Tag: newborn

The rooting reflex

- Julie Matheney

The rooting reflex (RR) is a fascinating developmental milestone that begins even before birth and continues to evolve during infancy. RR is an automatic response in newborns characterized by turning their head toward a touch on their cheek or mouth. When you stroke or touch your baby's cheek or the corner of their mouth, they will instinctively turn their head in that direction, open their mouth, and make sucking motions. By turning towards a

touch, babies instinctively position themselves to find their food source and initiate feeding

The RR starts to develop in utero, typically around the 32nd week of pregnancy. During this time, baby's neurological and sensory systems are maturing rapidly. Once baby is born, the rooting reflex becomes more pronounced and functional. Immediately after birth, and often during the first few weeks of life, you can observe your baby's natural response to touch on their cheek or around their mouth. It’s a reflex, so this is also why they will try to root and latch to dad’s nose or even to grandma’s chest.

The RR is at its strongest during the newborn phase, the first 0-3 months. Babies rely heavily on this reflex to initiate feeding, whether at the breast or with a bottle. As baby's neurological system continues to mature, the rooting reflex gradually integrates with other feeding skills. By around 4 to 6 months of age, babies start to gain more head control and may rely less on the rooting reflex for feeding.

You can actively support baby's RR by:

- Positioning baby close during feeding. Their chin and cheeks should be physical touching your breast and your fingers can touch their cheeks during bottle feeding

- Let baby lay on both of their sides during tummy time, not just on their belly. As the floor triggers the reflex, it helps not only integrate it, but also will eventually help with rolling over and finding toys

- Being responsive to your baby's cues and feeding needs, especially during the early weeks and months.

Have you noticed the rooting reflex in your baby? Share your experiences and insights in the comments below! 💬🍼 #RootingReflex #NewbornDevelopment #ParentingJourney

What you weren’t told about breastfeeding a preemie

- Julie Matheney
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Babies born under 38 weeks gestation are considered premature, with those born between 34-36.6 weeks gestation, known as late preterm infants. While those born in the 37th week are considered term, lactation consultants call them the Great Pretenders, because they can look like full term babies, but still act like late preterm babies. All of these babies exhibit distinct feeding habits compared to full-term infants (those born at 38+ weeks). Here are the primary differences:

Feeding Efficiency:

   -Late Preterm Infants: Often have less developed oral motor skills, which can lead to less efficient suck-swallow-breathe coordination. This can make feeding slower and more labor-intensive for both the infant and the caregiver.

   - Full-Term Infants: Typically have more mature feeding skills, allowing them to feed more effectively and efficiently from the breast or bottle.

Energy Levels and Fatigue:

   - Late Preterm Infants: These babies tend to tire more quickly during feeding due to lower energy reserves. This can result in shorter, more frequent feedings and a need for longer feeding sessions.

   -Full-Term Infants: Generally have higher energy levels and stamina, enabling them to complete feedings more quickly and efficiently.

Latching and Milk Transfer:

   -Late Preterm Infants: May struggle with latching onto the breast properly, leading to inefficient milk transfer. This can necessitate additional support, such as the use of nipple shields or supplementary feeding devices.

   -Full-Term Infants: Usually latch more easily and effectively, facilitating better milk transfer during breastfeeding.

Feeding Frequency:

   -Late Preterm Infants: Often require more frequent feedings due to their limited ability to consume large volumes of milk in a single feeding session.

   -Full-Term Infants: Can typically consume larger amounts of milk per feeding, allowing for longer intervals between feedings.

Supplementation Needs:

   -Late Preterm Infants: More likely to need supplementation with expressed breast milk or formula to ensure they meet their nutritional needs and support adequate growth and weight gain.

   -Full-Term Infants: Generally able to meet their nutritional requirements solely through breastfeeding or standard bottle feeding.

Risk of Jaundice:

   -Late Preterm Infants: Higher risk of developing jaundice, which can affect feeding patterns and overall health. Effective and frequent feeding is critical in managing this condition.

