Ask the expert

Weight Gain in Your Breastfed Baby

February 22, 2016 by theleakyb@@b Leave a Comment

by Shari Criso, RN, CNM, IBCLC

This post made possible by the support of EvenFlo Feeding

____________________

One very common concern that comes up frequently for breastfeeding moms and dads is that their breastfed baby is not gaining weight fast enough, or as quick as other babies. This often happens when parents take the baby to the pediatrician and the pediatrician says that the baby’s just not gaining fast enough. They will use a growth chart, plot your baby’s weight on the growth chart, and then say your baby needs to be growing faster!

As you can imagine, this can be very concerning for a breastfeeding mom, because you’re thinking, ”do I need to supplement?”…”am I just not making enough?”

What I want to talk about here are normal growth patterns of breastfed babies.

Unfortunately, because we have so few exclusively breastfed babies in this country (and this really is the case, that there aren’t that many babies that are being breastfed for an entire year) their weights are being compared to formula fed infants that often grow and gain faster and weigh more, especially in the second half of the first year.

So what is a normal weight gain for a breastfed babies?

Typically breastfed babies will gain faster in the first 4 months of life. Typically somewhere around 4-8 oz or 5-7 oz a week on average, is the amount that a breastfed baby will gain.

When I say average, what I mean is that they won’t ALWAYS gain that amount every single week or consistently, so weighing them every week will actually be a problem. They will have growth spurts, and gain more weight some weeks and less weight other weeks. Typically this is somewhere between 5-7 oz per week, for the first 4 months, on average…and then around 4-6 months you’ll start to see this weight gain drop to about 4-6 oz per week, and then from 6-12 months, 2-4 oz per week is the average norm for breastfed babies. Remember, this is just basic standard or average, it does not mean ALL babies are going to follow the same patterns.

It’s important to watch your baby’s cues and take into account other things like your size – smaller parents, smaller baby; are they reaching all their milestones, are they hydrated, are they peeing, are they pooping, are they smiling, are they doing as expected developmentally – these are all important factors to consider in making sure your baby is healthy…not just are they gaining weight! Are they gaining length, is their head circumference growing as well?

Another very important thing to keep in mind is and to understand are the growth charts themselves. This comes up with my clients all the time! Some pediatricians are using the incorrect growth charts to measure and plot your babies weight gain. What you should be asking is, “are you using the WHO growth charts for breastfed babies?” Many of these charts being used in these offices are charts that are based on formula fed infants. The older CDC charts actually measured breastfed babies against formula fed infants, and we know that this is not accurate. So you want to be sure that your office is using the WHO charts to make sure that they are plotting it correctly.

The other thing to do is to notice that just because a baby is at the third percentile, does not mean that your baby is not within normal parameters. Your baby does not have to be at the 50th percentile or the 90th percentile!

A baby that is at the 3rd or 5th percentile for weight is just as healthy as a baby who is at the 70, 80 or 90 growth percentile. These are the normal ranges, and what you really want to keep an eye on is that your baby is staying consistent in their growth. That is really what will tell you the difference. I’m going to post some links here so you’ll have those growth charts, and if for some reason your doctor is not using them, you’ll have access to them to bring them with you and have them use that chart to help plot your baby’s growth.

____________________

Have you been concerned about your baby’s growth? Does your child’s doctor use the correct charts?

____________________

For over 23 years, Shari Criso has been a Registered Nurse, Certified Nurse Midwife, International Board Certified Lactation Consultant, nationally recognized parenting educator, entrepreneur, and most importantly, loving wife and proud mother of two amazing breastfed daughters. See the entire library of Shari’s My Baby Experts Video Program here.

Filed Under: Article, Ask the expert, baby, Breastfeeding, breastfeeding health, breastfeeding support, breastfeeding video, Featured, video Tagged With: Ask the expert, baby weight, Breastfeeding, breastfeeding video, Evenflo

Increasing Breastmilk Supply With Pumping For Milk Donation

February 3, 2016 by theleakyb@@b 5 Comments

by Jessica Martin-Weber and Dr. Pamela K. Murphy

This post made possible by the support of Ameda

When my 4th baby was just a few months old, a friend of mine who had adopted a little girl from Vietnam asked me for breastmilk for her daughter. Her own milk supply was dwindling and after over a year of pumping after inducing lactation even before she had her daughter, her body was done producing milk and the effects of Domperidone had left her struggling with weight and energy issues. Initially they introduced formula but her daughter reacted with painful eczema head to toe. Convinced she needed breastmilk, my friend asked me to help her little girl.

Breastmilk truly is amazing and while many babies thrive on breastmilk substitutes, the healing nature of breastmilk is something that can’t be denied. We know it can help save lives, particularly the most fragile of our society. Giving breastmilk is giving the gift of life and health for another to thrive.

I’ve always responded well to pumps, particularly if can hook up and get busy doing something else. But my supply was well established for my own baby and because I had a job that allowed me to bring my baby with me, I wasn’t pumping very much for her. I was more than willing to help my friend but I wasn’t sure how to get enough milk for two babies with my supply regulated for my one. I decided to see what I could do.

Having a tendency to easily develop over-supply and then have issues with mastitis, I knew I needed to be careful with this process. After talking with a couple IBCLC friends, I began to add pumping sessions to each of my existing feedings to slowly increase my supply and not interfere with my baby getting what she needed first. It worked so well that 2 years later with my 5th baby I intentionally increased my supply to donate to human milk banks and two other friends who had adopted little ones and with my 6th, as soon as my supply was established I began again for another friend’s baby and the Human Milk Bank Association of North America.

To get my supply up for those babies and to donate to a milk bank I started adding 10 minute pumping session to the end of my breastfeeding sessions. Then I started pumping one breast while feeding off the other. Two feedings a day I started increasing my pumping time to 20 minutes after my baby would finish which would be long enough to cycle through another let down. Sometimes this meant that I would pump with maybe just a few drips for 5 minutes or so or even without anything at all and then I would get another let down. The first feed of the day I always pumped one breast while my baby was on the other and in just a few days I had increased my supply so much I needed to pump into a large milk storage bottle. By 3 weeks I had added 2 full and one half pumping sessions in my day and by a month I was pumping one breast and feeding off the other 3 feedings a day (the first one in the morning was always my highest output) and then pumping 3 full sessions in between feeding my baby. By that point I was pumping enough milk in a day to completely supply another baby’s feeds and have some extra for back up. When I wanted to increase my supply again, I followed a similar pattern with extending my pumping times and adding a pumping session in the morning but it was adding an extra pumping session before bed that led to the morning pumping session to increase even more in just 3 days time.

