I’ve Had My Baby - Now What?: Breastfeeding During the First Week

Originally published on Jan 24, 2014; Revised Feb 22, 2025

Author: Robin Kaplan, M.Ed, IBCLC, FNC

Welcome to our new series, I’ve Had My Baby - Now What?  This is a guide with basic information to help you navigate the first days, weeks, and months of chest/breastfeeding your new baby.  

Today we would like to talk about that first week after your baby has arrived.  Chest/breastfeeding can often seem overwhelming and  unfamiliar.  New parents often receive a *huge* amount of differing advice from many well-intentioned people, which can be incredibly confusing and discouraging.  Below is a quick guideline to what “normal” chest/breastfeeding looks like, as well as some examples of when things aren’t going as they should and when you might want to seek help.

ABOUT SDBFC

The San Diego Breastfeeding Center was established in 2009 by Robin Kaplan, International Board Certified Lactation Consultant, Functional Nutritionist, and parent.  Her vision was to create a judgment-free, inclusive support system for families navigating infant feeding challenges.  SDBFC offers a wide range of one-on-one breastfeeding, infant feeding, and nutrition consultations - as well as classes, support groups, online articles, and social media - making it your one-stop-shop for all things infant feeding!

How often should my new baby be eating and how long should each feeding take?

A newborn needs to feed 8 or more times in 24 hours.  It’s especially important in the early days to feed your baby “on demand”, or whenever the baby shows signs of hunger, regardless of when baby ate last.  If your baby is not asking to eat every 2-3 hours, or 8 or more times in 24 hours, it is important to wake the baby to feed him/her, until they have regained their birth weight.  A feeding session typically takes approximately 30-45 minutes, and both breasts should be offered during this time.  It’s important to keep the baby actively feeding during those 30-45 minutes.

How do I know my baby is getting enough milk?

A great way to be sure baby is getting enough breastmilk is to keep a physical log of all feedings (start time and length), as well as all pees and poops. A baby who is taking enough milk will be feeding 8 or more times in 24 hours, for 30-45 minutes, and having 1 pee diaper and 1 poop diaper per day of life, until day 5.  For example, on day 1, baby should be having 1 pee and 1 poop diaper, day 2, 2 of each, etc.  After day 5, baby should be having 5 or so of each per day.  A baby who is getting enough should be satisfied for approximately an hour or two after feeding.  However, most babies will cluster feed for a 4-5 hour period during the day, when they may want to eat more frequently.  This is normal baby behavior!

How much milk does my baby actually need?

A baby needs very little milk per feeding during their first few days of life.  This is because they’re born full of meconium, which are those first few poops.  This is a perfect fit for you, as your first milk, colostrum, is low in volume.  The small amount you make is just the right amount for your baby.  The amount your baby needs slowly increases, and as your milk makes the transition from the low volume colostrum, to the higher volume mature milk between day 3 and day 5, your baby’s needs go up as well.  Nature works beautifully!

I need to supplement my baby, what are my options?

Sometimes, a baby may need to be supplemented with additional milk.  There are many reasons for this - a baby has jaundice,  is not latching well, there is a delay in the parent’s milk “coming in”, etc.  When supplementation is necessary, it’s important to remember that you can use your own pumped milk.  If you aren’t able to pump the amount you need, you can use donor milk instead.  Formula is the last resort option.  There are various methods to supplement your baby as well.  You can supplement your baby at your chest/breast using a supplemental nursing system, you can finger feed your baby, or cup/spoon feed your baby.  A slow flow bottle is always an option as well and a lactation consultant can show you how to feed your baby a bottle in a chest/breastfeeding-friendly manner.

Holy moly,  my boobs are like rocks!  They hurt and I can’t get baby latched on, what can I do?

As  your milk transitions from the low volume first milk, to the higher volume mature milk, it is common for your chest/breasts to feel full and sometimes experience engorgement.  Engorgement occurs when the chest/breasts fill up with so much milk that they become hard and  uncomfortable.  It can sometimes be difficult to get the milk flowing and baby sometimes has a hard time latching on.  

Some tricks to latch your baby on during this time are:

• Pump or hand express for a few moments before latching your baby to soften your chest/breasts and get milk moving

• Use warm compresses or take a shower just before feeding

• Use cold compresses in between feedings to reduce inflammation.  

  If you still  feel incredibly uncomfortable after your baby feeds, you can pump or hand express some additional milk - but it is important to only pump to comfort as you don’t want to send the message to your body to make even more milk.  

  Please be aware that if you begin to run a high fever, have flu-like symptoms, and hot or red spots on your chest/breast, you may be developing a breast infection (mastitis) and it’s important to seek medical attention immediately.  

Why do my nipples hurt and what can I do to heal them?

It’s normal for all parents to feel some initial nipple tenderness and discomfort in the first days and weeks of chest/breastfeeding.  Anything beyond tenderness is a sign that something may not be going right, especially if there is any tissue breakdown, damage, cracks or bleeding.  If you experience any of these, please seek the help of a lactation consultant.  Great healing items are organic coconut oil and hydrogels, or soothing gels, sold by many different companies and available at big box stores.  The best prevention for sore nipples is a good latch. If you are having trouble finding a correct latch, give us a call!

When should I seek help?

There may be times when things aren’t going the way they should.  Our IBCLCs can absolutely help you with all of this!  Some signs that you might need some additional help:

• Damaged/cracked/bleeding nipples.

