Breastfeeding the Older Baby: 12-18 Months

Written by Anna Choi, BS, IBCLC

Thank you for joining us for our third and final article in our blog series, Breastfeeding the Older Baby – What to Expect and How to Adjust. I’ve enjoyed writing these articles, as we have explored the evolving breastfeeding relationship between mama and baby, and I hope to have provided some insight for you about what this evolution might look like for you and your little one. In this final article, we will look at months 12 through 18 of your toddler’s life.

 

How often do toddlers breastfeed?

This answer varies greatly from one toddler to the next. Some mothers and nurslings have slowly decreased the number of breastfeeding sessions they have each day and may find that at this age, their toddler is breastfeeding as little as once or twice a day. Others may have a toddler who nurses like a newborn and goes to breast frequently throughout the day, nursing as many as 10 or more times in 24 hours. What’s important to remember is that there is no one “right” way to nurse a toddler and no magic number for how many times each day your toddler should or shouldn’t nurse. As long as mama and baby are happy with their nursing relationship and have found a rhythm and balance that works for them, then breastfeeding is going well.

Photo credit Chris Wojdak

Photo credit Chris Wojdak

Now that my little one has celebrated his/her first birthday, do I need to introduce cow’s milk or another milk alternative?

Such a great question – and one that we find ourselves answering frequently! In order to provide you with the most educated answer to this question, I enlisted the help of one of San Diego Breastfeeding Center’s favorite Registered Dieticians, Rachel Rothman. Here is what Rachel had to say:

Cow's milk is a good source of fat, protein, calcium and vitamin D, though it is not the only potential source of such nutrition. As infants become toddlers, many pediatricians make the recommendation to start baby on cow’s milk in order to meet baby’s specific nutrient needs.   If your baby is consuming a sufficient amount of these nutrients (in other forms), there is no reason he/she needs cow's milk or an alternate milk source.   One note I always give to my patients is that for children up to at least 2 years of age it’s advisable to give them full-fat / whole milk dairy products (cheese, yogurt, or milk) to ensure they receive enough fat to satisfy their needs. Keep in mind -  breast milk is an excellent source of fat and other nutrients.

- Rachel Rothman, MS. RD

If you find yourself having further questions about your little one’s diet, I encourage you to reach out to Rachel, as she possesses a wonderful wealth of information on nutrition {http://rachelrothman.com}.

 

I’ve reached my goal of breastfeeding for one year and I am ready to wean, what is the best method?

Congratulations on reaching your goal! If you are ready to wean from breastfeeding, there are several methods to choose from. Weaning gradually often makes for the smoothest transition for you and your little one {and your breasts!}. To start the weaning process, choose one breastfeeding session and replace it with something else {such as previously pumped breastmilk, water, solid food, etc}. After a few days, you’ll choose another breastfeeding session to replace with something else, and so on. Usually the nursing sessions before naps and bedtime are the hardest to wean from, and therefore the last to go. Your little one will appreciate extra snuggles as they adjust to this big change in their life. Depending on the temperament of your child, and how often they are currently nursing, the weaning process may take a few weeks or a few months. If you’d like more information on weaning, check out this link to a previous blog series all about weaning an older child

 

Can I stop pumping at work and continue to breastfeed when I’m with my toddler?

Absolutely! As a working mom myself, I was eager to put away the pump after my little one turned one year old. I knew I’d miss that lovely womp womp womp sound and getting undressed and redressed in the middle of my workday, but figured I’d somehow survive. How soon you can stop pumping at work will depend on your work schedule, baby’s solid food intake, and what you have decided baby will consume in place of the pumped breastmilk you’ve been supplying. If you stop pumping at work and continue to breastfeed your toddler when you are with them, your supply should adjust to meet the needs of this new routine. Some moms find that their supply decreases as a result, but this usually isn’t a huge concern since your toddler should be eating plenty of table foods at this point. If you decide to stop pumping at work, remember to drop pumping sessions and reduce the amount of time spent pumping gradually, to reduce your risk of engorgement and plugged ducts.

