A Short Guide to Breastfeeding Part 2

Challenges Part 2
Allergies
     While it may not be the only reason, sometimes something in YOUR diet is causing the baby to not tolerate your breastmilk as well as expected. This can lead to excessive gassiness, fussiness, poor weight gain, mucous and even blood in stools with more severe cases. This is a great article with symptoms by Le Leche League. If your baby has these symptoms it does not mean you have to stop nursing your baby (although in rare cases this may be true) but it does mean your diet will need to change. There are many examples of elimination diets out there but you can find the one I recommend here.
     The long and the short of it is you eliminate all but basics for several days or until the baby is asymptomatic and then, just as when starting solids, you slowly reintroduce things one by one until you find the culprit. It works well if done correctly and its a miserable first few days. [I know by experience because my Lil Bit is intolerant of tomatoes and still to this day has a miserable gut for several days when she manages to digest one.]
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(My own breastmilk-mustached little one)
Nursing Strike
Every breastfeeding infant is different and therefore every experience nursing can be different as well. I cannot tell you the number of times I’ve had a mom come into my office in tears having difficulty breastfeeding, even those with babies 2, 3 or 6! Nursing strikes happen but the child and course of said strike will determine the length of the strike and the method for getting through it.
Most infant strikes are due to one of three things:
  • Age (developmental stage)
  • Personality (busy-bee or curious baby versus laid-back)
  • Health status (teething, upper respiratory infections or head cold)
Teething and colds can cause nasal congestion (stuffy nose) making it more difficult for babies to latch therefore time and saline with bulb syringe nasal suctioning before feedings may help. Age is a factor for those easily distracted as they begin to explore the world around them more and more. Finding places free from distractions will be helpful with this particular situation. Depending on your child’s age the nursing strike with older infants may be more of self-lead weaning. Personality as cause for nursing strike generally speaks for itself. Some children are far too precocious and independent to nurse as long as others.
Weaning
So far we’ve addressed the who, what, how but not the when. As in, when do I stop nursing? To this I respond to my patients: how long do you want to nurse? My job is to help mommies meet their goals. The recommendations generally point to at least 6 months for optimal nutrition and up to 1 year of age with supplemental foods added.
If your infant is still small (under 6 months) switch out his least favorite nursing feeds first (generally this tends to be not just after waking, prior to nap or bedtime) with a bottle of expressed breast milk or formula appropriate for age (follow your primary care provider’s recommendations). Another thing I tell moms to do is to have a support person (dad, partner, grandparent) give the non-breastfeeds, slowly weaning for both baby and mom’s safety.  Don’t invest in several of one bottle but rather buy a few different types in order to save you some grief as your infant may not take to a certain brand/shape.
Once your child is older they can use a soft-tipped sippy cup in lieu of a bottle. Most infants are generally going to less and less feedings of their own accord by this time. If you are truly struggling it may not be a bad idea to discuss your case one-on-one with your lactation consult or primary care provider as they know you and your infant better than this blog post.
I hope you have found some comfort or instruction in this short guide. I more than welcome any other future suggestions and would love to hear your stories, triumphs and tribulations with breastfeeding. Please feel free to comment below.

Everyone knows we face many challenges as we go through our journey breastfeeding our babies. To keep this short I will address a few of the more common challenges that I have encountered both myself and in practice

 

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A Short Guide to Breastfeeding Part 1

New to breastfeeding or looking for help with challenges? Want to be a better provider for your patients and their families? Look no further!
We all know that breast is best (human milk for human babies), however, let me just go ahead with a disclaimer that I tell my own patients who are struggling or have conflicting reasons both medical and personal–if you are feeding your baby with formula and  both of you are happy and healthy, you are doing the right thing. I will never belittle a mother or parent for doing what you feel is best for you and your family as long as it is safe and you and your child are healthy.
Moving on…
A Little About Breastfeeding and Why It’s Considered “Best”
So what’s the big deal with breastmilk? The CDC (Center for Disease Control), WHO (World Health Organization), and AAP (American Academy of Pediatrics) all have guideline recommendations in for why we should breastfeed our babies. It’s great for baby AND MOM (physically and emotionally)! It’s great for disease prevention. Hell if you want to get down to the nitty gritty of things, because it does so much good it reduces money spent on healthcare. I’m not going to list all of the things it helps prevent (which when you look at the reports they make it seem like it is prevention rather than formula causing problems but let us not go there…) because I said I would make this a SHORT guide.
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(Pic courtesy of fineartamerica.com)
Getting Started 
Pregnant? Planning on getting pregnant? Rather or not you think you want to breastfeed or bottle feed (or a mixture of the two) it never hurts to get more information!
  • Take a class!
    • Many local hospitals and Le Leche League chapters hold free to low-cost breastfeeding classes
  • Read a book!
    • My personal favorite is The Womanly Art of Breastfeeding which I had read cover-to-cover (borrowed) as a floor nurse prior to having children because nursing school had taught me very little about breastfeeding and I wanted to be a great resource for my patients. I bought the book when I became pregnant and read it again, passing it own to a friend shortly after my daughter was weaned.
    • Breastfeeding Made Simple I didn’t care for this one quite as much and basically skimmed it. That being said if your library only carries this one or you want more than one choice, it’s not a bad one and is in fact a bestseller on amazon.
  • Ask Someone! Talk with your friends who have kids, talk with your mom (and then back all of this up with one of the above)
  • Keep in mind everyone’s experiences are different and that even amongst themselves, each baby can be different!
 
