/About children/Breastfeeding and artificial feeding. Complementary feeding/HB problems
- Why does a child refuse to take one breast?
- How to return to breastfeeding?
- Why does milk taste different in breasts?
- What happens if you feed on one breast? Is it dangerous?
Your baby is actively sucking and gaining weight well. But one day you notice that he is reluctant to take, for example, the right breast, preferring the left. And one day he “flatly”, with tears, refuses one breast, and shows amazing persistence.
Why does this situation arise, how to avoid it and what to do if one breast has already become “unloved”? We will look into these issues together with our forum members and lactation consultants.
Why does a child refuse to take one breast?
Annet : The baby is 7.5 months old. A week ago he stopped latching on his right breast, he just sucks twice and spits, turns away, gives him another - he eats. I didn't do anything right away. A week later I tried to express milk and compare. The color and taste are different. In the “worker” one it is white, more transparent and sweet, and in the other one it is more yellow and saltier, or as if soda was added to it. I tried to express so that new milk would come in - it became more, but the taste remained, the baby does not take this breast.
In this situation, of course, it was in vain that my mother did not act immediately, but waited for a whole week - her timely persistence would most likely have allowed her to avoid the problem. But why does such a “dislike” of a baby for one breast arise?
There may be several reasons.
- Neurological problems in a child. Often mothers notice that the baby does not like this or that position, for example, on one side he is calm, and on the other he cries. A neurologist or pediatrician will check to see if your neck muscles are normal. If something really turns out to be wrong, then, in addition to treatment, you need to find a position for feeding with this particular breast, in which feeding will be comfortable.
- Perhaps feeding one of the breasts is uncomfortable not for the baby, but for the mother - something is in the way, or there is pain. This means that she does not place the baby so comfortably, and she strains more, which disrupts the calm flow of milk.
- One breast is “more comfortable” than the other. For example, the nipple is more convex, or milk flows more easily - of course, the baby will prefer this breast to the one from which milk must be “pulled out”. By the way, it happens the other way around - the baby does not want to eat from the breast from which the stream of milk flows like a “fountain”, and chokes - we advise you to lightly express from it before starting feeding.
One breast or two?
Recently, on one forum, a young mother from Germany posted a post with recommendations from a midwife and maternity hospital nurses on how to care for a newborn. Among other recommendations, there was this: for one feeding, 2 breasts, on one for 10-15 minutes, on the second for 10-15 (or until he lets go/falls asleep), start feeding from the breast that was the last one. (With). In theory, such feeding is a prevention of lactostasis and also helps to increase milk production.
Some mothers agreed with this feeding method. However, some mothers were perplexed by such frequent breast changes, since, according to them, the baby will not receive fatty “hind” milk, and accordingly, will not gain weight.
I believe that in order to understand how often you should change breasts, it is worth understanding the process of milk production itself.
Everyone knows that in the mammary gland of any adult woman there are ducts with a small amount of secretory tissue. However, during pregnancy, under the influence of estrogen and progesterone, the secretory tissue begins to grow and alveoli are formed at the ends of the ducts, the walls of which consist of secretory epithelial cells - lactocytes and the surrounding layer of myoepithelial cells.
From mid-pregnancy, lactocytes produce colostrum, and a few days after birth, under the influence of the hormone prolactin, they begin to produce milk. At the same time, the rate of milk production is not constant, and it depends on the degree of emptiness of the breast: the more empty the breast is, the faster milk is produced in it. Accordingly, if a child empties one breast during feeding, then milk production in that breast will be in full swing. At the same time, in the second, not emptied breast, the process of filling with milk will proceed more slowly.
The fact is that milk accumulated in the breast itself stops the work of the cells that produce it. This happens because it contains a substance that inhibits milk production. This substance is called “factor inhibiting lactation” (FIL), or “inhibitor”. The more milk accumulated in the breast, the greater the concentration of inhibitor in it, the slower new milk is produced. During feeding or pumping, the inhibitor is removed from the breast along with the milk, and accordingly, the rate of milk production increases. In addition, lactocytes of alveoli stretched from a large amount of milk react worse to prolactin. This mechanism was invented by nature in order to prevent breast overfilling and allow the baby to regulate the amount of milk from the mother himself.
Thus, despite the fact that the level of prolactin in the blood is the same for both one and the other breast, the rate of milk production may be different. The produced milk accumulates in the alveoli and ducts, but this process, as we have already found out, is not endless. Every woman has a maximum amount of milk that can collect in her breasts - the so-called breast “capacity”. It can be different even for the right and left breasts of the same mother, not to mention different women. It is worth noting that breast size and “capacity” do not always coincide.
As milk accumulates in the breast, it gradually begins to separate into “front” (usually less fatty) and “back” (which has much more fat). There is no clear dividing line between “foremilk” and “hindmilk” - the transition from one to the other occurs very smoothly. This is due to the fact that the more liquid part of the milk, accumulated between feedings, gradually flows forward - towards the nipple, leaving behind heavy fat molecules, which gradually attach to each other, to the walls of the alveoli and get stuck in the ducts.
