Surviving the Festive Season as a Breastfeeding Mum 

 

As we start to think about the festive season approaching (only a few weeks away, sorry! 😆🎅🏼), the admin team at Breastfeeding Support and Information UK (BfSI UK) thought we’d remind you of some important information about issues that may arise with breastfeeding when the festivities and socialising begin 😊🎉

 

*ALCOHOL CONSUMPTION*

There are several different sources of information on alcohol, which I will link below. They all generally agree that a drink or two is okay.

Alcohol flows freely into the milk and will loosely match the blood alcohol level. So, for example, if a mum had a blood alcohol content (BAC) of 0.08% (the drink drive limit) then her milk alcohol content (MAC) would also be around 0.08%. To put that in context, drinks which are labelled as non-alcoholic (including orange juice!) can have up to 0.5% alcohol, a much higher level.

To have a MAC of over 0.5% (the level at which your milk would be considered an alcoholic drink if bottled and sold) your BAC would also need to be around 0.5%. This is practically impossible – around 50% of the population wouldn’t even survive drinking enough to make their BAC this high.

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However, it is important to bear in mind a couple things:

– the age of the baby, as before three months old as they will be slower to metabolise alcohol traces and could become sleepy/not feed well if they were regularly exposed – the odd drink is still okay though.

– the rate of metabolising alcohol varies from person to person; also, drinking with a meal is different to drinking without.

– it is not considered safe to bedshare whilst under the influence of alcohol, so all alcohol would need to have left your system before doing so (alcohol leaves milk at the same rate as it leaves blood).

for further information around alcohol and breastfeeding, please see the following links:

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*SOCIALISING WITHOUT BABY*

Often, new mums on maternity leave are eager to go to their work’s Christmas party and reconnect with their colleagues. Remember that when you feel ready to leave your baby is totally up to you, so if you’re not ready then don’t be pushed into it, and if you are ready then don’t be talked out of your glad rags!

If you are planning on leaving your baby for the first time, planning can be really helpful. Thinking ahead to how long you are likely to be out will help you to plan how much milk you will need to leave.

We would normally suggest leaving 1-1.25oz EBM per hour apart, in small portions. So, for example, for a night out of four hours, from 7-11, it would be a good idea to leave 4-5 oz, as 3 x 1.5-2oz bottles or 2 x 2-2.5oz bottles. It would be a great idea to discuss paced feeding with whoever is looking after baby; for more information about that, see here and for a great video demonstration of paced feeding, see here

You may also need to consider your own comfort if you are not used to being apart from baby, so for a long night out or if your baby is still young you may need to consider expressing during the evening. Contacting a venue in advance might be helpful for organising this, but another solution might be to drive to the venue and sit in your car to express.

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*SOCIALISING WITH BABY*

If you’ve had your baby in the latter part of the year, you may find yourself needing to go out and about for Christmas meals and nursing in public for the first time.

We’ve had many posts on the group about tips for nursing in public, so do search on BfSI for this topic if you’re a member, but some general tips are to try and be confident (even if you don’t feel it), remember you aren’t doing anything wrong and the law protects you. Although you may have heard ‘horror stories’, in reality these sort of occurrences are very few and far between, and the many, many times a day mums all over the UK breastfeed in public no one notices or cares!

For our top tips on nursing comfortably in public, do have a read of our blog on nursing in public. 

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*SOCIALISING WITH OTHERS*

The festive season tends to bring about a lot more socialising with family and friends, and often it means seeing family members that we don’t see regularly, and spending a large amount of time around people that don’t necessarily share our own values. Supportive relatives are amazing, and I’d much prefer to talk a lot about them, but no one really needs support with supportive relatives! 😆

So how do you handle criticisms? Well, if you’re a member of our group you’ll find there’s some good experience and ideas on this post (feel free to add your own too!)

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Generally, not engaging tends to be the easiest way to deal with this. So saying things like, ‘Well, we all have different options about that,’ or, ‘We’re quite happy as things are,’ or, ‘I’d rather we didn’t discuss that,’ can be helpful. For more info on this approach, see here

Another issue with well-meaning relatives can be actually getting to feed the baby! People often want to ‘help’ by holding or settling your baby, but remember breastfeeding is a two-way relationship and you need each other; don’t let your supply be jeopardised by not feeding when you need to.

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Speaking to your partner or mum or other close relative in advance can be really helpful for making sure that you’re on the same page and you have someone to advocate for you when you need it. For anyone that you think needs encouragement in being supportive, signpost them to our friends and family group and we can help them to help you!

 

*FOOD AND DRINK*

What you can eat and drink while breastfeeding is probably one of the most myth-ridden subjects to travel around the internet! Contrary to what you might read, you actually have very little need to worry about what you’re eating while you’re breastfeeding.

You may be fretting about your sage and onion stuffing on Christmas Day. It’s true that there is some evidence to suggest that sage can reduce supply, however this is when it’s consumed frequently/far in excess of the sprinkling in your stuffing, so don’t worry about tucking in as normal. The same can be said of your peppermint or other herbal tea – for more details this is a great link.

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Your favourite veggies can also be a cause for concern, but relax, there’s no evidence to suggest that sprouts and other seasonal favourites will create a windy baby.

If you like a buffet over the New Year period, some nice cheeses are a popular choice. Whilst there are some cheeses that require caution during pregnancy, there is no need to avoid any of them whilst breastfeeding, so feast away!

That being said, there are always a few mums that are avoiding certain foods because they’re feeding a baby with CMPA or other allergies. It can really be miserable feeling you’re missing out – so don’t! There are so many alternative treats out there to replace the foods you can’t have, and the BfSI allergies group has albums full of tasty recipes and shopping/product tips, so please don’t struggle alone.