Here’s what I learned in increasing my breastmilk supply to donate:

Don’t focus on the output. The volume isn’t the point and it will take some time before you see it so focus on why you’re doing it, remember that babies don’t actually eat that much, and every single drop counts.

Baby helps. Your baby is your ally in increasing your supply. Skin-to-skin contact doesn’t just feel good and provide your baby with neurological stimulation that is beneficial for their development, it also tells your body to make milk. And if you can pump while they are feeding from the other breast, your body will be more willing to give up more milk.

Ask and it shall be given. Your body will give what it can when you ask it to. Unless you have some physiological barrier, if your body is asked for more milk, it will make more milk.

Hands-free. Pumping isn’t fun for most even it comes easily. Going hands-free can help free up your mind to focus on something else and help you feel more productive or at least entertained in the process.

Hands-on. It helps to be distracted but taking a little time with each pumping session to be hands on with some hand compressions at the breast (like a breast massage) can significantly increase your output and send the message to your breasts to make more milk. This video is an excellent demo of how to do so.

Be patient. The process takes time and responding to the pump may be an adjustment for your body. That’s ok. Don’t rush the process.

Wean off. When it’s time, whatever the reason (and please respect your boundaries and stop when you need to), wean off slowly. Supply increase is real and not draining the breast could lead to infection and mastitis is even worse than pumping so stop slowly.

Celebrate. This is hard work and it’s a sacrifice of love. Celebrate that. Celebrate babies getting human milk.

Not everyone is going to want to increase their supply to that amount for donate but every little bit helps. You may not be able to add so many pumping sessions to your schedule but you still want to donate. If you choose to donate, do what you can and resist the urge to compare with others. Every single drop really does count.

So you want to get started increasing your supply to donate, Dr. Pamela Murphy, PhD, CNM, IBCLC shares with us some helpful information and tips to get you started:

Will pumping to increase supply take milk away from mom’s own baby?

Not if you pump after breastfeeding or in the middle of a long period when your baby isn’t breastfeeding (like a long nap). If you are trying to stock up some extra milk for when you are apart from your baby or to donate, pump 1-2x a day after breastfeeding or in the middle of a long sleeping stretch. Your body will start to make more milk to meet your new demands, just like when your baby goes through a growth spurt and breastfeeds more. This cluster-feeding helps increase your milk supply! Just keep in mind, be patient, it can take a few days to see your milk supply increase.

How do our bodies just start making more milk when we start pumping more?

Hormones! The more often you drain your breasts of milk, the more milk they make! Breastfeeding and pumping stimulates the release of prolactin, a hormone that increases your milk supply. Isn’t is amazing how nature works! Check out this quick video to learn more.

Should moms take medication, herbs, or eat certain foods to increase their supply for donation?

Normally you do not want to take anything to increase you milk supply unless you have to. Very few moms need to take anything to increase their milk supply if they are draining their breasts often. Medications, herbs and foods that help increase milk supply are called galactogogues and work by increasing the hormone, prolactin, which helps your body make breast milk. If you decide that you want to try to increase your milk supply to donate more milk, talk to your healthcare provider or lactation consultant to figure out what galactogogue might work best for you. Keep in mind that galactogogues can cause side effects, health complications or allergic reactions for you or your baby. And most milk banks won’t accept milk from a mother on certain medications, including herbs used to boost supply. If you are donating to a family directly, be sure to disclose if you used any herbs or medications to increase your supply so they can make an informed decision. Here are some additional tips about your diet while breastfeeding.

What kind of pump should moms use? What should they avoid?

Once you have established your milk supply use a quality double electric pump like the Ameda Purely Yours. It really depends though, every woman is different and responds differently to different pumps. Some actually prefer hand expression and get more milk that way but most will do better with a double electric. A single pump or hand pump may make it harder for you to keep up with your pumping schedule since it will take longer to drain both breasts at the same time. Here is some more info about choosing the right breast pump for your situation.

How to store milk intended for donation?

Check with your milk bank to see if they have special guidelines. Some general guidelines are to always use clean pump parts and wash your hands. Collect your milk and store in either a bottle or milk storage bag. Do not store milk from more than one pumping session in the same bag. Here is some additional information about pumping and storing your pumped milk.

Anything else to keep in mind regarding being a milk donor? Even if you cannot produce enough to donate remember that milk banks are always looking for volunteers. You can still do you part to help babies! If you are a social media user, follow non-profit milk bank accounts and share and interact with them, believe it or not this is an excellent way to raise awareness and increase the number of women who donate when they become aware of the need. Find a milk bank near you.

____________________

Are you a breastmilk donor? How did you get your supply up? What tips would you add to our list to encourage other donors-to-be?

_______________________

Pamela K. Murphy, PhD, MS, CNM, IBCLC has worked with birthing and breastfeeding families for more than 15 years. Her lactation practice extends from the preterm/high risk infant to the healthy newborn both in the inpatient and outpatient settings. She has published research on pregnancy, nutrition and lactation in peer-reviewed journals including Breastfeeding Medicine, JAPNA, the Journal of Midwifery and Women’s Health and Advances in Neonatal Care. She is shown here with her once breastfed & beautiful daughter Audrey.

Filed Under: Article, Ask the expert, Ask the IBCLC, breastmilk donation, breastmilk pumping, Featured Tagged With: ask the IBCLC, Breast pumping tips, breastfeeding and donating, breastmilk donation, breastmilk pumping, building your breastmilk supply for donation, how to become a breast milk donor

Having Enough Milk for Your First Day Back

February 1, 2016 by theleakyb@@b 3 Comments

by Shari Criso, RN, CNM, IBCLC

This post made possible by the support of Evenflo Feeding

____________________

As you are preparing to return to work, you’ll be wondering how much should I be storing and how far in advance do I need to prepare. As with anything, it is always best not to leave things to the last minute and pumping enough breast milk for your return to work is certainly at the top of that list!

