Common Concerns While Breastfeeding - Yikes! Why Are My Nipples Burning?

Welcome to our blog series…. Common Concerns While Breastfeeding.  These aren’t the complicated, ‘come-to-my-house-immediately’ phone calls I 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, I would like to share those tricks with you!

Why Are My Nipples Burning????

Oh, those itching and burning nipples and breasts.  It takes all of your will power to not walk up to the closest tree and rub your front side on it, like a bear would rub on a tree to get rid of fleas.  The itching can feel insatiable.  This is often your first sign that you have thrush, which is a yeast infection of a mucus membrane, your breasts being one of them.

How did I get thrush?

Well, just like a vaginal yeast infection, thrush is caused by an overgrowth of yeast in your gut.  Breastfeeding moms may often find that they get thrush after a dose of antibiotics.  This is because antibiotics kill NOT ONLY the bad bacteria in your gut, but also the good bacteria.  Yeast loves when there is an absence of good bacteria in your gut, so it decides to multiply and aim for any mucus membrane. 

Moms and babies who also have inflammation, such as a food intolerance which limits the absorption of important nutrients, or are just temporarily dealing with a compromised immune system, are also more susceptible to thrush. 

What does thrush look like?

• Burning, itchy nipples and breasts

• Red or pink nipples and areola

• Painful feedings after a time period of painless feedings
  

• And thrush doesn’t just affect the mom.... babies can get thrush as well.  When your baby has thrush, he may have white, cauliflower-textured spots in his mouth along the gum line or on his cheeks.  He may also have a raging diaper rash.  Babies with thrush may cry while breastfeeding because the milk stings the sores in their mouths.  And to complicate matters more, your baby may show no signs of thrush at all!

How does one get rid of thrush? 

• First and foremost, make sure that the pain you are feeling is not due to a less-than-perfect latch. Also, if the burning happens to only occur after the feeding, not during the feeding, it might be worth it to see if you have Raynaud's, which is a vasospasm of the nipple.

• Remove sugars (including most fruit and fruit juices) from your diet for about a week. Yeast grows on sugar, so removing it from your diet restricts yeast growth. It might help to eliminate dairy as well.

• Consider starting a course of a high-quality probiotics to help recolonize your gut, and your baby’s gut, with good bacteria. I would recommend choosing a probiotic from the refrigerator in the herb section of a natural food store. Probiotics are alive and begin to die off when at room temperature, so don’t purchase anything sitting on a shelf, unrefrigerated.

• You will want to wash all of your bras and underwear in a distilled white vinegar rinse cycle. Also, soak anything that goes in the baby’s mouth, like a bottle nipple, in apple cider vinegar before rinsing it in soapy water. The vinegar should help kill off the yeast hanging out on these items.

• All Purpose Nipple Ointment (APNO) - if that pesky thrush will not go away after trying the above recommendations, Jack Newman has a protocol for getting rid of thrush. You can ask your primary care physician for a prescription for this to bring to a compounding pharmacy. Midwives often have recipes for this as well, that you can make with over-the-counter medications.

• If all else fails, you can ask your physician for Diflucan, which is the same medication used to clear vaginal yeast infections.

• Lastly, definitely discuss this issue with your pediatrician or a lactation consultant. He or she may have some other recommendations to help remedy the out of control yeast.

Help a Mama Out: Surviving the First Few Weeks of Breastfeeding

What tips do you have for surviving the first few weeks of breastfeeding?

Maren: Lots of skin to skin to get those endorphins going so you can take advantage of all that delicious oxytocin (which will make you want to keep breastfeeding, even with things might be tough!)  Take advantage of all of the support you can – it will help normalize the experience so that you feel totally confident in your decision to breastfeed.  And know ahead of time that there is definitely a learning curve, but it only gets better and better, so hang in there!

Amanda: Make sure to talk to your partner about how you need him/her to support breastfeeding and encourage you, even when you get discouraged and feel like giving up!

Jamie: Get the latch correct right away!  Take advantage of the lactation consultants at the hospital and ask for a referral even if you don’t think you will need one.

Andrea: Trust your body!  Skin to skin, lots of water, and lots of rest.

Heather: Surround yourself with at least one supportive person.  I would never have made it through those weeks without the support of my husband.

Alicia: Hire a postpartum doula.

Juli: Surround yourself with women (and men!) who support breastfeeding.  It gets easier – it is definitely worth pushing through the tough parts in the beginning!

Billie: Make really good friends with the lactation consultant and local breastfeeding support group before delivery.  They will be able to offer so much support in those first few weeks.  Trust your supply.  Make sure you are comfortable!

Monica: I went to classes and read books, which helped, but nothing prepares you for the real thing.  Get help early, if you need it.  Hiring a lactation consultant was the best thing I did.  Keep telling yourself you will try it for one more day and one day it will become second nature.  Coconut oil worked wonders on sore nipples.

Christine: OMG… best advice I got was to rub breastmilk around your nipples after every nursing session!  My cracked tatas healed within 2 days of doing that!

Chelle: If it hurts and you are dreading the next nursing session, don’t just tough it out!  Get help ASAP before it gets worse or turns into an issue that makes you quit! Take a prenatal class.  Breastfeeding is natural, but that doesn’t mean you will naturally know what to do.

Sarah: Don’t expect anything else from yourself.  Set up what you can ahead of time and find someone else to do everything else that needs to be done.  Establishing your breastfeeding relationship is your job.

Jen: Get a Netflix subscription and ignore the dirty dishes!

Danielle: Don’t do anything but rest, breastfeed, nap, and eat.  Nothing else matters right now.

Abbey: Celebrate every success, no matter how small it seems!

Desiree: Find support!  And be patient…it’s not always easy, but it’s most certainly worth it! 

Sofia: Learn the basics!  Before birth is possible!  Proper latch, how milk supply works, most common myths about breastfeeding, how to know if your baby is getting enough, why it is REALLY important to feed on cue rather than a schedule, why baby doesn’t need ANYTHING else but your breastmilk, etc.

Amanda: Don’t give up! Get help and support!  Spend as much time as you can with your baby (in bed if you can.)