 

*WINTER WEAR*

Don’t let the cold weather put you off getting out and about and wearing your baby. When baby-wearing remember that as well as working out the practicalities of keeping yourself warm, you will need to think about how many layers baby has on if they are going to be inside your coat. here are some great tips for baby-wearing in cold weather.

Do consider what your baby is wearing when moving between indoors and outdoors. Often, having plenty of layers can be helpful so you can adapt quickly to changing temperatures. Remember if you’re travelling by car that coats should be removed before strapping a baby into a car seat. You could consider a loose blanket over the top of the straps if you are worried about baby being too cold.

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At night time, it’s worth thinking about what baby needs to wear to bed, and what tog their sleeping bag or covers are – a room thermometer can be helpful for judging what layers you will need to prevent overheating. theres some useful information here.

 

We hope you find our top tips helpful for surviving. We wish you a good winter, a merry Christmas, and a happy new year! BfSI UK will be running all the way through the festive season, and remember that the breastfeeding helplines are open as normal if you need breastfeeding support 😊

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Written by Alison Thomas on behalf of Breastfeeding Support and Information UK

 

 

 

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Time to wean – Introducing Solids

 

It’s a question we hear a lot. When should I introduce food to my baby? Both the World Health Organisation (WHO) and the NHS are quite clear that babies can receive all the nutrients they need from breast milk or formula milk for the first six months of life, after which point solid foods can be introduced to complement a baby’s milk intake. This has been the guidance since the early 2000s and there is absolutely no indication that this advice will change.

Although this is the official guidance, food packaging states that food is suitable from four months, which can cause confusion for some mums. So if the guidance is six months, why does food packaging say four months? It all comes down to the WHO code. In the UK, we have only placed parts of the International Code of Marketing of Breast-Milk Substitutes into law. You can read more about the WHO code here. Just like the aggressive marketing of formula, baby foods are supposed to come under the same kind of scrutiny according to the WHO code. But why label your food as suitable from six months when there is no law that says you cannot label it from four months? That’s two months’ worth of sales you are going to lose. In countries where the WHO code has been fully enshrined in law it is illegal to market these foods as suitable from four months. Until we take further steps in the UK to abide by the WHO code, companies will continue to place doubt in the minds of new mums by mislabelling their products to increase their profit margins.

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Back in the seventies, eighties and the early nineties, guidelines were to wean a lot earlier.  Most people here were probably introduced to solids between two and four months of age. As parents, when we don’t know the answer to a question our instinct is to speak to our own parents. It’s sometimes here that we are told the age-old-line, “Well, we did it this way and you turned out just fine.” That may be the case but we didn’t know then what we know now. Research has since proven that waiting until six months is best for babies’ kidneys and digestive system. By allowing these to properly develop before introducing solids, we reduce the risks of illness and infection.

So how do we know when our baby is ready for their first solids? There are three key signs to look for in your baby to show they are ready for solid foods. It is rare for all these signs to appear together before six months of age.

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Your baby is around six months old and shows all the signs of being ready for solid food? So now you need to make the decision about which method of weaning you would like to follow: Baby-Led Weaning or Traditional Weaning?

Baby-Led Weaning

Baby-Led Weaning means just that, letting baby take the lead and feed themselves from the very start. With BLW there is no need to purée those meals or buy any jars, your baby can eat just what you eat. BLW teaches our children to chew first and then swallow, whereas with traditional weaning they learn to swallow first and then to chew later on.

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If you wish to try BLW then here are a few tips to get you started:

  1. Think chips! Cooking and cutting food in to chip-style batons gives your baby something easy to grasp onto and control. Cooked carrot sticks that can be mushed between your fingers, cucumber batons and fingers of toast are a good starting point. As your baby gets older you will be able to cut the food into smaller pieces for them to grab, which also helps with the development of their pincer grip.
  2. Prepare for the mess! If you are having a roast dinner there is no reason that baby needs to miss out. Letting them explore the different textures and flavours is great for their development. It may however be worth investing in some plastic matting to pop under the high chair and protect your carpet.
  3. You can start with three meals a day. As your baby will be completely in control of their food intake, you can start offering them foods whenever you are eating. You may find that they don’t actually eat too much (or anything at all!) to begin with, but don’t worry – it takes time to learn a new skill.

Traditional Weaning

Some people will prefer to wean traditionally. Although BLW has been around for many years now, it has only recently started gaining popularity. If you wish to take the traditional route then there are slightly different ways to introduce solids.

  1. Start with single-flavoured smooth purées. A smooth purée should contain no big lumps, pips, seeds or skin. You can mix the purée with breast milk, or full-fat cows milk if your child is over six months old. Research has shown that offering savoury flavours first, such as vegetables,makes children more accepting of vegetables later on. After purees, you can move on to mashed foods and introduce mixed flavours. Mashing with a fork will allow you to achieve a lumpy consistency. You can again add milk to the mashes to help achieve the consistency you desire.
  2. Offer finger foods with meals to allow your child to experience different textures. These can be soft so your baby is able to bite into them.
  3. Follow your baby’s lead. When spoon feeding your baby, sit opposite them and make eye contact. Wait for them to indicate they are ready for the next spoonful. Let them go at their own pace.

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When you begin weaning, your baby is going to be introduced to a whole new world of textures and flavour. As well as experiencing this, they will also be learning new skills of chewing and swallowing. With this comes the possibility they may gag on food. It’s important we know the difference between gagging and choking. Our children have a heightened gag reflex to help prevent them from choking. Interfering with a gagging child can actually cause them to choke. A gagging child will be coughing and spluttering – making noise. They will possibly go red in the face and thrust their tongue forward as they work out how to remove the blockage. A choking child will be silent and start to turn blue. This is when you will need to help them by using first aid to remove the blockage.

Remember: if they’re loud and red, let them go ahead. If they’re silent and blue, they need help from you.