   -Full-Term Infants: While jaundice can occur in full-term infants, it is typically less severe and easier to manage through regular feedings.

Growth Monitoring:

   -Late Preterm Infants: Require closer monitoring of their growth and development to ensure they are meeting milestones and gaining weight appropriately.

   -Full-Term Infants: While growth and development are monitored, they generally follow a more predictable growth pattern.

Understanding these differences is essential for caregivers and healthcare providers to offer the appropriate support and interventions to ensure that both late preterm and full-term infants thrive.

 

This means your expectation is you may have to triple feed or do lots of pumping until baby becomes efficient, which is usually 2-3 weeks PAST their due date. They need extra time to figure out how to efficiently feed. Many parents who had babies born at 37 weeks were not told their baby may struggle to breastfeed for the next 4-6 weeks, so they give up on breastfeeding just a few weeks in  don’t give up!!! Your baby just needs time to figure it all out  

#preemie #preemiestrong #preemiepower #preemiemom #preemieawareness #preemielife

Do I need to fortify my preemie’s milk

- Julie Matheney

In the delicate world of premature babies, every ounce of care and nutrition matters profoundly. For mothers of preemies who choose to breastfeed, human milk fortification emerges as a vital intervention that can significantly impact the health and development of their fragile infants.

Breast milk is undoubtedly the gold standard for infant nutrition, offering a unique blend of nutrients, antibodies, and growth factors that promote optimal growth and immunity. However, many families with preterm infants typically 31-33 weekers) may be told their breast milk isn’t nutritionally adequate and they either need to supplement baby with formula or a human milk fortifier. It’s not that your milk is inadequate, it’s that babies born early miss out on a surge of nutrient absorption that normally would have occurred during the third trimester. Preemies have higher nutrient requirements, especially for protein, minerals like calcium and phosphorus, and certain vitamins like vitamin D. They should have been getting these nutrients from your placenta which takes these nutrients from your blood and bones. A preemie’s gastrointestinal tract is also very immature, less efficient at processing nutrients and more prone to distress. Preemies who experience medical complications including infection, respiratory disorders, surgeries, and stress, experience an increase in metabolism and increased caloric demand. So babies born prematurely have multiple reasons for needing more nutrients than an otherwise healthy full-term baby. Human milk fortifiers are designed to supplement breast milk with these essential nutrients to match the specific needs of premature infants, supporting their growth and development, that they missed.

Currently there are two main types of human milk fortifier available. The first is made using cow-based protein. It comes as either a powder or liquid which get added to pumped breast milk. The second fortifier is actually made of donated human milk from other pumping mothers. The only manufacturer of human based fortifier in the US currently is Prolacta Bioscience, and is only available to hospitals. Donated milk is modified into a frozen liquid concentrate which is added to pumped milk in the NICU.

Premature infants often struggle with catching up to the growth milestones of full-term babies. Fortifying breast milk helps enhance calorie intake and nutrient absorption, aiding in weight gain and promoting more rapid growth without increasing the volume of milk intake.

Preterm infants are at increased risk of various health complications, including necrotizing enterocolitis (NEC) and developmental delays. Fortified breast milk has been shown to lower the incidence of NEC and other serious conditions by providing a more robust nutritional profile.

Adequate nutrition during the neonatal period is critical for preventing long-term health problems such as neurodevelopmental impairments and metabolic disorders. Fortifying breast milk ensures that preemies receive the essential nutrients necessary for optimal brain and organ development.

Human milk fortification enables mothers to continue breastfeeding while meeting their preemie's unique nutritional needs. This approach supports the emotional and physiological benefits of breastfeeding while addressing the challenges posed by premature birth.

How long after birth they need to be supplemented depends upon many factors, including baby’s gestational age at birth, medical condition, nutritional status, and the individual practices of the NICU team your baby worked with. It’s very common for NICU graduates to require special nutrients for weeks to months after going home. This might be as simple as adding small amounts of over-the-counter preemie formula to pumped milk, adding in a few bottles of preemie formula each day, or as complex as using specialized prescription formulas. 

