Question & Answer - Breastfeeding
What are your suggestions for my 2-month old whom I am attempting to breast-feed but he also gets a bottle a few times per day?Answer from Kathleen Ott, MS, CCC-SLP in Boston, MA, USA
I have a 2-month old with feeding difficulties whom I am attempting to breast feed, but he also gets a bottle a few times/day. He is fussy and has difficulty latching on to both the breast and the bottle but latches better when he is tired. He only takes 1- to 2-oz at a feeding and is typically hungry again in about an hour. He had a tongue tie revision a month ago, but this has not helped. The baby is gaining weight, but I am scheduled to go back to work soon and want to have this figured out. I even adjusted my diet to see if there is anything I am eating that is causing his distress. Any suggestions?
Answer from Kathleen Ott, MS, CCC-SLP in Boston, MA,, USA
Feeding difficulties can be very hard on parents, especially with a new baby. I would start by seeking out an International Board Certified Lactation Consultant (IBCLC). Even if you have seen a lactation consultant already, they all have different levels of training/comfort/expertise, so finding one who is knowledgeable about tongue ties may be helpful.
Breastfed babies need about 25ozs of milk/day, so if the baby is taking ~1-2ozs every hour or so, this is right on target. Feeding him on demand when he shows signs of hunger (licking, sucking, rooting) is often recommended instead of scheduled feedings or waiting until the baby is very hungry (i.e., fussy, crying) which can make feeding more difficult, negatively effect baby’s weight gain and hydration, and decrease Mom’s milk supply.
Positioning is the most important change a mother can make. Laid-back breastfeeding can be very helpful and even relaxing for mothers. In this position, Mom leans/lays back (using supports such as pillows to make sure her body is comfortable and supported) and cradles the baby on top of her chest. This allows the baby to have contact with Mom at the baby’s chin, torso, hips, legs, and feet which signals baby to latch and feed. This also means the baby will have more control to actively remove milk from mother’s breast, instead of gravity quickly pouring the milk down his throat.
Trying nursing in an upright position while keeping baby skin to skin may also be helpful. For example, you can nurse while wearing the baby in a carrier by lengthening the straps and dropping baby’s head to the height of your nipples. After nursing, tighten the straps to bring the baby back up so he is at a height close enough to kiss.
Possible Contributing Factors
The symptoms you describe may be due to an overactive let down. This happens when a mother’s breast milk comes out very quickly and a young baby is unable to keep up. Symptoms may include the baby gulping, coughing, and/or biting down on the nipple during feedings, baby popping on and off of the nipple during feedings, short feedings (5-10 minutes total), baby arching his back and/or holding himself stiffly, a gassy baby who frequently spits up, and/or green, watery or foamy stools.
The baby may also be experiencing gastro-esophageal reflux (GER) which should be evaluated by a doctor.
Babies suck differently at the breast and the bottle, so you may want to focus on establishing a good latch at the breast before re-introducing bottles. When re-introducing bottles, using paced bottle feeding in conjunction with a preemie/slow flow nipple, can help mimic the flow of milk from the breast. Paced bottle feeding involves stroking baby’s lips from top to bottom to encourage baby to take the nipple into his mouth, then periodically tipping the bottle down to encourage pauses and mimic the letdowns that he would experience while nursing at the breast. This also ensures that he does not take too much milk too quickly. Like us, if we eat too fast, we do not realize that we are full and are more likely to overeat. Note, babies being bottle fed should be fed in a more upright position and the feeder should switch sides to allow baby to develop symmetrically.
Tongue Tie Follow Up
Since your baby had a tongue tie, he may need follow up after his revision. He learned to swallow in utero with the tie, and it may take working with an IBCLC (or other professional knowledgeable about tongue ties and breastfeeding) to facilitate a strong suck and swallow using a new sucking pattern.
Gassiness in baby has not been shown to be related to typical gassy foods that Mom eats, so it is unlikely that diet changes are necessary. However, a very small percentage of babies do have a food allergy/sensitivity (most commonly cow’s milk), so when Mom eats this type of food, it could affect the baby.
The rates of women meeting their breastfeeding goals increases with in-person support from a breastfeeding group such as La Leche League or a group offered by a local hospital. I encourage you to reach out to a group leader and attend a group that works with your schedule.
About the Author
Kathleen Ott is a speech-language pathologist specializing in pediatrics. She works in both Early Intervention and school settings. In addition to working with children with speech and language delays, Kathleen enjoys working with children with feeding difficulties and bilingual English/Spanish children. She is also a mother and a La Leche League Leader who makes her home on Boston's south shore.
Kathleen Ott, MS, CCC- SLP