Priscilla: Relax.  Don’t listen to anyone that’s not helpful. Determine your own needs for comfort.

Joanna: Expect to care for your baby and get others to help with meals and housework.

Thanks to everyone who responded to our questions on our San Diego Breastfeeding Center and The Boob Group Facebook pages.  Check back every Tuesday for a new Help a Mama Out tip!

To find an international board certified lactation consultant, visit www.ilca.org

Here are a few more articles on our website, specifically dealing with breastfeeding a newborn:

Advice for a Newly Breastfeeding Mama’s Partner

Breastfeeding Expectations for the First Month

Newborn Hands: Why are they always in the way while breastfeeding?

Advice for the New Breastfeeding Mom

Supplement Options: Donor Breastmilk, Milk Banks, and Formula

This past week, we released one of my most favorite episodes on The Boob Group: Low Milk Supply: Donor Milk, Milk Banks, and Formula.  I had the esteemed pleasure of interviewing Amber McCann, an International Board Certified Lactation Consultant, fierce supporter of all things mothering, and dear friend.  I wanted to know what options were out there for mothers who needed to supplement their babies, as well as the pros and cons of each.

I pulled out the most salient points for this blog article, but you can click here to listen to the Boob Group episode in its entirety: Low Milk Supply: Donor Milk, Milk Banks, and Formula.

What are your options if you need to supplement your baby?

When feeding an infant, the World Health Organization lists a hierarchy:

• Milk taken directly from the mother’s breast
• Expressed milk from baby’s mother
• Expressed milk from another mother (wet nurse, donor milk, milk from a milk bank, etc.)
• Breastmilk substitute (formula)

Is it safe to offer your baby another woman’s breastmilk?

Making the decision as to what to feed your baby should never be taken lightly.  It is important when one is considering offering donor breastmilk to their baby to balance the risks and benefits.  You should always consider asking the potential donor mom for a copy of her prenatal blood work to check for sexually transmitted diseases and other potential pathogens.  It is also important to ask questions about lifestyle choices, such as alcohol use, smoking, diet, medication use, etc.  Eats on Feets has a Resource Guide with great lists of questions for both the donor and recipient of expressed breastmilk, as well as an extensive list of health considerations.

What are the main benefits of using donor milk?

• It’s breastmilk!  It has everything your baby needs, nutritionally and immunologically.
• It has every benefit that a mother’s own milk would have.

What concerns may arise when using donor milk?

• A number of pathogens enter into human milk if a mother is infected, however few diseases can be transmitted through human milk, itself. 
• The main diseases that cause concerns are HTLV, HIV, and CMV.  CMV is typically only a challenge for premature infants.  Fortunately, HTLV can be deactivated by freezing and HIV by flash heating.

Where can a mother find someone to donate milk?

• Start with your own social group.  If you have friends or friend of friends who are breastfeeding, there is always a chance that they or someone they know has an excess supply in their freezer or would be willing to pump for you, if they knew there was a need.  All you have to do is ask!
• Informal milk groups, such as Eats on Feets and Human Milk for Human Babies
• Milk Banks

What are milk banks?

Milk banks are non-profit organizations where breastfeeding moms can donate breastmilk, should they fit the milk bank’s criteria.  The Human Milk Banking Association of North America requires that their donors be in good health, not regularly on most medications or herbal supplements, willing to undergo additional blood testing, and be willing to donate at least 100 oz.  Donated human milk is pasteurized and then either sold to hospitals to feed critically ill babies or to families who purchase directly from the milk bank. 

How should I choose between donor milk, milk from a milk bank, or formula?

This is such a hard decision and definitely not one to take lightly!  What is most important is to look at your needs, your baby’s needs, what you feel most comfortable supplementing with, and what’s the best choice for your family.  So, sit down, research all of your options, and choose with your heart and knowledge. 

As a follow up to this article, several moms submitted stories about their experiences using donor milk or donating to a friend or milk bank.  Stay tuned, as we share them during the rest of the week!

If you have a story about using donor milk or donating breastmilk to a friend or milk bank, and you want to share it with our readers, please email it to me at robinkaplan@sdbfc.com.

Did you have to supplement your baby with donor milk, milk from a milk bank, or formula? 

How did you choose which supplement to use?

Update on 2013-01-24 15:36 by Robin

Here's your Call to Action:

Too many breastfeeding mothers have no idea that human milk sharing is an option and we want to change that!

If you are a breastfeeding mother and have used donor milk or have donated your own milk, we would love to hear your story!  Other breastfeeding moms need your support!  Just knowing that someone else out there went through a similar experience.... well, that can make all of the difference in how a mother views her own breastfeeding experience!  Your stories are beyond powerful!  They need to be heard!

If you would like to have your stories posted on our website, as well as The Boob Group's website, please send your story to robinkaplan@sdbfc.com.  

We will begin posting your stories as soon as we receive them! 

Toddler Nursing Part III - Super Breastfed Baby!

Written by guest blogger, Andrea J. Blanco, IBCLC

My seven year old is really, really into the Super Diaper Baby series. So much so (embarrassing story for which I will pay for dearly in 10 years coming up right now) that the other day, he fished through all the dirty clothes to find 8 (yes, 8!!!!) underwear to put on simultaneously along with a cape so that he could reenact parts of the book. I’m not entirely sure why clean underwear couldn’t be used, but hey, welcome to the gnarly world of 7 year old boys. I’m still getting adjusted.  Anyway, whenever he yells “SUPER DIAPER BABY!!” all I hear is “SUPER BREASTFED BABY!!!” (you better have read that in your booming announcer voice; if not, please go back and reread).

Super Breastfed Baby is not a baby anymore. He’s a toddler who can leap off everything, get all bruised up and bounce right back up. He can run amazing distances while laughing hysterically at you chasing him and fall over 15 times, but who’s counting? He scoffs at the mere thought of you trying to clean. Or sit. Or cook. Or sleep. He knows what he wants and isn’t taking no for an answer. This is the breastfed baby magnified – the one that I was reminded of as I read some of your comments to Toddler Nursing Part I and Toddler Nursing Part II of the Toddler series. Super Breastfed Baby is who we’re going to tackle today.

