American Airlines Attendant Defends Babywearing

By Victoria Wilson
originally shared on Facebook


On my American Airlines LEX -- CTL flight earlier this week an amazing attendant went to bat for us. I wish I could remember her name, and write in the hopes that she will see this. She said to her colleague who asked me to remove Harper from our wrap before take off, "Look at this baby. She is happy and perfect in her mother's arms. Think about this logically. It is much safer for the baby in this snug wrap. If anyone has a problem they can talk to me."

My flight home is unfortunately not as accommodating. Another mother was asked to remove her baby from her carrier. I am nursing and decided not to put Harper back into ours. Sharing publicly and tagging the airline as a way to raise awareness and ask for this policy to change.

Editors' note: Babies under age 2 riding "in arms" on airplane flights are far safer wrapped securely to mom or dad, or fastened into a quality carrier on a parent's chest. The seatbelt should be placed below baby, snug across a parent's lap. Airline policies that call for parents to remove a baby from a wrap or carrier are misguided and/or misinformed as to babywearing safety -- and comfort/security/happiness for baby as well. Let's encourage airlines to review and update their policy with current data and information available.

American Airlines current policy on traveling with babies states that an "infant may be held by an adult in their lap" but that "any device that positions a child on the lap or chest of an adult" is not approved for use. Read the full policy here: https://www.aa.com/i18n/travel-info/special-assistance/traveling-children.jsp


#BabywearingFlightSafety #TakeOffWrappedUp

Breastfeeding and Alcohol

By Jack Newman, MD, FRCPC, IBCLC
Originally shared in part on Facebook (2014) and (2013)
Learn more from Dr. Jack Newman: https://www.BreastfeedingInc.ca



Around the holidays, and with events such as weddings and family gatherings, many parents write to ask about breastfeeding and alcoholic drinks. To begin, in short: you do not need to "pump and dump" (a terrible expression) afterward having a drink, and you do not need to wait a certain amount of time after your drink to restart breastfeeding. The amount of alcohol that gets into the milk is minuscule and will not hurt baby.

Think of it this way, in most jurisdictions, you are too impaired to drive if you have 0.05% alcohol in your blood. Alcohol appears in the milk in the same concentration as in the blood. Thus if you have 0.05% alcohol in your blood you will have 0.05% alcohol in your milk, and as it decreases in your blood, it will decrease in your milk. Even de-alcoholized beer sold in my local store has 0.6% alcohol -- more than 10x more than the breastmilk will contain if it contains 0.05% alcohol.

I am not saying it is fine to get falling-down drunk because if you are breastfeeding, you must be sober and capable of caring for your baby safely. However, the problem is your coordination and ability to parent your child -- not the amount of alcohol in your milk.

The following is from a scientist who tested her own milk for alcohol and shared these results with me. She did not test with one of those useless kits that you can buy at various stores (they are designed solely to profit off breastfeeding mothers), but instead she tested at a toxicology laboratory. I will copy from her post the methods she used and the results. I think this puts to rest the notion that women should not drink while breastfeeding, or that they need to "pump and dump" (an appalling term) after having even one drink.

****
Method 

First, I took a sample of my milk (about 1 mL) prior to drinking any alcoholic beverage. I expressed the milk mid-nursing session. After completing the nursing session, I mixed myself an alcoholic beverage consisting of 2 oz of 80 proof (40%) vodka in 10 oz of soda (Sprite). I proceeded to drink the entire 12 oz in about 30 minutes. About 30 minutes after finishing (1 hour after beginning to drink), I expressed some milk (about 1 mL) and labeled it 'immediate'. I then waited 1 hour and expressed more milk (about 1 mL) and labeled it '2 hours'. In the 2 hours (from the beginning), I did not drink any more alcoholic beverages, drink other beverages, or eat any other foods.

Another day, 1/2 of a beer (4.3% alcohol) and 2-6 oz glasses of wine were consumed within 1.5 hours. About an hour from the beginning of the last drink, a milk sample (about 1 mL) was taken. This sample was labeled '1 hour - 3 drinks.' Another sample was taken about an hour after that (2 hours after the beginning of the last drink). This sample was labeled '2 hours - 3 drinks.' The samples were stored in the refrigerator until processing.

An Agilent headspace instrument was used to run the tests. Propanol and ethanol standards were also tested to ensure the instrument was within limits. The instrument is maintained by the KSP Lab Toxicology Section and used in forensic determinations of blood and urine alcohol content.

Results

The sample labeled as 'immediate' registered as 0.1370 mg/mL which correlates to 0.01370% alcohol in the sample. The sample labeled '2 hours' registered as 0.0000 mg/ml which correlates to 0.0000%. The sample labeled '1 hour - 3 drinks' registered as 0.3749 mg/mL which correlates to 0.03749% alcohol in the sample. The sample labeled '2 hours - 3 drinks' registered as 0.0629 mg/mL which correlates to 0.00629% alcohol in the sample.

Conclusion

The alcohol content in breastmilk immediately after drinking is equivalent to a 0.0274 proof beverage. That's like mixing 1 oz of 80 proof vodka (one shot) with 2,919 oz of mixer. By the way, 2,919 oz is over 70 liters. Two hours after drinking one (strong) drink the alcohol has disappeared from the sample entirely. Drinking about 3 drinks in 1.5 hours resulted in higher numbers, but still negligible amounts of alcohol would be transferred to a nursing baby. One hour after imbibing in 3 drinks, the milk was the equivalent of 0.07498 proof beverage. That would be like adding 1 oz of 80 proof vodka (one shot) to 1,066 oz of mixer (1,066 oz is over 26 liters). Two hours after imbibing in 3 drinks, the milk was 0.01258 proof. That would be like adding 1 oz of 80 proof vodka to 3,179 oz of mixer (over almost 80 liters). So, even though an infant has much less body weight, any of these percentages of alcohol in breastmilk is highly unlikely to adversely affect a baby in any way.

****

A good deal of the confusion that exists, or the roots of confusion over breastfeeding and alcohol consumption, stem from the fact that alcohol consumption during pregnancy is not safe for a growing baby inside, being fed directly from the placenta. "People tend to treat the two scenarios in the same way, but the mechanisms of exposure to alcohol are entirely different," says Kirsten Goa, chair of La Leche League Canada. "In utero, you’re sharing your bloodstream with your baby; if you’re drunk, your baby is even more drunk because they’re so small and their liver is still developing. But your breastmilk only contains the same amount of alcohol as your bloodstream." Drink responsibly, and within reason (i.e. do not become too intoxicated to care for your baby) and all well be well.

Photo courtesy of Michelle in Rhode Island

The timing of drinking doesn’t matter, either. So, don’t be tempted to “pump and dump,” which is a waste of perfectly good milk. Breastfeeding is a relationship between a child and mother, and if that child is old enough to be upset at not being fed, you’re doing far more harm to your baby than if you were to breastfeed after (or during) a couple of drinks. If we forbid having a drink while breastfeeding, mothers become discouraged to breastfeed at all -- doing far more damage to a developing child, than the non-risk that exists in having drink and breastfeeding too. Because the World Health Organization, and virtually every pediatric organization the world over recommends a minimum 24 months of human milk for human babies, tacking two years onto the 9-10 months of pregnancy (when consuming alcohol is not safe), is extreme and not scientifically justified.

In the case of premature babies who are in the NICU, and receiving expressed milk, or nursing directly from mom with hospitalized care, Goa advises LLL moms to avoid alcohol until baby is home merely because these premature babies are more sensitive than a baby born at full term. However, if the option is (1) human milk from a mother who has had a drink vs. (2) formula, human milk is always the better option for baby's health and development.

Goa notes that this is "all about parental function." "If we are going to be honest with mothers, even if they go on a bender and have someone to safely look after their baby, by the time she sobers enough to safely care for her baby, she is okay to breastfeed." Prohibiting alcohol while breastfeeding is not scientifically sound, and is just another way we make life restrictive for breastfeeding mothers.


• Learn to recognize more Breastfeeding Mythshttp://www.drmomma.org/2014/08/breastfeeding-myths.html

• Your Baby's Signs of Hunger: http://www.drmomma.org/2013/01/your-babys-signs-of-hunger.html

• Making More Milk: Breastfeeding, Supply, and the Feedback Inhibitor of Lactation: http://www.drmomma.org/2014/08/making-more-milk-breastfeeding-supply.html

• The Breastfeeding Group: FB.com/groups/Breastfed


Dr. Jack Newman graduated from the University of Toronto medical school in 1970, interning at the Vancouver General Hospital. He did his training in pediatrics in Quebec City and then at the Hospital for Sick Children in Toronto from 1977-1981 to become a Fellow of the Royal College of Physicians of Canada in 1981 as well as Board Certified by the AAP in 1981. He has worked as a physician in Central America, New Zealand and as a pediatrician in South Africa (in the Transkei). He founded the first hospital based breastfeeding clinic in Canada in 1984. He has been a consultant for UNICEF for the Baby Friendly Hospital Initiative, evaluating the first candidate hospitals in Gabon, the Ivory Coast and Canada.

