Category Archives: Breastfeeding

6 Tips for Sweet Newborn Sleep

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Nothing can prepare you for the changes in your sleep when you welcome a newborn baby into your family. Experienced parents will issue dire warnings and tell you to sleep while you can during the last few weeks of pregnancy. (And you will think, yeah right, there’s a large boulder resting on my bladder, and sometimes it kicks for good measure.)

But then the baby arrives, and your world changes forever. Sleep disruption is one of the most immediate and dramatic changes associated with parenthood. It isn’t just that you’re getting less sleep; it’s that your sleep is suddenly dependent on this baby sleeping. And even though newborns sleep a lot – as much as 16-18 hours per day – it feels disorganized and unpredictable.

The thing is, babies, even brand new ones, actually do have organized sleep, it just isn’t organized like yours. But under the surface, baby is working towards being more like you in his sleep. During the first few months, you have no choice but to go with the flow and sleep when the baby sleeps (something I was never good at), but it can help to understand the inherent patterns in your baby’s sleep/wake cycles so that they become more predictable. Your goal is to work with your baby’s biology, find some time for your own sleep, and support your baby in his natural development towards more mature sleep patterns.

In the research for my book, I’ve buried myself in research papers on infant sleep, trying to glean some knowledge that can be helpful to parents in these first few months of baby’s life. Here’s what I’ve come up with so far:

1. Understand newborn sleep cycles. Newborn sleep alternates between active and quiet sleep (akin to REM and non-REM sleep in adults). During the first few months of life, infants usually begin each sleep period in active sleep. Then, after about 25 minutes, they’ll transition to a cycle of quiet sleep, also about 25 minutes long. During active sleep, babies will twitch and flail their limbs, grunt and sigh, and maybe even cry a little. Their eyes move beneath translucent closed lids and may even open from time to time. In quiet sleep, babies breathe slowly and rhythmically, and their bodies are still 1,2.

Why care about the biology of sleep? Because it can help you in these practical ways:

  • Babies wake easily from active sleep, so if your baby falls asleep in your arms, wait until you see signs of that deeper, quiet sleep before you try to move him.
  • Around the 45-50 minutes mark, baby will be finishing up that first active/quiet sleep cycle of 45-50 minutes. Transitioning from one cycle to the next can be tricky for a new baby, so if he wakes during this time (particularly if it’s after just one cycle), see if he wants your help returning to sleep before assuming that he’s ready to eat or play.
  • Active sleep is noisy. Parents often mistake the normal vocalizations of active sleep as the baby waking, and in their efforts to soothe the baby, they’ll actually wake him up. If you think your baby is waking up, pause and watch him for a moment. He may just be dancing in his sleep, or he might be waking briefly only to return to sleep on his own.

IMG_42252. Help your baby find a rhythm. We are adapted to Earth’s 24-hour cycle of light and dark, and our physiological circadian rhythms help us to feel awake during the day and sleepy at night. Newborn babies, on the other hand, sleep just as much during the day as they do at night. It takes them some time to develop rhythms to match our day/night cycle. You can help by sending baby strong environmental and social cues about day and night.

During the day, keep the baby in a light, maybe even noisy place, even as he naps. At night, keep the lights as low as possible and the environment quiet. Even as you’re feeding frequently during the night (and you probably are), keep your interactions with your baby very quiet, uninteresting, and unstimulating. Be boring. With these cues, babies start to show physiological circadian rhythms quickly. A rhythm in body temperature can be detected around one week of age, and by two months of age, babies have robust rhythms of the hormones melatonin and cortisol. By two to three months, most babies are sleeping for most of the night (just waking briefly to feed) and have some distinct periods of wakefulness during the day (with some naps, of course)3–6. One study reported an outlier – a baby that hadn’t developed a day/night circadian rhythm at five months. Turns out that night owl took his night feedings in a brightly lit room – he had received confusing signals about nighttime7.

