Category Archives: Breastfeeding Basics

Sleep Training and the Breastfeeding Infant (The Newborn Sleep Book)

There’s a “New Method” to help newborns sleep through the night and it’s been making its rounds in all of the groups that I’m in. It doesn’t even matter which method it is at this point. A method like this routinely crops up under new names with different explanations. The general idea is this:  You teach your infant to expect to be fed at certain intervals and no sooner. So the child’s body adapts to those feeding times and you get sleep.

Sounds good, doesn’t it?

So why are people so against it? Why are the lactation consultants, the breastfeeding advocates, and everyone with knowledge of breastfeeding up in arms? Is it a conspiracy to deprive us all of the sleep we need?

There is a geeky saying. ‘It’s not only not right, it’s not even wrong.” Where something cannot be argued against in a logical manner because the understanding that it was built on is ridiculously flawed. The phrase is attributed to Wolfgang Pauli, a theoretical physicist known for colorful objections to sloppy thinking.

These methods are like that for people that know how breastfeeding works, how the human body works, how the mother-infant relationship work. The idea that you can space out feedings to encourage a newborn to adapt to a specific feeding pattern? It reduces us to jaw-hanging horror because it’s… Not only not right. It’s not even wrong. It’s incredibly naive and… It just doesn’t work. You can’t say that two plus two is five. How do you even go about talking about something that is… that.. off?

You have to back up. All the way. Start from the beginning and teach a person how a baby’s body works. What human milk is made of. How different types of milk mean different things. You have to teach them… Everything. That is how flawed the method is. You can’t even say “the conclusion is wrong”. The entire thing is broken.

Let’s try this.. Did you hear about the method of reducing gasoline consumption by spacing out refilling to once a month so that your car learns to expect to only be refilled then? It works.. technically. Just with some obvious pitfalls for most people.

The newborn sleep training method that spaces out feedings so that the baby will only expect to eat at certain intervals? Remarkably similar. But instead of running out of gas mom’s supply tanks and baby may end up with failure to thrive.

You cannot change how something works without understanding it and respecting it.

These methods capitalize on the mystique and misunderstanding surrounding the most basic biological process. It is snake oil and glitter promising to change how biology functions.

This method should have a huge glaring informed consent warning label on it. “USING THIS METHOD WILL INVOLVE FORMULA SUPPLEMENTATION EXCEPT IN RARE SITUATIONS“.

Let me introduce you to the human mother. The human mother’s body performs a balancing act between her baby’s needs and her own physical health. If a human mother is making unlimited milk constantly across the day and is making more milk than her baby needs then she is rapidly burning through her own resources by funneling all of her energy and vitamin intake into the production of milk. If the human mother makes unlimited milk then she will have constant engorgement and leaking. This places the human mother at a high risk of mastitis and thrush. So how does mom stay healthy? Mom’s body is protected by how breastfeeding works. Human milk has a protein in it called “Feedback Inhibitor of Lactation” or FIL. When mom’s breasts are full of milk they are also full of this protein which signals to mom’s body that her breasts are not being emptied and that her body should make less milk to conserve resources and prevent infection. If mom’s breasts are not emptied regularly then her milk supply decreases.

Let me introduce you to the human infant. The human infant acts as the counterbalance to mom’s body’s natural drive to decrease supply.  The human infant is biologically hardwired to cry to be near mom, to suck when awake, to sleep when full (human milk contains tryptophan which naturally encourages sleep), and to wake when their body needs more milk. Their stomach capacity is small- from the size of a marble up to the size of a chicken egg. They rapidly digest human milk so that they will be ready to nurse again and keep mom’s supply where it needs to be. This on-demand feeding is what helps the small weak infant with an under-developed brain grow healthy and strong. It promotes normal human development and growth. Human infants are categorized as “carry mammals” by science, which has analyzed the milk of different species that rear their young in different ways. Human milk is similar to the species that carry their babies around and feed all across the day and night. The human baby requires frequent feedings.

We now have the basis of the cycle. Mom’s breasts need to be kept empty in order to produce milk. Baby’s natural biological rhythms of hunger and nursing encourage baby to keep mom’s breasts empty by nursing frequently.

You cannot change the human mother’s milk into the milk of a deer which feeds around once every twelve hours and you cannot change the human infant’s digestive system into that of a baby deer which requires the specific balance of its mothers milk.

It doesn’t work. You  just break the cycle.