Dr. Newman was a staff pediatrician at the Hospital for Sick Children emergency department from 1983 to 1992, and was, for a period of time, the acting chief of the emergency services. However, once the breastfeeding clinic started functioning, it took more and more of his time and he eventually worked full time helping mothers and babies succeed with breastfeeding. He now works at the Newman Breastfeeding Clinic and Institute based at the Canadian College of Naturopathic Medicine in Toronto. 

Dr. Newman has several publications on breastfeeding, and in 2000 published, along with Teresa Pitman, a help guide for professionals and mothers on breastfeeding, called, Dr. Jack Newman's Guide to Breastfeeding, (revised editions: 2003, 2005, 2009, 2015), and The Ultimate Breastfeeding Book of Answers, (revised edition: 2006). The book has been translated into French, Indonesian, Japanese, Spanish and Italian. In 2006, Dr. Newman, along with Teresa Pitman, published The Latch and Other Keys to Breastfeeding Success (Hale Publishing) and was translated into French. He has also, along with Edith Kernerman, developed a DVD as a teaching tool for health professionals and mothers. It is available in English and French. As well, it is subtitled in Spanish, Portuguese and Italian.




Breastfeeding Myths

By Jack Newman, MD, FRCPC, IBCLC
Revised by Edith Kernerman, IBCLC
Photographs by Peaceful Parenting readers. Have a myth-debunking photo to share? Email with your name to DrMomma.org@gmail.com
Read more from Dr. Newman at Breastfeeding Inc. and the International Breastfeeding Centre site, as well as in his published texts.


There are so very many 'booby traps' for nursing mothers today. Myths and misconception are rampant across many of our sub-cultures, and misunderstanding when it comes to lactation and mother/baby-nutrition is so ubiquitous that even medical professionals commonly dish out poor advice to new moms. Here, Dr. Newman responds to many of the myths alive and present in our world today - those that commonly hinder a mother's breastfeeding relationship with her baby.

1. Many women do not produce enough milk. Not true! The vast majority of women produce more than enough milk. Indeed, an overabundance of milk is common. Most babies that gain too slowly, or lose weight, do so not because the mother does not have enough milk, but because the baby does not get the milk that the mother has. The usual reason that the baby does not get the milk that is available is that he is poorly latched onto the breast. This is why it is so important that the mother be shown, on the first day, how to latch a baby on properly, by someone who knows what they are doing.

2. It is normal for breastfeeding to hurt. Not true! Though some tenderness during the first few days is relatively common, this should be a temporary situation that lasts only a few days and should never be so bad that the mother dreads breastfeeding. Any pain that is more than mild is abnormal and is almost always due to the baby latching on poorly. Any nipple pain that is not getting better by day three or four or lasts beyond five or six days should not be ignored. A new onset of pain when things have been going well for a while may be due to a yeast infection of the nipples. Limiting feeding time does not prevent soreness. Taking the baby off the breast for the nipples to heal should be a last resort only. (See Information Sheet Sore Nipples).


3. There is no (not enough) milk during the first three or four days after birth. Not true! It often seems like that because the baby is not latched on properly and therefore is unable to get the milk that is available. When there is not a lot of milk (as there is not, normally, in the first few days), the baby must be well latched on in order to get the milk. This accounts for "but he's been on the breast for 2 hours and is still hungry when I take him off". By not latching on well, the baby is unable to get the mother's first milk, called colostrum. Anyone who suggests you pump your milk to know how much colostrum there is, does not understand breastfeeding, and should be politely ignored. Once the mother's milk is abundant, a baby can latch on poorly and still may get plenty of milk, though good latching from the beginning, even in if the milk is abundant, prevents problems later on.

4. A baby should be on the breast 20 (10, 15, 7.6) minutes on each side. Not true! However, a distinction needs to be made between "being on the breast" and "breastfeeding". If a baby is actually drinking for most of 15-20 minutes on the first side, he may not want to take the second side at all. If he drinks only a minute on the first side, and then nibbles or sleeps, and does the same on the other, no amount of time will be enough. The baby will breastfeed better and longer if he is latched on properly. He can also be helped to breastfeed better and longer if the mother compresses the breast to keep the flow of milk going, once he no longer drinks on his own (Information Sheet Breast Compression). Thus it is obvious that the rule of thumb that "the baby gets 90% of the milk in the breast in the first 10 minutes" is equally hopelessly wrong. To see how to know a baby is getting milk see the videos at nbci.ca.


5. A breastfeeding baby needs extra water in hot weather. Not true! Breastmilk contains all the water a baby needs.

6. Breastfeeding babies need extra vitamin D. Not true! Everyone needs vitamin D. Formula has it added at the factory. But the baby is born with a liver full of vitamin D, and breastmilk does have some vitamin D. Outside exposure allows the baby to get the rest of his vitamin D requirements from ultraviolet light even in winter. The baby does not need a lot of outside exposure and does not need outside exposure every day. Vitamin D is a fat soluble vitamin and is stored in the body. In some circumstances (for example, if the mother herself was vitamin D deficient during the pregnancy) it may be prudent to supplement the baby with vitamin D. Exposing the baby to sunlight through a closed window does not work to get the baby more vitamin D.

7. A mother should wash her nipples each time before feeding the baby. Not true! Formula feeding requires careful attention to cleanliness because formula not only does not protect the baby against infection, but also is actually a good breeding ground for bacteria and can also be easily contaminated. On the other hand, breastmilk protects the baby against infection. Washing nipples before each feeding makes breastfeeding unnecessarily complicated and washes away protective oils from the nipple.

8. Pumping is a good way of knowing how much milk the mother has. Not true! How much milk can be pumped depends on many factors, including the mother's stress level. The baby who breastfeeds well can get much more milk than his mother can pump. Pumping only tells you have much you can pump.

9. Breastmilk does not contain enough iron for the baby's needs. Not true! Breastmilk contains just enough iron for the baby's needs. If the baby is full term he will get enough iron from breastmilk to last him at least the first six months. Formulas contain too much iron, but this quantity may be necessary to ensure the baby absorbs enough to prevent iron deficiency. The iron in formula is poorly absorbed, and the baby poops out most of it. Generally, there is no need to add other foods to breastmilk before about 6 months of age.

10. It is easier to bottle feed than to breastfeed. Not true! Or, this should not be true. However, breastfeeding is made difficult because women often do not receive the help they should to get started properly. A poor start can indeed make breastfeeding difficult. But a poor start can also be overcome. Breastfeeding is often more difficult at first, due to a poor start, but usually becomes easier later.


11. Breastfeeding ties the mother down. Not true! But it depends how you look at it. A baby can be breastfed anywhere, anytime, and thus breastfeeding is liberating for the mother. No need to drag around bottles or formula. No need to worry about where to warm up the milk. No need to worry about sterility. No need to worry about how your baby is, because he is with you.

12. There is no way to know how much breastmilk the baby is getting. Not true! There is no easy way to measure how much the baby is getting, but this does not mean that you cannot know if the baby is getting enough. The best way to know is that the baby actually drinks at the breast for several minutes at each feeding (open mouth wide—pause—close mouth type of suck). Other ways also help show that the baby is getting plenty (Information Sheet Is my Baby Getting Enough Milk?). Also see the videos at nbci.ca.

13. Modern formulas are almost the same as breastmilk. Not true! The same claim was made in 1900 and before. Modern formulas are only superficially similar to breastmilk. Every correction of a deficiency in formulas is advertised as an advance. Fundamentally, formulas are inexact copies based on outdated and incomplete knowledge of what breastmilk is. Formulas contain no antibodies, no living cells, no enzymes, no hormones. They contain much more aluminum, manganese, cadmium, lead and iron than breastmilk. They contain significantly more protein than breastmilk. The proteins and fats are fundamentally different from those in breastmilk. Formulas do not vary from the beginning of the feed to the end of the feed, or from day 1 to day 7 to day 30, or from woman to woman, or from baby to baby. Your breastmilk is made as required to suit your baby. Formulas are made to suit every baby, and thus no baby. Formulas succeed only at making babies grow well, usually, but there is more to breastfeeding than nutrients.

