Category Archives: New Moms

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.

Take a Bath with your Baby!

Infant Health & Safety, New Moms

Does bathing with your baby seem like an odd idea, strangely appealing, or both?   Even a very young baby can go in the tub with either parent. The warm, deeper immersion is very relaxing yet stimulating to newborns and infants, perhaps reminding them of time floating in utero. You and your baby will love it, and it’s the easiest way to bathe your baby without screaming, while also earning you a nice hot soak at the end – that alone should make you a convert!

Why take a bath with your baby?

Baby’s happiness: Newborns often cry in the infant tub because only half their body is submerged in the warm water while the other half is cool. Also, the smaller amount of water tends to cool off quickly. Floating in a warm deep tub with a parent is a very different and enjoyable sensation for your baby. In the bathtub, watch your baby, with wide open eyes, calmly stretch out her arms and legs and float. It’s also very easy to wash your baby head to toe in the big tub, and it’s certainly a beautiful photo opportunity!

Bonding: Skin to skin in warm water is a delicious feeling for both parent and baby. In a breastfeeding family, having the non-nursing parent take a bath with baby offers physical closeness and is a bonding activity that has nothing to do with feeding and changing diapers. Partners enjoy having a special activity to share with baby, and being the one to have a regular baby-bathing routine. If dad feels a little funny about it, he can wear boxers or swim trunks.

Start any time: Some parents begin co-bathing during baby’s very first week – you don’t need to wait for a newborn’s cord to fall off before giving an immersion bath. Simply dry the area around the cord gently after bathing. Some parents find co-bathing a perfect remedy to a young baby who screams in the infant tub, or who no longer fits in the baby tub but is still too young to sit alone in the big tub. At any rate, there’s no age or time limit on co-bathing – it’s neither too soon nor too late to give it a try.

How to do it: Set up for Safety and Success

Prepare the tub: Your bathtub doesn’t have to be especially large or pristine. Rinse out the tub, and then fill it deeply with water that is quite warm – not as steamy as you’d like if you were bathing for relaxation, but not lukewarm either. Don’t use bubble bath, this is irritating to baby skin.

Prepare the room: Gather what you’ll need for washing your baby, and set up a diaper, lotion and clothing for afterwards. Keep the bathroom door closed while you’re filling the tub, to create a warm and humid room environment. Set up your baby’s bouncer seat or car seat, lined with a bath towel and cloth diaper, right next to the tub. Place your naked baby in the seat and then get into the tub yourself.

In and out safely: Once you’re safely sitting in the tub, reach over and pick up baby from her seat. When exiting the tub, do the same thing in reverse: while still sitting in the tub, lean over and place baby back in her lined seat and cover with the towel before exiting the tub yourself. This way you’ll avoid needing to climb in or out of the tub while holding your baby.

Floating in the Bath: With your hand behind baby’s head, allow your baby to freely float – she’ll LOVE the deep warm water. Watch her arms and legs stretch out, wave and kick. Your baby’s eyes may open wide open in amazement while she remains calm and alert throughout the bath. This is the perfect time for your partner to take some photos!

Don’t drink the water: Always keep your baby’s chin above the water line. Babies may try to lap at water they feel near their lips. Try to avoid your baby’s drinking of the bath water (though a lap or lick of water will not harm your baby). If you notice that your baby pees, don’t worry! Baby urine is a tiny amount and essentially sterile and is no problem in the tub. Poop, however, does end the fun – fortunately, it’s a rare occurrence!

The Hand-Off: If your partner is home, arrange to “hand off” baby after her bath. Your partner can get baby soothed, moisturized, diapered and dressed – all without your interference. All the while, YOU can add more hot water to the tub and soak for another 20 minutes! This may be the only time all day you’ve spent caring for yourself or having your own space. When you’re in the tub, you also can’t hover, help, critique or multitask. Just sit there, relax and soak.

 

Freaky Baby Things to Worry About

Feeding, Infant Health & Safety, New Moms,

I spend so much of my time helping new parents understand and demystify normal baby behaviors to (hopefully) reduce their anxiety and concerns, while increasing parenting skills and confidence.  But just for fun, today I’ll just go ahead and scare you with a few freaky things that are serious enough to be real worries.

