12 Key Ways to Decrease Your Infant’s Risk of a Sleep Related Death

Fingers Of Newborn BabyAs I was standing in Pottery Barn Kids innocently looking at crib sheets, I overheard the lady behind me who was purchasing a gift ask the sales clerk, “Are you really supposed to use bumper pads? I thought that they weren’t safe.”  To my dismay, the sales associated responded, “Oh, I think it is really up to you. They should be safe; otherwise, we wouldn’t sell them. And, they keep babies from getting their legs and arms stuck in the cribs.” The family physician and public health specialist in me was fuming! I wanted to correct her. I wanted to set the record straight. I wanted to grab the bumper pad from her hands and say, “Don’t buy it!” I debated with myself for just a little bit too long. I didn’t want to sound rude or all-knowing, but I wanted her to know that bumpers can contribute to Sudden Unexpected Infant Deaths (SUID). By the time I had built up the courage to add my two cents, the purchase had been made, and the innocent gift giver was out the door.Cute Baby At Hands Of The Mother In An Embrace, Monochrome

Every décor savvy mom longs for a beautiful bumper to complete her infant’s crib. Well, keep on longing! I have created a beautiful nursery for our daughter…bumper free. It sounds cliché, but “SAFTEY FIRST” should be every mom’s motto. Let’s review the updated recommendations to reduce the risk of Sudden Unexpected Infant Deaths. If you are already following them, give yourself a pat on the back. If not, then now is the time to start.

Sudden Unexpected Infant Deaths are deaths that occur suddenly, and unexpectedly in infants under one year of age. These deaths do not have an immediately obvious cause. But, after investigation, most of them fall into one of three main categories: Sudden Infant Death Syndrome (SIDS), accidental strangulation and suffocation in bed, and unknown cause. According to the Centers for Disease Control, approximately 4,000 infants die each year in the United States from SUID, and Sudden Infant Death Syndrome is the third leading cause of all deaths for infants.Newborn Beautiful Baby Sleeping

The American Academy of Pediatrics has updated its recommendations on safe sleep environments for infants in an effort to reduce SIDS and sleep related deaths. Here is a breakdown of the key recommendations, but be sure to look at the hyperlinks in this article for more detailed information.

  1. Infants should be placed on their BACK every time they sleep
  2. Use a firm sleep surface-a firm mattress with a tightly fitted sheet
  3. Keep your infant in your room, but not in your bed (this can reduced SIDS risk by 50%!!!)
  4. Keep soft bedding and loose objects out of the crib (no stuffed animals, pillows, blankets, or BUMPER PADS)-there is no evidence to say that bumper pads prevent injury, they do, however, raise the risk for suffocation, strangulation, and entrapment according to the AAP. Sleep sacks are great to use instead of blankets. They keep the baby warm without the risk of suffocation.
  5. Avoid infant smoke exposure during pregnancy and after the infant is born.
  6. Breastfeed if possible for at least the first 6 months
  7. Offer a pacifier at naps and bedtime. Even if it falls out, its use has been linked with SIDS prevention.
  8. Avoid Overheating-Don’t over-bundle your infant for sleep
  9. Immunize your infant
  10. Avoid devices sold to “prevent” SIDS, including positioners. These are not considered safe.
  11. Do not use home cardiorespiratory monitors to prevent SIDS. These have not been found to lower the risk.
  12. Make sure to incorporate supervised awake tummy time for your infant. This helps strengthen neck muscles.Mother Father And Baby Feet Under Blanket

Although this may seem like a long list, most of you are already complying with many of these recommendations. They aren’t always convenient, or baby décor conscious, but what could be more important than your infant’s safety? Sudden Unexpected Infant Deaths are not all that “common”. But, if SUID only stole one infant’s life each year instead of 4,000, and that life was your child’s….? Don’t tempt fate. Protect your child. Reduce their risk of SUID.

From The Mom in Me, MD

Breastfeeding a Preemie: thoughts from a mom who has been there!

