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breastfeeding, chestfeeding

Let’s talk about poo

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When I became a parent with my first child, I had no idea I’d start talking about poop so much!

Is she pooping? Is it frequently enough? Is it the right kind of poop? What does it all mean?

Well, let’s get to the bottom of this issue (pun intended!).

Frequency

Newborn babies poop a lot after the first few days! Maybe your baby is even stooling with every feeding. This is totally normal! Remember, that what’s normal for you as an adult is very different than what’s normal for your tiny, brand-new baby.

The number of poops increases day-by-day. Ideally, baby should have a minimum of 3 poops by day 2 or 3. As baby progresses through the poo-poo rainbow of colors the amount increases, too.

Once baby is a month old, they may poo less frequently but should still go at least once per day. Poo is a by-product of digestion but also serves to remove other waste products. When baby isn’t going daily, that usually means that we should pay attention.

When we look at babies in areas and cultures that haven’t had an interruption to breastfeeding (unlike the US which had decades of pervasive formula use) they poop about 3 times per day until they are 1 year old.

Color

Mustard, yellow, 1970s grandma’s couch…these are all ways I’ve described normal chestfed infant’s poo. At first, the stool is black meconium and through colostrum feeding babies pass this in a day or two. Poo then looks greenish and finally lands back on grandma’s couch until we start the wonderful world of solid foods!

Occasionally, baby may have a greenish stool which can be from a virus or even swallowing lots and lots of drool. If baby has these stools every day, we need to look into it. Don’t be alarmed though! Talked with your Lactation Consultant or provider about what might be going on.

Texture

Yep, texture. What does it look like? Seedy? Liquidy? More solid than that?

Your baby’s poo is a reflection of what they eat. If they are having your milk then their stool will be liquidy and you may see “seeds” (which are digested milk proteins).

If they have some formula or are starting baby foods, the stool will be thicker.

Frothy: baby may be swallowing lots of air or have excess gas from a microbial gut imbalance, or could be have some trouble digesting some component of their milk

Mucous or snot-like: it could be a virus or it could be a gut imbalance (especially if it’s a lot or happens frequently)

Green and a “shredded grass” texture: baby may not be getting a full feed from the breast and is not digesting the feeding well

For any of these concerns, give your friendly Lactation Consultant a call so we can observe a feed and report to your doctor.

If you want to look deeper into this issue check out this guide.

❤ Megan Dunn, IBCLC

breastfeeding, chestfeeding

Feeding Difficulties: Perspective from an SLP Mom who had a Baby with Tongue Tie

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Alexa Blake, CCC-SLP, has been working for the last two and a half years to develop and grow an infant feeding and swallowing program that serves Linn and Benton counties. She works at Samaritan Lebanon Community Hospital and considers it her passion project to serve these little warrior humans and their parents, optimizing feeding safety and function and meeting the goals of the family. She works with infants who have feeding difficulty from prematurity, tongue tie, torticollis, and general oral motor weakness, using a variety of oral motor and sensory based techniques to meet the unique needs of each patient. The thing that makes her work even more special to her, though, is her own experience with nursing difficulty with her son who was born with a tongue tie.

Here’s her perspective:

I began working with infants prior to having my own child, and I really enjoyed it. It was a unique challenge and very different from any other kind of patient population I’d worked with previously. So when it came time to feed my own child, I figured I had a leg up on how to make it successful for both of us. Once he arrived however, it was a whole different ball game.

My son was born health and happy at 39 weeks, and I weathered my birth experience just fine. All things considered, we were off to a great start. The first time he nursed, just about half an hour after he came in to this world, he ate for a full 80 minutes and I was proud of this accomplishment, taking that as a sign he was hungry and ready to eat. Nursing did not feel great, but compared to childbirth it was nominal pain. The discomfort persisted and worsened over the first several days and my nipples became bruised, chapped, bloodied, and so on. It got to the point that I could not nurse him without tears streaming down my face from the pain. My son was colicky and screamed at all the things everyone said would make him happy (baby swing, I’m looking at you), had frequent and aggressive spit up out his nose, gas, and was a sleepy eater. I did not know how to fix our feeding difficulties or any of the other resultant challenges we were having.

