Category Archives: Breastfeeding

Wean Me Gently poem

Breastfeeding, Feeding, New Moms

Wean Me Gently

I know I look so big to you,
Maybe I seem too big for the needs I have.
But no matter how big we get,
We still have needs that are important to us.
I know that our relationship is growing and changing,
But I still need you. I need your warmth and closeness,
Especially at the end of the day
When we snuggle up in bed.
Please don’t get too busy for us to nurse.
I know you think I can be patient,
Or find something to take the place of a nursing;
A book, a glass of something,
But nothing can take your place when I need you.
Sometimes just cuddling with you,
Having you near me is enough.
I guess I am growing and becoming independent,
But please be there.
This bond we have is so strong and so important to me,
Please don’t break it abruptly.
Wean me gently,
Because I am your mother,
And my heart is tender.
Credited to Cathy Cardall
Always makes me weepy. How about you?

Oral Motor Muscle Stimulation Exercises… For Babies

bottles, Breastfeeding, Feeding, Infant Health & Safety, solids, Uncategorized,
This may be cute (sort-of), but it’s certainly not the technique I outline below

Sometimes babies need some help “waking up” all their sucking muscles prior to nursing or taking a bottle. Other babies simply seem to latch or eat solids (purees or textures) better several days after starting these exercises.

Oral Motor Muscle Stimulation massage techniques as follows:

Remember to do each movement several times, with gentle pressure, slowly and deliberately. The entire “routine” should take less than 30 seconds.

  1. Cheek circles (gently move cheeks in circular motion, and inward to make “fishy lips”. Repeat x5
  2. Over the ears and under the jaw. (With both hands, stroke from each cheek to the temples, then around the ears and under the jaw. Repeat x5 )
  3. Trace top lips and bottom lips with finger (“applying chapstick”) x5.
  4. Trace down from nose to lip to chin. Use finger or knuckle to (slowly) gently stroke from bridge of nose down to top lip, bottom lip and chin, gently rolling bottom lip out (only if baby allows) and gently press chin down as if opening mouth (only if baby allows).

Notes:
1. If you are working on tongue extension, remember to stick your tongue way out several times while massaging and praise baby for mimicking the motion.

Sore Nipple Comfort and Healing

Breastfeeding, New Moms

Here are some suggestions and useful products to help sore nipples heal and feel better quickly.

  1. Warm Soaks or Compresses – two or three times each day, apply a warm wet washcloth to your nipples, or lean forward and lower your nipples into two bowls of warm water placed on the kitchen table. After your warm soak, then apply a thin layer of lanolin cream or a few drops of expressed milk onto the nipples. This process of rehydrating the skin of the nipples speeds healing and reduces scabs. Applying breastmilk also helps prevent infection if there are any cracks or open areas on the nipple.
  1. Hydrogel Pads – these soothing pads are placed against the nipple and held in place by a bra, in between feedings. Hydrogel pads feel a bit like a cool sheet of gelatin and provide a healthy environment for the skin of the nipple to heal more quickly. They feel fantastic against tender nipples, and since many moms like using them when chilled, you may want to keep gel pads in the refrigerator between uses. Alternate using hydrogel pads with breast shells for best results.
  1. Breast Shells – one of the most helpful products for new nursing moms, these are comfortable dome-shaped small plastic cups worn over your nipples and held in place by your bra. Breast shells help the skin of the nipple heal (and provide great comfort) by preventing anything from pressing or rubbing against the nipples between feedings. They are especially helpful for women with nipple damage, since a bra or nursing pads tends to flatten or fold the nipple back into the breast tissue, interfering with healing. Breast shells should have air holes to allow for circulating air around the nipple.
  1. Ibuprofen – Ibuprofen (Advil or Motrin) can be useful to reduce swelling and provide pain relief. Ibuprofen works best when taken every 6 hours as needed. Ibuprofen is considered safe for use by breastfeeding women and is approved by the American Academy of Pediatrics for use with nursing mothers and infants. As with any medication, check with your health care provider for recommendations for your specific situation.
  1. Experiment with different pillows and chairs. You may find that a bed pillow or couch cushion works better than a traditional nursing pillow, or, you may decide you don’t need to use a pillow at all. Try different chairs, couches and positions too until you find a combination that lets you nurse without having to hunch over to feed, and make sure your body, arms, and hands are comfortably supported. A folded cloth diaper or rolled baby blanket is the perfect size to tuck under your hand for additional support.
  2. Nipple Shields These thin plastic “nipple protectors” are worn during feeding, and may be useful in certain situations, such as when a young or small baby needs help staying latched to the breast. Nipple shields are also used to help coax a non-nursing baby to the breast, or when a nipple is too sore or damaged for “direct” breastfeeding. However, nipple shields are often purchased and used without professional advice and in some situations can lead to milk production issues or poor infant weight gain. A nipple shield should never be used without guidance and requires follow up and support to gradually transition away from using the shield. Pumping after breastfeeding several times each day may be recommended to ensure stimulating a strong milk supply when a nipple shield is being used.

