Tag: breastfed baby

Pace bottle feeding

- Julie Matheney

**What is Paced Bottle Feeding?**

Pace(d) bottle feeding is a responsive feeding technique designed to mirror the slower, more controlled flow of breastfeeding. The idea is to allow babies to feed at their own pace, promoting better digestion, reduced gas, and helping to prevent overfeeding. There are a few things about how it’s being taught to families with older babies, though, that have always bothered me as NICU trained SLP.

Pace bottle feeding was originally used and taught in the NICU setting with preemie babies for before their suck, swallow, breathe coordination was fully developed. We needed to be in charge of the bottle, because babies born before their due date lack maturity for self pacing and are at a higher risk of fatigue and other medical issues like aspiration and bradycardia/tachycardia from feeding.

Pace bottle feeding is often shown as baby sitting upright with the bottle nipple only half full of milk. Caregivers are encouraged to tip the bottle down frequently every few swallows to slow baby down. The bottle is also removed at regular intervals for burping. This can work fine for the first week or two while baby is learning to feed, but there are a few flaws to this.

📌I’m not a fan of half full nipples. Air mixed with milk is what increases swallowing air which can cause reflux and digestive discomfort. I recommend keeping the nipple full

📌Externally pacing the baby is fine in the initial weeks after birth, but we really want baby pacing themselves. If they are constantly chugging from the bottle, that’s a bottle issue. Decrease the level or nipple or change bottles to find a flow that allows baby to take breaks when they want to

📌An upright position is fine for babies 3+ months, but I see so many newborns hunched or scrunched in this position, which leads to pressure on the belly. Having baby in an upright side lying position mimics being at the breast and allows a long, straight torso for easier digestion

📌Yes!!!! We want baby to pace their feedings. That means it would take a similar amount of time as the breast: 15-30 minutes for the first 6-8 weeks and then to match the time at the breast after that it can range from 5-30 depending on how fast mom’s let down is.

How Paced Bottle Feeding has been taught:

👶🏻Hold Baby Upright: Sit baby in a semi-upright position to reduce air intake and reflux

🍼Controlled Bottle Angle: Hold the bottle horizontally, allowing milk to fill the nipple (some are taught to only fill it half way) but not flow freely.

🧭Pause and Check-In: Offer short breaks during feeding to gauge baby's cues for hunger or fullness.

💡Encourage Sucking Reflex: Let baby control the pace of feeding by actively sucking to draw milk, rather than having milk continuously drip.

🔮Observe Cues: Watch for signs of satiety (e.g., slowing down, turning away) to know when baby is full.

Benefits of Paced Feeding:

- **Supports Digestion:** Reduces the risk of overfeeding and minimizes gas and spit-up.

- **Mimics Breastfeeding:** Helps babies develop a natural feeding rhythm similar to breastfeeding.

- **Promotes Self-Regulation:** Encourages babies to eat until they are satisfied, rather than finishing a bottle due to continuous milk flow.

**When to Use Paced Bottle Feeding:**

- **Breastfeeding Transition:** Ideal for young babies who are both breastfed and bottle-fed to maintain consistency in feeding patterns.

- **Preventing Overfeeding:** Helps prevent babies from overeating by allowing them to control the pace.

- **Bonding and Interaction:** Fosters a closer feeding experience between caregiver and baby.

**Final Thoughts:**

Paced bottle feeding is not just about feeding; it's about creating a nurturing and responsive feeding environment for your baby. By tuning into your baby's cues and allowing them to guide the feeding process, you can support healthy growth and development while fostering a positive feeding relationship.

Have you tried paced bottle feeding with your baby? Share your experiences and tips below! 💬🍼 #PacedFeeding #ParentingTips #BabyCare

Breast milk nutrition

- Julie Matheney

Breast milk is a complex and dynamic fluid that provides all the essential nutrients a baby needs for optimal growth and development. Its composition varies not only between different stages of lactation but also from one feeding session to another. Here’s an in-depth look at the key components and nutritional value of breast milk:

Macronutrients

- Proteins: Breast milk contains two primary types of proteins: whey and casein. Whey proteins, which are easier to digest, make up about 60-70% of the total protein content. Casein constitutes the remaining 30-40%. These proteins are crucial for the baby's growth and immune function.

