Review: Why Mothers’ Medication Matters

Author: Wendy Jones

Publisher: Pinter and Martin

ISBN: 978-1-78066-585-6

Why mothers medication matters review

“There is evidence out there for the vast majority of drugs that should enable mothers to continue breastfeeding while obtaining the medical treatment they need… none of this is difficult. If we value breastmilk for its wonderful properties, practice evidence-based medicine, and respect mothers, we could transform women’s experience of seeking treatment.” Wendy Jones “Why Mothers’ Medication Matters”

A while ago, I had the privilege of reviewing this wonderful book, my review has now been published, so I am excited to be able to share it with you all here.

Wendy Jones is an inspiring figure in the field of lactation. A massively experienced Breastfeeding Supporter for the Breastfeeding Network and a qualified pharmacist; Wendy has tirelessly worked to help parents who breastfeed. Any breastfeeding supporter or counsellor should be aware of the brilliant “Drugs in Breastmilk Information Service”. This wonderful resource tirelessly gives information to lactating people about medications they may need to take during breastfeeding.

Prescribing medication for breastfeeding parents can be difficult for health professionals yet parents often need medication, whether it is short-term use of painkillers, antidepressants, or drugs to treat chronic conditions. Women are often given misinformation about what medications they can and cannot take.

In this book, Wendy Jones sets out to give mothers and health professionals information they need to make decisions about medication and to reassure fears that parents may have about adverse effects on babies of drugs passing through breastmilk.

Wendy Jones opens her book with an introduction to her subject, providing heartstring tugging examples of why better support around medications and breastfeeding really matters. Putting a human face and empathy on what could easily be quite a dry subject matter is something she continues to do throughout the book. The case studies are really moving, covering examples like postpartum women on a maternity ward being told they could only take paracetamol while recovering from c-sections or episiotomies and mothers dealing with weaning decisions after being given a cancer diagnosis, among many others.

Further chapters explore topics like why prescribing for lactating people can be so fraught with confusion, drugs during pregnancy and birth and their impact, treatment of chronic health conditions and depression as well as looking at ‘lifestyle’ drugs including alcohol and recreational drugs. The chapter on over-medicalisation of common issues like infant reflux, CMPA and colic are a must read for any peer supporter, particularly those among us who provide support on online forums where suggestions of reflux and CMPA are common. Some of the facts and studies Wendy discusses are truly eye-opening and the book is well referenced with a focus on remaining evidence-based.

why mothers medication matters book

Wendy ends her book with a discussion about where women can go on to get support around prescribing issues, and talking about milk donation. The final chapters are a heartfelt overview of the differences between breastmilk and formula milk and why we shouldn’t be assuming “formula milk is fine” if a lactating parent needs medication and her conclusions about why medication matters for breastfeeding parents.

This book is about so much more than medication; it is a wide-ranging overview of issues breastfeeding parents may face dealing with their healthcare. The ideal length and level of detail for a breastfeeding peer supporter, as well as a good introduction to the topic for training breastfeeding counsellors and health professionals I would whole-heartedly recommend “Why Mothers’ Medication Matters to anyone.

Buy “Why Mothers’ Medication Matters” by Wendy Jones and other excellent titles from the ‘Why it Matters’ range, over at Pinter & Martin

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*I draw no income from my writing, my blog features no ads, be reassured links given to purchase this title are completely independent and not affiliate! #adfree

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The 12 Days of Boobin’! Christmas Tips for Breastfeeding Mums

Enjoying the holidays, and breastfeeding your baby are not mutually exclusive

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It’s beginning to look a lot like Christmas! Soon many of us will be spending time with friends and family, and while we may look forward to the holiday, some may find the idea of breastfeeding over the Christmas break brings up a few anxieties.

First of all, in my view, there is one brilliant advantage to breastfeeding over the Christmas period, You have the perfect excuse to slip away and get some quiet time (hopefully with a box of choccies to keep you company) because “baby feeds better without distractions”. Another bonus- you also have the perfect excuse for turning down events you don’t really want to go to. Maybe that’s just me. I am happiest in PJs with a glass of wine.

Other people may prefer to drink their wine wearing their party gear, and worry that this breastfeeding malarkey means they are going to miss out on all the fun.

I know often concerns revolve around family members, particularly breastfeeding in front of them. Some people worry that Auntie Lynda will go on (and on) about how she thinks the baby should be on bottles/formula/Christmas dinner and all the trimmings by now.

christmas breastfeeding meme

So here are a few of my thoughts on how to make life easier as a breastfeeding mum over the Christmas holidays.

Baby Wearing

Worried about baby being passed around like the tin of Roses, during peak cold and flu season? Wear your baby! You will be surprised how much less well-meaning relatives will demand a cuddle when they see a baby all cosy in a sling.

Wearing Your Baby has the added advantage of keeping them close, which leads me onto my next point…

Expect Baby to Change Their Feeding Habits

Often over holiday periods, things are busier and babies are more stimulated. It is easy to miss feeding cues, or breastfeeds. During long journeys, a baby might sleep more than usual. Lights and music and new people often mean distracted babies that don’t feed as well or cue for a feed less. Quite often babies are being passed around for cuddles. Sometimes Uncle Gary might decide he can soothe the crying baby himself rather than passing them back to Mum. Sometimes mum is distracted entertaining friends and family or making food.

Building in times during the day to breastfeed might be a helpful way to combat this, or alternatively see above; Wear baby more so they stay close! If you are undertaking long journeys build in some rest breaks to allow time for boobin’.

