Wednesday, July 30, 2008

Tell us what you think about this blog!

Please tell us what you think about this blog! Are there any additional topics that you wanted to find or wanted more information on that aren't on here? Did you find the information helpful? How?

Your feedback helps me to improve the blog! Comments welcome here or on other posts!

Wednesday, July 2, 2008

Frustrated Mama Tip: Power Pumping to Increase Supply

Generally speaking, it takes most moms a few days to a week to see an increase from more frequent pumping. Milk is a supply/demand process - demand more milk and your body will make more milk. For moms with supply issues, it helps to pump in addition to nursing. The general idea is that to make more milk you must remove more milk. Power pumping is a way of boosting supply. It is basically adding a 10 minute extra session to your normal pumping schedule, using massage and compression. For us supplementing moms, that extra milk and extra demand/stimulation can really help!

The way I've always done power pumping is like this...
Pump as normal for 20 minutes or 5 minutes past the flow of milk, whichever is LONGER.
Stop. Massage for 5 minutes. (I also found using hot, wet compresses also helped.)
Pump again for 10 minutes using compression.

This mimics a growth spurt and if done a couple times a day for a few days to a week usually yields gains for most moms. Even if you do it and get NOTHING, it doesn't mean it isn't working. Also, some moms find that adding even one power pumping session a day will elicit another letdown. For some moms this is just a bit, but for others can be significant. Also, consider using hand expression after your regular pumping session. Some moms can actually hand express an oz or more after pumping, even if the pump isn't getting anything out.

For me, power pumping helped. And, I almost always got another little letdown. For us moms "short on milk", that extra 1/2 to 1 oz helped a lot. And, if I hand expressed, too - I might even be able to get more!

Good luck! Let me know how power pumping goes for you!

Supplementing Options - Supplementing the Older Baby

A couple of moms have asked for more information on supplementing and daycare issues - namely, what to do when you can't pump enough and have to supplement. So, this post is an expansion on what we covered in the previous supplementing options post.

Obviously, a mom with a younger baby who wasn't pumping enough for daycare bottles would need to supplement with formula, unless she had a friend who could donate milk. But, a mom with an older baby has some options!

Let's say baby is at daycare for 8 hours. All babies are different, so some babies need more or less frequent feedings and amounts do vary. That all said, we are going to assume here that baby is in daycare from 8 am to 5 pm - which is a standard time for most parents who drop off before work, do an 8 hour work day, and then return to pick up baby. So, for most babies - that's a 9 hour day at daycare. Most older babies will be eating/drinking about every 3 hours. We'll base this on a baby that is around 8 months old, eating solids fairly well, and is on the above schedule. Again, your baby may be different but this post is to just give you a sample and some ideas. And, this also assumes that mom is nursing well and fine when with baby.

For this time frame you'd need 3-4 bottles (or sippy cups!). I'd limit breastmilk bottles 2-4 oz total. This way you'd only need 12 oz of BM max a day. One of those "bottles" could be a 6 oz cup with 4 oz juice and 2 oz water mixed - or you can serve this in one 6 oz or two 3 oz cups (remember that the American Academy of Pediatrics says no more than 4 oz juice for baby a day, ok? "Fruit juice should be used as part of a meal or snack. It should not be sipped throughout the day or used as a means to pacify an unhappy infant or child. Because infants consume fewer than 1600 kcal/d, 4 to 6 oz of juice per day, representing 1 food serving of fruit, is more than adequate. Infants can be encouraged to consume whole fruits that are mashed or pureed."). And it is generally recommended that all juice be given in a cup, not a bottle.

I'd give two meals at daycare - ones that are "solid" in terms of nutrition. By 8-9 months she'll likely be able to eat soft solids (instead of mush!), but even if she isn't any of this can be mashed or put in the food processor! So, let's assume 3 bottles of BM (2-4 oz each unless you pump more!) and one cup of juice mixed with water (it is important to mix with water so that baby doesn't develop a sweet tooth!) will be old enough for a sippy, probably, by that age. Start introducing the sippy EARLY in her high chair with just plain water.