14. If the mother has an infection she should stop breastfeeding. Not true! With very, very few exceptions, the mother’s continuing to breastfeed will actually protect the baby. By the time the mother has fever (or cough, vomiting, diarrhea, rash, etc) she has already given the baby the infection, since she has been infectious for several days before she even knew she was sick. The baby's best protection against getting the infection is for the mother to continue breastfeeding. If the baby does get sick, he will be less sick if the mother continues breastfeeding. Besides, maybe it was the baby who gave the infection to the mother, but the baby did not show signs of illness because he was breastfeeding. Also, breast infections, including breast abscess, though painful, are not reasons to stop breastfeeding. Indeed, the infection is likely to settle more quickly if the mother continues breastfeeding on the affected side. (Information Sheets Breastfeeding and Medication and Breastfeeding and Illness).


15. If the baby has diarrhea or vomiting, the mother should stop breastfeeding. Not true! The best medicine for a baby's gut infection is breastfeeding. Stop other foods for a short time, but continue breastfeeding. Breastmilk is the only fluid your baby requires when he has diarrhea and/or vomiting, except under exceptional circumstances. The push to use "oral rehydrating solutions" is mainly a push by the formula manufacturers (who also make oral rehydrating solutions) to make even more money. The baby is comforted by the breastfeeding, and the mother is comforted by the baby's breastfeeding. (Information Sheets Breastfeeding and Medication and Breastfeeding and Illness).

16. If the mother is taking medicine she should not breastfeed. Not true! There are very very few medicines that a mother cannot take safely while breastfeeding. A very small amount of most medicines appears in the milk, but usually in such small quantities that there is no concern. If a medicine is truly of concern, there are usually equally effective, alternative medicines that are safe. The risks of artificial feeding for both the mother and the baby must be taken into account when weighing if breastfeeding should be continued (Information Sheets Breastfeeding and Medication and Breastfeeding and Illness).

17. A breastfeeding mother has to be obsessive about what she eats. Not true! A breastfeeding mother should try to eat a balanced diet, but neither needs to eat any special foods nor avoid certain foods. A breastfeeding mother does not need to drink milk in order to make milk. A breastfeeding mother does not need to avoid spicy foods, garlic, cabbage or alcohol. A breastfeeding mother should eat a normal healthful diet. Although there are situations when something the mother eats may affect the baby, this is unusual. Most commonly, "colic", "gassiness" and crying can be improved by changing breastfeeding techniques, rather than changing the mother's diet. (Information Sheet Colic in the Breastfed Baby).

18. A breastfeeding mother has to eat more in order to make enough milk. Not true! Women on even very low calorie diets usually make enough milk, at least until the mother's calorie intake becomes critically low for a prolonged period of time. Generally, the baby will get what he needs. Some women worry that if they eat poorly for a few days this also will affect their milk. There is no need for concern. Such variations will not affect milk supply or quality. It is commonly said that women need to eat 500 extra calories a day in order to breastfeed. This is not true. Some women do eat more when they breastfeed, but others do not, and some even eat less, without any harm done to the mother or baby or the milk supply. The mother should eat a balanced diet dictated by her appetite. Rules about eating just make breastfeeding unnecessarily complicated.

19. A breastfeeding mother has to drink lots of fluids. Not true! The mother should drink according to her thirst. Some mothers feel they are thirsty all the time, but many others do not drink more than usual. The mother's body knows if she needs more fluids, and tells her by making her feel thirsty. Do not believe that you have to drink at least a certain number of glasses a day. Rules about drinking just make breastfeeding unnecessarily complicated.


20. A mother who smokes is better not to breastfeed. Not true! A mother who cannot stop smoking should breastfeed. Breastfeeding has been shown to decrease the negative effects of cigarette smoke on the baby's lungs, for example. Breastfeeding confers great health benefits on both mother and baby. It would be better if the mother not smoke, but if she cannot stop or cut down, then it is better she smoke and breastfeed than smoke and formula feed.

21. A mother should not drink alcohol while breastfeeding. Not true! Reasonable alcohol intake should not be discouraged at all. As is the case with most drugs, very little alcohol comes out in the milk. The mother can take some alcohol and continue breastfeeding as she normally does. Prohibiting alcohol is another way we make life unnecessarily restrictive for breastfeeding mothers.


22. A mother who bleeds from her nipples should not breastfeed. Not true! Though blood makes the baby spit up more, and the blood may even show up in his bowel movements, this is not a reason to stop breastfeeding the baby. Nipples that are painful and bleeding are not worse than nipples that are painful and not bleeding. It is the pain the mother is having that is the problem. This nipple pain can often be helped considerably. Get help. (Information Sheet Sore Nipples and Vasospasm and Raynaud’s Phenomenon). Sometimes mothers have bleeding from the nipples that is obviously coming from inside the breast and is not usually associated with pain. This often occurs in the first few days after birth and settles within a few days. The mother should not stop breastfeeding for this. If bleeding does not stop soon, the source of the problem needs to be investigated, but the mother should keep breastfeeding.

23. A woman who has had breast augmentation surgery cannot breastfeed. Not true! Most do very well. There is no evidence that breastfeeding with silicone implants is harmful to the baby. Occasionally this operation is done through the areola. These women do have often have problems with milk supply, as does any woman who has an incision around the areolar line.

24. A woman who has had breast reduction surgery cannot breastfeed. Not true! Breast reduction surgery does often decrease the mother's capacity to produce milk, but since many mothers produce more than enough milk, some mothers who have had breast reduction surgery sometimes can breastfeed exclusively. In such a situation, the establishment of breastfeeding should be done with special care to the principles mentioned in the Information Sheet Breastfeeding—Starting Out Right. However, if the mother seems not to produce enough, she can still breastfeed, supplementing with a lactation aid (so that artificial nipples do not interfere with breastfeeding). See Information Sheet Lactation Aid.

25. Premature babies need to learn to take bottles before they can start breastfeeding. Not true! Premature babies are less stressed by breastfeeding than by bottle feeding. A baby as small as 1200 grams and even smaller can start at the breast as soon as he is stable, though he may not latch on for several weeks. Still, he is learning and he is being held which is important for his wellbeing and his mother's. Actually, weight or gestational age do not matter as much as the baby's readiness to suck, as determined by his making sucking movements. There is no more reason to give bottles to premature babies than to full term babies. When supplementation is truly required there are ways to supplement without using artificial nipples.

26. Babies with cleft lip and/or palate cannot breastfeed. Not true! Some do very well. Babies with a cleft lip only usually manage fine. But many babies with cleft palate do indeed find it very difficult to latch on. There is no doubt, however, that if breastfeeding is not even tried, for sure the baby won’t breastfeed. The baby's ability to breastfeed does not always seem to depend on the severity of the cleft. Breastfeeding should be started, as much as possible, using the principles of proper establishment of breastfeeding. (Information Sheet Breastfeeding—Starting Out Right). If bottles are given, they will undermine the baby's ability to breastfeed. If the baby needs to be fed, but is not latching on, a cup can and should be used in preference to a bottle. Finger feeding occasionally is successful in babies with cleft lip/palate, but not usually (See Information Sheet Finger and Cup Feeding).

27. Women with small breasts produce less milk than those with large breasts. Nonsense!


28. Breastfeeding women cannot take the birth control pill. Not true! The question is not about exposure to female hormones, to which the baby is exposed anyway through breastfeeding. The baby gets only a tiny bit more from the pill. However, some women who take the pill, even the progestin only pill, find that their milk supply decreases. Estrogen-containing pills are more likely to decrease the milk supply. Because so many women produce more than enough, this sometimes does not matter, but sometimes it does even in the presence of an abundant supply, and the baby becomes fussy and is not satisfied by breastfeeding. Babies respond to the rate of flow of milk, not what's "in the breast", so that even a very good milk supply may seem to cause the baby who is used to faster flow to be fussy. Stopping the pill often brings things back to normal. If possible, women who are breastfeeding should avoid the pill, or at least wait until the baby is taking other foods (usually around 6 months of age). Even if the baby is older, the milk supply may decrease significantly. If the pill must be used, it is preferable to use the progestin only pill (without estrogen).

29. Breastfeeding babies need other types of milk after six months. Not true! Breastmilk gives the baby everything there is in other milks and more. Babies older than six months should be started on solids mainly so that they learn how to eat and so that they begin to get another source of iron, which by 7-9 months, is not supplied in sufficient quantities from breastmilk alone. Thus cow's milk or formula will not be necessary as long as the baby is breastfeeding. However, if the mother wishes to give milk after 6 months, there is no reason that the baby cannot get cow's or goat’s milk, as long as the baby is still breastfeeding a few times a day, and is also getting a wide variety of solid foods in more than minimal amounts. Most babies older than six months who have never had formula will not accept it because of the taste.

