Saturday, January 31, 2015

All About Working and Pumping!

All About Working And Pumping!




Going back to work after having your baby is daunting enough, but throw pumping in the mix and it can be downright anxiety inducing! Here are some things you can do before you even return to work.

1. Make a plan before you return to work. Inform your boss and HR rep that you will be pumping at work upon return. Inform them you will require a 20 - 25 minute break every 2 1/2 to 3 hours. Try and come up with suggestions of how to make this work so you can come in and say "I can pump at X time in X place". This may be harder if you are the first one to work and pump at your company! 
2. Know the law! Check state and national laws covering pumping!http://www.ncsl.org/issues-research/health/breastfeeding-state-laws.aspx 
3. Invest in a good pump! Many insurance companies are now covering double electric pumps. Call your insurance company and ask what they will cover. 
4. Invest in a hands free pumping bra. You can purchase them online or make one from an old sports bra. This will make it not only more comfortable for you, but also give you the freedom to do something else while pumping! 

Paced bottle Feeding:

All the time you hear people talk about “paced bottle feeding”.  What is this and why is it important?
First, let’s talk about how babies nurse. Unlike a bottle, a baby has to work for the milk from the breast: they control the flow. With a bottle there is a constant stream of milk, when nursing sometimes baby is sucking for comfort and not getting any milk at all. This means that a baby who is nursing is used to getting milk, then the milk stopping while they stimulate another letdown, and then continuing to nurse. Also throughout the nursing session the flow of the milk will change. The initial letdown is usually stronger. This is why when your baby nurses you will notice different suck patterns.

But what does this have to do with bottles? When you give a baby a bottle there is no work for the milk and no way for them to control the flow. This means a breastfed baby can quickly chug down milk, 4 or more oz, and then still cry for more. If more milk is offered this can cause overfeeding and an upset stomach. Think of it as when you eat a meal too quickly, overeat, and then feel off later.

So, first off, make sure your bottle size is appropriate. Most breastfed babies take bottles of 2 – 4oz every 2 – 3 hours. Your care providers should PACE the bottles.  They should take 5 mins to feed each oz of breastmilk.  So a 3 oz bottle should take 15 mins to feed a baby, a 2 oz bottle should take 10 mins.  In order to do this, they should try to mimic the breastfeeding pattern—give an oz of milk, then give a paci, or finger, or toy, or washcloth, or WHATEVER he will suck on, and then once 5 mins have gone by, then give another oz of breastmilk. Here is the link for a handy print-out you can share with your care provider about the best way to pace bottles: http://www.cuidiudsw.ie/wp-content/uploads/2012/03/Paced-Bottle-Feeding.pdf

Make sure the baby is napping well. An overtired baby will seem hungry and want to nurse because they are tired.  Most babies under 6 mos will be awake for an hour or two hours tops before it's time for another nap. If you notice your care provider offering bottles every 45 minutes to 1 hour, chances are they are missing the sleep ques for your LO and baby is overtired.

Encourage our care provider not to feed the baby after a specific time of day. For example if you will pick the baby up at 4pm ask that a bottle not be given after 3pm or provide a small bottle (1 or 2oz) to be used after that time. If a large bottle is given right before you pick up the baby they may not be interested in nursing right away. Nursing as soon as you can after being separated will help you add extra nursing sessions in when you are together and will help to keep your supply up. 

As your baby gets older many care providers, especially those not familiar with breastfed babies, will say things like "your baby needs bigger bottles" or "you need to move to a faster flow nipple". Most of the time this is not true. Breastfed babies should take the same size bottles at 9 months as they do at 3 months. During a growth spurt they may need a small increase in milk, but it should only be a temporary increase over the course of the growth spurt. The same can be said for a faster flow nipple. The speed they get milk at the breast doesn't change, they don't need a faster flow nipple as they get older either. 

If your care provider starts asking you to provider larger bottles try providing fewer larger bottles. For example if you had sent 4 3oz bottles try sending 3 4oz bottles to be given father apart. 

When you are together: NURSE!
Babies need to drink about 25-35 ozs of milk per day--which is an oz-oz and a half per hour.  http://www.kellymom.com/bf/pumping/milkcalc.html Therefore the rule for daycare is always to send 1 – 1.5oz per hour (minimum requirement, you can send more if you can keep up with the pump, but an oz per hour is enough as long as you nurse on demand at home).  If you are away from the baby for 7 hours, you should send them with 7 - 10ozs. 

