Weaning

At some point in your breastfeeding relationship the topic of weaning will come up. Well-intentioned family and friends will ask and even you yourself will question the when and how of the process.

The American Academy of Pediatrics (AAP) recommends that, “Breastfeeding should be continued for at least the first year of life and beyond for as long as mutually desired by mother and child.” Babies very rarely self-wean before 18-24 months. If your baby has suddenly stopped nursing or is acting fussy at the breast before this time period, he or she is probably not self-weaning and it is possible that you are experiencing a nursing strike. The World Health Organization (WHO) recommends exclusive breastfeeding for the first 6 months of life, and the introduction of appropriate solid foods at 6 months together with continued breastfeeding up to 2 years of age or beyond.

There is no one right or “natural” time in your or your child’s life to wean. Every baby is different, not every mother has the same breastfeeding goals, and not everyone weans at the same time.  Nursing can be a tremendous logistical, emotional, and physical challenge, and there are many factors which may contribute to a situation in which breastfeeding is no longer appropriate for you. We understand weaning from breastfeeding is a very personal decision for each mother. Only you know when it is the right time for your nursing relationship to end, and we support all mothers making their own decisions about when to stop nursing. No matter what age weaning occurs, it is going to be an emotional process for you and your child. Even if you are fully ready to wean, once the process is over you will probably find yourself feeling sad and depressed. Know that this is very normal and common.

Weaning Before Age 1

Before age 1 the primary source of nutrition for your baby is either breastmilk or formula. If you choose to begin the weaning process before your baby is 1 year old, this means that you will need to offer frozen breastmilk, donor milk, or formula in place of each missed nursing session.

When weaning, the key is to take things slowly. You don’t want to abruptly go from nursing 6 – 8 times a day down to 0 nursing sessions a day: this can create problems such as painful clogged ducts or mastitis. Slow and steady is the key. Aim to drop one nursing session a week. Start by picking your LOs least favorite nursing session and offer a bottle instead. For example, if you normally nurse right after an afternoon nap every day, for one week you can offer a bottle and a cuddle after the afternoon nap instead. Choose a different session to drop the next week, and continue this process until you have dropped all nursing sessions. If at any point you start getting clogged ducts, it’s a sign you are moving too fast. Your body will need time to adjust. During the period of adjustment after dropping a nursing session you will notice some engorgement. Try to limit pumping, as pumping tells your body to keep making milk. Instead, try hand expressing just a little a bit for comfort, using cold compresses, and wearing loose-fitting clothing. Your body will soon learn that making milk at that time is no longer necessary, and the engorgement will subside.

How your baby reacts to the process varies very much from baby to baby. If your baby is used to nursing overnight you may experience a sleep regression, and your baby may be extra clingy. If you have been nursing your baby overnight regularly, continue to offer bottles overnight in place of those nursing sessions.

Some women decide they want to wean their babies completely by 12 months. Before 12 months remember that you can not drop nursing sessions without replacing that missed breastmilk with either frozen milk, donor milk, or formula.

Weaning After Age 1

After age 1, weaning changes. A one year old may be offered more solids and alternative milks in place of nursing sessions.

That being said, a little food for thought: Babies develop interest in solid food at different times. While at 12 months some babies may be eating 3 meals a day plus snacks with no problems, others may still only be eating a little solid food and getting the majority of their nutrients or calories from nursing. Abruptly stopping nursing at this point and switching to an alternative milk may not be in your baby’s best interest. While after age 1 you can offer cow’s milk in place of breastmilk, large quantities of cow’s milk are not recommended for toddlers. Too much cows milk can cause anemia. While there are other alternative milks now (soy, coconut, almond, etc), these contain additives and lack the fat and protein that a growing toddler needs. These milks can be a great occasional snack, but they are not adequate to replace breastmilk. If your baby is still not interested in lots of solid food and you want to wean, you may want to consider talking to your doctor about a toddler formula to use instead of cow’s milk.

So, with that being said, after age 1 weaning is different. As with babies, you will want to wean your toddler slowly. Start with the least favorite nursing session and drop one a week. You can either offer a snack or a cup of milk in replace of the nursing session, depending on how often your toddler is nursing and how much milk your child needs.

