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DO YOU FEEL YOUR MILK SUPPLY IS LESS? DOES YOUR BABY STAY DISSATISFIED AT BREAST?

SOME IMPORTANT FACTS

  1. Most of pregnant people start producing colostrum at around 14-18 week of pregnancy.
  2. No one can check your milk supply by squeezing at your breast / nipples.
  3. If a baby is not being put at the breast immediately at birth, or if the baby gets other things like honey or animal milk etc., the baby might have challenges breastfeeding correctly.
  4. Your baby needs to grab a large part of your breast to withdraw milk from your breast, nipple shape size / shape does not matter if baby is correctly put at the breast at the earliest after birth.
  5. If you have received intravenous fluids / artificial oxytocin or any other drug to induce labor/ steroids, these all can affect your milk release.
  6. If breastfeeding did not happen well in the initial days, milk gets pooled up and many mothers may notice hardness/painful lumps in their breasts by day 3-4 of delivery.
  7. Milk production majorly depends on how effectively the baby is suckling at the breast.
  8. The milk making powders/ tablets mostly are not required.
  9. Even if the initial days were not good, you can still breastfeed.
  10. Some breastfeeding is better than no breastfeeding.

  • If the place where you delivered, did not have skilled lactation support, they might not have known many of the above things and might have doubted your milk supply or nipple size shape etc.….
  • If something like this happens/ has happened with you or your family/ spouse, look for skilled lactation support, and in the meanwhile checkout the resources shared below.
  • If you are concerned that your milk supply might be low…. follow the flow diagram below and see where things might be going wrong.

MOSTLY THE CHALLENGES HAPPEN BECAUSE OF THE WAY BABIES ARE PUT ON THE BREAST AND NOT BECAUSE OF LOW MILK SUPPLY, BUT IF THIS KEEPS HAPPENING FOR SOME TIME, THE MILK PRODUCTION STARTS SLOWING DOWN.


ATTACHING BABY AT YOUR BREAST

ATTACHING BABY AT YOUR BREAST

SIGNS OF EARLY HUNGER

SIGNS OF EARLY HUNGER

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WHEN YOUR CHILD REFUSES TO EAT !

It gets very stressful for parents when their child refuses to eat or is not eating well.

Mostly in those situations, we try to distract(use screens), coax, force or bribe the child into eating.

Why do most of us do that is because of our societal norms around eating. We have our preset notions about eating and we get worried if our child is not following that. More so, in situations where the child is towards leaner side. Often parents get extra worried if the people around them start offering suggestions, thus, making the parents feel judged or incompetent.

Let us explore common reasons for it…..

Why is the child not eating? 

Can it be that we are stressing the child out? Now this can happen in many situations, like always trying to make the child eat, pressing the child to eat, overwhelming the child with coaxing, stressful family environment due to conflicts etc.

Another reason could be that the child is on lots of animal milk and on junk snacks like biscuits / cookies etc.

In children with anaemia, and other chronic illnesses appetite can be suppressed.

A word about breastfed children…..

Breastfeeding complements eating (or vice versa), it is NEVER the cause of child not eating well.

Breastfed babies get 60 percent of their caloric and nutrient requirements from breastmilk in between 6-12 month of age and around 40 percent of same in the 2nd year.

If your child is breastfed and not eating well, explore your way of offering foods, to figure out why your child is not eating well. It is a good idea to introspect and explore your own food related issues and complexes. Also notice if you are leading by example as far as healthy eating is concerned.

Observe your family’s mealtimes and see if you need to work on some family related issues.

Coming to what happens if your child is not eating well….

If your child is breastfeeding, continue breastfeeding on demand and keep offering healthy, balanced complementary food options in a relaxed way and keep modelling healthy eating behavior, your child will slowly settle.

Trust your child’s ability to identify his/ her hunger and let them decide how much he/ she wants to eat. Your job is to provide healthy/ wholesome food options.

If you force them right now, they might rebel once they are able to run away from you and also are prone to develop unhealthy eating patterns in future.

If your child is bottle fed / animal milk fed, work on gradually decreasing the milk intake and offer healthy / wholesome food options in a relaxed environment and of course modelling healthy eating behaviour, your child will soon start settling.

Consult your Paediatrician and ask for an appropriate referral :

#If inspite of following the above general measures your child is not settling

# the child has some difficulty eating/ swallowing

#frequently chokes or gags

# has challenges with particular type / textures of food

PRO TIPS:

# Not eating well for a few days will not do much harm, but if you force / coax/ punish/ bribe / scold etc….these will cause long term challenges . More struggle for you in coming days and eating disorders for your child in future.

# Contrary to popular belief, your child does not need foods high in sugars and fats, they need Nutrient rich food, ie foods containing all sorts of nutrients (Vitamins, minerals, fats, proteins, carbohydrates etc).

