Dr. Annie Answers: Breastfeeding 101

Happy World Breastfeeding Week! Given the celebration of lactation we are in, I wanted to get out a quick and dirty, insider basics style guide to breastfeeding for mamas to be or current lactaters. It’s not comprehensive – for more details, please check out La Leche League, Kelly Mom and/or get a lactation consultation or talk with your own provider! These are just some hard-won tips of the trade.

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On demand means on freaking demand

Breastfeeding is not easy, people. I have lots of family doctor and OBGYN mommy friends who have ALL said at one point or another, “this was so much harder than I though it would be!” … and of all people we should know what to expect! Some people certainly have an easier go of things than others – a challenge rather than the literal blood, sweat and (so many) tears battle other mamas fight through. But if it’s possible to get your baby that “liquid gold”, the health benefits are innumerable for you and babe alike. Also… No shaming here for the mamas who truly can’t make it work! Breast is best, but fed is a damn close second.

1) Initiation

Starting breastfeeding off right begins at birth. This is a super important part of breastfeeding going well with less difficulty. Many hospitals around the country have signed on to the “Baby-Friendly Hospital” guidelines to help mom and baby get an optimal start to breastfeeding and bonding, which is FANTASTIC! This includes (see Baby Friendly USA for more info) 10 items the hospital must comply with to show they are on board with supporting breastfeeding.

Probably the most important of all is recommendation #4: “Help mothers initiate breastfeeding within 1 hour of birth”.

This goes along with another important recommendation that isn’t always included in hospital protocols: The Magical or Golden Hour. Babies should be delivered and immediately placed naked, skin-to-skin with mom and kept that way for at LEAST 1 hour after birth. That means no bath first (there is actually very good evidence your baby should NOT be bathed in the hospital at all to keep their healthy skin flora), no shots, no eye ointment, and assessments done ON MOM unless there is an urgent medical concern that requires otherwise for the first hour of life.

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Sweet Mimi in her Golden Hour

This is not the favorite policy of many Labor and Delivery floors because it delays some of the tasks needed to wrap up post-delivery care. As much as I love and hugely appreciate my L&D RN friends, this efficiency concern gets a big ol

The Magical Hour is profoundly helpful in establishing proper physiology, bonding and strong initiation of latch and breastfeeding and should be protected. It is truly magical. Most babies will, completely independently, literally crawl up mom to the breast and latch themselves properly with practically no intervention. Check out the YouTube video and hundreds of others if you don’t believe me.

There are, unfortunately, sometimes medical emergencies that make this not possible. That’s ok too! Do as close to this as you can. Mom can’t do skin-to-skin? Dad/partner/birth partner can do it. Baby needs to be monitored more closely? Get mom or dad touching them as soon as it’s medically safe. Once you can, do skin-to-skin for as many hours of the day as you can to catch up. Some wonderful providers have even started doing skin-to-skin in the OR for their cesarean birth patients when it is safe. Do your best!

2) After The First Latch, Lube it Up

After you get that initial magical latch in, the real fun starts. Bring in and use nipple oil (I prefer coconut oil, some use lanolin or compounded ones with both) after EVERY feed. Warm it gently between your fingers and slather it on there. Wipe off any excess gently with your breast pad before the next feed – but no need to wash off.

Whichever your choose (if you can, buy a small one of each and figure out which you like best), try to pick an organic one – we’re talking about some of the very first things to go into your baby’s mouth and gut. Spring for the best.

3) Ask for Help

If you don’t have a doula to personally help you, ask for help from the birth center. Most hospitals now have staff lactation specialists who can come help you. DON’T pass this up!!! Unless you’re an ultra experienced mom of multiple babes or lactation nurse yourself, have them check you out. Get comfortable with what to look for in a good latch and have them demonstrate with you and your actual baby several different positions.

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upside down side lying position to sooth baby for photo shoot… not super highly recommended

 

If you don’t have access to one right away, there is guaranteed to be an experienced nurse on the floor who can help and then schedule your lactation consult for after discharge. La Leche League website is a great place to find local support and resources for follow up.