30. Women with flat or inverted nipples cannot breastfeed. Not true! Babies do not breastfeed on nipples, they breastfeed on the breast. Though it may be easier for a baby to latch on to a breast with a prominent nipple, it is not necessary for nipples to stick out. A proper start will usually prevent problems and mothers with any shaped nipples can breastfeed perfectly adequately. In the past, a nipple shield was frequently suggested to get the baby to take the breast. This gadget should not be used, especially in the first two weeks! Though it may seem a solution, its use can result in poor feeding and severe weight loss, and makes it even more difficult to get the baby to take the breast. (See Information Sheet Finger and Cup Feeding). If the baby does not take the breast at first, with proper help, he will often take the breast later. Breasts also change in the first few weeks, and as long as the mother maintains a good milk supply, the baby will usually latch on by 8 weeks of age no matter what, but get help and the baby may latch on before. See Information Sheet When a Baby Does not yet Latch.


31. A woman who becomes pregnant must stop breastfeeding. Not true! If the mother and child desire, breastfeeding can continue. Some continue breastfeeding the older child even after delivery of the new baby. Many women do decide to stop breastfeeding when they become pregnant because their nipples are sore, or for other reasons, but there is no rush or medical necessity to do so. In fact, there are often good reasons to continue. The milk supply will likely decrease during pregnancy, but if the baby is taking other foods, this is not a usually a problem. However, some babies will stop breastfeeding if the milk supply is low.

32. A baby with diarrhea should not breastfeed. Not true! The best treatment for a gut infection (gastroenteritis) is breastfeeding. Furthermore, it is very unusual for the baby to require fluids other than breastmilk. If lactose intolerance is a problem, the baby can receive lactase drops, available without prescription, just before or after the feeding, but this is rarely necessary in breastfeeding babies. Get information on its use from the clinic. In any case, lactose intolerance due to gastroenteritis will disappear with time. Lactose free formula is not better than breastfeeding. Breastfeeding is better than any formula.

33. Babies will stay on the breast for two hours because they like to suck. Not true! Babies need and like to suck, but how much do they need? Most babies who stay at the breast for such a long time are probably hungry, even though they may be gaining well. Being on the breast is not the same as drinking at the breast. Latching the baby better onto the breast allows the baby to breastfeed more effectively, and thus spend more time actually drinking. You can also help the baby to drink more by expressing milk into his mouth when he no longer swallows on his own (See Information Sheet Breast Compression). Babies younger than 5-6 weeks often fall asleep at the breast because the flow of milk is slow, not necessarily because they have had enough to eat. See videos at nbci.ca.

34. Babies need to know how to take a bottle. Therefore a bottle should always be introduced before the baby refuses to take one. Not true! Though many mothers decide to introduce a bottle for various reasons, there is no reason a baby must learn how to use one. Indeed, there is no great advantage in a baby's taking a bottle. Since Canadian women are supposed to receive 52 weeks maternity leave, the baby can start eating solids after 6 months, well before the mother goes back to her outside work. The baby can even take fluids or solids that are quite liquid off a spoon. The baby can start learning how to drink from a cup right from birth or older, and though it may take several weeks for the older baby to learn to use it efficiently, he will learn. If the mother is going to introduce a bottle, it is better she wait until the baby has been breastfeeding well for 4-6 weeks, and then give it only occasionally. Sometimes, however, babies who take the bottle well at 6 weeks, refuse it at 3 or 4 months even if they have been getting bottles regularly (smart babies). Do not worry, and proceed as above with solids and spoon. Giving a bottle when breastfeeding is not going well is not a good idea and usually makes the breastfeeding even more difficult. For your sake and the baby's do not try to "starve the baby into submission." Get help.


35. If a mother has surgery, she has to wait a day before restarting breastfeeding. Not true! The mother can breastfeed immediately after surgery, as soon as she is awake and up to it. Neither the medications used during anaesthesia, nor pain medications nor antibiotics used after surgery require the mother to interrupt breastfeeding, except under exceptional circumstances. Enlightened hospitals will accommodate breastfeeding mothers and babies when either the mother or the baby needs to be admitted to the hospital, so that breastfeeding can continue. Many rules that restrict breastfeeding are more for the convenience of staff than for the benefit of mothers and babies.

36. Breastfeeding twins is too difficult to manage. Not true! Breastfeeding twins is easier than bottle feeding twins, if breastfeeding is going well. This is why it is so important that a special effort should be made to get breastfeeding started right when the mother has had twins (See Information Sheets Breastfeeding—Starting Out Right and The Importance of Skin to Skin Contact). Some women have breastfed triplets exclusively. This obviously takes a lot of work and time, but twins and triplets take a lot of work and time no matter how the infants are fed.

37. Women whose breasts do not enlarge or enlarge only a little during pregnancy, will not produce enough milk. Not true! There are a very few women who cannot produce enough milk (though they can continue to breastfeed by supplementing with a lactation aid). Some of these women say that their breasts did not enlarge during pregnancy. However, the vast majority of women whose breasts do not seem to enlarge during pregnancy produce more than enough milk.

38. A mother whose breasts do not seem full has little milk in the breast. Not true! Breasts do not have to feel full to produce plenty of milk. It is normal that a breastfeeding woman's breasts feel less full as her body adjusts to her baby's milk intake. This can happen suddenly and may occur as early as two weeks after birth or even earlier. The breast is never "empty" and also produces milk as the baby breastfeeds. Is the baby getting milk from the breast? That’s what’s important, not how full the breast feels. Look skeptically upon anyone who squeezes your breasts to make a determination of milk sufficiency or insufficiency. See videos at nbci.ca.

39. Breastfeeding in public is not decent. Not true! It is the humiliation and harassment of mothers who are breastfeeding their babies that is not decent. Women who are trying to do the best for their babies should not be forced by other people's hang-ups or lack of understanding to stay home or feed their babies in public washrooms. Those who are offended need only avert their eyes. Children will not be damaged psychologically by seeing a woman breastfeeding. On the contrary, they might learn something important, beautiful and fascinating. They might even learn that breasts are not only for selling beer. Other women who have left their babies at home to be bottle fed when they went out might be encouraged to bring the baby with them the next time.

40. Breastfeeding a child until 3 or 4 years of age is abnormal and bad for the child, causing an over-dependent relationship between mother and child. Not true! Breastfeeding for 2-4 years was the rule in most cultures since the beginning of human time on this planet. Only in the last 100 years or so has breastfeeding been seen as something to be limited. Children breastfeed into the third year are not overly dependent. On the contrary, they tend to be very secure and thus more independent. They themselves will make the step to stop breastfeeding (with gentle encouragement from the mother), and thus will be secure in their accomplishment.

41. If the baby is off the breast for a few days (weeks), the mother should not restart breastfeeding because the milk sours. Not true! The milk is as good as it ever was. Breastmilk in the breast is not milk or formula in a bottle.


42. After exercise a mother should not breastfeed. Not true! There is absolutely no reason why a mother would not be able to breastfeed after exercising. The study that purported to show that babies were fussy feeding after mother exercising was poorly done and contradicts the everyday experience of millions of mothers.

43. A breastfeeding mother cannot get a permanent or dye her hair. Not true! I have no idea where this comes from.

44. Breastfeeding is blamed for everything. True! Family, health professionals, neighbours, friends and taxi drivers will blame breastfeeding if the mother is tired, nervous, weepy, sick, has pain in her knees, has difficulty sleeping, is always sleepy, feels dizzy, is anemic, has a relapse of her arthritis (migraines, or any chronic problem) complains of hair loss, change of vision, ringing in the ears or itchy skin. Breastfeeding will be blamed as the cause of marriage problems and the other children acting up. Breastfeeding is to blame when the mortgage rates go up and the economy is faltering. And whenever there is something that does not fit the "picture book" life, the mother will be advised by everyone that it will be better if she stops breastfeeding.

