Extended Breastfeeding Benefits

www.baltimoresun.com/health/sns-rt-us-breast-feeding-20131225,0,5236029.story

baltimoresun.com

Longer breastfeeding tied to better development

Shereen Jegtvig

Reuters

11:02 AM EST, December 25, 2013



NEW YORK (Reuters Health) - Children who were breastfed for more than six months scored the highest on cognitive, language and motor development tests as toddlers, in a new study from Greece.

Earlier research tied breastfeeding to better thinking and memory skills. But how it's related to language skills and movement and coordination had been less clear.

The new study doesn't prove breastfeeding is responsible for better development, but it shows a strong association, researchers said.

Most evidence "pretty clearly shows there are significant medical benefits of breast-feeding," Dr. Dimitri Christakis told Reuters Health in an email.

Christakis is a professor of pediatrics at the University of Washington and director of the Center for Child Health, Behavior and Development at Seattle Children's Research Institute. He was not involved in the new study.

"I think that the evidence is now of sufficient quality that we can close the book on these benefits and focus instead on how do we succeed in promoting breast-feeding because all of the studies, including this one, that have looked at it have found a linear relationship, which is to say that the benefits accrue with each additional month that a child is breastfed," he said.

For their report, Dr. Leda Chatzi from the University of Crete and her colleagues used data from a long-term study of 540 mothers and their kids.

When the babies were nine months old, the researchers asked mothers when they started breastfeeding and how long they breastfed. They updated the information when the children were 18 months old.

Psychologists also tested children's cognitive abilities, language skills and motor development at 18 months.

About 89 percent of the babies were ever breastfed. Of those, 13 percent were breastfed for less than one month, 52 percent for between one and six months and 35 percent for longer than six months.

Children who were breastfed for any amount of time scored higher on the cognitive, receptive communication and fine motor portions of the test than children who weren't breastfed.

Scores on the cognitive, receptive and expressive communication and fine motor sections were highest among children who were breastfed for more than six months, the researchers reported in the Journal of Epidemiology and Community Health.

For instance, on cognitive assessments with a normal score of 100, toddlers who were never breastfed scored about a 97, on average. Kids who were breastfed for more than six months scored a 104.

Chatzi and her colleagues expected to see more breastfeeding than they did.

"We were surprised by the fact that breastfeeding levels in Greece remain low, even though there is an ongoing effort by the Greek State to promote breastfeeding practices," Chatzi told Reuters Health in an email.

Christakis pointed out that in the United States, about 60 to 80 percent of women start breastfeeding their babies, but by four months less than 30 percent are still breastfeeding.

The World Health Organization recommends exclusive breastfeeding - without any formula or solid food - until a baby is six months old, followed by breastfeeding with the addition of appropriate foods through age two.

"One of the reasons we see such a big drop off in the United States and elsewhere around four months is because women return to work," Christakis said.

"The real challenge we have is with sustaining breast-feeding," he said. "I believe very strongly that we need a public health approach to doing so because these are public health issues - improving child cognition and improving in this case as they showed a child's physical development, benefits society as a whole and society has to support women achieving that goal."

"We need to have baby-friendly work places that help women continue to either breast-feed or pump when they return to work," Christakis said.

"There's that African proverb, ‘it takes a village to raise a child,'" he said. "It takes a village to breast-feed a child as well, and all sectors have to contribute."

SOURCE: http://bit.ly/JPdFqm Journal of Epidemiology and Community Health, online December 13, 2013



Copyright © 2013, Reuters

Lactation Consultants help new Moms

Lactation Consultants Increase Breast-feeding

Megan Brooks
December 20, 2013





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Pre- and postnatal visits with a certified lactation consultant (LC) coupled with electronic reminders for healthcare providers to discuss breast-feeding at prenatal visits may boost breast-feeding duration and intensity, new research shows.

The American Academy of Pediatrics recommends exclusive breast-feeding for the first 6 months after birth, followed by continued breast-feeding for 1 year or more as other foods are introduced. Yet less than 75% of infants in the United States are breast-fed at all, and fewer than half are still being breast-fed at 6 months, according to the Centers for Disease Control and Prevention (CDC). Under the Affordable Care Act, private insurers must cover professional breast-feeding support without cost-sharing.

In 2 separate clinical trials, Karen Bonuck, PhD, from the Department of Family and Social Medicine, Albert Einstein College of Medicine of Yeshiva University in New York City, and colleagues found that integrating professional LCs into routine care alone or combined with electronic prompted guidance (EP) from prenatal care providers increased breast-feeding at 3 months postpartum.

The studies were published online December 19 in the American Journal of Public Health.

In the Best Infant Nutrition for Good Outcomes (BINGO) trial, 666 primarily low-income women were randomly allocated to 1 of 4 groups: LC alone, LC+EP, EP alone, and usual care (the control group). The LC protocol included 2 prenatal sessions, a hospital visit, and regular telephone calls postpartum though age 3 months or until breast-feeding ceased.

The study team followed-up with the women periodically to assess breast-feeding "intensity," defined as the percentage of all feedings during the last 7 days that were breast milk. They defined high intensity as 80% or more of feedings involving breast milk, medium intensity as 20% to 79%, and low intensity as 19% or less.

At 3 months, high-intensity breast-feeding was greater in the LC+EP group (17.3%; odds ratio [OR], 2.72; 95% confidence interval [CI], 1.08 - 6.84) and the LC-only group (20.5%; OR, 3.22; 95% CI, 1.14 - 9.09) compared with usual care (8.1%).

In addition, women in the LC+EP group were more likely to initiate breast-feeding, do "any" breast-feeding (vs none) at 1 month, and breast-feed exclusively at 3 months postpartum compared with the control group. The EP group did not differ from the control group on any outcome.

The Provider Approaches to Improved Rates of Infant Nutrition & Growth Study (PAIRINGS) study included 275 women from more economically diverse backgrounds (compared with BINGO participants), many more of whom planned to breast-feed exclusively (62% vs 37% in BINGO).

They were randomly allocated to a usual care control group and a group receiving both the LC+EP interventions. For the PAIRINGS primary outcome of exclusive breast-feeding at 3 months, rates were significantly higher with LC+EP than usual care (16.0% vs 6.2%; OR, 2.86; 95% CI, 1.21 - 6.76).

As in BINGO, any breast-feeding and both high- and medium-intensity breast-feeding were more likely with LC+EP than usual care.

Finding Was Robust in Tough Groups

The researchers point out that black/non-Hispanic, younger, overweight and less-educated women are known to have some of the lowest rates of breast-feeding, and together, these women made up a large majority of those enrolled in the BINGO and PAIRINGS trials.

The findings were "robust in what is traditionally thought of as a difficult-to-support breast-feeding population," Dr. Bonuck noted in an interview with Medscape Medical News.

Although neither trial came close to attaining exclusive breast-feeding for 6 months, as advocated by the American Academy of Pediatrics, about 95% of women in the 2 trials at least started breast-feeding, which exceeds the goal of 82% that the CDC has proposed in its Healthy People 2020 report, Dr. Bonuck points out.

"This study is significant because it shows that integrating lactation consultants into prenatal care increases breastfeeding rates among low income racial/ethnic minority women," Tonse N.K. Raju, MD, chief of the National Institutes of Health's Pregnancy and Perinatology Branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, said in news release.

"We need additional studies to see if this and other interventions can enhance breastfeeding by these women beyond a few months," Dr. Raju added.

This research was supported by the National Institute of Child Health and Human Development and the National Institute on Minority Health and Health Disparities. The authors have disclosed no relevant financial relationships.

Am J Public Health. Published online December 20, 2013. Abstract






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Tongue-ties interfere with successful breastfeeding

Low-risk snip may help tongue-tied infants breastfeed



Is this baby tongue-tied? Few doctors agree on how best to find out, say breastfeeding experts.

Is this baby tongue-tied? Few doctors agree on how best to find out, say breastfeeding experts.

Photo Credit: © 2013 Thinkstock


Lack of training remains an obstacle to treatment of a relatively common cause of breastfeeding problems, warn experts.

An estimated 4-10% of babies have "tongue-tie," or excess tissue anchoring the tongue to the floor of the mouth. Also known as ankyloglossia, the condition can make it difficult for some infants to breastfeed, resulting in slow weight gain, colic and early weaning. It's also linked to poor milk supply, nipple trauma and infections in nursing moms.

But the simple fix — a quick snip of the offending tissue with surgical scissors or a zap with a laser to release the tongue — seldom features in pediatric literature or training.

Called a frenotomy, the voluntary procedure has almost "no risk if done correctly" and often results in immediate improvements in both the ease and comfort of feeding, says Lawrence Kotlow, a pediatric dentist from Albany, New York. He performs the surgery six to eight times a day.

"It doesn't require anesthesia or stitching, it takes maybe 20 seconds to do, the baby is put on the breast immediately afterwards and most parents find a significant difference because now the baby can have a deeper latch."

Even so, it can be difficult to find a physician to perform the procedure, as both diagnosis and treatment of tongue-tie remain a longstanding source of controversy in the medical community.

The Canadian Paediatric Society hedges that the procedure "cannot be recommended," except in cases where "the association between significant tongue-tie and major breastfeeding problems is clearly identified and surgical intervention is deemed necessary."

Similarly, a recent CMAJ Practice article suggests reserving the procedure for newborns with feeding difficulties caused by "severe" tongue-tie.

A systematic review of 17 studies suggested that "frenotomy is a safe procedure that may facilitate breastfeeding in women who may otherwise have given up," but acknowledged that most studies were not randomized and therefore not a good indication of "any true benefit" (Arch Dis Child 2011;96:A62-3).

One such trial recently showed that frenotomy for infants with mild or moderate tongue-tie "did not result in an objective improvement in breastfeeding" at the end of a five-day period.

However, the study's authors noted that 17% of those randomized to "usual care" did not last five days before the mothers demanded a frenotomy, and 15% switched to bottle feeding. After the five days, most women in the comparison group opted for a frenotomy for their infant.

