Breastfeeding Truly Takes a Village!

A few months ago, we sent out a Call for Breastfeeding Stories.  Our desire was to flood the Internet with beautiful breastfeeding stories of triumph, overcoming challenges and struggles, and positive outcomes, regardless of the total amount of milk a mom was producing.  We are thrilled to share these stories with you, our readers, and hope that they offer support and inspiration for you, wherever you are in your breastfeeding journey. 

Thank you to all of the mothers who submitted their stories!  If after you read these memoirs you are inspired to submit your story, feel free to send it to RobinKaplan@sdbfc.com.    

This Breastfeeding Memoir is from Natalie

Before my son was even born, I knew I wanted to breastfeed him. I attended multiple classes on breastfeeding, stocked up on nursing pads, nipple butter, and felt as prepared as I could be prior to his arrival. After a precipitous labor/delivery, he ended up being born in front of the hospital! One benefit was that I got to hold him immediately, so we had lots of skin to skin time which was emphasized in the classes. We tried breastfeeding within one hour of his birth, and he immediately latched! We had a lactation consultant visit at the hospital, and she said everything looked great! I even scheduled my first lactation appointment at SD Breastfeeding Center when my son was 4 days old. We weren't having issues, but I quickly learned that breastfeeding my son was way different than the practice doll we used in the class! During that visit, I learned my son had lip and tongue ties. Nobody else evaluated him for these, but being tongue tied myself it didn't come as much of a surprise. Fortunately, he was transferring well and the ties did not seem to be interfering with his feeding.

Fast forward 2 weeks, and my son was not at his birth weight. He was feeding for over an hour, falling asleep, and seemed very irritable and unhappy. As a new mom, I assumed this was normal. I pushed on for another week and then decided to schedule another visit with the LC for an evaluation. There, I did a weighted feed and learned that he wasn't transferring effectively. The LC explained how he was being restricted by his lip and tongue ties, and this could potentially decrease my supply. She recommended I consider a release of his ties, so I immediately called a provider and had them addressed the next day.

I read how many mothers noticed instant results and symptom relief post release. I didn't notice immediate results, but was confident that things would improve over the next few weeks. When they didn't, I followed up with Melanie, our LC. She assessed him and noticed that he still seemed restricted, wasn't transferring adequately, and recommended we take him for body work. Due to his poor weight gain (6 oz in 2 weeks) she taught me how to use my breast pump and implement an SNS (supplemental nursing system). She also recommended a galactagogue supplement. Things weren't moving in the direction I wanted, but I was committed to do everything I could to continue breastfeeding.

At this point, I was feeling very defeated and inadequate. I felt like I was doing everything I could, and was so sad that my little baby was not growing at the rate he should. My pregnancy and delivery were so natural and without issue that I naively thought breastfeeding would follow. I called my sister in law, who happens to be a breastfeeding mother.  She immediately came over with galactagogue-rich foods and tea, and even pumped for my son while I built up my supply!

After additional LC visits, support groups, and the implementation of bodywork, I made the decision to have a second release for my son. Even though we are still post op and performing stretches, I already am seeing results. My son is happier, and I no longer have to use the SNS system. I have a nice freezer stash of my milk, and he is thriving with weight gain. He's not even three months old, so I don't know how this journey will end. I do know, however, that I'll do everything I can to preserve our nursing relationship. Without the help of multiple providers, I'm not sure where we would be. "It takes a village" is such an appropriate phrase for this season of my life. I am so thankful to live in a community that has SO much support for breastfeeding mothers.

Breastfeeding After Breast Reduction - A Memoir

A few months ago, we sent out a Call for Breastfeeding Stories.  Our desire was to flood the Internet with beautiful breastfeeding stories of triumph, overcoming challenges and struggles, and positive outcomes, regardless of the total amount of milk a mom was producing.  We are thrilled to share these stories with you, our readers, and hope that they offer support and inspiration for you, wherever you are in your breastfeeding journey. 

Thank you to all of the mothers who submitted their stories!  If after you read these memoirs you are inspired to submit your story, feel free to send it to RobinKaplan@sdbfc.com.    

_____

This breastfeeding memoir is from Jenna

Ten years ago, eighteen-year-old Jenna was bouncing between San Diego and Los Angeles counties looking for a plastic surgeon. They had to be willing to do a keyhole incision and leave my nipple attached while they performed a bilateral breast reduction. I was a senior in high school and had my breast reduction surgery during spring break. 

Fast forward six years. I find out I'm pregnant the day my boyfriend gets to Djibouti, Africa, where he'll be deployed for the next 7 months. I sought out a natural birth provider in my network after reading the book, Defining your Own Success: Breastfeeding After Breast Reduction Surgery by Diana West. In this book, it encouraged mothers to birth as naturally as possible for the best chance at breastfeeding after a reduction and this book had become like a Bible for me, so I followed its every recommendation. After finding midwives, a doula and a baby-friendly hospital, I looked for an IBCLC and a Breastfeeding 101 class. I knew I needed to be prepared or I would succumb to all of the "boobie traps" within the first few days. My daughter was born on the much later end of normal, well past 42 weeks, was 9lbs 11oz at birth, and was born with a tongue tie and upper lip tie. I was given hell at the hospital for not wanting to give her formula, after requesting several times to be seen by the in-house IBCLC. The nurses and pediatricians said they'd never seen a mother be able to exclusively breastfeed after a reduction and feared that I wouldn't feed my baby because of my determination to nurse. 

