Ina May's Guide to Breastfeeding
As Your Baby Gets Older
Pressure to Get Your Baby to Sleep All Night
It’s a good idea to resist any pressure you receive from well-meaning friends or relatives to “train” your baby to sleep all night, especially if your baby’s weight gain is less than it should be. Yes, sleeping all night is nice for you, but most nursing babies need to be fed at least twice (and maybe more) during the night throughout their first months of life. Lots of babies will continue to need that night feeding for several months. If your baby begins to sleep through the night and his weight gain slows down, it’s good to increase the number of feedings during the day or to wake him during the night.
When trying to judge whether or not your baby is gaining enough weight, take into account that it’s normal for babies who gained rapidly during the first few months to have a slower weight gain during the last half of the first year. Weight gain in breastfed babies between the fourth month and the end of the first year averages about four to five ounces per week. This means that the average breastfed baby weighs about two and a half times his birth weight at the age of one year.
As your baby grows older and more curious about the world around him, you may find that his weight gain slows down because he stops eating before he becomes full. Some babies nurse until they are stuffed, while others mess around and become distracted during a feeding. If you sense the latter is happening, you may find it more satisfactory to feed him in a quieter room with fewer distractions.
Teething ordinarily begins around the age of four to five months, and teething episodes may take place intermittently until a child is about two years old. A teething baby will usually drool more than usual and have tender, swollen gums in the places where a tooth is about to erupt. Most babies find teething uncomfortable to some degree. It can cause low-grade fevers, irritability, and fitful sleeping in some babies. If you’ve ever had a puppy, you know that teething time is when your shoes or slippers will be in danger, since all teething mammals want to chew on something; this is also true of babies.
There are several common remedies that can help the discomfort of teething in babies. Your initial response might be to gently massage the swollen gum in the area that is most tender. Most babies enjoy this (especially after the first few touches) and find it more comforting than chewing on their own fingers. You might also find that a chilled damp washcloth makes a great chew toy for your baby. Keep a couple of these in your freezer.
Many mothers have reported good success with homeopathic remedies for their teething babies: Chamomilla is one that is quite frequently helpful for babies who are extremely cranky and who like biting down hard on something. Babies are given the remedy in pill or drop form, and it helps relieve the urge to bite. Two other remedies that may prove helpful are Hyland’s Teething Tablets, which combine a number of homeopathic remedies into little pills that can be placed under your baby’s tongue at intervals to comfort his teething pain (visit 1-800Homeopathy.com to order), and Gentle Naturals Homeopathic Teething Liquid, which is made by Orajel.
There are also some over-the-counter medicines that you can find, but I would recommend that you try the ones mentioned above before resorting to anything that contains benzocaine, a numbing medication. This drug will numb not only the affected gum but also the tongue in that area, which can interfere with good nursing. Try to use a gel containing benzocaine only if your baby has trouble sleeping from teething pain and the more gentle homeopathic remedies don’t seem to help.
You can give your baby anything to gnaw on that is not a choking risk (meaning that it won’t break up into little pieces if your baby chews on it) and is not toxic. If you buy a plastic teething ring, make sure that you choose one that is labeled “PVS free” and “BPA free,” since many of the teething rings still on the market may contain phthalates or BPA (Brio, First Years, Gerber, Haba, and Tiny Love are all non-phthalate products).
Babies, with extremely rare exceptions, are born without teeth, so biting is not something most mothers have to cope with during the early months of nursing. When babies begin to teethe, the tenderness and swelling of their gums often prompts them to clamp down on anything placed in their mouths, including Mother’s nipple. Mothers who are taken by surprise will often give a loud yelp and immediately take the baby off the breast. Such a reaction is no more violent than any other mammalian mother might exhibit: It’s quick and definite. It is normal for the baby to cry because of the suddenly interrupted access to Mother; more rarely, a very sensitive baby might be so startled by being abruptly set aside that he refuses the breast for a while. If you think your baby might be one of these sensitive ones, it might be a good idea to extract your nipple by inserting your fingers between his gums instead of removing him completely from your breast.