According to the authors, it's unclear "how many women would have given up breastfeeding if frenotomy had not been available in a few days' time."

In the absence of clear cut evidence, few doctors outside of specialty breastfeeding clinics even assess for tongue-tie, says Dr. Howard Mitnick, a breastfeeding management expert at the Goldfarb Breastfeeding Clinic at Jewish General Hospital in Montréal, Quebec. His clinic is "overwhelmed" with frenotomy referrals from across the province. "There are major chunks of Canada where no one's doing them … because you don't look for something you can't deal with."

Adding to the confusion, there's no standard way in which physicians diagnose the condition. Some doctors identify tongue-tie based solely on anatomical criteria, such as the degree of fusion between the tongue and the floor of the mouth. Others look for signs of limited function, such as an inability to raise or stick out the tongue.

In both cases, it's hard to attribute feeding problems to tongue-tie without a "baseline expertise" to rule out other possible causes, says Mitnick. "Lots of the women I see are struggling with breastfeeding, and the baby has the anatomy of a tongue-tie, but it's not a tongue-tie problem; it's a confidence, knowledge or positioning problem."

According to Dr. Jack Newman, founder of the International Breastfeeding Centre in Toronto, Ontario, "most physicians have no idea how to diagnose a tongue tie, at least the more subtle ones."

"We see babies in our clinic who have very significant tongue ties, yet the parents were told by the doctor that there was no tongue-tie," he wrote in an email. "And most physicians will not release a tongue tie because they don't know how."

The fact that dentists and lactation consultants often know more about the condition than physicians can further complicate the issue.

"If the family doctor doesn't recognize it, and a nonphysician says it's there, you run into a conflict," says Kotlow.

Ultimately, the losers in these scuffles are the babies and parents, who may spend months bouncing from one provider to another in search of a solution.

Mitnick argues that the wait-and-see attitude adopted by many physicians puts mothers at unnecessary risk of having to supplement poor milk supply with formula or giving up breastfeeding entirely. "We know very well that if babies are not exclusively breastfed there are genuine medical concerns, so if the alternative is frenotomy, it should be seriously considered, especially when the risks of the procedure are so low."


DOI:10.1503/cmaj.109-4675

— Lauren Vogel, CMAJ




Copyright 1995-2013, Canadian Medical Association. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.

Early skin-to-skin contact promotes breastfeeding, benefits baby : OBGYN News

Early skin-to-skin contact promotes breastfeeding, benefits baby : OBGYN News

The co$t of infant formula

Budgeting for Baby: The Cost-Saving Benefits of Breastfeeding

September 3, 2013

Budgeting for Baby: The Cost-Saving Benefits of Breastfeeding
Of course, there are many benefits of breastfeeding to consider for both mom and baby, but what about cost? We all know that starting a family means a significant financial commitment – in other words, babies are expensive. No matter what your budget is like, it’s important to plan ahead and prepare for the lifestyle change that a new baby brings.

Whether you’re about to welcome a little one into the world or thinking about your current breastfeeding journey, you might be wondering how much breastfeeding costs. But first, take a look at the cost of not breastfeeding:

Powdered formula, the least expensive type of formula, usually costs between $20 and $30 per large can and formula-fed babies will likely need about 1-1.5 cans of formula per week. Feeding formula means spending $80-$150 or even upwards of $250 per month if your baby requires special formula due to allergies or other special nutritional needs. This means that in one year, your family could spend $960 (low end) to $3,000 (high end) on formula.

Compare that to breastmilk – perfect, complete nutrition without having to mix bottles or carry extra feeding gear – which is totally free. The Surgeon General of the United States notes that following optimal breastfeeding practices can save $1,200–$1,500 in the first year of your baby’s life when compared to buying formula. With that in mind, even spending a couple hundred dollars on a breastpump and supplies winds up costing considerably less than purchasing formula for your baby. We all know about the health benefits of breastfeeding, but don’t forget that healthier infants can also require fewer doctor visits, which lowers healthcare costs (and less time out of work for mom + dad). You can find more of the Surgeon General’s cost-saving benefits of breastfeeding here.

We can also take a look at the big picture. A study published in the Official Journal of the American Academy of Pediatrics found that the United States could save $13 billion per year (in direct and indirect health costs) and prevent almost 1,000 infant deaths if 90% of families chose to breastfeed their babies exclusively for 6 months.

Breastfeeding saves money (and lives) while creating a lifelong bond between you and your little one.

What made the biggest impact on your decision to breastfeed?

Addressing breastfeeding myths | womenshealth.gov

Addressing breastfeeding myths | womenshealth.gov

Rethinking Rice Cereal with Babies

Rethinking Rice Cereal







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by Deborah Pike Olsen
November 09, 2013

When it’s time for babies to eat food other than breast milk or formula, many parents reach for baby cereal—particularly rice cereal. For years, pediatricians have recommended that babies’ first food be iron-fortified cereal, particularly rice, which has a low risk for allergic reaction.

Recently, concerns have been raised about the levels of arsenic in rice and rice-based products, including baby cereal. New research on the topic from the U.S. Food and Drug Administration (FDA) has led that agency and others, including the American Academy of Pediatrics (AAP), to take a closer look at rice cereal and offer more recommendations on introducing solids to your baby.

What is arsenic?
Arsenic is a chemical element in the earth’s crust, present all around us, in both organic (naturally occurring) and inorganic forms. Both forms can be found in water, air, soil, and foods. Organic forms are released from volcanoes and through erosion of mineral deposits; inorganic arsenic, the more toxic form, is added to the environment through human activities such as burning coal, oil, gasoline, and wood, mining, and the use of arsenic-containing compounds in pesticides, herbicides, and wood preservatives.

The Environmental Protection Agency (EPA) describes inorganic arsenic as a carcinogenic (cancer-causing) agent. Several studies have linked inorganic arsenic with increased risk of skin cancer, as well as cancer of the prostate, liver, bladder, kidney, nasal passages, and lungs. For children, long-term exposure may cause lower IQ scores; exposure in utero and early childhood may increase mortality risk in young adults. Low level exposure can cause nausea, vomiting, stomach pain, circulatory problems, damage to blood vessels, a “pins and needles” feeling in the hands and feet, and redness and swelling of the skin.

Experts currently don’t know what level of arsenic is dangerous to public health. Since 2011, the FDA has analyzed samples of rice and rice products. As FDA Commissioner Margaret A. Hamburg, MD explains, the agency is “committed to ensuring that we understand the extent to which contaminants such as arsenic are present in our foods, what risks they may pose, whether those risks can be minimized, and to sharing what we know.”

Research
The FDA has monitored arsenic levels in food for nearly two decades, with the latest analysis being its most ambitious and far-reaching effort to date. The report provides data on 1,300 samples of rice products, 200 first reported in 2012 and an additional 1,100 tested in 2013. Products included in the analysis ranged from over-the-counter cookies and rice snacks to infant formula and baby cereal, ready-to-eat and hot cereals, rice “milks,” and more.

The FDA measured levels of inorganic arsenic and total arsenic for each product type. The FDA focused on rice because, unlike other crops, rice readily absorbs arsenic from the environment.



Results
FDA researchers found that arsenic levels varied widely from sample to sample within the same product. For the various products, levels ranged from 0.1 to 7.2 micrograms of inorganic arsenic per serving. However, serving sizes also varied.

In the absence of dietary limits, it is hard to know how to interpret these results, but the full text is available online. Readers can consider the relative risks of such products as rice cakes, rice milks, brown rice, and more. (Note that brand details about samples are not provided.)



Recommendations
The Illinois attorney general’s office conducted similar testing in 2012 in conjunction with Consumer Reports. Based on the “troubling” results, Consumer Reports and Illinois Attorney General Lisa Madigan have called on the FDA to set federal maximum levels for arsenic in food, especially baby food, and to caution the public about eating large amounts of rice and feeding it to small children. In fact, the next step in the FDA’s process will be risk assessment.



In the meantime, parents can take the following steps to minimize the risk of arsenic exposure for themselves and their children:
•Choose a different first food for babies. Former chair of the AAP’s nutrition committee Dr. Frank Greer notes that the group has “been trying to move people away from the use of rice cereal for the first weaning food … because it does not really provide that much nutrition.” Some experts suggest starting with meat, poultry, or tofu, which are iron-rich foods. Currently, the AAP’s position on introducing solids is that there is not sufficient evidence to show that introducing solids in any particular order is beneficial. Instead, the organization suggests babies should be offered a wide variety of nutrient-rich foods, including a variety of grains, within the first year to reduce exposure to arsenic from rice. Other good first-food options include sweet potatoes, squash, carrots, avocado, apples, pears, bananas, and peaches.
•For babies with gastroesophageal reflux (GERD) tendencies, consult a pediatrician. While rice cereal has traditionally been recommended as a thickener for these infants, the FDA notes that “wheat, barley and other grain-based infant cereals also readily absorb liquid and are similarly effective for infants with esophageal reflex tendencies.” Parents should talk with their child’s doctor.
•Avoid rice milk for children younger than age 5. Some of the highest levels of arsenic were found in products marketed as “rice milk.”
•Eat a balanced diet, with a variety of grains. Everyone should consume a varied diet. For nutrition guidance, the ChooseMyPlate website can be a good place to start.
•Limit rice consumption. Consumer Reports provides specific recommendations of servings per week for children and adults, noting, “for infants, children, and pregnant women, risks may be heightened.”

The Maternal Bond — News Room - UNC Health Care

The Maternal Bond — News Room - UNC Health Care

Early skin-to-skin contact linked to higher breastfeeding rates

Early skin-to-skin contact linked to higher breastfeeding rates

Your new baby and visitors

Bringing Baby Home: Four Ways to Manage Visitors

March 19, 2013

Bringing Baby Home: Four Ways to Manage Visitors
Bringing your new baby home for the first time can be one of the most exciting moments in your life! Before you ease into the calm and comfort of your home sweet home, prepare to be greeted by supportive friends and family. At times, it’s lovely to have visitors, but let’s be honest, it can also be exhausting. Blogger Amy Morrison recently shared a post on managing guests after birth. Here are some tips to help you relax and get support needed to ease into motherhood.