• Baby isn’t gaining weight/parent’s milk hasn’t “come in” by day 5.

• You suspect your baby is tongue-tied.

• Baby isn’t peeing or stooling the amount that they should.

• Breast infection/Breast abscess

• Oversupply

• Extremely fussy/gassy baby

If you’re unsure about your baby’s latch, milk intake, or feeding patterns, know that you’re not alone—we’re here to help!

The first week of breastfeeding comes with many changes, and it’s completely normal to have questions or concerns along the way. Whether you need guidance on positioning, reassurance about your baby’s feeding cues, or support with any challenges that arise, our team is here to provide the care and expertise you deserve. Schedule a one-on-one appointment (consider a virtual appointment, if you don’t live in San Diego!) with one of our lactation consultants for personalized care and expert advice tailored to your baby’s unique needs.

SDBFC is committed to providing high-quality lactation and functional nutrition consultations to parents in San Diego and beyond. Explore our postpartum, prenatal, and functional nutrition consultations, take a breastfeeding class or attend a workshop.

About the Author

Robin Kaplan has been an IBCLC since 2009, the same year that she opened up the San Diego Breastfeeding Center.  Robin was the founding host of the Boob Group podcast and published her first book, Latch: a Handbook for Breastfeeding with Confidence at Every Stage in 2018.  Melding her passions for supporting lactating parents and holistic health, Robin finished her Functional Nutrition Certification in 2023. In her free time, she enjoys hanging out with her two teenage boys, hiking, traveling, weaving, cooking, and searching for the best chai latte.

Help! My baby won’t take a bottle!

Originally published on June 24, 2019; Revised August 27, 2024

Author: Robin Kaplan, M.Ed, IBCLC, FNC

Photo by Brytny.com on Unsplash

So your breastfed baby is refusing bottles.  Isn’t the typical concern that a breastfeeding/chestfeeding baby may prefer bottles over nursing and not the other way around?  While breastfeeding refusal can happen as well, any type of feeding rejection is your baby’s way of communicating that something is feeling challenging.  So let’s dive into some of the reasons why a nursing baby rejects the bottle and some tips to remedy a bottle feeding aversion.   

ABOUT SDBFC

The San Diego Breastfeeding Center was established in 2009 by Robin Kaplan, International Board Certified Lactation Consultant, Functional Nutritionist, and parent.  Her vision was to create a judgment-free, inclusive support system for families navigating infant feeding challenges. 

SDBFC offers a wide range of one-on-one breastfeeding, infant feeding, and nutrition consultations - as well as classes, support groups, online articles, and social media - making it your one-stop-shop for all things infant feeding!

Why do babies refuse to take bottles?

your Baby lost their innate sucking reflex

All babies are born with an innate sucking reflex.  This is the reflex that causes them to start suckling as soon as something (nipple, finger, bottle, pacifier) is placed in their mouth.  Well, that innate sucking reflex at some point becomes integrated, usually between 8-12 weeks old, making it such that the baby now decides whether he/she wants to suck, rather than relying on the reflex.  And if your baby hasn’t practiced bottle feeding before the reflex is integrated, they might have no interest in trying out this new feeding skill.

Tips to overcome bottle rejection with an older baby: 

• Try offering when your baby is sleepy - this is when the innate sucking reflex comes back temporarily!

• Change the temperature - maybe warming the milk will be more enticing

• Try some distraction techniques - face your baby away from you, try lying your baby on their side, bounce on a yoga ball, go outside for a distraction, have an older sibling show the baby a toy or book

• Offer your baby just the bottle nipple (no milk in the bottle), after nursing. Think of this as playful practice, which removes the stress and keeps this low pressure.  Once you find a bottle nipple that your baby is willing to suck on without milk, then offer the bottle with milk the next time around.

Your baby doesn’t like that particular bottle nipple or flow

Bottle nipples come in many different shapes, sizes, and flow rates.  Don’t fall for the marketing hype when the bottle packaging says that it is ‘just like the breast.’  If your baby is struggling with the flow of milk coming out or cannot form a good seal around the bottle nipple, that is going to feel very frustrating to him/her and could cause bottle refusal of that particular bottle(s)

Tips to overcome bottle rejection when your baby doesn’t like the bottle nipple or flow: 

• Focus on what your baby does when you put the bottle into his/her mouth.  

• If his/her lips don’t form a great seal around the bottle nipple (milk spilling out of the sides of her/his mouth, lips curled under, etc), choose a different shaped nipple/bottle.  

• If he/she looks overwhelmed by the milk flow (eyes bugging out, hands splaying, etc), go with a slower flowing nipple or switch to a completely different bottle brand.  And practice paced bottle feeding

• If your baby is struggling to get milk out of the bottle, move up to a higher nipple size to see if that helps.

Pumped milk has excess lipase in it

Does your pumped milk smell soapy, metallic, or sour?  Was your baby willing to take freshly pumped milk before he/she started rejecting the bottle?  It’s possible that your milk might have excess lipase. Lipase is a natural enzyme that breaks down fats in pumped milk, making it easier for babies to digest. However, when lipase levels are too high, it can cause the fats in milk to break down faster, especially when stored in cool temperatures. This can change the taste and smell of the milk, making it less appealing to babies. 

Tips for overcoming bottle rejection due to excess lipase: 

• First, you’ll want to figure out when your milk starts to become sour.  

• Next, you can scald your milk to deactivate the lipase, stopping it from souring your milk.  

