My Baby Has Reflux!

“My pediatrician says my baby has reflux! She says there are medications to help. I really don’t want my baby to take medicine. He’s so little. But I also don’t want him to suffer and spit up so much. What should I do? Can you help me?”

Although the diagnosis of reflux seems ominous, keep in mind that all babies have reflux to some degree. The sphincter muscle that separates the stomach and the esophagus is loose and lets fluids go back and forth. That’s why it’s common for babies to spit up after a meal. If your baby seems uncomfortable, however, he may need some help.

I see many babies diagnosed with reflux in my practice. I have found that some simple changes in feeding posture or management can decrease symptoms substantially. Most of my clients do not need to medicate their babies.

If your baby is squirmy, uncomfortable and excessively “spitty” during or after feeds, he may simply be eating too much or too quickly. Do you have an over-abundant milk supply? Does your baby struggle to “keep up” when breastfeeding? Is he gaining weight rapidly?

• Give your baby frequent burping breaks.
• Offer baby just one breast per feeding.
• Position your baby at an incline so that his trunk is higher than his hips and his spine is straight. Try the Pollywog Nursing Positioner at www.pollywogbaby.com.
• Try breastfeeding lying down on your side with baby beside you.

If your baby has green, frothy stools in addition to discomfort, he may be struggling with a foremilk/hindmilk imbalance. This is usually corrected easily by offering just one breast per feeding. Be sure to check with your pediatrician or lactation consultant to ensure your baby is is gaining weight properly before making any changes to your feeding routine.

For assistance with breastfeeding management, contact Renee Beebe at www.second9months.com.

See also, Is My Baby Getting Enough Milk?

For more information on infant reflux, including helpful products, please see www.pollywogbaby.com.

Claire’s Breastfeeding Story

The mother in the video contacted me when her baby was 5 weeks old. Her first week of breastfeeding resulted in cracked, bleeding nipples and a bacterial infection. Her nipples were so sore, she had to stop breastfeeding. She did, however, pump regularly to preserve her milk supply. Breastfeeding was important to Claire. She had fond memories of nursing her first daughter. She desperately wanted to nurse this new baby as well; but was afraid to try again.

Claire told me her story and asked for help to breastfeed her newborn daughter without pain. She was concerned that, after 4 weeks of bottle-feeding, her baby may not want to breastfeed. She was also concerned about her milk supply—she was not able to “keep up” with her baby—needing to supplement with some formula each day.

Needless to say, Claire was nervous about trying breastfeeding again. The memories of that first week of pain were still vivid. We worked on getting the latch just right—making sure baby’s mouth was open wide enough. Claire had lots of guided practice to help her baby latch deeply onto the breast well behind the nipple. Her baby daughter was happy to cooperate.

To view a video clip of one of Claire’s practice sessions, click here. But first, read on for a brief description of what you will see.

As you watch the clip, notice the position of the baby relative to Claire’s breast. The baby is slightly under the breast and her upper lip is lined up with the nipple. When baby opens wide, Claire quickly brings the baby all the way to the breast. Baby’s top lip barely covers the nipple. In her effort to help her baby to latch deeply enough, she goes just a bit too far, but she adjusts her baby’s position accordingly when she knows the latch feels right.

Claire generously provided this video in hopes of helping other breastfeeding mothers. She and her infant daughter are now a happy breastfeeding couple. Her milk supply increased when she started breastfeeding again and her baby is thriving without supplements.

See also, “Cross Cradle Latch with Claire” for video.

Cookies for Milk Supply?

As a lactation consultant, I have the privilege of talking with hundreds of breastfeeding moms every year. Many of those mothers are concerned with milk production at some point in their nursing career. As you can imagine, (and as many of you know!) it’s very frustrating to do everything “right” and still not have enough milk for your baby. Moms know that breast milk is the best thing for babies, yet when supply problems exist, it can be difficult to give baby 100% breast milk. I have found that moms will do just about anything to help increase their milk production—prescriptions medications, strenuous pumping regimens or drinking bitter herbal concoctions.

Recently I was approached by the founder of Milkmakers. She enthusiastically told me about her product—a cookie—that reportedly helps with milk production in breastfeeding moms. Some of the ingredients in Milkmakers are known to support milk production, but I was skeptical, to say the least.

Since this is a new product and an interesting idea, I decided to do a little research. Seattle moms with concerns about milk supply agreed to eat these delicious, nutrient-dense cookies for a week and let me know how they “worked.” All of the women who tried the cookies had healthy, thriving 3-4 month old babies. Most were back at work and were concerned about being able to pump enough milk. Much to my surprise, every mom who participated in my little experiment noticed a measurable increase in milk production!

