Category Archives: Breastfeeding

Diaper Surprise! 12 Freaky Things to See in Baby’s Diaper during the first year

Breastfeeding, Feeding, Infant Health & Safety, New Moms, solids

Changing your baby’s diaper may feel a bit like unwrapping a surprise gift or delicately defusing a small package bomb. You’re never quite sure what’s inside until its too late, and the contents may shock you, amuse you, or make you run for Dr.Google.

Don’t underestimate the fascination you may have with your baby’s diaper contents. Embrace this stereotypical new parent obsession, though do try to limit detailed diaper discussions to other new parents, and those who feign polite interest without turning white or audibly gagging.

Surprise! Here are 12 freaky things you might find in your baby’s diaper during the first year:

Day 3: Brick dust (uric acid crystals) – a rust or pinkish colored residue staining the front of the diaper. This resolves as baby’s urine becomes more dilute.

Week 2: Gel crystals. These look like oversized grains of sugar stuck to your baby’s genitals. Don’t panic – they’re not coming from your baby! Instead, they’re from the absorbent lining escaping from tiny tears in a disposable diaper.

Week 6: Green spinachy-looking poop. Like the occasional random projectile vomit, these bizarre baby things sometimes happen, possibly on days when baby is nursing more than usual. Unless it’s frequent, frothy, with mucus and blood, don’t worry about occasional green poop in the diaper.

Month 3: Nothing. No poop. Nada. Perhaps several days or even a week may go by with nary a stool. Perfectly normal for breastfed babies, as long as baby is content and pee is plentiful. No need to intervene. What goes in will eventually come out (and usually at the least opportune time and in abundance), so be fully prepared for a poop explosion.

Month 4: Containment Failure or Blow Out. When baby is in a seated position (car seat, bouncer, baby carrier) there’s really only one place for poop to go, and that’s UP. Tell-tale sign of the Blow Out is a yellowish wet spot located at the small of the baby’s back. Usually involves a complete change of clothes, bath optional. For both of you.

Month 5: Mom’s hair (because it’s falling out everywhere). Tip: Time to get a short, sassy hair cut. Hint: Beware the Hair Tourniquet.

Month 6: Slimy mucus in poop when baby has a cold. Swallowed mucus isn’t absorbed by the GI tract and will pass through unchanged into the diaper with poop.

Month 8: Little black threads which look exactly like tiny worms. These are from baby eating fresh bananas (not jarred). They’re just like the little black strings you see in homemade banana bread. Mmm. Banana bread.

Month 9: Gas-mask worthy smells. The strongest odors yet are typically from introducing more protein foods. Whew. Just. Wow.

Month 10: Bits of paper are likely from the tag she was chewing in the store or cardboard from gnawing on the corner of a board book. Paper is one of the four basic food groups of mobile babies. Bonus points if you can still read a letter or word.

Month 11: Easily identifiable bits and pieces of food. Oh, there’s a blueberry! Hey, look, a lima bean! Tip: If you want to know how long it takes for food to make it through your baby’s digestive tract, feed baby some corn. My estimation is you’ll see it again in about 18 hours.

Month 12: Poop that looks (and smells) just like big-people poop. If it’s not too squashed, you can shake it into the toilet instead of sealing it up in the diaper. The more solid food your baby eats, the more their poop will start to look more “familiar”.

Bonus – 18 months: Brightly colored flakes – from that crayon you needed to pry out of your toddler’s mouth. Makes for some pretty poop, though!

Pumping at Work: Uneven Production

bottles, Breastfeeding, Feeding, New Moms, ,

I’m back at work and my baby is 14 weeks old. I have been pumping twice during my workday (9 AM and 1 PM) and I can pump about 10 to 12 ounces a day with these sessions.

My left breast is producing a lot more milk than my right, and might look a little larger. 

After 2 min of stimulation, milk starts to flow from my left breast. I don’t see any milk from right breast until about 5-8 min into pumping, and maybe collect two ounces by the time the session ends between 15 and 20 min. Suggestions? ( I’m using size 27 cups with Medela freestyle).