3. Start to develop a soothing bedtime routine. It’s never too early for this. Find some calming rituals that you repeat each night before bed. These become part of the social cues that will key your baby into the nighttime rhythm and let her know that sleep time is coming. Tell your baby what is happening: It’s almost time for bed, so we’re having a bath. Then you’ll have some milk, and I’ll sing our bedtime song. And then it will be time to sleep. (Bedtime routines have been shown to help babies fall asleep faster and get more sleep during the night, but they’ve only been empirically tested in older infants8. I just think it’s smart to start this within the first few months.)

4. If you’re breastfeeding, breastfeed at night. During pregnancy, baby was exposed to mom’s day/night rhythm of melatonin, which increases during the dark night and decreases during the light of day. If you breastfeed, you keep sending that sleepy melatonin signal to your baby through your milk, even before he begins to produce his own melatonin. Human breast milk reflects maternal plasma melatonin concentrations, peaking between midnight and 4 AM and being virtually undetectable during the day9–11. Melatonin during a night feeding should help baby transition peacefully back to sleep. Consider this if you supplement with formula or use pumped breast milk for a nighttime bottle. Nighttime breast milk (pumped or from the breast) might mean better sleep for baby.

IMG_32495. Let your baby practice falling asleep in different ways. You’re going to want to hold him a lot, and so will all his doting family. There is nothing like watching a newborn fall asleep in your arms. He’ll also fall asleep feeding. You might enjoy having him sleep on your chest in a wrap or sling while you go about your day. Enjoy all of these snuggles with your baby. But every once in a while, see if you can put him down sleepy but awake. Some, but not all, babies can be surprisingly flexible during the first months of life about how they sleep. Letting him practice this now may give your baby the skills he needs to sleep well later. Babies that are able to fall asleep without a lot of active soothing (i.e. feeding, rocking, bouncing, walking, driving) tend to be the same babies who sleep well during the night12. This is a great time to encourage flexibility while also providing secure and predictable routines.

6. Observe your baby. Observing your baby means learning his particular signals for when he’s feeling sleepy; then you can work together towards getting comfortable for sleep. Observing your baby may mean that when you hear him start to grunt and move around during the night, you wait a moment and watch to see what he’s doing and if he’s trying to communicate with you. Is he hungry? Uncomfortable? Wet? He’ll let you know that. But he may just be transitioning from one sleep cycle to the next. He may want to go right back to sleep, or he may not have woken at all but instead is in a noisy active sleep period. Babies that learn to transition between sleep cycles without your help will grow into better sleepers later in infancy, but you have to give them a chance to practice this valuable skill12–14. Wait a moment or two to see if he needs your help, and if he does, soothe him quietly.

What advice do you have for helping babies and parents find their groove with sleep?

REFERENCES:

1. De Weerd, A. W. & van den Bossche, R. A. S. The development of sleep during the first months of life. Sleep Med. Rev. 7, 179–191 (2003).

2. Anders, T., F. in Encycl. Early Child. Dev. (Tremblay, R. E., Boivin, M. & Peters, Rd.) 1–8 (Centre of Excellence for Early Childhood Development and Strategic Knowledge Cluster on Early Child Development, 2010). at

3. McGraw, K., Hoffman, R., Harker, C. & Herman, J. H. The Development of Circadian Rhythms in a Human Infant. Sleep 22, 303–310 (1999).

4. Mirmiran, M., Maas, Y. G. . & Ariagno, R. L. Development of fetal and neonatal sleep and circadian rhythms. Sleep Med. Rev. 7, 321–334 (2003).

5. Custodio, R. J. et al. The emergence of the cortisol circadian rhythm in monozygotic and dizygotic twin infants: the twin-pair synchrony. Clin. Endocrinol. (Oxf.) 66, 192–197 (2007).

6. Ardura, J., Gutierrez, R., Andres, J. & Agapito, T. Emergence and Evolution of the Circadian Rhythm of Melatonin in Children. Horm. Res. 59, 66–72 (2003).

7. McMillen, I. C., Kok, J. S. M., Adamson, M., Deayton, J. & Nowak, R. Development of Circadian Sleep-Wake Rhythms in Preterm and Full-Term Infants. Pediatr. Res. 29, 381–384 (1991).