Nobody enjoys being bitten in a tender place, but depending upon how a mother responds to this, a bite can be a single or rare experience, or the baby can develop a habit of biting and the problem can continue (and worsen) for weeks or months. Occasionally, a mother will shy away from stopping the feeding when her baby bites, worried that her baby might start crying. She may even come up with a reason why his biting is her fault (maybe she let him drink from a kind of cup that required something like a bite), so she continues to allow it. When this happens, the baby eventually learns to enjoy hurting his mother, a situation that really does neither him nor her any good. In no other species would a mother allow this kind of behavior. When I encounter a situation like this, my advice to the mother is to study the behavior of other mammalian mothers by watching nature programs on television. Observing the mothering skills of other species can teach human mothers how to discourage certain behaviors in a firm way that is neither angry nor threatening.
I remember Amanda, whose response the first time she was bitten by her oldest child was an instinctive one: She let out a sharp cry. Her baby let go of the nipple and howled for a minute or two but never bit her again. However, Amanda told me that she felt so guilty about the incident that she wondered for months if she had permanently traumatized her daughter. It wasn’t that her baby refused to nurse or seemed to be afraid of her in any way, but Amanda just couldn’t forget that look of surprised betrayal on her baby’s face once she let go of her mother’s bitten nipple. Because of her guilty feelings, by the time Amanda had her second baby she had already decided that she would try as hard as she could not to follow her instinctual response to biting, because she could not fit it into her image of how a mother should act.
When her second baby was five months old and bit her sharply for the first time, Amanda took her off the breast and quietly but firmly told her, “No, don’t do that. Don’t do that. It hurts Mommy.” Oblivious to verbal correction, baby number two kept on biting her. Frequent quiet lectures to the baby made no difference at all, and Amanda’s nipples soon became so tender and sore that she ended up weaning the second baby much earlier than the first. Looking back on her two experiences with biting, she concluded that her instinctual response had actually been the better one, because it allowed the nursing relationship to continue longer. For what it’s worth, both girls grew up to be sane, well-balanced adults.
Annie’s story also shows how effective a mother’s innate response to biting can be.
Annie: My son already had some teeth, and one time he decided it was time to try them out on Mom and he bit me. I was not expecting this sudden attack and spontaneously pinched his cheek. (I did this without thinking.) He immediately let go of the breast and started crying. I pulled down my sweater and decided, “No more milk for him for a while.” Then I noticed that he still had a red mark on his cute little cheek and I felt ashamed. But, still, you cannot have the baby you breastfeed bite you. The baby has to get a clear message of how to behave and how not to. I think that my response was almost like an animal instinct. At any rate, my son never bit me again, and so he kept on nursing for several more months.
Tips on Keeping Biting from Becoming a Habit
It should not be necessary to wean your baby if he keeps wanting to bite you. Instead, your goal should be to teach him to continue nursing without injuring your nipples.
When your baby is teething, give him your full attention during a feeding. This way you’ll be more likely to notice the mischievous look that usually precedes his bite. End the feeding if you see this look. It will often come after he has satisfied his hunger and has begun to get bored. I’m not saying that you can never read a book, talk to an older child, or talk on the phone while nursing your teething child, but it’s not a good idea to do these extra things while you’re teaching your baby not to bite you. Once the lesson is learned (which may take a few days), you should be able to return to a pleasant nursing relationship.
If your baby does bite, don’t try to pull him from your breast when his gums or teeth are firmly clamped to your areola. Insert your finger between his gums or teeth, entering at the corner of his mouth, and then remove your breast. Be quick about it. After you’ve detached him from your breast, you should immediately and without anger set him on the floor (or several feet away from you). Don’t resume feeding your baby for several minutes—although you can give him a cold washcloth or cold chew toy. How long should you wait before giving access to your breast again? Maybe ten to fifteen minutes; a minute or two usually isn’t enough for the lesson to sink in. This doesn’t mean that you shouldn’t console him if he’s crying; just don’t offer your breast for a while. He won’t starve, but he will get the message that biting causes him to temporarily lose access to the goodies. Contrary to what you may imagine, this will not break your child’s spirit. It will keep your nipples from being damaged, which is important if you wish to continue nursing.
