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Babies bringing up milk after feed


Reflux | Breastfeeding Challenges | Start for Life

Breastfeeding challenges

There may be times when breastfeeding is challenging. Never ignore any issues you may have – talk to your health visitor, midwife, GP or breastfeeding specialist as soon as possible, they will be able to help you sort it out quickly.

Here are some common breastfeeding issues, and tips on what to do.

  • Colic
  • Constipation
  • Mastitis
  • Milk supply
  • Reflux
  • Sore nipples
  • Thrush
  • Tongue-tie

Baby reflux

If your baby brings up milk, or is sick during or after feeding, this is known as reflux. Reflux, also called posseting or spitting up, is quite common and your baby should grow out of it, usually by the time they are 12 months old.

What causes baby reflux?

The muscle at the bottom of the food pipe acts as a kind of door into the stomach – so when food or milk travels down, the muscle opens allowing the food into the stomach.

However, while this muscle is still developing in the first year, it can open when it shouldn't (usually when your baby's tummy is full) allowing some food and stomach acid to travel back up again. Acid in the stomach is normal and a necessary part of the digestion process – it helps break down food.

In most babies, reflux is nothing to worry about as long as they are healthy and gaining weight as expected.

Baby reflux symptoms

  • Constant or sudden crying when feeding.
  • Bringing up milk during or after feeds (regularly).
  • Frequent ear infections.
  • Lots of hiccups or coughing.
  • Refusing, gagging, or choking during feeds.
  • Poor weight gain.
  • Waking up at night a lot.

GORD

When reflux becomes painful and it happens frequently, this is known as 'gastro-oesophageal reflux disease' (GORD). GORD is more serious than mild, everyday reflux. The strong stomach acid can irritate and make the food pipe sore and inflamed, which is painful for your baby and may result in them needing medication.

The main signs and symptoms of GORD in your baby are:

  • spitting up frequently
  • abdominal pain
  • feeding difficulties
  • seeming unsettled and grizzly after a feed

These symptoms can lead to your baby not gaining weight, or even losing weight.

Silent reflux

Silent reflux can be confusing as there are no obvious signs or clues (such as spitting up). It's when the food travels back up the food pipe – but it's swallowed rather than spat out so is harder to identify. But your baby may display similar symptoms to those of regular reflux.

Breastfeeding Friend from Start for Life

The Breastfeeding Friend, a digital tool from Start for Life, has lots of useful information and expert advice to share with you – and because it's a digital tool, you can access it 24 / 7.

Breastfeeding tips for babies with reflux

  • Feeding little and often (smaller feeds stop their tummy getting too full).
  • Burping them requently during feeds – have a look at our guide to burping your baby for techniques.
  • Try a different feeding position – check out our our guide to breastfeeding positions.
  • Keep your baby upright, for at least an hour after feeding, this should help keep the milk down.

If you are mixed feeding (combining breastmilk and formula feeds), have a look at our advice on bottle feeding and reflux.

When to see the GP

If your baby has difficulty feeding or refuses to feed, regularly brings milk back up and seems uncomfortable after a feed, talk to your pharmacist, GP, or health visitor. They'll be able to give you practical advice on how to ease the symptoms and manage it – they may also need to rule out other causes (such as cow's milk allergy).

It might be helpful to keep a record of when your baby feeds, with details of how often and how much your baby brings the food back up, and how often your baby cries or seems distressed. This will help your health visitor or GP decide if your baby needs treatment.

Why is my baby spitting up so much breast milk?

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My baby is frequently spitting up – it seems like it’s all of my breast milk! I never thought breastfed babies spit up this much. This can’t be normal, can it? Is there something wrong with my baby?

Don’t worry – we get these questions often. Caring for a baby who spits up can be stressful for parents, creating worries about the baby’s health and proper growth. Spitting up is a very common occurrence in healthy babies, and usually won’t cause any issues in regards to the baby’s growth or development. This often happens because the baby’s digestive system is so immature, making it easier for their stomach contents to flow back up into the esophagus.

Several different factors can contribute to babies spitting up, including:

  • Babies regularly spit up when they drink too much milk, too quickly. This can happen when the baby feeds very fast, or when mom’s breasts are overfull. The amount of spit up can appear to be much more than it really is.
  • Food sensitivities can cause excessive spitting up in babies. Products with cow milk in the mom or baby’s diet can be a common food sensitivity.
  • Some babies can become distracted when feeding at the breast, pulling off to look around. This can cause babies to swallow air and spit up more often.
  • Breastmilk oversupply or forceful let-down (milk ejection reflex) can cause reflux-like symptoms in babies.

