Pediatricians: when to stay and when to go

One of the keys to a great breastfeeding relationship is a supportive care provider for your child. Many pediatricians claim to be supportive of breastfeeding however the advice they offer is far from supportive. So why do we get this bad information and how can we weed out the good information from the bad? It is hard to look at a doctor and say "no, i think you are wrong". Generally the train of thought is "they went to medical school, they must be right". But how much education on breastfeeding did they actually get?

In 1999 a study was publicized by the AAP that actually asked doctors how they supported breastfeeding in their practice. The entire study is an interesting read, but the responses show that not all doctors are comfortable with breastfeeding advice and many are not offering advice that the AAP recommends. Only 58% had actually received breastfeeding management training during their residency. This means that over 40% of pediatricians who responded had NO breastfeeding management training. 72% of pediatricians who responded had no idea about the new initiatives to make hospitals baby friendly and even more had no clue if the hospital they were affiliated with was working to become baby friendly. Only 65% of pediatricians actually recommended to moms to exclusively breastfeed and only 37% of the pediatricians who responded to the survey encouraged breastfeeding for at least a year. http://pediatrics.aappublications.org/content/103/3/e35.long

While this study was done over 10 years ago it highlights the attitude that not all pediatricians are created equal and assuming that just because your doctor has a medical degree means they understand breastfeeding is a dangerous assumption. 

So what can you do?

First off, interview your pediatrician! Pediatricians are used to this. Many actually have a meet and greet so respective parents can come visit. the AAP actually has a great handout with questions to ask at an interview.http://www2.aap.org/breastfeeding/files/pdf/AAP%20FindFriendlyPractice.pdf

If you disagree with what your pediatrician says say so! State "You know, i don't really feel comfortable with this". Explain your position. Reschedule another appointment and return to your doctor with documentation helping to support your feelings. 

Remember YOU are paying your doctor for a service. While your doctor went to medical school, that doesn't mean they are always right. If you don't like your pediatrician simply walk away and find a new one. 

Some warning signs that your pediatrician is not as breastfeeding friendly as they state:
- informing you to schedule feedings (only 15 minutes every 2 - 3 hours)
- Encouraging early night weaning (ie: your baby should be sleeping through the night by 6 months)
- Encouraging cry it out 
- Pushing to start rice cereal early to help "baby sleep better". 
- Pushing solids in the first year. Food before 1 is just for fun!
- Encouraging you to quite breastfeeding for nipple pain/latch issues. 
- Not being encouraging of working with a lactation consultant
- saying things like "after 6 months there is no value in breastfeeding" 
- encouraging formula supplementation without talking with a lactation consultant. 

If you have a breastfeeding concern ask your pediatrician about talking to a lactation consultant before doing any supplementing with formula. A lactation consultant, specifically an IBCLC, is trained in breastfeeding support. They can help identify a milk transfer issue, a tongue tie, or a true supply issue. Most pediatricians are not trained to correctly identify these issues. Working together with a lactation consultant and pediatrician when issues arise is key. 

Remember that there are many parenting styles and there are many pediatrician styles. Find a doctor that you mesh with, not one that your best friend uses. Think about what is important to you to get from the doctor. Do you want someone who is more hands off and relaxed? Someone who has a checklist of questions? Someone who is female? Someone who has weekend and night hours? Also remember that your childs primary care doctor does not have to be a pediatrician. Many women use a family doctor instead if there is no pediatrician near them they like. 

The key take away from this is that as parents we need to question and research everything on our own. There are lots of wonderful supportive doctors who are great at helping moms breastfeed. There however are also lots of doctors who haven't read the newest information released by the AAP and WHO or whom haven't kept up to date with breastfeeding information. If your doctor tells you something that sets off a warning bell, ask around.

All About Sleep!

You know the routine. You have had a horrendous night with your baby. It seems like nothing worked to get them to sleep. Blurry eyed with a large cup of coffee you suddenly have a friend/coworker/relative go "Oh junior was sleeping through the night by now!" It takes all your willpower not to burst into tears and cry "WHAT AM I DOING WRONG?!"

The answer however is you are doing nothing wrong! 

First off, lets talk a little about newborns. They are supposed to wake every 2 - 3 hours in those initial weeks to eat. Their stomachs are small and breastmilk metabolizes quickly. They go through many growth spurts in those early days too which makes them nurse more frequently because they are telling your body to make more milk. This is 100% normal and to be expected! 