Expect your toddler to be upset and extra clingy during this process. They do not understand why they can not nurse anymore. Offer comfort and reassurance as well as distractions. Finding activities to do that will keep you busy can help. If you are on the move and doing things, it can be easier to distract a toddler from melting down. If you are in the middle of the weaning process, set a time your toddler can nurse. Say “milk before bed” and reinforce that over and over when your child wants to nurse. Again, it’s going to be difficult for your child so be sure to reassure them often.

The big picture here to take weaning slow and steady. Don’t rush and abruptly go from nursing on demand or nursing 3 times a day to nothing. This will only end in clogged ducts, breast infections, and meltdowns. Understand it will be emotional for you, and that’s okay. Its normal!  

Emergency Weaning

In some circumstances, there is a need to wean rapidly: acute medical needs like chemotherapy required for cancer treatment, for example. Weaning in a rush means both that there is no opportunity to gradually taper nursing sessions and that there is no time to prepare emotionally for the weaning process.

If you abruptly stop nursing, your breasts will become engorged. If at all possible, pump and gradually taper down the pumping sessions to reduce the risk of clogged ducts or mastitis. Full breasts signal the body to stop producing milk; removing milk signals your body to continue producing it. Hand expressing small quantities, using cold compresses, and wearing loose-fitting bras or other clothing can help to make you more comfortable. Some measures may also help to more rapidly dry you up: cold cabbage leaves applied to your breasts, strong peppermint tea, and foods with sage added are commonly cited among them. These, along with any medications which have been said to reduce milk supply, should be taken only after consultation with your healthcare provider.

For many women, not being able to respond to your child’s need to cuddle at the breast, or grappling with your own emotional need to connect, may be the hardest part of the weaning process. You may be angry at the need to wean, or overwhelmed by a sudden feeling of separation. It’s normal to feel sad, anxious, or frustrated. Nursing can be a comfort measure for moms and babies both; if you cannot nurse, you may look for other ways to connect and comfort both yourself and your child. If you have a support network, this is a time you may want to lean on it: talk about your feelings. Whether you have a personal support network or not, there are many wonderful community groups and programs for mothers. Be sure to reach out if you are struggling.

When You Have To Stop Nursing Suddenly

When we begin nursing we are all aware that one day that relationship must come to an end. Most moms have a goal in their mind. For some that may be weeks, for others months, and for some years. Sometimes however, as we all know, life throws surprises our way and a mom may find herself ending her breastfeeding journey before she is ready. There are extra obstacles to overcome when a mom has to abruptly stop nursing.

Drying Up
Even if you have to stop nursing suddenly that does not mean you should stop expressing milk. If you are nursing or pumping on demand suddenly stopping nursing or pumping will lead to clogged ducts and mastitis. You want to make sure to express milk for comfort. Slowly decrease the number of times you are expressing milk a day over a few weeks. There are some medications that can hinder milk production. Talk to your doctor or IBCLC about medications that may be appropriate for your situation. Cabbage leaves worn in your bra can help reduce milk supply and engorgement. http://kellymom.com/bf/concerns/mother/engorgement/

Introducing Bottles or Cups 
If your baby is under 1 you will need to replace the nursing sessions with either formula or donor milk. A baby over 1 can be offered whole milk. Make sure to talk with your pediatrician about the best option for your situation. Your baby may not take right away to the taste of something other than breastmilk. You can mix expressed breastmilk with formula (prepared according to the manufactures direction) or whole milk to help slowly adjust your baby to the taste. You can then slowly change the ratio of formula to breastmilk. 

Another obstacle many moms run into is getting their baby to take a bottle. Especially an older baby who has never taken a bottle before may be very reluctant. Don’t fear: There are many alternative feeding methods! Try leaving the house so that someone else has to offer the bottles at first. If your baby is over 4 months old, consider trying a straw or sippy cup instead. There are many cups designed for this age range. If all else fails consider using a syringe to feed. http://www.nbci.ca/index.php…

Taking Care Of YOU
Whatever the reason you needed to stop nursing, take a second and remind yourself YOU BREASTFEED! You are AWESOME! Remember that with weaning comes hormone changes and depression after weaning is real. If you are feeling like you are struggling more than normal, please reach out to a care provider and talk to them about your feelings. Don’t feel ashamed, you are not alone. Signs of depression after weaning are anger, anxiety, increased feeling of sadness, or mood swings.http://kellymom.com/…/wean…/wean-how/depression-and-weaning/ 

While weaning is the end of a breastfeeding journey, it is only one chapter of your relationship with your child. Take time to snuggle daily and find new special routines to do together. Replace those nursing sessions with story time or cuddling in the rocking chair. Remind yourself that you did an amazing job and that you are an awesome mother. Think fondly of those special moments together and remember that there are many more amazing moments to come.

