Busting Baby Sleep Myths

Whether or not your baby sleeps through the night, remember your success as a parent is defined by so much more.

Without a doubt, sleep deprivation is one of the biggest challenges I have faced to date while raising A. The lowest points were after her twelve week birthday. We went to bed together one evening as normal and instead of the couple of hours I had become used to, she woke up after forty-five minutes. And then forty-five minutes after that. And…well you get the picture. For a long time, she woke very frequently. She was *gasp* a couple of months shy of four before she really consistently slept for most of the night.

I cannot count the hours I spent googling baby sleep. Sleep became an all-consuming topic for me. I read everything. Worried about everything. I was determined to find out WHY my baby would not sleep. I lacked a lot of knowledge about what is normal sleep, not just in babies, but in toddlers and preschoolers. I wasted a lot of time. While we did find some triggers for her frequent waking, some of it was just personality. Miss A is now a bright, inquisitive, smart and curious pre-schooler and sleep, well sleep is boring isn’t it? Her father also gets by happily on less sleep than average. Indeed, some studies have suggested the way our children sleep, may actually be largely genetic.

I really want to say one thing I think a lot of parents need to hear, so listen up. If your baby doesn’t sleep through the night, it is unlikely to be your fault.

Here are some of the most common myths about how and where babies sleep:

Your baby should be sleeping through the night by *insert arbitrary figure here*

A lot of popular information suggests babies should be capable of sleeping through the night from an early age. In reality, instead of talking about “sleeping through the night” we should talk about babies sleeping in ‘consolidated blocks’. In many scientific studies, ‘sleeping through the night’ is defined as sleeping a 5 hour period between midnight and 5am. Not quite the picture parents have in mind! Research has shown huge variance in when babies start to sleep in consolidated blocks and whether they settle themselves, or ‘signal’ (read yell their little heads off) for assistance. We don’t know why there is such a big difference, though many feel the answers lie in the personality of the baby.

BASIS suggests it is completely normal when infants wake frequently for the first year and beyond. Indeed, they say 13% of year old babies, still do not sleep in a consolidated block of 5 hours or more regularly. Gives us a slightly new perspective on those baby sleep books!

Toddlers definitely shouldn’t be waking up at night though right?

Though there seems to be a huge divide about when babies should sleep through the night, it feels like most people are in agreement that toddlers definitely should. However, again, the research doesn’t particularly back this idea up. Studies have shown that toddlers often continue to wake up during the night and need input from their parents, well into the second year of life.

Sarah Ockwell-Smith, someone who has spent an awful lot more time talking in an evidence-based fashion about how children sleep than me, suggests sleeping through is more like a roller coaster, than a linear trajectory. Basically, children are all different, and some may sleep “well” from babyhood, others may well be into their pre-school years before they consistently start to “sleep through”. Both are normal.

Formula or solid food helps babies to sleep better at night

Yeah, I had high hopes for starting solids too. My baby was totally going to sleep through once she was on solid foods! Except she didn’t. Also, formula fed babies still wake up frequently at night, the difference is, you also have to go downstairs and make bottles when they do. When people insist babies fed formula sleep better it is frankly insulting to their hard-working parents, who are up with bottles in the middle of the night. Seriously, it’s not like safe formula prep at 2am is the easy option! I wish we would stop saying that it is. These pervasive myths are by far best addressed by this lovely video from the team at Swansea University (I apologise if the catchy tune gets stuck in your head!):

If you stop feeding your baby at night, you will get more sleep

Sometimes night weaning might be helpful, and sometimes- it might not. This is because advocates of night weaning often forget that night waking is not just about food for babies. Development spurts often play their part. It is particularly common to hear parents asking about night weaning when they are smack in the middle of a leap. This may be absolutely the worst time to attempt night weaning. Your child is waking because they need reassurance, pulling away might actually make things worse or result in a lot of distress. Successful night weaning often depends on whether the child (and the mother) is truly ready.

I gently night weaned my preschooler when she was three. I’ll be honest, at first it made absolutely no difference to her sleep, and in fact, she still wakes up and asks for a cuddle and a drink. So if you are considering night weaning, it might be a good idea to think carefully about how you will feel if sleep does not improve. If your child still wakes up, will night weaning still help you feel more rested? For me, it made quite a lot of difference as I struggled to sleep through night feeds, but could sleep through a cuddle. If you are a mum who finds you can sleep through the night feeds anyway, it may make less difference.