 

How do I handle unsolicited advice about my toddler being “too old to breastfeed?”

The short answer is, don’t feel the need to defend yourself. When someone makes a comment about your toddler breastfeeding, simply say, “We are doing what’s best for our family. Thank you.” And then, walk away.

If you’d like to get a little more detailed with your response, or perhaps provide some breastfeeding education to the person, you can reference the American Academy of Pediatrics and the World Health Organization’s recommendations, which advocate continued breastfeeding past twelve months of age. You can also let them know that nursing toddlers are generally sick less often and have fewer allergies than non-breastfeeding toddlers.

 

What did breastfeeding look like for YOU during months 12-18?




 

Big Latch On 2016!

We are so excited to announce that the San Diego Breastfeeding Center and Buddha Baby are co-hosting a 2016 Big Latch On event!  For those who are unfamiliar with the Big Latch On, this is an event that started in New Zealand in 2005 during World Breastfeeding Week.  The mission of the Big Latch On is to protect, promote, and support breastfeeding women and each year groups of breastfeeding women come together at locations all around the world to latch on their children at a designated time and day in honor of this mission and to attempt to set a new record!  This year, our Big Latch On event will be sponsored by Sakura Bloom, Tula Baby Carriers, Luludew, and the San Diego Breastfeeding Coalition.

So, here are the details:

 

When is the Big Latch On?

The Big Latch On event will take place on Saturday, August 6, 2016 from 9am-11am.  The actual Big Latch On will take place at exactly 10:30am, so don’t be late!  

Where will the Big Latch On take place?

At the Kensington Mini Park, just west of the Kensington Library.  The address is: 4121 Adams Ave. San Diego,CA 92116

 

Do I need to RSVP for the Big Latch On Event?

Yes, please!  Since we need 1 non-breastfeeding witness for every 10 breastfeeding mamas, it would be wonderful if you can RSVP before the event.  If you forget, please come anyway.

 

 

What is the agenda for the Big Latch On?

9:00am-10:20am - Registration and mingle.  Purchase tickets for our Opportunity Drawing; proceeds to be donated to the San Diego Breastfeeding Center Foundation.  First 100 attendees will get an awesome Goodie Bag, filled with nipple cream, tea, lactation bars, and other amazing items!

10:20-10:25am - Settle in and get ready to latch on

10:30-10:31am - Big Latch On!

10:40-11:00am - Opportunity drawing winners announced

11am - Event ends

What takes place at registration?

Each breastfeeding mom needs to register, with her name and email address, so that she can be counted during the event.  Also, each mom will decide whether she gives her permission to be photographed during the event.

 

What takes place during the Big Latch On?

9:00am-10:20am: Once moms have registered, there will be plenty of time to relax, mingle, play at the playground, and grab some coffee and breakfast at Starbucks, Stehly Farms, and the Kensington Cafe.  You will also have time to purchase tickets for the opportunity drawing items.  Definitely bring a water bottle so you can stay hydrated.

From 10:30-10:31am, all of the participants will latch on their child(ren).  Each breastfeeding mom will be counted by one of the non-breastfeeding witnesses so that she can be accounted for in setting the Big Latch On record.

From 10:40-11:00am, opportunity drawing winners will be chosen.  Winners must be present to receive the gift.

What are the opportunity drawing details?

We are in the process of collecting items for our opportunity drawing!  Each Big Latch On participant will be given one ticket to enter the opportunity drawing.  Additional tickets can be purchased at the event: $1 for 1 ticket, $5 for 6 tickets, $10 for 12 tickets.  All money raised will be donated to the San Diego Breastfeeding Center Foundation to help pay for reduced-fee breastfeeding consultations for low-income breastfeeding families in San Diego.  If you have an item or service that you would like to donate for the opportunity drawing, please contact Robin Kaplan, at robinkaplan@sdbfc.com.

Sponsorship opportunities!

This year we are offering Sponsorship Opportunities, at a variety of levels, ranging from Goodie Bag donations to official sponsorship of our event.  If you are interested in sharing your service or product with our local families, please contact Anna Choi at AnnaChoi@sdbfc.com for more sponsorship information.