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There are also certain foods that should be avoided in the early day. These include honey, whole nuts and certain fish. You can find more information on foods unsuitable for young babies here: https://www.nhs.uk/conditions/pregnancy-and-baby/foods-to-avoid-baby

Grapes, or similar small round fruit, are also considered a choking hazard. If you wish to give grapes always cut them length-ways into quarters. Grapes cut in half width-ways or still whole can block a child’s throat, and with their shiny skin they can be difficult to remove.

No matter which weaning route you take, there are a few things you should remember.

  1. Milk before food. Milk is still a baby’s main source of nutrition for the first year, so offer milk before you offer food. It’s important to continue breast or bottle feeding responsively to ensure your baby is getting all the milk they need. You may find milk feeds reduce over time as your baby’s solid intake increases, but let your baby lead this.
  2. Watch the salt! Babies under 12 months should have a salt intake of less than 1g per day. You will be surprised about the salt levels in the every-day foods we take for granted. Don’t add salt to your baby’s food and avoid giving your baby food that has been cooked with salt.
  3. Don’t worry too much about how much your baby is eating. Milk still provides lots of calories and nutrients, so as long as you continue to feed responsively there is no need to panic if your child doesn’t seem massively interested in solid food.
  4. Offer water with meals. Although your child may not be particularly interested in water, it is good to introduce a cup at this age. Water will also help with the absorption of food and help prevent constipation. At six months of age it is fine to give tap water to your baby.
  5. Embrace the mess! No matter which way you wean, get ready to find food everywhere. Have the camera ready to capture those first carroty grins and enjoy yourself!

written by Siobhan Hagan

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From Dad to Dadvocate – My Breastfeeding Journey

Once upon a time there were men and women. The women had babies and the men hunted for food whilst the women looked after the babies and fed them, by milk, from the breast.

This was all man-kind ever knew and it worked, it was natural, just as nature intended, there was no other way.

Fast forward several tens of thousands of years. What would our ancestors think should they be able to view today’s society and see how it has evolved? Would they be able comprehend that this most basic and natural of human acts is now looked upon as if it is the product of some alien race, introduced to us by an alien order who force us to feed our children in a fashion that would seem totally foreign and incomprehensible to them?

Man-kind has developed far beyond the imagination and comprehension of what any human could have dreamt of only 100 years ago, never mind a thousand or 10, 000 years ago. We fly in metal birds at supersonic speed, can destroy each other in the blink of an eye with weapons that were once the realm of science fiction and have developed computers and the internet and can view and send information at the speed of light. Yet for all our advances, we have regressed from feeding our infants from the way nature intended and in its place we have introduced another of mans inventions as a substitute to breast milk, formula milk!

Where did it all go wrong? Why did we allow this to happen? The truth is, I don’t really know. I could make a guess that it was purely a product of commercialism, something dreamt up for financial gain in a world that now revolves around money instead of the sun?! Whether it started out more innocently than this I don’t know? Was it as an alternative feed for orphans or for the third world, if it’s even politically correct to use this term anymore? Either way, one thing’s for sure, it is the staple food for new-borns across western society and we are immorally forcing it upon the rest of the world too!

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Rewind 25 years, back to my first marriage. My first son was only a few months old, but was already by this time totally reliant on formula, fed by bottle. I feel almost ashamed to admit this now, but I have to confess that back then, I didn’t know any different, I didn’t know any better, I, along with my first wife had been indoctrinated by society. We accepted that feeding our son formula was the norm, it’s how we and many others fed our new-borns. Was I conscious of this? No! I was totally immersed in helping my wife feed our son. I would sterilise the bottles and prep for the nights feeding and when the night came I would dutifully bottle feed my son whilst my wife slept, proud to help and let her sleep, fulfilling my husband and fatherly duties.

Now, I need to be open and transparent when I say this. My first wife did attempt to breastfeed my son, but she didn’t find it easy at all. We bought creams, nipple guards and she even attempted to express, but she found it hard, her nipples were extremely sore and blistered and within a matter of a few short weeks we succumbed to formula.

It would be fair to say that at that time I do not remember us receiving any advice or assistance from health professionals. There was no help in assisting us to try to continue with breastfeeding and it was all too easy to give up. This said, it was also all too easy to do what it seemed at the time like everyone else was doing and formula fed. I’m sure there were plenty of women out there who were breastfeeding, but these women/families seemed the minority and not the majority and so we, like so many other parents formula fed our son and we played our part in life’s big game of parenting like so many others, spending most weekends shopping at Mothercare or many places like this, buying our baby products, clothes and yes, formula like it was the most natural thing in the world. We conformed like so many to what seemed like the norm, the only way you could or for that matter should, bottle feeding with formula.

Now, I do need to qualify this point by saying that I do understand that for some, breastfeeding is not an option, whether this be on medical grounds or because the baby is unable to latch or for many other reasons. However, for the vast majority of people, I believe it’s just seen as the easiest option and is all too easy an option to fall in to.

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Twenty one years and another son later, I was re-married to Ali and we were expecting our first child together. Ali had been stating for some time by now that she intended to breast feed and I, of course supported her in this stance, although I must admit, I thought this would be doomed. I was of course only looking at this situation from my previous experience. This is the first time I have admitted this and I take no pride now in confessing this.

The thing is, it was my pre-conceived idea that was doomed because there was one factor I had not considered in all this breastfeeding talk and that factor was, of course Ali.

