Low Milk Supply

One of the most common concerns of the breastfeeding mother is that they aren’t making enough milk for their baby. Let me assure you, true low supply, or the inability to produce adequate milk, is rarely the problem. What signals your body to make more milk? Removing milk!

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“But he wants to eat all the time!”

Ok…Let’s look at the whole picture:

  • Is baby very young? Newborns have a stomach that, at 10 days old, is still only the size of an egg, and he’s eating a perfect food that is completely digested quickly.
  • How old is he? Just like a teenage boy that eats all the time, babies are growing…and fast! There are several physical and developmental spurts that occur, usually around the same time for each child. Take a look at the Wonder Weeks chart (http://www.whosthatmom.com/wonder-weeks-week-by-week/) and see if your baby is either having a growth spurt or about to have one.
  • Is he latched correctly? Can you hear him swallowing? A proper latch is comfortable for you, not painful, and allows baby to efficiently remove milk from the breast. If you have access to an IBCLC, have them check baby’s latch. There are several valuable resources here, as well: http://kellymom.com/ages/newborn/bf-basics/latch-resources/

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“He fusses at the breast. I don’t think any milk is coming out.”

  • Let’s talk about supply and demand. Babies demand milk…and you supply it. Fussing at the breast, beating on you, on-and-off nursing, etc, all signal your body to make more milk. Your breasts don’t ever truly become “empty”, they continuously make milk.
  • Does he need to burp? Is he distracted or overstimulated? Are you distracted or stressed?
  • Is he getting too much milk? Check our document on oversupply to see if it sounds like you.

“I’m pumping barely anything.”

  • Pumping is never a good way to judge what you’re actually producing. Babies are much more efficient at getting milk out than a pump.
  • Also see our document on Pumping Tips for help when pumping at work.

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“My breasts feel empty. I think my supply dropped.”

  • Probably not. Most of us only experience super-full feeling breasts for a limited time. What is most likely happening is that your supply is regulating. Your body and your baby’s demands have come to an understanding and your are meeting his needs without becoming overfull.
  • Your breasts always make milk. When milk is removed, they make more. “Your breasts are a factory, not a storage facility.” They are never truly empty.
  • Babies can typically always get out more milk. Even if it’s minimal; they are very efficient at their job.

“How do I make more milk?”

  • Firstly…nurse your baby more. Most concerns about supply can be fixed by simply nursing more.
  • Nurse baby on demand. Let him decide when he wants to eat.
  • Pay attention to baby’s hunger cues. Rooting, smacking lips, sucking hands, etc, are all signs of hunger. Crying is a late hunger cue.
  • Soothe at the breast. Comfort nursing can be frustrating sometimes, but it is the best means of comforting your baby and ensuring an abundant supply of milk.
  • Nurse until baby lets go. Let him decide when he’s done.
  • Don’t be a clock-watcher. Allow baby to run on his own time.

Signs that your baby is getting plenty of milk:

Birth-2 weeks:

  • baby starts gaining weight after your milk comes in. Remember, weight gain varies with every individual. Don’t compare your baby to your friend’s or yourself.
  • baby is having at least 3 quarter-sized poops per day. These can be spread out over a 24 hour period. More than three is fine.
  • baby is swallowing when he’s nursed.
  • baby is nursing at least every three hours until he reaches about 10 pounds. Again, more is fine.

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2-6 weeks:

  • baby passes birth weight by around 2 weeks. Remember to calculate that by baby’s lowest weight.
  • baby continues to gain weight.
  • still has 3 quarter-sized poops per day. Until around 6 weeks, this is what we want to see. Others may tell you that it is normal for exclusively breastfed babies to go several days or even a week or more without pooping. That is not true until around 6 weeks, and even then, not the norm.
  • baby has gotten the hang of latching on and staying attached.
  • baby is sucking with long, steady sucks soon after latching.

6 weeks on:

  • baby continues to gain weight.
  • baby is meeting developmental milestones.
  • baby has plenty of wet diapers and regular poops (they become less frequent around 6 weeks).
  • baby is getting longer and gaining in head circumference.

What if your supply is truly low?

Sometimes baby really isn’t getting enough milk. It’s important to understand why.