How will the photographs be used after the event?

We are so thrilled that Ariel Dolfo, of Ariel Dolfo Photography, will be documenting our Big Latch On event for the third year in a row!  Photographs will only be taken of mothers who give permission to be photographed.  Group photos will be taken to document the event and sent with our final number of participating breastfeeding mothers, as well as placed on the San Diego Breastfeeding Center website.  

Looking forward to seeing you all there!  

 

Why Has My Pumping Output Decreased?

I love when we receive emails with questions that our blog readers could benefit from!  Here is a question from one of our mamas who is wondering why her pumping output has decreased.  

-----------------------------------------------------------------------

Hi Robin!

I met with you awhile back when I first went back to work to set up a good pumping schedule.  It has worked like a charm these last 6 months.  Thank you for that!

My little guy is about to turn one and I’ve noticed a big reduction in my pumped breast milk the last few weeks. I’ve gone from pumping around 25 ounces of milk/work shift to around 15 oz.  It feels like it happened overnight. I’m just wondering if you have any suggestions on things I can do to get milk back or if this is just a normal progression.  I’m not ready to give up breastfeeding yet, but want to make sure he is getting enough milk.  He has been eating ALOT of solid food for about 5 months, so I’m sure this has had an impact on my supply :-(

Thanks for your time!

N

-----------------------------------------------------------------------------
Hi N,

I am thrilled to hear that our plan worked so well for you!  That is awesome!  

So, pumping output can dip for many reasons, regardless of baby’s age.....

1. Baby is sleeping through the night.  When babies start to go longer stretches in the middle of the night without eating, it can cause a mom’s milk supply to dip overall.  If your kiddo is going to sleep a few hours before you are, you can consider adding in a dream feed or pumping before you go to bed so that your breasts don’t go for such a long period of time without removing milk.  Also, if your kiddo wakes up in the middle of the night, you could consider breastfeeding at that time, rather than soothing back to sleep right away, if you are worried that your supply is dipping too low.

 

2. Pump suction is losing its stamina (which is HUGE and definitely common!)  I would recommend getting your pump suction checked immediately.  Many lactation consultants have pump suction gauges to check the pressure created when running.  A less-than-stellar functioning pump can definitely decrease pumping output, even when supply is right where it needs to be.  Renting a hospital-grade pump will also help you determine if your own pump is not working as well as it should.

3. Pumping frequency has gone down while at work.  As moms get closer to that year mark, many prefer to cut down on the pumping frequency at work.  Sometimes they are able to keep up their supply when this is done.  Others find that their milk supply is more sensitive, so it requires that extra pumping session.

4. Baby is eating solids before breastfeeding (when mom is with baby), so he isn't as hungry when breastfeeding. Up until about a year, solids should be offered after breastfeeding so that babies are getting the bulk of their nutrition from breast milk and getting solids after their bellies are more full.  

5. You got your period and are experiencing a temporary dip. When mom’s hormones are shifting due to her cycle, this can temporarily dip her supply.  

6. Something else has changed in mom’s routine…. More working out on a regular basis, not eating enough calories per day, recovering from stomach flu or a cold, etc.  Again, all temporary.  But, make sure that you are eating at least 2000 calories a day to keep up your supply, as well as even extra, if you are working out.  If you are recovering from an illness, this will take a few days to rebound once you are feeling better.

That being said, 15oz of pumped milk at 1 year is pretty awesome!  At this point, your little guy doesn't need much more than that to complement all of the whole foods he is eating.  Plus, that doesn’t even take into account how much breastmilk he is getting from you while breastfeeding.  As long as he isn't getting frustrated at the breast, then just keep on plugging along, knowing that a breastfeeding baby should always be able to take out more than the pump.

Hope that helps!  Definitely get your pump suction checked, asap, and let me know if you have any other questions.

