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Thread: Tips for Nipple Shield Weaning

  1. #11
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    Default Re: Tips for Nipple Shield Weaning

    Ok great. I am really happy that dr. is keeping a close eye on the gain. Here are some general suggestions for when weight gain is in question.
    Scale error happens. So from now on, weight checks should all be on the same scale (not same type of scale, same exact scale.) Baby naked or in dry diaper.
    Human error happens. If you have any question in your mind about whether the weight check was done or written down correctly, ask for another weigh-in.
    A baby who has normal output in terms of poops (At least 3- 5 poops a day that are big enough to count (see link about "ok" diaper log below) but is not gaining normally, is unusual. So if poops are telling a different story than the gain, something aside from not enough milk may be going on. Wet diapers alone do not indicate baby is getting enough to eat the first few weeks. (This changes after about 6 weeks when pooping may become much less frequent.)
    An ounce a day is the general average gain one expects from the age of about one week to 3 months. (After that gain normally slows.) But this does not mean a baby gains an ounce every day, some weeks a baby will gain more and some less. And of course while some babies gain faster than this, some gain slower and are still perfectly healthy and getting plenty to eat.
    Consider keeping both a poop log and a feeding log to record both breastfeedings and any supplemental feedings.

    I did tell him that I plan on working in extra pump sessions when she's sleepy in the mornings and giving whatever I can express back to her the same day, and he agreed that that's a good plan. I should get more milk that way, right?
    Yes, pumping as well as frequent nursing is likely to help milk production. Be aware that even when supplementing with your own milk, you want to be careful.
    ANY supplemental bottles, even of milk mom pumped the same day, has the potential of of making baby less likely to nurse as much as baby otherwise would. This does not mean do not supplement, if baby needs supplements it is vitally important baby gets them. What I mean is, make sure bottles are small and given in a breastfeeding supportive way. This could mean a cup or syringe or lactation aid, rather than a bottle, it could mean a bottle but maybe using paced bottle feeding. What is right for your baby will depend in part on how the tongue tie might affect these other feeding methods.

    What increases milk production and keeps it normal is frequent, effective milk removal. (So for example, your baby nursing so much in the evenings is normal behavior that should help increase milk production.) Usually this is accomplished just fine with only nursing. However since your baby is likely tongue tied and thus presumably not transferring milk all that well at the breast, pumping and supplementing may be warranted and be helpful.

    Did the IBCLC do a before and after nursing weight check?

    Diaper log: http://www.llli.org/docs/00000000000...diaper_log.pdf


    paced bottle feeding http://www.llli.org/docs/00000000000...astfedbaby.pdf

    Alternatives to bottles http://www.askdrsears.com/topics/fee...atives-bottles
    Last edited by @llli*maddieb; January 10th, 2015 at 09:23 PM.

  2. #12
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    Default Re: Tips for Nipple Shield Weaning

    Quote Originally Posted by @llli*maddieb View Post
    Ok great. I am really happy that dr. is keeping a close eye on the gain. Here are some general suggestions for when weight gain is in question.
    Scale error happens. So from now on, weight checks should all be on the same scale (not same type of scale, same exact scale.) Baby naked or in dry diaper.
    Human error happens. If you have any question in your mind about whether the weight check was done or written down correctly, ask for another weigh-in.
    A baby who has normal output in terms of poops (At least 3- 5 poops a day that are big enough to count (see link about "ok" diaper log below) but is not gaining normally, is unusual. So if poops are telling a different story than the gain, something aside from not enough milk may be going on. Wet diapers alone do not indicate baby is getting enough to eat the first few weeks. (This changes after about 6 weeks when pooping may become much less frequent.)
    An ounce a day is the general average gain one expects from the age of about one week to 3 months. (After that gain normally slows.) But this does not mean a baby gains an ounce every day, some weeks a baby will gain more and some less. And of course while some babies gain faster than this, some gain slower and are still perfectly healthy and getting plenty to eat.
    Consider keeping both a poop log and a feeding log to record both breastfeedings and any supplemental feedings.



    Yes, pumping as well as frequent nursing is likely to help milk production. Be aware that even when supplementing with your own milk, you want to be careful.
    ANY supplemental bottles, even of milk mom pumped the same day, has the potential of of making baby less likely to nurse as much as baby otherwise would. This does not mean do not supplement, if baby needs supplements it is vitally important baby gets them. What I mean is, make sure bottles are small and given in a breastfeeding supportive way. This could mean a cup or syringe or lactation aid, rather than a bottle, it could mean a bottle but maybe using paced bottle feeding. What is right for your baby will depend in part on how the tongue tie might affect these other feeding methods.

    What increases milk production and keeps it normal is frequent, effective milk removal. (So for example, your baby nursing so much in the evenings is normal behavior that should help increase milk production.) Usually this is accomplished just fine with only nursing. However since your baby is likely tongue tied and thus presumably not transferring milk all that well at the breast, pumping and supplementing may be warranted and be helpful.

