The “Witching Hour”

The more I work with babies, the more I see how so much of their behavior and idiosyncrasies are biologically driven. They are really quite primitive little people at birth and for the first few months. Understanding why this is and how it affects their behavior makes parenting those first weeks with a newborn make so much more sense. Although some of this behavior can be challenging, overwhelming, and exhausting, knowing that it is normal and why it happens makes it much easier to deal with.

This is particularly true of what has been come to be known as “the witching hour” (which in reality for most babies is more than an hour; often as much as 3 or 4 hours in the beginning). This is the time of day- typically in the evening for most babies, where they are just plain crabby. Sometimes, even inconsolable. Unfortunately, it also coincides with the time of day where toddlers are overtired and crabby too, and mom and dad aren’t at their best either! For some babies, it falls around dinnertime. For others, it’s a bit later…my kids were all like that from 8:00pm to midnight (I could practically set a clock by them). For some unfortunate parents, the witching hours fall in the middle of the night for their babies. It’s particularly hard to deal with a fussy baby who won’t sleep from 2:00am until the sun comes up! So why does this happen?

When babies are born, their brains are one quarter of the adult size. Humans have evolved to be born with small brains when we began to walk upright and the pelvis narrowed with this stature. In order for a baby to fit out of the birth canal and through the narrow pelvic inlet, they have to have smaller brains or they wouldn’t be able to get out! In the first year of life, their brains will grow to 2/3 the adult size- a HUGE amount of brain growth in such a short span of time! That’s why their fontanelles stay open for over a year- so they have room in their heads for their brains to grow. What this means is that your baby is very neurologically immature in the first months of their lives.

In the womb, it was dark, quiet, warm, and your baby rocked gently in your pelvis with your movement. At birth, they come into a world where the light has to be blinding (ever walk into a brightly lit room after being in the dark?!), the sound is deafening, there is touch on their body that they’ve never experienced before, and it is about 30 degrees colder than it was inside. Suddenly, they are thrust from a warm, dark, safe place where all their needs were met, onto a very strange planet. Now they must breathe, circulate, warm themselves, learn how to feed and process all the stimulation that the world barrages them with. It is sensory overload.

Because it takes time for their brains to mature, for the first few months of their lives this sensory overload is difficult for them to cope with. At the end of the day after being bombarded with all the stimulation of their world, they are like a raw nerve. And they don’t know how to settle themselves. They need our help.So how can you help your baby get through the witching hour and maintain your own sanity at the same time?

Breastfeeding moms have the magic boob- don’t be afraid to use it. Obviously, your baby can’t eat for 3-4 hours straight or they would explode! But letting your baby “live” on your breast while nursing on and off can avert the whole fussy period entirely. It makes no sense to walk the floor with a screaming baby when you can snuggle on the couch with your partner, watch a good movie, and keep your baby close to you. Trying repeatedly to put them down because “it’s bedtime” can start the whole process all over again. It can be frustrating and overwhelming to have a barnacle baby, especially when you’re tired and would like a little time to yourself at the end of the day. But if you can look at it as a way that you are helping your very immature little baby cope with what's hard for them, it can actually feel like a blessing that you have this miraculous way to keep them calm.

Bouncing on an exercise ball is a great baby soother, and something partners can do when mom needs a break from the breast. Bounce gently, or with gusto…your baby will let you know which they prefer!

Take a bath with your baby. Very young babies are often not enthralled with baths in general, especially in a baby bathtub where they are not totally immersed. But getting in the tub with them, with all that lovely skin to skin, warm water and perhaps a little nursing can really help calm them. Play some music and light a candle and it can feel like a wonderful way for mom to relax too! Partners can also bathe with baby if mom needs a break. (just warn them of the poop hazard so they won’t freak out if it happens!)

Walk outside with your baby. (even in cold weather!) You don’t have to walk the neighborhood, just up and down the driveway a few times. There’s something about going outside and the change in atmosphere that can make a fussy baby settle down. I have known parents who have gotten so desperate that they put the baby in the car to go for a ride at 3:00am, but I don’t recommend it as driving while exhausted is not safe and it’s not a great habit to start.

Take turns with your partner when you need a break, but keep in mind that very young babies equate mom with survival, so often they won’t settle unless they’re on home base. Partners can help moms with this fussy period by doing the other stuff that mom can’t get to like getting the other kids’ things ready for daycare the next day, putting the older children to bed, doing the dinner dishes that are sitting in the sink and driving mom crazy, or folding the laundry that’s sitting in a pile on the couch. Sitting next to her on the couch and keeping her company helps too!

Expect this time of day to happen for the first weeks of your baby’s life. Plan ahead and prepare for it. If your baby’s witching hour falls at dinner time, do meal prep early in the day, use a crock pot or enlist the help of family and friends to provide meals. If your baby’s fussy time is in the middle of the night, go to bed early. Sitting up and watching a movie only to go to bed right when your baby is gearing up for the middle of the night antics makes no sense. If your baby’s fussy time is 8:00-midnight like my kids, take an afternoon nap. If you are exhausted and ready to go to sleep right when your baby is melting down, it is much harder to cope with. I have had so many moms tell me that they dread the night coming because they know how hard it can be. Knowing that it’s normal, preparing yourself for it as best you can, and coming up with tactics that help your baby through it make it much more manageable. And before you know it, the 3 hours becomes 2, than one, then completely disappears as your baby becomes better able to handle what the world has to offer. Someday, you will look back and miss those days of snuggling on the couch and smelling that sweet baby smell with that lovely little barnacle in a little ball on your chest!

Bottle refusal

Lately it seems that I’ve had a bunch of moms contact me because their babies won’t take a bottle.While I am delighted that their babies are happily breastfeeding, I understand how stressful this can be when mom has to go back to work. It is stressful for the parents, for the caregiver, and most of all, for the baby. Their tiny tummies are designed to fill with milk every few hours (or less!) and to go all day, often over 8 hours when moms are working full-time, is unnatural and uncomfortable. It isn’t necessarily unhealthy, even though it feels that way for a baby to wait that long to eat. Babies being the resourceful little people that they are, will usually make up for it by nursing non-stop once mom and her breasts are back in the neighborhood. For the most stubborn of babies, I try to reassure moms that this length of time would be no different than if the baby were sleeping through the night and not nursing at all for that span of time (although it’s a rare breastfed baby that sleeps that long!) Putting it in that context seems to relieve moms of some of the worry that they feel when their babies aren’t eating the whole time she is at work. Keeping baby close at night so they can partake of the all-night diner can help moms allow their baby to make up for lost time and still get their rest.

Usually when a mom calls me to look for solutions to her baby’s bottle refusal, they have already tried every trick in the book and every nipple on the market. In that case, I don’t have a magical suggestion that will suddenly convince the baby that bottles aren’t so bad. Usually patience and persistence pays off, and most kids will eventually give in and accept the bottle, even if a bit grudgingly.

So what are some of the tricks you can try if your baby is bottle resistant?

* experiment with different nipples- for every nipple out there, there is a baby who loves it and a baby who hates it. Experiment with different shapes, different lengths, different flows….Generally, it is recommended that breastfed babies should always stick to the slowest flow nipple so that they don’t drink too much too fast. But if mom has a strong letdown and a fast and furious milk flow, her baby might be frustrated with a slow flow nipple. Also, babies have a suck/swallow reflexive cycle, which means if they swallow, they’ll suck again. So if the nipple starts to flow once you put it in baby’s mouth and they swallow, you might be able to get them in the suck/swallow mode. Wide base nipples are marketed to breastfeeding moms because they look more like a breast, but many babies know very well that it is NOT the breast, and do better with a more narrow nipple. Your baby’s oral anatomy can impact how well they can suck on certain nipples, so it is definitely not a once size fits all proposition. Certainly don’t buy a whole set of any bottles and nipples until you find one that works for your baby. Buying an expensive starter set of a whole bunch of the same bottle is almost a guarantee that your baby will hate it!

*experiment with different people trying to feed baby- Moms are often told that they should be nowhere around when daddy or grandma are trying to give the baby a bottle because the baby will sense that the breast is nearby and be more likely to refuse. While this can be true for some kids, there are many babies who take the bottle better for mom. She is the one that baby associates with feeding, and she might be more able to finesse the baby to take it. She also can do the “bait and switch” that sometimes convinces some babies to give in and take the bottle. To do this, put baby in nursing position with their cheek right next to your bare breast. Let them nurse for a couple of minutes to take the edge off their hunger, get them in the suck/swallow mode, and let them know they are being fed. Then quickly (really quickly!!) take your breast out and put the bottle nipple in. I’ve seen many resistant babies eventually accept the bottle with this technique.

*experiment with different times of day- Often parents try the bottle in the evening, because that’s when partners are home from work, and that’s when it will give mom a much needed break. The trouble with this though, is that evening is most babies’ fussy time. They are crabby and overstimulated at the end of the day, and this is when most kids want to cluster feed to help them settle. A bottle is the last thing they want when they really need mama to comfort them with the magic boob. Try mid-day on the weekends, or a morning feeding before partners have to leave for work.

*try different positions/places to give the bottle- Maybe your baby doesn’t want to be held in their nursing position to take a bottle. Try with them facing out, try walking around while feeding them, or sitting on an exercise ball. You can go outside (if weather permits) and the change in scenery might distract your baby enough to accept the bottle. You could even try getting in the tub with them! Let them relax in the warm water with you, enjoying that skin to skin contact…they will be nice and calm and you might be able to convince them that the bottle is not so bad after all. Obviously, this is not a technique that you could use for all feedings (daycares might have an issue with it!), but if it will initially convince a resistant baby, it could be a start in gaining bottle acceptance.

*Use small amounts of milk and experiment with different temperatures- If your baby rejects the bottle after they’ve had it in their mouth, you can’t save the milk for another day. Once baby’s saliva mixes with the milk, it will introduce bacteria, so the milk would need to be used within an hour or two of trying it. (don’t re-refrigerate it; just keep it at room temperature if you’re going to try again within a short period of time). You don’t want to waste your precious milk and all the time and effort it took to pump it. Just start with an ounce in the bottle until you know that baby is going to take it. Some breastfed babies want their milk warmed, like it is when it comes from the original tap, while others will take it room temperature or even cold from the refrigerator. (teething babies sometimes appreciate this and will chew on the nipple which can lead them to eventually start sucking from it)

*try a cup- if you’ve tried all the tricks and your baby still refuses, you can easily feed a baby with a cup- not a sippy cup, just a small, flexible, open-top cup. Some parents find that using the little cups that come with cough syrup work well for this. Hold your baby sideways on your lap supporting their head and neck with your hand; with your other hand, put the edge of the cup to the baby’s lower lip and gently tilt it so the milk reaches the baby’s upper lip (don’t pour, you don’t want the baby to choke). As the milk touches the baby’s upper lip, they will sip. It’s the cutest thing and they can drink a good amount of milk relatively quickly with this method. For a baby that doesn’t want to suck on anything but mom, this can work really well. You can watch You Tube videos of how to do it. If you have an active, exuberant baby, you might need to swaddle them so their flailing arms don’t send the milk flying.

*most of all, don’t make it a battle- if you push a resistant baby to take a bottle, it is a battle that you will lose. You want to be very low-key about it and stop if the baby starts to get upset. A little frustration might be expected, but if they are really getting agitated, you want to stop and try again another time. You don’t want to the baby to have a negative association with the bottle or they will see it on the counter and start to plant their feet! It’s hard not to do when you are terrified about going back to work with a baby who won’t eat, but that anxiety can just add to the negativity of the experience for the baby.

I have certainly come across a few kids through the years that never gave in…just waited for mom to come home to eat. Most of the time, however, with patience and persistence, even the most stubborn babies will eventually give in. The best way to avoid this problem is not to wait too long before introducing a bottle to your baby. You want to wait about a month after birth until breastfeeding is well established before giving it, but after about 6 weeks, many babies start to balk at it. Once you’ve introduced it, you don’t go too long in between bottle feedings, or baby may start to change his/her mind. Just because they took it early on doesn’t mean they will continue to do so if you don’t keep them familiar with it. It doesn’t have to be every day, and it doesn’t have to be a full feeding. Just an ounce or two in the bottle a couple of times of week will suffice. You nurse your baby afterwards so they still get their mommy fix, which will further reinforce that the bottle is not unpleasant.

If you need further help and encouragement, contact your Lactation Consultant. Though we are primarily breastfeeding advocates and advice-givers, we are baby feeding experts and can help in many ways, even if it’s just to reassure mom that it will be alright…

the holidays….unwanted germs and unwanted advice!