Warmly,

Robin

 

Breastfeeding the Older Baby: What to Expect at 9-12 Months

Written by Anna Choi, BS, IBCLC

Welcome back to our blog series, Breastfeeding the Older Baby – What to Expect and How to Adjust. Last month we took a closer look at what breastfeeding might look like for a 6-9 month old, and tackled some of the most common questions and concerns we hear from parents with little ones in that age range. We hope you found the information helpful and relevant and are happy to have you join us again!

Today, we’d like to talk about months 9 through 12 of your baby’s life. I think these are the last months we can classify them as babies, right? Don’t they officially become “toddlers” once they are over a year old? Crazy, I know! The days seem so long when you’re in them -- changing diapers, wiping their face clean, rocking them to sleep. But in an instant, the days have become weeks, and the weeks have become months, and soon, a whole year has passed by. Their first year. You kept them clean {mostly}, fed, happy, and above all, loved. Celebrate your accomplishments, mamas! But, I guess I’m getting slightly ahead of myself. My oldest “baby” turns 5 this month and I’m still trying to wrap my brain around it. So as we approach the end of your baby’s first year of life, what does breastfeeding look like?

What does breastfeeding look like in months 9-12? How often should my baby be eating and how long should feedings take?

Breastmilk continues to be your baby’s primary source of nutrition until his/her first birthday. Some babies will continue to space out their breastfeeding sessions as they approach this milestone birthday, nursing 4-5 times during the day, and once or more during the night. As your little one begins to explore the tastes and textures of more solid foods and consume more of them at each sitting,  you may notice your little one begining to nurse less frequently in response to their increased intake of solid foods. As long as baby is continuing to have five or more wet diapers each day, gain an average of 2-4oz per week, and baby seems satisfied and content after breastfeeding sessions, then your little one is most likely getting enough nutrition from breastfeeding.

When will my baby begin to drop his/her nighttime feeding sessions and sleep through the night?

Such a great question, and one that’s frequently on parents’ minds! When will my baby sleep longer at night? The short answer is, I don’t know when your baby will sleep through the night. Every baby is different and the timeframe for when one baby will sleep through the night versus another is going to be different. Babies wake throughout the night for varying reasons, including hunger, a need for comfort, a disruption in their sleep cycle, a need for a diaper change, sickness, teething, etc. Breastfeeding often meets more than one of baby’s needs, so it’s easy to fall into the routine of nursing your little one back to sleep. There is absolutely nothing wrong with responding to your little one’s needs by breastfeeding them! If you are happy with your nighttime routine, then please don’t feel pressured to make significant changes in order to cope with outside pressure and recommendations to “train” your baby to sleep longer at night. That being said, if you find yourself becoming frustrated with nighttime wakings and overtired during the day due to lack of sleep at night, then it might be time to take a closer look at your nighttime routine to make a plan for improving your quality of sleep. I find the following Kellymom article on night weaning to be extremely helpful at offering tips for gentle night weaning of older babies: http://kellymom.com/ages/weaning/wean-how/weaning-night/

I’ve heard people mention teaching breastfeeding manners to older babies.  How does that work?

It’s never too early to start teaching your little one age-appropriate manners. Just as we prompt our toddlers for “the magic word” when they ask for something, older babies can learn to be polite when breastfeeding. Teaching your little one a few basic signs from American Sign Language can be very beneficial in setting the stage for breastfeeding manners. The signs for milk, more, and please are fairly basic and many babies pick up on them quickly. {see here: http://www.babysignlanguage.com/dictionary/first-signs/} Once your little one has mastered the sign for milk, you can calmly remind him/her to sign milk when hungry instead of pulling your shirt down or crying out in frustration. Positive reinforcement will go a long way to reinforce the idea that you would like baby to sign milk when hungry rather than clawing at your chest. Baby will also be calmer and happier, seeing you sign milk, showing them you hear and understand their need and are going to breastfeed them soon.

My baby has been refusing to nurse, could he/she be self-weaning?

