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  • @llli*maddieb's Avatar
    Yesterday, 10:30 PM
    Are you actually separated from 6 am until bedtime? If you are home earlier than that, what happens if you offer to nurse when you get home? Some babies will nurse less often at night if they have the chance to nurse more during the day. So that is one reason to see if baby might nurse more during the day. Also more nursing would quite possibly mean baby takes less in bottles, if that is what you are looking to do. Overall, more frequent nursing so that nursing frequency is more or at least on par with bottles may increase the chances of the nursing relationship lasting longer, should that be something you would like. I see no reason nursing and bottle feeding have to match, at least not very closely. So, you could try increasing baby's nursing frequency when you are home with baby if you like and leave bottle frequency as it is. And/or, try increasing the frequency of bottles, as it may be that more frequent bottles will mean that they are smaller overall- that is how it works with older kids and adults, as typically, small meals more often helps reduce overall intake when that is needed. (Of course, you will have to watch any tendency to just keep giving baby the same huge bottle more often.)
    7 replies | 110 view(s)
  • @llli*livingtemple's Avatar
    Yesterday, 09:03 PM
    When I'm on a work day, I nurse him at wake up (6am) and bedtime (usually 6:30/7pm) and now with the new 1-nap schedule have him set to have a bottle before and after nap. I'm open to better suggestions, though! I was mostly just trying to mimic with a bottle what I do with nursing: Home day: 6am wake, nurse 7am breakfast 11am lunch 12pm nurse/nap 2:30/3 wake, nurse 6pm nurse/bed
    7 replies | 110 view(s)
  • @llli*maddieb's Avatar
    Yesterday, 08:46 PM
    No, the pauses should actually come every few sucks. So every 20-30 seconds. When a baby is nursing they pause very frequently to swallow and just see what happens. They do not unlatch, and nursing mom usually makes no note of it. But that is the pattern that paced feeding is supposed to mimic. This video explains the positioning and pauses very well: https://www.youtube.com/watch?v=UH4T70OSzGs How long are you at work and how often does baby get a bottle? That can give you the number. You are right the typical recommendation is baby needs about 25 - 35 ounces of milk total per day, and if baby is nursing at night and cue nursed when you are home, that translates very simply and effectively to baby's intake requirement being somewhere between 1 to 1.5 ounces per hour of separation. So, as an example, for an 8 hour separation, 8-12 ounces total. Broken into three bottles, that is about 3-4 ounces per bottle. Of course that number is the recommendation for a baby who is living entirely on breastmilk and gaining very rapidly as a baby does between 1-6 months or so. It is entirely possible your baby, who is eating lots of solids and most likely headed for (or already in) the big gain rate slow down that is typical at about a year, does not need anything like that amount of milk over 24 hours. It is very hard to find evidence based intake recommendations for babies this age, and except for the book My Child Won't Eat I am not sure where to send you for that info....
    7 replies | 110 view(s)
  • @llli*maddieb's Avatar
    Yesterday, 08:28 PM
    Hi hblwmom, sorry you are having this concern. I can assure you many, many moms have issues with low milk production and there are many ways to increase milk production. And even more moms think they have a production issue when in fact all is normal. It is hard sometimes to figure out what exactly is going on. What is interesting (and a good sign you are getting some pretty breastfeeding supportive advice, in my opinion) is that the supplementing plan your pediatrician has suggested is 1) very specific as far as total amount to supplement (yay! this makes me very happy you would not believe how rare that is) and 2) really is not much at all. And yes even that small an amount of supplement might be the difference between slow gain and baby gaining normally. But if all the pediatrician thinks baby needs is 3 ounces extra a day, that is not much of an increase needed in what baby gets at the breast. 3 ounces is the equivalent of 1-2 feedings, normally. So I wonder if simply increasing how often baby nurses would not do the trick just as well? What do you think? You are pumping. How much milk do you get when you pump? Could you/do you supplement with that milk? Sometimes moms are told there is a problem when in fact gain is within normal range. So if you would like to post a compete weight check history with weight and day/week of life, noting whenever a different scale was used, then we can comment about that. It would also help to know how many times a day...
    1 replies | 30 view(s)
  • @llli*livingtemple's Avatar
    Yesterday, 08:00 PM
    Thanks, all for your responses and help. Yes, LO is still getting up 1-3x per night but typically not nursing a full feed. Sometimes (more especially the first wake up) he will take a little more, but I've taken to not offering both breasts over night so as to gently encourage night weaning, also unlatching him perhaps a few moments before he might truly want. Usually he nurses a few minutes, I lay him down, he adjusts a bit and goes back to sleep. Work situation has been going on for a few weeks now, but baby has been fed bottles before (date nights, errands, etc.). Yes, parents and husband are doing pacing as much as they know how - holding bottle so nipple is more horizontal and not totally full of milk, giving him little "breaks," not encouraging him to drink and drink. I've asked that they also "switch sides" which I'm not sure is happening. @lli*maddieb, how often should one do the technique you mention (let all milk drain out of nipple and wait for baby to signal he wants more)? Every 3 minutes? 5 minutes? I agree that perhaps an "ounce limit" is in order to try other comfort measures to see if milk is being used as a "go-to." But not sure what that limit should be?
