Archive for November 2008

Introducing Solids

November 27, 2008

by Holly Lucard, IBCLC

The American Academy of Pediatrics recommends exclusive breastfeeding for the first six months of life. The AAP also suggests a gradual introduction of solids in the second half of the first year, which should complement the breastmilk diet.

Human Milk Is Baby’s Primary Nutrition
In my nineteen years of counseling breastfeeding mothers, I have received numerous calls from women who fear their babies are losing interest in breastfeeding and that they are losing their milk. The culprit in almost all of these cases? Solids! It is important to remember that human milk is the primary source of nutrition for your baby for the first year of his life. Breastmilk provides 100% of a baby’s nutritional needs for the first six months of life, and 75% for the second six months.
Important Guidelines
To ensure that your baby won’t wean before both you and she are ready, there are two important things to do when adding solid food to her diet.

1. For the first year, nurse immediately before giving solids. Don’t offer meals between or before
breastfeeding. Giving solids between feedings will stretch out the time between nursings,
causing a decrease in your milk supply.  Remember, the more you nurse, the more milk
you make. If you feed solids before nursing, your baby will likely become too full and won’t be
interested in breastfeeding.

2. Don’t rush into giving three meals a day. Start slowly with one meal a day, adding a second meal
in a few months, and the third a few months after that. Your baby may not be on three meals a day
until she is a year old. Gradually during your baby’s second year, the amount of solids your
baby eats will increase to become a major part of her diet. Keep in mind that your
baby will have a lifetime for eating solid food, but breastmilk is only available in the early years.

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Breastfeed a Toddler? Why on Earth?

November 27, 2008

By Jack Newman, MD, FRCPC
www.bflrc.com

 Because more and more women are now breastfeeding their babies, more and more are also finding that they enjoy breastfeeding enough to want to continue longer than the usual few months they initially thought they would do it.  UNICEF has long encouraged breastfeeding for two years and longer, and the American Academy of Pediatrics is now on record as encouraging mothers to nurse at least one year and as long after as both mother and baby desire.  Breastfeeding to 3 and 4 years of age has been common in much of the world until recently, and breastfeeding toddlers is still common in many societies.

Why should breastfeeding continue past six months?  Because mothers and babies often enjoy breastfeeding a lot.  Why stop an enjoyable relationship?

But it is said that breastmilk has no value after six months.
Perhaps this is said, but it is wrong.  That anyone can say such a thing only shows how ignorant so many people in our society are about breastfeeding.  Breastmilk is, after all, milk.  Even after six months, it still contains protein, fat, and other nutritionally important and appropriate elements which babies and children need. Breastmilk still contains immunological factors which help protect the baby.  In fact, some immune factors in breastmilk which protect the baby against infection are present in greater amounts in the second year of life than in the first.  This is, of course as it should be, since children older than a year are generally exposed to more infection.  Breastmilk still contains factors which help the immune system to mature, and which help the brain, gut, and other organs to develop and mature.

It has been well shown that children in daycare who are still breastfeeding have far fewer and less severe infections than the children who are not breastfeeding.  The mother thus loses less work time if she continues nursing her baby once she is back at her paid work.

It is interesting that formula company marketing pushes the use of formula (a rather imperfect copy of the real thing) for a year, yet implies that breastmilk (from which the imperfect copy is copied) is only worthwhile for 6 months.  Too many health professionals have taken up the refrain.

I have heard that the immunological factors prevent the baby from developing his own immunity if I breastfeed past six months.  This is untrue; in fact, this is absurd.  It is unbelievable how so many people in our society twist around the advantages of breastfeeding and turn them into disadvantages.  We give babies immunizations so that they are able to defend themselves against the real infection.  Breastmilk also allows the baby to be able to fight off infections. When the baby fights off these infections, he becomes immune.  Naturally.

But I want my baby to become independent. And breastfeeding makes the toddler dependent?  Don’t believe it.  The child who breastfeeds until he weans himself (usually from 2 to 4 years), is generally more independent, and, perhaps more importantly, more secure in his independence.  He has received comfort and security from the breast, until he is ready to make the step himself to stop.  And when he makes that step himself, he knows he has achieved something, he knows he has moved ahead. It is a milestone in his life.

Often we push children to become “independent” too quickly.  To sleep alone too soon, to wean from the breast too soon, to do without their parents too soon, to do everything too soon.  Don’t push and the child will become independent soon enough.  What’s the rush?  Soon they will be leaving home.  You want them to leave home at 14?

