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Daily Dose

Foods You Can Eat When Breast Feeding

1.30 to read

Should breast feeding moms avoid certain foods?I was making hospital rounds today and talking to all of the new moms (and dads) about their newborns.  I love talking to new parents about the importance of having healthy meals to support breast feeding! I even had a young dad asking “what foods should I avoid cooking for my wife while breast feeding?”  How cute is that! Can we clone him?!

After breast feeding my 3 children, I have decided that you can really eat whatever you want!  I know some people swear that certain foods you eat will cause a breast fed baby to have gas. But think about it, bottle fed babies and breast fed infants all have GAS!  None of the formulas contain broccoli, or cauliflower or beans or tomatoes and bottle fed babies have gas too. It is just a fact, newborn babies are gassy for the first several months as their digestive tracts mature. And yes, it is stinky too! So… I told this dad, “good for you for cooking for your wife.  Make her healthy, well balanced meals and throw in a few of her favorite foods.”  I would not change anything unless you can definitely correlate that a food ALWAYS makes your baby more uncomfortable (and that is so hard to keep track of). Eat what you want (in moderation) to be healthy and happy.  I have no data but feel certain that happier mothers must in some way have an effect on a  baby, so at least enjoy mealtime. When I had a colicky baby (previous post), I tried eating only broth and bland foods, and with me equally miserable and starving…this stressful situation only got worse. Final words, if I was going to try eliminating anything from my diet while breastfeeding to try and help “relieve “a gassy baby, it would be excessive dairy, as there has been some data on this. Remember, everything in moderation. I’m willing to bet that by the time your baby is 4 months old (the magic age) you are not even worried about what you are eating, as you are having too much fun laughing with your baby! What foods (if any) bothered your baby while breast feeding? I would love your comments.  Leave them below. That’s your daily dose for today. We’ll chat again tomorrow.

baby, breast feeding, Daily Dose, mom
Daily Dose

Breast-feeding is ‘On the Job Training’

So many of my mothers breast feed their babies and enjoy the experience. I think it is a little harder to breast feed in the early days after the your-baby is born, as your milk "comes in" and you deal with sore, full breasts as well as little sleep. Even with a well-prepared mom who has read all of the books, and practiced with dolls in different holds, real breast-feeding comes from "ON THE JOB TRAINING." But, over the next few weeks as the milk supply is established it will become much easier to breast feed and both mother and your-baby get the hang of nursing.

Saying this, it is not always possible for every mother to be successful at breast-feeding and not every mother wants to breast feed her your-baby. Although breast milk is ideal for an infant, formula works well too. The most important thing for your your-baby is for you to be a happy mother. Numerous studies have corroborated this fact, and if mother is happy, your-baby will thrive on breast milk or formula. When I discuss this with many mothers who are unhappy nursing, or are not making sufficient milk to provide enough calories for their your-baby to gain weight, there is such a sense of relief. Guilt is part of being a parent (seems especially so in us moms) but to start off your parenting feeling this way is not good for anyone. Do what is best for you and your child, and don't feel pressured by family, friends or coworkers. Lastly, there are all sorts of ways to successfully provide both breast milk and formula for your your-baby, so discuss your options with your doctor before feeling like a failure or stressing out. Just like babies, moms are all different too. That's your daily dose, we'll chat tomorrow.

Daily Dose

Breast Feeding Woes

1:30 to read

I recently read an editorial in The New York Times entitled “Overselling Breast Feeding”. It was written by Courtney Jung who is a professor of political science at the University of Toronto.  It was quite interesting to me as she stated “the moral fervor surrounding breast feeding continues unabated, with a steady stream of advocacy and education campaigns”.  The WHO (World Health Organization) developed “ten steps to successful breast feeding” in hopes of increasing breast feeding initiation and duration around the world. Hospitals have been designated “Baby-Friendly”  (aren’t they all supposed to be?)  if they adhere to these steps as well. But the United States has done well with breast feeding rates as 79% of mothers initiate breast feeding.

Most, if not all of the new mothers I make rounds on are proponents of breast feeding. They have read the books, gone to classes and are determined to be successful at breast feeding. But, in my experience over the last several years, I have actually seen more and more new mothers becoming over-wrought and wary of breast feeding fueled by the “rules” that they are being required to follow. With that being said, having someone “tell you that you must breast feed your baby in the first hour after birth”, and that “your baby must remain in your room 24 hours a day“, and that they “may not have a pacifier”, “and should “breast feed on demand” is actually anxiety promoting and leaves many a new mother exhausted and tearful within a day or two of having a baby. 