At 6 weeks old, my daughter was diagnosed with life-threatening food allergies making even allergen-free, prescription-only formula not an option. The first six weeks I pumped after every feeding.  My husband spoon-fed, finger-fed, syringe-fed, cup-fed, & I used an SNS. At our 2 month pediatrician appointment, our doctor told me to quit trying and that what we were doing wasn't sustainable. I sought out chiropractic care, craniosacral therapy, multiple tongue tie revisions, continuous IBCLC care, breastfeeding support groups, homeopathic remedies, acupuncture, removed all allergens from my diet, quit my job, and somehow decided, breastfeeding was worth it all. From eight weeks old, we exclusively nursed through recurring tongue ties, vasospasms, low milk supply, mastitis, severe food allergies, thrush, and an abscess, for over 3 years, through a pregnancy and tandem nursing for a year and a half. Her younger sister is 28 months and we don't see an end in sight. 

We Were Not Meant to Mother Alone

A few months ago, we sent out a Call for Breastfeeding Stories.  Our desire was to flood the Internet with beautiful breastfeeding stories of triumph, overcoming challenges and struggles, and positive outcomes, regardless of the total amount of milk a mom was producing.  We are thrilled to share these stories with you, our readers, and hope that they offer support and inspiration for you, wherever you are in your breastfeeding journey. 

Thank you to all of the mothers who submitted their stories!  If after you read these memoirs you are inspired to submit your story, feel free to send it to RobinKaplan@sdbfc.com.    

_____

Our first breastfeeding memoir is from Michelle

I booked at least 2 vacations for my maternity leave, all on airplanes. I was going to wear my baby everywhere, nursing her as we went along. I had the organic breast pads purchased, all the nursing tanks, and the most breastfeeding-friendly bottles, but of course I wouldn’t need those for at least several months. I would see Mamas nursing their babes at the beach and I would find myself staring as I daydreamed about my nursling that was to come. December 2013, my sweet baby girl arrived.  She latched and we were a nursing team. 24hrs later I was told she was Coombs positive and her jaundice levels were high. She was sleepy, was losing too much weight and I needed to give her formula in a bottle. I cried lots of tears. "FORMULA? No way!", but I had no other options. Every time I fed her, and I wouldn’t let anyone else feed her.  I felt awful and felt like I was letting her down. 7 days later I was told, "your daughter is failure to thrive". Queue more tears, more formula, more guilt, and not a lot of milk being produced from me. 

Over the next month, my journey consisted of doctors’ visits, pumping 8x a day, a baby screaming at the breast due to bottle preference and low supply, tube feeding, domperidone, and yet my milk never fully came in. 5 weeks in, a friend asked me to go to a breastfeeding support group.  I went and hoped no one would notice me feeding formula to my sweet baby who wouldn't latch more than 5 minutes. Everyone noticed, yet no one judged me. 

3 months in, at the Breastfeeding Support group that I now attended weekly, a Mama who I hardly knew asked if I wanted her to pump for me, and then another offered to help, as well. This would begin my donor milk journey, and a mental shift in my head that allowed me to stop seeing what I wasn't capable of, and start enjoying the beauty that came from a community that would end up feeding both of my babes! I threw away my pumping and tube feeding schedule right along with the lies that told me I wasn't enough because I couldn't get my body to do what I needed to do to fully feed my baby. We kept nursing as much as possible until 10 months and she got half formula and half donor milk. 

A few months later, I was pregnant with my son. After my prenatal appointment at the San Diego Breastfeeding Center, I got permission from my doctor to start hand expressing at 37 weeks to collect colostrum to give my baby in the hospital through syringe feeding at the breast to help flush any jaundice he would have since he would be Coombs positive, as well. I started to collect donor milk and I had a community that donated enough breastmilk to supply him 9 full months as I only provided him about 30% of his needs with my own supply. He was born and I had a tiny bit more milk and a lot more confidence. I knew that no matter what, a nourished baby is a loved baby. I knew now that if I needed to give formula, I wasn't less of a mother.  If I fed my baby pumped milk, donated milk, only could nurse a few times a day, used a cover, didn't use a cover, nursed for 3 months or nursed for 3 years, no matter what, I WAS ENOUGH. Even after a 6 day stay in the hospital for his Coombs, a tongue and lip tie revision, and a micro supply, we nursed for 10 months with donor milk through the SNS tube feeding at the breast. We then fed formula in a bottle and nursed as often as he wanted. He nursed until 16 months. 

Today I am working towards my IBCLC, because of the non-judgmental support I received from the San Diego Breastfeeding Center community. They didn't sprinkle magic fairy breastfeeding dust on me that fixed all issues, but they gave me a plan that was doable. They gave me tools to accomplish the goals I set for myself.  They gave me hope and they provided me with a community that was there to cheer me on. When I think about my breastfeeding journey, it is less about feeding my children, and more about the discovery that we Mamas cannot mother alone; we were never intended to do so. It takes a village to raise a baby, and for me, it took a village to feed mine. I am forever grateful. 