1.) Ask For Help
It’s easy to be overwhelmed by all the new responsibilities of being a mom. Don’t hesitate to ask guests for help. They’ll be thrilled to lend a hand and help you and your bundle of joy get comfortable in your new home.

2.) Make the Visit
Every family has one (or five) people who tend to visit for just a bit longer than most might prefer. If you’re not up for a marathon chat, offer to make the trip to see that person yourself (with your little one, of course). This way, you can choose to keep the visit short and sweet, or linger little longer if you’d like.

3.) Spread Out Guests
It’s okay to space out your visitors (and we don’t mean a few hours apart). Feel free to take a few weeks to get the hang of being a mom, and limit the amount of guests you have during this time. You’re a new mom whose life has just taken an exciting turn. Take some time to simply enjoy the giggles, smiles, and incredible little being you have by your side.

4.) Place Your Order
After diaper changes, breastfeeding, cleaning, playing, giggling and cuddling, it’s easy to lose track of your own mealtime. Remember, eating well and staying hydrated is one of the best ways to maintain breastmilk supply. So, say “yes” when visitors offer to bring over food. Moms deserve little treats too!

Read this before visiting a new Mom & Baby

Going to Visit Family or Friends Who Have a New Baby? Follow These Tips!

Posted on September 30, 2013


Baby in Hat

Your friend or family member has a new baby. You want to visit. You want to help. You want to meet that amazing new little person! Before you go, read this primer on how to be a good visitor to a family with a newborn in the house — the kind of visitor who will make the family feel loved, supported, and forever grateful!

Included are guidelines that apply to all visitors, plus tips specifically for close friends and family, long-term visitors, and friends and family who live far away but would like to help nonetheless.

In the United States, we shower attention on families during pregnancy, but not during the postpartum period — when in fact the postpartum period is the time when families need the support of their communities the most! Be a gentle, considerate visitor who puts the family’s needs first. Your thoughtfulness will be remembered and appreciated for years to come!

WHEN AND HOW LONG TO VISIT
◾Always call/message in advance to schedule the visit. Do not drop in unannounced. Be on time.
◾Front-porch meal drop-offs or short (10-15-minute) visits are good in the first several weeks, when families are overtired and commonly not feeling up to hosting company.
◾Longer visits (30+ minutes) are good in the later weeks/months, when long-term helpers (grandparents, etc.) have left; other visitors have stopped coming; and spouses have gone back to work. Mothers often report feeling isolated after 1-2-3 months at home with a newborn (and any other children), and welcome longer visits in the later weeks/months.
◾Very close friends/family may be invited to come for longer or more frequent visits to help in the early weeks, but should always ask the mother what type of visit — short or long — would be most helpful to her.
◾If the mother will be home alone with the baby most of the time (single parent, spouse deployed or working long hours), she may wish for visitors to stay longer. Ask.

PREPARING FOR THE VISIT
◾If you are ill in any way — even the tail end of a cold — stay home. Visit when you are well.
◾Do not wear perfume, scented body lotions, or aftershave. These linger for hours or days after your visit and are often overpowering for baby and mother, who have heightened senses of smell.
◾Leave your pets at home.
◾Leave your children at home. This is especially important in the early weeks, when the family is likely to want quiet, rest, and minimal outside germs. One exception is bringing your children over for a playdate or outing with the family’s older children, outside or away from the family’s house, which you plan to supervise.
◾Bring food. See “Bringing Food” below.
◾Bring small gifts for any siblings in the house, if you can. Gifts that do not make noise are best. Special food treats are a nice, inexpensive option.

DURING THE VISIT
◾Remember that the purpose of the visit is for you to help the family, not for you to spend time with the baby. Now is the time for you – not the family — to prepare food and clean up any messes made during the visit.
◾Do not expect or ask to hold the baby. (Yes, this can be difficult — new babies are so snuggle-able!) Wait for the mother to offer. Many won’t. One big exception is offering to hold the baby after a feeding so the mother can take a shower or a nap.
◾Wash your hands when you arrive, and let the mother know that you have washed them before touching her baby.
◾Greet any siblings enthusiastically. Give a big hello and lots of love to the older children before fussing over the baby — it will make them feel special during a time when the baby is the focus of most adults’ attention.
◾Do a chore. Do it without asking. Or say, “It would make me so happy if I could [do chore XYZ]. Will you indulge me?” (Saying something like this helps ease discomfort the family might feel about having someone clean for them.) Load the dishwasher. Wash the dishes in the sink. Wipe down a counter. Sweep the kitchen floor. Fold that basket of laundry you see sitting there. Take out the trash. Excuse yourself to the restroom and scrub the toilet or wipe down the counters.
◾Or, watch the older siblings, or take them out of the house on an outing.
◾Or, offer to take dogs for a walk, if you’re a dog person. Adjusting to a new baby can be hard for pets, too. They need a little extra love at this time, as well!
◾Give advice only if the parents specifically ask for it. Do not criticize.
◾Follow the mother’s cues about how long a visit she’d like. Remember that it can be very difficult for her to ask you to leave once you are there, even if she truly needs privacy to nurse or pump or perform postpartum self-care.
◾If the family has a premature baby in the NICU, they still need support — lots of it! Tell them “Congratulations!” (they do want their new little one to be acknowledged and celebrated). Ask them how they and the baby are doing, and then really listen. Give them gift cards to restaurants near the NICU; gas cards; or a care package of healthy snacks and drinks that do not need refrigeration (dried nuts/fruit/veggies, trail mix, homemade muffins, snack/granola bars, seltzer water, etc.). If they are staying near the hospital, away from home, offer to pick up mail, water plants, care for siblings or pets, or bring needed things from home to the hospital.

BRINGING FOOD

◾Most families welcome food anytime, but it is often especially welcome at these times: after any other long-term helpers (visiting family, etc.) have left; after the first several weeks when other visitors have stopped bringing food; and when the spouse goes back to work or is away on a business trip.
◾Ask whether the family has set up an online meal-delivery calendar, such as Meal Train or Take Them a Meal. If they have not, organizing one is is a great job for a close friend or family member (see below).
◾Check the family’s Meal Train page (or check with the family) for information about food preferences, sensitivities, and allergies, as well as any other preferences (food delivery times, locations, dates). Respect that information.
◾Bonus points: bring a complete meal (main dish, salad/veggie side, and dessert) and/or meals containing ingredients that promote breastmilk production, such as oatmeal (oatmeal lactation cookies are one option), whole grains, dark leafy greens, beans, vegetables, and nuts/seeds.
◾Avoid bringing foods containing large quantities of those herbs which are known to reduce breastmilk production, such as peppermint and sage.
◾If you do not cook, consider bringing a healthy store-bought ready-to-eat meal (such as rotisserie chicken or a complete dinner from the supermarket) or a collection of healthy snacks that the mother can grab and eat one-handed during the day or while nursing, such as nuts or trail mix (unsalted), dried fruit/veggies, healthy snack bars, precut fruits/vegetables, cheese, hummus, and whole-grain crackers. Trader Joe’s and Costco are great places to buy these things inexpensively.
◾Bring the food in disposable containers or in inexpensive reusable Rubbermaid or thrift store dishes that need not be returned.
◾Consider attaching a note to the meal specifying that the dish does not need to be returned and that no thank-you note is necessary.

IF YOU ARE A CLOSE FRIEND OR CLOSE IN-TOWN FAMILY MEMBER

◾Run an errand. School drop-off, grocery store, Target. For example, call and say, “I am going to the grocery store. What can I get you? I will drop it by on my way home.” Note that it is “What can I get you?” not “Can I get you anything?”
◾Be the one to organize a group of friends/family to deliver meals in the first three weeks (or longer). Use an online organizing service like Meal Train or Take Them A Meal. Be sure to include information about food preferences, sensitivities, and allergies. If the meal-receiving family is not large, have meals delivered every other day so that the backlog of leftovers does not overwhelm the refrigerator before the family can get to them. Spread word of the Meal Train throughout the family’s social circle.
◾Help the family write a Chore/Helper List. This is a list of tasks that other visitors can help with, so that when visitors ask what they can do, the family has immediate answers. Place it in a prominent place, like the refrigerator.
◾Help the family research the baby/parenting information they need, if they would like. With a new baby in the house, it can be hard to find time and energy to research lactation consultants, breastfeeding or postpartum support group meeting information, etc. A list of local maternity and parenting resources can be found here.
◾Lend an ear. Ask the mother how she is feeling, then follow her signals. Do not pry. If she wants to talk about her experiences, she will.
◾Observe the mother for signs that she may be developing postpartum depression (PPD) or anxiety (at least 1 in 5 new moms in the United States do). Know the difference between normal new mom stress and a postpartum mood disorder. Be gentle and compassionate with the mother. Ask her what kind of support would help her feel better. If she wants peer or professional assistance, this page has a list of local and national postpartum support organizations. To better understand what a mother with PPD is experiencing, her friends/family may find it helpful to read Brooke Shields’ memoir, Down Came the Rain: My Journey Through Postpartum Depression.
◾Watch the father for signs of anxiety or depression as well. Postpartum anxiety and depression occur in fathers, too. Like mothers, fathers need sleep, good nutrition, exercise, and alone time to stay well. This page has a great list of resources both for fathers experiencing postpartum depression themselves, and for partners of women experiencing PPD. Additionally, Postpartum Men Online Forum is an online community that these men may find helpful.