When the breast is stimulated, a rush begins: due to the action of the hormone oxytocin, the outflow of milk accelerates, and it is released through the ducts towards the nipple. As the breasts empty, fat molecules detach from the walls of the ducts and alveoli and begin to move along the ducts. Therefore, the longer the feeding, the more fatty milk is released from the breast as more fat molecules are pushed through the ducts. Accordingly, the level of fat content in milk is related to the degree of fullness of the breast: the longer the interval between feedings, the more full the breast is, the less fatty milk the baby will receive at the beginning of feeding, the longer it takes him to get to fatty milk.
Thus, in mothers with a large “capacity” of the breast, the newborn sometimes cannot empty the breast completely - so much simply will not fit into it. Therefore, if you take away such a capacious breast 10 minutes after the start of feeding, there will still be a lot of milk left in it (and the fattest one at that), which can lead to lactostasis in the mother and to a lack of fatty milk in the child (which is often declared the cause of the so-called “secondary lactase deficiency "and increased gas formation, since the "foremilk" is rich in milk sugar - lactose). Accordingly, the method proposed to the author of the post by the medical staff of the maternity hospital may not be suitable for mothers with large breast capacity.
At the same time, if the mother’s breast capacity is small, this method seems reasonable: the baby will empty both breasts during one feeding, thereby triggering the mechanism of accelerated production of new milk. This technique is not only justified in such a situation, but is also necessary in the first months to provide the baby with adequate nutrition.
During the transition of colostrum to milk, breast swelling and sometimes even engorgement are often observed. This occurs not only due to a sharp increase in milk volume, but also due to the influx of additional blood and fluid that is needed to prepare the breasts for feeding. At this time, it is especially important to feed the baby more often, completely emptying the breast, since the released milk makes room for excess fluid, and accordingly, the swelling subsides a little.
It is very difficult for a newborn to dissolve a swollen breast, and he is unlikely to cope in 10 minutes, so in such a situation it may take more time for resorption. A similar situation occurs with lactostasis or mastitis.
The shape of the nipple can also affect the time required to empty the breast, since when applied correctly, the nipple rests on the baby's palate, thereby stimulating the sucking reflex. However, there are mothers with flat and inverted nipples. Of course, this is not an obstacle to breastfeeding, but until the nipple extends, the baby may not be very comfortable sucking, and accordingly, it may take longer.
The diameter of the ducts also differs between mothers: the narrower the ducts, the longer the process of emptying the breasts takes (at the beginning of lactation the ducts may be narrower than later). Also, the number of streams of milk at the exit can be different even for one woman in the left and right breast, accordingly, the rate of milk outflow will also be different. In addition, the rate of milk flow decreases when the mother is stressed, experiences pain (for example, cracked nipples) and other circumstances that reduce the level of the hormone oxytocin.
When “mature” lactation is established, often those who gave one breast begin to give two breasts per feeding. And those who gave 2 breasts can offer three or even four (accordingly, the first again, and then the second again). This is due to the fact that milk no longer accumulates so actively between feedings, but comes mainly in response to the baby’s sucking. For some time the baby sucks idle, then there is a rush, and the milk flows in streams, frequent sips are visible and heard. Gradually the milk is sucked out, there is less of it, the baby receives not streams, but droplets. At this time, we can observe that the baby makes one swallowing movement for 6-7 sucking movements. Often the baby becomes nervous at the breast. In such a situation, it is worth offering another breast. And this can be offered again and again until the baby is ready to suck. If there are concerns about whether the baby will reach the hind milk or not, you can do a light breast massage or Newman compression before feeding - this will allow the fat globules to more easily separate from the walls.
Also, babies themselves empty their breasts at different rates. Hypotonia, prematurity, depression of the child’s nervous system after childbirth, short frenulum, improper grip, etc. may cause sluggish and ineffective sucking. In such a situation, it is very important to understand the cause of inefficiency and, if possible, eliminate it.
In order for the baby to receive the coveted “hind milk”, it is much more important to establish effective emptying of the breast (proper attachment, frequent feedings, cutting the frenulum if necessary, etc.) than to look at the clock. If, for example, a baby hangs on the nipple without grasping the areola, then he most likely will not reach the “hind” milk in either 5 or 20 minutes.
As a result: each organism is individual, and in the case of breastfeeding we are talking not about one, but about two entire individual organisms, accordingly, choosing a method suitable for a particular mother-child pair can only be done by trial. Moreover, this method may be subject to revision at different times, so it is worth taking a more flexible approach to this issue. The main thing is that the child is fed and happy!
You may be interested in the following posts:
Diet of a nursing mother and its effect on milk
Infant colic: concept, causes, how to help
Overview of carminatives
About stool standards for babies, and what to do in case of constipation
How to return to breastfeeding?
