Book Group Early-Bird Pricing Extended

1 év 2 hónap ago

By Popular Demand! We are extending by one week—to April 17—the early-bird pricing for our 2023 Book Group. Register now HERE!!!

How much can you save? Our early-bird pricing is:

  • 36 L-CERPs: $199 (regular price: $249)

  • No CERPs: $149 (regular price: $200)

How we connect virtually. This book group incorporates Zoom meetings and Thinkific, an easy-to-use online learning platform. A day or two after you register, you will get an invitation to join us on Thinkific, where you will see the required reading listed for each of our ten sessions.

You will need to get your own copy of Breastfeeding Answers, 2nd Edition, either a hardcover copy or an e-book PDF edition (available HERE). The 1st edition (or any of the earlier Breastfeeding Answer Books) will not do! So much has changed! You will read the assigned chapters, attend our live Zoom meetings (or listen to the recording of our live meeting discussion and its Q&A), and review any supplemental materials. If you registered for our 36 L-CERPs version, you will take the quiz at the end of each session. For IBCLCs using these L-CERPs to recertify by CERPs, see a breakdown of their topic areas HERE.

When will the book group take place? It will meet from 2:00 to 4:00 pm Eastern time on the following dates: 

  • Session 1: Sunday, April 30, 2023

  • Session 2: Sunday, May 7, 2023

  • Session 3: Sunday, May 21, 2023

  • Session 4: Sunday, June 4, 2023

  • Session 5: Sunday, June 11, 2023

  • Session 6: Sunday, July 2, 2023

  • Session 7: Sunday, July 9, 2023

  • Session 8: Sunday, July 16, 2023

  • Session 9: Sunday, July 23, 2023

  • Session 10: Sunday, July 30, 2023


Each session consists of a 2-hour Zoom meeting where we will discuss the materials and answer questions. It includes a 20-minute small-group break-out discussion of the practical applications of that session’s material. Before each session, you read the assigned chapters (some sessions cover one chapter, others two or three) and any supporting materials. If you registered for CERPs, after our Zoom meeting, you will take a short quiz.

You must buy the most recent book: Breastfeeding Answers, 2nd Edition by Nancy Mohrbacher (available HERE).

The Zoom meetings will be recorded so you have the flexibility of missing any or all of the live session if needed and then listening to them at your leisure on Thinkific. You will have access to all the materials until September 1, 2023.

To learn more about the book group, watch our short video below.

Hope you can join us!

Nancy Mohrbacher

Update Your Clinical Skills with Our 2023 Book Group

1 év 2 hónap ago

Want a fun way to take your lactation knowledge and skills to the next level? Looking to earn 36 L-CERPs in an interactive setting rather than passive screen time? Need to prepare for the IBLCE exam?

Early-bird pricing ends April 10 and space is limited in our upcoming book group. (Watch our short video below or click HERE for more details and to register.) Delve deeply with us into my 2020 comprehensive resource, Breastfeeding Answers, Second Edition.

What is a book group? It consists of like-minded people who read the same material then meet—often with a glass of wine!—for an informed discussion on its contents. The power of a book group lies in the insights and experiences shared by its members. It also offers welcome connection with colleagues.

Using the best learning technology plus live Zoom meetings, our book group will take place on 10 Sunday afternoons from April 30 through July 30, 2023 (skipping some Sundays). Once there, you can ask questions and share your thoughts. Live sessions are also recorded for later viewing.

For fun or to earn CERPs, join us while learning about the latest lactation research and techniques.

Structured, interactive discussions are led with warmth and wit by Barbara Robertson, MA, IBCLC (a Clinical Lactation Contributing Editor and IBCLC in private practice), this absorbing learning experience springs from Barbara’s passion and training in adult education. Barbara and I hope to provide inspiration we along with practical strategies for boosting your effectiveness with nursing families. 

An opportunity to connect with wise colleagues worldwide. Previous book groups included both experienced and new breastfeeding supporters from around the world. I am thrilled for this chance to spend time with an international group of lactation enthusiasts. Join us for this priceless opportunity to explore the secrets of my 2020 book and tap into our collective wisdom.

Hope to see you there!

Nancy Mohrbacher

A New and Better Way to Learn

1 év 8 hónap ago

I'm thrilled to share with you my new venture. I recently joined forces with Barbara Robertson, an IBCLC and educator from Michigan, to form a new lactation education entity for providers, LactaLearning.

Best Practices in Lactation AND Education
What makes LactaLearning a more enjoyable and effective way to learn? When Barbara and I began co-hosting an online Book Group at the height of the Covid pandemic during the dark, cold Chicago winter of 2020-2021, I discovered in Barbara more than just a kindred spirit in lactation. With her Masters degree in Curriculum Development and a special interest adult education, Barbara impressed me with her innovative educational methods and insights. When we began discussing new and better ways to train lactation providers, I got excited!

No More Endless PowerPoint Talks
Barbara knew from her graduate studies that passive listening to PowerPoint talks (online or in-person) isn’t the most effective way to learn or to change behavior. Yet this is how nearly all current course providers structure their courses.
What if instead we incorporated into lactation training the many ways students LIKE to learn and are most effective for retention: short videos, quick reads, infographics, animation, podcasts, interactive discussions? The possibilities were unlimited, and so desperately needed!

Many Courses to Meet Your Needs
Thus, LactaLearning was born. Visit LactaLearning.com to find:

  • Courses for aspiring IBCLCs both a self-study course—described in the video below—and a group version of the 95-hour course required to sit for the IBLCE exam

  • Professional Book Groups featuring interactive discussions with top authors in lactation

  • Comprehensive trainings for WIC staff

  • Trainings for hospital staff to support the Baby-Friendly Initiative

  • 5-CERPs courses on communication skills and ethics

  • Coming soon: recertification courses that make it easy for IBCLCs to tailor their topics to the specific areas required in the 2023 IBCLC Detailed Content Outline.

    Is there a better way to learn? Yes there is. By incorporating best practices in both lactation and education, LactaLearning gives you a better learning experience and better results for your hard-earned money. Check us out at LactaLearning.com!

 

Nancy Mohrbacher

Book Group Early-Bird Pricing Extended

2 év 4 hónap ago

By Popular Demand! We are extending by one week—to February 18—the early-bird pricing for our 2022 Book Group. Register now HERE!!!

How much can you save? Our early-bird pricing is:

  • 36 CERPs: $299 (regular price: $350)

  • No CERPs: $229 (regular price: $280)

How we connect virtually. This book group incorporates Zoom meetings and Thinkific, an easy-to-use online learning platform. A day or two after you register, you will get an invitation to join us on Thinkific, where you will see the required reading listed for each of our ten sessions.

You will need to get your own copy of Breastfeeding Answers, 2nd Edition, either a hardcover copy or an e-book edition: PDF, Kindle, or ePub (available HERE). The 1st edition (or any of the earlier Breastfeeding Answer Books) will not do! So much has changed! You will read the assigned chapters, attend our live Zoom meetings (or listen to the recording of our live meeting discussion and its Q&A), and review any supplemental materials. If you registered for our 36 CERPs version, you will take the quiz at the end of each session.

When will the book group take place? It will meet from 2:00 to 4:00 pm Eastern time on the following dates: 

  • Session 1: Sunday, March 13, 2022

  • Session 2: Sunday, March 20, 2022

  • Session 3: Sunday, March 27, 2022

  • Session 4: Sunday, April 3, 2022

  • Session 5: Sunday, April 10, 2022

  • Session 6: Sunday, April 24, 2022

  • Session 7: Sunday, June 5, 2022

  • Session 8: Sunday, June 12, 2022

  • Session 9: Sunday, July 10, 2022

  • Session 10: Sunday, July 17, 2022


Each session consists of a 2-hour Zoom meeting where we will discuss the materials and answer questions. It includes a 20-minute small-group break-out discussion of the practical applications of that session’s material. Before each session, you will read the assigned chapters (some sessions cover one chapter, and others cover two or three) and any supporting materials. If you registered for CERPs, after our Zoom meeting, you will take a short quiz.

You must buy the most recent book: Breastfeeding Answers, 2nd Edition by Nancy Mohrbacher (available HERE).

The Zoom meetings will be recorded so you have the flexibility of missing any or all of the live session if needed and then listening to them at your leisure on Thinkific. You will have access to all the materials until September 1, 2022.

To learn more about the book group, watch our short video below. You can also listen HERE to the free 30-minute book-group podcast I recorded with Barbara.

Hope you can join us!

Nancy Mohrbacher

2022 Book Group Hot Topics

2 év 5 hónap ago

Wish there was an interactive way to update your lactation knowledge and skills? Looking for a fun way to prepare for the IBLCE exam? Want to safely connect with other lactation enthusiasts worldwide? Join our Book Group from March 13 to July 17 and unveil the secrets of my 2020 comprehensive lactation resource, Breastfeeding Answers, 2nd Edition. For more details, see our short video below and register HERE.  Early-bird pricing ends February 11, so register now!

Timing issues? If our days and times don’t work for you, let us know. Our 2-hour sessions are recorded for later viewing. But if interest warrants, we can schedule another group at a different day and time to better meet your needs.

Hot topics. At our Book Group, Barbara Robertson and I will discuss:

  • Novel strategies for boosting milk production and pumping milk yields

  • Cannabis use during lactation

  • What research tells us about LGBTQ nursing

  • How families perceive their quality of lactation care

  • The effects of birth interventions on early nursing

  • Effective manual therapies and massage techniques

  • Early positioning strategies that cut in half the incidence of nipple and breast problems

  • New treatments for nipple pain and mastitis

  • Guidelines for nursing families with COVID-19

  • Milk-sharing safety

  • Insights into mammary dysbiosis

  • And much more

I know this Book Group will make our third pandemic year much more bearable for me. Maybe it can brighten your days, too! Registration details HERE. Early-bird pricing ends February 11. Hope to see you there!

Nancy Mohrbacher

Update Your Lactation Skills at Our 2022 Book Group

2 év 6 hónap ago

Want an engaging way to update your clinical knowledge and skills? Looking to earn 36 CERPs in an interactive setting rather than passive screen time? Need to prepare for the IBLCE exam? Limited space is available in our upcoming book group. (Watch our short video below or click HERE for more details and to register.) Delve deeply with us into my 2020 comprehensive resource, Breastfeeding Answers, Second Edition.

What is a book group? It consists of like-minded people who read the same material then meet—often with a glass of wine!—for an informed discussion on its contents. The power of a book group lies in the insights and experiences shared by its members. It also offers welcome connection with colleagues.