Some initial nipple pain or tenderness can be normal, but should improve within a few days. Severe nipple pain that makes you dread the next feeding, or nipple damage like cracks, scabs and blisters can be improved – often with small adjustments to latching and positioning.

Tummy Massage for Gas

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

Tummy massage for gas

Unlike other types of infant massage, this one has very specific hand movements and a very specific purpose. To gently stimulate peristalsis, to encourage motility of intestinal contents (BM and gas),  to provide a “cueing sound”, and finally to offer something for baby to strain against.

Here’s how to do my very specific “Tummy Massage for Gas”

  • Hand-Over-Hand on the Lower Belly: Gently stroke your baby’s tummy from top to bottom using first one hand, then the other, like a paddlewheel. As the belly first tenses, then gradually relaxes, press your hand deeper using a scooping motion.
  • Whoosh! Add your ‘whooshing” sounds during the which soon baby will recognize signals relief or relaxation.
  • Straight Across: Now stroke from YOUR left to YOUR right – straight across, gentle but moderate pressure, just at or below the belly button.
  • Now, Across and Down: Continue the Straight Across stroke, but now ADD the downward stroke, now moving across and down, ending inside the baby’s thigh crease. It’s like a sideways “L” or “7”.
  • Legs Up and Hold’em In Place: Flex baby at the hips and knees toward the tummy, gently press and hold in place, counting slowly to twenty. Repeat the entire sequence two or three times.
    (video coming soon)

Many babies will pass gas during the exercise or have a BM a few minutes later – success and relief for everyone!

Blocked Ducts and Clogged Nipple Pores

Breastfeeding, New Moms

Blocked Duct Care Plan

“Heat, Rest, Empty the Breast & Add Ibuprofen”

  1. HEAT before nursing or pumping
  2. COLD after nursing or pumping
  3. Ibuprofen 600mg every 6 hours with food/snack, for 48 hours as an anti-inflammatory (though will also help with discomfort)
  4. Frequent nursing or pumping with gentle breast massage and strokes toward nipple.
  5. COMBING the breast: get in the shower, soap up the breast, and use a wide toothed comb (or the long flat handle of a toothbrush) to comb from the base of breast down toward nipple, from each quadrant of the breast.
  6. DANGLE FEED (or pump) after shower/combing the breast. Lay baby on her back on floor, get over her, hands & knees with breast “dangling down” in free-fall, no bra, and nurse (or pump). Gravity helps draw any blockage down and out.
  1. Clogged Nipple Pore too? If you ALSO see what looks like a tiny white or yellowish “dot” on the nipple immediately after nursing or pumping, that is likely a related “clogged nipple pore” or “milk blister”.
    ADD the following to the treatment above:
  • Warm Soaks twice daily (shower counts) – warm/hot compress (wet washcloth or soft paper towel) or “dip”/lean nipple into a bowl of warm water for 2 minutes.
  • wear a cotton ball dipped in olive oil over your nipple for an hour (or longer is ok) after the warm soaks to help soften the local blockage. Then,
  • Apply a tiny dab of Hydrocortisone cream 3x/day to (only) the sensitive “clogged pore” dot.

Notes:
When a blockage clears, the breast still may feel bruised and tender for several days.

Do not “over-enthusiastically” massage/comb too hard – you don’t want to bruise already sensitive tissue.

Remember, a sore breast + fever and chills and flu-like symptoms = mastitis

 

© Nancy Holtzman RN IBCLC CPN

 

Why I LOVE the NuRoo Pocket

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

 

1. Skin to Skin for Parents and Preemies

The NüRoo Pocket is one of the only products truly designed to be completely NICU-friendly, allowing safe and uninterrupted Kangaroo Care for tiny preemies. Various secret openings allow nurses access for lines and monitors, and baby’s face is visualized the entire time.

Skin to skin care has many (many!) evidence-based benefits for baby (brain development, weight gain, heart and breathing regulation) and for mom (milk production, postpartum recovery) – these things are especially important for preemies, but are highly beneficial for every newborn or young infant. Skin to skin care is not just for premature babies, but when used in the NICU setting, the NüRoo gives a new mom a comfortable, discreet Kangaroo Care experience.