    7 replies | 110 view(s)
  • @llli*hbwmom's Avatar
    Yesterday, 06:44 PM
    3 month is old is 10 lb 9 oz and should be close to 12. I'm finding LO and I are lazy with feeding and she is content without being absolutely full. Our pediatrician wants us to supplement (1 tsp to 1 oz x 3/daily). Clearly my supply isn't given her the calories she needs. So now I'm making sure to offer her the other side, taking fenugreek, mothers milk tea and pumping 3 times a day. My breasts are feeling empty. She falls asleep at the breast all the time. I'm torn. Any advice to increase my supply? Anyone been in this situation? Thank you for the help!
    1 replies | 30 view(s)
  • @llli*maddieb's Avatar
    Yesterday, 03:47 PM
    So, not familiar with bottles. Curious if baby this age even needs a bottle rather than maybe a cup? Paced bottle feeding properly done is going to be your best bet for slowing down flow. All nipples drip. I suspect paced feeding is not being properly done as far as how baby and bottle are positioned. HOWEVER. A baby this age should really be able to 'pace' themselves. Paced feeding is really more for younger babies, I am not even sure it will work with an almost one year old. But I would suggest have caregivers making sure bottle and baby are being positioned properly (so the nipple is never full of milk and rate of flow is reduced by gravity) and that pauses in drinking (by tipping nipple up/bottle down so the milk drains out of the nipple, in order to stop flow all together for a few moments) are being encouraged. If baby wants more, bottle can be re-tipped up just enough so there is a little milk in the nipple. Sometimes the key is to not totally remove the nipple from baby's mouth, but to instead stop the flow for a bit to see if baby really wants more or not while tip of nipple rests on baby's bottom lip or gently in the mouth. If baby does not start 'reaching' to take the nipple again, then bottle can be gently removed. If this is not making sense let me know, may be I can find a video. I suspect perhaps a little laziness is going on, and baby is being fed bottle after bottle rather than caregiver engaging in other comfort measures or baby entertaining...
    7 replies | 110 view(s)
  • @llli*maddieb's Avatar
    Yesterday, 03:28 PM
    Unfortunately there have not been good studies on the impact on breastfeeding from tongue tie nor lip tie and whether surgical correction helps. Even the definitions/diagnosing criteria of tongue and lip ties is not agreed upon. What appears to be the consensus among breastfeeding experts including doctors who are also breastfeeding experts is that tongue tie CAN (but does not always) cause issues for nursing- meaning primarily, pain and injury from latch for mom and/or poor milk transfer by baby, and that surgical correction CAN (but does not always) improve the situation. There is less such consensus as regards lip tie. There is also consensus that properly performed surgeries are not likely to cause any harm. But no harm does not mean there will be improvement. I would suggest talking to whoever is recommending surgery and whoever is going to do the surgery for the experience of their clients and their recommendations for after care. This protocol on treatment of tongue tie from the Academy of Breastfeeding Medicine (doctors writing for doctors) may also be helpful to you: http://www.bfmed.org/Media/Files/Protocols/ankyloglossia.pdf I do not know anything about gag reflex tongue tie, but certainly a nipple shield might cause a baby to gag if it is too big (the tip is too long) for baby. A nipple shield would also cause air swallowing, particularly if it is too large. Colic occurs in babies with no feeding issues. It is very common. I know that some say air...
    3 replies | 127 view(s)
  • @llli*scoob626's Avatar
    September 23rd, 2016, 08:50 PM
    Hi, how long has your work situation been going on? I am just wondering if he is still adjusting to your absence? And just to clarify, everyone is doing paced bottle feeding techniques, right?
    7 replies | 110 view(s)
  • @llli*mommal's Avatar
    September 23rd, 2016, 07:30 PM
    Does baby ever nurse at night? I'm asking because it helps us know how much milk baby needs during the daytime hours. (night nursing babies typically need less than babies who sleep through.)
    7 replies | 110 view(s)
  • @llli*mommal's Avatar
    September 23rd, 2016, 07:04 PM
    Waking a baby in order to feed him more cannot hurt him. If you've ever heard "Never wake a sleeping baby", just remind yourself that that adage should really go "If baby is feeding often enough and is growing well, then mom can let him sleep long stretches as long as she is comfortable doing so. If baby is not feeding or growing well, or mom would like to nurse, there's no reason not to wake the baby." It's not as catchy as the first version, but IMO a lot more accurate!
    7 replies | 199 view(s)
  • @llli*krystine's Avatar
    September 23rd, 2016, 04:52 PM
    My daughter did at 7 weeks or so. They had a baby restraint jacket and quickly clipped it, no anesthesia because then she was able to nurse afterwards , small amount of blood . Sadly it didn't help her milk removal issues but at least we tried. Her baby brother has similar oral structures and nursed 2 yrs without it causing a problem . I know moms who have immediately noticed a difference though and it absolutely helped . P.s. I don't think a shield should help her latch. I would really try to get away from them. Are you working with an IBCLC ?