Start several weeks prior to your first day back at work and calculate how many ounces you will need for your baby on the first day as well as your freezer stash.

For example, if you will be away from your baby for 8 hours and will need to pump 3 times for 3-4 ounces each, that will be 9-12 ounces of milk needed for your first day back at work. If you add another 10 3oz bags for your freezer this will add an additional 30 ounces that you will ultimately need. In this scenario, in total you will need about 40 ounces of milk to be fully prepared.

Waiting to store this until the last week before you go back, will make it really difficult to achieve, and in this case I would recommend that you only focus on getting the 9-12 ounces pumped that you will need for your first day. You’ll have to catch up on the freezer stash later. Ideally, you will give yourself a minimum of 4-6 weeks to start pumping and storing.

Pumping 1-2 ounces per day in addition to the ½ ounce of milk that you will continue to feed to your baby each evening (just to keep the bottle going) will give you more than enough over the 4-6 weeks to have all the milk you need for your first day back at work, plus your freezer stash.

For some moms this is not a problem and for others you may find it difficult to pump in between feeding your baby to get this extra milk.

One of the ways to work around this is to not try and pump between feedings, but to express a small amount, like a ¼ of an ounce from each side prior to each breastfeeding during the day. If you’re breastfeeding 8 times, and you express a ½ ounce each time, you will essentially be storing 4 ounces per day. This is even more than I am even recommending you do, if you give yourself enough time.

____________________

To view the whole video, click here.

____________________

For over 23 years, Shari Criso has been a Registered Nurse, Certified Nurse Midwife, International Board Certified Lactation Consultant, nationally recognized parenting educator, entrepreneur, and most importantly, loving wife and proud mother of two amazing breastfed daughters. See the entire library of Shari’s My Baby Experts Video Program here.

Filed Under: Article, Articles from the professional experts, Ask the expert, Featured, Relational Resource Tagged With: Ask the expert, breastfeeding and working moms, breastmilk supply, working moms

“Let Love Flo” Infant Feeding Q&A With An IBCLC

February 1, 2016 by theleakyb@@b Leave a Comment

The Leakies with Shari Criso, MSN,RN, CNM, IBCLC

This post made possible by the support of EvenFlo Feeding

We’ve asked Shari Criso to share her answers to Leakies questions about feeding their babies. If you have any questions you’d like to ask Shari, leave a comment!

Hi Shari,

My baby is due in about a month and I’ll be returning to work full time at 6 weeks postpartum. I heard that I’ll need to introduce a bottle right away for my baby to accept one. But then I heard that if you introduce it too soon my baby will have nipple confusion. I’m confused now. When and how often should my baby be given a bottle while I’m on maternity leave? Is there anything Any clarity you can offer would be great, thank you!

Jamie, Nipple confused in California

Hi Jamie,

Congratulations on the upcoming arrival of your little angel! The question about when to introduce your breastfed baby to a bottle is one that can be confusing with the enormous difference of opinion that is out there even among lactation experts. Some will say that you should wait at least 6 weeks before introducing any artificial nipple to your breastfeeding baby due to the potential risk of “nipple confusion” or preference for the bottle over the breast…while other advice will encourage you to introduce it much earlier so to avoid rejection of the bottle. In my experience, waiting too long to introduce the bottle to your breastfed baby does increase the chance of rejection and this is really difficult on a mom who needs to return to work. By 3 weeks most babies will develop a “nipple preference” either way. The advice that I always give to my breastfeeding who want to introduce a bottle, is to wait until your milk has fully come in and when your baby is breastfeeding well and regularly without any issues. This timing can vary for different moms. Some will achieve this as early as a week or two after birth. When this happens I encourage mom to pump or hand express a small amount each day (no more than 1⁄2 ounce) and then feed it to the baby in a bottle. After that they can finish the feeding at the breast. You are not replacing the feeding, but rather you are consistently introducing the bottle to the baby early when the baby is more likely to accept it and less likely to reject it. This should be done daily until the baby is 6 weeks old. Then you can pump and replace a full feeding if you choose to. This method is very effective in supporting a breastfed baby to accept a bottle, while at the same time continuing to breastfeed without issues and interfering with your milk supply. For more information and instructions there is an entire chapter about this in my full online class “Simply Breastfeeding” on my website. I hope this helps!

____________________

Dear Shari,

With my first 2 babies I had horrible oversupply and developed mastitis within the first two weeks postpartum and the recurring frequently throughout the first few months. It was horrible. I’m so afraid of it happening again, is there anything I can do to avoid it? The idea of battling mastitis off and on for the next few months is enough to make me not want to breastfeed this time around even though I really want to. While I’m so grateful to have plenty of milk for my babies even though my first two had slight tongue ties, I’m really afraid of dealing with mastitis again. Please help me.

Ready to quit, again,

Lisa, in Florida

Hi Lisa,

I am sorry that you struggled so much with your prior breastfeeding experiences! It can be so difficult and stressful when you are trying so hard and encountering so many challenges! Most breastfeeding moms do not fully understand just how difficult it can be to have TOO MUCH milk and the ensuing issues like mastitis that can occur, unless they are experiencing it. In my experience, oversupply can sometimes be more difficult of an issue than under supply, although neither are easy! There are a couple of things that I would recommend. First, make sure that you are not pumping in the early days and weeks to empty the breast after the feedings. This is a BIG mistake that moms make or are encouraged to do, and this can lead to oversupply. Also, feeding your newborn on one side at a time will help to bring down your supply quicker. Lastly, one of the most common reasons for mastitis that I see is constriction or pressure on the breast tissue from improperly fit bras or the use of underwire bras, especially early on and when the breast is full and engorged. This extra pressure on the full breast can cause plugged ducts and inflammation, which can lead to mastitis. Nursing frequently, warm compresses, not pumping, and avoiding pressure on the breast, will all help to normalize your supply and hopefully prevent you from developing mastitis. See this video for further information on the issue of “oversupply” that may help. Good luck to you!!

