Monthly Archives: April 2012

Painful Toddler Nursing

Disclaimer: Many people do not experience a “bad” phase of nursing. So don’t expect that nursing a toddler will be painful for you.. But if you DO experience it, take heart. Others have, too. And there are solutions.

Painful toddler nursing seems to be a hot topic recently. I’ve seen four or five threads on this in the breastfeeding forums that I frequent, and I’ve had several friends mention it as either an annoying phase that they’re hoping will pass, or as the reason that they weaned or are planning on weaning.

If you are experiencing painful toddler nursing and WANT to wean, I don’t blame you. There were a few times when, after nursing for a couple of minutes, I wanted to hand my toddler to my husband and go away for three days until he forgot that breasts existed. It wasn’t just painful the way nursing a newborn was. It felt ABUSIVE. I knew that my son didn’t mean anything by it, but it was painful and it was rough. It hurt, and it felt violating.

It’s very hard to find good advice and support on breastfeeding a newborn, because many women have their attempts sabotaged by medical professionals. As our child gets older, it becomes even more difficult to get any advice other than “Maybe it’s time to quit”. Very few women make it to the one year mark, and most of those never make it to see two years. This means that there’s a tremendous lack of women that can answer questions, offer solutions and support and tell you that there’s a light at the end of the tunnel.

I’m still nursing my 27 month old. He has a full mouth of teeth, and we got past the nipple twisting, the “I want to nurse but I want to watch this tennis game on TV while nursing”, the “I want to nurse but I want you to sit on THAT side of the couch and I want to sit on the OTHER side of the couch, and I expect your nipple to accommodate this request by becoming magically rubber-like. If it does not work this way, I will subject it to medieval torture techniques” thing. Oh and the “My child seems to be related to some family of creature that has razor-sharp teeth, and I’m afraid that I’m going to lose my nipple” thing. And the biting thing.. And.. Oh. I still have my nipples. In fact, my son nurses more comfortably for me now than he did for the first year of his life.

So what do you do?

A lot of the time it boils down to nursing manners. As with anything in your life, you need to set clear boundaries with your toddler. Hitting is not acceptable, biting while nursing is not allowed.. But also less aggressive behaviors such as nipple twiddling, pulling away while nursing, etc.

Some of these behaviors can be hard to break a child of, as the child learns that twiddling mom’s nipple is comforting and it brings her milk down quickly. Or the child might want to pull away from the nipple to see more of the world around him. Or some of the problems can even be purely physical. A tooth might feel like a razor-sharp protrusion that hurts even when your child is latched on perfectly.

If your child is biting: If your child is biting you can try several different things. I’m starting with the one that worked for me: Simply keep your pinky finger near your child’s mouth. When your child starts to bite down, jam your finger into the corner of his mouth between his back gums and break the bite and the latch. If your child bites three times, announce that nursing is “done for now” and “No biting mama, that hurts.” Try to stay as calm as possible. With my son anything that scared him would make him bite down harder. Anything that didn’t scare him would amuse him and he’d… you guessed it, bite down harder. Other techniques involve:

– Yelping loudly in pain. Be careful doing this if you have a sensitive child or one that is amused easily. A sensitive child might refuse to nurse again out of fear. A child that is amused by your yelp might bite you again to see the funny reaction.

– Pressing the baby’s face into your breast so that his nose is covered and air flow is temporarily cut off. Baby doesn’t like the sensation and generally stops biting and doesn’t do it again. Just don’t do it for too long because obviously you don’t want to smother your baby. With my son, doing this frightened him and he nearly took my nipple off, but other parents have had success with this method- my mom used it on me and I only ever bit her twice in the four and a half years of nursing.

– Flicking your baby’s nose hard enough to startle but not hard enough to hurt. My son was amused by this when I did it lightly, and scared by it when I did it more strongly. MAJOR fail. Lots of biting. I had to pry him off and he left toothmarks in my breast. But this method worked on my brother.

– Terminating the nursing session as soon as the baby bites down. Say “NO BITING MAMA! We will nurse when you’re ready to not bite.” Some versions of this involve putting the baby down, sort of like a mini time-out. This just resulted in my son wanting to nurse for comfort and blubbering into my breast, but it has worked for many and seems to be one of the more commonly recommended ways for dealing with the problem of biting.