Gradually, she did what she always does, she read, she surfed the internet, she studied articles, she joined forums and she educated herself in all things breast. So that when the day came and Jessica entered the world she (Jessica) was already, to her father’s ignorance, in a position where she would be fed by breast, morning, noon and night, through sickness, both to Ali and Jessica, in the house, out of the house, on the bus, in the car, on the park bench, in the café, in the supermarket and, to much embarrassment, at the homes of our parents and families. Now, I say embarrassment because, unfortunately, this is how it was for most of them. In their defence, they were only guilty of perceiving breast-feeding as strange and almost weird where a woman is almost demonised for feeding her child in this way. This, I know wasn’t their thoughts, but it was how most of us have been educated, educated by a society of avarice, a society which cannot stop for a minute to think, unless that is to stop to make a formula feed. This is of course nobody’s fault, or at least I don’t think it is? We’re all the product of a society that tells us what is right and wrong. A society that allows product placement of formula beside the crib of the infant Jesus on a daytime TV show, a society that shows bottle-feeding in almost every TV soap as if there is no other option!

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My education started on 17th December 2013 when Jessica entered this world and it continues to this day. It wasn’t all straight forward though and to suggest it was would be a lie. We had our good days and our bad days, but through it all there was the unswaying belief of Ali that this was the right and only way to proceed. That breast is best, or to put it correctly, that breast is the norm!

This is where I tell it as it is. I never truly could connect at first, I felt awkward at times, sorry Ali, but I did. I saw the stares, I heard the hushed comments from people who saw her feeding and looked at us as if we had just breathed cigarette smoke all over them. And in truth, initially I found it hard to deal with because people can be so hostile to this, actually down right hostile and offended. The same people who feed their kids processed crap, who set their kids up for a possible lifetime of health related conditions and don’t even bat an eyelid for a second that they are doing anything other than the norm and what’s right.

Gradually, over the following few weeks and months I became more and more accustomed to the breastfeeding until after a while it was as if it was the only thing that had ever been. My concept of right and wrong had been irreversibly changed by Ali in her unswerving quest to ensure Jessica was giving the best possible start in her life, by her mum.

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I will claim some credit in helping Ali to achieve this goal though. I had initially taken two weeks paternity leave when Jessica was born. During this time I looked after Jessica during periods of the day when Ali was tired and needed to sleep. It was during these early days that we had a Health Visitor visit. When she called Ali was asleep upstairs and I was downstairs with Jess. She asked to see Ali immediately upon arrival and I replied quite innocently “she’s upstairs, in bed asleep”. She asked to go upstairs straight away. I felt terrible, I knew the reason why, safeguarding etc. but it didn’t make me feel any better, nothing personal, but she could have dealt with the situation better in my humble opinion. This knock back didn’t hinder us though. We continued on our breastfeeding journey.

I returned to work after two weeks, but would make Ali a packed lunch before I went, I knew this way she would be at least have something to eat during the day. In the evenings when getting home from work I would invariably cook tea, it was the last thing Ali wanted to do after looking after an infant all day. Sometimes she might make tea if Jessica had given her a good day, it also broke the routine, but generally it would be me and I had no problem with this. I would then take Jessica and have an hour or so with her to bond, but also to give Ali a rest. Sometimes Ali would take the opportunity to go for a bath, have a bit of time to herself. This might seem unfair on me, but actually it was fine, the payback for me was that as Ali was breast-feeding, I got to sleep all night and was ready for work the next day, generally refreshed and ready go. This was in stark contrast to those days many years ago when I helped bottle-feed and could be up for an hour or more every night.

During these early days I also attended a baby massage course and I would implement my new trained skills a couple of nights a week much to Jessica’s surprising pleasure, she seemed to like having oil rubbed into her skin and the massage that would follow, but who wouldn’t?!

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So, we had a routine and it seemed the most natural thing in the world and the weeks passed by and Jessica grew and I could stay awake at work and Ali was coping during the day and everything was going ok? However, we still faced challenges, particularly when we went out and were faced with the snares and comments, but I was becoming stronger and accepting and I stood up for my family and for Ali in particularly until I reached a point where I was ready for them, I was ready for anyone who cared to look and offer the most innocuous of looks or remarks, because I had been converted and I was now prepared to face down anyone who dared to challenge us. I was being protective, sometimes overly, but it was now natural and I thought to myself, how dare they, who do they think they are to look at us like we’re offending them, the absolute fucking cheek of these ignorant, servile idiots who dance to the tune of the multi-nationals. And there it was, I had come full circle.

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I was educated by an intelligent woman who is self-read, who by instinct does not comply with society’s norms. She is someone who researches her subject and makes decisions based on sound knowledge rather than by mere TV and newspaper advertising and by virtue of this also educates me. I too am now a boycotter of Nestle. I will not buy their products because of their unethical methods in which they sell their product to poorer nations and use financial incentive to bribe doctors into the bargain.   

I am and happy for Ali to administrate her breastfeeding support group along with her co-administrators and although I do find it a little time consuming and I hope she won’t mind me saying, sometimes all-consuming, I accept this because it is a role she takes very seriously and I know she is very dedicated in helping other women overcome the issues that many encounter from time to time.

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I wish everyone who is or is hoping to breastfeed their baby every success. I hope you are successful in achieving this goal. If like me you come from a background of ignorance, please know there is support and ultimately great satisfaction in choosing to breastfeed your infant.

I dedicate this post to my wife, Ali Thomas, mother of my daughter Jessica, breastfeeding advocate, Mother Supporter and breastfeeding champion. She introduced me to the wonder that is breastfeeding in breastfeeding Jessica, something she still continues to do today, albeit only now in limited circumstances, mainly at night, in the morning or when Jessica is ill or upset. I have had my eyes opened by a woman who knew right from the start of her pregnancy that this was the only way she wanted to feed our daughter in those early years, supplemented of course and in time by food and now in ever increasing portions by chocolate too!

I am a convert to breast, I have been converted by witnessing this most natural of acts and have defended my wife in many situations where people young an old have looked on in what seemed like utter disgust at my daughter feeding.  

I salute all you breastfeeding women in continuing to do what is so simple, yet so right and so mutually beneficial for everyone. Keep up the good fight (Ali, Jenny, Catherine, Paula, Rachel and all) and long live breast, I hope you continue to advocate, educate and support any woman who wishes to feed their child in this most basic yet normal of ways. Who knows, you might be the instigators of turning the tide of formula feeding and we may well be talking of breastfeeding being the norm again rather than the opposite in years to come.