However, this means that you need to nurse frequently during the time you are together to make up the rest of the milk that they need for the day.  Breastfeeding (as oppose to pumping) is also important for keeping up a good supply--it is never preferable to pump and give a bottle.  Nursing directly from the breast is ideal.

Ideas to help keep up nursing at home:
1.  Co-sleep so that baby can nurse frequently at night.
2.  Offer to nurse frequently (every 2 hours or less) when you are together.
3.  Nurse AT the daycare--when you get there to drop off and when you get there to pick up, or else in the car.  This can help especially if you are even having trouble pumping enough milk after initiating all these strategies.
Note that it is very normal for a baby to go through a mini nursing strike right after you return to work, especially if a baby is being overfed or bottles aren't being paced. They may protest or fuss more at the breast because they do not get the same instant gratification they do from a bottle. In this case the best thing you can do is keep offering the breast and NOT give a bottle. Try hand expressing a little milk first to achieve letdown and latch the baby on. Most babies will quickly realize that when mom is around they nurse and when they are at daycare they will get bottles. 

Make Sure To Pump When Apart!
Pump at the same times every day and pump for a set amount of time. DO NOT WAIT TO FEEL ENGORGED TO PUMP.   Pumping is all about routine and consistency.  Ideally you will pump in the same place(s) and at the same time(s) every day (while listening to the same music, or watching the same show or reading the same sort of book or whatever your pump routine is).   Some Moms are helped by looking at a pic of their baby while they pump, listening to a recording on their phone of the baby crying, or smelling a piece of the baby's clothes. 

When you add a new pump session or begin a pump routine, you might pump almost nothing at first.  This is normal.  Give yourself at least a week of pumping at the same time/place before you can expect to see much milk. The same applies to changing your pump. If you sudden switch to a different pump it can take your breasts time to adjust to the different suction.

But how often should you pump? Every 2 – 3 hours you are separated from your baby. Make sure to start the clock after your last nursing session! So, if you nurse your baby at 7 and return to your baby at 5 you would want to pump at least 3 times, ideally at 930, 12, and 230. Make sure each time you pump you are pumping for at least 20 minutes. While the milk may stop flowing at 10 minutes, most moms will get more letdowns over the course of the pump. Some moms report letdowns at the 25 minute mark! Remember pumps are not as efficient as babies, so  even if your baby only nurses for 10 minutes, make sure to pump for at least 20. If you are finding it difficult to get so many pump sessions in, we can help you come up with creative solutions. Many moms pump in the car on the way to and from work.  Even adding a 5 min session (in the bathroom/at your desk/in the car/someplace fast and easy) between your more significant pumps would make a huge difference. Ensure that you are doing breast compression while pumping! This extra stimulation can help get out more milk than just pumping alone. Using a hands free pumping bra will make this easier.

Remember if you are still not pumping enough, there are troubleshooting tips. First off, check your pump parts to make sure they are working correctly. Ensure you are using the correct size flange. Often times moms just use the flange that comes with their pump, which may not be the correct size for them. Make sure to do hands on pumping! http://www.nancymohrbacher.com/blog/2012/6/27/to-pump-more-milk-use-hands-on-pumping.html This can make a huge difference in output. Consider renting a hospital grade pump to  use at work.

Helpful links from Kellymom:
 How to Bottle-Feed the Breastfed Baby:  http://kellymom.com/bf/pumping/bottle-feeding.html
 How Much Expressed Milk Does Baby Need:http://www.kellymom.com/bf/pumping/milkcalc.html

Grocery Shopping When Dealing With Sensitivities

***Disclaimer: All information contained in this group is intended to help you navigate the difficulties of elimination diets, under the advisement of your care provider. This group does not purport to give you medical advice or direction. Do not take the advice given in this group as that given in a professional medical capacity.

When you have to give up a certain food item (e.g. dairy, soy, gluten, corn, eggs, nuts), you wonder how it is going to affect your approach to grocery shopping. If you are not in the habit of scanning labels and researching ingredients, now is the time to start. Going on an elimination diet can be difficult and intimidating at first. But, in time, you will realize that you can still eat well and be healthy, with a little more preparation.