So think in terms of balanced meal while preparing food for your child.

# Processed foods are not good for any of us, the so called “health drinks/powders” come under the category of Ultra Processed foods and thus do more harm than benefit. 

Author, Dr Shacchee is a Certified Infant Feeding & Young Child Feeding Specialist. Join her on monthly online Workshop for parents for more detailed knowledge on feeding and nutrition in children. CLICK here to book your session          

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Breastfeeding in COVID Times

All national and International bodies unanimously recommend that irrespective of a person’s COVID Status

  1.  All mothers and babies should be put in immediate skin to skin contact after birth.
  2.  Breastfeeding should be initiated at the earliest.
  3.  Exclusive breastfeeding should be practiced for 1st 6 months of baby’s life (and continued for a minimum of 2 years).

In addition, mum who is COVID positive should wear a mask, and maintain proper hand hygiene.

 The rationale behind these recommendations is that ….

  1. The data till now clearly shows that coronavirus does not get transmitted via breastmilk.
  2. When a lady who is breastfeeding gets infected by coronavirus, her body starts producing disease fighting chemicals (antibodies) which are also secreted in breastmilk, thus providing baby with readymade medicine against coronavirus. 
  3. Breastmilk is the normal food of a human baby and helps in building up a baby’s immunity. Breastfeeding is health for life.

We know, Immune status of a person is a big factor in his /her fight with Coronavirus infection….so the logical conclusion here is to breastfeed.

Some frequently asked questions in this context….

Q1 I am corona positive and I just delivered a baby, what should I do…

– Keep your baby close to you, breastfeed on demand and wear a well fitted mask, maintain proper hand hygiene.

Q2 I am corona positive can someone else give my Breastmilk to my baby if I pump it out and give it to them?

Yes, but first consider 2 things… 

How can you be sure that the other person is negative, maybe he / she is asymptomatic but still corona positive!! 

Breastfeeding is a lot more than just food. It is development of a bond, it is warmth, its security, its love and it’s for proper development of your baby’s face, jaws and teeth.

So, if you are able to directly breastfeed, do that. If you are hospitalized and/or are not able to directly breastfeed, then yes please try and express milk regularly and send Expressed Breast milk for your baby.

Q3 What happens if a COVID positive mother is sick and cannot feed baby directly.

She should be helped with expressing out her milk regularly and send it to the baby. As soon as she is able to, direct breastfeeding should be initiated.

Q4 I am facing challenges breastfeeding….how can I exclusively breastfeed?

Reach out to any experienced Lactation support person  in your area. A trained and skilled Lactation support person should be able to help you through this either via an in person consult or via a video consult. 

If you are COVID positive or  quarantined, you can do a video consult.

Q5 I was COVID Positive when I delivered and I did not feed my baby, now my baby is a few weeks old, and I feel my milk has dried up, can I get my milk supply back? Will it help my baby if I breastfeed my baby.

Yes, and Yes!

Even if you did not feed initially, with a proper plan, patience and effort, you can build up your milk supply and each drop of breastmilk counts so any amount of breastmilk is beneficial.

Look up for an experienced Lactation Support Person who can help you with this.

Q6 I am a breastfeeding mother and today I discovered I am COVID positive, should I continue breastfeeding?

Absolutely yes. When you breastfeed, you pass on Antibodies (against COVID) to your baby. There is a high probability that your child has already contracted the virus before you got tested, so getting antibodies via breastmilk will help protect the baby

Q7 What are the recommendations for those who are pregnant / yet to deliver?

  • Attend an “Online Pregnancy Breastfeeding class”, run by someone experienced.
  • Make sure that you stay at home / stay safe
  • Talk to your doctor in advance about immediate skin to skin contact and earliest initiation of breastfeeding, whatever your COVID status might be.
  • Read recommendations by WHO /Association of Lactation Professionals India /BPNI.
  • Read in person accounts of people who were COVID positive and who breastfed.

Once your baby comes breastfeed. Seek breastfeeding help at the earliest if you are facing challenges. Majority of experienced LCs are equally beneficial via virtual consults too.

VIDEO MADE ESPECIALLY FOR HEALTH CARE PROFESSIONALS
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Tongue-ties and Lip-ties- What Parents Should know

Dr Shacchee Baweja, who is an International Board Certified Lactation Consultant- IBCLC, speaks about the feeding challenges that might be associated with presence of Lip and Tongue ties and also highlights that merely the presence of a band below tongue or lip might not be the reason of challenges and one should work on other aspects of latching before deciding to excise this.

Below is the recording of Dr Shacchee’s session at I-Mumz on eve of International Women’s Day, March 2021

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The confusions and controversies around the Tongue and Lip ties!