Happy Mothers Day.

xxx

Written by Mark Thomas

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What do you mean, I can’t eat CHEESE?!

 

Living with a breastfed CMPA baby

As peer supporters on BfS&I, we are often asked by parents about whether dairy allergy (CMPA) is behind their baby’s colic, wind or general grumpiness.

So I thought I’d write a blog about dairy allergy, how it is diagnosed, what it is and what it’s like to live with one, from the point of view of a mummy with a CMPA child.

What is CMPA?

CMPA stands for “cows’ milk protein allergy” and it is the most common infant allergy in the world. However, it’s actually less common than it may seem from talking to people online. If you are concerned that your baby may have CMPA, it’s a very good idea to have a chat with a lactation consultant or breastfeeding specialist to rule out other, more common breastfeeding issues, such as shallow attachment, first.

Current research suggests:

  • Formula feeding increases the risk of CMPA
  • 2-7% of formula fed infants and 0.5% of exclusively breastfed babies are thought to suffer from the condition

There are two kinds of allergy response to consider:

  • ‘IgE allergy’ is what people most commonly identify as an allergy – in its most severe form, it includes anaphylactic shock. Symptoms of IgE allergies include hives, wheezing, swelling and projectile vomiting.
  • ‘Non-IgE allergy’ used to be called ‘intolerance’ or ‘CMPI’ (these terms are no longer used). Non-IgE allergies are delayed response allergies, meaning they can occur up to 72 hours after exposure. Symptoms of non-IgE allergies include reflux disease (GORD), eczema and ear infections.

It’s possible for a child to have a combination of IgE and non-IgE symptoms.

The Breastfeeding Network has a great factsheet on CMPA here which talks about the symptoms.  https://breastfeedingnetwork.org.uk/wp-content/dibm/cow%27s%20milk%20protein%20allergy%20and%20breastfeeding.pdf

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Is CMPA the same as lactose intolerance?

I want to shout this from the rooftops: CMPA is NOT the same thing as lactose intolerance! (more here) http://kellymom.com/health/baby-health/lactose-intolerance/

Lactose intolerance is common in adults. It is caused by the body not producing enough of the enzyme lactase to digest sugars in milk. Lactase production declines as we get older, and in some adults it declines to a level where digesting lactose becomes a problem.

Babies and infants normally produce plenty of lactase, which would make sense since their diet is entirely milk. Lactose intolerance from birth is a life-threatening and rare metabolic disorder, not an allergy.

How do you diagnose CMPA in a breastfed baby?

When I was confirming whether or not Amy had CMPA I followed the NICE guidelines, which meant removing all milk products from my diet for at least four weeks. An elimination diet like this is considered the best way to confirm allergies in infants. The reason for this is that tests to confirm allergies in babies are unreliable, and they will not identify non-IgE allergies.

I was able to continue to breastfeed while I did this. It’s very rare for a mum to have to stop breastfeeding if CMPA is suspected.

We saw an improvement in Amy’s symptoms within three weeks. After six weeks, I “challenged” to be sure we had an issue with CMPA – this involved simply having a glass of milk and watching for 72 hours to see if Amy’s symptoms returned, which they did.

In cases of children with severe allergies, this process must be managed under the guidance of a health-care team. Amy didn’t have a severe allergy so we could do this at home without supervision – do check with a health-care professional if you are unsure.

Before starting my elimination diet, I had breastfeeding support from an IBCLC and I also talked to a GP.

“What do you mean there’s milk in the pickled onions?” – Living with CMPA

I quickly had to get to grips with checking labels! I’ve found milk in wine, crisps, chorizo, bread and, yes, pickled onions! I soon learned you cannot assume something will be okay

wineThis wine reduced me to tears one Friday. Proof – wine can contain milk! So check the labels on everything.

In the UK we have strict labelling requirements, and common allergens need to be highlighted on the label in bold, which makes things easier for sleep-deprived parents!

Sticking to chain restaurants when eating out made our lives easier too. Big chains tend to take allergies seriously, and often have a special folder or menu for people with allergies. All places which serve food have to be able to tell you (at least verbally) what allergens their food contains. One exciting development is that Zizzi, Pizza Express and Pizza Hut all now offer vegan cheese and have dairy-free pizza bases. Who would have thought you can still go out for pizza and be dairy-free?

Make sure your server is aware you have a milk allergy so they can take extra care not to cross-contaminate food as they prepare it. It is always worth asking, “What’s in that?” rather than just, “What is dairy free?” You don’t know what the person serving you understands as dairy. Many people assume eggs are dairy, so they may be excluding things from the menu unnecessarily; worse, they may assume something isn’t dairy when it is.

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I also always make sure I take ‘safe’ snacks or a packed lunch for Amy with me if we are going out now she eats solid foods, and a small pot of alternative milk for me.

May Contains- to eat or not to eat?

One thing which can be confusing when you first go allergen free is the labelling on products like “may contain milk” or “not suitable for milk allergy”.

Now this looks like it isn’t suitable if you are eliminating milk doesn’t it? However, what may be useful to know is that a ‘may contain’ label isn’t a legal requirement. Any food you buy which is pre-prepared, or in a café, or restaurant is a ‘may contain’ even if it doesn’t say this explicitly. If you still prepare dairy foods in your own kitchen this would class as a ‘may contain’! Therefore avoiding ‘may contains’ can make eliminating dairy or other allergens very difficult. The risk of reaction from these products is often so very small many Mums (myself included) decide not to avoid ‘may contains’.

The thing about cheese and chocolate

Good news – there is amazing dairy-free chocolate! Most dark chocolate is dairy-free and many are soya-free too. There are also specialised “free from” chocolates like “Moo Free” and “Booja Booja” (who do the most amazing ice cream too).