Start Simply
At the beginning, you may be mourning the loss of the food item you have to give up. And, that is more than OK. Give yourself the time to grieve for the food changes you have to make. But then, get down to business. Invest time into researching the common problems associated with the allergy or intolerance you are trying to manage. We have files on the most common allergens and diet eliminations. Once you know what you need to avoid, start with what you have. The less you focus on what you cannot eat, the less deprived you will feel. Almost everyone can eat most meats and produce. Depending on your eliminations, you can likely have at least some grains, including rice, millet and quinoa. Barring a nut allergy, you can freely enjoy nuts. Plus, chances are really good that you can still have your coffee, tea or wine.

Navigating the Store
When you look at the average grocery store, you will notice that they are largely laid-out in a similar fashion. Produce, dairy, deli, the meat counter and the bakery generally run around the perimeter of the store. For the most part (and of course there are exceptions), the most natural foods you can get are on the perimeter. In the center, in the aisles, you find processed, packaged and frozen foods. Once you know where the stuff you need to buy is located, you can start work on your shopping list.

Creating a Shopping List
Hopefully, by now you have checked our other files for your specific allergy or intolerance and you know what to look for. You might feel intimidated about how you are going to find anything to eat. After all, several people have already told you that “everything has dairy/soy/eggs/gluten/corn/nuts” in it. In fact, this is not entirely true. It is true that a lot of packaged foods have ingredients you would not expect. But, this is not the end of the universe. Consider elimination to be your opportunity to seriously cut back on the amount of processed and packaged foods you bring into your home.

There are two approaches to grocery shopping while eliminating, and you will probably do both to some degree. The first is to keep it simple, and start making foods from scratch that you know do not contain the ingredients you are trying to avoid. Don’t worry! If you do not have a lot of experience cooking or baking, just start slowly. The Internet is full of easy recipes to help you get started. When you plan your shopping list, start with what you know. Plan to fill up your cart with the basics, including fresh fruit and vegetables, meat, safe grains and nuts if you can tolerate them. Think about healthy oils you can use for baking and frying. Don’t forget herbs and spices to season your cooked food. If you choose to buy canned or frozen goods to supplement your list, be sure to check the ingredients before you buy.

The second approach is to buy some packaged foods that you know are free from the item(s) you are eliminating. This takes a little more research in the shop, as you will need to carefully examine the ingredient lists. At the bottom of this file, you will find ingredients to avoid based on your particular elimination. Some products will be advertised as “dairy-free” or “gluten-free” or whatever. You still have to read the ingredient list to be sure. Even with all this care and research, you may still occasionally fall victim to “hidden” sources of that allergen. If you do your best to inform yourself and avoid the ingredient, this will be a minimal occurrence.

Replacements
Since manufacturers realized there is a big market out there for people who want or need to avoid eating a particular food, tons of products have flooded the market that claim to be “gluten-free,” “paleo,” etc. Take these packages with care and a grain of salt. Just because a product is “organic” or free of whatever you are trying to avoid, does not mean it is automatically healthy. For example, many people eschew cow’s milk because it is processed and, in some cases, contains antibiotics and hormones. If you are trying to go dairy-free, you might be excited by the hordes of alternative milks you can choose from instead of cow’s milk. But, before you start buying, take a look at the process. You cannot milk almonds or rice. These products are heavily processed and have a lot of cheap fillers to make them taste better and increase the manufacturers’ profit margins. So, they are dairy-free, but not particularly healthy. You may find that making these things yourself is not just cheaper, but healthier and tastier. The same goes for those gluten-free Oreos. Buy them as a snack if you will, but don’t interpret a lack of certain ingredients as your license to binge.

Striving for a healthier diet is a big part of elimination. If you start slow, you can make it easy to adjust. Before you know it, you will be telling others that it was not that hard.

