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.
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
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.
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.
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.
The vernix caseosa is a greasy, cheese-like coating that covers baby’s skin in the womb to protect their skin from getting pickled by amniotic fluid prior to birth. According to present knowledge, vernix production is unique to humans. At birth, vernix may cover the entire skin surface or only be found in body folds. Its color may actually help indicate intra-uterine problems or disease.
😳In utero: When swallowed by baby in utero, vernix helps:
• Develop the gut
• Prevents loss of electrolytes and fluids
• Seals the skin to prevent the amniotic fluid from turning baby into a raisin
• Acts as a microbial barrier from pathogens
• Protects skin growing underneath it
😳In birth: The oily texture may naturally lubricate the birth canal to reduce friction as baby makes their exit. It can also help with mother’s perineal healing!
😳 In postpartum:
• Vernix protects baby’s skin from drying out
• Reduced risk of bacterial infections
• Help baby retain heat
😳 In breastfeeding: The scent of vernix might be involved in triggering neural connections in babies’ brain needed for breastfeeding. The immune proteins found in vernix and amniotic fluid are similar to those found in breastmilk. Swallowing vernix and amniotic fluid in utero help coat baby’s lungs and digestive tract, preparing the digestive tract for the similar peptides found in breastmilk. The smell may also help baby find the breast!
The majority of the vernix is absorbed within the first day, so so it’s recommended to wait until after the first 24 hours to bathe baby. Vernix doesn’t fully absorb until day 5 or 6, so it’s best to wait until then.
PERSPECTIVE
“My hospital nurse told me to feed baby every 2 hours with 15mL and my pediatrician told me to feed baby every 3 hours with 30mL.”
“My IBCLC told me there is a tongue tie but the ENT said there wasn’t one.”
“One consultant told me to use a nipple shield as lo as needed. The other said get off as quick as possible”
“They said don’t let baby feed more than 10 minutes per side, but my baby won’t stay latched that long.”
I hear this all the time in my practice and it can be confusing for families. Why did I get different advice from different people? Perspective. Doulas, midwives, pediatricians, even lactation consultants all come from their own training, education, clinical practice and personal experience. When in doubt, the best person to get lactation advice from is an IBCLC. They have had to go through extensive training and mentoring to become certified in the study of human lactation. But remember: even lactation consultants come from different perspectives.
A hospital based IBCLC typically only works with babies in the first 2-4 days after birth and may see dozens of babies in a week, getting only a short amount of time with each family. A private practice IBCLC may have more time to spend with you but experience and expertise may vary. An IBCLC who is also a nurse will approach breastfeeding differently than one who is also a feeding therapist or who started out as a mother who struggled to breastfeed and became passionate to help others going through what she went through. My best advice is find some one who listens to you, educates on why they want you to do something, and supports you in your journey. Because you have a unique perspective, too.
It’s normal to experience nipple tenderness for the first few days after delivery. Tenderness peaks between the 3-6th days postpartum and then should resolves by the end of the second week. Any damage to the skin of the breast or nipple should be taken care of immediately to avoid further damage or infection.
Painful breastfeeding is not normal. The first step to decreasing pain while breastfeeding is to identify what’s causing it. Usually the simplest way to reduce nipple pain is to make sure baby is in the right position. Baby’s tummy should be touching mom’s body, with the belly button touching. Baby’s arms hug the breast and their face comes straight to the nipple. Baby’s Head should be straight, with their ear, shoulder and hip making a straight line. Their head should be slightly extended backward to allow the nose to pop up off the breast. Pulling baby in closer through the shoulders usually helps get a deeper latch. If nursing is still painful, even with careful attention to latch and positioning, there may be other things at play. Usually there is a tongue/lip tie, tension in baby’s body like from a long labor and delivery (greater than 24 hour labor and/or more than 4 hours of pushing), or tension on baby’s body from intrauterine position (sitting really low for a large portion of pregnancy or being breech). Having the tongue tie released and/or doing tummy time and bodywork on baby should resolve the pain. If you’re working on release and baby’s body, consider the temporary use of a nipple shield to protect nipples, until damage is resolved and the underlying cause of the damage is managed.