Of course, breastfeeding can, in some situations, be used to foster an over-dependent relationship.  But so can food and toilet training.  The problem is not the breastfeeding.  This is another issue.

What else?  Possibly the most important aspect of nursing a toddler is not the nutritional or immunological benefits, important as they are.  I believe the most important aspect of nursing a toddler is the special relationship between child and mother.  Breastfeeding is a life-affirming act of love.  This continues when the baby becomes a toddler.  Anyone without prejudices, who has ever observed an older baby or toddler nursing can testify that there is something almost magical, something special, something far beyond food going on.  A nursing toddler will
sometimes spontaneously break into laughter for no obvious reason.  His delight in the breast goes far beyond a source of food.  And if the mother allows herself, breastfeeding becomes a source of delight for her as well, far beyond the pleasure of providing food.  Of course, it’s not always great, but what is?  But when it is, it makes it all so worthwhile.

And if the child does become ill or does get hurt (and they do as they meet other children and become more daring), what easier way to comfort the child than breastfeeding?  I remember nights in the emergency department when mothers would walk their ill, non-nursing babies or toddlers up and down the halls trying, often unsuccessfully, to console them, while the nursing mothers were sitting quietly with their comforted, if not necessarily happy, babies at the breast.  The mother comforts the sick child with breastfeeding, and the child comforts the mother by breastfeeding.

Why do Babies Wake at Night?

November 27, 2008

Written By Therese DeChristopher, RN, IBCLC and LiseAnne Dietz McGalliard

Our baby has finally arrived, and it seems the first question everyone asks is, “Does your baby sleep through the night?” You know your baby is keeping you up but you are afraid to say so. Everyone seems to think sleeping through the night is a desirable goal for infancy, as well as a measure of your parenting skills.  Should sleeping through the night be such an important issue, and is it what your baby needs?

Most babies wake several times throughout the night. For a baby, sleeping through the night is not really a desirable goal. It may not even be possible. The fact is that babies are designed to not sleep through the night. Babies are not adults and their sleep patterns are not the same as adult sleep patterns. Babies have shorter and lighter sleep cycles that prevent them from falling asleep as deeply as adults do. If babies slept as deeply as adults, they might not be able to wake themselves.
There are important reasons why infants wake during the night. They might be hungry, hot, cold,ill, or having trouble breathing.

Some research indicates that one of the possible causes of SIDS is a baby who is sleeping so deeply that is she unable to wake herself. Babies who wake frequently are actually well adapted. Babies who sleep longer and more deeply may be at greater risk. Formula-fed babies may sleep for longer periods at night because formula is not as easily digested as breastmilk. Artificial baby milk forms large tough curds in the baby’s stomach and may make the baby “feel” full longer and stay in deep sleep longer. One of the benefits of breastfeeding is that breastfed babies sleep the way nature intended. They wake more easily in response to their physical needs.

Not only does night waking provide important survival benefits, it is normal behavior for babies. It is natural for babies to awaken two or three times a night from birth to six months, once or twice from six months to a year, and once a night after one year. Keep this in mind: The medical definition of “sleeping through the night” is only a five-hour stretch.

As parents, what should we do? The more we push the issue, the more difficult it is likely to be for everyone. A baby’s sleep habits are determined more by individual temperament than by her parents’ nighttime parenting abilities. It is not your fault that your baby wakes at night. If there is less stress surrounding the issue, sleeping through the night may actually occur sooner than later because everyone, including baby, benefits from a more relaxed environment.

At some point, all children learn to “sleep through the night.” Until this happens for your child, remember that frequent waking is normal and beneficial for your baby.

What if I want to Wean my Baby?

November 27, 2008

Diane Wiessinger, MS, IBCLC

Breastfeeding your baby for even a day is the best baby gift you can give.  Breastfeeding is almost always the best choice for your baby.   If it doesn’t seem like the best choice for you right now, consider the following:

If you nurse your baby for just a few days, he will have received your colostrum, or early milk.  By providing antibodies and the food his brand-new body expects, nursing gives your baby his first — and easiest — “immunization” and helps get his digestive system going smoothly.  Breastfeeding is how your baby expects to start, and helps your own body recover from the birth.  Why not use your time in the hospital to prepare your baby for life through the gift of nursing?

If you nurse your baby for four to six weeks, you will have eased him through the most critical part of his infancy.  Newborns who are not breastfed are much more likely to get sick or be hospitalized, and have many more digestive problems than breastfed babies.  After four to six weeks, you’ll probably have worked through any early nursing concerns, too.

