breastfeeding, chestfeeding

Let’s talk about poo

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, reflux, supplementing

Reflux…regurgitation…spit up

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

Uncategorized

So your baby has a tongue tie…

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

Uncategorized

Reasons you should feed your baby responsively

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

Should I get the vaccine if I’m breastfeeding?

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.

breastfeeding, milk supply

Why I don’t recommend lactation cookies

Over the last few years it seems like everyone is jumping on the lactation cookie trend. New pre-made products have been popping up online and in stores all with strong claims about how they will help.
I love a cookie as much as any one (warm oatmeal or spicy snickerdoodle…yes, please!) but I don’t recommend them as a Lactation Consultant for milk production.

Image: Betty Crocker

This is for a few reasons. I have noticed that lots of my patients come to me already trying to take herbs and alter their diet to support milk supply. They invest hundreds of dollars sometimes without really knowing the exact cause of their milk supply problems. Often the issue is low milk supply perception without an actual issue but when there is a problem, it needs to be addressed by a medical provider who can investigate the source and give you personalized recommendations.

Different problems need different solutions.

A thorough assessment and history taking can often pinpoint the problem and then we can give you the right “medicine” for what’s really going on. Otherwise, it’s like throwing a dart in the dark. It might hit the target, it might get close, but it’s probably just a random shot.

Milk supply is governed by milk removal. When we take supplements to boost our milk supply there may be some effect but it might also temporarily boost our supply without setting us up for good long term habits. At the beginning, prolactin hormone brings in our supply and transitions milk from colostrum to mature milk. Oxytocin hormone is the main reason that milk sprays and drips out. Over time, our breasts become less sensitive to these hormones and what we need for continued supply is a baby who can breastfeed well!

Which brings us to the next issue. If we take herbs or eat cookies that artificially boost our supply it can mask baby feeding problems. If your baby’s suck is weak or uncoordinated, I want to know that right away and get you on the path to healing! We can work with suck training, a physical therapist, or occupational therapist to make sure your baby is thriving. We don’t want to miss those early signs .

Homemade baked goods are about the most delicious thing I can think of but sometimes the ingredients might actually lower supply. Many recipes call for a fair amount of sugar so if the milk supply problem is created by insulin resistance it won’t be supportive. Some of the other herbal ingredients might also lower supply. Some of the most common herbal ingredients for milk supply are not compatible with the medical conditions which are most likely to impact supply!

And lastly, I think it’s important to consider that we do not need to eat a special or different diet while breastfeeding. Our milk can be plentiful and super healthy following standard recommendations for adults. Our diets may need to be altered for medical reasons and if so, ask your provider to help you come up with a plan. Many of the ingredients in lactation cookies are expensive and hard to find. I’d rather see you snuggled up in bed nibbling on a grocery store oatmeal cookie than driving from store to store for specialty ingredients.

As always, take what works for you and leave the rest behind. Know that this Lactation Consultant won’t judge or tell you what to do. We are here to support you. And if you sister or kind neighbor brings you lactation cookies, feel free to eat them if they work for you and you want to. Just know you don’t *have* to eat them to make lots of milk.

If you are experiencing low milk supply check out our local Lactation Consultants for support and up-to-date information.

<3Megan Dunn, IBCLC

breastfeeding, supplementing

Paced Bottle Feeding

What is Paced Bottle Feeding?
Paced Bottle Feeding is a method of bottle feeding that allows the infant to be more in control of the pace of the feeding. This method slows down the flow of milk, allowing the baby to eat more slowly and take breaks. Paced feeding reduces the risk of overfeeding that may result in discomfort to the baby. This feeding method is recommended for any baby that receives bottles.

Many parents are worried about baby swallowing air or getting gassy with bottle feeding. The old-school way of bottle feeding often increases gas and air swallowing because the flow is simply too fast! Baby doesn’t have time to follow their suck-swallow-breath pattern and ends up accidentally swallowing air.

Just like you and I take breaks when we are drinking, baby needs them, too. Using a slower paced feeding method also teaches parents to recognize baby’s communication cues. Overall, the feeding is a lot more pleasant for everyone!

Caretakers and grandparents may need a refresher on how to give bottles in a way that respects baby’s needs. There are lots of videos on YouTube, Vimeo, etc which show how to do paced feeding. They all vary a little but this is how I teach it:

Paced Bottle Feeding Steps:
1. Choose a small, 4 oz. bottle and a slow flow nipple. Pick something baby can latch onto deeply, with fully flanged out lips.
2. Hold baby in your lap in a semi-upright position, supporting the head and neck.
3. When baby shows hunger cues, touch the nipple to baby’s lip so he opens his mouth wide.
4. Insert nipple into baby’s mouth, making sure the baby has a deep latch with the lips turned outward.
5. Hold the bottle flat (horizontal to the floor).
6. Let the baby begin sucking on the nipple with the bottle angled just enough to fill the nipple about halfway with milk.
7. Watch baby during the feeding: cues that baby may need a break can include leaking milk, hands held with the fingers wide apart, a creased brow, wide open eyes that look startled, gulping, or clicking noises
8. Every 2 minutes or if you notice any stress cues, tip the bottle down and remove it from baby’s mouth keeping the nipple just touching baby’s lips.
9. After a few seconds baby will try to latch back onto the nipple.
10. Continue this Paced Feeding until baby shows fullness signs – no longer sucking after the break, turning away or pushing away from the nipple.