8. Mindell, J. A., Telofski, L. S., Wiegand, B. & Kurtz, E. S. A nightly bedtime routine: impact on sleep in young children and maternal mood. Sleep 32, 599–606 (2009).

9. Illnerová, H., Buresová, M. & Presl, J. Melatonin rhythm in human milk. J. Clin. Endocrinol. Metab. 77, 838–841 (1993).

10. Cubero, J. et al. The circadian rhythm of tryptophan in breast milk affects the rhythms of 6-sulfatoxymelatonin and sleep in newborn. Neuro Endocrinol. Lett. 26, 657–661 (2005).

11. Cohen Engler, A., Hadash, A., Shehadeh, N. & Pillar, G. Breastfeeding may improve nocturnal sleep and reduce infantile colic: Potential role of breast milk melatonin. Eur. J. Pediatr. 171, 729–732 (2011).

12. Burnham, M. M., Goodlin-Jones, B. L., Gaylor, E. E. & Anders, T. F. Nighttime sleep-wake patterns and self-soothing from birth to one year of age: a longitudinal intervention study. J Child Psychol Psychiatry 43, 713–25 (2002).

13. Pinilla, T. & Birch, L. L. Help me make it through the night: behavioral entrainment of breast-fed infants’ sleep patterns. Pediatrics 91, 436–44 (1993).

14. Wolfson, A., Lacks, P. & Futterman, A. Effects of parent training on infant sleeping patterns, parents’ stress, and perceived parental competence. J Consult Clin Psychol 60, 41–8 (1992).

 

Breastfeeding a Toddler? Should You Be Concerned About Iron Deficiency?

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You may have heard about a study published in Pediatrics last week (Maguire et al. 2013) showing an association between iron deficiency and breastfeeding beyond a year. If you’re breastfeeding a toddler, or considering it, you might be wondering if you should be worried about iron deficiency. There is very little research on breastfeeding beyond a year in developed countries, so this study is worth a closer look. (If you’re interested, I’ve written before about some of that research, my own reasons for choosing to breastfeed beyond a year, and my experience of weaning my two-year-old.)

What This Study Shows

This was a cross-sectional study of children ages 1-6 in Toronto, Canada. Blood samples were taken from 1647 children, and their mothers were asked, “How long has your child been breastfed?” We always have to be cautious about studies based on parental recall. However, research shows that mothers actually answer this question with good accuracy (Li et al. 2005). Of the children in this study, 93% had been breastfed at all, and median breastfeeding duration was 10 months. Twenty-seven percent of children were breastfed for more than one year, and 4% breastfed for more than two years.

The children’s blood samples were analyzed for serum ferritin and hemoglobin. Serum ferritin reflects the amount of iron stores available for use by the body, so it can be used to assess iron deficiency. If an iron deficient child also had low hemoglobin, he was diagnosed as having iron deficiency anemia. In this study, the prevalence of iron deficiency was about 9%, and 1.5% had iron deficiency anemia, findings similar to other studies in developed countries (Baker et al. 2010, full text here).

This study showed that kids that were breastfed for longer were more likely to be iron-deficient. Each month of breastfeeding beyond baby’s first birthday increased the risk of iron deficiency by about 5%. Children who were breastfed for longer than a year were estimated to have 1.7 times the odds of being iron deficient than those breastfed for less than a year. The researchers corrected for several potentially confounding factors: age, gender, birth weight, BMI, ethnicity, household income, day-care attendance, age of introduction of solids and cow’s milk, and current daily intake of cow’s milk. Children with iron deficiency were also more likely to be heavier at birth (bigger babies have higher iron requirements), younger (meaning that older kids seemed to have recovered from iron deficiency), and to be drinking more cow’s milk (something I wrote about here). Breastfeeding duration was not associated with iron deficiency anemia, which would indicate a more severe deficiency.