IF YOU ARE A FAMILY MEMBER VISITING FOR AN EXTENDED PERIOD
◾Come for an extended visit only if the family has invited you to do so. Never invite yourself.
◾Ask if the family would prefer that you stay in a hotel during your visit. Be gracious if they say yes.
◾Offer nighttime help. Offer to stay up late with baby while they catch a few early-evening hours of sleep. Offer to burp/walk/bounce a fussy baby after a midnight nursing/feeding so that the parents can sleep. Nighttime is often a time when help is scarce but dearly needed.
◾Be their personal assistant. Do whatever they indicate they need. Drive them to appointments or support meetings. Run errands. Grocery shop. Pick up prescriptions. Babysit siblings. Cook. Clean. Do laundry. See “During the Visit” above.
◾Encourage them. Tell them that they are doing a wonderful job. Tell them that you are proud of them. Especially for a nursing mother struggling with breastfeeding, the words, “You are doing a great job,” are magical.
◾If you are a generation older, understand that parenting techniques likely have changed since you last cared for babies. Ask the parents about their parenting philosophies. Follow any specific baby-care instructions they provide. Reading (and following) the same baby-care books that the parents are can be helpful.

IF YOU LIVE FAR AWAY BUT WOULD LIKE TO HELP
◾Pay for the services of someone who can help in person: a postpartum doula, a house cleaner, a diaper service, a grocery delivery service. A list of such local resources is available here.
◾Be part of the family’s virtual support team. Let the mother know that you are a friendly, supportive ear that she can call or Skype at any time, day or night.

IF YOUR SPOUSE OR CHILDREN WANT TO HELP, TOO

As stated above, having a crowd of visitors in the house — or running in and out of the house — can be overwhelming for a family with a new baby. But having a work crew tackle the work literally piling up outdoors? Such a help. If you can bring your own tools (for example, rakes and leaf bags for raking leaves) so you have no need to ask where to find supplies, it’s all the more helpful.
◾Pet care. Walk the dogs. Poop-scoop the yard. Change the litter box or the hamster cage.
◾Yardwork. Mow the lawn. Rake the leaves. Shovel the snow off the driveway and sidewalk. Snow and leaf blowers can be grating on the nerves — avoid them.
◾Garden work. Weed. Pick veggies. Especially good for parents of babies born during harvest season!

FURTHER READING
◾Why Are America’s Postpartum Practices So Rough on New Mothers? (The Daily Beast)
◾A Letter to Grandparents by Penny Simkin
◾After the Birth, What a Family Needs (Gloria Lemay)
◾How To Be the Best Post Partum Visitor in 15 Minutes or Less (There Are No Ordinary Moments)
◾The Answer Is Always “YES!” (Or, How To Help a Struggling New Mom) (Dou-la-la)
◾For Parents: Visitors After the Baby? 10 Tips for New Parents (Huffington Post)
◾For Parents: Is DAD the Ideal Postpartum Doula? (The Birthing Site)
◾For Parents: DONA International’s Postpartum Plan (DONA)

This post has been several years in the making. Sincere gratitude to the many mothers who have contributed, both directly and indirectly, the ideas, suggestions, and wisdom reflected within it!

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Amarillo doc asked to revise drug label info for women | Amarillo Globe-News

Amarillo doc asked to revise drug label info for women | Amarillo Globe-News

Breastfeeding Lowers Odds of Maternal High Blood Pressure --Doctors Lounge

Breastfeeding Lowers Odds of Maternal High Blood Pressure --Doctors Lounge

Insurance companies may cover breast pumps, supplies and consults

Healthcare Insurers Graded on Support for Breastfeeding Moms: Anthem and Aetna Score Highly National Breastfeeding Center has released a scorecard of healthcare insurance companies based on coverage policies for breastfeeding support. Share on TwitterShare on FacebookShare on Google+Share on LinkedInEmail a friend . . Insurers are now tasked with making sure that healthcare dollars are spent more wisely and invested in long-term preventive care. To do less than their best for their littlest members is simply not good enough. New York, NY (PRWEB) September 06, 2013 Anthem and Aetna both score highly out of 100 healthcare insurance companies graded by the National Breastfeeding Center (NBfC). Research was conducted to see how the insurance industry is responding to the Patient Protection and Affordable Health Care Act (PPACA), specifically the part of the law concerning coverage of breastfeeding support, a provision which went into effect on August 1, 2012. “It has been a year since the mandate went into effect," says Susanne Madden, COO, of the National Breastfeeding Center, "so there has been plenty of time for insurers to adjust to the law. We wanted to see how insurance companies are performing when it comes to supporting nursing mothers and their babies." Madden says that the NBfC research uncovered a wide range of insurance company policies and compliance. "We were encouraged to find that some insurers really recognize the importance of improving breastfeeding and support the intent of the mandate by covering fully qualified lactation care providers and effective breastfeeding equipment. But many more provide only the bare minimum required by law, such as a manual hand-operated breastpump and advice given during a well care exam by providers that may have little lactation care experience." "We weren't surprised to see Aetna near the top of the score card," says Beverly Curtis, the Executive Director of NBfC. Aetna was quick to open its network to lactation care providers who have certification as International Board Certified Lactation Consultants (a designation awarded by an independently-accredited program). Curtis points out, "it is important that insurance companies support care delivered by independently certified professionals as these are the providers best qualified to address and improve lactation care." Madden said that the Anthem Group of companies came to the top of the list due to such provisions as covering home visits and allowing pumps to be dispensed from both providers and medical supply companies. "Companies should see our score card as a helpful tool for evaluating their breastfeeding support policies," Curtis says, "and like Aetna and Anthem, aspire to be the best in this critical area of mother and infant healthcare insurance coverage.” NBfC assessed commercial insurance companies’ published policies and guidelines and assigned a grade based on the adequacy of coverage provided. Using The Verden Group’s Policy Search tool to locate official Medical Policies and Google to search insurers’ member and public domains for guidelines and newsletters that contained information about each company’s breastfeeding coverage, “we believe we’ve conducted a comprehensive review of the information available,” says Madden. Why grade insurance companies on their breastfeeding support policies at all? "The purpose of the mandate is to improve breastfeeding initiation and duration rates," Curtis replies. "It follows that mothers should receive lactation counseling support from a provider educated in lactation care.” Madden agrees and says "It's the best way to insure that the care provided is appropriate to each mother’s concern or issue and that each has access to breast pumps that perform appropriately according to her medical or societal needs. Insurers are now tasked with making sure that happens, and that healthcare dollars are spent more wisely and invested in preventive care. To do less than their best for their littlest members is simply not good enough. We want to bring attention to that," Madden concludes, "and prompt insurers to do even better going forward." ****** National Breastfeeding Center (NBfC) The National Breastfeeding Center (NBfC) provides expertise to corporations/employers, hospitals/health systems, healthcare providers and organizations to improve breastfeeding promotion and support. Our unparalleled experience in the business of medicine, blended with our broad insurance experience and deep clinical knowledge, delivers powerful insights and innovative solutions. For more information on the NBfC, visit http://www.NBfCenter.com. Share on TwitterShare on FacebookShare on Google+Share on LinkedInEmail a friend PDF Version PDF Printer Friendly VersionPrint Contact Susanne Madden, COO National Breastfeeding Center +1 855-777-6232 1 Email .Beverly Curtis, Executive Director National Breastfeeding Center 855-777-6232 2 Email . Attachments Insurers Breastfeeding Policy Scorecard Insurers Breastfeeding Policy Scorecard Healthcare Insurers Scorecard for Breastfeeding Support Model Policy Model Policy Guidelines for Insurance Company Coverage of Breastfeeding Support and Counseling Services, Pumps and Supplies .

Infographic: Breastfeeding - It's only natural | womenshealth.gov

Infographic: Breastfeeding - It's only natural | womenshealth.gov

Health Insurance Lactation Assistance

Many Breast-Feeding Moms Unaware Of Health Law Help By Lisa Stiffler and Seattle Times | Kaiser Health News, Published: August 27 . New moms crave information, whether it’s car-seat safety ratings, the pros and cons of pacifiers or how best to sooth a colicky infant. So it’s a little surprising that many moms aren’t up to speed on how the Affordable Care Act could benefit them. The law has specific requirements targeting moms, including coverage for breast pumps and consultants to help breast-feeding mothers. “So many moms don’t know about the benefit,” said Cary Seely, director of provider relations at Pumping Essentials, a California-based company selling supplies and services to assist in breast-feeding. While many of the changes mandated by the Affordable Care Act will benefit low-income Americans by expanding access to health insurance, the Obama administration has tried to build support among a wide swath of the public. Officials routinely tout reforms included in the new law that are designed to help the middle class. Among them are provisions that mandate insurance coverage regardless of pre-existing conditions; allow adult kids to stay on their parents’ insurance plans until they’re 26; require free preventive services such as mammograms, colonoscopies and flu shots — and institute the breast-feeding provisions. But in a recent poll, only 36 percent of Americans surveyed said the law “will make things better” for the middle class. When Whitney Courson, of Seattle, was pregnant earlier this year with her first son, a friend advised her that her insurance might pay for a breast pump, which generally costs $200 to $400 for an electric model. She forgot about the tip, even putting the pump on her baby-gift registry, hoping someone would buy it for her. Then another parent mentioned the benefit at a childbirth class. This time, Courson called a representative at Premera Blue Cross, her insurance provider through her husband’s job at Amazon.com, and learned it would cover the cost of a breast pump. She bought one and had her baby, Nicholas, in July. She loves the ability to pump and store milk so that she can bottle-feed her son when she needs to, or so that someone else can feed him in her absence. “Now I’m telling everybody I know, ‘Call your insurance, this is amazing,’ ” she said. The Affordable Care Act provision supporting breast-feeding went into effect for new health-insurance plans a year ago, but many plans didn’t incorporate the benefit until January 2013, when they were renewed. One hurdle to more widespread use of the provision is the vague language used to describe it, leaving insurance companies to come up with their own interpretations of what it means. Many plans require women to purchase their supplies from an approved medical-device provider, while other others will allow a mom to get reimbursed for a purchase made anywhere. Some will pay only for a handheld, nonelectric device, while others cover more premium pumps. The rule is even more unclear on the lactation-support provision, with no definition of who is qualified to assist a woman trying to breast-feed. When Courson initially found breast-feeding difficult, she again turned to her insurance provider. “I had so many questions and concerns. I wanted to see a lactation consultant so I called insurance just to see.” Courson learned that she had coverage for counseling, and found a provider who would visit her home. Now more than a month after delivering Nicholas, breast-feeding is going well. “Knowing this kind of care is available and covered … that is huge,” she said. Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communications organization not affiliated with Kaiser Permanente. Reprints