Alternatively, baby might be out of sorts, cranky, overstimulated and want boob ALL THE TIME, also normal! In fact, in these situations, nursing can be a godsend. It is often much easier to calm a baby with a breastfeed.

Nursing also gives you an excuse to get out of peeling the sprouts or doing the cooking. I may or may not have personally used this as an excuse to sit on my bum eating Christmas cake (“It’s for the baby!”).

Make time to express if you are apart from your baby

If you are away to a party, or out for the day Christmas shopping you may want to build in some time to express. This is more important the younger your baby is. Not removing milk from your breasts may lead to engorgement and blocked ducts, and eventually lowered milk supply.

If you do find you develop some blocked ducts or engorgement, following self-care is important, this is great information from the Breastfeeding Network.

If your baby is having bottles while apart from you, making sure responsive feeding methods are used can be helpful. Click the link for a video demo.

Alcohol and breastfeeding

Most sources suggest a moderate intake of alcohol while breastfeeding is fine. You can still have a glass of wine or two and breastfeed. However -and this would be true however you feed- as a parent you need to be careful you are still fit to care for a small child. Bedsharing after drinking alcohol is also a no-no. If you fancy a blowout, expressing some milk in advance might be helpful, as well as enlisting a babysitter.

Some useful links:

Pass the stuffing, please!

Christmas is often a time when the food police come out to tell you that you can’t eat your veggies because “baby might get windy” or that you need to avoid the stuffing or after-dinner mints because the sage or peppermint might “lower your milk supply”.

The good news is, there is no evidence-based research showing foods themselves will make your baby gassy (unless they already have a known allergy or intolerance to a certain food), and you would need to be eating absolutely VAST quantities of stuffing/mint for there to be any effect on your milk supply, so tuck in, and don’t worry.

In case you overdo things, many indigestion remedies are safe to take while breastfeeding. All on the link there. You’re welcome.

Don’t feed the baby!

baby food christmas breastfeeding

I’m not talking about breastfeeding here of course! However, older babies that have solids may be filled up with Christmas ‘treats’. It can be helpful to put aside some time for boobin’ toddlers too unless you are planning on weaning.

Sometimes, you may need to watch out for relatives trying to feed younger babies solids. Remember, some relatives may be from a generation where babies were given solids much younger than they are now, and may have no idea this isn’t OK. If you suspect this might happen, it might be helpful to be upfront; for example saying something along the lines of “It is important to me that the baby is closer to six months before giving them food, the research now suggests this is best for babies, and this is also what our health visitors have recommended”.

You may even want to think about ‘recruiting’ any prime suspect onside, have them “watch out for anyone who might give baby solids accidentally”. It is amazing how well giving people some trust and responsibility can work in your favour.

If well-meaning relatives are convinced giving baby Christmas dinner is the key to a full nights sleep- show them this!

Dealing with criticism

Make sure people know that you are proud of your breastfeeding relationship and that you see it as a good thing. If your relatives don’t see this as a chore they can relieve you of, you might find their attitude changes.

If you feel your choice to breastfeed is questioned, or that those surrounding you aren’t supportive, the “pass the bean dip” approach can be useful: https://twolittlegrasshoppers.com/tag/the-bean-dip-method/

If you have an older nursling, and you are worried about people questioning why you are “still breastfeeding”, Kellymom has some useful suggestions here too: https://kellymom.com/ages/older-infant/criticism/

Family members are generally well-meaning. They may be basing their ideas on outdated things they have been told. They might be open to learning about how recommendations have changed if you approach the subject gently.

Remember, you are the advocate for your baby/toddler/child. They cannot stand up for what they want. Give yourself permission to be unashamed. You do not have to answer to anyone else about your feeding relationship. Your boobs, your baby, your choice.

christmas babies

Choose clothing that provides easy boob access

Worried about feeding in front of family members? Consider practicing in front of a mirror, seeing how little is exposed might reassure you a little, especially if you use the “one up, one down” technique.

If you don’t feel comfortable getting your boobs out in front of family (maybe you have an inappropriate drunken uncle or two), the muslin trick is an inexpensive tip. Using a large muslin, tie one corner to the strap of your bra, and use the loose cloth to cover up any exposed areas. Or employ your partner on distraction duty to get uncle Roy into the kitchen for another sherry if that’s what makes you feel happier. Or, if like me you like a bit of a breather, use it as an excuse to get a bit of peace and quiet. When it comes to feeding, it is about what makes you feel more comfortable first and foremost.

If you need a party outfit or even some new fashion ideas for breastfeeding friendly clothing, why not join Can I Breastfeed In It? They are a UK facebook group, which have fantastic tips and ideas for feeding fashion (and they even have a selling page so you can grab yourself a bargain too).

christmas with a baby

So there you have it, some helpful tips for enjoying Christmas while continuing to breastfeed. Is there anything you think I have missed? What are your tips for breastfeeding over the holidays?

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Does Big Business Really Want to Help you Breastfeed?

When advice and help isn’t all that it seems

Breastfeeding Support

Boots, it seems, want to help you to breastfeed. They now produce a leaflet which you can pick up in store, and have a section on their website devoted to it. I see photos of this leaflet shared on breastfeeding groups, usually with the caption “Found this in Boots, isn’t it brilliant they have this?”

As someone who volunteers in infant feeding, this sort of thing sets off my cynicism alarm. Retailers are in business to sell you things, altruism usually isn’t high on their list of priorities.

hmmm breastfeeding

Confession time: I’m going to be picking on Boots a bit here. They are one example in truth, they certainly aren’t the only brand to do this sort of thing. Other companies also like to give out information about breastfeeding. Infant formula or bottle companies, for example, often do this too.