2. Truly the Perfect First Baby Carrier: Safer Babywearing from Newborn to 15 lbs

It’s quick, easy and secure and very simple to use, which helps new moms feel more confident with babywearing and soothing. Learning to use a wrap or ring sling can feel overwhelming to a new mom, and the inserts needed for soft structured carriers add a lot of bulk. Young babies need to be held, cuddled close and kept moving so much of the time! It’s important for a new mom to be able to put her baby into a carrier swiftly, easily and safely positioned. This carrier is designed specifically for tiny newborns through about 3-4 months – it’s rated to 15 lbs. Use it as a baby carrier, but at home, take advantage of the ability for true skin-to-skin babywearing, which helps with breastfeeding and milk production.

3. It feels sooooo good to wear baby in this “garment”

I’m a chronic baby-wearer and advocate, both personally and professionally. For the past 25 years, I’ve had the persistent desire to scoop up young babies and pop them in a sling. And I’ve always looked at various objects (scarves, bags, backpacks) and pieces of clothing and said “wow, I could make a baby carrier out of that!” (and, frankly, have been known to do so, with varying levels of success…)  This is exactly the shirt/system I’ve created “makeshift” numerous times in the past. Baby slipped inside a snug stretchy shirt, then safely secured by the tails of a sweater or over shirt. And, like magic, here it is.

I’m calling it a baby carrier, but it’s really a shirt (and fashionable, at that). Stretchy, lightweight fabric feels comfortable on, but once you have baby in the pocket and secure the waist-band support belt snugly, it truly feels wonderful. You can run your hands over that sweet baby bump and with your baby cuddled so close, secure and content, look down and kiss that sweet head, then go take a walk or make a sandwich in the kitchen.

4. I’ve watched it grow and develop – and now, be born!

The NüRoo Pocket is the result of several years of hard work, research and love by two Rhode Island mamas Daniela and Hope (moms, health care providers, and kangaroo care/skin to skin specialists), who asked to meet with me at Isis Parenting in 2011. I admit to being initially skeptical (Do we really need another baby carrier? Do we need a special garment to facilitate skin to skin care?), but after seeing the early prototypes, I fell in love with their vision. And over two years of development, they returned again and again to show updated prototypes, discuss features and fabrics, and bring samples for me to try and comment on. In 2013, I finally saw the end result and I was blown away. This is the perfect product for safe, easy newborn and infant babywearing, and a wonderful gift for a mom with a baby in the NICU. Available at Babies R Us and online at NüRoo Pocket.

The Gassy Baby: Such Digestive Drama

Baby Sleep, bottles, Breastfeeding, Feeding, Infant Health & Safety

“Why is my baby so GASSY?”
Is your young baby gassier than the average baby? Most newborns are both gassy, and dramatic about it, with lots of grunting, straining, arching, thrashing and tooting, and so it’s not surprising that most moms believe their new baby must be “gassier than normal”.

If your baby is gassy, it’s probably not from something in your diet, nor a sign he wasn’t burped enough after a feeding. Intestinal gas is a normal byproduct of food or milk digestion rather than from air swallowed while eating or crying. Most swallowed air will eventually come up as a burp (sometimes with milk attached) either with or without your help.

The Gastrocolic Reflex – or –  Why young babies are squirmy, grunty, gassy little people who are dramatic about their digestion

Most newborn gastrointestinal distress is caused by the sensations of motility, called the Gastrocolic Reflex, rather than gas. These peristaltic wave-like muscle contractions of the stomach and intestines propel stomach contents and stool through the small and large intestines. The gastrocolic reflex is triggered when your baby begins swallowing during a feeding and the stomach receives the milk. Inch by inch, the entire GI tract begins to wake up and contract, all the way from the stomach to the rectum. This is why babies may get squirmy or fussy 5 or 10 minutes into a feeding, and why feeding often prompts a bowel movement in a young baby.

Young babies are still getting used to the strange sensations (and products) of digestion, and aren’t shy about letting you know it. Once you see the “contents under pressure” explosion of poop some babies produce, it’s not surprising that they may react to the feeling of contents moving through their intestines at such high velocity with some distress.