Teddy and Alexa

 I went to three different lactation consultants over the next week to try and solve my nursing pain, and each of them hinted at a posterior tongue tie. Initially, I was offended. I was a new feeding therapist, how could my child have a tongue tie? And even more, how could I not have been the one to figure it out? I had been given holding techniques to try, nipple shiels, creams, etc. to address our feeding struggles and nothing was working. I felt scared and frustrated. I wanted to nurse so badly and felt I would’ve failed my son to do otherwise.

At 11 days old, I took my son to an ENT who laser beamed my son’s tongue to release the tethered tissue. I thought that would be the end of it and things would get better. I was instructed to stretch his wound 6 times a day for a whole month to help it heal properly. To me, in the throws of a post-partum hormone crash with a colicky baby, those stretches were pure torture for both myself and my newborn son. I loathed them, and yet, I was fearful that if I did not do them it would all be for naught.

It was at this point that I asked for help from anyone and everyone I could think of who would help my baby’s mouth and keep us nursing. We went to OMT, we had a home visit from my PT superwoman coworker Patsy Yelsa, I consulted fellow feeding therapists on what an SLP could do, I saw lactation. It was my mission to turn this experience around. And slowly but surely, we did just that. I found a combination of frenotomy stretches and oral motor exercises that allowed my son to do rehab without causing me to feel I was hurting him. We addressed my baby’s whole body experience with his tongue tie, not just his mouth. We worked hard on tummy time, proper positioning, and latch. My nursing pain subsided and my supply stabilized. It took the first 8 weeks of his life before I felt like we both knew what we were doing. It took a whole team of people and professionals help us be successful. He continued to grow, his colic subsided, his reflux improved, and I felt capable of sustaining him with my own milk.

Our nursing journey concluded 15 months after he was born, slowly and on both our terms, when he was ready to move on to bigger and better toddler things. The experience of nursing my child has been one of the greatest treasures I’ve ever had and I’m so thankful we were able to continue for as long as worked for both of us.

My experience with tongue tie has also been invaluable for my clinical practice as I have really been able to incorporate that compassion and first-hand understanding of what it feels like to be a mom with a baby who just can’t eat properly into my therapy. I know better now what is reasonable to ask of new mom’s/parents, I know what consistency and determination can do. I also know that my journey is not everyone’s journey and that finding a way to help moms’ meet their goals for feeding their children must be central to any therapy I do. I love my job, I love working with babies, and I am so privileged to get to walk alongside families on their feeding journeys.

breastfeeding, chestfeeding, reflux, supplementing

Reflux…regurgitation…spit up

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Whatever you call it, it’s pretty common for newborns. When our babies spit up often or forcefully it can be worrisome. We wonder if we ate something which is upsetting baby. Are we burping the right way and long enough? Should we change something about how we are feeding baby?

Let’s set the record straight with some facts about infant reflux:

Reflux is common and not a problem for most newborns.

  • About half of babies aged 2 weeks to 4 months have reflux (which just means they spit up once or more times per day). 
  • Most babies outgrow reflux by 6 months. 
  • Reflux is more common if your baby was born prematurely, has Down syndrome, or other conditions which affect neuromuscular function.
  • Symptoms peak at 4 months and gradually get better.
  • Very few infants have GERD (uncomfortable or painful reflux with additional symptoms like weight gain difficulty, crying, etc)
Newborn looking into the camera, blowing bubbles with their tongue sticking out.

Okay, so what causes it?

Overfeeding is one of the most common causes. Many parents are told to feed their babies every 3 hours which is less often than what most babies would like. Spacing out feeds means that baby may be taking larger volumes than their stomach can comfortably hold.

Laying baby down after a feed puts pressure on the stomach. Because the sphincter (a ring of muscle at the top of the stomach) is immature laying baby down after feeding or putting pressure on their belly can cause spit up.

