Category Archives: Articles

Storing Breastmilk Safely

Making The Most of the Breastmilk You Pump

By Meri Hanson Levy, MFT, CLE

Make the most of your breastmilk storage by safely pumping and storing your milk.

  • Wash your hands before you pump. Starting with clean hands ensures your milk is free from bacteria that can spoil it more quickly.
  • Store your milk in 1-4 oz amounts to reduce wasted milk when thawing for bottles.
  • You can combine milk pumped at different times as long as all the milk is chilled before combining.
  • Refrigerated milk has more anti-infective properties than frozen milk. Use refrigerated milk before frozen milk if you have it handy.
  • Breastmilk can be stored at room temperature for up to 10 hours, in a refrigerator for up to 8 days, or in a freezer up to 6 months (if your freezer is cold enough to keep ice cream hard).
  • Use hard-sided plastic or glass containers with tight-fitting lids, or freezer bags that are designed for storing breastmilk.
  • You can thaw and heat breastmilk under warm, running tap water. Never boil or microwave breastmilk.
  • Mix or shake bottle before testing the temperature. It is normal for breastmilk to separate when stored.
  • If milk has been frozen and thawed, it can be refrigerated for up to 24 hours for later use. It should not be refrozen.
  • Once heated and offered to your baby, you may offer the remaining breastmilk one more time, but it should be discarded after two hours.

Coping With Sore Nipples

By Meri Levy, MFT, CLE

You’ve decided to breastfeed, and you should feel great about it! You are doing a wonderful thing for your baby and yourself. However, there’s nothing quite like nursing a newborn to make even the most confident new mom feel like a complete amateur. New babies can be sleepy, squirmy, and fussy during feeding times, and having sore nipples only makes it harder to feel confident and patient with the learning process.

During the first two weeks breastfeeding, it is normal to have some mild soreness or tenderness in the breasts and/or nipples. The usual reasons for this are three:

  1. your breasts are not used to being used as a food producer, feeding method, and pacifier up to 12 times or more each day.
  2. early feeding sessions are more likely to create soreness, since the baby suckles harder to try to bring down the colostrum. Once there is real milk to reward the baby for his efforts, the suckling becomes more manageable.
  3. mom is more likely to tolerate a less successful latch-on in the early days, while she is learning how to feed, which can cause soreness.

However, if your nipples are extremely sore and cracked, bleeding, bruised or blistered, or if any more than mild soreness lasts for more than about two weeks, it is usually a sign that a deeper latch is needed.

PROPER LATCH-ON TECHNIQUE

The most important single factor in preventing and resolving sore nipples is to get a deep latch-on with the baby. If you feel the roof of your mouth, and then move back to the soft palace farther back, you can imagine how much more comfortable it is to have your nipple rubbing against the latter and not the former. In order to get a good latch, there are three factors that I think are most important.

  1. POSITIONING. Hold your baby securely for feedings, with the baby’s body aligned (the head is not turned to the side), the baby’s hips flexed, and the head free (in whatever position you choose, make sure that the baby is free to tilt his head back to open his mouth wide). Proper positioning is crucial for newborns to stimulate their reflex to open their mouth wide and draw the nipple far back into their mouth.
  2. ASSYMMETRICAL LATCH. The baby should be held somewhat below the breast level, so that the baby tilts his head back to open wide, and latches onto the underside of the areola first. One trick is to point your nipple at the baby’s nose, and when the baby opens wide and tries to latch on the underside of the areola, flip the nipple into the baby’s mouth. This technique often gets a deeper latch than pointing the nipple straight into the baby’s mouth.

When your latch is good, even if your nipples are sore, you should notice less pain during feedings. Traumatized nipples should heal quickly. If your baby’s suckling hurts like heck for more than just the first minute of feeding, you probably don’t have a deep enough latch. Use your pinky in the corner of the baby’s mouth to take the baby off the breast and try again.