Gentle Tummy Pressure can help: 

  1. Try laying your baby tummy-down across your lap, with her face turned to the side, so that her tummy is gently resting against your thigh. Pat or rub her back.
  2. Do you have a yoga/gym/physioball? Stabilize the ball and place a small receiving blanket over it, then carefully lay your baby tummy down over the ball on the blanket. Keep both hands on your baby, and rock your baby gently forward and back.
  3. The “colic hold” – drape your baby over your arm so that her face is supported by the inside of your bent elbow, and your hand is supporting her side and thigh between the legs. Her belly should be resting against your forearm. Gently press your arm, and baby, in towards your body, applying gentle tummy pressure, and either walk or sit on a physio ball and bounce.

Tummy massage for gas

  • Gently stroke your baby’s tummy from top to bottom using first one hand, then the other, like a waterwheel. Add your ‘whooshing” sounds.
  • Stroke from YOUR left to YOUR right – straight across, gentle but moderate pressure, just at or below the belly button.
  • Add the downward stroke, now moving across and down.
  • Flex baby at the hips and knees toward the tummy, gently press and hold in place, counting slowly to twenty. Repeat the entire sequence two or three times.

Many babies will pass gas during the exercise or have a BM a few minutes later – success and relief for everyone!

Is Burping Always Necessary?

bottles, Breastfeeding, Infant Health & Safety, Uncategorized

I’m often asked about burping: when to try, how long to try, what if baby doesn’t burp?  Burping is optional, not mandatory every time for all babies, and your baby may or may not burp at any given session. Chances are, you’ll learn the ins and outs of your own baby soon, and will decide how important (or not) burping may be to your baby.

Though most young babies are “gassy” (ahem: Gassy Baby: Digestive Drama) this is only partially due to swallowed air that might come up with a burp. Much of the gas experienced (and passed) by infants is related to digestion and motility, rather than swallowed air. If you are trying for a burp for a minute or two with no luck, try another position (see below) or give up and continue with the feeding or next activity.

When breastfeeding, most babies don’t take in a lot of air (though some might, especially if there is a lot of on/off at the breast during feeding) and might not have a big burp to release. However, it’s worth trying for a burp most of the time. Sitting your baby up to burp after nursing on the first breast may help to rouse her for the second breast, helping her take in a little more milk. Then, burping after ending the feeding may help the milk to settle in her tummy and prevent extra spit up. Or not.

When bottle-feeding, it’s definitely a good idea to take a pause midway through the feeding for a burp, and at the end of the feeding as well. This helps to “pace” or slow down the bottle feeding, allows for additional interaction, and may help to reduce spit up.

Whether breastfeeding or bottle-feeding, use the baby’s natural pauses to time a burp break. Don’t pull away the nipple from a baby who is busy eating – she may protest, cry, and take in air, likely defeating your goal! Instead, when she begins to fall asleep, flutter-sucks with long pauses, or releases the nipple from her mouth, that’s a good time to try.

Try these favorite burping positions for newborns. In these positions, pat your baby’s back gently, or a little more firmly, or alternate pats and circle rubs on her back, while putting a little gentle pressure on baby’s tummy area.
And, baby may not burp – it’s ok!

  1. Resting with her tummy HIGH up on your shoulder (for gentle tummy pressure) with her head cuddled near your neck.
  2. Sitting upright (or slightly leaning forward) on your lap with her chin/cheeks supported in your hand. (this one is good for helping to rouse a sleepy baby)
  3. Laying tummy down over your lap with her face turned to the side.

A note about Spit Up:
Some babies tend to spit up a lot, with or without regular burping. If you have a spitter, you’ll know!
If your baby is a spitter, position a burp cloth, receiving blanket or small towel over your shoulder or lap when burping. It’s common for a mouthful (or more) of milk to come up with a burp, and this doesn’t mean your baby overfed. Expect to see more spit up, not less, by the 3rd or 4th month as baby is eating larger volumes and jiggling her body, arms and legs more.

Common Freaky Newborn Behaviors NOT to Worry About

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

Normal newborn behavior can seem concerning and sometimes alarming to the uninitiated. Is she eating enough? Is she eating too much? Why is she crying? Why won’t she sleep? How much spit up is normal?  With so much to worry about, it might be refreshing to learn about some newborn behaviors that often make parents wonder, but are usually nothing to worry about. Of course, if you like to worry, here are Freaky Things Parents of Babies and Toddlers CAN Worry About.