Usually around 6 - 8 weeks babies will start to sleep a bit better. Sometimes you will get a 5 or even 6 hour stretch. Congratulations, your baby is now sleeping through the night! Wait, what? Yes, for a baby sleeping through the night is considered a stretch of sleep longer than 5 hours. Many new mothers don't realize this. When they hear their baby should be sleeping through the night by 3 months they are thinking 10 - 12 hour stretches. Yes, some babies do sleep through the night for 10 - 12 hours at 3 months, however most do not.http://www.askdrsears.com/topics/sleep-problems/8-infant-sleep-facts-every-parent-should-know

We have already talked about the joys of sleep regression in our previous tip of the day. http://dairyqueenstheblog.blogspot.com/2013/07/tip-of-day-sleep-regression-normal-part.html I just want to reiterate that it is very normal for your baby to go through periods of great sleep and periods of bad sleep. Think of the first year like a roller coaster filled with ups and downs. 

But wait, your fiend Jane has a 3 month old that sleeps 10 hours, your friend Liz has a 3 month old who is up twice, and your have the baby that wants to wake up every 2 hours on the dot. What gives?

There are many factors in how a baby sleeps. There are many reasons a baby wakes overnight. Babies wake for hunger, for thirst, and for comfort. Personality can play a big role in how often a baby wakes and how "easy" it is to get your baby back to sleep. Some babies are high needs and need lots of comforting and assistance to fall asleep and stay asleep. Some babies will quite happily fall asleep on their own from day 1. 

So what can you do if you are the one with the baby who "never sleeps"? 

**Please note that we do NOT recommend full night weaning before the age of 1. Nursing overnight is very important in the first year as it helps to maintain your supply. We also do not recommend any form of CIO sleep training** 

First off, set a realistic expectation for yourself. Realize that babies wake overnight and this is normal. Many studies have been done on baby sleep in the first year and it overwhelmingly shows that babies wake up at night! So just because all your friends say that their babies "sleep all night long" that may not really be the case.http://kellymom.com/parenting/nighttime/sleepstudies/ 

Start with good sleep habits early. You can't force your kids to sleep but you can help encourage them gently. In the daytime try and get exposure to light and the outside. At night at bedtime have a soothing bedtime routine that your baby will come to expect. this routine can be as simple as a short song and a story. And no, its never to early to start. You can adjust the routine as your baby gets older. Make the sleep area inviting for sleep. Keep lights dim, if you get a lot of sunlight consider black out curtains, play soft soothing music. 

Try not to overstimulate or overwhelm your baby when bedtime is nearing. Stick to calming activities in the hour or two before bed. This can be harder with older kids, especially if mom or dad works and they get excited at night when the family is together again.

Make sure your baby is napping well in the day. If your baby isn't napping enough in the day this will throw off their overnight sleep. Remember that newborns need lots of sleep and can get overtired quickly. Most babies before the age of 3 months only really should be awake for about 1.5 - 2 hours before taking another nap. Try watching your baby closely for sleep ques to make sure that you aren't letting your baby get too overtired. http://www.parents.com/baby/sleep/basics/age-by-age-guide/

Evaluate bedtime. Is your LO going to bed too late or too early? Every family's schedule and routine is different however plan on your LO needing about 12 hours overnight (with 2-3 brief nursing sessions throughout the night being normal). So if you are getting up between 6 and 7am aim for bedtime to be between 6 and 7pm. Putting your LO to bed later in hopes of them sleeping better always backfires! A lot of moms feel like putting baby to bed long before they go to bed only means they won't get any sleep because baby will wake up as soon as mom lays down. Many moms have luck with trying a "dream feed" right before heading to bed themselves. So if baby goes down for the night at 7pm, and mom doesn't go to sleep until 10, try gently picking up baby and trying to latch baby on at 9:45. Most infants will nurse in their sleep and this can sometimes buy mom a few extra hours before baby wakes for an overnight feed. This is also helpful for older infants when they start to become easily distracted or during a nursing strike. http://www.kellymom.com/store/handouts/newborn/sleep.pdf

Evaluate your sleeping arrangement. Are you cosleeping? Room sharing? Is your LO in their own bed? Some babies like their own space and their own crib. If your baby is in your room try moving them to a new space and see what happens. Some babies love the closeness at night of their parents and co sleeping can be a wonderful thing to help everyone sleep better. Please make sure to follow the guidelines for cosleeping safely. http://kellymom.com/parenting/nighttime/familybed/

Many people will say that you need to "sleep train" your child to make them sleep better. Sleep training usually involves a form of cry it out that we as a group don't promote. As stated above there are many reasons that babies wake overnight. Adults wake overnight too most of the time. However when we wake up we can get up and get a drink or snack or use the bathroom, a baby can't do that. Trying to force sleeping for 10 - 12 hours a night before your LO is ready can also impact milk supply. Overnight nursing is normal and during a growth spurt important to help keep and boost supply! 