Don’t be fooled by the title. This blog is helpful for all breastfeeding moms! I have been asked on several occasions now to touch on breastfeeding a preemie or a baby who is in the NICU. Mommies ask…I answer! While I’m not a lactation consultant, my role as breastfeeding mom to a preemie has given me quite an education. I’ve decided to address some of the common challenges that go along with breastfeeding a preemie. Some of these challenges also exist for non-preemie babies…so, all of you nursing moms may want to keep reading.Newborn baby boy covered in vertix inside incubator

1. Not Yet Ready To Breastfeed

Many moms with preemies have a sense of helplessness. They want to protect and take care of their newborn, but this is incredibly challenging in the NICU setting. Breastfeeding is one significant way for moms to impact their preemie’s health. But, one of the major challenges of having a preemie or sick infant in the NICU is that they are not yet physically ready to breastfeed. Many little ones require a feeding tube and IV nutrition for their early meals. Eventually, many preemies will be ready to breastfeed, but in the meantime, moms can have an incredible impact on their preemie’s health by pumping breast milk to be given through the feeding tube. Research tells us that infants (specifically preemies) that receive breast milk have better outcomes. Since preemies are already at a disadvantage from day one, giving them any extra health benefits is MAJOR!

That being said, pumping often feels like a task rather than an opportunity. Having your breasts hooked up to a suction machine for thirty minutes, twelve times a day is far from pleasant. It doesn’t afford the same bonding that actual nursing creates, but don’t give up. Eventually your baby will be at the breast, and you will be able to pump much less frequently.

This is often a slow process and starts with nonnutritive feedings, where your preemie is simply put to the breast but not expected to actually transfer milk. Be patient. With time, your preemie will figure things out. In the meantime, I can’t say this too many times, pump, pump, pump. Be diligent in establishing a good milk supply from day one. Pumping every several hours for at least 20 minutes to start will help ensure a good supply. Being in the room with your preemie while pumping can also increase the amount of milk that you produce. The times that I sat looking at my preemie while pumping I often was able to pump at least an extra ounce of milk.

Getting enough sleep is also an important part of milk production. Once your milk supply has been established, allow yourself to go one somewhat longer stretch at night (not more than 6 hours-you don’t want to get engorged) without pumping. This extra sleep may help keep your supply up. Drinking enough water is another important component to an adequate supply. Water…Water…Water! Keep refilling your bottle.Mother breast feeding her baby with closed eyes

2. Small Mouth

Most preemies have tiny mouths, making it difficult for them to latch correctly. Make sure that you are using the help of a lactation consultant when teaching your baby how to latch. They have amazing tricks for helping the little one open widely and latch deeply. If your baby is latched too shallowly not only will they be unable to get milk efficiently, they will also cause you incredible pain! You are not going to gag your baby! Sandwich your breast with your hand and shove your baby’s mouth as deeply as possible onto your breast. The angle of their mouth should line up as though they are taking a bite from a sandwich. If you are in extreme pain, simply slide your finger into the corner of your infants mouth to break the suction. Unlatch and try again. Don’t let your baby feed with an incorrect latch! Sometimes a nipple shield may be necessary as well.

3. Lazy Feeder/Tired

Many preemies are tired. They don’t have much of an energy reserve due to their small size and lack of body fat. Overdoing it can definitely tire them out. Don’t expect your new preemie to eat efficiently at the breast for some time. It will come eventually. Some tips to help your little one stay awake to feed include stripping them down to a diaper and tapping the soles of their feet or stroking them.Mother Breastfeeding her newborn

4. Bradys

Many preemies will have bradycardic events (drop in heart rate) while breastfeeding. This is incredibly common. If this happens, take the baby off of the breast and stimulate them either by rubbing their back or the soles of their feet. Eating takes a lot of energy and sometimes if they are not yet efficient at handling milk flow, they may “choke” or “gag” resulting in a brady. Your nursing staff will help you know how to look for the warning signs before it happens. I always knew when I was nursing when my daughter was going to have a dip in her heart rate before it showed up on the monitor. She had the same tell every time where she acted like I was water boarding her with milk. If a very fast flow is an issue for your baby, you may need to pump for just a couple of minutes first to get the fast let down out of the way. This may benefit your preemie anyway, because they will be getting more of the hind milk which is richer in fat. If you notice that your baby is starting to struggle or gag, it may be a good idea to remove them from the breast for a moment and let them recover.