45. Breastfeeding mothers cannot breastfeed if they have had X-rays. Not true! Regular X-rays such as a chest X-ray or dental X-rays do not affect the milk or the baby and the mother may breastfeed without concern. Mammograms are harder to read when the mother is lactating, but can be done and the mother should not stop breastfeeding just to get this done. Furthermore, there are other ways of investigating a breast lump. Newer imaging methods such as CT scan and MRI scans are of no concern, even if contrast is used. And special X-rays using contrast media? As long as no radioactive isotope is used there is no concern and the mother should not stop even for one feed. Herein are included studies such as intravenous pyelogram, lymphangiogram, venogram, arteriogram, myelogram, etc. What about studies using radioactive nucleotides (bone scans, lung scans, etc.)? The baby will get a little radioactive nucleotide. However, as we often do these very same tests on children, even small babies, and the potential loss of benefits if the mother stops breastfeeding are considerable, the mother should, in my opinion, continue breastfeeding. If you feel you must stop for a period of time, express milk in advance so that the baby can be fed your milk and not formula. After two half lives, 75% of the compound will be out of your body. This is surely waiting long enough (the half life of technetium, which is used in most radioactive scans is only six hours, so that 12 hours after the injection, 75% of it will be out of your body). The exception is the thyroid scan using I131. This test must be avoided in breastfeeding mothers. There are many ways of evaluating the thyroid, and only very occasionally does a thyroid scan truly have to be done. If the scan must be done, doing it with I123 requires the mother to stop breastfeeding for 12 to 24 hours only depending on the dose. Check first before taking the radioactive iodine—the test can wait until you know for sure. In many cases where the scan must be done, it can be put off for several months. Incidentally, lung scans with radioactive contrast no longer is the best test to rule out a lung clot. CT scan is now the preferred test to prove or disprove the diagnosis. [See also Information Sheet Breastfeeding and Medications)

46. Breastfeeding mothers' milk can "dry up" just like that. Not true! Or if this can occur, it must be a rare occurrence. Aside from day-to-day and morning-to-evening variations, milk production does not change suddenly. There are changes which occur which may make it seem as if milk production is suddenly much less:

An increase in the needs of the baby, the so-called growth spurt. If this is the reason for the seemingly insufficient milk, a few days of more frequent breastfeeding will bring things back to normal. Try compressing the breast with your hand to help the baby get milk (Information Sheet Breast Compression). A change in the baby's behaviour. At about five to six weeks of age, more or less, babies who would fall asleep at the breast when the flow of milk slowed down, tend to start pulling at the breast or crying when the milk flow slows. The milk has not dried up, but the baby has changed. Try using breast compression to help the baby get more milk. See the website nbci.ca for videos on how to latch a baby on, how to know the baby is getting milk, how to use compression. The mother's breasts do not seem full or are soft. It is normal after a few weeks for the mother no longer to have engorgement, or even fullness of the breasts. As long as the baby is drinking at the breast, do not be concerned (Information sheet Is My Baby Getting Enough Milk?). The baby breastfeeds less well. This is often due to the baby being given bottles or pacifiers and thus learning an inappropriate way of breastfeeding.

The birth control pill may decrease your milk supply. Think about stopping the pill or changing to a progesterone only pill. Or use other methods. Other drugs that can decrease milk supply are pseudoephedrine (Sudafed), some antihistamines, and perhaps diuretics.

If the baby truly seems not to be getting enough, get help, but do not introduce a bottle that may only make things worse. If absolutely necessary, the baby can be supplemented, using a lactation aid that will not interfere with breastfeeding, or by cup if the baby will not take the aid. However, lots can be done before giving supplements. Get help. Try compressing the breast with your hand to help the baby get milk (Information Sheet Breast Compression).

47. Physicians know a lot about breastfeeding. Not true! Obviously, there are exceptions. However, very few physicians trained in North America or Western Europe learned anything at all about breastfeeding in medical school. Even fewer learned about the practical aspects of helping mothers start breastfeeding and helping them maintain breastfeeding. After medical school, most of the information physicians get regarding infant feeding comes from formula company representatives or advertisements.

48. Pediatricians, at least, know a lot about breastfeeding. Not true! Obviously, there are exceptions. However, in their post-medical school training (residency), most pediatricians learned nothing formally about breastfeeding, and what they picked up in passing was often wrong. To many trainees in pediatrics, breastfeeding is seen as an "obstacle to the good medical care" of hospitalized babies.


49. Formula company literature and formula samples do not influence how long a mother breastfeeds. Really? So why do the formula companies work so hard to make sure that new mothers are given these samples, their company's samples? Are these samples and the literature given out to encourage breastfeeding? Do formula companies take on the cost of the samples and booklets so that mothers will be encouraged to breastfeed longer? The companies often argue that, if the mother does give formula, they want the mother to use their brand. But in competing with each other, the formula companies also compete with breastfeeding. Did you believe that argument when the cigarette companies used it?

50. Breastmilk given with formula may cause problems for the baby. Not true! Most breastfeeding mothers do not need to use formula and when problems arise that seem to require artificial milk, often the problems can be resolved without resorting to formula. However, when the baby may require formula, there is no reason that breastmilk and formula cannot be given together.

51. Babies who are breastfed on cue are likely to be "colicky." Not true! "Colicky" breastfed babies often gain weight very quickly and sometimes are feeding frequently. However, many are colicky not because they are feeding frequently, but because they do not take the breastmilk as well as they should. Typically, the baby drinks very well for the first few minutes, then nibbles or sleeps. When the baby is offered the other side, he will drink well again for a short while and then nibble or sleep. The baby will fill up with relatively low fat milk and thus feed frequently. The taking in of mostly low fat milk may also result in gas, crying and explosive watery bowel movements. The mother can urge the baby to breastfeed longer on the first side, and thus get more high fat milk, by compressing the breast once the baby sucks but does not drink. (Information Sheets Colic in the Breastfed Baby and Breast Compression). Also see videos at nbci.ca

52. Mothers who receive immunizations (tetanus, rubella, hepatitis B, hepatitis A, etc.) should stop breastfeeding for 24 hours (3 days, 2 weeks). Not true! Why should they? There is no risk for the baby, and he may even benefit. The rare exception is the baby who has an immune deficiency. In that case the mother should not receive an immunization with a weakened live virus (e.g. oral, but not injectable polio, or measles, mumps, rubella) even if the baby is being fed artificially.

53. There is no such thing as nipple confusion. Not true! The baby is not confused, though, the baby knows exactly what he wants. A baby who is getting slow flow from the breast and then gets rapid flow from a bottle will figure that one out pretty quickly. A baby who has had only the breast for three or four months is unlikely to take the bottle. Some babies prefer the right or left breast to the other. Bottle fed babies often prefer one artificial nipple to another. So there is such a thing as preferring one nipple to another. The only question is how quickly it can occur. Given the right set of circumstances, the preference can occur after one or two bottles. The baby having difficulties latching on may never have had an artificial nipple, but the introduction of an artificial nipple rarely improves the situation, and often makes it much worse. Note that many who say there is no such thing as nipple confusion also advise the mother to start a bottle early so that the baby will not refuse it.

Questions? First look at the website nbci.ca or drjacknewman.com. If the information you need is not there, go to Contact Us and give us the information listed there in your email. Information is also available in Dr. Jack Newman’s Guide to Breastfeeding, and/or our DVD, Dr. Jack Newman’s Visual Guide to Breastfeeding (available in French or with subtitles in Spanish, Portuguese and Italian); and/or The Latch Book and Other Keys to Breastfeeding Success; and/or L-eat Latch and Transfer Tool; and/or the GamePlan for Protecting and Supporting Breastfeeding in the First 24 Hours of Life and Beyond.

To make an appointment online with our clinic please visit www.nbci.ca. If you do not have easy access to email or internet, you may phone (416) 498-0002.



The Breastfeeding Group

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Dr. Jack Newman graduated from the University of Toronto medical school in 1970, interning at the Vancouver General Hospital. He did his training in pediatrics in Quebec City and then at the Hospital for Sick Children in Toronto from 1977-1981 to become a Fellow of the Royal College of Physicians of Canada in 1981 as well as Board Certified by the AAP in 1981. He has worked as a physician in Central America, New Zealand and as a pediatrician in South Africa (in the Transkei). He founded the first hospital based breastfeeding clinic in Canada in 1984. He has been a consultant for UNICEF for the Baby Friendly Hospital Initiative, evaluating the first candidate hospitals in Gabon, the Ivory Coast and Canada.

Dr. Newman was a staff pediatrician at the Hospital for Sick Children emergency department from 1983 to 1992, and was, for a period of time, the acting chief of the emergency services. However, once the breastfeeding clinic started functioning, it took more and more of his time and he eventually worked full time helping mothers and babies succeed with breastfeeding. He now works at the Newman Breastfeeding Clinic and Institute based at the Canadian College of Naturopathic Medicine in Toronto.

Dr. Newman has several publications on breastfeeding, and in 2000 published, along with Teresa Pitman, a help guide for professionals and mothers on breastfeeding, called, Dr. Jack Newman's Guide to Breastfeeding, (revised editions: 2003, 2005, 2009), and The Ultimate Breastfeeding Book of Answers, (revised edition: 2006). The book has been translated into French, Indonesian, Japanese, Spanish and Italian. In 2006, Dr. Newman, along with Teresa Pitman, published The Latch and Other Keys to Breastfeeding Success (Hale Publishing) and was translated into French. He has also, along with Edith Kernerman, developed a DVD as a teaching tool for health professionals and mothers. It is available in English and French. As well, it is subtitled in Spanish, Portuguese and Italian.

