Tag: milk supply

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.

Nausea while breastfeeding

- Julie Matheney

The interplay between oxytocin and stress hormones is a fascinating aspect of our neuroendocrine system. Cortisol and oxytocin are both regulated by the hypothalamus, a critical part of the brain that helps maintain hormonal balance. The hypothalamus plays a pivotal role in maintaining the balance between these hormones.

Oxytocin is produced in the paraventricular nucleus inside the hypothalamus, a small but crucial part of the brain that regulates many autonomic functions. From the hypothalamus, oxytocin is transported to and released by the posterior pituitary gland into the bloodstream which then travels to the breast and causes the pulsatile contractions known as the Milk Ejection Reflex (let down).

In response to stress, the hypothalamus releases corticotropin-releasing hormone (CRH). CRH prompts the anterior pituitary gland to secrete adrenocorticotropic hormone (ACTH). ACTH then stimulates the adrenal glands to release cortisol and adrenaline into the bloodstream, preparing the body for a 'fight-or-flight' response. The hypothalamus coordinates the release of CRH and oxytocin, attempting to balance the stress response with mechanisms that promote recovery and resilience

These hormones counteract each other: cortisol increases alertness and stress, while oxytocin reduces anxiety and fosters calmness, helping to restore equilibrium in the body's stress response system

What Causes Let-Down Nausea?

The sudden surge of oxytocin, combined with fluctuating levels of other hormones released by the hypothalamus, can activate the parasympathetic nervous system, which can sometimes trigger nausea. This response is similar to the body's reaction to certain stressors or stimuli

Breastfeeding is both physically and emotionally demanding. Anxiety, lack of sleep, and overall stress can exacerbate nausea during let-down

Blood Sugar Levels: Low blood sugar, a common issue for new mothers who might skip meals or eat irregularly, can also cause or worsen nausea as hormones are fluctuating during breastfeeding

Managing breastfeeding nausea

Hydration and Nutrition: Ensure you're staying well-hydrated and eating balanced meals regularly. Small, frequent meals rich in protein and complex carbohydrates can help stabilize blood sugar levels and reduce nausea, especially when eaten a few minutes before moving milk

Relaxation Techniques: Practice deep breathing, meditation, or gentle yoga to reduce overall stress. Creating a calm and comfortable environment during breastfeeding or pumping  can help

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.

Pump Flanges: Size Matters

- Julie Matheney

The history of the 24mm pump flange is closely linked to the evolution of breast pump technology. Breast pumps have been around for over a century, but significant advancements began in the 20th century. Early breast pumps were manual, cumbersome, and often inefficient.

In the mid-20th century, electric breast pumps were introduced, revolutionizing breastfeeding by making it easier and more efficient to express milk. However, these early models were still quite rudimentary in design.

The 1980s and 1990s saw significant improvements in breast pump technology, with companies like Medela and Ameda leading the way. During this period, a range of flange sizes was developed to accommodate different nipple and breast sizes. The 24mm flange size became a standard option, as it was thought to fit a significant portion of women effectively. However, over time, it has become evident that the 24mm size is often too large for many women. Research and user feedback have shown that the majority of women actually require smaller flange sizes for a proper fit and comfort.

The predominance of the 24mm flange as a default size reflects an initial lack of understanding and support for the anatomical diversity among breastfeeding mothers. Many women experience discomfort and inefficient milk expression due to using flanges that are too large. This mismatch can lead to reduced milk supply and a negative breastfeeding experience.

Today, there is a growing awareness of the need for a wider variety of flange sizes that truly support the diverse needs of breastfeeding mothers. Companies are increasingly offering smaller flange sizes and more customizable options to ensure a proper fit for all users. This shift towards inclusivity and better support for all anatomical variations marks a significant improvement in the breast pump industry, aiming to enhance the breastfeeding experience through better technology and design.

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.

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.

Having a baby means you are a targeted market.

- Julie Matheney

Where did 10,000 steps a day to better health come from? The 10,000 steps concept was initially formulated in Japan in the lead-up to the 1964 Tokyo Olympics. Because the Japanese character for “10,000” looks like a person walking, the company called its device the 10,000-step meter. Thus the 10,000 steps a day was not based on science, but a marketing strategy to sell step counters. Modern research has actually shown that 4,00-7,500 steps a day can be just as beneficial to health and a more realistic goal without discouraging people from walking fewer steps than the elite 10,000.

