Age-appropriate Portions for Toddlers (and Moms)

This post is by Rachel Rothman, MS, RD, and is the third post in the three-part blog series about introducing solids to your little one.  Rachel is a mom to a toddler, a pediatric dietitian and instructor of “Introduction to Solids” and “Nutrition for Toddlers and Preschoolers” at the San Diego Breastfeeding Center.  Join us for the next Nutrition for Toddlers and Preschoolers class on October 29th at 10:00am.  More information and registration can be found here.

In case you missed it, I discussed the feeding relationship in my previous two posts, and these may be summarized using the division of responsibility. Parents are responsible for the “what, when, and where of feeding; children are responsible for the how much and whether of eating” [1].  In this third post we discuss age appropriate serving sizes – however, as with all nutrition advice, sustainably learning the behaviors associated with this division of responsibility will be as important, if not more influential, than simply choosing specific serving size, as all of our young ones progress at slightly different paces and individual ways.

Most of the food we eat- and the nutrient measurements we rely on – use the idea of serving sizes. But what does a serving look like?

Adults struggle with this because it’s hard to learn at home, and when we eat out, it’s nearly impossible to get consistent feedback.  As children, most parents did not learn to react this way, and an age of abundant and convenient food has limited the effects of our natural impulses.  

When we feed our children, many parents second-guess themselves and their children’s eating behaviors.  Is my child eating enough?  Is my child eating too much?  Here are some helpful guidelines when it comes to your children and serving sizes, starting from the beginning, when first introducing solids.

Tips and guidelines when thinking about the appropriate serving size for your infant and toddler:

- Around 6-7 months, as your baby is first starting solids, it’s important to remember serving sizes are very small.  If you are offering purees, you will want to start by offering 1-2 teaspoons, keeping in mind initially your baby may not take more than a small taste.  You will most likely be advancing to 1-3 tablespoons as your baby moves toward 7-8 months.

- From 6 months to around 1 year, breast milk or a breastmilk substitute should still make up the majority of your baby’s calorie intake.  Offer breast milk or a breastmilk substitute before solids, especially when starting out. 

- All babies are different.  Some babies love solids right off the bat and may take more than 2-3 tablespoons.  That’s okay!  It may take other babies some time to begin their solid intake and they may refuse for a while.  That’s okay, too! The important thing is to continue to offer solids, but let your child decide whether he/she wants to eat.

A typical toddler breakfast: 2-3 tablespoons of yogurt, 1/4 cup fruit and 2-3 small pancakes (and it’s okay if they don’t finish the whole thing!).

-Around 8-11 months your baby continues to grow, so does his/her appetite.  Solid intake may increase, but not by much.  A full day’s worth of solids might be: ¼ cup of fruit, ¼ cup vegetables, 1-3 tablespoons protein and ¼ cup whole grains.  A serving of vegetables, however, may still be closer to 2-3 tablespoons.  

- After one year of age, baby’s growth slows (most babies triple their birth weight over the first year!).  With a decrease in growth rate may also come a decrease in appetite.  Do not be alarmed if intake decreases after one year of age.  It’s most important to monitor your baby’s weight gain and growth. 

Snacks and lunch packed for daycare: 1/2 peanut butter and jelly sandwich, blueberries, oat and spinach muffin, string cheese and nectarine slices.

Additionally, after one year of age, your toddler may be eating more meals and snacks throughout the day.  When thinking about meals and snacks to serve, try to offer something from each food group.  Meals should consist of a fruit or vegetable, carbohydrate and protein, while a snack might consist of a fruit and vegetable and a carbohydrate. Don’t be afraid to think outside the box and try new things.   One of my daughter’s favorite on the go snacks is a mix of chick peas and green peas;  a combination of protein and carbohydrates with a healthy mix of vitamins and minerals.  

Stay positive! Picky eating behaviors often develop during this time and can persist as a phase many healthy kids go through.  If you stay positive and dedicated to offering a broad variety of healthy, whole foods, you have the best chance of continuing to nourish your little one while accommodating their tastes and preferences.

