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

A: An age old question is, “How can I tell my baby is full?” Just as important as the previous post (How Can I Tell My Baby is Hungry?) is being able to tell when your baby is full, so that baby gets just the amount of intake he/she needs for optimum growth and development.

Some signs to watch out for in the infant include:

  • Falling asleep after emptying or softening at least one breast
  • Infant pushing away from the breast or fussing with back arching
  • Reduced sucking
  • Infant drawing head away from the nipple
  • Infant’s body relaxes with extended and relaxed hands/arms

Young babies under 3 months of age may not give clear signs of hunger and fullness, but these cues are usually clear by 3 to 6 months of age. For optimal health and growth, parents should check to see if their baby is still hungry after a pause in feeding by looking for satiety cues. This is important before continuing forward in the feeding, especially in babies that are bottle fed. Parents are often eager to have a baby finish an entire bottle of expressed breast milk or formula, simply because they see the contents in the bottle, instead of letting the baby decide when or how much to take at a feeding.

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: 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: I Need Breastfeeding Help! Who Can I Call?

If you are a new mother having trouble establishing breastfeeding, don’t feel discouraged. There’s help out there for you! Always check out your local hospital (or where you delivered) to access lactation consultants and breastfeeding help. In each country there are often many breastfeeding support groups and non-profit organizations providing resources and peer/professional support. Examples include the La Leche League (US and UK), National Childbirth Trust (NCT) in the UK, and the Association for Breastfeeding Advocacy (Singapore).  In the United States, you may also be able to get lactation consultant help from a Special Supplemental Nutrition Program for Women, Infants and Children (WIC) agency near you, and don’t forget to check out what may be available at the State level. For example, the Arizona Department of Health Services actually operates a 24 hour Breastfeeding helpline for breastfeeding questions.

Here are a few additional handy numbers and resources to take note of (by country):

UNITED STATES:

This is through La leche League (LLL) and is a toll-free number. If no one answers, leave a voice message. You can get connected to a local LLL leader and local LLL support group too.

UNITED KINGDOM (there are lots of phone numbers!):

  • National Breastfeeding Helpline: 0844 20 909 20
  • Association of Breastfeeding Mothers: 0844 412 2949 (9.30 am -10:30pm)
  • Breastfeeding Networks Supporterline: 0844 412 4664 (9.30 am – 9.30 pm)
  • La Leche League Great Britain: 0845 120 2918 (24 hour line)

SINGAPORE:

  • Joyful Parenting and Breastfeeding Helpline: 64880286 (Mon-Sat, 10.00am – 5.00pm)

Want more information? These websites might help:
http://www.abas.org.sg/information.htm
http://www.nct.org.uk/branches/southampton/breastfeeding-support
http://www.lalecheleague.org/nb.html

Quick Tips to Prevent or Ease ‘Milk Lumps’

If you are breastfeeding your baby, you can sometimes experience these. If a milk duct is not draining well, it can become plugged or clogged, and inflammation builds up. This creates a tender, sore, lump in an area of the breast. These ‘milk lumps’ can come quickly and without warning. For me, it begins when I suddenly notice a bit of discomfort or tenderness in a spot, and then I can feel a small hard lump when I press on the area. Occasionally, I may get a lump forming from over pumping or when baby suddenly revs up demand for breast milk, causing the breasts to try to increase milk production quickly to match the increase in demand. Once the ‘milk lump’ forms though, it seems to take the better part of the day to resolve fully and I have to apply many measures including getting baby to consistently drain that spot for a couple of feeds. So the best thing I would advise is to keep checking (especially the prone breast or side that tends to get ‘milk lumps’ more easily) frequently, even daily if possible. But if you already feel a tenderness and hard lump forming, don’t worry—here are a few things from experience that you can try which may help ease the discomfort:

Massage, massage, massage.
When you feel a ‘let down’ reflex, especially at night, it often helps to massage the breast tissue (especially the outer parts of the breast) thoroughly using the base of your hand/palm in a big gentle circular motion to help with milk flow and circulation. Another tip is to massage the breast tissue all around the nipple as baby is sucking on that breast so as to help drain the different areas of the breast around it evenly.