An obvious limitation to this study was that the observed relationship between breastfeeding and iron deficiency was just a correlation. There are other factors that could come into play that weren’t examined, like timing of umbilical cord clamping and how much iron these kids were getting from their diets or supplements. For example, it’s possible that moms who breastfeed longer are less likely to give their toddlers a multivitamin or other iron supplement. It that case, it wouldn’t be the breastfeeding that increased the risk of iron deficiency, but rather something else about moms who choose to breastfeed beyond a year. This is a major limitation, but to be fair, almost every study that shows positive outcomes for breastfeeding has the same problem.

Why be concerned about iron deficiency?

Iron is a mineral essential to life in all animals. Most of the iron in the body is used to make hemoglobin and myoglobin, so iron is really critical for oxygen transport to all tissues of the body. Iron is also part of several enzymes involved in energy metabolism. Every cell in the body requires iron, but blood, brain, and muscle cells are the ones that really suffer if there isn’t enough iron around. A person with severe iron deficiency will develop iron deficiency anemia, one of several types of anemia.

Iron deficiency in the first years of life, even without anemia, has been associated with cognitive, motor, and behavioral deficits (Lozoff et al. 2006). There are a lot of confounding variables in these studies, because kids that are iron deficient are likely to have other disadvantages as well. However, there are mechanisms for a causal relationship established through animal research (McCann and Ames 2007). So there’s some controversy as to just how scared we should be about iron deficiency, but given that we’re talking about brain development of our kids and that iron deficiency can be corrected with dietary changes, I think we should pay attention to it.

The current study was the first to look at the relationship between breastfeeding and iron in toddlers. Many studies have shown that exclusively breastfed babies are at higher risk for iron deficiency during late infancy (reviewed by Baker et al. 2010, full text here). Human breast milk is low in iron, but babies are usually born with enough iron, passed from mom via the placenta, to last for about the first six months. Delayed cord clamping at birth can extend the iron stores by another month or two. If breastfed babies aren’t getting some good iron-rich solid foods by late infancy, they can become iron-deficient.

So should I be worried about my breastfed toddler?

Worried? I wouldn’t go that far. Instead, I’d say you should be alert to the possibility that your breastfed toddler could become iron deficient. The good news is that it isn’t that hard to prevent iron deficiency if you’re mindful about nutrition.

How can I ensure that my breastfeeding toddler is getting enough iron?

Why would a breastfed toddler be at greater risk for iron deficiency? The study at hand doesn’t tell us, but I’ll speculate for you. Breast milk doesn’t have much iron. Yes, the iron in breast milk is well-absorbed, but there is still very little there. That’s probably a good thing for an infant (more on that here), but it means that breast milk really can’t provide complete nutrition for a growing toddler. Toddlers need good iron-rich sources of solid foods in their diets.  If a toddler fills up on breast milk, then it may be challenging for him to get balanced nutrition.

So how can you make breast milk part of a balanced diet for a toddler?

  • Talk with a health care provider about your child’s risk for iron deficiency. Consider having him tested so that you know if you should be concerned. If he does test low for iron, then depending on the severity, your pediatrician might recommend a supplement or suggest trying to correct the problem through diet.
  • Include lots of iron-rich foods in your toddler’s diet, like meats, legumes, whole grains, green veggies, and dried fruits. Of course, toddlers can be picky, so this may be easier said than done. Know that it may take many low-pressure exposures for your kid to be ready to try new foods. Iron-fortified breakfast cereals are a good option for more skeptical eaters. You can find a list of iron-rich foods, as well as strategies for increasing iron absorption, in this post.
  • Cow’s milk inhibits iron absorption. If your toddler is breastfeeding AND drinking cow’s milk, consider limiting cow’s milk to just one or two cups per day (or even none at all). Of course, without cow’s milk, you’re losing a good source of vitamin D (also low in breast milk), so you may want to consider a vitamin D supplement.
  • Evaluate if breastfeeding is getting in the way of your toddler eating well at meals. This might be an issue if you’re breastfeeding on demand throughout the day. Toddlers do better with eating if they have structure around their meals and snacks. To you and your toddler, breast milk is probably much more than a food. It is comfort, closeness, and a moment of quiet together. But, it is also calories, and there’s no getting around that. Toddlers who snack on breast milk throughout the day might not come to the table hungry and be ready to eat a variety of foods with the rest of the family. If that seems like it might be an issue for your child, consider fitting breastfeeding into times of day when it is unlikely to interfere with eating, such as before nap and bedtime.

