Baby bringing up milk after every 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

Questions to the pediatrician - articles from the specialists of the clinic "Mother and Child"

If after each feeding the breast is additionally pumped, then the body of a nursing woman receives incorrect information about how much milk needs to be produced, and produces more and more of it. As a result, pumping "leftovers" can turn into a continuous process

Doctors recommend feeding the newborn on demand, in this mode, he eats the amount of milk he needs. At the next feeding, the required amount comes again, and no pumping is necessary

A breast pump can be an indispensable tool in some situations. For example, the child categorically refuses to breastfeed, the mother needs to leave for a long time, the baby is not yet able to breastfeed (premature)

WHAT HAPPENED BEFORE

Previously, a nursing mother was advised to express her breast after each feeding, otherwise there will be excess milk, lactostasis and mastitis, and besides, it was believed that pumping contributes to the production of milk and the baby certainly will not remain hungry. Yes, pumping increased the amount of milk, but this did not take into account the fact that the mother's breast adapts to the needs of the baby - and produces milk exactly as much as the baby sucks. It is now known that if after each feeding the breast is additionally expressed, then the body of a nursing woman receives incorrect information about how much milk needs to be produced, and produces more and more of it. As a result, pumping "leftovers" can turn into a continuous process: with each pumping, milk comes in, the baby cannot completely suck it out, the mother has to express the leftovers, and by the next feeding the milk again comes in excess. What's wrong here? Excess milk is a direct road to its stagnation (lactostasis), and a woman is forced to constantly express her breasts. It turns out a kind of vicious circle.

WHAT THEY ARE SAYING NOW

Today, doctors recommend feeding a newborn on demand, in this mode, he eats the amount of milk he needs. By the next feeding, the required amount comes again, and no pumping is necessary. Yes, there will be periods of growth of the child when he needs more milk than before, but the baby will regulate this process on his own. At some point, the baby will begin to suck harder and ask for the breast more often than before. At first, it will seem to the mother that there is not enough milk, but in a couple of days everything will stabilize, the milk will begin to come in the right (larger) amount and no pumping, let alone supplementary feeding, will be required.

WHEN TO PUSH

So pumping is not necessary at all? Most often yes, but still there are some situations when you simply cannot do without it. When pumping is needed:

1. If the baby is premature or weak, he cannot breastfeed on his own yet and must be bottle fed.

2. If the mother has a very strong flow of milk, incipient mastitis or the first signs of lactostasis. In general, with a strong rush of milk and lactostasis, it is recommended to apply the baby to the breast more often, but if this does not help, then the breast will have to be expressed.

3. If there is not enough milk, but only if it really is, and not “I think so” or “my mother-in-law said that I have little milk and I need to pump”.

4. If it is necessary to part with the baby for a while, but at the same time you want to keep lactation.

5. If a breastfeeding mother falls ill and is prescribed medications that are incompatible with breastfeeding.

HOW IT WORKS

If you still need to express your breasts, you can do it by hand or with a breast pump. The advantage of manual pumping is that there are no material costs, but, perhaps, this is all its advantages. There are many more disadvantages: not all mothers know how to express their breasts correctly (even after looking at the instructions). And most importantly, manual pumping is not as effective as mechanical pumping, and in general is often unpleasant and even painful. But expressing breasts with a breast pump is much more convenient: it quickly helps to express a significant amount of milk, saves time and effort and does not cause pain. And there is only one minus - it costs money.

HOW TO CHOOSE A BREAST PUMP

· Do not rely on the opinions of friends and reviews on the Internet: like someone else's breasts, it is impossible to try on someone else's pumping experience.

· Examine the breast pump model carefully. For a device already purchased or donated, the size of the funnel, the intensity of pumping, the shape of the handle, the number of parts, the noise level may not be suitable.

· The more often you plan to pump, the more advanced and versatile you need.

· Strictly follow the instructions supplied with the appliance. Remember to sterilize your breast pump before each use and keep it clean.

· Don't get carried away: if you use it too intensively, there is a risk of hyperlactation - more and more milk will be produced, and as a result, pumping will be endless.

WHY THE PROBLEMS HAPPEN

0061 to for more effect. There may be several explanations for this. Or there is really little milk, and then you need to express at least a couple more minutes after the last drop appears. Or the device itself turned out to be not very suitable for a particular breast . For example, manual breast pumps are far less convenient and efficient than electric breast pumps. They, in fact, mimic manual pumping, just a little more comfort. However, they are also small in price. So if you really need a breast pump, then it is better to choose models with high power, decanting both breasts at the same time, electric, stationary, with the ability to change traction and speed. There are no problems at all with such breast pumps: put it on your chest, turn on the button - and go about your business.

As you can see, there is no unequivocal opinion about pumping. With normal well-established lactation, it is not necessary, but it becomes necessary for some problems. The same can be said about the breast pump. And if so, then we feed calmly, focusing only on our situation and the needs of our baby.

Article "Pumping - when and how?"

There are times in the life of mother and baby when breastfeeding is either 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 an infant can also be offered expressed milk.

The same applies to the situation when the baby is sick 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:

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