Diet While most babies are not sensitive to anything in the parent’s milk, they can have spit up more frequently with formula feeding. Using the right formula which baby can digest more easily helps reduce the frequency of reflux.

Crying We all know that babies cry and sometimes it’s unavoidable like when you are driving and can’t comfort baby. And sometimes you can comfort baby but it seems like nothing is working…it happens to us all. Excessive crying can make reflux worse so talk with your provider to get to cause of baby’s discomfort.

Sometimes parents think baby is crying because of the spit up but it’s usually the other way around. Unlike adults, baby has a very acid in their stomach so it doesn’t burn or hurt when they spit up most of the time.

It’s developmentally normal. Spitting up that doesn’t bother baby or cause any problems with growth and development isn’t something to worry about medically.

What can we do to reduce it?

•Get a great latch! Have your baby’s latch and suck assessed by an experienced Lactation Consultant.

•Keep baby upright without abdominal pressure for 30 minutes after feeds. Babywearing works great!

•If you need to lay baby down and you can keep an eye on them try laying them on their left side. If you are doing tummy time, use a prop like a nursing pillow under their chest to keep pressure off the belly

•Frequent burping, after each breast

•Frequent, unscheduled feeds.  Responsive feeding

•If using formula, use a hydrolyzed whey formula

•If using a bottle, use paced feeding techniques

As always, check in with your Lactation Consultant for tips and tricks! We are here to help!

❤ Megan Dunn, IBCLC

breastfeeding

5 Signs Your Baby May Need Help With Feeding

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Baby sleeping on the parent’s chest.
  1. Sleep problems

    Baby sleep is undoubtedly very different from adult sleep. Their sleep patterns involve a lot more light sleep than we see in older children and adults. They have shorter sleep cycles and need a ton more sleep than we do!

    Babies need to nap frequently (about every 45min up to 3hrs) and they should sleep about 90 minutes to 3 hours. After 8 weeks some babies are ready for longer sleep stretches lasting 4-5 hours at night.

    If your baby isn’t napping well or is sleeping much longer stretches it can indicate feeding difficulties.

  2. Lots of spit up

    While spit up under 4 months is pretty common in newborns, it should just be a dribble most of the time. If baby is having big spit ups after most or every feed or they tend to launch it across the room, a visit with your Lactation Consultant should be considered!

  3. Not pooping every day

    After 1 month, baby may poop less frequently but we should still be seeing about 1-4 stools per day.

    I remember being told about my own baby that breastmilk was such good stuff that they absorbed it all and there was no waste. That’s just not how digestion works. There are always products left over and if baby isn’t stooling every day they may not be getting enough milk or they might have a digestion problem which is slowing down the process or even constipating them.

    There’s plenty we can do to get baby pooping regularly! You can try these exercises to help with gassiness and pooping!

  4. You notice they tend to turn their head only one direction

    You might also notice they prefer to breast/chestfeed on one side and not the other. This can be a sign of tight muscles on one side of the body. You can try doing some baby massage or see a provider who does bodywork for infants.

  5. Leaking or dribbling while eating

    If baby is “springing a leak” while eating it lets us know they haven’t formed a good seal on the nipple. This can be due to lip tone or tongue movements. If you are bottlefeeding it could be that we need to try a different bottle or we need to switch to paced bottle feeding.

If you notice any of these signs, it’s time to check in with your Lactation Consultant for an evaluation. We’d be happy to help ❤

Megan Dunn, IBCLC

Uncategorized

So your baby has a tongue tie…

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Lots of parents are surprised to find out their baby has ankyloglossia (tongue tie) and that such a tiny piece of tight tissue under the tongue is causing so many feeding problems!

Luckily, it a simple procedure to release the tongue and get on our way to easier feeding!

In my experience providing care for babies with tongue tie, doing just “the snip” isn’t enough to get full results. If we think about how baby has never had full range of motion with the tongue it makes sense that they will need time and help to get to normal movement.