Hi Shari,

Is it possible to not make much milk? With my son I was looking forward to breastfeeding but it just didn’t work out. I was heartbroken, I had tried so hard, used a system to supplement at the breast, had my son’s slight tongue tie revised, ate oatmeal every day, did everything I could find to do. I saw an IBCLC and she told me I may not have enough milk making tissue. My breasts aren’t very small but they aren’t very round or close together and they never changed in pregnancy or even after giving birth. I couldn’t express any milk with a pump, well, never more than a few drops and hand expression wasn’t any better. Breastfeeding is really important to me but I can’t handle seeing my baby lose weight when they should be gaining and it was really hard to see that I was failing my baby while hearing from everywhere that breast is best and I just needed to try harder. Could I be too broken to feed my baby? Is there anything I can do this time?

Thank you for taking time to answer. Heartbroken Heather from West Virginia

Hi Heather,

First of all, you are not broken! I can feel your heartbreak in not being able to breastfeed your baby the way you wanted to. It can be very frustrating and even depressing to try everything you know and still not be able to produce enough milk for your baby. To answer your question…Yes, unfortunately it is possible for a mom to not make much milk and this can be caused by a variety of reasons. This could be caused by hormonal issues that exist and go untreated (such as PCOS or Thyroid dysfunction)…it can be caused by failure to establish an adequate milk supply after birth from improper latch, formula supplementation, or even an undiagnosed tongue tie in the baby, etc…and it can also be caused by a condition call Insufficient Glandular Tissue (IGT) where the breast does not have enough glandular tissue to produce a full milk supply. This is something that can be identified during pregnancy, but cannot be determined until after the baby is born and all attempts to produce a full supply are unsuccessful. As a mom that is experiencing this it can be so difficult to keep hearing people offering advice on the very things that you have been trying all along! There are some things to try and consider all with the support and advice of an experienced Lactation Consultant. There are medications and herbs (such as Goat’s Rue) that can sometimes help. Make sure you are addressing and treating any underlying hormonal conditions with your practitioner that may be possible. Lastly, whatever amount of breast milk you are able to produce is still going to benefit your little one. It is definitely not all or nothing! If you are producing some breast milk, you may choose use a supplemental nursing system to deliver the supplementation (donor milk, infant formula, etc…) to the baby and continue to breastfeed at the breast. This can also be done if you are not producing any breast milk but still want to maintain the physical closeness of the act of breastfeeding. Either way always remember that this is not your fault! You are a great mom regardless of HOW or WHAT you feed your baby…and the most important thing that you can ever provide to your child is your love, which is always abundant and overflowing!! For more information, see this video clip. Sending you lots of love!

____________________

For over 23 years, Shari Criso has been a Registered Nurse, Certified Nurse Midwife, International Board Certified Lactation Consultant, nationally recognized parenting educator, entrepreneur, and most importantly, loving wife and proud mother of two amazing breastfed daughters.

Filed Under: Article, Ask the expert, Ask the IBCLC, Featured Tagged With: Ask the expert, ask the IBCLC, breastfeeding questions

What You Need to Know About Jaundice, Breastfeeding, and Your Newborn Baby

November 12, 2015 by theleakyb@@b 1 Comment

by Linda Zager, RN, IBCLC

This post made possible by the generous support of Ameda, inc.

You just went through this transformative experience. You created life! And then, as you bask in the glow, you are told the newest member of your family has jaundice.

What does it mean? How concerned should you be?

Jaundice is a very common condition in newborn babies. Newborn jaundice is caused by a pigment substance, known as bilirubin, and when it increases in the baby’s blood it makes him/her appear yellow. More than half of all newborns become jaundiced within the first week of life. This situation is usually temporary and resolves on its own within a few days without treatment. This is termed physiological jaundice. Physiological means what happens normally in the body. Physiological jaundice is not a disease but a temporary condition.

So what exactly is bilirubin? Bilirubin is formed in our bodies when red blood cells die off. This is a normal process. Red blood cells contain the substance bilirubin. Newborns are born with a surplus of red blood cells. When greater numbers of red blood cells break down, this yellow pigment, bilirubin, accumulates in the newborn’s blood and is deposited in the skin, muscles and mucous membranes, causing the skin to appear yellow. Bilirubin is fat soluble, meaning it mixes easily with fats and oils. For the body to get rid of bilirubin, it needs to be water soluble. So how is it possible for the body to get rid of bilirubin if this is the case? That’s the job of the liver. The liver processes the bilirubin, changing it from fat soluble to water soluble and is then passed into the intestines. From the intestines, the bilirubin leaves the body through the newborn’s bowel movements. Some bilirubin, however, is reabsorbed back into the body after becoming fat soluble again. This occurs if the baby is having very few or no bowel movements. The less bowel movements, the more bilirubin gets reabsorbed, resulting in higher bilirubin levels. The most common cause of increased reabsorption of bilirubin is insufficient intake of breast milk. Bilirubin levels on the third day is directly linked to the number of EFFECTIVE breastfeeds per day in the first few days of the baby’s life.

Some mothers are informed by their health care provider that they need to stop breastfeeding and start feeding their little one formula in order to lower the bilirubin levels in the blood but options are available to treat jaundice without interrupting breastfeeding. For the healthy, full term baby, breastfeeding should continue so it does not become more of a challenge for mother and baby. The solution is not to stop breastfeeding but to resolve the breastfeeding issue so the baby gets the breast milk needed to have regular bowel movements.

Colostrum, the first milk available to the newborn, is actually a laxative which causes bilirubin to pass into the meconium stools. However, when a newborn does not receive enough colostrum as a result of inadequate feeding; either too few feedings, ineffective feedings, or both during the first few days, the bilirubin levels are exaggerated by day three. All mothers and babies should be assessed for effective breastfeeding while in the hospital by the nursing staff every shift and by a Lactation Consultant if a problem has already been identified. A newborn can be at the breast frequently but not breastfeeding. They do not become jaundiced from the breast milk but from a lack of breast milk. That is why it is necessary to have the nursing staff and/or a lactation specialist evaluate baby for effective latch and nutritive breastfeeding. Milk transfer is critical. Mothers may need to be taught how to latch their baby correctly to the breast and to recognize effective breastfeeding. This action assures mothers of comfortable, efficient breastfeeding and prevention of newborn jaundice.