    Did the IBCLC do a before and after nursing weight check?

    Diaper log: http://www.llli.org/docs/00000000000...diaper_log.pdf


    paced bottle feeding http://www.llli.org/docs/00000000000...astfedbaby.pdf

    Alternatives to bottles http://www.askdrsears.com/topics/fee...atives-bottles

    Maddie, you're helping me out tons here, thank you.

    Her weigh-ins at the doctor's are on the same scale with a dry diaper only.

    We are logging. She tends to have poop in almost every diaper, because she moves her bowels often feeding often. We'd been told to count poops that are at least as big as a coin, so we're counting more than that "okay" standard. However, I feel like she probably has three that are that size per day. But she's just barely making the cutoff, just like she's gaining weight but slowwwly.

    I didn't know that pumped supplemental bottles could make her nurse less, but she has spent less time nursing today. We gave her just shy of two ounces in the early evening (that's all I was able to pump today.) But she hasn't skipped feedings, in fact she's wanted to eat every hour or every other hour, it's just drinking for a good stretch and then stopping rather than staying on me for hours on end, which, frankly, my sanity has appreciated. There was a feeding where I felt that she fell off too quickly, but I pumped after to make sure my breasts were emptied and only got 1/4 oz total. As long as I'm vigilant about having her come to the breast often, and pumping if there's any doubt that my breasts are emptied often, is this going to accomplish my goal of getting more milk into the baby? I just want to do everything I can to help her gain some ground while I'm working on getting these nursing issues worked out.

    What constitutes a "small" bottle, by the way? Is two ounces at a time okay or should we do two one-ounce bottles spaced out instead?

    I did a nurse-and-weigh both at the peds office and at the LC's, and it was the same both times: One ounce net change in weight, after about a twenty minute feed on just one side. Which isn't a lot but I wouldn't expect that feeding to hold her for three hours, maybe one hour.
    Last edited by @llli*msviolaceous; January 11th, 2015 at 04:02 AM.

  3. #13
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    Default Re: Tips for Nipple Shield Weaning

    As long as I'm vigilant about having her come to the breast often, and pumping if there's any doubt that my breasts are emptied often, is this going to accomplish my goal of getting more milk into the baby?
    This will accomplish the goal of getting milk removal where it needs to be for normal milk production if baby is not nursing often or well enough, and so, presumably, also increase milk into baby as there is simply more milk even if baby is not nursing all that well. If you also give baby your pumped milk, that will directly increase milk into baby.

    I did not want to scare you with my caution. Normal pump output varies tremendously. Some moms express a fairly large amount of milk when they pump, and in a situation like yours, can find themselves pumping more and more and nursing less and less. It's the same snowball effect that can happen with formula supplements, basically. What you are pumping and supplementing at this point is unlikely to be any issue, and of course again it is vitally important that a baby who needs supplements gets them, and if that can be moms own milk, so much the better. Also FYI what you are pumping sounds normal. What type of pump is it, and is pumping comfortable?

    In other words I think you are doing really well.

    What constitutes a "small" bottle, by the way?
    Small bottle would be no more than 2 ounces. But how much each time to give is hard to predict. Just keep in mind that 2 ounces is considered a 'complete' feeding at the breast (although of course sometimes they want more and sometimes less.) Please keep in mind that baby is obviously getting milk from you, quite a bit- enough for baby to not only be alive and healthy, which alone takes a lot of energy, but to GAIN. Yes the gain is slow, but the difference between slow gain and normal gain may well be just a few extra ounces a day.

    I did a nurse-and-weigh both at the peds office and at the LC's, and it was the same both times: One ounce net change in weight, after about a twenty minute feed on just one side. Which isn't a lot but I wouldn't expect that feeding to hold her for three hours, maybe one hour.
    After 20 minutes was baby asleep? I am wondering why baby was not put to other side. Also a baby could possibly take four ounces and want to nurse again in half an hour, or get one ounce and fall asleep for three hours. How long a baby "goes" between nursing sessions may tell us something, but the variety to normal nursing behavior is so great that this is simply not an accurate measure of intake.
    My understanding is that what is typically desired is to see with a before and after nursing check is at least a 2 ounce transfer at the breast. But that would be a "good" session, (which would be defined by mom probably, in comparison to how baby nurses at home) and nursing both sides. Timing gives some info, but some babies are simply slower nursers.

    Are you also having pain and injury btw?

    Have you tried breast compressions and/or switching sides once or more each session? These are techniques for keeping a less active or sleepy baby nursing longer, and getting more milk into baby in a shorter time. Not sure how compression will work with shield. http://www.breastfeedinginc.ca/conte...agename=doc-BC
    Last edited by @llli*maddieb; January 11th, 2015 at 09:49 AM.