The Scenario: You and Super Breastfed Baby are home and you are trying to get things done around the house.

I hate to say it, but nothing about this will ever get easy. But it can get easier. Having a child, nursing or otherwise, around the house means being very strategic in all that you do. Your toddler wakes at 7, you say? Well then, 6:15 is the time to set the alarm so you can chop veggies for tonight’s dinner, put a load of laundry in the washer, and prepare a to-do list for your partner. Waking earlier than your little one doesn’t work for you? Try naptime or after bedtime. When they’re awake what they want is to be entertained. By you. Because you’re the awesomest. EVER. And no one else can compare to the way YOU entertain them. And when you aren’t in the entertaining mood? You still have breasts. Which they love. All I keep thinking as I’m typing this paragraph is “That which you resist, persists.”

It’s easy to get caught up feeling like “I HAVE TO DO THIS NOW”, but sometimes, if you stop for a second and give in to Super Breastfed Baby’s demands (of nursing or block building or nursing while block building), you will find that time to do what you were looking to do suddenly appears afterwards. And if it doesn’t appear? And you still have to vacuum? Rip a play out of my dear friend’s book and wear your baby right around naptime. She vacuums the floors, makes the bed, washes the dishes and sometimes even mows the lawn with her toddler strapped to her back in the Ergo. Most times he’s too busy loving the view, but sometimes, her little superhero falls asleep while she’s at it. 

The Scenario: You and Super Breastfed Baby are, well, just home.

You may have noticed that when you’re home or *gasp* sitting down, your normally easy to distract child becomes Mr. Grabby Pants (which definitely feels like a superhero quality), demanding to nurse every. five. minutes. This one is a little trickier to fend off because mommy sitting = easy target. Most toddlers nurse that frequently out of boredom and/or familiarity. If you’re like most moms, for the last year, most of you and your baby’s breastfeeding took place either sitting or laying down. So it just means that your little princess was paying attention and now that she sees you sitting or laying down again, she thinks it’s nursing time. If you have realistic expectations of what’s about to happen, then you may be better prepared to deal with it. Another way to fend off Mr. or Ms. Grabby Pants is to “relax” in a new or exciting (but safe) environment. Toddler areas at local museums or indoor play gyms tend to be enclosed – use that to your advantage. Your busy, curious, newly independent toddler will be much less likely to think of nursing when there’s other stuff to do and see.

The Scenario: You and Super Breastfed Baby are at an impasse and you’re not too sure you want to continue nursing.

You’re trying to set boundaries, but it seems nothing is working. It’s not so much that you want to wean Super Breastfed Baby (or maybe it is), but you would like for nursing to feel like it’s more on your terms than at his demand. First, there is absolutely NOTHING wrong with you feeling that way. Nursing is a mutual relationship – both you and your child have to want to continue. As I mentioned in Part II, if you’re feeling like you want to slow down the demands of nursing or even wean, first try to pinpoint which is the MOST difficult nursing time for you. For me, it wasn’t the morning, nap and night – those I could deal with. But it was all the in-betweens. However, I didn’t realize that I could deal with, and actually cherished, the morning, nap and night until I was able to really cut back on the in-betweens. It took lots of creativity and motion, but after a few weeks, he didn’t even realize the in-betweens were missing. As with any change to a child’s sense of normalcy, employing gentle techniques combined with lots of love and patience along with waiting (if you can) until the child is communicative enough to understand, even if he doesn’t agree, will yield the best results.

The Scenario: You and Super Breastfed Baby have found your groove, but sometimes, she acts like there isn’t enough milk.

Super Breastfed Baby is one smart cookie. Maybe it’s that x-ray vision or her supernatural senses, but something has alerted her that there is less milk. Did you read that sweet momma? LESS MILK. Less milk is different than “NOT ENOUGH” milk. A few months ago, when you started solids because your little one showed all the signs of being ready, the weaning process began. Your body naturally slowed down its milk production to meet your baby’s needs and has continued to be super efficient in adjusting to those continued needs. Yes, you do have less milk, but, in conjunction with the other foods he’s eating, he’s still getting exactly what he needs. In addition, Super Breastfed Baby knows what he’s doing when he seems to be kneading the breast or trying to “play” with the other nipple. He’s actually trying to elicit a faster flow of milk for himself. For most moms, the kneading is nowhere near as exasperating as the nipple twiddling. Toddlers need to learn manners, too, and where better to learn them then at the breast where they are happy and relaxed and met with love? If you’re trying to curb behaviors such as nipple twiddling, be consistent each time. Explain to your toddler that it hurts momma. Use words she can understand. And repeat each and every time. Sometimes, along with consistency, a little bargaining might help, too. “Instead of hurting mommy by touching my breast that way, you can [insert substitutive, less exasperating behavior here]”.

So many of my past New Year’s Eves were spent with a baby in arms, or in a sling, or on the breast, picking confetti (or food) out of their beautiful, thick brown hair. Some years, it seemed I would never have my body free at midnight – or ever. My Super Breastfed Babies are babies no more…I can’t even say they are in jest. This year, we weren’t nursing at midnight. I wasn’t holding them. Yet, there we were, all of us snuggled up and interlocked when the clock struck 12. Maybe not as it had been in years past, but then again, not much different either. Maybe it was because, as others would say, I “nursed them *forever*”. Or maybe it’s because, through the nursing process, I realized there’s nowhere else I’d rather be.

Happy New Year! 

Andrea Blanco is an International Board Certified Lactation Consultant at The Milk Collective Lactation Care, working with families in the Miami/Ft. Lauderdale area. She is the proud mom of 2 loving, spirited boys, who teach her humility, patience, humor, and the rules to more sports than she thought she’d need to know every day. When she’s not helping families achieve their breastfeeding goals, you can find her on the sidelines, at karate tournaments, or with her toes in the sand. She can also be found at themilkcollective.co, on Instagram @themilkcollective_ , facebook.com/themilkcollectivelactation or by email at: andrea@themilkcollective.co.