Of course, working with a tongue tie-saavy Lactation Consultant and your provider is key but there are also things you can do at home!

Top 5 At-Home Tongue Tie Care

  1. Tummy time

    You may already be doing this with your baby but there are some modifications which may improve outcomes for tongue tied babies. Try rolling up a blanket or using your nursing pillow under their chest. This can be more comfortable for some babies and make the whole process more enjoyable.

    My favorite recommendations come from the Tummy Time Method which has parent handouts and lots of suggestions for tongue tie specifically

  2. Guppy Hold

    The Guppy Hold is great for stretching tight neck muscles and it’s very easy to do! Babies love it.
    Check out this video for more info

  3. Play with baby’s mouth!

    Try running a clean finger from one side of their gums to the other. They will “chase” you with their tongue. This is a fun stretch which encourages good movement.

    You can also insert a clean pinky finger, nail side down, once baby starts sucking pull gently. You are just adding a little resistance for baby to help strengthen their suck.

    When I’m doing these games, I like to sing a little made up song to engage baby and reinforce that what we are doing is happy playtime!

  4. Give baby options

    Move around where you place baby during the day when they aren’t snuggling in your arms. Switch up how they are faced at bedtime. Baby will naturally turn their head toward you so by switching it up, they will take turns looking both ways.

    The same goes for feeding. Breastfeeding on both sides is great and bottle feeding on both sides is great, too!

  5. Massage

    Massage and gentle touch is beneficial for many conditions, tongue tie included. This video has a great demonstration of massage parents can do on their own.

The biggest thing, is to have patience and keep working with your experienced tongue tie-saavy Lactation Consultant for continued help.

❤ Megan Dunn, IBCLC

breastfeeding

Breast Cancer and Breast/chestfeeding

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October is famously breast cancer awareness month. We see everything from t-shirts to yogurt donning a pink ribbon to promote the big messages of the month:

-Risk reduction (eg. not using tobacco products)
-Monthly self exam
-Annual checks with your provider

You may already know that breastfeeding reduces your risk of developing breast cancer long term. Did you know it takes about 20 years to see the protective effect?

People who become pregnant also have a lowered risk, long term, of developing breast cancer. Basically, the fewer menstrual cycles you have, the lower your risk of breast cancer. In the short term, however, people who have been pregnant may be at risk for cancer.

Because of that risk, recommendations for screenings including mammograms may change depending on your personal and family history.

While we should all be doing monthly breast self exams, we may also need to check with our providers regarding more frequent medical exams and mammograms.

Screening mammograms are well known to improve survival in breast cancer, and this impact is most significant for women 40 to 50 years old. 

The American College of Radiology (ACR) recommends considering yearly screening during pregnancy and lactation for the following women:

  • under the age of 30 who are at high risk for breast cancer
  • 30-39 who are intermediate to high risk of breast cancer
  • over the age of 40 at average risk for breast cancer

Mammograms are totally safe to do while pregnant and lactating! You should express your milk before the procedure but there’s not need to “pump and dump” after.

As always, check with your provider if you have concerns or notice any changes to your breasts.

❤ Megan Dunn, IBCLC

Uncategorized

Reasons you should feed your baby responsively

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New parents are given lots of advice about how to feed their baby.  Where to feed, when to feed, how to hold baby, how long to feed, and so much more!

You may have been told to feed your baby at least 8 times a day or every 3 hours but feeding on a schedule doesn’t really meet baby’s needs.

Baby has a high need for frequent feeds to keep them alert and build their brains!  Research shows that with responsive feeding there is a high variability in how many times a day baby will feed but it’s much closer to 12 times per 24hours than 8.  

Preliminary research from Swansea University regarding how many times per 24hrs babies feed

Reasons you should feed your baby on cue:

Readiness – Feeding your baby when they cue means you are offering a meal when they feel hunger and are alert enough to communicate that to you.  Imagine being offered your favorite meals when you are super tired…would you feel ready to eat?  Or would you have just enough before falling into a deep sleep?