Don’t worry (much) about…

  1. Breastfed babies over 1 month old that don’t poop every day, or even every few days. As long as they’re eating well and wetting plenty of pee-diapers, poop will happen, eventually – Probably requiring a full bath and several changes of clothing. Some dramatic babies poop only once or twice a week (but continue to eat and urinate as usual).
  2. Happy babies that spit up a lot. Whether it’s a lot of milk or a little, if the baby is otherwise happy and thriving, consider spit-up a Laundry Problem, not a pathology. If milk’s been down less than an hour, it will look and smell like milk. If it’s been down there longer, it will probably look and smell like curdled cottage cheese. Normal.  Spitting up – even 20 times a day –  is a normal baby behavior, and some healthy babies spit up far more than others.
  3. Infants who love the pacifier (once breastfeeding is well established). Give it or don’t give it, as you see fit. Don’t stress and agonize too much. It’s a just little piece of plastic, not crack cocaine. If it works for your baby, go with it. Around six months, your baby will begin to learn to self-comfort herself by sucking her fingers or thumb, and you can remove the binky altogether if you desire. If you choose to keep the pacifier, begin to restrict use to the car and crib once your baby is mobile.
  4. Occasional random projectile vomit. Yes, Exorcist Baby just likes to keep you guessing. And mopping up. As long as baby seems comfortable and is able to later eat normally without further projectile vomiting, just shrug it off  and mop it up. Repeated projectile vomiting, when milk seems to “shoot out” with volume and force, means a call to the pediatrician but a one-time occurrence doesn’t have to mean anything.)
  5. Sneezes and snuffly noses. A baby’s nose is a (mostly) self-cleaning device. Babies produce lots of thin mucus and a have reflex which causes them to sneeze a few times in a row when you step out into bright sunlight, essentially causing them to “blow” their cute little noses. Thin clear mucus, sneezing and snuffly sounds are normal for infants and are not the sign of a cold.
  6. Babies who spit up through their nose. Rarely discussed in baby books, and very normal (albeit kind of freaky). It must not be too comfortable for your baby, but there’s not much you can do about it. Remember when your friends made you laugh while drinking Pepsi and it would come out your nose? Yeah, like that. It’s all connected back there.
  7. Newborns who fall asleep but forget to shut their eyes, leaving only the whites showing. You can gently close their eyelids, it won’t bother them. They’ll grow out of this one fairly quickly. Thankfully, right? Looking for things to worry about? Here’s some Freaky Things Parents of Babies CAN Worry About.

Pumping and Working? Here’s What to Pack

bottles, Breastfeeding, New Moms, Uncategorized, ,

Heading back to work, messenger bag on one shoulder, breastpump bag on the other? There’s a surprising amount of extras to pack to make pumping at work more efficient!

What to pack in your pumping bag

  • Hands Free Pumping Bra: the Simple Wishes Hands-Free Bustier is truly a must have for those who pump regularly. Watch 5 Tricks for Better Pumping  to learn the benefits of hands-free, hands-on, double pumping.
  • Hand Sanitizer – alcohol-based, like Purell.
  • Medela Quick Clean Wipes – an easy way to clean pump parts between use, may also be used to wipe down a desk or table before expressing milk.
  • Enough milk storage bottles for the day (typically six are needed – one pair of bottles for each of three pumping sessions during a full work day) plus extra zip seal milk storage bags.
  • Lids. For some reason, moms often pack the bottles but forget the caps. Milk storage bottles don’t work so well without the lids!
  • Baby’s receiving blanket: Drape this over your lap when pumping to protect your clothing from drips, and to serve as a tactile reminder of your sweet baby.
  • Nursing cover-up, scarf or shawl for semi-private pumping locations (your cube, staff room, car in parking lot…).
  • Alternate Power Source: Extension cord or vehicle lighter adapter – Pumps that use AA batteries quickly begin to lose cycling speed and efficiency as the batteries drain down. It’s better to plug directly into the wall, or use the car battery (not while driving!) instead of an external battery pack, when possible. Pack spare batteries just in case. Pumps with internal lithium-ion batteries, like the Medela Freestyle, have the clear advantage here.
  • Non-perishable snacks or protein bars. Keep your bag stocked with high-protein snacks easy to eat with one hand.
  • Olive oil in a tiny Ziploc bag. Dip your clean finger in and lubricate the flange to reduce friction.
  • Large cooler to hold your milk and pump parts. Use several frozen water bottles as your ice packs – you can sip the ice water as it slowly melts throughout the day, while pumping.
  • Headset or earphones so you can make phone calls, listen to music or podcasts or participate in webinars (like my weekly baby chats!) while pumping.
  • Your keys or bus/train pass: store these in your cooler bag so that you cannot leave work without your day’s milk!
  • Packing List: Tape a printed checklist of everything YOU like to pack in your pumping bag, to take a quick audit when packing your bag for work each day – much less chance of forgetting something!