******Important****** If baby is initiating long stretches of sleep on their own and they are gaining weight well and have good diaper output, then it is not necessary to worry about supply. Your body will regulate to your baby's needs and if he/she needs more sleep, your body will make plenty of milk for their daytime feeds. Long stretches of sleep initiated by sleep training are what cause issues with supply.

http://www.askdrsears.com/topics/sleep-problems/sleep-trainers-buyer-beware

You will also hear "don't let your baby nurse to sleep" and "don't nurse overnight". Neither of these will help your baby sleep through the night. In fact nursing before bed is very soothing and will help your baby unwind! Like stated above night nursing is vital in keeping supply up. On a personal note my oldest son was not nursing overnight by 15 months, however he still routinely woke up until he was 2 1/2. Night weaning does NOT equal sleeping. 


Some great books to read to find out more about normal newborn sleep are "The No Cry Sleep Solution" and the Dr Sears Sleep book. Both talk about setting realistic sleep expectations and how to gently encourage your child to sleep better. 

http://kellymom.com/parenting/nighttime/sleep/
http://www.askdrsears.com/topics/parenting/sleep-problems/31-ways-get-your-baby-sleep-and-stay-asleep
http://kellymom.com/parenting/nighttime/got-sleep/

Oversupply and Forceful Letdown (Overactive Letdown)

Oversupply and forceful letdown are a topic that many women struggle with, but few talk about. This topic tends to be taboo in the breastfeeding world for a couple reasons. First of all, mamas who have over supply are often able to pump high volumes of milk even after nursing baby exclusively all day. In fact, even mamas who respond well to pumping won't pump as much as most oversupply mamas (.5-2 oz TOTAL for the entire pumping session is normal and typical for a mama who nurses baby exclusively). Because normal pumping output is such a source of anxiety for most moms, mamas with oversupply may feel like they are hurting other mama's feelings or boasting if they talk about their high pumping output. This is also an issue because there is so much misinformation about what low supply truly is, mamas with oversupply are often overlooked and told to be happy you can produce so much milk.

Oversupply is a large issue. In fact some moms mistakenly think they don't make enough milk when in fact they make too much! Some of the big signs a mom may have a forceful letdown or oversupply are:
- milk sprays when baby unlatches during a letdown
- milk pours out babies mouth when nursing
- baby chugs milk during the letdown
- baby pills off sputtering/gasping during a letdown
- baby clamps down when nursing or clicks when nursing
- excessive spit up and gas
- bright green (lime green) foamy stools
- baby refuses to nurse.
- baby gains weight very quickly 

It is important to note that not all moms who have a strong letdown have an oversupply. It is possible to have a strong letdown without oversupply. 

A mom doing laid back nursing 

There are ways to help with forceful letdown so you and baby can have a happier breastfeeding experience. First of all, try changing your nursing position. Side lying is often the preferred nursing position for moms with forceful letdown. This position allows baby more control of the flow (because breast and baby are level instead of baby being below the breast where the flow is stronger), it also allows extra milk to dribble out of baby's mouth so baby does not choke on a mouthful of milk as more comes rushing in. Another great position is laying baby on top of mom so baby is above the breast (mom laying down or heavily reclined). This greatly reduced the force of the letdown and allows baby to better control flow. 

Another option is to latch baby on until letdown, then unlatch baby and allow the forceful spray to go into a towel or bottle for storage. Then, latch baby back on. You can also try hand expressing until letdown, let the spray go into a bottle for storage, and then latch baby on. Both of these methods will stop that initial strong letdown. 

If you have tried these methods and are still struggling, you can consider block feeding. It is important to note you should work with an IBCLC before beginning block feeding. Block feeding can be a lifesaver for a mom with oversupply, but as the result is lower milk supply, you need to be sure that you have true oversupply. Block feeding should not be done for your entire nursing relationship. Typically once your supply has established (about 2-3 months) you would resume offering both breasts each nursing session. 

Block feeding is offering only one breast each nursing session. There are many "ways" to block feed, and working with an IBCLC can help determine the best method for you. Many moms have a set amount of time where they nurse on one breast, typically starting with 2 or 3 hours. In this time frame every time baby nurses mom would offer the right breast, then switch to the left breast for 2 - 3 hours. Another option is to rotate breasts each nursing session. 1 nursing session on the right breast, the next on the left. Working closely with an IBCLC to monitor baby weight gain is vital.

Remember: If you have a strong letdown or oversupply pumping is NOT recommended. Pumping can actually make the situation worse as you are stimulating your breasts to make more milk. Some women hyper respond to a pump so just one short pump session a day can throw everything off.

Also remember that after your baby hits a growth spurt its normal for you to have some oversupply for a few days. The growth spurt is your baby telling your body it needs more milk. Typically after a growth spurt things level off again quickly. 