Introducing the Top 8 Allergens to Infants

Written by Rachel Rothman, MS, RD, CLEC

A frequent question I encounter in my practice and in my Introduction to Solids classes, is how to introduce foods that may be allergenic to babies.  The last 15 years have brought significant attention to allergens, and most parents are now keenly aware of the risks.  However, a drumbeat of new research published on the causes of allergies and allergy prevention has brought new strategies to light and debunked old myths. Until 2008, the American Association of Pediatrics recommended that parents delay exposing infants to certain allergens until after one year of age. The guideline changed because after a review of research and patient outcomes, there was no evidence for waiting. I help many moms and dads make sense of this new world, as they are understandably cautious about what this all means for their child.

 

What are the top 8?

The “top eight allergens” are: cow’s milk, eggs, peanuts, tree nuts, fish, shellfish, soy and wheat.  These foods are associated with the eight most common food allergies, though it is possible for an allergy to occur with any food. 

So when can I introduce these foods?

Most pediatricians will tell you that you can begin to introduce these foods soon after starting solids. I usually recommend starting solids with foods not on the top 8 list, and getting 1-2 months of solids before introducing any of these more common allergens, just to note whether baby has any reactions to other foods.  That might mean you begin to offer the 'top 8' foods around 7-9 months of age.  And if your child is at a higher risk for food allergies, consult with your pediatrician.

When offering one of the top 8 allergens, it will be easiest if you only introduce one at a time, and that you observe and note any changes in baby in the first minutes, hours, or days.  If all goes well, wait a few days before offering another new food so you’ll be able to isolate any food that may be causing an issue.  If you’re concerned that something seems different, consult your pediatrician.

Let’s break down each of the allergens and discuss some ways to introduce:

Cow’s milk: Most of us have heard, no cow’s milk before one year of age.  This refers to the fact that cow’s milk should not be a replacement for breast milk or formula before the first year.  Why?  Cow’s milk has different nutrient properties than breast milk/ formula, primarily a higher proportion of protein and lower amount of fats and carbohydrates, including some differences in vitamins and minerals.  Breast milk contains the perfect proportion of all nutrients.  Cow’s milk should not be used as a replacement for breastmilk or formula. But, cow’s milk can be used in recipes, like soups, baked goods, or other foods before the first year.  Some families choose not to introduce cow’s milk, which is fine too.  This is a hot topic, so stay tuned for a post dedicated to the dairy debate!

Eggs:  Eggs are a staple in my house for my daughter, my husband, and myself.   It was previously thought to hold off on egg whites before one year of age, but like the recommendations for allergens, most pediatricians say you can introduce whole egg soon after starting solids- just be sure the egg is thoroughly cooked!  I love eggs as a finger food- they are so nutritious, and easy for baby to pick up and eat relatively early on.  Making an egg and vegetable scramble or frittata is a great way to include vegetables in baby’s breakfast as well.

Two-ingredient egg and banana pancakes: easy for baby to eat!
 

Peanuts and Tree nuts:  These are among the most highly allergenic foods, so be sure to monitor for reactions when introducing peanuts and tree nuts.  Keep in mind that whole nuts are a choking hazard for children until about 4 years of age.  When introducing nuts, try spreading a thin amount of nut butter on a piece of bread, mixing a bit of peanut butter into oatmeal or putting a very small amount of nut butter on a spoon (too large of a scoop can be a choking hazard, as well).  If your baby loves peanut butter as much as mine did, she’ll be well on her way to learning how to use a spoon!

Fish: Fish is great food for babies because of all of the nutrient benefits- just be sure fish is thoroughly cooked. Fatty fish is an excellent source of omega-3 fatty acids (specifically DHA) which baby needs for brain growth, especially under 2 years of age.  You will want to choose a fish type that is lower in mercury (some fish to avoid include King mackerel, marlin, orange roughy, shark, swordfish, tilefish, ahi tuna, and bigeye tuna).  The EPA has this great guide which lists the mercury content and sustainability level of many types of seafood. Flaked salmon can be a great finger food (or even mashed with avocado or sweet potato), or try making crab cakes or tilapia cakes.

A bit of flaked salmon, sautéed zucchini rounds and potato wedges – a perfect dinner for a 9 month old!
 

Soy: Some pediatricians do recommend waiting to introduce soy until baby is tolerating other foods.  If your baby has already been diagnosed with a soy allergy, you will want to speak with your pediatrician on it’s introduction, and keep in mind many packaged foods contain soy-based ingredients.  Baked or sautéed tofu can be a great finger food, or try adding tofu into lasagna in place of ricotta cheese.  You may want to wait until baby is about 9 or so months of age before introducing soy.

Wheat: Research and opinions are mixed on the introduction of wheat.  Many pediatricians recommend waiting on introducing wheat until other grains have been introduced (like oats, rice, or barley) to see if baby has any reaction to grains.  Wheat does contain gluten, and some babies might have a gluten intolerance or sensitivity, but note this will be different than a true wheat allergy. 

And again, always follow your pediatrician’s recommendations and speak with your pediatrician if food allergies run in your family, as the recommendations may be different.  Families of babies that have a history of an allergic condition, including a food allergy, asthma, allergic rhinitis or eczema, should absolutely speak with their pediatrician before offering any of these foods. 