1. Hair Tourniquet.

A what? Yes, a Hair. Tourniquet. One of mom’s long hairs gets wrapped around baby’s finger or toe, cutting off circulation. (New moms – don’t be surprised when your hair begins mass shedding a few months after giving birth…) Baby’s finger gets swollen, cold and blue, but you can’t even see the culprit – the tightly wrapped hair – anymore because the finger swells around it, so parents usually have no idea why baby is screaming. Off to E.R. you go. The treatment? A nice dab of “NAIR” dissolves the hair quickly & safely without having to cut near baby’s swollen finger or toe.  If your baby is ever screaming inconsolably, after trying your usual approaches, take baby to the changing table and strip completely naked, then examine carefully, head to toe. Sometimes it’s as simple as a sharp corner of a diaper pressing into baby’s waist. But be sure to check those little fingers and toes for wrapped hair, and all the skin folds too.

2. Nail-Clipping Fail.

Nipping baby’s finger when clipping nails. Usually I’m all “Don’t worry about this; Don’t worry about that” so parents may be surprised when they tell me they nicked the baby’s finger and I’m not casual about it at all. A tiny cut at the tip of baby’s finger actually CAN be a big deal. Why? Baby fingers go everywhere and are very prone to infection. So keep your eyes on any cut around your baby’s finger or nail bed. Do warm soaks or compresses several times a day and watch the area closely.  If the fingertip becomes warm, pink or swollen and tight, call your pediatrician right away. This infection is called “Paronychia” and requires oral antibiotics to prevent a worsening infection. So if you have a little “oops” when clipping your baby’s nails, you don’t need to freak out, but do keep it clean and keep a close eye until it heals to make sure an infection isn’t setting in.

3. Febrile Seizures.

These are typically not serious in the big picture but can seriously freak out a new parent who has never encountered a febrile seizure before. Febrile seizures are most common in babies and toddlers between 9 months and 3 years.  Surprisingly, the seizure may occur at the very beginning of the fever when temperature is rising rapidly and may be the first sign of fever or illness in a toddler: a young child can go from playful to cranky to seizure in under an hour. It may be a relief to learn that febrile seizures are not related to epilepsy or lifelong seizure disorders. Keep your baby or toddler safe on a soft surface but put nothing in or near the mouth. Of course you’ll call your pediatrician after witnessing a febrile seizure, but these are usually able to be managed at home and are not a medical emergency. If the seizure is lasting more than 2 minutes, or if you are worried about your baby’s breathing, call 911.

4. Projectile Vomiting 3 times in a row.

Most babies spit up plenty, and many will randomly projectile vomit every once in a while just for kicks and giggles, but if the milk comes shooting back out quickly and with force after most feedings, that is different and concerning.  If a young baby projectile vomits 3 times  in a row,  call your pediatrician and pack your bags – you’ll be going to the hospital to have your baby evaluated for Pyloric Stenosis, a blockage between the stomach and the small intestine. This is more common in male babies, may be genetic, and most often occurs at around one month of age. Don’t worry about the rare, random projectile vomit episode, but if it’s frequent and persistent, call your doctor.

5. Nursemaid’s Elbow.

Radial head subluxation (official name, for medical-geeks) is a common injury in toddlers, caused by a simple tug, pull or jerk on the child’s arm. This can and does occur even during normal active physical play, like swinging a child by the arms for fun (not so fun in this case, and not recommended!) or if you quickly need to pull your toddler out of danger. Because infant and toddler joints are still quite loose, it’s relatively easy for the ligament to slip over the  radial head, making the elbow bone move out of place. Suspect a Nursemaid’s Elbow injury if you see that your toddler refuses to use one arm and keeps it tucked close to the body. There is usually no visible injury or swelling and very little pain as long as the arm is kept still.

I hope you’ll never need to know more about any of these issues, but at least this practical list of real-life concerns can take the place of Common Freaky Newborn Things Not To Worry About. You also may like to explore 12 Freaky Things You’ll Find in Baby’s Diaper During the 1st Year.