If your baby has been refusing to breastfeed for several breastfeeding sessions or days in a row, then it’s more likely that you and your little one are experiencing a nursing strike, rather than self-weaning. It is very uncommon for a baby to self-wean before their first birthday. As we have said before, babies need breastmilk to be their primary source of nutrition until at least their first birthday. Also, self-weaning is usually a gradual process, where as a nursing strike is characterized by a sudden and complete disinterest and refusal to breastfeed. Nursing strikes are common in older babies and can be in response to teething, distraction, illness, bottle-preference, and other developmental milestones. Tips for surviving a nursing strike and encouraging baby to breastfeed again are:

- Always offer breastmilk before any solids during baby’s first year of life. If baby won’t breastfeed, you can offer baby breastmilk in a sippy cup, to ensure baby’s nutritional needs are being met through breastmilk. Solid foods are supposed to complement breastmilk during baby’s first year, not replace.

- Limit or eliminate bottles and pacifiers. Only use bottles when baby is separated from mom and then put baby back to breast when baby is with mom. We want baby’s sucking needs to be met at the breast.

- If distractibility seems to be playing a role in baby’s refusal to breastfeed, try wearing a nursing necklace to keep baby’s attention focused on mom during breastfeeding. You can also try giving baby a small toy to hold during feeding sessions, nursing in a quiet room, and nursing baby in a baby carrier.

If you feel your milk supply has decreased, and this has led to the nursing strike, then it is a good idea to visit a breastfeeding support group or make an appointment with a Lactation Consultant to come up with a breastfeeding plan to help you increase your supply and meet baby’s needs moving forward.

 

What did breastfeeding look like for YOU during months 9-12?

Join us next time when we discuss breastfeeding during months 12-18!

Giving Up Gluten for Breastfeeding Moms

Written by Stacy Spensley

The last thing you want to hear as a breastfeeding mom is that you can't eat something. You probably want to eat everything! You're legitimately eating for two right now.

But if your baby is showing symptoms of a reaction to something in your diet, you're also probably willing to do anything to make it better. Dietary changes are tough, especially on top of being a new mom, but here are some tips that can help make the process easier.

While there are several common foods that can prompt an elimination diet, today we'll start with gluten. It's a bit of a buzzword nowadays, but it's more than a weight loss trend. Gluten can be tough on your baby's tummy.

WHAT IS GLUTEN?

Gluten is simply the protein found in wheat and other grains than can cause inflammation. Note that the root of gluten is "glue," and that's no accident. Gluten is what makes bread dough stretchy and elastic.

When moms eliminate gluten from their diets, many see results in a week or two, but some may take longer. Eating "limited" gluten won't make a difference - if it is affecting your baby’s digestive system, it really has to be all cut out to make sure.

WHAT CONTAINS GLUTEN?

The big one is wheat - all varieties. In addition, wheatberries, durum, emmer, spelt, semolina, farina, farro, graham, Kamut, einkorn, rye, barley, triticale, malt, and brewer's yeast. Cross-contamination can also be an issue, especially with oats. It's recommended to avoid bulk bins in case of cross-contamination and to look for certified, tested gluten-free products.

The major categories of gluten-containing foods are bread, pastry, pasta, crackers, baked goods, breading/batter for frying, roux-based soups, sauces and gravies, flour tortillas, and beer. Other less obvious foods are soy sauce and sushi, pre-seasoned meat, salad dressings and marinades (often wheat is used as a thickener), seasoned potato chips, granola or energy bars, and some candy.

The Celiac Disease Foundation has a more in-depth list and a longer explanation of cross-contamination if you're interested.

Does that sound like every food ever? I promise it isn't.

SO WHAT CAN I EAT?

www.hipfoodiemom.com

www.hipfoodiemom.com

Fruits, vegetables, meat, dairy, beans, legumes, and nuts, and other grains are all naturally gluten-free. If you buy prepared versions you should check labels, but the plain versions are safe.

Which grains and flours specifically are OK? Rice, cassava, corn, soy, potato, tapioca, beans, sorghum, quinoa, millet, buckwheat (also called kasha), arrowroot, amaranth, teff, flax, chia, yucca, nut flours, and gluten-free oats.

Again, here are more details from the Celiac Disease Foundation.

