding is your goal, just keep offering the breast and pumping often.

Tandem breastfeeding

- Julie Matheney

It’s common for a toddler, or an even older child, to ask to breastfeed after a new sibling is born. Toddlers who were weaned immediately before or during pregnancy may be especially curious. Many just want to know if you’ll say yes – or they may just want your attention or “babied” themselves. Continuing to breastfeed, or letting them try to breastfeed again after weaning, can ease the transition of gaining a sibling. They are less likely to be jealous of the baby who is always with mommy if they can nurse alongside them. Nursing your older child once the new baby arrives can reduce engorgement when colostrum transitions to mature milk and can protect milk production if your newborn is not feeding effectively. If you say yes to a weaned child, many will just touch, lick or kiss the nipple, some will have forgotten the mechanics of how to breastfeed and won’t have further interest. Others can successfully breastfeed again. If you are happy to nurse your toddler, go for it. If it is overwhelming, it is still your body and you get to decide when and for how long toddler is allowed to breastfeed. You may prefer nursing your baby and your toddler separately or together. Breastfeeding is normal and it is normal for children to be curious and want to breastfeed at 2, 3, or even 4 years old.

When you give birth your body will continue to produce colostrum, with milk becoming plentiful after around 3-5 days. As with your first baby, breastfeed at least 8-12 times per day to establish your milk supply. Some will feed their newborn baby first or encourage the older sibling to nurse less until breastfeeding has been well established to ensure the newborn has full access to breast milk. Look out for feeding cues and give your newborn unrestricted breast access to help ensure they get plenty of milk.

Some times if your toddler is breastfeeding frequently, they may lose interest in solid foods for a while from increased milk intake. They may have looser stools. This is normal and should regulate with time.

It can take a while before your body adapts to the needs of two different feeders. You may feel lopsided if one breast drains more than the other. Eventually things will even out and you’ll find your rhythm. Alternating breasts for each feed helps with development of newborn vision and keeps the size of your breasts balanced. However, some mums find that giving a toddler his ‘own side’ works for them.

You will not run out of milk, your body will make more to accommodate however many nurslings there are.