Here is a sample schedule - assuming baby is eating foods on her own - this would need to change if she can't "chew or mash" foods on her own yet. Offer breakfast at daycare at 8ish and lunch at noonish, snack at 10ish and 2ish. Make sure to offer protein or "hardy" foods at lunch and breakfast.

Nursing AM (7:00 am) - nurse baby one last time before daycare at home!

Breakfast (8:30 am) 1/2 avocado spooned out to baby, 1/4 cup scoop of cheerios, spoonful of pears, 2-4 oz BM

Snack (10:00 am) - 1/4 cup cubed cheese or cut up cheese sticks, handful grapes cut in half (choking hazard here if left whole, and must be cut in half until child is 3 or 4), couple goldfish crackers or cheerios for texture OR small cup yogurt w/ fruit, 3 oz juice/water mix in a SIPPY CUP or plain water if you prefer to give the mix as a 6 oz cup later in the day.

Lunch (12:00 pm) - 1/4 cup black beans rinsed, well cooked spiral noodles (can be cold that is ok), banana chunks 2-4 oz BM

Snack (2:00 pm) - handful of diced turkey, cheerios or crackers or rice (some sort of carb) 2-4 oz BM

Nursing PM (4:30 pm) - nurse at daycare when you pick up baby or right when you get home. If it is going to be a long time before you can get home then ask daycare to offer baby another very small snack at around 4:00 pm, so baby won't melt down in the car! Nurse immediately when you get home.

Then, nurse on demand throughout the evening and night. You can offer baby a small dinner. But, when you are with baby always nurse FIRST before meals so that baby takes in more milk and stimulates your supply. A baby that is 8-9 months old still needs to have BM or formula be the MAIN source of nutrition. Thus, baby should be nursing/getting BM about 6-7 times a day MINIMUM at this age. So, nursing 2-3x a home in the evening will do the trick! If baby cues more or wants to eat at night, well, that is pretty normal and you should let baby nurse.

If baby is still needing to do mushy foods at this point and is on regular baby food, just use what you can that makes sense. You can EASILY make your own jars or containers of beans pureed in the food processor for her to take with her. Grinding up some turkey and rice is easy, too - use a bit of chicken broth if it is too dry.

IF you pump enough so that you can do all FOUR bottles/cups with BM with no problem, I'd do that INSTEAD of the juice. Also, tell daycare that if at anytime baby drinks it all and wants more, to offer baby some water in a cup and allow them to give an extra small snack - like beans. If you have no history of allergies in your family, something like just a tad of peanut butter on a bagel can also be a good snack. Amounts above are ballpark and baby may not eat it all. So, that is ok. Some babies may do fine with smaller amounts.

Avocado - can be sliced in half, pit removed and spooned out to baby. She can eat it "raw" as long as it is ripe (and somewhat soft) - if it is "hard", it isn't ripe enough. If she likes to feed herself you can dice it (I'd go with the firmer ones to do that - but it is messy, so spoon it if at all possible).

Beans - any kind will do. My DD loved black beans. If baby isn't yet really eating anything with "form" to it yet, I'd mash them or put them in the food processor for a few and spoon them to her. A bean dip consistency is good - and babies LOVE these. Once they can eat them on their own they are the easiest thing to they are easy to pick up and put in the mouth. I recommend for black beans to rinse them first to avoid a big black gooey mess, lol. Well cooked green beans, limas, navy beans, black eyed peas, etc, etc...are also just fine. And, you can start them at any age. People in cultures that are "bean heavy" usually serve mashed beans as a first food.

Noodles - tossed with a bit of olive oil or plain. Well cooked...for once baby can mash foods with her teeth or gums. IF baby can't eat on her own and is still on "regular" baby food, then you'll need to go with one of those options. Always watch for choking and make sure that baby really can mash/chew before you throw lots of these down!

