Are you an employed or student mom who just so happens to be breastfeeding your baby, or a breastfeeding mom who is employed or attends school full time? Whether you identify more with your role as a breastfeeder or an employed/student mom, your pump is the lifeline that connects you to your baby when you are separated. Love or hate your pump, wouldn’t it be a dream to minimize the amount of time and effort that goes into the ritual of pumping?
Time Saving Tricks
- Enlist help: If your partner is looking for a way to lighten your load, a great way to support you is to take on the nightly duty of washing your pump parts and packing your pump bag for the next day.
- Go hands free: A hands-free pumping bustier allows you to get your regular work done while expressing milk for your baby. Don’t want to shell out the extra cash for a special bra? You can also cut flange holes into an old sports bra or rig up your flanges using this rubber band trick.
- Stockpile parts: Get a second (or third) set of pump parts so you don't spend as much time washing parts at work. Your partner or other family members (see #1 above!) can wash and sterilize them all in the dishwasher or in a microwave steam bag when you get home. As an added benefit, keeping an extra set of pump parts at work can avert a potential crisis if you forget a crucial piece.
- Be lazy: Depending on your situation, you may be able to get by without washing your pump parts after each use. Pump and accessory wipes are a great time saver, but they can be expensive. Some moms cut them into smaller sections to make them stretch farther. Another time saver is to put your fully-assembled pump parts in the fridge (covered with a plastic bag) in between pumping sessions. This may not be an ideal solution for some moms, especially those feeding premature or otherwise medically-fragile babies. Use your own judgement - you may decide that refrigerating pump parts and skipping a wash or two may work well for your needs. At the end of the work day, all parts should be thoroughly washed and dried.
Maximizing Milk Production
- Get in the zone: A 2011 study showed that mothers who listened to a guided relaxation recording for 20 minutes a day produced significantly more milk than those who didn't. You can download the meditation for free on iTunes or figure out which relaxation techniques work best for you.
- All hands on deck: Some moms find that a little pre-pumping breast massage can aid in milk letdown. Follow along with the one minute Jiggle, Roll, Stroke YouTube video, and you’ll be well on your way. Then, use hands-on pumping to get even more milk from each session. (Studies have shown that this simple technique can improve milk output by 48%!) After your pumping session is done, turn off the pump, and hand express any remaining milk directly into your pump flanges. You may be surprised that there is still milk in there that your pump couldn’t get!
- Protect your production: Don’t skip pumping sessions. (If you aren’t sure how often to pump, you can calculate your “magic number.” Make a standing appointment on your calendar or set an alarm on your phone to remind you to pump regularly while you are separated from your baby – and stick to it. Since milk production is based on supply and demand, each time you skip a pumping session you’re telling your body that the demand is less. Sooner or later, your body will respond by producing less.
Troubleshooting Lowered Production
- It’s not you, it’s the pump: Most moms who see a decrease in their pumping output mistakenly assume that they are losing their milk. But before you jump to that conclusion, rule out pump failure first. Pumps don’t sound any different when they gradually (or even suddenly) become less effective, so the only outward clue you may notice is that you aren’t pumping as much as before. One test you can try is to crank up your pump to the strongest suction possible, and if it’s not uncomfortable, it may not be performing at 100% capacity.
- Swap membranes: The easiest thing you can do is to install new membranes on your pump assemblies. See your user manual or a troubleshooting guide on the website for your pump for instructions. Membranes are generally supposed to be replaced every 4-6 months anyway, and you may see your production bounce back pretty quickly after replacing them.
- Test the suction: If new membranes don’t do the trick, you can have your pump suction tested to make sure that the motor isn’t dying. Many hospital lactation stores and support groups have the ability to test your pump’s suction. If the motor is, indeed, the problem, call the pump manufacturer; they’ve been known to send a new pump immediately, especially if it is still within the warranty period.
- Check your flanges: Did you know that pump flanges (aka breast shields or horns) aren’t one-size-fits-all, and ill-fitting flanges can cause pain, damage, and sub-optimal milk output? Find out your ideal flange fit and re-evaluate from time to time. Your flange size can change through the course of lactation or even vary between your breasts. If you have a hard time finding the right size, you can try Pumpin Pals, which offer an alternative with more flexibility in sizing.
NOTE: Not all pumps are created equal! This article can help you decide which pumps may be the best choice for your particular situation.
Storing, Freezing, and Organizing Milk
*Freeze your milk storage bags flat to save space and make it easy to organize your freezer stash.
*Repurpose a gift bag (or shoe box) to cycle through the oldest milk first: You can organize the milk vertically from left (oldest) to right (newest), taking from the left and stocking the right with newly-frozen milk. Another method is to cut a slit in the bottom side edge of the gift bag (and reinforce the opening with tape). Add newly-frozen milk to the top, and slide the oldest milk out of the opening at the bottom.
*Freeze only once a week, providing the previous day’s pumped milk to the caregiver. Fresh milk contains optimal nutrition and antibodies and will save you money in freezer bags. However, you can freeze your milk on Friday and cycle through your oldest freezer milk on Monday to keep your milk from exceeding recommended storage guidelines.
- Working and Breastfeeding Made Simple by Nancy Mohrbacher
- Working without Weaning
by Kirsten Berggren
- Balancing Breast & Bottle by Amy Peterson and Mindy Harmer
- Exclusively Pumping your Milk by Stephanie Casemore
- Breastfeeding USA: Hand Expression
- Breastfeeding USA: To Pump More Milk, Use Hands-On Pumping
- Breastfeeding USA: The 'Magic Number' and Long-Term Milk Production
- Breastfeeding USA: Choosing a Breast Pump
- Balancing Breast and Bottle
- LowMilkSupply.org: How to Pump
- Best for Babes: A Babe's Guide to Pumping
- Breastfeeding Mom's Guide to Returning from Maternity Leave
- Breastfeeding in Combat Boots
- Kellymom.com: Hands-free Pumping
- Pubmed: Combining hand techniques with electric pumping increases milk production in mothers of preterm infants
- Academy of Breastfeeding Medicine: An Audio Galactagogue (Relaxation Meditation)
- WorkAndPump.com: All About Pumping
- Jiggle, Roll, Stroke (YouTube tutorial)
- Ameda: Good Breast Flange Fit
- Pumpin' Pals alternative pump flanges
- Nancy Mohrbacher: For the Caregiver of a Breastfed Baby
- Nurtured Child: Baby-Led Bottle Feeding
- Stanford Medicine: Maximize Milk Production with Hands On Pumping
- Kellymom.com: Milk Storage Guidelines
- WorkAndPump.com: Smart Use of Your Freezer Stash
- Parenting in the Workplace Institute
- The Working, Traveling, Pumping, Nursing Mother
- TSA: Traveling with Children
- Limerick: Airport Lactation Rooms
© Copyright Breastfeeding USA 2015. All rights are reserved.
Escrito por Norma Ritter, IBCLC, RLC
¿Te has fijado en la cantidad de bebés hoy día que están siendo diagnosticados con frenillos linguales o frenillos labiales cortos? ¿Qué son los frenillos linguales y es verdad afectan la lactancia? ¿Por qué son más comunes hoy que nunca? ¿Cómo se podrán arreglar?
Hay mucha confusión alrededor de los frenillos cortos, también conocidos como anquiloglosia. He aquí información que podrá ayudarte a entender los hechos y los mitos con respecto a este tema.
¿Qué es un frenillo lingual?
El desarrollo normal de un feto incluye el crecimiento de pedacitos de tejido llamado frenillo (también conocido por frénulo), el cual adhiere a la lengua al piso de la mandíbula inferior. Todos nacemos con este tejido, pero para algunos bebés, éste es tán apretado que no pueden mover sus lenguas de manera debida. Esto puede afectar sus habilidades de amamantar, y hasta su capacidad de comer de un biberón o sostener succión en un chupete/chupón.
Los frenillos linguales cortos también pueden tener efectos serios de salud. De manera parecida, el frenillo labial puede adherirse a las encías, haciendo difícil que un bebé se prenda bien al pezón. Bebés quienes tienen los frenillos labiales cortos casi siempre tienen los frenillos linguales cortos.
Las lenguas y os labios solo se consideran cortos o atados si hay restricción de movilidad. Es importante tomar en cuenta que hay quienes tienen frenillos cortos que no causan problemas. Cada caso debería ser evaluado individualmente.
Hay diferentes tipos de frenillos cortos linguales. Estos son clasificados según su posición de atadura en la base de la lengua.
Clasificación #1: La atadura sucede en la punta de la lengua. Estos frenillos son a los cuales la mayoría de la gente se refiere al pensar en frenillos linguales cortos.