It’s the most wonderful time of the year! I love the holidays…the preparation, the anticipation, decorating, baking, family traditions- I love it all. But with all of the wonderful, meaningful things that go along with the holidays, sometimes an overdose of family togetherness can bring some unwanted aspects along with it. For years, I have listened to moms kvetch about unwanted advice, thoughtless comments, and this year especially, the exposure to the germs that you try so hard to protect your baby from. So what can you do to be able to glean some joy and not just dread from the holiday season?

First of all, you are not being an overprotective parent if you refuse to play “pass the baby”. I have had moms tell me they have had to practically wrestle well-meaning relatives to give their baby back to them. For some reason, many people think that they are the ones that can make your baby stop crying or fussing, and will stubbornly continue to refuse to give the baby back. A good way to prevent this is to wear your baby to family gatherings. If your baby is literally tied to your body, they aren’t able to grab them from your arms. And if you put your baby down, it’s a guarantee that someone will pick them up- even if they are asleep! If it is your partner’s mother (aka mother-in-law), it can be harder to be assertive with her for fear of making her angry or upset. So let your partner run interference for you! A good excuse is to tell them that the pediatrician told you not to let others hold the baby because it is cold and flu season and your baby is too young to be exposed to those germs. (and this isn’t untrue!) If you are breastfeeding, you can always tell family that you have to go nurse the baby…Generally, I encourage moms to go ahead and feed their baby wherever they are- no need to leave the party to breastfeed. But if you want to use it as a reason to get away- go for it!

Another problem that I hear of frequently is the multiple sets of grandparents that all expect a visit at the holidays. Sadly, my generation has a high divorce rate (over 60%!!) so many parents having babies now have a mom and a step-dad, and a dad and a step-mom. Multiply that by two for each parent and that gives you four sets of grandparents that expect you to see them every holiday! Dragging overtired, overwired little ones from place to place just makes everyone miserable and often leads to tense visits when baby or toddler is melting down from overload. It is okay to say no! If you’re up for it, you can invite them to come to you so that you’re not schlepping all over the place and having to put little ones in and out of the car multiple times. If that would be a source of stress, just say no. You have your own little family now, and it’s okay to cocoon yourself at home and enjoy the day with just yourselves. Spending the day in your pajamas, making a simple meal instead of spending days in the kitchen, and relaxing and enjoying each other’s company can be one of your most special holidays of all. There will be plenty of years when your kids are older that you can do the visiting circuit when everybody is more able to roll with it.

This year in particular, there is extra worry about germs. After Covid, we have all become more wary of what that errant cough or sneeze that someone bestows on you might be, and it is especially worrisome with a young baby. What is a simple cold in an adult or older child can bring on a case of RSV in an infant. Facebook is loaded with scary stories of babies who require hospitalization due to severe cases of that virus. Moms have become afraid to go anywhere for fear of exposing their baby to such germs and risking contracting these viruses. Isolation, loneliness and depression are much more common for new mothers due to this self-inflicted home confinement. Being careful is smart, being paranoid is not necessary. It’s okay to join a family gathering if you really want to go. As I said, just wear your baby, don’t let people touch them on their hands or face, and absolutely no kissing! (even grandmas…and I’m a grandma, so I know how hard that is to resist). If there are children at the family gathering, try to keep your distance from them as kids are germy and are generous with sharing their germs.

What about unwanted advice? Hearing things like “is your baby sleeping through the night yet?”; “isn’t your baby getting a little old to still be breastfeeding?”; “you’re feeding that baby again?! Maybe your milk isn’t good enough!”; and comments like that can make you want to scream. The best tactic is to smile and nod and not engage in a discussion that opens you up to more unwanted advice and debate. You know your baby best, and you know what works for them and for your family. Don’t let other people’s tactless comments get to you (it’s hard, I know!) If others’ comments become ruthless (I’ve heard some doozies from moms over the years!), come back with a snarky comment to put them in their place. It’s hard not to feel judged when people make comments that cause you to question yourself, but knowing that most of those kind of comments come from a place of ignorance might help you to not take it so seriously.

It would be a shame to have your holiday season be filled with nothing but negativity and dread. Making some minor adjustments to your usual routine and sticking to your guns if you get pushback from family members can really help to keep some joy in the season instead of trepidation. Stand together as a united front so that one parent isn’t left to fend for themselves when unwanted advice or advances come your way. Your babies are only little for such a short time and you want to make the most of it…especially during the holiday season. Happy holidays!

Six things every new mother should know

*Your baby is already a person when they are born- in fact, they are a person even before they are born! I think often, new parents believe that their new baby is a little lump of clay…that as long as they mold and shape this little lump in all the right ways, they will model the perfect child. But very soon you realize that you have given birth to a very intact little person, with all their personality traits hardwired into them already! I frequently hear from mothers that their high needs baby was crazy active in the womb, kicking and tossing and turning day and night. And I will usually say, “and so you thought that just because they made the magical passageway out of the womb and into the world, that they would become a calm and placid baby?!!” Some babies are calm and some babies are wild, and you will adapt the way you parent them according to the baby that you have. You will know your baby best, so the advice that others feel so compelled to give you will not always work for your child. Most of parenting is trial and error and you will find what works best for you and your baby. You cannot change the traits that your baby is born with any more than you can change your partner’s.

*Mothers and babies are meant to be together- Boy do I wish our culture could grasp this concept! Look at all the baby equipment that is touted to new parents as “essential” on your baby registry- video cams to watch your baby; contraptions that rock, jiggle,or sing to your baby; mattress pads that alarm if your baby isn’t moving/breathing, and on and on and on. All of these “essentials” are things that are designed to separate parents from their baby. Don’t get me wrong, if a vibrating bouncy seat will get you an uninterrupted shower, that’s a beautiful thing! But the underlying message is, “don’t hold your baby too much, put your baby down, watch your baby from a camera rather than keeping them close and watching them”….All mammals in the animal kingdom keep their babies close to them when they are tiny and vulnerable. Yet humans (who have the most immature babies at birth of all the mammals for the record) are the only ones who put our babies down and leave them alone. Our babies can’t feed themselves, warm themselves, transport themselves, or protect themselves…no wonder they panic when we put them down and walk away from them! Our babies know that a mama-roo is no substitute for mama’s arms, and that’s why they protest when left alone. Moms and babies were a unit during pregnancy, and are still a unit in the baby’s mind for many months after birth.

*New mothers need nurturing- Yet as a culture, we do a lousy job of taking care of new moms. Women are expected to “get back to normal” as quickly as possible, and the truth is- there will never be that same kind of normal again. The marathon of giving birth and the healing, hormones and exhaustion that come with it require rest and caring help in order for a new mother to recover. In many cultures, new mothers are given the finest foods and have all the daily tasks taken care of by family and friends so that they can rest and take care of their babies and nothing else. American women often come home from the hospital and immediately try to jump right back into their old routine of cooking, cleaning, laundry and childcare. That’s why American women crash and burn postpartum. It is not physically possible to do it all. Unfortunately,, we see it as a sign of weakness to ask for help and that is just so very sad. Moms who have caring help post-birth are far less likely to suffer from postpartum depression and will heal and feel better faster when allowed the chance to rest and recover. Don’t be afraid to ask for help, and when people offer, let them!

*Your baby’s cries are meant to be disturbing- listen to them! Crying is your baby’s only language. They do not have the cognitive ability to manipulate or form bad habits. When a baby cries, it’s because they need something. It’s our job to figure out what that need is and try to meet it. Sometimes it can be frustrating or confusing to try to figure that out- you’re just getting to know this new little person. But when you keep trying (remember- trial and error!), you will usually figure it out. And if you don’t…at least your baby knows you’re trying and that you’re there with them. Leaving them alone to cry is harmful to your baby who needs you to help him. Being responsive to your baby’s cries will ultimately result in them crying less. (refer to my blog, “The risks of crying it out.”)

*Don’t be a “bossy pants” new mom! Sometimes moms make the mistake of thinking they’re the only one who really knows what the baby needs. And if you’re breastfeeding, that’s usually because you have the super power of the magic boob. No matter what the baby’s issue (teething, crabby, tired, hungry, just got their shots, overstimulated, etc), the magic boob will fix it. This often leads to partners feeling inept and left out. Moms can exacerbate this feeling of helplessness in their partner by hovering nearby when they have the baby, giving instructions (“don’t hold him like that; he likes it like this”…etc) and waiting to swoop in and rescue baby leaving the partner feeling like the baby doesn’t like them and that they are useless. Leave the room, resist the temptation to instruct, and let them figure out their own way to care for the baby. Their way may be very different from yours, but that doesn’t mean it won’t work! If you are a bossy-pants mother, you may find that your partner no longer offers to help because they’ve been made to feel that they just aren’t any good at it.

*You don’t need to be perfect… There is no such thing as a perfect mom. Every mom gets frustrated, overwhelmed, and yes, even angry at times. We’re human…and being a mom is a 24/7 job with very few “atta boys” involved. Yes, those baby smiles are a reward unto themselves, but the truth is, much of motherhood is grueling and unrewarding. Expecting that you should be enjoying every moment, have an immaculate house, cook lovely nutritious gourmet meals, all while finding time to exercise so that you can fit into your pre-pregnancy jeans is just not realistic. (Unfortunately, social media contributes to our feelings of inadequacy when you only see the highlight reels of people’s lives). Love your babies, allow yourself time to rest each day, get outside when the weather allows, and be patient with yourself. Babies get less needy and time consuming as they grow, and you may find yourself longing for the days when you sat on the couch snuggling for what felt like hours on end. If all you did was hold, nurse, and rock a fussy baby all day, then you did a lot!! Let go of the idea that you need to get things “done” every day. Seek the company of other moms (see my blog on the importance of mother to mother support) and let go of the illusion of perfection. You will be much happier for it.

These six things only scratch the surface of all there is to know about being a new mom. For now, that is enough…

Starting Solids

Sometimes, moms overthink things…(no, really?!). That can make what should be a simple task turn into something daunting and overwhelming. I find that to be true for mothers when they begin to think about starting solids. What should be a fun and exciting time for both mom and baby turns into a source of worry, work, and consternation. Moms will research the heck out of when to, how to, what to, and whether to. It needn’t be something that requires such forethought or agita. It’s really quite a simple thing- you are basically just slowly moving from a milk drinking baby to a food eating toddler. So what DO you need to know about starting solids?

First and most importantly is when. People will often tell you that a baby is ready to start solids when they show an interest in you eating. I’ve always said that a baby will show the same fascination in watching you put rocks into your mouth! Just because they find it captivating to watch you eat does not mean they are coveting your food and that they’re ready to eat it themselves. Babies should be at least 6 months old before you introduce any solid food. That’s when they experience what is known as “gut closure” which means that their intestines are less permeable and therefore less susceptible to irritation. They also should be able to sit up unassisted (eating in a reclined position isn’t advisable) and should no longer have a tongue thrust reflex. Some moms will wait until their baby can master the “pincer grasp” which means they can pick up little bits of food with their fingers. This is helpful if you’re going to skip purees and go right to “real” food. Keep in mind that the main source of their nutrition for their first year is either breast milk or formula, so any solids before that point are just for learning and fun. You don’t want to go too quickly and jump to three meals a day right away, or your baby will cut back on their milk intake which is not in their best interest.

How to introduce food is easy. (this is where moms can really go overboard!) No baby food cookbooks, baby bullet food processors or hours of preparation are necessary! Your goal is to introduce your baby to the food they will be eating in your family. You obviously need to avoid foods that are potential choking hazards or common allergens, but preparing special recipes and spending extra time making baby’s own meals is not needed. The main “rule” is to wait several days in between introducing new foods so that if your baby has a reaction, you will know what caused it. Doctors will often tell you to wait three days, but I always recommend waiting a week so it is clear if your baby breaks out in a rash or has a funky poop, you can tell what caused it. Start with one meal a day and see how your baby does and how they react. Some babies aren’t ready at six months and will do more throwing and feeding the dog than eating. Some babies will have tummy issues or constipation when they start food. It’s perfectly okay to back off and wait awhile longer if they don’t seem to be enjoying it or tolerating it. Slowly progress to two meals per day, and then by one year, your baby can enjoy all three meals with the rest of the family. If you are formula feeding, you can discontinue formula at the one year mark (no toddler formula needed), but breastfeeding can continue as long as both mom and baby want to keep going.