- Fats: Fats are the most variable component of breast milk and provide the primary source of energy, comprising about 50% of the total calories. The fat content can range from 3-5 grams per 100 mL, depending on the time of day and how long since the last feeding or pump session. These fats include essential fatty acids, such as DHA and ARA, which are vital for brain development and vision.

- Carbohydrates: Lactose is the main carb in breast milk, providing about 40% of the total caloric content. It aids in the absorption of calcium and supports the growth of beneficial gut bacteria.

Micronutrients

- Vitamins: Breast milk contains a range of vitamins necessary for the baby's development. These include fat-soluble vitamins like A, D, E, and K, as well as water-soluble vitamins such as C, riboflavin, niacin, and B12.

- Minerals: Key minerals found in breast milk include calcium, phosphorus, magnesium, sodium, potassium, and trace elements like zinc and iron. These are essential for bone development, cellular function, and overall growth.

Immune-Boosting Components

- Antibodies: Immunoglobulin A (IgA) is the most abundant antibody in breast milk, playing a crucial role in protecting the infant from infections by forming a protective barrier on mucous membranes.

- White Blood Cells: Breast milk is rich in leukocytes, which help fight infections and bolster the infant’s developing immune system.

- Enzymes and Hormones: Enzymes such as lipase and amylase aid in digestion, while hormones like leptin and ghrelin help regulate the baby’s appetite and metabolism.

Caloric Content

- Calories: The caloric content of breast milk can vary significantly. On average, breast milk provides about 20 calories per ounce (approximately 67 calories per 100 mL). However, the caloric density can range from 15 to 30 calories per ounce (50 to 100 calories per 100 mL) based on factors such as the stage of lactation and the time of feeding. Colostrum, the first milk produced, is lower in calories but higher in proteins and antibodies, while mature milk produced later is higher in fat and overall caloric content.

Variability and Adaptability

One of the remarkable features of breast milk is its ability to adapt to the baby's changing needs. For example:

- **Foremilk and Hindmilk**: At the beginning of a feeding session, the milk (foremilk) is typically more watery and lower in fat, quenching the baby's thirst. As the feeding progresses, the milk (hindmilk) becomes richer in fat and calories, satisfying the baby's hunger and providing sustained energy.

- **Circadian Rhythms**: The composition of breast milk can also change based on the time of day. For instance, evening and nighttime milk often contain higher levels of melatonin, which can help the baby sleep better.

Breast milk is a highly specialized and ever-changing nutritional source that supports infants' growth, development, and immune function. Its unique composition, tailored to meet the specific needs of human infants, underscores the benefits of breastfeeding for both mother and child. The dynamic nature of breast milk, with its varying caloric content and nutrient composition, ensures that babies receive optimal nourishment during the critical early stages of life.

Cluster Feeding

- Julie Matheney

Cluster feeding is a normal and common behavior in newborns, where they nurse frequently and irregularly over a period of several hours, often in the evening. This behavior helps stimulate milk supply and can also provide comfort to the baby, who may be going through a growth spurt or developmental leap. Despite its normalcy, cluster feeding can be particularly challenging and frustrating for new parents, especially if they are unprepared for its intensity and duration.

New parents may find cluster feeding overwhelming for several reasons. First, the frequent and seemingly incessant nursing sessions can lead to physical exhaustion and a sense of being constantly tethered to the baby. The lack of predictability in feeding patterns can also make it difficult for parents to find time for their own basic needs, such as eating, sleeping, and showering. This can contribute to feelings of frustration and stress, as the demands of cluster feeding can seem relentless.

Additionally, new parents might worry that their baby is not getting enough milk or that there is something wrong with their breastfeeding technique. This anxiety can be exacerbated if they are not aware that cluster feeding is a typical behavior that helps regulate and increase milk supply. The emotional toll of seeing their baby seemingly insatiable and unsettled can add to their frustration.

Education and support are key in helping new parents navigate cluster feeding. Knowing that cluster feeding is a normal part of newborn development can alleviate some of the stress and help parents manage their expectations. Seeking support from lactation consultants, pediatricians, or breastfeeding support groups can provide reassurance and practical advice. Understanding that this phase is temporary and that it plays an important role in establishing a healthy milk supply can also help parents cope with the challenges of cluster feeding.