Using the best learning technology plus live Zoom meetings, our book group will take place on 10 Sunday afternoons from March 13 through July 17, 2022 (skipping some Sundays). Once there, you can ask questions and share your perspectives. Live sessions are also recorded for later viewing.

For fun or to earn CERPs, join us while doing what you meant to do anyway: update yourself on the latest lactation research and techniques.

Structured, interactive discussions are led with warmth and wit. The latest in a series of book groups from Barbara Robertson, MA, IBCLC (a Clinical Lactation Contributing Editor and IBCLC in private practice), this absorbing and engaging learning experience springs from Barbara’s passion and training in adult education. Barbara and I hope to provide the inspiration we all need during these challenging times along with practical strategies for boosting your effectiveness with nursing families. 

An opportunity to connect with wise colleagues worldwide. Previous book groups included both experienced and new breastfeeding supporters from around the world. I am thrilled for this chance to spend time with an international group of lactation enthusiasts. Join us for this priceless opportunity to explore the secrets of my 2020 book and tap into our collective wisdom.

Hope to see you there!

Nancy Mohrbacher

When Is Pumping Too Much, Not Enough, or Just Right?

2 év 9 hónap ago

I’m often asked the question: “Do nursing parents need to pump in order to make enough milk?” The short answer is no. Effective breast pumps have been available for only about the past 70 years. Clearly humans have successfully nursed their babies for far longer. Also, how many of the thousands of other mammal species need to pump to produce adequate milk? None, of course.  

But in some cases, pumping—and/or hand expressing milk—is crucial to meeting lactation goals. The key is understanding when pumping makes sense and how often and how much milk to pump. Too much pumping can lead to painful oversupply. Too little pumping sometimes leads to low milk production, especially when baby nurses ineffectively or the nursing couple is regularly separated at feeding times. Let’s consider this issue from the Goldilocks perspective: When is pumping too much, not enough, or just right?

When Is Pumping Too Much?

Nursing parents anxious about milk production often err on the side of too much pumping. Recently, a mother of a 2-month-old baby asked me when she could comfortably sleep as long as her baby slept at night without needing to pump to relieve her breast discomfort. Her baby recently started sleeping for longer stretches, but uncomfortable breast fullness prevented her from doing the same, not to mention she suffered from recurring plugged ducts.

As we talked, she revealed that soon after her baby’s birth, she began using her all-silicone Haakaa pump at every nursing session—day and night—to collect milk from one side while her baby nursed on the other side (see photo below). At the time, she was collecting 3 or 4 extra ounces (90-120 mL) of milk at each nursing session around the clock, and her freezer was full to bursting. Now I understood why her body would not let her sleep when her baby slept.

I explained that at birth, her body knew how much milk to make based on the number of effective daily milk removals. Although she gave birth to one baby, because she was expressing so much milk so often, her body thought she had delivered twins and was making twice as much milk as her baby consumed.

Before she could be comfortable sleeping for longer stretches, she needed to gradually reduce her pumping until she reached the right level of milk production for one baby, not two. To do this, I suggested she eliminate one daily Haakaa session every 3 to 4 days to give her body a chance to reduce milk production gradually and comfortably. Within 2 weeks or so, she could sleep for longer stretches at night without needing to pump, and her recurring plugged ducts were gone.

How much pumping is too much? On average, pumping once or twice a day is not enough to make a noticeable difference in milk production. But when a baby is nursing at least 8 times per day and a parent adds three, four, or more pump sessions each day, this can generate an oversupply, especially when pumping starts during the first 2 weeks after birth, a period when a birthing parent’s body responds most intensely to mammary stimulation.

Using an all-silicone haakaa pump while baby nurses

Some parents wonder if there can really be “too much of a good thing” when it comes to making milk. Definitely! Oversupply (aka hyperlactation or hypergalactia) is defined as making so much more milk than a normally-growing baby needs that the parent must express milk regularly just to stay comfortable. For this parent, oversupply often leads to painful fullness, recurring mastitis, profuse milk leakage, and painful nipples if baby clamps down during nursing to slow milk flow. For babies, very fast milk flow can make nursing challenging. They may gain weight at double or triple the expected range. Many also develop digestive issues (explosive green, frothy, or bloody stools) and colicky behavior.

A gradual reduction of excess pumping over time as described above can relieve these symptoms without triggering plugged ducts. For many families, slowing milk production to a more manageable level makes nursing a more positive experience for both parent and baby.

When Is Pumping Not Enough?

Are there times when more pumping is a good idea? Yes. When a baby is unable to nurse directly or effectively at feeds, pumping can substitute for baby in establishing or maintaining milk production. One example is the baby born so preterm that effective nursing is not possible for weeks or months. In this situation, intensive pumping is required to produce adequate milk, which can be stressful. When pumping substitutes entirely for a nursing baby, to reach full milk production (about 25 oz. or 750 mL of milk per day per baby), parents need to pump early (ideally within the first few hours after birth), often (at least 8 times per 24 hours during the first 2 weeks), and effectively. The hands-on pumping techniques described HERE increase pumping effectiveness by an average of about 50%.

More pumping may also be a good choice when the nursing couple is regularly separated at feeding times, such as when the parent returns to work or school. In this situation, pumping keeps the parent comfortable and prevents leaking milk while also providing the milk baby needs. For more details on how to meet nursing goals even with regular separation, see my book for employed nursing parents HERE.

For parents pumping long term, the key to keeping milk production stable is keeping the number of daily milk removals (nursing plus pumping sessions) at the right level over time. Parents’ “magic number” of milk removals (see my post on that HERE) varies based on the physical difference known as storage capacity. Knowing your magic number makes it easier to meet your long-term lactation goals. For a more in-depth explanation, see my journal article HERE.

When Is Pumping Just Right?

For families who plan to exclusively human-milk feed their baby for the first 6 months, expressing milk may play an important role. When away from their baby at feeding times for any reason, pumping keeps parents comfortable, their milk production steady, and provides milk for their baby. If a nursing problem such as latching struggles occurs, pumping can ensure ample milk until the problem is solved.

Teaching all birthing parents to hand express milk is part of the Baby-Friendly Hospital Initiative. By mastering this skill, new parents can relieve any mammary fullness when their sleeping baby cannot be roused to nurse. Expressing a little milk can more quickly reduce any engorgement and prevent plugged ducts. Pumping just “to comfort” (rather than fully draining the glands) as needed can make the early weeks after birth more pleasant as milk production adjusts to the baby’s needs.

On her website firstdroplets.com, U.S. pediatrician Dr. Jane Morton recommends all parents learn to hand express milk during the last month of a low-risk pregnancy. (A pregnancy is sufficiently low risk when sexual relations are not prohibited.) THIS 2017 Australian randomized controlled trial found this practice did not trigger early labor or any other pregnancy complications. Morton also suggests during the first 3 days after birth that parents follow nursing sessions by hand-expressing a little colostrum (the first milk) into a spoon and feed baby this “dessert.” Why? This simple act can prevent three common problems:

©2021 Dr. Jane Morton, used with permission

  • Excess infant weight loss

  • Exaggerated newborn jaundice

  • Delayed increase in milk production

 Studies also found that learning hand expression at the end of pregnancy can boost parents’ confidence in their ability to meet their feeding goals. Parents who learned to hand express before birth are less likely than others to use formula in the hospital (study HERE) and are more confident in their ability to produce enough milk (study HERE). See Morton’s instructional videos for learning hand expression during pregnancy at firstdroplets.com.

In other words, even when nursing is going normally, a little pumping or hand expressing is sometimes exactly the right thing to do.

Making Decisions

When is pumping too much, not enough, or just right? This is not a black-and-white issue. Like Goldilocks’ choices, subjective factors play a role. When pondering the best course of action, nursing parents need to consider their situation, their long-term goals, their body’s response, and their individual and family needs. Over time, many of these variables are likely to change, so as with all aspects of parenting, flexibility and an open mind are tremendous assets.

Nancy Mohrbacher

NEW! Breastfeeding Answers Pocket Guide 2021

2 év 10 hónap ago

Want a comprehensive lactation reference that fits into a pocket or tote?Looking for an up-to-date, compact resource for healthcare providers? Consider the new Breastfeeding Answers Pocket Guide, Second Edition (2021). For those shipping to U.S. addresses, it is now available HERE. At the top of that store page, you’ll also find links to its booksellers outside the U.S.

Written for those who help nursing families, this smaller, paperback version of my larger 2020 textbook Breastfeeding Answers, Second Edition (BA2e) includes all of its problem-solving strategies in a lightweight, easy-to-carry volume. Newly updated, it offers quick answers to the questions: “What do I need to remember in this situation?” and “What should I try next?”

What’s missing from this smaller volume? Thousands of citations, summaries of their contents, and explanations for its suggested strategies. What remains are the strategies themselves and the basic background details helpers need when assisting lactating families in a wide variety of common and unusual circumstances.

Intended for all levels of expertise, from beginners to advanced practitioners, this slim tome is ideal for hospitals, clinics, medical practices, public-health offices, and peer supporters. Think of the 2021 Pocket Guide as a portable companion to the larger, fully referenced BA2e. This indispensable resource provides easy access to research-based approaches to lactation challenges. It delivers what providers need to empower nursing families to meet their lactation goals.

Retail price is $43.95 USD, but the following volume discounts are available for bulk orders shipped to U.S. addresses.

VOLUME DISCOUNTS

Quantity              Discount             Price each

10                           10%                        $39.56

20                           15%                        $37.36

30                           20%                       $35.16

40                           25%                       $32.96

50                           30%                       $30.77

We accept purchase orders. You can also receive volume discounts for orders placed through our online store HERE by requesting a discount code from our Customer Service at info@nancymohrbacher.com. Let us know which title(s) you’re ordering and how many of each you want, and we'll send you a code to enter at checkout.

Happy World Breastfeeding Month!

Nancy Mohrbacher

Why Do Babies Spit Up and What Can We Do About It?

2 év 11 hónap ago

to reduce spitTING up, keep baby upright for 20-30 min. after feeds

Spitting up can trigger a host of worries in new parents, some related to their role in this behavior and others to do with baby’s growth and health.

  • Was it something I did?

  • Was it something I ate?

  • Will my baby’s weight gain suffer with the loss of so much milk?

  • Does my baby have reflux disease?

Along with these concerns, parents often ask themselves “What should I do next?” Here are the answers to these and other questions. 

Is Spitting Up Ever Normal?

Yes, because most young babies (between 50% and 70%) spit up at least some of the time.1 Why? In the early months, the sphincter muscle that keeps the milk in the baby’s stomach has low tone and relaxes often. On average, several times each day a baby’s stomach contents wash back into her esophagus. Known as reflux, this is normal in both children and adults.  