Let’s dissect the website information on Boots.com a little and see what we find.

The first sections: “Why is Breastfeeding Good For Me?”

Boots have chosen not to linger on the well-documented child health reasons to breastfeed, with a ‘blink and you’d miss it’ section, but they do have time to mention our appearance.

“There are lots of really good reasons to breastfeed, including benefits to mum. These include: It helps you to regain your old figure“.

Here we are, in 2018, with Boots suggesting weight loss is a top three reason to breastfeed. Talking about our body image before they mention the reduced risk of ovarian and breast cancers. I’ll leave you to think about that.

breastfeeding what

“How Do I Start Breastfeeding?”

Then we come to the next section “How do I start Breastfeeding”, where Boots have some advice from Clare Byam-Cook, a controversial figure* in breastfeeding support due to her lack of any breastfeeding specific qualification.

“Hold the baby close, facing the breast, with its shoulders and body in a straight line and it’s neck supported but the head free to extend (use a feeding pillow if more comfortable), offer your breast to the baby…”

ouch breastfeeding hurts

I am wincing reading that description. “Facing the breast” implies a “mouth to nipple” position to me, something most breastfeeding professionals will tell you is a recipe for a painful latch. This is a good demonstration as to why that is (thanks to the Empowered Birth Company for the video). It also says “head free to extend”, a clearer phrase I feel would be: “head free to tilt back”. Thirdly, “Offer your breast to baby” conjures images of a mother holding her breast and smooshing it into baby’s face, this would likely encourage an uncomfortable feed for the mother in an unsustainable position. Finally, we see them suggest “use a feeding pillow if more comfortable”, with a link taking you a range of pillows. I have nothing against pillows as long as they work for the mother, but this should be your first clue this isn’t a selfless exercise on behalf of a retailer.

“Common breastfeeding niggles solved”

The second passage is “Common breastfeeding niggles solved”. If you used the first section to give you information on how to attach your baby, you may need the information here.

My first problem with this section is it is so negative, it almost seems to scream “Breastfeeding will cause you excruciating pain!”

I am not going to sit here and tell you breastfeeding shouldn’t hurt. That would dismiss the lived experience of many mothers. Breastfeeding has a learning curve, and getting to grips with attaching a baby to the breast when hardly any of us see it on a regular basis can be hard. Sometimes, while establishing breastfeeding, mothers experience pain. What I would say is, if this is you, don’t feel like you have to wait for things to “toughen up”, or that the answer is expensive nipple creams. The research just doesn’t support that. A bit of support with attachment or a tweak may make it feel better.

I do question why, in a limited space, a large portion of this leaflet is devoted to pain? Surely some diagrams of attaching a baby instead, might help their mothers prevent some of these issues in the first place?

Well, reading further it becomes clear. They can sell you stuff to help with pain. We see links to nipple cream and a range of nipple shields. I have no doubt nipple shields are useful for some mothers, I know for some mothers, they kept them breastfeeding. However, they can be an absolute faff to use all the time, especially in public. Babies can get overly reliant on them. They also don’t solve underlying issues the mother or baby may have.

Moving on to “engorged breasts”. Here, we see suggestions that using breast-pumps and bottle feeding until the engorgement subsides is a good course of action. This is the section I find most shocking.

Engorgement is most common in the first days after birth. So why encourage parents to pump and bottle feed instead of using simple techniques to soothe and resolve engorgement, such as hand expressing, nipple stimulation and cool packs? Pumping is known to overstimulate supply in the early days (parents are usually advised not to pump unless necessary in the first few weeks). Using a bottle instead means possibly going longer between breastfeeds with engorged breasts! This is not a good thing for breast health or milk supply. Not everyone can effectively remove milk from their breasts with a pump, at least, not as well as their baby. No mention of how early introduction of bottles may be detrimental to breastfeeding in some cases and that the Baby-Friendly Hospital Initiative advises against bottles and teats in early breastfeeding.

Then we come on to the last “common breastfeeding niggle”, mastitis. Hardly a ‘niggle’, is it? Mum is instructed to go straight to the GP, sensible. A bizarre choice though, I feel, to spend so much time encouraging pumping and bottle feeding through engorgement, but offering no well-known self-care methods for clearing a blocked duct.

“Do I have to breastfeed all through the night?” & Other Anxieties

Not content with suggesting you use a pump once, Boots move on to trying to sell you them again (with handy links to their range of pumps). This time it is to get dad involved in night feeds while mum sleeps. Now, I know this is a strategy some parents will try, and if it worked for your family, great. However, they have omitted the facts that:

  • In the early months of breastfeeding, a mother will usually need to pump around the same time in the night, in order to avoid engorged breasts, blocked ducts, and mastitis.
  • Quite often a baby will drain the bottle, but still want boob, because breastfeeding is not all about the milk.
  • Night feedings can be important in supporting milk supply.

Then there is a section talking about new mothers breastfeeding in public. It’s OK though. Boots have a cover for that they can sell you. Oh and don’t forget about all the leaking. Boots can sell you stuff for that too.

This all seems to me, rather than helpful information, to be a fabulous example of how brands who sell you formula, pumps, bottles, and teats may complicate, or even sabotage breastfeeding, knowingly or unknowingly, in their quest to sell you ‘stuff’.

“What Can I Eat and Drink While Breastfeeding?”