If you nurse your baby for three or four months, his digestive system will have matured a great deal, and he will be much better able to tolerate the foreign substances in commercial formula.  If there is a family history of allergies, though, you will greatly reduce his risk by waiting a few more months before adding anything at all to his diet of breastmilk.  And giving nothing but your milk for the first four months gives strong protection against ear infections.

If you nurse your baby for six months, he will be much less likely to suffer an allergic reaction to formula or other foods.   The American Academy of Pediatrics recommends waiting until about six months to offer solid foods.  Nursing for at least six months helps ensure better health throughout your baby’s first year of life, and reduces your own risk of breast cancer.  Nursing for six months or more may greatly reduce your little one’s risk of childhood cancers.  And exclusive, frequent breastfeeding during the first six months, if your periods have not returned, offers 98 percent effective contraception.

If you nurse your baby for nine months, you will have given him the food that was designed for him — your milk — during the fastest and most important brain and body development of his life.  Nursing for at least this long will help ensure better performance all through his school years.  Weaning may be fairly easy at this age .  .  .  but then, so is nursing!  If you want to avoid weaning this early, be sure you are available to nurse for comfort as well as just for food.

If you nurse your baby for a year, you can avoid the expense, bother and risk of formula.  His one-year-old body can probably handle most of the table foods your family enjoys.  Many of the health benefits this year of nursing has given your child will last his whole life.  He will have a stronger immune system and will be much less likely to need orthodontia or speech therapy.  The American Academy of Pediatrics recommends nursing for at least a year.

If you nurse your baby for 18 months, you will continue to provide your baby with protection against illness at a time when illness is common in other babies.  He has had time to form a solid bond with you, a healthy starting point for his growing independence.  And he is old enough that you and he can work together on the weaning process, at a pace that he can handle.   A former U.S. Surgeon General said, “It is the lucky baby that nurses to age two.”

If your child weans when he is ready, you can feel confident that you have met your baby’s physical and emotional needs in a very normal, healthy way.  In cultures where there is no pressure to wean, children tend to nurse for at least two years.
The World Health Organization and UNICEF strongly encourage breastfeeding through toddlerhood.  Breastmilk is an important source of energy and protein, and helps to protect against disease during the child’s second year of life.  It just makes sense to nourish our children’s growing bodies with the milk that was designed for them.

Your milk provides antibodies and other protective substances as long as you continue nursing, and families of nursing toddlers often find that their medical bills are lower than their neighbors’ for years to come.  Mothers who have nursed long-term have a still lower risk of developing breast cancer.

Children who were nursed long-term tend to be very secure and are less likely to suck their thumbs or carry a blanket.  Nursing can ease you through the tears, tantrums and tumbles that come with early childhood, and helps ensure that any illnesses are milder and easier to deal with.  It’s an all-purpose mothering tool you won’t want to be without! Don’t worry that your child will nurse forever. 
All children stop eventually, no matter what you do, and there are more nursing toddlers around than you might guess.

Whether you nurse for a day or several years, the decision to nurse your baby is one you need never regret.  And whenever weaning takes place, remember that it is a big step for both of you.  If you choose to wean before your child is ready, be sure to do it gradually, and with love.

Tips For the Reluctant Bottle Taker

November 27, 2008

Some breastfed infants initially reject any attempts to feed by bottle.  With patience and understanding, this initial reluctance usually gives way over time.  Here are some suggestions to help you teach your baby to take a bottle.  While it would be impossible to do all of these things at once, if one idea doesn’t work with your baby, another may.  Remember that you can also feed your baby with a cup, spoon or eyedropper.Wait until your baby is latching on easily and your breasts and nipples are comfortable before starting bottles (or other artificial nipples), if possible.  Plan to introduce the bottle about two weeks before you return to work or are separated from your baby for an extended period of time. This will give you time to work out any problems that may occur.Let someone else introduce the bottle.  Your baby may not take a bottle from you because she can smell yourmilk and wants only the breast.  She may be more willing to take the bottle from a caregiver other than her mother.  It may be necessary for you to leave the room or even the house.

Offer the bottle before the baby is too hungry.

Wrap the baby in a piece of Mom’s clothing while offering the bottle.

Experiment with different types of nipples.

Run warm water over the nipple to bring it to body temperature.

Rock, walk or sway with the baby while offering the bottle.