Normal reflux becomes spitting up when the baby’s stomach contents make it all the way up her esophagus and out of her mouth. Spitting up peaks between 3 and 5 months, occurring less and less often as the digestive system matures and baby spends more time upright. By 12 months, only 4% to 10% of babies spit up.2  

Vomiting and spitting up are not the same. Usually, babies vomit when they are ill and spit up (or “spill”) when they’re not. Often, spitting up happens after feeding. Sometimes babies bring up a little milk and sometimes a lot. Even if it looks like much milk is lost, spitting up is not a cause for concern when the baby is gaining weight as expected and feeding well. Sometimes called “happy spitters,” think of spitting up in these babies as a temporary inconvenience that will resolve on its own over time. Some refer to this as a laundry problem, not a medical problem. See the later “Strategies” section for tips to minimize spitting up. 

Can Overfeeding Cause Spitting Up?

Sometimes yes. Babies who directly nurse are less likely to overfeed than babies who are bottle-fed, no matter what’s in the bottle.3 But overfeeding can happen with direct nursing, too, when parents produce much more milk than the baby takes (oversupply, aka hyperlactation) and especially when they regularly coax their babies to keep nursing after they are done.4 Babies who are fast nursers can sometimes take all they need in just 5 minutes. 

Nursing babies are less likely to overfeed and spit up in part because on average they consume less milk per feed than they do during a bottle-feeding. Why? During nursing, milk flow is fast during milk ejections (parents average five per feed, even though most don’t feel them all) and slower in between. These periods of slower milk flow between milk ejections gives babies time to realize they’re full and stop nursing before they overfeed.  

Unless paced bottle-feeding is used (described HERE), which makes bottle-feeding more like nursing, during bottle-feeding, milk flow from the bottle is consistently fast. When babies eat too fast (just like adults), they are more likely to overeat. Regular overfeeding doesn’t just trigger more spitting up, it also increases risk of child overweight and obesity.3 See the later “Strategies” section for tips to prevent overfeeding. 

Can Something I Ate Cause My Baby to Spit Up?

Many parents worry about this, but although it is possible, it is unlikely. An allergy or hypersensitivity to something in the nursing parent’s diet that passes into the milk occurs in only about 1% to 5% of exclusively nursing babies. 5,6 When it happens, the most common culprit is dairy, and in addition to spitting up, there are almost always other physical symptoms, such as a skin rash, congestion, or frothy, bloody, or mucusy stools. An allergy or sensitivity sometimes mimics symptoms of GERD (next section), as it may also cause irritation of the esophagus.7  

An exclusively nursing parent can rule in or out allergy to cow’s milk by avoiding all forms of dairy, including milk, yogurt, ice cream, cheese, and butter, plus anything containing casein and whey.8 It may take up to 4 weeks to see a significant improvement in the baby’s symptoms,7 but there is often some improvement within a few days. If the baby is also receiving formula (most are cow-milk based), use a hypoallergenic type until allergy is ruled out. 

Does Spitting Up Mean My Baby Has GERD?

When the normal reflux described in the second paragraph causes damage to the lining of the esophagus, this is called gastroesophageal reflux disease (GERD). A baby with GERD may or may not spit up, because damage to the esophagus can occur even if the stomach contents don’t make it all the way to the baby’s mouth (called “silent reflux”).  

Nursing with baby’s head higher than bottom can help

GERD can cause congestion, coughing, and other respiratory problems. The baby’s irritated esophagus may make feeding painful.9 Some upsetting behaviors linked to GERD include irritability, poor weight gain, back arching and head turning, and feeding distress.9  

GERD symptoms are sometimes attributed to “colic,”10 a term used to describe regular and unexplained periods of crying in babies younger than 3 to 4 months. If GERD is suspected, it’s time for baby to see her healthcare provider. 

 A treatment sometimes suggested for formula-fed babies with GERD is adding cereal or starch to formula to thicken it as a way to reduce the number of reflux episodes.1 Also, pre-thickened formulas are sold for babies with GERD.  

But thickening milk and giving solids before 6 months are not recommended for nursing babies with GERD. No evidence supports thickening milk for nursing babies11 and the American Academy of Pediatrics does not recommend it.1 See the next-to-last section “Will Switching to Formula Help” for research comparing the effects of direct nursing, formula-feeding, and solids on reflux, spitting up, and GERD. 

Are There Other Physical Causes of Spitting Up?

Some speculate that tongue-tie contributes to spitting up, but research does not yet confirm or refute this possibility.  

If spitting up happens more and more often and becomes projectile (milk shooting a distance from baby), it’s time for baby to be evaluated by her healthcare provider. Some babies with these symptoms have a condition called pyloric stenosis that can hinder baby’s weight gain and growth and needs immediate treatment.  

Strategies That Minimize Spitting Up

If baby is spitting up for any reason, these basic strategies may help. A 2013 study of babies with GERD12 found they improved symptoms by 50%.

When wiping baby, roll her on her left side rather than lifting her legs

  • Positional therapy means keeping baby’s head above bottom as much as possible. Nurse with baby’s head higher than her bottom. After feeds, keep baby upright for 20 to 30 minutes in arms or in an upright baby carrier.

  • When baby is awake and horizontal, lay her on her left side or tummy. The baby’s esophagus connects to the stomach near her back, and lying tummy down triggers less reflux than back-lying. 

  • Offer smaller, more frequent feeds. A nursing baby between 1 and 6 months needs on average about 25 oz. (750 mL) every 24 hours to grow and thrive. Taking less milk more often means less milk in the stomach to wash back into the esophagus and less time with an empty high-acid-content stomach. If oversupply is an issue, avoid prolonging feeds if baby seems done. If baby is bottle-feeding, pace them as described in THIS free handout.

  • Avoid putting baby in a car seat when not in a moving car, as this position increases reflux episodes.13

If the baby who spits up also has a rash, congestion, or unusual stools, to rule out allergy, try eliminating dairy for a few weeks to see if that makes a difference. 

Will Switching to Formula Help?

Some parents wonder if nursing is the cause of their baby’s spitting up. Some healthcare providers suggest weaning babies with GERD to formula under the mistaken assumption that it will help.  

avoid car seats unless baby is in a moving car

Unfortunately, giving formula is linked to more reflux episodes, more spitting up and can make GERD symptoms worse. Direct nursing, on the other hand, reduces reflux episodes. In 2017, a U.S. study using data from more than 2,800 babies14 compared how feeding method affected reflux episodes. Some babies directly nursed, some were formula-fed, some did both, and some ate solids. They concluded that feeding solids did not reduce reflux in nursing babies and that formula- and bottle-feeding increased the episodes of reflux.  

In Belgium, researchers found that exclusively nursing babies spit up less than nursing babies who also received formula.2 After examining medical records, Italian pediatricians15 found that nursing babies stop spitting up earlier than babies fed formula.  

Takeaways

For the vast majority of babies who spit up, this is just a normal—if messy—part of infancy that will gradually stop as they mature. But whether a baby’s spitting up is normal or it is triggered by overfeeding, allergy, GERD, or other causes, try the basic strategies described earlier. Anything that reduces laundry loads and house cleaning for new families is a definite plus.

References

1  Lightdale, J. R., Gremse, D. A., Section on Gastroenterology, H., et al. (2013). Gastroesophageal reflux: Management guidance for the pediatrician. Pediatrics, 131(5), e1684-1695.  

2.  Hegar, B., Dewanti, N. R., Kadim, M., et al. (2009). Natural evolution of regurgitation in healthy infants. Acta Paediatrica, 98(7), 1189-1193.  

3  Azad, M. B., Vehling, L., Chan, D., et al. (2018). Infant feeding and weight gain: Separating breast milk from breastfeeding and formula from food. Pediatrics, 142(4). 

4  Johnson, H. M., Eglash, A., Mitchell, K. B., et al. (2020). ABM clinical protocol #32: Management of hyperlactation. Breastfeeding Medicine, 15(3), 129-134. 

5  Munblit, D., Perkin, M. R., Palmer, D. J., et al. (2020). Assessment of evidence about common infant symptoms and cow’s milk allergy. JAMA Pediatrics, 174(6):599-608. 

6  Kvenshagen, B., Halvorsen, R., & Jacobsen, M. (2008). Adverse reactions to milk in infants. Acta Paediatrica, 97(2), 196-200. 

7  Salvatore, S., & Vandenplas, Y. (2002). Gastroesophageal reflux and cow milk allergy: Is there a link? Pediatrics, 110(5), 972-984. 

8  Heine, R. G. (2008). Allergic gastrointestinal motility disorders in infancy and early childhood. Pediatric Allergy and Immunology, 19(5), 383-391. 

9  Semeniuk, J., & Kaczmarski, M. (2008). Acid gastroesophageal reflux and intensity of symptoms in children with gastroesophageal reflux disease. Comparison of primary gastroesophageal reflux and gastroesophageal reflux secondary to food allergy. Advances in Medical Sciences, 53(2), 293-299. 

10  Vandenplas, Y., Badriul, H., Verghote, M., et al. (2004). Oesophageal pH monitoring and reflux oesophagitis in irritable infants. European Journal of Pediatrics, 163(6), 300-304. 

11  Kwok, T. C., Ojha, S., & Dorling, J. (2017). Feed thickener for infants up to six months of age with gastro-oesophageal reflux. Cochrane Database of Systematic Reviews, 12, CD003211. doi:10.1002/14651858.CD003211.pub2. 

12  Hegar, B., Satari, D. H., Sjarif, D. R., et al. (2013). Regurgitation and gastroesophageal reflux disease in six to nine months old indonesian infants. Pediatric Gastroenterology, Hepatology & Nutrition, 16(4), 240-247.   

13  Carroll, A. E., Garrison, M. M., & Christakis, D. A. (2002). A systematic review of nonpharmacological and nonsurgical therapies for gastroesophageal reflux in infants. Archives of Pediatrics and Adolescent Medicine, 156(2), 109-113. 

14  Chen, P. L., Soto-Ramirez, N., Zhang, H., et al. (2017). Association between infant feeding modes and gastroesophageal reflux: A repeated measurement analysis of the Infant Feeding Practices Study II. Journal of Human Lactation, 33(2), 267- 277. 

15  Campanozzi, A., Boccia, G., Pensabene, L., et al. (2009). Prevalence and natural history of gastroesophageal reflux: Pediatric prospective survey. Pediatrics, 123(3), 779-783.