It’s important to figure out if he’s not taking enough because you’re not making enough, or if you’re not making enough because he’s not taking enough, or if he’s taking plenty but not using it well.

Source: The Womanly Art of Breastfeeding, 8th ed., p.396

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What might be the issue with baby?

Possible causes of baby taking too little milk are:

  • he’s improperly positioned
  • his nursing time is being cut short
  • he’s being fed too infrequently
  • he has a tongue-tie or other latching issue

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What might be the issue with me?

Possible causes of mother making too little milk are:

  • thyroid problems
  • PCOS (Polycyctic Ovary Syndrome)
  • breast surgeries

If your supply is truly low and your baby is not thriving, it is our advice at Milky Mommas to seek out and meet with an IBCLC to identify and correct the problem.

Most of these scenarios are completely reversible, so don’t give up hope. Remember, if you must supplement due to medical indication – and at the recommendation of a professional – there’s a strong chance that supplementation need be only temporary and you can return to being your child’s sole source of nutrition.

Probiotics

Probiotics are living microorganisms. They improve digestive health and boost immune health. You might consider introducing probiotics if you or baby have had a round of antibiotics (antibiotics kill all good and bad bacteria in the body, which opens the door for thrush!), when solids are introduced, if baby is struggling with gas/colic, during cold/flu season, or anytime, simply to maintain good gut health.

It can be beneficial for all mommas and babies to take probiotics for immune and digestive health benefits! Probiotics are generally considered safe during breastfeeding and pregnancy. Very little probiotics are transferred through breastmilk, so if it is medically indicated, babies should have their own probiotics. As always, consult a healthcare provider before introducing any supplement to your or your baby’s diet.

Here are some of our favorite brands:

  • Klaire Labs Infant powder, Children’s chewable, or Women’s capsule *Allergen Free*
  • Udo’s Choice Infant or Adult (contains milk and soy)
  • Renew Life Ultimate Flora Baby or Women’s (contains milk and soy)
  • Garden of Life Kids or Women’s (dairy and gluten free)

These are all powders that need to be kept cold. You can put a dab on your nipple before nursing, on a pacifier or your finger, or you can mix with breastmilk and give via a syringe or in a sippy cup or bottles.

There are some shelf-stable brands like Culturelle which can help but they are not nearly as effective as the kind that needs to be kept cold. You can find many of these at Whole Foods, any natural food store, GNC, Vitamin Shoppe, thenaturalonline.com, or Amazon. Sometimes CVS and other pharmacies have them, just ask the Pharmacist.

Teething and Biting

Sooner or later, all babies and toddlers will start teething. Many breastfeeding moms fear this milestone due to the “danger” of biting. However, teething is no reason to wean! Millions of mothers comfortably nurse babies and toddlers with teeth every day. With these tips, you can too.
Teething signs can start early (2-3 months old) but an actual tooth may not appear until months later. Not all babies show the same signs when teething and any of the symptoms below can be a sign of teething.
Signs your baby is teething may include:
  • A tooth visible below the gum
  • Swollen, bulging gums
  • Trying to bite, chew, and suck on everything she can get her hands on
  • Drooling
  • Irritability
  • Rubbing her face
  • Difficulty sleeping
  • Turning away food
  • Grabbing at the ears
If you observe several of these symptoms together, the likelihood that teething is the culprit is higher – but there’s always the chance that something else is to blame. Low grade fever can also be a sign of teething, but look for other signs to ensure the fever is not associate with a virus (runny nose, cough, etc).
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Remedies
  • A clean cold wash cloth
  • A clean cold wash cloth that has been in the freezer for a bit
  • Frozen fruit like an apple slice or berries in a mesh holder (for those over 6 months and already on solids)
  • Milk-sicles (breastmilk frozen in a popsicle mold or ice cubes in a mesh holder)
Essential Oils and Tylenol/Acetaminophen are no longer recommended as remedies.
Many essentials oils are not considered safe for children under the age of 2, hence the reason they are no longer recommended.
Tylenol is no longer recommended as a pain reliever by the FDA. It is still considered a fever reducer but new guidelines recommend using it sparingly or skipping it all together.
“The FDA’s Nonprescription Drugs Advisory Committee and Pediatric Advisory Committee have together recommended that “pain relief” be removed from the label of Tylenol for babies and toddlers and other brands of acetaminophen because there is no reliable evidence that it relieves pain better than placebo in children under age two.”