Meat - diced. Turkey or ham from the deli section in the store does great for this ...get them to cut you one 1/4 inch "slab" and then you dice it at home for baby. Again, baby needs to be at the point that she can mash/chew such before then. You can also put this in the food processor if you want to give baby non-processed meat you cook at home.

Soft cheeses - diced...even some harder ones like cheddar can be cut into tiny little cubes for baby. Cheese sticks are a fav, too.

Yogurt - my kids both loved yogurt. As long as your little one doesn't have milk protein issues, then yogurt can be a great choice.

Whole fruits - like banana, strawberries, grapes cut in half, etc can be good choices, too.

Most of the items above CAN BE CHOKING HAZARDS if baby isn't watched and/or if baby isn't doing "harder" solids yet. But, by 8-9 months she'll probably be into these. Never let baby eat unassisted.

Let me know if you think this sample schedule might work for you! Our daycare also had some standard foods there once baby was one year old and they would also feed baby at one year old off of the regular daycare menu...

Please note that this is all based on you nursing baby on demand when she is with you so that she can make up for any deficits. Make sure to nurse FIRST before you give solids each time as BM needs to remain her primary source of food until she is one year old - at which point you can start a slow transition. But, if she nurses when she gets up, again when you get home with her, again at 7 or 8 when she goes to bed, and once during the night, then that is helping to make sure baby gets enough servings of BM a day for her ...she may still need more at this age, some babies do and a few take in less. If needs more, you might have to fit in an extra pump at home or work to do that. Most moms pump at work during the normal time baby would nurse.

I hope this helps give you all some ideas for older babies. Sometimes we think we need 5-6 eight oz bottles to get baby through the day! But, if we increase the QUALITY of food given (meaning, skip the no-nutrition puffs!) and give baby food with good sources of protein, calories, and fat, then we can support their nursing routine and not have to supplement with formula. For moms who can't then formula is a fine option!

As always, your feedback on this post and how helpful it was to you is greatly appreciated!

Saturday, June 28, 2008

Supplementing Options - What to feed baby?

When you first start to supplement, you may wonder what options you have for baby. Many moms are very opposed to using formula and investigate such things as rice, soy, or goat milk. Some moms wonder if they can use juice, solids, or cow's milk. In general, all these things do depend on your baby's age.

Here are my ideas based on what I've read and also done that worked.

For babies younger than 6 months old or for those who really aren't eating any solids of any significance at all, your options are pumped breastmilk or formula. The American Academy of Pediatrics (AAP) recommends the following options in terms of nutrition for very young babies from their first choice to the last:
1. Breastmilk via nursing
2. Mom's pumped breastmilk via bottle or other device
3. Pumped Breastmilk from a donor
4. Formula

The AAP also recommends that babies get breastmilk exclusively for the first 6 months - meaning no water, gripe water, formula, etc. For babies who must have a supplement, formula is the next logical choice, unless mom is able to pump or get donated pumped milk. Of course, some moms chose to use formula for various reasons and that is ok on here with us, but please do note the guidelines and that BM is considered best. So, if baby must be supplemented before 6 months old, use formula or BM before offering solids, as that is more in line with what is best for baby. That means, no rice milk, soy milk, cow's milk, water, gripe water, etc, etc...and no solids.

For older babies that need to be supplemented, mom may be able to get away with increasing solids or offering some limited other types of liquids - provided that baby is able to "make up" any deficits when with mom - so perhaps getting in an extra nursing session at night. Just make sure that you don't displace good fat/calories with a lesser source or that you don't skimp on it during the day at daycare without offering baby a chance to "catch up" later. Most babies who are nursing well remove milk much more efficiently than the pump - so even if mom has trouble pumping, most babies who are nursing effectively and efficiently will do just fine to make up the difference later that day when they are with mom. Just make sure you are offering frequently and not limiting time or access.