After several days of Paced Feeding, babies often start to learn to pace on their own. You will notice them taking their own breaks, and then returning to feeding. Positioning the baby upright and holding the bottle in a flat position helps babies be in control of their own feeding.

Part 2 here!

Megan Dunn, IBCLC

Uncategorized

Do I have enough milk???

Up to 80% of breastfeeding parents believe they have low milk supply. And while people do truly struggle with milk supply issues, it’s also true that only about 5% or less suffer from primary lactation insufficiency or a physiological inability to produce enough milk (usually because a health condition).

Milk supply issues can happen due to a secondary cause like a premature or complicated birth.  These situations can make it harder to establish a full milk supply right away. This doesn’t mean your breasts can’t make enough milk ever. It just means that they aren’t making enough milk right now—often we can fix these issues!

After many years as a Lactation Consultant, the majority of low milk supply concerns I see are actually non-issues.  That’s to say, parents feel like their milk supply is low but there’s no evidence that’s the case.  Often this occurs because we haven’t fully learned what our babies are communicating to us.  We think if our babies cry or fuss there might be something wrong with our milk! And it has a lot to do with how we feel about our bodies and how much we trust things to go well.

Perceived low milk supply is the number one reason breastfeeding parents give for why they stopped breastfeeding.  Figuring out what’s really going on can be tricky because it’s not just you but also your baby in the picture.  So milk supply has to match up with baby’s ability to eat well.

My baby cries and fusses often so my supply must be low…

Babies cry for lots of reasons!  As parents we are quick to blame ourselves and worry that we don’t have enough milk or that something in our milk is bothering our baby.  Most babies who aren’t getting enough are actually very sleepy.  They are difficult to wake and have a hard time staying awake for a whole feeding.  They are quiet, “good” babies.

Babies often have periods of fussiness related to gassiness, overstimulation, or just common evening crying.  Snuggling your baby close, skin to skin can help soothe some of these discomforts. Alternately, hold your baby in a carrier or sling and go for a walk.  The motion and change of scenery may help!

My baby wants to eat more often than every 2-3 hours…

Newborns who are fed responsively will feed on average 12-14 times in a 24hr period.  Older babies and bottle fed babies do this sometimes, too!  It’s normal to have increased feeding times at 4-6 weeks and 16-18 weeks.  It’s also normal that your baby will cue to feed for soothing and snuggles.  Touch and suckling are strong needs for baby and they are satisfied by breastfeeding.

My baby will take a bottle after breastfeeds so they must still be hungry

In the early weeks, suckling is a reflex.  A bottle nipple stimulates the right spot on the top of baby’s mouth and they suck reflexively.  The bottle nipple also drips which causes baby to swallow.  When they swallow the nipple releases more milk…and then you are in a cycle!
Babies also love to suck for comfort.  So they are willing to take more if it’s offered.  This can cause overfeeding which results in spit up and gas and that can cause more fussing!

I can’t pump as much as my friend so I think I’ve got low supply

On average, a pumping session without prior breastfeeding will yield 3-4oz (or about 1-1.5 oz if you’ve just breastfed).  More than that can be normal but it’s not necessary.  Baby’s stomach can only hold about 4oz. 
Also remember that milk flow comes from oxytocin (that lovey, warm hormone you get with skin to skin) and oxytocin isn’t as high with pumping as it is with your sweet, cute baby. 

Your Lactation Consultant can help you find the right pump for you and make sure you have a good fit and a pumping plan that works for your needs.

My breasts don’t feel full anymore.  I think I lost my supply.

In the early days our breasts can feel *very* full and heavy.  Lots of that is from milk but even more of it is from fluid retention (which can also cause our hands and feet to swell).  As that extra fluid is passed, our breasts get softer.  They also start to respond to what your baby needs so they tend not to get overfull after a few weeks.

For many people, anywhere from 1.5-3 months is when they notice these changes.  It can often coincide with returning to work and increased pumping sessions (see above). 

The best indicator for a sufficient milk supply is to look at your baby. 

Is your baby happy most of the time? 
Do they have some alert times during the day? 
Are they making daily bowel movements and lots of wet diapers? 
What about weight gain?  If they are gaining 5-7oz per week in the first few months then they are doing great!

If you ever have concerns, drop in for a weight check at your local breastfeeding group or schedule a visit with a Lactation Consultant.

Here is a list of local providers and breastfeeding support groups:

Resources – Linn Benton Lincoln Breastfeeding Coalition

Megan Dunn, IBCLC