Extended nursing and manners

While breastfeeding has been one of my proudest accomplishments as a mother, it has also been one of the most frustrating yet rewarding to persevere through. I won't go into all of the details but we just barely climbed over many hurdles in the early days. When we were approaching a year, I was ecstatic to meet my goal and I felt like a pro. However, you learn that sometimes throughout your breastfeeding journey you overcome difficulties only to approach new ones and feel like a novice all over again. These difficulties are absolutely normal for most moms and babies to experience. They are 100% worth getting through too. 

Getting the right latch with your newborn turns into.. keeping your distracted 3 month old latched on for a full feeding which turns into... balancing starting solids and nursing with your 6 month old which turns into... your 9 month old teething and comfort nursing for what seems like all the time which turns into... your 12 month old trying to nurse upside down while playing with a toy. Before you know it, you've hit a year and you find yourself saying things like:
You scratched my belly
Stop poking my eye
Don't pick my nose
No fingers in my mouth
Sit still for milkies
Don't lift my shirt in public
No twiddling mommy's other nipple 

Gone are your worries about whether your supply is sufficient, the latch is good or not, and how you will possibly make it to a year. Now you have new worries- like teaching some nursing manners so they don't drive you nuts! Starting nursing manners early on is a great way to avoid issues later down the road. If it slipped your mind or you didn't expect to nurse past 1 (like me) this is definitely not a case of not being able to teach an old dog new tricks. It's never too late to start!

The first thing you should do is evaluate your expectations. Be patient and remember that behavior changes take time. Sometimes they are just in a wonky stage and you have to wait for it to pass. 
It's probably not realistic for a 15 month old to say "I would like milk, please." and sit patiently while you grant their request. Maybe when they were younger, you started doing sign language. Maybe not and maybe you have no interest in learning or teaching signs- but what you can do now is start a signal for nursing so your little one can let you know when they would like to nurse. For some it may be a hand gesture, taps on the arm, or a specific noise. Just pick something and practice using it every single time they nurse. If they lift your shirt, lower it and practice the signal. Reward their consistency with lots of praise. With frequent use, they will get the hang of it. If they are older, only nurse them when they use their signal.

With toddlers, teaching them anything at all takes boat loads of patience and consistency. If you're okay with them gently touching your face while nursing, teach gentle touches by holding their hand and demonstrating on your face and praising their efforts. If you don't want your face touched at all, consider holding their hand or giving them a soft blanket to caress. Maybe even a nursing necklace or soft scarf you can wear. It's normal for them to seek sensory soothing. 

For toddlers who like to practice nursing gymnastics, having a key phrase to address their behavior is a good idea. "Sit still" is a good reminder and something like "No milk while you're squirming" is clear and direct as an explanation if you end the session because of the behavior. If they have excess energy, throw an impromptu dance party and get some of that energy out. You could also try wearing them in a carrier or nursing them in a quiet, dark area to keep distractions to a minimum. A trick that worked well for us was reading a book to my toddler while he nursed. He wanted to see the pictures on each page so he sat still. 

You may have a toddler who uses their signal consistently but wants to nurse constantly and you are at your wits end. It may be time to slowly limit the number of sessions you allow. Keep in mind this is technically a form of mother-led weaning and your toddler should have a well established and nutritious diet so the lack of nursing frequency is not damaging to their health. This doesn't mean you are weaning your toddler completely but night weaning and cutting out daytime nursing sessions means you will get less sessions and your supply will gradually lower as each cut occurs. Alternatively, you can let your child drop sessions on their own which would be considered child-led weaning. It's okay to do one or the other or a combination of both. It's your breastfeeding relationship and you will know what is best. We have a TOTD on weaning with more information. 

Anytime you feel that your little one is pushing the boundaries or forgetting their manners, feel free to break their latch and end the nursing session temporarily. Reiterate their manners and offer again or just wait until they ask again. Be consistent, though. I can't say this enough.. patience and consistency is key. 

Setting appropriate nursing manners can ensure a mutually beneficial nursing relationship that continues for months, years, or however long you both desire. 
Happy nursing, Dairy Queens!

