Ready to Land? Handling Baby Jet Lag

Ready for Baby Jet Lag? - Dietitianmom.com

Ready for Baby Jet Lag? – Dietitianmom.com

This summer I traveled back from Asia with my husband. Like the other trips, this involved a long total flight time of about 16 hours with an additional 2 hour layover in Japan. This time though, I traveled with two children, one being just four months, and the other being three and a half years old. That was a challenge in itself, but I was preparing myself for the bigger challenge: that of adjusting my four month old to the time zone changes, and readjusting my infant’s bio-clock. In a previous post, I had described the excruciating process (involving nearly 2 weeks) of converting my oldest daughter (then 4 months of age) to Eastern Standard Time (EST) after we returned from Singapore in 2013. What my husband and I ended up doing was to move our child’s bedtime half an hour to one hour later every night, so that her long stretch of night-time sleep could be preserved each night. Eventually after about 12 days we got her bedtime to where we wanted it (see post Baby Jet Lag…It’s Real). However this method meant that we as an entire family had to follow her schedule, down to eating our meals at night and having black out curtains.

This time, traveling back with our second daughter to the western hemisphere, I was open to trying a different method. The baby would be sleeping in a crib in the master bedroom and the idea of the whole family following our infant’s pace of time adjustment just didn’t seem feible with a toddler. The toddler would be used to playing in daylight hours, so would be very noisy and may interrupt the baby’s sleep during daytime. It is also likely that the toddler won’t be able to sleep with a baby crying several times at night. So I decided to try a different method: going cold turkey.

So what happened? The first day we arrived home, as our baby ended up staying awake most of the daytime hours. Then that first night she woke up at least 4-5 times at night, about once an hour. Each time she started to cry I had to quickly scoop her up out of the crib and then shush her by feeding her, as I was afraid to wake up my toddler. She would feed a little bit each time and then go back to sleep. In the end I put her in the same bed as me, as it was easier to breastfeed that way since I felt so exhausted from the day’s traveling. In the morning the baby passed some gas so I suspected she was waking up and crying at night more from gas in her tummy, and was really feeding more for comfort since she didn’t feed for long each time she woke up.

The second night she woke up about 3 times. Once it was about an hour after she had slept and seemed to be more from gas or an unresolved burp. I was able to quickly pat her back to sleep. Then she woke up again about 2 hours later. This time I made sure she drank at least 10 minutes on both sides in the breastfeeding session before putting her down, in the hopes that this would settle her the rest of the night. However, I really felt I needed a place to put baby without having to worry about the baby’s crying waking up our toddler. I ended up using a spare room that was away from our toddler’s room and putting an infant bath tub with a pillow for the ‘mattress’ cushion at the bottom. When the baby then woke up a few hours later, I was able to then scoop her up quickly and take her to this other room. I could then close the door. Even though I still fed her via my breast, I noticed she didn’t seem as hungry. The spare room (in this case we used a storeroom) provided some insulation of her crying from our toddler and other neighbors in the surrounding apartments.

The 3rd night, baby woke up about 2 times. The moment the baby awoke and started crying, I took her to the spare room. There I breastfed her only 5 minutes on each side as I wanted to slowly wean her off of being fed breastmilk at night. This seemed to satisfy baby and baby went back to sleep for 3 more hours.

The fourth night was when I went cold turkey. I decided she needed to cut out feeding altogether. I made sure I fed her a lot during the day (about every 2 hours and offered both breasts each session). The baby ended up sleeping quite well, though she did wake up with brief crying spells twice in the night. When she did wake up, I put her in the bed in the storeroom, and closed the door. She cried about 10 minutes the first time and then went back to sleep. Then she awoke briefly an hour later but was able to put herself back to sleep with only a few cries before waking up another hour later this time wide awake and hungry. So by the 4th night, our infant managed to sleep a 7 hour stretch relatively well, and was able to put herself back to sleep without much intervention on my part. In the end our infant got over her jet lag in just 4-5 nights…truly a miracle! The dark storeroom and the white background noise I created likely also helped.

The rest of the family survived relatively unscathed. My eldest daughter managed to get over her jet lag within 3 days. This involved some intentional steps of not allowing her to have an afternoon nap or a minimal one at best, lots of physical activity and waking her up in the mornings at the desired time. I think she would have gotten over it faster if her sister didn’t wake up wailing at certain times in the night the first few nights causing her to wake up and then have difficulty falling back asleep. My husband had broken sleep the first few nights but was able to sleep well by the 4th night, and quickly resumed his working during the daytime. As for me, I ended up just having a few sleepless nights!

I am writing this post to share my experience. Of course every baby is different and the age of the baby as well as the traveling circumstances (e.g., how long the flights are and the duration of travel) will also affect how quickly he/she gets over jet lag. Hopefully as you travel during this winter season, your baby will be able to adjust smoothly to each location and time change! Merry Christmas!

Qn of the Month: What are Early and Mid Hunger Cues?

