Breastfeeding Support

Weaning

• Anne-Marie R. Hi Melissa, It's best to start with one feeding at a time, possibly one per week. There are some great ideas in this article from Kelly Mom on weaning http://kellymom.com/ages/weaning/wean-how/weaning-techniques/ To avoid plugged ducts go slowly when you drop a feeding, and if you are very very full, pump or hand express just enough milk to be comfortable. Removing much more will tell your body to make more, and in this case you will want to be making less. Anne-Marie

Breastfeeding while pregnant

• Anne-Marie R. Hi Amanda, Yes, some moms do notice that nausea worsens during letdown and breastfeeding - though overall have said it helped at other times aside from these. See if there is any position that seems better, especially one that does not put pressure on your belly, like side lying or sitting up at your side. If a small snack like crackers helps have that before or during feedings, whatever makes you feel better. Maybe sips of ginger tea? Try some different foods or drinks to see if any help. Your milk production normally will decrease with your pregnancy, so your baby may be ready for some solids soon. Congratulations to you - Anne-Marie

Teeth are causing difficulty

• Anne-Marie R. Hi Rosanna, The top teeth are the ones that you can feel, as opposed to the bottom ones that you can't. So yes in a sense you will be feeling them. As they are coming in, babies sometimes nurse in a way to soothe the teeth that rubs harder on your breast - so cool packs before they nurse can help make your baby more comfortable. When they are fully in they are usually not as bothersome because they no longer are "teething". I would put a little lanolin cream or coconut oil on your breast after each feeding just for comfort for you. Hopefully it will be more comfortable soon. Anne-Marie

Breast rejection

Boob Boycott

• Anne-Marie R. Aliyah, Oh no - that's a hard thing to happen. Have you started any new medications that may have changed milk taste? Could there be a chance he is teething? If he's crying - stop and soothe him another way. Keep offering your breast whenever he seems content to take it. See if you can think of anything else that has changed for him, just starting bottles (flow preference?), new soap or detergent? Hopefully he is still getting lots of milk to keep him growing, but keep an eye on his diapers for at last 6 wet in 24 hours. Anne-Marie

• Aliyah Thanks Anne-Marie! I haven't started any medications but we do think he's been teething. He has started bottles but he cries initially when that's offered but he's much worse with the breast.

Supply and latch

• Anne-Marie R. Hi Katherine, If the weight gain is 0.4 oz for the whole week, your pediatrician will want him to be gaining more. They typically look for a 0.5-1 oz weight gain per day. It's probably best at this point to make a visit to the pediatrician and have a lactation consultant come to see you (check if your insurance will cover a visit). If his less strong suction is related to slow weight gain, he may not be nursing very effectively and pumping can help to increase your supply. There isn't something to do to keep a nipple hard other than stimulation like you are already doing. Supply issues can be caused many things, frequent nursing 8-12 times in 24 hours is a good place to start until you have some input from someone to go through anything else that may be contributing to it. Anne-Marie

distraction

• Anne-Marie R. Hi Emily Four months is a very typical time for babies to get distracted - when you can nurse without distractions, but know that if it's a busy time, she may make up for it during the evening, night, or a quieter time in the day. Each feeding is different and some will be bigger than others. And yes - one breast almost always makes more than the other. Sometimes double. It's totally normal. Anne-Marie

Supplementing and lowering Supply

• Anne-Marie R. Hi Jocelyn, You can never know exactly what he is getting - but you can listen for swallowing, and watch for signs of hunger after feedings. Also notice how long it is between feedings. Wet diapers are another thing to keep an eye on - at least 6 in a 24 hour period. If you are concerned about weight gain, you can always make a nurse visit at the pediatrician and just ask for a weight check to reassure yourself. For those feedings he seems frustrated - make sure to offer both sides. He's six months now so he'll soon be starting solids and that may be a time to offer them. It's natural that your supply has gone down as you settle into your routine and feed or pump a little less. As much as you are able, pump the 2 times when you are at work, that will help. Enjoy him! Anne-Marie

Bottle feeding issues

• Anne-Marie R. Hi Erica, I'm sure that makes it hard to relax when you are away. Hopefully it is short periods for now. I would try a different nipple, in case that helps any. Warming the milk and nipple and offering it when your baby is not full but not too hungry is a good idea. Even if it's small amounts that is a start. Better not to continue trying with the bottle if he's crying too long. Have him take some as he is happy, and then offer it later. Holding him in a different position than nursing may help, and sometimes even walking around can make it a little easier. I hope it gets easier for him soon. Anne-Marie

Our Q&A starts now!