Most gentle parenting and breastfeeding advocates do not suggest night weaning babies under twelve months old. These babies may still need night feeds. Which leads us on to…

A baby no longer needs to breastfeed at night once they have reached a certain age or weight

It is common for people to suggest babies do not “need” night feeds once they are six weeks/six months/double their birth weight etc…

Firstly, can we define ‘need’? Breastfeeding is, as well as a way to satisfy hunger, a relationship. A breastfeed is a cuddle, immunity, reassurance, warmth. How many times a night might you wake and have a sip of water, adjust your blankets, reach out for a warm body to snuggle into?

Secondly, this doesn’t take into account that all babies are different, and all boobies are different! Have a read about milk storage capacity here. Some mothers may need to feed more frequently to give the baby the same amount of milk per feed as her friend. This is not a mother with a supply problem, but natural variation. In order to support a healthy milk supply, breastfeeding works best when babies are fed to cue. In the first year milk is the most crucial part of baby’s nutrition and what is important is not how much baby gets per feed, but how much they get in twenty-four hours. A set rule for everyone just goes against basic biology.

In many cases, breastfeeding is a far easier way to get baby to sleep more quickly, and get better quality sleep. Use that magic while you can!

Responding to your baby every time they cry at night, makes children dependent and clingy

This is so far from the truth it makes me laugh. There is a wealth of research which suggests responsive parenting promotes healthy, secure and confident children. See Unicef’s “building a happy baby” leaflet or look into “attachment theory”. Not responding to children has been shown to do exactly the opposite of making children independent. Sleep training is a divisive subject and a blog post of its own. I will simply say, it isn’t the magic bullet people suggest, and that more information on it can be found here.

Responding to your baby does good things for both of you!

Bed-sharing is *the* most dangerous way for your baby to sleep! Don’t do it!

So this one was a massive bug-bear of mine. We previously have not been having nuanced conversations with parents about where breastfed babies should sleep. Positively, the tide seems to be turning a little recently, with the Lullaby Trust, Unicef UK, BASIS and PHE collaborating on new safe sleep guidelines which finally discuss bed-sharing in the mix.

Why is it important to talk about this? Because otherwise parents do not talk to their health visitors about this for fear of judgement. And then, they do not get the information they need about how to bed-share safely. On any given night 22% of babies will be bedsharing with their parents. Blanket recommendations not to bedshare have been clearly shown not to work and may have even increased the risk of SIDS for our babies.

We have historically focused more on the risk of bed-sharing to breastfed babies than we do on the increased risk of SIDS from other practices which parents might turn to instead- like sofa sleeping or giving formula instead to help their baby to sleep. Why have we not talked more about the impact of alcohol, smoking and drugs on SIDS rates? Risks which are so much greater? Why are we still not getting our knickers in a knot about the relationship between poverty and SIDS rates and holding society accountable for that? Focusing our support and resources on all of these things would have so much more impact.

Unicef Co-sleeping Guidance for Health Professionals

For a long time health professionals have been in a tricky spot. Advocating 6 months exclusively breastfeeding yet having to advise against one of the tools that help many people to achieve it. Studies suggest “breast-sleeping” (i.e. bedsharing as a breastfeeding mother) supports breastfeeding, with mothers showing increased responsiveness and increased breastfeeding overnight (see below for links to a wealth of research information). Mothers who bedshare also tend to breastfeed for longer than mothers who do not.

I could go on about this forever, but I won’t. I am glad the guidance is finally start to shift in line with the reality for many families. If you are considering bedsharing with your baby, read evidence-based information and decide what is right for your baby. Safety guidelines are really important if you go ahead. You can see these in the new guidance I have already linked, as well as here, and here, and here.

If I could wave a magic wand and change one thing, what would it be? I would love to do away with this culture where parents who announce their child is sleeping well get congratulated. I slept well for years before children. I am pretty sure nobody said “well done” every time I woke up after a full 8 hours. Nobody insinuated this made me a better person, or that it was because of the big dinner I had that night. I want to stop having to reassure and comfort tired parents in breastfeeding groups who think their baby is broken. Not because it annoys me to do so, but because this crippling pressure is unfair to them. We create it with expectations which are so off-kilter from reality it is ridiculous. I would love people to start showing empathy to parents rather than judgement. Maybe help them out around the house, or make them a coffee. In the absence of a magic wand, I hope the myths busted in this blog help. Watch this space, and subscribe or like me on Facebook, Instagram or Twitter for news of upcoming blogs about how to cope with frequent night waking, and gentle night weaning.