A: Instead of waiting till your baby starts bawling from hunger, look out for these signs (early and mid cues) that baby needs a feed…before he/she starts kicking and screaming in a fit of frenzy. Most people are not aware that crying is actually a late hunger cue. Early cues help signal that the baby is getting hungry, while mid cues signal that baby is REALLY hungry.

Early Cues:

  • Stirring in the sleep
  • Mouth opening as if he or she is nursing
  • Turning head from side to side
  • Seeking/Rooting

Mid Cues:

  • Stretching
  • Increased physical movement
  • Hand to mouth activity
  • Sucking on hands or clothing

Qn of the Month: How Can I Tell My Baby Is Hungry?

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You just came home a few weeks ago with a newborn infant. How can you gauge whether your baby is hungry or crying for another reason? What many parents don’t realize is that crying is actually a very late feeding signal. Here are 10 important cues that may point to a baby being hungry and needing feeding… before the crying starts!

Watch for these signs in your infant (arranged generally in order from subtle to more visible signs):

  • General alertness
  • Starting to bring hand(s) to the mouth
  • Making sucking movements and sounds
  • Turning to you (the caregiver)
  • Starting to stick his or her tongue out
  • Turning his or her face towards the breast (rooting)
  • Displaying Rapid Eye Movement (REM)
  • Flexing arms and legs
  • Clenching fingers and fists
  • Displaying fussiness/crying

If possible, try to identify these signs and not to wait until your baby is really fussing and crying before feeding, because the baby may end up not breastfeeding or bottle feeding as well. To encourage latching on, a breastfeeding mother can show the infant the nipple and gently brush the baby’s cheek. This will stimulate the rooting reflex, causing baby to turn to the breast and latch on.

Qn of the Month: Does My Breastfeeding Baby Need Iron Supplements?

Infant Grasping Mother's FingerA: This is another ‘yes’ and ‘no’ answer. Whether a breastfeeding baby needs iron supplementation is dependent on many factors such as whether the child was born full term or premature, fully breastfed or not, amount of iron-fortified infant formula consumed, the age of introduction of solids, what those complementary solids are and also country specific recommendations.

In the United States, the American Academy of Pediatrics (AAP) revised its recommendations in 2010 to better meet the iron needs of infants to prevent iron deficiency. For infants who are exclusively breastfeeding, the AAP currently recommends an oral iron supplement of 1 milligram iron per kilogram per day (1mg/kg/day) starting when the baby is 4 months of age. This should be continued until the baby is well established on iron-containing complementary foods to provide the same level of iron. This also applies to partially breastfed infants, who receive more than half of their daily feedings as breast milk. Some examples of iron-containing complementary foods would be iron fortified infant cereals and puréed meats.

All preterm infants should have an iron intake of a minimum of 2 mg/kg/day up until 12 months of age. For preterm infants fed breast milk, the AAP recommends 2 milligrams of iron per kilogram per day to be started at one month of age. This supplementation should be continued until the infant is transitioned over to an iron fortified formula and/or the diet includes complementary foods supplying 2 mg/kg per day of iron.

What about babies who are not breastfed? Fully formula fed term infants would likely have their iron needs met during the first 12 months of life from standard infant formulas alongside iron-containing complementary foods introduced after 4-6 months of age. For premature fully formula fed infants, the standard preterm or term infant iron fortified formula would generally be a sufficient source of iron, though some formula fed preterm infants may need additional iron supplementation. The exception to the need for supplementation is if the preterm infant was provided blood transfusions and is at risk for iron overload.

(Source: Baker RD, Greer FR, Committee  on Nutrition. Diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and young children 0 through 3 years. Pediatrics. November 2010. 126(5):1-11. http://pediatrics.aappublications.org/content/early/2010/10/05/peds.2010-2576.abstract. Accessed October 27, 2014.)

Qn of the Month: How Can I Drop the Middle of the Night Pumping Session?

owlA: There is no hard or fast rule on this.  Here are 4 suggested methods below. Feel free to pick the one that most suits you!

Option 1: Over several nights, gradually cut back on the amount of time you spend pumping during that night session. The goal is to get some relief but not empty your breasts completely. So slowly wean off, by pumping less and less each session. Your body will get the message to produce less breast milk during the night.

Option 2: Don’t drop the night pumping session completely, but just pump a little later each night. The goal is to gradually move it later and later each night until you’re close enough to the morning breastfeeding session to make it without pumping at night. So ultimately, the night pumping session ends up merging with the early morning feed.

Option 3: Stop pumping but switch to hand expressing. However, only hand express enough to relieve pressure and discomfort. Repeat this each night until your breast milk supply adapts to the decreased demand.

 Option 4: You can drop the pumping session at night, but then adjust the breastfeeding times. For example, instead of pumping at night, you could have a breastfeeding session later at night (e.g., 10:30-11pm) and then once more early in the morning at about 6 am.

Hope these suggestions help!

Keeping Baby On (Part 1): Breastfeeding Troubleshooting

Baby is a few months old now, and you’ve (finally) managed to establish a decent breast milk supply. You and baby are now more or less comfortable with each other on…and off the breast. Congrats, you’ve gotten through that first stage of breastfeeding and parenting! It may not have been easy. But perhaps, like me, you’ve also discovered that the road of breastfeeding is still quite bumpy. Some breastfeeding sessions just don’t go very well and you know it’s not a supply issue. So what could be the reason(s)?