If baby is older than 6 months, but younger than 12 months and you need to boost nutrition or perhaps are struggling because you can't pump enough for all of baby's bottles for say, daycare, then you might be able to use some other foods. For instance, avocado is very high in fat and calories. Beans are high in protein and a good source of fiber. My daughter LOVED black beans! So, look to make sure that the solids they are eating are the "best choice", meaning if your child isn't gaining well and must be supplemented or you can't pump enough for those bottles, then skip the "puffs" and chose a more nutritious option. Noodles with a bit of olive oil is a good choice. Always BF or bottle first, as BM or formula should be baby's primary source of nutrition - then follow up with a nice meal.

If baby needs some liquids (maybe on a hot day!), 4 oz of juice a day is all that is recommended - so you can mix that with water to make it go a bit further (and baby won't get too used to the super sweets!) or you can offer baby some ice water or water in a sippy. Juice should never be given in a bottle. But for a baby 6-12 months, you want to make sure that they get enough calories and if you are short on milk the best way to do that is from good solids or to use formula. So, skip the "puffs" and the regular cow's amounts of juice can be used (watch that 4 oz guideline!), or formula. Water can be given as a liquid to wash down food if baby is eating well and mom doesn't want to give formula and then offer to nurse or give pumped milk again, as appropriate.

Babies over 12 months of age have lots of options, including cow's milk, soy milk, etc. Again, the 4 oz juice rule is still in effect! So, chose good nutritious options and supplement as needed with regular WHOLE milk (baby's need the fat until they are 2 years old for optimal brain development!).

So, I hope this helped you think through some more options for supplementing based on age. Let me know what you think or if any of this helped you!

Friday, June 20, 2008

Frustrated Mama Tip: Paced Bottle Feeding for Getting Back to Breast

Paced bottle feeding is a way to slow the feeding down for baby.

It has several benefits as follows:
  • It makes the feed more variable, like the breast – so baby doesn’t get to gulp down “easy” milk. This often makes BF easier for a baby that has gotten a preference for the faster/easier flow of the bottle.
  • It prevents baby from gulping so much air – which helps with spitting up and reflux.
  • It helps prevent baby from overeating – which helps with spitting up and reflux, as well as setting baby up to gain too much weight too fast which has implications later on for baby as fat cells never go away!
  • It helps baby maintain their oxygen saturation. Many bottle fed babies experience decreases in oxygen saturation due to the mechanics of the bottle.
Basically, with the bottle, the flow is continuous. Once they suck – they must continue to suck/swallow/suck/swallow or choke as the mouth fills again and again with fluid. Thus, the pattern is typically, gulp, gulp, gulp, gulp, GASP, gulp, gulp, gulp, GASP, SPUTTER, Gulp, Gulp….etc. This pattern also has the nasty side effect of making mom think baby was “hungrily gulping” down the bottle (which they’ll take after BF even if they are full because they don’t know better) and make her think she was starving the poor babe. Paced gives baby a chance to end the feeding, instead of being forced to finish.

After awhile all infants learn to end a feeding when full by turning away or spitting it out, but very young babies and babies with little or no bottle experience (i.e., BF babies) don’t know to do this. Thus, they also end up associating being “overfull” with being satisfied. Then, they end up taking in these huge volumes. There is some research that suggests a link between all this and obesity later in life…as the person learns to think that they are only full when stuffed to the gills…Babies who used paced feeding also take in less food. If we remember that the average BF baby only eats 24 oz or so a day, you can again see where paced puts baby back at a more normal volume.

That all said – lots of good reasons to use paced feeding whether you are BF or not!

Here is how to do paced feeding:

Offer bottle to baby for 2 sips. Quickly remove the bottle. Wait for a clearing swallow and a breath, pop bottle back in for another 2 sips. Repeat.