So we come to the final section. The way this is written reads as if a mother needs to be hyper-aware of her diet: “good nutrition is more important than ever”. I find this paragraph pretty undermining. A good diet is important for everyone, it is not a necessity for breastfeeding. If it was I would be worried about my own child, since my early breastfeeding diet was 70% cake, 30% toast. Breast-milk is robust, and will in nearly all cases, still be the healthiest option for your child, (even on a 70/30 cake/toast diet). A mother would need to be malnourished for her breast-milk to be impacted.

“The occasional sweet treat is fine too- goodness knows you deserve a slice of cake”: Wow. Breastfeeding mothers of the world, quite frankly, if you want the whole bloody cake, eat it. Nobody needs permission from a shop to eat cake!

eating cake

Finally, the article ends with some links showing us more bottles, talking about pumps and baby food (we haven’t even managed to breastfeed yet and Boots are talking to you about baby food? Seriously?) Sadly, no links to any organisation which may help you establish breastfeeding (you can find these at the end of this blog).

Companies like Boots may want you to start breastfeeding. Shops want you to buy stuff for breastfeeding from them. Let’s face it, this is how they make money. I imagine they want to sell you some expensive pumps, nipple creams, covers, bottles, and shields. Unfortunately for some, following this sort of information may mean their breastfeeding journey is over sooner than they hoped.

Luckily, if you do have to stop breastfeeding, Boots have a large selection of infant formula they can sell you, often on code-breaking special displays.

I do wonder what is in it for companies, to suggest things like mothers need to follow a healthy diet to breastfeed? Or to give out information which might make breastfeeding painful for a mother? Or lower milk supply? Why devote so much time to suggesting that breastfeeding usually comes with pain and problems?

I can’t answer these questions for Boots or any other retailer. I don’t explicitly know their intentions. I do think we need to be careful where we choose to get our help from, and that the first question we should ask ourselves when a retailer tries to give advice is- “What’s in it for them?”

why breastfeeding

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This is an opinion piece, and all opinions expressed here are my own.

*For an example of said controversy Byam-Cook’s last appearance on ITV sparked a petition for them to use qualified breastfeeding experts in future. The petition was signed by nearly 5000 people.

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Breastfeeding a Baby with Reflux

How to get the support you need

As a breastfeeding support volunteer, I generally avoid sharing my own story as I prefer to focus on the parent in front of me but bear with me because my story is relevant to why this blog has been written and it is one of the reasons I am so passionate about infant feeding support.

My daughter was a “reflux baby” and she was treated with anti-acid medication for a long while, so when I talk to you about reflux, believe me, I know it, and I know how hard it can be.

I joke that when A was born she cried straight away and didn’t stop! My poor baby spent her first weeks wailing, coughing, writhing and red in the face, pretty much all day and most of the night. I felt trapped in the house. I remember feeling so desperate I wanted to cry when the health visitor left me in the house alone, with a baby who did nothing but scream at me. It was a pretty awful introduction to parenting. At 5 weeks old, she was diagnosed with reflux and we were prescribed infant Gaviscon by our GP. Like many parents, I took the prescription gratefully, and the numerous prescriptions that followed. It was the beginning of a journey which didn’t resolve for another twenty months.

What is problem reflux, or GORD?

Reflux simply means “a flowing back” and many babies spit up and vomit without being bothered by it at all. Problem reflux (GORD) has a variety of symptoms, which you can read more about here. Certain conditions can contribute to reflux, for example, it is more common in babies who are premature or babies who have other health conditions.

A baby who is spitting up a lot without distress or without other problematic symptoms it is unlikely to have reflux disease. If your baby is crying mostly during the evening hours yet content most of the day, they may be experiencing normal baby evening fussies.  So while these things can be alarming for parents (and messy!), it is important to be aware of the difference between what is normal and what is “reflux disease”.

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Mums who worry their baby has reflux often say to me, “I think it’s reflux because he just won’t let me put him down in the cot! I think he hates being on his back.” Here’s a secret which might help you feel better: most newborn babies hate being put down and prefer to be held. That’s normal baby behaviour.

Many medications used in the treatment of reflux disease are used “off-label”, they weren’t originally developed with infants in mind, and there are some studies which raise concerns about their use, especially over long periods of time.

If you’ve read all of the above and you are still with me at this point, I’m sorry. Dealing with reflux is a really distressing and difficult thing to cope with, and I know how it can feel relentless and never-ending. Here is some more information for you to consider.

Some common causes of reflux in breastfed babies

(This is not an exhaustive list!)

1. A shallow latch, or otherwise disorganised feeding

If your baby is not attached deeply to the breast or has a disorganised suckle they may take in more air as they feed. When air is expelled it can result in spitting up. Trapped air can also be very painful for the baby. This can result in reflux symptoms such as back arching, crying, and hiccoughs. Babies with shallow attachment may also struggle to transfer milk, leading to a fussy baby who wants to breastfeed 24/7.

This is why NICE recommends a breastfeeding assessment first as part of its quality standards: “A breastfeeding assessment should be the first step in supporting parents and carers with managing frequent regurgitation of feeds associated with marked distress. Correcting the breastfeeding technique for breastfed infants (for example, positioning and attachment) can improve or eliminate the symptoms.”

Sorting out a shallow latch can be as simple as doing a little work on positioning and attachment. Some babies with shallow attachment may have anatomical differences which hinder deeper attachment, for example, tongue tie or a high arch palate.

This is a great resource to help you with attaching your baby.