While breast feeding is “natural” it also requires some practice and the only practice is really “on the job” training.  Some babies just latch on quickly and are pros immediately, but not all babies will become proficient at breast feeding in the first day or two. The mothers are told to “let the baby nurse on demand” and some mothers have had their babies at the breast for hours on end and are exhausted, with sore and bleeding nipples. I have walked in to too many hospital rooms with a mother in tears and a fretful baby, and a “helpless” new father.  Some feel as if “they are failures” as mothers before they even are discharged, and at the same time are having serious doubts about continuing to breast feed.  They are sure that their baby will catch serious illnesses and have a lower IQ if they don’t breast feed, but how can they maintain this constant breast feeding and no sleep and never put a pacifier in their baby’s mouth??? Is there only one way to be successful at breast feeding?

I loved breast feeding but it was a long time ago and we were instructed by caring nurses “to just go home and put the baby to the breast every 2-3 hours”. While that may not have been the best education has the pendulum swung too far?  Will giving the baby one bottle when a mother is having postpartum anxiety and sleeplessness really harm the baby?  Should a mother have to sign an order allowing her baby to have a pacifier??   While guidelines for breast feeding are helpful should they be so rigid that a mother “gives up” on breast-feeding because she can’t follow 10 steps in the first 24-48 hours?   

The New York Times article was quite interesting and I had to agree with many of the author’s  points. Supporting a woman’s choice to breast feed is admirable and “policy changes promoting maternity leave, and flexibility” are definitely needed to encourage women to continue to breast feed. But as she states “is all of this breast feeding advocacy crossing the line?”   A mother should choose to breast feed because she wants to, and that does not mean if her baby does not breast feed in the first hour that she will never bond with her baby or be successful at breast feeding.  Some woman are unable to breast feed for a multitude of reasons and that decision should not label her as a “bad mother”.  Again, breast feeding, like a woman’s breast, is not “one size fits all”. 

 

Daily Dose

Foods You Can Eat When Breast Feeding

1.30

Should breast feeding moms avoid certain foods?I was making hospital rounds today and talking to all of the new moms (and dads) about their newborns.  I love talking to new parents about the importance of having healthy meals to support breast feeding! I even had a young dad asking “what foods should I avoid cooking for my wife while breast feeding?”  How cute is that! Can we clone him?!

After breast feeding my 3 children, I have decided that you can really eat whatever you want!  I know some people swear that certain foods you eat will cause a breast fed baby to have gas. But think about it, bottle fed babies and breast fed infants all have GAS!  None of the formulas contain broccoli, or cauliflower or beans or tomatoes and bottle fed babies have gas too. It is just a fact, newborn babies are gassy for the first several months as their digestive tracts mature. And yes, it is stinky too! So… I told this dad, “good for you for cooking for your wife.  Make her healthy, well balanced meals and throw in a few of her favorite foods.”  I would not change anything unless you can definitely correlate that a food ALWAYS makes your baby more uncomfortable (and that is so hard to keep track of). Eat what you want (in moderation) to be healthy and happy.  I have no data but feel certain that happier mothers must in some way have an effect on a  baby, so at least enjoy mealtime. When I had a colicky baby (previous post), I tried eating only broth and bland foods, and with me equally miserable and starving…this stressful situation only got worse. Final words, if I was going to try eliminating anything from my diet while breastfeeding to try and help “relieve “a gassy baby, it would be excessive dairy, as there has been some data on this. Remember, everything in moderation. I’m willing to bet that by the time your baby is 4 months old (the magic age) you are not even worried about what you are eating, as you are having too much fun laughing with your baby! What foods (if any) bothered your baby while breast feeding? I would love your comments.  Leave them below. That’s your daily dose for today. We’ll chat again tomorrow.

Daily Dose

Lactose Intolerance

How do you know if your child is lactose intolerant?A parent emailed me via our iPhone App and asked if her child’s constipation, which started as he was transitioning from formula to whole milk, could be a sign of lactose intolerance. She is concerned because her son is now having very hard stools.

