Introducing a Bottle to Your Breastfed Baby
Many mothers will need to utilize an alternative feeding method at some point during their breastfeeding journey.
It is not uncommon as a breastfeeding mom to worry about your nursling biting even before they develop any teeth. Be reassured you can continue to breastfeed throughout teething and beyond. A baby may bite during feeds for various reasons. These can include teething, discomfort, distraction or fast milk flow. Read on for some helpful tips regarding what to do if your baby bites while nursing.
If your baby bites you at the start of a nursing session, they may have discomfort from erupting teeth. Offer your baby a cold teether prior to nursing to help numb their gums. A frozen washcloth can also be used. A baby may also bite at the start of a feeding session if mom has a fast or forceful let down of milk. To help remedy this feed your baby in a more upright position such as koala hold or football hold. You can also apply gentle compression with your hand above your areola to slow milk flow.
If the biting occurs at the end of a nursing session, your baby may be distracted or simply done feeding. To help with distraction try nursing in a dark, quiet room or while the baby is drowsy. Avoid having the tv on or looking at something else besides your baby. You can also wear a baby safe teething necklace during feeds to help keep your baby’s focus on the breast.
If you sense that your infant is about to finish the nursing session, take them off the breast before biting occurs. A baby that has an effective latch and is actively feeding will not be able to bite. The best way to prevent your baby from biting is by watching intently during the nursing session. If your baby appears disinterested or his sucking and swallowing slows, this may be a sign that your baby is done. Unlatch your baby at this point. Be sure to use your finger inside of your baby’s cheek to break the latch. Avoid pulling your baby off the breast.
If your baby does bite, there are a couple of things to do to discourage it from happening again. First, calmly remove your baby from your breast and say nothing. This should send the message that biting leads to ending the nursing session. Offer your baby a teething toy to bite on when you remove her from the breast. You can also calmly say something like “Okay. All done nursing.” Try to avoid yelling or wincing out loud. Depending on your child’s age this may either scare them into a nursing strike or if they are older, they may think this is funny and turn it into a game. Give your baby a few minutes to rest and try to offer the breast again.
If your child bites you and will not let go you can try to sneak your finger into their mouth and unlatch them by putting pressure on their gums with your finger. You can also try to pull your baby in close which makes it slightly more difficult to breathe which will in turn have them open their mouth and pull off the breast. Watch for any signs of nipple damage and treat your nipples as needed to avoid infection.
If you are having issues with biting during feeding sessions contact The Care Connection either by phone 716-725-6370 or by email at firstname.lastname@example.org to speak with one of our IBCLCs.
There are many reasons as to why or how long a baby needs to be in the Neonatal Intensive Care Unit or “NICU”. Some babies only need to be monitored for a short period whereas other babies need extended stays. Either way, you can still provide your baby with the best nourishment possible, breastmilk. This is a contribution to the infant that only the mother can provide. If mom’s own milk isn’t available, donor milk is the next best option. There are many resources available to obtain donor breast milk. Ask your NICU staff or call The Care Connection so we may better direct you.
Each baby’s scenario is unique to them but if your baby was born preterm, or before 37 weeks gestation, they may have additional obstacles related to breastfeeding. Babies need to be able to coordinate sucking, swallowing, and breathing to breastfeed. This typically happens around 32 to 35 weeks gestation. A preterm infant will not have as forceful of a suck. Therefore, mom may need additional stimulation to help increase milk volume. Frequent skin to skin care as permitted by the neonatologist is very important. Some infants as early as 28 weeks gestation may be able to lick expressed milk from mom’s nipple. Be sure to discuss when your baby can have oral feeds with your neonatologist.
Preterm breast milk is designed specifically to protect your premature infant for life outside of your womb. It has a higher concentration of calories, lipids, high nitrogen protein, sodium, chloride, potassium, iron, and magnesium compared to full-term breastmilk.
So, what can you do to encourage a full milk supply? Depending on your own health, it is ideal to start stimulating the breasts as frequently as your infant would, which is about 8-12 times every 24 hours. Using a hospital grade pump is highly recommended as this is one of the best ways to insure adequate stimulation in the early stages. Your NICU should be able to provide this pump for you but you may need to bring your own tubing/plastics with you at each visit. You will want to pump both breasts simultaneously for 15 minutes. Once milk has stopped flowing, try hand expressing to further empty the breast. This technique is very effective in helping to increase milk production. Warm, moist heat or a warm rice sock applied to the breasts prior to pumping can also help increase output.