• Then, you will want to practice with the bottle nipple (like in the recommendations above) to demonstrate to your baby that bottle nipple doesn’t equal sour milk flavor.  

• Once your baby is willing to practice with the bottle nipple (without milk in it) then offer a bottle with non-sour milk.

Your baby has a tongue tie, upper lip tie, or high palate

Variations in oral anatomy can sometimes make bottle feeding challenging.  Some tongue ties restrict the way a baby extends or wraps his/her tongue around a firm bottle nipple, making it more difficult to extract milk from the bottle.  Some upper lip ties restrict the way a baby’s upper lip flanges, making it more difficult to form a good seal around a bottle nipple.  Some high palates are very sensitive, causing a baby to gag when a long bottle nipple touches that particular spot at the roof of the mouth.

Tips for overcoming bottle rejection due to a tongue tie, upper lip tie, or high palate:

• Work with a lactation consultant to identify which bottle might be most comfortable and effective for your baby, based on his/her oral anatomy, while protecting your nursing relationship.

• Work with a lactation consultant to evaluate whether a tongue and/or upper lip tie release would be helpful for bottle feeding (as well as continued breastfeeding and solid food feeding).

• Work with an Occupational Therapist or SLP who specializes in alternative bottle feeding methods for babies

If you’ve tried a few of these tricks and your baby is still refusing the bottle, STOP! It’s important to not force the issue or it could become very difficult to resolve. Your baby is trying to communicate that it is time to bring in a lactation consultant who has extra training in bottle refusal (like all of the lactation consultants at SDBFC!)

If your baby is refusing a bottle, we are just a consult away!

Don’t let bottle feeding struggles cause stress for you or your baby!  Our consultants can help identify the root cause(s) of why your baby isn’t taking a bottle and can offer suggestions for ways to overcome these challenges!  At each bottle feeding appointment, our lactation consultants complete a full oral assessment, try a variety of bottle nipples, and offer strategies for helping your baby build bottle feeding skills.  Book a one-on-one bottle feeding consultation today

SDBFC is committed to providing high-quality lactation and functional nutrition consultations to parents in San Diego and beyond. Explore our postpartum, prenatal, and functional nutrition consultations, take a breastfeeding class or attend a workshop.

About the Author

Robin Kaplan has been an IBCLC since 2009, the same year that she opened up the San Diego Breastfeeding Center.  Robin was the founding host of the Boob Group podcast and published her first book, Latch: a Handbook for Breastfeeding with Confidence at Every Stage in 2018.  Melding her passions for supporting lactating parents and holistic health, Robin finished her Functional Nutrition Certification in 2023. In her free time, she enjoys hanging out with her two teenage boys, hiking, traveling, weaving, cooking, and searching for the best chai latte.

Related Posts

So, What's in your Latch book, Robin?

Since we announced the release of my new book, Latch: A Handbook to Breastfeeding with Confidence at Every Stage, many of our readers have asked what they can expect to find in the book.  Well, let me tell you!

First we start off with how to prepare for breastfeeding.  Most of us spend months preparing for the birth of our child, but don't give much thought about what happens after our baby is born.  So, this book starts off with the basics of how milk production works, all about latching, as well as how to put together your Dream Team of Support for once your little one is earth side.

Then, we move into what to expect during those first two weeks after birth, which we know can feel the most overwhelming.  Hormones aplenty coupled with learning the new task of taking care of your newborn (and yourself!) can sometimes knock down our self esteem and make us second guess everything that we are doing.  This chapter will give you the tools to know what's normal (and not), what to expect, the multitude of breastfeeding positions out there, and where to go if you feel like you need more support and guidance.

The next chapter looks at the ways your breastfeeding journey can change and morph during  the next 2.5 months.  Babies begin to feed more effectively and efficiently.  Parents begin to gain back confidence when they see that their dedication is starting to show positive results.  Plus, you begin to get into a rhythm with your baby, which feels more predictable (aka magical!)  There still may be a few bumps along the path, which this chapter will help you solve, but things should continue to get easier and easier.  Now is the time when families begin to offer bottles, become friends with their pumps, start breastfeeding in public, and feel more comfortable with breastfeeding in general. 

The last three chapters look at going back to work strategies, typical infant sleep patterns and behaviors, introducing solids, and eventually weaning.  

My favorite part of the book is the personal stories from other breastfeeding moms.  There is such a sense of comfort when hearing that someone has gone what you have gone through.  That's why we seek out these connections in local groups and/or online.  We need to feel heard and that others have experienced what we are experiencing.  Plus, the determination and courage that these families share is awe-inspiring!

So, now is your chance to get a sneak peek of the book!  Check out some common myths and misconceptions about breastfeeding, straight from Latch!  You will have to buy the book to read the rest!  

Thanks for all of your support and please enjoy this first view of Latch!

Breastfeeding at 3-4 Months - It Can Look Very Different!

Written by Ashley Treadwell, IBCLC

Running two support groups every week, I get all sorts of questions from moms with concerns about their breastfeeding babies.  One of the questions/concerns I hear the most often is this: “My baby is suddenly not feeding for nearly as long as they used to and they aren’t interested in feeding as often.  They get fussy easily at the breast and pull off after just a few minutes.  I’m concerned that they aren’t getting enough milk from me!”  I can almost always predict the age of these babies - somewhere around 12-16 weeks.  And here’s why.