If your child has a sharp tooth: If your child has a sharp tooth, it can cause a lot of pain. Sometimes you can have deja vu with flashbacks to the early days of nursing. Little teeth can come out with bumpy jagged edges that HURT! Treat it like the newborh phase. Focus on latch, vary positions and try to find one that hurts less, or at least vary positions so that the tooth doesn’t rub on the same spot all the time. Coat your nipple and areola with some lansinoh or another nursing cream. A tooth typically only causes pain for about 1-3 weeks and then once the tooth has fully emerged the razor-surface has worn down a bit and become more dull, and your child has adjusted his latch so that it doesn’t rub quite as much. I found that with my son the first tooth on the top was the worst.  The bottom teeth didn’t hurt as much because my son’s tongue cushioned them. (Although he did have a short period of bad latch becuase his teeth irritated his tongue!), once he had two teeth on the top and two on the bottom, the rest of the teeth barely hurt at all. I was expecting the canines to hurt like crazy! Not even a little bit. :)

– If your child is pulling back from the breast and stretching the breast painfully: Give them no where to pull to! Nurse them dangle-style so that your body is too close for them to push away. Nurse them up against the side of the couch so that they’re pushed into a corner and would have to push your entire body away in order to get the breast away. Nurse them football-hold with pillows supporting their back and head so that they can’t pull. Side-lay nurse and put pillows behind them so that they have no place to roll to. Lay on your back and have them nurse while sitting up, it makes it so that if they pull away too strongly it breaks the latch and they get frustrated. If they dig their little hands into your breast and lock their arms and push (Yeah, my son did that.) push their hands away, and tell them “No” the same as you would biting. It’s nursing manners. Three strikes, and we’ll nurse later.  Explain “That hurts mommy”. If they’re nursing that way because they’re trying to see something, try to sit at an angle so that they can see whatever it is while they’re nursing. Otherwise reinforce what they CAN do with their hands while nursing. I encouraged my son to play gently with my hair, my earings, stroke my chin/face, point at my facial features so I could tell him the name of what it was, and stroke my collar bone area. He could also hold a truck and drive it across my collarbone area, or hold a blanket if he wanted. But he could NOT push away from me. That hurts mommy!

If your child is sucking so hard that it really feels like he’s sucking the marrow from your bones..  First check to make sure that he hasn’t over-latched. Make sure that his lips stay within your areola. If your toddler is taking in TOO MUCH breast tissue it can hurt even worse than if your toddler is taking in too little breast tissue or “nipple nursing”. I had to teach my son to latch shallowly on my left side because his mouth outgrew my areola in certain positions. This can result in the feeling that your breast tissue is being torn, and it actually can result in tears and bleeding! Ouch!

If it’s just a hard strong suck, this is somewhat normal. Toddlers become very efficient little suckers and sometimes it can be painful when they’re very hungry. Once your child is over a year old you can offer some solids before nursing. This usually slows the sucking down. If it doesn’t, demonstrate “gentle” and “hard” sucks on your child’s thumb. Say “GENTLE” and “OUCH!” and say “If you hurt mommy we can’t nurse now. Can you nurse gently?” Again, three strikes and the toddler is out and they can nurse again later.

If your child is nipple-twiddling the solution is much the same as the “pushing away”. Try to make it so that it CAN’T happen by keeping that side of your bra latched and pushing away any little hands that try to get under it. Hold your child’s hands, or even “swaddle to nurse”. Play hand-games, encourage your child to do the things that DO NOT hurt mommy. Buy a nursing necklace, let him play with a doll or a truck or a stuffed animal or blanket. Patiently insist that the child not twiddle, and practice three strikes.

Got a problem not covered here? We’d love to hear about your solution, or even just hear what the problem is. We might have experienced it, solved it, and forgotten about it. Or we might know someone who can get the answer for you. :)

(Original article on my former blog- CustomMadeMilk: http://custommademilk.wordpress.com/2009/02/23/painful-toddler-nursing/ )

“Getting Enough”

The average breastfeeding baby consumes 19-30oz of breast milk per day.1 with the most common amount being 25oz per 24 hours.

Oddly one of the more curious practices that I’ve heard of is bottle feeding a breastfed baby to “make sure they’re getting enough”. Why is this odd? Because 19-30oz is a rather big range of difference. How do you know that your baby needs 19oz rather than 30oz? Or 30oz rather than 19oz? With bottles you know how many ounces your baby is getting but you do NOT know “how many ounces does my baby NEED?” With a bottle you can very easily under-feed a less demanding baby, or over-feed one that drinks too quickly.

