Breastfeeding

Breastfeeding is a skill that doesn’t necessarily come naturally and often needs to be learned by both mother and baby. All women are different, breasts and nipples come in all shapes and sizes, and babies are complete individuals. Therefore, every woman’s breastfeeding experience will be different from the next and while some will cope with ease, others will never feel comfortable with breastfeeding and won’t particularly enjoy it. One big problem today is the lack of hands-on, genuine support which many mums really need. Years ago, in the 70’s & 80’s women used to stay in hospital after having a baby for up to 10 days and during that time had nurses and midwives around all the time to help get breast feeding established. So, before they left hospital feeding was fully established, problems ironed out, tongue-ties cut and the baby had to have regained birth weight before discharge.

There is a very good book by Clare Byam-Cook called What to Expect When Breastfeeding . . . And What to do If You Can’t, which is, in my view, the best and most comprehensive guide to the subject. It explains how to breastfeed and gives detailed and practical advice to help overcome all the issues that you may experience.

Bottle Feeding

It is a shame in today’s society that formula-feeding, when used in preference to breastfeeding, is almost frowned upon – to the point of making some women feel that they are ‘bad mothers’ if they choose it rather than breastfeeding. The first formulas designed to replace breast milk were produced commercially in 1867 and were used to remove the need for the wet nurse and also to save the lives of those babies whose mothers had either died, could not produce any milk or were unable to breastfeed. Since its introduction all those years ago, formula has continued

to improve in quality and most types now even contain lipids and pro-biotics, making them more similar to breast milk than ever before. Most babies will thrive and easily accept the usual dairy formulas which are readily available, although some who suffer intolerances, allergies or gastro- oesophageal reflux will do better with a goat's milk formula or one of the many specialized formulas.

Bottles & Teats

There are so many different makes on the market today that it must seem like a complete minefield when trying to choose which brand to use. For ease of use, my personal preferences are the MAM anti-colic bottles, which are super-easy to use and the teats closely resemble breastfeeding.

Undoubtedly there are some instances where specialized bottles and/ or teats may be necessary. For instance, premature babies, those with cleft palates or any that have severe feeding problems may not be able to suck efficiently from an ordinary bottle. Softer, smaller and more pliable teats may help.

Whatever bottles you choose, do always check that you are using teats with a hole size that matches your baby’s ability to suck. Nearly all teats are sold in age ranges, but many babies need a larger-holed teat sooner than the age recommendation states. If the teat is too small then it may cause the baby to gulp and suck too hard, which in turn can lead to problems with excessive wind. It is really trial and error to find which teat size suits your baby at any particular age. If you think he needs to move up a size because feeds seem to be taking longer and longer, then just try it out. You will soon be able to tell if the flow is too fast, as he may well cough, splutter or gag on the milk if too much is getting through.

Feeding & Sleep

In the early weeks most newborns will become quite sleepy after feeding and often even actually fall asleep whilst feeding. The temptation is then, to gently put baby down without rousing him in the hope he will sleep for a while. This, however, very quickly can lead to the common problem of your baby becoming reliant on feeding to be able to fall asleep. I always advise to try and wake baby up after a feed, change a nappy or move to a different environment and change of temperature, such as a quick walk around outside, and then if it is actually nap time and baby is tired, settle him down to sleep without feeding him to sleep.

I always work on the basis of a 12-hour day and 12-hour night and when I talk about night feeds these are the feeds given during the 12 hours of night and I’m not referring to the daytime and bedtime feed. As the weeks pass your baby’s need for nighttime feeds should lessen and they should naturally sleep for longer periods of time and by 12 weeks should easily be capable of sleeping through the night for a whole 12 hours. The general misconception these days is that babies continue to need night feeds for moths if not years on end, but this is simply not the case.

Very few animals and especially those within the mammal class, continue to feed around the clock and within a short space of time have regulated their feeding patterns to fall in line with their natural patterns and biological clock. For us mammalian humans, our digestive system and natural body clock is set to fall in line with night and day, light and dark and the sun and the moon. We are designed to take on fuel during the day and then during the hours of night and sleep, our digestive system will process, digest, empty and cleanse our system to produce the waste the next morning when we will then start the whole feeding process over again.

When babies continue to have night feeds post 12 weeks, they will soon become sleep deprived too because although they may wake, take a feed and go back to sleep – the digestive system is having to fully ‘wake-up’ to manage and process this extra fuel when the whole system should be resting and following the natural pattern of sleeping at night.