As the liver is responsible for converting fat soluble bilirubin to water soluble bilirubin problems can arise because a newborn’s liver is relatively immature and may be unable to convert all the bilirubin in the first few days. Premature newborns’ livers are even less mature so therefore have higher levels of bilirubin than full term babies.

There are other reasons for excessive red blood cell breakdown resulting in high bilirubin levels and jaundice. ABO blood type incompatibility can result when mother has type O blood and her baby is one of the other blood types, A, B or AB. During pregnancy, red blood cells can leak across the placenta from the baby to the mother. The mother’s immune system reacts to the baby’s cells by forming antibodies against the baby’s blood resulting in increased red blood cell breakdown after birth and jaundice. With appropriate treatment, jaundice resolves. If a baby has a difficult birth and this results in bruising or a hematoma, there will be more red cells broken down resulting in higher bilirubin levels and jaundice. These are all normal causes of newborn or physiological jaundice with some babies requiring treatment and others not. But all these babies have one thing in common; they can and should continue to breastfed a minimum of 10 times or more per day every 24 hours for the baby’s first 2 days of life. Frequent nursing should be considered the norm; rooming-in with your baby promotes more breastfeeding than if baby were kept in a separate nursery.

Some babies are often sleepy as the bilirubin levels increase, sometimes resulting in baby falling asleep soon after feeding begins or he/she won’t even wake up to feed at the breast. Try skin to skin, holding you baby between your breasts, keep baby in close proximity to enable you to observe feeding or waking cues and never watch the clock for when you should nurse next. Remember a minimum of 10 or more feeds in 24 hours is norm. If baby does not respond to various stimuli to breastfeed more effectively, then an alternative method should be used to supplement baby with expressed colostrum/breast milk, if necessary. Hand expression of the breast is a very effective means of collecting colostrum. It can be expressed into very small cups or spoons for feeding. Mom should receive instructions for using a Hospital Grade breast pump for milk expression and to breast stimulation for adequate milk production. Breast milk can be given by cup, syringe, eyedropper or small spoon. Formula supplementation, on a short term basis, may be needed if fewer effective breastfeeds in the first days has contributed to a lower milk supply. Mother can continue pumping and nursing during treatment.

Most cases of jaundice require no treatment or little more than exposure to direct sunlight each day, but if the bilirubin levels continue to rise, more action is needed. The child’s physicians will observe and monitor the baby’s jaundice and bilirubin levels which are obtained through a simple blood draw from the baby’s heel. Phototherapy is a common treatment for all types of exaggerated jaundice. Phototherapy uses fluorescent light to break down bilirubin through the skin. The bilirubin absorbs the light, changing the bilirubin to the water soluble form, which then is eliminated through the baby’s stools. The baby is placed in an Isolette or self-contained incubator unit that provides for controlled heat and humidity. The light source, called bili-lights, is placed over and/or on the side of the Isolette. The baby is naked but for his diaper. His eyes will be covered to protect his retinas and corneas from damage.

If breastfeeding is a priority talk to your doctor and nurses about options. Often, babies are taken to the nursery for this treatment but most hospitals give mothers the option of treatment in their room. Baby’s eye patches should be removed during feeding to make eye contact with his parents. The Wallaby phototherapy unit is a fiber optic blanket that is wrapped around the baby’s trunk and provides continuous treatment that does not require eye patching or separation. The blanket can be used both in the hospital and in the home after hospital discharge.

If your baby has jaundice, it doesn’t have to interrupt breastfeeding. You are your child’s number one advocate and if breastfeeding is important to you, communicating that with your child’s care providers is an important part of your child’s care. Breastmilk may be exactly what is required to help your new baby get well.

More information:

AAP Management of Hyperbilirubinemia in the Newborn Infant 35 weeks or More

AAP Clinical Practice Guidelines for Hyperbilirubinemia in the 35 week or more newborn infant

Bilirubin Screening and Management of Hyperbilirubinemia, Stanford Medicine

The Academy of Breastfeeding Medicine protocol for management of jaundice in the breastfed newborn of 35 weeks or more

___________________________

Did your baby have jaundice as a newborn? How were they treated? Were you supported in continuing to breastfeed?

___________________________

Linda Zager, RN, IBCLC

I’ve been an RN for 37 years, working in various hospital positions from Intensive Care to Hemodialysis/Plasmapheresis, Maternal Child Care and finally Lactation Consulting, my true calling in life. I have been an IBCLC for 23 years working with moms/babies in their homes and in the hospital. I left hospital work and now work as Ameda, Inc.’s Nurse Clinician/Lactation Consultant in the ParentCare division. I speak with mothers all over the country when they require resolution to breastfeeding/pumping issues.

Filed Under: Article, Ask the expert, Ask the IBCLC, Breastfeeding, Featured, guest posts, Relational Resource Tagged With: adoption and breastfeeding, Ask the expert, ask the IBCLC, breastfeeding jaundice, guest post, jaundice

Receiving Breastfeeding and Pumping Support Online and Over the Phone

September 17, 2015 by theleakyb@@b 1 Comment

by Linda Zager

In today’s busy world moms cannot always find time to meet with a lactation professional in-person when support is needed. These professionals can be far away, only have office hours at limited times and let’s be honest, when you have a newborn it can be near impossible to even get dressed let alone making it out of the house. But there is hope! Breastfeeding moms can receive support by reaching out by phone and speaking with a Lactation Consultant, nurse or a member of the breastfeeding community regarding breastfeeding or pumping concerns. Phone triage is a first step to resolving some breastfeeding issues. Mom’s face frustration caused by inconsistent information about breastfeeding and often, the unique personality of the baby is not taken into consideration.