So now we’ll throw in a “gotcha”. Mom has been told to space out feedings to no more than once every three hours or once every four hours. Mom’s body doesn’t know this. Mom’s body knows that she has a young infant that is feeding on demand. Mom’s breasts fill up with milk. Mom’s milk is full of that nifty little thing that tells mom’s breasts to make less milk. That milk stays in mom’s breasts. Baby screams in hunger while their parents bounce and shush and distract and attempt to pacify the baby that needs to eat. Mom’s breasts start making less and less milk. Baby eats what baby can eat in the time that mom allows him to nurse. (Typically fifteen minutes per side) and consumes either what mom’s breasts are able to let down in that time or what baby’s stomach capacity is. Either way… IT IS NOT ENOUGH. Mom’s supply reduces and instead of taking in what baby needs baby is taking in what mom’s body is able to produce on the schedule that is allotted.

In some mother-baby pairs this will work. Maybe mom has oversupply that is higher than usual in calories. Maybe baby’s rhythm is different.

Let’s go back to the car thing.. Maybe the car that you’re not refilling is a small fuel efficient hybrid or has an unusually large gas tank. Maybe you don’t drive much, or maybe knowing that you won’t be refilling the car as much makes it so you change your patterns. There are ways in which it can work.

There are also ways in which it will fail because it is completely and totally incompatible.

If your baby is asking to be fed more than once every three hours… That’s the low fuel light on your dash. It’s the thing that is telling you that less frequent refillings don’t work for your baby.

To summarize it- if this method is appropriate then your baby is one of those that only wants to feed at that interval. If your baby wants to feed more frequently it is NOT a safe method to use. Not for your baby and not for you.

The methods that purport to “fix” the natural rhythm of infants… Are BROKEN. They are fundamentally flawed from the bottom up. They cannot work any more than you can look at a potato and say “I’ll spell you like tomato instead and you will be red!”

There is nothing wrong with a parent trying a method with the knowledge that it will decrease their supply and require formula supplementation. As long as it is an INFORMED CHOICE and as long as they know that it’s not “my body doesn’t make enough milk” or “I failed to breastfeed”, it is “I made an informed choice to choose a method of sleep training that is incompatible with breastfeeding.”

Even if a baby is fully formula fed you still have to be cautious about restricting feeds this way because a baby’s stomach is tiny. It cannot hold much food. And a baby on a liquid diet simply needs to eat often in order to thrive.

The body can adapt to less frequent feedings. Certainly. But it is far from ideal.

You’re Making Me Uncomfortable Even When You’re Not There (NIP)

Dear Person(s) Unknown,

You make me far more uncomfortable than I make you. Think about it. I have no way of knowing if you’re lurking there in the corner thinking terrible things. I have no idea if you’re sitting there thinking sexual thoughts. I have no idea if you are thinking about calling the manager and trying to have me removed. I have no idea if you ARE the manager and if you plan on having me removed.

When I nurse in public sometimes I’m nursing in a train station with hundreds of people. Sometimes I am nursing in a restaurant with dozens. Sometimes I am nursing on a street or in a park.

And I have no way of knowing if you are there.

Lurking.

I have no way of knowing if you’re a public television persona that will use your platform to shame me. I have no idea if you’re a writer at some major magazine or newspaper that will do the same.

You may encounter me or someone like me once in a blue moon. If you saw nursing mothers on any sort of a regular basis I’m certain your head would explode.

I have to worry about YOU every. single. day.

I have to worry if you’re about to ruin my meal.

I have to worry if you’re about to have me removed from the bus. Or the plane. Or the train.

I have to worry if you’re about to call the police.

I have to worry if you’re going to say the most vulgar and nasty things about my nursing child.

I worry about you even when you’re probably not in the room.

I may make you uncomfortable for a moment or two here and there. I might “ruin a meal”.

Over the course of three children and many year of breastfeeding you have made for a ridiculous number of uncomfortable moments and many ruined meals.

The truth. The real truth of it is.. You’re in the minority. Most people don’t care. You are not in most of the places that I go. You are not in most of the places where my baby eats.

But since I can’t see you, and you don’t wear a T-Shirt or a hat or some form of easy to ID badge that says “I DON’T LIKE SEEING BABIES EAT” I have no way to know if you’re there until you suddenly pop out that opinion of yours and rub it in my face.