Many moms know that babies feed frequently in the early weeks.  They expect feedings around the clock that can last quite a while.  What many moms don’t realize is that this *can* change dramatically around the 3-4 month mark.  Babies who used to feed every 1 to 3 hours, for 30 minutes or more, babies who were always happy to breastfeed when offered - suddenly start refusing the breast at times, and when they do accept, may only feed for a few minutes before pulling off.  This can be a frustrating time for moms as they are often concerned that the baby may not be getting enough and are worried about this significant change in baby’s feeding patterns.  In this article, we’ll discuss why this happens, how to know if there is reason for concern, as well as how to manage this new behavior.

Why is this happening?

While it’s great to know that this behavior is normal, many moms want to know why their baby’s breastfeeding behavior has changed so much.  Much of it has to do with developmental changes that occur as baby grows and matures.  One reason the length of a baby’s feeding may shorten significantly is simply that baby is becoming more efficient at the breast - meaning she/he can get more milk out in less time.  This can be hard for moms to believe, so visiting a support group where you can do a weighted feed to see how much baby is taking is a great way to confirm this!  I can’t tell you how many moms come to my groups and are amazed at how much their baby can take in only 5-10 minutes.  Another factor is baby is experiencing a huge developmental leap at this time...  awareness of his/her surroundings is exploding.  Suddenly, your baby will notice the plant in the corner, the dog chasing it’s tail, the freckles on mom’s nose!  Everything is so new and exciting, babies are often too distracted to breastfeed.  They may go hours between feedings, and when they do go to breast, they will often pop off frequently to look around and interact with their surroundings.  

Should you be concerned?

If your baby has breastfed well up to this new stage, if weight gain has been within normal limits (4-7oz per week), and they are having the appropriate amount of wet and dirty diapers, you can rest assured that this is all normal behavior and your baby will not go hungry.  It is very uncommon for a baby who has gained weight well to suddenly start to have difficulties.  Yes, your baby may take in less during the day if they’re distracted by all that goes on around them, but they will make up for it in other ways.  Baby may start to wake more at night, asking to feed, to make up for the milk he/she missed during the day. This is one of the reasons that we don’t recommend night weaning at this time - your baby might need those middle of the night feedings! But don’t worry, tired mama, this won’t go on forever.  

• The signs to look for that will tell you that all is fine are as follows:

• Baby is having the appropriate number of wet and dirty diapers

• Baby is meeting the age-appropriate milestones

• Baby is gaining at least 4oz per week.  

While you may not know what your baby’s weight gain looks like in between doctors’ appts, you can visit a weekly breastfeeding support group to monitor baby’s weight on a weekly or monthly basis and be sure that he/she is gaining appropriately.  

What can you do?

• Offer your baby the breast when he/she shows signs of wanting it, but don’t worry too much if he/she don’t take it, or doesn’t feed for as long as she/he used to.  

• A couple of times a day, try to feed your baby in a dark, quiet place with fewer distractions.  

• Consider purchasing a nursing necklace so that your baby has something to play with while breastfeeding.  It will help keep your baby’s attention on you rather than the ceiling fan above your head.

• Try nursing in a carrier, which provides a nice, quiet, distraction-less space on the go.

• When your baby wakes at night, respond to him/her and breastfeed, as he/she may need these feedings now more than ever.  

• But mostly, relax!  Enjoy the shorter feeding periods and longer stretches between them.  Have fun with your baby as he/she explores his/her surroundings and learn about the world. Trust that your baby will let you know when he/she is really hungry and follow his/her lead!

 Here are a few more resources about breastfeeding a 3-4 month old:

Help a Mama Out: Tips for Breastfeeding the Distracted Baby

I've Had My Baby - Now What? Breastfeeding During Months 2-6

The Boob Group: New Mom Breastfeeding Manual 2-6 Months

Witching Hour vs Colic

Colic is a word that is often used for a baby who cries for any length of time, but did you know that it’s normal for babies to have a fussy period every day, often called the witching hour?  While it’s distressing for any parent to hear her baby cry, sometimes understanding that the behavior is a normal part of infant development can be helpful.  However, there are times when the behavior may be caused by something else, and even though the cause isn’t always immediately understood, there are measures that can be taken to reduce the symptoms of colic.

 

What is the “Witching Hour”?

The witching hour is described as normal fussy periods that almost all babies go through.  It happens around the same time every day and most frequently occurs in the late afternoon and evening hours.  It will often begin between weeks 2 and 3, peak around week 6, and then fade around 3 months.  During this time, your baby will likely want to cluster feed, which again, is a normal behavior for babies. A baby who may go 2 hours or more between feedings will suddenly want to eat constantly.  He/she may be fussier than normal and more difficult to soothe.  Often it seems like the baby doesn’t know what he/she wants!  The baby will want to feed for a few minutes, then fall asleep, only to wake 10 minutes later wanting to feed again.  Some babies will fuss at the breast, giving hunger cues, but then pull off and cry.  All of this is normal behavior.

What Causes the Witching Hour?

While our babies can’t tell us why they’re so cranky during these seemingly endless hours, we have some theories on what causes it.  As it happens often towards the evening hours, it could be because mom’s milk supply is lower than it was earlier in the day.  What is so important for moms to realize is that her supply is not TOO low, but lower, which is a normal fluctuation that all women experience.  As the milk flow is slower, the baby may grow frustrated, and as the milk volume is lower, the baby may want to feed more often.  Again, this is not a sign that mom doesn’t have enough milk, but a common occurrence in breastfeeding.  Another cause could be overstimulation.  Your baby isn’t able to self soothe, or shut him/herself down at this age.  So by the end of the day he/she may feel cranky and overstimulated and have a hard time calming down.  It’s also often the busiest time of day in a lot of households, when partners are returning home from work, older siblings from school, and mom is trying to juggle activities like making dinner, or helping another child with homework.