If your baby seems comfortable, is eating well, gaining weight and developing normally, there’s typically little cause for concern. “Happy spitters” will grow and thrive, despite spitting up frequently. As babies grow and get older, they usually spit up less. Most will stop spitting up by 12 months of age.

Consider these tips:

  • Keep your baby upright. Try feeding your baby this way and keep them upright for about 30 minutes after feedings.
  • Avoid engaging in immediate active play for at least 30 minutes after feedings. Active play includes use of a bouncy seat, vibrating seat, infant swing or bouncing the baby while walking/holding.
  • Frequent burps during and after each feeding can keep air from building up in your baby’s stomach.
  • Avoid overfeeding. Feeding your baby smaller amounts more frequently might help decrease spitting up.
  • Put your baby to sleep on his or her back. Placing a baby to sleep on its tummy to prevent spitting up is not recommended.
  • Monitor your diet closely if you’re breastfeeding. If you feel there are certain foods that might be upsetting your baby’s stomach, try avoiding them for a while.
  • If you notice weight loss, forceful spit up, fussiness or other symptoms, talk to your child’s pediatrician about your concerns.

Lactation Support Services at Texas Children’s Hospital offers a variety of services to mothers with questions and concerns regarding breastfeeding, pumping, medications and more. Click here to learn more.

Shelly Nalbone, APRN, CPNP, IBCLC

Pumping: when and how? | Articles by doctors of the EMC clinic about diseases, diagnosis and treatment

In the life of a mother and baby, there are moments when breastfeeding is impossible or difficult for some reason. For example, a child has to be left without a mother for several hours - which means that a supply of milk is needed for him. Or in the case when the baby sucks badly at the breast, but eats well from the bottle, and pumping is the only way to feed him.

This can happen if the baby is born prematurely, and the very process of sucking the mother's breast turns out to be hard physical work for him - such a baby can also be offered expressed milk.

The same applies to the situation when the baby is ill and feeling unwell prevents him from fully sucking, as he is too weak to make the efforts necessary to "extract" breast milk. In this case, it should be expressed for 2 reasons: firstly, to provide the child with complete and optimal nutrition for him, and secondly, to maintain lactation.

Situations are different, so it is important to understand why pumping is necessary, how to do it correctly and what are the conditions for storing breast milk.

When and why to express?

Pumping is the process by which a nursing mother manually or with the help of a breast pump extracts milk from her breast.

This is not a mandatory procedure for everyone, and it does not need to be carried out after each feeding, since the milk in the female breast is formed exactly as much as is needed to saturate the baby at a certain age. Those. how much milk the baby ate in one feeding - so much will appear in the breast by the next.

But if, after applying, you also express the rest of the milk, then by the upcoming feeding it will be produced more than the child can eat - and this often leads to stagnation of milk (lactostasis).

Milk should be expressed when:

  • Having to bottle feed or supplement a baby for one reason or another. If at the same time the pediatrician did not forbid the baby to eat breast milk, then the mother needs to feed the baby expressed.

  • The baby is left without a mother for a long time. There are times when a woman needs to go away, and she cannot take the child with her. In this case, you can leave a supply of milk for several hours, after decanting it.

  • Mom is sick. It happens that during lactation a woman becomes seriously ill and is forced to take medications that penetrate into breast milk, which is strictly forbidden to give to a child. Medicines contained in milk, once in the child's body, can have an adverse effect on it. To prevent this from happening, the pediatrician will help you choose the milk formula that you need to feed the baby during the mother’s illness. Pumping in such a situation will help a woman maintain lactation until recovery.

  • Mom goes to work. A mother's return to work before the end of lactation can put her before a choice: transfer the baby to formula milk or feed it with expressed milk. Recently, more and more parents are choosing the latter option, since breast milk is much healthier than artificial nutrition.

  • Injured nipples. With improper care and attachment of the child to the breast, cracks may appear on the nipples. Feeding in this condition of the nipples becomes very painful for the mother, and then the baby should be briefly transferred to expressed milk from a bottle. This is useful because the nipples are less likely to get irritated when they are expressed than when they are sucked by an infant. In a few days, the nipples will heal, and it will be possible to resume feeding the crumbs directly from the breast.

  • There is a risk of lactostasis. A child, especially in the first days after birth, is not always able to suck out all the milk. To avoid lactostasis, mom needs to express excess milk. If this is not done in a timely manner, stagnation of milk can lead to inflammation of the mammary gland - mastitis. However, you must follow all the rules of pumping and do not resort to it after each feeding: this will only increase the flow of milk.