The safest bet is usually cooking from whole ingredients. But you also have a newborn, and you're hungry. The upside to the gluten-free trend is that there are also tons of gluten-free products on the shelves, and many restaurants actually have a gluten-free menu, or note gluten-free dishes to make it easier for you.

HOW DO I GET STARTED?

First, make a list of all the things you already eat that are gluten-free.  Then you have a foundation for some familiar meals to cycle through.

Next, check your cupboards to see what you can't eat. Some people find it easier for their whole family to go gluten-free to avoid cross-contamination (think toast crumbs in the butter, or dipping crackers straight into the hummus). Read labels carefully.

Many people find it less overwhelming to start with substitutes. Switch to gluten-free pasta, gluten-free cereal, gluten-free pizza crust, gluten-free sandwich bread, there are even gluten-free bagels. The downside is that they do cost more, but sometimes mama needs a (gluten-free) cookie. It's a tradeoff.

www.familyfoodonthetable.com

www.familyfoodonthetable.com

Another approach is just to avoid dishes that are normally wheat-based. If you normally have cereal for breakfast, have eggs or a smoothie. Instead of a sandwich for lunch, have soup and a salad (no croutons!). Try polenta instead of pasta.

For most people, something in the middle works well. If you really want pizza, splurge on gluten-free crust and feel like a relatively normal person. Most GF sandwich bread isn't great, so finding an alternative may be better than feeling disappointed (especially at $7 a loaf). Most gluten-free flour blends also contain binders like xanthan and guar gums which aren't inherently bad, but can upset some people's stomachs.

WHAT ARE SOME COMMON MISTAKES?

At home, make sure you have a gluten-free prep area. Toasters are a major source of cross-contamination. It's not like it will kill you, but you don't know how much contamination it takes to affect your baby.  If the rest of your family still eats gluten, you can't share a jar of peanut butter. Either scoop out a portion before spreading on anything, or get your own jars and label them clearly.

At restaurants, don't be afraid to ask about gluten-free options from the start. There can be hidden ingredients in many sauces and marinades that you don't expect. Or seek out restaurants that advertise GF options to make it easier on yourself.

Don't give up too soon. Like I mentioned above, it can take several weeks for the gluten to completely clear your system, but that doesn't mean it's not making a difference.

BUT HOW DO I MAKE IT THROUGH A WHOLE WEEK?

Again, Celiac Disease Foundation to the rescue with a 7-day gluten-free meal plan.

I highly recommend meal planning. You can download a weekly menu planning template here. For recipes, Pinterest is an amazing resource, and the app is easy to use on your phone while you're nursing. I have several boards full of gluten-free recipe ideas.

Just having a roster of recipes can make a difference. Then you have a gluten-free menu to choose from when planning your meals. I even make a list of snacks so if I get hungry I don't even have to think. Stocking your pantry and fridge with foods you can actually eat makes the experience much easier.

A FEW MEAL IDEAS

Here are some basics for each meal to give you some ideas.

Breakfast: scrambled eggs or an omelet, green smoothies, GF oatmeal, breakfast hash, chia pudding parfait

Lunch: soup and salad, tacos (corn tortillas), GF pasta, lettuce wraps, quinoa salad

Dinner: "Paleo-style" burgers (no bun, just wrapped in lettuce) with fries, stir-fry with gluten-free soy sauce, burrito bowls, polenta with roasted veggies, grilled chicken or fish with veggies and rice

Snacks: trail mix, fresh fruit, carrots and GF crackers with hummus, hard boiled eggs, yogurt with fruit

It's a big change, but it IS possible! I hope this helps make the transition easier for you and your baby.


Stacy Spensley is a healthy life coach and semi-crunchy mama. She works with new moms and dads through classes and coaching to normalize the parenting experience so they feel more confident making parenting decisions and maintain their sanity while keeping everyone alive. She also helps families create meal plans when they have to incorporate an elimination diet.  Her friends would tell you she's bossy in the best way. Folding laundry is her least favorite activity. If you're a semi-crunchy mama, click here join the club and learn more.