Possible Reasons for A Newborn’s Fussy Stomach

Newborns are born with immature digestive systems.  Breast milk is the absolute best thing for their immature system, but even under normal conditions, their bodies/bellies/guts/and little butts are learning how to digest (and poop out) food for the very first time, so some difficulty and a “learning curve” is normal and to be expected.

However, even Moms who are exclusively breastfeeding might observe digestive issues in her baby that she would consider greater than normal: frequent spitting up, watery, green and/or mucousy poop, gas, or discomfort which leads to frequent crying, reflux, etc.

There are two VERY COMMON (more common than not) issues that can cause these digestive problems, and even if you are aware of them, it can be difficult to tease out WHICH of these things is the true issue or if it could be both.

These problems DO frequently co-occur!

Oversupply & Forceful Let-down

The first most common issue is oversupply which can be coupled with overactive letdown and typically a foremilk/hindmilk imbalance .  MOST Moms are made to nurse twins—evolutionarily it makes sense given the odds of twins and the fact that before formula, a baby who lost their mother during childbirth or who was separated from their mother for any length of time would need to be nursed by another mother also nursing her own baby.  It is literally more common than not to have SOME amount of oversupply; meaning that when the Mom’s milk comes fully in—usually between 5-10 days post-partum, they might find that they have much more than they need.

It is a common misconception that more milk is better.  In fact, it is best for your baby if you are making the exact right amount of milk and no more.

Oversupply causes a fussy stomach for several reasons:
One, the fast flow of the milk means that the baby is taking in extra air when he/she is nursing.  This extra air causes gas and discomfort.
Two, the milk that comes out at the beginning of a feed (foremilk) is very different than the milk at the end of the feed (hindmilk).  The milk at the beginning is watery and sugary, almost like milk-juice.  This sweet milk gives baby energy and motivation to keep them nursing.  However, the milk which comes out when the breast is getting more empty is equally, if not more important.  The hindmilk is much thicker and fattier, the “cream”.   This thick milk sticks to the stomach and makes it easier to digest.
The problem arises because oversupply means that often the baby gets full on the foremilk—they are already done nursing before they get to the “cream” which comes out of a more empty breast.  This foremilk is much higher in the sugar lactose, and lactose is much harder for a baby to digest.  This will cause watery, green poops, and stomach upset.

I think there is a further issue with oversupply which is rarely discussed—it is SUPPOSED to take WORK for the baby to extract milk from the breasts.  Babies who are used to a high supply do not have to work very hard to get milk out.  This can cause issues later when the supply regulates because the baby finds himself for the first time having to work hard to eat.  Many Moms at this point (3-5 months) will start to notice issues like bottle preference or fussiness at the breast.

In my opinion it is GOOD for your baby to learn IMMEDIATELY that life isn’t easy and that you don’t get something for nothing.  You can think of this as the first way to build self-esteem and self-efficacy.  You are teaching your baby that working hard will reward them, a lesson that is never too early to teach in my opinion.  Babies whose Moms have a regulated supply have much more patience and determination, not only for nursing but I believe this translates into other areas of life as well.

Oversupply can also cause issues for the Mom:  nipple pain.  Because the milk is often flowing too fast for the baby, they will clamp down on the nipple to reduce the flow.  I can tell you from experience: OUCH.

Chronic oversupply (lasting beyond the initial engorgement period) is often linked to tongue tie or lip tie or another physical factor....

If you think your main problem might be oversupply, see our suggestions:


Food Allergies and Sensitivities

Another very common issue is baby reacting to one or more foods in the Mom’s diet.  About half the time, the problem is dairy.  The next most likely culprit is wheat, after that, soy.  Some babies will have issues with caffeine, also, or you can have one like mine who basically reacts to EVERY food in existence.