2. Breastfeeding management

In the UK we have a cultural expectation of having a few hours between feeds and this impacts on how we feed and treat our babies. Instead of smaller, frequent feeds sometimes we encourage our babies to “go longer” and take in more milk, less often. Some babies cope with this just fine but others may struggle, with large volumes of milk hitting the stomach and then coming straight back up. Some babies may protest- loudly!- about having their feeds delayed. So responsive feeding, and watching our babies instead of the clock may help. More about responsive feeding.

Our babies also spend a lot of time on their backs, which is no help for reflux. We commonly feed babies in the cradle hold, and then they are placed on their backs in Moses baskets and in prams. However, our babies evolved to be held. You cannot cuddle a baby too much. Simply carrying our infants more and experimenting with other feeding positions can go a long way towards helping babies with a tendency to reflux feeds.

3. Food intolerances and allergies

If your child has been properly diagnosed with GORD, and you’ve had a breastfeeding assessment which found no problems, it’s interesting to note research suggests a significant link between food allergy particularly CPMA. Some studies show a link of up to around 40%. CMPA is discussed in the NICE guidelines as one differential diagnosis for GORD.

Does that mean all parents with reflux babies should immediately be told to cut out dairy products? No, I don’t think so.

As you can see above, there are other things to explore before taking drastic steps, unless your child is exhibiting other clear symptoms of cows’ milk protein allergy. If you want to learn more about CMPA you can read my blog, or the BfN factsheet might be helpful.

Addressing attachment, examining the oral anatomy and considering breastfeeding management first is usually quicker and easier than making big changes to your diet. It is far more likely a more commonplace issue is the problem and it can take 4-6 weeks for both mum and baby to be totally free of dairy protein. Looking at the basics first is really important.

If you are concerned about CMPA it’s also a good idea to speak with a GP or health visitor as you may need support from a dietician.

4. More great reading on the management of reflux and other potential causes here.

You’ve had a reflux diagnosis for your breastfed baby. What now?

We’ve talked about the NICE guidelines above and so we know a breastfeeding assessment may be helpful. It’s worth making sure the person who does the assessment is skilled and experienced in doing this, so you probably want to see a breastfeeding counselor, La Leche League leader or IBCLC.

It might be a good idea to make sure you see somebody who is familiar with tongue tie, just in case this is a factor.

The great thing about doing this is that an IBCLC can help you look at the full picture and consider all the angles such as:

  • Attachment and positioning.
  • Your baby’s suck/swallow/breathe pattern.
  • If there signs of oversupply or milk transfer problems.
  • Indications or risk factors for allergies.

In some cases, after doing all of this, medications can be appropriate and necessary. A pediatrician can discuss with you the risks and benefits so you can make an informed choice about the best way forward.

Coping with a breastfed baby with reflux

I’ve made this into a meme, for easy sharing and saving. Basically, “Think Boobs!” (I know, I’m a cheeseball, but I couldn’t resist):

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Reflux does generally pass and get easier with time. With some help and support, it may pass more quickly. Asking the right questions is the first step to moving forward.
How did my own story end? Well, after getting some support from an IBCLC, my daughter was diagnosed with a cows’ milk protein allergy. We finally came off all our medications and beat the demon that is reflux. She still didn’t sleep in her cot, but that’s okay – I liked the cuddles ❤.

This blog is not intended to replace the advice of a medical professional, simply to give information for further discussion. Please make sure any concerns about your baby are discussed with a medical professional or a health visitor.

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Further reading:

GPIFN: https://gpifn.org.uk/reflux-and-gord/

Kellymom: https://kellymom.com/hot-topics/reflux/

*This blog has been substantially updated from an article I wrote for Breastfeeding Support and Information UK‘s blog “Through the Eyes of a Breastfeeding Support Group” if you like you can still read the original here *

Before You Tell a Breastfeeding Mother to Cut Out Dairy, Consider THIS

Why supporting a breastfeeding parent with their diet is really important if their child has CMPA

giving up milk

I’ve always felt we need to tread very carefully around suggesting dairy elimination for mothers before basic breastfeeding issues have been worked out, and recently I have had personal experience of why it is so important to be mindful.
I don’t consume any milk products anymore, because my daughter has CMPA and I am currently breastfeeding her. I was keen to keep breastfeeding. Breastfeeding a baby with CMPA is really important, it avoids many of the pitfalls of using dairy free formula (like the bad taste), and it protects and safeguards your child’s nutrition. Mothers should absolutely be supported to do this if they need to. At first, I was amazed at how good I felt when I cut out milk (and I still believe it doesn’t agree with me).
2 years in, I’ve recently discovered the downside. I’m currently taking v high strength vitamin D, calcium and omega 3 oils because despite spending so much of my time supporting others and knowing all the recommendations to supplement and be careful with diet, my levels got low, really low. I actually started to feel quite unwell, mentally and physically.
You see, lots of people like to say dismissively “Pfft, we don’t actually NEED milk”, and this is true, however, our bodies do need the nutrients within it. Fats, Calcium, Iodine, Vitamin D. Some milk also has Omega 3 added to it. Non-dairy milk and dairy substitutes often contain lots of Omega 6 (sunflower oils, nut oils etc) but we need a balance of both Omega 6 and Omega 3 at the very least, and while following a non-dairy diet, if you aren’t careful it can be easy to throw this out of balance. Omega 3 is thought to play an important part in reducing inflammation in the body, inflammation is linked to things like joint pain, chronic illness, weight gain, and depression.
Removing dairy from the diet is a huge dietary change, we need to be mindful of that. In my opinion, breastfeeding parents who need to avoid dairy should be offered support with their diet, rather giving them a blanket recommendation to supplement (NICE guidelines), however, unfortunately, the guidance only discusses dietetic input in regards to the child. I feel this is a huge oversight, when treating breastfeeding parents and children it is surely better to treat the dyad, but that aside, things that can help are:
Sometimes, depending on your diet, considered supplementation may be needed.
It is easy to make light of the impact milk elimination might have on a mother’s body, or to forget about this ourselves, especially when we are busy parents whose primary focus is our child. It is easy to let nutrition slip when you are tired and touched out anyway, let alone if you are avoiding a major food group. So if you have an allergic child, I am sending you so much love, I know it is tough! And what you are doing is so important for your babies, and so wonderful, just make sure to take care of you at the same time.
More information and sources:

10 Tips for Seeking Breastfeeding Support in Online Groups

Navigating the world of online groups and forums

woman-smartphone-girl-technology

Lots of people feel passionate about the world of online breastfeeding support. It’s easy to recognise the value. I’m a member of several groups myself, I’ve been an admin in an online breastfeeding support group. Mother to mother support is so important. Many of us have found groups immensely helpful. There’s no doubt for me these online communities save breastfeeding relationships in a world where breastfeeding support groups, and even other breastfeeding parents can sometimes be thin on the ground.

The admin teams of good online support groups are amazing too, they give up so much of their time, for free, to support women. It is an incredibly generous thing to do.

An online support group should ideally be a complement to, not instead of, in real life, face to face support. The best groups know this, and you will often see those asking things like “do you have a local breastfeeding support group?” or “have you thought about seeing an IBCLC?”

Online we often don’t have the full picture of what is going on for somebody. Many of us may have also been unknowingly given ‘advice’ which isn’t always evidence-based when it comes to breastfeeding. And when we start to pass that ‘advice’ onwards, that can be a problem.

Examples of commonly heard phrases in online support groups which may be detrimental to another’s feeding journey:

  • “A gain is a gain, don’t worry about the charts- they are based on formula fed babies anyway” (Incorrect, charts in the UK have been based on breastfed babies for years now, and a gain, unfortunately, is not just what’s important, lower than average gains over a consistent period of time = faltering growth and failure to thrive).
  • “Breastfeeding really hurts at the start but just power through!” (Imagine you are a mum with severe nipple damage hearing this).
  • “Just feed, feed, feed” (What happens if that baby isn’t producing enough wet and dirty nappies? Or has faltering growth? Most of the time cluster feeding is normal, but we need to be sure we have the whole picture).
  • “I used formula top ups/bottles/dummies/weaned early and it was fine! No effect on my supply at all!”

So how, as mothers, do we protect our breastfeeding relationship while still making use of the support and information from an online group?

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Identifying a good online breastfeeding support group and making the most of it- 10 tips!

1. If you are seeking breastfeeding support consider the audience. Is this a breastfeeding specific support group? If not, the responses you will get will be wide-ranging and reflect the nature of the group, and not everyone will feel positively about breastfeeding. Are they selling a service, or affiliated with a brand name? If so, consider the information you get might not be impartial. This is particularly true for parenting groups affiliated with infant formula or baby food companies.

2. Ask for evidence if you feel unsure. Never take something at face value, especially if it doesn’t feel ‘right’. There are evidence-based sources out there you can check in with too, a reliable source will be run by a national body like a breastfeeding charity or in some cases a lactation consultant. Alternatively, the national helplines are on hand to talk things through with.

3. Who are the group admins? Are they active? Are there enough of them for the size and activity level of the group? Do you see them addressing misinformation regularly? Importantly- are they nice? Do they treat the members with respect? All of these points are important for keeping groups a positive place to be.

4. If it is a breastfeeding support group, are the admin trained peer supporters or above?  If the admin running the group aren’t trained in breastfeeding it might be wise to be a bit wary, as they may not have the knowledge base to know the good from the bad.

5. Is it a closed group, and do you have to go through a screening process to get into the group? If you are going to discuss intimate details of your life, make sure they don’t let any old random into the group. Some popular parenting websites use an open forum format, where anyone can comment or join in, and the results are searchable and completely open to the public. It is worth considering if that is a safe environment to get breastfeeding information.

6. Do they have group rules? Do they seem well thought out? Are the rules enforced?

7. This might be a controversial point, but it is something I feel is important. If we undermine health care professionals in an open forum we breed distrust among breastfeeding parents when it comes to their healthcare. This, in turn, means we see people disengaging with their healthcare services, and this isn’t always a good thing. Nurses, doctors, dentists, and health visitors can also be participants in the group, seeking breastfeeding support themselves. It’s nice to be nice. So thinking about this point, is the group generally respectful towards health care professionals?

Health care professionals are people who take a lot of responsibility for child health if we aren’t in the consultation we do not know the full picture, and we do not know how what was actually said was interpreted or understood. A good group will ensure the members pass on evidenced-based information without insulting the mother’s health care team, and if they are concerned by the actions of a HCP they will pass on details of the appropriate channels to pursue a complaint.

8. If you have a lactation consultant or are already under the care of a real life breastfeeding specialist, remember they are absolutely best placed to support you effectively. It can be sensible to think twice before you throw out a plan from a professional based on advice you get online. Remember you can always go back to discuss it with the trained person supporting you.