Congratulations on making the (hard, so hard!) transition back to work, and wow, expressing 10 – 12 ounces in two sessions is great. Good job, you!

Since you mention pumping at 9 AM and 1 PM, you might consider adding a “before leaving work” pumping session after you’re done for the day but before leaving. This might mean that you arrive home with 15 ounces instead of the 10 – 12, if that is important to you. You can pump at work and still breastfeed on arrival home or to childcare.

When pumping,  see if the 24mm flange might do better on the right breast, even if the 27mm does better on the left. If that is the case, it may stimulate more milk let down and removal over time. Try a dab of olive oil for lubrication and use my suggested pumping techniques (hands-on, massage and compression, repositioning angle of nipple several times, varying vacuum strength and cycling speed accordingly)

It’s normal to find a discrepancy between the two breasts – we are not mirror-image or symmetric people (we have one liver, one spleen, one heart) and each breast functions independently from the other. Between the two breasts, you should be able to make all the milk baby needs and then some, but you may not make an even amount from each.

Some women become aware that one breast makes a lot more milk than the other only once they begin doing a lot of pumping. Other moms can see physical differences in breast size (up to 1 – 2 bra cups sizes) and some moms or babies have a clear preference due to production (with oversupply or very heavy let down, baby may prefer the slower-producing other breast!).

How can you “even things out”?

When nursing your baby, you could try to start her on the right breast – babies are typically most vigorous at the beginning of the feeding session and this “enthusiasm” might help encourage the milk to flow and assist with production. Use lots of breast compression and massage to help things along.

Another perspective: if she is cranky when starting on the “slower” side because she’s used to a fast flow from the bottles and frustrated at having to work hard and wait for the milk when starting on the right side, then instead, you could try starting her on the left breast, and then switch her over to the right to nurse and linger longer. There’s no definitive answer, just try out some of these ideas and see if one helps more than the other.

Keep up the awesome hard work, Mama!

 

 

Help! Baby Won’t Take Bottle! and IBBM Method

bottles, Breastfeeding, Feeding, Infant Health & Safety, New Moms, ,

Hello,
Since you’re here, you’re probably pretty stressed. Sorry about that. I’m here to help with resources and support. I have a pretty good track record on this – which is why you’re here 😉
Hang in there.

Please READ:
Won’t Take a Bottle
Selecting Bottle Nipple
Bottle Feeding the Breastfeed Baby

Please WATCH:
Help, Won’t Take Bottle.

Please TRY IBBM 2x/day for 5 days.

Personalized Support – Home and Phone Consults

Changes in Routine over the Holidays

Baby Sleep, Breastfeeding, Infant Health & Safety, New Moms, , ,

It’s easy for everyday routines to be disrupted over the busy holiday weeks. Travel, visitors, parties, new decorations, and changes in childcare or playgroup routines , plus alterations in meals, nap and bedtime routines may result in both excitement and stress for infants, toddlers and parents.

Some simple steps may help to maintain a sense of security and routine during these busy days:

Keep mealtimes as regular as possible, or offer healthy snacks if a family meal is being held later than your child might like. Most toddlers have a short attention span in the highchair, so bring along some appropriate diversions to keep a child content at the table a little longer, or allow him to play with quiet toys on the floor next to the table if appropriate.

When traveling overnight, bring along some favorite toys, books, music and blankets and try to keep to your regular bedtime routine, even if it’s a little briefer or later than usual. If you usually bathe, read, rock, sing with your little one at bedtime, follow that pattern. Your baby will recognize the familiar rituals, even in a new environment. White noise may help mask unfamiliar city or party sounds.

Unfamiliar faces or crowded rooms at parties may take your child some time to get used to. Sometimes visitors are so eager to see the baby that they want to rush in and envelop the baby in a hug. Explain to visitors and relatives that most young children need some time to acclimate to new places and people (even grandparents, if it’s been awhile since their last visit). Hold your child and let her watch you interact with friends and relatives first. Wait until she seems more relaxed and shows a willingness to explore the environment or be held by someone new.  Using a sling or frontpack is a great way for relatives to see and interact with the baby, while parents are still able to maintain a sense of safety and security.

