Wednesday, July 23, 2014

Breastfeeding questions and concerns

A couple of days ago, a friend emailed me with some concerns about breastfeeding, and I thought I'd share several of the general points here, because they are often asked by mothers of new babies. I'm not a lactation consultant, of course, but as a dietitian and as someone who loves breastfeeding, I often find myself answering questions such as what a mother should eat while nourishing a baby at her breast, when baby is supposed to start solids, etc. 

1. Crying baby = hungry baby = "you don't have enough milk"

Are you familiar with this scenario? You go on a visit to your relatives. After some time, your baby starts crying. "She must be hungry," rightly observes the nearest auntie or your mother-in-law. You go and feed the baby. Half an hour later, the baby is crying again. "Oh no!" cries the concerned relative. "The baby is obviously still hungry. You don't have enough milk" (variation: "your milk must not be nourishing enough"). 

In truth, there may be a million reasons why babies cry. Maybe they are hungry; maybe they just messed up their diaper; maybe they are tired, have a rash, or are fussy or over-stimulated. Or maybe it's colics/teething. I realize how comforting it is to think that we can always pinpoint and control the reason why a baby cries, but it just isn't so.

2. "Perhaps the baby is colicky because your milk is of 'low quality', and formula would be better"

Baby colics - inexplicable tummy pain that doesn't have to do with a known issue such as reflux - are commonly thought to be related to the growth process of the digestive system and the muscle spasms associated with it. The symptoms certainly aren't caused by "low quality milk", and though it isn't scientifically proven, my logic tells that the food of nature - mother's milk - is certain to be gentler on a new and sensitive digestive system than a bottle of something based on cow's milk.

3. "It isn't normal for a baby to be hungry so often. Your sister-in-law's baby is fed formula and usually looks satisfied for a much longer time after a bottle."

It's normal for babies to have growth spurts and, at a time, nurse more often than usual. It's also normal for breastfed babies to determine frequency of feeding - for example, "cluster feed" in the evening (which is when things get a little crazy, because you want to have your dinner, and the baby wants to have his!) and sleep for a stretch of time at night. It's normal for breastfed babies to nurse more often than formula babies take a bottle, because the proteins in mother's milk are more easily digested than cow milk protein, and also because a breastfed baby isn't urged "to finish these last 20 ml from the bottle". Think how you feel after a light, easily digested meal, vs. a big, heavy meal. Most likely you will want to lie down and have a nap after the bigger meal. This doesn't mean that it's healthier.

4. "I think my baby is gassy because of what I eat!"

Often mothers will ask me, "what should I eat while breastfeeding?", and more importantly, "what shouldn't I eat?". One was particularly anxious recently. She asked if she must exclude cabbage, oranges, chocolate, beans, milk, eggs and a million other things from her diet, because she "heard it might give the baby gas". The thing is, food passes through our digestive system and breaks down. Then it is absorbed into the blood flow. Then it's made into milk and is received by the baby. So, while it's true the baby is getting his nutrition from you, it's not like you ate cabbage = the baby ate cabbage. Sure, you might have indigestion, but the baby's digestive system isn't dealing with it all - yours does the job! 

Or it might work the other way: "my baby was absolutely miserable until I eliminated eggs, all dairy products, all grains, beans, and almost all fruits and vegetables from my diet. Now the baby is happy but I don't know what to eat." 

First question is: how long ago did you do that? It's very probable that the baby's colics/gas/whatever symptom was development-related and has passed on its own, while the mother is convinced her diet was the culprit and continues to needlessly restrict herself for months (frustration and early weaning, here we come!). 

Second question: did you eliminate all those foods from your diet at once? More often than not, the answer is yes. If so, even if one of the foods in question was indeed the cause of the trouble, you have no way of knowing which. Consider: there was a wave of crime in the neighborhood, and ten suspects were arrested. The crimes stopped, so obviously you've caught the culprit. The problem is, nine innocents are held captive for no fault of their own. Obviously the investigation must continue until we can pinpoint the criminal! 

If you are suspicious that a particular food is giving your baby certain symptoms, you might want to eliminate this particular food from your diet for a week or two, then re-introduce it and see what the effect is.

I hope all breastfeeding mothers out there eat well, drink plenty, and are happy and healthy. I wish you all a long and successful breastfeeding relationship with your baby, and hope you enjoy it as much as I enjoyed mine. 

1 comment:

Marivene said...

When a breastfed baby cries soon after eating, my first thought would be that the baby has a bubble & needs to burp. I was on the lactation team at the hospital where I used to work, & we always told the mothers that if it was less than an hour from the last feeding, to just pick up the baby, place on their shoulder, & either pat the baby's back or rub it it gently. The vast majority of the time, the baby was rooting, & "looking", as newborns will instinctively try to "fix" any stomach issue by nursing. It was usually less than 2 minutes before the baby burped, settled down on Mom's shoulder & went right to sleep.