How to wean off / independent sleep training

• Anne-Marie R. Hi Lucy, It is exhausting being up a lot at night. I would say for now to start with little baby steps. Put aside sleeping through the night for now. Work on finding ways to breastfeed your baby to sleep and be able to have him stay asleep without being in your arms. Swaddling, sneaking in a pacifier (if he's over 3-4 weeks), or breastfeed side-lying with him next to you so you can rest too. If you feed side-lying on a firm surface with no fluffy things nearby, you may be able to keep him in his position and get up yourself without waking him. I know these are really trying days. Make yourself a cup of tea and try to eat well, and take a nap yourself if you can. These days will pass, and he will sleep more one day. All the care you give him now will help him grow into a happy independent boy one day. Anne-Marie

Relactating

• Anne-Marie R. Hi Chamani, Relactating is possible, how big your supply will be depends on how long it has been, and how large your supply was to start. The biggest part of relactating (or increasing any supply) is frequent milk removal. As frequent as possible throughout day and night. Aside from that, there are herbs and foods that are thought to help too. Oatmeal, barley and brewers yeast are some popular foods. Herbs are fenugreek (not if you have diabetes or a peanut allergy), moringa, shatavari, goats rue, etc etc. I would recommend the website www.lowmilksupply.org for a full list of galactagogues (foods and herbs to help increase production). But frequent removal is the most important thing! Anne-Marie

Weaning a 15 month old whos can't have milk?

• Anne-Marie R. Hi Amber, I would say mostly plain water is great, along with healthy whole foods and your milk. If you want to give her some other type of milk, there are a lot of cow milk substitutes available like coconut and almond milk that you could try. I wouldn't worry about her not having cow's milk. She will get her protein and fats from other foods and your milk. Anne-Marie

• Amber Thank you. It just makes me nervous with her not getting as much milk when I'm at work. She makes up for it at night she's been nursing 3/4 times a night again. I am really wishing I didn't have to go back to work I'm exhausted all the time again.

Gassy baby

• Anne-Marie R. Hi Rebecca, Babies normally get more air when they drink from a bottle - so it doesn't seem like that is the issue. The most common food that can cause gas problems for babies is dairy in our diet. The protein in cow's milk and it's products can be hard for some of them to digest (this is not an allergy or lactose problem). Try taking out all dairy (casein, whey, nonfat dried milk, etc etc,) for a couple of days and see if you notice a difference. While it is true that it takes much longer to be totally out of your system, you would see an improvement within a few days. Be really careful (baked goods are notorious) so you are sure if that seems to be it. If you have a very large abundant milk supply, that can also cause some gas problems. If that is true for you, feeding from one breast per feeding can help alleviate the problem. Anne-Marie

1 year anniversary - Weaning?

• Anne-Marie R. Hi Maya, There are always benefits to breastmilk, the biggest one being the immune protection (all those antibodies to everything you are both exposed to). Your baby can get his or her nutrients from food now, and whole milk has lots of fat that is good for your baby, but water is also important. I would ask your pediatrician about their suggestions, but lots of plant based, nutrient dense foods make a great diet. Avocado and seed or nut butters are good examples. Good luck, Anne-Marie

Pumping/Supply

• Anne-Marie R. H Leah, No harm at all! I would say because you are also doing a lot of breastfeeding right now and you have a lot of time before returning to work, to pump once a day. You'll tend to get more in the morning, so that is when lots of moms do that one pumping, but any time that fits into your routine is good. Remember that breastmilk can be stored in the freezer for up to 6 months, so keep that in mind if your stock becomes large! Anne-Marie

Extended breastfeeding

• Anne-Marie R. If your baby hates food, I wouldn't cut out any feedings right now, to be sure nutritional needs are met. I would offer food throughout the day - so it is always available, before or after breastfeeding. Keep offering healthy foods like sweet potato, avodado and oatmeal without forcing them. It's hard to say what a normal day looks like, but many a one year old is still nursing every few hours. They need some more iron now, so keep that in mind when offering food choices. Kelly Mom website has some good articles on extended nursing, as does LaLeche League (llli.org). Mothering your Nursing Toddler is an oldie but good book. Anne-Marie

how to not get engorged during the night

• Anne-Marie R. Hi Nailett, The great news is your baby is sleeping at night. I would pump just before you go to bed, after she has nursed to sleep. If you are so full during the night that it wakes you up, just pump to comfort (a few minutes) and not longer. Every time milk is removed from your body, it's a signal to make more. It is true that your supply will dip a bit, but at this point it is a natural progression of breastfeeding. Enjoy the sleep. Anne-Marie

Weaning

• Anne-Marie R. Hi Katrina, My first comment is do you really want to or need to wean? The American Academy of Pediatrics notes "continuation of breastfeeding for *1 year* or longer as mutually desired by mother and infant". That being said - if you do want to begin the process you are right on the money. One feeding at a time and when that is established (it may be longer than 1 week) drop the next one. Avoid the rocker if that is the place you always nurse. Distraction is the best thing, as well as offering a snack and drink. A favorite snack followed by a favorite activity (library or outside for a walk) can be really helpful. Happy birthday to you! Anne-Marie

• Katrina Thank you! Just trying to gain back some freedom during day. But i will go slowly as yes not emotionally ready. How do i know it has been established? I mean i can see her trying to snuggle up trying to nurse and i just keep refusing?

