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Friday, 07 March 2014 14:15

Your Breastfed Baby & Colic

Many mothers experience fussiness in their babies once in a while, and this is usually accepted as part of the trials of motherhood. However, some babies have “colic,” which is described as a healthy baby, who is gaining weight steadily, crying inconsolably for over 3 hours, for an incidence that happens more than 3 days a week, for over 3 weeks.  The crying usually starts at around the same time every time and is usually in the evenings. 

It doesn't matter whether you bottle feed or breast feed your baby--roughly one in every five babies experience colic. Colic starts at around 2 weeks and ends at around 4 months old. Some identifiers of colic are:

  • baby pulls up his legs while crying

  • baby's hands may be in a fist

  • baby is very gassy and his stomach is harder than normal.

The worst part about colic is that there is no proven treatment. 

I was one of the "lucky" moms with both of my babies having colic, and at first I blamed myself. I thought I did something wrong and that my children were suffering because of what I did.  I just did not understand how my children could be experiencing colic since I took care of myself during both pregnancies and during breastfeeding: I exercised, limited my caffeine intake, rarely consumed any dairy products (I have never liked cow’s milk), ate plenty of fruits, legumes and vegetables and ate organic as much as possible. Yet both of my babies experienced colic during their first four to five months of life, and even though my second daughter is having bouts less frequently, she still has periods of extreme fussiness. The change is that I now know how to treat and even sometimes prevent them. 

Although no one really knows what causes "colic", everyone has their own theory. It really annoyed me when people would tell me I needed to stop eating my kale, cabbage, onions and spicy foods (being from Southern California, spicy Mexican foods have become a part of my heritage!) and that the colic would go away on its own. While studies show that some babies might indeed have an allergic reaction to certain food proteins that resist digestion in the small intestine and find its way into breast milk (usually typical allergens such as dairy, nuts or soy), I didn’t stop eating my kale and onions without looking into other possible problems and how to fix them. Here are some things to consider based on my studies and research:

Incorrect Latch Issues

A good latch is the key to easy breastfeeding! A lot of parents don’t realize that proper latch on the breast is absolutely necessary for a successful feed. This problem happens usually to newborns in the first few days after their mother’s milk has come in. If your baby is not latched on correctly, he could be swallowing a lot of air, thus making him gassy. Moms are also likely to have very painful nipples and even mastitis due to the improper latch. Latch is the easiest problem to solve if it is what causes your baby to have colic. 

My Suggestions:

proper latch is when the baby’s chin is pressed against mom’s breast and their nose is well away from the breast. I like to call the shape baby’s lips make a “fish’s tail”. Baby should also not be making loud sucking noises when he feeds. Contact a lactation consultant, your midwife or doctor if you have any concerns or issues with your baby latching on. 

 

Overactive or Forceful Letdown (Milk Ejection Reflex)

With both of my daughters, I have had an overactive letdown; sometimes so much that I could feel the letdown coming quite painfully. With an overactive or forceful letdown, your milk comes down very forcefully, making it hard for your baby to swallow while breastfeeding. Baby may even gag and swallow a lot of air along with the milk. An overactive letdown can cause baby to be fussy at the breast. Baby may also become unhappy once the flow of milk starts to slow down. 

When baby fills up on the watery foremilk, he may get a stomach ache from the combination of filling his stomach too fast, swallowing air to keep up with the let-down, and the laxative effect of a large quantity of lactose (milk sugar). The enzyme lactase, which digests the sugar, may not be able to handle so much milk sugar at one time and the baby will show symptoms of lactose intolerance—crying, gassiness, and explosive, watery, green poop. While people might that that having “too much” milk is a good thing, it can be very frustrating for both baby and mom.  

My suggestions: 

Keep baby on one breast per feed. If your other breast is too uncomfortably full, pump just enough between feeds to relieve the fullness, but not so much that you overproduce milk (Remember that milk production is a supply-and-demand issue). Make sure that your baby drains that breast completely to get all of the fatty hind milk, even if you have more than one let down. With a forceful letdown, it is usually the first let down that is the most painful.

Find a position that keeps baby’s head above your breast, such as propping baby up in a “sitting” position with your arm supporting him, to prevent choking during the letdown. You can also try feeding your baby while lying down in a side-lying position. 

My last suggestion is to take your baby off the breast when you feel a strong letdown coming. Catch the overflow of milk in a clean cloth, then place baby back on your breast once the letdown slows. This may or may not upset your baby more, so make sure you follow baby's signs cues. 

 

Sensitivity to cow’s milk proteins

This is NOT lactose intolerance. Lactose intolerance is the inability to digest the sugar lactose found in milk, while Cow’s Milk Protein Intolerance (CMPI) is an immunological reaction. Babies who are sensitive to dairy in mom’s diet are sensitive to specific cow’s milk antibodies in the form of proteins (not lactose) which pass into the mother’s milk. Cow’s milk (either in the mother’s diet or added into formula) is a common source of food sensitivity in babies. If your baby is sensitive to dairy in your diet, it will not help to switch to lactose-free dairy products. The problem is the cow’s milk proteins, not the lactose. 