What to feed them is easy too! It’s a personal preference whether to start with purees or little bits of real food. The concept of baby-led weaning is to give your little one pieces of appropriate food that they can hold and feed themselves. Some parents are wary of this method because of the fear of choking, but if you stick to soft foods that aren’t potential air-way blockers (no hunks of steak or hot dogs!), choking is unlikely. If you cut up their meal into tiny pieces that they can pick up themselves, it is even less likely that they would have a problem. Just be sure to put small amounts on their tray at a time rather than a whole pile of food at once because some eager little ones will stuff the whole bunch into their mouths all at once! Eating solids is really supposed to consist of just that- solid food, not mush. Learning to eat involves chewing and getting used to textures and how to swallow them. Pouches are not advisable because although convenient and less messy, babies should not be “sucking” their solid food. Baby cereal has little nutrition, is a common cause of constipation, and tastes like wallpaper paste! Food should be yummy, especially when you give your baby their first taste of something other than milk! They love soft pieces of fruit, avocado, pasta, whole grain toast, rice, beans, and little pieces of sweet potatoes or squash. You can give them scrambled eggs made with just the yolks (wait a year to introduce the whites- that’s the more allergenic part of the egg) and pieces of pancakes or french toast. Meats are better waited on to be introduced until a little later (after 9 months) as they can be harder to chew and harder on the digestive system of many babies. Don’t worry about spices or seasonings (although don’t go too hot!), babies don’t need everything plain or bland.

Whether to start solids is again, a personal choice. Just because your baby reaches an arbitrary age doesn’t mean it’s a necessity. Many kids don’t start solids until close to one year, and they do just fine waiting. I have heard moms say that they’ve been told that if they don’t start solids by a certain point, their babies will never learn how to swallow solid food- like there is a window of opportunity and if you miss it, they will never learn to eat! This is silly and blatantly untrue. My last three children didn’t start solids until they were over 9 months old because they were all December babies which meant they turned six months in June. It was WAY too difficult to think about doing solids when it was vacation time, swimming lesson time, and summer activities and trips that would have made giving the baby food in the midst of all that much more trouble than it was worth. We waited until life settled into more of a routine in September, and all they did great starting food at that point in time.

So, when you and your baby are both ready to take the plunge and begin eating “real” food, go slowly, relax, and enjoy! Eating is supposed to be pleasurable, not pressured. If your baby doesn’t seem to like certain foods, don’t force it. If you offer nutritious foods, they will pick and choose what they like. Babies have preferences and opinions, just like we all do. Stay away from processed foods and things with additives and lots of sugar. Most prepared baby foods are processed to the point where there is very little nutritional value to them. Foods in as close to their natural state as possible are always the best choice not only for your baby, but for the whole family. If you maintain a low-key, relaxed attitude about eating, your baby will too!

Causes of Breast and nipple pain

I always feel so sad when I hear of a mother who has stopped breastfeeding due to breast and/or nipple pain because there is almost always a reason and therefore a way to fix it. Many moms hear horror stories of damaged nipples, painful engorgement, plugged ducts, and mastitis before they even have their babies. Unfortunately, this can be a deterrent for some women to even want to try to breastfeed. There is so much misinformation and bad advice out there that when hearing these horror stories, moms don’t realize that most of these problems are preventable in the first place. So, what are some of the reasons for breast and nipple pain?

First and foremost- poor positioning. I have seen mothers nursing their babies in the most contorted positions (which not only will cause breast and nipple pain, but neck, back, shoulder and wrist pain as well!). I’m not talking about nursing an older baby where “stunt” breastfeeding is the norm, but poor positioning in the newborn period. There is so much emphasis on the “Latch” that mothers are often focusing on the wrong thing when putting their babies to breast in the beginning when both are learning. Scrutinizing to the point of practically getting out a protractor to check for the proper angle is not necessary! My experience is that if the positioning is optimized, the latch will be good! (except in the case of oral ties, which I will refer to in a minute). New mothers need someone to show them how to properly position their babies- it is not an innate skill. Sadly, not all nurses in the hospital are experienced with good positioning. I have seen far too many instances of a nurse grabbing the baby, grabbing the mother’s breast and screwing the two together. Not only does that not help either to learn, but neither moms nor babies appreciate this forceful approach. Seeking the help of an experienced lactation consultant soon after birth to show mom how to position baby properly so that he/she can learn to latch comfortably is so important to avoiding problems from the start. Too many mothers wait until their nipples are badly damaged to seek help, and it’s so much wiser to be proactive and not have to fight your way back from pain and damage!

Vasospasms- While not the most common cause for breast/nipple pain, it is certainly not a rare occurrence. A vasospasm is basically a sharp, throbbing pain in the nipple and breast most noticeable right after the baby unlatches at the end of the feeding. Nipples will look white (like the color has been sucked out of them!) and then change to purple and/or red. This change in color is accompanied by the piercing pain. Vasospams are a circulatory issue and are most common (but not confined to) women who have Raynaud’s syndrome. In severe cases, there are medications that are helpful to some women, but often the most comforting and relieving thing is to put heat on the nipples immediately after feeding. Interestingly, many women who experience vasospasm pain will say that their nipples will hurt like that when they go through the freezer section of the grocery store since cold exacerbates the symptoms.

Oral ties- Lip and/or tongue ties (they almost always go together) are a relatively common cause of nipple pain. If the baby does not have normal tongue function and range of motion, they will compensate with an abnormal suck which is not only ineffective, but painful and damaging to nipples. If positioning is good, (remember, poor positioning is the most common reason for nipple pain and damage) and mom is still experiencing nipple trauma, then baby should have their oral anatomy assessed by an experienced lactation consultant. A cursory look into their mouth is not adequate for identifying oral ties, and a full feeding assessment is vitally important to determine the extent of dysfunction. Refer to my article “Breastfeeding and Oral Ties” in an earlier blog entry for more extensive information on this problem.

Thrush- Thrush is a fungal yeast infection of the baby’s mouth and the mother’s nipples. With the use of antibiotics in labor for treating moms that are positive for Group B strep, as well as their administration to the mother during a c/section, thrush is becoming a very common cause for breast and nipple pain. While antibiotics kill bad bacteria like Group B strep, they also kill good bacteria that keep fungus like yeast from growing. Breastfeeding is very conducive to yeast growth because everything is warm and dark and wet and sweet- just the environment that yeast loves to grow and flourish in! In the baby, it will manifest itself in a white, velvety coating on their tongue. Babies can have white on their tongues since their diet is milk- often what you’re seeing is just milk residue. But thrush is usually a thicker coating that won’t wipe off if you try to scrape it off the baby’s tongue. They will sometimes have it on the insides of their cheeks as well, but not always. Babies can also get an angry fungal diaper rash when yeast is present. The skin on their little bottoms will be very red and raw, sometimes even to the point of bleeding. In the mother, nipples will look extra pink and sometimes a bit shiny, with burning stinging pain. Water hitting them in the shower will be uncomfortable and even your clothing rubbing against them can be irritating. This is different than nipple pain from poor positioning. One or the other of the mother/baby pair can be asymptomatic, but both will need to be treated or you will just keep passing it back and forth. Call your pediatrician for advice on how to treat the baby- they will usually prescribe an oral solution to use in the baby’s mouth. Moms can start by using an over the counter anti-fungal cream (either vaginal cream or athlete’s foot cream will work!) for their nipples, however, if you get sharp, shooting pains deep in your breast, you may need an oral antifungal which would be prescribed for you by your OB. Some mothers find that taking a good probiotic (either starting before birth or immediately after) can help to prevent thrush from happening because it puts back some of the good bacteria that deters yeast from growing.

Plugged ducts/Mastitis- Plugged ducts occur when thickened milk blocks the duct preventing the flow of milk from the glands that make it to the outside of the breast through the nipple. This can occur when the baby starts to sleep longer at night and you miss a feeding, or when going back to work and nursing less, wearing underwire bras or even sleeping on your stomach (anything that reduces the flow of milk). Some moms have it happen when the baby gets to the distractible age where they keep pulling off to look around instead of settling in and nursing nicely! Moms will notice a plugged duct when they feel a tender, bruise-like place on their breast, often with a whole quadrant of the breast behind it where the breast is firm and full because that part can’t empty. Inflammation can ensue, which is ultimately what can lead to mastitis. I have found that almost all plugged ducts can be resolved with proper treatment without becoming a full-blown breast infection. Cold on the breast in between feedings can help to reduce inflammation, but heat before feeding can soften the thickened milk and make it easier to get it out of the breast. Gentle massage (go easy! no vibrators or electric toothbrushes please!), leaning over baby and “dangling” your breast to let gravity help while stroking gently downward toward the nipple can be very effective. Sometimes, it will feel like instantaneous relief like the dams opening, or sometimes more gradual, where you have to work on it for a little while before it resolves completely. Some moms find that castor oil compresses or soaking in epsom salt is helpful. If you develop angry redness, unresolved or worsening pain, fever, chills, body aches etc (you feel like you’ve been hit by a truck!) then it is becoming mastitis and you need to call your OB for treatment. I wouldn’t recommend going to an ER or walk-in clinic as they often don’t have much experience with dealing with mastitis. Mastitis can also be caused by nipple trauma where bacteria gets into the breast through broken/macerated skin on the nipple. See the section on proper positioning to avoid this problem!

Teething- many babies will chomp on the breast at least once when teething- no viciousness intended, just a natural reaction when their gums are sore. Usually watching them like a hawk while nursing can avoid this from occurring since babies can’t bite when they are actively suckling since the tongue covers the bottom gumline when they are feeding. If they stop nutritively suckling, getting your finger in between their gums before they can clamp down can avoid the bite. If they do manage to nip you, saying “no biting, that hurts mommy” then putting them down every time they do it will work with some kids. You don’t want to be too vehement in your admonishing, because sensitive babies will become upset (especially if you scream, which is sometimes a natural reaction when someone bites your sensitive nipple!). Other more feisty babies will look at you and laugh when you react (little buggers!), but usually trying to avoid the bite to begin with is your best tactic. Fortunately, this is usually not a prolonged problem for most kids and giving them lots of things to bite down on in between nursings can help (frozen damp washcloths or breastmilk popsicles are favorites!)

Breastfeeding should not be painful. Learning about these potential pitfalls before you have your baby can usually avoid pain! If you do experience painful feeding, please seek help. As I’ve stated, these issues can either be avoided or remedied with a skilled lactation consultant to assess both mother and baby and give you strategies and suggestions to treat the problem. Nursing your baby should be a comfortable, enjoyable experience for both parts of the team!

Working and breastfeeding

With the onset of Fall and back-to-school, it seems like this is a good time to talk about going back to work as a breastfeeding mom. It can seem a daunting proposition, and believe me, it’s no small feat to work and be a mom. Add pumping and maintaining a breastfeeding relationship with your baby to the mix, and it’s nothing short of heroic. Yet, most of the moms I talk to make it harder than it needs to be, feverishly trying to stock a freezer with their milk and trying to make concrete “plans” of how it will all work. So what do you need to know to be a working/breastfeeding mom?

First of all, make sure your baby is familiar with and comfortable with a bottle. It’s so stressful to have to leave a baby for 8-10 hours who refuses a bottle. It’s difficult for mom, the caregiver, and the baby. While we don’t recommend introducing a bottle before 4 weeks of age due to bottle preference (we all prefer easy and instant gratification if given the choice- babies are no different), but if you wait too long, your baby may balk at a bottle. I find that 6 weeks seems to be the age when a lot of babies start to become opinionated. After 2 months, many kids will flatly refuse. So somewhere around the one month mark, you want to start to familiarize your baby with a bottle. It doesn’t have to be every day- a couple times a week is enough, and it doesn’t have to be a full feeding: just an ounce or two to keep them comfortable with it. You can nurse after to give them their “mommy fix”. Moms are often told that they should never be the one to give the bottle since the baby knows you’re the one with the magic boob, but I have seen some kids that take it better from mama. Whoever is going to give the baby their bottle needs to know how to pace- bottlefeed (you can watch it on YouTube) so that the baby doesn’t drink too much too fast. You want it to hit their brain that their tummies are full. Probably the most common issue I encounter with working moms is the constant pressure from daycare that they need more and more milk. Breastfeeding is a leisurely dining experience and often even after drinking more than a feeding’s worth of milk from a bottle, a breastfed baby will look like they’re wanting more. Really, what they want is that warm, cuddly experience that they get at the breast. If your baby doesn’t immediately fall into a milk-drunk stupor after their bottle, the daycare may think they need more. A breastfed baby should never need more than 4oz in a bottle if they are still nursing at home and during the night.

