Ask an Expert: I’m Afraid She Isn’t Getting Enough

Fan Question: My daughter was 5 weeks early and spent 9 days in the NICU. I pumped and then we began breastfeeding but she latched only for a short time, which we followed with bottles. A month later she’s latching better, but even if she nurses for a while, she still seems hungry and may take a 2 oz bottle. I’d like to EBF, but I am afraid she is not getting enough.

NANCY MOHRBACHER, IBCLC: Breastfeeding is in large part a confidence game. Keep in mind that babies’ feeding patterns differ when fed by breast and bottle. If a breastfeeding baby acts hungry, just go back and forth from breast to breast as many times as she wants. Unlike a bottle, your breasts are never empty. It’s not uncommon for a baby this age (your baby is now a full-term newborn) to spend the whole evening nursing. Try just going with it. The shortest distance between where you are now and EBF is to devote a few days to keeping your baby on the breast as much as possible. You will know she’s getting enough milk if her number of wet diapers and poops per day stays the same and if your breasts feel comfortable. (If she isn’t taking enough you would feel fuller and fuller over time.) If you want more reassurance, arrange for weight checks at her MD’s office or rent a Medela BabyWeigh scale for a week and do daily weight checks at home. (Go to http://www.medelabreastfeedingus.com/bnnsearch, enter your zip code, click on the “Rent Products” tab, and then on BabyWeigh Scale.) Babies younger than 3 months typically gain about an ounce per day. If needed, you can also eliminate bottles and reinforce breastfeeding by supplementing her at the breast. For help with this, consult a lactation consultant near you by going to www.ilca.org, click on the “Find a Lactation Consultant” link, and enter your zip code. I know you can do it! 
unnamedNancy Mohrbacher, IBCLC, FILCA is a board-certified lactation consultant in the Chicago area who has been helping breastfeeding families since 1982. Her books for professionals are used worldwide. Her books for parents include Breastfeeding Made Simple: Seven Natural Laws for Nursing Mothers, which she co-authored with Kathleen Kendall-Tackett, and her tiny problem-solving guide, Breastfeeding Solutions In 2013, Nancy released her Breastfeeding Solutions smartphone app (available for Android and iPhones) to give mothers a quick, go-everywhere source of breastfeeding help. Nancy speaks at events around the world.

Ask an Expert: Dairy and Elimination Diets

I’ve been on a dairy elimination diet for several months. What is the best way to determine if by baby still reacts to dairy? Are there certain dairy products (cheese, butter, cream) that are easier for the transition back to dairy?

NANCY MOHRBACHER, IBCLC: The good news about a dairy sensitivity is that most babies outgrow it by about 6 months, some sooner. The most reliable way to know if your baby still reacts to dairy is to do a challenge. This means you consume dairy and watch for a reaction, which should occur with 24 hours. If baby reacts, you need to wait longer to introduce dairy back into your diet. Typically, babies react to the protein in dairy, so butter (which is mostly fat) is a good place to start. Cheese and yogurt tend to produce less of a reaction because they have undergone processing. If you try one of these dairy products and see no reaction, a glass of straight cow’s milk should tell you for sure whether or not your baby is ready for you to go back to your regular diet.
unnamedNancy Mohrbacher, IBCLC, FILCA is a board-certified lactation consultant in the Chicago area who has been helping breastfeeding families since 1982. Her books for professionals are used worldwide. Her books for parents include Breastfeeding Made Simple: Seven Natural Laws for Nursing Mothers, which she co-authored with Kathleen Kendall-Tackett, and her tiny problem-solving guide, Breastfeeding Solutions In 2013, Nancy released her Breastfeeding Solutions smartphone app (available for Android and iPhones) to give mothers a quick, go-everywhere source of breastfeeding help. Nancy speaks at events around the world.