  4. #14
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    Default Re: Tips for Nipple Shield Weaning

    Quote Originally Posted by @llli*maddieb View Post
    This will accomplish the goal of getting milk removal where it needs to be for normal milk production if baby is not nursing often or well enough, and so, presumably, also increase milk into baby as there is simply more milk even if baby is not nursing all that well. If you also give baby your pumped milk, that will directly increase milk into baby.

    I did not want to scare you with my caution. Normal pump output varies tremendously. Some moms express a fairly large amount of milk when they pump, and in a situation like yours, can find themselves pumping more and more and nursing less and less. It's the same snowball effect that can happen with formula supplements, basically. What you are pumping and supplementing at this point is unlikely to be any issue, and of course again it is vitally important that a baby who needs supplements gets them, and if that can be moms own milk, so much the better. Also FYI what you are pumping sounds normal. What type of pump is it, and is pumping comfortable?

    In other words I think you are doing really well.

    Small bottle would be no more than 2 ounces. 2 ounces is a 'complete' feeding at the breast (although of course sometimes they want more and sometimes less.) Please keep in mind that baby is obviously getting milk from you, quite a bit- enough for baby to not only be healthy and happy but to GAIN. Yes the gain is slow, but the difference between slow gain and normal gain may well be just a few extra ounces a day.
    Thank you. I need to keep hearing all of that, especially the part about "some weight gain is different (better) from no weight gain." It's taking everything I have not to give her formula at this point, because it's killing me to think that she's feeling hungry or not getting what she needs. I'm hoping that if I can self-supplement a little that it'll get us past these issues without ever having to formula supplement, but it's increasingly hard to keep my head on straight about it. For the most part, trusting my "mom instinct" has served me well in tackling the breastfeeding challenges, but now I don't know if I'm being overly anxious or if, by not giving formula, I'm ignoring my instincts.

    My pump is a Medela PIS and I'm still somewhat of a novice at it, but it's comfortable.

    After 20 minutes was baby asleep? I am wondering why baby was not put to other side. Also a baby could possibly take four ounces and want to nurse again in half an hour, or get one ounce and fall asleep for three hours. How long a baby "goes" between nursing sessions may tell us something, but the variety to normal nursing behavior is so great that this is simply not an accurate measure of intake.
    My understanding is that what is typically desired is to see with a before and after nursing check is at least a 2 ounce transfer at the breast. But that would be a "good" session, (which would be defined by mom probably, in comparison to how baby nurses at home) and nursing both sides. Timing gives some info, but some babies are simply slower nursers.
    She was sound asleep after the first side, which is normal for her. Between her falling asleep and my coping with damaged nipples for the first few weeks, and now with her 24/7 nursing behavior, I've gotten into the habit of rarely trying to offer the other side. If I want to, I'd have to go wake her up with a diaper change or something equally extreme. But if I wait, she'll wake up on her own and want to nurse again, and then I switch sides. She did ultimately feed from the other side at the LC's office, but we didn't weigh her after the second side. We were also trying to work on getting her off the shield throughout all of this. I would call it a "good" session, and I feel like she emptied my breasts.

    Are you also having pain and injury btw?

    Have you tried breast compressions and/or switching sides once or more each session? These are techniques for keeping a less active or sleepy baby nursing longer, and getting more milk into baby in a shorter time. Not sure how compression will work with shield. http://www.breastfeedinginc.ca/conte...agename=doc-BC
    I had badly cracked and bleeding nipples the first two weeks, but with lots of work on my own getting them healed (spending a ton of time with my nipples exposed to air, using lots of balm, etc) and work on improving her shield-latch (it wasn't always as pretty as a picture), I haven't had any more visible damage. But I still have pain, and I'm taking a little bit of ibuprofen (200 mg twice a day on average) to cope with the soreness. I also came down with mastitis on Christmas day, but it's all better now.

    I do breast compressions and it has helped with keeping her awake, although she's improving on that front a she gets older. I don't switch sides frequently because with her nursing habits (see above) it doesn't make a lot of sense to me. My typical day is one long nursing session. The only time I'd switch sides would be when feeding her after a more than two hour break, and when I expect there to be another break of at least an hour. But that doesn't happen much.
    Last edited by @llli*msviolaceous; January 11th, 2015 at 10:06 AM.

  5. #15
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    Default Re: Tips for Nipple Shield Weaning

    ok. So again I really think you are doing really well and are right to trust your instincts. If formula becomes necessary, that can also be given in a breastfeeding supportive way.

    There is still the issue of tongue tie to look at and possibly have treated and of course that is a physical barrier to normal milk transfer and comfortable nursing. So treatment, if needed, while not always an immediate fix, (sometimes it is, sometimes it is not) at the very least makes it physically possible for a baby to eventually nurse normally.