Breastfeeding and Low Supply: Common and Surprising Causes and Solutions

Breastfeeding and Low Supply: Common and Surprising Causes and Solutions

Great 4th Trimester Info

The Fourth Trimester – AKA: Why Your Newborn is Only Happy in Your Arms. July 6, 2012 tags: 4th trimester, baby calming, baby colic, baby only happy if being held, baby wants sleep, baby won't sleep, baby won't stop crying, babycalm, babycalming, babywearing, can't put baby down, contented baby, controlled crying, fussy baby, Gina Ford, gripe water, happiest baby, high needs baby, how to calm a crying baby, how to put baby in a routine, how to relieve colic, how to settle baby, how to stop a baby crying, how to treat baby colic, in utero, newborn colic, newborn help, skin to skin, stop baby crying, The Baby Whisperer, the fourth trimester, treatments for colic, womb to world . 67 Votes Quantcast “My baby is only happy in my arms, the minute I put her down she cries” “He sleeps really well but only when he’s laying on my chest, he hates his moses basket” “She cries every time we lay her on her play mat” “He hates going in his pram, he cries the second we put him in it”. How many times have you heard these comments from new parents? How many times have you said them yourself? I’ve lost count of the amount of times I have been asked these questions! What amazes me though is that society in general doesn’t get it, they don’t get why so many babies need to be held by us to settle and what perplexes me even more is that we do spend so long trying to put them down! How to calm a crying baby, treat colic, baby wants sleep, baby won't sleep, baby won't stop crying, baby cries unless in my arms, newborn colic, unhappy baby, fussy baby, gina ford routine, find my local antenatal classes, find local baby classes We spend more than time though, the ‘putting babies down’ industry is worth millions, rocking cribs, battery swings, vibrating chairs, heartbeat teddies and the list goes on………………having been a first time parent who bought all four of the items listed above I am embarrased to admit now it honestly didn’t enter into my head that perhaps the answer was to *not* put my baby down and I certainly didn’t consider why these things might help. It took me a long time to understand and empathise with my baby, to see the world through his eyes so to speak. “Empathy: the intellectual identification with or vicarious experiencing ofthe feelings, thoughts, or attitudes of another.” To empathise with our newborns feelings we need to put ourselves in their place, to imagine experiencing their world – but which world? The world they have spent most of their life in, their ‘womb world’ or the world they are in now – our world. To fully understand we must appreciate the enormous transition they have made – a concept known to many as ‘The Fourth Trimester’ -some make the womb to world transition easily, others less so and it is this latter group in particular “the clingy babies” we can learn so much from through this concept. “Birth suddenly disrupts this organization. During the month following birth, baby tries to regain his sense of organization and fit into life outside the womb. Birth and adaptation to postnatal life bring out the temperament of the baby, so for the first time he must do something to have his needs met. He is forced to act, to “behave.” If hungry, cold, or startled, he cries. He must make an effort to get the things he needs from his caregiving environment. If his needs are simple and he can get what he wants easily, he’s labeled an “easy baby”; if he does not adapt readily, he is labeled “difficult.”” – Dr. William Sears. So lets quickly compare the two different ‘worlds’ your baby has lived in: The fourth trimest, womb to world, life in utero, why babies cry, how to calm a crying baby Pretty different huh? On top of this the big thing to understand is that in utero the baby’s world was constant, each day was the same, the stimulation didn’t change, but now they are born each day is different – ever changing, ever stimulating! the fourth trimester, 4th trimester, womb to world, newborn colic, why is my baby only happy in my arms, babywearing You’ll find a more in-depth discussion on this idea and much more in my BabyCalm Book – available from Amazon in the UK or with worldwide free delivery from The Book Depository if you live elsewhere in the world. how to calm a crying baby, find local antenatal classes, stop baby colic, treat colic, how to get baby to stop crying, how to get baby to sleep, baby classes, babycalming The concept of the fourth trimester helps us to understand the transition a newborn must make over their first few weeks earthside and once we understand we find so many ways we can help – but to me the most important facet of the fourth trimester is parental understanding and empathy, once that exists everything else will flow naturally. Here are some common newborn calming techniques that tend to work quite well, but remember each and every baby is different, if you don’t already know, you will soon learn what your baby likes best and that’s what matters, that it is unique to *your* baby. Prescriptive ‘do this/don’t do this’ baby calming lists don’t help anybody – because they forget they are dealing with individuals – both parents and babies! Some things on this list will be inappropriate for you and your baby, some simply won’t work, some you won’t like – and that’s OK! because really it isn’t about these tips it’s about you and your baby getting to know each other! Movement The womb is a constantly moving space, Braxton Hicks would squeeze your baby at the end of pregnancy and each time you moves your baby was wobbled around inside. Imagine how walking upstairs feels for a baby in utero! Babies tend to love movement but so often we put them down somewhere completely still. You could try dancing, swaying from side to side, going for an exaggerated quick walk or bumpy car ride. Swaddling Imagine how snug your baby was at the very end of your pregnancy inside of you – now imagine how strange it must feel to them after they have been born and have so much space around them! The absolutely best thing you can do is to envelop your baby in your arms, but for times when you don’t want to or indeed can’t then swaddling is an option. Swaddling is becoming increasingly popular, however there are important safety guidelines to be followed if you choose to swaddle your baby, if you are breastfeeding please make sure feeding is established before swaddling and take care not to miss your baby’s hunger cues if you are feeding on demand: Never swaddle over your baby’s head or near his face Never swaddle your baby if he is ill or has a fever Make sure your baby does not overheat and only swaddle with a breathable/thin fabric Only swaddle your baby until he can roll over** Always place your baby to sleep on his back Do not swaddle tightly across your baby’s chest Do not swaddle tightly around your baby’s hips and legs, his legs should be free to “froggy up” into a typical newborn position. Lastly start to swaddle as soon as possible, do not swaddle a 3 month old baby if he has not been swaddled before. ** The American Academy of Paediatrics recommends swaddling for babies 0-14wks. Skin to Skin Contact Such a brilliant baby calmer! Being in contact with your warm, naturally (un)scented, skin is heaven for a baby, it helps to stabilise their body temperature, heart rate and stress hormones and stimulates the release of oxytocin – the love and bonding hormone – in you both. Topless cuddles, shared baths, baby massage and bedsharing are all great skin to skin experiences for your baby and you. Bed-Sharing Sharing a bed with your baby is an amazing way of getting more sleep for everyone, babies are generally much calmer and sleep more easily if they sleep with you in your bed, yet it is such a taboo topic and although 60% of parents will share a bed with their baby at some point it’s a subject that makes society very uncomfortable, but…it is an *amazing* baby calmer! It’s really important that you think about how bedsharing will work and follow some important safety guidelines HERE. babywearing, baby carrier, baby sling, moby wrap, good carrier for a newborn baby, good sling for a newborn baby Babywearing Wearing your baby in a sling is one of the ultimate ways to keep them calm and happy. It increases the time a baby spends in a state of “quiet alertness” – a time of contentment when they learn the most. When a baby is in utero they spend 100% of their time in physical contact with us – yet the moment they are born this is estimated to drop to only 40%! Babywearing also means 2 free hands! Choose your sling carefully. A good sling will be easy to use and will support both yours and your baby’s spine whilst not placing any pressure on your baby’s growing hips – newborns should always be carried facing inwards with a “frog leg” pose, not a crotch dangle pose so commonly used by commercial baby carriers. Also seek to carry in an ‘in arms’ position – i.e: how your baby would be held if you were holding them! This great picture from JePorteMonBebe highlights this newborn hold position perfectly. Babywearing is a great way for dads to bond with babies! It is quite common for a baby to cry once placed in a sling, this does not mean that they hate the sling – it just means that you need to move, so get dancing! As with swaddling,babywearing is becoming increasingly popular, however there are important safety guidelines to be followed, the TICKS acronym below neatly sums them all up: babywearing, safe babywearing, ticks guide for safe babywearing, how to choose a baby sling, how to choose a baby carrier Position The “tiger in the tree” position below, taken from baby yoga, is often magical, stopping a crying baby in an instant! newborn colic hold, baby colic hold, tiger in the tree, tiger in a tree, baby yoga Noise Babies love sound, but for many not the sound you might think. For many babies a hoover is much more calming to a baby than a lullaby. A white noise CD such as the one by BabyCalm HERE can be played on loop whilst your baby sleeps to help keep them calm. Feed If your baby is hungry nothing will calm him, so watch for his hunger cues. Feeding is always better if it is baby led, not led by a routine – whether you are breast or bottle feeding. Remember as well that your baby may not always be hungry for a full feed, they may want a quick drink, a quick snack or just some comfort sucking. Babies also find sucking the ultimate relaxation and comfort tool. Sucking helps a baby’s skull bones to return to their normal position after birth as well as providing them with comfort and security. If you are not breastfeeding you might find your baby will relax when given a dummy/pacifier. Deep Bathing The womb is a wet, warm place. The world as we know it is dry and cold! Sometimes a nice deep, warm bath can stop a baby’s tears in seconds – even better if mummy or daddy goes in the big bath with baby too as skin to skin contact is a wonderful baby calmer. Outside If all else fails many babies stop crying the minute they hit the open air – I’m not sure if this is because we are usually moving (e.g.: walking over cobbles with the buggy/ bouncing in a sling and the drone and movement of a car) or because of the change in air – but it works! attachment parenting book, fourth trimester book, babycalm book, babycalming book, parenting book If you like this article you’ll find many more suggestions and discussions on baby sleep, colic, babywearing, co-sleeping/bed-sharing and much more in my newly released BabyCalm Book – available from Amazon in the UK or with worldwide free delivery from The Book Depository if you live elsewhere in the world! Written by: Sarah (Mum to Four, Parenting Author and Founder of BabyCalm Ltd) You can read more of Sarah’s articles HERE. Share this: Twitter538 Facebook10K+