 

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!

 

Home Visit Info (Boston or San Francisco areas)

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

Only By Direct Referral.

Home Visits for New Parents –
To help answer some logistical questions about a home visit, here’s some general information.

Who am I?
I’m a board-certified pediatric nurse (RN, CPN) as well as a board-certified lactation consultant (IBCLC), with over 25 years of experience helping new mothers, families and babies.

My areas of focus are maternal health and lactation, newborn and infant care and development, infant feeding (breast, bottle, solids) and newborn sleep. (Learn more Here and Here)

Initial Home Visit: During our consult, I will come to your home for about 2 hours, complete a detailed history, observe or assist with a breastfeeding and/or pumping session, including pre/post feeding weights with a highly accurate scale if indicated, answer all your questions, and together we will come up with a workable plan you are comfortable with. After the consult, I’ll email you a visit summary with reminders, suggestions and resources based on your specific situation. A check-in by phone or email is included after your visit, and Follow Up visits are available as desired.

Consultation Fees (San Francisco)
Initial Home Visit is $350 for the initial visit (about 2 hours) including phone/text/email check-in.
Follow Up Home Visits are $250 and about 75 minutes.
Phone consults are $150 and 50 minutes.
Day, Evening, Weekend and Next-Day Appointments May Be Available

For questions or to schedule, leave a message at 617.803.5614. 

All consults, including phone consults, include a brief summary and resources, receipt for insurance or FSA reimbursement and a check-in by phone, text or email within several days of the consultation.

I do not accept insurance, however, your insurance company may reimburse you if your policy covers lactation visits. Clients are expected to pay by cash or electronic payment at the time of the visit. I will provide you with a detailed receipt appropriate to submit to your insurance company or Flexible Spending Account (FSA) to request reimbursement.

Please DO:

  1. Have baby’s weight history and any recent feeding, supplementing and pumping  app data or logs available. (If possible, email me any summaries ahead of time)
  2. Plan to have baby ready for a feeding about 30 minutes after the start of our appointment. I will want to collect information first – but – babies are not predictable! Don’t try to “hold off” baby for too long, we’ll make whatever the situation work.
  3. Have pump and pump parts ready to use in case we want to also observe/improve a pumping session.
  4. Plan for payment at time of visit (cash or electronic payment please).
  5. Your partner, friend or a support person is welcome to be present during our consultation.
  6. Keep pets in another room. I love animals, but they are often curious or anxious with a stranger in their home and near their “people”.
  7. We’ll visit and feed where you typically care for your baby, using your usual chairs, pillows and environment.
  8. If possible, have available: a cloth diaper or burp-cloth, a receiving blanket (thin cotton),  a firm bed pillow, and a small pillow such as a couch pillow or decorative pillow. Don’t stress over this though!

Please Don’t:

  1. Worry about clutter, laundry and dishes – your home should look lived in!
  2. Shower or dress yourself or baby specially for the visit.  Be comfortable.

 

Help, Baby Won’t Take the Bottle!

bottles, Breastfeeding, New Moms, , , , ,

One of the biggest stressors for a new mom preparing to return to employment is the baby who WILL NOT take the bottle.

In my experience, there are two types of “bottle refusal” – Passive Refusers, and Active Refusers. A “Passive Bottle Refuser” will allow the bottle nipple into his mouth but then doesn’t really seem to know what to do with it – he may just chew or play around with it, rather than latch and transfer milk, and eventually will get frustrated, hungry or bored, and begin to fuss. The “Active Bottle Refuser” doesn’t want the bottle nipple in (or sometimes, even near!) his mouth, and will resist or protest attempts to feed him with the bottle: he may cry (or scream), arch, fight or pull away as the bottle nipple approaches or enters the mouth.

The Passive Refuser seems like he doesn’t know what he’s supposed to do with the bottle. The Active Refuser is angry and upset about the whole scenario!