9. What rules are in place about recommending other groups? Some support groups will have recommended groups which they know are safe. If there is a free for all around groups, those groups suggested may not be totally evidenced based. It might be worth asking the admin for their opinion on the groups they prefer.

10. Finally, use normal internet caution within a group. Don’t post identifying information, be cautious with your photos, even with a well-run group, trolls can infiltrate.

Make sure that when you are out there in the big wide internet world of breastfeeding support, you keep yourself safe, and remember you are the advocate for your baby-so if in doubt- check it out with a reputable source or seek out a trained breastfeeding professional.

Breastfeeding helplines and websites

Your health visitor or midwife should know details of local groups in your area, or you can search here for information on your local group.

Helplines

  • National Breastfeeding Helpline – 0300 100 0212
  • Association of Breastfeeding Mothers – 0300 330 5453
  • La Leche League – 0345 120 2918
  • National Childbirth Trust (NCT) – 0300 330 0700

Websites

Colic and Crying Babies

What evidence is there for conventional or complementary colic treatments?

Crying Baby in Brown and Black Hooded Top

A quick skim over most baby advice forums often throws up the same kinds of queries. “My baby is so unsettled – do they have colic?” In response, we often see helpful parents talking about remedies and medicines, which are often easily available over the counter, and discussing what did or didn’t work for them.

Most babies will have periods of crying. Often these ‘witching hours’ coincide with the early evening. This kind of crying tends to peak at around 6-8 weeks and then starts to subside.

Kellymom talks about fussy evenings here: fussy evenings

So what is “colic”?

NHS defines colic as, “Excessive, frequent crying in a baby who appears to be otherwise healthy.” The criteria for colic is often given as more than 3 hours a day, for more than 3 days a week, for more than 3 weeks.

And that is basically it. Colic is simply a ‘medical’ term for a baby who cries a lot, and sadly colic is one of those mysteries of nature; we still don’t actually know what causes it.

Commonly suggested treatments for colic

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Not quite the shelves of Boots the Chemist these days, but when looking for something to help with baby’s colic it can feel like there are a lot of different options people try to sell you! Crying babies are big business. So let’s look at what the evidence says around commonly suggested remedies to treat colic.

Infacol (simethicone) & Dentinox Drops (Dimethicone):

The active ingredient in Infacol is simethicone. It claims to work by helping the little-trapped gas bubbles join into bigger bubbles which your baby can more easily bring up as wind.

What evidence is there that Infacol is effective? Basically – not much!

“But my Doctor/Health Visitor/Midwife recommended I try Infacol?” I often hear parents ask. “Why do they say this if it doesn’t work?”

Well, for the answer to this question, up until 2017 the NICE guidance suggested a one week trial of the orangey stuff. Crucially though, it was not because it worked: “Although studies of simethicone have not provided evidence of benefit in infantile colic … a 1-week trial as a placebo may still be worth a try because … the simple act of being able to give their baby something may help parents cope better with the crying.” (NICE guidance prior to 2017).

It was prescribed or recommended because was suspected to have a placebo effect on the parent.

Since 2017 there has been new guidance in place which says:

“Do not recommend the following management strategies, as there is insufficient good-quality evidence for their use: Simeticone (such as Infacol®) or lactase (such as Colief®) drops.”

There have also been no longer-term studies of the impact of introducing remedies like Infacol into the infantile gut.

Dentinox drops contain an activated version of simethicone called dimethicone. Again, much like Infacol, there is no good evidence that these actually work.

If your health visitor or GP do recommend Infacol or Dentinox to you it may simply be they haven’t yet come across the relatively new guidelines.

Colief (Lactase Drops):

The BfN statement on assessing the evidence for colic treatments shows lactase enzymes like Colief were shown to be largely ineffective.

One small study claimed to show that lactase drops, if mixed with the milk and left for 24 hours before feeding, reduced colic in one randomised trial, but other studies have not shown this. Meanwhile, the positive study was criticised for being small and biased, because it was not independent of industry.

Again, the revised 2017 NICE guidelines have stated that lactase drops should no longer be recommended or perscribed.

Gripe water:

Gripe water is an old-fashioned remedy which has changed substantially in formulation since it was invented. The original ‘Woodward’s Gripe Water’ contained 3.6% alcohol and sugar water! These days the sugar and the alcohol have been removed for obvious reasons, but it is worth thinking about why that original formula may have been effective and therefore why this ‘treatment’ has been passed down through the generations.

A 2000 review found that most of the ingredients in modern gripe water are of little value in relieving discomfort. It is worth bearing in mind that the WHO says receiving any liquid other the breastmilk in the early months can have a detrimental impact on establishing breastfeeding as it can replace breastmilk intake.

Homeopathy or herbal treatments – colic granules e.g. Nelson’s granules, Colocynth Crystals, Fennel Tea, Star Anise:

There is only low-quality evidence to suggest homeopathic and herbal remedies are an effective treatment for colic.  It is also important to consider the possible impact of such treatments on your breastfeeding relationship and on your baby’s developing gut biome. As with gripe water, concerns have been raised about the possibility of these liquids reducing baby’s intake of breast-milk.

Some herbal treatments such as star anise are not recommended, because some studies have indicated they can be harmful to the baby.

Dairy-free diets

At any given time, on any breastfeeding forum, you will see recommendations for parents to cut out dairy (and sometimes soy) from their diet to resolve colic.

There is some limited evidence to suggest a dairy-free or low-allergen diet can help reduce the symptoms of colic, and this is certainly true if your little one has a cows milk protein allergy.