Tongue Tie's effect on breastfeeding

Tell Me About Tongue Ties! By Norma Ritter, IBCLC, RLC Have you noticed how so many babies these days are being diagnosed with tongue and/or lip ties? What are tongue ties, and do they really affect breastfeeding? Why do they seem to be more prevalent lately? How can they be treated? There is a lot of confusion about tongue ties, also known as ankyloglossia. Here is some information to help you wade through the facts and myths surrounding this topic. What is a tongue tie? The normal development of a fetus includes the growth of little bits of tissue called frenums (also known as frenulums), which attach the tongue to the floor of the lower jaw. We are all born with some of this tissue, but for some babies it is so tight that they cannot move their tongues properly. This can affect their ability to breastfeed, or even take a bottle or a pacifier. Tongue tie can also have other serious health effects. In a similar way, a baby's lips can be attached to his gums, making it difficult to get a good grasp on a nipple. Babies who have lip ties almost always also have tongue ties. Tongues and lips are only considered *tied* if their movement is restricted, impairing mobility. It is important to note that many people have frenums which do not cause any problems at all. Each case needs to be assessed on an individual basis. There are different kinds of tongue tie. They are classified according to where the frenum is attached on the base of the tongue. Class 1 ties are attached on the very tip of the tongue. These are the ones that most people think of when they talk about tongue ties. Class 2 ties are a little further behind the tip of the tongue. Class 3 ties are closer to the base of the tongue. Classes 1, 2, and 3 are also known as anterior ties. Class 4 ties, also known as posterior ties (PTT), may be submucosal, ie. underneath the mucous membrane covering, so they must be felt to be diagnosed. Babies with this kind of tie are often misdiagnosed as having a short tongue. This video shows how to recognise a PTT. Lip ties are classified in a similar way. They range from Class 1 which are tiny, reaching only from the underside of the upper lip to the top of the gum, to Class 4, which have tissue connecting the lip to right under the gum ridge, located between the positions where the top front teeth will emerge. Tongue and lip ties are considered to be midline defects. Midline facial defects tend to run in families. These include cleft lip, submucosal cleft palate, cleft chin, extra or missing teeth, nasal atresia and deviated septum. How and why does it affect breastfeeding? Babies who are tongue-tied may have problems affecting a secure latch to the breast. They can overcompensate by increased suction causing nipple damage and pain. When they can no longer maintain latch through suction, there may be a click and a slight loss of suction or the baby may completely detach from the breast. This may not only cause pain, but also affect the baby’s ability to adequately drain the breast, leading to supply issues. In severe cases, baby is really not able to attach at all. Why do we seem to be seeing more tongue ties now? Babies have always been born with tongue ties. You may have heard stories of midwives who used to keep one fingernail long and sharp to cut class 1 and 2 ties at birth as a matter of routine. When bottle feeding started to become popular, it was considered to be not just a viable alternative to breastfeeding, but actually superior to it, and mothers were encouraged to feed their babies “scientifically.” Tongue tie was one of the reasons given to wean the baby to a bottle, and most of the accumulated knowledge about it was forgotten. When breastfeeding became popular again, the attention to the problem re-emerged. For a long time, only anterior tongue ties were recognized. It was easy to spot the typical heart-shaped tongue of ties which started at the tip of the tongue. Even so, it was very difficult to find a doctor who was willing to snip the tie, so mothers either suffered the pain or, more frequently, switched to bottle feeding. But lately, in the past ten years, things have started to change. There has been a tremendous amount of new information from research studies, especially about posterior ties, and the use of lasers for very delicate surgery has revolutionized the treatment. The newest research is looking into environmental factors, and the possibility of a specific gene mutation being linked to the cause of tongue ties. In a recent informal poll on a Facebook page for healthcare professionals dealing with tongue and lip ties, every one of the International Board Certified Lactation Consultants (IBCLCs) in private practice who responded stated that the vast majority (over 90%) of the babies they saw had tongue and/or lip ties. Another Facebook page, which acts as an online support group for parents whose babies are tongue tied, has over 3,600 participants, with about 100 new people joining every week. What is going on? First, you have to realize that IBCLCs in private practice tend to see the most difficult cases. Since it can hurt to nurse if your baby is tongue tied, many mothers stop breastfeeding in the first few days. Some of those who do seek help are told that breastfeeding is not affected by tongue ties, or that bottle feeding is the solution, or even that there is no such thing as a tongue tie. Those who persevere may eventually get their babies treated, but the tongue may not be released sufficiently, and so the problem persists. Many of these mothers may have seen several health care providers before finding that knowledgeable and supportive Facebook page. In one case, a mother saw ten IBCLCs before she found one who recognized the problem! All these mothers are looking for validation and for personal recommendations to practitioners who both recognize and release ties. There are many myths about lip and tongue ties, but here are some facts. It is possible to have both an anterior (frontal) tie AND and posterior one. Although some (anterior) ties are associated with heart-shaped tongues, tongue tips can look rounded or squared if there is posterior tie Posterior ties are often misdiagnosed as a short tongue. A baby with a tongue tie may be able to stick out his tongue. Tongue and lip ties, like the webs of skin between your thumbs and index fingers, do not suddenly shrink, stretch, or disappear. Tongue and lip ties can affect a baby's ability to breastfeed. Babies who are tongue tied are often not able to drink well from a bottle or take a pacifier. Older tongue-tied babies may have difficulty in swallowing solid food. Their tongues may not be mobile enough to move the food to the back of their mouths. A mother whose baby is tongue tied may start out with plenty of milk, but the lack of adequate stimulation to her breasts can result in a decrease of her milk production. This, of course, can lead to poor weight gain in the baby. Digestion starts in the mouth, and so tongue ties can lead to digestive problems like colic and reflux. Tongue tie can affect speech, causing both delays in speech onset, and also in the ability to form certain sounds and words correctly. Tongue tie can affect the way teeth come in. For example, the front bottom teeth may be pulled inwards. Babies with tongue ties often have narrow palates, so teeth may be overcrowded. When you see a lip tie, there will almost always also be a tongue tie. Babies who have lip ties are not able to open up and properly flange their lips, and this can affect their ability to grasp the breast. Lip ties may push the two front teeth apart, leading to expensive orthodontic work later. In many cases, if the lip tie is not released, the front teeth will grow apart again after the braces have been removed. Tooth decay can be caused by food being pushed into the pockets on either side of a lip tie. It may seem trivial, but tongue-tied babies will eventually become tongue-tied children and adults who cannot lick an ice cream cone or French kiss - not trivial to those affected; it is much easier, safer, and less traumatic to fix a tongue tie in infancy than to wait until later childhood or adulthood. Treating tongue and lip ties If you suspect that your baby has a lip or tongue tie, you will want to get it evaluated. This is where an experienced IBCLC can help. The number of health care providers who are knowledgeable about tongue ties is growing, and your local IBCLC will be able to recommend a practitioner (usually a pediatric dentist or Ear, Nose and Throat Specialist (ENT) who can diagnose and release the tie. Tongue and lip ties can be released either with a scalpel or scissors, or by laser. Lasers do not require anesthesia, and *seal* the revision instantaneously, so there is minimal bleeding and no risk of infection. Here are three videos of older children's tongue ties being released by lasers. Most people are amazed at how quickly it can be done. Warning, these are graphic! Laser Anterior Tongue Tie Revision In Calgary, Alberta Laser Posterior Tongue Tie Revision in Calgary, Alberta Lip tie release This video shows how the healing takes place, day by day: After-care – who does what? You will be able to nurse your baby immediately after the procedure, and many mothers notice a difference in the way their babies nurse right away. However, there is still more work to be done. After a couple of hours your baby's mouth will start to be sore, and doctors usually recommend an over the counter analgesic. Some mothers prefer to use homeopathic preparations. Your baby may be fussy, but he or she will soon calm down. Do not be surprised if your baby refuses to nurse during this time because of the soreness. This is a very temporary nursing strike and usually resolves quickly. During this time, you can hand express or pump your milk to relieve engorgement, and feed it to your baby with a spoon, cup or bottle. As the videos show, an incision is made into the frenum to release the tightness. This incision needs to be kept open while it heals. This is done very quickly, three or four times a day for about 2 weeks, by stretching the tongue and massaging the incision. This video shows how: It is easiest to do the stretching from behind the baby's head. One way is to place him on the floor and sit behind him. With an older baby or a toddler, some mothers find it helps to positioning your knees over their child's shoulders to keep their arms from waving around. A tongue-tied baby who cannot breastfeed properly learns to compensate. After his tongue has been released, he needs to learn how to nurse using a different set of muscles. This is where bodywork, like chiropractic and craniosacral therapy, can help by releasing the muscles needed. This bodywork is very gentle, done mostly with fingertips, and some of it can be done while the mother is holding the baby. When the baby's latch to the breast is good, it should feel comfortable for the mother and enable the baby to breastfeed efficiently. An IBCLC who specializes in latch issues can help your baby get the deepest possible latch. The IBCLC can also teach you some gentle exercises to help your baby strengthen and stretch his newly-released tongue. If your baby has not previously been able to nurse, she can help you in getting him to the breast and in increasing your milk production. You can read more about aftercare here: For more information about tongue and lip ties, see the references below. REFERENCES 1. Coryllos, E. Watson Genna, C. Salloum, A. (2004) Congenital tongue-tie and its impact on breastfeeding American Academy of Pediatrics

Tongue Tie effect on Breastfeeding.