Want to learn more about introducing solid food to your little one?  Join me at the San Diego Breastfeeding Center for my next introduction to solids class on January 28th at 10:00-11:30am. Learn more here

Rachel Rothman, MS, RD, CLEC is a mom, pediatric dietitian, and instructor at the San Diego Breastfeeding Center.  Rachel specializes in working with children and families.  She lives in San Diego with her husband, Ben, and daughter, Sydney.  You can contact Rachel here.

References:

Introduction of Solids and Allergic Reactions. (2009, December 7). Retrieved from https://www.aap.org/en-us/about-the-aap/aap-press-room/pages/Introduction-of-Solid-Foods-and-Allergic-Reactions.aspx

Fliescher, D. M. (2013, January 28). Early introduction of allergenic foods may prevent food allergy in children. Retrieved from https://www.aappublications.org/

Greer, F. R., Sicherer, S. H., & Burks, A. W. (2008, January). Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children: The Role of Maternal Dietary Restriction, Breastfeeding, Timing of Introduction of Complementary Foods, and Hydrolyzed Formulas. Retrieved from http://pediatrics.aappublications.org/content/121/1/183

Age-appropriate Portions for Toddlers (and Moms)

This post is by Rachel Rothman, MS, RD, and is the third post in the three-part blog series about introducing solids to your little one.  Rachel is a mom to a toddler, a pediatric dietitian and instructor of “Introduction to Solids” and “Nutrition for Toddlers and Preschoolers” at the San Diego Breastfeeding Center.  Join us for the next Nutrition for Toddlers and Preschoolers class on October 29th at 10:00am.  More information and registration can be found here.

In case you missed it, I discussed the feeding relationship in my previous two posts, and these may be summarized using the division of responsibility. Parents are responsible for the “what, when, and where of feeding; children are responsible for the how much and whether of eating” [1].  In this third post we discuss age appropriate serving sizes – however, as with all nutrition advice, sustainably learning the behaviors associated with this division of responsibility will be as important, if not more influential, than simply choosing specific serving size, as all of our young ones progress at slightly different paces and individual ways.

Most of the food we eat- and the nutrient measurements we rely on – use the idea of serving sizes. But what does a serving look like?

Adults struggle with this because it’s hard to learn at home, and when we eat out, it’s nearly impossible to get consistent feedback.  As children, most parents did not learn to react this way, and an age of abundant and convenient food has limited the effects of our natural impulses.  

When we feed our children, many parents second-guess themselves and their children’s eating behaviors.  Is my child eating enough?  Is my child eating too much?  Here are some helpful guidelines when it comes to your children and serving sizes, starting from the beginning, when first introducing solids.

Tips and guidelines when thinking about the appropriate serving size for your infant and toddler:

- Around 6-7 months, as your baby is first starting solids, it’s important to remember serving sizes are very small.  If you are offering purees, you will want to start by offering 1-2 teaspoons, keeping in mind initially your baby may not take more than a small taste.  You will most likely be advancing to 1-3 tablespoons as your baby moves toward 7-8 months.

- From 6 months to around 1 year, breast milk or a breastmilk substitute should still make up the majority of your baby’s calorie intake.  Offer breast milk or a breastmilk substitute before solids, especially when starting out. 

- All babies are different.  Some babies love solids right off the bat and may take more than 2-3 tablespoons.  That’s okay!  It may take other babies some time to begin their solid intake and they may refuse for a while.  That’s okay, too! The important thing is to continue to offer solids, but let your child decide whether he/she wants to eat.

A typical toddler breakfast: 2-3 tablespoons of yogurt, 1/4 cup fruit and 2-3 small pancakes (and it’s okay if they don’t finish the whole thing!).

-Around 8-11 months your baby continues to grow, so does his/her appetite.  Solid intake may increase, but not by much.  A full day’s worth of solids might be: ¼ cup of fruit, ¼ cup vegetables, 1-3 tablespoons protein and ¼ cup whole grains.  A serving of vegetables, however, may still be closer to 2-3 tablespoons.  

- After one year of age, baby’s growth slows (most babies triple their birth weight over the first year!).  With a decrease in growth rate may also come a decrease in appetite.  Do not be alarmed if intake decreases after one year of age.  It’s most important to monitor your baby’s weight gain and growth. 

Snacks and lunch packed for daycare: 1/2 peanut butter and jelly sandwich, blueberries, oat and spinach muffin, string cheese and nectarine slices.

Additionally, after one year of age, your toddler may be eating more meals and snacks throughout the day.  When thinking about meals and snacks to serve, try to offer something from each food group.  Meals should consist of a fruit or vegetable, carbohydrate and protein, while a snack might consist of a fruit and vegetable and a carbohydrate. Don’t be afraid to think outside the box and try new things.   One of my daughter’s favorite on the go snacks is a mix of chick peas and green peas;  a combination of protein and carbohydrates with a healthy mix of vitamins and minerals.  

Stay positive! Picky eating behaviors often develop during this time and can persist as a phase many healthy kids go through.  If you stay positive and dedicated to offering a broad variety of healthy, whole foods, you have the best chance of continuing to nourish your little one while accommodating their tastes and preferences.