4) Fuel Up

You’ll need to eat and drink a LOT for your body to make enough good milk. You should aim for 3-4 liters of water or other hydration daily. Keep a LARGE water receptacle by you at all times. Make sure your support person knows to refill when low. If you’re thirsty, you’re already over a quart of water low.

Breastfeeding burns up to 800 calories a day in the early days. As you’re starting out, you’ll want to eat like a teenage boy doing two-a-day practices in the middle of a growth spurt. All of a sudden, the crazy guy who speed-eats 100 hot dogs will seem somewhat reasonable. Go for it. If you want to be “healthier”, focus on getting in LOTS of fat and protein and limiting stuff with chemical additives or added sugar. Yes fat. You’ll burn it off later – don’t worry. No dieting of any kind until after 6 weeks when your milk is established. period.

5) Forget All Else

This is the last of the basics I’m gonna throw at you. For the first month (or two) of your baby’s life, breastfeeding should be your only task. If people want to come over? Great! they have to be people who 1) you’re ok with seeing your boob flopping around and 2) be willing to do chores with 3) no actual promise of holding or even touching the baby. Let everything else go – you eat, sleep and breastfeed.

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or not sleep…

Breastfeeding on demand (which will feel like the full 24 hours of the day) is the best way to make sure your milk comes in and your baby has enough. Almost no one truly does not make enough milk if they initiate feeding on demand without formula (or nosy know-it-all in-law) interference. Let your baby’s health care provider guide you on whether there’s enough milk getting in. Your job isn’t to guesstimate volume of milk, it’s to put a boob in the baby’s mouth every time they seem hungry. TheMilkMeg sums it up:

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Happy Feeding Mamas!

Dr. Annie is a family doctor and mom of 2 with 1 on the way with 25 months personal breastfeeding experience and lots more hours helping others. Please add your questions and personal tips to comments below! Let’s help each other this week and all weeks!

Dr. Annie Answers: Kid Vitamin Basics

Mother’s Day is this weekend which has me thinking about all the things moms have to worry about… one of the most common being the nutrition and health of our precious little ones. Almost every day at my clinic, I get some sort of question about vitamins – What’s safe? What’s necessary? Where do I get good ones? The answer, of course, varies by your particular health needs and should be discussed with your own medical provider. A few things are pretty generalizable though and I’ll delve into them here by age. This post is about kiddos – coming up next will be an adult version, so make sure you FOLLOW US to get that update!

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Vitamin D is needed for all babies who are breastfed half or more of their milk intake. I nearly always recommend Baby Ddrops for those who can afford the $10/month averaged cost. These are concentrated drops so, instead of getting your tiny baby to choke down a whole milliliter of vitamin D like the generic ones at the pharmacy, you only have to put 1 drop on your clean finger and put on baby’s tongue before a feeding. If your baby is formula fed, no vitamins needed, they’re already in there – see below for details.

Breastfed Babies, 4 months through 12 months: Add 6-11mg Iron

Iron is recommended for breast-fed babies after the first 3 months of life. Mom’s iron from the womb keeps them going up until that 4 month mark.

Sidenote…. One of the potential benefits of delayed cord clamping at birth is increasing baby’s iron stores for that first 3-4 month period (great review on this by Dr. Raju et al here.) . This is, of course, an important thing to discuss with your own pregnancy care provider, but worth considering for this and other benefits if there is no reason not to do it.

From ~4 months through the rest of the first year, baby will start eating more and more ‘real’ foods which can supply some iron, but usually not enough. The recommended amount by the American Academy of Pediatrics for babies 7-12 months is 11mg per day. For reference, you’d have to get your baby to eat 2 cups of cooked spinach to get that much – not gonna happen.