Families can experience stress once they bring their baby home from the hospital. There may be questions surrounding breastfeeding and learning to “read” the newest addition to their family. A phone conversation can dispel common myths. Offering a small amount of education and lending an empathetic ear goes a long way. By listening carefully, a lactation professional will be capable of addressing some issues by phone. Offering mom different ideas of how to resolve simple issues can also empower moms! Follow up is often necessary to assess if the advice resolved the issue. The lactation professional may detect a more complicated issue that cannot be addressed over the phone, and in that case, the mom will be referred to a skilled Lactation Specialist for an in-person assessment.

The challenge for those who are providing support to breastfeeding women over the phone will be to distinguish between the mothers and babies whose situations are uncomplicated and those who will need the special assistance of a skilled International Board Certified Lactation Consultant(IBCLC). Proper assessment of the breastfeeding process requires an understanding of how the anatomy, physiology and psychology of how the mom and infant interact during lactation. Conducting a thorough history of the breastfeeding woman’s pregnancy, labor and delivery and postpartum period can shed light on any complications that could affect breastfeeding.

Pumping moms can seek advice over the phone to resolve problems they are experiencing with breast pumping. All Moms are unique and may have different experiences when using a breast pump. Not all breast pumps are made to operate in the same manner and one type of breast pump can work very well for one woman and poorly for another. Therefore the person offering advice on pumping by phone requires education on various types of breast pumps, which pump is best for the reason mom is using it, basics of pumping and suggestions to help stimulate a milk letdown. Moms need to be directed to READ the instruction manual of their breast pump and not assume it works like her friends or the one she used 3 years ago. Mom needs to be patient with her body as it adapts to a breast pump to express her milk. The first few pumping sessions should be looked at as practice. Pumping is very different than nursing a baby and a body needs to adapt to this difference. Pumping should never be a painful experience. If a mom is stating pumping is painful, factors such as flange size, suction pressure and pumping technique must be reviewed with her.

At Ameda, we have ParentCare Specialists available that are knowledgeable in the basics of pumping and how the Ameda breast pump functions. The representatives are responsible for thorough troubleshooting of the Ameda breast pump if an issue occurs so the mom has a positive pumping experience. If a ParentCare Specialist cannot resolve the issue, the mom’s case file is escalated to one of our IBCLC’s for assistance. And that is where I come in, I am a RN and IBCLC. I assist moms with both breastfeeding and pumping issues using phone triage to find a resolution to an issue. A mom who finds breastfeeding support during her motherhood journey can reach her goal of feeding her baby breast milk – a truly special gift.

Linda Zager, RN, IBCLC

I’ve been an RN for 37 years, working in various hospital positions from Intensive Care to Hemodialysis/Plasmapheresis, Maternal Child Care and finally Lactation Consulting, my true calling in life. I have been an IBCLC for 23 years working with moms/babies in their homes and in the hospital. I left hospital work and now work as Ameda, Inc.’s Nurse Clinician/Lactation Consultant in the ParentCare division. I speak with mothers all over the country when they require resolution to breastfeeding/pumping issues.

Filed Under: Article, Ask the expert, Breastfeeding, breastfeeding video, breastmilk pumping, Featured, Pumping Tagged With: Ameda, Ask the expert, Breastfeeding, breastfeeding and pumping support, IBCLC, over the phone, ParentCare Specialists, pumping

Avoid These 3 Common Babywearing Mistakes

September 2, 2015 by theleakyb@@b 42 Comments

by Beth Warrell Leistensnider

This post was made possible by the generous support of Catbird Baby Carriers.

The benefits of babywearing abound. It promotes physical and emotional development, strengthens the bond between parent and baby, allows baby a bird’s eye view of the world, allows parents to be hands-free and can allow for on-the-go breastfeeding. Here are some common errors when first using a carrier.

Too Low, Too Loose

Always aim for the baby to be high and tight or “visible and kissable.” You always want to be able to keep a close eye on your baby and be able to monitor his breathing. Remember to reposition baby after you’ve finished nursing him.

Babywearing too low and too loose

High and comfortably snug

Fit Tip: When putting the carrier on, hold your baby in the proper position on your body (on your chest where you naturally hold him), then bring the carrier to your baby and tighten while supporting his weight. If you support the baby’s weight gently in one hand, it will be much easier to adjust your carrier.

Carrier That’s Too big

When using a carrier that’s too big, getting the proper fit can be tough and safety can become an issue. Infants may not get the lateral and spinal support they need, the carrier may be too tall/cover the head, or their knees may be spread too far apart. When using traditional SSCs with newborns, follow the manufacturer’s instructions, make the proper adjustments and use recommended inserts as indicated. Remember, visible and kissable! *An earlier version of this article did not include photos of adjusted fit for proper and safe babywearing. Those images have been added for clarity.

Traditional soft structured carrier that is too wide/tall for this baby.

Adjusted for proper fit

The unstructured design of mei teis, ring slings, wraps and buckle carries like the Catbird Baby Pikkolo are great for newborns.

Fit Tip: When babies are little, less is more. Look for carriers that provide snug support without excess fabric or padding.

Compromised Airway

Babiess can sometimes slump into a chest to chin position when in their baby carriers (or car seats or bouncers). The upright, tummy-to-tummy position is the easiest way to maintain an open airway.

Cradle position poses a risk

Tummy-to-tummy position for safety

Fit Tip: Make sure that your baby’s chin is off the chest and that there is adequate airflow. Never cover baby’s head with a blanket.

Babywearing is a great parenting tool! With the right carrier (or carriers) for you, you and baby will look and feel comfortable. If you’re having trouble getting the right fit, babywearing groups, volunteer and certified babywearing educators are wonderful resources.

________________________

What is your favorite babywearing safety tip?

Share with us below and visit CatBird Baby on Facebook for more information and babywearing safety support.

Beth Warrell Leistensnider is the founder and owner of Catbird Baby. She is a pioneer in the baby carrier industry and leader in both local and international babywearing circles. A former volunteer babywearing educator, she is also a certified babywearing instructor with the Center for Babywering Studies and on the executive board of the Baby Carrier Industry Alliance. She started babywearing with her daughter who is now 12.