However, luckily, half the time, eliminating dairy in the Mom’s diet will solve the whole issue.

Our society has a growing awareness of food sensitivities, and it is increasingly common to discover sensitivities to dairy, wheat, gluten, soy, etc.    Luckily it has never been easier to lie allergy-free.

Like oversupply, food sensitivities can cause watery poops, gassy stomach, frequent spitting up, and colic.

Elimination diet info


So if your baby has a fussy stomach and is exhibiting these symptoms, what is the problem?  Is it oversupply or food sensitivities?  It can be very difficult to tease apart the problem, but there are a few ways to tell.

Oversupply will often start causing symptoms from the first week or two.  Mom will often feel engorged, experience her milk leaking, letdowns when the baby isn’t hungry . . . the baby will often be satisfied with only one side.  If the Mom ever pumps and can get more than 4 ozs per side, that is a sure sign of oversupply.    Again, the nipple pain is also a very good sign.

Oversupply is often linked to an overactive letdown…this has many tell-tale signs.  After a minute or a few minutes of nursing,  the baby might start fussing—come unlatched and cry, or be sputtering and choking on the milk.  Mom sometimes sees her milk spraying at this time.  This is a definite sign of oversupply.

Oversupply will more often cause GREEN watery poops, sometimes in huge diaper blowouts.  The green is evidence of the excess lactose in the milk.

Baby will have issues from the first or second week and the symptoms would usually get BETTER over time, though some Moms unknowingly make the problem worse by pumping off extra milk.

Supply is highest in the morning and lowest at night.  If you have oversupply you might notice the most spitting up and discomfort in the morning and early afternoon, while the spitting up is less frequent at night.  HOWEVER MOST babies have fussy evenings and want to nurse frequently in the evenings, so this can be a hard thing to gauge.

Oversupply, especially in the absence of excess pumping, will get better over time instead of worse, often resolving itself between 3-5 months.

Meanwhile, food sensitivities look a little different.

Most food sensitivity issues will not be present immediately.  If oversupply is not an additional problem and it is ONLY food sensitivities, Mom probably would not see many digestive problems in the first month.  However, between months one and two she would notice an increasing problem.  Weeks 6-8 is the most frequent time for food sensitivities to start causing major issues.

Food sensitivities will also cause watery poop, and it can be green.  However it is much more likely to be mucousy, and BLOOD in the poop is a very good sign that it’s a food sensitivity issue.  It is less likely to see diaper blowouts.   With my son I NEVER saw “seedy” poops until we eliminated all problem foods.  It was VERY watery.
With food sensitivities, you would notice more of a variety in babies’ symptoms from day to day.  Instead of spitting up equally after every feed, you would more likely have occasional large amounts of spit-up and not as much on other days/times.  You would notice the digestive issues being worse after you eat certain meals and less of a problem on other days.   However, if you are someone who eats a LOT of dairy, wheat, and/or soy with every meal, it can again be difficult to tell if the issue is food-based.

Food sensitivities can also cause other issues such as a rash (most typically on the face), and/or a flushed red blotchy look to the skin after nursing.  It is much more likely than oversupply to cause weight gain issues, colic, or reflux.

Food sensitivities from week 8 will typically get WORSE over time (from months 2-5 or longer).  Some babies do gain the ability to process the sensitive food eventually, though, so after getting worse it can start to get better.

Wheat vs Gluten Allergy vs. Sensitivity WHAT THE HECK IS THE DIFFERENCE??

Often when it comes to figuring out sensitivities, a common problem is wheat and/or gluten.  However, wheat sensitivity and allergy is different than gluten sensitivity.  Let’s try to figure this out now...

Wheat sensitivity is exactly as it sounds.  When you or your baby consume wheat, you get symptoms that suggest a reaction such as rashes, gas, funky stools and mucous.  It’s not life-threatening nor does a sensitivity show up in traditional allergy testing.  People that are sensitive to wheat should avoid wheat including products that say “may contain wheat.” 