Do you have any additional questions for Andrea about nursing a toddler?  Share them in the comment section and we'll ask her to write another article!

Common Concerns - Do I Have Mastitis?

Welcome to our blog series…. Common Concerns While Breastfeeding.  These aren’t the complicated, ‘come-to-my-house-immediately’ phone calls I 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, I would like to share those tricks with you!

Why is my breast so swollen???

Does your breast suddenly feel like it is going to explode, like a balloon, off of your chest?  Does it hurt to breastfeed, yet you know you have to remove your milk ASAP?  Are you starting to feel exhausted and lethargic... not something that can just be blamed on being a new mom?  Sounds like you may have mastitis!

What is mastitis?

Mastitis is inflammation of the breast, usually (although not always) from a bacterial infection.  Mastitis happens when milk gets stuck in the milk ducts and that milk stasis  causes engorgement and inflammation.  Not all mastitis is an infection of the breast and can often be treated with natural remedies.  Indications of an infection, and the need for antibiotics, are:

• Mastitis in both breasts

• Baby is less than 2 weeks old or you were just hospitalized

• Nipple has obvious infection

• Pus/blood in the milk

• Red streaking is present

• Temperature increases suddenly

• Symptoms are sudden and severe

(per Kellymom, Plugged Ducts and Mastitis)

How will I know if I have mastitis?

Mastitis often starts as a plugged duct.  This pesky blockage starts to get harder and more painful over a few hours as the milk stays 'stuck' in the milk duct.  As with a plugged duct, mastitis typically affects one breast, rather than both.  Plugged ducts often resolve within a few hours to a few days, and while uncomfortable and tender, they are relieved with a few comfort measures over time. 

Mastitis, on the other hand, has a few additional symptoms:

• Painful, hot area on the breast

• Breast may have a red streak over the hardened area

• Breast looks swollen and the affected area is tight and uncomfortable

• Mom feels like she has the flu - extreme exhaustion, achy, chills

How can I treat mastitis?

Once you start feeling like your plugged duct is exacerbating into mastitis, you want to start treating it as quickly as possible.  Mastitis can often be treated with many natural remedies, rather than needing antibiotics.  The reason we want to leave antibiotics as a last resort is that they kill off both the bad bacteria, as well as the good bacteria, leaving your body wide open for increasing your risk for thrush... Huge bummer!

Here is a list of my personal favorite natural remedies for treating mastitis:

• Bed rest! This is your body's way of telling you it's time to rest and take care of yourself. Think of yourself as having the flu. While mastitis is not contagious, you definitely need to remove your milk and feed your baby. The best way to do this is to spend the rest of your day in bed.

• Fluids and nourishment. Drink lots of fluids (like water, coconut water, and green smoothies) and eat warm nourishing meals (like soup.) The laundry can wait, I promise!

• Remove milk every 2-3 hours. If it hurts too much to breastfeed on the side with mastitis, you will need to pump instead.

• Castor oil compresses - Castor oil used topically helps to move things under the skin. Pour castor oil on a face cloth (it stains, so not on a nice one) and place the face cloth on your sore breast. Place a heating pad over the face cloth, as the heat will help the body absorb the castor oil and move the blockage. Check every 20 minutes and use as long as it takes to soften your breast.

• Dandelion tincture. Dandelion is a natural antibiotic and a great way to battle any infection. Two droppers full, 3-4 times a day, can often do the trick. The flavor is definitely intense, but well worth it!

• Vitamin C and Echinacea. Mastitis is your body's way of telling you it's time to slow down. Both vitamin C and Echinacea boost your body's immune system. A safe dose to take is 3000-5000mg/day (mega dose to be used acutely during mastitis) of Vitamin C and 900mg of Echinacea per day (acutely).

• Homeopathic belladonna. These tiny little pellets can make a world of difference to reduce your temperature while battling mastitis. Plus, you cannot overdose on homeopathy... if it isn't working, then you just stop taking it. 2-3 pellets, under the tongue, every 30 minutes for up to 6 hours.

How can I prevent mastitis?

Once you get mastitis, you definitely never want to get it again, so how can you prevent it from happening even in the first place?

Ways to prevent mastitis:

• Effective and frequent removal of milk. Engorgement or ineffective removal of milk can cause your milk to get backed up in the ductal system, causing inflammation and mastitis. Tongue-ties, latching problems, oversupply, limiting baby's time at breast, nipple shields, sleepy baby, and skipped feedings can all decrease the baby's effectiveness at breast, thereby allowing the breast to fill up too much.

• Make sure certain areas of your breast are not being constricted. Tight, under wire bras and restrictive clothing can put undo pressure on a particular area of your breast, which may cause a plugged duct.

• Seek help ASAP when you have cracked or bleeding nipples, as these wounds increase your risk for infection.

• Support your immune system. Having a new baby can be draining on your body and immune system, especially if you are recovering from an exhausting birth, cesarean, or just too many visitors in your space. In many cultures, new moms don't leave their homes for 6 weeks and their family and friends cook all of her meals and help her take care of her new baby. Unfortunately, in the United States, that is simply not the norm. When our immune system is run down, we are much more susceptible to illness and inflammation. Limit visitors in the first few weeks to only HELPFUL visitors, and ask them to bring food. Relax and rest during and in between breastfeeding sessions to let your body heal after the birth. Eat warm, nourishing foods to keep your blood flowing and your body healthy. Take an Omega 3 supplement (from a reputable company, like Nordic Naturals) to reduce inflammation.

Disclaimer: Most herbal treatments have not been thoroughly researched, particularly in regard to lactation. Herbs are drugs, and some caution is necessary. I am presenting this data as is, without any warranty of any kind, express or implied, and am not liable for its accuracy nor for any loss or damage caused by a user’s reliance on this information.

Toddler Nursing Part II – Toddler vs. Breastfeeding

Written by guest blogger, Andrea J. Blanco, IBCLC

Have you ever read Dinosaur vs. Bedtime by Bob Shea?

“ROAR!! I’m a dinosaur! ROAR! NOTHING CAN STOP ME!”