You have some idea that I am in the room before I begin to nurse. There’s a baby there. Maybe the diaper bag is suspiciously small. You have the option of leaving quietly without fuss or drama to go elsewhere with your thoughts. I have no idea that you’re in the room until you choose to react. Until you choose to take a picture of a nursing mother to share on Twitter. Until you choose to bad-mouth me or mothers like me on your television show. You’re an invisible plague.

I, at least, have some kind of a good reason for the discomfort that I may momentarily cause. A child that needs to nurse. A child that needs comfort, or food. You’ve got an OPINION. A thing that you don’t want to see. A sense of entitlement and privilege that says your ideas about how things should be done is the most important thing in the room.

I could launch into a miles long list of all the reasons why I should be allowed to nurse in public. The laws involved. The health reasons. But the truth is? If you haven’t heard it already you’ve had your head under that blanket of yours a bit too long. You already know the reasons. You just don’t care about anyone but yourself.

And you’re making me uncomfortable. And I find it disgusting.

Please keep that opinion of yours in your head under a blanket where it belongs. You’re making a lot of people uncomfortable. Even when you’re not in the room.

-A Nursing Mother

“Just” for Comfort

Dear Daughter,

Sometimes you nurse “just” for comfort. Just. Because at two you “shouldn’t” need this anymore. Because the nutrition that you get from food, from meals cooked at the stove and from snacks picked from our garden, from the farmer’s market organic grass-fed milk.. Somehow renders this other milk, this mother’s milk, the milk made just for you.. Unnecessary. Placed below the devalued “just” comfort. Not even meeting the bar to be included in “just”. So inessential. Not even needed like water, a substance it is sometimes compared to once society has run out of the desire to feel that what you say you need is really a need and not “just” a desire.

Just comfort contains a lot of things in this case. Amazing fats, lipids, antibodies, vitamins that absorb better than vitamins from pretty much any other source. Stem cells, probiotics. And yes. Comfort.

We don’t value comfort in this society. We value “luxury”. Luxury cars. Luxury cruises. Luxury vacations of excess. We don’t value comfort in this society. We value deluxe. We value sexy. We value exotic. We value the uncomfortable headiness of early love over the comfort of waking up in the morning next to a human that we know inside out. We value new and shiny, or sometimes the very rare antique.

What is it with our desire to play down comfort? To uncomfortably accept “comfort foods” as the junk that we eat when we’re mourning the loss of our latest and greatest love. To accept “comfort spending” and other vices. But to reject the things that actually provide comfort in a wholesome and healthy way?

“Just” comfort. Just a pair of arms to hold onto you in a sea of emotional chaos.
“Just” comfort. A hand to hold while waiting to hear news that may turn your life upside down.
“Just” comfort. A shoulder where you can bury your face and sob, not worried about snot or tears.
“Just” comfort. A pair of hands that hold your hair away as you heave over a bucket when you’re sick.

Just. Just comfort.

Because if we were truly big enough and strong enough, we could rock this toddler thing like James Bond. All cool in a slick sports car

Because if we were truly independent we could do something mature like shove our feelings down into our size six toddler shoes like a pair of rumpled up socks, and we could deal with all this stuff all on our own.

I don’t know. Seems kinda silly.

Yes. I’ll nurse you “just” for comfort. I’ll smile. Yeah. Maybe it is “just” comfort right now. I’m fine with that. I’m fine with teaching you that comfort is a thing you find in the arms of someone safe that you love.

Maybe if you learn this now, when you are little, you won’t spend your whole life looking.

<3 Mama

Pumping Too Much Milk is Not Good

I label my milk as “three hours” instead of “three ounces”

This year I planted an experimental garden. Among the plants I chose were cherry tomatoes. These little tomatoes are very prolific. So prolific in fact that I cannot pick them all and handfulls of them fall to the ground to rot and be eaten by insects.

They over-produce. We get several pounds of tomatoes each day.

When my daughter was born, I over-produced too.

This led me to have engorgement, mastitis and painful leaky breasts. It led my baby to have frothy green poops and painful gas that kept her up at night crying because her belly hurt from all the milk.

I was able to pump 9 ounces in a single session after she took a longer nap, and then wake her up and nurse her until her belly was full.

This is TERRIBLE.

Unless you are exclusively pumping (in which case you want to pump as much milk as you can to overcome supply stabilization and the difficulties of exclusive pumping), pumping large amounts is never a good thing.