You can find more good information about sleep here:https://www.basisonline.org.uk/

Recommending reading about infant and child sleep:

Bedsharing research:

For more papers from Prof Helen Ball

Evidence based bedsharing info from BASIS site

Prof. James Mckenna’s work here

Image Credit: https://www.basisonline.org.uk/co-sleeping-image-archive/

Updated: 27/03/19

Tips for Breastfeeding a Baby With a Tongue Tie

When my daughter was born we had issues establishing breastfeeding. Feeding her was painful, and her weight gain was slow because she was tongue-tied. My memories of the early days of motherhood are still a haze to me, but by far one of my clearest (and saddest) memories was of looking at my perfect baby girl, willing her not to wake up. I couldn’t bear to feed her again. My nipples were bruised and cracked. I was on strong painkillers, because I had an emergency C-section, yet even with those, the pain far outweighed the wound I was recovering from. For various reasons, I was feeding my daughter for seven weeks before her tie was fully released and feeding started along the slow path to improvement. I won’t dwell too much on my story, perhaps I will tell it more fully one day on another blog. The purpose of this one is to share a few things I found helped me during the long weeks, plus a few things I have learned during my training in breastfeeding support.

There may be many reasons you are waiting to have a tongue tie division or indeed you may have decided the procedure isn’t the right decision for your family. Here are a few ideas and tips for you to consider.

Seek experienced feeding support whatever position you find yourself in. Find a lovely boob group too. Whatever happens on your breastfeeding journey, remember it is a journey. Sometimes a division isn’t an instant fix. Ongoing experienced support and moral support can be really helpful. Find a breastfeeding group here.

A breastfeeding counsellor or IBCLC can help you experiment with different positions. Some positions which work well for tied babies include laidback breastfeeding, the rugby hold, the straddle hold. Pay particular attention to the fundamentals of good attachment as this may be a harder to achieve with a tongue tied baby.

Get skin to skin! Skin to skin feeding can really help encourage a baby’s natural latching reflexes and has the added bonus of removing layers which separate you and the baby. It may just make that bit of difference.

Experiment with exaggerated latch techniques. These can be really helpful to encourage a deeper attachment. Options include tilting the nipple (“flipple”) or shaping the breast (“breast sandwich”).

It can be really helpful to use a couple of different positions while feeding when feeding is painful. This is because it stops the same part of the nipple being hurt and potentially damaged at every feed.

If baby struggles to transfer milk effectively while feeding

If feeds are very lengthy, painful or your breasts don’t feel relieved afterwards- there are a couple of things you can try. Breast compressions can improve milk transfer. Switch nursing can keep an ineffective feeder from falling asleep too soon at the breast and maximise milk intake. Combining both techniques can be particularly effective. Using both techniques during a feed might look like this; offer boob one, when the baby looks like their sucking is slowing (fluttering) or getting sleepy use compressions to speed up the milk flow again. You might find that sleepy baby springs awake again because babies often respond to milk flow! Once compressions become less effective, switch baby to side two and repeat. Once the same thing happens, then offer the first side again, and continue switching until baby signals they are done. You will ideally offer 4 sides minimum per feed.

Patience and support are important when feeding tied babies. Feeds may take longer than average and babies may feed more frequently to compensate. It can be helpful to reflect on your wider support network. Can someone help around the house or with other children while this is going on? Can your partner/family/friends offer any extra support?

Keep a close eye on nappy output and weight gain, and keep in contact with that experienced breastfeeding support I talked about earlier. An experienced supporter can help you to decide if your baby needs additional supplements of expressed milk and give you information about how best to do this while protecting your milk supply.

Sometimes the baby may be doing well but you may be struggling with engorged breasts, blocked ducts and even bouts of mastitis. If this is the case, firstly ouch, I am so sorry! One thing to consider may be expressing milk for a short amount of time after feeds to soften the breasts. This may also protect your long-term milk supply. If you need support with blocked ducts this factsheet might be useful.

“I can’t carry on! Feeding is too painful!”