  • When we talk about babies with oral restrictions, what does it mean? 
  • My LC tells me my baby has a tie, my paediatrician says it’s nothing, I’m about what to do! confused
  • Why is there so much controversy in it?
  • Why is it that we are seeing so many cases these days? 
  • Is frenotomy a complete solution. I hear many times symptoms do not get better or can even worsen post frenotomy?

If you have any of these questions, Read on….

At the outset it is very important to understand a few facts:

  1. Feeding is an all-body function so just looking at the mouth will not give us the complete assessment of the situation. So even if your baby has obvious ties, there is much more that needs to be assessed and worked on.
  2. We need to look at the whole body.
  3. Breastfeeding is a complex interplay of many factors (Birth, earliest skin to skin contact, initial breastfeeding experiences, infant anatomy, maternal feelings, maternal knowledge, support to the mother, and many more)
  4. There are large knowledge gaps in the health care workers, in relation to skilled lactation support.
  5. Even among lactation Professionals, clinical skills are widely divergent, depending on their qualifications and experiences.

With the above facts in mind lets discuss further.

Oral restrictions in the baby are the Frenula (mucosal connections) that can be present under the upper lip(labial frenulum) and /or under the tongue (lingual frenulum) and or between the cheek and gum(buccal frenulum).They can cause problem if they restrict the normal functioning of tongue and other muscles during the process of breastfeeding / bottle feeding.

There is so much controversy around it because of many reasons.

  1. Mostly it’s something that we have started exploring recently and most of the health care providers have not had much knowledge and experience about these issues.
  2. As oral restrictions are not the ONLY reason to cause breastfeeding difficulties, If we just cut these restrictions, without addressing the other issues as well, the challenges do not settle (or at times worsen), thus making people feel that corrective procedures are useless.
  3. Similarly, if other factors are worked upon, in quite a lot of dyads, even in the presence of oral restrictions, the challenges settle, thus the hypothesis that we do not need to do any procedures!
  4. There are not much conclusive studies on these topics.

So, most of the clinicians/ providers see things based on their perspective and experiences only and give their opinion accordingly. What is needed is a comprehensive assessment of the whole mother baby dyad, so that an idea of all that’s going sub optimally can be assessed and thus corrected.

This needs a team of trained professionals working together and thus can mean more expenses.

In a country like ours, there is a scarcity of teamwork or rather appropriately trained professionals (except maybe in major metro cities) and also there is lots of skepticism and hesitancy in families against paying for breastfeeding support!

To understand it further let’s talk about a few factors that can have implications on breastfeeding.

1 Positioning of the baby inside the uterus

A baby in a vertex position, with ample amniotic fluid, no cord issues, Versus a baby who had positioning issues in utero (eg: Cord around neck, oblique lie, twin pregnancy, uterine myomas etc), both can behave differently while breastfeeding.

2 Type of birth:

A calm comfortable spontaneous vaginal birth, with baby being kept skin to skin with the parent, generally results in baby latching on his/ her own without any need of support..

(while we are at it, lets discuss birth here too! Contrary to popular belief, we ourselves are the people most responsible for our changing births and increasing rates of cesarean sections.For example,Our dietary habits, Our sedentary lifestyles, Lack of knowledge about pregnancy and child birth…..are a few factors)

Versus an augmented labor with lots of non-natural uterine contractions, Interventions like fundal pressure/ forceps / ventouse/cesarean…..resulting in possible physical and mental trauma, separation , delayed initiation of breastfeeding. Versus a Cesarean section….All have different impact on baby’s natural reflexes and thus on baby’s breastfeeding efficiency.

3 Early days after birth

The kind of breastfeeding knowledge and motivation the family has. If they have had Antenatal Breastfeeding education.

The kind of support / information they got post birth.

4 Later days how the baby is being kept, like if the baby is kept mostly swaddled on his or her back, or mostly on the parents’ body. If the baby held and soothed each time the baby is distressed. Is the baby kept lots in baby carriers / car seats etc

For a mother and baby to breastfeed well, we need a healthy and comfortable mom a healthy and comfortable baby and ample opportunities to breastfeed on demand.

Anything that interferes with it can cause breastfeeding challenges.

So if we just look at the frenulums and overlook the other issues, problems will remain.On the other hand if we sort out the other challenges and then if the challenges persist , we get the frenulums corrected, we get optimal benefits!

Lactation professionals in India: COVID 2021 response

Begin Ed India and Association of Lactation Professionals India conducted a QnA session for Healthcare professionals involved in care of New borns and nursing mothers. It addresses day to day queries of Nursing mothers and dilemas faced by healthcare professionals in dealing with breastfeeding issues in the ongoing COVID pandemic.

The Focussed Question and answer session stats at 7 min and ends at 44 min, while rest of the session is also very informative on the topic.