Punishing your baby’s bad behavior isn’t the only way to stop him from biting; you must also reward his good behavior. Don’t forget to give praise or thanks when your baby doesn’t bite you! The idea is to reinforce the behavior that you’d like to see.
Sometimes biting begins when Mother goes back to work. Usually, this kind of biting behavior changes when you give the baby your full attention while nursing.
Some mothers say that they can feel friction from the baby’s teeth for a while during teething, even when the baby isn’t biting. This friction may mean that the baby isn’t latched as well as he could be. Take extra care to make sure that your baby’s latch is good before going on with a feeding. The friction problem often solves itself when the baby learns how to hold his tongue in such a way to accommodate the new teeth.
Teaching Nursing Manners to Your Older Baby
If you never feel that you have become a martyr to your baby’s needs, skip this section—it isn’t for you. But if you notice, when your baby is around the age of seven or eight months (or older), that you have become a plaything for him in a way that doesn’t feel good to you, read on. You may need to teach him some good nursing manners so that breastfeeding will once again be enjoyable for you, as well as for him. It’s a good idea to teach manners as early as necessary, particularly if you want to continue nursing into toddlerhood.
Once a new mother’s nipples have become accustomed to the baby’s sucking and the baby has a good latch, nursing should become a sensuous and fulfilling experience for both the mother and the baby. It should not be a negative experience or an energy drain, even when Mother happens to be tired. Newborn babies, once they set up a regular sucking rhythm, melt onto their mothers, continuing to suck and rest until they are full or too sleepy to drink anymore. As the young baby grows older and friskier, though, he can become bored at the breast once his belly is full. When this happens, nursing may not be as comfortable and fun as it was when the baby was younger and more innocent. We’re not talking here about the bite of a teething child who doesn’t realize what he’s doing; we’re talking about the conscious actions of a bored child who decides to have fun playing with you, as if you were a toy. He may find it amusing to pull your hair or to tweak your other nipple while nursing or he may delight in kicking you with one foot while nursing. Maybe you don’t mind this; some do, some don’t. It is not really painful, but it is irritating. My recommendation is that you end the feeding just as soon as you sense that your baby has gone into this state of mind. Draw the line between feeding and playing. If your baby still seems hungry and ready to settle down for some serious eating, resume the feeding. If he moves again into irritating behavior, end the feeding again. Babies learn quickly if you are consistent. Another way to teach your baby nursing manners is to avoid feeding him when he’s squirmy. Wait until he is in a calmer state of mind to begin a feeding.
You are not obliged to become a punching bag just because you are a mother. Allowing an older baby or toddler to punch, kick, or walk on you only teaches your child bad manners, which he will not only impose on you but perhaps on other people he meets later on in life. A mother who submits to abusive behavior from her own child runs the risk of raising a future adult who is inconsiderate of others. Linda described her son’s antics this way:
Linda: I enjoyed breastfeeding so much. I had plenty of milk, and my son grew and thrived. And thrived. And thrived. Pretty soon, he was a really big baby for a little old lady like me (I was forty-eight). He was a big, active baby who loved to play at the breast. He would pull on my nipples to look around, chew on them, and stretch them out as far as he could. I thought I knew all the tricks for training a baby to be nice, but this guy was really a workout. He was a wonderful child in many ways, but I began to suspect that maybe he wasn’t the reincarnation of the Compassionate Buddha.
I have known mothers who adopted such a submissive role in relation to their babies that they weren’t able to enjoy them when they were three or four years old. It is easy enough to slip, step by step, into this position if you are already short on sleep and you have adopted the idea that you should always follow your baby’s lead. It’s important to realize that a young toddler who manages to dominate his (or her) own mother is hardly feeling secure in this role.