Ask an Expert: Oversupply and Block Feeding

I’m a first-time mother who has been struggling with breastfeeding for 6 months. First I thought my daughter’s constant pulling off and crying were due to low milk supply but when I took fenugreek, it got worse. I wonder if our issue might be oversupply. Is it too late to fix this problem?
NANCY MOHRBACHER, IBCLC: I’m sorry you two have had such a rough time! Your experience is proof that there really CAN be too much of a good thing. It’s definitely not too late! Many mothers end up with oversupply when they’re too diligent about pumping. How can you be sure of the cause of your problem? Your baby’s weight gain will tell you. If she is gaining twice or more the expected weight gain of 1 oz. per day during her first 4 months, it’s time to consider bringing down your milk production. If her weight gain is average, instead, consider it a milk-flow issue and adjust your nursing position so gravity gives her more control over the flow. See my blog post, The Dos and Don’ts of Block Feeding, for the specifics about these strategies.
unnamedNancy Mohrbacher, IBCLC, FILCA is a board-certified lactation consultant in the Chicago area who has been helping breastfeeding families since 1982. Her books for professionals are used worldwide. Her books for parents include Breastfeeding Made Simple: Seven Natural Laws for Nursing Mothers, which she co-authored with Kathleen Kendall-Tackett, and her tiny problem-solving guide, Breastfeeding Solutions In 2013, Nancy released her Breastfeeding Solutions smartphone app (available for Android and iPhones) to give mothers a quick, go-everywhere source of breastfeeding help. Nancy speaks at events around the world.

Ask an Expert: Frustrated at the Breast

Fan Question: Sometimes my baby gets frustrated at the breast and won’t latch on. I’ve been breaking down and giving him a bottle of formula. What else can I do?

NANCY MOHRBACHER, IBCLC: What a worry! The most important thing is not to let your breast become a battleground. If your baby is fussy, walk him, rock him, and comfort him in other ways rather that fighting at the breast or giving the bottle. What may help after he calms is to get into a semi-reclined position (try the position you use to watch TV), and lay him tummy down on your body. That triggers your baby’s inborn feeding reflexes, and he should start to bob around looking for the breast. This can even work when he’s drowsy or in a light sleep, which you can recognize by eyes moving under eyelids or other movements. These more natural breastfeeding positions often make it easier for babies to latch. Plus baby’s full frontal contact with you is calming and acts like a GPS, telling him where he is and what to do. To read more about this, see my blog post on laid-back breastfeeding.

unnamedNancy Mohrbacher, IBCLC, FILCA is a board-certified lactation consultant in the Chicago area who has been helping breastfeeding families since 1982. Her books for professionals are used worldwide. Her books for parents include Breastfeeding Made Simple: Seven Natural Laws for Nursing Mothers, which she co-authored with Kathleen Kendall-Tackett, and her tiny problem-solving guide, Breastfeeding Solutions In 2013, Nancy released her Breastfeeding Solutions smartphone app (available for Android and iPhones) to give mothers a quick, go-everywhere source of breastfeeding help. Nancy speaks at events around the world.

Ask an Expert: Should I Wake My Baby to Eat?

Fan Question: My first baby will be born soon and I’m wondering if I should wake my baby to nurse at night or if I should wait until he wakes to breastfeed.

NANCY MOHRBACHER, IBCLC: The answer is “it depends.” You need to know first if your baby is feeding effectively. His weight check at 2 weeks should answer that question. If his weight gain is good (at birth weight or gaining about 1 oz. per day), you can stop paying attention to the time and wait for him to wake you at night. During the first 2 weeks, it’s fine if your newborn sleeps for one 4- to 5-hour stretch, as long as he is nursing at least 8 times during the rest of the day. If your baby is gaining weight well, you don’t have to worry about the other details. Once he’s proven that he’s an effective feeder, you can trust your baby to let you know when he needs to feed. If a healthy baby sleeps a lot at night, he will just “cluster nurse” during the day to make up for lost time. Good luck!

unnamedNancy Mohrbacher, IBCLC, FILCA is a board-certified lactation consultant in the Chicago area who has been helping breastfeeding families since 1982. Her books for professionals are used worldwide. Her books for parents include Breastfeeding Made Simple: Seven Natural Laws for Nursing Mothers, which she co-authored with Kathleen Kendall-Tackett, and her tiny problem-solving guide, Breastfeeding Solutions In 2013, Nancy released her Breastfeeding Solutions smartphone app (available for Android and iPhones) to give mothers a quick, go-everywhere source of breastfeeding help. Nancy speaks at events around the world.