Biting
Sometimes teething babies will bite in order to soothe gum pain, or bite playfully. There are many methods for dealing with this, some better than others. Try out these tips to prevent your nursling from biting!
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Weaning

Is it Time to Wean?

Sooner or later, every breastfeeding mother faces the prospect of weaning. It begins when you start offering anything other than breastmilk to a breastfed baby. It is nice to know that weaning is a natural part of development. It is best to determine when to wean based on the mother and child’s needs, not the expectations of others.
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If you’re considering weaning your child, it might be best to clarify your feelings—why do you want to wean? What are your goals? It’s important to understand that your feelings will affect your child. If you’re feeling anxious or worried, your child may pick up on that and want to nurse more, creating a vicious cycle that will leave you both frustrated.
Determine your goals—what do you want to or believe you will achieve? Do you want your child to be more independent? Or is more sleep what you’re after?
Next, are your goals realistic? Many women wean thinking that their child will now sleep through the night and that just isn’t the case. “Sleeping through the night” is a very loose term, but for most professionals, sleeping 4-5 hours in one stretch is considered “sleeping through the night.” So, logically, if an infant goes to bed at 9:00 pm and only wakes at 3:00 am, he’s already sleeping through the night. Weaning most likely will not affect that. Instead of being able to easily comfort a child back to sleep with nursing, you’ll now be stuck with trying other methods to comfort a now awake child.
For an older baby or toddler, nursing is not just about food, necessarily. Nursing is a source of comfort and feeling of closeness to momma.
It is important to also note reasons not to wean. Those reasons include:
  • Teething
  • Mastitis
  • Returning to work
  • Mom or baby facing surgery or medications
  • Mother or baby’s illness or hospitalization
  • Pregnancy
Although each of the reasons listed above presents challenges, usually a solution can be found that does not require weaning. However, a nursing relationship is a symbiotic relationship and can only continue as long as both parties—mom & baby—are happy.

Approaches to Weaning

Gradual weaning is best. This allows mom’s body to naturally decrease her milk production, preventing mastitis and a host of other problems. How you wean will largely be determined by the age of your child.
  • 0-9 mos: you’ll need to substitute bottles instead of nursing.
  • 9-12 mos: you can use sippy cups/other foods to replace some nursing sessions **Please consult your pediatrician to determine best ways to meet your child’s nutritional needs.**
  • > 12 mos: planned weaning of a toddler should be a positive experience that helps a child develop independence.
One approach you might consider is Partial Weaning. Partial Weaning includes eliminating some, but not all nursing sessions. If your child is older than 1 year, you can also try shortening the nursing sessions. If your child is less than 1 year, though, it is best to consult with the doctor to make sure your child’s nutritional needs are being met.
Until at least 1 year, a breastfed baby gets most of their nutrition from nursing. If you are cutting those nursing sessions or shortening them, you will need to substitute with something—formula, pumped milk or other foods. You might be able to make up that missed nursing session with food and drink, or substitute with formula or pumped milk (either from mom or donor milk).
Abrupt Weaning is extremely hard on both mom and baby. For the mom, the physical discomfort and risk of mastitis or breast abscess is a very real possibility. Also, there will be hormonal changes as a result. The hormone prolactin is associated with feelings of well-being. Abrupt Weaning will cause a sudden drop in prolactin, which can lead to mood changes and is associated with depression.
For the baby, abruptly stopping can be especially traumatic. Nursing is not only food, it is comfort and closeness. If that is suddenly gone, the emotional trauma to a baby or toddler can be severe, leaving the child feeling as if the mother has withdrawn her love and rejected him.
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Methods of Gradual Weaning