Another common question is what kind of bottle/nipple is best for a breastfed baby? I always answer that by saying, “ask your baby!”. For every nipple out there, there’s a baby that loves it and a baby that hates it. Wide base nipples are marketed to breastfed babies because it more closely resembles a breast, but your baby knows it’s not the breast and may prefer a longer, more narrow nipple. The one thing you want to do is ALWAYS stick to the slowest flow. The nipple manufacturers want you to move up in “size” (categorized differently depending on the brand) so that you need to keep replacing and buying nipples, but sticking to the slowest flow is important for a breastfed baby so that they don’t drink too much too fast. Buy just one nipple of a couple of differing sizes/shapes and see which one your baby prefers. If you buy a 16 bottle starter kit of one particular kind, that’s a guarantee that your baby will hate it!

Then we have the question of when to start pumping. Other than to help your baby latch when you’re engorged postpartum, or if your baby isn’t nursing effectively at first to protect and preserve your milk production, you don’t need to be doing a lot of pumping in the first weeks of breastfeeding. Tiny newborns feed very frequently, which can feel overwhelming, and adding the pressure of pumping to start storing milk can be too much. Plus we know that the first few weeks lay the foundation for milk production and establishing your supply, and if you’re pumping like crazy, you essentially tell your body you have two babies. You might think the more breastmilk, the better, but more is not always better! More is often too much. Moms who overproduce are more prone to plugged ducts and have babies who are gassy and fussy from too much watery, sugary foremilk. Plus, who wants to walk around overfull and leaky all the time? It’s a wonderful thing when your body is in sync with your baby and your breasts are only full when it’s time for a feeding. So the best time to start pumping is when you’re ready to start introducing the bottle. Many moms find it works well to pump first thing in the morning at the same time the baby is nursing. Just keep your pump set up on your bedside table, and then plunk the baby on one breast and the pump on the other. Your breasts work as a team, so you’ll get a good letdown that way, and most moms find that early in the morning their breasts are quite full. If you make that your morning routine every day, you’ll end up with a nice little stash, as well as some milk to begin familiarizing your baby with the bottle. You don’t need a freezer full of breast milk to go back to work. Fresh milk is always better. So each day, you’re pumping at work for the next day’s feedings. You only need enough stored for the first day and some to spare in case you get stuck in traffic on the way home, or god forbid, somebody drops a bottle and spills your milk! I could tell you numerous stories of moms who had freezers full of breastmilk, only to have it all go bad during a power outage, a freezer malfunction, or somebody not closing the freezer all the way.

It is important to have the right size flange for optimal milk removal and comfort. Consult a lactation consultant for help with this. Most breast pumps come with flanges that are too large for the average woman. Choosing a good pump is important too. If your insurance doesn’t cover the better quality pumps, it is worth it to invest the extra money to upgrade. (or put it on your baby registry!) Many moms are attracted to the wearable pumps, which are trendy and expensive. My experience with them is that most moms find they don’t work as well, and the convenience is not worth the deficit in milk output.

When it’s time to leave your baby (sniff…) make sure you always have what I call the “bookend” feedings- meaning you nurse last thing before you go out the door (or at daycare, if it’s a drive from your house) and then first thing when you get back at the end of the day. You don’t want to drop off a baby that needs to eat 15 minutes after you leave and you certainly don’t want to arrive at the end of the day with full breasts, and daycare just fed them a full bottle! If you give them these “bookends”, it will cut down on the amount of milk you have to leave and thus make pumping less of a pressure. What works well for many moms is to have a very early morning feeding before you get up where you can nurse and snuggle and have a nice leisurely feeding. Then you can get up and take your shower, get dressed, eat, etc. and then feed your baby once more right before leaving. Figuring out how many feedings you’ll miss and how much milk you need to leave is trial and error. If you’re a planner, this can be a tough one. Many moms I talk to want to know exactly how much milk and how many bottles they need to leave. There are “formulas” for figuring this out mathematically, and I’ve never been one to quantify like that. Some babies just take the bare minimum, some babies drink more (especially if they’re not being appropriately fed), and there is not really a way to figure this out ahead of time. Start with smaller amounts in the bottle (especially if your baby doesn’t seem thrilled with them), so that you’re not wasting your precious milk. The caregiver can always add more, but if the baby doesn’t finish it, you have to toss it unless they finish it within an hour or so of first offering it. I am not going to go into milk storage guidelines here, as they are readily available from many sources. You will find that there are differing recommendations when it comes to breastmilk storage, which is confusing and frustrating, but that’s because some sources list the most conservative or “ideal” guidelines, while some list “acceptable” recommendations.

Remember that your employer must provide you a private place to pump that is not a bathroom and they are also required to allow you to pump when you need to. You can refer to your state statutes for guidelines on the current laws for pumping while working. It is helpful to work out these details before returning to work. Contact your employer and tell them you will need to pump and ask them where your designated pumping space will be. Fortunately, most workplaces have already had their share of pumping moms, so lucky for you, other moms have paved the way for you! If you run into a conflict about this, contact your human resources person to address the issue.

A hands-free bra is a must so that you can do compressions while pumping, which increases pumping efficacy and output. It also enables you to eat or complete paperwork while pumping! Watching a video of your baby, complete with all their adorable little sounds can help you relax and get more milk. Some moms find that bringing an article of their baby’s clothing to smell before pumping also helps increase milk yield. Breastfeeding is a hugely hormonal experience and thinking of your baby and getting those pheromones going can really help. If you’re panicking about how much milk you’re getting, some moms put little socks over the bottles so they’re not constantly watching (and obsessing over) how much milk they’re pumping. Make sure you continue to eat enough and drink enough water- busy working moms often neglect this. You need fuel to produce milk for your baby! Flooding yourself with water doesn’t make you make more milk, but if you’re not drinking enough and get dehydrated, that can make you produce less. If you have concerns about your milk supply or pumping output, as always, contact your lactation consultant.

While working and pumping and continuing to breastfeed may seem impossible at first, most moms find that given proper management, it is certainly doable. It becomes easier once your baby gets to 6 months and can start a little food, and your routine is established. At one year, you can kick that breast pump to the curb and continue nursing your baby while home with them, but no longer needing to leave bottles all day. It is truly a gift to be able to continue to give your baby all your wonderful antibodies (daycares are germy places!) and it is so satisfying to come home at the end of the day and reconnect with your baby by sitting down and nursing. It’s still the thing that only you can do for your baby, which is very satisfying for moms when they have to share the care of their baby with their nanny or daycare provider

Most of all, don’t think about working and pumping and leaving your baby in the first weeks of your baby’s life. I would often have moms asking me about this in the hospital with their hours-old baby in their arms. I always have said, don’t think about leaving your baby until the time comes. The only thing you have to do is make sure your baby is familiar and comfortable with the bottle. Otherwise, relax and enjoy your baby. Even if you’re fortunate enough to have a longer maternity leave, it will go by in a blink.

The importance of mother to mother support

Never has it been more obvious to me how vitally important mother to mother support is than during the covid pandemic. Although I always knew how important that connection was for new moms, it was the lack thereof, that proved how vital it really is. I remember my own experience with this, when as a very young new mom (I was 20 when I had my first child), I was totally isolated for my first few years as a mother. I had two children under the age of two and was pregnant with my third baby. We lived on a new street with only a few houses, and our only neighbors were working couples with no children. We only had one car at the time, so my husband took the car to work each day leaving me stranded with my little ones and no adult interaction whatsoever. Because I was young, all my friends were either still in college, or living the single life going to bars and living it up. My days were filled with diapers, wiping up messes and endless walks up and down our dead-end street just to get out of the house. To say I was lonely, was an understatement. It wasn’t until we moved (and I had 3 more children) that I knew the glory of having mom friends. Weekly playgroups, birthday parties, and social gatherings as couples became a source of great satisfaction and happiness for both me and my family.

I began my breastfeeding career as a La Leche leader, an organization that operates on a mother-to-mother support premise. This group later became the impetus for the first Lactation Consultants, and it was how I got started on my path to become board certified. But that was not the beauty of that group. La Leche League welcomed pregnant women thinking about breastfeeding, new moms struggling with breastfeeding, and seasoned moms who offered their support and encouragement to the newest moms. It not only helped many, many mothers to successfully breastfeed their babies, but provided the opportunity to form friendships and to connect with people who knew exactly what you were going through as a new mother, because they were going through it themselves.

From there, I began working at an OB office, where I ran a weekly support group for new moms. It was clear that this group was a lifeline for mothers, many of whom had the same isolation and loneliness that I experienced when my kids were small. I always felt it was like weekly therapy- we laughed, we cried, we commiserated and supported one another. We talked about everything from sex lives, to postpartum depression to how sweet and irresistible that new baby smell is. Many moms formed friendships from that group, and I am gratified that so many women who met there are still friends today. It left such a void when I could no longer hold the group when Covid hit. Although we continued the mother to mother support via Facebook, it was not the same as meeting in person. I will never forget one day during the group many years ago, when a mom came into the room and immediately burst into tears. Everyone rallied around her and told her it was okay to cry, but would she like to talk about what was upsetting her? She managed to choke out, “I’m the worst mother in the world! My baby was on the couch right next to my husband and me, but somehow she managed to flip off the couch and onto the floor!!!” She then began to cry uncontrollably with the guilt and worry that she shouldered. Right away, the other moms in the room started confessing their own transgressions. “Well, my baby fell off the changing table,” or “my baby fell out of his carseat”, or “my baby rolled off the bed onto the floor”. The sobbing mom looked up, dried her tears, and said, “Really? I guess I’m not the worst mom in the world after all!” I knew that if she hadn’t come to moms group that day, she would have carried that guilt with her like stones in her pocket for the rest of her days as a mom. Having the other moms admit to their accidents with their babies relieved her of that guilt. That’s what moms can do for each other!

And mom support shouldn’t end when our babies are small. Moms need other moms through all the stages of their child’s life. We need to talk about tantrums, and potty training, kindergarten readiness, and teenage angst. Having other mothers to relate to helps ease the loneliness and provide friendship and support in hard times. Sadly, the internet has become the substitute for in-person contact, which was necessary during Covid, but not any longer. The picture perfect images that moms see on Facebook merely add to feelings of inadequacy and guilt, as we only get to see the “highlight reel” of people’s lives there. In person contact is real…feeling the human connection face to face allows for true feelings to emerge, like that mom in my group.

The statement “it takes a village” has become a catch-phrase, but it is an empty sentence if we don’t try to accomplish it. It can be daunting to take that step when you’re a brand new mom and unsure of yourself and just getting out of the house feels intimidating. But trust me, it’s worth it, and you will be so happy that you did. Seek a group of like-minded moms. Sometimes it takes a few tries to find your tribe that you feel comfortable with.There are many opportunities and if you can’t find one that fits, start your own! I am happy to report that I will be starting a new group after Labor Day, meeting on Thursdays at Northwest Park Early Childhood Center from 11:30-1:30. There is no charge for the group,and all babies 12 months and under are welcome. I will have a brief topic each week, with plenty of time for socializing and questions. Check out my Facebook group- “Robin’s Lactation Services” to check starting dates and for any cancellations. I would love to see you there!

food sensitivities and breastfeeding

I have been working with breastfeeding mothers for over 35 years. In that period of time, I have seen more and more moms struggle with babies who have intolerances to something in their mother’s diets. I have often wondered why this is so, and the reasons I can come up with are merely speculative, not “evidenced based”, but nonetheless still quite plausible. I believe that there are probably multiple factors (as with anything!) and the problem is often multifaceted. So why do I think more babies have a sensitivity?

1) Increased use of antibiotics… Moms didn’t used to get antibiotics in labor for the treatment of Group B strep. (I won’t get into whether or not this is necessary- that’s a discussion for another time). If you have a long labor, this is MANY doses of strong antibiotics which change the gut flora. If you have a c/section, you are also given antibiotics as a routine part of the surgery. If you have a uterine infection, urinary tract infection or breast infection postpartum, you will also receive antibiotics. The “microbiome” of the gut is altered with the medication, and while antibiotics kill bad bacteria like Group B strep, they also kill good bacteria which create a healthy environment in the gut.

2) Additives in our food…preservatives, dyes, chemicals etc. all lead to an altered microbiome and affect our health overall, but especially our digestive health. Moms who have a “leaky gut” (intestines that are more permeable which allows the proteins to leach into the bloodstream) are more prone to having babies with sensitivities because the culprit foods are more available to the baby from the mother’s bloodstream into her milk.