Filed Under: Article, Ask the expert, Babywearing, Babywearing, Featured, motherhood, Parenting, Relational Resource Tagged With: babywearing, babywearing mistakes, Babywearing Safety, Catbird Baby, How to wear your baby safely

Ask the CPST with clek- Keeping Your Newborn Safe

July 6, 2015 by theleakyb@@b 539 Comments

This post features questions from readers for a CPST (Child Passenger Safety Technician) focusing on car seats and is made possible by the generous sponsorship of clek who have made their staff CPSTs available to The Leaky Boob community in order to answer your questions and help you keep your children safe. For more questions related to infants in car seats, see questions 1, 2, 3, 4, and 5 from our live chat on TLB Facebook wall.

Dear Trudy,

I think we have everything just about in place for our new babe due in about 6 weeks but I’m completely overwhelmed and have anxiety about that drive home from the hospital with our new baby. Is there anything special we need to keep in mind with a newborn in a seat? Older babies seem less concerning as they can support their own heads better and have more muscle tone. I know we’ll have to get comfortable driving with our baby but those first few trips are particularly stressing me. I asked about car seat checks at our hospital tour and they said they’ll send a nurse out with us to be sure we have a proper seat but they aren’t responsible for ensuring we are using it properly. What can we do? What do we need to keep in mind with buckling a newborn?

Thank you for your help!

Worried in Wisconsin.

Dear Worried in Wisconsin,

Having a baby is such an exciting time in life! Having new concerns and worries pop up as you near the big day is perfectly understandable.

You’re right that a newborn baby has a weaker neck and needs help in supporting its head. Installing your car seat so that it’s reclined properly will make sure that your new babe’s head is supported and doesn’t tip forward. Your rear-facing car seat will come with instructions for adjusting the recline and installing it in the vehicle.

Before baby arrives I’d recommend reviewing the information in your car seat manual about securing babe in their car seat. Using a teddy bear or other stuffed animal can help give you some familiarity about how to use and tighten the harness.

When you put baby in the first time, you’ll want to check how they fit in the seat. Depending on the seat you choose, you may need to make some minor adjustments to either the harness height and/or the crotch buckle before leaving the hospital. Your car seat manual will have those instructions in it. Most manufacturers recommend that the harness be positioned so that the straps are at the closest height either even or below the baby’s shoulders.

Once you’ve checked that your seat is adjusted properly for your new babe, make sure that their bum is snug to the back of the seat so that they’re not slouching, and then adjust the harness so that it’s snug over their body. A snug harness has no visible slack, but doesn’t push their body out of position.

I’d also recommend getting in touch with a Child Passenger Safety Technician (CPST). A CPST has training in helping families install and use their seats properly, and might give you that last bit of peace of mind. You can check for a tech near you by visiting the Safe Kids website and searching by your city and state.

Best wishes as you finish the final preparations for your new baby.

Trudy

Dear Trudy

It has been 9 years since I had my last child and now I’m expecting again. The world of car seats seems to have changed a lot and I’ve learned I made a lot of mistakes with my 9 year old, which has caused me to question what I thought I knew. With my son, I used one of those newborn head support inserts that didn’t come with his seat. I have been given a cute little newborn head support insert for this baby but I’ve heard that these aren’t safe yet I noticed many of the seats we have considered for this new baby come with them. Can I not switch out the one in the seat for the cute one we were given?

Sincerely,

Confused and Concerned

Dear Confused and Concerned,

Congratulations on your upcoming new arrival! You’re right – car seats certainly have changed a lot in the last 9 years!

Car seat manufacturers test their seats using the specific covers and accessories that come with the car seat, and carefully select each piece to make sure that the car seat will keep your baby as safe as possible. You’re right that the extra head support inserts that are available in stores shouldn’t be added to your car seat. Most car seat manuals include instructions to only use products provided and approved by the car seat manufacturer for use with the seat, so in most cases you wouldn’t be able to switch out the one that came in the car seat.

The extra head supports available in stores definitely are cute. It’s possible you may be able to use it in your stroller instead and then you can still enjoy the cute factor.

Safe Travels,

Trudy

Dear Trudy,

Some of the materials I’ve read say that a baby isn’t safe to be left in a car seat due to possible breathing concerns and now I’m worried about my baby’s breathing even when we’re in the car. If it isn’t safe for a baby to be left in a bucket seat while they nap in the house, how can it be safe in the car? Are there some seats that are less of a risk than others for breathing issues?

Peace,

Ready to breathe easy.

Dear Ready to breathe easy,

There are a few reasons that experts recommend limiting the amount of continuous time an infant spends in a car seat, but the most substantial one is related to possible breathing concerns as you’ve discovered.

Using a car seat in the car is different than using it in the house for a few reasons. Car seats generally sit at a different angle when they’re properly installed in the car vs. when they’re sitting on a surface outside of the car. This increased recline in the car ensures that their head stays in position and doesn’t tip forward. If a car seat sits more upright in the stroller or on the floor, it may lead to positional breathing problems. Infants also typically spend less time in their car seat on an average car ride, than they would if they were napping or sleeping or playing in their car seat outside the car.

In most cases, positional breathing problems happen after a baby has been buckled in to a car seat for an extended period of time. If you have any long car trips coming up while your baby is less than 6 weeks old, I would recommend talking to your baby’s doctor to see if they have any recommendations on how often you should stop for a short break to remove baby from the car seat. In the absence of special medical needs, I generally recommend planned stops at least every 1.5 hours.

Rear-facing only seats are designed to provide protection to your precious cargo at their smallest size, and all rear-facing only seats have a recommended recline angle for when the seat is installed in the car. There can be some variation in the manufacturer’s preferred recline between different models, but provided the seat is installed according to directions, your baby fits the seat properly, and baby’s head doesn’t tip forward chin-to-chest during trips, then you can breathe easy knowing that your baby will breathe fine during car trips.

Safe travels,

Trudy

Dear Trudy,

Our infant car seat from my two older children has expired and we need to get a new one for the baby on the way. I’m trying to figure out if there is any reason to get two different seats or if it is more practical to get a convertible that will go down to newborn weight ranges. Is there anything we need to consider when looking at convertible car seats with the intention of using it from the beginning? Are these truly safe options? How does it work to cover such a wide range of sizes? Would it actually be better to just get two different seats?

