Wednesday, February 23, 2011

Getting an Older Baby to Breastfeed

There are situations when a mother has an older baby, a baby beyond the newborn stage, who is not breastfeeding. It may be an adopted baby. It may be the case of a child who has weaned and the mother wants to get the baby breastfeeding again. Whatever the reason, there are ways to help transition an older baby, or even toddler, to the breast. has some good information on getting baby to the breast. She suggests that, especially with an older baby, you think about coaxing baby to the breast. These are just a few of her suggestions:

Your goal is to coax baby to the breast. Do not attempt to force your baby to breastfeed. Forcing baby to the breast does not work, stresses baby, and can result in baby forming an aversion to the breast. As baby gets better at nursing and is able to get more milk via nursing, he will grow to trust that breastfeeding works and will have more patience when latching.

  • Lots of skin-to-skin contact can help your baby nurse better and even gain weight faster. Keep your baby with you as much as possible, and give him lots of opportunities to nurse (even if you're not successful). Get skin-to-skin with him, first when he is sleepy, right after a bottle feed (or however you're supplementing). This way baby has the opportunity to sleep and wake up happily, skin to skin at mom's chest, and mom is right there to catch the earliest hunger cues. If baby moves toward the breast and then falls asleep before even mouthing the nipple, or after sucking twice, then these are positive baby steps, not failures.
  • Carry your baby close to you ... "Wear," carry, hold and cuddle your baby as much as possible; carry baby on your hip while doing other things, play with baby, and give baby lots of focused attention.
  • Sleep near your baby. If baby sleeps with you, you'll get more skin-to-skin contact, plus baby has more access to the breast... If baby is not in the same bed, have baby's bed beside your bed or in the same room so that you can catch early feeding cues, breastfeed easier at night, and get more sleep.
  • Nipple shields can be helpful at times for transitioning baby to the breast. Talk to your lactation consultant about using this tool.
  • Comfort nursing is often the first to come, followed by nutritive nursing. Offer the breast for comfort any time you see a chance- at the end of a feeding when baby is not hungry, when baby is going to sleep or just waking up, when baby is asleep, and whenever he needs to comfort suck If your baby is actively resisting nursing, then try encouraging comfort nursing after baby is comfortable with skin-to-skin contact. After baby is willing to nurse for comfort, you can then proceed to working on nursing for "meals" as well. You are working to seduce your baby back to breast. Again, coax, don't force!

    There are more things you can try:
    • Offer the breast when he is not hungry.
    • Try giving him most of his feeding by bottle and then switching over to the breast.This is known as the Finish at the Breast method.
    • You can change the way you bottle feed to help the transition. There are methods of bottle feeding that are more supportive of breastfeeding.

    SNS At Breast Supplementer

    If you have tried all of the suggestions above, without success, there is another approach you can try. I will describe steps in a method that is often used to teach older infants to breastfeed. How quickly you go through these steps will depend upon how your baby is responding. You will need an at breast supplementer to do this.

    Lact-Aid At Breast Supplementer
  • First, only mom feeds the baby (both solids and bottles). Baby is always held by mom when being fed.
  • Don’t allow baby to hold his own bottle. If baby is used to holding his own bottle you may need to gradually get him used to you holding it. Put a sock over it so that it looks more like a piece of clothing than a bottle.
  • When baby is comfortable with mom holding the bottle, and being held by mom while feeding, you are ready to try the at breast supplementer (abs). The first step is to thread the tube of the abs through the bottle nipple he usually takes, and feed him that way (you can use a tapestry needle to thread supplementer tube into the nipple, it only needs to stick out a little).
  • Next, move the bottle nipple over your own nipple. Once he is comfortable sucking on the nipple with the abs over your nipple you are ready to try and move him to your breast. Toward the end of the feeding try and switch him to your breast.
  • Once you get baby to latch on to the breast directly, you may try to feed at first with the abs (even if you have a good supply) as baby may like the faster flow he is used to getting from the bottle.You can eventually wean off of the abs (usually very quickly if you have a good supply).
Here is how one mother describes her progress:

From Child of My Heart
All the next day I bottle-fed him in the nursing position. He was content, but I found it so awkward. Breastfeeding leaves you with one hand free, and I'd never really realized that bottle-feeding takes two hands! The next day I began to work on the gradual transition to the breast. My first step was to thread the tiny tube of the nursing supplementer through the same type of bottle nipple he was used to. Then I placed the bottle nipple (without the collar) over my breast for the feeding. This way Joshua got used to being against my skin, while still sucking on his familiar bottle nipple. His formula now flowed from the supplementer rather than the bottle and to all outward appearances, he was breastfeeding.

Another mother describes their progress:

From We Are Breastfeeding
During the third week, I began put the tube of an at-breast supplementer next to the bottle nipple. I planned to put this tube next to my nipple while breastfeeding so he could get more milk at the breast. He needed to get used to that idea, so I pulled the tube through the bottle nipple with a needle, and then filled the supplementer bag with milk... ...At the end of the third week I put the bottle nipple closer to my breast and then right over my breast. Then I could move him toward me into a breastfeeding position. We were almost breastfeeding even though he had not yet latched on. He got milk from me while being held in my arms. He felt my skin next to his belly. He felt my breast against his cheek. He looked into my eyes. He smiled back at me.