Allergen Checklists:

Dairy:
Butter
Animal Milk (typically cow or goat)
Butter
Cheese
Casein
Whey
Sodium Caseinate
Lactose

Soy:
Edamame
Miso
Natto
Shoyu
Soy (soy albumin, soy cheese, soy fiber, soy flour, soy grits, soy ice cream, soy milk, soy nuts, soy sprouts, soy yogurt)
Soya
Soybean (curd, granules)
Soy lecithin
Soybean oil
Soy protein (concentrate, hydrolyzed, isolate)
Soy sauce
Tamari
Tempeh
Textured Vegetable Protein (TVP)
Tofu

Gluten:
Wheat
Barley
Rye
http://www.glutenfreegluten.com/wp-content/downloads/Hidden_Gluten_Sources.pdf

Egg:
http://www.kidswithfoodallergies.org/docs/Egg_Allergy_Avoidance_List.pdf

Corn:

http://www.cornallergens.com/list/corn-allergen-list.php

All About Gluten

***Disclaimer: All information contained in this group is intended to help you navigate the difficulties of elimination diets, under the advisement of your care provider. This group does not purport to give you medical advice or direction. Do not take the advice given in this group as that given in a professional medical capacity.  This document is property of Dairy Queens.***


Gluten is a protein found in wheat and other related grains including barley, rye and spelt.  Gluten is also used a protein source and a binding agent in many processed foods.  The most common sources of gluten are wheat, barley, rye, spelt, bulgur, and malt.  When cutting gluten, it is not enough to cut the obvious sources of gluten in bread, pasta and cereals because it is hidden in many processed foods.  A “little bit of gluten” is not safe for people that are sensitive to gluten and safest way to avoid gluten is to choose foods that are naturally gluten free such as meat, dairy, eggs, vegetables and fruit and to read all labels on sauces, marinades and spice mixes.  For very sensitive people, they may need to avoid products produced in facilities that process wheat and other gluten grains.

Gluten free doesn’t mean grain free.  Gluten free grains include corn, rice, quinoa, amaranth, millet, teff, buckwheat and certified gluten free oats.  Sometimes very sensitive people experience cross-reactions to these grains so again, it’s all about how you feel when you consume these grains. 

Gluten sensitivity in babies may present as reflux, stomach ache, gas, unusual stools, mucous and/or green stools, constipation, diaper rashes, red-ringed anus, cradle cap, eczema, fussy, restless and not easily settled, and asthma.  Sometimes when there are no improvements by cutting other allergens, cutting gluten may be the solution.  We don't always understand the chemistry at play behind sensitivities and testing, and doctors don't either. Remember a lot of elimination is about how you and your baby feel.

Gluten sensitivity in adults has many symptoms that can occur across the body including mental health.  There are a few links below that describe these symptoms in more detail. 

There are many gluten free products that act as nice substitutions for your favorite gluten foods.  However, these products do contain a small amount of gluten.  There is some debate about the use of these products as a staple in the gluten free diet because consuming too much of these products may still create gluten sensitive reactions.  Aim for a balance between naturally gluten free foods and these substitutions in your daily diet.

Safe and Unsafe Ingredients for the Gluten Free

Below is a list of more gluten related resources



NATIONAL and INTERNATIONAL RESOURCES 
National Foundation for Celiac Awareness

Canadian Celiac Association

Celiac.com
Resources, articles, messageboards

Gluten Free Restaurants in US (National Foundation for Celiac Awareness GREAT kitchens)

Shelly Case, Registered Dietitian 

Gluten Free Guide/Celiac Disease

RESEARCH


PUBMED
Gluten Sensitivity (Free Full Text, 10 years)

Gluten and Autoimmunity (Free Full Text, 10 years)

 NEWS ARTICLES
This is your Gut on Gluten by Amy Myers, M.D.

This is your Brain on Gluten by James Hamblin

Gluten and Dairy

47 Symptoms of Gluten Poisoning


Gluten and Eczema

 BLOGS ON GLUTEN, CELIAC DISEASE and NUTRITION

Pretty Little Celiac

Celiac Chicks (Restaurant and Product reviews, recipes)

Gluten Dude

The Celiac Diva

GLUTEN AND KIDS

Gluten and Reflux

Celiac Disease and Kids

DOCTOR'S SITES and BLOGS
Dr David Perlmutter author of Grain Brain
  
GLUTEN FREE LIFESTYLE, RESTAURANTS and RECIPES
  
Celiac Support Association (recipes, restaurants)

Gluten Intolerance Group

Gluten Free Goddess

Gluten Free Girl

Elana's Pantry


Mom, Whats for Dinner?
http://whatsfordinner-momwhatsfordinner.blogspot.ca/

All About Soy

***Disclaimer: All information contained in this group is intended to help you navigate the difficulties of elimination diets, under the advisement of your care provider. This group does not purport to give you medical advice or direction. Do not take the advice given in this group as that given in a professional medical capacity.