Have the caregiver hold the baby in a position other than the traditional  “cradle hold” when offering the bottle,such as having the baby facing outward or propping her against the caregiver’s outstretched legs.

Hold the bottle in an armpit and draw your baby close as though breastfeeding.

NOTE: If one of these tips doesn’t work with your baby, the next suggestion
may be the one that will.  Don’t give up, most babies take a bottle eventually.

Stress and the Nursing Mother

November 27, 2008

The birth of a baby comes to us as a revelation in many ways.  It opens the door to a level of love and commitment most of us have never before experienced.  What comes as a greater surprise to many of us, though, is how stressful such a joyful event can be.Experts tell us that major life changes, whether negative like loss of a job or a loved one, or positive like welcoming a new baby to the family, are among life’s most stressful events.  In his book, Stress Free Living, (DK Publishing, Inc., 2000), psychologist Dr. Trevor Powell writes that new parents “can expect to have less sleep, less money, less time for going out and relaxing, extra work and less sleep.”  Clearly, this is a recipe for stress.  And the mother may feel a double whammy because she experiences stress from both physical sources (recovery from labor and delivery, hormonal shifts, and sleep deprivation, to name a few) and emotional sources like self-doubt, concerns about balancing her own needs with those of her changing family, and the need to redefine her self-image.

The stress of being a parent doesn’t end after the first few months.  Because children are constantly growing and changing, their parents must also continually adapt.  The mother and her partner must redefine their relationship on an ongoing basis as they strive to meet the changing needs of their children and to function as a team.  The expenses of child rearing may strain the family financially, another major source of stress.  And these factors are added to the day-to-day problems and annoyances that stress us all.

We all know that stress doesn’t make us feel good, and we may have seen that it interferes with the way our bodies function.  But don’t believe those who tell you that stress can prevent you from breastfeeding successfully.  As Martha Sears, R.N. and William Sears, M.D., point out in The Breastfeeding Book (Little, Brown & Co., 2000), “You can deliver enough milk to your baby even under the most stressful conditions.  After all, for centuries mothers have successfully nursed their babies during wars, famines, and floods.”  However, chronic stress can make breastfeeding (and life in general) less enjoyable and more difficult.

Studies have shown that breastfeeding women have reduced levels of stress hormones in their bodies and enhanced levels of hormones that foster feelings of well-being.  However, chronic stress can reduce this benefit.  The Searses explain that, “the adrenal hormones that surge when you’re overstressed can interfere with the hormones that make milk. . . . Chronic unresolved stress throws off the

biochemical equilibrium of your body, explaining why some women notice a reduction in their milk supply following a family crisis . . . and also why unhealthy reactions to the daily grind can zap a milk supply.”  Since stress is unavoidable for the parents of young children, how can we minimize its negative effects?  The experts offer the following advice:

♥ “Realize that you can’t control situations, but you can control your reactions to them,” advise the Searses.  “Children get sick.  People lose jobs.  Some setbacks in life are beyond your control. Yet what is always within your control is how you react to those setbacks.”

♥ Seek Out Information.  The more information you have about a situation, Dr. Powell suggests, “the more prepared you will be to deal with it, and therefore the less likely you will be to worry.” Read a parenting or breastfeeding book, attend a nursing mothers meeting, or call your counselor – all are sources of reliable information that can help put unreasonable fears and concerns to rest.

♥ Focus on Solutions, Not Problems.  “This destressor is especially valuable for breastfeeding mothers,” write the Searses.  Instead of letting sore nipples or a reduction in milk supply defeat you, find help in working out a solution.  The very act of doing so will make you feel empowered and less stressed.  “Believe in your body,” the Searses advise. “It will work for you.”  Dr. Powell has similar advice.  “Try to visualize the result you want to achieve,” he writes, “then work out what you need to do to get there.”  For many nursing mothers, seeking out positive voices is critical because our culture is filled with discouraging messages about breastfeeding.  Take advantage of the knowledge and support your nursing mothers counselor has to offer!

♥ Keep a Sense of Proportion.  “Don’t miss sleep or waste energy over life’s annoyances that reduce your energy for making milk and caring for your baby,” suggest the Searses.

♥ Feel Good about Yourself.  “Each day remind yourself that you are doing the most important job in the world: nurturing a human being.  And you are doing what no one else in the whole world can do: make milk that is custom tailored to meet the needs of your baby.  Each day (or even at each feeding) remind yourself that the milk you are giving your infant is going to make your baby smarter and healthier. . . . You are very important.”