COVID-19 Taking Care of your family- Protection First

How to protect you​r family

These are  few measures one can take to protect your loved ones…

  • Wash  hands frequently with soap and water for at least 20 seconds. If soap and water are not available, use  any hand sanitizer which as at least  60% alcohol.
  • Limit your close contact with people other than family members  by practicing social distancing. This means staying home as much as possible.
  • Keep children and elderly away from others who are sick or keep them home if they themselves are ill.
  • Educate everyone at home, especially kids to cough and sneeze into  their arm or elbow, not their hands. And to immediately wash hands even if they have accidentally coughed or sneezed into hands.
  • Clean and disinfect your home as usual using regular household cleaning sprays or wipes. No special solutions are needed.
  • Wash stuffed toys in the warmest water possible and sun-dry them.
  • Avoid touching your face, nostrils, eyes, etc; teach your children to do the same.
  • Avoid travel to highly infected areas.
  • Follow  restrictions laid down by local government authorities with 100% compliance

If your child has been exposed to COVID-19, or you are concerned about your child’s symptoms, call your pediatrician immediately.​​​​

Matter inspired by guidelines issued by American Academy of Pediatrics(AAP), CLICK Here to view more info by AAP.

Head Injury

Immediately after a fall, most children cry excessively for next few minutes because of the sudden fall, even if they are not having so much pain. So firstly, they should all be consoled and cuddled and reassured that every thing is OK. At times small children vomit due to excess cry, which is OK and should not be confused with vomit due to a head injury.

If there is any external injury and a bleeding is seen, then a compress the bleeding area withany clean cloth for FULL 10 minutes by Watch and DO NOT repeatedly remove the pressure to look for any bleeding, before 10 minutes are over.

If there is no external Injury and you can pin-point the site of Injury, apply a cold pack(Cold Gel pack or Cold hand towel) over that area for 10-15 minutes and give a dose of Paracetamol for pain relief.

If the Height of Fall is more than 4 feet, then the child must be evaluated by a doctor or Neurosurgeon.

For next 24 hrs after any head injury, following points should be looked for..

  • Any Abnormal movements
  • Not moving any part
  • Repeated vomiting
  • Not sleeping or very irritable
  • Sleeping excessively… to check this, child has to be checked in middle of sleep after 2-3 hrs of sleep.
  • Any bleeding or discharge from nose or ear Headaches
  • Abnormal speech
  • Any Abnormal Behaviour.

If any of these signs are seen in next 24 hrs of a Head Injury, they may suggest an Internal Injury and parents should report to the doctor.

Powders which boost milk supply

Every monday during my rounds of postnatal mothers and babies I am saddened and angered by the massive amounts of formula tins and jars of the so called “Ayurvedic powders supposed to boost the milk supply” I see on each bedside…

Why mostly on mondays… because sunday is the only day I am not around in the wards to give anticipatory guidance to moms.

I am not as much against these powders as I am by the negative impact prescribing these have on a new mother’s psychology…….adding something to build up milk supply, implies that the lady wasn’t producing enough….. what the new mum’s brain perceives is that she is incapable of fulfilling the needs of her baby! Then when there is breast fullness on Day 3/4 the credit goes to the powder….

Other harmful aspect is that the actual cause of baby staying dissatisfied at breast…. Which most commonly is a suboptimal latch goes unaddressed …

As a result their take home message is that the powder helped in making sufficient milk. So they started their breastfeeding journeys underconfident and insecure .

And if the latch is not good enough mom keeps having complaints that baby is dissatisfied or takes very long feeds or causes pain etc etc

Is there a solution to this? Fortunately yes!!

If everyone knew the simple basic principle of milk production, how to latch on a baby effectively and how to assess good milk transfer, we will not even need these powders.

Add to it a little more knowledge about a newborn’s tummy size, behaviour, significance skin to skin contact and technique hand expression… And we have a winning formula.

So in a nutshell..

Get information on breastfeeding from a good/ reputed Antenatal class when you are pregnant where they tell you about all these things before you deliver your baby and incase you face challenges after birth of your baby, get help from a trained lactation professional / LC.

PS: Till date, no scientific study has actually concluded that these powders actually boost milk supply!!

When to worry about bed wetting or nocturnal enuresis

Boys usually are dry by night by the age of 6 yrs, while girls are faster and achieve night control by 5 yrs age. So, after these ages, it is a matter of concern if your child is not dry in night. It is of even more concern if the child had started remaining dry in night for more than a year and now again is bed wetting in night. Worms in tummy are very unlikely to result in bed wetting and there are other more common causes like excess water intake, constipation, urine infection, excess TV watching or video games.

So, First of all, one has to identify these causes  and remove them or treat them. If still child continues bed wetting then we have to do bladder training for 4-6 months Lastly, if everything fails, then special medications are given to get the results. It is important to note that these special medications will be of no help if other factors as mentioned above are not taken care of and bladder training has not been attempted religiously for 4-6 months

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