I will continue to offer herbs, medications and other proven protocols for my clients with serious milk production issues. I will also offer Milkmakers as part of the solution—particularly for moms who may need a boost when returning to work.

If you are having problems with supply, contact a lactation consultant for help. In addition, give Milkmakers a try. They will give you delicious lift!

Milkmaker cookies can be found at www.milk-makers.com.

Working and Breastfeeding

Women have been combining work with motherhood for thousands of years. Since babies get their nutrition directly from their mothers, society expected moms and babies to be literally joined at the hip for the first year or more. It’s only been in recent history that “going back to work” has been a potential roadblock to continuing to breastfeed. Although it is normal to work while caring for baby, our modern world and societal expectations often requires moms to be separate from baby while working.

So, is it really possible to continue breastfeeding while working away from baby? Absolutely! It takes some planning and commitment, but as a mother,  you’re already committed to your baby and you’re probably a master planner and multi-tasker! Just make sure you have the tools and information you need to be successful.

If you are working more than 20 hours a week, you will need a professional-grade breastpump that is designed to be used every day, several times a day for a year or more. Expect to pay 200 to 300 dollars. Some very good brands include: Medela, Hygeia and Ameda.  (Hygeia is a new company. Check them out at www.hygeiababy.com)

Talk to you employer and colleagues about your plan to continue breastfeeding while working. Find other mothers in your workplace who have pumped at work.  Remember you only need a small, private space and a chair.  You don’t even need an outlet if your pump has a battery pack!

Before you return to work, make sure your baby knows how to take your milk from a bottle or cup. Give your baby at least 2 weeks to learn this new skill.

Store a few bottles of milk in the freezer just in case! Accidents happen—milk gets spilled, milk gets left at work, etc. You don’t need a whole freezer full of milk! Remember you’ll be replacing what your baby drinks every day!

If possible, visit your baby at lunch. Or arrange for your baby to be brought to you. Mothers who have access to their babies breastfeed longer.  This practice will also do wonders for your milk supply!

Most importantly, take care of yourself. Learn to delegate! Make sure you eat well and sleep whenever you can. Remember, you have two jobs now!

Breastfeeding and Milk Supply

Why do some mothers seem to be overflowing with milk and others barely keep up with their babies? The answer to that questions remains a mystery. We do know, however, which practices enhance milk production and what may decrease milk supply.

Newborns need to eat frequently. All that early suckling before your milk “comes in” helps set the tone for later milk production. Think of as your baby placing an order to be filled at a later date. On the other hand, restricting breastfeeding in the first few days may lead to decreased milk production overall.

You’ve probably heard that milk production is based on supply and demand. That means that the more milk that is removed from your breasts, the more milk you will produce. If more milk is consistently removed from your right breast, your right breast will consistently make more milk than your left. If baby regularly sleeps from 10pm to 4 am, but breastfeeds every 2 hours during the day, you will eventually have less milk in the middle of the night than during the day.

How do your breasts know that your baby is growing and needs more milk? Very simply; the baby asks for it! Your baby will breastfeed more frequently when he needs more milk. After a few days of what may seem to be constant eating, your breasts catch up and all is well. When your baby gets older and doesn’t need to breastfeed as often, your milk supply will naturally decrease.

As long as your baby is gaining weight appropriately, just let your baby be your guide and your milk supply will take care of itself!

See also:  “Can I Increase My Milk Supply?”

Can I Increase my Milk Supply?

Do you feel that you are breastfeeding  “all the time”? Does it seem that your baby is never really satisfied at the breast? Is your baby wakeful? Fussy? Sometimes, despite doing all the “right” things, you may find yourself producing less milk than your baby needs. Here are some things you can try:

• First, check with your lactation consultant or pediatrician to get an accurate weight for your baby. Then you will know if your baby needs some extra nutrition while you are working on your supply.

• Go to bed with your baby for a whole day and breastfeed and sleep. Arrange for help so that you are not getting up for anything but bathroom breaks. Sometimes getting more rest and a day of unrestricted breastfeeding can give your body a much-needed boost.
• Try pumping (double) immediately after feeds for 5 minutes or so. The purpose of this is to tell your breasts to make more milk. It’s ok if you don’t actually pump out any milk. But if you do get extra milk, you can offer it to your baby at the next feeding!
• Eat well! Now is not the time to try to lose weight. Losing more than 1 pound a week may interfere with milk production.
• Try a bowl of oatmeal every morning. Many mothers have found this delicious intervention helpful.
• Avoid hormonal birth-control methods. Even the progesterone-only “mini” pill can cause a reduction in milk supply.
• If you’re back at work, try adding an extra pumping session during the day.
• Discuss the issue with a lactation consultant. There are herbs and prescription medications that can help with milk supply but you need professional guidance. There is a possibility of side effects and incompatibility with just about anything!
• If your milk supply is truly inadequate for your baby’s needs, be sure to supplement as necessary with human milk or formula. Aside from normal weight loss in the first few days of life, it is never OK for a baby to lose weight. See your health care provider or a lactation consultant for guidance on supplementation.