If you have learned that you need to avoid eating soy because your baby is reacting to it, you may be a little confused. After all, if you aren’t eating tofu, edamame or even drinking soymilk, you aren’t eating soy, right? Unfortunately, that assumption is incorrect. Soy is a little different when it comes to avoiding the ingredient. With some care and research, you can readily avoid soy contamination, for you and your baby’s health.

Signs of Soy Intolerance
Soy is a fairly uncommon allergy. Only about one percent of children seem to be allergic to soy. However, there are many degrees of intolerance. And, children who react to dairy often react to soy. The proteins are similar, so cross-reactivity is fairly common. This is why intolerance to milk proteins is often referred to as Milk-Soy Protein Intolerance (MSPI). The Mayo Clinic identifies signs that you or your little one is reacting to soy:
·         Tingling in the mouth
·         Hives, itching or eczema
·         Swelling of the lips, face, tongue and throat, or other parts of the body
·         Wheezing, runny nose or trouble breathing
·         Abdominal pain, diarrhea, nausea or vomiting
·         Redness of the skin

If left untreated, the allergy (in rare cases) may progress to anaphalaxis, which presents itself with the following symptoms:
·         Constriction of airways, including a swollen throat that makes it difficult to breathe
·         Shock, with a severe drop in blood pressure
·         Rapid Pulse
·         Dizziness, lightheadedness or loss of consciousness

The good news is that eliminating soy (and possibly also dairy) from your diet should reduce or eliminate these symptoms fairly quickly.

What to Avoid
While soy is occasionally eaten whole, it is usually consumed in one of its many processed forms. You find soy in a variety of ethnic cuisine, but also as a common emulsifier and way to add cheap protein to processed foods, nut butters and even meat. So, be sure to check your products to make sure they contain no added soy. These are the ingredients you should look for:

Edamame
Miso
Natto
Shoyu
Soy (soy albumin, soy cheese, soy fiber, soy flour, soy grits, soy ice cream, soy milk, soy nuts, soy sprouts, soy yogurt)
Soya
Soybean (curd, granules)
Soy lecithin
Soybean oil
Soy protein (concentrate, hydrolyzed, isolate)
Soy sauce
Tamari
Tempeh
Textured Vegetable Protein (TVP)
Tofu

Helpful Links:
http://www.mayoclinic.org/diseases-conditions/soy-allergy/basics/symptoms/con-20031370

http://www.foodallergy.org/allergens/soy-allergy

CORN SENSITIVITY: NAVIGATING THE MINEFIELD

When we think of foods that are a major part of the average diet today, grains are the bulk of most plates.   If you’ve ever driven through the heartland of America, you know that corn is a tremendous crop.  It’s everywhere.  And, it’s in everything.  And it can have a dubious reputation!  Corn allergies and sensitivities are on the rise – most likely because consumption is at an all-time high.  While a true corn allergy can result in immediate hives, rashes and even anaphylaxis, corn sensitivities are more about symptoms that crop up after a few hours or even days.  Sometimes, those symptoms might not even show up until corn has been consumed several times.  When looking at corn sensitivity in babies, we tend to look at the likelihood when some symptoms crop up and aren’t managed after elimination of our more frequent offenders of dairy, soy and wheat.  Typical symptoms in babies include:
·         Eczema that gets progressively worse with time and exposure
·         Mucous filled or bloody stools
·         Reflux  - silent or violent, it’s usually there with corn
·         Restlessness (especially with corn syrup/HFCS exposure)
·         Dark under eye circles
It’s worth noting that these symptoms are pretty much the same that you are going to see with any food sensitivity.  When you’ve eliminated dairy, soy, and wheat – we usually start wondering about CORN! There are varying degrees of sensitivity and tolerance to certain forms, but it’s best to avoid most ingested things if you have a little one that reacts to corn. 
Corn syrup is used in most commercial baby formulas.  It’s easier to get it out of your breast milk than switch to a formula substitute.  We have heard of babies reacting to even hypoallergenic varieties of formula that was prescribed by doctors to help with sensitivities/allergies.   
With the saturation of our food supply, you have to learn to read labels for EVERYTHING.  Look specifically for anything that says “corn” or course, but also keep in mind that there is a terrific amount of food product that involves corn.  There are many places where you will find corn or possible corn ingredients that you might not think of think of!
·         Ascorbic acid
·         Alcohol
·         Barley malt
·         Powdered/blended sugar
·         Baking powder
·         Baking soda
·         Caramel and caramel color
·         Citric acid
·         Distilled white vinegar
·         Erythritol
·         Food Starch
·         Hydrolyzed vegetable protein
·         Mannitol
·         Modified cellulose gum
·         MSG
And that’s a SHORT list! Do your research if you have a super sensitive little one!
Here are a few handy sites to check if you have questions about some ingredients:
As with any food that you eliminate, it’s always worth journaling your experience when you are going through the process.  You might not realize how much corn you are actually consuming in hidden forms.  It might seem very difficult at first, but unless you are dealing with a severe allergy in you or your baby, you can find a happy medium and a happy baby!
We are mothers, sharing our experience and research with you – not doctors or nutritional professionals.  As with any health-related matter, seek medical attention and expertise as indicated. Any  advice given here is not to be taken as medical advice.