♥ Take Care of Yourself.  Although your time may never have seemed more limited, it is critical that you spend some of it on yourself.  “Chronic, unresolved stress exhausts your brain’s neurotransmitters, keeping you from feeling good and thinking clearly,” the Searses explain. Relaxation allows your brain to recuperate.  Seek out activities that relax the body and the mind, generating endorphins, hormones that promote pleasurable feelings.  Take a bath, spend a few minutes walking or doing other moderate exercise, listen to music, or practice a hobby or other activity that makes you feel good – the fact that you feel relaxed afterwards is more important than what you do.  Try to train yourself to focus on positive images of your baby, which will “get your milk-making hormones flowing,” the Searses advise.  “As a bit of preventive medicine, as soon as you feel a disturbing thought coming on, quickly switch channels and fill your mind with positive thoughts before negative ones sink in.”  And don’t forget your physical health.  Good nutrition can help your body fight the negative effects of stress, advises Dr. Powell.

♥ Laugh and Play A Lot.  “There is a biochemical basis for the belief that laughter is your best medicine,” write the Searses, because “laughter stimulates those ‘feel good hormones,’ endorphins.”  They recommend three enjoyable activities that have been shown to increase endorphins and are good for the nursing mother – exercise, laughter and sex.

♥ Seek Out Support and Share Your Feelings.  It is important not to bottle up your feelings and to share both the positive and the negative emotions you are experiencing, advises Dr. Powell.  Find a trusted sounding board who will validate your feelings, but help you recognize unrealistic expectations of parenthood, your family and yourself.  Of course, it is important that you share your feelings with your partner, but sometimes
a more objective view is valuable.  Your counselor has been trained to listen in a
nonjudgmental way and to offer support for your feelings, whatever they may be.

It is important to remember that what ultimately determines the quality of our lives as new parents is not the stresses that we face, but the way in which we face them.  With the help of tools like those above, we can avoid the cycle of worry, frustration and fatigue that can overwhelm us and focus instead on the positive and joyous aspects of this irreplaceable time in our children’s lives.

Recognizing Your Newborn's Feeding Cues

November 27, 2008

Mary Catherine Bolton, BS and Cathy Snyder, RN, BSN, IBCLC

For years, women have been told that feeding “on demand” is best for breastfeeding newborns.  However, demand feeding implies the mistaken notion that baby needs to cry to be fed.  Recent research suggests that parents should be alert for feeding “cues”, which are instinctive behaviors an infant displays before crying.

Babies may cry for many reasons – overtiredness, overstimulation, discomfort, or loneliness, to name a few.  On the other hand, sometimes babies who are very hungry do not cry.  Newborns who have jaundice, who are small or born prematurely, or affected by labor medications during birth may be groggy or sleepy.  Even a baby who has a calm temperament may not cry very often.  A baby in any of these situations may be undernourished if fed only when he cries.

The best approach is to respond to a baby’s feeding cues. These behaviors, although more subtle than crying, are distinctive and can be easily recognized by watchful parents or caregivers. Even a very sleepy newborn is likely to display feeding cues during periods of light sleep, and will be easier to wake at such times. The American Academy of Pediatrics recommends, “Newborns should be nursed whenever they show signs of hunger such as increased alertness or activity, mouthing or rooting. Crying is a late indicator of hunger.”

Feeding on cue offers many advantages. Mother and child are more in tune with one another, which fosters bonding and trust.  Mother respects her infant’s individual and changing needs.  Baby learns to cry less, making the home more peaceful and parenting more pleasurable. Baby is likely to latch on more easily and nurse more calmly. Mother is more likely to develop a milk supply that matches baby’s biological needs and baby is more likely to have his comforting needs met.

Research has shown that cue-based feeding works. In one study, premature babies who were fed on cue were discharged sooner than those fed on a schedule. Since parents had learned feeding cues, these babies were also less likely to have problems with weight gain once home.

These behaviors, although more subtle than crying, are distinctive and can easily be recognized by watchful parents or caregivers.  Very sleepy newborns, who may be difficult to wake for feedings, are likely to display feeding cues during periods of lighter sleep and will be easier to wake at such times.

Feeding cues are one of the many ways in which your newborn communicates with you and attempts to control his environment.  When you recognize and respond to his preverbal “voice,” you reinforce his efforts to interact with the world around him.  Perhaps even more importantly, you show respect for him as a unique person capable of expressing his needs and entitled to have those needs met.