If your baby handles you in a way that isn’t comfortable while nursing, you might try holding his hand firmly while he drinks. If he tries to pull away with your nipple in his mouth, release your nipple and set him off your lap. You may get a surprised or even a reproachful look. If so, remember why you did it. Mothers are not supposed to be treated roughly by their children any more than children are supposed to be abused by their parents. If the look is one of surprise, invite your baby to come back and finish nursing if you think he might still be hungry. If your baby doesn’t learn what you want after one interaction such as this, repeat it as necessary.
Breast Refusal in Older Babies
Babies who have been successfully nursing for weeks or months sometimes refuse the breast. Although this behavior is not common, it can be upsetting. It’s a good idea to calmly assess how much of a problem really exists. Older babies might refuse the breast during the day but nurse as well as ever during the night—enough so that they continue to gain well. If your baby refuses the breast sometimes but still feeds well three or four times per day, he will probably be taking in enough milk to remain healthy. You should make sure that your baby isn’t becoming dehydrated, though, by counting the number of wet diapers you get per day (six in twenty-four hours should be enough).
Trying to force your baby to nurse when he doesn’t want to tends to aggravate the problem. Gentle coaxing may persuade him to return to the breast, particularly if he’s sleepy, or you can try to express some milk and see if he’ll take it from a cup. Remember that a sleepy baby will usually be more likely to nurse.
Though it is rare, there are some medical reasons why a baby who previously nursed eagerly might refuse the breast. For instance, a baby with an ear infection might refuse to take one of your breasts if he would have to lie on his infected ear in order to reach it. The same goes for a baby whose nose is congested because of a cold. In either case, changing your nursing position might solve the problem—for example, you may do better if you feed him in a more upright position than usual. If he is still unwilling to nurse, he will probably drink your expressed milk from a cup. Try using a cool-mist vaporizer in the room where he will be most of the time, as this can help address the underlying problems. Many short feedings may work better than fewer long sessions.
Your baby might also be refusing your breast if you have mastitis or a blocked duct, since these conditions can create congestion in your areola or a portion of your breast that slows down the flow of your milk. You will need to remedy these problems as soon as you suspect them, as both can lead to more-serious conditions (see pages 131 through 136).
There are a few other possibilities to explore when your once-eager nurser refuses the breast:
· Sometimes the problem may be that you have given him too many bottle feeds or solid foods at too early an age.
· Anything that is emotionally upsetting to you can affect your baby’s nursing patterns as well.
· If you have a knot in your midsection because of family tension, your baby may reflect this by temporarily refusing to nurse.
Concentrate on getting your milk into your baby, and avoid other drinks, such as water, juice, or formula. See pages 113 through 117 for more possible explanations for breast refusal. Whatever tactic you take, you should carry him around with you, getting as much skin-to-skin contact as possible, because this cuddling attention and proximity to your breasts may entice him to nurse. Most babies will pass through this phase and return to their former nursing patterns, and you may never know what prompted his refusal to nurse.
Effect of Birth-Control Methods on Feeding
Sometimes babies become fussy at the breast because their mothers have begun to take birth-control pills containing small amounts of estrogen. Even low levels of estrogen can decrease some mothers’ milk supply significantly. This is likely to be part of the reason for your baby’s trouble if he was gaining well and contentedly nursing for several weeks and then became fussy within a week or so of your going on the pill. Another indication that this is the problem is if your baby seems to want the breast but then pulls away, frustrated, after he starts nursing. By doing this, he is showing you that he is hungry but that the slow flow of milk is unsatisfactory for him. The best remedy for this problem is to stop taking the pill.