If you do have oversupply and end up with a lot of milk in the freezer that you don't need, consider donating through Human Milk 4 Human Babies Global Network or Eats on Feets or even to a friend or family member who may be in need. It's truly an amazing gift to give a mama with true low supply or other breastfeeding difficulties. Families who are adopting are also looking for breastmilk donations. So please keep this in mind if you choose to pump off your extra supply.

http://www.llli.org/faq/oversupply.html
http://kellymom.com/pregnancy/bf-prep/milkproduction/
http://www.ncbi.nlm.nih.gov/pubmed/8960706?dopt=Abstract

Supplementing And Supply

Supplementing, while sometimes necessary, can be an incredibly slippery slope. Especially when an IBCLC is not involved. For every oz you supplement, you are telling your body it doesn't need to make that oz of milk. In which case, your body begins to decrease it's supply with each bottle. An IBCLC can help to try and keep this from happening through additional pumping and other methods of increasing supply. 

There are many reasons moms believe that they need to supplement. Most of this comes from misinformation, lack of support, and predatory marketing on the part of the formula industry. Let me be clear we in no way are bashing or looking down on moms who formula feed or supplement. As said above, it can be a necessity, and most of the admins on this page have had to supplement with formula at one point or another. But it is important to know when it may be necessary to supplement, and when being a nervous mom is making us feel as if we are not making enough for our babies. 

http://kellymom.com/bf/got-milk/supply-worries/low-supply/

So the first thing to remember is that our bodies were made to feed our babies. Milk production is an amazing, and seemingly complicated process that happens just by putting our babies to the breast and letting them nurse (http://kellymom.com/pregnancy/bf-prep/milkproduction/). To quote this link directly, "For the most part, milk production is a “use it or lose it” process. The more often and effectively your baby nurses, the more milk you will make." This means that if a true supply issue exists (as opposed to a milk transfer issue such as latch problems or TT/LT), bringing baby to the breast is the best way to remedy this. Galactagogues such as fenugreek, mothers milk tea, blessed thistle, oatmeal, etc. do nothing for milk supply if you aren't bringing baby to the breast as much as possible. Increasing baby's time at the breast alone will typically boost supply on it's own. 

Here are some common reasons moms believe they are not producing enough milk for baby, and thus feel they need to supplement:

*Baby is fussy after feedings and does not seem satisfied or is nursing constantly - This is common, especially during growth spurts and developmental milestones such as rolling over and sitting un-supported. Growth spurts make babies feel generally yucky because of bone growth and brain development. It's a confusing, and sometimes painful time for babies and they will fuss. That's just the nature of it. It's most common to see this in the evenings, accompanied by cluster feedings (another reason mom's believe they aren't producing enough milk to satisfy baby). This is a great link that discusses cluster feedings and fussy baby and how it does not have to be a link to low supply http://kellymom.com/parenting/parenting-faq/fussy-evening/
http://www.ivillage.com/growth-spurt-or-low-milk-supply/6-a-127423

*After nursing, baby quickly takes another ___ oz from the bottle - This is a common misconstrued sign that baby is still hungry after nursing. The first thing to consider is how long it takes for the receptors in the brain to tell the tummy it is full. That is why paced bottle feeding is so important when exclusively pumping or when baby is with a caregiver. After nursing, it may take 10-20 minutes for baby's brain to actually signal to his/her tummy that it is full and satisfied. Especially if there has been a long stretch of sleep. In these instances, it can be helpful to nurse baby on one side for 10-15 minutes, then take a short break. Maybe 10-15 minutes to change their clothes and diaper and interact with them, then offer the first breast again. This gives their tummy some time to know it is full. Another reason babies seem to drain a bottle after nursing is due to sucking and swallowing reflexes. An older baby will probably refuse the bottle if they aren't really hungry (although not all). But a younger infant will suck on anything you put in their mouth. When a bottle is placed in a baby's mouth, they will instinctively suck. Then, their mouth will fill up with milk and they will instinctively swallow. This will go on until the bottle is empty. (http://www.mother-2-mother.com/cc-baby-B.htm#Fussiness)

*Baby is fussy at the breast and seems angry like no milk is coming out, but will gulp down a bottle without a problem - Like most humans, babies are impatient. They want what they want, and they want it now. Unlike adults, however, babies do not have the cognitive ability to understand that they will get what they need if they put in a little effort. When baby gets a bottle, even the slowest flow nipple is easier for them than the breast. This is often how nipple preference happens. Baby figures out that they will get their milk quicker and with less effort from the bottle, so they prefer to eat that way. While this kind of fussing at the breast is quite common during growth spurts, it doesn't have to be an issue all the time. A good way to help with this is to feed baby before they are really hungry. When baby starts to show the very first signs of hunger (like, waking up), put them to the breast and start the feeding. When babies get so hungry that they start to cry, it is usually necessary to calm them down in order to nurse them happily at the breast. A very hungry baby has a hard time latching on because they are feeling distressed and cannot calm down. If this seems to be a regular occurrence,make sure you are putting baby to breast as soon as you see early hunger cues. http://kellymom.com/bf/normal/hunger-cues/

*My breasts feel soft, they never actually fill up (anymore) - This is common, especially after your milk has regulated around 6 weeks. The shapes, size, and feel of your breasts do not indicate a supply issue. It is actually better that your breasts do not feel like rocks all the time. That is called engorgement and can lead to clogged ducts and mastitis if it happens often. Some moms may never feel their breasts get hard and full, even from the beginning. Again, this is not an accurate sign of low milk supply.

