Tag: breastmilk

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 supply tips

- Julie Matheney

It's crucial to remember that every breastfeeding journey is unique, and breast milk pumping outputs can vary widely from person to person and even from day to day. Comparing your output to someone else's can create unnecessary stress and pressure.

Natural Variation: The amount of milk a person can pump varies based on factors like breast storage capacity, hormonal levels, baby's nursing habits, and more. Some people naturally produce more milk than others, and this doesn't reflect on their ability to nourish their baby

Frequency and Timing: Pumping output can fluctuate throughout the day and with different pumping sessions. It's normal for milk supply to be higher in the morning and lower in the evening. The timing and frequency of pumping sessions can also impact how much milk is expressed

Storage Capacity: Breast storage capacity differs among individuals. This affects how much milk can be stored in the breast at one time and consequently how much can be pumped in one sitting

Baby's Needs: Babies' needs vary, and not everyone needs the same amount of milk. Your baby's growth and development are better indicators of whether they're getting enough milk rather than the volume you pump

Typically, a newborn consumes around 1-3 ounces per feeding in the first few weeks. However, this can vary based on baby's age, appetite, and individual needs. Here are some general guidelines:

Early Days: In the first few days after birth, when your milk is transitioning from colostrum to mature milk, you might pump smaller amounts (e.g., 1/2 to 2 ounces per session)

Established Supply: As your milk supply regulates (around 4-6 weeks), you might pump around 2-4 ounces per session

Later Months: Pumping output can range from 2-5+ ounces or more per session as your milk supply adjusts to meet your baby's needs

Remember, the best indicator of successful breastfeeding is your baby's growth, diaper output, and general well-being. If you have concerns about milk supply or breastfeeding, it's always a good idea to reach out to an IBCLC for personalized support. And most importantly, be kind to yourself and focus on the special bond you're nurturing with your little one.

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.

Milk supply at night

- Julie Matheney

Infant sleep patterns, especially during the early months, are characterized by frequent waking, often every 2-3 hours, which is largely driven by their need for regular feeding. Night feedings play a crucial role in maintaining and boosting breast milk supply due to the hormonal mechanisms involved. Prolactin, a hormone essential for milk production, tends to be at its highest levels during nighttime. When an infant breastfeeds at night, the mother's body receives signals to produce more milk, ensuring an adequate supply for the baby's needs. Frequent night feedings help to maintain high prolactin levels and stimulate continuous milk production. Consequently, consistent night feeding is vital for establishing and sustaining a robust breast milk supply, particularly during the early weeks postpartum when the milk supply is being established. Skipping night feedings can lead to decreased milk production as the demand decreases, sending signals to the body to reduce milk output. Therefore, understanding and supporting infant sleep patterns that include night feedings are essential for successful breastfeeding.

Research indicates that newborns typically wake every 2-3 hours during the night for feeding. This frequent waking is due to their small stomach capacity and high metabolic rate, requiring regular intake of nutrients. Studies show that by the age of three months, many infants may start to sleep for longer stretches, though it is common for them to still wake at least once or twice during the night for feeding. On average, these night wakings can last anywhere from 20 minutes to an hour, depending on how quickly the baby feeds and settles back to sleep.

A study published in *Sleep Medicine Reviews* highlighted that infants between the ages of 0-6 months wake up approximately 2-3 times per night. Another research in the *Journal of Clinical Sleep Medicine* found that these night wakings typically decrease in frequency as the infant grows older, but individual patterns can vary widely. Some infants may continue to wake frequently throughout the first year, especially if they are breastfed, as breast milk is more quickly digested than formula, necessitating more frequent feedings.

Night feedings are crucial for maintaining breast milk supply due to the elevated levels of prolactin during nighttime. Consistent night feeding supports ongoing milk production by keeping prolactin levels high and ensuring that the body continues to respond to the infant's nutritional demands. Thus, understanding typical infant sleep patterns and their need for night feedings is essential for breastfeeding success and ensuring adequate milk supply.

What medicine can I take while being sick and still breastfeeding?

- Julie Matheney

There is nothing worse than being sick. It’s even harder when you still need to breastfeed when all you want to do is sleep and there’s nothing that sounds good to eat or drink. So what can you take get help feel better fast? There are still safe medications and herbs/supplements. Thomas Hale wrote the textbook on medications and breast milk and categorized medications as follows:
L1 Safest
L2 Safer
L3 Probably safe
L4 Possibly hazardous
L5 Hazardous

🤒Pain and fever
👍🏼Ibuprofen (Motrin/advil), acetaminophen (Tylenol), and paracetamol (L1) are safe to take while breastfeeding.
👎🏻Aspirin (L2) can pass into human milk and cause a serious condition called Reye’s syndrome in baby. Reye’s syndrome is associated with brain and liver damage.
👎🏻Use of codeine is not recommended while breastfeeding. If essential, and only where there is no alternative, it should be at the lowest effective dose, for the shortest possible duration and you should stop taking it and seek medical advice, if you notices side effects in baby such as:

  • Breathing Problems
  • Lethargy
  • Poor Feeding
  • Drowsiness
  • Bradycardia (slow heart beat)

🤧Sinus congestion
👍🏼Saline rinse L1
👍🏼Afrin and Nasacort L3 Because these medicines are not absorbed well from the nasal passages, they don’t have the same effect on milk supply that decongestants taken by mouth can have.
👎🏻Pseudoephedrine L3
Medications containing pseudoephedrine (Sudafed, Zyrtec D) — use with caution because they can decrease milk supply

😮‍💨Cough/chest congestion
👍🏼Guaifenesin (Robitussin/Mucinex) L2
👍🏼Dextromethorphan (Robitussin DM/Delsym) L3 The amounts of dextromethorphan and its active metabolite in breastmilk are very low and are not expected to affect the nursing infant. It is best to avoid the use of products with a high alcohol content while nursing.

Not sure if the medications you want to take is safe? Call Infant Risk at 806-352-2519

Kellymom.com also is a phenomenal resource for safe things you can take and do while sick and breastfeeding

Drinking and Breastfeeding

- Julie Matheney

Milk is made from your blood, so what you drink can impact your milk supply. 

💦 How much water should you be drinking? There are some ridiculous answers out there. If your breast milk production has decreased, helpful people may suggest that you chug tons of water. Your lack of water intake may contribute to but is not completely responsible for your supply drop. Drinking too much water can inadvertently harm your milk supply

💦 When you drink too much water, your body tries to restore the electrolyte balance in your body by dumping the excess water into your urine. This results in water being diverted away from your breasts, which in turn decreases your milk supply. Water dense foods can also be just as hydrating as plain water from the tap. 

💦 You will lose up to 30oz of water through your breast milk to your baby; so do try to drink 8-12 glasses of water a day

☕️ Coffee is safe to drink: 300-500mg of caffeine per day max

☕️ Younger babies (< 6 months), preterm and medically fragile babies process caffeine slower and they may be sensitive to it. 

☕️ If you consistently drank coffee during pregnancy you baby is already used to caffeine

☕️ It takes 15-20 minutes for coffee to hit your bloodstream and is usually completely gone by 4-7 hours. So if you’re concerned or having it for the first time after birth, either breastfeed baby first and then have your coffee or have it while breastfeeding

🍷 According to the CDC, moderate alcohol (up to 1 standard drink per day) is not known to be harmful to baby

🥂 Less than 2% of alcohol reaches breastmilk and typically peaks within 1/2-1 hour after consumption *however* factors such as food, weight & body fat need to be considered

🥂 Alcohol does not accumulate but leaves breastmilk as it leaves the bloodstream. There is no need to pump and dump when consuming limited amounts of alcohol

🥂 If you are feeling like you NEED to consume large amounts of alcohol regularly, speaking to a qualified professional is admirable and a very good option

ALCOHOL AND BREASTFEEDING

Is it ok to have alcohol and breastfeed? The short answer is yes, in moderation. No, you don’t need to pump and dump for 1 standard drink. Yes, those alcohol testing milk strips are kinda dumb. 

Alcohol passes freely into breast milk and peaks around 30-60 minutes after consumption (60-90 minutes if you drink with food) so what you would breathalyze you would “breastalyze”. This does not mean your milk has an much alcohol as you consumed or as a straight up alcoholic beverage. It means you milk has the same amount of alcohol as your blood. For instance, if your Blood Alcohol Content (BAC) is 0.10 (or 0.10%, 1/10 of 1 percent) from drinking, you breast milk has 0.10% alcohol in it. In comparison, a typical beer has 4.5% alcohol, a glass of wine has 15% alcohol, and a shot of vodka has 40% alcohol. 

Let’s interpret that: if you breastfeed while you’re having your first drink, your baby will most likely be finished feeding before the alcohol hits your system. There’s no need to pump and dump your milk. Only time clears the alcohol from your system. If you’re breastfeeding a newborn, premature or medically compromised infant, you’ll want to be more cautious of the alcohol you consume and may want to consider waiting longer to breastfeed than an older baby. Such a small portion of alcohol gets into your milk, if you have an older baby and have only had one drink there’s really no need to wait to pump or feed. 

If you want to have an occasional drink, I will never judge you!!! Go for it!! If you need alcohol, large quantities or alcohol or are struggling with alcohol, please find a qualified counselor to work with ❤️ 🍻

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)

Empty breasts make milk faster than full breasts

- Julie Matheney

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

- 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.