Meeting all baby’s needs – Baby wants to feed and be close to you for lots of reasons!  You are their home.  You smell like home, you sound like home, you taste like home.  Feeding our baby promotes bonding, reduction of stress hormones, brain development, and so much more than just calories and nutrients!

Milk supply – Your baby doesn’t feed on a regular schedule and your body doesn’t make the same kind of milk every 3 hours on the dot.  AM milk is different from PM milk.  Milk composition changes, too.  At different times of the day it will have higher fat or sleep hormones to help set your baby’s clock and meet their nutritional needs.  If we schedule all the feeds we miss the opportunity to give baby the perfect custom meal each time!

Feeding when baby asks also supports a robust milk supply! Frequent feeding communicates a need to your body to keep making lots of milk!

Capacity – Different breasts/chests hold different amounts of milk (no, this isn’t related to size).  Some people have smaller capacity and can make all the milk baby needs but they need to feed more often.  Scheduled feeds or expectation of only 8 feeds in the day can make parents feel like their milk supply is low – when it’s totally normal!

Responsiveness = communication, trust, and independence – What do all these words have in common? They are what happens when we are responsive feeders.   When we respond to baby’s needs and pay attention to their body language (rooting, sucking, wiggling, lip smacking) we tell them they are heard.  When we respond to our babies they build trust and know their communication will be heard and they will get their needs met.  And that’s how we get independence!  Studies show that responding to our children and meeting their needs results in more independence in toddlerhood and beyond.

❤ Megan

Uncategorized

Not pumping enough?

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  1. Is your pump new?  Your insurance will provide you a new pump with each baby.  The motor wears out with use!

  2. Are you using the right size flange/shield?  It should be just big enough to comfortably fit your nipple.

  3. Have you tried other settings?  Many pumps have a “letdown” mode with stronger and faster cycles to start MER.  When your milk slows turn this mode back on.

  4. Visualization makes milk flow! Sit in a comfortable place, take some deep breaths, and imagine your milk flowing easily.  Cover up the bottle so you can relax and not worry about how much you are pumping.


  5. Membranes, valves, and tubing need replacing regularly (between 3 weeks and 6 months depending on how often you pump).

This is also a good time to explore what “enough” is. Some bottles are really huge! And other parents on social media share huge pumping session successes which may not reflect what is average or achievable.

On average, exclusively pumping parents can express 3-4oz (90-120mL) with each session. Whereas, parents pumping after feeding baby will express about 1.5oz (45mL).
This is a reflection of what baby’s stomach can hold. Around 4-6 weeks most babies reach their maximum intake and can hold up to 5oz at a time. This doesn’t mean they need all 5oz (I don’t want to feel Thanksgiving dinner full after every meal!).

Over the course of a day, baby will take 27-30oz and this does not increase with age for breastfeeding babies!

So….how are you doing? Are you expressing 3-4oz when you exclusively pump?

If not, try some of the tips above and if that doesn’t work, check in with your IBCLC for a full evaluation and support!

❤ Megan

Uncategorized

Should I get the vaccine if I’m breastfeeding?

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Yes!

The vaccine is safe for breastfeeding people and effective at preventing infection. The vaccine cannot give you or your baby a Covid infection.

Here’s where to find out where you can get vaccinated

Here is more information from the CDC about getting the vaccine when you are breastfeeding

Recent research has shown that out milk contains anti-bodies in response to the vaccine that we then are passing onto baby. This may help protect baby from infection!

“Antibodies and T-cells stimulated by the vaccine may passively transfer into milk. Following vaccination against other viruses, IgA antibodies are detectable in milk within 5 to 7 days. Antibodies transferred into milk may therefore protect the infant from infection with SARS-CoV-2”
-Academy of Breastfeeding Medicine

Currently the Covid vaccine is available for people aged 12 and up. There are clinical trials in place for ages 6 months to 12 years to determine safety. Experts think that we may have expanded use for younger children available this Fall.

If you do become infected with Covid-19 while breastfeeding the CDC has guidance for you.