    3 replies | 127 view(s)
  • @llli*charlie2015's Avatar
    September 23rd, 2016, 02:53 PM
    I don't know anything about this topic, but just wanted to say good luck! You sound well informed.
    3 replies | 127 view(s)
  • @llli*livingtemple's Avatar
    September 23rd, 2016, 02:43 PM
    Hello helpful LLL ladies! I need some guidance on a handful of related issues. I'm writing a lot but want to be as thorough as possible, so please read on and bear with me :) I have returned to work and am home with my LO (now 11, almost 12 months) one day per week plus weekends. On the other 4 workdays he is bottle fed my breastmilk by husband, childcare, or family. He enthusiastically eats solids 2-3x/day - we don't push it, but he really enjoys food. If we happen to miss or skip a meal every once in a while, we don't worry about it. Up until about a week ago, he was nursing 6x/day on a typical day with me: wake, before AM nap, after AM nap, before PM nap, after PM nap, and bed, with meals in between. For about a week and a half straight he fought his PM nap and pushed back his AM nap to the extent that I think we've entered 1 nap/day territory. So he only just recently is nursing more like 4x/day - wake, before nap, after nap, and bed. Sometimes a little extra in between :) When I pump, I usually pump anywhere from 4-6 (sometimes 7) oz. 1. Everyone says he "whomps" the milk down from the bottle. I know it's common for BF'd babies to take milk faster via bottle than breast and that paced feeding, sitting upright, switching "sides," etc., can all help with this. People have tried all of the above. I'm working on getting a slower-flow nipple also, though the ones we use (LifeFactory) are Stage 1 (on that note: anyone know the slowest nipple out there??). The tough...
    7 replies | 110 view(s)
  • @llli*asingleton5's Avatar
    September 23rd, 2016, 10:52 AM
    Okay good. Ya my right side could literally keep pumping more in the morning! That's a good point worth a try anyway maybe I'll try that. Thank you!
    2 replies | 76 view(s)
  • @llli*maddieb's Avatar
    September 23rd, 2016, 09:26 AM
    This is just how it is, not just sometimes, most of the time. Most moms produce more on one side than the other. What you are pumping total is an entirely normal amount to be pumping, even maybe on the higher end of normal, and if you are otherwise exclusively nursing your baby and baby is gaining normally, that all indicates your overall production is entirely normal and does not need to be increased. However you can always try increasing production on one side by increasing the frequency or effectiveness with which milk is removed from that side. Effectiveness I mean- For example you might think about if your pump is perhaps not fitting as well on the left. Some moms need a different size flange for each side.
    2 replies | 76 view(s)
  • @llli*maddieb's Avatar
    September 23rd, 2016, 09:18 AM
    The vast majority of the time, milk production reduces because milk is not removed with high enough frequency. After a bout of mastitis or plugged ducts there may be a temporary drop in production, but in that case it is usually easily gotten back up with normal nursing frequency. In other words I suspect that if your milk production is low, it is because of the extreme infrequency that your baby has been nursing more than anything else. And really the only way to counteract that is to increase the frequency with which milk is removed from the breasts. Galactagogues may help, a little, and for some (but not all) moms, pharmaceutical or herbal galactagogues in high enough dose helps fairly dramatically. But by far the most important practice is frequent milk removal. Frequent meaning at least 8 times in 24 hours. So, my suggestion would be, if you really have low production (see article linked below, many moms think they have low production when in fact all is normal) would be to dramatically increase the frequency of milk removal from the breasts both by encouraging baby to nurse more often and by pumping and/or hand expressing. If, rather, milk production is normal, you can concentrate only on increasing the frequency with which baby nurses to a normal amount so your production stays normal.
    7 replies | 199 view(s)
  • @llli*cw591's Avatar
    September 23rd, 2016, 08:42 AM
    Thanks for the comments all. I'm working on it. My supply has gone down quite a bit (esp on the side that had mastitis) so I'm working on getting it back up to what it was before. ie: more stimulation on that side, oatmeal and mothers milk tea (which has been helpful in the past when I've felt low). I can't really remember how long it has taken in the past to get supply back up but hopefully a couple days? Any other suggestions are welcome. I'm also just watching him a little more closely to see if there is something i've been missing cue wise. Opinions on waking a sleeping baby to feed? I've also talked to the public health nurse, went to a breastfeeding clinic yesterday and will see the lactation consultant next week.
    7 replies | 199 view(s)
  • @llli*asingleton5's Avatar
    September 23rd, 2016, 08:27 AM
    I am EBF but have been pumping once in the morning for back to work storage or a bottle for my husband if he's home with her while I'm out. My right side always produces more than the left. I'm pumping about 2.5-3oz total. Usually if I do 3 I get about 1 from the left and the rest I'll get from the right. How can I increase the left supply? Or is that just how it is sometimes?
    2 replies | 76 view(s)
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