With her oldest brother I was barely able to pump, and I was so jealous of the women who could pump ounces at a time. At most I was able to pump a quarter of an ounce from both breasts combined. He exclusively breastfed for 6 months, gained like a chubberoo, and then went on to continue nursing until he self-weaned at 3.

With her middle brother I was able to pump a lot. But by then I understood that is not necessarily a good thing.

Like the cherry tomatoes, when you over-produce the leftovers go to waste. If you do not remove the milk from your breasts, it can cause mastitis. If you do remove the milk from your breasts you maintain an oversupply that eats away at your nutritional reserves in order to feed bags in a freezer. Bags that pose just as much of a threat to your supply as those cans of formula I refused to bring home.

Oversupply is not a good thing unless you’re looking to feed another baby from the pumped milk.

Ideally you make exactly what your baby needs, no more and no less. When your baby’s needs change the change in nursing patterns tells your breasts to adapt the milk to meet baby’s needs without stretching his belly. Through this he learns to nurse until his needs are met. Not to stuff himself. Not to over-eat. But to nurse until his needs are met and he pops off ready to explore the world.

I realize now what I didn’t realize before. Breastfeeding is not a milk making competition. A stockpile of hundreds of ounces is not always necessary and is not always good. Pumping that much milk destroys mom’s nutritional reserves, and weaning from those pumping sessions can be hard. Too many bottles from a stockpile can destroy mom’s milk supply or give baby bottle preference causing her to go from oversupply to a bottle fed baby while wondering what happened.

Breastfeeding is supply and demand, not something that needs to be stockpiled. Even if I have to return to work it’s best to pump what you eat while we are separated rather than having massive stores of milk that make it tempting to skip a pump break here and there and that allow my supply to slowly spiral.

I like to keep an emergency supply on hand, but that can be built up without needing to pump huge amounts.

a half ounce to 3 ounces is average pump output and does not run that much of a risk of mom having too much oversupply. I tend to stop pumping once I hit the three ounce marker. That’s three hours worth of milk in a bag that I label as “three hours” just so no one will be confused about how much to feed the baby while I’m gone.

A healthy supply is maintained by feeding baby from the breast whenever possible, using bottles as seldom as possible, feeding smaller amounts by bottle, and not being tempted to maintain or use a huge stash of either pumped milk or formula.

Latch Tricks

1- Try “gravity assist” positions. Laid back nursing where baby nurses “on top”, dangle nursing where you get on your hands and knees and lower your breast into baby’s mouth. It’s harder for baby to latch on shallowly when the weight of their head or the weight of your breast is helping them latch on.

2- Try the “spring loaded” deep latch trick: http://www.drmomma.org/2010/08/breastfeeding-latch-trick.html

3- Try the “roll up and point for the palate” trick. Similar to the trick above you roll the nipple up. But instead of letting go and letting it spring into baby’s mouth, try to aim it for the baby’s palate and then move it up and down while stroking their cheek to encourage latch. I do this with my daughter when she’s refusing to latch. Which is almost every time I latch her on. (She has a mean tongue thrust/gag reflex). To do this, support baby’s neck in the crook of one of your arms. With the opposite hand place your middle finger under the breast and your thumb on top of the breast. This leaves your index finger free to stroke baby’s cheek. Press your thumb down and back towards your body to “roll the nipple up”. Touch your nipple to baby’s nose and then bring it down to chin and back to nose, etc. until baby opens up. When you bring it up above baby’s nose baby sort of cranes head back and opens his mouth. Aim the nipple for the palate and insert. If baby tries to chomp down too soon, pull nipple back and tease baby a bit more until he opens his mouth wide enough to get the nipple into his palate area. move breast up and down until baby latches on.

4- If baby is flailing arms and bobbing head, baby is probably having trouble finding the nipple. Babies don’t rely on sight, they seek the nipple through feel. Lay baby’s face on your breast and put baby’s hands on your breast before you try to latch baby on. When baby can feel the breast baby tends to calm down and latch on a bit easier.

5- Listen for sounds. If baby’s making clicking sounds, baby’s tongue is either on top of or in front of your nipple instead of under it. If the nipple is creased, it’s on top of the nipple. If the nipple has blisters at the tip, it’s in front of the nipple. Unlatch and re-latch. “Finger training” where you let baby suck on your pinky finger – pad in the palate and nail towards the tongue) can be helpful with clicky nursers.

6- If baby won’t latch onto one side, try the other side. Sometimes baby’s just having a hard time with a particular position and  moving to the other side can help baby figure things out.