Tell Me About Tongue Ties! By Norma Ritter, IBCLC, RLC Have you noticed how so many babies these days are being diagnosed with tongue and/or lip ties? What are tongue ties, and do they really affect breastfeeding? Why do they seem to be more prevalent lately? How can they be treated? There is a lot of confusion about tongue ties, also known as ankyloglossia. Here is some information to help you wade through the facts and myths surrounding this topic. What is a tongue tie? The normal development of a fetus includes the growth of little bits of tissue called frenums (also known as frenulums), which attach the tongue to the floor of the lower jaw. We are all born with some of this tissue, but for some babies it is so tight that they cannot move their tongues properly. This can affect their ability to breastfeed, or even take a bottle or a pacifier. Tongue tie can also have other serious health effects. In a similar way, a baby's lips can be attached to his gums, making it difficult to get a good grasp on a nipple. Babies who have lip ties almost always also have tongue ties. Tongues and lips are only considered *tied* if their movement is restricted, impairing mobility. It is important to note that many people have frenums which do not cause any problems at all. Each case needs to be assessed on an individual basis. There are different kinds of tongue tie. They are classified according to where the frenum is attached on the base of the tongue. Class 1 ties are attached on the very tip of the tongue. These are the ones that most people think of when they talk about tongue ties. Class 2 ties are a little further behind the tip of the tongue. Class 3 ties are closer to the base of the tongue. Classes 1, 2, and 3 are also known as anterior ties. Class 4 ties, also known as posterior ties (PTT), may be submucosal, ie. underneath the mucous membrane covering, so they must be felt to be diagnosed. Babies with this kind of tie are often misdiagnosed as having a short tongue. This video shows how to recognise a PTT. Lip ties are classified in a similar way. They range from Class 1 which are tiny, reaching only from the underside of the upper lip to the top of the gum, to Class 4, which have tissue connecting the lip to right under the gum ridge, located between the positions where the top front teeth will emerge. Tongue and lip ties are considered to be midline defects. Midline facial defects tend to run in families. These include cleft lip, submucosal cleft palate, cleft chin, extra or missing teeth, nasal atresia and deviated septum. How and why does it affect breastfeeding? Babies who are tongue-tied may have problems affecting a secure latch to the breast. They can overcompensate by increased suction causing nipple damage and pain. When they can no longer maintain latch through suction, there may be a click and a slight loss of suction or the baby may completely detach from the breast. This may not only cause pain, but also affect the baby’s ability to adequately drain the breast, leading to supply issues. In severe cases, baby is really not able to attach at all. Why do we seem to be seeing more tongue ties now? Babies have always been born with tongue ties. You may have heard stories of midwives who used to keep one fingernail long and sharp to cut class 1 and 2 ties at birth as a matter of routine. When bottle feeding started to become popular, it was considered to be not just a viable alternative to breastfeeding, but actually superior to it, and mothers were encouraged to feed their babies “scientifically.” Tongue tie was one of the reasons given to wean the baby to a bottle, and most of the accumulated knowledge about it was forgotten. When breastfeeding became popular again, the attention to the problem re-emerged. For a long time, only anterior tongue ties were recognized. It was easy to spot the typical heart-shaped tongue of ties which started at the tip of the tongue. Even so, it was very difficult to find a doctor who was willing to snip the tie, so mothers either suffered the pain or, more frequently, switched to bottle feeding. But lately, in the past ten years, things have started to change. There has been a tremendous amount of new information from research studies, especially about posterior ties, and the use of lasers for very delicate surgery has revolutionized the treatment. The newest research is looking into environmental factors, and the possibility of a specific gene mutation being linked to the cause of tongue ties. In a recent informal poll on a Facebook page for healthcare professionals dealing with tongue and lip ties, every one of the International Board Certified Lactation Consultants (IBCLCs) in private practice who responded stated that the vast majority (over 90%) of the babies they saw had tongue and/or lip ties. Another Facebook page, which acts as an online support group for parents whose babies are tongue tied, has over 3,600 participants, with about 100 new people joining every week. What is going on? First, you have to realize that IBCLCs in private practice tend to see the most difficult cases. Since it can hurt to nurse if your baby is tongue tied, many mothers stop breastfeeding in the first few days. Some of those who do seek help are told that breastfeeding is not affected by tongue ties, or that bottle feeding is the solution, or even that there is no such thing as a tongue tie. Those who persevere may eventually get their babies treated, but the tongue may not be released sufficiently, and so the problem persists. Many of these mothers may have seen several health care providers before finding that knowledgeable and supportive Facebook page. In one case, a mother saw ten IBCLCs before she found one who recognized the problem! All these mothers are looking for validation and for personal recommendations to practitioners who both recognize and release ties. There are many myths about lip and tongue ties, but here are some facts. It is possible to have both an anterior (frontal) tie AND and posterior one. Although some (anterior) ties are associated with heart-shaped tongues, tongue tips can look rounded or squared if there is posterior tie Posterior ties are often misdiagnosed as a short tongue. A baby with a tongue tie may be able to stick out his tongue. Tongue and lip ties, like the webs of skin between your thumbs and index fingers, do not suddenly shrink, stretch, or disappear. Tongue and lip ties can affect a baby's ability to breastfeed. Babies who are tongue tied are often not able to drink well from a bottle or take a pacifier. Older tongue-tied babies may have difficulty in swallowing solid food. Their tongues may not be mobile enough to move the food to the back of their mouths. A mother whose baby is tongue tied may start out with plenty of milk, but the lack of adequate stimulation to her breasts can result in a decrease of her milk production. This, of course, can lead to poor weight gain in the baby. Digestion starts in the mouth, and so tongue ties can lead to digestive problems like colic and reflux. Tongue tie can affect speech, causing both delays in speech onset, and also in the ability to form certain sounds and words correctly. Tongue tie can affect the way teeth come in. For example, the front bottom teeth may be pulled inwards. Babies with tongue ties often have narrow palates, so teeth may be overcrowded. When you see a lip tie, there will almost always also be a tongue tie. Babies who have lip ties are not able to open up and properly flange their lips, and this can affect their ability to grasp the breast. Lip ties may push the two front teeth apart, leading to expensive orthodontic work later. In many cases, if the lip tie is not released, the front teeth will grow apart again after the braces have been removed. Tooth decay can be caused by food being pushed into the pockets on either side of a lip tie. It may seem trivial, but tongue-tied babies will eventually become tongue-tied children and adults who cannot lick an ice cream cone or French kiss - not trivial to those affected; it is much easier, safer, and less traumatic to fix a tongue tie in infancy than to wait until later childhood or adulthood. Treating tongue and lip ties If you suspect that your baby has a lip or tongue tie, you will want to get it evaluated. This is where an experienced IBCLC can help. The number of health care providers who are knowledgeable about tongue ties is growing, and your local IBCLC will be able to recommend a practitioner (usually a pediatric dentist or Ear, Nose and Throat Specialist (ENT) who can diagnose and release the tie. Tongue and lip ties can be released either with a scalpel or scissors, or by laser. Lasers do not require anesthesia, and *seal* the revision instantaneously, so there is minimal bleeding and no risk of infection. Here are three videos of older children's tongue ties being released by lasers. Most people are amazed at how quickly it can be done. Warning, these are graphic! Laser Anterior Tongue Tie Revision In Calgary, Alberta Laser Posterior Tongue Tie Revision in Calgary, Alberta Lip tie release This video shows how the healing takes place, day by day: After-care – who does what? You will be able to nurse your baby immediately after the procedure, and many mothers notice a difference in the way their babies nurse right away. However, there is still more work to be done. After a couple of hours your baby's mouth will start to be sore, and doctors usually recommend an over the counter analgesic. Some mothers prefer to use homeopathic preparations. Your baby may be fussy, but he or she will soon calm down. Do not be surprised if your baby refuses to nurse during this time because of the soreness. This is a very temporary nursing strike and usually resolves quickly. During this time, you can hand express or pump your milk to relieve engorgement, and feed it to your baby with a spoon, cup or bottle. As the videos show, an incision is made into the frenum to release the tightness. This incision needs to be kept open while it heals. This is done very quickly, three or four times a day for about 2 weeks, by stretching the tongue and massaging the incision. This video shows how: It is easiest to do the stretching from behind the baby's head. One way is to place him on the floor and sit behind him. With an older baby or a toddler, some mothers find it helps to positioning your knees over their child's shoulders to keep their arms from waving around. A tongue-tied baby who cannot breastfeed properly learns to compensate. After his tongue has been released, he needs to learn how to nurse using a different set of muscles. This is where bodywork, like chiropractic and craniosacral therapy, can help by releasing the muscles needed. This bodywork is very gentle, done mostly with fingertips, and some of it can be done while the mother is holding the baby. When the baby's latch to the breast is good, it should feel comfortable for the mother and enable the baby to breastfeed efficiently. An IBCLC who specializes in latch issues can help your baby get the deepest possible latch. The IBCLC can also teach you some gentle exercises to help your baby strengthen and stretch his newly-released tongue. If your baby has not previously been able to nurse, she can help you in getting him to the breast and in increasing your milk production. You can read more about aftercare here: For more information about tongue and lip ties, see the references below. REFERENCES 1. Coryllos, E. Watson Genna, C. Salloum, A. (2004) Congenital tongue-tie and its impact on breastfeeding American Academy of Pediatrics

Pacifiers? Good or Bad?