From experience, here are 5 simple reasons why baby might pull off the breast suddenly during a breastfeeding session, and some quick solutions to help you keep baby on the breast:

Check the latch.BFingMomBabypic2shorthair
Make sure baby has a good ‘mouthful’ of breast tissue so that the nipple is far back in baby’s throat, and baby’s lips are turned out (think of fish lips). Otherwise baby may be sucking on just the areola and not getting much and so pulls off. Baby is very smart! Why work for milk when there doesn’t seem to be any there? A bad latch would also not be very comfortable for you. If you think the latch is not good, then gently detach baby from the breast (by inserting your pinky finger into baby’s mouth to break the suction) and then try putting baby on the breast again.

Baby needs a mini-break.
Let’s not forget—sucking can be tiring! Baby may simply need a little break. Stand up, turn around or go briefly to another room. Sometimes just a minute’s break or change of scenery is enough. Also a tiny break may give the breast a chance to fill up a little more in the interim. Some other ‘mini-break’ ideas: change the baby’s diaper or change the clothes, and then offer the breast again.

Change the position.

Sometimes a change in the breastfeeding position is all that’s needed to get baby to suck a few more minutes, and this may allow more milk to be pulled out of the different milk gland areas on the breast. Baby may also latch on better in a different position. Often when breastfeeding, I would use two different breastfeeding positions per side.

Another idea is to try a completely new position that you have not tried before…who knows, this could turn out to be your baby’s favorite! If you’ve tried all the conventional positions (e.g., Cross-Cradle Hold, Cradle Hold, Football Hold and Side-Lying Hold), invent one yourself or try this new position that I’ve used regularly with my own little one during the breastfeeding phase (see A New Breastfeeding Position: the “Bear Hug”).

Got gas?
Try to sit baby up and burp baby. Once a burp is out, a baby is usually happy to get back on the breast. This is especially the case for younger babies. When my little one was between 4-6 months, she would often have at least one burp when she finished one side (and multiple burps when she was younger!).

Check the temperature.
Check the temperature of the room. Is it too hot? What about baby? Know that often breastfeeding and holding baby can increase both your body temperatures (and may cause you and/or baby to sweat), so check baby’s clothes to make sure she’s not wearing too much. Baby could be feeling a bit hot and bothered!

If you’ve done this bit of troubleshooting, and these are not the reasons why baby is pulling off the breast, try not to worry too much. Baby may have really had enough breast milk to drink! As babies mature and grow, the length of time on the breast and of breastfeeding sessions in general usually decrease. Often this is because babies become much more efficient at sucking and may also need less once solids are introduced into the diet.

Qn of the Month: Help! Baby May Be Constipated…What Can I Do?

First, what is considered constipation? According to the American Academy of Pediatrics (AAP), a baby is more likely to be having constipation if he/she displays the following signs and symptoms: being excessively fussy; spitting up more; unusually hard stools or stools containing blood; a big difference in bowel habits or bowel patterns; straining for more than 10 minutes without success.

Before I talk about some strategies that may help, I want to mention two key points. First, while many babies may follow the ‘book’ in terms of stooling and wet diaper patterns, this may not always be the case for some babies. For breastfed babies, especially, there can be a wide range of normal, with baseline stooling patterns varying from a few times a day to some only going once a week. This is fine, as long as feeding is not affected, and the baby does not seem bothered. Second, prevention (fluids, fiber and frequent movement) is easier and still better than treatment. For more on that, see some upcoming posts dealing with this topic.

Now here are a few simple strategies that may help your little one:

  • Food: If your baby has started on solids, you can try mixing in a bit of home or commercially prepared prune puree or a tiny bit of diluted prune, pear or orange juice into your baby’s food
  • Fluids: For an older baby, you could offer fluids like water more frequently during the day (in between breast or formula feeds). For a younger baby, you could offer some water after a breastfeed, so as not to impact the breastfeeding, as well as add a bit more liquid (expressed breast milk, formula or water) into his/her solids. Just make sure that you don’t compromise the texture too much. It is still important to make the texture appropriate to your baby’s age and abilities, so that it won’t be a choking risk.
  • Movement: A bit of bicycling/cycling motion with the legs (with baby on his/her back and facing up) a few times a day can always help!
  • If medicine is really needed, the doctor may prescribe something like lactulose. Don’t worry, lactulose mainly works by just helping to draw water into the gut to help with softening and moving the stools along baby’s gastrointestinal tract.

Lastly, I just want to mention that some bowel pattern changes are normal. For example, over time as my little one got older and began to eat more solids, her stooling also gradually changed. At first it was a few times a day, then there was a transition period with the introduction of solids, so that it eventually became once a day, or once every other day. As she started to eat more, of course the quantity was also a lot more (and as my husband would say, “More pungent!”). And let’s not forget that teething is another factor, often making stools looser/more frequent during those periods!