I’ve personally found vegan cheese can have a bit of an aftertaste, and if you are going directly from eating proper cheese to ‘chease’ it can be a shock. I found after giving up on cheese for a while I was happier with the vegan stuff.

My favourite options are the pizza cheeses – Violife Pizza Cheese is stocked widely in Holland & Barratt, and another lovely one (which is a bit harder to get your hands on) is Mozzarisella.

The bad news? I unfortunately didn’t lose weight on a dairy-free diet after I discovered the majority of bourbons were dairy free…

bourbons.jpg

Adjusting to your new normal

It can feel overwhelming when you first go dairy free. That’s okay. It’s not selfish to feel fed up about not being able to have cheese or to feel upset because OAT MILK IN YOUR TEA IS NOT THE SAME. I get that. It does get an awful lot easier as time passes.

It helps to seek out ongoing support, either in real life or online. As well as BfS&I, there are some fantastic CMPA-specific breastfeeding support groups on Facebook (https://www.facebook.com/groups/breastfeedingwithallergiesUK/) where you can get recipe ideas and generally have a rant if you need to.

For me, it probably took about six weeks to come to terms with my new diet, and it was all worth it in the end. Amy was a much happier tot! I’m so grateful I was able to breastfeed her. Mummy milk means I have never worried about my daughter’s nutrition or had to deal with tricky prescription formulas and, for me, that all makes it worth giving up cheese.

Written by Paula Rowley.

More information on CMPA

https://breastfeedingnetwork.org.uk/wp-content/dibm/cow%27s%20milk%20protein%20allergy%20and%20breastfeeding.pdf

https://cks.nice.org.uk/cows-milk-protein-allergy-in-children 

file:///C:/Users/User/Downloads/CMA_MAP_Algorithm_2.pdf

http://kellymom.com/health/baby-health/food-sensitivity/

https://gpifn.org.uk/cmpa/

This blog is not intended to replace the advice of a medical professional, simply to give information for further discussion. Please make sure before making significant changes to your diet or your child’s diet to discuss this with a medical professional or a health visitor first.

The Reality of Baby Sleep, and How to Cope When They Won’t!

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THIS is the question the BfS&I admin team would like to put in their room 101.

On BfS&I, we often spend time giving reassurance about sleep. Our members worry their babies aren’t sleeping normally, they compare their baby to their friend’s baby who is waking less, they worry baby needs to learn to “self soothe” or that baby is waking because they don’t have enough milk. People pressure them about sleep training. Parents are told formula or solids will help baby to sleep much better. (It doesn’t. Here’s proof.

So, as an admin team, we are passionate about normalising infant sleep for our members. In the spirit of doing just that, here is a snapshot of our little ones and when they first slept through!

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Asha: “Euan started to sleep more than 5h around 2.5 years old and sleeping all night (bed to wake-up) around 3.5 years old.”

Ali: “Jess slept through (midnight-5am) from about 4-16 weeks, then not again till she was about 2! She still often wakes one or two times in an average 10-hour sleep at 3.5 years old.”

Alice: “Yet to do so! We’re still having at least one wake up at nearly 14 months.”

Catherine: “Joshua has got sleep a bit backwards. From around eight weeks to ten months he went to sleep around 7.30 each night and slept for ten hours solid. Obviously we thought we had it all sussed! Then at ten months-ish he started waking in the night and he hasn’t stopped yet, aged 3 1/2.”

Claire: “At about 8/10 weeks Grace started sleeping six hours…I thought, “Wow, this is it, our sleepless nights are over!” About four weeks later she started waking every 45 minutes, and that improved to every 2-3 hours over about six weeks. She slept through at 13 months.”

Jenny: “Mmmmm don’t ask?? Still wakes most nights at 5 years and 3 months!”

Kirsten: “My little girl slept six hours from four weeks… and 12 hours from around 14 weeks! The four-month sleep regression didn’t really affect her… The 6m leap did though – I thought I was losing my mind at this point. Same with the 12m leap: she went from sleeping 12 hours to point blank refusing to go sleep.”

Paula: “Amy woke every 45 mins from 16 weeks (thanks four-month sleep regression) and she did that for a long time, every two hours was a good night! She finally slept through the night at 21 months old. She’s now 2.5yrs old and we are still waiting for it to happen again!”

Rachel:  “Eleanor first slept for nine hours at eight weeks old and by three months was sleeping consistently for long stretches… I’ll admit I was smug. I honestly thought her great sleep was due to me doing everything right! Then Blake came along: payback time! Waking every two hours would be a good night! At 19 months, he’s only just started going longer stretches, but no more than four hours at a time.”

Sarah S: “Samuel didn’t sleep longer than two hours until he was around 2. A bad night was him awake every 45-60 mins. By 2.5 he had dropped night feeds but he still woke up at least two or three times.”

Siobhan: “I was so smug when at 10 weeks Paige started sleeping from 6pm to 4am, waking for a feed, then going back down until 7/7.30. It lasted a whole two weeks and then she was back to waking every two hours!”

Trudi: “Noah slept through from about seven months but started waking again at about age 2. He generally sleeps well now at age 5. Elisabeth started to sleep through at three months but started waking again at six months. She has rarely slept through since then, usually waking at least twice for a feed.” 

Sarah A: “My eldest slept through at around 3 years old, my youngest still stirs to feed a few times (she’s 28 months now). Getting them to go to sleep in the evenings though is driving me slowly insane!”

The reality of infant sleep, in the words of the admin team! As you can see, it is really variable. Some babies sleep through from a few months old, some take a lot longer, and a child’s sleep pattern can change an awful lot well into the toddler years.  So if you’ve been blessed with a wakeful baby, we hope you take heart from this: your baby is not broken, and you aren’t doing anything wrong.