7- Change baby’s diaper and wash off their diaper area with a wet washcloth instead of a wipe. Sometimes babies will refuse to latch if they’re uncomfortable.

8- Get baby rooting. Touch their nose and chin with your nipple, stroke their cheek. If they’re rooting they’ll latch on better.

9- Try “side laying” nursing. Lay down on your side, lay baby down on his side facing you. Pull baby close. Rotate baby’s body to see if there’s a good angle where baby is close, baby’s nose is clear of your breast, and baby can latch easily. Often my daughter will latch on like this even when she’s fussy.

10- Make sure baby can feel your breast. Baby will bob his head and move his hands around trying to find your breast and will often push it out of the way. Put his hands on your breast and hold his face against it and see if that helps him calm down to latch.

11- Make sure you support baby by the back of the neck NOT the head. Often a baby will pull away if their head is being pushed or held. I’ve found that sometimes when my daughter is reluctant to latch it helps to move my arm down so that it’s behind the upper part of her shoulders and the lower part of her neck so that her head tilts back slightly.

Schedules Bad, Routines Good.

I don’t have my six and a half week old daughter on a schedule. Many of my friends hear this and say “OF COURSE NOT!” and some ask “why not?” I’m of the opinion that schedules are harmful for breastfed babies and for the breastfeeding relationship. I have three reasons.

Reason One: The baby needs to thrive. In order for an infant to thrive, the baby needs to eat enough and the food has to meet the right nutritional balance. The way breasts and babies work together is designed to make this work. Schedules interfere with the way breastfeeding works, which can interfere with the baby thriving. When eating is baby-driven the baby will not eat unless the baby is hungry, and the baby will not go without eating when the baby is hungry. When the baby eats the type of milk that the baby gets will depend on the last time that the baby nursed. If the baby has gone some time without nursing then the baby will get a rapid flow of foremilk which will fill the baby up quickly and which is digested quickly. If the baby is still hungry the baby will eat more and more until the baby also gets higher fat hindmilk which is digested less rapidly. The more frequently the baby eats, the more hindmilk baby gets. The more hindmilk baby gets the less rapidly the milk is digested and the less often baby will need to nurse. The longer baby goes without nursing, the more foremilk.. You get the idea. It’s self-regulating and a baby-driven balancing act driven by the question of “what does baby need?”

Now throw a monkey wrench in the works. Baby’s hungry. Baby gets told “No baby, it’s not time to eat yet.” Suddenly baby has to wait exactly three hours between feedings. Baby has 20 minutes on each breast, and then baby has to wait another three hours between feedings. Three hours means that baby gets a lot of foremilk. Maybe baby fills up on it since there’s so much. Baby is then full of rapidly digesting food that doesn’t have much fat, and needs to wait another three hours to feed again even though it doesn’t contain what baby needs and even though it digests rapidly. Instant recipe for infant weight loss exactly when infants need to gain.

To make matters worse, breasts are designed to scale supply according to demand. So you have reduced demand (feeds every 3 hours, baby can’t take all the milk, doesn’t empty the breasts completely) and the breasts recognize this. Your milk contains a protein called “Feedback Inhibition of Lactation” (FIL). When your breasts are emptied there is less FIL and production speeds up. When your breasts are not emptied there is more FIL and your breasts make less milk. Full breasts make less milk, empty breasts make more milk. Spacing out feedings lowers your supply.

Remember. Baby needs to thrive. You suddenly have a baby whose feeds are infrequent, rapidly digested and low in fat. And you have a feeding pattern that decreases milk production. You also have a rule about the baby only getting a certain amount of time on the breast, so they cannot work to increase supply.

In order for baby to thrive on a schedule mom must have a supply that is not very sensitive, she must store just enough milk so that baby gets enough milk to not become dehydrated but not enough that baby is only eating foremilk at each feeding. Baby must be able to take in enough milk, digest slowly enough to use all of the portions of the milk, and must not have any physical issues such as reflux, spitting up, a high palate, a faster metabolism, a tongue tie, a lip tie, etc. that interfere with either digestion, weight gain or nursing effectiveness.

In other words, everything must be eerily perfect in order for baby to thrive on a schedule without supplementation.