So, if your baby is insisting on still waking for, or demanding night feeds post 12 weeks of age, you could look into all the information I give on this subject in my book The Sensational Baby Sleep Plan which will explain how to reduce, remove and stop night feeds. Equally ‘The Plan’ will take you through the early weeks when night feeds are obviously necessary and very important for newborns, however, one rule I always stick to is that ‘I never wake a sleeping baby at night unless there is a medical reason to do so!’ I advise waking your baby during the day to keep up with following the daytime feed/sleep schedule, but I never wake them at night and only feed during the hours of darkness when they wake and want to be fed.

Feeding Problems

Sadly, feeding problems are very common and can range from a difficulty to latch, falling asleep during the feed and seem impossible to wake, staying attached to the boob for hours, only taking small amounts or very quick breastfeeds, sore & cracked nipples, crying during or after feeds, only wanting to feed at night and refusing daytime feeds, pulling off the boob and ‘woodpeckering’ at the breast, squirming and grunting when being fed and rarely seems relaxed,  spitting up mouthfuls of milk or vomiting whole feeds – to even a complete feed refusal which can occur on either breast or bottle!

Sadly, for many mothers who struggle with breastfeeding, it’s often either your own boobs, nipples, body or stress levels that are blamed for the problematical feeding and very few health professionals will examine the baby properly and can fail to recognise that the baby indeed has tongue-tie or has oral thrush, for example. Or perhaps baby is suffering with some degree of acid reflux which is preventing an easy latching or effective feeding action.

Like wise, when a baby is being bottle fed, not feeding easily or seeming comfortable, most parents will try every bottle, teat or imitation breast in a bid to get their bottle-refusing baby to take a feed without realising there is a likely underlying cause.

There is always a reason why the problems listed above can occur and we just have to find out the cause! It can be fairly straightforward to work out what is wrong and find the solution, but often it can be quite tricky to try and deduce what is causing the issue as there may well be more than one cause, but I will try to address them here, give probable reasons and then tips on how to find a resolution.

Short feeds /snack feeding – as mentioned in the sleep section, an overtired baby will often cry and can really protest at bedtime as they are just too tired to feed. Many parents have been completely amazed to see that many feeding issues and feed refusals/aversions have been resolved simply by getting the baby sleeping better. Typically, if the baby is too tired, they might only feed for a short while before falling asleep but then wake just 30 to 45 minutes later and cry again as they are still hungry but again will only feed for a short while and so the situation repeats.

Tongue-tie, either anterior or posterior is known as ankyloglossia and occurs when the frenulum (the tissue connecting the tongue to the floor of the mouth) is shorter or tighter than it should be, potentially restricting tongue movement and causing feeding difficulties. This restriction of tongue movement can make it difficult for babies to breastfeed or bottle-feed, leading to struggles with latching, milk intake, and potentially weight gain and it is often a contributory factor in an acid reflux problem.

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Signs and symptoms of a potential tongue or lip tie can show as;

• Difficulty latching or staying attached to the breast or bottle teat

• Feeding for a long time and needing frequent feeds

• Dribbling a lot during feeds

• Coughing, choking, or making clicking noises while feeding

• Taking only a small amount of milk at each feed

• Losing weight or struggling to put on weight

• Tongue that appears notched or heart-shaped when stuck out

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If you suspect a tongue-tie then it’s best to get a professional to carry out an assessment and you can find a list of registered experts on The Association of Tongue-tie Practitioners.

Tension or muscle tightening in the jaw and neck can affect the whole sucking and swallowing mechanism and make feeding quite difficult, with many babies developing a preferred side to feed from or cry when put into a feeding position as it causes discomfort in their already, tightened neck muscle. This is called torticollis and also known as "wry neck.” It is a condition where the baby's head tilts to one side and the chin points in the opposite direction due to a stiff or tight neck muscle, often the sternocleidomastoid muscle. Torticollis is basically a stiff neck that makes it hard or painful to turn your head. In older kids and adults, it can happen after sleeping in a funny position. Babies can be born with a stiff neck from being squashed in a certain position in the womb and most don’t feel any pain from it. Others though, can quickly develop a form of torticollis due to back sleeping and keeping their heads in one position, which also creates the plagiocephaly flat head syndrome. The problem usually gets better with simple position changes or stretching exercises done at home or the most effective way to redress the tightening and flattening of the head is by changing the sleep position. (Please see the sleep section to understand Alison’s ethos on tummy sleeping.) Seeing a cranial osteopath can also help relive some of the tension.