Working And Extended Nursing

One thing I knew when I had my first child was that I would be returning to work when he was 2 – 3 months old. Staying home was never an option for me I realized that I would have to pump. As my oldest approached his first birthday I began researching what happened next. Everyone seemed to be preparing to give their children cow’s milk, but did I really need to do that? Was there something my son would be missing by not having cow’s milk? But what about our nursing relationship? At 12 months I was not ready for that to end. My oldest, while not a comfort nurser, was still easily nursing 4 times a day and taking a bottle of expressed milk at naptime. After doing my research I came to a conclusion: There was absolutely no reason I had to offer cow’s milk, or any alternative milk for that matter. 

Working moms are covered by the healthcare act to pump at work for their child for up to age 1. After that however, there is no law saying your company must allow you time to pump. However just because they don’t have to allow you time to pump does not mean they will not. As your child approaches their first birthday there are a few things to consider. 1) How much milk is your baby drinking? At age 1 some babies are drinking a few oz a day of milk from a bottle while others still may be getting most of their nutrition in the day from breast milk. 2) How often are you pumping at work? At this point some women may only be pumping once a day. 3) What are your breastfeeding goals? 

If you wish to continue pumping at work, go for it! Personally I pumped until my kids were 14/15 months old respectively. At that point I was pumping one time a day for 20 minutes and after 9 months of daily pumping my coworkers were quite used to me taking my pump breaks! If your company will not allow you time in the work day to pump, there is no reason you cannot use your lunch break to pump. 

If you are ready to quit pumping at work, that does not mean the end of your nursing relationship! There is absolutely no reason you cannot nurse on demand at home when you are together. Your body will adjust to the demand of not pumping in the day. When you do stop pumping at work, you will want to cut your sessions down gradually. Abruptly stopping pumping can lead to clogged ducts and mastitis. Remember, everyone’s bodies react differently to stopping pumping. Personally I found myself engorged at night for a few weeks until things regulated. Some women find things adjust more quickly. 

But what about alternative milks such as cow’s milk? Don’t those need to be introduced? As long as you are nursing at home together 3 – 4 times a day and your child is eating a good variety of solid food, there is no reason you need to introduce any other milk. (http://kellymom.com/nutrition/starting-solids/toddler-foods/) If you nurse before work, after work, and before bed that is 3 nursing sessions right there. In the day if you wish to offer cow’s milk, go ahead: However you can also simply offer water instead.

Many moms think that stopping pumping and turning 1 is the end of their nursing relationship. The reality is that your nursing relationship can last as long as you and your child wish. My oldest stopped nursing at 26 months. My youngest is 27 months now and still nursing twice a day. I have been breastfeeding for a total of 51 months with no break, and I pumped at work for a combined total of 2 years. I had a love/hate relationship with my pump and made every mistake possible (forgotten flanges? Yep. Forgotten bottles? Yep. Left milk at work? Yep. Spilled an entire pump session worth of milk down my pants at work? Yep) yet it was still hard to pack it away at the end of each year of pumping. The pump and pump breaks, while trying and frustrating, allowed me to continue my breastfeeding relationship while working. And I can honestly say still to this day one of the highlights of my day is those quiet nursing sessions at night together.
So to the moms with a newborn dreading going back, you can do this. To the moms who have been pumping for a few months and what to give up daily, you can do this. To the moms whose babies are approaching one and unsure as to what to do next, you can do this. Working does not mean you have to cut short your nursing relationship.

Nursing an Older Child

I nursed a five-year-old. Actually, I nursed a kindergartener. My daughter nursed briefly right after her first day of kindergarten, when she was almost five years and four months old. At that point, she only nursed once every 2-3 weeks. So when she weaned, I had no idea that the seconds-long nursing session would be her last. It wasn’t until two months had gone by that I knew she was done for good.

Let me start this by saying that I was glad my daughter was still nursing when my son was born. She was almost three. I knew there was a chance he would be born prematurely, and he was, at 35 weeks. I knew he would be needy, as all newborns are. And, I worried about how much attention I would be able to lavish on her in those early weeks. So, having her still nursing gave me the ability to attend to both of them when my son nursed more or less constantly in the first couple months.

But after a year of tandem nursing, I was over it. Thankfully, she had long since nightweaned, and I limited her to nursing three times a day. But, I was tired of her begging for it, which she did rather frequently. Older nurslings are often reminded to nurse when a younger sibling nurses far more often. By her fourth birthday, I was ready to call it quits.