Vitamins and Supplementations
Vitamin D
Long gone are the days for the majority of the civilized world where women continue to work in fields or roam nomadically across the plains to scavenge for foods with their babies strapped or carried with them. In fact we know sunburns are detrimental for our skin in the long run and thus we avoid or use sunblock which prevent production of vitamin D.  Humans need sun for vitamin D production and we need vitamin D for bone growth (and new studies suggest that it may help innate immunity and play a role in prevention of diseases such as diabetes and certain cancers).  As such mom nor their babies tend to make enough vitamin D. Therefore the AAP and CDC recommendations include either baby receiving supplementation of 400IU daily or mom taking an extra 5000 to 6000IU daily so that baby receives enough through breastmilk.  Commercial formulas contain vitamin D so supplementation is not generally needed.
Iron
Breastmilk does not readily contain a large amount of iron and healthy, full-term (born at 38 weeks or later) infants generally have used up their stores by 6 months of age and iron-fortified infant cereal, other iron containing foods or supplementation with iron drops/vitamins are recommended.
Challenges
Breastfeeding is not easy for everyone and can hold many challenges. I once had a physician friend tell me that some women were just meant to be wet nurses. She said this semi-jokingly but also as reassurance to me that I was not the only working mom struggling to keep my supply up (it did not help I was not only working full-time but in graduate school for the entire stent as well). That being said here are some of the things that I have not only found helpful for myself but have in my practice also found helpful for my patients and their babies.
Latch difficulties
This often becomes difficult for my patients before they ever even reach my office. Once the baby is born, most hospitals are now trying to follow recommendations that babies go straight to mom’s chest. This helps regulation baby’s body temperature, blood glucose levels and helps with breastfeeding initiation but not all moms have a baby that just latches on with ease, nor do all mom have “optimal breastfeeding nipples” or even the nursing staff with knowledge about breastfeeding.
  • Asking for a lactation consult is always a big help as well as either forgoing modesty or kicking all of your family out of your room until you and baby get things figured out. If a lactation consult isn’t available and you and baby aren’t quite getting the hang of it consider
  • Nipple shield
  • Pumping for about 5 mins and then trying to attach baby
  • Multiple positions (football/rugby hold is great for new babies, craddle-hold, side-lying, australian crawl or biological hold)

breastfeeding positions

(Pic courtesty of mama-milk.co.uk)
Don’t be afraid to do what you need to do!
Decreased Supply
There are many many reasons for decreasing supply:
  • hormonal (starting menses, thryoid issues, pregnancy)
  • medications (antihistamines)
  • poor-latch
  • pumping (not all women respond well to the pump)
  • stress
  • infrequent feeding and/or bottle feeding (ladies our breasts are supply-and-demand responders)
so what can we do about it?
  • more frequent feedings/pumping sessions
  • stop medications causing decrease if possible (consult your physician!!)
  • seek help with latch issues
  • make pumping as comfortable as possible with a good pump and a good-fitting flange, warm blanket, cup of tea, comfie spot in which to pump, relaxing music, an item that smells like baby
  • de-stress! (i.e. with postnatal yoga, getting a massage, seeking medical care if your are over-anxious or depressed)
  • take a nursing holiday (you and baby cuddle skin-to-skin all day and nurse on demand while taking it easy and eating well, taking in plenty of fluids)
  • consider supplements (Mother’s Milk Tea, Fenugreek capsules (it may take up to 3200mg of fenugreek for some women to see results but start low and go slow, avoid it altogether if you have thyroid or pituitary issues))
Just a reminder that this a SHORT, very abbreviated guide. I hope you enjoy and find it helpful and informative. The second part will explore more challenges and weaning.