There are six strategies you can use to start weaning, gradually. They are listed and discussed below.
  • Changing your daily routine: Most children have certain times and places they expect to nurse. Think about your routines. Try to come up with a way to change your routine so that your child is not reminded of nursing. For example, when my oldest son was weaning, I could not sit down in our nursing chair. As long as I didn’t sit down in that chair, he was not reminded of nursing. On the upside, my house has never been so clean!
  • Daddy’s turn: Remember all those feedings in the middle of the night when baby wanted no one but momma? Remember those nights where you tried for hours to get your baby to go to sleep and Daddy just slept or did his own thing? *This* is when you get payback! Remember when Daddy complained, “When do I get to help?” Well, now’s the time! Daddy can start helping by getting up in the night and handling those bottles (if your child is less than 1 year). If your routine has been to nurse first thing in the morning, perhaps Daddy can get up and fix your child breakfast, thereby breaking up that nursing routine. If your routine has been that you do baths and then nurse down for the night, perhaps now Daddy can take over that chore of giving baths and settling down for the night by reading a book.
  • Anticipate nursing and distract with a substitution: This method works better for some children than others, so if it doesn’t work, don’t stress yourself. This method works well for older children who are not dependent on nursing for nutrition. If you are familiar with your child’s routines and can anticipate when he will want to nurse, you can offer a snack and drink before he asks to nurse. Then distract with something else, like playing with a new toy, going to the park, playing with older children. Once the child has already asked to nurse, it will be much harder to distract and/or substitute.
  • Postponement: This method works better and easier for older children that understand the sequence of events. If your child can understand “Not Now… when Momma gets done [insert activity here].” Or if your child understands “Only when the sun is up/down” or “Only at night-night time.” Sometimes they will forget about asking to nurse again.
  • Shorten length of nursing sessions: If you are able, you can shorten how long your child stays latched. Many women either set an alarm on their phones or use a count-down method (“Ok, now I’m going to count down. When I get to 1, you need to let go.”).
  • Bargain: If all else fails, bribe ‘em! Just kidding, but seriously, some children can be motivated to stop nursing with the promise of a new toy or new privilege.
Most importantly, it is imperative that you, the mom, remain flexible. Understand that some nursing sessions are more important than others (i.e. bedtime, during an illness). Weaning is a process. It is not going to happen overnight or possibly even over a week or month. It might take months. And some days will be better than others.
Sometimes, it’ll even be two steps forward and one step back before any sort of progress will be made.
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There are certain behaviors associated with weaning too fast. If your child starts to exhibit these signs, you are strongly encouraged to back off on the weaning process for a little bit and resume some time in the future.
  • Child becomes upset/cries/distraught/insists upon nursing
  • Stuttering
  • Night-waking increases
  • Increased clinginess during the day
  • New attachment to an object or a toy
  • New or increased fear of separation
  • New habit of biting.
For mom, there are also signs that weaning is going too fast. Signs for mom include:
  • Mastitis or breast abscess
  • Uncomfortably full feeling of the breasts
  • Feelings of resentment
  • Being overwhelmed with meeting the child’s needs to make up for not nursing.

Weaning is an emotional process for mothers and children. It is a transition from some of the last parts of babyhood into full fledged toddler or childhood. With the freedom of weaning comes new challenges and stages in your child’s live. We wish you all the best!

Medication Resources: What is BF Friendly?

Are you trying to find out if your medicine is breastfeeding-friendly?
Were you told you need to “Pump and Dump?”
Don’t worry! The experts are ready to weigh in. Use these resources to make sure your medications are compatible with breastfeeding.
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Search Lactmed or call Infant Risk to determine if your medication is breastfeeding-friendly:
LactMed: Via Phone App or website.
Infant Risk: +1 806-352-2519 (hotline open during central standard time business hours)
Infant Risk is the leader in medication safety when it comes to breastfeeding. They have a website and a number you can call for free info on medications and their safety.
App for Android and iPhone website.
All-inclusive list of breastfeeding/medication safety resources here.
Motherisk: (phone 416-813-6780) at The Hospital for Sick Children in Toronto, Ontario, Canada. Call or visit their website for evidence-based information about the safety or risk of drugs, chemicals and disease during pregnancy and lactation.
Drugline (phone 0844 412 4665) at The Breastfeeding Network, Paisley, Scotland. Call the Drugline for information on taking prescription drugs while breastfeeding, or visit their website for handouts on drugs and breastfeeding.
Approved Cold and Allergy Meds:
Holistic/Homeopathic Remedies for Cold/Flu Season:
oscillococcinum, vitamin c (Emergen-C, powdered vit c, chewables), vit d3, elderberry syrup, local raw honey with lemon, eucalyptus oil, thieves oil and echinacea.
Phone Apps:
LactMed
MommyMeds