Clasificación #2: Estas adhesiones están un poco detrás del punto de la lengua
Las clasificaciones 1, 2 y 3 son conocidas como ataduras o adhesiones anteriores.
Clasificación #3: Estas adhesiones ocurren más cerca de la base de la lengua.
(Clasificaciones #1, #2 y #3 también son conocidas como ataduras sublinguales anteriores.
Clasificación #4: También conocidas como ataduras posteriores. Pueden ser submucosas (debajo del recubrimiento de las membranas mucosas), y deben ser palpadas para ser diagnosticadas. Muchos bebés con este tipo de frenillo corto frecuentemente son erróneamente diagnosticados con tener las lenguas cortas.
Este video muestra como reconocer una atadura posterior en la lengua:
Los frenillos labiales cortos son clasificados de manera parecida.
Ellos varían entre la clasificación #1 (la cual es un atadura pequeña que alcanza desde el área que está entre la parte de arriba del labio superior y la parte de arriba de la encía) hasta la clasificación #4 (la cual conecta el labio superior precisamente en el área en medio de donde saldrán los dos dientes anteriores en la cresta de las encías).
Ataduras de la lengua y de los labios se consideran defectos de la línea media. Defectos de la línea media en la cara tienden a ser genéticos. En estos se incluyen los labios leporinos, los paladares hendidos, las barbillas hendidas, dientes adicionales o de menos, la atresia coanal y los tabiques desviados.
¿Cómo y por qué afecta a la lactancia?
Cuando bebés nacen con frenillos cortos linguales o labiales puede que tengan problemas prendiéndose al pecho. Al sobre compensar por el frenillo corto, aumentan su nivel de succión, lo cual afecta en nivel de apego físico al pecho causando daño y dolor al pezón. Al no poder mantener el apegamiento físico a través de la succión al amamantar, puede que se oiga un chasquido o un clic, que se pierda un poco la succión, o que el bebé se desprenda por completo del pecho.
No solamente ésto puede causar dolor, sino que puede afectar la habilidad de que el bebé vacíe por completo el pecho, causando problemas con el suministro de leche. Hay casos de bebés con frenillos tan severamente cortos que ni siquiera se pueden prender al pecho.
¿Por qué, al parecer, ahora vemos más frenillos cortos linguales que nunca?
Siempre han habido bebés que nacen con frenillos cortos. Tal vez has escuchado cuentos de parteras (comadronas) que, por protocolo, mantenían sus uñas siempre largas y afiladas para cortar las ataduras clasificadas como #1 y #2 al nacer. Cuando se popularizó el uso del biberón, éste no solo se llegó a considerar a ser una alternativa factible, sino que también se consideró superior a la lactancia, y a las madres se les animaba a darles de comer a sus bebés "científicamente". De hecho, en los tiempos de antes, el que un bebé tuviera su frenillo corto era suficiente razón para destetarlo y darle biberón, y como resultado, mucha de la información sobre los frenillos cortos se fue olvidando. No fue hasta que la lactancia se fue popularizando nuevamente que se le volvió a dar atención al tema de los frenillos cortos.
Por mucho tiempo, solo los frenillos linguales cortos anteriores se reconocían. Era fácil reconocer el área, parecida a un corazón, donde comúnmente se adhieren las lenguas con adhesión anteriores. Aún así era difícil encontrar un doctor dispuesto a desprender el frenillo corto, asi que las madres sufrían adoloridas, o cambiaban el método de alimentación de sus bebés al biberón.
Pero últimamente, en los pasados diez años, las cosas han empezado a cambiar. Ha habido muchísima información de estudios científicos, especialmente alrededor del tema de frenillos cortos linguales posteriores, y el uso de láser para cirugías delicadas ha revolucionado el tratamiento de éste. Los estudios más recientes se enfocan en factores ambientales, y en la posibilidad de que la mutación de un gene específico sea la causa de los frenillos cortos.
En una encuesta informal tomada en una página de Facebook de profesionales de salud, cada una de las Especialistas Certificadas por la Junta de Examinadores en Lactancia (conocidas como IBCLCs en inglés) que respondió compartió que la gran mayoría de los bebés que ellas ven en sus prácticas tienen frenillos cortos linguales o labiales.
Otra página de Facebook, la cual sirve de grupo de apoyo para padres quienes bebés tienen los frenillos cortos, tiene más de 3,600 miembros, con unas cien personas pidiendo membresía semanalmente.
¿Qué estará pasando?
Sobre todo, tienes que entender que las IBCLCs en práctica privada tienden a ver los casos más complicados. Como el amamantar a un bebé con frenillos cortos linguales duele, muchas madres paran de dar pecho dentro de los primeros días. A algunas de las cuales procuran ayuda se les dice que los frenillos cortos en realidad no afectan a la lactancia, que el dar biberón es la solución, o que las ataduras son mitos. Las madres que perseveran muchas veces sí logran que un profesional le desprenda el frenillo corto a sus bebés, pero tal vez no se les desprenda el frenillo lo suficiente durante el procedimiento, y por ende sigue existiendo el problema.
Muchas de estas madres han visto varios profesionales de salud antes de encontrar esa página sabia de apoyo en Facebook. De hecho, hubo un caso en el cual una madre visitó a diez IBCLCs antes de encontrar a una quien pudo reconocer el problema (del frenillo corto). Todas estas madres están buscando que las validen y están buscando recomendaciones personales a profesionales que reconocen y desprenden frenillos cortos linguales y labiales.
Hay muchos mitos sobre los frenillos cortos linguales y labiales, pero he aquí algunos hechos.
Es posible el que un bebé tenga ambos tipos de frenillos linguales cortos: el sublingual anterior y el sublingual posterior. A pesar de que los frenillos cortos anteriores se asocian con lenguas que forman un corazón, el punto de la lengua de lenguas que tienen la parte posterior atada pueden también formarse de manera redonda o cuadrada.
Frenillos linguales cortos posteriores frecuentemente son diagnosticados incorrectamente como lenguas cortas.
Algunos bebés con frenillos linguales cortos pueden sacar sus lenguas.
Los frenillos cortos de la lengua y de los labios (tanto como la piel entre tu dedo gordo y tu dedo índice) no se estiran de repente, no se encogen y no se desaparecen.
Los frenillos cortos linguales y labiales pueden afectar a la lactancia.
Es común que bebés con frenillos cortos no tomen bien ni el biberón ni el chupón.
Los bebés mayores con frenillos cortos pueden tener dificultad tragando comidas sólidas. Sus lenguas posiblemente no se puedan estirar lo suficientemente para mover comida hacia la parte de atrás de sus bocas.
La madre de un bebé con el frenillo corto puede que empiece su lactancia con un suministro alto de leche alto, pero al no tener la estimulación adecuada de un frenillo suelto, se le puede ir disminuyendo la producción, lo cual pudiera resultar en que un bebé no aumente de peso de acuerdo a lo necesario
La digestión empieza en la boca, así es que el frenillo corto puede resultar en problemas digestivos como el cólico y el reflujo.
Los frenillos cortos linguales pueden afectar el habla, causando retrasos del habla y la habilidad de formar correctamente ciertos sonido y palabras.
El tener el frenillo corto (sublingual o labial) puede afectar cómo entren los dientes. Por ejemplo, los dientes del medio de abajo puede que sean jalados hacia adentro. Bebés con las lenguas atadas frecuentemente tienen los paladares estrechos, causando hacinamiento de dientes.
Cuando hay un frenillo corto labial, lo más probable es que también haya uno sublingual.
Los bebés que tienen los frenillos labiales cortos no pueden abrir sus labios adecuadamente o desenroscarlos lo suficiente para poder apegarse bien al pecho.
Los frenillos labiales pueden empujar aparte los dos dientes del frente, el cual puede resultar en futuros procedimientos ortodónticos caros. En muchos casos, si el labio no se desprende, los dientes del frente pudieran volver a crecer apartes aún después de que se remuevan los frenos dentales.
Caries dentales pueden ser causadas por comida atrapada dentro de los bolsillos creados en cada lado del frenillo labial.
Tal vez suene de baja importancia, pero los bebés con frenillos cortos linguales eventualmente se convertirán en niños con frenillos linguales cortos quienes no podrán lamer una barquilla de nieve o dar besos de lengua—temas de suma importancia para quienes tienen el frenillo corto; es mucho más fácil, seguro, y menos traumático el desprender un frenillo corto durante la infancia que esperar hasta más tarde en la niñez o ya de adulto.