If you have an Active Refuser, the first step is to reduce the stress and negative associations already established around bottle-feeding attempts. Avoid reinforcing negative associations with the bottle/nipple. If your baby is crying and fighting and trying to push the nipple out of his mouth, don’t keep pushing it back into his awareness: take a break or stop for that session. Forcing it on the baby, or making him gag and cry with the nipple in his mouth will not magically result into drinking from the bottle. It just reinforces the negative experience and makes the baby anxious the next time the bottle presented.

Here are a variety of suggestions that can be successful. Some may seem non-traditional, but when the usual suggestions aren’t working, sometimes you need to think out of the box.

Timing: Consider Morning, Not Evening

If the non-nursing partner is offering the bottle, try mornings rather than evenings. In general, everyone’s stress level is lower in the morning, and most babies are happier in the morning and grumpier in the evening. If the bottle isn’t going well, working on it during an already stressful time of day won’t help.

Positioning

Try some non-traditional feeding positions if the usual “sit, cuddle, feed” position isn’t working for you.

Up and Out: Hold baby in a sitting position, facing out against your chest, as you walk around the room, or better yet, walk around outside. Movement and distraction can be very helpful.

Bounce: Sit on a physioball (gym-, yoga-, birth ball) and bounce while offering bottle. Try both a cradled position and a facing out position.

Wear the Baby: Does baby like his carrier? Wear baby in the ERGObaby, Moby Wrap or BabyBjorn, walk around indoors or out, while offering bottle.

The “Disembodied Arm” Technique: Just what it sounds like! Have baby in a car seat or bouncer seat facing something distracting (television?). Sit behind baby, out of sight, with bottle coming around from behind.

Don’t worry that you’ll need to feed your baby using these unusual methods in the long term, we’re taking it step by step. The first step is to encourage baby to allow the bottle nipple into his mouth, latch and transfer milk effectively. Once this is happening reliably, you can work on transitioning that skill to occur in different settings and positions, such as sitting in a rocking chair.

Bottle nipples

Try a few, not dozens: If you’ve had any success with a particular bottle nipple, stick with that one. It’s generally not an issue of trying 20 different bottles/nipples until you find the magic one that baby will accept. It does make sense to try a few but then try working with the one you think baby did the best with.

Nipple flow rate: The flow rate can be another helpful factor. I usually recommend a slow-flow bottle nipple for most breastfed babies, but if you know that your baby gets a lot of milk at the breast in a short amount of time (for example, if you have a heavy milk letdown), then you might want to try the next flow rate up (size 1-2 or 3+ month size). Just make sure to hold her upright and keep the bottle almost horizontal, so she doesn’t feel flooded out with too much milk if she does start sucking.

Latex or Silicone? Bottle nipples are usually available in two different materials. Even with the same shaped bottle nipple, a latex (tan-colored) nipple will feel softer and squishier than a clear, firm silicone nipple. It’s worth trying both latex and silicone to see if your baby has a preference regarding texture and firmness.

Read more on Selecting a Bottle Nipple.

Tease-Remove Technique

Have you seen your baby, sound asleep still attached at the breast, barely flutter-suckling, body relaxed, arms limp? Yet, the moment you try to break the latch and take baby off the breast, he’ll start sucking frantically, like saying “wait – wait – no – don’t take that away, I wasn’t done!” Try eliciting that response with the bottle nipple: when you feel baby tentatively latching on the nipple, gentle traction back as though you’re teasing to take the nipple away. Some babies will respond by sucking harder to draw the nipple back in and keep it there. If this happens, try using some movement and distraction (quick!) and see if baby will continue sucking and get into a suck-swallow-breathe pattern. Remember to always aim the tip of the bottle nipple toward the roof of the baby’s mouth.

Milk for the Discerning Palate

Some babies are very particular about what’s in the bottle. Try using freshly expressed milk, if your baby has been refusing frozen. And, though I’m not usually particular about the temperature of the milk offered (most babies don’t mind lukewarm or even cool milk), if you have a bottle-refusing baby, try making the milk quite warm. For some reason, very warm milk seems to work better for many babies who are reluctant about the bottle. If your baby is over four months old, you could consider trying one ounce of white grape juice and one ounce of water. Some babies will initially refuse milk, but readily take juice from the bottle. Though the recommendation is exclusive breastmilk close to six months, other pediatricians (and certain groups within the AAP) do suggest solid foods (cereals, fruits and vegetables) any time after four months. Again, this is an untraditional approach (and I’m not one to encourage juice intake, especially from a bottle!), but one that may help bridge the ability to bottle feed an older baby.