See also: “Breastfeeding and Milk Supply.”

Hidden Hazards of Nipple Shields

As I’ve stated many times to anyone who will listen,  nipple shields can be helpful if a baby is having trouble breastfeeding. In the wrong hands, however, they can be downright dangerous. Just today I saw 2 moms who were given nipple shields in the hospital within 48 hours of their babies’ birth.  Their 2 stories had very different outcomes.

Story number 1:  Three -week- old baby. Mom given nipple shield day 2 because baby was having a hard time latching. Baby was able to latch with the shield, but he nursed for 45 minutes to an hour each feeding and never seemed satisfied. Things seemed to go OK the first week, but at a routine check-up 2 weeks later, baby hadn’t gained any weight. The pediatrician told mom to start supplementing immediately and referred her to me. I saw her the next day.

After a little guidance, baby latched on to the breast easily and nursed well. Mom’s milk supply is very low, of course, since baby was not transferring milk well with the nipple shield. Now this mom has quite a bit of work ahead to increase her milk supply. In the meantime, this baby will need to be supplemented with formula.

Story number 2:  Three- day- old baby. Mom was given a nipple shield after the very first attempt at breastfeeding because her baby’s latch was incorrect and her nipple felt pinched. Fortunately, this mom had arranged to see me prior to her son’s birth and I consulted with her in her home.   The baby latched easily after I showed his mom how to help him find the breast. He breastfed happily while his parents watched in awe—surprised that he could do so well without the nipple shield. Mom was absolutely comfortable and delighted that breastfeeding did not hurt!

Story number 2 turned out well. It likely would have had a very different ending, however, if this mom had continued to use the nipple shield.

The lactation consultants who dispensed the nipple shields (2 different hospitals, by the way!) did not attempt to correct the underlying problem BEFORE resorting to plastic.  In addition, they did not teach the moms how to assess the babies’ effectiveness using the shield while breastfeeding. Finally, there was no follow -up offered or suggested to ensure that either of the babies were transferring enough milk to gain weight.

I wish these 2 stories were isolated incidences. They are not. I see more or less the same scenario several times a week. So how can you avoid this very common problem?

• Know that your baby was born to breastfeed!
• Avoid nipple shields in the first 24 hours.
• If you’re having trouble breastfeeding, insist on getting help. If the hospital cannot provide you with timely, knowledgeable, REAL help, ask a nurse for a referral to a private lactation consultant.
• If you decide to use a nipple shield, make sure someone in the hospital evaluates an entire feeding with you to help you feel confident.
• Arrange for a lactation consultant visit and a baby weight check as soon as possible after leaving the hospital.

www.second9months.com

What is a Nipple Shield?

Nipples shields are molded silicone “nipples” that fit over a natural nipple. They look a bit like a sombrero, and the rim or base of the shield extends out about an inch to adhere to the breast. There are usually 4 holes in the nipple that mom’s milk can flow through. They are very thin and made in several sizes and styles. They are designed so that baby can latch on to the shield and get milk from mom.

So why on earth would anyone want to use a plastic nipple?

Nipples shields can be helpful when a baby is unable to form a strong vacuum at the natural breast. Sometimes, if baby’s tongue is not doing what it should, a nipple shield can enable a baby to breastfeed who otherwise would need to be bottle fed.

Nipple shields are also commonly used when a baby has nursed incorrectly and caused nipple soreness. A shield can make breastfeeding more comfortable while mom and baby learn to breastfeed comfortably.

Always seek guidance from an experienced lactation consultant before considering the use of a nipple shield. Improper use can lead to inadequate milk intake and subsequent weight loss, which, in turn could lead to a decrease in your milk supply.

Whether to alleviate soreness, or to help a baby who is learning to suck properly, a nipple shield is a temporary fix. Your lactation consultant should provide you with a detailed plan for the use of the shield and when and how to discontinue its use. When your baby is ready, he will breastfeed happily and comfortably without it!

Renee Beebe, M.Ed., IBCLC
www.second9months.com