*When I pump, I only get a couple oz out, so baby must not be getting much - It is NORMAL for a mother who is nursing on demand to pump between .5-2 oz TOTAL for an entire pumping session (between 2 boobs). Your baby is WAY more efficient at removing milk from your breasts. More efficient than a pump will ever be. So pumping output CANNOT be used as a gauge to how much milk you are making.

So how do you know your baby is getting enough milk?http://kellymom.com/bf/got-milk/supply-worries/enough-milk/
If baby is gaining weight (and following their own growth curve), if baby is producing enough wet/dirty diapers a day (5-6 sopping wet diapers a day and a few poops), baby is alert when awake, and baby is relatively happy, you are very likely producing plenty of milk for your baby.

If you are not seeing these signs, contact an IBCLC ASAP to have your baby's latch checked for milk transfer issues. If low supply is suspected by your IBCLC, he or she can advise you of methods that can help you increase your milk supply. It is important to remember that anything you ingest to increase milk supply has risks and benefits to you and your baby and should be done so after evaluating said risks with an IBCLC.

Green Poop!

Green stools happen. So do brownish, orange, and reddish; on top of the yellow seedy stools you are told to watch for in breastfed babies. Stools can be striped; a little brown and a lot of yellow for instance. Stools come in all shapes and sizes. Stools that indicate a medical emergency are black tar-like stools (in infants), white (all ages) and those containing blood (all ages). Please note - if you give your baby iron supplements that can cause black stools. 

And to that note many supplements, either taken by you or given directly to baby; may cause stool discoloration. Examples of these include: colic calm (baby), gripe water (baby), fenugreek (mama). To tell if these supplements are the cause, discontinue for at least 48 hours and re-evaluate stool output then. (fenugreek specifically can cause a foremilk/hindmilk imbalance where there was not one before, which can lead to green stools. In addition, mamas who have a soy or nut allergy or a baby with soy/nut allergies or sensitivities should NOT take fenugreek to increase milk supply).

The occasional green stool is NOT a concern. If you eat a lot of green foods it can cause baby's stool to be green. 

If your baby receives ANY formula; at all, and the stool is green this to is NOT an indication that there is a problem. Formula will change the color and consistency of baby's stools. This is true no matter HOW little formula you give. Even an ounce a day may have an affect. 

If mom is lactose intolerant, but still eats/drinks foods that contain lactose this can also affect baby's stools. 

Introducing solids will change baby's stools. Color, texture and consistency. Again, green stools after starting solids; totally normal.

Green stools CAN be a red flag however IF they are more common not. 

Green mucusy stools CAN also be caused by a stomach virus and teething. Teething creates a lot of extra saliva and when swallowed can lead to stomach aches and stools that looks worrisome. 

If baby has green mucusy stools AND ALL of the above bullet points have been looked at (mom's diet, any formula, supplements, solid foods, stomach virus and teething) AND the green stools are CONSISTENT then mom should look at 1) whether or not she has oversupply (creating a foremilk/hindmilk imbalance) or 2) baby has an intolerance or allergy to a food mom is eating (such as dairy or soy - FYI fenugreek is part of the soy family). One of the easiest ways to tell the difference between 1 and 2 - is the texture of the green stool. A milk imbalance will cause stools to look more foamy; whereas a baby with a food intolerance or allergy will have additional symptoms such being fussy, sleeping little, and skin rashes.

If an oversupply is suspected please refer to the documents on this board and keep in mind fixing an oversupply is a balancing act and will require a good deal of trial and error and many people do not see results overnight. 

If a food allergy or intolerance is suspected please visit our DQ board dedicated to dealing with these issues. This too has no overnight fix, and while it may seem like formula is the answer it is NOT as most formulas contain the allergens you are trying to have baby avoid. They may prove to be a short term fix, but often in the long term the are not. Even during the food investigation process, it is better to breastfeed baby (or look into donor breastmilk) than to feed a baby with food sensitivities, formula. 

All in all - the occasional green stool is NOT a problem. And before being concerned about oversupply or allergies - slow down and review the list of possible causes for green stool.

Mastitis vs Clogged Duct!

One of the more common issues to run into when breastfeeding are clogged ducts. The clog may be easily seem (a milk bleb, which appears as a tiny blister on the nipple. It is usually a bit of skin that has grown over a duct and is blocking milk from coming out) or a clog further into the duct that isn't visible. Sometimes the only sign you have a clog is pain in the breast and redness. If you pump you will notice a decrease in output from that side. A clogged duct can occur for many reasons, and some women are more prone to clogs than others. Some things that will increase the chances of getting a clog are missing feedings, not removing milk efficiently (either via pumping or nursing) and applying lots of pressure to the duct (for example by stomach sleeping). 