A wheat allergy occurs when the immune system becomes sensitized and over-reacts to wheat.  The body’s immune system puts up a fight to attack the allergen and this shows up in a variety of symptoms including rashes, hives, nausea, vomiting, diarrhea, asthma, and anaphylaxis.  To test for an allergy to wheat, a skin-prick test or a blood test which measures IgE antibodies in the blood are most commonly used by allergists.  A wheat allergy is potentially life-threatening and needs to be managed by avoiding all sources of wheat and wheat contamination.  Some people may even require the use of an epi-pen or other medicines to mitigate against serious reactions.

A non-celiac gluten sensitivity occurs when people eat gluten products and have reactions similar to a wheat sensitivity but do not have the autoimmune response in the body that a person with Celiac Disease has when they eat gluten.   In addition, people with gluten sensitivity have to avoid more than just wheat.

If we think of these sensitivities in a hierarchy of consequences, a wheat allergy stands on its own because allergies are different than sensitivities and allergies can be life-threatening..  When it comes to sensitivity, the hierarchy will be wheat sensitivity, followed by gluten sensitivity, followed by Celiac Disease.  Celiac Disease is an autoimmune disease where the immune system attacks the body in response to eating gluten and it is THE reason for the gluten free lifestyle.  People with diagnosed Celiac Disease have great consequences on their health than those with wheat or gluten sensitivities.

Avoiding gluten is a bit more challenging than just avoiding wheat.  Unlike wheat, which is a top 8 allergen that must be identified on food labels, you will not find labeling on a food package that says “this product contains gluten.”  So when shopping, you really need to be familiar with what gluten is and where it could be found in food.  People that are sensitive to gluten must avoid wheat, barley, rye, spelt, triticale and other wheat and barley derivatives such as couscous, farina, farro, durum, barley malt.  There is a host of hidden ingredients that may indicate gluten and nearly 80% of processed food items contain gluten.  It is found in the most unexpected places including chocolate and other candy, dressings, soy sauce and other condiments, seasoning mixes and the list just goes on and on.  Here is a link for ingredients to be avoided when on a gluten free diet.  http://www.celiac.com/articles/182/1/Unsafe-Gluten-Free-Food-List-Unsafe-Ingredients/Page1.html

We often see on our board, “What grains are safe for someone avoiding gluten?  Gluten sensitive people can still eat rice, quinoa, corn, buckwheat, sorghum amaranth, millet.

Another common slip up is oats.   Read this: Oats are gluten free.  I repeat oats are gluten free.  That said, people avoiding gluten or wheat should be purchasing certified gluten free oats.  This is because oats are commonly contaminated by wheat and the only safe product for those avoiding wheat and gluten is certified gluten free oats.

So how do you avoid wheat and gluten and make wise shopping choices?  The easiest is to first choose foods that are already naturally free of these products including butcher meats, fruits, veggies, gluten free grains, beans, legumes, nuts, eggs and dairy.  These items are on the outside perimeter of your grocery store.  Remember, many processed foods contain gluten.  The second is to read all labels carefully.  If a product says “may contain wheat” avoid it for now.  Third, if you must want to find a suitable substitute for your favorite bread or pasta, choose a labeled gluten free food.  For a food to be labeled gluten free, the gluten content in the product must be below 20ppm.  This means it’s a safe product for those with Celiac Disease.   Fourth, avoid choosing items in bulk bins.  Flour flies!!  Bulk bins are a major source of contamination for other allergens.  Fifth, if you don’t recognize the ingredient or can’t remember all the potential sources of gluten, just avoid the product and make another choice. 

Julia's Elimination Journey

I’m no stranger to screaming babies. All four of my children are sensitive to common elements of the standard American diet.  So much of what brought me to the world of dietary elimination while breastfeeding and specifically the development of this Elimination group was my third baby, Elizabeth.  From birth, things were different.  Her latch was awful.  She screamed around the clock.  Even while sleeping, she would fuss and make awful faces.  Everyone assured me that she was fine.  She was gaining weight.  She was just fussy.  Having dealt with two previous “fussy” babies, I knew that this baby was different.  At seven weeks, things went from bad to worse.  Elizabeth contracted RSV and pneumonia.  She was hospitalized for a week.  The pneumonia was a double strain and required intense antibiotics that I was told might make her tummy “a little off” for a few days after we got home.  She was also unable to nurse for more than a few moments due to her labored breathing for over a week. 

