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.
Many mothers have questions or concerns regarding the use of a pacifier while breastfeeding. Pacifiers have long been used as a soothing technique for a crying baby. So why does this work so well and what complications can using a pacifier cause to breastfeeding? Let’s look at these issues below.
When a baby suckles, the hormone cholecystokinin is released into the intestine. Cholecystokinin is responsible for satiety and sleepiness, helping to soothe the infant. This hormone is released when a baby suckles on a pacifier or the breast. The first release occurs about 10 minutes after suckling and the second about 30 minutes after. Over use of pacifiers can result in missed hunger cues, missed feedings and inadequate weight gain.
Pacifier use can affect the initiation of breastfeeding. Many infants when placed skin to skin with mom, uninterrupted after birth will find the way to the breast on their own and begin to suck. Studies have also shown that the early use of a pacifier can reduce the frequency and duration of breastfeeding. Using a pacifier before 2 weeks of age and before breastfeeding is well established can result in ineffective suckling by the baby. Decreased stimulation to the breast results in decreased milk production. Early weaning or supplementation often occurs when a mom feels she has low milk supply.
If a pacifier is used, it should only be offered after about 3-4 weeks or until breastfeeding is well established. Some hospitals use pacifiers as a soothing technique for infants during painful procedures such as a circumcision.
The statement below is found in the Breastfeeding Policy by the American Academy of Pediatrics.
“Given the documentation that early use of pacifiers may be associated with less successful breastfeeding, pacifier use in the neonatal period should be limited to specific medical situations. These include uses for pain relief, as a calming agent, or as part of structured program for enhancing oral motor function. Because pacifier use has been associated with a reduction in SIDS incidence, mothers of healthy term infants should be instructed to use pacifiers at infant nap or sleep time after breastfeeding is well established, at approximately 3 to 4 weeks of age”. If the pacifier falls from the infant’s mouth during sleep it does not need to be replaced.
Seek the assistance of a lactation consultant if you are having problems with your baby latching and sucking at the breast prior to introducing any artificial nipples or pacifiers. Often times a lactation consultant will recommend offering the infant a clean finger to suck on instead of using a pacifier. They can also counsel you on other soothing techniques that may work for you and your baby. Should you have any questions regarding the use of pacifiers and breastfeeding call The Care Connection at 716-725-6370 to speak with a lactation consultant.
1. Take a breastfeeding class before delivery: Breastfeeding is a natural, healthy choice for mom and baby. Learning how to breastfeed can help you in your journey. Regardless if you’re a first-time mom, have had a negative experience, or you’ve never nursed before, a prenatal breastfeeding class will prepare you.
2. Breastfeed in the delivery room: Place your baby skin to skin after delivery. This will help regulate his body temperature, respirations, and glucose levels. Many babies will be interested in feeding shortly after birth and often find their way to the breast and latch! Early breast stimulation and skin to skin with your baby has a positive impact on your milk production. Remember your baby has a very small stomach capacity (about 1 teaspoon) so he does not require a large feeding. Your colostrum is all he needs at this point.
3. Learn to hand express: Learning this useful skill can help benefit both mom and baby. Studies have shown that early hand expression can also have a positive impact on milk production. See one of our previous blogs for details on this.
4. Latch is key: The position of your nipple and areola in baby’s mouth is very important for comfortable breastfeeding and removal of milk from the breast. If you are in pain get help asap!
5. Watch for hunger cues: rooting, hands to the mouth, tongue thrusting to name a few. Crying is a late sign of hunger. Offer the breast early and often. It is important to offer both breasts in the early weeks.
6. Feed your baby throughout the night at first: This helps bring about a good milk supply and assures that your baby gains weight appropriately.
7. Avoid skipping feedings especially in the early weeks: Frequent breast stimulation and removal of milk is key to establishing your milk supply. If milk is not removed this will signal your body to decrease production.
8. You don’t need a breast pump right away: Your baby is most efficient at emptying the breast. It is recommended your baby exclusively be at the breast for the first 3-4 weeks. As mentioned above frequent feedings help get breastfeeding off to a good start. You can focus on establishing a freezer stash of milk later. If you do require the use of a breast pump for a medical reason it is important to seek assistance of a lactation consultant to get you off to a good start.
9. Practice several nursing positions: these can include football, cross cradle, cradle, and side lying. Side lying can be a great position for mom to get a little rest while feeding baby. You will find what works best for you and adapt as baby becomes older.
10. Nutrition: Moms can often forget to care for themselves as they are busy caring for their baby. Try to keep a few snacks and bottle of water handy in areas where you nurse your baby or in a diaper bag.
11. Know your resources and have a support system: It is important to choose a pediatric provider for your baby that is supportive of breastfeeding. When choosing a provider for your baby research if they have a lactation consultant on staff. There are many support groups geared toward breastfeeding mothers including La Leche League, WIC, Baby Cafes, and Moms Morning Out at The Care Connection. Know who to direct your questions to before you have them. This can include a hospital lactation consultant, a pediatrician, or an outpatient lactation consultant. Do not hesitate to ask questions. Most of these professionals chose their careers to help moms just like you!