This sounds easy, but it isn’t innate and it feels “Wrong” at first. Also, baby may be VERY mad and get angry at the bottle being taken out. Just remember, this is to help baby and he’ll get over being mad. My daughter was very angry at first, but quickly learned to like it and ejected the bottle every couple sips to get some air. Much more like BF. For a baby who really likes that easy/fast bottle flow, it disrupts the meal enough that often they realize that the breast is a better place to be – no interruptions! They are left alone to nurse and drink to their own content. I’ve found MANY former babies who liked to do the “breast freak out” eventually went on to prefer the breast over the bottle after using paced feeding.

Let me know what you think of this "Frustrated Mama Tip". I hope this helps you as much as it helped me!

Thursday, June 19, 2008

New Mama Trap: Baby Acting Hungry

The most common reason that I hear for supplementing is that the baby was "acting hungry". Usually this means baby was fussy. Unfortunately for most moms, babies are fussy creatures. Baby's behavior should NEVER be used as an indicator of if baby "got enough" or not. The ONLY reliable indicator of intake is weight gain and output (i.e., wet/poopy diapers). If those are good, there is NO WAY baby did not "get enough" from nursing no matter how he is acting.

I've had a screaming fatty and a perfectly content baby that gained NOTHING in two weeks. If I had gone on just behavior, well, I'd have fed that fatty even more...and my little content one would have continued to have no growth. And, a baby that is fully BF will "hungrily gulp down" a bottle just because the mechanics of the bottle are different. Doesn't mean they are hungry and "wanted" the bottle. Many a supplementing mama has fallen into that trap.

So, if you are on here wondering if you should supplement or not ask yourself this - is baby losing weight? Are you only wanting to supplement because baby is fussy or because baby really isn't doing well in terms of his output or his weight gain? And, if baby is gaining SOME, but maybe not as much as your doctor would like, the first step is ALWAYS to FIX the breastfeeding, not to supplement right away. Even if the baby is a slow gainer, he isn't in danger. There is TIME to fix this without getting into the terrible trap of supplementing. Ask for a referral to a lactation consultant. We'll talk more about gaining issues in another post.

Are you feeding baby frequently enough? I've found that babies not doing well a lot of time are put on "schedules" and expected to go 3 hours between feedings. Breastmilk digests in 90 minutes. BF babies, as a rule, don't go 3 hours usually when they are newborn and some well into the first year. Count feedings from the START of one feeding to the START of the next, regardless of how long it took baby to eat. Fussiness can often be attributed to a frantic very hungry "too long between meals" baby. So, if baby nurses at 8 am and eats for 45 minutes, you'd feed him again around 10 am, or 2 hours later, even though he ate for 45 minutes. Start to start.

Friday, June 13, 2008

Welcome to Breastfeeding & Supplmenting

Hi there,

If you are here, then you are probably supplementing your baby or thinking about it. You may be here because your baby isn't doing well or you are having a hard time making exclusive breastfeeding work. You may be here because you chose to supplement for your own reasons. I hope this blog will help other women who are struggling to find good advice on supplementing. Much of the advice and information out there is for moms who breastfeed (on the breast and exclusively) or who exclusively formula feed. So, for those of us who supplement with formula or breastmilk or who exclusively pump and bottlefeed breastmilk, there is no real source of support or information. We hang out in this no man's land of being judged by people who breastfeed and people who formula feed. Both think we are bonkers!

While I do think breastfeeding is best, I know (from personal experience) that exclusive breastfeeding isn't always possible. I also don't think formula is evil. I will encourage moms to avoid formula, when feasible, but I certainly don't judge moms who chose formula or who are ready to wean to formula. I've "been there - done that" and I did supplement both my kids with formula and was grateful to have it to make up the difference between what I could produce and what they needed to thrive and do well.

Welcome. Feel free to post comments and questions. I'll try to post new ideas and answers to common questions at least weekly.