Nancy Mohrbacher

Sore Nipple Infographic Debuts

3 év 5 hónap ago

Today’s busy families want lactation information that is quick, easy, and lovely to the eye. That’s why I joined forces with the talented people at Noodle Soup to create for those in the U.S. a series of infographics on some of the most in-demand lactation topics.

 I’m thrilled to announce a new addition to this series! The #2 reason new parents give formula and wean prematurely is nipple pain. This new infographic—“Sore Nipple Basics”—directly addresses this problem and offers guidance on ways to achieve comfortable nursing. My hope is that it will help more families meet their feeding goals.  

All five of my infographics come in tearpads of 50 with one side in English and the other side in Spanish. You can find all five on one page HERE, or you can click on the titles below to link to their order pages on the Noodle Soup website.  

Sore Nipple Basics Includes positioning and latching strategies that can reduce pain, as well as other possible causes of nipple pain and who to contact for help.

Is Baby Getting Enough Milk?  Includes reliable signs that baby’s milk intake is adequate, expected feeding patterns in nursing newborns, and the most common false alarms. 

Working & Breastfeeding  The most important aspects of working and breastfeeding that nursing families need to know to meet their long-term feeding goals.

Pumping Primer  A simple guide to expressing milk that includes the key points needed for successful pumping.

For Baby’s Caregiver  Ways caregivers can support nursing families, including how to pace bottle feeds to avoid overfeeding during the workday.

Nancy Mohrbacher

Book Group: Extended Holiday Special

3 év 6 hónap ago

By Popular Demand! So many enrolled in our Breastfeeding Answers, 2nd Edition book group, we've already covered our basic expenses. Yay! That's why we decided to keep our doors open wide and continue our early-bird pricing through January 1, 2021 as a holiday special. But there's more! For those shipping my book to a US address, through 1/1/21, I will continue our 20% discount on the hardcover edition. (Look for your discount code in your book-group confirmation email.) Register HERE right away, as we have just a few spots left!!!

Our early-bird pricing is:

  • 36 CERPs: $299 (2021 price: $350)

  • No CERPs: $229 (2021 price: $280)


At this book group we will use Zoom Meeting. and Thinkific, an easy-to-use online learning platform. A day or two after you register, you will get an invitation to join us on Thinkific, where you will see the required reading listed for each of our ten sessions.

You will need to get your own copy of Breastfeeding Answers, 2nd Edition, either a hard copy or an e-book edition: Kindle, ePub, or PDF (available HERE). The 1st edition (or any of the earlier Breastfeeding Answer Books) will not do! So much has changed! You will read the assigned chapters, attend our live Zoom meetings or listen to our recording meeting discussion with Q&A, review any supplemental materials. If you registered for our 36 CERPs version, you will take the quiz at the end of each session.

When will the book group take place? It will meet from 6:30 to 8:30 pm EST on the following dates:

  • Session 1: Sunday, January 17, 2021

  • Session 2: Sunday, January 24, 2021

  • Session 3: Sunday, January 31, 2021

  • Session 4: Sunday, February 14, 2021

  • Session 5: Sunday, February 21, 2021

  • Session 6: Sunday, February 28, 2021

  • Session 7: Sunday, March 7, 2021

  • Session 8: Sunday, March 14, 2021

  • Session 9: Sunday, March 28, 2021

  • Session 10: Sunday, April 4, 2021


Each session consists of a 2-hour Zoom meeting where we will discuss the materials and answer questions. Before each session, you will read the assigned chapters (some sessions cover one chapter but others cover two or three) and any supporting materials. If you registered for CERPs, after our Zoom meeting, you will take a short quiz.

You must buy the most recent book: Breastfeeding Answers, 2nd Edition by Nancy Mohrbacher (available HERE).

The Zoom meetings will be recorded so you have the flexibility of missing a session if needed and then listening to the recorded Zoom meeting at your leisure on Thinkific. You will have access to all the materials until 4-15-21.

To learn more about the book group, watch our short video below, or listen HERE to the free 30-minute book-group podcast I recorded with Barbara. Hope you can join us!

Nancy Mohrbacher

Book Group's Hot Topics

3 év 6 hónap ago

Wish there was an interactive way to update your lactation knowledge and skills? Looking for a fun way to prepare for the IBLCE exam? Want to safely connect with other lactation enthusiasts worldwide? Join our Book Group from Jan. 17 to April 4. For more details, see our short video below and register HERE.  Early-bird pricing ends December 17, so register now!

Timing issues? If our days and times don’t work for you, let us know. Our 2-hour sessions are recorded for later viewing. But if interest warrants, we can schedule another group at a different day and time to better meet your needs.

Hot topics. As our Book Group explores the secrets of my new Breastfeeding Answers, 2nd Edition Barbara Robertson and I will discuss:

  • Novel strategies for boosting milk production and pumping milk yields

  • Cannabis use during lactation

  • What research tells us about LGBTQ nursing

  • How lactation supporters’ view of their role affects how families perceive their quality of care

  • The latest on the effects of birth interventions on early nursing

  • The practical impact of symptomatic and asymptomatic tongue-tie

  • Effective manual therapies and massage techniques

  • Early positioning strategies that cut in half the incidence of nipple and breast problems

  • The safety of using stored human milk expressed during a candida infection

  • New treatments for nipple pain and mastitis

  • Guidelines for nursing families with COVID-19

  • Milk-sharing safety

  • Insights into mammary dysbiosis

  • And much more

I know this Book Group will make my long pandemic Chicago winter much more bearable. Maybe it can brighten your days, too! Registration details HERE. Hope to see you there.

Nancy Mohrbacher

Update Your Lactation Skills at Our Book Group

3 év 6 hónap ago

Want an engaging way to update your clinical knowledge and skills? Looking to earn 36 CERPs in an interactive setting, rather than passive screen time? Limited space is available in our upcoming book group. (Watch our short video below or click HERE for more details and to register.) Delve deeply with us into my new comprehensive resource, Breastfeeding Answers, Second Edition.

What is a book group? It consists of like-minded people who read the same material then meet—often with a glass of wine!—for an informed discussion on its contents. The power of a book group lies in the insights and experiences shared by its members. In this time of COVID, it also offers welcome connection with colleagues, which many of us are missing right now.

Uses the best learning technology plus live Zoom meetings, our book group will take place on 10 Sunday evenings from January 17 through April 4, 2021 (skipping two Sundays). Once there, you can ask questions and share your perspectives. Live sessions are also recorded for later viewing.

For fun or to earn CERPs, join us while doing what you meant to do anyway: update yourself on the latest lactation research and techniques.

Structured, interactive discussions are led with warmth and wit. The latest in a series of book groups from Barbara Robertson, BA, MA, IBCLC (a Clinical Lactation Contributing Editor and IBCLC in private practice), this absorbing and engaging learning experience springs from Barbara’s passion and training in adult education. Barbara and I hope to provide the inspiration we all need during these challenging times along with practical strategies for boosting your effectiveness with nursing families. 

An opportunity to connect with wise colleagues worldwide. Previous book groups included both experienced and new breastfeeding supporters from around the world. I am thrilled for this chance to spend time during our cold, dark Chicago winters with an international group of lactation enthusiasts. Join us for this priceless opportunity to explore the secrets of my new book and tap into our collective wisdom.

Hope to see you there!

 

Nancy Mohrbacher

The Study I've Waited for Is Finally Here!

3 év 7 hónap ago

Is there a specific approach to early positioning that nursing families can use to reduce by half the incidence of nipple and breast problems? Yes, according to THIS brand-new randomized controlled trial from Italy.

This New Italian Study

For years, when giving talks to lactation supporters, I asked aspiring researchers to please study the impact of using the Natural Breastfeeding (NB) approach to early positioning (aka “biological nurturing” and “gestalt breastfeeding”) on the incidence of nursing problems. The NB approach involves using relaxed, semi-reclined feeding positions (see photos) rather than sitting upright to nurse. From what I knew from experience and previous studies, its impact was huge.

Finally, the study I was hoping for is here, and its conclusions are just what I expected. Its research team randomized 188 pregnant women to one of two groups. Before delivery, the usual-care group was taught to nurse sitting upright. The intervention group watched videos of families using the NB approach. After birth, both groups had skin-to-skin contact with their newborns, were encouraged to nurse on cue, had 24-hour rooming-in, and as needed, were helped in the hospital with the approach to positioning that was consistent with their group.

During the first 4 months of nursing, the researchers found significant differences between the two groups. Compared with the usual-care (upright) group, those using the NB (semi-reclined) approach experienced about half the incidence of nipple and breast problems, such as nipple pain and cracks, engorgement, and mastitis. Before hospital discharge, the NB group had fewer latching struggles. Although not statistically significant, the study team noted a trend toward more exclusive breastfeeding among those in the NB group.

The study’s authors concluded that the NB approach was effective in a real-life hospital setting and that anything that cuts in half the incidence of nipple and breast problems “has the potential to become an important public-health measure for the promotion of breastfeeding.” These conclusions were the same I reached more than a decade ago.

The Natural Breastfeeding Approach

My own “aha moment” about early positioning came in 2009, when I happened upon a UK STUDY that challenged my assumptions and changed my practice. As I began to use this new positioning strategy, I saw many families quickly overcome some of the thorniest nursing challenge simply by making small changes in their nursing positions. There will never be an intervention that works 100% of the time, but because this one takes advantage of the innate feeding behaviors present in healthy babies at birth, I’ve found that in most cases, it makes a great starting point.

When I promoted this approach during my talks to clinicians, sometimes my colleagues were willing to give it a try—often only as a last resort—but more often they weren’t or told me later, “I tried it once and it ‘didn’t work.’”

An entrenched practice such as upright positioning can sometimes be difficult to change. But I kept honing my message and developing new teaching tools, because I saw with my own eyes what a night-and-day difference it made for so many families struggling to nurse their newborns.

NB Digital Teaching Tools

As I attempted to find the words and images that made this approach easier for parents and professionals to use, I partnered with OB Dr. Theresa Nesbitt. We named this approach Natural Breastfeeding and created a simplified vocabulary and easily accessible visuals. We included a free demo video on the home page of our Natural Breastfeeding website HERE, so families can become familiar with this approach both before and after birth. We hoped that watching a diverse group of mothers with different body types discussing the adjustments that worked for them might get the message across in a format many of today’s parents prefer. I created an ad-free YouTube channel HERE, where families and colleagues can watch short clips of mothers and newborns using the NB approach.

