lactation consultant
When Your Baby Bites While Breastfeeding
What to do if your Baby Bites While Nursing
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 careconnection@hotmail.com to speak with one of our IBCLCs.
Baby in the NICU
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 thecareconnectionlw@gmail.com.
Pacifier Use
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.
Breastfeeding During Cold and Flu Season
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.
Preparing for your Lactation Consultation
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.
When Should I Call a Lactation Consultant?
There are many situations and issues that may arise in which you will want to consider speaking with a lactation consultant for support.
Prenatally, seek the guidance of a lactation consultant by taking a breastfeeding class. If mom will be returning to work after baby arrives it is also a good idea to seek support for this as well. A lactation consultant can provide advice on when to pump, cleaning of breast pump parts, and proper storage of milk along with several other concerns working moms may have.
Now let’s look at issues involving baby. If you have a premature or late pre term (34-36 6/7 weeks) infant it is recommended you seek extra support for breastfeeding. If your baby refuses to latch, has difficulty latching or staying on the breast contact a lactation consultant for an evaluation. Difficulties with latch or breast refusal can occur with babies of all ages. Remember pain with feeding is not normal, reach out for support sooner than later. If you feel your baby is not gaining weight, is jaundiced, spitting up frequently, or crying for prolonged periods of time collaborate with your pediatrician and a lactation consultant to get to the root of the issue.
For mothers many situations also exist in which additional lactation support is recommended. Seek support if you have flat/inverted nipples, sore nipples, breast engorgement, or a history of breast surgery. Should you have concerns regarding your milk production and whether or not baby is taking in enough milk seek the assistance of your pediatrician and a lactation consultant. Lactation consultants can also help advise you on issues like mastitis, thrush, and clogged ducts. Your physician as well as an IBCLC can also address questions regarding medications and breastfeeding. If you need to have a surgical procedure seek support, as breastfeeding will not likely need to be disrupted. Other unique situations can include breastfeeding an adopted baby or re-lactating.
Lastly, if you are feeling stressed, discouraged, or just need reassurance reach out! Many times a simple phone call can be just what a mom needs to keep things going in the right direction.
The Care Connection has lactation consultants on staff to help you. They can be reached at 716.725.6370 and can also see you in the office if they are unable to answer your questions over the phone. Give them a call today!
How to Know if Your Baby is Getting Enough
One of the most common frustrations with breastfeeding is not knowing how much your baby is getting at each feeding. The good news is there are signs to watch out for.
1) Watch for your baby’s hunger cues and feed during the early signs of hunger. Hunger cues can include any of the following: rooting (when your baby turns their head towards your chest looking for your nipple), lip smacking, opening their mouth, and putting their hands in their mouth. A late sign of hunger is crying. Try to catch your baby’s hunger cues early.
2) Feed your baby on demand or at least every 3 hours. Watch and listen for signs from your baby that they are hungry and feed them when you first notice any. Some sleepy babies need to be woken up to feed during the early days even at night.
3) Monitor your baby’s diapers. Good output means sufficient input.
Average diapers by age:
Age Stools Wet diapers
4 days-6 weeks 4+ stools/day 6+ wet diapers/day
6 weeks- 12 months Stools vary by baby as long as there is good weight gain 4-5 wet diapers/day
4) Is your baby’s weight gain consistent? This is typically monitored by your pediatrician or an IBCLC. Each pediatrician’s recommendations vary slightly for how much weight gain they expect from your baby. A general rule of thumb is that your baby should be back to birth weight by 10- 14 days and then continuously gaining.
5) Is your baby effectively removing milk from your breasts at each feeding? There are signs you can look for including a good latch. With a good latch you should be able to hear or see your baby swallow. You should also see wide jaw movements and milk in your baby’s mouth. If you are feeling any pain during the latch, take your baby off and latch them again as this is a sign of an inefficient latch. Consult with an IBCLC to learn what your baby’s swallows sound like and to ensure your baby has a good latch. Do your breasts feel softer at the end of the feeding compared to at the beginning? This is another good sign that your baby is removing your milk. Your breasts will not always feel engorged before feeding so monitor what they feel like before and after the feedings.
6) Does your baby seem satisfied after feedings? Your baby’s body should look completely relaxed when they have taken in enough milk. Your baby will no longer have that tense appearance on their face with eyebrows furrowed and their hands will no longer be in a tight fist. This look is where the term “milk drunk” comes from and is different than a sleepy baby that falls asleep before the feeding is finished. Many babies may want to soothe themselves by sucking even after a good feed. Try offering a clean finger, pacifier or placing baby skin to skin against you. Know that cluster feedings (short/frequent feedings) can be normal especially during the newborn period and during growth spurts. If you and your baby are showing these signs be confident that your breastfeeding journey is off to a good start.