To learn more about introducing solids to your little one, join me at the SDBFC in one of my Introduction to Solidsor Nutrition for Toddlers and Preschoolers classes.  More information can be found here.

[1] Satter, Ellen M.,  Child of Mine: Feeding With Love and Good Sense, Bull Publishing Company; Revised edition (March 1, 2000) http://www.amazon.com/Child-Mine-Feeding-Revised-Updated/dp/0923521518 

Rachel Rothman, MS, RD is a mom, pediatric dietitian, and instructor at the San Diego Breastfeeding Center.  She lives in San Diego with her husband Ben and daughter Sydney. 

Fall Diaper Donation Drive to Benefit the IRC in San Diego

San Diego Breastfeeding Center is excited to announce our Fall Diaper Drive, which will benefit the International Rescue Committee in San Diego! Beginning on Wednesday, October 12th and continuing through Wednesday, November 30th, we will accept donations of new, unopened packages of diapers at our office in Hillcrest [3355 4th Avenue, San Diego, CA 92103]. Diapers can be dropped off during our weekly Breastfeeding Support Group, every Wednesday between 11:30am and 1pm. If you would like to make a diaper donation, but are unable to drop off during this time, please contact Anna Choi of the San Diego Breastfeeding Center to arrange a pick-up of your donation [annachoi@sdbfc.com].

Chris Williams, Resettlement Program Manager in San Diego, tells us:

The International Rescue Committee [IRC] welcomes more than 1,000 refugees to San Diego each year from war-torn nations around the world, including Syria, Iraq, Somalia, Afghanistan, the Democratic Republic of Congo, and others. Many such families have arrived in just the past few months, and after years, or even decades, in transition, they’re looking forward to a new life and a fresh start in San Diego. IRC provides assistance to these families in a number of different ways, however the first month after arrival can be very difficult, especially for families with young children. Families receive limited financial assistance through the federal government and as such, the IRC really relies on donations and support from the community to help provide for these newly arriving families. What may seem like a small donation of a package of diapers can go a long way in helping people feel safe, welcome, and comfortable in a new place.

As a mother myself, I know how quickly the cost of diapers can add up, and I can’t imagine what it must feel like for these parents to arrive in a new country with uncertainty about how they will provide for their little ones. With that being said, I encourage everyone reading this blog, who has the means to, to consider making a small donation {or a large one!} by purchasing an extra package or box of diapers the next time they are at the store, to donate to the IRC. The IRC has a particular need for diapers in sizes 3 and up and would greatly appreciate donations in these sizes.

For more information about the diaper drive, or to arrange a pick-up, please contact Anna Choi at annachoi@sdbfc.com. Thank you!

How to Help Your Little One Feel Full with Solids

This post is by Rachel Rothman, MS, RD, and is the second post of a three-part series about introducing solids to your little one.  Rachel is a mom to a toddler and a pediatric dietitian. Rachel is the instructor of "Toddler Nutrition" and “Introduction to Solids” classes at the San Diego Breastfeeding Center. Join us for the next Toddler Nutrition class on October 29th at 10:00am.  More information and registration can be found here.

In my previous post, I addressed a parent’s responsibilities for the “when” (setting meal time) and the “what” (the food to be served) of feeding.  This approach is generally referred to as the feeding relationship: Parents are responsible for the “what, when, and where of feeding; children are responsible for the how much and whether of eating” [1].   The relationship is between parent and child, and between the child and the food they eat.  Now that we’ve established the parent’s responsibilities, we can move to the child’s responsibilities – whether to eat, and how much to eat.  

By controlling the WHAT, parents introduce foods, and should be actively monitoring how children respond. Getting started is fairly simple: you offer the food, and your child decides how much and WHETHER they want to eat it.  Yep, that’s it.  

However, this will surely bring a challenge (and for some, the harder obstacle to overcome) to be okay with how much and whether your child accepts the food.  