We brought our baby home and expected things to go back to normal.  We hit a new normal of shrieking screaming, bad, BAD diapers when she would have a bowel movement, less sleep and further nursing problems.  I didn’t even know where to begin.  My pediatrician offered formula after I mentioned that my older kids seemed to have dairy issues.  One night, when Elizabeth was 15 weeks, I almost gave up.  I was having vasospasms.  She hadn’t pooped in three days and her last diaper was pure mucous.  My husband just cried with me.  He told me he’d support whatever I needed to do. 

I decided to try a full elimination diet.  I was already dairy and mostly soy free.  I went to our local health food market and talked to the nutritionist there.  We came up with a game plan based on Elizabeth’s very specific issues: Eczema, inflamed bowels and extreme colic.  Let me be clear here:  I had no other options.  This was extreme.  Nothing was working.  My baby was broken.  I started off with bone broth, steamed carrots, grass fed beef and free range chicken, steamed pears and apples. I took a high powered probiotic and gave Elizabeth one, as well. I added fruit juice sweetened gelatin after a week.  That was it.  It wasn’t overnight.  It wasn’t even over a week.  After two months of a very extreme diet, we had a somewhat normal diaper.  (I totally took a picture and sent it to my husband at work.)

I called it a success, but we weren’t done yet.  At seven months, our nursing issues came back with teething.  So did extreme mucous.   I knew I couldn’t eliminate anything else from my diet.  I had just added raw fruit and vegetables back in.  A fellow admin had just had her daughter’s lip and tongue ties revised.  I sent her a picture of Elizabeth’s mouth.  She was MAJORLY tied.  I made an appointment for the following week.  Post revision, she spit up twice.  And never again.  Our nursing issues ended and we had much better diapers. 

In the end, I learned that elimination isn’t a one size fits all shirt.  We had combined extreme issues with Elizabeth.  As a whole, our kids are allergic to diary and cannot digest eggs.  Our girls can’t handle wheat.  Elizabeth has an anaphylactic allergy to peanuts.  While nursing Elizabeth’s baby sister, I have to remain free of soy, dairy, corn, peanuts, wheat, eggs, and pecans.  We’ve done extensive testing.  We work with a fantastic team of doctors to maintain Elizabeth’s health and wellbeing and that of her siblings. 

This can be done.  It’s never easy.  It is seldom fun.  We’re all a team and here for each other.  Ask me anything, ladies!  

Does My Baby Have A Sensitivity?

Getting Started:
Elimination can easily go overboard when we expect immediate results. Many times, one bad day leads us to believe that WE are doing something to harm our babies through our breastmilk.  Babies, like their mommas, are entitled to feeling off and cranky.  Let’s explore some reasons to eliminate foods while breastfeeding.  

·         Consistent fussiness or colicky behavior:  This means several days – sometimes growth spurts or teething can really look like a major issue when they are a normal part of infancy.

·         Eczema:  While it can be managed or treated with creams or lotions, often times, eczema is a result of a food sensitivity. 

·         Blood/Mucous diapers:  Mucous is a sign of inflammation.  If it happens one day and not for another month – it’s not an issue.  If it’s an everyday thing, there is likely an issue that needs uncovered.  Blood is always alarming and I take it very seriously.

·         Reflux/spit up: You’d be surprised what a little elimination in your diet can do for your wardrobe, ladies. 

·         Sibling history:  You have had a baby with reactions to something in the past and suspect it may happen again.

And here are some reasons NOT to eliminate:

·         Baby is not sleeping through the night:  Some babies do.  Some babies don’t.  It’s not a food sensitivity if your baby is having normal night waking.

·         Occasional spit up:  Again, sometimes, this just happens.

·         Baby wants to nurse frequently:  This is very normal infant behavior. Growth spurts, developmental leaps or comfort nursing are a huge deal for infants. Also, I don’t like to eat on a schedule and some days I’m hungrier than others.

·         Occasional mucous in an older, previously unbothered baby:  Usually a result of teething or maybe a little post nasal drip.