Option 1: at this age, stop Vitamin D supplement and change to multivitamin. Poly-vi-sol with iron is the go-to recommendation for most health care providers. However, my daughters both projectile vomited it, so we had to use alternatives. Other options are Zarbees Baby Multivitamin with Iron  and Honest Company makes an easy-to-give vitamin powder: Link herepexels-photo-533360.jpeg

Option 2: continue with Ddrops and give iron-only supplement like this one or give a serving of iron-enriched cereal daily. I personally, along with a growing number of pediatric care providers, recommend the former along with introducing iron-rich foods such as pureed meats, dark leafy vegetables, beets and beans before cereals as part of a healthier early diet. Baby cereals don’t otherwise have much in the way of nutrition or “taste education” for that little one. (References here in AAP News and here from NIH)

Formula-fed Babies up to 1 year

Breast-milk is best for moms and babies that can do it in all aspects except these 2 vitamins. Formula comes conveniently stocked with both Vitamin D and Iron so you don’t have to worry about the supplements. Certainly not a reason to choose it over breastmilk, but a nice side-benefit if it ends up being the right option for you. I usually recommend Baby’s Only Organic Formula or Plum Organics Grow Well Formula. Screen Shot 2018-05-07 at 5.58.09 PMThey are well tolerated (review here), have the right amount of all important nutrients and both come out to roughly $1/ounce (compare to Similac Advance Non-GMO at $1.25/ounce). They are also organic and free of corn syrup solids and chemical additives – which, when you’re talking about the ENTIRE nutrition of your tiny rapidly growing baby is important. AND!! You can get them both on auto-ship from Amazon so no leaving the house – bonus!

After 1 year: Vitamin D 400-1000 Units Daily +/- others…pexels-photo-61129.jpeg

This now depends on how picky of an eater your kid has become. If you have that amazing, adventurous eater who loves a variety of meats, fruits, and vegetables and drinks 2+ cups of milk per day, multivitamins are unnecessary. If your child doesn’t get 400-1000 units Vitamin D from fortified milk and other foods, they will need a vitamin D supplement again. Why? What about kids before the advent of vitamins?? Well, kids were outside ALL DAY without sunscreen back then. We now know better and protect their skin – the downside of which is low vitamin D.

If you do have a picky eater  – even if you’re not sure how picky is picky – a multivitamin can fill in the gaps. Again, the above mentioned Zarbee’s and Honest options are great as is Renzo’s Picky Eater Multi. If they’re getting extra of some of those vitamins, they will pee them out.

Hang on…. I hear a question coming out of the Ether….

“Dr. Annie, are the examples you listed above the only good options?? What about Flintstone’s vitamins or Olli Chewables?” Of course those aren’t the only vitamin brand options. If you want to check out others, just read the fine print on the label on the back and make sure they have the right amounts of the recommended vitamins.

Wait…. another one coming in…. “What about probiotics??” I’m so glad you asked! YES probiotics are so important from infancy through the rest of life – so important I’m going to write a separate post all about it ;^)

94 Dr. Annie is a family physician, wife and mom of 2 picky eaters In the Sacramento Area.

Why I love bats, and why you will too.

Call me crazy, but I find myself obsessing over bats. They are my favorite mammals, other than my cat, for several reasons.

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The best reason ever is that they can eat over 1200 Mosquitos an hour and can consume their body weight in insects every night! That’s right. Stupid, disease carrying, biting, poopy mosquitoes. BUHBYEEEEE

They are also great pollinators! So at night when they are flying around, they are pollinating your area so that the ecosytem can be maintained. Thank you fruit bats!

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Thirdly…they freaking ECHOLOCATE! Not all species of bats do. Fruit bats, for instance don’t echolocate at all. It is said that in a light rain, they can navigate through the raindrops(I don’t care if this is true or not), but if it is then they are basically superheroes. They are the only mammals whose front limb has adapted into a wing and are capable of true flight! And boy, are they awesome to watch at dusk dive-bombing to find all those dumb mosquitos. DIE MOSQUITOS…actually, don’t cause then the bats would leave.

Before you FREAK OUT and go all “count Dracula” horror movie about bats, yes I know they can be freaky looking. They sleep upside down for goodness sake! But take some time to consider that, yes while vampire bats do exists, they do not “suck blood”. They lap it up. Ok ok ok, calm down! I know that isn’t any better. But unless you’re in South America where some bats have been seen to be lapping up blood from a cow or goat here and there, you’re fine. (sorry South American cows)

Ok now that I’ve convinced you of their awesomeness, lets look at how to attract bats to your property.