5. Poor Suck-Swallow-Breath reflex

Preemies have a lot to learn. Unlike other infants, they are expected to be high achievers before they were even supposed to enter the world. They shouldn’t have to breath air, suck a breast, or swallow milk yet. Expecting them to put all three of these activities together in a coordinated fashion is incredibly demanding. Most full-term infants are born with a suck-swallow-breath reflex. It happens naturally. For most preemies this is not the case. Give your baby time. Eventually they will figure this out. I was incredibly frustrated because I thought that my daughter would figure it out immediately. It took her nine weeks before this became natural.

The list of concerns and complications goes on and on when dealing with feeding a preemie. I have only touched on a few of the common issues. Please feel free to comment with questions, concerns, and your experiences.baby near mother's breast

From The Mom in Me, MD

 

 

Am I a Bad Mom if I Give my Baby a Bottle?

With Le Leche League advocates, physicians (myself included), lactation consultants, and many moms pushing the breastfeeding agenda…where does that leave the bottle feeding mom? Many moms that I know have been unable to nurse their babies. Some had preemies who were unable to nurse. Other moms’ milk didn’t come in. Some moms gave breastfeeding a great effort before “quitting,” while others decided from the start that they only wanted to bottle-feed. Although I’m a strong supporter of breastfeeding, I’m also a strong supporter of moms, their health, and their sanity.

Cute Baby At Hands Of The Mother In An Embrace, MonochromeEvery woman should be able to decide how she is going to feed her baby-without judgement or criticism! Several of my friends have adopted babies. Clearly, breastfeeding isn’t even an option in their situation without going to incredibly great lengths. The stares and comments that they have received for feeding their babies formula is insane. The fact that strangers feel comfortable criticizing how a baby is fed (breast vs. bottle) without even knowing the whole story is shocking to me.

Since I had a preemie, I was required to give my daughter two formula fortified bottles a day. Granted my bottles were breast milk mixed with formula, but all that most people saw was that I was mixing formula into a bottle. I could tell that I was getting disapproving looks. The idea that I felt guilty over feeding my baby formula (that she actually needed for the phosphorus and extra calories as a preemie) now makes me shake my head. I was doing what was best for my baby. I didn’t need other people making me feel like a bad mom.

I definitely don’t want anyone to think that I’m bashing breastfeeding! Quite the opposite. I do believe that breastfeeding provides infants with incredible benefits and that breast milk is the best nutrient option for most babies. But, I do want to give a shout out to all of the amazing mothers who either chose not to breast feed or who couldn’t. A formula fed baby can and will still grow, be healthy, develop a healthy immune system, and potentially go on to win a Nobel Prize! Baby Bottle And Milk With Clipping Path

As moms…we are all doing our best. We all have our children’s best interest at heart. Bottle feeding moms are just as amazing as breastfeeding moms. Don’t let anyone tell you differently or make you feel differently.

From The Mom in Me, MD

When breastfeeding doesn’t go your way…

Seeing other moms discretely breastfeed their babies while sipping lattes, answering text messages, and having in-depth conversations with their friends left me wondering what I was doing wrong. Why couldn’t I make breast-feeding look this easy? I wanted to sit at Starbucks perfectly covered by a pretty, Petunia Pickle Bottom nursing cover! Instead, I was still working on getting my baby to latch correctly without biting off my boob in the process. Would it ever get easier?SCARSDALE, NY - SEPTEMBER 15, 2013: A tall Starbucks coffee in f

I know that you are all expecting me to say, “Yes, my daughter became a model breastfeeder! I was sipping my own lattes at Starbucks in no time.” But, the reality of the situation was that breastfeeding was always a challenge for me. My daughter eventually figured out how to latch correctly, but then she decided to start biting me! YES, BITING! After we had a pretty heated chat about how naughty it was to bite mommy, she then decided that home was the only place she liked to nurse. Each month it seemed like a new breastfeeding challenge arose. Each month, we muddled our way through.Mother breast feeding her baby with closed eyes