COMFORT MEASURES FOR SORE NIPPLES

For ordinary soreness, or for increasing the comfort of traumatized nipples while they are healing, the following products are recommended:

  1. Glycerin gel pads can be chilled in the refrigerator, and cut into four pieces each to get the most out of each pad. They feel soothing, promote healing, and protect your nipples from friction while they are sore.
  2. Modified Lanolin nipple ointments. Long the stand-by for treating sore nipples, these ointments are derived from sheep’s wool and purified to remove allergens and contaminants.
  3. Natural nipple salves. For moms who want to avoid animal products and mineral oil, or who don’t like the goopiness of lanolin (or the fact that it can stain your bras), there are natural nipple salves from Earth Mama Angel Baby or MotherLove. These organic salves contain ingredients such as shea butter and calendula to help heal sore nipples, and they are safe in the quantities involved for your baby to ingest.

PREVENTING SORE NIPPLES

If you haven’t yet begun breastfeeding, there are some things you can do to minimize the risk of sore nipples.

Don’t bother using nipple creams before your baby is born or before you feel any soreness. Using such products once you do feel tenderness is just as effective as using them from the start, so have them on hand, but save the nipple cream for when (or if!) you need it.

Despite the common misconception that nursing less often is beneficial for preventing soreness, the opposite is truer. Nursing frequently or for long periods, with a proper latch, will not harm your nipples. But less frequent nursing can cause a couple of problems:

  1. Engorgement, leading to latching difficulties. When your breast is engorged with milk and tissues are inflamed, it can be very hard to get the baby latched on correctly.
  2. A very hungry baby who is difficult to latch on correctly without a lot of trauma to the baby, the mother, and the mother’s nipples

So, one way to help prevent sore nipples is to nurse often (at least 8-12 times/day), for as long as the baby wants. And, learn to recognize and respond to your baby’s early feeding cues, so you can feed before your baby is frantic.

WHEN TO GET PROFESSIONAL HELP

If you do not get relief within 48 hours from an improved latch, or if you are unable to obtain a better latch, there may be something more going on, and it would be appropriate to see a Lactation Consultant. There can be many reasons why you and your baby can’t get a good latch, from something simple to the more complex, and a Lactation Consultant can help you get it sorted out.

Safe Sleep Choices

By Meri Levy, MFT, CLE

Regardless of where you stand on the issue of bed-sharing versus cribs, there are safe ways and unsafe ways to put your baby to sleep. Here are some tips to help your baby sleep safely with or without you.

Crib Safety

The Problem: Over 9,000 children are brought to hospitals each year due to injuries suffered in cribs. An average of 54 children per year die from crib injuries.

How to Keep Safe: Avoid used cribs with corner post extensions, ill-fitting mattresses, wide slats, or other features that can cause injury. If you are not sure if a used crib is safe, don?t use it!

Features to Beware of:

    • Corner posts should not be higher than the end panels on the crib. Children’s clothing can get caught on extended corner posts and pose a strangulation hazard.
    • Space between slats must be less than 2 3/8″ and no slats should be missing.
    • All screws, bolts and hardware must be in place and tight to prevent the crib from collapsing.
    • Mattress must fit snugly so that two adult fingers cannot fit between the mattress and the crib side.
    • Do not use cribs with cutout designs in end panels. Child can strangle due to entrapment.

 

Crib Safety Tips:

  • Never put infants to sleep on fluffy, plush surfaces such as sheepskins, quilts, comforters or pillows.
  • Never fasten a pacifier around a baby’s neck
  • Never hang any object from a string where a baby could become caught it in and strangle
  • Never leave a child in the crib with the side rail lowered.
  • Remove crib gyms and mobiles when baby is able to push up on hands and knees
  • Keep drapes, ribbons, blind cords and wall hangings out of child’s reach
  • Make sure crib sheets fit securely. If they come loose, they can pose a strangulation hazard
  • Always put your infant to sleep on his or her back, unless your doctor directs otherwise

Safe Bed-Sharing

The problem:

The Consumer Product Safety Commission has warned parents against bed-sharing due to the risks presented by adult bedding and the concern that parents may roll over on their babies.

How to Keep Safe:

Make sure that your bed is a safe sleeping environment for a baby, and never allow a smoker or an adult who is impaired by drugs, alcohol or medications to sleep with your baby.