Actually, lactose intolerance does not typically cause constipation, but conversely causes abdominal pain and often loose stools or diarrhea.  In the case of this 1 year old child who suddenly is having hard stools, it may seem to be “caused” by the switch from formula to whole milk, but is probably coincidental. It is routinely recommended that parents stop giving a child a bottle and formula at 1 year, which often results in a toddler drinking less milk (recommended amount is about 16 ounces /day) and therefore they are getting less fluid which may result in harder stools. This is also the age that children’s diets are changing as they are self feeding and often eat a lot of carbohydrates (breads, noodles, rice etc) and fewer fruits and vegetables, even when offered as they become “pickier” eaters. All told this often leads to bouts of constipation that can be managed with the addition of more fluids as well as clever ideas such as apple prune juice, bite sized prunes (often can be “sold” as raisins to a young child) and even with milk of magnesia if necessary. (see older posts on constipation) Lactose intolerance is defined as the inability to digest lactose which is a sugar found in milk and milk products.  It is due to a deficiency in the enzyme lactase, which is produced by cells lining the small intestine.  Lactose intolerance is uncommon in young children and is typically not seen before the age of 2 -3 years.  It is more common in older children and teens who may complain of abdominal pain, cramping, gas, bloating and diarrhea after ingesting dairy products. In most cases lactose intolerance is diagnosed on clinical history alone, and if suspected is managed by eliminating dairy products to see if the symptoms improve.  In many cases even children with a lactase deficiency may tolerate some lactose in their diet such as a scoop of ice cream, or milk on their cereal, but only experience symptoms when they have “too much milk”. Fortunately, there are products, such as lactose free milk, which will provide a child with the necessary vitamin D and calcium which is so important during childhood. Dietary supplements should also be used in children who do not drink milk in order that they meet their daily calcium and vitamin D requirements. Lastly, lactose intolerance is different than a milk allergy which is fairly uncommon and is due to an allergy to the proteins in milk, not the lactose.  True milk allergy usually presents in early infancy. That's your daily dose.  We'll chat again tomorrow! Send your question to Dr. Sue!

Daily Dose

Make Breastfeeding Enjoyable, Not Hard Work

The New Year is off to a quick start and my office is busy with so many new babies. Such fun, and happily most of my new babies are being breast fed, which is the best source of nutrition for a new baby.

The most interesting phenomena to me is that over the last year or so I have noticed many young mothers are “breastfeeding” their babies, but they really just pump breast milk and then give the expressed breast milk to their baby in a bottle. Now, in some circumstances, such as an infant in the NICU, or a baby who has difficulty with sucking and swallowing, it may be a necessity for a mother to pump her milk and then the milk is given in a bottle to the baby. But, these are perfectly healthy babies, and the mothers really want their babies to receive breast milk, but the moms are so concerned about the amount of breast milk that their baby is getting that they want to pump and measure it and quantify their baby’s intake. What happened to just putting the baby to the breast and feeding the baby every 2 -3 hours? I know I must be getting old, but half of the fun and enjoyment from breastfeeding came from having skin to skin contact with the baby, as well as the ease of just lifting the nursing bra and putting the baby to the breast. I don’t think I even thought about pumping breast milk until I was heading back to work. I never really “knew” how much milk they received, but they were nursing and gaining weight and I guess I just “believed” that it would all work. Now, it seems that so many of my young mothers cannot stand not knowing how much milk their baby is getting, even if they are gaining weight and are thriving. They just want to quantify every ounce and it makes them feel better to pump and then bottle-feed. That just seems like SO much work to me. It is not an exact science. Sometimes they probably receive a different amount of milk than at other feedings, but an infant is like the rest of us in that they too may eat different amounts. I use the analogy of “sometimes I order a salad at lunch and sometimes a double cheeseburger” it just depends how I feel that day. Your baby is the same; he or she does not “have” to take the same 4 ounces at every feeding. That is the wonder of breastfeeding; you just nurse for 10 to 15 minutes per side and “voila” the baby wets and poops and gains weight. Unless there are problems with weight gain it really doesn’t matter how much the baby gets at every feeding. It is not an exact science. This concept of breastfeeding and not knowing the exact amount has been driving many new mothers crazy, as they want to put the exact amount down for each feeding and are “sure” if their baby only took 4 ounces instead of 3 that their baby would sleep better. The parents have also been able to enter all of this information into their iPhones and they have spreadsheets and calorie counts to show me. What I wouldn’t have done for that when I was a resident and had to calculate how many calories a sick baby had eaten in the last 24 hours. Again, this was only done for sick babies in the hospital, not a healthy newborn or infant. Too much information is not always better. Relaxing and enjoying your baby is so important. Try to make it easier rather than harder, and just nurse your baby and pump occasionally to give the baby a bottle if you plan on being out, or just need to take a relaxing bath and let your husband feed the baby. But counting every ounce and calorie in a normal healthy newborn and measuring breast milk for each feeding is not necessary. And you know what, the baby will not sleep any better either! That’s your daily dose, we’ll chat again tomorrow.