Bat houses

Make the bats feel welcomed! Build a bat house using plywood or cedar. The rough surface will make it easier for bats to climb in and out of the house. Keep the roughest side of the wood to the inside of the house. Bat houses work best if they’re at least 2 feet tall, 1 foot wide, and 3 inches deep. Keep the temperature between 85-100 degrees F, as bats prefer a warmer climate. To ensure this, place the bat house in a location facing the sun for the afternoon hours.  NO TREES as they are more susceptible to predators in a tree as well as too much shade.  To give ample enough room for the bats to drop before they take flight, put your bat house at least 15 feet up in the air. An east or west facing chimney is an ideal place.

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Cool, right?

Food and Water

Now that you’ve invited them home, give them food and a water source. Bird baths work well as ponds. Planting night blooming flowers can attract nocturnal garden insects, which, in turn, attracts bats! Marigolds, Dahlias, and Thyme are all good plant examples!

Screw you wasps

Make sure you check your house regularly so that you are not just making a home for bees, wasps, or hornets. Also check your house for holes before you put up your bat house! Seal and fill them as best you can. Bats can fit into a hole the size of a quarter, and we want to prevent cohabitation! After all, this roommate stays up ALL NIGHT!

Rabies

Yes, bats can carry rabies. But you’re more likely to have an encounter with a nasty raccoon or skunk than a bat. After all, they are way better at avoiding you with their echolocation than you are with your human eyes and ears. Plus, the benefit way outweighs the risk in my opinion, knowing that less than 1% of the bat population actually carry rabies. 2014-wildlife-us

Ok, so have I convinced you yet? Bats…do it…you’ll thank me later when you can enjoy your back porch without the Zika virus. Plus look how cute they can be!

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Dr. Annie Answers: Hair Rescue

As a working mom I sometimes feel almost like Jeckle and Hyde between my “clinic self” and my “mom self”. Dr. Annie wears coordinated outfits and looks like she knows what she’s doing. Mommy Annie wears stretchy pants and has did-she-just-get-electrocuted hair most of the time. Or I wear this hat:

Converting between the two is sometimes a challenge. My natural hair is somewhere between “relaxed waves” and “actually curly” that never, ever looks good the day after sleeping on it. If I’m on my game, I’ll get a blow-out or do it myself (ultimate mom-hack, finding room in your budget for a blow-dry bar membership! Blow Me Away is my current obsession with monthly memberships starting at $60). If not, these are two of my go-to rescue hair-do’s that work for any length lob or longer.

The Faux-bun

This one looks so fancy and takes almost zero effort if you can make a ponytail. Below is me, literally having just rolled out of bed. Some bloggers have it together enough to put on make up and stuff before they do their post pics… I’ll put that down as #bloggoals 😀

First, if the top of your hair is greasy from not washing (no judgement – I frequently can’t name the last time I’ve showered), spray in your face dry shampoo. I like this one: Moroccan Oil Dry Shampoo for Light Tones mostly for the smell, lots of others work great.

If, however, it’s frizzy, rub a little tiny bit of conditioner with water and smooth through the top. Then I like to use something with a little hold like this: Bumble and Bumble Dryspun through the roots.

Once the prep is done, brush that rat’s nest out! Then, make a ponytail wherever you want the bun. Divide hair roughly in half top and bottom. Next, you’re going to stick your fingers through one loop of the elastic from the pony side towards the scalp, like so:

Grab the top half and pull it under. Do the same on the bottom half. Then pull on the inside of your loops just like you’re tightening a regular ponytail.

 

Scrunch around, and go!

The Braid-Bun

This one starts the same. Prep scalp and brush. Then, divide hair roughly in half along your natural part and then each half in half. Do a simple braid of each section as far down as you can and secure with small hair bands like these: Goody Clear Elastic Hair Ties.

Next, tie the braids in a few knots and then tuck up and pin with these hair-miracles:

Goody Hair Spin Pins which work like 100 Bobby pins in one.

Comes out like so:

👆👆👆 actually me after getting dressed this morning. Next up, make up, coffee, food, kids lunches, get kids dressed, kids breakfast, get new outfit because they spilled, spend 3 lifetimes getting their shoes on and getting them in car seats, and Voila! Professional Dr. Annie made it to work on time.