Believe it or not, there are some other issues that could LOOK very much like food issues.  Before you start living on unicorn tears, double check the following:

·         Do you have oversupply?  Oversupply can cause all KINDS of funky diapers.  Lime green, frothy poops are a hallmark of oversupply.  Oh, and a VERY fussy baby.

·         Has your baby been evaluated for a lip and/or tongue tie?  Unfortunately, so many health care providers are only familiar with an anterior tongue tie.  Spit up, mucous and green poop can all be signs.  Poor weight gain is a big one, too. 

·         Are you taking supply boosting herbs, such as fenugreek?  They are notorious belly achers!  

We really strive to make elimination diets user friendly.  Make sure to check out our “First Steps to Elimination Survival!”

First Steps to a Successful Elimination Diet and Breastfeeding

Breastfeeding is natural.  It’s beautiful.  It’s also hard work.  Add in suspected food sensitivities and you’ve got double the work and often times, none of the pizza!

Here are a few tips to get you started and make it a bit more streamlined:

·         START SMALL:  We usually advise dairy and soy elimination first.  By far and away, these are the MOST common offenders.  They can take a while to clear out, so we like to start there for that reason, also.

·         KEEP A FOOD JOURNAL:  I can’t stress the importance of this enough.  We like to start small with eliminations here – but a food journal can be so helpful if we need to dive deeper into elimination land! Be exacting.  Brands, times, everything!  Make sure to add any vitamins or drinks, also. 

·         CHECK EVERYTHING:  Vitamins.  Gum.  Candy. Bread. Soap.  Lotion.  It’s everywhere, friends.  If your baby is sensitive to it, you’ll find it even more places than you imagined. 

·         PINTEREST AND GOOGLE ARE YOUR NEW BFFS:  Need a recipe that’s dairy free?  Need a substitution for eggs?  Fire up those search engines!

·         IF YOU THINK YOUR BABY IS SENSITIVE, DON’T PARTIALLY ELIMINATE IT:  Here’s why  -it takes twice as long to figure out.  If you think your baby can’t handle dairy, don’t play around.  Just eliminate it.  You can always trial it in baked goods later!

·         DON’T GET CAUGHT UP:  Slow and steady will win this race.  You may have to eliminate a ton of food.  You may have to eliminate one food.  But don’t jump in headfirst.  Your baby deserves a sane mother! 

·         IF YOU NEED HELP, ASK:  We’ve been there.  We’ve done that.  We’re still alive.  We’re here for you! 

·         IS IT WORSE?  IS IT THE SAME? IS IT BETTER?  This goes with the food journal – keep track of perceived reactions and what they are.  It’ will help down the road.

·         STAY STRONG!  It’s really not worth the pizza.  

Help! My Baby Isn’t Gaining Weight

It’s a story that has been told time after time. A mom leaves her pediatrician’s office in tears. “My baby isn’t gaining weight, they told me I have to use formula” is often the phrase we hear. Moms are often upset, sad, angry, and confused. “I thought everything was fine!” “she acts so happy” “he’s hitting all the milestones!” 

So what is a mom to do if she is told by her pediatrician her baby isn’t gaining weight?

This shows an example of a baby
who has stopped gaining weight

Step 1: Evaluate your baby’s weight gain from birth to current.

The first thing to do is look at a detailed weight history. Look at the scales and other factors when all weights were taken. Was baby naked? Was it a different scale? Remember that birth weight can sometimes be inflated, it is best to go from the lowest recorded weight when looking at weight gain.

Is your pediatrician using a correct growth chart? Often times a pediatrician will use an incorrect growth chart when assessing a baby’s weight. Remember that the WHO growth chart is to be used for breastfed babies. Sometimes a pediatrician will say there is a problem when there is none just because of this factor.

Is your baby staying on their growth curve? This is important. Some pediatricians feel a baby should “catch up” and get to the 50% even if they are born in the 5%.  This simply does not happen typically. A baby should stay in the same % range and follow a growth curve. A baby in the 5% who stays in the 5% is fine. A baby who starts in the 50% and drops to the 5% suddenly is a concern.

Has anything changed between the last visit and now? An illness? A change in behavior?  Did mom go back to work?