CMPI can cause colic-like symptoms, eczema, wheezing, vomiting, diarrhea, bloody filaments found in stool, constipation, hives, and/or a stuffy, itchy nose1

My suggestions: 

If your baby is only a little sensitive to dairy proteins, you may be able to relieve baby’s symptoms by eliminating only the obvious sources of dairy: milk, cream, yogurt, butter, cheese, sour cream, ice cream, cottage cheese. You may even be able to eat small amounts of dairy without it affecting baby.

If your baby is highly allergic, it will be necessary to eliminate all sources of dairy proteins, which requires a careful reading of food labels. Also, a large amount of babies allergic to cow’s milk proteins are also allergic to soy1,2 and some may even react to goat’s milk, sheep’s milk, and even beef. 

 

Sources of Cow’s Milk Protein:

Beef, butter, butter fat, buttermilk, casein, cheese, cottage cheese, cream, ghee, half & half, kefir, lactoglobulin, lactose, all forms of milk (condensed, sweetened, whole fat, non fat, evaporated, skim, malted), nougat, pudding, sour cream, whey, whey proteins, yogurt. 

**Also make sure to avoid deli meats since many of them do contain dairy products or may have been contaminated with dairy during the process. 

Sources of Soy: 

Edamame, soybeans, soy proteins, soy milk, soy bean oil, tofu, tempeh, soy sauce, tamari, soy flour, miso, soy lecithin, and soy isoflavones.

 

It can take up to 2-3 weeks for the proteins to completely exit the mother’s system1, but sometimes baby can show improvement within as little as a week2

Once the trigger foods have been eliminated from your diet for some time, you can try slowly reintroducing dairy products. If baby still reacts, it is best to wait until baby is around 6 months old and his digestive system is stronger before reintroducing dairy into your diet3.  

The main concern with a CMRI elimination diet is the fact that dairy is a major source of calcium for many breastfeeding mothers, and without dairy it may be difficult for them to maintain the 100 mg daily recommended dose.

However, it is possible to consume enough calcium without dairy. Here are some sources of non-dairy calcium: 

Collards- 1 cup boiled and drained – 357 mg calcium

Rhubarb – 1 cup cooked– 348 mg calcium

Sardines – 3 oz / 85 grams – 325 mg calcium

Spinach – 1 cup boiled and drained – 291 mg calcium

Turnip Greens – 1 cup boiled and drained – 249 mg calcium

Blackeye peas – 1 cup cooked – 211 mg calcium

Kale – 1 cup boiled and drained – 179 mg calcium

Bok choy – 1 cup boiled and drained – 158 mg calcium

Beans, baked– 1 cup – 142 mg calcium

Okra – 1 cup boiled and drained – 136 mg calcium

Shrimp – 3 oz / 85 grams canned – 123 mg calcium

Crab – 1 cup canned – 123 mg calcium

If you are not sure that you are getting enough calcium through diet alone, consider a calcium supplement. If you do this, make sure that the supplement you choose is combined with magnesium in a 2:1 ratio so that your body will readily absorb it. 

**Before starting any elimination diet, please consult a nutritionist or your doctor to ensure you will be getting enough nutrients and to make sure you will not be deficient. 

 

Sources:

"Dairy and Other Food Sensitivities in Breastfed Babies." Kelly Mom. 26 July, 2011. Web. Mar 2014. 

"Cow's milk protein allergy through human milk." National Center for Biotechnology Information. March 19, 2012. Web. Mar 2014.

"Eating Like a Cow: Breastfeeding & Cow's Milk Protein Intolerance." Childhood 101. n.p. Web. Mar 2014.

Published in Feeding Baby
Friday, 09 August 2013 14:14

Breastfeeding With Lip Tie

When my daughter Jade was born just over a year ago, I planned on exclusively breastfeeding. I had successfully breastfed her sister Josie for 14 months, at which point Josie had self-weaned. I loved breastfeeding and the bond that it gave me with Josie. Breastfeeding Jade was something that I was looking forward to.

When I had Josie, I had minimal problems over the first couple of weeks, and I expected that I was an old pro and Jade and I would have no problems at all.

I couldn’t have been more wrong!

In those early days, breastfeeding Jade was very painful, but I assumed it was just my nipples getting used to breastfeeding. I was certain that by the end of the second week, I would be just fine. Instead, things just got worse. My nipples were cracked and bleeding. I slathered on the Lansinoh and walked around topless to the dismay of my five year old daughter. Still, things were not getting better. Every time Jade ate, I was in excruciating pain. Every time she ate, the sores were opened up again.

My midwife came to visit when I finally admitted that I wasn’t the successful breastfeeding mother that I thought I would be. I actually thought I had a milk bleb. My midwife took one look at me and said that it wasn’t a blister. That little bump I could see was all that was left of my nipple. She said that it was the worst nipple damage that she had ever seen. She advised me to express from that side until it healed, and to feed my baby the milk that I had expressed. 

I was stunned.