Recruit a Confident and Experienced Feeder

Have a very experienced bottle-feeder offer the bottle. A professional caregiver who feeds many babies regularly or a friend or fellow new-moms-group attendee who bottle feeds her own baby may have body language, tricks and methods that you or your partner haven’t yet tried. Make sure s/he knows NOT to force the bottle, and that it’s perfectly alright if it doesn’t end up happening that day. You don’t want her to push too hard in her attempts to be successful and save the day! Experiment with sitting right in front of your baby so she can see you, or leaving the room or having the caregiver walk around in another room while offering the bottle.

Don’t Try a Holding out Game

Do not attempt to withhold the breast for an extended period in order to force the baby to take the bottle out of hunger. It is unkind, unnecessary, and usually unsuccessful, especially if baby has not been able to successfully transfer milk from the bottle before. Slow, consistent, unstressed encouragement tends to yield the best longer-term success.

Which brings us to perhaps the most effective and successful technique: Intermittent Bottle By Mom (IBBM)

Intermittent Bottle by Mom

One less-traditional, but highly successful technique I find works well is to have mom work on the bottle feeding since you are the person your baby most associates with feeding, and you are both comfortable and relaxed together. Also, you have the “luxury” (ha!) of time in the morning to work together over several subsequent feeds, whereas your partner is usually trying to work on bottle feeding in the evening during the hardest time of the day, when no one has much energy or patience left.

During an early morning feeding, begin nursing at the breast as usual, and then interrupt the breastfeeding and offer the bottle. If she doesn’t accept the bottle, don’t force it, just put her right back on the breast for another minute or two, and then try once again with the bottle. Go back and forth between the breast and bottle without forcing it at her. Try to have the attitude of “you can get milk here (breast), you can get milk here (bottle), it’s all milk, it’s all good, either is fine!”. Pretend like you don’t mind if she refuses the bottle, just put her back on the breast. If she ends up not taking any of the milk at that early morning feeding, you can leave it on the counter (or refrigerate and rewarm) and try again at the next feeding, 2 hours later before deciding to toss it – that’s why I suggest only using an ounce or two of milk in the bottle, so you won’t be wasting much if she refuses it altogether.

Try this Intermittent Bottle By Mom (IBBM) technique for several feedings during the day, for several days in a row. Remember, never let baby get distressed with this method: If she resists or refuses the bottle, allow her to go right back to the breast. Almost always, moms begin to see success by day 3 or 4, and by 7 – 10 days, baby is often readily taking an ounce or more from the bottle. Success!

Introducing the Bottle to your Breastfed Baby: Feed the Baby but Protect the Breastfeeding

bottles, Breastfeeding, Feeding, New Moms, solids, , ,

Focus on Breastfeeding First

bottle feed 2During the first few weeks after birth, just focus on getting breastfeeding up and running – that’s enough. You may need to express milk in certain situations, but in general, just work on establishing a comfortable nursing relationship and milk supply through breastfeeding. Once breastfeeding is well established, you may consider expressing some breastmilk and introducing the bottle, perhaps around week three or four of your baby’s life.

Why 3 to 5 weeks?

A newborn’s sucking is reflexive until about 5 to 6 weeks, so introducing the bottle between 3 to 5 weeks is an optimal time, if bottle-feeding skills are required. Most babies will accept the bottle without much difficulty when it is introduced between 3 to 6 weeks. It may be more challenging to wait until later before introducing the bottle. Of course, not all babies need to take a bottle, and many babies can begin learning to drink from a spouted cup as early as 4 to 5 months, but this post is focused on parents who do want to introduce the bottle to their breastfed infant. Beginning to express milk around week three or four may establish and maintain a strong milk supply, if storing milk for the return to work is desired. Slowly beginning to store several ounces of milk every few days once baby is about a month old,  will gradually create a stash of back up milk you’ll appreciate once you’re back at work.