Tratamientos para ataduras linguales y labiales
Si sospechas que tu bebé tiene el frenillo sublingual corto, procura una evaluación. He aquí donde una IBCLC con experiencia le podrá ayudar. El número de profesionales de salud quienes tienen vasto conocimiento del diagnóstico y el desprendimiento de los frenillos cortos linguales está incrementado, y tu IBCLC local te podrá recomendar algún profesional, quien por lo general sería un dentista pediátrico u otorrinolaringólogo (“ENT” o “Ear, Nose and Throat Specialist” en inglés) quien podrá diagnosticar y soltar frenillos cortos.
Los frenillos linguales o labiales pueden ser desprendidos con un escalpelo (o bisturí), tijeras, o con láser. En procedimientos donde se usa el láser no se requiere anestesia y se sella el desprendimiento al instante--así el que hay mínimo sangrado y ningún riesgo de infección.
Aquí hay videos de los frenillos cortos de niños mayores siendo desprendidos con láser. La mayoría de personas se sorprenden al ver lo rápido que se puede hacer. Advertencia, los siguientes videos contienen gráficas fuertes.
Procedimiento de Desprendimiento con Láser de Frenillo Corto Lingual Anterior en Calgary, Alberta
Procedimiento de Desprendimientto con Láser de Frenillo Corto Posterior en Calgary, Alberta
Muestra cómo se sana el desprendimiento, día a día
Cuidado post-tratamiento –¿Quién hace qué?
Vas a poder darle el pecho a tu bebé tan pronto le hagan el procedimiento, y muchas madres sienten una diferencia inmediata en el modo de prenderse de sus bebés. Pero aún hay más que hacer.
Ya después de un par de horas, la boca de tu bebé empezará a sentirse adolorida, y médicos por lo general te recomendarán analgésicos (sin receta). Hay madres quienes prefieren usar remedios homeopáticos. Tu bebé tal vez estará inquieto, pero pronto se calmará. No debe sorprenderte el que tu bebé de repente reuse tomar el pecho por sentirse adolorido. Esto se conoce como una huelga de lactancia temporera y por lo general se resuelve rápidamente. Mientras sucede ésto, puedes sacarte la leche manualmente, o con una bomba, para aliviar pechos congestionados, y le puedes dar la leche expresada a tu bebé con cuchara, vasito o biberón.
Como muestran los videos, se le hace una incisión al freno para desprenderlo. Esta incisión debería mantenerse abierta por lo menos unas dos semanas. El estirar y masajear la incisión tres a cuatro veces al día por dos semanas ayudará a mantener abierta la herida mientras sana, y es algo que se puede hacer bastante rapidez. Este video te enseña como.
La manera más fácil de hacer los ejercicios de estiramiento es desde la parte de atrás de la cabeza del bebé. Puedes ponerlo en el piso y sentarte detrás de él. Con un bebé mayor o un niño entre uno y tres años, a algunas madres se les hace más fácil posicionar sus rodillas encima de los hombros de sus niños para ayudar a prevenir que sus brazos se muevan demasiado.
Un bebé quien no haya amamantado correctamente aprende a sobrecompensar. Luego de que se le haya desprendido la lengua, éste tiene que aprender a usar otros músculos. He aquí el lugar en el cual pudiera ayudar un quiropráctico o especialista de terapia craniosacral, quienes pueden ayudar a estirar o a relajar los músculos necesarios. El tipo de terapia ofrecida por quiroprácticos y terapistas craniosacrales es hecho mayormente con las puntas de los dedos, y mucha de la terapia se puede hacer mientras el bebé está en los brazos de su madre.
Cuando el bebé se prende bien al pecho, la mamá se debería sentir cómoda y el bebé debería lactar eficientemente. Una IBCLC quien se especialice en problemas del agarre o del apegamiento al pecho puede ayudar con el que tu bebé abarque el pecho con más profundidad.
La IBCLC también pudiera e enseñarte algunos ejercicios leves para ayudar a fortalecer y a estirar su lengua recién-desprendida. Si tu bebé hasta ahora no ha podido lactar, ella te puede ayudar a prendértelo y a incrementar tu producción de leche.
Puedes leer más sobre el cuidado post-tratamiento aquí:
Para más información sobre los frenillos cortos linguales o labiales, vea las siguientes referencias:
1. Coryllos, E. Watson Genna, C. Salloum, A. (2004) Congenital tongue-tie and its impact on breastfeeding American Academy of Pediatrics Section on Breastfeeding Newsletter, Summer 2004, 1-6
2. Photos - "Is My Baby Tongue-tied?" Retrieved April 2013
3. "Hazelbaker Assessment Tool for Lingual Frenulum Function" Retrieved April 2013
6. Øyen, N, et al (2009), Familial Recurrence of Midline Birth Defects—A Nationwide Danish Cohort Study, Am. J. Epidemiol. doi: 10.1093/aje/kwp087 First published online: May 4, 2009. Retrieved April 2013
7. Kotlow, Larry, DDS Infant Reflux and Aerophagia Associated with the Maxillary Lip-tie1 and Ankyloglossia (Tongue-tie) Retrieved April 2013
8. Palmer, Brian, DDS, Frenum Presentation, Retrieved April 2013
9. Hong, P et al, Defining ankyloglossia: a case series of anterior and posterior tongue ties.Int J Pediatr Otorhinolaryngol 2010; 74(9):1003-1006
10. Notestine, Dr. Gregory, The Importance of the Identification of Ankyloglossia as a Cause of Breastfeeding Problems, Journal of Human Lactation 1990; 6(3):113-115
Norma Ritter tiene tres hijos adultos y es abuela de seis nietos, todos quienes fueron lactados.
Traducido al español or Laura María Gruber, IBCLC, RLC.
© Breastfeeding USA. Todos derechos reservados. Mayo, 2013
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You may have heard someone say that breastfeeding our babies is a basic human right. However, it isn't uniquely human. In fact, we share breastfeeding with non-human mammals—cats, cows, and capybara, to name a few. In fact, the term mammal comes from the word mammalis, which is of Latin origin and means "from the breast." Mammals share many features, such as warm-bloodedness, hair, a four-chambered heart, as well as feeding of the infant with milk from the mammary glands.
Does breastfeeding in humans have any similarity to breastfeeding in other mammals? As a zoologist and former zookeeper, I've often been struck by the similarities of mothering among mammals, a very diverse group in many other respects. I've seen giraffe, camels, antelope, gazelles, kangaroos, babirusa, zebras, elephants, and lemurs nurse their own and, sometimes, their close relatives' infants. The basic act of nursing is very similar to our own, mechanically speaking. Of course, the biggest similarity is that we all, humans and non-humans, are evolutionarily and biologically built for the job! What else do we share with these non-human mothers? Consider some aspects of breastfeeding in the human condition and how these compare with other mammals' parenting practices.
For me, there is nothing as strong as that sudden desire for water that I feel when I first sit down and feed my baby. While nursing, I feel like I need to consume about twice as much water as I would when I am not breastfeeding, especially when out in the heat or being physically active. As a zookeeper working out in the hot sun, sometimes it felt like I couldn't possibly take in enough water to quench my thirst between pumping sessions, and I'd joke with the zoo's veterinarians about hooking me up to IV fluids. Of course, being a little thirstier than usual isn't only a human thing. Being thirsty can even change an animal's natural behaviors, as seen in the Grevy's zebra and Somali wild ass.
The Somali wild ass and the Grevy's zebra are both tough animals from the Horn of Africa, found in Kenya, Somalia, Eritrea, and Ethiopia. They are Equids, which means they are related to horses, but they've both become specialists in their desert lifestyle. They can eat very unpalatable and dry vegetation—coarse brush, sedges, and thorny plants that domestic goats, cows, and even camels avoid. Adults of both species have adapted to have very low water requirements and can go up to five days without drinking. Naturally, lactating females are different. Lactating Somali wild ass females need to drink every day, while Grevy's zebra females need to drink at least every other day. During lactation, females of both species have a smaller range which allows them to stay closer to water sources. For Equids and for us, the behavior is similar: keep a water source nearby and drink to thirst.
What a Big Baby!
The blue whale is the largest animal alive—adults can be 75-100 feet long and weigh more than 150 tons, the weight of almost 4 semi-trucks with full loads. Baby blue whales have to coordinate breastfeeding with surfacing to breathe and are one of the few species that have to learn to do something before they can breastfeed. A mother blue whale will guide her newly-born offspring up to the surface to catch its first breath before going underwater again to nurse. Babies will consume up to 50 gallons of milk a day, which is of toothpaste consistency and 35-50% fat. All of this fat is needed, of course, because a baby gains around 10 lbs an hour and about 250 lbs—about as much as LeBron James, professional basketball player—in a day.