Try using a different breastfeeding position.
Sometimes the tendency is to stick to a breastfeeding position because that’s what you and baby are used to. But if you find one particular position may be causing a milk lump to form on a part of a breast more frequently, then it may be time to try a new or different position! Your current breastfeeding position may be what is causing the milk lump to form, because a certain area is not being draining properly.

Change baby’s sucking direction.
During the course of a breastfeed session, you can switch positions and baby’s sucking direction a few times, to help drain different parts of the breast. If you already have a lump formed, then try lining up baby’s chin with the location of the lump so that it forms a straight line vertically, diagonally or horizontally to help with draining that specific area.

Try a hot shower.
A hot shower with hot water directed at the area, and some added massaging can help ease the discomfort you feel. Another idea is to put a hot wet cloth on the affected part of the breast a few times a day to help soothe that area.

Moms Aware! What You Should Know About Keeping Breast Milk in the Fridge

As you may have seen by now, recommended storage times for expressed breast milk (EBM) in the freezer and in the fridge can vary quite a bit, depending on which guidelines you look at and factors like the type of freezer used.  For freshly pumped breast milk, the UK and US government guidelines are generally the same, which is that EBM can be stored in the back of the fridge for up to 5 days at a temperature of 4o C (39o F) or lower.

There is a study, cited in the American Academy of Pediatrics (AAP) 2012 position statement on Breastfeeding and the Use of Human Milk, which looked at the changes in expressed breast milk stored in a refrigerator in a hospital setting. Many factors were measured over time, including the pH, bacterial count, protein level and white blood cell counts. It found that EBM could be kept in a fridge for up to 96 hours (4 days) with minimal changes to its integrity. That’s good news. But, should expressed breast milk really be kept this long in the fridge? What about its taste?

What I have found over the months, is that the length of time the fresh breast milk sits in the fridge also impacts its taste. Very fresh breast milk tastes really good! It has a mild sweet aftertaste but is essentially quite bland. Think of 1% or non-fat cow’s milk but with a lighter, more watery and slightly sweet taste. By day 2, the expressed breast milk is already starting to taste a little ‘off’; you can taste a tiny bit of the free fatty acids from the lipases working, and a whitish layer forming on the top of the milk. By day 3, the ‘off’ soapy bitter taste is even stronger, even after mixing in the fat layer to the rest of the milk. I think at this point the baby may not be as willing to accept the milk already. If this is the case, you could try warming the milk more before offering it to baby, or use it in baby’s solids instead. By day 4, the ‘off’ taste gets even stronger. Much stronger.

The take home message? I would recommend using your expressed breast milk within 24 hours if kept in the fridge to optimize its taste and acceptability to the baby. Otherwise, definitely use it up by 4 days (96 hours). And still keep it at the back of the fridge! If you don’t think you’ll use it within 24 hours, then it may be best to freeze it, and then when you need it thaw the expressed breast milk and use it as soon as you can after it is thawed!
 

Sources:
1. Centers for Disease Control (CDC). Proper handling and storage of human milk.  http://www.cdc.gov/breastfeeding/recommendations/handling_breastmilk.htm. Accessed 26 October 2013.
2. National Health Service (NHS). Expressing and storing breast milk. http://www.nhs.uk/conditions/pregnancy-and-baby/pages/expressing-storing-breast-milk.aspx#close. Accessed 26 October 2013.
3.Section on Breastfeeding. American Academy of Pediatrics. Breastfeeding and the use of human milk. J Pediatr 2012;129: 3: e827-e841. http://pediatrics.aappublications.org/content/129/3/e827.full.pdf+html. Accessed 26 October, 2013.
4. Slutzah M, Codipilly CN, Potak D, Clark RM, Schanler RJ. Refrigerator storage of expressed human milk in the neonatal intensive care unit. J Pediatr. 2010;156(1):26–28.