Keep extra-vigilant at holiday gatherings and parties when there are many adults and children present. It’s often assumed that someone else is watching a child, when in fact the toddler may be unobserved exploring an area that is unsafe or mouthing a potential choke-hazard. Sometimes a well-meaning relative may give a baby or toddler a food or plaything that is unsafe or not age-appropriate. Party foods (including candy, nuts, chips and baby carrots), festive decorations and toys for older children are all tempting and potential hazards for a crawling baby or young toddler.

 

Links and such

Baby Sleep, Breastfeeding, Infant Health & Safety, New Moms, Uncategorized

(This may look like a random collection of links to most. That’s ok, feel free to click and enjoy)

five babies on bolsters

History, Legacy, Feel-Good Stuff:
Great Beginnings New Mothers Groups. My Legacy. Begun in West Roxbury, 1995. Ended in 2014, after reaching 25,000 families in five states and thirteen locations. The curriculum is continued in a variety of community centers, childcare programs, birth centers and parenting programs nationally.  See the experiences of some original Isis participants. 

Magic Beans says a thoughtful Goodbye to Isis Parenting and Nancy

The Atlantic covers the MIT Program Building a Better Breastpump 

Boston Globe’s thoughts on  What Happened to Isis. (they only get it half-right, but it’s still nice)

Journal of Obstetric, GYN and Neonatal Nursing (JOGNN) free access to my publication abstract on Early Parenting and Sleep.

AWHONN (Association of Women’s Health, Obstetric and Neonatal Nurses) see my  Super Cool Sleep Poster presentation on supporting parents around infant sleep.

Links Related to Topics Discussed

Go on, take a bath together! Newborn Co-Bathing is a thing if your baby hates the baby tub.

Brief Pump, Store and Feed Careplan may be useful. More on this later.

Breastfeeding Webinar Five Tips for Better Pumping with info about why I recommend pumping after breastfeeding, not mid-way between feeds.

How to Nurse Sidelying  and on both sides!  Best tweaked in person – remind me.

Soon less crying, more playing on the Changing Table! I promise!

Cradle Cap from Mayo Clinic (a trustworthy clinical source for parents IMO) – we can discuss if you want to use Head’n’Shoulders ( if pedi-approved)  and get rid of it in a week, or nothing or jojoba or coconut oil and get rid of it in 1-2 months. Either way works.

How to SAVE a Baby’s LIFE –  INFANT CPR ! Watch this 3 min. video. Also, a 2 minute choke-saving skills video review. Let’s review both of these important skills!

For S.: my favorite Infant Massage music – the original House at Pooh Corner.  We also talked about Tummy Massage for Gas.

 

Verify Credentials:  RN CPN IBCLC

RN: View my Registered Nursing License here, current and in good standing since 1989.  That’s 30 years if you are sleep deprived 😉 Check credentials.

CPN: View my Board Certification for Pediatric Nursing here, an advanced credential held for a decade and recertified every two years. View verification

IBCLC: International Board Certified Lactation Consultant – in continuous practice  since 1998. Yes, I have been a BOARD CERTIFIED feeding specialist for over 20 years, learning more each week from every mom and baby I meet. Verify IBCLC credential

Biting and Breastfeeding

Breastfeeding, Feeding, Infant Health & Safety

Is your growing baby starting to bite at the breast?

Do your best to (a) be proactive and divert the bite from occurring, (b) If a bite occurs, remove baby from the breast safely using the smoosh-in/release method rather than instinctively pulling your baby away from the breast (which can cause damage, especially once there are has teeth). ( c) No biting/teething/gnawing on other people’s flesh. (fingers, nose, etc)

Biting is most common just before cutting a tooth, and so may come and go as a phase. Babies tend to be most likely to bite toward the end of a feeding so if you know your baby is in a nippy phase, you can be proactive and end the feed yourself when baby slows down, is on and off or mostly “playing around” toward the end.