Still not convinced? Here’s an interesting fact from the Infant Sleep Information Source:

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As an admin team we don’t advocate sleep training. You can find out more of the research around this and why we take that stance here.

So as we all have a lot of collective experience of night waking, we decided to put our heads together and share some tips to cope with it!

 

BEDSHARING – Paula says: “I realised trying to avoid having Amy in bed with me not only meant she slept less, it was putting Amy in danger. One night I came to as I was about to drop her off the edge of the bed! I looked into safe bed-sharing rules the next day”. Many of the admin team have found bed-sharing really helpful to get more rest. It is important to follow the safe sleep guidance if you bed-share.

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EARLY NIGHTS – Many babies have their longest sleep after they first drop off at night. If this is your baby, take advantage of this, even if it is 7pm! Getting a few hours sleep in a row means you get some restorative sleep. The earlier you are in bed, the more sleep you get in total too, even if that sleep is broken. If you can’t sleep, you can still relax.

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SUPPORT – We all agreed the support of our partners and families was crucial. Our partners often took over the running of the household so we could rest in the evenings. Paula, Catherine and Ali find it helpful for their partners to take over in the morning while they have a lie in. Grandma comes in handy for Rachel so she can take the odd nap in the day.

GET RID OF THE CLOCK – Not checking the clock can be helpful. It is so easy to focus on *how long* and *how often* your baby wakes. Not being able to put a number on wake-ups can be really useful for your mental wellbeing.

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SIDE LYING FEEDING- We know for some mums this can be tricky. Keep trying! When it clicks it is so useful. This tutorial for side lying feeding is helpful. Your boobie group can also help you figure out how to latch your baby on lying down. Yes, you may feel ridiculous while you practice it, but need for sleep is more important than pride. Peer supporters will understand!

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Catherine & Joshua

 

REDEFINE REST – Rest does not have to mean sleep. Put your feet up, take a gentle walk in the fresh air, watch some telly, and eat good, nourishing food. If you’ve got other kids who need entertainment, stick a movie on and snuggle up on the sofa, or get out the puzzles… remember you don’t need to be superwoman. Leave the housework. BE LAZY!

ACCEPTANCE – Difficult to achieve, but sometimes a change in mind-set is your most powerful tool. In the words of our admin Sarah Helen Slater:

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APPRECIATE THE BEAUTY – Okay, you probably want to throw something reading that, but bear with us. You will never have these years again, and one day you will miss these sleepy nursing snuggles. If you are having a night or day where it is all getting you down, try to focus on a small detail that makes you go all gooey inside – your baby’s eyelashes resting on their cheek, the smell of their head, their tiny relaxed little hands. Remember the love.

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BREASTFEEDING GROUPS – It can be cathartic to have a proper whinge sometimes, and helpful to remind yourself you are not alone! Breastfeeding groups are a fantastic place to do this, or you could have a good old rant on BFS&I… we are always here to listen to you!

Love…The Admin Team xxx

If you have enjoyed this blog, here are a few of our favourite reads about baby sleep:

The rollercoaster of real baby sleep

What’s really happening to your baby’s sleep

Normal sleep development

4-5 month old sleep thieves

And 8-10 month old ones!

 

Team comments written as quoted, blog edited by Paula Rowley.

Why I Want To Talk About Infant Reflux

 

It has taken me quite a while to write this blog. As a breastfeeding peer supporter I generally avoid sharing my own story, but my story is relevant to why this blog has been written so I’ll start with this.

So here’s my confession: my daughter was a “reflux baby” and was treated with pretty strong medication for two years. I didn’t investigate this, I took the information I was given at face value, and it is one of my biggest regrets as a parent.

I joke that when Amy was born she cried straight away and didn’t stop! Amy spent her first weeks wailing, coughing, writhing and red in the face, pretty much all day and most of the night. At 5 weeks old, she was diagnosed with reflux and we were prescribed infant Gaviscon by our GP. Like many Mums, I took the prescription gratefully, and the numerous prescriptions that followed.

 

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An illustration of our first weeks of parenthood from grizzling, to full-on screaming!

 

As a new mum, I didn’t know that a breastfeeding assessment should have been the first thing offered to help me, or that there are many things known to cause ‘reflux’ in babies. It was a long, hard road, and one which could have been shortened with good timely support.

So now, as a peer supporter who has a lot more knowledge about reflux, I find it frustrating when I come across a fellow ‘reflux mum’ and after some gentle questions it is clear mum has been sent on her way with medication for her baby without further support or investigation too.
Problem reflux (GORD) has a variety of symptoms, which you can read more about here.
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. Many babies spit up and vomit without being bothered by it at all. 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”. Lots of babies without reflux disease are sick, have periods of being unsettled, fart, look like they are trying and failing to poo, burp and bring up their legs in what seems to be discomfort. Mostly this behaviour is simply down to an immature gut, and it will pass with time.
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.
So it’s worth asking yourself, “Does my baby really have GORD?” before starting medications for reflux. If you aren’t sure, a breastfeeding professional, your GP or HV should be able to talk this through with you.
Many medications used in treatment of reflux disease are used “off label”, they weren’t originally developed with infants in mind, and there aren’t many studies into the long term effects of reflux treatments on babies.
So you’ve read all of the above and you still believe your baby may have GORD? I’m sorry if you are still with me at this point. Dealing with reflux is a really distressing and difficult thing to cope with, and I know at times it can feel relentless and never ending. Here is some more information for you to consider.

 

Three common causes of reflux in breastfed babies (this is not an exhaustive list)
1. A shallow latch

If your baby is not attached deeply to the breast 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 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 as part of its quality standards:


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 – things like tongue tie and high arch palate are increasingly being linked to reflux.

 

2. Breastfeeding management

Culturally, we have an expectation of having a few hours between feeds and we do see this impact 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. Responsive feeding, and watching our babies instead of the clock may help with fussing. More about responsive feeding.