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Inverted or flat nipples, previous breast surgery or nipple realignment can also make breastfeeding quite tricky. In many cases nipple shields may help and allow the baby to latch more easily or try different feeding positions.

Nipple thrush can develop in some women, often due to having to take antibiotics during or after birth and the thrush can sting and be quite painful. It can also transfer into the baby’s mouth but using a nipple shield can create a barrier to prevent the constant cross-contamination whilst you treat the thrush with appropriate medication from the GP.

Oral thrush in a baby can develop in the baby’s mouth and cause problems with feeding as the baby’s mouth will become sore and sting due to the build up of thrush and therefore make baby reluctant to feed or only feed for a short time before they stop and refuse anymore. It can be caused from an exposure to antibiotics either given to mum during pregnancy, birth or whilst breastfeeding or given to baby directly and the it is a well know fact that antibiotics, whilst killing a bacterial infection also can leave an imbalance of gut flora which allows bad bacteria to multiply and grow as a form of thrush, often showing in the baby’s mouth. Many professionals will only recognise thrush as defined white spots ion the baby’s, gums or inside of the cheeks, but it can also show as white, yellow or grey patches on the roof of the mouth and the gum line where teeth will eventually grow. In fact, many people think they are looking at the bone in the mouth where teeth will come from, but the inside of a baby’s mouth should really just be pink/red, tongue/gum colour and if you see what looks like ‘bone’ or a white coating on the tongue that doesn’t wipe away then it’s likely to be thrush. Thrush can also develop in babies that have any degree of acid reflux due to the contents of the stomach constantly rising up in the oesophagus The stomach contents – known as refluxate, also contains much of the gut bacteria and bacteria likes a warm, moist area in which to grow – namely, the oral cavity. The bacteria mixes with saliva and then settles in mouth causing thrush to grow, which can build up to the point that it makes feeding very painful. This needs to be treated with Nystatin oral suspension and/or daktarin gel, prescribed by a doctor.

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Laryngomalacia or ‘floppy larynx’ is a congenital softening of the tissues of the larynx (voice box) above the vocal cords. This is the most common cause of noisy breathing in infancy and the baby can make odd noises when trying to feed. The laryngeal structure is malformed and floppy, causing the tissues to fall over the airway opening and partially block it. Basically, a baby should be able to breathe air into the windpipe at the same time a sucking and swallowing milk down into the food pipe, but when they have a floppy larynx it allows a crossing of the air into the food pipe and milk splashes into the windpipe. This can make feeding quite tricky and baby will often be very noisy whilst feeding, make gulping noises as air is swallowed and often pull of either the boob or a bottle and cough, splutter and almost choke! Using a thickened milk can really help with this as obviously the thinner the milk the more easily it splashes around and when thick it is easier to maintain a steady flow and help prevent the choking that can occur.

Acid reflux can really cause quite a lot of feeding issues and because it induces so many different symptoms and responses in individual babies it can make it very difficult to determine whether it is a reflux issue or not. Dietary related intolerances and full-blown milk / lactose allergies will also make feeding pretty difficult and if you suspect any of these issues then please refer to the ‘reflux door’ to find out more.

What you can do

Having researched and read all the information about feeding and feeding problems that I give in booth my books, through the podcasts I’ve recorded and scrolling though my Instagram , I would hope you now might have some idea of what might be causing your little one’s feeding issues.

Often, all that is needed is to work out why there is a feeding issue, which then makes it easier to address the underlying problem and bring resolution.

It might be simply ‘bad habits’ have been learned and they need to be ‘un-learned’.

It could be you nee use nipple shields to help with the latch or express some milk and feed from a bottle.

It might be your little one simply needs some extra help in learning to feed and seeing a lactation consultant might help.

A baby that is not sleeping well and is therefore overtired, will often not feed well and maybe you need to promote better sleep associations for your little one by following the advice in my book.

It’s possible that you’re little one is simply unable to feed easily due to an underlying digestive discomfort, acid reflux and or milk/food intolerance or allergy issue.

Whatever the problem, it can be changed, fixed, rectified and your baby’’s feeding. Experience can turn into a positive one.

• You can read both my books.

• You can listen to my webinar recordings and watch my videos on YouTube.

• You can listen to the podcasts Alison has recorded on sleep and reflux.

• You can scrutinise my Instagram page and replay many of my ‘live’ posts and Q and A sessions.

• You can seek direct help from Alison through an online consultation.

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There is definitely a light at the end of the tunnel and you, like thousands of parents before you, can and will promote and establish positive feeding habits for your baby, toddler or child.

Good Luck!