Ultimately, human milk fortification represents a critical component of neonatal care for premature infants. It empowers mothers to provide the best nutrition possible for their preemies, supporting their babies' health and development during this vulnerable stage of life. Healthcare providers play a pivotal role in guiding mothers through the process of human milk fortification, offering education and support to optimize outcomes for these tiny fighters.

By recognizing the importance of fortifying breast milk for preemie babies, we can enhance the quality of care and improve the long-term health prospects of these resilient little ones. Every drop of fortified breast milk signifies a step forward in nurturing and protecting the smallest members of our communities.

The composition of breast milk undergoes significant changes to meet the evolving nutritional needs of infants as they grow. The differences between preterm (colostrum and transitional milk) and mature breast milk are particularly important for understanding how mothers can support the unique requirements of preterm babies. Here's a breakdown of these differences:

**1. Protein Content:**

   - Preterm Breast Milk: Higher in protein, specifically whey protein, which is easier for preterm infants to digest.

   - Mature Breast Milk: Lower in total protein compared to preterm milk, with a higher proportion of casein protein.

**2. Fat Composition:**

   - Preterm Breast Milk: Contains more medium-chain fatty acids and higher levels of essential fatty acids like DHA (docosahexaenoic acid) and ARA (arachidonic acid), which are crucial for brain and visual development.

   - Mature Breast Milk: Higher in long-chain fatty acids, reflecting the changing needs of the growing infant.

**3. Carbohydrates:**

   - Preterm Breast Milk: Contains higher levels of lactose and oligosaccharides, providing readily available energy for the developing preterm baby.

   - Mature Breast Milk: Still rich in lactose but with a slightly lower concentration compared to preterm milk.

**4. Minerals and Vitamins:**

   - Preterm Breast Milk: Generally higher concentrations of certain minerals like calcium, phosphorus, and zinc to support bone and overall growth.

   - Mature Breast Milk: Adequate levels of minerals and vitamins tailored to the needs of a growing infant.

**5. Immunological Factors:**

   - Preterm Breast Milk: Richer in immunoglobulins (especially secretory IgA) and other immune factors to bolster the preterm baby's immature immune system and protect against infections.

   - Mature Breast Milk: Continues to provide valuable immunological support but at levels adjusted for the older infant's immune needs.

**6. Growth Factors:**

   - Preterm Breast Milk: Higher levels of growth factors like insulin-like growth factor (IGF) to support rapid growth and development.

   - Mature Breast Milk: Contains growth factors in appropriate proportions to sustain healthy growth without promoting excessive weight gain.

**7. Micronutrients:**

   - Preterm Breast Milk: Often supplemented with higher levels of vitamins and minerals to meet the increased requirements of preterm infants.

   - Mature Breast Milk: Provides sufficient micronutrients for the needs of older infants, although additional supplementation may be necessary depending on the infant's diet.

Understanding these differences underscores the importance of tailored nutrition for preterm infants. While human milk is always beneficial, preterm breast milk offers a specialized blend of nutrients and bioactive components uniquely suited to support the growth and development of premature babies during the critical early stages of life. As preterm infants transition to mature breast milk, the composition adjusts to meet their changing nutritional demands, ensuring optimal health and development as they continue to thrive on mother's milk.

 

Trauma informed postpartum care

- Julie Matheney

Giving birth is a profound experience that can impact a person both physically and emotionally. For individuals who have experienced trauma either before or during childbirth, receiving care from trauma-informed healthcare professionals (HCPs) is crucial for well-being and recovery.