 

Start Small

When introducing solids to your little ones, starting small is essential to help him learn to physically accept solid food and learn to taste, chew, and swallow effectively.  If you choose to start by offering purees, offer a small amount of a pureed food to your little one.  If the child opens his/her mouth toward the spoon, help guide the food into his/her mouth.  If the child turns away from the spoon, trust his/her instincts that he/she does not want that food or is simply not ready.   If you choose to use the baby led weaning approach, start by placing food in front of your child on his/her high chair tray or the table. Trust that your baby knows what he/she needs.  And keep in mind, especially when starting out, breast milk or a breastmilk substitute will make up the majority of your little one’s calories and nutrition until he/she is close to a year old.  Your job is to help them learn how to eat.  You are letting them know they can choose how much and whether they would like to eat.  

When you move beyond purees and toward more complex foods, offered more frequently, this approach can, and often will, get more challenging.   As your child gets older and enters toddlerhood less of his/her nutrition may come from breast milk or a breastmilk substitute.  However, this is when it is more important than ever to keep in mind your child’s ability to self regulate.  As you offer more food at a given meal, you’ll be looking for signs that your child feels hungry.  That feeling (rather than a specific amount of food) helps your child to learn appropriate eating habits.

 

Experiencing Hunger and Feeling Full

Allow your child to experience the physical and cognitive effects of being hungry before eating - his/her young body’s regulatory reflexes come from feeling hungry and then knowing when he/she full.  

Research shows that children who are taught in this manner develop positive food attitudes, interest in eating a variety of foods, an intuitive sense of how much to eat, and long term skills for healthy eating and meal planning.[2]

There are a few things you can do to encourage your child to feel hungry and full, such as only offering a meal or snack every 2-3 hours (allow your child to feel hunger and sensation of fullness) and only offering water in between meals (rather than juice or sugary beverages).  

Eat Meals Together

Sit and have meals with your child, as time allows, and eat the same foods as they eat.  Not only will you be in a better position to monitor your baby’s preferences, but you can encourage her choices and ease her frustrations through words and sounds.  When your child tries a new food or enjoys an old favorite, you can show him that his choices matter to you.  Another benefit is cognitive: take the opportunity to teach your child the names of the foods he’s eating!

Lots of Exposure to the Same Foods

Keep in mind it can take up to 20 exposures of a new food before a child accepts it.  This is true when introducing solids to an infant as well as more complex foods to a toddler.  Before you rule out a food and dismiss your child as disliking it, keep offering it.  Chances are, after enough exposures, your child may have a change of heart.   While some degree of pickiness is normal, if you feel concerned with your child’s feeding habits, consult your pediatrician or a registered dietitian.

With the principles above, you’ll be on your way to raising a healthy eater!  Stay tuned for our next post, “Age-appropriate portions”.  If you’d like to keep exploring this topic with us, we’d love to see you in our next  Introduction to Solids class.

[1] Satter, Ellen M.,  Child of Mine: Feeding With Love and Good Sense, Bull Publishing Company; Revised edition (March 1, 2000) http://www.amazon.com/Child-Mine-Feeding-Revised-Updated/dp/0923521518

[2] Satter, “Eating Competence: Definition and Evidence for the Satter Eating Competence Model” Journal of Nutrition Education and Behavior ● Volume 39, Number 5S, September/October 2007  http://www.ellynsatterinstitute.org/cms-assets/documents/101150-596171.ecdefandev.pdf

Rachel Rothman, MS, RD is a mom, pediatric dietitian, and instructor at the San Diego Breastfeeding Center.  She lives in San Diego with her husband, Ben, and daughter, Sydney.  You can contact Rachel here.

Nighttime Weaning

Written by Anna Choi, IBCLC

A few months ago, when my youngest daughter was between 15 and 18 months old, I found myself hitting a rough patch in terms of sleep deprivation. After almost a year and half of waking up throughout the night to nurse her back to sleep, I was exhausted and frustrated. “It’s time to night wean,” I told my husband. I had been hoping and hoping she would start sleeping through the night on her own after her first birthday, but it hadn’t happened yet and I was at the end of my rope. I loved the amazing breastfeeding relationship we had built and was nervous to make a change, but knew it was needed.