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An ‘On-Demand’ Life and the Basic Needs of Babies

By Mary Tarsha and Dr. Darcia Narvaez


On-demand services may have spoiled parenting! Yes, by their convenience. For example, we no longer have to plan our schedule around the airing of our favorite program or make efforts to record a particular show. With a few clicks we can escape into streaming thousands of movies (and other forms of entertainment) from our TV, computer, or mobile device. We can use Google to answer a question about almost anything. We can order ahead from a favorite restaurant and our order will be ready when we arrive. An Uber is just around the corner. We don’t have to wait, or slow down our pace. We can stay focused on our own needs and goals. Always thinking ahead.

How does this fast pace focused on getting the next thing done influence our relationships? If we are tilted forward towards checking off the next thing on our list, can we really be in the present moment? Why does it matter? A present-moment focus is linked to happiness (e.g., mindfulness). But it is also required for being a good friend and a good parent.

Being emotionally present is especially important with those who are still learning to be human—babies and young children. They operate at a slower pace and expect caregivers to be with them in the moment (notice how your young child will start to demand attention when you are on the phone—which is probably why we evolved to have a village of caregivers and playmates!)

When we get used to things on demand we start to think that everyone should act accordingly. We lose patience with people who move too slow and or take too long. We can start to think that babies should conform to our preferences on demand too. But they cannot. They follow an inner compass of growth and development. Practically speaking, tending to the needs of babies means meeting their needs in the here and now, not demanding that they conform to adult schedules. Their basic needs are many and include the components of what we call the evolved nest: on-request breastfeeding, extensive affectionate touch, self-directed play and quick responsiveness (see previous post here). When an infant receives care that satiates needs as they arise, with a present-moment focus from the parent or caregiver, the infant develops normally, along a healthy trajectory, into adulthood.

Why does early experience matter so much? Because as the infant’s needs are met, the neuronal architecture of the brain and neurobiological systems are supported as they are developing rapidly, enabling proper functioning. At a very basic level, babies are self-actualizing when their needs are met—they are getting support to follow the inner guidance system that Maslow found so important for self-actualization to occur. Maslow agreed with psychoanalytic theory that the thwarting of the self, of one’s normal path to self-actualization, occurs in early life from the betrayal in relationships. When we don’t provide the evolved nest, it is a betrayal to babies’ soul/spirit/being.

Meeting basic needs in the early years carries long-term benefits that protect the child throughout life, physiologically and psychologically. Adults who received nurturing and responsive care environments in their early years demonstrate greater resilience to stressful situations, better immune functioning, less anxiety and overall, fewer physical health problems (Shonkoff et al., 2012). There is a plethora of research from neuroscience, developmental psychology, molecular biology, chemistry, genomics and sociology validating the importance of early care experiences upon brain development, specifically the prefrontal cortex, amygdala, and hippocampus, critical parts of the brain that control learning, memory, and behavior (Suderman, 2012; Champagne & Meaney, 2007; Gunnar & Quevedo, 2007).

Recognizing the overwhelming, converging evidence from an array of disciplines, the American Academy of Pediatrics (AAP) issued a report in 2012 addressing the importance of early care experience for adult health. The report encourages all pediatricians to be the “front-line guardians of child development” because “many adult diseases should be viewed as developmental disorders that begin early in life” (Shonkoff, 2012, p.2). The AAP is calling for a greater awareness of the importance of early care experiences, proclaiming that many adult diseases begin in early life and more emphasis should be given to providing healthy environments to infants and children.


Unmet Needs = Toxic Stress

So, what happens when an infant’s needs are not met? The Answer: potential toxic stress is created. Toxic stress and traumatic attachments in early life influence brain development, specifically the right hemisphere, resulting in:


  • An inability to regulate emotional states under stress, including regulating fear-terror states 
  • dysregulation of the “fight or flight” system (part of the Autonomic Nervous System) dysregulated “flight” systems results in PTSD and dysregulated “fight” systems potentially leads to aggression disorders 
  • dysregulation of the vagus nerve which connects with major body systems and governs social capacities (Porges, 2017) 
  • personality disorders in early adulthood (Schore, 2003).


In short, the individual is stunted or thwarted in reaching their full potential. Long-lasting effects include both personality and emotion regulation disorders. Deprivation of basic needs in the early years of life leads to an internal divisiveness; children become divided within themselves and divided against the world (Narvaez, 2016). It pushes the child off the trajectory for self-actualization.

There is evidence that suggests that deprivation of basic needs (neglect or undercare) may be more detrimental than physical abuse. Neglected children demonstrate more severe cognitive and academic deficits, social withdrawal, limited peer interactions and internalizing problems compared to children who were physically abused (Hildyard & Wolfe, 2002).

Meeting Basic Needs Buffers Against Toxic Stress

Supportive and responsive care has a profound role in mitigating the effects of adverse (stressful) experiences (The National Scientific Council of the Developing Child, 2011). A nurturing and responsive environment is a buffer against toxic stress, helping the infant return to baseline (non-stressed condition) and consequently, continue along an adequate developmental trajectory (for species-typical normal development, the full evolved nest would need to be provided). However, if supportive and responsive care is not provided in the midst of stressful events, toxic stress ensues, and severe traumatic attachments can develop.

A Practical Suggestion for Young Child Care

What is one practical way to increase the quality of infants’ early care experiences? Build extra time into the family’s schedule. Create buffers of time around scheduled events in the caregiving routine. For example, if you need to leave the house by a certain time, factor in an extra 15-20 minutes as a buffer. In this way, if the infant or child requests to nurse, needs a diaper change, needs extra play time, or more affectionate touch, these needs can be met in a non-stressed manner. Extra pockets of time allow the caregiver to meet the infant’s needs, safeguarding against an “on-demand” mentality but also, may diminish the caregiver’s stress. A parent or caregiver that is less stressed and anxious is able to be more responsive to the infant’s need, picking up on subtle cues from their baby. Less mental and emotional energy is dedicated to navigating the schedule (trying to get the infant/child out the door on time), freeing the caregiver to be nurturing, warm and responsive in the here and now, safeguarding against an “on-demand” mentality toward infants. Thus, built in buffers of time have the two-fold benefit of ameliorating caregiving stress and facilitating the meeting of the infant’s needs.

Early Investment in Baby has Long-Term Benefits

When infants and children are not treated with warm, responsive care, bad things happen. However, when they are given a healthy start with responsive, stable and nurturing relationships around them, infants flourish into happy and healthy adolescents and adults. Many pitfalls are avoided and the long-lasting consequences of learning disabilities, emotional disorders and physical health conditions are averted. Investing in infants provides a return of better health and happiness!

What if you didn’t meet your child’s needs in the early years? Even if your child is older, you can begin providing responsive and nurturing care now. See this post about promoting thriving in school-aged children. Physical and emotional health is one of the greatest gifts to any child. All is takes is some time, warmth and responsiveness to their needs.



Related Reading

More on what scholars say about early nurturing here.

How raising babies is different from raising children.

More on what babies need here.

Also by Dr. Narvaez at Peaceful Parenting:

Where Are All the Happy Babies?

The Dangers of Crying It Out

Psychology Today series on infant circumcision


References

Champagne, F. A., & Meaney, M. J. (2007). Transgenerational effects of social environment on variations in maternal care and behavioral response to novelty. Behavioral neuroscience, 121(6), 1353.

Gunnar, M. R., & Quevedo, K. M. (2007). Early care experiences and HPA axis regulation in children: a mechanism for later trauma vulnerability. Progress in brain research, 167, 137-149.

Hildyard, K. L., & Wolfe, D. A. (2002). Child neglect: developmental issues and outcomes. Child abuse & neglect, 26(6), 679-695.

Narvaez, D. (2016). Embodied morality: Protectionism, engagement and imagination. Springer.

National Scientific Council on the Developing Child. Excessive Stress Disrupts the Architecture of the Brain: Working Paper #3. Available at: https://developingchild.harvard.edu/resources/wp3/.

Schore, A. N. (2003). Early Relational Trauma, Disorganized Attachment, and the Development of a Predisposition to Violence. Healing Trauma: Attachment, Mind, Body and Brain (Norton Series on Interpersonal Neurobiology), 107.

Shonkoff, Jack P., Andrew S. Garner, Benjamin S. Siegel, Mary I. Dobbins, Marian F. Earls, Laura McGuinn, John Pascoe, David L. Wood, Committee on Psychosocial Aspects of Child and Family Health, and Committee on Early Childhood, Adoption, and Dependent Care. "The lifelong effects of early childhood adversity and toxic stress." Pediatrics 129, no. 1 (2012): e232-e246.