3) Poor nutrition in general…highly processed foods, diets high in sugar, GMO’s- also contribute to a leaky gut and poor health in the mother. Many mothers also eat foods that they are sensitive to, but ignore the symptoms that go along with that (“oh, I just have a tendency for gassiness, congestion, eczema” etc etc). I have worked with so many moms that find that they feel so much better when they eliminate foods from their diet for their babies, and then realize that they themselves had a problem with that food. The mother’s sensitivity and antibodies are shared with her baby.

4) Increased awareness of this problem… Thanks to the internet and mothers being more educated in general about the potential for food intolerances in their babies, we are more aware of the issue. Years ago, moms were simply told that their babies had “colic” and left to deal with a miserable baby for months to come. Unfortunately, there are still some pediatricians who will tell moms this, but more and more I am hearing them suggest that moms eliminate certain foods from their diets, and many doctors even test babies stool for blood which indicates significant irritation. Colic is not a real affliction, it simply describes a baby who cries a lot. Babies cry for a reason…and when you identify the reason, the “colic” goes away!

So, what are the signs that your baby might have an intolerance to something in your diet?

1) Increased fussiness- usually it takes a week or two (or sometimes longer) for a baby to start to react to something in mom’s diet. That’s because it takes a number of exposures for them to start to build the intolerance. I always use the analogy of bee stings to explain- you can have a bee sting or two and not have a reaction, but if you step on a hive and get many stings at once, then you have an allergic reaction. It’s the increased exposure that’s like the straw that breaks the camel’s back.

2) Gassiness, spittiness, reflux, congestion, “rattly” breathing

3) Rash- telltale sign is a red ring around the anus. Many babies also get rashes on their face, their trunk, and eczema like patches on their arms and legs.

4) Green, mucousy, watery, stinky poop. Green poop means rapid transit through the gut due to an irritant. Mucous is due to irritation of the gut lining (mucous membranes on overdrive). While breastfed babies typically have liquidy poop, watery is not normal and it should have a not- unpleasant buttermilk like smell. If it’s a stinky offensive smell, (this goes for their gas too) then something is bothering them.

5) Discomfort at the breast- babies should be calm and comforted while nursing. If they are grunting, scrunching up their legs, fussing and pulling at the breast while feeding, that’s another sign that something in your diet is troublesome.

Some babies have many of the symptoms, while others only have one or two.

What are the most common culprits?

Dairy, soy, eggs, and nuts are the ones I see most often. (dairy being by far the most common- you have a human baby, not a baby cow. Human babies are not meant to digest cow’s milk protein) Less commonly seen irritants are gluten and corn. Things like tomatoes and other acidic foods can exacerbate reflux symptoms, but are not sensitivities like the other foods. Many moms find they can eat foods like that in moderation, but the true intolerances need to be completely eliminated.

It can take 2-3 weeks to see improvement in your baby’s symptoms. While the culprit foods will be gone from your milk much sooner, it can take awhile for your baby’s system to settle down. Don’t abandon ship too quickly. Also be sure to have every bit of the problem food eliminated- even the smallest amount still present in your diet can keep your baby’s symptoms activated. That means reading all labels and being aware of sneaky places that the ingredient might be present. (for example, many breads contain non-fat dry milk powder. This doesn’t mean you can’t have bread, it just means you need to read the label to avoid that brands that have it). Casein and whey are dairy derivatives, so look out for that in your labels. Fortunately, allergy labeling has gotten easier to decipher since most foods will simply say “contains dairy (or whatever)” at the bottom of the list of ingredients.

Be careful of eating out or eating at friend’s houses while first eliminating foods and trying to interpret what the problem is. People will often tell you that what they’re serving is dairy-free, but they don’t stop to think that the bread crumbs they used have cheese in them, or the butter they cooked the chicken in is dairy. Once you’ve eliminated the problem food from your diet and your baby’s symptoms are improved, little indiscretions like that won’t be a big problem, (maybe just one funky poop or a gassy night), but while you’re trying to settle your baby's system, even a small amount can keep them activated.

Unfortunately, some babies can have more than one sensitivity. It can take some time to do your detective work and figure out exactly what the problems are. It can be frustrating and make you feel quite helpless when you watch your baby struggle with discomfort. Many moms feel like they are hurting their baby with their milk. It’s not your milk, it’s what’s in your diet that’s the problem. Babies are ALWAYS better off with breastmilk. Formula is cow’s milk protein. So if you chose to switch to formula because of a concern about your breastmilk causing your baby distress, you would most likely end up with a hypoallergenic formula, which is VERY expensive, and not very good tasting or smelling! (and doesn’t contain ANY of the benefits of breastmilk!)

When will your baby outgrow the intolerance? It depends on the baby. Some kids outgrow it pretty quickly and other more sensitive babies take longer. But if you avoid exposing the problem food to them through your milk, they will eventually outgrow it. If you just chalked up your baby’s symptoms to “colic” and didn’t change your diet, they would most likely go on to have a problem with it long-term due to the continued exposure. While it’s definitely a sacrifice on mom’s part, it’s certainly worth it to have a more comfortable baby! Sometimes you inadvertently challenge the baby by mistakenly eating the problem food by accident, or you may choose to purposely try it to see if they still have an issue. Either way, you will know if you still need to avoid the food, or if you can now put it back into your diet. I have seen literally hundreds of babies with food sensitivities and many, many dedicated mamas who sacrifice lots of yummy foods for the sake of their babies. Fortunately with the increased incidence of food allergies, there are many more alternatives available. Ben and Jerry’s and Haagen-daz even make dairy free alternatives now!

If you suspect your baby might have a sensitivity, talk to a Lactation Consultant about it. They can help you troubleshoot and make it easier to figure out. It’s definitely a process, but a process well worth it. I’ve heard so many moms say, “It’s like I have a different baby!”. What a wonderful thing that is!

the basics of new motherhood

So many times through the years, I’ve heard moms say, “What did I used to do with my time before I had this baby??!!” Suddenly, even the most simple daily tasks seem monumental. It can be overwhelming, frustrating and downright depressing when something as basic as taking a shower becomes the accomplishment of your day. Gone are the days of spontaneity…things like running out to the store or finding time for exercising become next to impossible. So how do you handle even the most fundamental daily tasks when you have a new baby? Here are some suggestions and helpful hints…

how do I take a shower? * Shower when your partner is home;* Bring a bouncy seat into the bathroom with you and put the baby right outside the shower- they like the sound of the running water, and you can peek out at them and talk to them while you get yourself clean;* Take a bath with your baby- they love to be in the tub with you much better than bathing on their own and both of you get clean at the same time! (beware the poop factor though).

how do I cook dinner?* do the prep work early in the day when baby is happiest- they are often fussy at the dinner hour and it’s much harder to get anything done during their “witching hour”;* Wear your baby while you cook- just be careful to keep them out of reach of the hot stove or boiling water;* Simplify! No need for fancy meals with a new baby in the house; *Try a slow cooker- many meals are super easy and will cook all day without any intervention necessary; if friends and family ask how they can help, tell them a home-cooked meal would be much appreciated! People want to help and new moms are often hesitant to ask. *Get take out- when you have a day with an extra needy baby, this can feel like a real treat- put a candle on the table next to the pizza box and it will feel like a night out!

how do I go grocery shopping?* Of course these days, almost all stores deliver for a small fee which is well worth it to not have to schlepp your baby to the store (and there’s always Amazon);* Some moms want to pick out their own groceries (and a trip to the store can feel like an adventure when you’ve been stuck in the house for days). If that’s the case, wear your baby to keep them away from roving hands (and they will be happy through the whole shopping trip which won’t be the case if they’re in their carseat).* You can also make grocery shopping a family date night and go with your baby and your partner. Stop for an ice cream on the way home and it will feel even more like a fun night out!

how do I find time to eat? * Buy healthy snacks that are grab and go so that when you don’t have time to fix yourself anything, there’s always something you can eat when you’re hungry and have no time to make anything;*Have your partner make you a sandwich to put in the fridge before they leave for work, so you can have lunch without any preparation necessary; *Eat while you nurse your baby! They don’t mind if you drop crumbs on them and you can nourish yourself at the same time you nourish your baby; Remember that you need fuel to make milk for your baby, and if you’re not getting enough calories, this can affect milk production

how do I use a public restroom? * Again, wear your baby…just be careful that any tails/straps on your baby carrier don’t go into the toilet!; *If your baby is in a stroller, use the handicap stall- there’s plenty of room to push it into the stall with you. Once you have a roving toddler, you will realize that using the bathroom with an infant is a piece of cake compared to a 2 year old who wants to touch everything dirty and will open the door while you’re sitting on the toilet! (one of my kids crawled under the divider into the next stall- even better…)

how do I get sleep? Everyone tells new moms to “sleep when the baby sleeps”, but that’s not as easy as it sounds! Especially if every time you put them down, they immediately wake back up again. Refer to my blog, “Babies don’t sleep!” for hints about sleep and safe sleep sharing; *Enlist the help of willing grandparents- grandmas and grandpas would love to come over and snuggle a baby while you nap. They will get you if you’re needed and you can rest without listening with one ear for your baby to call out for you, enabling you to get a much better rest.

how do I get any chores done? Lower your standards. A pristine house is not a priority when you have a new baby. Do the essentials and forget the rest. Laundry doesn’t have to be folded and put away- clean underwear taken out of the dryer and put on is still clean underwear! Encourage your partner to help- make a “honey do” list and put it on the refrigerator if asking for help is hard for you. *If people ask what gift you might need/want for your new baby, tell them a cleaning lady! Having someone come in and do the things you don’t have time for is the best gift ever.

how do I get my hair done? Find a stylist who works out of their home or who can come to you. I had one of my moms’ groups enlist a stylist to come to one of their homes and they had a haircut party! A bunch of moms came and they took turns holding each other’s babies while each mom got her hair done. It was great fun and the stylist made a lot of money that day with all the grateful moms who came en masse for the event. *Bring your baby! They will get lots of attention from the other ladies in the salon while you get your hair done and you will not have to worry about them being unhappy while you’re away from them.

How do I breastfeed in public? Wear the right kind of clothes so that you don’t have to expose yourself. (and you don’t need special nursing apparel- except maybe for dresses; it’s virtually impossible to nurse discreetly in a dress!) A tank top with a t-shirt over it covers everything except where the baby is- pull the t-shirt up and the tank top down so your midriff is covered and nobody will even be able to tell you’re nursing. practice in front of your partner so they can tell you if they see any skin. *Try nursing in comfortable places at first- new moms groups are a great place to practice because you won’t be the only one there doing it! Know that it is a law to be able to breastfeed your baby in public in all 50 states. You will be surprised that if you get any comments at all from people around you, they will be compliments like, “what a good mom you are!” or “what a lucky baby you have!”

All of these seemingly impossible tasks can be daunting at first, but with practice and patience, you will find that you’ll be doing all these things without a second thought! You can do it, of that I am certain..

the risks of “crying it out”

If there’s anything that makes me cringe when a mom asks me about it, the topic of letting her baby “cry it out” is the most cringe-worthy. I get it…. I totally do. I remember being so sleep deprived, I didn’t feel like I could complete an intelligent sentence, and I worried that I might fall asleep while driving, I was so exhausted. I even threatened to throw one of my sons out the window if he didn’t go to sleep…(which I of course, didn’t really mean, but at that moment, I kind of did… Along those lines, if you need a good laugh on the subject, look up Samuel L Jackson’s rendition of “Go the F**k to Sleep” on You Tube) Being sleep deprived is known to be a form of torture, so exhausted parents desperate for a good night’s sleep are tempted to do anything to accomplish that. For more info on the physiology of infant sleep, go back and read my blog “Babies don’t Sleep!”

Often, the “cry it out” method is touted as the answer for getting your baby to sleep. It’s a process known as extinction, meaning that by systematically ignoring your baby’s cries for you at night, the baby will eventually stop crying and no longer need you. But is that what is really happening? Have you really “trained” your baby not to need you anymore? If they stop crying, does it mean your efforts to get them to sleep longer have been successful? Some people believe so…But the science tells us otherwise.

When a baby is left to cry, they release large amounts of the stress hormone, cortisol. This hormone has been proven to result to damage in the hippocampus, the part of the brain that is associated with memory and learning. Babies have developing brains (only 25% the adult size at birth, growing 3 times its size in the first year of life) which are particularly vulnerable to the effects of this stress. Interestingly, when cortisol is measured in the baby’s system who is left to cry it out, the same amount of cortisol is still present even after the baby has “given up” and is no longer crying. So even though it appears that the sleep training was successful, that baby is still bathing their brain in cortisol- clearly still stressed by the lack of response by their caregivers.