  • Not enough milk is produced. Pumping will help normalize lactation, as it leads to an increase in the production of milk in the breast, which can be useful during a lactation crisis.

5 pumping inhibitions

In order not to harm herself and not leave the baby without breast milk, the mother must know and be sure to follow the basic rules of pumping:

  1. Do not express more than 3 times a day if pumping is combined with breastfeeding because this will lead to excess milk production. If the mother is sick and the baby is not applied to the breast, it is necessary to express with a frequency approximately equal to the number of feedings (on average, once every 3 hours - 8 times a day).

  2. Do not express immediately after feeding, as this may lead to hyperlactation, ie. increased milk production.

  3. Do not express "to the last drop". The main indicator by the end of pumping should be a feeling of relief in the chest. The female body regards the emptying of the breast without a trace as an increased need for milk by the child - and begins to produce more milk, which the baby cannot eat, therefore, there will be a threat of milk stagnation.

  4. Do not express during the night, as this may also lead to the formation of excess milk. The main hormone responsible for milk production - prolactin - has a daily rhythm of formation, most of all it is produced at night, in response to the baby sucking or pumping.

  5. Do not express on the first day after the arrival of milk. Usually, when lactation begins, more milk is produced than the newborn needs, and it is necessary to get rid of its excess. Therefore, just at the time of the arrival of milk, you can not express everything without a trace. If the breast is very dense, then it is recommended to express only a small amount of milk so that it becomes softer and the baby can fully capture and eat it.

Substances that signal that milk is being produced in excess appear in the filled breast after about 1 day. If you express all the milk accumulated in the chest earlier than in a day, then it will be produced in the same amount.

Hand Expression Technique

There are two ways to express - manually and with a breast pump. Usually, each mother chooses the most convenient option for her. It is better to do it manually at home, when a woman has enough time, since the whole process will take some time. Breast pumps will help a working mother, which greatly facilitate the pumping process.

Rules for hand pumping

It is best to express milk 10-15 minutes after the end of feeding the baby. Wash your hands thoroughly beforehand. If you use any breast cream, wipe the skin and nipples with a cotton swab or pad soaked in breast milk. Prepare a wide-mouth milk container by first washing it under running water and then sterilizing it (by boiling, in a steam sterilizer or in a dishwasher).

Sit comfortably, keeping your back straight, because pumping can take some time, and an uncomfortable position can cause back pain.

Gently grasp the chest: the little finger is under the chest at the ribs, the remaining fingers are positioned so as to support the chest from below. The thumb lies on top, about 3-4 cm from the nipple. In this case, the thumb and forefinger are located opposite each other, forming the letter "C".

Use your thumb and forefinger to gently press down on your chest and hold this position for a few seconds. In no case do not bring your fingers together, they should remain in the same position, the letter "C".

Repeat pressing, moving the palm in a circle - this way you will use all the ducts of the mammary gland.

Be patient, milk may not come out immediately, but only after a while. If you are pumping for the first time, check with your doctor or lactation consultant beforehand to show you how to proceed.

Manual pumping errors

Do not squeeze the nipple: this way you will only hurt yourself and injure the breast, and you will not express milk fully.

Do not press the palm too tightly against the skin, moving the hand across the chest so that there is no irritation and microtrauma.

Do not give up at the first unsuccessful attempts, be patient.

Breast pumps

Breast pumps make pumping much easier, as they are designed to fit all the anatomical features of the female breast.

Which one to choose? Breast pumps are divided into mechanical and electrical. In the first case, the pumping process is carried out manually: by squeezing the “pear”, the woman starts the suction mechanism. Electric models are good because they work independently: from the mains or from batteries (batteries, accumulators) and do not require additional effort on the part of the woman.

Mom usually chooses a breast pump model according to her taste and financial capabilities. It should be borne in mind that devices powered by batteries lose power faster than devices powered by the mains.

Many women are confused by the fact that electric breast pumps are loud enough. To date, there are a large number of silent devices, which is recommended to pay attention to when buying. The most effective are electric breast pumps that express both breasts at the same time and have the option of adjusting the thrust force and suction speed.

When choosing a breast pump, pay attention to the presence of the “boil and sterilize” marking. There must be the possibility of such heat treatment of parts of the apparatus. If the model cannot be boiled and sterilized, it is better to refuse to purchase it and look for another one.