Sunday, February 6, 2011

Milk Sharing: Good or Bad?

There is no question in my mind, and in most people's minds: Breastmilk is better for babies than formula. Human breastmilk is specifically designed to meet the needs of human infants. There is no changing that fact. As "good" as formula has become in the last 50 years, it still has only a fraction of the ingredients that are found in breastmilk, and none of the live cells and antibodies found in breastmilk.

Clearly I am a strong proponent of breastfeeding and feel that breastmilk is the best food for human infants. Milk sharing is big in the news right now. Even the mainstream media has picked up on the buzz about milk sharing websites such as Eats On Feets and Milk Share. So why am I feeling a little it uncomfortable about the huge rise in popularity of milk sharing?

I am not uncomfortable about the risks of milk sharing. I believe that, in most cases, the risks of formula are greater than the risks of donated milk. Nancy Mohrbacher has an excellent article on this: Should Milk Sharing Among Mothers Be Encouraged?

I'm not against moms sharing milk. In fact, have used donor milk (from friends) with two of my babies. I was forced to "pump and dump" for 48 hours due to a less than ideal choice on medication by an ER doctor when my son was only 2 1/2 months old and exclusively breastfed. I had some milk in the freezer, but it wasn't quite enough to make it through. Not wanting to compromise his virgin gut, I requested some milk from a couple of friends who were currently breastfeeding. My adopted baby was on formula while I was working to bring in a milk supply for her, and I gladly accepted some donations of milk from two friends to replace some of the formula.

In some of the stories I have read about moms who have used donor milk, I got the feeling that it was "okay" to "give up" on breastfeeding, because they would be able to get donor milk for their baby. Is donor milk the new "formula"? This is a concern with the explosion in milk sharing. My concern is that moms will give up too easily thinking that donor milk is "just as good". What have moms been told for years when breastfeeding got hard? "It's okay, formula is just fine." Will the new mantra become, "I'ts okay, he will still get breast milk, and that's just as good."?

Our culture seems to sing the praises of "breast milk" more than "breast feeding". Breastmilk IS the best food for babies, but it is not the best thing for babies, that is breastfeeding. When you look at the feeding recommendations from the World Health Organization (WHO) you will find that the first choice for infant feeding is breastfeeding. If that is not possible the choices are:
  • “The second choice is the mother's own milk expressed and given to the infant in some way.
  • The third choice is the milk of another human mother.
  • The fourth and last choice is artificial baby milk (infant formula)”

So, while donor milk is certainly better than formula, it is still pretty far down the list, just one above formula. With the wide availability of donor breastmilk, all we have is another widely available substitute for breastfeeding. While most infants will do just fine on commercial formula (you don't have to go far to hear "My baby was formula fed and he is fine!"), there are babies, who for a variety of reasons, really need human breastmilk in order to grow and thrive.

Breast milk feeding does NOT have the same benefits as breastfeeding, as I talked about in my post It's Not About the Milk. Even the milk itself is not as beneficial. For example, breast milk has the highest level of antibodies when baby takes it directly from the breast, and is second-best when it is freshly pumped. The mother's body actually responds to her baby’s saliva to make milk that is just right for him. If baby is exposed to something that he needs antibodies for, this is how the mother's body “learns” to make those antibodies for him. The longer the milk is stored, the more of these antibodies are deactivated. Freezing destroys even more antibodies. (Frozen milk still provides excellent nutrition and protection for your baby, just not as good as directly from the breast or freshly pumped.)

What is needed much more than another substitute is to help the mothers who want to breastfeed to be successful. The reality is, most of the mothers who "can't" breastfeed could be successful with the right information and support. The numbers just don't work out for moms who "need" to supplement. According to the Centers For Disease Control (CDC) as of 2007, only 33% of breastfed babies are breastfed exclusively, without supplements, at three months old. This is not hard to believe when you find out that, even though only a small percentage of newborn babies have a true medical need for supplements in the first few days, currently approximately 50% of newborns born in California are getting formula supplements in the first days of life in the hospital. Moms who want to breastfeed exclusively are being set up to fail.

This issue of milk sharing is of particular interest to me. As I said before, I have given two of my babies donated milk. I have also been in the situation of being handed a newborn baby when I had no milk of my own to give. As I struggled to induce lactation I came to a conclusion: Given the choice I would rather "breastfeed" my baby with formula, than bottle feed my baby with breastmilk. Why? Bottle feeding is a feeding method, breastfeeding is a relationship.

Bottom line, my biggest concern is that all of the hype about the benefits of milk sharing will draw the attention even closer to the "breast MILK" is best idea, and away from the "breast FEEDING" is best view.

What do you think?