Exposure to extreme stress in infancy has been shown to effect the part of the brain that responds to stress, potentially causing a physiological change that is related to physical illnesses as well as psychological disorders such as depression and anxiety. Chronic stress in infancy and early childhood has been identified as a major contributor to adult health problems.

In addition to these physical responses, the baby’s trust in their caregiver is undermined. When parents are responsive to their baby’s cries, the baby learns to trust. They grow secure in knowing that someone is there when they need them. This ultimately results in a baby crying less. When baby’s needs are met, they develop a sense of trust in their world and their relationships. When a baby’s needs are ignored, they develop a sense of mistrust and their self-confidence is undermined. Many studies have been done on infants raised in orphanages where they are never picked up when they cry. In fact, you could go into a room with many babies in it and not hear one single cry. Why is that? Sadly, they have learned that no one responds to their cries, so why bother? Often, these children, even when adopted into loving homes with well-meaning, responsive parents, end up with serious behavioral problems and anti-social issues. They never seem to be able to make up for the deficit of not being responded to as infants, and thus, their sense of trust and security is forever broken.

So Mamas and Daddies, listen to your heart when your baby cries. A baby’s cry is meant to be disturbing, so we are compelled to respond to them and calm their distress. You are not “spoiling” or causing bad habits. You are teaching a tiny, vulnerable, helpless little human learn that they can trust that their needs are met, that the arms of someone you love makes you feel safe and secure, and that someone listens when you need them. Isn’t that what we all want? Yes, letting a baby cry it out may eventually result in them no longer crying for you…but at what cost?

Breastfeeding and Dental Issues

Often mothers are blamed for causing what is known as “bottle mouth syndrome” (cavities and decay in a very young child) with the assumption that nighttime breastfeeding is the reason for these dental caries in their nursing toddlers. Dentists who tell mothers this are ignorant of the mechanics of breastfeeding. Bottle mouth syndrome comes from a baby/toddler going to sleep with a bottle in their mouth. The bottle spontaneously drips, pooling sweet milk around the gums and teeth. (teeth don’t even have to have erupted yet for this to be problematic). This causes decay in a very young child’s teeth, which can be so severe that it requires oral surgery. When babies fall asleep with the breast in their mouth, however, this doesn’t happen. The breast doesn’t continuously drip like a bottle does. Babies have to suck to elicit the flow of milk from the breast. Babies have what’s called a suck/swallow reflexive cycle- which means if they suck, they will swallow. Therefore, they won’t have pooling milk in their mouths due to a dripping bottle nipple. They also draw the breast nipple all the way back to the juncture of the hard and soft palates, so when the milk is flowing more forcefully with letdown, it just sprays into the back of their mouths, nowhere near their gums or teeth. A bottle nipple sits more forward in the baby’s mouth, bathing their gums and teeth with milk. Despite this difference in mechanics, some nursing toddlers can still get tooth decay. This is in spite of breastfeeding, not because of it. So what would the cause be then? There are several reasons that toddlers can get cavities:

1) Sweet foods and juices. Kids who drink fruit juice from a sippy cup or a bottle can get decay from these sugary drinks. Fruit snacks, puffs, foods with carbohydrates that stick in the teeth can be a problem too. Toddlers are notorious for being carboholics and often eat lots of these less than ideal foods.

2) Bacteria. This is the known cause of most dental disease. Kids can get these decay causing germs from their caregivers. Mouth kissing (hard to resist those little lips- but not good for your baby!) and sharing cups and utensils can be the mode of transmission. Parents who have dental disease themselves can easily share their bacteria with their child this way.

3) Yeast. Candida, which is persistent in many adults can be transmitted to your baby as well. Taking a good probiotic can help to keep yeast at bay, and is good for both you and your baby’s gut health.

4) Hygiene. Once a baby starts to eat food, dental hygiene becomes important. Brushing with a soft toothbrush once teeth erupt is essential to good oral hygiene. Food particles around the gums and teeth are a significant cause of tooth decay, particularly overnight.

5) Lip ties. When a baby has a lip tie, pockets form in the upper gums where the labial frenulum restricts the movement of the upper lip. Food can get up in those pockets and can be next to impossible to brush in those tight spaces. (anyone who has ever tried to brush the teeth of a reluctant two year old can attest to this!) The trapped food particles can cause serious decay on the tops of the upper teeth.

6) Mouth Breathing. This is common in kids who have tongue ties that were not revised. Breathing through the mouth dries out the teeth which makes it more conducive to bacterial growth. This can not only affect their oral health, but their gut health as well.

All of these reasons can be the cause of dental caries in young children. Dentists who blame it on breastfeeding and label it “bottle mouth syndrome” are misinformed and mistakenly cause unnecessary weaning and often significant guilt for these kids’ mothers. If your baby/toddler is still nursing at night- lucky them! Just be sure to watch out for these other issues and know that nursing at night is not a risk for your child’s dental health.

On a positive note, babies who are breastfed have a reduced risk of needing orthodontia. The act of breastfeeding gives the baby a full jaw and facial workout with every feeding, and consequently, better spacing for teeth. The longer you breastfeed, the better this benefit will be.

Seek a dentist who is breastfeeding friendly and you will avoid some of these common misconceptions.

the formula crisis

Stories of the current formula shortage crisis are disheartening and scary for families who are struggling to feed their babies.Sadly, it has sparked a breast vs. formula debate amongst some, which in light of the immediacy of the shortage doesn’t help anyone. The suggestion “just breastfeed” is misguided and fails to acknowledge the realities of breastfeeding. It is not feasible or even possible for most mothers currently formula feeding to relactate and to suggest to these moms that they should just breastfeed only fuels guilt, frustration and anger.

Any mother who has breastfed a baby knows that breastfeeding is not always easy and it is certainly not free. Many women don’t have the time, resources, support, or physical ability to nurse their babies. For most of these women, the guilt and anguish that follows can be an unbearable burden. How to feed your baby is an extremely personal decision and reasons to use formula are diverse and can be warranted. So telling these mothers that if they were breastfeeding, they wouldn’t be in this predicament is simply thoughtless and unkind.

So what can we do? If you are currently breastfeeding, consider donating any excess milk. This can be done through a local milk bank or by donating to someone you know with whom you can share your medical and dietary history. You can refer to the Academy of Breastfeeding Medicine’s Statement on Informal Breast Milk sharing for guidelines on how to donate safely, including instructions for home pasteurization of human milk.

If you use formula, reach out to your pediatrician. Most pediatric offices have samples of formula and they can recommend alternative brands if yours isn’t available. Never dilute formula and don’t make homemade formula. Recipes have been circulating since the shortage began and they are not safe nor nutritionally adequate for any baby.

What we can do, is use this experience to help us in the future. There are approximately 10,000 babies born each day in the United States. Approximately 84% of these babies’ mothers initiate breastfeeding in the hospital. So why do we need so much formula?? Unfortunately, many of these babies are already being supplemented with formula before they leave the hospital. Mothers are not educated as to the risks of this and early formula use is directly linked to low rates of breastfeeding duration. The key to decreasing reliance on formula is breastfeeding support and education. If every mother had access to prenatal breastfeeding education and continuing support right after birth and follow up after going home, the breastfeeding success rates would skyrocket and the use of formula would be dramatically decreased. Women who want to breastfeed would be empowered to do so. I have seen many, many mothers overcome what would seem insurmountable obstacles in order to breastfeed their babies. But they need to have the clinical, physical and emotional support to do so.

So instead of guilting mothers by suggesting they should “just breastfeed”, let’s encourage our doctors, hospitals and community resources to help mothers successfully do so! If you have been fortunate to have successfully nursed your baby, reach out to pregnant friends and family and offer them support. Clearly, if 84% of mothers start out wishing to do so, we could be doing a much better job of making that possible for them. It definitely takes a village to support a new family. Be part of that village if you can…

Oral ties

One of the most common breastfeeding problems that can make nursing your baby much more difficult is a tongue and/or lip tie. It seems that this is an issue that is happening more often than it ever did in the past. It could be partly that we are getting better at diagnosing these ties, but there is also the theory that the high doses of folic acid that moms take in their prenatal vitamins can be contributing to it. While folate is beneficial in preventing problems like spina bifida because it builds connective tissue (and frenulums are connective tissue) this could be contributing to the increase in oral ties. There is also a genetic component, so if either or both parents have a tongue tie, the baby is more likely to as well. I certainly have seen many babies with ties whose siblings have had them too.

So what exactly is a tongue or lip tie? The frenulum is the little stretchy piece of tissue that connects the upper lip to the upper gumline (called the labial frenulum), and the lingual frenulum is the connective tissue under the tongue. We all have frenulums and they are not problematic unless they are thick, short and/or tight. An anterior tongue tie is very noticeable because it extends to the tip of the tongue, often causing a heart-shaped appearance to the tongue. A baby can also have a posterior tongue tie, which is further back towards the middle of the underside of the tongue where it is more difficult to see without a proper examination. It takes an experienced practitioner to identify a posterior tongue tie. The lip tie will extend down to the bottom of the upper gumline, often causing a little notch in the gums. If you try to flange the baby’s upper lip with your fingers, you can see pockets on either side of the frenulum and the lip will resist flaring up. Even if these ties are evident, it is not always a problem because it is all about function, not appearance. I have seen some babies with visible oral ties who nurse beautifully with no issues, and have seen some kids whose ties look less severe but who have many problems because of them.

What kinds of problems do oral ties cause? The tongue is an integral part of many oral functions.For breastfeeding, a normal tongue moves in a wave-like motion which helps to scoop the nipple far enough back into the mouth to effectively suckle. If the tongue is tethered, it instead moves in a piston-like motion, preventing the baby from drawing the nipple far enough back into the mouth. This causes nipple pain and damage for the mother, but also can result in ineffective milk transfer. Babies will often struggle to gain weight due to an inefficient suck, and this becomes a vicious cycle when mom’s milk production suffers because the baby is not suckling effectively. This then effects the baby’s growth even further. Babies often swallow air due to their abnormal suck (called “aerophagia”) which can lead to a gassy, fussy, spitty baby. Tongue ties can also cause reflux, sleep apnea, difficulty swallowing (especially solid foods), and later on, speech issues. Because everything in the body is connected, tethered oral tissue can affect jaw and facial development and orthodontic problems. Lip ties can cause decay on the upper teeth because food gets trapped in the little pockets on either side of the frenulum. With breastfeeding, a lip tie can lead to a baby tiring at the breast because they have to hang on tightly with their upper lip in order to sustain their hold on the breast. Normally, the lip flanges to form a seal around the breast, but if the lip tie won’t allow for that, the baby has to struggle to maintain suction. They often won’t feed for an adequate amount of time because they tire before they finish. This can also result in poor weight gain and a reduced milk supply for mom. It can also lead to a baby who wants to feed constantly, because they never sustain a nutritive suck long enough to be satiated.

What to do if you think your baby has a tongue and lip tie? (they usually go together) It is important to seek an appointment with a lactation consultant who is experienced in working with babies with oral ties. A thorough feeding assessment is vital. You can’t look in a baby’s mouth and determine if their oral anatomy is a problem without first assessing function. If you think your baby is experiencing feeding issues for any reason, it is necessary to have a complete feeding observed and a full oral examination performed. If it appears that oral ties are present and a cause of feeding difficulties, then a consult with a pediatric dentist who is experienced with treating babies with tongue and lip ties is warranted. It is also important for the baby to receive bodywork with a baby chiropractor and/or a cranial-sacral therapist. This will help to loosen the jaw, neck and facial muscle restriction that goes along with tongue ties. As the baby is developing in the womb, these ties restrict all the muscles that are connected.

If the pediatric dentist deems the procedure necessary, a laser frenotomy will be performed. It is a quick procedure with no sedation necessary for an infant- just a tight swaddle and a topical numbing agent. Babies are sometimes fussy the first day or two as their little mouths are sore, but they bounce back quickly and will often start to feed more effectively relatively quickly. Oral exercise and “stretches” are necessary to help the baby begin to move their tongue normally and to prevent reattachment. This warrants another visit to the lactation consultant and continued bodywork. Though no mother wants to put her baby through an uncomfortable procedure, the long term benefits surely outweigh the very temporary discomfort that the baby experiences. I am always somewhat surprised when parents are hesitant to have the frenotomy performed, when they have had their baby circumcised! Circumcision is 1000 times more invasive and painful for the baby, and is simply a cosmetic procedure with no medical benefit whatsoever.