Evaluate how often your baby is nursing. Is your baby under 6 months nursing at least 8 times a day? Are you offering both breasts each time you nurse? Before 6 months a baby should be nursing at a minimum 8 times a day and be offered both breasts each time.  While a baby may not take both breasts, they should both be offered.  A baby struggling with weight gain needs to be nursing more: 10 – 12 times at least.

A breastfed baby should gain 5 – 8oz per week in the first 4 months of life. From 4 – 6 months a baby should gain 3 – 5oz, and from 6 – 12 months 2 – 4oz per week. http://kellymom.com/bf/normal/weight-gain/ Gaining outside of this range would be a cause for concern and further investigation.

So, you have determined there is an issue. Your baby is not gaining weight appropriately for their age. They are falling off their growth curve. What do you do?

Step 2: Meet with an IBCLC

Most pediatricians are NOT trained in lactation. In fact some may have never taken a single class. While a pediatrician is great to help you with general health questions, for breastfeeding concerns you need to be working with an IBCLC. You can locate one near you using this website: http://www.ilca.org/i4a/pages/index.cfm?pageid=3432

A good IBCLC will do a variety of things. They will watch you nurse,  assess latch and transfer, and do a weighted feed. They also should check for a lip or tongue tie and if they are concerned refer you to a specialist for further help.

What is a lip or tongue tie? This site from Breastfeeding USA explains it nicely: https://breastfeedingusa.org/content/article/tell-me-about-tongue-ties Ties are often the reason for poor weight gain in a baby. They can cause poor milk transfer which means that even if you are nursing enough your baby may not be transferring milk well. Many times mom think if a baby doesn’t gain it must be the milk, but often times that is simply not the case. This is especially true with a baby who shows a sudden drop in weight gain around 4 -6  months.  At this point supply regulates so baby has to work harder for the milk. It also means that your supply has regulated to what your baby is taking, and if there is a tie they are not transferring efficiently. If your LC doesn’t check for a tie or you still have concerns of a tie, get a second opinion. Signs of a tie could include poor weight gain, clicking whe nursing, a shallow latch, extreme nipple pain, cracked bleeding nipples, and a lip stick shaped nipple. This facebook group is an excellent resource: https://www.facebook.com/groups/tonguetiebabies/ The procedure to correct a tie is quick and minor and can be done in a matter of minutes in a doctor office.

But what can I do in the meantime?

Step 3 – NURSE NURSE NURSE

Sometimes you may not be able to meet with an IBCLC right away. There could be a waiting period of a few days. The same is true of a specialist to check for ties. In the meantime, there are a few things you can do to help your baby get more milk.

1 – Nurse. Nurse every 2 – 3 hours in the day and at least every 3 hours overnight. Sometimes babies who don’t gain well are sleepy to conserve energy. They need to be woken to eat. Make sure to offer both breasts each time you nurse.

2- Pump. Pump after every nursing session.  If your baby isn’t gaining well and an IBCLC suggests you need to supplement, you can do so with your own pumped milk. Remember: Pumping .5 – 2 oz combined after nursing is totally normal. If your baby is older and you haven’t pumped recently you can expect to get less. Make sure your pump is working correctly and your flanges fit right. Over time your body will produce more to feed the pump.

3 – Do breast compressions while you are nursing or pumping. Breast compressions help get the most milk out. If your baby can’t latch and transfer well, it helps make it easier for them.

The take away here is that poor weight gain is a serious issue. Sometimes it is quickly resolved with more nursing sessions and offering both breasts each time. Other times the issue is related to transfer, latch, or in rare cases true low milk supply.  In very extreme cases a baby may have a medical disorder that prevents them from gaining weight. Often moms who have a baby gaining slowly are told “Its normal” or given advice to just “take X supplement”. While the advice means well, it does not help identify the underlying issue. If your baby is not gaining appropriately for their age you need to be working with your doctor and IBCLC to come up with a plan to help your baby gain. Weight gain in infants is crucial for brain development. It is a serious concern and needs to be addressed with medical professionals. 

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

 How Often to Feed Baby: http://www.kellymom.com/bf/start/basics/hunger-cues.html

Hands On Pumping: <a href="#" role=button>http://www.nancymohrbacher.com/blog/2012/6/27/to-pump-more-milk-use-hands-on-pumping.html </a>

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