Relax: Offer, Don’t Push!

Introduce the bottle in a stress-free, low-pressure manner. Let your baby draw the bottle nipple into his mouth – don’t force the nipple into the baby’s mouth. Try stroking the bottle nipple against baby’s cheek, then lips. See if he’ll turn slightly or open his mouth to seek out the nipple – called the rooting reflex. When the bottle nipple enters the baby’s mouth, angle the tip slightly upward, toward the roof of the mouth rather than pushing the nipple against the tongue.

If your baby cries or resists, take a break or try again later or the next day. Avoid creating a struggle or reinforcing a negative association with bottle-feeding.

Use Expressed Milk

If your baby is exclusively breastfed, don’t casually introduce formula “just to see if he’ll take it” or “to get him used to it”. This introduces foreign proteins (cow’s milk protein, or soy) unnecessarily, and also interferes with the breastfed infant’s normal intestinal flora. There is something very special and beneficial about the immune and digestive system of an exclusively breastfed baby. Avoid introducing anything other than breast milk during a baby’s early months unless medically necessary.

Offering the Very First Bottles

When preparing the very first bottle for a breastfed baby, start with just one ounce of expressed milk. This way, you won’t end up wasting milk if baby doesn’t take the bottle, or doesn’t finish a larger amount. If you’re offering just an ounce and baby finishes it and seems to want more, you can either offer another ounce, or put baby to the breast to “finish” their meal.

Continue offering a small (one ounce) bottle each day until the baby seems fairly comfortable with the bottle feeding process and finishes it reliably, then gradually increase the volume, moving to 1.5, then 2, then 2.5, then 3 ounces over several weeks’ time.

Three to four ounces of milk, given over 15-30 minutes, should be plenty for most babies at 2 to 4 months. Babies gradually increase their volume slowly over the next few months, typically “maxing out” around 5 to 6 ounces at 5 to 6 months. Don’t be in a rush to increase the milk volume just because your baby finishes the bottle. If the volume seems to keep him content for a couple of hours, it’s probably the right amount of milk. Babies love to suck, and enjoy milk, and will often take more milk than perhaps they actually need, if it is continually offered. Finishing a bottle or being willing to drink more doesn’t necessarily mean your baby is still hungry.

Helping Your Baby Adjust to the Bottle

Some babies will take a bottle easily the first time, while other babies require more time to become comfortable with accepting a very new way to eat. Be patient, calm, positive and consistent. This is a new skill for your baby (and for you). Consider this: If we took an exclusively bottle fed baby and put him to the breast, would we expect him to know exactly what to do the first time, without prior experience or practice? He might, but far more likely, would take a little time to get used to this new way of eating.

Some babies are more willing to drink from a bottle when drowsy, or when not frantically hungry. You might try nursing for a few minutes, then switching to the bottle half-way into the feeding.

Some babies are more willing to take the bottle from someone other than mom. Have a family member or helper try offering the bottle, either while sitting, or while walking around the room with the baby sitting up and facing out – the movement and distraction may be helpful.

Some breastfed babies are more willing to take the baby from mom, since they already associate mom with milk and with feeding. See more tips for the reluctant bottle feeding baby.

What counts as “Taking the Bottle”?

Offer the bottle once a day until your baby seems to begin drinking an ounce or two easily (this may be the very first and second tries – right off the bat.). Then you may switch to one bottle every other day or so. It’s a good idea to offer one bottle every couple of days so that your baby remains comfortable with the skill.

If your baby can drink an ounce from the bottle without difficulty, that is successful. If they are able to transfer milk from the bottle effectively (and the skill remains familiar with regular practice), they have the ability to drink more if necessary, even if they don’t particularly love the bottle.