Bed-Sharing Safety Tips:

  • Always place your infant on its back to sleep. Do not use anything to prop or hold your baby in place.
  • Be careful when using certain medications, drugs or alcohol. If you or your partner are taking any substance that makes you drowsy, it is best to place baby in a crib next to your bed, to avoid the risk of mistakenly smothering your baby.
  • Avoid using fluffy pillows, stuffed toys, plastics and loose bedding, which pose a suffocation hazard. Place the baby on a firm flat surface which is covered by a tight fitting sheet ? even for naps.

Other tips for safe sleeping:

  • Do not let anyone smoke around your baby. Second-hand smoke affects normal infant breathing and can cause respiratory and other medical problems. Do not bedshare if you are a smoker.
  • Do not put baby to sleep on sofas, recliners, waterbeds, futons, or beanbags, even for naps.
  • Avoid overheating your baby. Your baby should be lightly clothed for sleep, and the temperature of your home should be kept comfortable for a lightly clothed adult. Your baby should not feel hot or moist to the touch.

For more information on safe sleeping, contact the Contra Costa SIDS Program at 925-313-6254. For more information on crib safety, contact The Danny Foundation at 1-800-833-2669.

Information for this article was provided by the Contra Costa SIDS Program and The Danny Foundation.

Why Wear Your Baby?

By Meri Levy, MFT, CLE

Increasing numbers of parents are discovering the joys of “babywearing,” using slings, pouches, wraps and other carriers. How does wearing your baby benefit both baby and caregiver?

Promotes Bonding

Wearing your baby encourages attachment, which is crucial to your baby’s emotional development. Keeping baby close encourages communication between baby and caregivers, and results in a greater sense of trust and security for your baby. Keeping baby close also encourages frequent breastfeeding, which improves the chances of breastfeeding success.

Reduces Crying and Colic

Many studies have shown that babies that are carried more, cry less. Whether your baby is colicky, fussy, or just cranky sometimes, frequent carrying in arms or in a carrier ensures less crying and a more comfortable baby.

Reduces Physical Strain and Allows Freedom of Movement

Using a carrier distributes your baby’s weight better, giving your arms a rest. For parents with carpal tunnel or tendinitis, this is much easier on the arms. And the benefits increase as baby gets older and heavier.

Carriers also allow freedom of movement and the ability to use your hands for something other than carrying your baby. Having a baby may mean feeling like nothing gets done, but having a hand free can mean getting a little more done, while keeping baby happy.

For more information on babywearing, visit the following sites:

www.TheBabyWearer.com

www.mothering.com

www.WearYourBaby.com

Starting Solid Foods

By Meri Levy, MFT, CLE

Breast milk or infant formula are adequate to meet all your baby’s nutritional needs until at least four to six months of age. Sometime between four and six months, depending upon your baby’s development, you may want to start introducing solid food. This does not mean that the milk feeding is no longer important. Most of your baby’s nutritional requirements should be met by the milk feeding until he reaches at least nine months to one year.

A full term, healthy baby receiving an adequate supply of milk will start needing iron from other sources by six to nine months of age, and may begin to require calories in addition to breast milk during this timeframe as well. In addition, some babies not started on solids by nine months or later may reject solid foods when offered.

Most babies will develop an interest in food between four and six months. This is the best time to start introducing solids. This is a developmental milestone, and signals that he is ready to begin the next stage of his life, exploring the wonder that is food. By the end of the first year, your baby will be taking 3 meals a day and one or two snacks, sitting at the table, eating table food and drinking from a cup. What a concept!

Breastfed babies tend to digest solid foods better and earlier than bottle-fed babies, because breast milk contains enzymes that help digest fats, proteins and starch. In addition, breastfed babies are exposed to a wide variety of tastes, since the flavors of many foods you eat pass into her milk. So they may more readily accept a variety of food offerings.

BEGINNING SOLIDS

When you are starting solids, most parents offer a cereal (such as rice or oatmeal) first, because it can be mixed with breast milk or formula, and therefore has a familiar flavor. The order in which you introduce foods, however, is a matter of choice. It is a good idea to introduce less allergenic foods first, to determine if your baby is highly sensitive, and to introduce one food at a time in the beginning, avoiding salt and other spices. If your baby does not like cereal, try something else. If the baby reaches for the potato on your plate, and he is tolerating foods well, it is fine to give him a little taste, and you can mash some up if he likes it.