Some mothers can really relate to a quickly gaining baby. My own son, for instance, never lost weight in the hospital, was always in the 99% for weight, and as a preschooler currently dwarfs many second graders. It's important to realize that all babies grow at different rates and that quickly growing breastfed babies aren't overweight; they are just following their own growth pattern, which is frequently genetic. This can be reassuring to know when your in-laws start making comments about your own big (or petite, for that matter) baby.
How does a mammal so primitive that it lacks nipples still feed its baby? The platypus, an egg-laying mammal from Australia, has so many quirky characteristics that the first specimen brought to Europe was considered a hoax. This funny looking mammal not only has flipper feet, a beaver-like tail, and a duck-shaped bill, but it is also one of the few mammals that is venomous. The way in which she feeds her infant is also a unique characteristic. Since the platypus does not have nipples, she secretes milk from her mammary glands onto her skin and her offspring lap up the milk on her chest as she reclines in her den.
Some mothers leak a little milk now and then. Other mothers never leak any milk. Then there are the mothers who wake up to a soaking wet sheet in the morning, due to milk leakage overnight. These moms also carry plenty of breast pads and an extra shirt in their diaper bag, just in case. Leaking milk isn't fun, but when it happens to us, we can remember the platypus and her soggy feeding condition.
Your Older Nursling
Let's face it—some folks in our society today frown on nursing a baby older than 12 months, the minimum duration recommended by the American Academy of Pediatrics. Many women with older nurslings breastfeed "in the closet"—secretly at home without their friends', pediatrician's, or in-laws' knowledge. Some feel embarrassed or ashamed to still be nursing. Even those who don't feel embarrassed may just shy away from revealing the fact that their toddler (or preschooler) is nursing in order to avoid receiving well meaning advice or being in conflict with others who have chosen a different parenting path. A common but mistaken idea in our society is that breastfeeding should be over by the baby's first birthday. As a friend of mine once said to her pediatrician, "Why is breastfeeding so great for the first 365 days, but on day 366, it suddenly isn't okay anymore?"
Let’s consider the nursing habits of some of our closest primate relatives. The chimpanzee, gorilla, and orangutan all share more than 95% of our DNA. Their parenting styles are very similar to ours—they carry their infants continually and nurse on demand. The weaning age of a chimpanzee is around 48 months, a gorilla will nurse until 52 months, and a Borneo orangutan will nurse on average 42 months, and may continue to nurse for as long as 5-7 years! These apes all have a longer average breastfeeding period than industrialized human societies today, despite the fact that human infants are born less developed than any of the apes, are less self-sufficient for longer, and have a longer infancy. The typical nursing period in pastoral societies in developing countries is much nearer the durations seen in the apes. It's time that we forget about the 12-month weaning recommendation and go with the flow.
The okapi is a secretive creature related to a giraffe, which is found in the rainforests of the Democratic Republic of the Congo. It has a neck somewhat shorter than a giraffe and is dark brown, except for having white stripes on its rear end. As a zookeeper, I've had the pleasure of watching several okapi being born. Before our first okapi was born, we prepared for the birth of these unique animals by doing some research. We discovered that the newborn okapi does not defecate for up to a month after birth because it uses its mother's milk so efficiently. This may have been an evolutionary advantage because okapi babies do not follow their mothers, but remain in hiding, where defecation might alert a predator to their presence. Some of the first okapi babies born in zoos were treated by vet staff for constipation when, in fact, this stooling pattern was a normal phenomenon.
Of course, breastfed human babies do not follow the okapi pattern of defecation. However, sometimes breastfed babies over a month do not defecate as frequently as a health care professional would expect. A mother may be fearful that her baby is constipated. An older baby may defecate once daily. Some babies have been reported to defecate every few days or even once every five days or longer. Whether there is a reason for this defecation pattern compared to more frequently stooling breastfed babies isn't entirely clear. Generally, as long as the baby is gaining well, feeding normally, and is otherwise healthy, it's considered a normal variation to have a longer stretch between bowel movements. Also, it's important to realize that consistency of stool, rather than frequency, determines constipation, which is rare in breastfed babies. When a baby is constipated, his stool is hard in consistency, a far cry from the soft, mustardy-seeded stools typical of the breastfed baby.
He's Constantly Nursing!
My second born, the big boy, was also one of those babies who wanted to nurse very frequently. Especially at the beginning, it seemed like I'd scarcely settle him down and he'd want to be up and attached again. He'd sleep in a wrap in my arms, always just a wiggle away from another snack. I've commiserated with other moms about similar nurslings—those who just want to be attached to mom nearly 24/7.
When we have a baby with this nursing pattern, it may remind us of the kangaroo. A kangaroo joey is very immature at birth, compared to other mammals. At the size of a lima bean and the look of a fetus, it crawls up its mother's body and attaches to her nipple. And there it remains, continuously attached inside her pouch. Her nipple swells in the baby's mouth so that the baby will stay permanently attached during the first stages of lactation. In fact, the kangaroo newborn doesn't even have the ability to detach and reattach herself; if she unlatches before she's developmentally ready, she could die. As she develops, she will gain fur and her eyes will develop. Eventually, the baby will cease her continuous nursing and begin to stick her head out of the pouch. Later, she will climb out of the pouch to explore but will go back in when she needs comfort, a safe place to go, or a meal. Finally, she may be too large to return to the pouch but may continue to nurse by putting her head back inside the pouch. Our continuously nursing newborns? They'll grow out of it, too.
Health Consequences of Bottlefeeding
There are many reasons why women may resort to formula feeding, even when they are aware of the health risks associated with it. Frequently, this is a very complicated and challenging decision-making process. Wild mammals do not have infant feeding choices to make. If the mother is unable to produce enough milk, becomes separated from her young, or is eaten by a predator, infants not at or near weaning age will typically die. Some primates and a few other mammals, such as elephants, will occasionally feed orphaned infants, especially ones they are related to, with their own milk. There are even a few cases of cross-species milk sharing (if you're interested, do a Google search on interspecies nursing), but they are striking because they are not the norm. Also, since milk is species-specific, cross-fostered babies do not always survive or have the best of health.
Non-human, bottle-fed mammals do exist on farms, in sanctuaries or zoos. I've been lucky to watch many young mammals feeding from their mothers (or sometimes aunties, if mother doesn't happen to be nearby). There are rare cases when a newborn has to be hand-reared with a bottle--if the mother dies or becomes too ill to care for her youngster. Hand-reared young mammals can be less robust when compared to their mother-reared counterparts. They may be smaller and have more health problems, such as diarrhea. While adequate milk replacers have allowed us to save the lives of these young animals, rarely do they enjoy great health. Also, the bonding and natural behaviors they learn while nursing from their mothers seem to help them prepare for parenthood, themselves. This may be why hand-reared female mammals do not always have the skills to raise their own babies. Hand rearing in zoos and sanctuaries is now done sparingly, with a trend towards keeping the offspring with other members of the same species which may, in turn, allow the hand-reared baby a better chance of parenting her own offspring. I can't help drawing a parallel to our own society. When our young people grow up around nursing babies, when society sees nursing as a norm, and when our own mothers have nursed us, breastfeeding may come more easily for us, as well.
10 Incredible Tales of Interspecies Nursing. Retrieved 4/12/2015 from http://scribol.com/environment/10-incredible-tales-of-interspecies-nursi...
About Grevy's Zebras. Retrieved 4/12/15 from http://www.grevyszebratrust.org/about-grevy-zebra.html
Blue Whale. (2015). Retrieved 4/12/15 from http://www.marinemammalcenter.org/education/marine-mammal-information/ce...
Bonyata, K. (2011). Is My Breastfed Baby Gaining Too Much Weight? Retrieved 4/12/2015 from http://kellymom.com/bf/normal/weight-toomuch/
Estes, R.D. (2012). The Behavior Guide to African Mammals. Los Angeles, CA: University of California Press, 235-249.
Feldhamer, G. et al. (1999). Mammalogy: Adaptation, Diversity and Ecology. Boston, Ma: McGraw Hill, 5, 177-179, 364-365.
Lindsey, S.L. (1996). The Okapi: Mysterious Animal of Congo-Zaire. Austin, TX: University of Texas Press, 87-110
Lauwers, J and Swisher, A. (2011). Counseling the Nursing Mother: A Lactation Consultant's Guide. Sudbury, MA: Jones and Bartlett Learning, 306, 416, 429-432
Moyal, A. (2004). Platypus: The Extraordinary Story of How a Curious Creature Baffled the World. Baltimore, MD: John Hopkins University Press, 120-135.