There are two types of intrauterine devices (IUDs) available in the United States today: One, the Mirena, releases small amounts of progestin, which causes the uterine lining to thin too much to support implantation. Because the Mirena does not release estrogen, it is supposed to have no negative effect on milk production. The American Academy of Pediatrics considers this contraceptive method to be compatible with nursing; however, while many women do not experience any noticeable reduction in milk production, I have heard of at least one case in which a mother’s milk supply did drop significantly shortly after this IUD was put in place. That one case may have been an anomaly. Women who easily forget to take the pill and don’t like barrier methods tend to be happy with this device. Some women have reported lighter periods once the Mirena was in place for a while, and others have said that it caused them to get more yeast infections than usual.
The other IUD available in the United States is the ParaGard, a copper variety that is completely nonhormonal (the metal seems to have a spermicidal effect). Some women find that this IUD causes longer and heavier-than-usual periods.
IUDs are not considered advisable for women who haven’t already given birth, because the smaller size of the uterus makes for more irritation and a higher rate of expulsion of the device. Additionally, they aren’t a good choice for women who will have more than one sex partner, because of the risk of infection.
Many babies are ready to eat their first solid foods at about the age of six months. By this time, your baby will probably be able to sit up, pick up food, and put it in his own mouth. There are several good reasons to delay offering solid foods until the six-month mark. Exclusive breastfeeding provides your baby with immunities to many ailments during his most vulnerable period and protects him from many childhood diseases; also, babies less than six months old who are nursing well will get all of the nutrients they need from mother’s milk. Since their digestive systems haven’t matured sufficiently to digest foods other than your milk, there’s no reason to introduce solid foods before this time. Poorly digested solid foods are a burden to the baby’s system, which may lead to stomach pains and uncontrollable crying. It is especially important to delay this introduction if you have family members with allergies. There is supported evidence that food allergies, asthma, and runny noses have been linked to early introduction of solid foods.
Once your baby has begun to show signs of interest in what others are eating and is about six months old, you might want to experiment with introducing a new food. Some babies may not have any interest in solid foods even at the age of eight or nine months of age. If this is the case with your baby and your doctor is concerned, you can get your baby’s iron levels checked with a simple hemoglobin test. Breastfed babies absorb the iron they get from mother’s milk with great efficiency, so it’s rare for breastfed babies to become anemic.
It’s a good idea to nurse your baby before you first offer him a solid food. Introduce only a single kind of food at a time, as this will help you pinpoint whether he exhibits sensitivity to it.
Watch him closely for allergic symptoms. These include:
· Rashes or a sore bottom
· Gas, vomiting, diarrhea, constipation
· Nasal congestion
· Ear infection
· Asthma or wheezing
If he likes what you have introduced and he doesn’t react badly to it, continue supplementing his diet with only that food for a few days before introducing another. Avoid the temptation to give him as much as he will accept; it’s better to start small until you see how he tolerates each addition to his diet.
Foods to Offer
Some good choices for your baby’s first food include avocados, potatoes, mashed bananas, or sweet potatoes. Most babies like these foods, they are unlikely to cause allergic reactions, and they are easy to prepare. Watch your baby closely to see if he is able to swallow, without choking, whatever you offer him. Take your time and be patient.
Foods to Avoid
It’s a good idea to avoid offering dairy products during your baby’s first year of life. Many people are allergic to cow’s milk, and your baby will not be missing out on any essential nutrients if you don’t feed him dairy products. Eggs, peanuts, citrus fruits, strawberries, and raspberries are other foods that should be withheld during the first year of life, since many young children are allergic to them. You should also avoid feeding your baby foods that are fried or high in saturated fat, those that are quite sweet, and those that are flavored with artificial flavors or sweeteners. Salty crackers and potato chips are two examples. Not only do these types of foods contain unhealthy additives, but they will also overstimulate your baby’s tender taste buds. Honey should also be avoided, as it may contain botulism spores that his immature digestive system cannot handle.
If you choose to offer your baby raw vegetables, you must grate them very finely because of the danger that he might choke on too large a chunk. If pieces come through undigested in his diaper, it’s a sure sign that this food did him no good at all. Steamed vegetables that have been run through a food mill will be more digestible and will still be nutritious.