Suderman, M., McGowan, P. O., Sasaki, A., Huang, T. C., Hallett, M. T., Meaney, M. J., ... & Szyf, M. (2012). Conserved epigenetic sensitivity to early life experience in the rat and human hippocampus. Proceedings of the National Academy of Sciences, 109(Supplement 2), 17266-17272.


About the Authors

Darcia Narvaez, Ph.D., is Associate Professor of Psychology at the University of Notre Dame and Director of the Collaborative for Ethical Education. Her current research examines the effects of parenting on child and adult outcomes. Narvaez has developed several integrative theories: Adaptive Ethical Expertise, Integrative Ethical Education, Triune Ethics Theory. She spoke at the Whitehouse's conference on Character and Community, and is author/editor of three award winning books: Postconventional Moral Thinking; Moral Development, Self and Identity; and the Handbook of Moral and Character Education. Her text, Human Nature, Early Experience, and the Environment of Evolutionary Adaptedness was a fantastic addition to a growing body of literature on a healthy, happy, babyhood. Visit Dr. Narvaez' website for additional books, papers, classes, websites and contact information.

Mary Tarsha is a graduate student in Developmental ​Psychology and Peace Studies at the Kroc Institute for International Peace at the University of Notre Dame

Your Baby's Signs of Hunger



This poster, created by the Women's and Newborn Services of Royal Brisbane and Women's Hospital, highlights a human baby's hunger cues - her way of communicating to parents that she needs to eat.

As highlighted in the 2010 article, 7 Breastfeeding Fact You Should Know, parents are reminded that stirring, mouth opening, turning a head (to seek a nipple) and rooting are signs that your baby is hungry. Stretching, becoming agitated, and sucking on her fist, fingers or thumb is your baby's way of telling you that she is really hungry. By the time fussing and crying start, your baby is experiencing hunger that is physically painful. It is the type of hunger you experience after your belly has been empty for 14-16 hours. Your baby's belly is very small - this is the reason she gets full so quickly, and then hungry again so soon. Her tiny stomach cannot handle more than this, and does not have any place to 'store' some for later. She is entirely dependent upon you to provide that fill-up according to her cues that she is hungry.

Too often new parents believe they should schedule feedings or wait until their baby cries to nurse. But crying is a late indicator of extreme hunger. Always eating when you are so famished, when your belly hurts and stress hormones from being anxious to eat are at an ultimate high, leads to things like reflux, gas, stomach aches, 'colic,' and general agitation and general withdrawal from the world around - especially if you are brand new and helpless in this world.

Don't wait until your baby is in pain to nurse. Instead, feed at the first cue of hunger, and everyone will be much healthier and happier all around.

For related reading, see the Breastfeeding Resource Page.


A little tiny tummy wisdom from Baby Wisdom (UK):

Size of a baby's stomach.
Day One - the size of a cherry
Day Three - the size of a radish
Week Two - the size of a large egg
Month Two - the size of an apricot

For this reason, babies need to eat small amounts very often throughout the day and night time hours. Watch your little one and his/her cues. Nursing on cue, around the clock, leads to a baseline level of health, development, and happiness for babies, and their parents.


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The Myth of Foremilk / Hindmilk Imbalance

By Danelle Day © 2018


"If we had the power to eliminate just one misunderstood notion about breastfeeding, it would be the concept of foremilk and hindmilk!" write Cindy and Jana, Registered Nurses and International Board Certified Lactation Consultants (IBCLCs) who have assisted over 20,000 breastfeeding mothers.

Research clearly demonstrates that nursing mammals (human babies, too) receive milk near the end of most natural nursing sessions that is higher in fat content than milk at the beginning of that feeding. One biological reason for this is that early milk is the thirst quencher - baby can cue to nurse for just a few minutes to satisfy thirst, or comfort needs. Early milk is also power-packed in immunobodies and glyconutrients (the healthy sugars that kill cancer cells and feed the developing immune system) - super charging baby's immunity even when nursing briefly on-the-go. As breastfeeding continues, milk gradually becomes more and more dense in (healthy) fat content with each swallow baby takes. This beneficial fat feeds the cells of the rapidly developing brain and body. When baby is able to choose his/her time to breastfeed, because of this perfect set-up, s/he can get a quick snack for thirst and comfort and immunity, or s/he can get a full hearty meal that fills the tummy and feeds the brain.

This being said, there is no magic set amount of time from one mother to the next, one baby to the next, one nursing session to the next, or even one breast to the other, at which milk suddenly changes from 'foremilk' to 'hindmilk.' It is all just milk! Very gradually fat content increases. With each swallow baby takes, milk content shifts to meet baby's needs. When s/he is in control (and able to nurse effectively) baby is able to determine just the right amount of time to breastfeed to get just what s/he needs. This is why it is so vital to watch your baby, not the clock.

For one mother this may mean baby nurses on one breast for 30 minutes. For another mother baby may nurse each side for 20 minutes, or 15, or 10. Baby may nurse for 5 minutes, and come back 10 minutes later to nurse again. And again. Baby may nurse for longer periods of time at night than in the morning. One baby may nurse differently than his/her sibling did. Baby may nurse differently today than s/he did yesterday, and change week to week, due to his/her needs and also mom's hormone fluctuations. Milk content changes from one swallow to the next, from one baby to the next in the same mother, from one day to the next, and certainly from one mother to the next. In the midst of this beautiful dance of lactation and normal baby feeding, there is no 'foremilk / hindmilk imbalance' that occurs within any one individual mother's breasts.

When well meaning friends or ill-informed medical professionals tell nursing moms to "make sure your baby nurses long enough to get hindmilk" or "if your baby's poop is green, you have a foremilk/hindmilk imbalance" they are not dispersing information based in science, and this leads to mothers being troubled and thinking something is wrong. Many U.S. hospital postnatal rooms reinforce this myth by having mom record "how long baby breastfeeds on each side" on a chart that is reviewed by nursing staff. Breastfeeding moms wonder, "How long is 'long enough' for baby to get hindmilk?" "Should I only feed from one breast to try and help my baby gain?" Women want to do what they are being told by hospital staff, and begin to watch the clock instead of their baby -- the precise thing we should not be doing.

"A little knowledge can be a dangerous thing." writes Nancy Mohrbacher, author of the fantastic books, Breastfeeding Made Simple, and Working and Breastfeeding Made Simple, among others. "This has never been so true as in the ongoing debate about foremilk and hindmilk and their impact on breastfeeding. The misunderstandings around these concepts have caused anxiety, upset, and even led to breastfeeding problems and premature weaning."

Where did the foremilk / hindmilk imbalance myth arise from?

The foremilk / hindmilk imbalance idea was coined in a 1988 journal article * that reported the qualitative observations of a few mothers who breastfed by the clock, switching baby from one breast to the other after 10 minutes, even if baby was not finished nursing on that side. This is not something that is ever good to do as it does not allow baby to gradually control the amount of milk s/he takes in. The results from this one report have never been duplicated, and newer research calls its methods and conclusions into question. Many well versed in lactation science doubt there is even such a thing as a foremilk / hindmilk imbalance.


Myth-busting Lactation Facts: 

There are not two distinct kinds of milk. That's right - 'foremilk' and 'hindmilk' (as commonly as the terms are used) do not actually exist. There is no magic moment when foremilk becomes hindmilk. As noted above, the increase in fat content is gradual, with the milk becoming fattier and fattier over time as the breast drains more fully.

It is the total milk consumed daily by baby—not 'hindmilk' alone—that determines baby’s weight gain. Whether babies breastfeed often for shorter periods, or go for hours between feedings and nurse for longer times, the total daily fat consumption does not vary significantly.

Early milk is not always low-fat. The reason for this is that at the fat content of 'foremilk' varies greatly depending on the daily breastfeeding pattern. If baby breastfeeds again soon after the last nursing, the early-consumed milk at that feeding may be higher in fat than the late-consumed milk at other feeding. The longer a baby goes between feedings, the more varied milk will be from beginning to end when baby breastfeeds next. If baby is nursing more often than every 2-3 hours (frequent breastfeeding is normal and healthy for many babies at many points of development) than baby will be consuming fattier milk from the start.

