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Breastfeeding Support

Anne-Marie R.
ANNE-MARIE R.
International Board Certified Lactation Consultant
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Join Anne-Marie Rohrberg, IBCLC to talk about weaning, pumping, supply issues and more!

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Message Anne-Marie
ANNE-MARIE ADDED A NEW COMMENT!
Refusing to breastfeed
MONICA

My 2.5 week old daughter won't latch on to breastfeed. She was latching on very well after birth, but then during the first week we had to supplement with a bottle, which we are still doing (although she is gaining weight now, but the pediatrician said so). Also, she was diagnosed with posterior tongue-tie and at 1.5 week old she had a laser procedure to release the tongue. After that, breastfeeding had gotten much worse and over the last two days she is almost always refusing the breast, while happily drinking from the bottle. I have been pumping all along and my supply seems to be good enough. Any advice to make her enjoy breastfeeding more? thanks.

ROSANNA

I just want to give you encouragement; I met a mom in one of the groups I go to who had similar issues. With perseverance she successfully got the baby to latch and breastfeed regularly.

Anne-Marie
ANNE-MARIE

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

ANNE-MARIE ADDED A NEW COMMENT!
Supply and latch
KATHERINE

I am currently ebf my 3 week old son. He initially had a very strong suction but seems to have weakened over the past week. My nipples are fairly large and he doesn't seem to get a lot of the areola in his mouth when latched. Roughly a week ago my nipples also seemed to get softer. He falls asleep while nursing but when I take him off he wakes up and cries until I relatch him. He is gaining weight, though only .4 oz this past week. I had supply issues with my daughter and had to supplement from early on. Do I need to start supplementing? How can I make my nipples stay hard besides always trying to massage before latch. How can I increase milk (I already eat oatmeal, use fennel oil, lactation cookies and tea). Thanks!

Anne-Marie
ANNE-MARIE

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

ANNE-MARIE ADDED A NEW COMMENT!
Bottle feeding issues
ERICA

I have a 5 week old baby boy who is doing amazing breastfeeding however, baby boy hates the bottles. Any advice? He will take enough to eat but will cry and scream until I come home and breastfeed him.

Anne-Marie
ANNE-MARIE

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

ANNE-MARIE ADDED A NEW COMMENT!
Deeper Latch Tips
MEGAN, PARENT OF 5 YEAR OLD

It can be hard to get my two and a half week old to latch deeply. He doesn't always open his mouth wide and I get some friction/rubbing when he sucks sometimes. It causes occasional nipple pain, especially on the left side. Fyi: His weight is great (over 11lbs) and he gets multiple letdowns with drinking while nursing. It's possible he has a posterior tongue tie but I'd rather not treat it if it's not necessary. Any tips for a deeper latch?

KATHERINE

Following

Anne-Marie
ANNE-MARIE

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

ANNE-MARIE ADDED A NEW COMMENT!
Supplementing and lowering Supply
JOCELYN

Hi, my son will be 6 months next week. I started supplementing with formula when he was about 4.5 months. On weekends, I am trying to continue to nurse most feedings(except for 1 or 2 sessions) and during week I am nursing before work and 1 session after work. He's also getting up once to eat in middle of night which i nurse then. I haven't been great pumping- 1 or 2 times while I'm working most days. Before supplementing I used to get 4oz pumping every time or more. Now I am getting 2-3 ounces most times. I am eating lots of oatmeal, water, lactation cookies, etc to try and help
My supply. If it's not going to go back up again, i can live with that. BUT how can I be assured that my baby is getting enough milk when
He is nursing? He does have some feedings where he seems Frustrated but most are fine and he rarely cries at the end but still how do I know he's getting enough if clearly my supply is down?

Anne-Marie
ANNE-MARIE

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

Breast rejection
MONICA

ANNE-MARIE ADDED A NEW COMMENT!
Extended breastfeeding
HILLARY, PARENT OF 4 YEAR OLD

I've had a hard time finding resources regarding how to nurse past 1 year. My baby hates food so I don't know if I should cut out all sessions except morning and bedtime after a year or what. What does a typical day in extended breastfeeding look like?

KATRINA

Following

Anne-Marie
ANNE-MARIE

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

ANNE-MARIE ADDED A NEW COMMENT!
Teeth
HILLARY, PARENT OF 4 YEAR OLD

ive heard to not let my 10 month old nurse to sleep or. It's at night bc it will ruin his teeth. Is there truth to this? I love nursing him to sleep and nursing him when he wakes up at night.....it's the best and saves my sanity.

HILLARY

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

Anne-Marie
ANNE-MARIE

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

ANNE-MARIE ADDED A NEW COMMENT!
Low supply at 6 months
SHRUTI, PARENT OF 6 YEAR OLD, 3 YEAR OLD

I have a 6.5 month old who has been tricky to nurse from the beginning, so I am pumping about 6 times a day (I also work from 8-5). He nurses well in the early morning when he is sleepy, but is very distractible when I try to nurse him at other times. He tends to bite and pull at the breast when he is disinterested or frustrated, and is also very restless when he nurses. He doesn't like the bottle much either!

I have always had a low milk supply, and it is really dwindling given that I barely nurse him during the day (pumping only 2-3 ounces every 3-4 hours), so we are supplementing with formula. I have tried various herbal supplements, Gatorade etc. without much benefit.

I am feeling a bit discouraged since I had hoped to breastfeed (even if only partially) for a year. Now I am wondering how I will continue for even a few months.

Hoping for some suggestions to improve this situations. TIA!

Anne-Marie
ANNE-MARIE

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

ANNE-MARIE ADDED A NEW COMMENT!
When to pump to maintain supply and relieve engorgement?
HILLARY, PARENT OF 3 YEAR OLD, 15 MONTH OLD

Hello - My question is when to pump in order to 1. maintain my supply, 2. start building reserve supply, and 3. to minimize uncomfortable engorgement?
I have a 6 wk old who is exclusively breastfed, with one feed per day via a bottle, in the evening when my husband gets home. She's a good nurser and I have a healthy supply; I usually only nurse from one breast per feeding, for 10-20 min (9-10x per day). She goes "to bed" when we do, around 10pm after a final feed (breast). She is now sleeping 5-6 hours for this first stretch, then another 2-3, and maybe a final 1-2 before we get up for the day. I am now usually pumping once per day, during or immediately after she feeds in the morning, around 8 or 9am.
So...
Do I need to pump during her long stretch of sleep to maintain my supply or will my body adjust? Also, if I don't, I wake up very engorged (especially in the breast I didn't last nurse on) and my daughter has a hard time processing all that milk during her night feed (choking, spilling). However, I'd rather sleep than wake just to pump!
And/or should I pump during/right after the night-time feed (~4am)? One or both breasts? Sometimes she will feed from both at that time but not always. Again, I'd rather wait until morning so I can maximize sleep...but also want to relieve the pressure and maintain supply.
Finally, should I pump when she has her evening bottle? My breasts typically hurt at that time since I'm skipping a feed, but I know my supply is much lower in the evening so worry I won't get much, and I prefer to nurse a lot before bed to fill her up so I don't want to pump too much and mess up nursing.

Thank you!

Anne-Marie
ANNE-MARIE

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 r/>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!