Talking with a good friend whose breastfed daughter was the same age as my little one, and also not sleeping through the night, reassured me that there was nothing “wrong” about our situation. We agreed though that we were ready for more consistent sleep stretches and began researching gentle night-weaning strategies, thinking we might approach this next big step together so we could support one another through the ups and downs. We spent two months researching and delaying [trying to choose the best time to start – when the littles were not sick or teething, we had a few days off work, not during a trip out of town, etc], and then, as luck would have it, both of our girls began sleeping through the night on their own around 18 months old. How’s that for irony?

Even though I ended up not needing to move forward with a night-weaning strategy, I thought it would be helpful to share what I learned with my fellow sleep-deprived mamas of toddlers, as well as answer some of the most common questions we get as Lactation Consultants regarding nighttime breastfeeding of a toddler over 12 months old.

Why is my 1-2 year old waking at night?

It’s important to remember that there are a variety of reasons your little one may continue to wake throughout the night. These reasons can include hunger, a need for comfort, pain from teething/illness, and external factors such as noise, just to name a few. Even though you may be using breastfeeding as the primary means to settle your toddler back to sleep, it may not be the reason your little one is waking in the first place. If you are able to pinpoint a cause for the night waking [such as your little one being too hot/cold], then you can oftentimes make a simple change [adjust the temperature of their room by using a fan/space heater] to decrease nighttime wake-ups.

What are some options for approaching nighttime weaning?

Once you have addressed outside variables such as room temperature, teething, etc, and feel as though baby primarily needs comfort and assistance transitioning back to sleep during nighttime wake-ups, there are several choices for how to move away from using breastfeeding as the means to settling your toddler back to sleep. These are a few of the gentle nighttime weaning methods and links to more detailed information about each one:

Jay Gordon Technique

This method uses gentle behavior modification by slowly reducing the total time spent breastfeeding at night, while replacing the nighttime nursing sessions with another comfort measure.

http://drjaygordon.com/attachment/sleeppattern.html    

Cues For “Bye-Bye Milk”

Depending on the age of your toddler and their understanding of verbal cues, some mothers find that using a verbal cue [and possibly ASL sign] for the end of a nursing session can help transition baby off the breast more smoothly. Many toddlers already use a sign or word to ask for milk, and this idea flips that routine to the ending of the nursing session. Once your toddler responds well to mommy saying, “bye-bye milk” or “all done milk,” or another phrase that works for you, this technique can usually be transitioned into explaining that when it’s dark, or nighttime, mama’s milk goes night-night too.

http://www.mommypotamus.com/so-you-want-to-night-wean-your-toddler/    

Will my milk supply decrease if I choose to night wean?

The short answer is, yes it probably will. However, for most breastfeeding mothers, the dip in supply will not be drastic enough to cause any adverse effects on the breastfeeding relationship. Now that your little one is a toddler and should be eating plenty of solid foods throughout the day, the small dip in supply will likely go unnoticed. As long as your toddler continues to nurse during the day, you will continue to produce breastmilk for him/her.

General tips for approaching nighttime weaning:

1. Enlist the help of a support person. No matter which path you take, nighttime weaning will involve providing comfort for your toddler in another way besides breastfeeding. Having another adult, whether this is your partner, a grandparent, your best friend, or a postpartum doula, available at night to help provide this comfort and/or support you through this change will be immensely helpful.

2. Create a bedtime routine and stick with it. If you haven’t already, I highly recommend you come up with a simple bedtime routine that you do with your toddler each night. Consistency is important for helping to establish boundaries and teach your little one what to expect during the night. Bedtime routines do not have to be elaborate. Something basic such as: bath, pajamas, story or song time, breastfeeding, toddler laid down in their sleep space, is all it takes.

3. Remember, it doesn’t have to be all or nothing. If your little one is waking multiple times throughout the night, you may wish to focus on eliminating one nighttime breastfeeding session at a time. Taking this slower approach can be helpful for avoiding engorgement as well.

4. If at any time during the night weaning process you have second thoughts or feel as though this isn’t the best decision for you and your family, then stop. You aren’t signing a contract when you embark down this path, and it’s okay to stop the process and wait to start again in a few weeks or a few months. Trust your gut and your mama instincts.