If you’re breastfeeding beyond a year, what do you do to balance breast milk and foods in your toddler’s diet?

Weaning My Toddler

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So, I have some more big news to catch you up on. I weaned Cee a few weeks ago, soon after her second birthday. I took a few notes along the way, but I never pulled it together to post on the blog about it. I thought I’d share some of those notes here and reflect back on our experience.

Cee may be weaned, but she still nurses her own baby all the time.

Cee may be weaned, but she still nurses her own baby all the time.

11/24/12

Tonight, I nursed my baby girl for the last time. She’s not so much of a baby anymore. She turned two last week. But I savored the feeling of her curled into my arms. I noticed how her long eyelashes cast a shadow across her cheeks and how soft her face looked, the tension of the day melted away.

I remembered nursing her in those early days, when her eyelids were still translucent, tiny blood vessels visible. I remembered how she would be frantic to nurse one second and peaceful the next, her little hand clasped in a fist, resting on the top of my breast.

Cee and I started talking about weaning a few weeks ago. We usually read books while we nurse, and lately I’d noticed that she was so enthralled with the books that she could hardly nurse. I’d turn a page, and she would break her latch to look closer at a picture, pointing something out to me. We were going through the motions because we always had, but nursing didn’t feel that important to either of us anymore. It felt like it was time to make this change.

We had been down to nursing just at naptime and bedtime since the summer. We dropped the naptime feeding first. All fall, Cee had gone down just fine without me and my milk at daycare and with Husband, and there were only a couple of days of brief protest over this change.

Down to just nursing at bedtime, Cee and I talked about how Mama didn’t have very much milk anymore. We talked about how babies (like our friends’ 3-month-old) need a lot of milk, but kids like Cee eat lots of good food and can drink their milk in a cup. We talked about how we love snuggling and nursing, too. I guess I wanted a chance for us both to appreciate our final days of nursing.

A couple of days ago, Cee watched me as I undressed for a shower. She pointed at my naked breasts and said, “Milk?” Continue reading →

Tummy Troubles, Colic, and Mama’s Diet

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This question comes from a ScienceofMom reader, who wrote me to ask:

I’m looking for good quality information on whether mom’s diet can really cause tummy trouble in babies, outside of perhaps a milk protein allergy.  I’ve seen arguments that it does, but they seem largely anecdotal.  Yet my pediatrician has never mentioned the possibility that my diet might be causing my 3-month-old infant to have gas bouts at 4 a.m. or so every. single. night.  Instead I’m routinely told that I just need to wait and by 4 months her digestive system will grow up.  –KT

Most of us have heard and read that we don’t need to give up any of our favorite foods in order to breastfeed our babies. In general, this is true, and it is an important message. Between sore nipples and engorged breasts during those first few weeks of motherhood, moms need to know that breastfeeding will eventually (usually) be an easy fit to their lifestyle.

There has even been some recent research showing that maternal diet restriction during lactation may increase baby’s chances of developing allergies. If your baby is NOT showing any signs of tummy troubles, your best bet is to eat a balanced variety of whole foods. Think of it as gently introducing your baby to the proteins of the world via your milk.

However, there have been several studies of the effect of mom’s diet on colic symptoms. Approximately 1 in 5 U.S. infants between 0 and 4 months are considered to have colic. The “Rule of Threes” is used to define colic: A colicky baby has incessant, inconsolable crying for at least 3 hours per day on at least 3 days per week, for more than 3 weeks. Crying is usually the worst in the evening hours. {It isn’t clear from K.T.’s note if her baby actually has colic or just gas – they’re not always the same. I’ve focused this post on colic, because that’s where the research is, but I’m willing to speculate that what works for colicky babies may also help babies with milder types of GI discomfort.}

The truth is that we really don’t know what causes colic. It is probably multi-factorial and has different causes in different babies. (For an interesting account of the history of our understanding of colic and how to manage it, check out this article,The Colic Conundrum, from The New Yorker.) However, there are several lines of evidence that colic is related to intestinal immaturity or imbalance. Colicky babies often seem to be gassy and to have GI discomfort, pulling their legs up to their bellies while crying as if in pain. Research has also shown that colicky babies have intestinal inflammation and abnormal gut motility [1]. In addition, we know that proteins from mom’s diet can pass into breast milk, and some babies seem to be allergic or intolerant of these proteins. That’s where the role of mom’s diet comes in.