Daily Dose

Supporting Moms in Their Quest to Breastfeed

A recent article in Archives of Pediatrics reviewed pediatrician's attitudes, knowledge and practices surrounding breastfeeding. They looked at surveys pediatricians completed in 1995 and 2004 and compared the results. It was interesting that in spite of increased knowledge and even personal experience with breastfeeding, pediatrician's attitudes toward breastfeeding have deteriorated between 1995 and 2004.

But, concurrent with the drop in pediatrician's attitudes, breastfeeding rates in the U.S. have actually been on the rise. This may be due to other factors such as hospital policy and support for nursing mothers. The American Academy of Pediatrics recommends that infants be exclusively breastfed for the first six months of life, and recommends continuing breastfeeding along with solid foods, until one year of age. The take home message for me is that we pediatricians need to continue to support new mothers in their quest to successfully breastfeed. For some mothers (I was not one of these) breastfeeding just happens, and is easily established, but for others it is "on the job training" and requires a village to get the your-baby to the breast. My friends who already had babies laughed at me when I "wondered if my milk was in?" as this is not something you learn in medical school or residency. They were all correct; you will know when it does! But practice, practice, practice will usually get even the most stubborn your-baby to the breast and for most mothers breast feeding gets going and all is well. That being said, there are mothers who do not feel comfortable breastfeeding, or have inadequate milk supply and the your-baby is not gaining weight, or have post partum complications that impede breast feeding. In my opinion, it is my job as their pediatrician, to support new parents (and I guess in this case, specifically the mother) in her decision to breastfeed or not. The most important factor for any newborn is maternal-infant bonding. That bonding comes with a sense of maternal well-being, and a mother should NOT be "guilted" into breastfeeding if she chooses otherwise. Parenting is a long haul, and this issue is just the first of many that does not have a 100% right answer. One size does not fit all. That's your daily dose, we'll chat again tomorrow.

Daily Dose

Breastfeeding Needs Patience & Practice

It is not uncommon for many new mothers to be concerned and breastfeeding and also finding it to be a little more challenging than the books would say.Those first several days home with a newborn can be very difficult and not exactly like the Gerber your-baby on TV. I typically see a newborn in my office several days after they are discharged from the hospital, so day four to six of life. That gives parents several days to have been home alone with their your-baby and then the questions begin.

It is not uncommon for many new mothers to be concerned and breastfeeding and also finding it to be a little more challenging than the books would say. The first thing I tell them is that there is not a book that will provide the same information as on the job experience (kind of like the rest of parenting!) Breast feeding may take a bit for both your-baby and mother to get used to, new job for both, and don't let that discourage you. I found the person who was most helpful getting me comfortable with breastfeeding was a friend who had done it before and who was a cheerleader for me. The adage practice, practice, practice is important here, and you will make breast milk (trust me on this one) and your your-baby will get the hang of it, but be patient. It can bring even a CEO new mother to tears but this is not like running a business, the your-baby has their own agenda, and despite your best intellectual efforts this event is based on patience and persistence, not IQ. By day four to six a mother should have breast milk and you should see that your your-baby is having wet diapers and that their stools are changing from dark, sticky meconium to yellow, seedy stools. There are usually numerous stools and wet diapers as the your-baby picks up their nursing and "gets the hang of it". Don't be alarmed if every feeding does not go as smoothly as the next, the your-baby is just like you, eats more some times than others. The important things are to get the your-baby to the breast every two to three hours, for the nursing mother to drink lots of fluids and to eat well. Lastly, both your-baby and mother need rest, so hop back in bed between feedings. That's your daily dose, we'll chat again tomorrow.

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