    What you are doing now with all your efforts with pumping and nursing frequently will, if nothing else, make sure your milk production is in good shape when baby is able to nurse efficiently. I think these things are doing much more than that of course.

    Switching sides- So switching sides aka switch nursing may not work well for you due to the nursing/latch pain. But let me explain why moms may do this some or all of the time in cases where milk production and weight gain is in question.
    This is one time that 'limiting' baby at the breast- but only on one side, not limiting the length of the session- is a good idea. So rather than letting baby stay on one side until baby seems 'done' on that side and baby chooses to switch or not as baby pleases, as one would with normal nursing, instead, mom instead takes baby off before baby is done- how long will vary, but,- say, 10- or 15 minutes, and then immediately puts baby to the other side. Then again, after nursing for 10 to 15 on that side, perhaps even switching baby again, and even again.

    This is a technique for increasing milk production that has been around for a long time. It also tends to keep a baby more 'awake' at the breast and more vigorous with nursing and thus, more milk into baby. http://breastfeeding.about.com/od/mi...ch-Nursing.htm

  6. #16
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    Default Re: Tips for Nipple Shield Weaning

    Can you think of anything else besides a sneaky tongue tie that might be at issue given a latch that's gorgeous from the outside but nursing problems that persist in this way?

    I can handle the marginal additional pain of re-latching. The shield helps with that. I might try the switching sides thing. You think it would help supply more than her current usual "daytime" pattern of twenty minutes on, ten minute nap, switch, twenty minutes on, ten minute nap?

    I'm starting to think my right breast isn't as productive as my left. Hmm. Anything I can do about that? Pump it more often?

  7. #17
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    Default Re: Tips for Nipple Shield Weaning

    Frankly, I think the term gorgeous latch is misleading. There are plenty of babies who get plenty of milk at the breast and mom is comfortable nursing with a latch that looks 'wrong,' and babies like yours who may have a textbook looking latch and whose latch is obviously clearly off. My personal opinion is that lactation science is going to keep moving away from ideas about how a latch should or should not look, just as it has moved away from strict rules about how to position a baby at the breast, and more to what latch feels like to mom and what the result is- namely, if there is normal milk transfer/weight gain, or not.

    Anyway, what causes a poor milk transfer -assuming there is enough milk overall- is either a poor latch or a poor sucking "technique" or both. This can be caused by physical issues or not. Tongue tie is one that is more readily and dramatically treated. Others are high palate, low fat in the cheeks, tightness in the neck and jaw...I am sure there are others, but I am not an IBCLC. Your LC or local LLL may have the book 'Supporting Sucking Skills in breastfed infants" by CW Genna you can borrow. She has some info about tongue tie on her site as well, and other articles you may find helpful. http://cwgenna.com/quickhelp.html

    I have no idea if switch nursing will help in your situation. lets put it this way- unless it causes you more injury, I do not see how it could hurt.

    I'm starting to think my right breast isn't as productive as my left. Hmm. Anything I can do about that? Pump it more often?
    well this is normal, for one side to produce more, and I am not a big believer in trying to fix what is normal. If pumping more on that side is a doable thing for you, fine, again, it can't hurt. But you want to be sure both sides get pumped some, while also nursing so much, and you have to sleep sometime. So I would not over stress about that.
    Last edited by @llli*maddieb; January 11th, 2015 at 01:22 PM.

  8. #18
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    Default Re: Tips for Nipple Shield Weaning

    Oof. First experiment in switch nursing: Switched her too early by accident, then had her fall sound sleep on boob 2 in 9 minutes, managed to get her partially awake and latched again on boob 3 (by which I mean second pass at boob 1, I am in fact humanoid), where she fell asleep in four minutes. She's a stubborn one.

    How does one fix a poor sucking technique? When I let her suck on my finger, it feels as though she's pushing forward with her tongue. Is that normal?

  9. #19
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    Default Re: Tips for Nipple Shield Weaning

    How does one fix a poor sucking technique?
    You work with a lactation consultant. There are probably exercises you can do at home, but to be doing the right ones, you need the help of someone practiced with this to show you what and why. As far as if that sensation is normal, I am so sorry but I have no idea! I think it depends on what is happening exactly. Babies use their tongues to nurse the breast, so you should feel the tongue working, undulating. But if the tongue is thrusting the nipple forward or "out" I think that may be a sign of tongue tie.

  10. #20
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    Default Re: Tips for Nipple Shield Weaning

    Fair enough. Thanks again for helping me through the weekend. I was going a little crazy sitting on my hands but soon I'll be able to call and get her an appointment.

    In related news, I was all set to start counting "ok" sized poops when the little stinker stopped pooping completely! Plenty of wet diapers but suddenly zero poop. The nurse line for our pediatrician says not to worry and that it can be normal for breastfed infants to not poop often, but it's awfully sudden for my taste.

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