The good news is that you can work to clear a clogged duct fairly easily. Lots of extra nursing, warm compresses, as well as breast compression while nursing can help. Also ensure to nurse in different positions. If you get recurrent clogged ducts you may want to have your babies latch evaluated to make sure there are no issues with transfer or nipple issues that are causing the reoccurring clogs. taking lecithin has also been shown to help.

Why is it so important to clear a clogged duct? A clog can lead to a breast infection called mastitis. Mastisis is when you have the symptoms of a clogged duct along with the sudden onset of flu like symptoms: chills, body aches, and a fever. If the symptoms you are feeling are very mild then you can still use the techniques for clearing a clogged duct, however if the symptoms have lasted more than 12 hours then it is time to seek medical help. Antibiotics may be prescribed to help cure the infection. During this time it is crucial to keep nursing as much as you can to help clear the clog and thus help clear the infection. If you are taking antibiotics you may also want to consider taking a probiotic to help prevent yeast infections or thrush.

Many woman are quick to rush to the doctor for antibiotics at the first sign of a clogged duct. If there is no fever or other flu like symptoms or the symptoms are mild and have been present for less than 12 hours there is no need to call the doctor. If your baby is under 2 weeks old, you have an obvious open sore on your nipple, or the symptoms are sudden and severe then a trip to the doctor is a must. Keep nursing as much as you can, rest, and drink fluids! 

http://kellymom.com/bf/concerns/mother/mastitis/

http://kellymom.com/bf/concerns/mother/recurrent-mastitis/

Growth Spurts!

So everything was going along great, baby was sleeping and eating so perfectly. It almost seemed like baby was creating their own perfect little schedule. What are they talking about, this isn't that bad.....Then WHAM! Every hour on the hour, your infant is nursing, crying, fussing, and beating up your boobs. What gives, kid?

Most likely, your baby is going through a growth spurt. Infants have pretty predictable growth spurts through the first 6 months of their life, and then experience growth spurts as they reach other milestones in their life through the teenage years (although by that point, it's not quite as predictable when it will happen). It's pretty typical to see growth spurts at 7-10 days, 2-3 weeks, 4-6 weeks, 3 months, 4 months, 6 months. Growth spurts happen with stages of development, not only for the body but also the brain. So in the beginning, they need those crazy nursing spurts to grow in size, but later on they'll need them for the purpose of brain development as they learn to sit, use fine and large motor skills, crawl, walk, talk, etc...The day my daughter "found" herself in the mirror at 5 months, she nursed like an animal for 3 days straight. 

So what can you expect. Well first of all, you can expect to stop sleeping soundly for a few days.  Growth spurts are exhausting. However, overnight is when baby does the majority of their growing. You may also find that baby sleeps longer stretches but then nurses every 1/2 hour in between those stretches. It can be different for every baby, but the main thing to know is that there will be a lot of nursing. In the first 6 weeks, these growth spurts are also super beneficial to building and regulating your milk supply. On the other side however, after a growth spurt babies can be extra sleepy. So hang in there! 

Another thing to expect during a growth spurt is a fussy baby. Fussy, fussy, fussy. As adults, we don't really think about (or remember) what it's like for our bones to grow and our bodies to change rapidly. Once we reach a certain age, our body just kinda does it's thing over time. Babies, however, double, triple, and even quadruple in size in their first 1-2 years of life. That means growth spurts are a time when those little bones are lengthening and their little bodies are rapidly changing. During times of major milestones (rolling over, sitting up, becoming mobile), their little brains are on hyper drive, trying to keep up with their development. So now consider all of this as an adult, and now put it into the tiny mind of an infant that has no ability to cognitively understand what is happening to them. And I go back to my original statement, expect a fussy baby. You aren't doing anything wrong, your baby has't turned into a gremlin you have to be afraid of after midnight, they are just unhappy and want a boob. The best way to get through a growth spurt with the least amount of anxiety and issues, is just give them what they want. The more we fight their needs, the more exhausting it all becomes.

In the early stages of a growth spurt, you may find that baby is beating you up and changing up the way they suck. They aren't protesting. When your typical nursing "schedule" is every 3 hours and your body has gotten used to that, baby has to work a little harder to alert your body of his/her needs for the purpose of the growth spurt. So the first couple days, baby is going to attack your breasts in an effort to stimulate prolactin release (the hormone in your brain responsible for milk production), which in turn kicks in your letdown. Once your body gets used to this new way of nursing (at least for the moment), it should regulate to your baby's needs for the growth spurt. It's really important to respond to your baby's cues to nurse because your body needs to make the extra milk to keep up with your baby's demand. If you are working or going to school during a growth spurt, it is advisable to get in a few extra pumps a day to keep up with what baby will need, and to keep your supply going for those overnight feedings. 