When your nipples are already damaged:
Step one: Wash and Rinse Damaged nipples are prone to bacterial infection. Washing and rinsing damaged nipples can help prevent this type of infection. When bacteria grows in a wound, they create a bio-film that lengthens healing time. Baby’s saliva also fosters this bio-film. Washing cracked or fissured nipples gently twice a day with a gentle, fragrance free soap (not an antibacterial soap) and rinsing them with water can help remove the bacterial bio-film and allow faster nipple healing. Stop washing with soap once the nipples are healed. After every feed, rinse nipples with either clean water or a saline rinse. You can make your own saline rinse by mixing ¼ rounded teaspoon of sea salt with 8 ounces of warm water. Soak your nipples in this solution for 30-60 seconds. Soaking for longer may actually over hydrate your skin and increase cracking.
Step Two: Moist Wound Healing after washing and rinsing and/or soaking your nipples, dry and apply your antimicrobial ointment of choice. This could be virgin coconut oil, Dr Jack Newman’s All Purpose Nipple Ointment, or medihoney. There are other nipple balms and butters on the market. Make sure the one you’re using is antimicrobial. While you may think airing the nipple out will help scab the nipple over, Keeping cracks covered with some type of ointment promotes moist wound healing which is better for the sensitive nipple tissue which is a different kind of tissue than the rest of your skin. A non-stick wound pad, reusable breast pad, or a cooling breastfeeding gel may be placed over the ointment to keep your nipples from sticking to your bra or clothing. Ointment should be applied like chapstick, in a thin layer. Gently wipe off any leftover ointment before baby feeds. Disposable nursing pads should be avoided as these do not allow for good air flow and the quick wicking material tends to stick to nipples. Wool breast pads are preferable for their antibacterial and air flow properties.
Monitor for Infection Contact your primary caregiver physician and an IBCLC lactation consultant if you have any signs of infection like increasing redness, fever, or pus. If you have a fever of 100 degrees or greater for 24 hours, or bacterial infection which will require oral antibiotics. Research suggests that taking probiotics containing lactobacillus fermentum and lactobacillus salivarius can also help treat bacterial infections of the breast.
Good bye pumpkin, hello peppermint. Tis the season for peppermint bark, candy canes, peppermint lattes, and holiday cookies with crushed red and white striped mints. While you may binge on all things peppermint this December, be warned: it may drop your milk supply.
Peppermint is a soothing herb best known for treating stomach and digestive problems. Popular products like toothpaste, chewing gum and tea are often flavored with peppermint. The calming and numbing effect of peppermint treats headaches, menstrual cramps, diarrhea, anxiety, nausea, and skin irritation. Peppermint oil has even been used to treat cracked nipples!! It is also used as an active ingredient in vaporizers and chest rubs. Menthol and methyl salicylate, the active ingredient of peppermint, possess antibacterial, antifungal, and antiviral properties.
It’s been commonly reported that peppermint and spearmint decrease milk supply, especially when taken in large amounts such as during the holidays. Drinking an occasional peppermint latte shouldn’t be a problem. But if you start to notice your supply taking a dip this holiday season, check your peppermint intake.
Paced bottle feeding (meaning you’re setting the pace for how fast/slow baby drinks) helps prevent over feeding baby: it takes 20 minutes for the stomach to tell the brain that it’s full. If a baby takes a bottle too quickly, the mouth can still be “hungry” and wanting to suck when the stomach is actually full. Like going to an all you can eat buffet and eating a lot of food quickly and then realizing half hour later you ate way too much. A baby that happily sucks down too much milk from a bottle can make you think you don’t have enough breast milk even if you make a normal amount. It can also make baby frustrated by the flow of milk from the breast and inadvertently sabotage breastfeeding
These pictures are the same baby in two different positions for paced feeding: semi upright and side lying. Side lying is my favorite position to use as it puts baby in the same position as breastfeeding. Many parents feel baby is more supported in this position. Baby is supported by your leg or breastfeeding pillow.
Tips:
🍼Never feed baby on their back
🍼Keep the bottle parallel with the floor with about half the nipple filled with milk
🍼Use the slowest flow nipple baby will tolerate
🍼Rub the nipple gently on baby’s lips, allow baby to latch at their own pace, don’t force it into their mouth
🍼It should take 15-20 minutes to finish the bottle
🍼Watch the baby and not the bottle, stop when they show signs of being full
🍼Resist the urge to finish the bottle, even if there is only a little left, when baby is showing signs their tummy is full
🍼Take short breaks to burp and give the tummy time to fill naturally
🍼If baby is gulping or chugging, slow down
🍼If baby has taken a good volume of milk (2-4oz) in a short amount of time and is still acting hungry, offer a pacifier for a few minutes to help them digest and give the tummy to to tell the brain it’s full. If they’re still hungry, slowly offer more in 1/2oz increments