For providers, we created the Natural Breastfeeding Professional Package (NBPP) HERE, which offers licensing rights to use our teaching videos and images in hospitals, public-health departments, and private practices. (See also our short video about the NBPP HERE.) A subscription to the NBPP allows providers to give an unlimited number of families access to our 6-module NB digital program. A perfect educational option during a pandemic, families can view this lactation course (and its more than 60 short videos) before and after birth at their own pace on their phones, tablets, and computers. The NBPP also includes staff training materials and handouts.

For those who still think that nursing upright during the newborn period is best, it’s time to rethink this assumption. Please read this new study, watch our videos, and give the NB approach a try. For a more detailed, fully referenced explanation of the NB approach, see Chapter 1 of my new book for lactation supporters, Breastfeeding Answers, Second Edition.

Nancy Mohrbacher

Nursing Is Much More Than Milk

3 év 11 hónap ago

When discussing lactation, the health effects of human milk often get top billing, but nursing gives children much more than calories and immune-boosting ingredients. Nursing provides sensory stimulation that enhances infant neurodevelopment.[1] It is one of baby’s first social interactions. The sucking of nursing calms and comforts little ones during fussy periods and meltdowns, which is why some call nursing an “all-purpose parenting tool.” Although some consider “nursing for comfort” unimportant, its positive effects are clear. Not only is it “okay” to use nursing as a way of comforting a baby, this can play an essential role in child development. Read on for more details.

Nursing on Cue and Parent-Child Synchrony

How do parents know it’s time to nurse? Health organizations recommend nursing whenever baby shows early feeding cues (rooting, hand-to-mouth, fussiness) rather than on a schedule.[2] One way to describe this approach is nursing on cue, and most lactation supporters know that this strategy is the best way to achieve both healthy growth for baby and healthy milk production. (If a nursing newborn is not gaining weight as expected, a sleepy baby may need extra stimulation to nurse more actively, as described HERE. During the first 2 weeks, babies need to be monitored closely to make sure they’re feeding effectively. With a healthy weight gain, it’s no longer necessary to track feeds and diaper output, as is often emphasized in the hospital.)

When parents nurse on cue, offering to nurse as the first response to a fussy baby is always appropriate. When nursing is offered, sometimes baby will nurse. Sometimes baby will prefer another soothing technique or something else. Nursing on cue simplifies life with a baby, in part because it meets so many of baby’s needs. Especially during the first year, with regard to nursing, what a baby wants generally coincides with what they need, so it is easy for parents to trust baby’s cues.

Simplifying life with a baby is always a plus, but another benefit of responsive, cue-based parenting is that it promotes something scientists call parent-child synchrony. Researchers describe synchrony as harmonious, rhythmical interactions that involve mutual and reciprocal behaviors.[3] When parent and child are “in sync,” they respond to each other intuitively. This synchrony—or lack of it—is the first of a baby’s essential life lessons on what it means to be human. Stronger parent-child synchrony is linked to better mental and physical health in both parents and children. And cue-based care is associated with greater synchrony.

Getting in Sync: How and Why

Getting in sync with a baby involves focusing on a simple goal: keeping baby calm and comfortable as much as possible. Some describe this as “helping babies keep their stress levels dialed down,”[4] which is something most new parents do instinctively. Getting in sync often begins at delivery with immediate skin-to-skin contact, which is promoted in many birthing facilities because it helps vulnerable newborns better regulate their body temperature, blood sugar, heart rate, and breathing, easing the transition from womb to world.[5] After birth, if a newborn’s stress levels get dialed up and stay that way, over time this causes physical changes, such as lower blood sugar levels, which increase the risk of health problems such as hypoglycemia.[6] Just as in adults, the more often and longer babies experience high stress levels, the greater the risk of physical and mental-health problems.

Soothing a fussy baby may seem like the simple, obvious response, yet many don’t realize that these behaviors also play a profound and complex role in baby’s development. In an overview article, US neuropsychoanalyst Allan Schore noted that when parents and babies interact—nursing, talking, looking into each other’s eyes, touching—this creates a direct, intimate brain connection between them during which the adult helps regulate baby’s state (i.e., fussy, calm). Schore explained that the resonance between the parent’s and child’s brains allows the baby’s immature nervous system to be “co-regulated by the caregiver’s more mature and differentiated nervous system.”[7] 

Because every baby is different, getting in sync involves experimenting with calming strategies to find those that work best with that specific baby. For many babies, the nurturing and comforting aspect of nursing is a key part of this. Very quickly, new parents become the experts on what their baby needs to stay calm and content most of the time.

Fortunately, perfection is not required for strong synchrony. Simply doing our best is good enough. Employed parents can ask baby’s caregivers to feed on cue and comfort baby when needed. And it’s never too late. If a baby spends time in the NICU after birth, responsive parenting can begin at home. For an adopted baby, it can begin after baby is placed with the new family.

What are the broader, long-term effects of responsive, cue-based parenting? Studies found it teaches children how to handle stress and strong emotions. It teaches them about compassion and how to relate to others.[3] One U.S. study of 101 6-month-old babies and their mothers found that strong mother-baby synchrony was associated with better mental and psychomotor development at 9 months.[8] In other studies, responsive parenting was linked to greater emotional resilience in children and later in life with fewer mood and anxiety disorders, as well as fewer serious psychiatric problems.[9] Some parents worry that responding to their children freely and providing comfort as well as food may create an unhealthy dependence, but the opposite is true.

A review of the literature on parent-infant synchrony concluded that parents in sync with their babies had a closer emotional bond. This bond helped children learn to better manage their emotions. It also concluded that greater parent-child synchrony improves a child’s ability to learn language and develop healthy relationships with others.[10]

But responsive parenting has benefits for parents, too. According to this same review of the literature, after a new baby’s arrival, a cue-based parenting style made adjusting to parenthood easier. Responsive parents in sync with their babies enjoyed this closer relationship and felt a greater sense of competence. They were also at reduced risk of depression and anxiety and were less likely to adopt a more controlling and negative parenting style, which could put them at odds with their child.

Nursing fits naturally into this bigger picture, even partial nursing in families where babies receive substantial nourishment from nonhuman milks. In addition to sucking dialing down baby’s stress levels, the hormones released during nursing make it easier for parents to get in sync with their baby. A US study used MRIs to examine brain activity in nursing and non-nursing mothers and found that nursing mothers showed greater activation of the brain regions associated with nurturing behaviors and empathy, as compared with the non-nursing mothers.[11] A Dutch study found a link between duration of nursing, responsiveness and more secure attachment. [12]

Origins of Conflicting Advice

If responsive parenting is so good for families, why do some authors and online resources recommend feeding schedules and caution parents against letting baby “use them as a pacifier” (for more on this click HERE). To put this advice in context, it may help to understand its origins.

A less responsive approach to parenting arose in the 1920s, when for the first time, male scientists began providing families with child-rearing guidance. Before this, parents turned mainly to their female family and friends for advice. These emerging experts drew from the science of behaviorism to promote unproven baby-care strategies known collectively as scientific mothering. This approach involved feeding babies (even newborns) on a strict 4-hour schedule. They cautioned parents to avoid holding their babies too much to prevent “spoiling.”[13] They advised parents to be unresponsive to their baby’s cries to prevent their babies from “manipulating” them, which they claimed would eventually result in less crying.

In the 100 years since scientific mothering first debuted, these strategies were studied and found both ineffective and potentially harmful. But over time, these ideas seeped into the Western cultural fabric. Some aspects of scientific mothering are still present today. Examples include the idea that schedules are good for babies (even though babies have no sense of time), that tiny babies can manipulate parents by crying (despite lacking the thought processes necessary to do so), that self-soothing needs to be taught (this occurs naturally as babies grow and develop), and that too much holding can “spoil” a baby (disproved in cultures where babies are routinely kept close). 

When deciding on your own approach to baby care, keep in mind that today’s recommendations for cue-based care come from solid evidence. Research found years ago, for example, that when parents respond to their babies’ crying rather than ignoring it, this results in less crying over time, not more.[14]  

The biggest downside of scientific-mothering is that rather than parent and child being on the same team, it puts parents and children in opposition to one another, encouraging parents to mistrust their child. If parents need to be on guard against their baby “using” or “manipulating” them, this can undermine their relationship with their baby and indeed their whole outlook on parenthood. Who needs this kind of negative attitude toward their baby? Even without it, early parenting is challenging enough.

Nursing Without Worry

Negative messages about creating “bad habits” by nursing on cue or comforting a baby with nursing are rooted in scientific mothering and have no basis in fact. There’s no doubt that caring for a newborn can sometimes feel overwhelming, and adopting a less-responsive approach may sometimes sound tempting. Peer support, especially during the first 6 weeks, helps many families navigate these challenges in a more positive way. (See my video account HERE of my rough evening of nonstop nursing during my oldest child’s intense first 40 days.)

But even when nursing and newborn care are stressful and exhausting, being responsive to your baby brings its own rewards. Many families find that nursing and cue-based care make life more rewarding for everyone. Those same hormones that help you get in sync with your baby can soothe and relax you during the rough times. While it sometimes feels as though babies will need this kind of nonstop day-and-night parenting forever, this intense need lasts only a very short time in what will be a long and loving relationship. Perhaps someday your children will even thank you for it, but probably not until they have children of their own.   

References

1  Bergman, N. (2017). Breastfeeding and perinatal neuroscience. In C. W. Genna (Ed.), Supporting Sucking Skills in Breastfeeding Infants (3rd ed., pp. 49-63). Burlington, MA: Jones & Bartlett Learning.

2  AAP. (2012). Breastfeeding and the use of human milk. Pediatrics, 129(3), e827-e841.

3  Leclere, C., Viaux, S., Avril, M., et al. (2014). Why synchrony matters during mother-child interactions: A systematic review. PLoS One, 9(12), e113571.

4  Ball, H. L., Douglas, P. S., Kulasinghe, K., et al. (2018). The Possums Infant Sleep Program: Parents’ perspectives on a novel parent-infant sleep intervention in Australia. Sleep Health, 4(6), 519-526.

5  Moore, E. R., Bergman, N., Anderson, G. C., et al. (2016). Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database of Systematic Reviews, 11, CD003519.

6  Takahashi, Y., & Tamakoshi, K. (2018). The positive association between duration of skin-to-skin contact and blood glucose level in full-term infants. Journal of Perinatal & Neonatal Nursing, 32(4), 351-357.

7  Schore, A.N. (2001). The effect of early relational training on right-brain development, affect regulation, and infant mental health. Infant Mental Health Journal, 22(1-2), 201-269.

8 Evans, C. A., & Porter, C. L. (2009). The emergence of mother-infant co-regulation during the first year: Links to infants’ developmental status and attachment. Infant Behavior and Development, 32(2), 147-158.