I was determined to breastfeed for at least a year. And, although I loved the bonding that breastfeeding brought, I couldn’t help counting down the days until her first birthday. Because she was a preemie, I still had to pump in order to give her fortified bottles with breast milk. The extra step of pumping several times a day in addition to nursing left me feeling akin to a dairy cow. I was exhausted, moody, and sometimes downright irritable.Cute Baby At Hands Of The Mother In An Embrace, Monochrome

Would I do it all over again? Absolutely! Reminiscing about my love-hate relationship with breastfeeding reminds me that most things worth doing are challenging. Although breastfeeding doesn’t always get easier for some of us, neither does motherhood! Poopy diapers, skinned knees, toddler melt-downs, teenage rebellion…as moms, we are in it for the tough stuff. Although I love the beautiful moments that motherhood brings such as cuddle time, kisses on my nose, and a little hand to hold; I’m also grateful for the challenges. These remind me of what I’m made of…or at least what I’m becoming…someone a little less selfish, a little more genuine, and a lot more determined to be the best at my biggest title…MOMMY!

From The Mom in Me, MD

 

 

Breastfeeding Musts: 10 tips to make nursing easier

Although breastfeeding is “natural,” it can also pose some pretty great challenges for new and established moms. If you are determined to give it a try (which I strongly suggest) here are a few items, ideas, and resources that I found helpful for my boobs, my baby, and my sanity!baby near mother's breast

1. Get Some Help Sooner than Later

Several of my friends had struggled with breastfeeding, and their experiences clued me into the absolute necessity of lactation consultants, breastfeeding support groups, and breastfeeding friends. While breastfeeding is “natural” many babies have to learn how to feed. They may not want to latch correctly, they may be lazy eaters, or they may have medical issues that complicate effective nursing. On the other hand, breastfeeding challenges often stem from mommy related issues-difficulty positioning, low milk supply, flat or inverted nipples, exhaustion from every 2 hour feeds, and the list goes on! Getting help early on can reduce a whole host of potential frustrations. While lactation consultants may not be able to “fix” every problem, they can offer the encouragement and support that every tired mom needs.

2. Invest in a Good Pump or Borrow One

Symphony-02.jpg

Medela Symphony Pump-image from Medela website

-Although you many not want to start out with any bottles, pumping can give you the opportunity to go on a date with your husband, get to the gym, or even have a spa evening at home while your partner watches the baby. Most babies have established nursing after 4 weeks. Once they have figured it out, introducing a bottle with pumped breast milk is an option. Another benefit of pumping is that it allows your partner to have the special experience of feeding the baby. Although I nursed my daughter most of the time, my husband loved the opportunity to feed our daughter. If you aren’t interested in doing any bottles or in pumping…no worries…simply skip this section. I had to pump since my baby was a preemie.

-I decided to spend the money on the best Medela Pump that Buy Buy Baby carried. It was portable with a battery so that I could travel with it. It was worth the money! I’ve now loaned it to a friend who simply had to change out the tubing (for sanitary reasons of course). Since we spent some time in the NICU, I also used a hospital grade pump by Medela. These pumps have a different type of suction mechanism, and I actually felt that it was the best at getting the most milk. I ended up renting this pump from the NICU. I couldn’t travel easily with it (no battery and very bulky), but for women who feel like pumping “doesn’t work!” this might be a good option to try. It is pricy as well, but many insurance companies are now covering pump purchases and rentals. Make sure that you save your receipt to submit to insurance! If insurance won’t cover it, you can still count it as a non-reimbursed medical expense…this is a tax deduction! Supplies are a deduction too!

-If you feel like your pump all of the sudden doesn’t have good suction, check the tubing to make sure that it is pushed in completely. If that doesn’t solve the problem, next check the “membranes”. Not all pumps have these, but these small white flaps can get tiny tears from being frequently removed for washing. You can find replacements at most Targets and Walmarts.

-Label your breast milk with the date so that you know when you need to use it by. Check out this helpful table for info on breast milk storage. It comes as a magnet (which I kept in my freezer). Make sure NOT to store your milk on the fridge or freezer door. This won’t keep it cold enough.mother breast feeding her child

3. Simplify Your Routine 

-If you are pumping at night or giving bottles of pumped breast milk at night, consider keeping a cooler or mini fridge in your room. This will prevent you from having to run to the kitchen in the middle of the night.