So if you suspect that your baby is having feeding problems that might be related to their oral anatomy, start with a feeding assessment with an experienced lactation consultant. A cursory peek into the mouth is nowhere near an adequate judgement, and waiting many months until the problems become insurmountable is regrettable when early intervention can avoid these issues. It is definitely a “fixable” problem with proper guidance and care.

Why extended breastfeeding is wonderful!

Many moms find that once their baby nears their first birthday (or often even much earlier than that!) people start asking them, “how long are you going to do that for??!! “ (referring to breastfeeding, of course). It is a common assumption in our culture to expect that once a baby has teeth or is beginning to walk, they should no longer need to breastfeed anymore. Some pediatricians have even been known to tell mothers that babies don’t need breastmilk once they hit the one year mark. While this is true of formula, nothing could be further from the truth with a breastfed baby. Breastmilk doesn’t suddenly become less good, or unnecessary just because the child hits an arbitrary age. In my experience, most mothers who end up nursing a toddler never intended to do so. They just kind of grow into it. As baby nears a year, breastfeeding is easy, baby is healthy, and nursing has become part of your lifestyle. So, why stop now? The next thing you know, you’re approaching your toddler’s second birthday, and still breastfeeding. So what are the reasons to keep nursing your toddler?

Toddlers are notoriously picky eaters. Your little one who used to eat everything with gusto now only wants pasta and goldfish crackers. Moms worry incessantly about this. By continuing to breastfeed, you are basically giving your toddler a nutritional insurance policy. Breastmilk continues to provide substantial amounts of important nutrients well beyond the first year of life, especially protein, fat, and most vitamins. In the second year of life, 15 ounces of breastmilk per day provides 29% of energy requirements, 43% of protein, 36% of calcium, 75% of vitamin A, 76% of folate, 94% of vitamin b12 and 60% of vitamin C. This makes it much easier to relax and not worry so much when your little person is being particularly persnickety about eating well.

Even though the volume of milk consumed by a baby into the toddler years decreases, studies show that the immune factors increase in concentration during the second year. Nursing toddlers between the ages of 16-30 months have fewer illnesses and illnesses of shorter duration than their non-nursing peers. This is especially helpful for kids in daycare who put everything into their mouths and share their germs generously with their little friends.

Toddlers are walking disasters waiting to happen…this is the stage where it’s the contusion of the day. Toddlers fall constantly, bang their heads frequently, and seek out precarious behaviors like climbing everything in sight and jumping off any surface that’s jumpable! Nursing is the instant cure for all those boo-boos that happen on a daily basis. Just a couple minutes of nursing will make a screaming toddler calm instantly and forget their injuries, ready to move onto the next disaster.

Nursing is also a quick and easy way to get a very busy little person to settle down for a nap or to sleep for the night. Kids this age often don’t want to quit- the world is just so much fun and there’s so much to explore. But a few minutes of being in mommy’s arms and some nice soothing nursing will calm even the wildest child.

Many studies show that one of the best ways to prevent allergies and asthma is to breastfeed exclusively for at least 6 months and to continue breastfeeding long term after that.

Extensive research in the relationship between cognitive achievement (IQ and grades in school) and breastfeeding has shown the greatest gains for those children who were breastfed the longest.

The American Academy of Pediatrics, The American Academy of Family Physicians, The World Health Organization and Unicef all emphasize the importance of extended breastfeeding, citing the significant health and developmental benefits to the child. It is stated that, “ if the child is younger than two years of age, the child is at increased risk of illness if weaned.”

Mothers also benefit from extended breastfeeding. Breast cancer, ovarian cancer, endometrial cancer,and uterine cancer are all less likely the longer a woman breastfeeds. Moms also have a lower risk of heart disease, diabetes, osteoporosis, and depression. The longer you nurse your child, the more these benefits increase.

Often when people first have their babies, they will ask me how long they should breastfeed for. I will never answer that question. (I never “should” on anyone!) That’s because when you’re holding a brand new baby in your arms, one year seems like forever away. In the beginning when breastfeeding can sometimes be a challenge to get going, thinking that you have to make it to one year can seem daunting and impossible. I usually just respond by saying something like, “the longer the better…one day of breastfeeding is better than none; two days is better than one and so on”. Giving moms the proper support will get them past the rough patches in the beginning. and the next thing you know, your little one is celebrating their first birthday and you are still happily breastfeeding, seeing no reason whatsoever that you should stop. In fact, there are so many reasons as I’ve stated, to keep going! So the next time somebody asks you how long you’re going to do that for, just smile and nod as tell them as long as you and baby want to keep going.

Babies don’t sleep

I’ve always kind of jokingly said, “I’m going to write a book someday, and the title is going to be- ‘Babies don’t Sleep’!” If you look in the parenting section of the book store, there are more books written about sleep than any other topic. That’s because parents will do anything to get their baby to sleep! They are constantly in search for the magic bullet, that elusive secret, that will enable them to get their little one to go to sleep and stay asleep. People spend thousands of dollars on “sleep experts” or “sleep trainers”, desperate to find the answer that has been evading them. The real answer is….babies don’t sleep! Nor are they supposed to!

When your baby is born, his/her brain is very immature. They are also still figuring out how to breathe efficiently, remember, they didn’t breathe in the womb. Newborns will often experience what is called “periodic breathing” where they skip a breath and then breathe quickly to make up for it. Waking frequently helps prevent this immature little person from experiencing spells of apnea, where they forget to breathe. This is one of the reasons that breastfed babies have a lower incidence of SIDS (sudden infant death syndrome). Because they rouse more frequently, they don’t get into that period of very deep sleep where they’re more at risk for apnea.

Babies sleep cycles are also much different than an adult’s. Adults spend only 20-25% of their total sleep time in REM sleep, with the rest (75 to 80%) in quiet or deep sleep. Adults have more than twice as much quiet or non-REM sleep as babies. The frequency of REM sleep in infancy gradually decreases to adult levels between 2-3 years of age. (which means they are more prone to waking until that happens). You can tell when your baby is in a REM stage of sleep by the movement of his eyes beneath his eyelids, twitches, facial expressions such as smiles and grimaces, and irregular breathing. Babies also have shorter sleep cycles than adults- meaning the time going from a REM to a non-REM state of sleep is less. Adults sleep cycles typically last about 90 minutes, where babies’ sleep cycles shift every 50-60 minutes. During these periods of transition, babies are more easily aroused and will wake up. It also takes babies longer to go into a deeper period of sleep. When adults fall asleep, they typically go quickly into a quiet state of sleep without passing through an initial period of REM sleep. Babies, however, go through a period of REM sleep (usually lasting about 20 minutes) before entering into a deeper, quiet stage of sleep. That is why they often wake up as soon as you try to put them down, because they are still in a lighter state of sleep. This is why babies need to be “parented” to sleep, rather than just put down. Nursing, rocking, walking, snuggling all will help your baby as he/she transitions to a deeper sleep.

Babies also have no concept of night and day. There is a common misconception in our culture that you can “teach” a baby the difference by trying to keep them up during the day, feeding them more often during the day so they won’t need to eat as much during the night, or even giving them solid foods prematurely because it will make them sleep through the night. While it is useful to help your baby eventually be able to differentiate between night and day by keeping him/her around activity and sights/sounds during the day and keeping nighttime dark and quiet, this doesn’t happen overnight (no pun intended). Babies need to eat during the night- their stomachs are small and their milk is quickly digested. They also need the reassurance of your presence. Their world is very small at first, and if you are a few feet away from them, in their minds, you don’t exist! No wonder they cry for you to be close to them! You are their comfort, warmth, food, protection and security. When you are near your baby, they feel “right”. They regulate all their bodily functions more efficiently. Their need to be near you is just as real as any of their other needs.

So what does this mean for tired parents? If babies don’t sleep, how are parents to survive? This is a hotly debated topic with very strong opinions on both sides, leading parents to question themselves and what the “right” thing to do is to get your baby to sleep. The bottom line is- what is right for one family, may not work for the next. Or even, what worked with one child in the same family, might not work for the next. I have six children, and they were very different in their nighttime neediness, even though they were nighttime parented in relatively the same way. In my experience, the vast majority of parents end up sleeping with their babies at least some of the time, simply for survival. You can’t be awake multiple times a night for months without losing your mind (or selling your baby to the gypsies!) at some point. If bringing baby into bed gets the whole family more sleep, then most parents end up doing it, even though they have been strongly cautioned not to by family, friends, and our society in general. The key is…if you’re going to sleep with your baby, you need to do it safely. It makes more sense to me to tell parents- “yes, the safest place for your baby to sleep is on their back in their own space. But if they will not sleep like that and you choose to sleep with your baby…here’s how to do it safely”. So here are the tenants of safe sleep if you choose to bring your baby into your bed with you:

* Never sleep with your baby if you are under the influence of any mind-altering substances. This doesn’t have to mean drinking a six-pack or smoking something funky- it doesn’t have to be illicit to dull your faculties. Allergy meds, pain meds, sleep aids etc..can make you less aware of your baby next to you. If you have your wits about you, will be aware of your baby’s presence.

*Make sure the mattress is a firm surface with no pillows or blankets up around baby. Breastfeeding mothers sleep with their babies at breast level, so don’t pull the blanket up to your shoulders where it would be up around baby.

*Neither parent is a smoker. Smoking dramatically increases the risk of SIDS.

*baby is on his back to sleep. You can nurse side-lying, but then baby should be rolled onto his back to sleep.

*no older children in the bed. Toddlers are all over the bed, and wouldn’t have an awareness of the baby’s presence like mom does.

*Keep the bed low to the ground. Many parents just put their mattress on the floor to avoid the risk of baby falling off the edge of the bed. Also keep the mattress a good distance away from the wall to avoid the risk of the baby getting trapped between the edge of the bed and the wall.

*Baby is breastfed. Because breastfed babies have a lower incidence of SIDS, formula feeding parents should not cosleep.

If your baby will sleep in their own space, praise the lord and do it! But it seems patently unfair and unrealistic to me to tell parents to never sleep with their babies, leaving them no options other than to let their babies cry (which is proven by research to be harmful to young babies), or to cosleep without the knowledge of how to do it safely.

The bottom line is…babies don’t sleep. For biologically and physiologically very good reasons. Often just knowing that it’s normal, and that “this too, shall pass” helps parents cope. The expectation that babies should sleep sets parents up for frustration and self-doubt. How often is the first question that people ask a new parent is “how do they sleep?” or “are they sleeping through the night?” Yes, it’s exhausting and overwhelming…but it’s normal. I promise you, you WILL sleep again someday. And then you will miss that little face waking up next to yours…it’s true.

Common breastfeeding myths

*Breastfeeding is much harder than bottlefeeding…Maybe in the very beginning when both mom and baby are learning and when difficulties are most likely to arise. But ultimately?! No way! No bottles to prepare, no time waiting for milk to heat up while a hungry baby cries, no washing or sanitizing (well, maybe an occasional shower!), no running to the store to buy formula…It takes exactly two seconds to pull up your shirt and pop that baby on there. You don’t even have to wake up fully for nighttime feedings.

*Breastfeeding hurts…. I’ve known so many women through the years that thought they never experienced postpartum engorgement because they were waiting for painful breasts. Yes, breasts can feel firm, full, heavy, and like they belong to someone else for a few days, but they don’t have to be painful! My experience is that most moms who have very painful engorgement just haven’t been told how to manage it. What about sore nipples? While some nipple tenderness is normal (most nipples aren’t accustomed to being sucked on 10 times per day!), prolonged soreness, extreme pain, cracked/bleeding/damaged nipples are not normal. Most damage is due to positioning/latch problems or related to oral ties. Seek the help of a Lactation Consultant (IBCLC) if nipple pain is severe or unresolved after the first week.

*Many mothers do not make enough milk for their babies. Not true! Breastfeeding is a beautifully designed system of supply and demand. If a baby is nursing effectively and often, most mothers will make plenty of milk for their babies. While supplementation can be warranted occasionally, many women do so unnecessarily which causes a “slippery slope” effect of baby nursing less, so mom makes less milk, so supplementation is increased etc…If baby is not gaining weight, rather than immediately resorting to supplementing, seek the help of an experienced Lactation Consultant to help determine the cause and come up with a feeding plan to enhance the breastfeeding rather than sabotage it.