Having a newborn is such an emotional time. The reality was not matching up to my expectations. I had to go back to work when Josie was six weeks old. I expressed until she was nine months old and I was able to quit my job. I absolutely did not want to express to feed Jade, and in my irrational, just-had-a-baby mind, I was a failure. Never mind that Jade would be getting my milk. It was coming from a bottle! Making matters worse was that she struggled to latch onto a bottle. But I soldiered on, determined that expressing was going to be a short term fix and that I would be able to breastfeed without pain soon.

I wanted an answer. I saw nurses, midwives, and lactation consultants. I called breastfeeding helplines. The consensus was that Jade’s mouth was too small to make a good latch. I was assured that once she grew, her mouth would get bigger and breastfeeding would not be painful.

In the meantime I became very anxious every time I thought about feeding Jade. It hurt. I honestly would call it excruciating pain. I was in tears multiple times a day. I thought about quitting.  Even though I was super committed to making it work, if I hadn’t had a good experience with Josie I don’t think that I would have had the confidence or desire to continue with Jade. But I had taken on the mindset that I was a breastfeeding mother, and there was no way I was going to give up. I kept reflecting on the experience I had with Josie, and I knew that breastfeeding could be euphoric. I was determined to do anything I could to feel that with Jade. I affirmed to myself that I could breastfeed successfully.

Over time, my nipples both healed. Jade’s mouth grew and she wasn’t damaging me as she fed anymore. However, I knew that her latch still wasn’t right. It didn’t look like Josie’s latch. Her top lip was always tucked under. She was often gassy and fussy and I was still uncomfortable feeding her. At this point she was 10 weeks old.

I decided to search the internet for “baby’s top lip tucked under” and I found myself on a forum where mothers were discussing lip tie. I had never heard of lip tie. I know that the nurses, midwives, and lactation consultants had all checked Jade for tongue tie and said that her tongue was fine. But lip tie? Nobody had mentioned that. Lip tie, I learned, was when skin at the top of the lip is attached tightly to the upper gum. There was a link in the forum to images of lip tie.  I looked at the photo. Jade was in my arms. I flipped up her top lip, and she most certainly had lip tie. 

I cried. I was so relieved to finally know what was ‘wrong’. Then I was angry. It was frustrating that nobody had caught it. I expected that lactation consultants would have checked for this structural problem. But I couldn’t dwell on the negative. I had to switch my focus to fixing the problem. I decided that I could cope with the discomfort, but I had to determine whether this lip tie was going to cause Jade any long term problems.  The forum had led me to Dr. Lawrence Kotlow’s website. I studied his website, fact sheets, and videos. The research I did led me to believe that there was a risk of dental and speech problems if I left the lip tie. Dr. Kotlow was a dentist and he corrected lip tie with a laser. I started calling dentists in my area. None of them would perform the procedure.

I took Jade to the doctor to confirm that she had lip tie and to find out my options for treatment. I was told that I could take her to a pediatric surgeon. I did not want to put my baby under general anesthetic. I started to look into dentists in Sydney, which was about a three hour drive from where we live in Canberra, Australia. I was able to find a dentist that would use a laser to cut the lip tie. I sent the photo of Jade’s lip tie to the dentist and he confirmed that it was lip tie and that he could correct it. We made an appointment for a couple of weeks later.

My husband and I made the trek to Sydney. The procedure, though quick, was very difficult for us as parents. Jade hated being restrained, and Jon had to hold her very still on his lap.  There was more blood than I expected, and Jade refused to feed as she was very angry, numbed, and possibly sore.  What took a few minutes felt like hours, but eventually Jade calmed down and had a good breastfeed.

I wish I could say that this was the start of euphoric breastfeeding. It wasn’t. Because Jade was already three months old, she was set in her ways. On top of that, I was overly full many times and she wasn’t able to latch well unless I expressed first. The damage she had done to my nipple led me to have what the doctor said was a cyst from the poor latch. This ‘cyst’ remained until Jade was ten months old. She bit it one day as she was slipping off my breast and it opened and drained.  Finally I could feed comfortably.

Yes, it took ten months to breastfeed comfortably. Jade has just turned one, and I hope she doesn’t wean as early as her sister did. I’d like to enjoy our breastfeeding journey for a little while longer, while it’s still enjoyable.

I hope that by sharing this story I can raise awareness of lip tie. I think that if Jade’s lip tie had been caught earlier, we would have had a much better breastfeeding experience. I also know that if I hadn't previously breastfed successfully it's very likely that I would have given up due to the excruciating pain. I hope that by sharing my story I can prevent other mothers from unnecessarily giving up on breastfeeding, or from going through what I went through. I believe that when there are problems with attachment, health care providers should be checking for tongue and lip tie. I am happy to report that I was able to share Jade's photo with my midwife, who in turn shared it with her colleagues. I share the photo of Jade's lip tie with nurses and midwives when I get the opportunity. One by one, I know that my story and Jade's photo can make a difference in the lives of mothers. 

To learn more about lip tie, visit Dr. Kotlow's website - www.kidsteeth.com or see his fact sheet on tongue and lip tie here: http://www.kiddsteeth.com/articles/ttfactssheet.pdf

 

 

Published in Feeding Baby

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