Offer your baby the foods that he is interested in, as long as they are not a choking hazard or likely to be allergenic. Common allergens that you should avoid at first are nuts and nut pastes, beans, citrus fruits, strawberries, chocolate, corn, soy (unless your baby is on soy formula), eggs, and wheat. Egg yolks can be introduced at nine months, and egg whites at a year. For the other “no no” foods, use your judgment. If you have a family history of allergy or allergy-related conditions, such as hives, eczema, or asthma, you may want to hold off on these foods until a year, and chocolate and peanuts until age two, but if your baby has tolerated other foods well, introducing small amounts of wheat (after seven to ten months) and other likely allergens can happen earlier. If your baby reacts to something new, take it off his list for a couple of months and try it again with your doctor’s permission. Many food allergies in babies are outgrown fairly quickly.

Don’t worry too much about how much your baby eats, as long as he is tolerating his food well and getting adequate milk. Babies of this age will not overeat, and they will let you know when they want more. Past six months of age, soft foods do not need to be pureed — mashing with a fork is all that is necessary. Relax, feed the baby at your mealtimes, and as he becomes a more accomplished eater of solid foods, offer a greater variety of foods at a sitting.

The easiest way to provide your baby with iron after about five or six months is from meat. Infant cereal has iron, but it may be poorly absorbed, and can cause the baby to be constipated. Using a manual or electric food grinder at this time can be helpful, because it may be a while before your baby can chew meat.

There is no reason to introduce vegetables before fruit, unless you prefer it. Breast milk is far sweeter than fruit; so don’t worry that the baby will take vegetables better if they are introduced before fruit. Your baby will develop likes and dislikes regardless of the order in which you introduce new foods.

RELAX AND LET YOUR BABY BE THE BOSS

Many babies will, as they reach eight or nine months of age, become pickier about what and how they are fed. Your baby may want to feed himself. Offering small pieces of soft finger-foods is fine at this stage. Pull up the rug or put down a tarp and do deep breathing exercises, but respect his autonomy and worry about the mess later.

Feel free to respect your baby’s likes and dislikes, and remember that avoiding power struggles and stress regarding eating is the best way to ensure your baby will be a good eater (although temperament controls in this regard). There is no one food that is essential to your babies health (except the milk feeding). If there’s a food you prepare often that you would like him to enjoy, offer it occasionally, but don’t make it a big deal.

OFFERING SOLIDS OR THE BREAST FIRST

Many parent worry about offering the milk feeding or the solid foods first. To start out, if your baby is hungry, offer the breast or bottle first. This will make him more relaxed during his initial solid food adventures. Your baby doesn’t know that this stuff is food yet! After that, if breastfeeding or bottle-feeding and the introduction of solid foods both are going well, it is not necessary that they be provided in a specific order.

As long as the baby continues to take four to six milk feedings a day (three to four feedings by nine months, about 24-32oz of formula, if bottle feeding), there is no reason that a baby needs both breast or bottle and solids every time he eats. As the baby approaches one year, the milk feedings may drop off to two to four a day. You may also offer a cup of water during solid feedings, since many babies enjoy water at this stage. Don’t bother with sugary juices if your baby is happy with water: there’s plenty of time for those later! If your baby is breastfed, tap water (filtered if necessary) will provide your baby with some fluoride, which can help prevent cavities (juice does the opposite, of course).

Most of all, enjoy your baby’s discovery of food, and make mealtime as fun and relaxing as possible. Your job is to provide your baby with healthy food offerings, and his job is to eat what and how much he likes. It’s one of those small but important steps along his long path to independence.

Sources:

Starting Solid Foods, c. 2000, Jack Newman, MD, FRCPC, www.keepkidshealthy.com.

Child of Mine: Feeding With Love and Good Sense, c. 2000, Ellyn Satter, Bull Publishing Company.

