How many minutes should baby breastfeed for?


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

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?

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

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

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)

Empty breasts make milk faster than full breasts

FULL/EMPTY BREASTS

While it seems counterintuitive, the emptier your breasts are, the faster they make milk. A full bread has no place to store or hold the milk, so milk production slows to prevent plugged ducts and breast discomfort. Cluster feeding on an emptier breast actually tells the body to make more milk at a faster rate!! Some incorrectly assume you have to wait for the breast to “fill up” before feeding your baby or for pumping while at work. This will eventually lead to less milk, as a fuller breast tells your body baby isn’t eating very often and to slow milk production. The more frequent you empty the breast, the higher the fat content in that milk and the faster milk is made. The longer often you wait and the fuller the breast, the higher the water content in that milk and the slower your body will make milk overall.

W atch the baby, not the clock. Breasts may feel really full between feedings in the first few weeks after birth, but they’re also not supposed to stay engorged. There will come a time when they stay soft and don’t feel full between feedings or pumping, so waiting for that as a cue to feed will also sabotage your supply. Don’t be alarmed when your breasts no longer feel full between feeding. You’re entering a new stage where you’ll still make plenty of milk for your baby as long as you’re routinely emptying that milk. Trust your body. Trust your baby.

Nursing aversions and breastfeeding strikes

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?

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

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

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.