Another key factor is to make sure your flanges fit well. An improper fit can negatively affect your milk supply and cause nipple trauma. Request to have your flange fit checked by a lactation consultant. Pain, pinching, or discomfort while pumping is not normal. Your nipple should move freely within the tunnel of the flange. If you have questions you can also get measured for the proper flange fit at The Care Connection.
Along with any other breastfeeding mother it is important to avoid things that are known to decrease your milk production. These things can include smoking, caffeine, birth control pills and injections, decongestants or antihistamines, and extreme weight loss diets. Excessive amounts of oregano, parsley, peppermint, and sage can also impact supply. Discuss any supplements or medications with your neonatologist prior to taking.
It is important for any infant, especially an infant in the NICU to avoid any possible bacterial contamination to breastmilk. This can happen with collection and storage. Prior to pumping wash your hands thoroughly including under your fingernails. Wipe your nipple area with water only (no soap). Plastic bags are not recommended for milk storage for preterm infants. Ask your NICU staff about the use of Snappies for milk storage. These are hard, plastic, leak proof storage bottles that are free of BPA. When milk collection is finished, wash all pump parts thoroughly with hot soapy water and rinse. Sterilize pump parts/collection bottles at least once a day. Be sure to label all expressed milk with labels printed from your NICU. If they do not provide you with labels make your own that includes your child’s name, date of birth, medical record number, and date and time of pumping. Check with your NICU staff about their current recommended storage guidelines.
Once your baby can start feeds at the breast, ask for a lactation consultant in the NICU to assist you in latching your baby to your breast.
Finally, having a baby in the NICU can be a challenging time for anyone involved so make sure to take care of yourself. Join support groups or speak to other NICU families. A follow up appointment with a lactation consultant after hospital discharge can also be very beneficial. If you have any questions or concerns or would like to speak to a lactation consultant contact The Care Connection by phone 716-725-6370 or by email at email@example.com.
If you are exclusively breastfeeding and your baby is not meeting the minimum weight gain requirements or is having difficulty transferring milk at the breast it may have been recommended by your pediatrician to supplement your baby. Ignore that mommy guilt, you are still doing a great job! There are probably as many opinions about how to supplement your baby as there are lactation consultants themselves. Each method has pros and cons.
First off, if you have any breast milk in your refrigerator or freezer, use this milk first before formula. Your baby needs it more than the freezer does. There may be other opportunities to replenish your stock pile later. If you have a very young baby and do not have any milk stored formula may be initially advised. Another option is to mix breastmilk with formula for supplementation if you have a small amount stored. Rest assured this is usually a temporary measure until your milk production increases. Be sure to discuss a plan for supplementation with your pediatrician and IBCLC including how much you should give and how often. Regular weight checks during this time will help to gauge when supplementation can be decreased. Gradually weaning down on the amount/frequency of supplementation while continuing to monitor baby’s weight and diaper output is usually the best course of action.
Whenever your baby gets any form of supplement away from your breast, you need to be stimulating your breasts by pumping or hand expressing. This goes back to the supply and demand of breastfeeding. Extra stimulation is demanding your body to make more milk.
A supplement does not always need to be given in the form of a bottle. If your baby has not taken a bottle yet and a supplement is needed, ask an IBCLC about options available to you. Often times if a bottle is introduced early on, especially if baby is having difficulty nursing at the breast it can pose complications. A baby can become used to the fast flow of a bottle and refuse the breast. Some babies may also start to prefer the firm shape of a bottle nipple over mom’s soft breast. Let’s review several of the options you can use to offer a supplement to your baby. One option is a Supplemental Nursing System, also known as an SNS. This device allows the baby to be fed extra milk through a small tube while latched onto your breast. If the SNS is not an option for you, your baby can be supplemented by giving breastmilk in a cup, spoon, oral syringe, or by finger feeding. Finger feeding is a method where your baby gets extra milk through a small tube attached to your finger while they suck. You may find that you need to try out several of these options to find the best one that works for you and your baby.
If a bottle is the only option for you and your baby, the best way to offer it is through paced bottle feeding. Please refer to one of our previous blog posts for further details on paced feeding.