-buy more than one set of pumping equipment so that you don’t have to wash it after every pumping

-Ask your partner to help you get your pumping equipment ready before bed

-Ask your partner to change the baby and hand him to you to breastfeed. This may give you a little extra shut-eye in the middle of the night.

-If you are doing any bottles, ask your partner to do one night-time feeding on a regular basis

4. Relieve Engorgement ASAP

Don’t let yourself get engorged, but if you do…try these tips.

-try taking a hot shower and angle the water toward your chest

-place warm compresses on your breasts

-massaging your breast before nursing or pumping

-place your infant skin to skin on your chest if you are having trouble getting a let-down of milk. This simple solution often does the trick.

Mother and her Newborn Baby. Happy Mother and Baby kissing and h

5. Have Some Soothing Options for Sore Boobs-you will get sore at times!

Lanolin

Motherlove

Hydrogel -these gel pads by Medela are awesome. Because they are a little pricy, you can cut them into smaller sections if you only need to cover a small area.

Young Mother Breastfeeding A Baby In Nature

6. Make Sure You are Comfortable When Nursing

Ways to ensure comfort:

-Have someone help you get positioned early on as you are trying to get the hang of things.

-Make sure that baby is latched correctly so that you won’t be missing a nipple after the feeding-baby needs to have a wide open mouth and needs to latch deeply. You won’t gag her!

-Use a nipple shield if you have to.

-Get a good Boppy or supportive pillow like those from My Best Friend Nursing

-Consider a foot rest if you are sitting in an upright chair

-Buy the most comfy chair that you can find. Make sure that the back of the chair comes high enough for you to be able to lean back with your head supported.

IMG_2921

one of my favorite nursing tanks by Pea in a Pod!

-Find a cute nursing cover if you prefer some privacy

7. Wear the Right Clothes

-Nursing tank-these saved my life! You can wear a nursing tank under any loose shirt and then lift the shirt up or pull it down easily without your belly showing!

-Not too many nursing bras-If you are using nursing tanks, you won’t need too many nursing bras. Make sure to get at least one because you may want to wear a dress at some point.

-Nursing sleep wear-having comfortable nursing sleep wear makes middle of the night feedings much easier. Check out Motherhood Maternity for a pretty good selection.

8. Keep the Leaks to Yourself

Although I didn’t have trouble with leaking, many nursing moms do! Here are some suggestions from my friends who leaked.

Lilypadz– I purchased these and liked them, but didn’t end up really needing to use them. I have some friends who swear by them though!

Medela Disposable Nursing Pads-if you don’t want anything extra to wash

Dr. Brown’s Washable Nursing Pads-if you don’t mind throwing these in with the laundry

9. Keep Your Supply Up

-Nurse frequently or pump often! This is the best way to ensure a good supply.

-Fenugreek is a natural supplement that may increase milk supply. This comes as a pill, in lollipops, in drinks etc. Most local vitamin, nutrition, or drug stores will carry this. Talk with your lactation consultant about this option.

-Drink lots of water! Making milk means staying hydrated. Drink, Drink, Drink!Pouring Water Into Glass On Blue Background

-Limit your caffeine

-Oatmeal may do the trick! Oats are thought to increase milk supply as well. By switching to oatmeal for your daily breakfast you may notice an increase in your supply.

-Throw some NUTS into your oatmeal! Nuts may also increase your supply.

10. Be Willing to Admit that Nursing Sucks at Times! 

Although breastfeeding can be an amazing bonding experience with your infant, at times it down right SUCKS…literally! That’s why it’s so important to have a strong support system and to remember WHY you are breastfeeding your baby.

A. It is the best nutrition for your baby with a perfect mix of fats, fluids, carbohydrates, vitamins (minus vitamin D) and protein.