What Can I Do to Help My Baby During the Witching Hour?

While you may not be able to 100% prevent the fussy period, there are lots of things you can do to help calm your baby and make your own life a little easier.  The best thing you can do is to offer your breast often.  Wearing your baby and learning to breastfeed in the carrier can be an absolute lifesaver!  Wearing your baby will also help to keep him/her soothed and your hands free, so you can attend to other children or activities that need to be done.  Another idea is to prep dinner earlier in the day so that you don’t feel the stress of having to do that during your baby’s fussy period.  Take a walk with your baby in the carrier, as the fresh air will benefit you both.  As much as you can, don’t plan events during this time.  And lastly, don’t be afraid to ask your partner for help!  A baby’s cry is incredibly stressful for mom and sometimes you may need a break.  Ask your partner to step in for a while to soothe baby while you take a bath, go for a drive or walk, or just sit in a quiet room.

What is Colic?

Colic is different than the normal witching hour and is defined as a baby who cries for 3 or more hours a day, 3 or more days a week, for 3 or more weeks at a time.  Colic can begin in the early weeks and often fades by month 3 or 4.  The behavior of a colickly baby is markedly different than that of a baby experiencing normal witching hour.  The crying is often more intense and the baby is unable to be soothed.  The crying may be accompanied by behavior that indicates the baby is physically uncomfortable - he/she will arch his/her back, or seem to want to change positions, or tense his/her legs up near the abdomen.  

What Causes Colic?

Like the witching hour, there is no hard and fast evidence about what causes colickly behavior in a baby.  There are however, some things that you can definitely rule out if you suspect your baby is colicky.  One common cause for colic is too much milk.  Mom with an oversupply of milk may find her baby exhibiting the symptoms described above.  If mom has a very forceful letdown and fast flowing milk, the baby can take in too much air while feeding which can cause lots of gas and periods of great discomfort.  Sometimes an oversupply can cause a baby to have a foremilk/hindmilk imbalance.  This also means discomfort for the baby as he/she is getting more of the diluted foremilk and not enough of the fattier hindmilk.  The foremilk doesn’t have enough fat in it to help balance the lactose, which can cause it to be difficult for the baby to digest.  

A tongue-tie or lip tie can also cause this type of behavior, even when mom doesn’t have an oversupply of milk.  A baby with a restricted tongue or upper lip may not be able to create a seal while feeding at the breast, which again, like the oversupply, causes baby to take in too much air while feeding.  

A sensitivity to something in mom’s diet can also be a culprit in causing this colicky behavior.  

What Can I Do to Help my Colicky Baby?

Change up your breastfeeding position.  If you feel like you may have a forceful letdown, try using the laid-back position.  This can help slow down your flow, making it more manageable for your baby.

If you suspect that something in your diet may be causing your baby discomfort, try keeping a food journal for 48 hours.  Record everything you eat, the time you ate it, along with the times your baby is exhibiting the colicky behavior.  If you start to notice a trend of discomfort following a certain type of food, you can eliminate that food from your diet for a few weeks to see if the behavior improves.  The foods most likely to cause sensitivities are dairy, soy, gluten, eggs, and nuts.  

Most importantly, seek the help of an IBCLC (International Board Certified Lactation Consultant) as she can help you identify oversupply, forceful letdown, tongue/lip tie, as well as a food intolerance/sensitivity.  Lastly, contact your pediatrician to rule out any serious conditions.  

And most of all, remind yourself that this will pass!

Breastfeeding Your Baby with Jaundice

Written by Danielle Blair, IBCLC

The term jaundice gets used a lot regarding babies.  It can have many different meanings depending on the context.  From the Mayo Clinic website:

“Infant jaundice is a yellow discoloration in a newborn baby's skin and eyes. Infant jaundice occurs because the baby's blood contains an excess of bilirubin, a yellow-colored pigment of red blood cells.”

Types of Jaundice 

Baby's livers are immature, and they may not break down the bilirubin efficiently after birth.  Some amount of jaundice is considered normal for healthy babies.  We expect the bilirubin levels to rise slowly in the first several days after birth before peaking and then decreasing.  This type of jaundice is called “physiologic jaundice” and typically requires no treatment other than good feeding management.  Physiologic jaundice can be intensified in breastfed babies by mild dehydration that often occurs before milk volumes increase, which then can lead to “breastfeeding jaundice”.  In the case of physiologic or breastfeeding jaundice, the baby's skin may appear slightly yellow, often just on the face or torso.  A second peak of jaundice known as “breast milk jaundice” may occur during the second week of life.

In some cases, bilirubin levels rise very rapidly in the first 24 hours after birth.  This is not considered normal and can be a sign of infection or improper liver function, and merits immediate evaluation by a doctor.  Babies born before 38 weeks gestation, babies with bruising from delivery, babies with different blood types than their mothers (also known as ABO incompatibility), and breastfed babies are at increased risk of clinical jaundice.

Test for Jaundice

Bilirubin levels are determined by blood testing.  The levels that are considered normal depend on the baby's relative risk of jaundice and the number of hours since birth.  For example, a premature baby will be considered clinically jaundiced and require treatment at a lower bilirubin level than a full-term baby.