Poelker, C. (2011). Rearing Antelope: Three Thriving Examples at the Saint Louis Zoo. Animal Keeper's Forum. 38(7/8). 340-343.
Rowe, N. (1996). The Pictorial Guide to the Living Primates. Charlestown, RI: Pogonias Press, 219-234.
© Copyright Breastfeeding USA 2015. All rights are reserved.
The following articles may be of interest to mothers and those who support them. This is just the beginning of an extensive online library which will grow over time as the organization grows. Our goal is to provide evidence-based information and support: What Does Evidence-Based Mean? Each article is well researched and contains up-to-date information. An Editorial Review Board ensures the quality of the articles. Our website and these articles are brought to you by the generous donations and memberships of others in communities across the USA. Please consider making a contribution or joining Breastfeeding USA today.
Preparing to Breastfeed
Just for Teen Mothers
Positioning and Latch
Infant Growth and Development
Caring for Your Growing Baby
Expressing Your Milk
Special Breastfeeding Circumstances
Family and Community
We extend sincere appreciation to all the authors that have donated articles to Breastfeeding USA.
One of the most common questions I receive by email or Facebook message from mothers seeking breastfeeding support is, “What can I take, eat, or drink to increase my supply?” The Internet contains countless articles, blogs, advertisements, and testimonials about using galactagogues to increase milk production in breastfeeding mothers. A galactagogue is a food, drink, medication, or supplement that is ingested by the mother with the intention of increasing the amount of milk produced. The concern I find with answering this type of inquiry is that most of the time, mothers are looking for a quick and easy way to boost supply, when there may either be an underlying problem related to milk production that needs to be addressed, or the mother may already have an adequate milk supply.
In addition, while there is certainly a great deal of anecdotal evidence of the use of some foods or supplements successfully increasing milk supply, little research exists supporting the effectiveness of galactagogues to increase milk production. This makes it difficult to be confident that their use is safe or effective. The Academy of Breastfeeding Medicine has noted the need for research in the area of galactagogues stating, “There is a clear need for well-designed, adequately powered, randomized controlled trials using adequate doses of galactagogues in populations of women in which both the experimental and control groups receive modern, appropriate lactation support.” This lack of research leaves mothers who seek to increase milk production through galactagogues vulnerable to potential unknown interactions with other medications they may be taking, other unknown safety risks, or simply wasting money on useless supplements in the hopes of correcting a problem that can often be addressed without consideration of galactagogues.
If you are in a situation where you are seeking to increase your milk production, the first and most important thing to determine is whether you are truly not producing enough. Many mothers expect that their supply will be abundant and feel that they are not making enough milk, when they actually have a perfectly sufficient supply. Some mothers will find that while their babies seem to be satisfied after feeding, they are unable to ever express very much when pumping. It is important to note that the amount of milk you are able to pump does not necessarily correlate to the amount that you are producing. No pump can remove milk as efficiently as your baby can, and you may be transferring significantly more while feeding at the breast than you are while pumping.
To determine whether you are making enough milk, examine your baby’s weight gain and diaper output. By the fourth day of life, your baby should be having at least four to six wet diapers per day, and this should continue as your baby grows. In the first few weeks, babies should have at least two to three yellow, seedy stools per day. However, after the first month or two, the frequency of bowel movements will start to vary more by each individual baby, with some having multiple bowel movements each day and some having only one every few days. Your baby’s health care provider can confirm for you whether your baby’s weight gain is sufficient at your well baby visits. If you have concerns, however, you may consider seeking assistance from an IBCLC, or International Board Certified Lactation Consultant, who can help you assess whether your baby is getting enough milk. You can find the nearest IBCLC at www.ilca.org. You can find more information on whether your baby is getting enough milk on the Breastfeeding USA website or the Ask Dr. Sears website.
If your baby is not gaining enough weight and/or is not producing enough urine or stool, don’t simply jump to the conclusion that you are not producing enough milk. There can be a number of explanations for why a baby may not be gaining weight as quickly as expected, many of which are easily addressed. If you are unable to determine the problem, this is a good time to contact a Breastfeeding USA Counselor or an IBCLC. Please see the end of this article for information on finding someone who can help.
Before turning to galactagogues, the tactics below may be useful in helping improve a reduced supply or a perceived reduced supply due to other breastfeeding issues.
- Ensure that you are following your baby’s feeding cues. Babies can’t speak, but they are excellent communicators. Once you learn to “speak” their language, your baby will let you know when he wants to breastfeed, as well as when he is finished. Feeding on demand – or when your baby cues you that he wants to feed – is one of the most important things you can do to ensure you are feeding him frequently enough. Breastfeeding works on supply and demand, which means that when you feed your baby, your breasts receive the “message” that they need to make more milk. If you feed baby when he is hungry and until he indicates that he is full, your breasts will “know” how much milk to make. Conversely, if you schedule feedings or limit the amount of time your baby spends eating from each breast, your baby may not get the amount of milk he needs, and your body will not receive the signal that more milk needs to be produced.
Crying is a late sign of hunger in infants. Babies will give cues such as bringing their hands to their mouths and opening and closing their mouths as they begin to become hungry. They will generally then move into fidgeting or trying to position their bodies to access the breast and rooting (moving his head toward you when touched). Responding to these early cues will help to ensure that baby is fed when hungry. In addition, babies will usually continue to nurse on one breast until they are finished with that side. They will either unlatch or change from swallowing milk to non-nutritive sucking. At this time, you can offer the other breast, and baby will feed until he is full. There are exceptions, particularly in the early days when babies may fall asleep at the breast, even when not quite finished eating. Usually, baby will cue you both when he is hungry and when he is full.
- Feed your baby frequently. Nothing is better at signaling your body to make more milk than feeding your baby. Every time your baby breastfeeds, your body learns. Both removal of milk from the breast and stimulation of the nipple by suckling tell your body that more milk will be needed to continue feeding your baby. If you feel that you may not be producing enough milk, try putting baby to the breast more often. Feedings need not be limited to after waking or before sleeping, or any other time when your baby shows obvious hunger. Offering the breast often will allow your baby to feed as often as she needs, and the more frequently she breastfeeds, the greater your supply will be.
- Make sure that you have a good, deep latch. Latch. is a topic that could be (and has been) discussed in its own article. For a variety of reasons, it is crucial that the baby has a deep latch with a good amount of breast tissue behind the nipple in his mouth. First, a poor latch can lead to pain for mom. A small amount of discomfort in the early days for the first few seconds of breastfeeding is normal, but pain that lasts after the first few days or lasts throughout the feeding or between feedings is not. Toe-curling pain is never normal and should be addressed immediately. A suboptimal latch can also lead to poor milk transfer and cause reduced milk supply.
If you are concerned that you may not be getting a good deep latch, a breastfeeding professional or volunteer Breastfeeding USA Counselor can be helpful in assisting you to improve it.
- If you are pumping, make sure that you are pumping often and long enough. If you are pumping while away from your baby, make sure that you are doing so at least once for every missed feeding whenever possible. Pumping less frequently can lead to lowered milk production. In addition, make sure that you are draining the breast as completely as possible. Make sure not to stop pumping before the milk stops flowing. In addition, continuing to pump after the milk slows to a trickle can be helpful. Remember, breastfeeding works on supply and demand, and continuing to pump for few minutes after the milk has slowed significantly helps to signal your body that it needs to produce more milk.
- Try using breast massage and compressions. The use of breast massage and compressions can be helpful in removing more milk from the breast when you breastfeed or pump. The more milk that is removed, the more you will make. For more information, see Nancy Mohrbacher’s article To Pump More Milk, Use Hands on Pumping. While it specifically addresses pumping milk for premature babies, the techniques translate nicely to pumping for full-term and older babies and can be used in feeding at the breast, as well.
- Keep an eye on your stress level. Stress can negatively impact your milk supply and inhibit your letdown. Take some time to relax. Have a warm bath, let dad or a friend care for the baby, even for twenty minutes, so that you can do some deep breathing, yoga, or take a walk around the block, lie down and close your eyes, or whatever is a good stress buster for you. Make sure to get adequate sleep, napping whenever your baby does, as well.
- Enjoy some snuggly time with your baby. Spending some time skin-to-skin can help boost your milk supply. Undress baby down to her diaper and hold her close to you. Take the opportunity to relax, take a break, and snuggle up while she naps and you catch up on a great book or those DVR episodes of your favorite shows that you’ve been saving.
- Eat well and drink plenty of water. While there is not a great deal of concrete evidence that caloric intake or even intake of water has a direct effect on milk supply, it is important to nourish your body to make sure you are able to nourish your baby. Many mothers report feeling thirsty when they nurse and have water or their favorite non-caffeinated beverage handy.