It’s a cute little book about this dinosaur who faces many challenges, and wins all but one. The dinosaur is FOR SURE a toddler. I just know it.

In my previous post, we talked about some of the reasons why nursing a toddler can be a helpful transition for you and your little one. Dealing with a little person who has so many changes going on all at once can feel a lot like those battles in Dinosaur vs. Bedtime. Here are some suggestions for turning the tables on your little dinosaur or dinosaurette.

I want to keep nursing, but am being pressured to quit.

In this society, if you happen to be nursing your 3 month old, you are in the minority. Six months? You are an anomaly. If you’ve gotten to the point where you’re thinking of nursing your toddler, then it is safe to assume that not everyone around you will understand or agree that you are doing a very important, *normal* thing. However, dealing with that lack of support is crucial to your wellbeing and to the likely continuation of your breastfeeding relationship. So what can you do if the people closest to you don’t necessarily share your same enthusiasm?

First, have a conversation about their concerns. Be a good listener and find out why continued nursing is bothersome for them. It’s rarely about YOU nursing YOUR toddler that is offensive to them and has to do with other concerns, like spending time with you (in the case of a partner) or spending time with the baby (in the case of extended family) or concerns (real or perceived) over your work duties (in the case of an employer). If you’re able to get to the real issue for which breastfeeding is taking the hit, making small changes to show you are conscientious of their concerns will get the attention off the nursing and you and your toddler can continue your breastfeeding relationship.

There are times when despite your best efforts, it will feel like a lonely journey. However, in this day and age, that needn’t be the case. A lot of communities offer breastfeeding support groups and even breastfeeding toddler groups. Check with your local hospital or La Leche League chapter to see if there are any in your area. When my first was approaching toddlerhood, I found my support through online forums where I met some great, like-minded mommas whose virtual support was key to our continued breastfeeding success. If you’re on Facebook, become a member of one of the many groups there are offering mother-to-mother support. Are you on Twitter? Search #breastfeeding and for the most part, you’ll be met with tons of virtual kindness. What about downloading some great podcasts from The Boob Group? You don’t need an army of people cheering your name – sometimes one person who gets what you are going through is enough. Toddler Nursing vs. the World? Toddler Nursing WINS!

My toddler is very demanding about wanting to nurse, even when I don’t want to.

As you’ve probably realized, toddlers are VERY demanding about EVERYTHING. Nursing will definitely not be excluded. It’s easy to continue to fall into this routine of “on-demand” nursing when you’ve been at it for so long, but with your child’s developing language comes the understanding that we live in a world where patience and manners are necessary and there are boundaries. While breastfeeding does still serve a nutritional purpose in that second year of life, it probably isn’t what your toddler is surviving on alone. In the same way that you are curbing the throwing of sippy cups on the floor so hard that the top comes off and the water (if you’re lucky, it’s just water!) spills everywhere, you can begin to curb the octopus arms toddlers suddenly develop when trying to get to the breast. Model the behavior you wish to see and be gentle, but firm about it (laughing or smiling and cooing at how cute it is that your little one grabs at your shirt and pulls so hard while yelling for some milkies when you’re trying to say no isn’t very effective). Octopus Hands vs. Nursing Manners? Nursing Manners WIN!

But, what if I’m out and my toddler still wants to nurse?

Maybe nursing a baby in public has been a challenge for you. If so, then the idea of nursing a toddler in public is really intimidating. Because toddlers are all about exploring the world around them, they are [generally] easy to distract when you’re out. There was, however, that one time at mass when my little angel decided that the crayons and snacks I’d brought along weren’t going to cut it. Nothing like hearing “BOOOOOBIEEEEEE” being yelled out in a quiet room built to echo. As mortified as I may have been at the moment, it’s also one of my most cherished memories. If distraction isn’t working, with a little quick thinking, there’s always a quiet place you and your little one can go for that needed pit stop, breastfeeding under the choir robes included. Also, while you are aware you’re nursing a toddler, most people wouldn’t even think of it, so just as in the case of a baby, to a passerby, it can look like your child is sleeping on your lap, and nothing else (this, of course, doesn’t apply if your son has already announced his plans to the entire congregation). Boobie vs. Echo? Boobie WINS!

When all else fails, don’t forget – you can set boundaries. It doesn’t have to be all or nothing. I’ve dealt with countless clients who, by the time their child gets to a certain age, are having a hard time continuing the nursing relationship because of these demanding moments. If you are at your wit’s end and feel like you want to keep nursing but…, try to find a middle ground. If you are able to target the most stressful times and/or nursing behaviors, you can then find ways to work around them. Maybe that means finding gentle ways to say no by way of distraction more often than you are used to, but if it goes hand in hand with keeping your sanity and in turn, continuing your nursing relationship, then, whether your toddler agrees with you at the particular moment or not, it’s still a win/win situation. Demanding Toddler vs. Boundaries? Boundaries WIN!

Nursing a toddler, like having a toddler, isn’t always easy, but if you so happen to embark on the journey, you may find it is always worth it. It gives you another mothering tool to help navigate those battlefield moments and is a sure fire way to connect with your child amidst this busy life we lead. One day my little one got his finger caught in the door and came wobbling over to me, tears of pain streaming down his soft, round toddler cheeks. Instinctively, I lowered my shirt and offered the breast. The older one, worried about his brother, came over and said to him “You see, B? There is love in there so you’ll be ok.” I realized the only reason he felt that way was because of what he experienced at the breast by way of watching and doing. I couldn’t have asked for a bigger reward from my nursing relationships. Toddler vs. Breastfeeding? Love always wins. 

Andrea Blanco is an International Board Certified Lactation Consultant at The Milk Collective Lactation Care, working with families in the Miami/Ft. Lauderdale area. She is the proud mom of 2 loving, spirited boys, who teach her humility, patience, humor, and the rules to more sports than she thought she’d need to know every day. When she’s not helping families achieve their breastfeeding goals, you can find her on the sidelines, at karate tournaments, or with her toes in the sand. She can also be found at themilkcollective.co, on Instagram @themilkcollective_ , facebook.com/themilkcollectivelactation or by email at: andrea@themilkcollective.co.