To learn more about introducing solids to your little one, join me at the SDBFC in one of my Introduction to Solidsor Nutrition for Toddlers and Preschoolers classes.  More information can be found here.

[1] Satter, Ellen M.,  Child of Mine: Feeding With Love and Good Sense, Bull Publishing Company; Revised edition (March 1, 2000) http://www.amazon.com/Child-Mine-Feeding-Revised-Updated/dp/0923521518 

Rachel Rothman, MS, RD is a mom, pediatric dietitian, and instructor at the San Diego Breastfeeding Center.  She lives in San Diego with her husband Ben and daughter Sydney. 

Understanding Infant Sleep - 6 weeks to 4 months

In our previous sleep article, we discussed normal sleep patterns and realistic sleep expectations for infants up to 6 weeks.  By the time we hit 6 weeks, our children have gone through so many developmental changes, including what shapes their sleep patterns.  What do these patterns look like now and when will you start to actually get some sleep?  

What does research tell us about sleep patterns for 6 week - 4 month old infants?

• Babies this age still receive about a ⅓ of their food during the middle of the night.

• Between 6 weeks and 4 months, babies begin ‘sleep consolidation’, which means that they start to combine 2 or more sleep cycles together without waking in between.

• Babies at the age tend to falls asleep more easily after eating in the middle of the night, which is a welcomed trend after the first 6 weeks of your child wanting to party after each meal in the middle of the night.

Take home message:  Your baby is still going to wake up in the middle of the night to feed, but he/she should be able to fall back asleep much more quickly after eating.  This means less walking around the house, singing lullabyes at 3am.  Whoo hoo!

What does science tell us about how babies sleep at this age?

• 6-12 week old babies still fall asleep in active sleep, i.e. dreaming, hence the eye movements, silly smiles, and sporadic arm movements. However, active sleep time becomes shorter and shorter at the beginning of the sleep cycle, which means you may only have to wait a few minutes before you can put your baby down without waking him/her.

• A baby’s circadian rhythm is settling in now, which means deeper sleep at night, with less jarring movements, allowing baby to stay asleep much more easily.

• 12-16 week old babies now fall asleep in quiet sleep, similar to adults. This means that your baby doesn’t fall asleep dreaming (REM), but rather begins to drift to sleep and stay asleep.

• Patterns vary from baby to baby, therefore it is not a lack of parenting skills if your baby is still waking every 2-3 hours in the middle of the night. It is important to remember that every baby is different and has different needs.

Take home message:  Your baby is going to start to fall asleep and stay asleep more easily.  His/her days and nights will no longer be mixed up and he/she will start to fall into a deeper sleep in the middle of the night.

What are common sleep patterns for a 6 week to 4 month old baby?

• Daytime naps are still sporadic and frequent. Some babies fall asleep right after eating, while others are awake after eating and then fall asleep after some alert time.

• Daytime naps can range from 20 minutes to several hours, while some of the longest naps can take place while you are out and about.

• Babies love to nap while being worn or out on a walk. The fresh air seems to lull them to sleep.

• Evening sleep will be all over the place, especially during the ‘witching hour.’ What this will most likely look like is eat, sleep for 20 minutes, eat, sleep for 20 minutes, and repeat for a few hours. Here are some great ways to survive the witching hour!

• Nighttime sleep is starting to get better. Your baby might have one longer chunk of sleep for the first half of the night (for example, like a 4-5 hour stretch between 8pm and 1am). Then your baby might continue to wake every 2-4 hours after that. Remember, your baby’s stomach is still really small and this frequent waking in the middle of the night is protective against SIDS.

Take home message: Babies at this age still have fairly unpredictable sleep patterns. Since your baby may start to sleep longer in the beginning of the night, you might consider going to bed earlier than usual, to take advantage of this long stretch of sleep.

What are some tips for parents to get more sleep?

• Mastering the sidelying position can be a game changer. Your baby is much sturdier than he/she used to be, therefore sidelying can be much easier and comfortable now, for both of you.

• Look into safe co-sleeping guidelines, as research has shown that families who safely co-sleep or bedshare get more sleep than those whose babies sleep in a different room.

• If you are uncomfortable with bedsharing for the whole night, consider setting your alarm for 20 minutes, while nursing in the sidelying position in bed. Then, if you end up falling asleep, your quiet alarm will wake you and then you can place your baby in his/her own bed, bassinet, or sidecar.

• Try what the authors of Sweet Sleep call ‘Front Loading:’ do more work early in the day and start to unwind earlier in the evening.  If you can unwind earlier, that means you can fall asleep earlier and easier, as well.  Check out this Huffington Post article about 15 Science-Backed Ways to Falls Asleep Faster

Resources for evidence-based info about normal infant sleep:

http://www.secretsofbabybehavior.com/2010/04/science-of-infant-sleep-part-ii-big.html

http://www.amazon.com/Sweet-Sleep-Nighttime-Strategies-Breastfeeding/dp/0345518470

https://www.psychologytoday.com/blog/moral-landscapes/201302/normal-human-infant-sleep-feeding-method-and-development

Breastfeeding the Older Baby: 12-18 Months

Written by Anna Choi, BS, IBCLC

Thank you for joining us for our third and final article in our blog series, Breastfeeding the Older Baby – What to Expect and How to Adjust. I’ve enjoyed writing these articles, as we have explored the evolving breastfeeding relationship between mama and baby, and I hope to have provided some insight for you about what this evolution might look like for you and your little one. In this final article, we will look at months 12 through 18 of your toddler’s life.