Don’t Cry as Pacifiers Go Bye-Bye August 15, 2013 By Cindy Hutter Mixing Pacifiers and Breastfeeding Just because a mother is breastfeeding doesn’t mean her baby can never use a pacifier. The American Academy of Pediatrics recommends that breastfeeding babies only be given pacifiers after breastfeeding is established, typically after one month. In hospitals around the country the break-ups are happening. Pacifiers and babies are no longer being seen together. These once ubiquitous partners are now going their separate ways as hospitals are tossing pacifiers and other artificial teats following evidence that they can interfere with breastfeeding. Since beginning work to create an environment that supports breastfeeding—including removing artificial teats—Providence Hospital in Washington, DC, has seen its exclusive breastfeeding rates climb from 4 percent in July 2012 to 55 percent in April 2013. Texas Health Huguley Hospital in Forth Worth similarly has seen its exclusive breastfeeding rate rise from 33 percent in January 2013 to 49 percent in June. Break-ups are never easy. Hospitals purging the pacifiers say that educating staff and mothers as well as slowly ramping up removal efforts were vital to the successful systems change. “Once our team was educated about the drawbacks of pacifier use we shared it with physicians and got their buy-in. Then we started talking to the nurses and they saw that the pacifiers weren’t needed. This buy-in is what has made the removal so successful for us,” says Sharon McMillian, RN, director of the Maternal and Infant Health Unit at Providence Hospital. McMillian is part of a team at Providence that is participating in Best Fed Beginnings, a national quality improvement project that aims to help hospitals improve maternity care and increase the number of “Baby-Friendly” hospitals in the United States. The Baby-Friendly designation is granted to facilities that adhere to the evidence-based Ten Steps to Successful BreastfeedingExternal Link. One of the steps calls for giving no pacifiers or artificial nipples to breastfeeding infants because they interfere with the development of optimal breastfeeding habits. Lori Feldman-Winter, MD, MPH, faculty chair of the Best Fed Beginnings project, explains that sucking on a pacifier often leads to unrecognized hunger cues that would otherwise result in more breastfeeding. Also, the way a baby positions its mouth and tongue when sucking an artificial nipple is different than when at the breast. Going back and forth between the breast and artificial nipples is associated with breastfeeding problems such as poor suckling technique and damage to the mother’s nipple. A poster used at Texas Health Huguley Hospital to support their change efforts. A poster used at Texas Health Huguley Hospital to support their change efforts. Sharing this education with mothers has made all the difference. Providence Hospital’s Bilingual Parent Educator, Soledad Sheppley, RN, describes the education that mothers receive on pacifier use both prenatally and as inpatients as pretty extensive. And so far, it’s helped to reduce the number of mothers asking for pacifiers. Ragan Steelman, RN, IBCLC, a member of a team at Texas Health Huguley Hospital participating in the Texas Ten Step Star Achiever Breastfeeding Learning Collaborative, says when mothers at Huguley ask for pacifiers, staff first provide evidence-based education about the risks of pacifier use, including how it masks infants’ signs of hunger, reduces the number of feedings at the breast, interferes with effective feeding, delays milk production, reduces the volume of milk, and may contribute to painful latches. When it came time to make the shift at Texas Health Huguley, the team started with a few small tests to gain confidence and momentum for the change. “Staff support helps a lot in making a large-scale change like this,” says Steelman. “We start small by getting a few team members to be advocates and by finding supportive leaders to help push along those who weren’t quite as receptive.” Providence did the same. The team started with a test group and a small sample. It monitored the results for a few days, made adjustments and then expanded the test group. Providence Hospital’s Nurse Educator Lisa Cleveland, RN, says it didn’t take long for word of mouth about the change to start happening, so when the unit was ready to officially adopt the practice of no pacifiers, the job was easier. “Peers were communicating to each other about what they are doing and the excitement around the effort,” reflects Cleveland. “Using the small tests of change process has made our job more effective.” When the change was ready to be scaled up across the unit at Huguley, Steelman and her team made a pacifier discard bucket right near the circumcision table, one of two places a pacifier is allowed because it is used for pain management. The second place is in a unit for infants requiring higher levels of care. The team also put up “no pacifier zone” signs that reminded staff if they have one to throw it away. “Know that what you’re doing is improving the well-being of moms and babies. Be persistent and consistent,” recommends Steelman. To test the success of removing artificial teats at Providence, McMillian occasionally goes to the postpartum unit or the nursery and asks for pacifiers, even insisting there is a secret stash. Her efforts are quickly rebuffed, as staff reminds her there are no pacifiers anymore. “I was pleasantly surprised by how easy it was to remove the pacifiers once staff were educated and we took the time to scale up the change,” says McMillian. For more stories, sign up for NICHQ's monthly e-newsletter and follow NICHQ on Facebook and Twitter.

Should nursing Moms avoid certain foods?

Should breast-feeding moms avoid certain foods? Here are some tips to put nursing moms and their babies on the right track. By Chanie Kirschner Fri, Aug 02 2013 at 2:15 PM Related Topics: Healthy Eating, Raising Healthy Kids breast-feeding foods Photo: Oksana Kuzmina/Shutterstock Breast-feeding is a wonderful gift you can give your baby. And while you should always maintain a balanced diet, what you eat while you’re a nursing mom is especially important since the foods you eat are nourishing your baby as well. So what should you avoid while breast-feeding? “There are no foods that mothers ought to avoid while breast-feeding,” says Dr. Nancy Brent, noted pediatrician, lactation consultant and medical director at the Breastfeeding Center of Pittsburgh. “In fact, most mothers can eat anything they want while breast-feeding. However, if your baby is fussy and you’re noticing other unusual gastrointestinal symptoms, such as bloody or mucus-y stools, try cutting out dairy and then soy.” If you eat something and notice that two feedings later (about the time for that food to enter your breast milk) your baby is especially fussy, you might try cutting out that food and seeing how your baby responds. “Then, after two weeks, gradually add that food back into your diet and see if your baby tolerates it,” Brent advises. She’s quick to add, though, that without any gastrointestinal symptoms, infant fussiness is likely not the result of maternal diet, and can be a sign of overtiredness, colic or acid reflux. Though foods mentioned above may or may not have an effect on your breast milk, there are certain things you should avoid while you’re breast-feeding to ensure your baby’s health. First item on the list? Alcohol. The American Academy of Pediatrics says that an occasional drink for a breast-feeding mom is OK, and Brent agrees. “Generally, a woman can have one drink of beer or wine two to three times a week. She should time it immediately after a feeding. If she's feeling the effects, then the alcohol is in her milk. If she's still feeling a little drunk when it's time to nurse next, she needs to give a bottle of previously expressed milk or formula.” You can “pump and dump” the milk to avoid engorgement and clogged milk ducts. Either way, too much alcohol can harm your baby, and it’s important to monitor your intake. Another thing to avoid while you’re breast-feeding is caffeine. While a morning cup of coffee is OK, experts say to limit your daily intake to no more than 300 mg a day. That’s generally one cup of fresh-brewed coffee, though actual amounts of caffeine may vary a little. If you’re like me and you just like the taste, feel free to go crazy on instant decaf — there’s only 2 mg of caffeine in a cup. Be watchful of other things that contain caffeine, such as chocolate or caffeinated tea. (If you’re unsure how much caffeine that certain food items have, check out this chart.) Finally, trim your seafood intake while you’re breast-feeding, especially if white tuna, swordfish or mackerel is your thing. That’s because these types of seafood are known to contain high levels of mercury, which could potentially harm your baby’s nervous system in high doses. If you do like seafood, choose fish that are typically low in mercury, such as wild-caught Alaskan salmon. Salmon is also high in omega-3s and protein, two essential nutrients for breast-feeding moms. You don’t need to go crazy to avoid specific foods while you’re breast-feeding. Just be smart about your intake and feel confident knowing you’re doing the best you can for you and your baby. Happy nursing! Related breast-feeding stories on MNN: •What not to eat when you're pregnant •More U.S. mothers breast-feeding, CDC says •Breast-feeding mama gets happy surprise at restaurant

How to be the Best Post-Partum Visitor in 15 Minutes or Less

Resources How To Be The Best Post Partum Visitor In 15 Minutes Or Less How To Be The Best Post Partum Visitor In 15 Minutes Or Less Have a friend who had a baby and you're on the roster to drop off a meal? Here's everything they want you to know and do, but are too shy and polite to say and ask. They are tired. Breastfeeding is still awkward and having people around makes it more awkward. The mother is recovering physically, either from a surgical birth, or from the equivalent of a triathlon where the prize was a grapefuit sized head flying out of her vagina. Either of these things makes you sore and tired. They would like to see you, but don't want to be tired out by a long visit. You are not going to stay longer than 15 minutes, no matter how polite the parents are in saying you can stay longer. If your visit/meal drop off scheduled for 5.30. BE ON TIME. Make plans for 6:15 so that you HAVE to leave. Read More Before you walk in the door, put your game face on. Set a timer, on your phone or watch for 15 minutes. When it goes off, get out of there! Remember that you are going to be a quiet, productive blessing. This visit is NOT about you. It is not about the parents hosting you and putting on a cup of tea so you can sit and visit and hold the baby. Think about how you would feel if you had either had surgery or ran a triathlon. What would you want people to do for you? This visit is about blessing the parents and making their life a little bit easier. Your prize is getting a quick peek at the cute new human. Here's how to play out your 15 minute visit: 1. Bring a healthy meal. Include a salad or fresh vegetables. Only use disposable dishes. There is nothing more annoying than a) having to wash more dishes when you have a new baby and b) having to try to return dishes to all sorts of random people when you have a new baby 2. In addition to your meal, bring cut up veggies and fruit, unsalted trail mix or nuts, or other such healthy snacks for daytime munching for mom to eat while she's nursing. 3. Go into the kitchen and spend 5 minutes clearing off a counter, washing a sink-full of dishes, loading the dishwasher etc. Don't ask permission, just do it. Then set the table for their dinner. 4. Before you leave your house, put some paper towels and some powdered bathroom cleaner like Commet or Ajax in a baggie. Stick it in your purse. While you are at the house, go and use the washroom...and while in there do a three minute bathroom shine-up, using your paper towels and cleaner. 5. Coo over the baby, but wash your hands before touching it. 6. If they want to eat right then, heat the food up and put it on the table, give everybody kisses and then leave. 7. Take the garbage out when you go. In and out. This will be the best visit the parents will have had. They will love you and you will be awesome in their books forever. You can come back and have a longer visit when the parents have adjusted to their new normal.