If your baby is nursing more often, s/he is consuming more 'foremilk' that is higher in fat than babies who breastfeed less often. In the end, whether baby nurses for loooong stretches and goes 2-3 hours between, or breastfeeds more frequently, for less time, it all evens out at the end of the day, and watching baby and his/her cues is crucial (Kent 2007). Breastfeed on cue, around the clock, and safely sleep by your baby so that cue nursing and dream-feeding at night is easy too. See also: Your Baby's Signs of Hunger

Mohrbacher re-emphasizes: "What’s most important to a baby’s weight gain and growth is the total volume of milk consumed every 24 hours. On average, babies consume about 750 mL of milk per day (Kent et al., 2006). As far as growth is concerned, it doesn’t matter if a baby takes 30 mL every hour or 95 mL every three hours, as long as he receives enough milk overall (Mohrbacher, 2010). In fact, researchers have found that whether babies practice the frequent feedings of traditional cultures or the longer intervals common in the West, they take about the same amount of milk each day (Hartmann, 2007) and get about the same amount of milk fat. Let’s simplify breastfeeding for the mothers we help and once and for all cross foremilk and hindmilk off our 'worry lists.'"

Pumped breastmilk does not look like other forms of processed milk (cow, goat, etc.) that we are accustomed to seeing in the store. Cow milk is made perfectly for baby cows, not humans, as it is different in composition for the mammal it is designed to feed, and it also does not appear this way directly from a mother cow to her calf. Instead, natural human milk has a thin and watery appearance, with a creamy fat layer that may or may not develop when milk sits in the fridge. This is normal, and it will vary from one pumping to the next, and from one breast to the other.

If you are breastfeeding on cue, around the clock, babywearing in the day and safely cosleeping at night to keep baby close, and still find yourself concerned about baby's consumption, take note of how your baby nurses rather than watching any clock. Is your baby swallowing? Is s/he relaxed and content after nursing? Do her little hands open up into a tiny 5-point starfish when she is full? Is he gaining weight over the course of weeks passing? Baby's behavior matters far more than timing, and when we watch our babies and tune into their cues, we allow them to lead the way. In situations where baby is not gaining weight, an IBCLC can do a weighted nursing session (before/after breastfeeding), check for latch and suckle techniques by baby, and also note if a tongue or lip tie is preventing effective milk consumption. Reach out to an experienced lactation consultant in your area, and join local La Leche League and mom's milk cafe groups near you.


What about Green Poop?

Baby’s first bowel movements are the black and tarry meconium that was in the gut at birth. As breastfeeding commences, around Day 3 of life on the outside, baby’s poop changes to 'transitional stools,' which have a dark greenish color. Around Day 5, baby's poop color shifts again to yellow. Its consistency while exclusively breastfed (that is, while nothing but human milk is consumed) may look like mustard or split pea soup - liquid with seedy bits in it. Even when baby’s poop is all liquid with no seeds, and any variation of yellow-orange-green-brown, this is also normal.

In general lots of milk consumption in the early months, means lots of poops, no matter their color or how liquid or seedy they are. After 2 months of age, it is normal for many babies to poop only once every 3-4 days. There is very little waste in human milk, and this does not mean that baby is not receiving enough. Before 6-8 weeks of age, if baby is not pooping daily, a weight check is justified to ensure baby is receiving adequate amounts of milk.

Baby's poop color is not reason to worry if baby seems well and is gaining weight. In her book, Baby Poop: What Your Pediatrician May Not Tell You, Dr. Linda Palmer reminds readers that green is the most common color of baby stools seen, and should not cause alarm. "Beyond the newborn stage, the first matter of order when seeing green is to determine whether baby has eaten some especially green food, including kiwi, spirulina, or green veggies. It's said that grape-flavored Pedialyte [and other grape or chocolate or dark flavored/dyed items] can turn baby poop a bright green. If a child is being given iron supplements, these can turn his stools a dark evergreen." Palmer continues, "[I]f it's not a food pigment, then...green is the digestive juice bile; the same stuff that, when properly digested, imparts the normal yellow to brown colorations of poop. When bile comes out green, it is because the stool has been rushed through baby's digestive system, and not hung around long enough to break down. The question to ask is why."

Causes of Green Poop: 

1) Food dye, natural coloring, or flavoring in mom or baby's diet. This is the most common reason for green colorations of baby poop. In the majority of cases, something minor has shifted poop coloration for a few days.

2) A virus. When baby is ill, the body produces excess mucus that is swallowed by baby. This rushes poop through the digestive tract faster, and poop color may change for several weeks. Keep breastfeeding! It’s the best way to support baby's immune system in fighting the virus.

3) Antibiotics, which also cause stool to rush through baby's system.

4) Teething. When baby is teething large amounts of saliva are swallowed, entering and irritating the digestive tract, causing matter to rush through more quickly. Give baby plenty of teething options to make the process as painless as possible. See: Teething Solutions.

5) Abundant milk supply. If mom produces so much milk that baby receives mostly high-sugar/low-fat milk, it may overwhelm baby’s gut in the early weeks and cause watery or green stools. One way to change this is to simply pump for a few minutes before nursing, and use the pumped milk for your later freezer stash when milk supply regulates, and/or baby grows to be more effective at nursing, with a larger mouth and bigger stomach. We've also used this high-immunity pumped milk to turn into breastmilk popsicles for teething or toddler days. Doing this gets baby fattier milk from the start, and gradually decreases milk production when baby does not fully empty the breasts. Another form of reducing milk supply is block nursing (or block feeding).

6) Inability to breastfeed effectively. A health or anatomy issue (tongue tie, lip tie) may prevent baby from getting the milk s/he needs. See an IBCLC in person to determine if this is the case.

7) Sensitivity to a food or drug in mom's diet. There are certain foods (cow's milk, nuts, soy) that contain proteins that cannot be digested by newborn human babies, but pass easily through mom's milk when they are in her daily diet. This impacts all babies in their early life, but some much more than others. If you notice that your baby is agitated, "colicky," has gas or tummy pain, reflux, sometimes combined with frothy/green stools, it is very likely that your baby is responding more intensely to these items in your diet. Eliminating nuts and soy in the early months, and switching to vanilla rice milk (for example) instead of cow's milk, will help baby's digestion, discomfort, and pain in virtually all cases. For an easy-to-understand synthesis of the research on this, see Palmer's excellent book, Baby Matters: What Your Doctor May Not Tell You About Caring For Your Baby.

In conclusion, the foremilk/hindmilk myth is a misconception that is popular, but not based in lactation science. Breastfeed your baby on cue, around the clock, in a pattern that is baby-led (not clock-led). Find comfortable ways to babywear and sleep by your baby to make life easier for you, and to provide baby with round-the-clock access to the milk s/he needs. Provided s/he is gaining weight, wetting, and occasionally pooping (yellow, green, orange - lots of variations of normal), and is a happy and alert baby, all is well.


References:

Aksit, Sadik, Nese Ozkayin, and Suat Caglayan. "Effect of Sucking Characteristics on Breast Milk Creamatocrit.Paediatr Perinat Epidemiol Paediatric and Perinatal Epidemiology, 16.4 (2002): 355-60.

Hartmann, P.E. (2007). "Mammary gland: Past, present, and future." in eds. Hale, T.W. & Hartmann, P.E. Hale and Hartmann's Textbook of Human Lactation. Amarillo, TX: Hale Publishing, pp. 3-16.

Kent, J. C. (2007). "How breastfeeding works." Journal of Midwifery & Women's Health, 52(6), 564-570.

Kent, J. C., Mitoulas, L. R., Cregan, M. D., Ramsay, D. T., Doherty, D. A., & Hartmann, P. E. (2006). "Volume and frequency of breastfeedings and fat content of breast milk throughout the day." Pediatrics, 117(3), e387-395.

Mohrbacher, N. Breastfeeding Answers Made Simple: A Guide for Helping Mothers. Amarillo, TX: Hale Publishing, 2010.

Mohrbacher, N. Breastfeeding Made Simple: Seven Natural Laws for Nursing Mothers.
New Harbinger Publications, 2nd Edition, 2010.

Palmer, L. Baby Poop: What Your Pediatrician May Not Tell You. Sunny Lane Press, 2015.

Palmer, L. Baby Matters: What Your Doctor May Not Tell You About Caring for Your Baby. Baby Reference, 3rd Edition, 2015.

* Woolridge MW and Fisher C. "Colic, 'overfeeding,' and symptoms of lactose malabsorption in the breast-fed baby: a possible artifact of feed management?" Lancet. 1988 Aug 13;2(8607):382-4.

Breastfeeding mothers are welcome to join the Breastfeeding Group on Facebook: FB.com/groups/Breastfed


About the Author

Danelle Day focused on human labor and lactation sciences as part of her graduate work in human development. After ten years teaching at the university level, Day left full time academia to raise babies of her own, and joined Peaceful Parenting in 2006 as a clinical advisory board member where she has served thousands of breastfeeding families since that time.

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