12. Don’t wait too long to offer a bottle: As mentioned above it is recommended to exclusively have your baby at the breast for at least the first 3-4 weeks. If you will be going back to work or will need to be away from home from time to time start offering a bottle weekly around 3-4 weeks. If you have questions and concerns about returning to work, offering a bottle, or pumping consider taking our Return to Work Pump for Success class here at The Care Connection.
13. Each mom is unique, and each mom has a different experience with breastfeeding: Do not get discouraged if your breastfeeding journey does not look like another mom’s. If you have questions or concerns reach out and speak with a board-certified lactation consultant.
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.
Many moms experience tender or sensitive nipples in the first few weeks of breastfeeding. Often times this can be due to postpartum hormonal changes. This tenderness is normal and should improve as you and your baby get into a good breastfeeding routine. Breastfeeding is not supposed to be painful!
Cracked or bleeding nipples are not normal and should be evaluated with the assistance of a lactation consultant. Many times sore nipples are caused by improper positioning or issues with latch. It is important to get this corrected early on to prevent further damage, infection, and give mom a positive breastfeeding experience. Sore nipples can often lead to early or abrupt cessation of breastfeeding. When a mother is in pain this can affect her let down of milk, further complicating things. Often times a thorough visit with a lactation consultant to check latch and position helps solve the problem!
If you experience soreness you may want to start the feeding on the side that hurts less. Massage your breast first and hand express milk to stimulate milk flow. Make sure that your baby is positioned properly with a wide open mouth, like he is yawning. Aim your nipple at the roof of his mouth when latching. He or she should have a large mouthful of breast, taking in all of the nipple and most of the areola. This is why it’s called breastfeeding and not nipple feeding! If you’re still in pain, break the suction using a finger in between your breast and baby’s mouth, then reattempt latching. Try to avoid abruptly pulling your baby off of your breast. Rotating feeding positions combined with short, frequent feeds can help ease discomfort.
One of the easiest things a mom can do to treat soreness is applying expressed breastmilk to her nipples after feeds and allowing them to air dry. Coconut oil, olive oil, lanolin/organic nipple balm, and Rachel’s Remedy are also good alternatives. Breast shells worn inside a bra help promote air flow and prevent nipples from rubbing against clothing. If you experience cracking, hydrogel pads provide a cooling, soothing sensation while promoting healing. It is also very important to keep bras and breast pads clean and dry.
By trying the above measures your soreness should gradually improve, making feedings more comfortable. If your pain persists after a few days, or you have unresolved bleeding or cracking it is imperative that you seek the assistance of a lactation consultant and or your OB/GYN as soon as possible.
Please contact us at The Care Connection today 716.725.6370 to schedule a consult appointment or speak with one of our lactation consultants should you experience any pain with breastfeeding.
Hand expression of your milk is an important skill to have. Learning to hand express has proven to benefit both mom and baby in many situations.
In the first few days postpartum, hand expression has been shown to be more effective at removing colostrum than a breast pump. Colostrum as well as breast milk can be collected in a bottle or syringe to be given to your baby if needed. Studies have shown that frequent hand expression the first three days postpartum has a positive impact on milk production. The sooner a mother starts doing so the better.
Hand expression can be done anytime you need to empty your breasts, if you’re separated from your baby, or if your baby is unable to feed. It carries no documented risks to mother or baby. Hand expressing milk can protect milk production until baby is ready to latch, promote oxytocin release, and provide thorough breast drainage without the need for any additional tools. We can use hand expression to help provide your baby with breastmilk while assessing the cause of latch issues.
During hand expression a mother’s hands provide the body with the tactile and sensory stimuli it needs to release milk. Warmth and massage from mom’s hands aids in oxytocin and prolactin release. These are two hormones that work to produce milk and release it from the breast. Many mothers find that they can combine a pumping session followed by hand expression to help drain the breast, yielding more milk. Hand expression can often be more comfortable for a mother than pumping.
Learning to hand express your milk can be helpful during times of engorgement, soreness, should you develop a blocked duct or be diagnosed with mastitis. As mentioned previously, it can often drain the breast more comfortably and efficiently.
Hand expression just prior to feeding can help evert the nipple and entice your baby to latch. It can also be helpful in removing milk prior to latching for a baby having difficulty managing milk flow.
Follow these steps below for hand expression:
1. Using clean hands apply warm, moist heat to your breasts and massage
2. Position fingers near your areola.
3. Press back toward your chest.
4. Compress fingers together to express milk, gently rolling downward
5. Be sure to relax and get a rhythm going. It may be helpful to listen to sounds of your baby crying, listen to relaxing music, or look at a picture of your baby.
6. After five minutes move fingers to a different position on the breast and repeat.
You can also view these steps by following this link: http://newborns.Stanford.edu/Breastfeeding/HandExpression.html
If you have any questions about hand expression of your milk don’t hesitate to call 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.