Thanks for helping us keep our babies safe!

With gratitude,

Two and One on the Way

Dear Two and One on the Way,

The decision about whether to start with a convertible car seat or a rear-facing only car seat is one that a lot of families debate. The answer about which style of seat is better is going to be different for each family, but there are some factors you can consider that should help make the decision easier for you.

Convertible seats come in a wide range of sizes and designs. Most of them start at 5lbs, but some of them do a better job of fitting a newborn than others. Depending on how big your baby is at birth, and the model of convertible seat selected, sometimes a newborn doesn’t fit properly in to a convertible seat. Some convertibles, such as Clek’s Foonf and Fllo when used with the infant-thingy, have inserts available that allow newborns to be properly positioned and fit the seat well.

Rear-facing only seats are designed to fit newborns, so if you’re expecting a smaller baby, then they are generally the preferred choice. A rear-facing only seat also has the benefit of being easily portable. This can be helpful if you live in either a very hot climate or a very cold climate since it lets you buckle baby in in the comfort of your house and then carry him or her to your car. It also gives a lot of convenience if you frequently have short trips with a lot of stops along the way.

Provided you’re fairly certain baby will be full-term and of average size, the convenience factor is often the easiest way to decide which option will work best for you. If you plan to babywear, or not use the car seat outside of the car, then choosing a convertible seat may be a practical plan for you. If you think you will appreciate having the carrier option, then that may mean that purchasing two seats is the best choice for your family.

If you decide to go with a convertible seat, I’d recommend researching different models to find a model that fits in your vehicle at a newborn recline, and is also known for fitting small babies well. Google images or visiting a company’s facebook page where customers often share their pictures can be very helpful in giving you a feeling for how a newborn looks in the bigger seat.

Congratulations on the upcoming addition to your family!

Safe travels,

Trudy

________________________

Not only does clek want to help us all get comfortable with getting our little ones secure in our vehicles, they’re going to physically help one Leaky do just that!

Clek is giving away a Foonf Convertible Car Seat in Flamingo or Tank to a Lucky Leaky.

Foonf is Clek’s no-compromise convertible child seat – introducing revolutionary safety technology, extended rear-facing to 50 lb, innovative convenience features, and it’s recyclable.

Total Retail Value: $449.99 USD ($549.99 in Canada)

Visit www.clekinc.com for more information

______________________

Good luck to everyone! Please use the widget below to enter. A big thanks to Clek for their support of TLB and all breastfeeding women; please be sure to take a moment to thank Clek on their Facebook page for their show of support! You can also follow Clek on Twitter and Instagram: username @Clekinc

a Rafflecopter giveaway

________________________

Trudy Slaght, Clek CPST, CRST-IT As Clek’s Child Passenger Safety Advocate, a previous board member of the Child Passenger Safety Association of Canada, and a CRST Instructor from Edmonton, Alberta, Trudy Slaght pretty much breathes, eats, and lives child passenger safety. With her brain crammed full of valuable tips and advice, Trudy attends and speaks at various industry conferences across North America and provides everything from simple helpful guidance to advanced technical support for parents, caregivers, and even fellow technicians.

A mom of three, Trudy has been involved in the field for over 7 years, spending lots of time thinking about, practicing, and preaching the best methods to keep our little ones safe for the ride. And, even with all this on her plate, Trudy still somehow has the passion and energy to be a contributing author to Canada’s National Child Passenger Technician Training curriculum.

Filed Under: Article, Ask the expert, baby, Car Seat Safety, car seats, Featured, giveaway, Relational Resource Tagged With: ask the CPST, Ask the expert, car seat safety, clek, clek fllo, clek foonf, CPST, Giveaway, newborn car seats, Trudy Slaughter

Weight Gain in Your Breastfed Baby

Increasing Breastmilk Supply With Pumping For Milk Donation

by Jessica Martin-Weber and Dr. Pamela K. Murphy

So you want to get started increasing your supply to donate, Dr. Pamela Murphy, PhD, CNM, IBCLC shares with us some helpful information and tips to get you started:

Having Enough Milk for Your First Day Back

by Shari Criso, RN, CNM, IBCLC

“Let Love Flo” Infant Feeding Q&A With An IBCLC

The Leakies with Shari Criso, MSN,RN, CNM, IBCLC

For over 23 years, Shari Criso has been a Registered Nurse, Certified Nurse Midwife, International Board Certified Lactation Consultant, nationally recognized parenting educator, entrepreneur, and most importantly, loving wife and proud mother of two amazing breastfed daughters.

What You Need to Know About Jaundice, Breastfeeding, and Your Newborn Baby

by Linda Zager, RN, IBCLC

This post made possible by the generous support of Ameda, inc.

Linda Zager, RN, IBCLC

Receiving Breastfeeding and Pumping Support Online and Over the Phone

by Linda Zager

Linda Zager, RN, IBCLC

Avoid These 3 Common Babywearing Mistakes

by Beth Warrell Leistensnider

Ask the CPST with clek- Keeping Your Newborn Safe

Support The Leaky Boob

Search

Get Email Updates Here

Categories

Disclamer

by Jessica Martin-Weber and Dr. Pamela K. Murphy

So you want to get started increasing your supply to donate, Dr. Pamela Murphy, PhD, CNM, IBCLC shares with us some helpful information and tips to get you started:

by Shari Criso, RN, CNM, IBCLC

The Leakies with Shari Criso, MSN,RN, CNM, IBCLC

For over 23 years, Shari Criso has been a Registered Nurse, Certified Nurse Midwife, International Board Certified Lactation Consultant, nationally recognized parenting educator, entrepreneur, and most importantly, loving wife and proud mother of two amazing breastfed daughters.

by Linda Zager, RN, IBCLC

This post made possible by the generous support of Ameda, inc.

Linda Zager, RN, IBCLC

by Linda Zager

Linda Zager, RN, IBCLC

by Beth Warrell Leistensnider

Support The Leaky Boob

Follow us

Search

Get Email Updates Here

Categories

Disclamer