PHOTO CREDIT CHRIS WOJDAK

How often do toddlers breastfeed?

This answer varies greatly from one toddler to the next. Some mothers and nurslings have slowly decreased the number of breastfeeding sessions they have each day and may find that at this age, their toddler is breastfeeding as little as once or twice a day. Others may have a toddler who nurses like a newborn and goes to breast frequently throughout the day, nursing as many as 10 or more times in 24 hours. What’s important to remember is that there is no one “right” way to nurse a toddler and no magic number for how many times each day your toddler should or shouldn’t nurse. As long as mama and baby are happy with their nursing relationship and have found a rhythm and balance that works for them, then breastfeeding is going well.

Now that my little one has celebrated his/her first birthday, do I need to introduce cow’s milk or another milk alternative?

Such a great question – and one that we find ourselves answering frequently! In order to provide you with the most educated answer to this question, I enlisted the help of one of San Diego Breastfeeding Center’s favorite Registered Dieticians, Rachel Rothman. Here is what Rachel had to say:

Cow's milk is a good source of fat, protein, calcium and vitamin D, though it is not the only potential source of such nutrition. As infants become toddlers, many pediatricians make the recommendation to start baby on cow’s milk in order to meet baby’s specific nutrient needs.   If your baby is consuming a sufficient amount of these nutrients (in other forms), there is no reason he/she needs cow's milk or an alternate milk source.   One note I always give to my patients is that for children up to at least 2 years of age it’s advisable to give them full-fat / whole milk dairy products (cheese, yogurt, or milk) to ensure they receive enough fat to satisfy their needs. Keep in mind -  breast milk is an excellent source of fat and other nutrients.

- Rachel Rothman, MS. RD

If you find yourself having further questions about your little one’s diet, I encourage you to reach out to Rachel, as she possesses a wonderful wealth of information on nutrition {http://rachelrothman.com}.

I’ve reached my goal of breastfeeding for one year and I am ready to wean, what is the best method?

Congratulations on reaching your goal! If you are ready to wean from breastfeeding, there are several methods to choose from. Weaning gradually often makes for the smoothest transition for you and your little one {and your breasts!}. To start the weaning process, choose one breastfeeding session and replace it with something else {such as previously pumped breastmilk, water, solid food, etc}. After a few days, you’ll choose another breastfeeding session to replace with something else, and so on. Usually the nursing sessions before naps and bedtime are the hardest to wean from, and therefore the last to go. Your little one will appreciate extra snuggles as they adjust to this big change in their life. Depending on the temperament of your child, and how often they are currently nursing, the weaning process may take a few weeks or a few months. If you’d like more information on weaning, check out this link to a previous blog series all aboutweaning an older child

Can I stop pumping at work and continue to breastfeed when I’m with my toddler?

Absolutely! As a working mom myself, I was eager to put away the pump after my little one turned one year old. I knew I’d miss that lovely womp womp womp sound and getting undressed and redressed in the middle of my workday, but figured I’d somehow survive. How soon you can stop pumping at work will depend on your work schedule, baby’s solid food intake, and what you have decided baby will consume in place of the pumped breastmilk you’ve been supplying. If you stop pumping at work and continue to breastfeed your toddler when you are with them, your supply should adjust to meet the needs of this new routine. Some moms find that their supply decreases as a result, but this usually isn’t a huge concern since your toddler should be eating plenty of table foods at this point. If you decide to stop pumping at work, remember to drop pumping sessions and reduce the amount of time spent pumping gradually, to reduce your risk of engorgement and plugged ducts.

 

How do I handle unsolicited advice about my toddler being “too old to breastfeed?”

The short answer is, don’t feel the need to defend yourself. When someone makes a comment about your toddler breastfeeding, simply say, “We are doing what’s best for our family. Thank you.” And then, walk away.

If you’d like to get a little more detailed with your response, or perhaps provide some breastfeeding education to the person, you can reference the American Academy of Pediatrics and the World Health Organization’s recommendations, which advocate continued breastfeeding past twelve months of age. You can also let them know that nursing toddlers are generally sick less often and have fewer allergies than non-breastfeeding toddlers.

What did breastfeeding look like for YOU during months 12-18?

Understanding Infant Sleep - The First 6 Weeks

“I slept like a baby”  

When I hear this saying, I immediately envision sleeping deeply, soundly, and for 10 hours straight.  Whoever came up with that saying clearly didn’t have children!  All of the babies I know definitely do not sleep soundly for an extended period of time until at least toddlerhood… and even then sleep can be disrupted by teething, colds, and just regular night waking. With current infant sleep recommendations stating that babies should learn to sleep on their own, all night, by 6 months, I have to wonder how much of this information is hearsay and old-wives’ tales and how much is evidence-based (using good research models). 

So, let’s break this down using the most current research.  

SOURCE: UNITED STATES BREASTFEEDING COMMITTEE

What does research tell us about infant sleep patterns?