When nursing, keep your hand close behind baby’s head/neck/shoulders (such as cross cradle position) so that if baby does bite down, you can use your hand to quickly “Smoosh” his face directly right into the breast – because this covers his nose and he can’t breath, he’ll immediately open his mouth, then you can take him off the breast safely without more pain or damage, and calmly but firmly say “No biting”. Do not yell or act angry (or playful). Sometimes it’s hard not to yelp (once child has top and bottom teeth) but you can frighten an older baby into a nursing strike. For a young baby, you can try re-latching or switching sides. For an older baby or toddler, after another bite at the same session, you may consider saying “no bite!” and ending the feeding. (Can try again in a little while).

Starting around 5-6 months (or just before teeth erupt),  don’t let him “chew” on your fingers (or chin or nose) any more. No biting anyone else’s flesh (he doesn’t understand why it’s ok to teethe on your fingers but not your nipple), or, why it’s ok for him to chew on your fingers before he has teeth, but not after…

Biting is an unpleasant phase but like most stages, this too shall pass.

Engorgement

Breastfeeding, New Moms

Engorgement – too much of a good thing?

What is it?
A moderate to severe “over-fullness” of the breasts, especially during the first week after birth.

During the first day or two after delivering your baby, your breast tissue will probably feel firm but soft and pliant – fairly “normal”. Then, typically on day 2, 3 or 4 after a vaginal birth, or, day 3, 4 or 5 after a cesarean section, you may notice that your breasts are becoming warmer, tender and swollen. Some people describe this as “milk coming in”, as the colostrum becomes more plentiful and transitions into a thinner, yellowish milk. The breast tissue may feel very firm or even hard and extend into the armpit area. The fullness of the breast is only partly milk, it is also extra blood flow and body fluid (edema) creating the swelling. If this fullness transitions into a painful, hot, hard swollen breast, that is typically called “engorgement” as the breast is engorged, or “overfull”. Again, it’s not all milk that makes the breast so full and hard. But, frequent nursing (or expression) will provide some relief and encourage resolution of the symptoms.

Ice or Cold Packs: keep six small bags of frozen peas or corn in the freezer. These make the perfect ice packs to place around your breasts in between nursing sessions – the cold packs will help reduce swelling and provide needed comfort. Just keep refreezing and reusing, as long as needed.

Add ibuprofen. Ibuprofen is the generic name for Advil or Motrin. This NSAID (non-steroidal anti-inflammatory drug) can help in several ways: by offering relief from discomfort, reducing a low-grade fever (if present) and by helping to reduce the inflammation or swelling of the breasts. Use the ibuprofen (400 – 600 mg) every six hours regularly for best anti-inflammatory action. This medication is approved by the American Academy of Pediatrics for use in breastfeeding women and is considered safe for most. It’s recommended to take ibuprofen with meals or a snack. As always, check with your provider for specifics about your own care.

Engorgement care plan:

  1. Use ice after and between feeding sessions. Keep 6 small bags of frozen vegs (peas, corn) in freezer to re-use/re-freeze. These adjust/form perfectly over your breasts & under armpits just where you need and want them.
  2. Use warmth just before nursing or pumping. Hot washcloth or shower may help soften breast and get milk flowing.
  3. Ibuprofen 600 mg every 6 hours with meal or snack x 48 hours. Keep it up as an anti-inflammatory; it will help to reduce swelling and discomfort.
  4. Pumping to relieve engorgement: it’s okay! As long as you don’t pump frequently, then softening or even emptying your breasts once or twice a day will NOT lead to over-supply or make engorgement worse. Rock hard breasts are NOT healthy, and don’t make it easier to breastfeed.
  5. Not all the fullness in the breast is milk. It’s also edema, interstitial fluid. So pumping may soften breasts but may not relieve all fullness.
  6. Babies will latch easier when the areola is softer. Otherwise, it’s like trying to latch onto a firm beach ball with an M&M glued to it, covered in olive oil. Good luck, and she’ll just grasp the nipple and hang on for dear life. Ouch.
  7. You can use manual (hand) expression, or a manual-pump, or your electric breastpump to soften the breast just prior to nursing. Express to relieve fullness or allow the milk to let down and spray before bringing the baby to the breast.
  8. Positioning: Baby under breast will be overwhelming if the milk is flowing fast. Have baby’s head either level to, or above, the breast especially at the beginning of a feeding session when the flow is heaviest if he tends to cough, choke or splutter with fast flow.