- Avoid supply killers. Some medications can be particularly detrimental to your milk supply, such as hormonal birth control and decongestants. In addition, caffeine, alcohol, and smoking can all reduce production. Even some herbs like sage, peppermint, and parsley, when taken in large quantities, can affect production. If you are not sure whether a medication you are taking can reduce supply, you may want to visit the National Institute of Health’s LACTMED database.
Keep in mind that none of these solutions will work overnight, and none are magic wands. Allow time to determine if a given tactic is making a difference. When you have questions, find a breastfeeding support person who can help counsel you through the process.
Finding a Breastfeeding Support Person Breastfeeding USA has counselors in many areas who are volunteers, eager to help with most normal breastfeeding issues. To find the Breastfeeding USA Counselor nearest you, visit https://breastfeedingusa.org/content/article/find-breastfeeding-counselor.
Occasionally, a breastfeeding question or concern is more complex or requires evaluation for potential medical intervention. In these cases, you may want to seek an International Board Certified Lactation Consultant (IBCLC). You can find the IBCLC nearest you at www.ilca.org.
Additional links to breastfeeding professionals and volunteers can be found at http://kellymom.com/bf/concerns/bfhelp-find/.
If You Decide to Use Galactagogues
Galactagogues really may work for some moms, and you may decide to use them but, hopefully, not as a first line of defense. They can simply mask the problem instead of offering a solution. Not all galactogogues are the same. An IBCLC can help you find the reason why you are not making enough milk. Whenever taking a medication or supplement, be certain to consult with a health-care professional regarding the safety of the medication, making sure to disclose any other medications you may be taking to avoid negative drug interactions. If you decide to consume foods or drinks that you have heard increase your supply, be sure to do so safely, and don’t expect a miracle from a bowl of oatmeal, a “lactation cookie,” or a sports drink.
© Copyright Breastfeeding USA June 2015. All rights are reserved.
There it is: one beautiful beating heart on the ultrasound screen… and then you see another. Whether you knew it was a possibility or not, the moment you discover you’re having more than one baby is life-changing.
Preparing for the birth of your babies:
While it is true that twin pregnancies are more likely to have complications (though only slightly higher than singletons when twins have their own amniotic sac and placenta) and are statistically more likely to end in cesarean section, having twins does not mean you can’t exclusively breastfeed or have a fulfilling breastfeeding experience.
Breastfeeding is the way human babies were made to be fed, regardless of whether they shared the womb with a sibling or not. Twins, statistically, are born earlier than singletons, and premature babies are even more in need of the healing power of their mothers milk. Especially if this will be your first time breastfeeding, it is very important to find evidence-based sources of information right away. Well-meaning medical professionals, friends, and family can set “booby traps” that can prevent you from reaching your breastfeeding goals.
Get mentally prepared:
Know that for the first few weeks of their lives, feeding your babies and sleeping should be your top priorities. Plan to do nothing but feed and love your babies, so when you do get an hour of freedom to go take a shower or close your eyes for a moment, you’ll feel refreshed instead of stressed that you only have an hour. The first few weeks can be exhausting, so keep reminding yourself that babies change quickly--it will not be like this forever. Perspective makes a big difference in times like these.
Build a strong support network and seek out information:
Physician support and knowledge about breastfeeding can differ greatly, so dialogue with your provider and get a feeling for the level of support that you will receive. Ideally, you can find a really knowledgeable health care provider before your babies are born. You may need to seek out other sources of help in your community. In our culture, bottles are the default way to feed a baby (even if they contain human milk instead of formula), and it can be difficult to sort through the information available. It is imperative that you have breastfeeding-knowledgeable people in your corner ready to lend you a hand if things don’t go perfectly.
Find a local Breastfeeding USA chapter and attend meetings before the birth of your babies. Seeing other mothers breastfeed and hearing their real-life stories are two of the most important things you can do to prepare for breastfeeding, as explained in this article. If there is no Breastfeeding USA group in your area, find another local breastfeeding group. Make sure to include your partner and support people in your learning, so they won’t unknowingly undermine your efforts. Visit credible websites like Kellymom.com, Dr. Jack Newman’s site, or Best for Babes, and remember that the people in forums and chat groups share personal experiences and opinions which may not be evidence-based. Take a breastfeeding class with your partner and know who to call in case you need help (Breastfeeding USA Counselor or IBCLC).
Making enough milk:
Regardless of the number of babies you are breastfeeding, establish and maintain good milk production by watching your baby and responding to your baby’s hunger cues. Let the baby determine the length of feedings. Feeding as soon as you can post birth is important for establishing a good latch and good production. Learn more about baby-led latch here.
Your breasts will respond and make as much milk as needed, based on the amount of milk that the babies remove. Your baby will let you know if s/he is getting enough with the usual clues: frequent breastfeeds (at least 8-12 times in 24 hours), many wet and soiled diapers, steady weight gain. Newborns feed often; this is normal and how your body establishes milk production. If you are concerned about the frequency of feedings, especially when one baby seems to be breastfeeding a lot more often and/or longer than the other, it’s a good idea to get some help. Here is some more information about frequent feedings.
So many messages tell mothers of twins that they cannot make enough milk for two babies at once. It is assumed by many medical professionals that twins will have to be supplemented, but in fact the opposite is true. Most mothers of twins can make more than enough milk for their babies. Trust that your body was built to do this; confidence and successful breastfeeding go hand in hand. Surround yourself with positive messages. Join groups online full of positive people with positive stories to share. Read positive books, ones that tell you how to breastfeed twins, not just how to manage bottle-feeding twins. A great book is Mothering Multiples: Breastfeeding & Caring for Twins or More by Karen Kerkhoff Gromada. Know that your babies are no different because they came together; they are just two babies who need their mother’s milk, and your body was made to provide it.
What if one or both of my babies is in the NICU?
Some babies who stay in the NICU are not strong enough or coordinated enough to breastfeed. This does not mean that mothers cannot provide their babies with breast milk. The number one priority in this situation is to establish and maintain your milk production, pumping every 2-3 hours around the clock with a high quality electric breast pump. Hospital grade pumps are available for free or rent at some hospitals. Ask for help from an International Board Certified Lactation Consultant (IBCLC) at the hospital, if one is available, and contact a Breastfeeding USA Counselor for further support. Your babies can receive your milk via a supplemental feeding device used while breastfeeding, finger feeding, syringe, spoon, cup, or bottle. Discuss feeding options with your baby’s care team. Even if one or both of your babies don’t start out breastfeeding, with the proper support you can get them back to the breast when they are bigger and stronger.
Meeting the needs of each baby:
Feeding twins on cue can be very different from feeding a singleton on cue. It’s possible that your babies will start showing hunger cues around the same time for most feedings. If they do--great! Some twins, especially fraternal twins, have different temperaments and different needs. One twin may need to eat every two hours, while the other is content with every three or even four! You may hear that you have to keep them on the same schedule, but there are different ways to handle babies who seem to have naturally different rhythms.
- feed both babies when the first one gets hungry.
- allow both babies to follow their own patterns and feed them individually.
- use a combination of both methods.
Some mothers find that they can follow individual cues throughout the day but need to keep both babies on the same feeding rhythm at night to minimize night wakings. Get creative! Whatever you decide to do, remember that you can try something new at any time. Your babies will be growing and changing quickly in the first few months; nothing will stay the same for long.
Tandem or individual feeding? How to juggle breastfeeding twins:
Breastfeeding two babies feels like a juggling act, but with a little practice, creativity, and planning, it can be done with ease.
In the early days and weeks of breastfeeding, both you and your babies are learning to breastfeed. Even if your twins are not your first breastfed babies, having twins often feels like being a new mom all over again. Breastfeeding two babies simultaneously is a wonderful skill to learn. It saves so much time if you can nurse your babies together instead of one after another. But like any skill, it takes practice. If one of your babies is struggling to achieve a good latch, it’s okay to breastfeed them by themselves until you both become more skilled. Get creative with breastfeeding positions, and try them more than once or twice. Here are a few possible positions to try.
Babies change a lot during their first few weeks and months. When you have more than one baby reaching the milestones, it can seem much more intense, especially the relief when things suddenly get a lot easier! Babies naturally become more efficient at breastfeeding as they get older, spending less time at the breast and eventually nursing less frequently. Positions that were impossible to imagine using when your babies were 2 weeks old suddenly are your favorite positions when they are 6 months old.
Two vs. one, is it that big of a difference?