Today I am going to discuss sleep patterns and behaviors for infants during the first 6 weeks.  I will continue to share information about sleep patterns for older babies throughout the next few weeks.

How much does a 0-6 week old newborn typically sleep in a 24 hour period?

• Newborns sleep in short spurts, both day and night.

• Most babies this age sleep between 9-19 hours over a 24 hour period (that’s a huge variation!)

• Newborns have extremely small stomachs, which means they need to eat small, frequent meals, at least 8-12 times per day (as a minimum).  These feeding sessions can take anywhere from 15 minutes to over an hour, on average.  

• Newborns eat about ⅓ of their food during the night.

• Some babies may take one longer stretch of sleep at the beginning of the night (maybe 4 hours), but then may spend more time eating throughout the rest of the night and day to make up for the food intake they missed while sleeping longer. 

Take home message: It is biologically and developmentally normal for your baby to sleep in only 1-3 hour increments during the first 6 weeks because they are unable to eat enough at a feeding session to go for longer.  

Why do newborns wake often?

• Besides having a small stomach capacity, newborns are hard-wired to wake frequently during the day and night.  This is one of the ways their bodies are protected from SIDS.

• Newborns’ sleep cycles are different than adults: when they fall asleep, they spend more time in active (REM) sleep rather than quiet sleep (which means they wake more easily), their temperature doesn’t drop in the middle of the night (which means that they cannot distinguish daytime from nighttime), and they have no circadian rhythm.

• Newborns are often unable to join multiple sleep cycles together.  This takes a few months for their bodies to figure out.  A newborn sleep cycle is 45 minutes long.  You might get two sleep cycles strung together for 90 minutes of uninterrupted sleep, but then they are right back up again.

Take home message: Babies are programmed to wake frequently and sleep lightly.  This is developmentally normal infant behavior.

What are realistic sleep expectations for your 0-6 week old newborn?

• Your baby’s sleep patterns are going to be all over the place.  Unpredictable. Some short spurts (20 minutes).  Some long spurts (3 hours).  This is normal and will become more predictable over time. 

• Your baby is going to wake frequently during the day and night until he/she develops a circadian rhythm around 3 months.  At 3 months, your baby may still wake frequently during the night, but will at least be able to fall back asleep fairly easily and quickly.

• Your baby is also going to eat all of the time.  This is what builds and maintains your milk supply.  This is also what helps your baby gain weight and grow.

• Sleep patterns will be disrupted during growth spurts.  Growth spurts happen around 2 weeks, 4 weeks, and 6 weeks.  What this means is that your baby will sleep less for a few days and want to eat more.  Once these growth spurts pass, your milk supply should be even more robust than before and your baby will slow back down to eating slightly less frequently.

What are some tips for parents feeling really overwhelmed and sleep deprived with baby’s frequent waking?

• Sometimes just knowing that these sleep patterns are normal and temporary makes the situation seem more manageable.  Remember, your baby will eventually start sleeping for longer chunks of time (which we will discuss in the next few articles)

• Have your baby sleep on someone’s chest while you take a nap.  Babies LOVE to sleep on an adult’s chest and usually sleep a bit more soundly and longer.  This is not spoiling your baby or creating a bad habit.  This is meeting your baby’s developmental need to be near others.

• Look into safe co-sleeping guidelines, as research has shown that families who safely co-sleep or bedshare get more sleep than those whose babies sleep in a different room. 

• Try what the authors of Sweet Sleep call ‘Front Loading:’ do more work early in the day and start to unwind earlier in the evening.  If you can unwind earlier, that means you can fall asleep earlier and easier, as well.  Check out this Huffington Post article about 15 Science-Backed Ways to Falls Asleep Faster

• Start filtering out the misinformation you receive from others about what they think your baby should be doing regarding sleeping and eating.  This will only create a situation where you think there is a sleeping problem, when in actuality your situation is most likely perfectly normal.

In our next article about infant sleep, we will discuss normal sleep patterns for babies 6 weeks to 4 months.

Resources for evidence-based info about normal infant sleep:

http://www.secretsofbabybehavior.com/2010/03/science-of-infant-sleep-part-i-first-6.html

http://www.amazon.com/Sweet-Sleep-Nighttime-Strategies-Breastfeeding/dp/0345518470

https://www.isisonline.org.uk/hcp/how_babies_sleep/

https://www.psychologytoday.com/blog/moral-landscapes/201302/normal-human-infant-sleep-feeding-method-and-development

Breastfeeding Memoirs: Best 'Bring Your Baby to Work' Situation EVER!

In honor of World Breastfeeding Week 2015, we are sharing inspirational stories from breastfeeding/working moms.  

Today’s story was written by Margo Byrd.