Do not be surprised if you become engorged, especially the day or 2 after a growth spurt when baby's nursing becomes less frequent again. Unless pumping is part of your daily routine anyway, it is advisable to just follow your baby's nursing cues and refrain from pumping off the extra milk, as this will continue to signal your body to make more. If you become uncomfortable, try hand expressing a little bit into a cup or bottle to add to your stash, just to relieve the pressure. But a full on pumping session will just continue the cycle of production and engorgement. If you typically have an oversupply, it can be helpful to block feed for a couple days after a growth spurt to help signal to your body that production can slow down.

Another important piece of advice is to stay hydrated and don't ignore your body if it says its hungry. Don't be afraid to add an extra 300 calories a day to your diet during a growth spurt. You WILL burn it off with all that extra nursing. Eat things like fresh fruit, whole grains, coconut oil, and high protein items like fish and chicken. These food items will increase your energy and keep your body going strong. Avoid food items that are high in sugar, high fructose corn syrup, white processed flour, and dairy as their empty calories will likely only contribute to weight gain and cravings. 

Sleep when you can. The rest of the world will wait. Trust me. This will not last forever. This is just a 3-5 day blip on the radar of the rest of your life and it is soooo important to your baby's growth and development.

Pumping and Oversupply!

Oversupply is when a mother produces too much milk. While this sounds like a great thing it actually causes a unique set of problems for both mom and baby. For baby it can cause fussing and the breast, gas issues, spluttering and choking during feeding, and latch issues as baby tries to compensate for all the milk flow. For mom it can cause pain, reoccur ant mastitis and clogged ducts, and frustration! The first advice usually given to moms with oversupply is "stop pumping!!"

The reason we don't advise pumping with oversupply is that the pump is signaling your body to produce more milk. This causes the oversupply cycle to get worse. More milk gets produced so you have to keep pumping to help get the milk out. Repeat cycle. But what if you need to pump? 

If you only need milk occasionally for a night out pumping a few days before the event would suffice to build up a small stash. If you want to pump to build up a freezer stash make sure to hold off on starting until after your milk supply is established and your oversupply is tamed a bit. usually this happens at 8 - 12weeks. Then add in 1 shorter pumping session a day, watching for signs oversupply is returning. 

If you are a working mom with oversupply this is where things can actually sometimes work in your favor a bit. A few days before returning to work pump once a day to ensure you have enough milk on hand for your LO. Your first week back at work aim to pump every 2 - 3 hours. After the first few weeks gauge how much your LO drinks, how much you are pumping, and how you feel. Expect to feel engorgement the first weekend home. Try not to pump. If you notice after the first few weeks you are bringing home a lot more milk than you need try extending the time slowly. For example if your LO drinks 12oz when you are gone but you are pumping 20 - 25oz you can probably pump less frequently at work. Instead of every 2 - 3 hours aim for every 3 - 4 hours. This will also help with the feelings of engorgement on the weekend. Remember that your body will adjust to the pump so its normal to see a dip after a month of working and pumping. If you are ever concerned you can always add an extra pump session back in. When working and pumping with oversupply remember that when you stop pumping at work you will have to slowly back off of pumping sessions. Stopping cold turkey can be painful and cause mastitis. Aim to space out and shorten your work pumping sessions slowly over a period of a month aiming to get down to 1 very short 3 - 5 minute session before stopping. An initial adjustment period when you change your pumping schedule is normal! 

Something to consider with oversupply and pumping, you could very well store WAAAAAYYYYY more milk than you will ever need. Please pay attention to the dates on your frozen milk and consider donating extra oz if you do not think you will need them. It is a beautiful and selfless way to help a mama who wants to avoid formula supplementation.

How much milk to leave baby when you are away and paced bottle feeding.

For many of us, the anxiety of going back to work or school circles around making enough milk to leave for baby while we are away. It's nerve wracking. But it doesn't have to be.

Lets go over a couple things  
1.) Milk supply cannot be determined by pumping output. Baby is WAY more efficient than the pump, so what you pump out does not equal how much milk you are making for your baby. .5-3oz TOTAL per pumping session is NORMAL. So again, LOW PUMPING OUTPUT DOES NOT EQUAL LOW SUPPLY.

2.) Taking galactagogues to increase milk supply does not have any effect if you are not pumping more to signal to your body that more milk needs to be made. If you are going to take something to increase milk supply for the purpose of pumping, you HAVE TO ADD IN AN ADDITIONAL PUMPING SESSION, or even a few. You have to tell your body that you need more milk. You also need to put baby to your breast as often as possible. Meaning, when you are home, no bottles. 