However, it is important to remember that the current evidence for rates of cows’ milk protein allergy in exclusively breastfed babies suggests it affects only a tiny percentage. If you are concerned about this your clinician should take an allergy-focused clinical history- it is a more likely scenario if you or baby’s other parent have any atopic conditions such as eczema, asthma or other allergies.

I cannot stress enough how it’s important not to jump to conclusions and start cutting out food groups without guidance from a dietician and without ruling out other causes of baby’s distress first. Going to see a breastfeeding counsellor might be a good first step.

Probiotics 

An emerging area in the treatment of infant colic is the use of probiotics, particularly ones containing the strain L reuteri.

Over recent years there have been several studies with conflicting outcomes, and a recent meta-analysis concluded that they may help with colic. However, more recent studies have suggested probiotics need to be personally tailored to the individual to be effective. Concerns have also been raised about adding bacterial strains into a baby’s developing gut without having a clear understanding of what the baby’s gut bacteria may or may not be missing. We just do not have any research into the long-term safety of using probiotics in young babies. The good news is if you breastfeed your breastmilk contains the absolute best probiotics for your baby.

We are expanding our knowledge all the time in this area, so it is always worth keeping up to date with the research as things can change quickly! I wrote this blog originally in 2016, and I have updated this section three times now.

Cranial Osteopathy

Research looking at the effects of cranial osteopathy on infants is mixed, with some trials showing a benefit and others showing no benefit when compared with ‘sham’ manipulation.

While some parents will say they found osteopathic treatment useful, unfortunately, the evidence around these therapies is fairly inconclusive and it isn’t available on the NHS. On the positive side, cranial osteopathy is a gentle and non-invasive intervention, it doesn’t involve introducing new things into a baby’s delicate gut, and many parents report their babies to enjoy it.

Baby Massage

Baby massage is another common suggestion for help with colic and if I was recommending any intervention to help with colic, this would be it. In terms of its use as a colic treatment, more research needs to be done as the results have been a mixed bag, however, what has been shown is that baby massage is a great way to promote parent-child bonding. This means, even if it doesn’t help the colic, it will help you to cope with it better. Signing up for a baby massage course has the added advantage of getting you out of the house and talking to other sympathetic parents and making friends. All very positive things for your own mental health. It is also a gentle and non-invasive way to soothe a baby, with the added bonus that it gets all that oxytocin flowing!

Block Feeding

One thing most breastfeeding supporters wish they could stop people recommending willy-nilly is the suggestion that “oversupply” is the cause of a baby’s colic, wind or reflux.

Block feeding – where a mother offers baby the same breast for a set number of hours – is an effective technique used to reduce supply in mothers who have an over-abundance of milk. Where oversupply has been identified by a breastfeeding professional, this may help with an unsettled baby.

However, the problem is that the symptoms of oversupply are remarkably similar to the symptoms of shallow attachment. If the baby isn’t attached to the breast deeply enough, they may struggle to handle the flow and splutter, cough, gag and take in lots of air.

Parents who block feed in this situation may start out with a perfect milk supply for their baby’s needs but end up with a low milk supply, simply because the breasts are not being stimulated enough. If you are concerned about oversupply, your best course of action is to seek out an experienced breastfeeding professional to observe a feed and take things from there.

So what works?

In conclusion, the word on the street from Cochrane is, “At the present time, evidence of the effectiveness of pain-relieving agents for the treatment of infantile colic is sparse and prone to bias. The few available studies included small sample sizes, and most had serious limitations. Benefits, when reported, were inconsistent.”

So, if you think your baby has colic what can you do?

1. Look at breastfeeding management, attachment, and positioning

There is some evidence to suggest that making sure a baby is well positioned during breastfeeding may lead to a reduction in colic-type symptoms. There is also evidence for allowing the baby to finish feeding on the first breast before offering them the second breast. So there’s no need to time feeds per breast, and it’s best not to remove the baby from the breast before they decide they are done themselves.

Sometimes a little chat and some work on attachment and positioning with a peer supporter or breastfeeding counsellor can really help.

2. Find experienced breastfeeding support from a breastfeeding counsellor or IBCLC

If simple adjustments do not help, this is when skilled help to assess your baby feeding can be really useful. A breastfeeding counsellor or IBCLC who is skilled enough to look at baby’s suck/swallow/breathe technique, and who can do an examination of baby’s mouth, will be able to talk to you in detail and may be able to pinpoint some things for you to try.

3. The Comfort Cycle

This is my list for dealing with cranky babies in helpful meme form!

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Even if none of these things work, the action of just doing something can help make you feel better about the situation.

4. Talk to somebody

When you have a baby who is unsettled and cries a lot, it can be incredibly hard. It can really shake your confidence in your ability as a parent and affect how you view your breastfeeding relationship.

Talking to somebody about the situation can go a long way towards helping you feel better about the situation, even if the colic doesn’t improve instantly.

So if your baby has colic, and if you just take one thing away from this blog, remember this too will pass. Remember, you are doing a GREAT JOB. Time is the number one treatment for infant colic, and it is nearly always a cure.

If you are struggling with a crying baby and really need to talk to somebody urgently, the breastfeeding helplines will be happy to talk to you.

This blog is not intended to replace the advice of a medical professional, simply to give information for further discussion. Please make sure if you are concerned about your baby to discuss this with a medical professional or a health visitor.

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*This blog has been substantially updated from an article I wrote for Breastfeeding Support and Information UK‘s blog “Through the Eyes of a Breastfeeding Support Group” if you like you can still read the original here *