Pregnancy and breastfeeding

- Julie Matheney

If you’re still breastfeeding and become pregnant, your mature breastmilk will transition back to colostrum around the end of the first trimester in preparation for whenever the new baby is born. By 4 months gestation, the placenta is large enough to suppress most milk production. Your body will prioritize your fetus over your nursling in terms of milk and produce the appropriate milk for the more vulnerable child. Colostrum is a high protein, laxative milk to help newborns poop out meconium. It is saltier in taste and thicker in consistency. Many older babies don’t care if it tastes different, but some will and may wean themselves. The supply is not likely to be able to support an infant 10 months old and younger. But if the older infant (11+ months) or toddler is eating solids and drinking other liquids, those babies may not care if they are getting milk or “dry nursing” until the next baby comes. Some choose to supplement younger babies with donor milk or may transition to formula until the new baby arrives and then continue to tandem feed with their own breastmilk again. 

Pregnancy hormones can make breasts and nipples more sensitive and uncomfortable. And these sensations often will make one want to wean or experience a nursing aversion. Toddlers may still aggressively want to nurse and it’s ok to put boundaries on your nursing. 

The typical things recommended to increase supply (additional feeding/pumping, herbs and supplements, etc.) are not appropriate and are ineffective since the placenta will continue to increase in size. Hormones supported by the placenta are what impact milk production and there’s not much you can do to combat the hormone shift as it’s needed to support the pregnancy. 

Hunger cues for baby

- Julie Matheney

How do I know my baby is hunger and not just fussy, has a wet diaper, or is lonely and wants to be picked up? Babies have a limited communication repertoire when they are first born. Every cue can look the same. It does get better with time as you learn your baby and your baby grows and matures. In general, young babies go through stereotypical phases of hunger cues. Some times we can miss these cues when the baby is swaddled or in a crib or bassinet away from where we are. 

Early

  • Licking or smacking their lips
  • Opening and closing their mouth
  • Sucking on their lips, tongue, hands, fingers, or anything within reach
  • Time to get your breastfeeding pillow and grab a snack and some water!

Active

  • Rooting around and attempting to latch on anything nearby their mouth
  • Hitting you on the arm or chest repeatedly and/or grabbing at your clothing
  • Trying to get into a nursing position 
  • Fidgeting/squirming
  • Becoming fussy
  • Breathing fast: get ready for them to start crying!
  • This is the best time to latch!

Late

  • Crying
  • Moving their head frantically from side to side
  • You’ll need to calm the baby before attempting to latch!

Many newborns are very sleepy after birth and may actually need to eat more often than they exhibit hunger cues. Newborns should be offered the breast anytime they cue hunger, which can be between 1-3 hours since the beginning of the last feeding. Watch the baby and not the clock. Don’t make the baby “wait” until some mythical hour to be fed. Feed the baby when the baby is hungry. 

Hand sucking is not as reliable an indicator of hunger as baby ages. Starting at around 6-8 weeks, baby will begin to gain more control over their hands and will begin to explore their mouth and everything else in their environment with their hands. Babies also suck on their hands during teething. Symptoms of teething can sometimes occur weeks and even months before the first tooth erupts.

How many minutes should baby breastfeed for?

- Julie Matheney


15 minutes per side is a recipe for baking, not breastfeeding. Not every baby needs 15 minutes per side. Some babies take a full feeding in only a few minutes minutes, and from just one breast per feeding. Other babies may feed for a few minutes off each side. Older, more distractible babies are efficient eaters with more important things to do than state at your chest. They may graze at the boob a few minutes at a time or want to go back and forth from side to side.

Other babies may be boob barnacles and need much longer at the breast. Or they may want to be at the breast for more than just nutrition: teething, growth spurts, you going back to work, developmental leaps, sickness. Being on your body brings healing, comfort and stability while they’re going through all kinds of rapid changes and growth. Being on you for an hour or more is the best medicine to what ails them.

The only time we should be limiting time at the breast is in NICU with premature babies where fatigue is a factor or under the direction of a lactation consultant because of true low supply, tongue tie or other oral motor disfunction while on a triple feeding plan. This would be a temporary plan because of a true lactation issue.

In general, you know baby is getting enough breast milk when you have a pain free latch where the nipple goes in and out of baby’s mouth the same shape. You can hear baby swallow and don’t need to keep them awake at the breast for them to continue feeding. Baby should be making lots of heavy wet diapers and pooping daily or every other day. They also gain weight to their own curve and are a similar size of your unique family genetics.