It’s hard to explain to people who have never had the experience of caring for two babies simultaneously what it is like and how it is different from caring for just one. I had a single baby, then twins, then a single baby again, and I can confidently say that breastfeeding my twins in the first few weeks was both the hardest and one of the most empowering things I’ve ever done as a parent.
Having people around who believed that breastfeeding twins was normal and possible was the only way I made it over the hurdles I encountered in the first few months. By the time my twins were six months old and we had really gotten the hang of things, I was so incredibly thankful that I didn’t have the extra work of preparing and cleaning bottles of formula, or pumping, then preparing, and cleaning bottles of breast milk. I was so glad that I had help and persevered through the first weeks when feeding twins. It is a huge job no matter how you choose to do it! Get informed; get help; and you, too, can breastfeed your babies!
© Copyright Breastfeeding USA 2015. All rights are reserved.
Did you know that “Vitamin D” is not really a vitamin? It’s actually a steroid hormone produced in the body after direct exposure of the skin to ultraviolet B (UVB) radiation in sunlight. Both the vitamin D that your body produces and the vitamin D from supplements must be changed by your body several times before it can function properly. Vitamin D manages the amount of calcium in your blood and other body tissues, helps cells all over your body communicate properly, and assists your immune system in functioning effectively (Vitamin D Council, 2013).
What are the consequences of Vitamin D Deficiency?
Vitamin D deficiency may present with seizures due to abnormally low calcium levels, growth failure/failure to thrive, lethargy, irritability, and a predisposition to respiratory infections during infancy (Balasubramanian, 2011). In extreme cases, vitamin D deficiency can result in the development of rickets, a childhood bone disorder where bones soften and become prone to fractures and deformity.
If you have older children and are wondering why this wasn’t an issue when they were babies, the American Academy of Pediatrics (AAP) recently updated its vitamin D recommendations based on research that was published in April of 2010; it took a few years for the policy change to take full effect.
Nutritional Recommendations for Vitamin D
The AAP recommends supplementation of vitamin D for all infants as a preventive health measure. The AAP recommends that all children, including infants, take in 400 international units (IU) of vitamin D per day. Infants 0-12 months should not exceed 1,000 IU (25 µg) per day. Recommendations for adult intake vary depending on the organization, but usually advise an upper limit of 5000 - 10000 IU/day.
To Supplement or not?
Exposure to natural sunlight allows the human body to make its own vitamin D. The amount of the vitamin produced, however, is dependent on a variety of factors. Cynthia Good Mojab, MS, IBCLC, RLC writes, “The amount of sunlight exposure needed to prevent vitamin D deficiency depends on such factors as skin pigmentation, latitude, degree of skin exposure, season, time of day, amount of pollution, degree of use of sunscreen, altitude, weather, the vitamin D status of the lactating mother, and the current status of vitamin D stores in the infant’s body. Recommendations do and should, therefore, vary around the world, taking into account local conditions and practices.” (Mojab, 2003).
The World Health Organization recommends two hours per week of direct sunlight exposure for infants when the face is the only part of the body exposed, or 30 minutes if upper and lower extremities are exposed. But remember that the factors listed above must also be considered. Due to increases in skin cancer rates, often due to sun exposure and/or tanning beds, many healthcare professionals would prefer that unprotected sun exposure be kept to a minimum. Consequently, sunlight exposure recommendations are not hard and fast rules.
The decision on whether or not vitamin D supplementation is necessary for your child can and should be made in conjunction with your child’s health care provider. The most important thing is to make an informed decision, feeling comfortable bringing up your own questions and concerns, and sharing your informed perspective. A blood test (the 25-Hydroxy Vitamin D test) can assess your child’s existing levels of vitamin D (NIH-NLM, 2012).
Breastfeeding and Vitamin D
When breastfeeding exclusively, a mother’s pre-existing deficiency in vitamin D can result in lower levels of vitamin D in the milk she produces. If her baby gets enough sunlight, the mother’s deficiency is unlikely to be a problem for her baby. However, if her baby is not producing enough vitamin D from sunlight exposure, her milk will need to meet a larger percentage of her baby’s vitamin D needs.
The Vitamin D Council advises mothers to choose to either supplement their infant with vitamin D drops, or take a high-dose supplement of vitamin D themselves when exclusively breastfeeding (Vitamin D Council, 2013). Maternal supplementation of 6,000 IU of vitamin D per day would prevent the need for infant supplementation; the milk would likely have enough vitamin D for baby (Wagner et al., 2006). If the mother is not taking a supplement, getting a good amount of sun exposure, or taking less than 5,000 IU per day of vitamin D, her baby might need a vitamin D supplement. Mothers who choose high-dose maternal vitamin D supplementation should consider getting their vitamin D levels tested to see if supplementation is needed. Mother and baby could then be tested a few months later to track the levels.
Optimal vitamin D levels and the impact of deficiency on the body are the subjects of ongoing studies. For mothers, the prevention of rickets and other known effects of deficiency in babies is the main concern. How this is accomplished should be decided by parents making an informed choice based on available information and discussion with the mother and baby’s health care providers.
AAP. (2010). Vitamin D Supplementation for Infants. Retrieved on February 23, 2014 from http://www.aap.org/en-us/about-the-aap/aap-press-room/pages/Vitamin-D-Su...
Balasubramanian, S. (2011). Vitamin D deficiency in breastfed infants & the need for routine vitamin D supplementation. The Indian Journal of Medical Research, 133(3), 250–252. Retrieved on February 23, 2014 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3103147/
Cannell, J. (2009). Newsletter: Vitamin D Question & Answers. Retrieved on March 3, 2015 from https://www.vitamindcouncil.org/newsletter/newsletter-vitamin-d-question...
Mojab, C. G. (2003). Frequently asked questions about Vitamin D, Sunlight, and Breastfeeding. Retrieved on February 23, 2014 from http://home.comcast.net/~ammawell/vitaminD.html#FAQ
NIH National Library of Medicine. (2012). 25-Hydroxy Vitamin D Test. Retrieved on February 23, 2014 from http://www.nlm.nih.gov/medlineplus/ency/article/003569.htm
Vitamin D Council. (2013). Vitamin D supplementation for pregnant and breastfeeding mothers. Retrieved on February 23, 2014 from http://www.vitamindcouncil.org/further-topics/vitamin-d-during-pregnancy...
Wagner, C. L., Hulsey, T. C., Fanning, D., Ebeling, M., & Hollis, B. W. (2006). High-dose vitamin D3 supplementation in a cohort of breastfeeding mothers and their infants: a 6-month follow-up pilot study. Breastfeeding Medicine, 1(2), 59-70. Retrieved on February 23, 2014 from http://www.ncbi.nlm.nih.gov/pubmed/17661565
© Copyright Breastfeeding USA 2015. All rights are reserved.
Tandem breastfeeding two children at once is something I never expected to do, and I certainly never imagined breastfeeding three (you only have two breasts after all; how would that even work?). But somehow I ended up nursing 21-month-old twins and a newborn. It sounds a little unusual to me now, too, but in the moment it was the right choice for my family. Most people don’t anticipate breastfeeding two (or more!) children at the same time, but there are some wonderful reasons to give it a try.
What is tandem breastfeeding?
Tandem breastfeeding is defined as two or more children of different ages who breastfeed at the same time. It might refer to having one child on each breast simultaneously or children who take turns breastfeeding throughout the day.
Do people really tandem breastfeed?
You might be asking yourself, “Since I’ve never heard of anyone I know tandem breastfeeding, do people really do it?” Absolutely. You may have heard of someone who has breastfed twins, but you might have never heard of someone breastfeeding children of different ages. In many cases, the older child only nurses a few times a day. S/he may not need to nurse when out in public and might be too busy when people are around, so often tandem breastfeeding occurs in the privacy and quiet of home. Because breastfeeding a toddler is beyond the current cultural norm, mothers who are breastfeeding toddlers often just don’t talk about it.
Why should I consider tandem breastfeeding?
Children who are allowed to wean themselves typically will continue nursing from 2 to 6 years. However, in the United states, only 27% of children are breastfeeding at 12 months, though the World Health Organization recommends breastfeeding AT LEAST until two years of age. Breastfeeding provides comfort, nutrition, normal development of the immune system, and social and intellectual development for as long as it continues. Breastfed toddlers may be less likely to be picky eaters because of the ever-changing flavor of breast milk!
The addition of a sibling is a huge change for a family. Breastfeeding connects children with their mothers in an emotional and physical way and also connects siblings as they “share” their mother’s milk. It’s very common for mothers to feel some guilt about spending so much time caring for their newborn when that time used to be spent caring for their older child. Breastfeeding allows mothers to reassure themselves and their older child that they still share the same bond and love as they did before.