Understanding Infant Sleep - 6 weeks to 4 months

In our previous sleep article, we discussed normal sleep patterns and realistic sleep expectations for infants up to 6 weeks.  By the time we hit 6 weeks, our children have gone through so many developmental changes, including what shapes their sleep patterns.  What do these patterns look like now and when will you start to actually get some sleep?  

What does research tell us about sleep patterns for 6 week - 4 month old infants?

• Babies this age still receive about a ⅓ of their food during the middle of the night.

• Between 6 weeks and 4 months, babies begin ‘sleep consolidation’, which means that they start to combine 2 or more sleep cycles together without waking in between.

• Babies at the age tend to falls asleep more easily after eating in the middle of the night, which is a welcomed trend after the first 6 weeks of your child wanting to party after each meal in the middle of the night.

Take home message:  Your baby is still going to wake up in the middle of the night to feed, but he/she should be able to fall back asleep much more quickly after eating.  This means less walking around the house, singing lullabyes at 3am.  Whoo hoo!

What does science tell us about how babies sleep at this age?

• 6-12 week old babies still fall asleep in active sleep, i.e. dreaming, hence the eye movements, silly smiles, and sporadic arm movements. However, active sleep time becomes shorter and shorter at the beginning of the sleep cycle, which means you may only have to wait a few minutes before you can put your baby down without waking him/her.

• A baby’s circadian rhythm is settling in now, which means deeper sleep at night, with less jarring movements, allowing baby to stay asleep much more easily.

• 12-16 week old babies now fall asleep in quiet sleep, similar to adults. This means that your baby doesn’t fall asleep dreaming (REM), but rather begins to drift to sleep and stay asleep.

• Patterns vary from baby to baby, therefore it is not a lack of parenting skills if your baby is still waking every 2-3 hours in the middle of the night. It is important to remember that every baby is different and has different needs.

Take home message:  Your baby is going to start to fall asleep and stay asleep more easily.  His/her days and nights will no longer be mixed up and he/she will start to fall into a deeper sleep in the middle of the night.

What are common sleep patterns for a 6 week to 4 month old baby?

• Daytime naps are still sporadic and frequent. Some babies fall asleep right after eating, while others are awake after eating and then fall asleep after some alert time.

• Daytime naps can range from 20 minutes to several hours, while some of the longest naps can take place while you are out and about.

• Babies love to nap while being worn or out on a walk. The fresh air seems to lull them to sleep.

• Evening sleep will be all over the place, especially during the ‘witching hour.’ What this will most likely look like is eat, sleep for 20 minutes, eat, sleep for 20 minutes, and repeat for a few hours. Here are some great ways to survive the witching hour!

• Nighttime sleep is starting to get better. Your baby might have one longer chunk of sleep for the first half of the night (for example, like a 4-5 hour stretch between 8pm and 1am). Then your baby might continue to wake every 2-4 hours after that. Remember, your baby’s stomach is still really small and this frequent waking in the middle of the night is protective against SIDS.

Take home message: Babies at this age still have fairly unpredictable sleep patterns. Since your baby may start to sleep longer in the beginning of the night, you might consider going to bed earlier than usual, to take advantage of this long stretch of sleep.

What are some tips for parents to get more sleep?

• Mastering the sidelying position can be a game changer. Your baby is much sturdier than he/she used to be, therefore sidelying can be much easier and comfortable now, for both of you.

• Look into safe co-sleeping guidelines, as research has shown that families who safely co-sleep or bedshare get more sleep than those whose babies sleep in a different room.

• If you are uncomfortable with bedsharing for the whole night, consider setting your alarm for 20 minutes, while nursing in the sidelying position in bed. Then, if you end up falling asleep, your quiet alarm will wake you and then you can place your baby in his/her own bed, bassinet, or sidecar.

• Try what the authors of Sweet Sleep call ‘Front Loading:’ do more work early in the day and start to unwind earlier in the evening.  If you can unwind earlier, that means you can fall asleep earlier and easier, as well.  Check out this Huffington Post article about 15 Science-Backed Ways to Falls Asleep Faster

Resources for evidence-based info about normal infant sleep:

http://www.secretsofbabybehavior.com/2010/04/science-of-infant-sleep-part-ii-big.html

http://www.amazon.com/Sweet-Sleep-Nighttime-Strategies-Breastfeeding/dp/0345518470

https://www.psychologytoday.com/blog/moral-landscapes/201302/normal-human-infant-sleep-feeding-method-and-development

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.