Reason Two: Supply. Supply is regulated by demand. Both “Amount eaten” and “frequency of eating”. As mentioned before, your milk contains FIL which reduces supply. Infrequent spaced out nursing decreases supply. This is a good thing because if baby’s not hungry and goes a while without eating, supply reduces so mom is not overproducing and wasting her resources on milk that is not needed, and the milk isn’t sitting in mom’s breasts raising the risk of mastitis. With scheduled feedings that space out feedings this is NOT the case. Baby IS hungry, baby would nurse if allowed to nurse. Supply is reduced not because of decreased demand, but because of spaced out feedings.

Breastmilk is not present in mom’s body in a static amount. It is created according to demand. An artificial reduction to demand results in a very real reduction of supply.

Reason Three: Duration of breastfeeding. The AAP recommends that exclusive breastfeeding happen for at least the first six months of baby’s life and that breastfeeding continue to at least a year with complementary solids. Exclusive breastfeeding can only happen if baby is thriving. A schedule which means that EVERYTHING has to meet a delicate balance that many babies and moms are not able to meet.. Means that the duration of exclusive breastfeeding is drastically reduced. A schedule in the early weeks means that mom’s supply may be damaged for the long haul and that in order to restore breastfeeding mom has to feed more frequently than she would have if no schedule had been in place during the early weeks and mom’s supply was allowed to regulate according to baby’s demand and needs.

 ROUTINE is different from schedule. My partner wakes up at 6:30. His alarm clock tends to wake up the baby who nurses and then wants a diaper change, and then nurses again and falls back to sleep for her first nap of the day. Her brothers and I have lunch at 12:00 which means I’m sitting down so she wakes up in her wrap and eats as well. The routine encourages feeding at a certain time, but it does not require feedings to be spaced out. Before we go anywhere I nurse her so that she can wait until we get where we are going. An offered feed is very different from a delayed feed. Routine is different from schedule.

You can have all of the benefit of convenience without spacing out feeds or being on a rigid schedule. Offer feeds, have a good consistent routine. Everything falls into place without needing to watch the clock and push a pacifier into your baby’s mouth because “it’s not time to eat yet”.

laid back/upright nursing

 

LaidBackUprightLove this nursing position. Laying on my side with my legs curled up behind baby and my torso rotated slightly back, baby sitting up and nursing. Great for refluxy babies and fast letdown. Added bonus: baby tends to burp herself when nursing like this. It’s the snuggliest most comfy position I’ve found. And it works from newborn up.

When baby is smaller you can support baby’s bum with a pillow or your arm. As baby gets bigger then baby will be self supporting.

I like this nursing position because the baby can unlatch/pop off if the milk flow is too fast whereas it is a bit harder for baby to do this in normal “top laying” positions.

LaidBackUpright2

Is Breastmilk Deficient in Vitamin D?

Breastmilk does have vitamin D. Low amounts of it that do not meet the RDA. Some call it “deficient”. This is misleading.

Vitamin D is actually a prohormone, not a vitamin. Our skin synthesizes it when it is exposed to sunlight. It was never intended to be absorbed through diet, therefore it is not passed through breastmilk in any substantial quantity. Or any milk, for that matter. Breastmilk is not “deficient” in vitamin D because it is not SUPPOSED to contain large amounts of D.

Our lifestyle is deficient in sunlight, and therefore our bodies are deficient in D. Because we avoid sunlight, live sedentary lives indoors and slather on sunscreen when we go outside, many people are D deficient. This can cause rickets which are weakened bones (vitamin D is needed by the body for the body to use calcium properly) as well as other health issues.

The body stores vitamin D , and when mom is pregnant she passes the vitamin D stores on to baby, so babies are born with enough D to last through the winter without much sunlight. If mom’s D deficient, baby will be born D deficient or with lower stores of D and will need vitamin D drops. (NOT multivitamin drops)

Whether you supplement with D depends on this:

1- Do you live in a climate that gets enough sunlight?

2- Do you regularly expose your baby to sunlight without a hat or sunscreen? Is it safe to do so? (in Florida, for example, it may be too easy for baby to get a sunburn. Or in very northern climates it may be too cold to expose baby to enough sunlight with enough skin being bare. (Sunlight through windows doesn’t work.)

3- Were you regularly exposed to sunlight throughout your pregnancy?

4- People with darker skin have a harder time with vitamin D synthesis than people with lighter skin, so this needs to be taken into account as well.

There are a variety of “Just D” drops for breastfeeding babies that do not have the additional vitamins commonly found in the often-prescribed multi-vitamins.  Read the ingredients, as some of these still have unnecessary ingredients that your baby may be sensitive to.

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/