Treatments for Jaundice

If bilirubin levels rise very quickly after delivery, a baby may be monitored closely for good feeding, and may need treatment such as phototherapy (often called “bili lights”) or assistance with feeding to ensure that the baby takes in enough fluids to flush out the bilirubin.  A baby with very high bilirubin levels will likely have very yellow or orange colored skin from head to toe.  He may be very sleepy and feed poorly.  In rare cases, prolonged high bilirubin levels can cause brain damage.  This is why some cases of jaundice may require treatment.  

If your baby has elevated bilirubin levels, you may be encouraged to breastfeed more frequently, to use breast compressions to help baby take in more milk, or to offer some expressed breastmilk in addition to breastfeeding.  

For the baby who is not feeding well or is very sleepy, expressing milk and feeding in another way, such as by spoon, dropper, tube/syringe, or bottle, may be a temporary solution to help baby take enough milk volume to prevent severe jaundice.  Offering expressed milk in addition to breastfeeding can also help keep bilirubin levels under control in high-risk babies.

If better feeding management does not work, your baby may need phototherapy to help break down excess bilirubin in the bloodstream.  A “bili blanket” is a pad with UV lights that is wrapped around the baby, allowing baby to stay with mom and continue breastfeeding.  “Triple lights” are arranged in an isolette to allow as much of baby's body as possible to be exposed to the UV lights to bring down elevated bilirubin levels as quickly as possible.  For triple lights, a baby will typically be admitted to a NICU or special care nursery.

Sometime supplementation with formula is necessary to keep a jaundiced baby well-hydrated and to help treat the jaundice.  Formula should only be used if an insufficient volume of breastmilk is available.

Also, don't forget to check out our Boob Group podcast episode, Breastfeeding the Jaundiced Baby

Does Your Baby Have a Tongue or Lip Tie?

Painful, cracked, compressed-after-breastfeeding nipples.  Baby not gaining weight well.  Constant breastfeeding sessions that seem to take over an hour.  Excessive baby fussiness and gas.  These are some of the many signs that your child may have a tongue and/or lip tie.  So, what is a tongue and lip tie and how do they affect breastfeeding? What are ways to fix them and improve breastfeeding?

With several fantastic articles already written on this subject, we are going to give brief answers to these questions and link to our favorite comprehensive resources.  Also, over the next month, we will be sharing stories from breastfeeding mothers whose babies had tongue and/or lip ties.

 

What is a tongue tie and lip tie?

There are pieces of connective membranes under the tongue and behind the upper lip called frenula.  Everyone has a lingual (tongue) frenulum and a labial (lip) frenulum, which means that if your baby has one, it doesn’t automatically mean that you are going to have breastfeeding challenges.  It’s how the tongue and upper lip function that determine if the frenula are causing a problem.

Tongue tie

Upper lip tie

How do tongue and lip ties cause breastfeeding challenges?

When the frenula are tight, they act like rubber bands, tethering down the tongue to the base of the mouth or the upper lip close to the upper gumline.  This makes it difficult to move the tongue in an effective manner or flange the upper lip out.  When the tongue doesn’t have full range of motion, it can cause all sorts of issues.  Some moms’ nipples will be compressed, causing pain and ineffective milk extraction.  Some babies will become very tired and fatigued while breastfeeding, having to work extra hard to compensate for the lack of range of motion in their tongues.  This can turn into ineffective, long feedings and slow weight gain for babies.  Other babies gain weight perfectly fine, but have tons of gas and excessive fussy periods because they are taking in so much air while breastfeeding due to the inability to push the milk back in a wavelike motion.  Babies with tongue ties or significant lip ties often continually fall off the breast, as they are unable to form a good seal and suction.  Other babies have such difficulty latching on to the breast that they refuse to breastfeed altogether.

Here are two articles that describe how tongue and lip ties can affect breastfeeding:

A Breastfeeding Mom’s Symptoms are as Important as Baby’s

Baby’s Weight Gain is Not the Only Marker of Successful Breastfeeding

Why didn’t my healthcare provider mention this to me? 

Most health care providers have not been trained to assess and diagnose tongue or lip ties.  Again, it is how the tongue and lip function (or not function) that cause the breastfeeding challenges.  Most health care providers have not been trained to complete suck assessments on infants, therefore they cannot accurately assess what the tongue is doing while feeding.  The best person to assess for a tongue or lip tie is a trained IBCLC (International Board Certified Lactation Consultant).

Who can treat my child’s tongue and/or lip tie and what are my options?

The best person to diagnose and treat a tongue or lip tie is a trained dentist, ENT (Ear, Nose, and Throat surgeon), oral surgeon, naturopath, pediatrician, or other medical professional trained to do minor surgery.  Make sure to do your research, as not all professionals that revise tongue and lip ties know how to release them effectively.  If the professional doesn’t do the revision procedure effectively and completely, then it will not fix the breastfeeding challenges completely and your baby may have to have the procedure again.  

In most cases, the tongue or lip tie revision is done at an office visit.  Some practitioners will numb the area before the procedure, although it isn’t necessary.  Some practitioners, such as ENTs and pediatricians, may use blunt-edged scissors to snip the tight frenulum.  Others, such as dentists, may use laser for the revision procedure.  

Are there any negatives to having the tongue or lip tie revised?