Cow’s milk appears to be the most common culprit when it comes to food allergies in infants. It has been estimated to occur in about 0.5-1.0% of exclusively breastfed infants [2]. Studies on the relationship between cow’s milk allergy and colic are mixed, however. In one study, 66 mothers of exclusively breastfed colicky infants eliminated cow’s milk from their diets, and “colic disappearance” was noted in more than half of the infants [3]. When the moms later drank cow’s milk again as a test, colic symptoms returned in 2 out of 3 of the babies. Based on this study, cow’s milk allergy or intolerance would seem to be an important cause of colic. Continue reading →

Why Care About Breastfeeding Research?

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Since becoming a mom, and especially since starting this blog, I have paid particular attention to new breastfeeding research. After all, my training is in nutrition, and breast milk is one of the most interesting foods around. Plus, I’m currently lactating and still breastfeeding my daughter a few times per day, so it’s on my mind.

When I look back at the papers that I have covered and those that I find on other blogs and media outlets, I notice that many focus on how breastfeeding improves outcomes in babies.

But I also notice that when I blog about breastfeeding research, I have to spend a big chunk of the piece talking about the limitations of the study. Breastfeeding research – at least when conducted in humans – will always have big limitations that require disclaiming and explaining. The problem is that it is impossible to randomize breastfeeding trials or to “blind” the subjects to feeding type. It is difficult to know, despite the fanciest statistical methods, if it is breast milk that makes those babies thinner, smarter, stronger, cry more, etc, or if there are other factors at play in this complex thing called human life. Sometimes, by the time I’ve listed the problems with interpreting a breastfeeding study, I wonder if these findings were actually meaningful, and I’m sure my readers feel the same way.

Elsewhere around the Internet (not so much on my blog), I often see comments to this effect on articles about the latest research on the benefits of breastfeeding:

“Another useless study. Obviously we mammals were meant to feed our babies breast milk. I don’t know why scientists waste their time and our money with this stuff.”

Why bother doing more research on outcomes associated with breastfeeding? It is pretty clear that breastfeeding is a great way to feed an infant. Maybe it is time to stop oohing and awing over breast milk. Continue reading →

Bottle-feeding and Obesity Risk

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Source: Wikimedia Commons

A study published this month in Archives of Pediatric and Adolescent Medicine looks at the relationship between infant feeding practices and weight gain (1). Breast milk vs. formula? Nope, it isn’t that simple.

Led by Dr. Ruowei Li of the CDC, this prospective longitudinal study tracked feeding and weight gain in 1900 infants during their first year of life. Each month, mothers were asked how they fed their babies in the last 7 days, and from their replies, infants were grouped into the following categories across ages:

  1. Breastfed only
  2. Breastfed and human milk by bottle
  3. Breastfed and formula by bottle
  4. Human milk by bottle only (i.e. exclusive pumping)
  5. Human milk and formula by bottle
  6. Formula by bottle only

The mothers in this study were mainly white, married, and had at least a high school education. A third were on WIC. About 50% were overweight or obese. Statistical methods were used to adjust the findings for a range of maternal factors, including BMI, as well as infant sex, gestational age, birth weight, and age of solid food introduction.

The most important finding from this study was that infants fed by bottle only – whether fed formula or breast milk – gained more weight than those fed breast milk at the breast. Continue reading →

The Apparent Breastfeeding Paradox: What is optimal nutrition for a premature baby?