You are welcome to weigh your baby anytime during store hours at The Care Connection. We are open Monday – Friday 11am to 6pm and Saturdays 11am to 2pm.
*ALWAYS check with an IBCLC or your pediatrician if there are any concerns about your baby’s weight gain
How Can I Prepare for Breastfeeding?
Prenatally, there are several things you can do to help your breastfeeding experience get off to a good start!
First, you need to choose a healthcare provider for yourself and baby that is supportive of breastfeeding. Talk with your doctor or midwife about how birth interventions can effect breastfeeding. Also, consider having a doula experienced with breastfeeding with you for support during and after delivery.
Another important step you should take is to enroll in a breastfeeding class near you. Consider bringing your partner with you for support. Having knowledge of breastfeeding basics can help ease postpartum stress and make you more confident in your breastfeeding journey.
Contrary to what you may have heard, you do not need to prepare your breasts or “toughen up” your nipples prior to delivery. If you have issues with flat/inverted nipples, serious medical conditions, or history of breast surgery, consider speaking with your doctor and a lactation consultant.
During your pregnancy research and establish what breastfeeding resources are available to you. These can include baby cafes, La Leche League groups, WIC counselors, and lactation consultants. Reputable online resources include: Kellymom.com, Academy of Breastfeeding Medicine, American Academy of Pediatrics and Center for Disease Control. At The Care Connection, we offer a twice monthly Mom’s Morning Out group led by a lactation consultant to ask questions, get help with breastfeeding, and meet other moms that are going through similar experiences.
Lastly, when it comes to delivery inform hospital staff that you plan to breastfeed and your baby should not be given formula, water, pacifiers, or artificial nipples without your permission. If you are developing a birth plan, this would be an ideal place to put this information.
Everyone has a different experience with breastfeeding. At The Care Connection, we are here to help prepare you, support your journey, and help you to feel confident as a breastfeeding mom. If you have additional questions on preparing to breastfed, please give us a call, we’re here to help!
Written By: Shawna Radder, RN, IBCLC
Would a Lactation Consultant Help Me and My Baby?
What is a lactation consultant? In simple terms, a trained professional who helps a mother breastfeed.
The official title of a lactation consultant is IBCLC. This stands for ‘International Board Certified Lactation Consultant’. In order to earn this title, a person needs to obtain in-depth education, have a minimum of 500 hours of hands-on experience with breastfeeding mothers, and take an international exam which is given around the world during the same few days each year. Before a mother even sees an IBCLC, the IBCLC has already seen hundreds of other babies and mothers and some with the same exact issue that you might be having.
Although a person does not need a background in healthcare to become an IBCLC, it helps to have that additional knowledge to evaluate a mother and her baby as a whole. These professionals are aware of so many factors that can affect breastfeeding. They may also be more in tune with a ‘problem’ that is actually not breastfeeding related at all.
IBCLCs assist mothers in the breastfeeding process with their knowledge of breastfeeding and lactation. Some examples of topics that IBCLCs are educated in include: how breast milk is produced, how it is maintained, maternal and infant anatomy and physiology, hormones and their affect on breastfeeding, and pumping and storing milk. Even though there are many types of breastfeeding educators, not all have the in depth training on these topics like IBCLCs.
Seeking help from an IBCLC does not mean you are not a ‘supermom’. In fact, seeing an IBCLC means you know what resources are available to you to help you and your little one which in fact DOES make you a supermom! There is never any harm in speaking with an IBCLC.
Seeing an IBCLC early on can save a mother and her baby pain and frustration. A latch that is not perfect can end up leaving a mother’s nipples damaged and in pain. This can also leave the baby frustrated from less than superior milk transition.
You have probably heard at least one person say “I could never breastfeed” or “I never produced enough milk”. The reality is there are only a small percentage of women that cannot breastfeed or produce enough milk to sustain their baby’s growth. WIth the help of an IBCLC, your situation can be evaluated and with some tips and tricks breastfeeding may be a possibility when you thought it was not.
The Care Connection Lactation and Wellness Center has many IBCLCs on staff, all of which are registered nurses. If you have any questions on breastfeeding or need some one on one help, don’t hesitate to give our office a call [716.725.6370]. With small group classes and private lactation consultations, we can help you achieve your breastfeeding goals.
Written By: Christie Davis, RN, IBCLC