If your baby typically latches for you, and feeds well, and refuses to latch, they most likely are done. Follow your baby’s lead and get to know their feeding habits. Trust your baby and trust your body. If you’re concerned about how your baby is feeding, schedule and appointment with a breastfeeding expert: an IBCLC lactation consultant.

Tricky Posterior Tongue Ties

- Julie Matheney

Some times even the best lactation consultants and feeding therapists can miss a posterior tongue tie in the immediate days or weeks after birth. Having a frenulum under the tongue doesn’t automatically mean it’s tied. A long, stretchy frenulum that allows full movement of the tongue is normal and not something that needs released. However, sometimes a frenulum can allow the front of the tongue to do what it needs to, but still be tied at the back. These are what I can tricky posterior ties. Mom may have lots of milk and baby transfers well from the breast in the early days or weeks post delivery. Mom may have no nipple pain or damage whatsoever. Only they come back a month later with new symptoms like slow weight gain or feeling like there breast isn’t emptying. Why is that?

Mom’s body often compensates well during the early weeks post delivery. The uterus doesn’t tell the breasts how many babies came out. So her body goes into overdrive to make more milk than needed from the start. As time moves on, the body figures out how much milk to make and drops supply to just what is being emptied. A baby that rode on mom’s robust post delivery flow may all of a sudden start to struggle at the breast as supply regulates. Based on how the anatomy is, there may never have been nipple pain or damage. If the baby has a high palate where the front of the tongue can still move well and mom has a large nipple that fills baby’s mouth well, the nipple may come out creased or pinched, but without pain. The anatomy on one or both sides masked the tie while baby was small. 


If breastfeeding was going well in the beginning, but symptoms start to pop up later, working with a qualified lactation consultant can help figure out what’s going on. And some times that means finding a posterior tie that was originally missed where a release is necessary to get feeding back on track. 

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

- Julie Matheney

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

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

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

How to use my Spectra Breast Pump: Maximizing settings, suction and cycle levels

- Julie Matheney

Different stages of pumping require different pump settings. The wonderful thing about the Spectra pumps is their cycle variability.

Check out my video on YouTube for how to set and use the Spectra pump.

Colostrum is thick and sticky. Pumps are great for stimulating milk but they’re not the best at removing it from the breast and it can be very frustrating to pump and not see anything filling the bottles. Don’t be discouraged. Stimulation is super important in the early days after birth and the work will pay off. hand expression is the key to emptying colostrum when pumping. The pump will do a good job to stimulate your hormones to make milk and your hands will help empty it.

If you’re engorged or have an oversupply, you may need to pump to relieve the pressure in your breasts. Using the pump wisely can reduce your engorgment while not causing you to make too much milk and perpetuate your problem.

You can also pump to increase milk supply by pumping for an extra 5 minutes after milk stops flowing to signal to your body that it needs to produce more milk. If you’re breastfeeding and pumping after, aim for a 10-15 minute pump. If you’re exclusively pumping, shoot for a 30 minute pump.

Whether you’re pumping at work to maintain supply or trying to increase your supply, using the settings on the Spectra can help you reach your goals. Have you played around with your settings? What works for one person may not work for another. Try alternating back and forth between the settings and play around with the suction and cycle levels. If you need to have the suction cranked to the top, you’re most likely using too large of a flange.

Everyone responds differently to pumps. Play around the settings and cycles. What works for one person may not work for every person. Make sure your suction level is comfortable and you’re using the correct sized flange. If you have to crank the suction all the way up, you’re pumping with a flange that’s too large. Pumping should be comfortable. You should not have pain or damage from pumping. If you have any pain or damage, try a different range size, shape or cushion and try lowering the suction. If you’ve been pumping on a particular set of settings and start to notice a decrease in supply or suction, change the soft pieces of the pump like the duckbill or membranes and the tubing.

Breastfeeding weaning

- Julie Matheney

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

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

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

Tips for gentle weaning:

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

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

✏️Don’t offer, don’t refuse

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

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

✏️Change your routine

✏️Postpone: “After we play”

✏️Shortening the length of feeding or space feedings out

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

✏️Alternate between offering bottles and the breast

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

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

Ways to quickly wean:

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

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

⚓️Epsom salt soaks of the entire breast for soothing

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

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

⚓️Cabocream (an alternative to the cabbage leaves

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

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

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

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

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

🔑Solids were introduced too soon

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

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

🔑Medications or hormonal birth control which will decrease supply

🔑Lactating parent is pregnant

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