Breastfeeding with Hypoplasia

Today, on the San Diego Breastfeeding Center blog, I'm honored to share Fakiha Khan's memoir about her battle with Insufficient Glandular Tissue.  If you would like to submit your story as well, please email me at robinkaplan@sdbfc.com.  Thank you so much, Fakiha, for sharing your story with us!  It's stories like yours that make me want to be the best mom I can be! 

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When my son was born 2 and 1/2 years ago, I wanted nothing more than to be able to breastfeed him.  He was in the NICU for a week after he was born, and I really did not get to nurse him until he was a week old.  By that point, he had trouble latching on, and my milk just was not coming in.  For the next five weeks, I did what I could.  I tried to nurse him every hour and a half, I pumped, I took herbs, and I finally went to see a lactation consultant. 

I will never forget how shocked she was that my son transferred only 1/2 an ounce at the age of five weeks.  Other than telling me to continue pumping with a hospital grade pump, the consultant had no other ideas of why I was not producing milk.  She kept saying to me - it is the most natural thing to produce milk.  It's all about demand and supply.  If you keep putting him on your breast, the milk will come. Well, I kept trying, and after weeks of emotional torture and physical discomfort, I finally gave up.  I was producing an ounce of milk from both breasts at that point.  And, giving up was not easy.  I felt like a complete failure, like I could not do the thing that is supposed to be so natural. 

I got a second chance when my daughter was born two months ago.  I figured that, with my son, I just didn't get started on nursing quickly enough.  This time, I decided to be proactive even before the baby was born.  I talked to people and a lactation consultant prior to giving birth.  This consultant suggested that I might have a physiological problem such as hypoplasia, but I would not know until I got checked out.  I didn't get a chance to do so before I gave birth, but I went into the birth with hope of doing better this time. 

When the baby was born, I immediately put her on my chest and I nursed her within a half hour of birth; I kept her with me nonstop, nursing her whenever I could.  But, within the first two days, it was clear that I was not even making enough colostrum.  I had to give her some formula.  My fuller colostrum finally came in at day 3 and the milk first came in on day 5.  But, despite nursing every hour and a half, the baby was still fussing and clearly unsatisfied. 

Those old feelings of frustration and failure came rushing back to me.  I kept thinking, this is supposed to be so natural.  Every mammal mother makes milk for her child, yet, I can't feed my baby who is trying so hard to get out a few drops of milk from me.  All of the instructions from the breastfeeding class kept repeating in my head.  I kept thinking, maybe today I will suddenly make the milk my baby needs, maybe today.   

Before giving up, I went to see my doctor to find out if I had hypoplasia.  The doctor told me that hypoplasia was not possible, as I did not have the physical signs (tubular breasts that are set far apart) and because I was making some milk even if it was only an ounce at a time.  So, I thought, ok, there has to be something I can do.  So, I did some research and found out about fenugreek.  I began taking that, and immediately I got a boost in my milk supply.  But, then within a week, it started going back down again.  At this point, I was ready to scream, but before giving up, I decided to consult another lactation consultant.

As it happened to be, this consultant specialized in low milk supply.  She finally told me what I had been suspecting - I have insufficient glandular tissue.  The consultant suggested a number of herbs and medication, all of which I tried.  Again, my milk supply went up very quickly, but now after 3 weeks, I see it going back down again.  I still don't know if any of the medications or herbs (which I understand work by increasing hormone levels) really work with insufficient glandular tissue.  Can they create tissue where none exists?  No one can seem to answer this question for me. 

Now, I continue pumping during the day, saving the little bit of milk I made (about an ounce and half), and mixing it with formula.  I nurse when I can and regularly throughout the night.  But, I have resolved myself to the fact that I will not be able to exclusively rely on breast milk.  It's a very sad realization, and I wish I had a solution, something to fix this problem, or even a bit more information.  Alas, I do the only thing I can and, in the process, laugh at myself when I am proudly toting home the four-ounces of breast milk I take home after pumping 3 to 4 times at work.  To a regular breastfeeding mom, four ounces is probably how much she produces in one feeding.  For me, it's a day-long effort, and at the end of the day, I carry it home with the same pride as if I had just discovered gold!

What about My Freezer Stash of Breastmilk During a Power Outage?

As many breastfeeding moms prepare for Hurricane Sandy and her aftermath, we wanted to share a fantastic article written by our friend, Katy Linda of Stylin’ Momma.  Here’s all you need to know about what to do with your frozen breastmilk during a Hurricane, or any power outage for that matter. 

Our thoughts are with all of you on the East Coast who are bracing for this monstrous storm and hope Sandy is much weaker than expected.

Weathering a Storm with a Freezer Stash of Breastmilk

Reposted with permission by Katy Linda, IBCLC of Stylin’ Momma

As Hurricane Sandy approaches the east coast of the US, many moms are wondering, ‘What about my freezer stash?‘.  And with good reason.  There is concern about what this storm will do and how long people may be without power.  Many moms have worked hard to have frozen milk on hand for their babies, and the thought of losing that liquid gold is just too much to bear.

So how long can you go without power and still save that precious breastmilk?  Let’s see…

We know that the safest place to store breastmilk is in a chest freezer or deep freezer at a temperature of 0 degrees Farenheight. ABM Protocol #8

We also know that a freezer generally stays frozen for 24-48 hours without power, especially if it is full. via USDA

So, we know off the bat that breastmilk frozen in a full chest freezer is absolutely safe for 48 hours!  Great news.  The best way to protect your milk is to store it in the center of the freezer, where temperatures are more stable. This will ensure it stays frozen as long as possible.

And what if the power is out longer?  Let’s see –

Breastmilk is still considered frozen if there are ice crystals in it or it is a slushy consistency. via HMBANA’s best practice, 2005.

Wow.  So even beyond 48 hours we can look for ice crystals to tell us the milk is still frozen. Wonderful news. But what do we do when the milk is thawed and there are no ice crystals left?