Trauma-informed care is an approach that recognizes the widespread impact of trauma and emphasizes safety, trustworthiness, choice, collaboration, and empowerment in healthcare settings. It acknowledges the potential triggers and sensitivities that individuals with trauma histories may have

Why It's Important After Birth:

❤️Respecting Individual Experiences: It that every person's experience is unique and that past traumas can affect present health. It ensures that HCPs approach each patient with empathy, sensitivity, and understanding

  

❤️Reducing Triggers and Stress: Childbirth itself can be a triggering event for individuals with trauma histories. HCPs who are trauma-informed take proactive steps to create environments that minimize triggers and stressors, promoting a sense of safety and comfort

❤️Enhancing Communication: Trauma-informed care emphasizes clear and respectful communication. HCPs are trained to ask open-ended questions, listen actively, and validate patient experiences, fostering a collaborative and trusting relationship

❤️Supporting Emotional Health: Postpartum emotions can be intense and complex. Trauma-informed professionals are equipped to recognize signs of distress or post-traumatic stress and provide appropriate support and resources

❤️Promoting Recovery and Healing: By integrating trauma-informed practices, HCPs can contribute to the healing process and help individuals build resilience following childbirth-related trauma

Every person deserves to feel safe, supported, and respected in their healthcare journey, especially after childbirth

**How to Access Trauma-Informed Care:**

- **Ask Questions:** When seeking healthcare services after childbirth, inquire about the provider's approach to trauma and whether they have specific training or experience in trauma-informed care.

  

- **Advocate for Your Needs:** Share your trauma history and specific triggers with your healthcare provider. Open communication allows for tailored care that respects your boundaries and promotes your well-being.

- **Seek Support:** If you're unsure where to find trauma-informed care, reach out to local support groups, therapists specializing in trauma, or community organizations that can provide recommendations.

**Remember, You Deserve Compassionate Care:**

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This post aims to highlight the importance of trauma-informed care in the context of postpartum health and emphasizes the value of working with understanding and supportive healthcare professionals after childbirth.

Skin to skin for the win

- Julie Matheney

Skin to skin contact with baby is not just for bonding, it can help develop a healthy gut and immune system. Babies are born with essentially no microbiome and a very immature immune system. The gut microbiome is a complex ecosystem of millions of microbes and important for development of the immune system. The first microbes to colonize baby’s gut, skin, and mouth help teach the immune system what’s harmful and what’s not. Birth is an incredible process that starts this process. Passage through the birth canal allows baby’s gut to be colonized with healthy bacteria from the vagina. This good bacteria takes residence in baby’s gut to reduce the risk of immune-related diseases, asthma/allergies, inflammatory bowel diseases and obesity. A vaginal birth is not always possible, though. Another way that babies get exposed to this good bacteria, regardless of birth method, is through skin-to-skin contact and breastfeeding. Bacteria present in breast milk and on the skin around the nipple have been shown to contribute to this process. Some of the complex sugars in human milk are indigestible in the newborn, but are the perfect food for a subspecies of bacteria that coat intestinal wall, boost digestive function, and provide protection from harmful bacteria. Even if you had a c-section and are not directly breastfeeding, placing your baby in just a diaper on your naked chest helps boost baby’s immune system by exposing them to your good bacteria.

Skin to skin for the win

- Julie Matheney

Skin to skin contact with baby is not just for bonding, it can help develop a healthy gut and immune system. Babies are born with essentially no microbiome and a very immature immune system. The gut microbiome is a complex ecosystem of millions of microbes and important for development of the immune system. The first microbes to colonize baby’s gut, skin, and mouth help teach the immune system what’s harmful and what’s not. Birth is an incredible process that starts this process. Passage through the birth canal allows baby’s gut to be colonized with healthy bacteria from the vagina. This good bacteria takes residence in baby’s gut to reduce the risk of immune-related diseases, asthma/allergies, inflammatory bowel diseases and obesity. A vaginal birth is not always possible, though. Another way that babies get exposed to this good bacteria, regardless of birth method, is through skin-to-skin contact and breastfeeding. Bacteria present in breast milk and on the skin around the nipple have been shown to contribute to this process. Some of the complex sugars in human milk are indigestible in the newborn, but are the perfect food for a subspecies of bacteria that coat intestinal wall, boost digestive function, and provide protection from harmful bacteria. Even if you had a c-section and are not directly breastfeeding, placing your baby in just a diaper on your naked chest helps boost baby’s immune system by exposing them to your good bacteria.