PHOTO CREDIT CHRIS WOJDAK

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.

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 aboutweaning 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?

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

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?

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.

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.

Two Things More Important than Portion Sizes when Offering Solids to Infants

Join Rachel Rothman, MS, RD in our three-part blog series to learn more about introducing solids to your little one.  Rachel is a pediatric dietitian and the instructor of our Introduction to Solids classes here at the SDBFC. 

Introduction to Solids, Serving Sizes, Feeding Relationship

When babies are 4-6 months of age, many moms start thinking about how much solid food kids should eat.  It’s easy to get caught up in a race toward the “starting solids” milestone, but what comes next?  Many parents wonder, now that their little one has started eating solid foods, how much is enough?  Am I making him/her overeat?  Am I wasting food? Am I teaching poor habits? 

What might reassure you is that as long as your selections contain a balance of protein, carbohydrate, fats and vitamins and minerals, measuring “servings” of food consumed may not necessarily be the best way to ensure your baby’s success at adopting a solid diet.  

First, take a step back. Renowned feeding expert Ellyn Satter, MS, RDN, MSSW gives parents the helpful suggestion of a “division of responsibility.”  Parents are responsible for the “what, when, and where of feeding; children are responsible for the how much and whether of eating” (Satter).   Babies have the innate ability to self regulate.  They will let you know when they want more, such as opening their mouths when food is offered.  Conversely, will let you know when they are full, such as turning away from the spoon and sealing their lips tightly.  

Rather than a fixed “serving” - offer food to your child, but look for signs that they are full.  With that in mind, you have two things in your control: when is mealtime, and what are you serving.

When is mealtime?  

A general idea of how many meals you should offer each day depends on the age of your child:

Once you have an idea of when those mealtimes and snack times fit into your baby’s wake and sleep schedule, you’ll want to establish some strategies for how much to offer at each serving.  Start small: when first introducing solids, 1-2 teaspoons is enough for your little one.  And remember, up to one year of age breast milk or formula will continue to make up the majority of your baby’s calorie intake.  

Next, think about the overall composition of the meal:

Thinking about the composition of meals, know that all babies are different and some may progress through textures more quickly (or more slowly) than others. That’s okay.  As discussed above, you can only control the what and when.  Your child is in control of the how much and whether.

This process is bigger than serving size.  You’re trying not merely to nourish your little one; but to introduce your little one to a variety of new foods, textures, flavors, and nutrients.  This diversity is part of a journey you’re on, together with your young child, to ensure their healthy relationship with food.  These approaches will help your child to develop the tools to succeed when making food decisions on his/her own.

Stay tuned for my next post: “How To Help Your Little One Feel Full” to learn more about introducing new foods to your child.

Understanding Infant Sleep - The First 6 Weeks

“I slept like a baby”  

When I hear this saying, I immediately envision sleeping deeply, soundly, and for 10 hours straight.  Whoever came up with that saying clearly didn’t have children!  All of the babies I know definitely do not sleep soundly for an extended period of time until at least toddlerhood… and even then sleep can be disrupted by teething, colds, and just regular night waking. With current infant sleep recommendations stating that babies should learn to sleep on their own, all night, by 6 months, I have to wonder how much of this information is hearsay and old-wives’ tales and how much is evidence-based (using good research models). 

So, let’s break this down using the most current research.  

SOURCE: UNITED STATES BREASTFEEDING COMMITTEE

What does research tell us about infant sleep patterns?

Today I am going to discuss sleep patterns and behaviors for infants during the first 6 weeks.  I will continue to share information about sleep patterns for older babies throughout the next few weeks.

How much does a 0-6 week old newborn typically sleep in a 24 hour period?

• Newborns sleep in short spurts, both day and night.

• Most babies this age sleep between 9-19 hours over a 24 hour period (that’s a huge variation!)