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As a new mother, the fear of going back to work haunted me as my maternity leave days grew smaller and smaller.  Although I am one of the most fortunate mothers in the world who got to bring their child to work, I still feared that somehow it would not work out.   I worried that my company would decide my bundle of joy was not so joyous, or I would completely collapse under the pressure of feeding a 3 month old in my office. I personally struggled with postpartum.  I had irrational fears about what it would be like at work, felt completely helpless on multiple occasions, and had a very hard time letting my son out of my sight even to run to the bathroom (when my husband was home).  As those small fears subsided, coincidentally my bigger fear of breastfeeding in my new work environment grew. For the summer, my office would be shared with my boss as I am her assistant and during the school year I would have my own office (which happens to be all glass).  I work for the Boys and Girls Clubs of San Dieguito and while “Bring your child to work,” has always been a motto for our club, the fear of breastfeeding with 70-150 kids on the other side of my door was very apparent.  I envisioned curling up on a toilet wiping everything down with cleaners or hiding in dark closets on the floor while I lulled my 3 month old to sleep while comfort nursing. While I was promised a, “Safe,” environment to nurse I had no idea what to expect. The struggle of postpartum and the struggle of a new environment breastfeeding made me so nervous. I had never nursed in public, let alone nursed in front of my co-workers and peers.  Personally I was too scared and too naive to understand the support I would have at my job.

I had made up my mind when attending my first meeting with my supervisors to quit. With my hormonal self and hormonal worries I just felt that it was going to be a disaster.  Yet, as my son, Charlie, and I were greeted by each of my co-workers and supervisors, I started to see the support for my son’s health and well being would not only be my priority, but my entire leadership team’s priority.  I was greeted with warm smiles and happy faces.  To my surprise one of the first questions everyone asked was, “Are you still going to breastfeed?”  I sheepishly answered, “I am going to try,” and each person in my leadership team smiled and said, “Go girl!” The more people I talked with, the more I realized that our company fully supported my commitment to breastfeed him each and every day.  

One of the first things my company did was set up my office.  Not only did they put in a curtain to cover the glass in my office, my supervisor told me that whenever I needed to feed my son, I would have a quiet and safe place to do so.  They fashioned my office to make it more suitable for a changing table, pack and play, and a swing, as well as make sure my son had what he needed to be happy and healthy.  They removed large filing cabinets and replaced them with smaller ones so I could maneuver them so I could fit everything comfortably.  Over the summer, when I began to share an office with my boss, her commitment to making me feel comfortable was overwhelming.  My boss brought in extra items in case my son needed them, she did not put me on the schedule (so I could arrive within reasonable hours to take care of my son), and suggested making a sign for my door that said, “Feeding Charlie, Please Knock before Entering.”  I was completely overwhelmed with the support to breastfeed from the beginning.  And the most beautiful part of all of this was, even staff members who saw my sign on the door would knock and enter without hesitation.  Males, females, co-worker’s children and volunteers all felt comfortable and normal walking in.  I even held staff meetings with multiple staff at a time while feeding my son and the wonderful response to my question, “Would you mind if I fed my son,” was welcomed with an overwhelming, “Absolutely!”  

While I know I am blessed and incredibly lucky, I can only speak from my experience.  Each and every day is still challenging with our regular breastfeeding issues, but having the support of my co-workers and leadership team has been incredible.   I can contribute to my family, provide the best nutrients for my son through breastfeeding, and I can continue to watch my son grow within the walls of the Boys and Girls Clubs of San Dieguito.   

Breastfeeding Memoirs: Working as a Resident

In honor of World Breastfeeding Week 2015, we are sharing inspirational stories from breastfeeding/working moms.  

Today’s story was written by Amelia Sorenson.

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When I found out I was pregnant as I was about to start a surgical fellow, which can mean a seven day, sixty (sometimes eighty) hour work week with erratic long nights of call, I thought a lot about what it would be like to do the work while pregnant and how to manage maternity leave (six weeks, worked the day I delivered). What I didn't think about was how I would establish a breastfeeding relationship during those first few short weeks and how I would manage to keep breastfeeding when I went back.  

PHOTO BY ERIN AT THE THEO LOVES

Once my son was born I realized I should have been preparing for breastfeeding. I went to a breastfeeding support group three times in the first week and am so grateful to the mothers I met and the support from the lactation consultants.  (First piece of advice - figure out support groups BEFORE baby arrives and utilize them early. Every time baby latches he is learning what to do, so the quicker you can get him doing it right, the better).

The night before I started back at work my brand-new electric pump made one long whirrrr and wouldn't turn on again….necessitating a frantic trip to buy a hand pump (Second - buy a hand pump just in case). I was more than anxious that first day back with my little cooler and hand pump.  Fortunately, I work in a “baby-friendly” hospital and a NICU nurse gave me a kit to the hospital grade pump and a few days later I found the most beautiful lactation room with a view of the ocean (Third - Figure out where you will be pumping before you leave for maternity leave).   

I’ve never been able to make a schedule since surgical case length and clinic patients are too different, so I decided that food for my baby had to be on the list of priorities and that some pumping is better than no pumping and tried to pump every three to four hours. (Fourth – Feeding your baby is something important; so let yourself treat it like it is a priority).

Orthopedics is 90% men and I am the first woman in a long time to have a baby, so I’ve been straightforward about what I am doing, hoping that it will make it easier for the next resident. (Fifth – Tell people what you are doing.  You have to do it a lot and really aren’t taking a break.)     

Now that we have made it to 6 months and have enough supply to have donated milk I want to say that you can do it too! Don’t give up early or think that because you are working long hours you can’t do it.  Most of all enjoy the time with your baby before your go back to work. 

PHOTO BY ERIN AT THE THEO LOVES