9  Swain, J. E. (2011). Becoming a parent: Biobehavioral and brain science perspectives. Current Problems in Pediatric and Adolescent Health Care, 41(7), 192-196.

10  Baker, B., & McGrath, J. M. (2011). Maternal-infant synchrony: An integrated review of the literature. Neonatal Paediatric and Child Health Nursing, 14(3), 2-13.

11  Kim, P., Feldman, R., Mayes, L. C., et al. (2011). Breastfeeding, brain activation to own infant cry, and maternal sensitivity. Journal of Child Psychology and Psychiatry, 52(8), 907-915.

12  Tharner, A., Luijk, M. P., Raat, H., et al. (2012). Breastfeeding and its relation to maternal sensitivity and infant attachment. Journal of Developmental & Behavioral Pediatrics, 33(5), 396-404.

13  Watson, J.B. (1928). Psychological Care of the Infant and Child. W.W. Norton & Company: New York, NY.

14  Crockenberg, S. and McCluskey, K. (1986). Change in maternal behavior during the baby’s first year of life. Child Development, 57:746-753.

Nancy Mohrbacher

Myth or Fact: Never Wake a Sleeping Baby

4 év ago

When it comes to sleep and babies, parents often get conflicting advice. Should a sleeping baby be awakened every few hours to nurse? If a baby begins sleeping longer stretches, is pumping necessary to maintain milk production? As with many baby-care questions, the answer is “it depends.”

When babies sleep for long stretches, several factors influence the best course of action: your comfort, baby’s age, and baby’s growth. Some common practices may also affect these decisions. Let’s start with the basics.

Your Comfort

No matter what is going on with your sleeping baby, if you wake up feeling uncomfortably full of milk, it’s time to take action. Go ahead and nurse. You can do this without fully awakening your baby by encouraging what’s called a “dream feed.” This means stimulating your baby just enough during light sleep (eyes moving under eyelids, any body movement) to latch and nurse but not so much that she is wide awake. After dream feeds, babies usually continue sleeping. This kind of turnabout is fair play, as baby likely wakes you when she needs to nurse. The longer unrelieved breast fullness continues, the greater the risk you’ll develop a problem, such as plugged ducts or mastitis. Your health is important, too!

Baby’s Age and Weight

In addition to your needs, are there times when—for baby’s sake—you should awaken a sleeping baby to feed? Yes. Most often, this need arises during the early weeks.

Early weight loss and gain.  After birth, nursing babies commonly lose up to 10% of birth weight,[1] with the lowest weight occurring on Day 3 or 4. From that point on, babies gain on average about 1 oz. (30 g) per day until they reach 3 or 4 months of age, when weight gain naturally slows.[2] It’s a good sign if baby is back to birth weight by 2 weeks, but some well babies may take longer than this. Most health organizations recommend babies see their healthcare provider for weight checks within a day or two after hospital discharge and again at around 2 weeks. Weight gain is the most reliable gauge of how nursing is going.

The first 2 weeks are like a “trial period,” when it’s a good idea to keep a close eye on the nursing baby. This usually involves weight checks, tracking number of nursing sessions per 24 hours and diaper output.  If baby is not gaining weight as expected or has a weight loss of more than 10% of birth weight, it’s time to see a lactation specialist to determine the cause. In some cases, this is unrelated to nursing (see HERE). But it may happen if a baby spends too much time sleeping and not enough time nursing. An overdressed or swaddled baby may become too warm (for more on swaddling, click HERE), which increases sleepiness (use adult clothing weight as a guide for baby). Some newborns don’t nurse effectively due to a shallow latch or other issues, which can contribute to both weight-gain issues and nipple pain in the nursing parent. When an ineffective  baby’s resulting calorie intake is too low, this not only causes weight issues, it saps her energy, causing excessively sleepiness.

Between these early weight checks, what are some signs baby needs to be awakened to nurse?   

  • Number of nursing sessions per day: Make sure baby nurses at least 8 times each day (more is even better). Ignore the time intervals between feeds, focusing instead on each 24-hour period. Some thriving newborns sleep for one 4- to 5-hour stretch but still fit in at least 8 feeds by bunching their feeds close together, nursing like crazy while they’re awake (cluster feed). This pattern is common during the first 40 days.[3]

  • Dirty diapers. Changes in stool color are a reliable sign of adequate milk intake during the first week.[4] If nursing is going well, stools change from black to greenish by around Day 3 and to yellow or brown by Day 4 or 5. If stools stay black and tarry after Day 5, it’s time to contact baby’s healthcare provider to get baby weighed and evaluated. After stools turn yellow, 3 to 4 or more stools per day is a rough indicator baby is getting enough milk, which creates the stools and puts on weight.

If a sleepy newborn does not fit in at least 8 nursing sessions per day, stool color does not change when expected, or baby’s weight is of concern, it makes sense to wake her to fit in more feeds and seek lactation help. When it is difficult to wake baby to feed actively at least 8 times per day, it is time to contact baby’s healthcare provider.

As the months pass, baby may begin sleeping for longer stretches. As her tummy grows, she can hold more milk. Some babies continue to gain weight as expected on fewer feeds per day. Others need the same number of nursing sessions to grow and thrive.[5]

Even if your baby begins sleeping for longer stretches, don’t expect this to continue. With babies and sleep, it’s often two steps forward and one step back. The baby who was sleeping for 5 or 6 hours at night at 3 months is often the same baby who wakes frequently again for night feeds when teething starts and developmental changes (like rolling over, crawling, and walking) occur.

Is it necessary after the newborn stage to wake a baby to nurse? Assuming you’re comfortable, it all depends on how she’s doing. If baby is gaining weight as expected, no need to make any changes. If not, more feeds are likely needed. In some cases, nursing more often during the day might be enough for a baby to get the milk she needs. But if you have what’s called a “small storage capacity” (explained HERE), going for too long between milk removals (nursing or pumping) at night may slow milk production. Getting a sense of your own “magic number” (the number of milk removals per day needed to keep production steady, also explained on the link in the previous sentence) is vital to meeting your long-term feeding goals.[6]

Common Practices to Consider

Some nursing parents worry that if their baby sleeps for too long at night, this might decrease their milk production. But when they are responsive to baby’s cues, if milk production decreases, most babies will simply cue to feed more often to get the milk they need, which also stimulates ample milk production. In short:  if you continue to feed your baby on cue, day and night rather than following a feeding schedule (even a loose schedule), extra pumping should not be necessary to maintain milk production.  However, some common baby-care practices may interfere with this automatic demand-and-supply regulation of milk-making and cause a decrease production and infant weight gain. Unlike other mammal species, with our large brains, it is not only possible to overthink lactation, we can also be convinced to inadvertently thwart our biology.

Night weaning and sleep trainingMaking ample milk for our baby (even twins and triplets) is something that usually happens automatically when a baby nurses effectively and nursing parents are responsive to baby’s feeding cues. Even during the newborn stage, however, some baby-care authors advise parents to disregard human physiology and feed babies on a strict schedule, which the American Academy of Pediatrics linked to increased risk of dehydration and slow weight gain.[7] Other authors advise parents to night wean or use sleep-training methods to reduce infant night-waking. These practices involve being less responsive to baby’s feeding cues at night.

These methods may temporarily reduce baby’s night-waking, but they often need to be repeated multiple times as baby enters different stages of growth and development. In addition to being stressful for many nursing parents, depending on their storage capacity, milk production (and baby’s growth) may be compromised as nursing sessions are eliminated. When milk production is no longer automatically regulated by the baby, these practices may prevent families from meeting their long-term feeding goals.

When parents struggle to deal with night-waking, there are alternatives to these practices. An Australian study found that parents were better able to cope with infant night-waking when they learned about infant-sleeping norms and received support.[8] To learn about infant sleeping norms, a good place to start is the free Infant Sleep Info app (details HERE) created by UK infant-sleep researchers at the University of Durham. With this app, parents can chart their baby’s sleep patterns and compare them with other babies their age.

Bottle-feeding and baby’s sleep patterns. Many nursing babies are also bottle-fed occasionally, partially, or exclusively. Depending on how it’s done, bottle-feeding may either reinforce healthy nursing and sleeping patterns or distort them. If paced bottle-feeding techniques (described HERE) are used, this creates an ebb and flow of milk during feeds similar to nursing that helps prevent overfeeding. Bottle-feeding with a consistent, fast milk flow, however, increases risk of overfeeding, overweight, and obesity.[9] If babies are routinely overfed by bottle during the day (a common issue for employed parents), too much milk during their daylight hours can leave babies less interested in nursing at night. This major alteration in normal infant feeding patterns may decrease milk production and interfere with parents’ ability to keep their long-term milk production steady. If this happens, switching to paced bottle-feeding may help get nursing back on track.  

Should you wake a sleeping baby? One size definitely does not fit all. As with most aspects of parenting, following a simple adage will never be right 100% of the time. You are the expert on your baby. If your approach is working for your family and enables you to meet your feeding goals, trust your instincts. On the other hand, if a practice doesn’t feel right or negatively affects you or your baby, it’s time to consider alternatives or to seek help.

References

1 Kellams, A., Harrel, C., Omage, S., et al. (2017). ABM Clinical Protocol #3: Supplementary feedings in the healthy term breastfed neonate, revised 2017. Breastfeeding Medicine, 12(3), 188-198.

2 WHO. (2009). WHO Child Growth Standards: Growth Velocity Based on Weight, Length and Head Circumference: Methods and Development. (2006/07/05 ed. Vol. 450). Geneva, Switzerland: World Health Organization.

3 Benson, S. (2001). What is normal? A study of normal breastfeeding dyads during the first sixty hours of life. Breastfeeding Review, 9(1), 27-32.

4 Nommsen-Rivers, L. A., Heinig, M. J., Cohen, R. J., et al. (2008). Newborn wet and soiled diaper counts and timing of onset of lactation as indicators of breastfeeding inadequacy. Journal of Human Lactation, 24(1), 27-33.

5 Kent, J. C., Mitoulas, L. R., Cregan, M. D., et al. (2006). Volume and frequency of breastfeedings and fat content of breast milk throughout the day. Pediatrics, 117(3), e387-395.

6 Mohrbacher, N. (2011). The ‘Magic Number’ and long-term milk production. Clinical Lactation, 2(1), 15-18.

7 Aney, M.  (1998). ‘BabyWise’ advice linked to dehydration, failure to thrive. AAP News, 14(4):21.

8 Ball, H. L., Douglas, P. S., Kulasinghe, K., et al. (2018). The Possums Infant Sleep Program: Parents’ perspectives on a novel parent-infant sleep intervention in Australia. Sleep Health, 4(6), 519-526.