B. You are boosting your baby’s immune system with antibodies now and down the road!

C. You may be increasing your baby’s IQ

D. You are creating a special bonding experience for your baby

E. You may be decreasing your baby’s risk for SUIDS (sudden unexpected infant death syndrome or SIDS)

F. You may be decreasing your child’s risk for obesity later in life.

G. And the list goes on!!!!!

Although breastfeeding can be challenging at times, there are numerous ways to make it a successful experience. Breastfeeding was one of the hardest and best things that I have ever done. Give it a chance…even a fighting chance. If things don’t end up working out the way that you planned, know that you are still a great mother with your baby’s best interest in mind!Mother Playing With Her Baby Boy Son On Bed

From The Mom in Me, MD

If you can pee on a tree…I can breastfeed on a park bench!

mother breast feeding her childMen always seem to have this innate desire to be one with nature. Camping, chopping wood, and yes, even peeing on a tree seems to top their list of liberating activities. And, while peeing on a tree should probably be reserved for certain times and places…breastfeeding should not! Nothing is as natural as a mother nursing her newborn baby. And, while I don’t endorse an exhibitionist lifestyle for men or women, sometimes a little boob is gonna show!

As a first time mom (to a preemie), and a first time breastfeeder I was determined to make it work. Nursing without any additional complications can be challenging enough. Add in a tiny mouth that needs a lot of help latching correctly, and what should seem natural becomes a production. At home, I had my routine…a zillion pillows in just the right positions, my Boppy angled at just the right degree, and my feet propped to just the right height. But, nursing in public was a whole different story! My daughter hated the nursing cover. Actually, she despised it. I tried to convince her that Petunia Pickle Bottom was all the rage for covers (only the best for her), but every time the cover went down her scream reached new heights. If I was finally able to clam her down, I then had the complicated job of getting her to correctly latch so that she would get milk without biting off my boob in the process. Trying to stay covered while getting a preemie to latch correctly is like playing Twister naked with only a towel for cover…good luck!Happy Mother Breast Feeding Her Baby Infant

Since nursing with a cover always ended up with my baby (and me) in a meltdown, I resorted to finding “private” places to nurse such as bathrooms, designated nursing rooms, and the car. I quickly crossed bathrooms off of my list! Disgusting! I don’t ever eat in a bathroom…why should my baby have to? With limited options, and my frustration rising, I came to the conclusion that I just couldn’t leave the house, or if I wanted to leave I would have to pump and give her a bottle (pumping is no mother’s preference). My baby just wouldn’t breastfeed in public!

Looking back I now realize that my baby wasn’t the problem…my comfort level with openly nursing my daughter was the problem. If I had been willing to show a little boob, she would have nursed just fine. What was it that made me feel so uncomfortable breastfeeding without a cover? Was it my own sense of modesty? Was it my concern that I might offend someone or cause a vulnerable man to have “inappropriate” thoughts? Was it our culture that promotes larger than life Victoria’s Secret advertisements but is appalled by a breastfeeding mother showing any part of her breast? Honestly, probably all of the above.Young Mother Breastfeeding A Baby In Nature

Whether or not I will ever have another infant to breastfeed, I’m not sure; But, I’ve decided to change my opinion and my regard for what is currently, culturally acceptable and what I’m comfortable with. Most cultures around the world are comfortable with open breastfeeding. Many cultures rely upon breastfeeding as the safest source of nutrition for infants since clean water is scarce. Although the United States has established laws guaranteeing that nursing mothers can breastfeed in public, the fact that laws are necessary to ensure that a mother can feed her infant is disturbing. Isn’t it a little ironic that many developing countries are more advanced in their view of breastfeeding than those of us in the “first” world.

As women, our bodies were made to breastfeed. What could be more natural? Breastfeeding isn’t a sexual display or even a women’s lib movement. Instead, it is one of the best ways that a mother can nourish, protect, and bond with her infant. While I don’t think that nursing moms should walk around in public completely topless (although I’m all for it at home), I do think that breastfeeding moms should have the freedom to feed their babies where, when, and how it works best for their infant. If that means you need to plop down on a park bench with an exposed boob, so be it! If anyone has a problem with that…you can tell them to, “Go pee on a tree!”

P.S. For all of you mom’s who couldn’t or chose not to nurse, you are still amazing moms! Although I advocate for breastfeeding, every mom has to choose what works best for her and her infant.

From The Mom in Me, MD