GUT HEALING V. ELIMINATION DIETS – A Dairy Queen Perspective and Why We Are Here

Some of you are here for a few reasons.  You might have a fussy baby.  You might have some strange looking diapers.  You might have a rashy baby.  You might have all of the above.  We’re glad you’ve found us – we’re here to help!  The very vast majority of mothers with these issues chose to eliminate what they believe to be the trigger food in their diet.  Examples would include: avoiding dairy or avoiding soy or wheat/gluten.  This is a “watch and see approach” that works well.  Some have to go into really deep elimination – Corn, soy, dairy, gluten containing grains, nightshades, etc…the list can get REALLY long.  And the process can get really complicated.  At times, I feel like some of our mommas get very caught up in elimination.  You can eliminate yourself into oblivion without good results at times. 
We’re here to tell you and share with you (and have you all share!) what worked for us, why we did it, how we did it.  We want you to have access to what you need in this arena of breastfeeding and nourishing your family. With the very nature of this board, it’s easy to fall into the “I KNOW WHAT IS WRONG WITH YOU” trap. I want all of you to keep in mind the very personal and individual journey that each of us is on.  Some will need to eliminate one thing.  Some will need to eliminate five things.  Some will need a reset of the system that involves much personal research (highly, HIGHLY encouraged!) and food choices.  And we can help through our wonderful, cooperative peer-to-peer support system.  The admins and members are here to help and can guide you – but the choices and the path you take must be your own! 
 Your guts are dynamic.  They do amazing things when it comes to assimilating nutrition, protecting you with immunity, cleaning away toxins we introduce and just from everyday life.  But sometimes, those processes are interrupted because our guts become damaged or tired from all of the toxins and life and food choices and stress.  Gut-Healing is an intensive, multi-leveled process.  And if you need that, there are several of us who have been there and done that – we can absolutely share our experiences.  There are many paths to good health.  Gut Healing is one of them.  It’s a broad concept, with some detailed applications.  Some examples of a Gut-Healing protocol would include Gut and Psychology Syndrome (GAPS), The Candida Diet, The Select Carbohydrate Diet (SCD) and vegan/vegetarian versions of the aforementioned.  These are just SOME of the paths through Gut-Healing.  It’s truly an individual choice and an individual journey. 
Currently, we are in the process of making this a friendlier, more accessible resource for all of our members.  Our focus is breastfeeding mothers who are trying to eliminate one or some foods for baby’s digestion and health.  While we are primarily concerned with only the elimination aspect, we can share our gut-healing ideas and stories when needed and indicated.  We want to help you with resources for research, food information, recipes, understanding, and a light at the end of the tunnel.  Your stay here might be short and to the point.  It might be a life changing path that makes you look at the food you eat and the body you inhabit very differently.  We aren’t here to get into the deep crevices of specific issues – there are groups for that with professionals and more experienced people.  We want to help you feed your body and feed your baby.  If we can’t do that – take heart – we know how to find people that can!
We are mothers, sharing our experience and research with you – not doctors or nutritional professionals.  As with any health-related matter, seek medical attention and expertise as indicated. Any  advice given here is not to be taken as medical advice.