• Anne-Marie R. Hi Katrina, Do all you can to distract her, but there may be a day here and there when it is not possible. In that case, go ahead and breastfeed and try again to distract her the next day. It is not always one step forward without a step backwards sometimes. Once she stops asking to breastfeed at the feeding you are dropping - then start working on dropping the next one. Anne-Marie

• Katrina Great! Thank you so much!

Pumping

• Anne-Marie R. Hi Elizabeth, Most people find they get the most milk when pumping in the morning. Which also means your baby gets bigger feedings in the morning. I would try for pumping just after her first morning feeding, hopefully when she is nice and full (and maybe even napping). If you miss that one then any other time of day is fine too. If there is another time of day she normally falls asleep at the breast that may be one to try for. There is a new pump called the Haakaa (I have no interest in the company, but like the pump) that is single, silicone and hand held. It might do the trick if you like to pump on one side and have no cords that are distracting. Hope that helps, Anne-Marie

When to pump to maintain supply and relieve engorgement?

• Anne-Marie R. Hi Hillary, It sounds like you have a great supply. It is true that the more milk removed (pumping or breastfeeding) the more made. Since your baby is nursing during the night, if you are comfortable enough, don't pump during the night. If you become so engorged it wakes you, pump for just a bit to relieve the discomfort. If you don't pump and your daughter has a very full breast - take little breaks (and keep a cloth nearby for catching the extra milk if she comes off the breast) so she doesn't get too overwhelmed with the flow. Feeding her in an upright (slightly) position can help too. One side may be enough for her if you are very full. I would pump when she has her evening bottle though. Since you are awake anyway!! Make that a time for you to have a snack and a cup of tea, or watch a show. Even if it's just 10 mins it is worth it to help with keeping your supply up. That pumping can be stored milk if you need to have some frozen for use later. Anne-Marie

• Hillary Very helpful, thank you!

Supply question and going back to work

• Anne-Marie R. Hi Cindy, He sounds like a growing boy! It's normal that he would be breastfeeding 8-12 times in 24 hours, so if he's doing that and gaining well, your supply is just fine. If he pulls and grunts at the beginning of a feeding he may be waiting for the milk to get flowing, but if it's at the end of the feeding he may want some more. You can put some pressure on your breast to help increase the flow, or switch him to the other breast. Babies grow in spurts, so in the days (usually 1-2 days) they are really growing, they can eat a LOT. Since you are going back to work, I would start freezing some milk you have pumped now. Just start with once a day to have a little extra. When you are working it is great if you can pump in place of every feeding if that is possible. If you are not able to do that at your job, then you will have some frozen milk or formula to make up any amount you are short. You can breastfeed when you are with him to help keep your supply up. Anne-Marie

Refusing to breastfeed

• Anne-Marie R. Hi Monica, I know this is easier said than done - but give it some time. It's been a week since the tongue release and it may take a little longer. Offer the breast at each feeding, but if she is upset for longer than a few minutes, feed her with the bottle - using a slow flow nipple and pacing the feeding slowly - and then offer the breast again. Time at the breast can be for practice after a feeding, or half feeding. Spend some time skin to skin whenever you can as well, watching for signs she may be interested. It may take some time for her to get used to the new tongue movement. I would avoid pacifiers and consider supplementing her at the breast to make it easy for her to get more milk with less effort while still practicing at the breast. Medela makes a supplemental nursing system, but you can also just get tubing if you feel adventurous. The great part is that the tongue is released and you have kept up all that pumping. It's not easy, so pat yourself on the back for that! Anne-Marie

Pumping

• Anne-Marie R. Hi Courtney, You can start pumping any time you'd like, probably after 2 weeks just to give yourself time to settle in to being a new parent. Most people get the most milk when they pump in the morning, so pumping after the first morning feeding is a good one to try. Ideally it's recommended to wait until 3-4 weeks to introduce a bottle, when breastfeeding is established. When feeding from a bottle, chose a slow flow nipple so your baby isn't looking for a fast flow when feeding from the breast. Good luck! Anne-Marie

Our Q&A is now over.