​​Western 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 have been prescribed medication it’s interesting to note research suggests a significant link between allergies, particularly CPMA and GORD – some studies show a link of up to around 40%.

Does that mean all mums 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. The breastfeeding network talks about symptoms of CPMA here

Addressing attachment, examining 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 a good idea to speak with a GP or health visitor so they can arrange for you to see a dietician.
4. More great reading on 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 counsellor, La Leche League leader or IBCLC.
It might be a good idea to make sure you see somebody who is familiar with tongue tie and posterior tongue tie, and who knows the symptoms of oral ties, just in case this is a factor.
The great thing about doing this is that these are people who can help you look at the full picture and consider all the angles, including the things we have discussed above.

In some cases medications can be appropriate and necessary.

 

Coping with a breastfed reflux baby

 

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 among other intolerances. We finally came off all our medications and beat the demon that is reflux. She still doesn’t sleep in her cot, but that’s okay – I like the cuddles ❤.
By Paula Rowley

Further reading:

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

Kellymom: https://kellymom.com/hot-topics/reflux/
This blog is not intended to replace the advice of a medical professional, simply to give information for further discussion. Please make sure all medications and healthcare issues are discussed with a medical professional or a health visitor first.

Shopping for success

An alternative take on a how to prepare when you are planning to breastfeed

 

Something that we quite commonly see in our breastfeeding group is that an eager pregnant mum (whether first time mum or first time breastfeeding) will ask ‘What do I need to prepare for breastfeeding?’ in the spirit of the hospital bag question that dominates bumps groups a mum will expect and receive a shopping list of items that she absolutely needs beyond a shadow of a doubt.
Inevitably that list will include a host of unnecessary products. Whilst no one would dispute that some mums face breastfeeding challenges, the majority of breastfeeding journeys (the ones you don’t read about!) are fairly mundane, unchallenging and uneventful.
The average mum won’t need special cushions and creams, she won’t need pumps and bottles, and she won’t need flapjacks (unless she happens to like them!) so this is our alternative ‘breastfeeding shopping list’ for all your breastfeeding essentials!

 

Find your local group

Although most journeys are free from major obstacles, that doesn’t mean that breastfeeding is always easy. The fact is that it can be bit of a lost skill. For many of us, we may have never seen another woman breastfeed! We are so used to seeing bottle fed babies that we have had our instincts of how to hold a baby modified by what we see – bottle feeding positions. Good position and attachment is so important for breastfeeding, so after your baby is born it’s a great place to get face to face support with this. However there’s nothing to stop you popping in while you’re pregnant to get a few tips!

 

Research

Being prepared and knowing what to expect is hard… because you just don’t know what to expect! But a bit of the right reading can help you to get into the ‘breastfeeding mindset’. A good book such as Emma Picketts ‘you’ve got it in you’ is a great way to ease you into the way of thinking. Alternatively, if you’re more of an internet browser then articles about the 4th trimester are really useful and interesting.

 

Sling

These can be so handy. Not the structured carriers that you can buy on the high street, but a sling – whether a stretchy style or a woven is invaluable for managing to move around with a baby that just wants to be held. It can offer you opportunities for skin to skin, it can conquer the baby that like to be held, likes to be upright – you can even learn to breastfeed in one on the move!

 
Boxsets/TV subscriptions

If this is your first baby, a massive amount of your first weeks and months is going to be you tied to the sofa or bed. Having an interesting series to watch will help you while away those hours without getting bored or frustrated. It might even help you cut down on your Facebook time! …

 

Thermal cup & water bottle

As above. Set your ‘feeding station’ up!! You don’t want to be up and down once you get your baby latched on! Also you won’t believe the amount of cups of tea that can go cold when you’re busy with a baby.

 
Meal & snack preparation

It can be hard to eat properly when you’re glued to a baby. If you’re a cook then making a few one pot meals to stock in the freezer can be really useful. Especially if you can eat them one handed over a baby’s head… it’s also handy to have a few snacks prepared for using the day if you’re going to be on your own. Whether that’s leftover dinner, sandwiches/wraps made the night before or high energy nibbles like nuts and chopped fruit it can be really helpful to have something you can quickly grab.

 

Cleaner

If you can afford it, forget the fancy products, chairs etc and spend the money on a cleaner to relieve your stress. You’re on maternity leave not housework leave, so put your feet up and spend time with your baby while someone else looks after the house!

 
Vest tops

You don’t need expensive nursing clothes, or clumsy covers and shawls. Many mums find it so much easier to feed in public by using the ‘one up one down’ method of wearing a thin vest top under their clothes so they can pull their top top up and their vest top down, limiting the boob exposed in-between. For further information about nursing in public see our blog here 

 

Support for your family…

Make sure that dad/grandma etc are on side with you and ensure that they know the right way to support you; not by pushing you to express so they can ‘help’ but by supporting you to reach your personal goals. They could even help with some of the above by digging in with their share of meal prepping and cleaning. Every little helps. They can get some help and info from us if they want here

 

Save up for a Lactation Consultant

Finally, have some ‘just in case’ money put aside in a rainy day fund for an IBCLC. If you do face any issues – whatever they may be, then having enough money for a consultation with a lactation consultant could save your journey, and therefore be worth every penny. Think of it terms of how much you’d need to spend on formula and bottles as the alternative – an LC will pay for itself very quickly when you think in those terms!

 
This is by no means a replacement for everything else that you might want to buy, but remember – mums were breastfeeding long before we lived in such a commercial world. Breastfeeding can be beautiful in its simplicity… but that doesn’t mean you shouldn’t treat yourself to some gorgeous and extravagant nursing bras of course!
Good luck, and don’t forget to pop by and post your queries on our group any time while you’re pregnant or breastfeeding!

 

By Ali Thomas