Nipple shields are often considered by mothers in this situation. There can be some pitfalls to using shields, but if it is a choice between a shield or a bottle, a shield might be the better option. Ideally, shields need to be used with support from experienced breastfeeding support. Attention still needs paying to try to achieve a deep latch. Here is some more information to consider while using a shield.

I can empathise when mothers decide to use a bottle because they have tried so many options, and feeding is just too painful. Sometimes a mother may have nipple damage and just can’t bear feeding on demand at that time. I know how tough it is. If this is you remember to talk to your breastfeeding support person. In an ideal world you will still offer the breast for at least some feeds in a 24 hour period. As babies get bigger often latching can improve. It may also help with transition back to fully breastfeeding if this is what you want to do. Continuing to offer the breast, even if it is only a small amount to practise breastfeeding, protects your options down the line. If mixing breast with bottle, paced feeding techniques can be helpful to reduce the risks of bottle flow preferences. There are also alternatives to bottles, for example syringe or cup feeding.

If your baby is not breastfeeding much, or not at all, you may find the following information links useful:

Information on expressing: https://www.laleche.org.uk/expressing-your-milk/

Maintaining milk supply if the baby is not directly breastfeeding: https://kellymom.com/bf/got-milk/basics/maintainsupply-pump/

If using bottles or formula continuing to express when baby has a bottle can help support your milk production. Remember skin to skin is not only great for supply, but does good things for both of you, so keep baby close however you feed them. If you are using some formula it is important to prepare it safely.

Nipple damage

If you have sore nipples but no open wounds, there is no evidence a cream is more helpful than using your own milk rubbed into the nipple.

If you have bruising, the usual treatment for bruising can be helpful such as cold compresses after feeds.

If you have open wounds, moist wound healing may be helpful. This is essentially treating a cracked nipple like a cracked lip and not allowing it to dry out. Cracks in nipples that dry out may split open again at every feed, and this can be very painful. Keeping the crack soft can help healing from the inside out. There is no evidence any one cream is better than another, some mums prefer a lanolin based cream but soft white paraffin (Vaseline) can be just as effective and cheaper. Do use a new pot though and not something that’s been knocking about in the medicine cabinet for donkeys years! Both of these options are safe to breastfeed with, no need to wash off. Just wipe any excess off before feeds.

While we are on the subject of washing, if you have cracked nipples it is essential the wound is kept clean to prevent infections. Some mums use a fragrance-free soap (some babies can be bothered by strong perfumes), others prefer a salt water rinse like the one suggested here.

It might be helpful to start feeds on the least sore or damaged side, babies tend to suck more vigorously at the start of a feed. If you do this, listen to your body to make sure the other breast is still adequately having milk removed, via expression if necessary, to help avoid any engorgement or loss of supply.

If you are in a lot of pain feeding here is information on analgesics which you can use to help.

When you have a long wait for a tongue tie division, I know it can feel impossible. Like an eternity. Those early weeks can feel like months even when things go smoothly. I can totally empathise how overwhelming it might feel. I can’t tell you whether to stick it out, or what is best for you but I can tell you that you are stronger than you know you are.

I remember one day being asked why I had persevered with breastfeeding for so many weeks despite painful challenges. This is something I’ve considered a lot because on that day I couldn’t give an answer.  One thing I have come to understand is often it isn’t really about “the milk”, it is about an inner desire for this connection to our babies. Focusing on that can be more motivating than anything else. Try to remember why you started breastfeeding and why it is important to you. Encourage your partner to remind you of this. Hold on to any moments that are positive. Remember any breastfeeding you can do is significant. Setting small goals can be helpful- try to think about making it to the next day, or next week rather than longer term. This will all pass someday. By setting small goals one day you might suddenly realise you have stopped setting goals to get to next week and will know that the worst is behind you.

Whatever you decide to do, make sure you have support so you can talk it through and feel empowered to make decisions you feel at peace with. Finally, remember, there are lots of us out there to support you. You got this mama💚.

For more information and support:

Association of Tongue-tie Practioners for information about tongue tie

If you need support or someone to talk to fast about the issues you are having try the National Breastfeeding Helpline

Facebook tongue tie support group

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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.

Find me on Facebook! https://www.facebook.com/OxytocinAndOtherStories

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:

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

pharmacy-1507122_960_720

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.

Find me on Facebook! https://www.facebook.com/OxytocinAndOtherStories

*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 *