So what does this have to do with breastfeeding? You are being marketed to. Almost everything related to infant sleep and feeding (bottle AND breast) is a pitch to get you to buy something in your sleep deprived state at 2am from Amazon. Don’t fall for the marketing. Is the bottle marketed to look like a breast? Yes!! But in my experience the ones that look like a boob often don’t promote a breast-like latch at all. A cookie guaranteed to make milk? A cookie is just a cookie if you’re not actively moving that milk. A crib guaranteed to help baby sleep longer? It may work for some, but at what cost to development and the breast milk supply…

Yes, it is a fantastic time to be alive. We have more gadgets and gizmos than any other time in history. Some are amazing miracles of science and some are just downright times money suckers that will end up in the back of the closet to gather dust. If a products works for you, awesome!! Not every item will work for every family or every baby. Because we are all unique individuals

High Lipase: My breast milk tastes soapy

- Julie Matheney

Have you heard of high lipase in breast milk? Lipase is an enzyme that helps break down fat in breast milk. The breakdown of the fat in breastmilk by lipase is normal but not noticeable when the baby is feeding directly at the breast. When lipase occurs in excess, this process happens much more rapidly and can make the milk taste off or soapy after a period of time. Milk with excess lipase is safe to drink, but some babies dislike the taste and refuse it.

 

How do you know if you have high lipase?

  • Test prior to freezing – Before freezing large amounts of breast milk, you can test it for odor and taste changes due to lipase. Collect and freeze 1-2 bags or small containers of breast milk for at least 5 days and then evaluate the odor to see if your baby will drink it.

What can you do if you have high lipase?

  • Freeze milk as soon as you pump it whenever possible
  • Reduce intake of polyunsaturated fatty acids
  • Scald you’re milk prior to freezing 
  • To scald fresh milk: Heat it in a pot until tiny bubbles form around the edges of the pan (approximately 180° F) but don’t boil it. Remove the milk from the stove and allow it to cool before freezing.

Scalding fresh milk will stop the enzymes from breaking down the fat, preventing that soapy smell and taste. Scalding milk does reduce some of the beneficial components in breast milk, however, so give your infant fresh breast milk whenever possible.

To scald milk:

  • Heat milk to about 180 F (82 C), or until you see little bubbles around the edge of the pan (not to a full, rolling boil with bubbles in the middle of the milk).
  • Quickly cool and store the milk.

Scalding the milk will destroy some of the immune properties of the milk and may lower some nutrient levels, but this is not likely to be an issue unless all of the milk that baby is receiving has been heat-treated.

Per Lawrence & Lawrence, bile salt-stimulated lipase can also be destroyed by heating the milk at 144.5 F (62.5 C) for one minute (p. 205), or at 163 F (72 C) for up to 15 seconds (p. 771).

Lawrence R, Lawrence R. Breastfeeding: A Guide for the Medical Profession, 6th ed. Philadelphia, Pennsylvania: Mosby, 2005: 156-158, 203-205, 771, 781.

Lawrence RA. Storage of human milk and the influence of procedures on immunological components of human milk. Acta Paediatr Suppl. 1999 Aug;88(430):14-8.

Have a ton of freezer milk with high lipase? Some babies don’t mind the flavor and will drink it anyway. If you’re won’t, Before pitching it, consider trying the following:

  • Mix frozen milk with fresh milk to make it more appetizing to baby
  • Some moms find adding a few drops of alcohol free vanilla extract can mask the lipase flavor. 
  • Use it for a milk bath which can help with dry skin

Milk taste rancid or metallic? That's not lipase, the cause may be chemical oxidation (Mohrbacher, p. 461). Reducing intake of polyunsaturated fats may help. Certain minerals or metals in drinking water may also be to blame like copper or iron ions. When this happens, Mohrbacher has a few suggestions to try:

  • Avoid your usual drinking water (either drinking it or having milk come into contact with it) by using bottled or reverse osmosis filtered water instead
  • Avoid fish-oil and flaxseed supplements, and foods like anchovies that contain rancid fats
  • Increase antioxidant intake (including beta carotene and vitamin E like berries, spinach, beets, and beans).

Mohrbacher N. Breastfeeding Answers Made Simple. Amarillo, Texas: Hale Publishing, 2010: 460-461.

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Birth control and dropping milk supply

- Julie Matheney

Any birth control with a hormone in it can drop your milk supply. Hormones in birth control pills prevent pregnancy by:

  • Stopping or reducing ovulation (the release of an egg from an ovary).
  • Thickening cervical mucus to keep sperm from entering the uterus.
  • Thinning the lining of the uterus so that a fertilized egg is less likely to attach. 

The Pill (estrogen and progestin) tricks your body to think is pregnant so it won’t ovulate. Estrogen based pills will drastically drop milk supply, just like pregnancy does, and should be avoided while breastfeeding unless your weaning. Hormonal IUDs (Mirena, etc), arm implants (Nexplanon, etc), and the mini pill (progestin only) are often recommended as the best form of BC while breastfeeding because most research says that they don’t impact milk supply. Many who use these methods don’t experience any supply drop. For some, though, any hormone based BC will drop milk supply, some times drastically. Every body is sensitive to different levels of hormones. If you have an IUD or arm implant placed and notice a drop in supply, the only way to increase supply again is to remove them. Increased pumping or herbal supplements will usually not be enough to increase supply again because you’re working against hormones. If you’re considering a hormonal based IUD and aren’t sure if your supply will drop, consider taking a few rounds of the mini pill (progestin only) which is the same hormone in the IUD and implant. If your supply drops, you only have to stop taking the pill and your supply will rebound much quicker.