With those reminders out there, we'll get to the topic at hand. The current research has found that babies (under 6 months) at the breast consume, on average, 25 oz of breast milk in a 24 hour period. Calculate that at 25 oz divided by how many hours between feedings (lets say 3). That's estimating 8 feedings a day at around 3-3.5 oz per feeding. You can also generally assume that baby needs 1-1.5 oz per hour that mom is away. http://kellymom.com/bf/pumpingmoms/pumping/milkcalc/#toomuchlittle

So lets say you are gone for 9 hours between drop off and pick up. For some moms, this doesn't sound like a big deal. 9-13 oz a day, no problem. For a LOT of moms, this sends your anxiety into a tail spin. If I'm only pumping 1.5-2 oz per pumping session and I'm only pumping a couple times a day, how am I ever going to store enough milk so my baby isn't starving!!!!!!!!!!! Trust me, you are not alone in this feeling. Lets consider how you might "schedule" feedings for your baby while you are away. One way that can make it easier to work with a smaller amount of milk is to nurse baby right before you leave for the day. This way, baby gets in a full feeding off the bat. This would mean that baby should be able to go 2-3 hours before their 1st bottle of the day. You could do this in the car, in the daycare facility, or at home if you have an in home caregiver. But try to do it within 10 minutes of leaving baby for the day. If you repeat this as soon as you come to pick baby up, it is probably safe to leave baby with about 6-8 oz for 2 feedings. 

To accomplish this without too much trouble, it is important that your caregiver understand how to pace bottle feedings in a way that mimics breastfeeding. It should take 10-20 minutes for baby to finish a bottle of expressed milk (roughly 5 minutes per oz). I am pasting a link here because it makes the process so easy to understandhttp://kellymom.com/bf/pumpingmoms/feeding-tools/bottle-feeding/

In my opinion, this should be a HUGE factor of consideration in choosing a day care provider or in home caregiver. Find out if they have experience with bottle feeding breastfed babies and are they aware of pacing bottles and how it contributes to the health of baby and the breast feeding relationship. It is incredibly worth it!! 

Sometimes, baby will seem to not be eating at all while mom is gone. They may just drink an oz or so to take the edge off, but then be up all night nursing. This is called reverse cycling and is very normal. I will dedicate an entire TOTD to this in a couple days, but it's worth noting that many of you may experience this and it does not mean there is something wrong. It just means baby prefers to nurse and be close to mama. Unless there is a problem or an illness, babies won't starve themselves. 

It is important to remember that every baby is different. While this information may work for most babies, it won't be relevant for all. 

Sleep regression - a normal part of the first year!

Once the first 6 - 8 weeks of a newborns life passes sometimes babies start to sleep for longer stretches of time. Nothing is more welcome to a new mom than your baby suddenly sleeping 5, 6, or even 7 hours straight! Suddenly you feel more refreshed when you wake up. And then after a month of sleep suddenly your baby is back to waking up every 2 - 3 hours again. This is usually when moms start to think one of two things. 1) My baby isn't getting enough milk! and 2) I'm spoiling my baby by nursing overnight. Neither is true! 

Babies sleep regresses over the first year for many reasons. The first reason is a growth spurt. During growth spurts your baby will want to nurse more often, even overnight. Growth spurts are babies way of signaling your body to make more milk. Another reason for sleep regression is developmental spurts. If you stop and think about how much babies change in the first year it makes sense that their sleep will get disturbed. When baby starts to roll over they will do it in their sleep and wake themselves up. Figuring out how to crawl usually results in the same thing! Most moms will tell you they watched their baby crawl around in their sleep! Also cognitively their brain is growing and developing. The last big reason for sleep regressions is teething. Some babies are hardly bothered by teething, others are miserable teethers. Some are slow teethers and will seem to have symptoms for a month before a tooth actually pops up! 

Everyone has that friend who will proudly say "oh my baby sleeps for 12 hours a night". And you sit here with your baby who is up every 2 - 3 hours and think "what is she doing differently?! The reality is that while there are gentle ways to encourage more sleep every baby is different and babies will sleep when they are ready. Most moms will readily admit that their babies don't sleep through the night. 

I find that having a good mentality can be very helpful with overnight sleep. Think of the first year of sleep as a roller coaster filled with ups and downs, good nights and bad nights. You will have a period of a month where you swear something is wrong and you will never sleep again. And then suddenly sleep will happen again and you'll wreck your brains to figure out what you did differently. The answer is probably nothing! 

As for night nursing = more wake ups, this is not true either. In the first year night nursing is very important to help keep supply up, even more so if you are working! Many babies will nurse more overnight after mom returns to work because they miss the comfort and the nursing. Remember nursing is not only food for babies, it is comfort. Yes, every time they wake up they may not be hungry but they may need that extra comfort from you. Many woman will tell you that even after they night weaned their babies still woke up overnight consistently so they were still awake soothing their children back to sleep. 


http://kellymom.com/parenting/nighttime/sleep/
http://kellymom.com/parenting/nighttime/4mo-sleep/