The thing is, she wasn’t. Now, I know that tons of people have said and will say that mothers who nurse as long as I did are only doing it for themselves. I cannot disagree more. I have never felt the “bittersweet” feelings of weaning. When my daughter called it a day, I could have skipped down the road singing.

Of course, I didn’t know that she was done yet. True child-led weaning is actually quite gradual. From 2-4, my daughter nursed about five times a day. At four, I cut her back to 2-3 times a day. By the time she turned five, she had limited her nursing sessions to 2-3 times a month. Many times, I thought she had weaned. But a few weeks would go by, and she would ask to nurse again.

Her latch got really strange. I noticed that it happened shortly before her fifth birthday, when she lost her first tooth. I knew that kids who nurse into these later years eventually lose the reflex. She, who was once the master nurser in the house, began to complain that I had no milk. I had plenty, on account of her younger brother, who nursed much more frequently. I do think that her losing her baby teeth meant that it was time for her to move on.

It took awhile for her to get the hint, thought. By her fifth birthday, I had been done for a year, and was only barely tolerating it. We talked about it, quite frequently. She wanted to know what it was like to nurse her when she was little. She wanted to know how long Francis would nurse. She talked often about the babies she would have and how she would nurse them. I started to explain to her that all kids eventually wean. I told her that, someday, she would stop nursing and not nurse anymore. This frightened her, but it did not make her nurse more frequently.

Nursing an older child is many things. It is strikingly more academic than nursing even a three-year-old, as I am doing now with my son. My daughter and I have had countless discussions over the years about the relative merits, benefits and difficulties of nursing, pumping and bottle-feeding. We have talked about what my milk smells and tastes like. She has shown me again and again how she will grow up one day and nurse her own babies. She is excited to do it. And, since she was approaching 5.5 when she weaned, she will remember having nursed with her own mother.

Nursing an older child is not many things. It is not at all like nursing a baby, toddler or even a young preschooler. It does not force the child’s dependence on the mother, as my child who was more than happy to relegate me to the drop-off line at school has demonstrated. It is not a sign of my child’s relative immaturity. Rather, it is just a sign that I let her have this one. It was important to her to continue on until she was done. There are many things in my daughter’s life that are of significance to her, that I have been or will be unable to make happen for her. I am very glad that I could make this one work out, since it is so important to her and for her.

To be honest, I hope my son does not nurse as long. I think he may not, since he will not have a younger sibling to remind him that he wants to nurse 10-15 times a day. But, I cannot deny that nursing full-term has shaped who I am as a parent in significant ways. I look at the parenting process as long-term. That makes sense, since I have nursed every single day (without a day off) for over six years. In the beginning, I didn’t understand what people meant when they said that the newborn weeks are so short. But, I do now.

Written by Holly Elizabeth Smith 

Migraines and Breastfeeding

You’ve had your baby for a few months, and then it hits you. Headache. Bad. You open your eyes and the light is blinding. Your partner comes to ask you something and they might as well be screaming at you. Is it a migraine? Could be. Many women find that after they have a baby, their hormones change. In some cases, this can be a cause for chronic migraines. Whether you have had migraines for years or this is your first one, you need the facts. Migraines can be a serious problem, as well as a symptom for other serious problems. Take your migraines and their prevention and treatment seriously, and you and your baby should be in much better shape.

What is a Migraine?
Some people think that a migraine is just a really bad headache. While migraines are often severe, this is not entirely true. Migraines are a little different. Here are a few signs of a migraine, according to the Mayo Clinic:
• Pain on one side or both sides of your head
• Pain that has a pulsating, throbbing quality
• Sensitivity to light, sound and/or smell
• Nausea and vomiting
• Blurred vision
• Lightheadedness, sometimes followed by fainting

Migraines can last from four to 72 hours and range from mild to very severe. When you experience what you believe is a migraine, you should plan to see your doctor as soon as possible unless you are already under a current treatment plan for chronic migraines.

When you go to the doctor, take a moment to consider the factors that may have influenced your migraine. Migraines have triggers, which are usually environmental. Some women get migraines based on outdoor allergies or food intolerances. Other women suffer at different times of their menstrual cycle. If you are dealing with chronic migraines, start keeping a journal of the things you did prior to your migraine triggering. This will help you to identify your triggers. With your doctor’s help, get ideas on minimizing your triggers to minimize your acute migraine attacks.