Take a look at this:

“The data generated by the authors support the contention that milk is relatively robust. Milk that has been left unrefrigerated for less than 8 hours, or placed in the refrigerator for a day, is safe to use and retains a good portion of its nutritional value. Moreover, it appears that unpasteurized milk that has been accidentally thawed remains safe to use provided it has not been left too long in an unthawed condition. Based on these data, it appears that unpasteurized milk that has thawed in the refrigerator for up to 8 hours may be safely refrozen. Moreover, this data would seem to support the use of frozen milk to which fresh milk has been added and then refrozen. This should allow for more convenient storage and for the salvage of milk that mothers might otherwise have been told to discard.

 Rechtman DJ, Lee ML and Berg H. Effect of environmental conditions on unpasteurized donor human milk. Breastfeeding Medicine. Spring, 2006;  1(1): 24-26.

So it looks like thawed milk CAN be refrozen if necessary.

Let’s keep in mind that breastmilk is a living fluid, and is full of live cells and active immune factors and enzymes which can be, and are, damaged in the freezing process.  The BEST way to have breastmilk is fresh.  That is when the nutritional content is at its highest.  The more we change the temperature the more we denature the proteins, and we lose some of those important qualities.  You might consider leaving out the milk that would be used in the next 24 hours, then re-freezing the rest.

*** Keep in mind that this is to be used for emergency situations, not on a regular basis.  Since you don’t pump in a laboratory you may want to make sure the milk passes the sniff test before feeding it to the baby.  Breastmilk that is bad will smell BAD and you will know.  If it smells fine, it likely is.

Some tips to maximize the length of time your milk will stay frozen & safe -

1. Store milk in the center of a full chest/deep freezer. To help fill the freezer you can fill plastic bags or containers with water and freeze them into ice.

2. Group bags of milk into plastic container or larger bags to avoid leaking in case of defrost.

3. Avoid opening the freezer, this will allow warm/room temperature air in and speed up the thaw process.

4. Dry Ice can be added to the freezer to keep milk frozen for extended periods of time – More info can be found here.

5. Feed your baby directly from the breast as often as possible during the power outage, and avoid using the frozen milk when proper heating isn’t possible.

Stay safe and warm, and enjoy some downtime with your little ones.

*** This article was first posted on Stylin' Momma

Toddler Nursing and How it Helped Me Manage My Circus – Pt I.

Written by guest blogger, Andrea J. Blanco, IBCLC

When my first son was a baby, he absolutely hated car rides. On a trip to the bookstore, I came across Dr. Seuss’ “All Aboard the Circus McGurkus!.” I read that book to him every day and soon came to find the only thing to keep him calm during those car rides was my reciting lines from the book.

“The Circus McGurkus, the World’s Greatest Show. On the face of the Earth or wherever you go…” 

My son is seven now and I still remember most of the lines. So, when I asked a group of moms to give me one word to describe toddler nursing in preparation for this post, imagine my delight in realizing their answers could fit right into our beloved book:

“Amazing. Demanding. A Haven. Stupendous.”

“Loving. Convenient. Tantrum Fixer. Endless.”

Ok, so maybe no one said “stupendous”. But, you get the idea.

If you are the mom of a newborn, the mere thought of nursing a toddler probably seems really daunting, and my advice to you is the same advice I give to my clients: Take it one day at a time. Nursing isn’t a race and the person who goes the longest doesn’t win or lose. This is about your personal journey with YOUR baby and doing anything other than taking it day by day is rushing an already hurried adventure.

My son was ten months old when I first realized maybe I would nurse him past a year. I remember thinking there probably wasn’t going to be some alarm that went off to tell him (or me) that he was supposed to be finished with nursing because it was his 1st birthday. I remember feeling like maybe, in my heart of hearts, we would continue. And we did, but not without some questions.

Is it “ok” to nurse into toddlerhood? 

There are myths out there that after a certain age (I’ve heard as young as 4 months), your breastmilk loses all value and *poof* you’re making water. This couldn’t be further from the truth. Yes, by the toddler years, your baby will be able to eat a wide variety of foods, but your breastmilk is still perfectly suited for his growing needs. In this second year of life, your breastmilk’s most important role takes center stage: continuing to support an immature immune system. It is the ultimate immune booster and is packed with tailor-made antibodies to help your toddler fight off all those germs she’s picking up at the playground (“Sweetie! What is that in your mouth?!”) and on all those playdates (“No, honey, that is NOT your water bottle.”).

Will I still be nursing every 2-3 hours?!

For one whole year, you have been at your baby’s beck and call. You, sweet mommy, are AMAZING. Don’t let those words, which fit perfectly in a Dr. Seuss story, scare you! While some mothers find it’s easier at times to nurse when the toddler wants it (remember, “Tantrum Fixer” is also up there), you are now living with a busy little bee who is newly mobile and has time for a lot of things, but sitting still and nursing isn’t top priority. Consider yourself her pit stop. Discovering the new world is about the most fun thing ever, but being so independent is also frightening. No, you won’t be nursing for hours on end like you did when your baby was younger. Instead you will be her home base. You will be what grounds her and tells her that it’s ok to go explore. And you will be that sense of reassurance in the same way you have been for the last year – by nursing.

Why would anyone want to nurse a toddler?

Aside from the very real health benefits, nursing a toddler is like being Mary Poppins. Let’s face it – we aren’t dealing with the most reasonable age group. They want what they want when they want it and still aren’t verbal enough or patient enough to understand why that can’t always be. They have teeth coming in, separation anxiety, bumps and bruises all over, difficulty understanding why you don’t understand what they’re saying and their veryadamant point of view, timeouts to protest, physics experiments to practice [by flinging things across the room]. Nothing softens those blows like curling up on Mommy’s lap and taking in the scents, sounds and feelings of the familiar: Love. Whether you are at home with your children or working outside the home, the reconnection that happens when you take a break with your little one is incredible. Sometimes, we don’t have 30 minutes to try and solve the problem (and often times, reasoning with a toddler no matter how much time we have just doesn’t work). But, just like Mary Poppins, we too have a magic potion we’re able to use to our advantage. Breastfeeding in the time of the Toddler Meltdown is often all it takes to defuse the situation.