Remember, supplementation may be a temporary situation. It is important to choose a supplementation method that is the most comfortable for you to prevent yourself from getting “burned out”. Call the Care Connection at 716.725.6370 to talk with an IBCLC to explore which option may be best for you and your baby. We can work through this together!
With cold and flu season upon us many mothers have questions such as: “Can I breastfeed if I am sick, will I pass the illness along to my baby?”, “What should I do if baby becomes sick?”, “What medications can I take to help manage symptoms?” Let’s address some of these concerns below.
The most important thing you can do is to take preventative measures to avoid colds and the flu. Avoid any sick contacts, cover your nose and mouth when you cough or sneeze. Disinfect surfaces regularly around your home and work place. Be sure to wash your hands regularly. Most importantly, discuss with your doctor receiving the flu vaccine for yourself and your baby. The flu vaccine is safe for breastfeeding mothers and infants older than 6 months. Refer to the CDC website for further details regarding this.
Continue breastfeeding if you come into contact with the flu or have the flu yourself. The flu is not transmitted through breast milk. It is spread through respiratory droplets when a person coughs/sneezes/talks or if a person touches an infected surface then touches their mouth or nose. Your breast milk has antibodies that will protect baby from many colds and the flu. These antibodies destroy bacteria in a baby’s gut before they have the chance to make them ill. A baby’s saliva will enter a mother’s breast and can signal milk to change its composition to help fight illness.
If you become ill yourself keep your baby close by and try to nurse while lying down. This will allow you much needed rest. Be sure to increase your fluid intake as well. Always check with your doctor prior to taking any medications. Other good resources for safety of medications include the LactMed app or The Infant Risk Hotline (1-806-352-2519). If you are feeling too ill, express your milk to protect your supply and feed to your baby using a cup/syringe/bottle. Expressing your milk is also very important should the situation arise where mom and baby are separated. You can discuss with your doctor bringing your baby to you to feed in the hospital. It can be normal for mothers to experience a brief decrease in milk production during periods of stress or illness.
If your baby has a cold or the flu he can continue breastfeeding. Breast milk is ideal nutrition for him. If your baby is too ill to feed directly at the breast, a cup or syringe can be used to feed him or her your expressed milk. Withholding breast milk during periods of illness can increase the likelihood of your baby getting sick and deprives them of the comfort that comes along with breastfeeding. Very rarely is a supplement of water or juice needed when your baby is sick. Increase the frequency of feedings for your baby to help keep him or her hydrated. Speak with your pediatrician about treatments for your baby that may help cold or flu symptoms. However, if your baby is having decreased diaper output and is unable to keep feedings down contact your pediatrician.
If you are experiencing any difficulties feeding during times of illness please contact The Care Connection at 716-725-6370 and speak with one of our lactation consultants.
There are many different reasons as to when and why a baby receives their first bottle. Although it is recommended to wait until at least 3-4 weeks of age to introduce a bottle, sometimes circumstances arise where a baby needs to be given mother’s milk away from the breast. Examples of such situations could include a baby that is not able to latch or has an inefficient suck. If you have had a premature baby this can often be the case. Sometimes mom and baby are separated due to medical complications. If your baby is unable to feed directly at the breast the next best option would be to provide expressed breast milk. If you are working with an IBCLC (International Board Certified Lactation Consultant), they will most likely recommend giving the baby milk via a cup, spoon, syringe, or supplemental nursing system first before offering a bottle in the early days. Whenever a young breastfed baby receives a bottle, we always want to introduce it in a way that they will not prefer it over the breast. One way we can make bottle-feeding more like breastfeeding is to slow down the flow of the milk. There are a few different ways to accomplish this.
First, choose a bottle nipple that has a wide base and is labeled slow flow. Hold your baby nearly upright helping to keep your baby’s tongue down and forward, which is more like breastfeeding. Focus on holding the bottle horizontally. When the bottle is not in a vertical position your baby must work harder for the milk to flow. This is similar to being at the breast, where your baby controls the flow. Milk should just be covering the tip of the nipple, preventing excess swallowing of air. If the milk fills the entire nipple it will increase the flow of milk which is what we want to avoid. When beginning the bottle-feeding session, tap your baby’s bottom lip with the bottle nipple and wait for them to open wide (as if they were yawning). Once the bottle nipple is in your baby’s mouth, make sure they maintain a good latch with their lips flanged out. You may have to manually pull their lips out if they have not done so on their own. Make sure milk is maintained in just the tip of the nipple throughout the feed and adjust the angle of the bottle as needed. When your baby wants to take breaks, allow them to do so. When your baby is giving you signs they are finished eating do not force them to finish the bottle. The feeding should take a total of about 15-20 minutes. Any milk left in the bottle after 1 hour should be discarded. By practicing this method of bottle feeding we can also avoid over feeding a breastfed baby, which in turn can lead to gastrointestinal issues or a baby not eager to nurse at the breast.