9 Azad, M. B., Vehling, L., Chan, D., et al. (2018). Infant feeding and weight gain: Separating breast milk from breastfeeding and formula from food. Pediatrics, 142(4)

Nancy Mohrbacher

Milk Production and Menses: What's the Connection?

4 év ago

“I’ve heard that milk production can drop when I get my period. Is that true? Does that mean I won’t have enough milk for my baby?” Concerns about milk production top the “worry list” for many new parents. [1] Among these worries is whether the return of the menses will affect milk production. But keep in mind that for the vast majority of parents, milk production is a hardy process. Until about 150 years ago, our species’ survival depended on it. Before the 1880s, there was no safe substitute for human milk, and many babies who were not nursed did not survive. If milk-making was so fragile and easily disrupted, the human race would not have thrived. For many parents, an effective antidote to these worries is the empowerment that comes with a basic understanding of milk-making dynamics and how their own actions affect milk production.

How Milk Production Works

After birth, many new families mistakenly believe that healthy milk production is either there or it’s not there. While some lactating parents are naturally bigger milk producers than others, the most influential factor in the volume of milk made is what parents (and babies) do or don’t do. And that’s a good thing. While not every challenge can be overcome, it can be reassuring to know that many strategies are available to both prevent and address milk-production issues.   

What dynamics are most important to know? “Drained glands make milk faster” is one critical dynamic. [2] The breasts consist in part of glands, where with stimulation milk is made. For the lion’s share of nursing parents, more milk removals per day, either by nursing or milk expression, is the key to healthy milk production. The more times each day the milk is removed and the more fully it’s removed, the faster milk is produced. That’s how parents of multiples produce enough milk for twins and triplets. (And they do!) We even have recorded cases of parents producing enough milk for quadruplets. [3] How do they do it? They nurse their babies around the clock whenever their little ones show feeding cues (rooting, hand-to-mouth, fussing). Very frequent nursing (or pumping) gives their body the signal to keep making milk faster.

The opposite is also true: “Full glands make milk slower.” When parents replace nursing or milk expression sessions with formula (or even expressed milk from their freezer stash), the milk that accumulates in their glands sends their body the signal to make milk slower. Many new parents are unaware that feeding formula without pumping can decrease their milk production. [4] Sadly, some families find that as they supplement with formula more and more and stimulate their glands less and less, milk production slows and more supplements are needed.   

It is also common during the early weeks for families unfamiliar with nursing norms to misinterpret their baby’s normal feeding behaviors. Because their baby wants to nurse again soon after feeding (nature’s way of stimulating faster milk production), they erroneously believe this is a sign they don’t have enough milk. Newborns often bunch their feeds together (“cluster nurse”) during some parts of the day. This does not mean milk production is low. (Whatever the baby’s behavior, the expected weight gain is proof positive of ample milk production.)

Nursing and Fertility

In addition to affecting rate of milk production, nursing frequency also affects fertility. Due to the hormones released when baby nurses, in general, more frequent nursing leads to longer periods of infertility after birth. But each person’s biochemistry is unique, so the effect of nursing on fertility varies from person to person.

What’s average? When parents exclusively nurse from birth, gradually introduce solid foods around 6 months, and continue night feeds, some estimate that on average return of the menses occurs at around 1 year. However, if the lactating parent is not directly nursing at all feeds (even if expressed milk is given), solids are introduced earlier than 6 months, or the baby does not nurse at night, earlier return of menses is likely. [5]

During the nearly 40 years I’ve helped nursing families, I’ve seen a range of experiences. Some exclusively nursing parents begin menstruating as early as 6 weeks after birth, while others (myself included) go as long as 2 years before their first post-birth period. When nursing intensity is similar, this variation in body response is due to individual differences in biochemistry. After 6 months, the more time that passes before the first period, the more likely it is that ovulation will occur before the menses begin. [6] This means, of course, that it is possible to become pregnant before the first period.

Dips in Milk Production During the Menstrual Cycle

Many parents do not experience slowed milk production during their menstrual cycle, so this is another example of individual differences. Keep in mind that sometimes the return of the menses is a symptom of fewer daily milk removals, which also causes a slowing of milk production. In other words, rather than the menses causing slowed milk production, nursing or pumping fewer times per day may be the root cause of both the period returning and slowed milk production.  

What are signs of a decrease in milk production? Definitely an unexpected slowing of the baby’s weight gain. Are there other signs? Yes, but these may have other causes. A baby who was happily going for hours between feeds may suddenly revert back to the feeding frenzies (cluster nursing) common in newborns. Baby may want to nurse again within a few minutes or even all evening. But other factors—such as teething pain and illness—may cause these behaviors, too. If the number of milk removals per day dropped within the last few weeks (is baby sleeping longer at night?), this may cause slowed milk production, too. The overlap of this behavior with the menstrual cycle is sometimes coincidental.

Boosting Milk Production

Should slowed milk production cause panic? No. It’s helpful to know that at an average nursing session, babies only take only about two thirds of the milk available in the gland. [2] Nursing longer, more often, or even continuously gives a baby access to lots more milk. (Nature builds in a milk reserve.) Just keep moving baby back and forth from side to side until he is done. Think of the glands as fountains continuously producing milk rather than a container that can be emptied. Responding to baby’s cues to feed more often or longer not only provides the baby with more milk; it also stimulates faster milk production, quickly returning it to its previous level. Most likely, within a couple of days, baby will return to his normal feeding pattern. Giving formula or previously pumped milk, on the other hand, does NOT send the body the signal to make milk faster. When in doubt, take baby for a weight check. With a healthy weight gain, ample milk production is a given. In this case, another cause is responsible for baby’s change in behavior.

What is it about the menstrual cycle that causes some parents to experience a small but temporary slowing of milk production? After ovulation, blood levels of estrogen and progesterone rise and calcium levels fall. [7] For some, higher estrogen levels are associated with decreased milk production, [8] but to have this effect,  estrogen levels usually need to be much higher than the levels measured after ovulation.   

For parents who experience a noticeable slowing of milk production related to their menstrual cycle, taking a calcium/magnesium supplement may help. U.S. lactation consultants Lisa Marasco and Diana West suggest this in their 2020 book for parents,  Making More Milk. [9] (Its comprehensive second edition describes what is currently known about every aspect of milk production.) Although at this writing we have no research on the impact of taking calcium/magnesium supplements on milk production during the menstrual cycle, some report good results. These authors suggest taking between 500 mg calcium/250 mg magnesium and 1000 mg calcium/500 mg magnesium starting 3 days before an expected period and continuing it for the first 3 days after bleeding begins. They say some see results within 24 hours. 

The key point to remember is that for most families, milk production is extremely resilient. By taking advantage of frequent nursing and/or milk expression, even if milk-making slows in the short term, baby can usually get the milk she needs by simply nursing longer and more often. With this extra stimulation, milk production usually quickly rebounds to previous levels.

 

References

1 Morrison, A.., Gentry, R., & Anderson, J. (2019). Mothers’ reasons for early breastfeeding cessation. MCN: American Journal of Maternal/Child Nursing, 44(6):325-330.

2 Kent, J. C. (2007). How breastfeeding works. Journal of Midwifery & Women’s Health, 52(6), 564-570.

3 Berlin, C. M. (2007). “Exclusive” breastfeeding of quadruplets. Breastfeeding Medicine, 2(2), 125-126.

4 DaMota, K., Banuelos, J., Goldbronn, J., et al. (2012). Maternal request for in-hospital supplementation of healthy breastfed infants among low-income women. Journal of Human Lactation, 28(4), 476-482.

5 Labbok, M. H. (2015). Postpartum sexuality and the Lactational Amenorrhea Method for contraception. Clinical Obstetrics and Gynecology, 58(4), 915-927.

6 Lewis, P. R., Brown, J. B., Renfree, M. B., et al. (1991). The resumption of ovulation and menstruation in a well-nourished population of women breastfeeding for an extended period of time. Fertility and Sterility, 55(3), 529-536.

7 Dullo P, Vedi N. (2008). Changes in serum calcium, magnesium and inorganic phosphorus levels during different phases of the menstrual cycle. Journal of Human Reproductive Sciences, 1(2):77-80.

8 Oladapo, O. T., & Fawole, B. (2012). Treatments for suppression of lactation. Cochrane Database of Systematic Reviews(9), CD005937. doi:10.1002/14651858. CD005937.pub3.

9 Marasco, L., & West, D. (2020). Making More Milk: The Breastfeeding Guide to Increasing Your Milk Production (2nd ed.). New York, NY: M

Nancy Mohrbacher

Clicking During Nursing: What Does It Mean?

4 év 1 hónap ago

When a baby makes clicking sounds while nursing, parents often worry. Is this a sign of a major problem? Should they be concerned? No matter what the cause, if nursing is comfortable, baby is otherwise healthy and gaining weight normally, clicking may not be a problem.  

Common Reasons for Clicking

Most often, babies click at some feeds but not at others, which is not necessarily of concern. It may be a sign of a slightly shallow latch, which may cause baby to slip as she attempts to keep the nipple in her mouth. If clicking does not occur consistently, notice if it happens more often in one feeding position than another.  In this case, taking special care to ensure baby gets a deep latch may be enough to reduce clicking.

Does clicking always indicate broken suction? No. There are other reasons for clicking. A very fast milk flow, for example, may trigger clicking as baby quickly swallows large volumes of milk. (When this is the cause, you probably hear the clicking only at the beginning of a feed as your milk lets down and not as much near the end.) If the baby seems otherwise fine, this is not a cause for concern. If baby struggles with the milk flow, though, try feeding positions in which baby nurses tummy down (see photo), which gives baby more control over milk flow. 

Baby’s Palate, Throat, and Unsolved Mysteries

Aspects of a baby’s palate (roof of her mouth) may cause clicking. One example is the baby whose palate moves abnormally during feeds or is unusually high or has a bubble shape. Clicking during nursing may also happen in babies with a cleft—or opening—in their palate. Some clefts are not obvious, because they are located under a layer of skin (submucous clefts). Floppy skin in baby’s throat (specifically the larynx or pharynx) is another possible cause of clicking sounds during nursing.1 In this case, parents may hear clicking more often at inhale or exhale. If one of these anatomical issues is the cause, clicking would likely happen at most if not all nursing sessions. But changing feeding positions may reduce clicking.