The Technical Stuff. Did you know that, along with many other health agencies, the American Academy of Pediatrics recommends nursing for a minimum of 1 year and “continuation of breastfeeding for as long as mutually desired by mother and baby”? The World Health Organization recommends breastfeeding for “up to 2 years or beyond.” And, while it may not be common in the United States, considering the natural age of weaning worldwide is somewhere between 2.5 to 7 years, nursing into toddlerhood is really just a part of normal nursing.

In his book, Dr. Seuss introduces us to the Juggling Jot, “who can juggle some stuff you might think he could not”. Now when I read the original, longer version to my sons (If I Ran the Circus), I’ll be inclined to think that maybe, just maybe, he was really talking about the mom of a toddler as that Juggling Jot (he does, after all, juggle 22 question marks, 44 commas and also 1 dot). I, for one, am so thankful I was able to continue nursing past one year. Juggling my life, plus the life of my toddler and my family, would have been much more challenging had I stopped.

Come visit me again for Part II of Toddler Nursing, where we’ll talk about what to do when you have little support, how your milk supply will change while nursing a toddler, and how to handle tricky situations, like nursing a toddler in public.

Andrea Blanco is an International Board Certified Lactation Consultant at The Milk Collective Lactation Care, working with families in the Miami/Ft. Lauderdale area. She is the proud mom of 2 loving, spirited boys, who teach her humility, patience, humor, and the rules to more sports than she thought she’d need to know every day. When she’s not helping families achieve their breastfeeding goals, you can find her on the sidelines, at karate tournaments, or with her toes in the sand. She can also be found at themilkcollective.co, on Instagram @themilkcollective_ , facebook.com/themilkcollectivelactation or by email at: andrea@themilkcollective.co.

Have you enjoyed nursing your toddler?  

What advice do YOU have for other moms who are thinking about breastfeeding into toddlerhood?

When a Toddler Bites While Nursing

Written by guest blogger, Leigh Anne O'Connor, IBCLC

Nursing a toddler is a confounding joy! He demands you sit. He does gymnastics and yoga while slurping your sweet nectar. Nursing is a great tool to calm a wild child or heal a skinned knee or a broken heart. These little people are growing rapidly. One day they are crawling, the next they are waddling toward the stairs or the dog food dish.  One day they mumble “mama” and “gaga” and then they learn the power of “NO!!” 

Another big change going on in the little body is the mouth – teeth are multiplying like bunnies in there. If a baby is latched correctly, his teeth are covered by his tongue.  Ah, but the older nursling has teeth on top and bottom! Yikes! As he is feeling those incisors pushing through his flesh nothing will sooth that sensation like biting down on something nice – like a breast!  Ouch! 

So, what is a mother to do?

Just as when a baby of any age bites the hand, (or breast that feeds him), the thing to do is not scream,  “ You little demon, you nearly amputated my breast!” Nor is it to cry out and run weeping into the streets or punt him across the room – though these ideas may make sense at the time. You take the little chomper off your breast and calmly, but firmly, tell him “No, you may not nurse if you bite.” Put him down off your lap and remain as emotionally neutral as you have it in you to be. This should neither be a game nor a horrifying experience. Biting is simply an unacceptable behavior.  After a brief period of being ignored he will either go on about his business or he may plead to have more sweet milk.  If you do offer the breast again tell him in no uncertain terms, “If you bite me again, you may not “nonnie” (or whatever word you use to nurse) again.” I do not mean forever – just at this time of the day.   A time or two like this should tame your little piranha.

Another reason toddlers bite is if they have a cold and cannot breathe so well while nursing. Some saline spray or nursing in a steamy bathroom or bedroom with a humidifier can help open up those little nasal passages.  

Some moms say that her baby bites if she is pregnant or if her milk supply is low (which can be caused by being pregnant). I cannot count how many women have called me to discuss their newly biting toddler. We run through the list of possibilities.

“Are you pregnant?” I ask.

I can almost see through the phone the look of surprised possibility on her face.

“Well, I don’t know. I don’t think so. Well, maybe. I gotta go now!”  

A couple days later my phone rings. “You were right! I am pregnant!” She had run to the drug store to buy a pregnancy test.

If your baby really chomps down hard you can hold him tight to you so that he is forced to open his mouth. Another approach is to put your finger in his mouth   between the teeth and break the latch.

Many moms think this is a time to wean. It can be scary. And, if you talk about it you can be led to believe that this is a sure sign to wean. It is just a stage that some – not all, I promise – toddlers go through.

As you negotiate your way, nursing an older baby in a world where most babies are weaned by their first birthday, you step lightly in your discussions with other mothers. Sometimes you find you are part of a secret society. You find these other mothers who nurse their toddlers and you laugh together at the antics and the sweetness of nursing a talking, opinionated human. You share your battle scars, which can sometimes be teeth marks on your areola.

Here are a few other great articles about how to deal with a toddler who bites while nursing:

Teething and Biting by Anne Smith, IBCLC

Nursing a Teething Toddler by LLLI

Here is some advice from our Facebook readers:

Marie: A firm no and gentle tap on his cheek usually disctracted him.  If he continued to bite, then we stopped nursing for a minute.  If he was done, he’d go and play.  If he still wanted to nurse, I would try again.  A third bite meant we were done.  Also, I would use phrases he understood like, ”Biting gives Mommy owies.  We do not bite.”

Chloe: We have one serious bite at 8 months.  It was at the zoo.  I had to unlatch him and leave him with a friend to go to the restroom and deal with the blood.  That was traumatic enough that he didn’t do it again.  Sometimes he gets a little wild while nursing if something strikes him as funny, but he calms right down if I unlatch him for a minute.

What tips do you have for a mother whose toddler is biting while nursing?

Leigh Anne O'Connor is Lactation Consultant in Private Practice in New York City, as well as a La Leche League Leader. Her blog is Mama Milk and Me.  She lives with her husband, Rob, and their three children, Phoebe, Chloe & Finn.