With direct breastfeeding your breasts don’t have ounce markers, but baby has a very good indicator of “getting enough”. That indicator is that the baby cannot make sufficient output without sufficient input. The supply is regulated by the demand, and baby will generally change their nursing patterns to take in what they need and then comfort suck to avoid over-feeding. (There are rare exceptions to this rule if baby has severe reflux and mom has severe over-supply.)

Newborns will make one wet diaper per 24 hours of life. So in the first 24 hours your baby should make at least one wet diaper. In the second 24 hours the baby should make at least two wet diapers. This continues to day 6 or until mom’s milk comes in (whichever is first) at which point baby should begin making 6-8 wet diapers per day. In a newborn you want to make sure that the diaper count matches the day of life, and that the baby is passing meconium and transitioning to yellow breastmilk poops.

Infants will make 6-8 wet diapers per day, baby is getting enough in terms of ounces. A “wet” diaper is about 4 tablespoons of liquid, more than that is considered a “soaked” diaper which counts as two wets. A poopy diaper also counts as a wet diaper, and a poop + pee diaper is two wets. Watch for stronger more concentrated urine and “brick dust” in the diaper if you’re concerned about diaper counts.

Older babies slow down a bit on diaper production and tend to have more “soaked” and fewer “wet” diapers. In an older baby, especially a baby that has started solids, it tends to be a bit more important to look for other signs that baby is having problems with intake. Stronger concentrated urine is generally the first sign that something’s off.  (Although if baby’s eaten a food like cabbage or asparagus their urine will be a lot stronger than usual.)

If baby’s wet diaper count is low, baby is not getting enough. The cause of this problem varies. Mom may not be recognizing baby’s feeding cues, baby may be lethargic due to jaundice or another health problem, mom may have a hormonal or physical issue that has not been properly diagnosed or treated, baby may have a physical issue such as a high palate or tongue tie, or there may be a milk transfer issue due to poor latch. If your baby’s not getting enough milk, seek help.

WEIGHT GAIN is separate from the issue of “is baby getting enough”. If baby is making enough wet diapers, baby is getting enough in amount. But there can still be issues that cause slower weight gain. A milk transfer issue, reflux, over-supply, hyperactive letdown, metabolic disorders, food sensitivities, a tongue tie, etc. can cause slower or low weight gain and even weight loss. This is NOT an issue of “low supply” when there are enough wet diapers. If you are being pushed to supplement for suspicions of “low supply” then you should look for the advice of a certified lactation consultant, preferably an IBCLC who can help you determine the cause of your baby’s weight issues. Many pediatricians or lesser certified lactation consultants will have a mom supplement when baby’s weight loss is being caused by OVERSUPPLY and when the weight issues could be easily resolved by block feeding and reducing mom’s supply.

Over-used and ineffective techniques to “measure mom’s supply” include:

  • The “before and after a feed weigh-in”. This is ineffective because mom’s supply varies across the day. A morning feed often has the highest amount of milk, and evening feeds can result in very little intake. This is normal and healthy. Depending on when the weights are taken, mom may be at her high supply time or her low supply time. Baby may also be nursing less due to being in an unfamiliar environment, or mom’s letdown may be hampered by performance anxiety. Weights are an interesting bit of data but they have to be collected across 24+ hours in order for them to be meaningful.
  • The “pump and see how many ounces you get” is one of the least meaningful tests of mom’s supply. As with the “before and after” weigh-ins, the amount mom will get varies across the day. Even worse, the amount mom can pump has nothing to do with how much a baby can get out of the breast or how healthy mom’s supply is. Pump output varies widely from mom to mom. I personally have very low pump output and can usually pump a half ounce from both breasts combined. A friend who had most of her milk ducts removed and who requires supplemental feeds can pump more than I can in a session but cannot make enough milk across 24 hours to feed her baby without supplementation.
  • The “feed baby a bottle and see how much he will eat, and that’s how much he needs to get at every feeding” test is a terrible one, as babies easily over-eat from a bottle in a way that they would never eat from a breast.
  • Physical indicators such as breast size, “engorgement” and leaking are not reliable indicators of mom’s supply. Supply regulation happens across mom’s nursing relationship and the faster her body stops leaking or becoming engorged, the better it is for mom’s and baby’s health.

References:

1 http://kellymom.com/bf/pumpingmoms/pumping/milkcalc/