Babies Don’t Keep (poem)

Baby Sleep, Breastfeeding, New Moms

Song for a Fifth Child (Babies Don’t Keep) by Ruth Hulburt Hamilton

Mother, oh mother, come shake out your cloth!
Empty the dustpan, poison the moth,
Hang out the washing and butter the bread,
Sew on a button and make up a bed.
Where is the mother whose house is so shocking?
She’s up in the nursery, blissfully rocking!

Oh, I’ve grown as shiftless as Little Boy Blue
(Lullaby, rockaby, lullaby, loo).
Dishes are waiting and bills are past due
(Pat-a-cake, darling, and peek, peekaboo).
The shopping’s not done and there’s nothing for stew
And out in the yard there’s a hullabaloo
But I’m playing Kanga and this is my Roo.
Look! Aren’t her eyes the most wonderful hue?
(Lullaby, rockaby, lullaby loo.)

Oh, cleaning and scrubbing will wait till tomorrow,
But children grow up, as I’ve learned to my sorrow.
So quiet down, cobwebs. Dust, go to sleep.
I’m rocking my baby. Babies don’t keep.

This poem first appeared in the Ladies’ Home Journal in 1958. Our chores and distractions may have changed a bit in the past 60 years, but the sentiments here have not…

Nursing in Public

Breastfeeding, New Moms

Hi there, mammals. I mean, mamas. We are mammals, and we have mammary glands – breasts –  that serve a function: feeding babies. Whether they’re in use or not, as the saying goes, “that’s what they’re there for.”  So it’s a sad statement on our current culture that we even need to establish legal protections, fight to keep photos on Facebook, or lobby PBS to show the occasional breastfeeding baby “back” on Sesame Street to keep his bottle-feeding friends company.

If breastfeeding were the cultural norm, a nursing baby would be… well, unremarkable. They’d be everywhere. Commonplace. On the bus. In the park. At the coffee shop, in the store, at older siblings’ soccer games. Instead, we need legislation to protect a woman’s right to nurse wherever she is legally allowed to be, so that she can’t be harassed by unenlightened store clerks or hustled away by mall security.

A nursing mom usually just wants to feed and nurture her baby then get on with her day, and isn’t out to make a political statement. Yet, by breastfeeding your baby in comfortable public locations, you are doing something culturally significant each time. In addition to nourishing and nurturing your baby, you’re also doing some subtle public education reminding people that breastfeeding is, in fact, the biologically normal and expected way to feed a baby. In our bottle-feeding society, that’s an important reminder. Though initiation rates nationally are about 75%, fewer than half of American babies are breastfeeding at all by six months, and only one in four babies are nursing at all at one year. The more we, as a nation, see babies nursing, the more normal it will be, and the less fuss – and stress – will be made. So, mamas, do your part, be a mammal and feed your babies where and when you and your baby are comfortable.

My suggestions for breastfeeding when you’re out and about and away from your home:

1. Start early. Practice often.
Nursing isn’t always easy in the early days. Some moms have a very specific set-up at home with a certain chair, foot stool, pillows positioned just-so, and plenty of visibility and patience, to help get their baby latched on comfortably. It may take multiple attempts. There may be tears. The baby cries, too. It can be loud and messy. Keep at it. Get help if you need it. The first two weeks are the hardest. It gets better.

2. Get out of there.
Don’t get locked into the mindset that you need to be at home to make breastfeeding work. Even in the early days, with practice, you’ll begin to find it easier to get out of the house and feed your baby in a variety of settings. You’ll appreciate building flexibility and developing confidence into your ability to nurse on the go. You’ve got to get out of that house. Isolation is painful, and you’ll also discover that your baby is often happier and easier to care for when you’re out and about.