There is very little risk for having your baby’s tongue or lip tie revised.  Most parents comment after the procedure that their only regret is that they didn’t do it sooner, as it improved their breastfeeding challenges tremendously.  Some babies may be a little fussy after the procedure, but most will settle with some extra cuddles.  Some parents find that a little infant tylenol or homeopathy can help relieve pain (but always check with your healthcare provider for appropriate dosing.)  

How can I keep the frenulum from scarring down after the procedure?

It is very important that parents do suck and stretching exercises after the procedure to prevent scarring down.  My colleague, Melissa Cole, IBCLC, created this quick and easy video for suck exercises after tongue tie revisions: http://vimeo.com/55658345.  She recommends doing these a few times a day, during baby’s quiet alert time, to retrain baby’s tongue to suck effectively and to prevent scarring down.  A local dentist recommends bending baby’s upper lip up to his/her nose after an upper lip tie release to prevent scarring down.

Will my breastfeeding challenges resolve immediately after the procedure?

Most moms report some immediate improvement after the procedure, but it can sometimes take up to a few weeks or months to resolve all of your breastfeeding challenges, depending on other confounding issues, such as mom’s milk supply or baby’s progress.  Remember, your baby has been using his/her tongue and upper lip in this way since he/she was in utero, so it may take some time to ‘relearn’ how to use his/her tongue and upper lip effectively.  Body work, such as craniosacral therapy and chiropractic, can help speed up this process as it can reset your baby’s nervous system, as well as relax the muscle tension that your baby may have developed while using compensating mechanisms.

Here are some additional online resources that have excellent information about tongue and lip ties.  Stay tuned for our featured stories from moms whose breastfeeding challenges improved after having their babies’ tongue and lip ties revised.  Better yet, sign up for our newsletter and have these articles delivered directly to your email inbox!

Websites that offer ways to see if your baby might be tongue tied:

Catherine Watson Genna: Is My Baby Tongue Tied?

Dr. James Ochi: Tongue Tie Survey

More researched-based articles about tongue and lip ties:

American Academy of Pediatrics Tongue Tie article

Dr. Kotlow: Tongue Tie Fact Sheet

The Leaky Boob: The Basics of Tongue and Lip Tie: Related Issues, Assessment, and Treatment

Boob Group episode: Tougue Ties and Lip Ties: Symptoms, Treatment, and Aftercare

If you would like to submit your personal story about breastfeeding a baby with a tongue or lip tie, please email it to robinkaplan@sdbfc.com

Did your baby have a tongue or lip tie?

How did this affect breastfeeding?

Baby Jaws - Breastfeeding a Teething (or Toothy!) Baby

Duh Nuh Duh Nuh………….Duh Nuh Duh Nuh. (come on, you know you just read that out loud).  

You know they’re coming.  You’ve heard all the severe warnings from well-intentioned friends and family.  You’re scared of what’s to come, but know you’ve gone too far to turn back.  Shark-infested waters, you ask?  Noooooo - a breastfeeding baby who has grown TEETH!  

Somewhere around 6-8 months (sometimes earlier, sometimes later), your baby’s first tooth will erupt.  This is most likely an event you will celebrate, both because of the milestone that it is, but also because it may be a temporary break from the cranky, drooly, mouthy baby who replaced your own sweet one a couple of months back.  There are lots of symptoms that point to teething, but the most common ones are: red and swollen gums, increased irritability and drooling, sleep disturbances, and low grade fevers.  Your baby has most likely learned that chewing or gumming on items helps ease the pain and will try to cram everything within reach into his/her mouth.  As that tooth begins to emerge, there may be some small worries creeping in on your excitement about this next stage.  What will it be like to breastfeed a baby with teeth?  Will my baby bite me? Some moms will find that they do start to feel the baby’s teeth while nursing - baby may scrape teeth across nipple when latching or delatching.  And yes, sometimes the baby will bite.

Why did he bite me!?

Short answer is that it’s not because he doesn’t like you!  New teeth bring a whole new sensation for baby.  He may want to explore his world using his new teeth and will scrape and/or bite items that come into his mouth.  Another reason that your baby may clamp down onto your nipple during a feeding is because of teething pain. As mentioned above, babies learn that biting and chewing on items may offer them some relief.   If they are experiencing teething pain while breastfeeding, they may try to alleviate that pain by biting down.  Or, your baby is finished with the feeding and wants to play!

Note: Sometimes when persistent nipple pain starts when the top teeth come in, it can be caused by an unresolved upper lip tie that is causing the baby’s top teeth to scrape against the nipple.  Make sure your baby’s upper lip flanges out, like fish lips, to prevent this pain, or consider having his/her upper lip tie revised.

What should I do?!

Almost all moms will have the same reaction the first time their babies bite them while breastfeeding - some loud yelling and possibly a quick change of position!  This is a completely normal and expected reaction, but you may notice the sudden sound and movement startles your baby.  The best thing you can do is soothe your baby and resume the breastfeeding session.  If your baby should bite you again, calmly remove the baby, give them a quiet vocal command (‘no’, ‘that hurts mommy’, etc) and temporarily end that feeding session. If your baby is still hungry, then offer the breast again to finish the breastfeeding session.  

Also, some moms find it helpful to rub a cold, wet facecloth on baby's gums before latching to desensitize the teething pain before latching.