If you are returning to work and introducing a bottle to your baby it is also important that you review this method of feeding with your childcare provider.
If you have any questions about paced bottle feeding or if you have concerns about giving your newborn a bottle, please call The Care Connection Team at 716-725-6370 to further discuss with one of our IBCLCs.
Common Myths about Breastfeeding
1) Women with larger breasts make more milk.
The size of a woman’s breasts does not determine how much milk she will make. However, women do have different storage capacity in their breasts. Storage capacity is the amount of milk in a woman’s breasts when they are at their fullest. When a woman’s breasts become full this sends a signal to slow milk production. A woman with large storage capacity may be able to remove milk fewer times per day without it decreasing her production.
2) I have flat nipples, so I must use a nipple shield to breastfeed.
Having an efficient latch is determined on the pliability of your skin and breast tissue. You may have flat nipples, but your baby can still most likely get enough breast tissue in his mouth for a successful latch. A woman may also have adhesions or fatty tissue near the nipple. If a baby is latching properly, they may be able to break up these internal adhesions allowing the nipple to evert naturally. Your nipple shape can also be distorted by excess edema during pregnancy and from intravenous fluids given in labor. Many women will see an improvement with this within 1-2 weeks postpartum.
3) I have breast implants or have had breast augmentation, so I cannot breastfeed.
Many women who have breast implants or have had breast augmentation can breastfeed successfully. Factors including where the incision is, how much breast tissue/nerves were affected, and if the nipple was repositioned during the surgery can make a difference. In this situation it would be best to meet with an IBCLC prenatally to discuss a plan.
4) My baby received a bottle or multiple bottles in the hospital now they cannot breastfeed.
With an evaluation from an IBCLC, we can work to bring your baby back
to the breast. The sooner and more frequently a baby is offered the breast the better.
5) I need to stop breastfeeding because my baby now has teeth.
Most babies are able to nurse without biting. If your baby does bite, there are ways to help prevent it from happening again.
6) If I get sick I should stop breastfeeding my baby until I am well again.
The best thing for your baby if you are sick is to continue to breastfeed. Your body makes antibodies against your illness which will pass through the breastmilk and protect your baby.
7) My newborn lost weight in the hospital so that means I do not make enough milk for my baby.
Most babies lose weight their first few days of life and it has nothing to do with your milk supply. The initial decrease in weight is usually linked to fluid loss in baby. Continue to breastfeed and your baby should catch up. In the first few days of life your baby’s stomach capacity is about the size of a small marble, so they do not need larger volumes at one time. Always follow up with your pediatrician if you have any concerns.
8) I cannot feel when I have a let-down, so I must not make enough milk.
Each woman has different sensations when they have a let-down, and some do not feel them at all. All are considered normal.
9) The older my baby gets the more and more milk they will consume.
Breastmilk composition changes to match your baby’s needs so they do not need an increased volume of breastmilk as they age. Typically, breastfed babies take between 3-5oz per feed. Even when they are close to 12 months! Remember that breastmilk is efficiently and easily digested.
10) During growth spurts I need to give my baby formula because I do not have enough milk for my baby.
If you nurse as frequently and as long as your baby wants, your milk supply will adjust to your baby’s needs. No need for formula to be added.
If you have any questions or concerns or would like clarity on any myths about breastfeeding not listed above, feel free to call The Care Connection to discuss with one of our IBCLCs at 716-725-6370.
Traveling for vacation or work? This post will help address some concerns you may have for travel with and without your baby.
If you’re traveling with your baby bring along a nursing cover to help give you privacy in a crowded, busy place. This can also help with nursing an older baby as they may be easily distracted by things around them. Many nursing covers can also double as a car seat cover, high chair or shopping cart cover.