Handling Unwanted Advice

One of the biggest challenges facing new parents is the deluge of advice forthcoming from parents, friends, and everyone who’s ever had a child, or has even observed a child once or twice.

We’ve all experienced it:

  • “You really have to stop picking him up whenever he cries, or you’re going to spoil him.”
  • “She’s hungry: maybe you don’t make enough milk. Why don’t you give her a bottle and see if she takes it?”
  • “He’s not dressed warmly enough. When my babies were small, I always made sure they had on three layers of clothing.” etc., etc.

How do you these often unwanted intrusions make you feel? For many new parents, unsolicited advice makes them angry. You have no doubt made your decisions about how to care for your baby very carefully, and it is upsetting to have another person second-guessing your decisions. It can also make you feel uncertain about your own decisions, or hurt because you see another person doubting your parenting ability.

Don’t Take it Personally

It is important to recognize that most people who offer advice do not intend to hurt your feelings or make you angry. They are only trying to help. They probably truly believe that taking their advice will benefit you and/or your baby. So take a deep breath, and try not to take it personally. It’s not about you.

That being said, you do not owe it to anybody to listen too carefully to their unsolicited advice. You have many resources available to you to make parenting decisions. You most likely have already considered the point of view they are expressing, and have decided after careful consideration to do things differently. This is your baby. You are the parent, and you are the decision-maker when it comes to parenting your baby.

Distinguish Between Advice-Givers

So, how to respond? Well, it depends upon who is giving the advice.

If the advice-giver is someone you don’t have an intimate relationship with: the dry-cleaner, the clerk at Starbucks, etc., don’t feel you have to respond by justifying yourself or getting into an involved discussion. If you are rude to the person, however, you’re going to be left with a sour feeling, so keep it as positive as possible. A smile and a “thanks for your input” can end the conversion quickly. Remember, it’s not your job to educate the masses or your responsibility to justify yourself.

If you do find yourself in the midst of a debate in this situation, you can end it with “I guess I just have to figure it out by myself.”

It’s more complicated, of course, when you’re talking about your mother or mother-in-law, your best friend, etc. In these cases, it often helps to remind yourself of the good qualities of this person. They probably just want to help you out, however misguided their advice. And even if you disagree completely with the advice-giver, try to see if you can see the issue from their point of view. Many of our mothers were discouraged from breast-feeding or holding the baby all the time. Perhaps your approach makes them feel their mothering was inadequate. They believe they did the right thing, so it may be hard to see you doing it differently. They have developed opinions from other sources, without considering the information you have. So, if unwanted advice is ongoing, you may want to ask questions to understand their point of view and gain a better perspective.

Sometimes it helps to share articles or portions of books you’ve read, to help the advice-giver understand that attitudes and expert opinion has changed on many of these practices. This is one way to help them understand that you are not merely rejecting their approach out-of-hand.

Be Confident and Keep Your Boundaries Clear

Bottom line, you are the parent here. It is often hard to feel confident about your parenting abilities when this is your first baby. But you are undoubtedly doing a wonderful, thoughtful job of it. And while your opinions and attitudes may evolve over time, you must at all times do what you feel is right for you and your baby. Having full confidence in yourself and your decisions is especially important when you’re responding to advice from others.

Keep your boundaries clear. Do not feel you need to engage in debates, arguments, discussions, etc. with advice-givers. You do not have to justify your opinion, because you are the parent of your baby. If you are interested in what they have to say, ask them about it, without defending or justifying your own point of view.

If you really want the person to understand your approach, explain your perspective briefly, and acknowledge that there are many “right” ways care for a baby. Let them know that you have chosen yours for a reason. But don’t expect to be able to convince others that you are right. They are entitled to their point of view, and you will drive yourself crazy if you try to get their approval. If you want some affirmation, talk to a like-minded friend (or your mom’s group!) instead.

To end this kind of discussion, it sometimes helps to say: “I love you and really appreciate your input, but we need to make our own decisions about what is right for our baby. I’ll let you know when we need some advice.” And believe it or not, you may just want help or advice from this person when it comes to teething, baby-proofing, toilet-training, etc., so don’t knock those advice-givers completely!