Breastfeeding through pregnancy.
Many mothers who continue to nurse after they find they are pregnant fear they will not make enough milk or the right kind of milk for their new infants. Rest assured that the human body resets when a new baby is born and that it will produce the right kind of milk for the newest member of the family. Colostrum is very important as the first food and immune defense for the immature newborn. When the new baby is given free access to the breast, he will receive all the colostrum that he needs to get the best start in life.
But wait: If the milk changes for the newest baby, will my older child get what he or she needs from breastfeeding? Yes. Human milk is beneficial for all children of all ages. A toddler can benefit from the nutrient-dense colostrum (though you might notice some looser-than-normal stools for a bit) and the mature milk that follows. It is likely that the older breastfeeding baby or toddler is eating other foods.
Breastfeeding is also much more than nutrition. A child might continue to nurse after a mother’s milk has “dried up” for the comfort, closeness, and hormonal boost that comes from breastfeeding. Many women say they noticed a dip in their milk supply at the beginning of their pregnancy. This is due to hormonal changes, and there is no way to prevent it from happening About half of pregnant women report that their milk significantly diminished around the middle of pregnancy. For many babies this is a natural time for weaning, while others will continue to nurse. Whether or not an older sibling is nursing, the mature milk will begin to change to colostrum production during the second trimester of the pregnancy.
Many women experience discomfort, such as sore nipples, while breastfeeding during pregnancy. If this is the case for you, setting limits for your breastfeeding child is often a good compromise between nursing on demand and weaning completely.
A common concern about nursing during pregnancy deals with the ability to maintain good maternal nutrition for a growing fetus, the mother, and a breastfeeding child. Maintaining a healthy diet will always be more important during pregnancy with continued breastfeeding, but it's not significantly different from good nutrition during pregnancy itself--just more of it! Find out more about good nutrition for pregnant and breastfeeding moms.
If you have previously miscarried a pregnancy or delivered preterm, you may wonder if breastfeeding during subsequent pregnancies may increase your risk for either of these situations to happen again. Just as each child is different, so is each pregnancy. Talk with your healthcare provider about your situation. While breastfeeding can stimulate uterine contractions, so does sexual activity and to a much greater extent. If sexual intercourse isn't prohibited, then continued breastfeeding is less likely to be a concern. Ask questions of your health care provider, an International Board Certified Lactation Consultant (IBCLC), a Breastfeeding USA Counselor, and other mothers to learn as much as possible. Consider the needs of your older nursling and your own and your partner's feelings as you decide what is best for you and your unborn child
Some health care providers may not be well informed about the benefits of continuing to breastfeed through pregnancy, nor about the body’s ability to handle it. Check out the common “Booby Traps” that tandem breastfeeders may face and Myths vs. facts about pregnancy and tandem breastfeeding.
How do you juggle breastfeeding two children?
Sometimes juggling is the perfect word for breastfeeding two children! There are many different ways to approach tandem breastfeeding. How you choose to manage it will depend on your comfort level and the disposition of your children.
The most straight-forward option is to nurse your children at different times. In the early days as you and your new baby settle into a breastfeeding rhythm, you might choose this approach out of necessity, giving your newborn first dibs on the colostrum. There are ways to gently set boundaries for an older child when needed, as mentioned above.
Be prepared for a child who was previously uninterested in breastfeeding to be suddenly very interested again; this may include children who were previously weaned! When your older child is adamant about breastfeeding when the baby nurses, you might find it easier to breastfeed them at the same time. Getting creative will be important to finding positions that work for you. Usually, it’s easiest to get the littlest child settled first. Using a pillow or lying on your side can enable you to have at least one hand free to help your older child get into position. Once baby is comfortably latched and feeding, you can help your older child find a comfortable spot or (depending on the age and skill of your older child) letting them get comfortably situated all by themselves.
Possible positions include: older child and baby both straddling mom’s legs as she reclines (more information about laid-back breastfeeding here), older child in cradle position with baby lying on top in football hold, baby in cradle hold with older child kneeling or sitting next to mom, baby lying next to mom and older child sitting at mom’s back reaching over or lying on top of mom.
Here are some more tips for juggling a newborn and toddler.
Making enough milk.
Just like breastfeeding one newborn, establishing good milk production means feeding your baby on cue. The question when to feed your baby versus your older child is common. Should the baby always go first? Will the older child take all the hind milk? How can I be sure the baby is getting enough?
Your breasts will respond and make as much milk as needed, based on the amount of milk that is removed. Your baby will let you know if s/he is getting enough with the usual clues: frequent breastfeeds (at least 8-12 times in 24 hours), many wet and soiled diapers, steady weight gain. Newborns feed often; this is normal and how your body establishes milk production.
During the first few days, the baby should nurse first to ensure they get a full share of colostrum. After the first few days, you’ll need to find a breastfeeding strategy that works for you. You can alternate who gets which breast first, you can assign one breast per child (for the hour, the day or permanently), you can feed both children on both breasts as is convenient, or use a combination of all these strategies! There is no reason to be concerned about foremilk/hindmilk imbalance. Over the course of the day, your milk provides what your children need.
Is Tandem Breastfeeding For Everyone?
Not necessarily. The experience is different for every mother. It is natural for a mother to focus strongly on the needs of the new baby, and breastfeeding is the way she does this. She may feel more comfortable meeting the needs of the older child in other ways. Tandem nursing can be overwhelming at times. Some mothers set limits on the number of times that the older nursling can be at the breast. Other mothers actively encourage the older child to wean. Some mothers look forward to tandem breastfeeding and then are dismayed to find that they really don’t like it. There is no right or wrong here. Do what feels right for you and your family.
Tandem Breastfeeding Can Be Awesome!
Have you ever seen the slogan, “I make milk. What’s your superpower?” Breastfeeding one baby can be one of the most empowering and rewarding experiences of a woman’s life. For those women who choose to do so, tandem breastfeeding can expand those feelings exponentially! For me, tandem breastfeeding was just plain awesome.
- Thinking About Weaning? https://breastfeedingusa.org/content/article/thinking-about-weaning
- Booby Traps Series: “If we lived on an island where nobody else cared what we did…” How stigma hinders nursing past infancy: http://www.bestforbabes.org/booby-traps-series-when-are-you-going-to-sto...
- Breastfeeding Past Infancy: http://kellymom.com/ages/after12mo/ebf-refs/
© Copyright Breastfeeding USA 2015. All rights are reserved.
Book review: The Science of Mother Infant Sleep: Current Findings on Bedsharing, Breastfeeding, Sleep Training, and Normal Infant Sleep
Middlemiss, W. & Kendall-Tackett, K. (Eds.). (2014).The Science of Mother-Infant Sleep: Current Findings on Bedsharing, Breastfeeding, Sleep Training, and Normal Infant Sleep. Amarillo, Texas: Praeclarus Press. 220 Pages.
The Science of Mother-Infant Sleep is a compilation of recent research on such topics as bedsharing, breastfeeding, sleep training, and SIDS. The academic tone of the book is likely better suited to health-care professionals, although parents who would like an in-depth analysis of research without a lot of opinion-based commentary would also find The Science of Mother-Infant Sleep helpful. The text provides a thorough summary of the topic, and the references that follow each chapter make it easy for the reader to investigate the topic in detail.
Each chapter of the book focuses on a specific topic related to infant sleep through a review of the recent scholarly research. It is unlike the more traditional parenting books in that it does not provide a long list of detailed instructions or procedures to follow. Instead, readers can draw conclusions from the research and determine their own plan of action.
Many parents, who are experiencing “sleep problems” with their infants and have explored all of the commercial sleep training programs, would likely find this approach to sleep research refreshing. This book excels in its approach to controversial topics such as bedsharing and sleep training. By simply reporting on the conclusions of each scientific study, the authors of The Science of Mother-Infant Sleep are able to remove all personal judgment of the decisions the reader makes. Since debates on these topics significantly contribute to the so-called “mommy wars,” the objective approach of this book is unique. The evidence-based nature ofThe Science of Mother-Infant Sleep makes it an ideal reference for health-care professionals who would like to provide the most recent scientifically based information to the parents of children in their care.
There are numerous authors of this book and all have vast experience in the fields of infant sleep and breastfeeding. Nearly all the authors have a PhD, and one of the editors is an IBCLC (International Board Certified Lactation Consultant.). They are currently working in the fields of Anthropology, Psychology, and Pharmacology, which gives them a diverse range of knowledge and experience to review research and make recommendations for parents. There are no major conflicts of interest, although the authors rely on their own research to support their claims and conclusions.
Copyright Breastfeeding USA. All rights reserved. October 2014