Rules for expressing with a breast pump

Before pumping for the first time, carefully read the instructions for the device. Check that it is properly assembled.

Sterilize the funnel and sump (boil or use a sterilizer).

Position the funnel so that the nipple is in the center of the funnel.

The draw should be the lowest, especially at first, until the breast is accustomed to expressing with a breast pump. Each breast must be pumped until a feeling of relief, add 2 minutes to this time. On average, the process will take about 15 minutes.

Pumping, like manual pumping, should be carried out some time after feeding.

Basic mistakes when expressing with a breast pump

Incorrect position of the funnel of the breast pump can cause pain to the woman. Remember: the nipple should be located strictly in the center of the funnel of the device.

Very long pumping. Do not exceed the time required to collect milk, this can lead to hyperlactation (production of excess milk).

Very strong traction. If your breast pump has a selectable thrust function, you should use the smallest one so as not to hurt your breasts.

Care of the breast pump. A breast pump, like any machine, needs proper care. It must not be clogged so as not to contaminate the milk.

Each model has a care instruction, which you should definitely read before using the device.

When washing, always disassemble the pump completely, removing even the smallest parts. This will prevent stagnation of milk residues in them.

Before each use, sterilize all parts of the machine that come into contact with milk. This can be done with a sterilizer.

Milk defrosting

Never thaw or heat breast milk in a microwave oven. When heated in the microwave, the milk warms up unevenly, while feeding the baby can burn. Also, due to the rapid heating of frozen milk when using a microwave, most of the useful properties of this invaluable product are lost.

To defrost breast milk, place it on the refrigerator shelf, and when it becomes liquid, heat it up. To do this, lower the milk bottle into hot water or put it under hot water. Also, special heaters can be used to warm milk.

If you have questions or don't know how to express, it's worth talking to a specialist. The doctor will not only tell, but also show how to do it correctly, give recommendations on the pumping schedule and advise which method is better to choose.

Remember that milk is undoubtedly a valuable food for the baby, but feeding with expressed milk should be used in exceptional cases.

At the School of Moms, our doctors talk in detail not only about how and when to express milk correctly, but also about how to properly attach a baby to the breast, how to avoid common problems with breastfeeding, such as lactostasis, as well as the rules for self-examination mammary glands.

Solving five breastfeeding problems after the first month

Expert advice on solving the top five breastfeeding problems that may arise after the first month.

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Cathy Garbin, child health nurse, midwife and lactation consultant:
Cathy, a mother of two, was a research fellow at the renowned Human Lactation Research Institute, founded by Peter Hartmann, for seven years, providing support to breastfeeding mothers in clinics and at home. Today, she still works as a family counselor, and also conducts seminars for attending physicians and speaks at international conferences.

You and your baby have already fully established the process of breastfeeding and know what and how to do. It seems that all difficulties are left behind. However, some more surprises await you. The following are suggestions for dealing with breastfeeding problems that may arise later.

Problem #1. I need to be away from my baby

Whether it's social events, travel or medical treatment, at some point you may need to be away from your baby for a while.

Solutions

  • Express milk so that someone else can feed the baby. Now that breastfeeding is established, you can express and store your breast milk in the refrigerator or freezer. Try different options to find the most convenient time for pumping in your daily routine. Some mothers manage to pump more breast milk in the morning when the baby wakes up after a long night's sleep. For others, it's best to express 60 minutes after feeding. Remember that everyone is different. Don't be discouraged if you don't get enough milk the first time: it's possible that you'll be able to express enough for one feeding in just two or three pumpings. As with feeding, it may take time for your body to adjust to pumping.
  • Take your breast pump with you, , if you plan to skip a feed. Even if you leave your baby with expressed milk, but will be absent for more than two hours, you will need to empty your breast. Pump at the same frequency as you would breastfeed your baby. This will support milk production and prevent discomfort. Express milk regularly throughout the day without waiting for your breasts to overflow. 1 Most electronic breast pumps are battery operated, so you don't have to find an outlet nearby.

Problem #2. How to continue breastfeeding after returning to work?

You will probably have to leave your baby more often and for longer when you go to work, so it's especially important to find ways to continue breastfeeding and pumping that work for both of you. As mentioned above, you can build up a supply of breastmilk before you go to work and then pump regularly to support milk production, prevent discomfort, and make sure your baby has enough pumped milk the next day. Many companies now provide dedicated pumping rooms, and modern breast pumps work efficiently and reliably. If you have a regular work schedule or work part-time, you can still breastfeed your baby before and after work and at night.