• Newborns have extremely small stomachs, which means they need to eat small, frequent meals, at least 8-12 times per day (as a minimum).  These feeding sessions can take anywhere from 15 minutes to over an hour, on average.  

• Newborns eat about ⅓ of their food during the night.

• Some babies may take one longer stretch of sleep at the beginning of the night (maybe 4 hours), but then may spend more time eating throughout the rest of the night and day to make up for the food intake they missed while sleeping longer. 

Take home message: It is biologically and developmentally normal for your baby to sleep in only 1-3 hour increments during the first 6 weeks because they are unable to eat enough at a feeding session to go for longer.  

Why do newborns wake often?

• Besides having a small stomach capacity, newborns are hard-wired to wake frequently during the day and night.  This is one of the ways their bodies are protected from SIDS.

• Newborns’ sleep cycles are different than adults: when they fall asleep, they spend more time in active (REM) sleep rather than quiet sleep (which means they wake more easily), their temperature doesn’t drop in the middle of the night (which means that they cannot distinguish daytime from nighttime), and they have no circadian rhythm.

• Newborns are often unable to join multiple sleep cycles together.  This takes a few months for their bodies to figure out.  A newborn sleep cycle is 45 minutes long.  You might get two sleep cycles strung together for 90 minutes of uninterrupted sleep, but then they are right back up again.

Take home message: Babies are programmed to wake frequently and sleep lightly.  This is developmentally normal infant behavior.

What are realistic sleep expectations for your 0-6 week old newborn?

• Your baby’s sleep patterns are going to be all over the place.  Unpredictable. Some short spurts (20 minutes).  Some long spurts (3 hours).  This is normal and will become more predictable over time. 

• Your baby is going to wake frequently during the day and night until he/she develops a circadian rhythm around 3 months.  At 3 months, your baby may still wake frequently during the night, but will at least be able to fall back asleep fairly easily and quickly.

• Your baby is also going to eat all of the time.  This is what builds and maintains your milk supply.  This is also what helps your baby gain weight and grow.

• Sleep patterns will be disrupted during growth spurts.  Growth spurts happen around 2 weeks, 4 weeks, and 6 weeks.  What this means is that your baby will sleep less for a few days and want to eat more.  Once these growth spurts pass, your milk supply should be even more robust than before and your baby will slow back down to eating slightly less frequently.

What are some tips for parents feeling really overwhelmed and sleep deprived with baby’s frequent waking?

• Sometimes just knowing that these sleep patterns are normal and temporary makes the situation seem more manageable.  Remember, your baby will eventually start sleeping for longer chunks of time (which we will discuss in the next few articles)

• Have your baby sleep on someone’s chest while you take a nap.  Babies LOVE to sleep on an adult’s chest and usually sleep a bit more soundly and longer.  This is not spoiling your baby or creating a bad habit.  This is meeting your baby’s developmental need to be near others.

• Look into safe co-sleeping guidelines, as research has shown that families who safely co-sleep or bedshare get more sleep than those whose babies sleep in a different room. 

• Try what the authors of Sweet Sleep call ‘Front Loading:’ do more work early in the day and start to unwind earlier in the evening.  If you can unwind earlier, that means you can fall asleep earlier and easier, as well.  Check out this Huffington Post article about 15 Science-Backed Ways to Falls Asleep Faster

• Start filtering out the misinformation you receive from others about what they think your baby should be doing regarding sleeping and eating.  This will only create a situation where you think there is a sleeping problem, when in actuality your situation is most likely perfectly normal.

In our next article about infant sleep, we will discuss normal sleep patterns for babies 6 weeks to 4 months.

Resources for evidence-based info about normal infant sleep:

http://www.secretsofbabybehavior.com/2010/03/science-of-infant-sleep-part-i-first-6.html

http://www.amazon.com/Sweet-Sleep-Nighttime-Strategies-Breastfeeding/dp/0345518470

https://www.isisonline.org.uk/hcp/how_babies_sleep/

https://www.psychologytoday.com/blog/moral-landscapes/201302/normal-human-infant-sleep-feeding-method-and-development