When to Seek Immediate Medical Attention
Migraines can be a sign of more serious health conditions, such as stroke. You should plan to seek medical attention immediately if you suffer one of the following symptoms:
• An abrupt, severe headache like a thunderclap
• Headache with fever, stiff neck, mental confusion, seizures, double vision, weakness, numbness or trouble speaking
• Headache after a head injury, especially if the headache gets worse
• A chronic headache that is worse after coughing, exertion, straining or a sudden movement

Treating Acute Migraine Attacks
When you hear people talk about taking medications for migraines, they are usually referring to medications they take for an acute migraine attack. This means that they take this medication at the point they realize a migraine has been triggered. They do not take the medication on a daily basis. If you find that you are suffering from migraines more than just once in a blue moon, you may want to talk to your doctor about keeping a medication on-hand for acute attacks. Fortunately, many of the common migraine medications are safe to take while bf. Consider this list on Kellymom:
http://kellymom.com/bf/can-i-breastfeed/meds/migraine-meds/

You should note that many of these meds cause dizziness, nausea, lightheadedness or exhaustion as potential side effects. Until you know how you handle taking any particular medications, DO NOT plan to operate heavy machinery, drink alcohol or other sedatives, or care for your child alone.

These meds are not as simple as taking Motrin or Tylenol. They are serious prescription drugs, many with serious side effects. As such, what works for one woman may be awful for another. Your best treatment for chronic migraines is to work on identifying and minimizing your triggers, so that you can avoid them.

Natural Migraine Treatments/Preventatives
There are many OTC and natural migraine treatments and preventatives. Many people swear by taking Motrin or Tylenol with caffeine. You may also feel better if you go lay in a dark, quiet room with ice on the back of your neck. Some women say that their migraines have decreased in frequency and duration by applying peppermint essential oil, or taking regular doses of magnesium. However, if you are taking certain kinds of medications, especially those that affect your blood pressure or heart function, large doses of magnesium may decrease the efficacy of those medications. Be sure to ask your doctor before engaging in any treatment regimen, natural or otherwise.

Migraines are a horrible and horribly misunderstood affliction. If you are new to coping with chronic migraines, you may feel stuck in a vicious cycle. But, with consideration and treatment, you will eventually find a better path.

The Importance of Night Nursing for Working Mom

Night nursing is a big part of the breastfeeding relationship in the first year. Those overnight sessions help to maintain supply and offer our babies comfort when they are going through growth spurts and teething pain. But for working moms they are especially important to help maintain a good breastfeeding relationship and your supply. They can also be especially difficult.

If a mom is home with their baby all day, they have the opportunity to nurse on demand. This means whenever their baby is hungry, they nurse. A working mom has to schedule their pump sessions every 2 – 3 hours. Its very difficult for working moms to pump like a baby would nurse. Also babies are much more efficient than pumps at draining a breast so they could nurse for 5 minutes and ingest what it could take a working mom 20 – 30 minutes to pump.

Working moms are told over and over, the golden rule of leaving milk is 1 – 1.5oz per hour you are away. This number is determined based on the idea that in 24 hours your baby will take about 24oz of milk. A mom nursing on demand at home has the option of offering their baby to nurse more frequently in the day, therefore their baby may take much of the 24oz they need in the daytime hours and sleep better at night. For working moms however, it is not feasible to pump 24oz in an 8 hour shift. In fact in a typical 9 hour separation a mom would only expect to pump about 8 – 12oz. That is 100% normal. This is why it is so important to nurse on demand at home as much as you can.
A baby who drinks 8 – 12oz when mom is at work needs to nurse for the additional 12oz, which means ideally your baby should be getting at least 4 additional nursing sessions a day. If you figure mom nurses right before work, right after work, and before bed that’s 3, so therefore it is very understandable your baby will wake at night to nurse too. We also have to remember transfer rate varies from baby to baby and also the amount of milk baby takes will vary from nursing session to nursing session. This is why, for working moms especially, limiting nursing overnight can impact not only supply but their overall nursing relationship.