When traveling by plane, breastfeeding during take off and landing can help ease pressure changes that may upset your baby. Sucking at the breast can help relieve pain in baby’s ears associated with flying. Look for “nursing pods” in airports if you would feel more comfortable nursing or pumping in a more private setting.
Do the best you can to stick to your baby’s feeding routine, watching for hunger cues. This will help to maintain milk production and prevent problems such as blocked ducts and mastitis.
If you’re going to be traveling without your baby be sure to maintain a pumping schedule. Practice hands on pumping. Look at videos or pictures of your baby, or sounds of your baby crying to help your milk let down. Bringing along an article of clothing your baby has worn (and smells like them) to keep with you during pumping can also help your milk to let down.
Your breastmilk can be stored in an insulated cooler with 3 frozen ice packs for 24 hours as long as it remains below 60 degrees Fahrenheit. Breast milk can be left at room temperature for 4-6 hours at temperatures below 77 degrees Fahrenheit. If you have refrigeration available to you while traveling, your milk can be stored here for up to 5 days below 39 degrees Fahrenheit. Always make sure the refrigerator is plugged in and running before leaving any breastmilk in it. However, it is best to freeze your milk within 48 hours if you do not plan on using it right away. You can consider packing it in dry ice for transport to keep it frozen.
Another option for moms traveling without their baby is to ship collected breast milk to their home. FedEx is one company that offers this service. You can find out more by visiting: http://images.fedex.com/us/healthcare/pdf/Cold-Shipping-for-nursing-working-moms.pdf.
For moms concerned about traveling by plane with breast milk the TSA states you are allowed to bring any amount on board. Breast milk is not subject to the 3 oz liquid limit, regardless of whether your baby is with you or not. You will need to declare your breast milk upon security screening. Visit tsa.gov for more details.
Please contact The Care Connection at 716-725-6370 should you have any additional concerns regarding traveling and breastfeeding.
Having concerns about your milk production and whether or not baby is getting enough are common especially in the early days. Here are some things that you can do to ensure a good milk supply and help you in your breastfeeding journey.
Here at the Care Connection we see mothers for a lactation consultation for many reasons. Concerns with milk supply, latching, supplementing, nipple pain, and positioning just to name a few. During your 1 hour one-on-one visit we can address feeding concerns and any questions you may have in a comfortable, private setting. At the end of your visit with us we provide you with a take home plan to best suit your needs. Below are a few recommendations to help you best prepare for your appointment with one of our lactation consultants.
1. Feeding: We recommend scheduling an appointment around a time when baby normally feeds. Or at the very least try to avoid giving baby a full feed within an hour of your consult. However, we realize that sometimes this can be difficult, and baby may not be on any predictable schedule. If baby is ready and eager to feed when you arrive we will address that first. If not, we will talk first and work on developing a plan, then work on getting baby to the breast.
2. Clothing: Please wear something that you are comfortable in (even if this means pajamas!). Nursing tanks, nursing bras, or a shirt that opens down in the front provides easy access for feeding or skin-on-skin with baby.
3. Equipment: If you have been using any tools to assist with feeding baby like a nipple shield or a bottle please bring them with you in case we need them during your visit. Also, if you have been exclusively pumping or pumping after feedings please bring you pump with you. This way you can empty your breasts after the consult if necessary. It is helpful to see what you have been using to assist with feedings and discuss what may work best for you.
4. Supplements: If you are currently giving baby any supplementation or have been advised by you pediatrician to do so please bring this with you should we need it during our consult.
5. Questions: Please write down any questions you may have and bring to your appointment. This allows us to be sure that we address all of your concerns in a timely manner. Our lactation consultants are also available by phone for any questions or concerns that may arise.
6. Significant other or support person: As long as you are comfortable, bringing a support person to your consult is fine! Sometimes this person can take down notes for you and may remember things that you forgot when you get home. The more support you have to continue your breastfeeding journey the better!
7. Siblings: If you have other children it is best to find someone to care for them during the 1-hour consult. If this is difficult for you, please bring along something quiet for them to do in the room while we are working with you and baby. Bringing along a snack for them works well too!
8. Follow up: Depending on the outcome of your visit we may ask that you come back in for a follow up appointment. This will be scheduled at the end of your visit to best suit your needs.
If you need a consultation, please call The Care Connection (716.725.6370) to set up an appointment. Your health insurance may even cover the cost! Call today to get scheduled.