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Last week, I wrote about some of the unique challenges (and one potential solution) to breastfeeding a baby born prematurely. Another study recently published in BMJ Open provides more food for thought on breastfeeding preemies (1; full text available here).

A team of French researchers examined the relationship between breastfeeding, growth, and neurodevelopment in two observational cohorts of babies born very prematurely, at less than 32 or 33 weeks of gestation.

Between the two cohorts, a total of 2925 very preterm infants were included in the study. These babies were in the hospital for 50-60 days before they were allowed to go home. In the two cohorts, 19% and 16% of babies were breastfeeding at the time of discharge from the hospital. The study looked at associations between type of feeding at discharge (breast milk or formula), growth during hospitalization, and growth and neurodevelopment at 2 and 5 years of age.

Source: Wikimedia Commons

What were the findings? In these cohorts, formula-fed babies had gained more weight by the time they were discharged from the hospital. However, at 2 and 5 years of age, the formula-fed babies scored lower on neurodevelopment assessments compared to the breastfed babies. Breastfed babies also had greater head circumferences by 2 and 5 years of age, suggesting improved brain development, and they appeared to catch up to formula-fed babies in height and weight. Continue reading →

Pump up the music: Improving breast milk production in the NICU

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The breast pump is a fabulous invention. It is what gives modern moms the option to pursue a career and breastfeed. And for moms of babies born prematurely, it is everything. Their babies get a great start with breast milk, and moms can establish milk supply even if they are separated by prolonged stays in the NICU.

Source: Wikimedia Commons

In a study published in Advances in Neonatal Care last week, Douglas Keith and colleagues reported on their attempt to increase production in moms pumping milk for their preemie babies [2]. 162 moms of preemie (average 32 weeks) or critically ill newborns admitted to the NICU were given a hospital-grade breast pump and encouraged to pump 8 times per day. They were randomly assigned to one of 4 groups. A control group received standard support for breastfeeding, and the remaining 3 groups were given a recording to listen to during pumping. The second group received a recording with a spoken guided relaxation. The third received the same guided relaxation, but it was accompanied by soothing guitar lullabies. The fourth received the relaxation/guitar recording, plus a video player with images of their own babies. Milk production and milk fat content were measured over 14 days.

What effect did a little music and pictures have on milk production? The results were actually quite striking. Continue reading →

Put down the phone, Mama!

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We were getting settled for nap time. As I changed BabyC’s diaper, I talked with her in a quiet tone and told her that we were preparing to rest. We did one slow and whispered round of “Head, Shoulders, Knees, and Toes” on the changing table. I closed BabyC’s curtains and dimmed the lights. We fished her special doll and blanket from her crib, and then we all sat down into the rocking chair to nurse. BabyC was still a little wound up, though, and as we were getting settled, she swiped my phone from the side table. I don’t usually let her play with my phone, but in the interest of keeping things mellow, I figured I’d let her hold it for a while. She latched, and we both started to relax.

But then, BabyC turned on my phone. She started swiping her finger across the touch screen, just as she watches me do throughout the day. She hit at icons and watched colors flash on the screen, her eyes darting around. Suddenly, she was opening the address book and initiating a FaceTime video call with – who? Oh, an old college buddy of Husband’s, someone I’ve met once, about 5 years ago. Yikes! A surprise video call from my boob is probably not the best way to get back in touch. 

OK, BabyC, no more phone. I felt annoyed. I wanted BabyC to snuggle up with me and enjoy calming milk and our time together. It seemed ungrateful for her attention to be somewhere else entirely. Continue reading →

10 Tips for Starting Your Baby on Solid Food

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This post was originally published in September 2011 but is updated to reflect the American Academy of Pediatrics’ new policy statement on Breastfeeding and the Use of Human Milk, published online February 27, 2012. It is available in free full text online, and it includes a nice summary of the research supporting breastfeeding and the Baby-Friendly Hospital Initiative.

Starting solid foods is one of the major landmarks of a baby’s first year.  You play a very active role in your child’s experience with food, and your goal is to make that experience healthy, fun, and safe.

Here are 10 tips to get you off to a good start. Continue reading →