Some parents never find the reason for the clicking. One mother told me her little girl always clicked, whether she was nursing or drinking from a cup. This mother simply attributed the clicking—which resolved after her daughter started kindergarten—to her being a “noisy eater.” 

Frequent Broken Suction and Clicking

If broken suction causes regular clicking during feeds, this may repeatedly interrupt nursing. In this case, the baby may latch on and off frequently during feeds and may have difficulty nursing contentedly. Every nursing session may feel like a struggle. Or the baby may have unusually long pauses and spend time sleeping during most feeds. 

Tongue-tie and Clicking

Tongue-tie (an oral variation that restricts tongue movements) is one of the many possible causes of clicking during nursing. In a tongue-tied baby, this sound may occur as the tongue snaps back with each suck. Keep in mind, though, that as one review article concluded,2 at most only about half of babies identified as tongue-tied have nursing problems. In other words, if a clicking baby with a tongue-tie is gaining weight well, otherwise feeding normally, and the nursing parent is comfortable, this is not necessarily a problem and no action may be necessary.

Among the 50% of tongue-tied babies who do have difficulty nursing, tongue movements are so restricted by the membrane connecting the tongue to the floor of baby’s mouth (the lingual frenulum) that the baby may struggle to latch and stay latched. Other problems common in this situation include nipple pain, weight-gain issues, and constant nursing. Any baby who repeatedly breaks suction during nursing at most or all feeds should be checked for tongue-tie, because this may affect the baby’s ability to transfer milk. In one Brazilian prospective longitudinal study of 109 babies, 14 with nursing problems related to tongue-tie and 95 controls,3 the researchers reported that 64% of the tongue-tied babies with feeding problems made clicking sounds during nursing as compared with 14% of the control babies.  

Where to Seek Help

If your clicking baby also has nursing problems, such as slow weight gain, latching struggles, or you are in pain, it’s time to seek skilled lactation help. To find someone in your area, contact your birthing facility or your baby’s healthcare provider and ask for a recommendation. If your baby is doing well but you’re still feeling uneasy about the clicking, consider having baby checked by a pediatric ear-nose-and-throat doctor (ENT). ENTs are specialists trained to evaluate oral issues. In some areas, pediatric dentists have the training to evaluate issues like these.

Keep in mind that the most important thing is how your baby is doing. If she is healthy and gaining weight normally, regular clicking may simply be a sign of an oral variation and may not ultimately be a cause for concern. 

References

1 Genna, C. W. (2017). The influence of anatomic and structural issues on sucking skills. In C. W. Genna (Ed.), Supporting Sucking Skills in Breastfeeding Infants (3rd ed., pp. 209-267). Burlington, MA: Jones & Bartlett Learning. 

2 Power, R. F., & Murphy, J. F. (2015). Tongue-tie and frenotomy in infants with breastfeeding difficulties: Achieving a balance. Archives of Disease in Childhood, 100(5), 489-494. 

3 Martinelli, R. L., Marchesan, I. Q., Gusmao, R. J., et al. (2015). The effects of frenotomy on breastfeeding. Journal of Applied Oral Science, 23(2), 153-157.

Nancy Mohrbacher

Breastfeeding Answers, Second Edition

4 év 1 hónap ago

TO ORDER, CLICK HERE. It’s been a long 2 years! But now the labor is finally over and delivery is imminent. What am I delivering? A 6-pound comprehensive resource for lactation specialists. And let me tell you, the labor was a doozy! In addition to reviewing more than 4,000 studies and rewriting nearly every page in gender-inclusive language, I expanded the content of Breastfeeding Answers, Second Edition by adding more than 30 extra pages and more than 200 new images.

Hardcover Breastfeeding Answers, Second Edition (2020) $89.95

When I began this project, I sat down with my book designer and discussed how we could make this gigantic tome more compact. But even after doing everything we could think of with its layout to reduce its size, due to the immense amount of new information added, this second edition is even larger than the first, growing from 930 to 960 pages. Whew! For some of the highlights, see the flyer below.

Breastfeeding Answers, Second Edition began shipping its hardcover edition the second week of June (to order, click HERE. For bulk orders, scroll down on its store page for volume discounts. Links to our booksellers outside the US are at the top of each store page.

The e-book editions for the Kindle and other devices are now available for download HERE.

See our store for details on secure online ordering. If you have any questions, please contact customer service at info@nancymohrbacher.com.

Global and Personal Surprises

Just 8 weeks before finishing this second edition, it seemed as if we were cruising toward an awesome book launch. But wait. Just as this project neared completion, the whole world changed. I’m not sure I could have picked a worse time than a coronavirus pandemic to release a new book. But on the other hand, maybe the cancellation of so many live events will increase the appeal of an updated resource packed with new lactation strategies. Fingers crossed!

A more personal surprise also occurred as we were preparing to wrap. One evening, as I re-watched the one video my family recorded when our now-adult sons were small, I had a strange realization. I saw my much younger 1989 self announce that I was writing a new book for La Leche League International with the working title The Breastfeeding Management Handbook. Later retitled The Breastfeeding Answer Book, as I digested that scene, it suddenly occurred to me that I’ve been working on one version of this book or another for nearly my entire adult life. My oldest son Carl calls it my magnum opus and seems resigned to the fact that no matter how many years pass, I just can’t seem to stop working on it.

My Aspirations for This Book

Whatever edition of this book is on my plate, I always begin with the lofty goal of reflecting as accurately as possible the lactation zeitgeist of that time. I strive to put my own opinions and prejudices aside and allow myself to be guided by the research and the wisdom of my world-class reviewers and the other gifted colleagues I consult when wrestling with an especially thorny issue.

I hope you find the 2 years of blood, sweat, and tears I poured into this new edition well spent. My fondest hope is that you will discover in its pages strategies, techniques, and approaches that make you more effective at helping the nursing families who seek your guidance and care

Stay safe and healthy everyone, and happy reading!

Nancy Mohrbacher

Pump Fit Matters

4 év 2 hónap ago

Getting a good pump fit is vital, especially when you pump often and the breast-pump part your nipple is drawn into (the nipple tunnel) is composed of rigid plastic, as is true of most pumps. If it is made of soft silicone, which a few pumps are, it may mold more easily to different nipple sizes.

Figure 1

Pump fit affects both nipple comfort and milk flow. When a nipple tunnel is too small, it can lead to pain, skin trauma, and reduced milk flow, because it compresses the nipple during pumping. In pump-dependent families, this can put milk production at risk.

Pump Fit and Nipple Diameter

Pump fit is based on how well your nipples fit into the pump’s nipple tunnel. Pump manufacturers call the pump part with the nipple tunnel by different names (flange, shield, breastshield). Some parents refer to it as the “horn” or “funnel.”

Figure 2

Nipple tunnel diameter varies slightly by brand (Figure 1), with 24 or 25 mm the standard diameter of most pumps. One sign a different size nipple tunnel is needed is pain or discomfort during pumping, even near the pump’s lowest suction setting. Because the left and right nipples may vary in size, some parents get the best results when they use one size on one side and another size on the other side.

If pumping is comfortable with good milk flow, you probably have a good pump fit. If there is discomfort, even on low suction settings, watch your nipples during a pump session and see how they compare with Figures 2a, 2b, and 2c.  

Depending on the pump brand, larger or smaller nipple tunnels may be available for purchase separately.

How Often Are Larger or Smaller Nipple Tunnels Needed?

More often than you might think. In one U.K. study, 36 mothers with babies in the NICU pumped with a standard 25 mm nipple tunnel, and the researchers noted that because they reported discomfort, the opening was too small for 28%. The authors wrote: “If the [opening] is too small, pressure is highest on the nipple tissue, which can cause sore nipples and ineffective drainage.”2

In a U.S. NICU study, a different brand of pump with a 24 mm standard nipple tunnel was used. When both milk flow and comfort were assessed, a much higher percentage of mothers had better results with a larger diameter nipple tunnel. “[W]e found that 51.4%—or about half—of the 35 mothers who served as subjects in the research initially required either the 27 or 30 mm shield in order to achieve optimal, pain-free nipple and areolar movement during milk expression. As lactation progressed, 77.1%—or slightly more than three quarters—of the mothers eventually found they needed these larger shields.”3

Pump Fit Can Change with Regular Pumping.

A 2019 U.S. randomized crossover study compared the effects of nursing, hand expression and pumping on the nipple sizes of 46 lactating women1. The researchers found that unlike direct nursing and hand expression, with pumping, nipple length and diameter increased in size. Two U.S. lactation consultants used an engineer’s template to measure mothers’ nipples before and after pumping and also found that pumping causes nipples to increase in size. They wrote: “Pre- and post-pumping measurements taken with a circle template reveal that nipple size can increase 3 to 4 millimeters.”4 So even if parents are fitted well when they start pumping, it makes sense for them to check their pump fit over time to see if it has changed and whether they need a larger diameter nipple tunnel.

Signs a Larger or Smaller Nipple Tunnel Is Needed

Consider a larger nipple tunnel if:

You feel discomfort, even on low suction settings.

• Your nipple rubs along the tunnel, despite efforts to center it.

• Your nipple blanches, or turns white.

• Your nipple does not move freely in the nipple tunnel.

• You notice slow milk flow or less milk expressed than expected.

Consider a smaller nipple tunnel if:

You feel discomfort, even on low suction settings.

• More than about 1/8 inch (3 mm) of the areola is pulled into the nipple tunnel.

• Your nipple bounces in and out of the tunnel.

• You have difficulty maintaining an air seal.

Major breast-pump brands, such as Ameda, Medela, and Spectra offer fit options ranging from 20 mm to 36 mm. Another product that can sometimes help make pumping more comfortable is Pumpin’ Pal, which provides an angled nipple tunnel. Contact a lactation supporter for help in finding the best fit for you. See also the blog post HERE for other reasons pumping might feel uncomfortable.

References

1 Francis, J., & Dickton, D. (2019). Physical analysis of the breast after direct breastfeeding compared with hand or pump expression: A randomized clinical trial. Breastfeeding Medicine, 14(10), 705-711.

2 Jones, E., Dimmock, P. W., & Spencer, S. A. (2001). A randomised controlled trial to compare methods of milk expression after preterm delivery. Archives of Disease in Childhood. Fetal and Neonatal Edition, 85(2), p. F94.

3 Meier, P. (2004). Choosing a correctly-fitted breastshield. Medela Messenger, 21, p. 8.

4 Wilson-Clay, B., & Hoover, K. (2017). The Breastfeeding Atlas (6th ed.). Manchaca, TX: LactNews Press, p. 80-81.

Nancy Mohrbacher

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