If baby is sleeping for 12 hours overnight or not having any milk overnight, it means in those other 12 hours of the day they need to be drinking about 24oz of milk. If mom is only nursing 2 times a day and then at work that means your baby would be drinking 16 – 20oz of milk while you are gone. For most women pumping that much milk in a normal work day is not possible. Biologically it's not what our bodies were made to do. More stimulation = more milk. In this scenario mom is only having 2 nursing sessions and 3 pumping sessions a day. Babies in the first 9 months of life typically nurse at least 8 times a day. The end result is ultimately mom not producing enough milk at work for their baby and then ends up pumping more on the nights or weekends or supplementing.

So what is the best solution for a sleep deprived mom?

First off knowing that this too shall pass. It helps to have realistic goals. Anticipate nursing every 3 – 4 hours overnight in the first year. Remind yourself this night nursing is important to the nursing relationship. It's exhausting, but normal. If you have a baby that wakes every 1 – 2 hours, try sending your partner in to offer comfort. If you cosleep try moving your baby to a crib in their own room. If you don’t cosleep, consider it. Another trick is to try and tank your baby up before bed. If you get home at 5 and your baby goes to bed at 7, offer lots of nursing sessions in those few hours. That cluster nursing not only helps your baby fill up, it also helps to stimulate your supply. The big key however is finding a sleep situation that helps everyone get the best nights sleep possible.

How Does Food Really Affect Your Breastmilk?

Do any of these sound familiar?

“You’re not eating beans are you?! That will give your baby horrible gas!”
“You can’t eat that candy cane, mint will cause your supply to dry up!”
“Are you sure you want coffee? That’s going to keep your baby up all night long!”
“Bell peppers gave my kids horrendous gas. You should avoid them at all costs!”

We’ve all been told well meaning advice about what we should and should not eat when breastfeeding. Everyone will tell you a food that you should avoid, everything from broccoli to chocolate! But how much do we really need to be concerned with what we are eating when we breastfeed? 

First, let’s get one thing straight. No matter what you are eating, your body will still produce the perfect breast milk for your baby. 

So why do people suggest avoiding specific foods? First off, gas. How many times does someone say something made their baby gassy. Just because a food makes you a little gassy does not mean it will do the same to your baby. Newborns digestive systems are still immature, hence the gas. Often times gas is worse overnight or early in the morning, which is why women often think something they ate the night before is the cause. In most cases it’s just normal newborn gas. Thrush, oversupply, and a strong letdown can also cause gas issues in newborns. Gas is also notorious for showing up during growth spurts which are plentiful in those first months! These are much more likely culprits than something you may have eaten the night before. (http://kellymom.com/parenting/parenting-faq/gassybaby/) 

Another thing people are told to avoid is coffee and/or caffeine. While yes, some babies can be sensitive to caffeine, most are just fine. From Dr. Hale it’s rated an L2 and found at low levels in breast milk. And just because your LO suddenly wakes up at night doesn’t mean it’s the coffee! Remember sleepless nights are a large part of the first year due to growth spurts, teething, and sleep regression. In fact caffeine peaks in your system 1 – 2 hours post drink so unless you are having a late night coffee binge its probably just a fluke! (http://kellymom.com/bf/can-i-breastfeed/lifestyle/caffeine/) 

And what about supply lowering foods? Moms are told often to avoid specific foods because they will cause supply to decrease. While some herbs can have a negative impact on milk supply, the amount needed to do so is therapeutic quantities. This means that eating mint flavored chocolate or adding oregano to your cooking isn’t going to affect your supply. (http://kellymom.com/bf/got-milk/herbs_to_avoid/) 

When IS it appropriate to change your diet for baby? When you notice excessive spitting up, consistent green and mucousy poops, bad “baby acne” or eczema, dry skin, colic and fussiness.
Cutting out large amount of veggies and fruits from the diet (ie, eating a “bland” diet of starches and meats) is actually one of the worst approaches to this problem. In many cases the culprit turns out to be a dairy/soy sensitivity. 

So what is the take away here? Babies have gas, its normal. The chances are if your baby is gassy it is NOT something you ate. Babies not sleeping at night is normal, it’s probably NOT due to caffeine. If you are worried about your baby showing signs of a food sensitivity, keep a food log to try and track down the offending food. Dairy, Soy, and Gluten are 3 big offenders. 

Happy Eating!