3. First times venturing out? Go where the moms go.
Find out what’s in your area. Breastfeeding groups, new mom gatherings or mom and baby yoga classes are perfect places to start. Being in a clean, nurturing, private location surrounded by other new mothers also focused on caring for their babies makes for a comfortable place to practice feeding. No one will notice or care if your baby fusses, or you fumble a bit.

4. Plan one outing a day with a “Rest & Refuel” in the middle.
Get out every day, but one outing is likely all that’s feasible. DO NOT attempt to rush through your errands to be back home within a two-hour window before the next feeding. Instead, PLAN IN a time and place you can sit and rest, have a snack yourself, and nurse your baby before continuing with your outing. For example, return baby gift and walk around mall, make a pit stop at coffee shop for snack/nursing/bathroom/diaper change, then continue on to the grocery store, then home.

5. Choose your spots wisely.
Select places that are family-friendly and accustomed to children, places where you will feel most comfortable. Coffee shops, book stores, and “ladies lounges” are popular spots to nurse when you’re out and about. Do not nurse in a bathroom stall! If initially you prefer more privacy, your car or a fitting room is a far cleaner alternative. Don’t ask for permission. You don’t need to give anyone power over where you may or may not feed your baby. Want to use a fitting room to nurse? Just grab something off a rack and bring it in with you to “try on”.

6. Fine Dining?
In a restaurant setting, ask for a table where you will feel most comfortable. Some women find a booth gives them more privacy; others (especially those with bigger breasts or older babies) find they don’t have enough room to maneuver and prefer a table with moveable chairs. Some women like to sit with their back to the room, and others prefer to sit facing out. Experiment and find what works best for you and your baby. As an aside, try breakfast or lunch in a restaurant rather than dinner. Young babies are often happier early in the day and tend to be a little crankier in the evening.

7. Park it. Bench it.
In a mall or park, find a bench in a quiet area and park your stroller in front of you, then put the stroller brakes on. Now you have a bit of a privacy barrier and can also prop your feet up on the wheel or basket as a makeshift foot stool. This will help you be more physically comfortable and angle your lap for easier positioning. When the weather is nice, sitting on the grass with your back against a tree for support makes for a lovely “dining al fresco” experience.

8. Used to a nursing pillow? Try these makeshift tricks for extra support and lift:
Fold up your coat or sweater and rest it in your lap as a nursing pillow.
Tuck your diaper bag under your thigh to bring your lap higher.
Roll up a receiving blanket: this may be all you need to support your baby’s head or your own wrist for a more comfortable position.

9. What to wear?
Nursing tank-tops make it easy to turn any top into a nursing shirt. Pull up your shirt from the bottom: the nursing tank will keep your belly and side (aka muffin top) completely covered and warm. A little leaky? Choose tops with patterns rather than solid silky colors, they’ll hide all sorts of splotches from you or your baby. Hint: Always keep an extra shirt for yourself, and an extra onesie and outfit for your baby in a zip seal bag at the bottom of your diaper bag. Babies spit up or have diaper blow outs at the most inopportune times!

10. Nothing to see here, folks.
When a mom and baby are nursing, there’s usually nothing too exciting to see. Take the time to get your baby settled and latched on comfortably, then adjust your clothing, pick your head up and smile. When people walk by and look at you, they’re probably hoping to get a glimpse of “the sleeping baby” in your arms. Take a look in the mirror, or ask a friend or family member to take a photo so you can see… that there’s just really nothing much to see. This might help you feel more confident when nursing in different locations.

11. Nursing Cover Ups?
Breastfeeding is normal and doesn’t need to be hidden, yet each woman has her own level of comfort or modesty. I hope there are many (most!) places where you feel very comfortable nursing, but there may be occasional times or places when you prefer more privacy. Nursing cover-ups offer privacy but allow air to circulate, the baby is not covered by a heavy blanket, and mom and baby can see each other.
Around 4 – 5 months, some babies become more distracted when feeding and a nursing cover may help them stay focused on the task at hand, though some babies refuse to feed under a cover.
Pumping? A nursing cover is also helpful if you have a semi-private place to pump at work. Everyone knows what’s going on under there – baby or pump, chances are, you’re not hiding anything – but if it makes YOU more comfortable, that’s what’s important.