The Second Night

- Julie Matheney

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.

Why can’t I put my baby down to sleep?

- Julie Matheney

SLEEP IN THE FOURTH TRIMESTER

I was going back through pictures when peach was a tiny baby. I have so many pictures of her sleeping on me. Babies don’t like to be put down, especially in the first 3-4 months. All their instincts and reflexes are designed to get them on a body. Their neurological system is immature at birth and still needs time to develop. Being on your body:

🧠 Accelerates Brain Development: Holding baby on your body increases the development of essential neural pathways, which accelerates brain maturation

🧘🏽‍♀️ Calms, Soothes & Reduces Stress: Having your baby on your body soothes baby so much that babies’ cortisol levels (stress hormone) are measurably lowered after only 20 minutes of being held skin to skin. Babies who are held cry less

🛌 Improves Quality of Sleep: Development of mature brain function in infants depends on the quality of their sleep cycling. During skin to skin, most infants fall asleep easier and achieve “Quiet Sleep” for longer

⚖️Stimulates Digestion & Weight Gain: Reduces cortisol and somatostatin in babies, allowing for better absorption and digestion of nutrients. With a reduction of these hormones, baby’s bodies preserve brown fat (the healthy fat baby was born with), helping to maintain birth weight and maintain body temperature. As a result, baby’s body does not have to burn its own fat stores to stay warm, leading to in better weight gain

💪🏻 Enhances Immune System: Your mature immune system passes antibodies through your skin to baby. Being on your skin also increases baby’s skin hydration

❤️Synchronizes Heart Rate + Breathing: You are a pace maker and a respirator. Your body sets the pace for baby’s body

🔑Promotes Psychological Well-Being: As our babies touch our skin, oxytocin levels rise and stress hormones fall, causing us adults to relax

🥛Milk production: Placing baby in skin to skin on your body for 1 hour a day will show an immediate increase in milk supply

🔥Regulation of Body Temperature: Woman’s breast tissue regulates a baby’s temperature, and can either cool OR heat, a man’s breast tissue only heats baby. Female is thermostat and male is radiator

Vernix, delayed bathing, and breastfeeding

- Julie Matheney
My little Peach right after birth

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.

Caffeine and Breast Milk

- Julie Matheney

Caffeine is safe to take while breastfeeding in moderation (up to 300mg per day). Only about 1.5% actually enters breast milk. Caffeine enters your bloodstream about 15 minutes. It peaks in your blood within 60 minutes and has a half-life of 3-5 hours. The half-life is the time it takes for your body to eliminate half of the drug. The remaining caffeine can stay in your body for a long time. The half-life of caffeine is about 97.5 hours in a newborn, 14 hours in a 3-5 month old baby and 3-5 hours in a baby older than 6 months. Because caffeine takes much longer to clear out of a young baby’s system it is possible that high caffeine intake can make a baby irritable. If baby is sensitive to the caffeine now, they may not be when they’re older. Cut caffeine now and try again in a few months.

So if you drink a cup of coffee with 100mg of caffeine at 7am, you’ll have 50mg of caffeine in your bloodstream at 10am. Your baby would get 1.5mg of caffeine.

Every baby is different in how they react to caffeine. If you drank coffee while pregnant, your baby had an IV of caffeine (called the umbilical cord) and is already used to having it in their blood stream. If you didn’t drink coffee or switched to decaf, your baby may have a more noticeable reaction when you drink coffee. When drinking coffee after birth, go low and slow. There’s nothing you can do to decrease caffeine in your system except time. Start with a very small cup first thing in the morning and see how your baby reacts. Drinking your morning cup of coffee while your breastfeeding gives you the most time for the caffeine to peak and start decreasing before your next feeding.