• Anne-Marie R. Good luck to all you new moms. You're all doing great! Anne-Marie

Back to work

• Anne-Marie R. Hi Alyssa, I would give them enough to feed him every 3 hours plus two extra so you don't worry. Freeze your milk in the smallest amount that he takes, so that no milk is wasted. Those two extra bottles can just be kept frozen if they aren't used, but are extra if they need them. He may take less while at daycare than he does when home with you. Some babies make up for it by nursing more frequently when they get home. That part you won't know until he gets there, but you'll see how he does once he is settled in. Anne-Marie

Low supply at 6 months

• Anne-Marie R. Hi Shruti, Without getting into the reasons behind his difficulties from the beginning - is it possible to pump once more during the day? Or once at night when you get up to use the bathroom? That would increase your supply so that the flow is faster (in theory) when you breastfeed? I would offer him to nurse at any time that he is content, but not to push it if he is in any way upset at the breast, though it doesn't sound like that is the case. Some breast compression can help with the flow as well, if that seems to make him happier. Remember every bit he gets is great for him, and you are pumping good amounts and often. If his frustration seems position related, that may be something to keep in mind. When he gets a bottle, if he is a very fast eater, ask whomever gives it to him to keep it slow - so he doesn't wait for the same fast feeding when he is breastfeeding. A few thoughts for you..... Anne-Marie

Deeper Latch Tips

• Anne-Marie R. Hi Megan, It depends on how much pain the breastfeeding is causing. If it's sore at the beginning of a feeding but then improves, you're probably fine just being careful for a deep latch. To achieve that - start with your baby's nose at your nipple, his chin close or touching your breast. Touch your nipple right under his nose so that he has to open and come UP and OVER the nipple. Think of it as aiming right to the roof of his mouth. If it feels bad - and I'm guessing you can tell the difference between a deep and shallow latch - break the suction and start over. It's better to keep trying until you get the better latch than to become sore again. As far as the tongue tie - if your pain is ok and he's gaining weight I wouldn't jump to it either. The website www.cwgenna.com has good pictures under the Quick Help tab of tongue ties. If your nipples do become sore (not open) then some nipple cream - lanolin or coconut oil - are soothing. Anne-Marie

Teeth

• Hillary *ive heard nursing to sleep and in the night will ruin his teeth*

• Anne-Marie R. Hi there - I'm going to attach a link to a good article on tooth decay from Kelly Mom, a great resource for breastfeeding mothers: http://kellymom.com/ages/older-infant/tooth-decay/ I agree that nursing to sleep is a peaceful, sanity saving way to parent. Anne-Marie

Thrush and Supply

• Anne-Marie R. Mishell, Washing bras and towels in hot water and a vinegar rinse helps keep thrush at bay. Also washing or throwing away nursing pads every day. If you pump, boiling or microwaving your pump parts at least every few days is a good idea. Having thrush once may not mean you'll ever have it again. We all have the Candida yeast - but it's the overgrowth that causes the problems. Eating probiotics (acidophilus) or yogurt can help keep things in balance too. If it seems to be a problem and keeps recurring, limiting your intake of sugar and alcohol is a good idea. Anne-Marie

• Mishell Thank you!

How to wean?

• Anne-Marie R. Hi Jenny, Another consideration is to start "weaning" her while she is at daycare, and continue with the morning and bedtime feedings. As she drops one bottle (one per week or so), you can drop that one pumping. That will give you time to decrease your pumping and see if she will accept a sippy cup. Once you have weaned from daytime breastmilk, I would start with the morning feeding. Start by offering a sippy cup with a softer top, but if she refuses you can still use a bottle. I would leave the bedtime for last, maybe keep this one a little longer, since it sounds like she falls asleep very quickly breastfeeding and it may be a peaceful and easy way to transition to bed. I would not give her a sippy cup or bottle to go to bed, but instead a snack and a drink (however she will take it) and then to sleep by rocking or walking or some music. Anne-Marie

Amount and latch

• Anne-Marie R. Hi Lara, If her weight gain is going well, I wouldn't worry about how many ounces she is taking. It varies from day to day and from feeding from feeding. If the smacking noise is new with bottle use, I agree it may be how she uses her tongue. I have seen it with babies after starting to use a pacifier. They still take in the same amount, but it can cause a little soreness. Bottles don't require the tongue to come out as far, and so they can push up more to the roof of the mouth. If you've weighed her recently, then the 2-4 ounces is great. If it's been awhile and you want to check in, have another pre and post feed weight check to be sure her intake is the same it has been. There are so many bottles that all say they are the best. It seems the best one is the one the baby does best with. I like a wide base to help keep a nice wide mouth, but there is no need to go and buy more. Anne-Marie

• Lara Thank you!!