Because of the sucking mechanism babies use when breastfeeding, it is impossible for them to actually remove milk from the breast when they clamp down on the nipple, therefore biting may indicate baby isn’t hungry enough to feed.  This is clear when a baby will bite towards the end of the feeding.  One way to prevent this is to watch your baby while feeding, and when he/she starts to show signs that he/she is almost done (suck pattern will slow greatly, baby may come off often and smile and interact with you), calmly remove him/her from the breast and end the feeding session.  

For almost all breastfeeding babies, this biting is a temporary phase.  As they grow more accustomed to their new teeth and learn that biting means the breast is taken away, they will likely stop the behavior.  If your nipples become cracked or sore because of any biting, we recommend applying organic coconut oil - it is soothing along with having antibacterial and antifungal properties.  

Rest assured, the biting is normally a very fleeting behavior.  Before long, the waters will once again be safe to enter.  

Common Concerns While Breastfeeding - What is That White (and painful!) Spot on My Nipple?

Welcome back to our blog series…. Common Concerns While Breastfeeding.  These aren’t the complicated, ‘come-to-my-house-immediately’ phone calls we receive.  Rather, these are the questions that come from clients and friends in the middle of the night, by text or by email, that don’t necessarily warrant a lactation consultation.  They can often be easily resolved with a few simple tricks.  So, we would like to share those tricks with you!

Many moms know the pain associated with a shallow latch during the early days, but have you ever had nipple pain suddenly begin after weeks or months of pain-free breastfeeding?  After checking nipples for signs of a poor latch, you notice a white spot on the nipple in question - you pick at it for a few seconds, but it still remains.  What is it?  What caused it?  What can you do to resolve it and get back to pain-free breastfeeding?  This is what’s called a “milk blister” or “milk bleb” and is not cause for great concern, but it can be an uncomfortable and unwelcome guest!

 

What is a milk blister?

A milk blister is a small white or yellow spot on your nipple - it is normally blocking a milk duct, hence sometimes the pain associated with it is felt both at the tip of the nipple as well as radiating out into the breast.  It can’t easily be wiped away or removed.  It may sometimes be associated with a plugged duct.  It is perfectly safe to continue to breastfeed while you have one.

What causes a milk blister?

There are two causes for what we call a milk blister.  One is that a bit of skin has grown over an open milk duct, blocking it and creating a blister.  The other is the build up of fatty milk at the site of the milk duct, and the calcification of this fatty milk, which then blocks milk from flowing from this duct. The things that can increase risk for a milk blister are:

• A recent plugged duct

• Nipple is pinched often while baby is breastfeeding

• Oversupply

• Unusual pressure from a bra or sleeping position

• Thrush

How can I get rid of the milk blister?

• Place some organic coconut oil on a cotton ball and place it on your nipple, inside your bra, in between feedings for a few days.  This will help break down the calcification at the tip of the nipple, as well as fight off any bacteria or yeast.

• Soak your nipple/breast in a saline bath of warm water several times a day.  According to Kellymom.com, add 2 tsp of epsom salt to 1 cup hot water.  Allow the salt to dissolve and soak your affected breasts prior to feeding. Then place a hot, wet facecloth over your breast right after the saline bath and right before breastfeeding/pumping.  This should help to soften the nipple and help the blister release while baby is feeding or while pumping.

• Apply moist heat to nipple prior to feeding

• Try to remove the skin prior to feeding - rub with a warm washcloth

• If all else fails, you can also ask your healthcare provider to use a sterile needle to open the blister.  After this procedure, follow up with organic coconut oil to keep the area moist and allow it to heal.

What if I keep getting milk blisters?

• Consider seeking help from a Lactation Consultant to try to resolve the underlying cause of the recurring blisters.

• Be sure your bras provide soft but strong support - avoid ones with underwire that may cause plugged ducts.

• Consider reducing the amount of saturated fat in your diet.

• Consider taking sunflower lecithin, 1200mg, 4 times a day, to keep milk ducts ‘slippery’ thereby preventing recurring plugged ducts and milk blisters.

What Every Mom Should Know About Breastfeeding During the Early Weeks

How much breast milk does my baby need per feeding?
What is common nursing behavior for a newborn?
How will I know that my baby is getting enough?

As a new mom, these are common questions that you may ask your pediatrician, midwife, postpartum nurse, family, and friends and GUESS WHAT..... they may all have a different answer!

How complicated is that?  

Sometimes you may feel like there are ‘too many cooks in the kitchen’ and that all of the advice you receive contradicts what you just heard from someone else 5 minutes ago. 

Talk about frustrating! 

Well, one of our goals at the San Diego Breastfeeding Center is to make breastfeeding as seamless and uncomplicated as possible.  We want to empower moms with knowledge and confidence to get breastfeeding off to a great start!

After listening to local moms express discontent about hearing contradictory breastfeeding information, we decided to do something about it.   First, we canvased our local breastfeeding mamas and asked, “What information do you wish you would have known about breastfeeding during those early weeks?”  Then we hired one of those awesome mamas, Elisa Suter, of Paper Doll Design Studios, to design a brochure that shares our top tips that every mom (and pediatrician) should know about breastfeeding during the early weeks.

Here is the final product!  Isn’t it beautiful?  We hope that this brochure provides the clear, consistent, evidence-based breastfeeding information our mamas are looking for.  

If you live in San Diego and would like us to deliver these brochures to your pediatrician's office, please email us at robinkaplan@sdbfc.com. 

If you live outside of San Diego and would like to order the Adobe file to personalize this brochure for YOUR local pediatricians and clients, please email us at robinkaplan@sdbfc.com