Beware of the Bottle Feeding “Vacation”

One of the biggest anxieties for a new mom as her return to work approaches, is the baby who will not take the bottle. If it’s important to you that your baby be able to drink a bottle reliably, make sure to keep it familiar. Don’t assume that because baby drank the bottle once, many weeks ago, it’s a checkmark in the “will-take-a-bottle” box and the skill will be retained indefinitely. This skill needs be kept familiar or all bets are off.

Avoid the “bottle feeding vacation” or going 5 or 7 days without a practice bottle. Some babies will do fine with a rare or occasional bottle, but other babies, even those who had previously taken a bottle readily, will refuse after many days “vacation” when the bottle is re-introduced. Once the bottle is introduced, keep it familiar. Every other day, or about 3 or 4 bottles a week is usually enough to do so. If you don’t need to do a full feeding with the bottle, just one ounce in the bottle is enough to “count” as practice to keep it familiar. Give the ounce, and then finish the feeding at the breast.

Paced, Responsive Feeding Positions

Encourage family members and caregivers to bottle-feed with close physical contact, change positions several times throughout the feeding, and pause often to interact with your baby.

Babies should be bottle-fed in a semi-upright position with the bottle nipple almost horizontal (though filled with milk). This allows the baby to better control the flow and avoid being overwhelmed by too much milk. In the typical “reclined and cradled” bottle feeding position, the bottle milk will flow faster by gravity, and baby will need to drink faster in order to keep up with the flow. The more upright position will help pace the feeding better.

When baby pauses to rest or take a deeper breath, this is a cue for the care-giver to remove the bottle, talk to the baby, burp or take a little break from the bottle feeding. There’s no need to pull the bottle away from a baby who is actively sucking happily just because it’s been five minutes, or one ounce. Instead, wait for a natural pause to remove the bottle for a break, engage with eye contact or interaction, or a burp.

Remind caregivers to never prop a bottle – this can lead to choking or aspiration of milk. Babies deserve physical and social interaction during feeding. Finally, don’t put an older baby into a crib with a bottle of milk or juice. This is associated with increased incidence of ear infections and tooth decay.

How to Nurse Side-Lying

Baby Sleep, Breastfeeding, New Moms, , ,

sidelyingYou can nurse on BOTH SIDES lying down, without needing to roll over yourself and move baby! Here’s how:

You’ll need 3 pillows and a rolled up receiving blanket. (Oh, and a baby).

Place one pillow under your head, one pillow between your legs, one pillow (preferably a body pillow) behind your back.

Have your baby on his side, facing you, and use the rolled up receiving blanket behind him to keep him from rolling toward his back once he is latched on and sleepy – you could get sore if he slides down the nipple but keeps nursing.

Nurse on the bottom breast by rolling yourself slightly back onto the pillow behind you. Tuck your baby’s bum either nearer or further away from your tummy to get his head in the right position. (Think of your baby’s body like a “stick” in this position. If you want his head closer to you, move his bum slightly away. If you need his head a little further from you, bring his bum in closer to your tummy).  Nurse! You can use your “top” arm to position your baby and/or your breast. For women with very large/soft breasts, a rolled or folded washcloth under the breast can offer support and bring the breast to a good level for the baby to nurse. Your “bottom” arm is often most comfortable tucked up by your head, (though some people like to have it cradled around the baby). The arm kind of gets in the way.

Now, to nurse on the TOP breast. Shift your hips way back, and roll forward away from the back pillow. You’ll appreciate the pillow between your legs now. Adjust/flex your hips so you are supported rolled forward toward your baby comfortably. Roll your baby slightly more onto his back, using the rolled receiving blanket to keep him at the best angle, halfway between his side and his back. Nurse! Your bottom arm might be most comfortable under your head. Your top arm usually drapes around the baby.

Practice side-lying nursing during the daytime when you’re awake and can see what you’re doing, then you’ll get good at it and can nurse this way at night when the lights are low.

Note: If you’ve just had a c-section, place a folded or rolled towel against your incision area so baby’s feet don’t “kick” a sensitive area.

Note: The American Academy of Pediatrics advises that “Infants may be brought into the bed for feeding or comforting but should be returned to their own crib or bassinet when the parent is ready to return to sleep.”