Hope this helps you other lovelies out there!

Momday Faves

You know that feeling when you discover a new {item, gadget, service, app…} that revolutionizes your day-to-day mom life? That howdidIeverlivewithoutthis?? moment? Well these are a few of Christiana and Annie’s faves we’d like to share with you lovelies! If you’re on a strict budget…. stop reading now. You’re gonna want one all of these…

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First up, Christiana’s Faves:

Not being able to finish your coffee while it’s hot is the subject of more parenthood-memes than I have legos in my house. Enter: Ember Temperature Control Ceramic Mugember

This mug is my Monday morning hallelujah. No matter how many diaper changes, lost shoes, or forgotten hidden homework assignments try to derail my morning, I have hot coffee from first sip to last drop. All. Morning. Long.

Shout color catchers

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After my boys’ royal-blue shark towels turned nearly half of their summer wardrobes into a similar shade of blue in the wash, I lamented the catastrophe to a family member who looked at me like I had five heads and asked “Did you not use a color catcher?!”

Say whaaaat?? Yes, color-catchers are a real, actual “holy-cow-where-have-these-been-my-whole-life” thing. One tiny sheet literally ‘catches’ loose colors and prevents them from running onto other items in the same load. End result: wash colors and whites and everything (even shark towels!) together with no fear.  No separating, no worries. WIN.

The Endless Reader Apps

Although we are all on-board with American Academy of Pediatrics’ advice to limit screen time, those “limited” moments of distracted-child bliss are priceless. These apps, no joke, are at least partially responsible for having taught my kids their alphabet, sight word reading and basic numbers/math. They are fun enough that kids think they’re getting away with something, but 100% child-brain enriching.

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Annie’s turn:

Robotic Vacuum 

Our household contains not only one heavy-shedding dog (Chesapeake Bay Retriever) but also 3 heavy-shedding long-haired women. In addition to that, there is the usual dust, dropped cheerios, crushed goldfish, lint, etc… of a busy household. This miracle worker (ours is named Wall-E) is programmed to come on at 9 am when we’re (usually) out of the house and takes care of nearly ALL of it. The few days it has been unplugged or put away for some reason, there are actual rabbit-sized dust bunnies that build up in our house and this little guy keeps our floors – even the corners and UNDER FURNITURE – spick and span. Plus…

Our dog weighs 90 pounds, so can’t partake in this fun, so sad!

These are the highest rated models on Consumer Reports – we have a 2 year old version of the cheapest one that both my children have ridden around and it’s still trucking!

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Melissa and Doug Water Wow On the Go

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These little board books come with a “paint brush” that you fill with plain-old water. When the kids apply it to the magical board-pages, the colors show up as if they did, truly, perfectly-in-the-lines paint them. My kids will do these for an hour straight. Perfect for the car when you don’t want them to be watching the iPad for the entire 3 hour road trip, or just for those moments when you’re like “how is it an HOUR until naptime, if I have to clean up another mess I’ll just burn the house down!”. No mess, no problem.

I buy the three packs, in a pinch, the pages can be blow-dried for rapid cycling tantrum-aversion.

 

 

 

Nerium Hydrogel Patches and Eye Serum

These little babies should be given out at EVERY baby shower. And bridal shower. And just, everyone needs these. They will take your most brutal “baby-woke-up-7-times” or “we-had-too-much-fun-on-date-night” under-eye bags and virtually eliminate them in 25 minutes flat. And hey – for the dads out there, this is so popular with men it’s dubbed “man-makeup” because 5 minutes of serum can take years off. This is me on left, a family friend on right, same lighting, same camera, no make-up, NO EDITING, (yes, slightly different angle because I’m a doctor not a professional photographer):

And in case you’re wondering if it’s a short-term gimmicky-result… these are one of the few rapid treatments that also improve your results progressively with time. The other name for the serum? Unicorn tears. Nuff said.

Ok, now you have to share your favorites in the comments and share.

Bonus, if we get up to 50 followers from this wonderful sharing by the end of the week, Annie will send a free sample of this magical eye serum to 1 lucky follower!

Now go get your Monday on!