*If mom is breastfeeding, partners are left out. If this is happening, if is often due to what I refer to as “the bossy breastfeeding mom”. She knows she has the “magic boob” which will solve all the baby’s problems- whether he’s hungry, tired, bored, fussy, overstimulated, cutting a tooth…whatever. The partner doesn’t have the magic boob so mom is often hovering nearby, ready to swoop in and rescue baby so she can save the day by nursing. Partners need to find their own special ways to soothe baby (when feeding is not what the baby needs). Let them figure it out without being too quick to jump in and take over.

*If you are breastfeeding, you will be stuck at home all the time because it is too difficult or embarrassing to nurse in public. The opposite is true! Have breasts will travel. Your breasts go everywhere you do! The milk is always available, clean and hygienic, never runs out and ready to feed in an instant. You can nurse on the beach and not have to worry about how to keep the milk cold and then warm it, you can nurse on a mountain top, you can nurse on an airplane or a cruise ship (reminds me of that Dr. Suess book- “you can do it in a car, you can do it near or far!”…) Once you do it a few times and realize nobody is paying attention to you, you will get comfortable with it quickly. It is a law in all 50 states that a woman has the right to breastfeed her baby anywhere in public.

*Breastfeeding is stressful. Sometimes…in the beginning when you’re getting to know your baby and getting in the groove of being a breastfeeding mama. But ultimately, breastfeeding is very relaxing because of what are known as the “mothering hormones”. Every time you nurse your baby, you release oxytocin and prolactin. These hormones are known to give you a feeling of calm and relaxation. Being a new mom can be stressful, so having a built-in source of relaxing hormones is surely a benefit! Moms who breastfeed have less postpartum depression and anxiety. Generally, you will also sit down to nurse your baby (although many a mom has nursed cooking dinner!). I realized after my last baby weaned that I never sat down again! (except in the car to schlep the kids around)

*Small breasted women will have trouble making enough milk. Breast size has nothing to do with milk production.It’s all about the glandular tissue and milk storage capacity. I’ve seen many moms with teeny-tiny breasts produce copious amounts of milk.

*Breastfeeding moms get less sleep. Not true! Although your baby will probably wake more often during the night to nurse (a reason that breastfed kids have a lower incidence of SIDS), you don’t have to get up and prepare a bottle (or sit with a breast pump). Snuggle and snooze and you and your baby will go right back to sleep. Many breastfeeding moms can’t even remember how many feedings they had during the night by the next morning because it is auto-pilot.

*Breastfeeding isn’t worth the time and trouble that it takes. The biggest myth of all! A breastfed baby will be healthier for life because of all the amazing benefits that mother’s milk provides. Persevering through the initial adjustment period and the bumps in the road along the way are worth all the time and effort that goes into it. Don’t let all the misinformation and misconceptions scare you away from trying. And always…ask for help if difficulties arise. Most problems can be overcome with guidance and loving support!

The Value of Prenatal breastfeeding consultation

For a very long time (29 years!), I worked in an OB-Gyn office, teaching classes, seeing all new moms each day in the hospital after the birth of their babies, and running a weekly new moms’ support group. To me, it was the ideal way to give new mothers the support they need when beginning their breastfeeding journey. Prenatal classes give the foundation of information to help get off to a good start. Hands-on help in the hospital helps avoid problems with sore nipples and engorgement by helping moms learn good positioning and identifying potential issues like tongue tie, insufficient glandular tissue and babies who are at risk for not nursing well for a variety of reasons. One of the most frequent things I heard from new moms was that they were overwhelmed by the conflicting advice they received in the hospital, making it harder to know what to do and making them feel confused and frustrated. Weekly on-going support helps moms deal with issues that come up after going home with their babies and provides vital connection with other moms which helps ward off postpartum depression and anxiety.

Sadly, Covid hit and my job was eliminated and I had to find another way to help new moms and babies. I chose to begin my own private practice and since doing so, I have noticed an interesting trend. Most always, by the time a mom reaches out to a private practice Lactation Consultant, they have already exhausted all other resources, things are not going well and they are desperate for help. While it is gratifying to be able to try to help moms in need like this, it also often ends up feeling like you’re “picking up the pieces” and trying to rectify a very difficult situation that you know could have been helped better earlier on. This is where the value of a prenatal consult has become so clear to me.

When meeting with new parents before their babies are born, it not only gives us a chance to build rapport, but I can also give parents the information that helps them get off to a good start right after birth. Parents often don’t realize that things like giving a bottle or a pacifier can make it more difficult and learning ahead of time can help avoid those pitfalls. I also see that moms and their partners are more committed to breastfeeding when they learn about it before their baby’s arrival. This makes them more dedicated to sticking with it when/if obstacles arise.

Then once the new family is home from the hospital, we can get together again soon after the baby’s birth to reinforce the points learned prenatally and I can assess for potential difficulties and give tactics to avoid problems that could arise. This ongoing support gives confidence to parents and lessens some of the fears and concerns that are a normal part of being a new parent. This proactive approach is so much better than “picking up the pieces” as a last resort.

So I encourage you to consider the value of a prenatal consult. Knowledge, confidence and support make your success with breastfeeding your baby so much more likely. Every mom deserves that kind of ongoing support.

the fourth trimester

If I had to pick the one thing I’ve heard from probably almost every set of parents that I’ve helped over the years, it would hands-down be, “Every time I put my baby down, he/she wakes up!” I usually joke and say “it’s a baby conspiracy”, but the truth is- it’s normal newborn behavior. The problem is, it isn’t what we expect from a new baby nor what our culture conveys is normal. We prepare our “nurseries” with what we think are all the necessary accoutrements and we envision our babies peacefully sleeping in their idyllic surroundings. Then when we bring this beautiful little bundle home and try to put them down, they cry. So we pick them back up, rock, cajole, beg, plead and try once again, and as soon as their cute little heads hit the mattress, they immediately wake right back up again. To say that this isn’t frustrating to an exhausted new parent would be an untruth for sure. So why do they do it?

It’s all about biology. Babies are very neurologically immature at birth. Their brains are only about one quarter of the adult size at birth. By the age of one, their brain will be 2/3 the adult size. That’s a HUGE amount of brain growth in only one year! That’s why their fontanelles stay open for so long- they need room in their heads for their brains to grow. Their brains are small at birth so they can fit out the narrow passageway of the birth canal. Human babies are the most physiologically immature mammals at birth of all the other mammals in the animal kingdom. Yet we’re the only mammals that put our babies down and try to leave them alone. All the other mammals stick to their babies like glue when they are first born and vulnerable. And why is this? Because if they leave them alone, something will EAT them!! Now fortunately, we as humans don’t have to worry about something eating our young. But our babies don’t know this! They do know that they are completely helpless: they can’t feed themselves, move themselves, keep themselves warm, protect themselves etc etc…No wonder they panic when we put them down! Mama is home base for that baby- remember you carried him/her for 9 months and kept him/her calm, warm, fed and comforted in the cozy confines of your womb. It is a common misconception that babies can somehow manipulate parents into making them pick them up and that you will form “bad habits” if you do so. These babies are supposed to learn to self soothe….Ugh…just the sound of that makes me cringe. I don’t know about you, but if I’m sad, scared or upset, I sure do want someone to put their arms around me and help me feel better! Why should we expect any less for our helpless little newborns?

There is much research about how responding to a baby’s cry actually makes them cry less. And it isn’t because they manipulated parents into getting what they wanted. It’s because responding to your baby is good for them…ignoring their cries actually affects their brains, and though they do eventually stop crying, it’s not because they’ve soothed themselves. It’s because they’ve given up. Kids who were intentionally left to cry for long periods have more anxiety, depression and attachment issues as adults. Responding to your baby teaches them trust and will make them healthier more secure people for the rest of their lives.

So what is an exhausted parent to do when your baby wants to be a barnacle and be attached to you all day and all night?! First, knowing that it’s normal and that you are not doing anything wrong by responding to your baby goes a long way to making it more tolerable. Sadly, our culture doesn’t provide support for new mothers that makes this stage of parenting easier. In many cultures, mothers have their extended families around to help hold the baby while mom takes a shower or a nap; to provide meals and help with housework. Most American women go home and have to do it all on their own, with unrealistic expectations of what it’s like to physically, emotionally,and hormonally recover from giving birth. So how do we survive?

* Get a baby carrier- wearing your baby keeps them close and happy and allows you to eat, go shopping, or get something done.

*No time for a shower? Take a bath with your baby, soothing for them and lets you get clean.

*Go for a walk…studies show that moms who get outside for a walk each day have much less postpartum depression. Sitting in the house day in and day out is not good for your mental health.

*Nap/sleep with your baby. Practicing safe sleep (more to come on this in a future blog) allows for easy nighttime feedings and keeping your baby close provides much more sleep for both mom and baby.

*Seek out other like-minded moms. You need your tribe when you have a new baby. Honest sharing with other moms is the best therapy there is! Scrolling through Facebook or googling your concerns just leads to more anxiety.

So how long does the “fourth trimester” last? Parents often want me to commit to a certain time frame when this will pass. The answer is…it’s different for every baby. Some kids are less needy than others. It’s an evolution. You will find that as time goes by, they need to be glued to you less and less. The days where you barely get off the couch will be fewer. Then one day you realize that your little one is always squirming to get down when you try to snuggle them. So try to enjoy this fleeting moment in your new baby’s life. Yes, it’s exhausting and overwhelming and suffocating at times. But you will miss it. So soak up your sweet baby’s smell, keep them close and ignore those people who tell you to just “put that baby down or they’ll never learn”! Your heart will tell you to respond to your baby. Listen to it…you will never regret it.

sex after baby

  Ever wonder why you seem to lose your desire for intimacy after you have a baby? If this has happened to you, you’re not alone. The vast majority of women will experience some decline in libido after becoming a mom. So although it’s normal, it can be upsetting to both partners and ultimately damaging to your relationship. So why does this happen?

·         When breastfeeding, women don’t experience normal vaginal lubrication. That’s because when you have a little nursling, your body is keyed into providing food (and survival!) for that baby. Pregnancy diminishes milk production, so vaginal dryness is a biological deterrent to procreating. But people like to do it for reasons other than making a new baby, so lubricate, lubricate, lubricate! There are all kinds of cute products out there for this purpose, so have fun choosing together- this can lead to feelings of closeness and arousal.

·         Sleep deprivation is a huge reason for lack of desire. For most new moms, sleep is about the most orgasmic thing they can think about when they get in bed at night. Don’t forget morning lovemaking, or naptime, or even in the middle of the night after baby has gone back to sleep after feeding. Being creative can add to the anticipation.

·         Many moms have body image issues after having a baby. It’s hard to feel sexy with a paunchy stomach, leaking breasts, and stretch marks. It doesn’t help that we are bombarded with pictures of celebrities who’ve just given birth and they don’t look like they were ever even pregnant.

·          Feeling touched out…you have a little barnacle baby glued to you , and older babies like to twiddle, pinch, pull and chew on you all day long. The last thing you feel like doing at the end of the day is having someone else wanting to touch you!

·         Changing roles in your relationship can add to lack of desire. Partners are sometimes jealous of the intimacy between mom and baby, and moms sometimes resent partners’ freedom and ability to continue on with their lives much like before while every aspect of her life has been turned upside down.

·         Pain can certainly be a deterrent to wanting sex. Who wants to do it if it hurts? While some discomfort can be normal at first (a big thing came out of down there!), prolonged pain should be discussed with your doctor or midwife. Try different positions where mom has more control of depth of penetration and don’t forget to lubricate!

What to do about it?

·         Sharing your feelings…so important! This can help you feel closer and clear up any misunderstandings. Share what sex has meant up to this point and how it feels now. This kind of communication creates an opportunity for new intimacy.

·         Touching…rediscover hand-holding, hugging and kissing. Not all touching has to lead to intercourse.

·         Provide accoutrements…prepare good food (or order out!) for each other, listen to music together in the dark or by candlelight, add special new touches of tenderness and mystery. A glass of wine doesn’t hurt either!

·         Stroke each other’s ego…moms need to hear that they are still seductive and sexy and partners need to know they are still desirable.

·         Give yourself time…just because you get the green light to resume sex after six weeks doesn’t mean you’re ready. Find other means of gratification in the meantime.

·         Sometimes you have to “fake it till you make it”. Many moms find that although they might not have been in the mood initially, they end up enjoying it and feel better after having been intimate with their partner.

·         If after time goes by things don’t start to get better, seek counseling. Letting your love life go by the wayside can have long term negative consequences for your relationship. Sometimes having a third party to help you negotiate your feelings can be invaluable.