Solutions

  • Express as often as you would feed your baby. This will help maintain milk production and prevent discomfort, as well as reduce the risk of clogged milk ducts, mastitis and breast swelling. 1
  • Try double pumping. Double pumping not only takes half the time, but you get an average of 18% more milk than pumping from each breast in sequence. Milk is more nutritious and has a higher fat content. 2
  • Assemble and bring to work the set, which includes a breast pump, milk storage bags and, if desired, a bustier top for hands-free pumping. You will also need a cooler bag to carry your expressed milk.
  • Know your rights. In many countries, the law allows women to express and safely store breast milk at work. Discuss these options with your employer before returning to work. This will get you both ready.

Problem #3. It seems to me that the baby suckles only for pleasure

Sometimes you may feel that the baby takes your breast in order to calm down, and not to eat. However, do not forget that breastfeeding is not only nutrition, it is also comfort for your baby. "Soothing suckling" (when the baby suckles but does not eat milk) helps the baby to calm down and relax. Remember that a sudden increase in the frequency or duration of feedings may indicate insufficient milk production. However, if the baby continues to gain weight and you use enough diapers a day, this is unlikely.

Solution

  • Please be patient. The baby needs your care - listen to his needs and support him. Usually, the period of soothing suckling does not last too long, but it allows the child to feel your love and protection - and this is the best thing you can give him.

Problem #4. I want to switch from mixed to exclusive breastfeeding

Breastfeeding is so good for you and your baby that it's worth trying to fight for it. However, if you have rarely fed lately, your milk production may have been reduced. If your baby has only been mixed-fed for a couple of weeks, you will most likely be able to restore enough milk. Contact a lactation consultant or medical specialist who will help you and give you the necessary advice. This is a very individual process that depends on many factors. In any case, do not despair, because every drop of your milk is important for the child.

Solutions 1.3

  • Increase milk production. Try to put the baby to the breast more often, because the more milk the baby consumes, the more milk is produced. You can also express milk additionally. As mentioned earlier, double pumping in particular helps increase milk production.
  • Be in physical contact with your baby as much as possible. As in the first days after childbirth, close physical contact with the baby promotes the production of the hormone oxytocin, which in turn triggers milk production. It will also make both of you feel more calm and relaxed.
  • Reduce the number of formula feedings gradually. Resist the urge to stop supplementing with formula right away. If you gave your baby formula after each breastfeed, start giving it every other time until milk production rises. Keep a close eye on the number of soiled diapers and weight gain during this transition period. It is likely that at first the child will ask for the breast more often, and this is absolutely normal.
  • Speak with a lactation consultant or healthcare professional. He will be able to help you and strengthen the confidence that your baby gets everything he needs.

Problem #5. My child has lost interest in the breast

If your child, who always ate with appetite, suddenly began to refuse the breast for no apparent reason, this is a false refusal, the so-called "strike". You may assume that he is ready to switch to solid foods, or that he does not like your milk anymore, but this is most likely not the case. It's just that the child develops vision, and now he is more distracted by the world around him. Or maybe something frightened the child during feeding, or he reacts to a violation of the regimen, perhaps he has a stuffy nose or teething. What you take for lack of interest may actually mean that your baby has simply learned to breastfeed more effectively and therefore takes less time to suckle.

Solutions

  • Please be patient. False rejection is usually temporary and goes away after a few days. To provide the baby with the necessary nutrition during this period, give him expressed milk.
  • Find a quieter feeding area with as few distractions as possible. Baby is more likely to eat better if he can relax and focus on his chest.
  • Check in which position you feed. The baby may refuse to breastfeed if he is uncomfortable or unable to move his head to breathe during feeding.
  • Express milk to keep it flowing . You can try feeding your baby with expressed breast milk using the Medela Calma smart pacifier.
  • Do not start formula or solid foods. Supplementing with formula can lead to a decrease in milk production and will only worsen the situation. If your baby is regularly fed with expressed milk and is growing well, and the number of soiled diapers is normal, try not to worry. If the baby is less than six months old, you should not give him solid food: his digestive system is not yet strong and may not be ready for such a load.
  • Do not force-feed. Try to relax and be in skin-to-skin contact with your baby as much as possible, hug him and often offer the breast so that he can take it on his own. The release of oxytocin that body contact triggers will also help you pump. 4

Related content: Breastfeeding: what to expect after the first month

Literature

1 Kent JC et al. Principles for maintaining or increasing breast milk production.

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