What should you do if you still refuse one breast? How to persuade your baby to return to full feeding? Here are some tips.
- Correct the situation as soon as possible, at the stage of simple preference for one breast. In this case, there is still enough milk in both breasts, and its taste has not changed. Always start feeding from the less preferred breast, alternate them at each feeding and try to understand which of the possible reasons for the beginning refusal of one breast is yours.
- As we said above, changing your feeding position can be very helpful. For example, the position of “hovering” over a child helps many people. Or - standing, lying down, from under the arm...
- It is good to change not only the position, but also the place of feeding - in a word, to break the habit that the baby has already developed. For example, in another room or in the kitchen, on the street, in the car...
- Perhaps the most popular and effective advice is to offer the “unloved” breast in a dream. Before falling asleep, in order not to start struggling with refusal, you can give your preferred breast, and then quietly replace it. At night and in the morning, start feeding from the problem breast. When the breasts are well developed again and there is enough milk in it, the baby will most likely return to normal feeding during wakefulness.
- Stay confident in your abilities. There is no need to worry too much about this, nor do you think that everything is useless and there is no point in retraining the baby. Mom's stress actually makes milk flow worse!
“The main thing is to maintain a balance between the mother’s confident behavior and the child’s comfort. It would be absolutely correct to persistently offer both breasts, but trying to feed through the baby’s screaming and crying is fraught with real, complete abandonment of the breast.
Let's give the floor to the consultants again:
Galina Eltonskaya: What to do? Change breasts evenly. You can use this method - usually, “at the request” of the child, you give the other breast. Now you give the same breast, but in a different position. Slide the “unloved one” in when the child is sleeping, most often place it next to you on the left. You can cope with refusal of one breast by applying it to that breast as often as necessary to change breasts. Don’t let him cry under your chest, calm him down and... apply it again.
PolikanovaIrina : Let the problem breasts go to sleep, it just needs to be overcome with the help of your strong-willed decision. Rock the baby to sleep and, when he is almost asleep, give the breast.
Give the smaller breast more often, only give the smaller breast at night. Let him fall asleep with a larger breast, and at night only give him a smaller one. The same is true during the day, first try to correct unconscious behavior (in your sleep), and then suggest it during the day.
Tala Tratsevskaya | How to breastfeed
Question : Good afternoon! I hope for your advice based on my situation! The war was quite difficult to establish. By 3.5 months, normal lactation and feeding schedule seemed to have finally established, the baby was happy, seemed full, slept well at night, could sleep from 23:00 to 06:00 for example, then eat and sleep until 9. From just over 4 months it became there is not enough milk, the baby eats both breasts in one feeding (I’ve also heard the opinion that you can’t give both at once), but asks for more, worries, cries, and looks for a breast. You express the leftovers and eat everything with appetite, whether from a spoon or from a bottle.
I tried supplementing with formula many times and with different ones, but to no avail! Spit it out and wince! She cries, grabs her breast, sucks on an empty one, but still won’t eat formula. In the end, when he is completely exhausted, he falls asleep. At night he sleeps for up to 3 hours, then wakes up almost every hour. I have to take it to my bed. During the day he very often asks for the breast and eats both, although he feels like there is very little milk there and eats for only a short time.
At first there was not enough milk only during evening feedings, now after each feeding the baby looks hungry, cries and asks for more. Today the baby turned 5 months old. On the second day, we introduce dairy-free rice porridge as complementary food, ahead of time, because according to observations, he has already begun to hold his head up worse and nods on his stomach. Apparently there is not enough energy...
Please give me some advice on how to properly organize mixed feeding if there is no milk supply (I'm afraid this will affect his development) and the child refuses formula.. Please also note that the child is gaining weight normally. From 4 to 5 months he gained 800g, although most likely this is not an indicator if he requires more food.. Thanks in advance for your help! Best regards, Evgeniya
Answer : Evgeniya, hello, it’s very good that you are sensitive to the baby’s needs - you give both breasts for feeding, take them to your bed, supplement them with expressed milk and do not insist on supplementary feeding with formula. The best option for mixed feeding in your situation is supplementation with expressed milk. Since the baby is gaining weight well, you will be best able to determine the required amount of nutrition - try to start giving 200 grams of expressed milk per day and see if this is enough for the baby to feel better.
We give supplementary feeding from non-sucking objects - a spoon, a cup - in portions of 50 grams at the same time, for example, at 9:13, 17, 21.
In order for more milk to be produced, it is important for the baby to latch onto the breast correctly (it doesn’t hurt the mother, the baby swallows the milk, the nipple comes out round after feeding), not to limit the sucking time, to feed at night, not to use a pacifier, not to supplement the baby with water, baby tea, Plantex and others not nutritious liquids, offer both breasts several times during feeding, and lactation also increases from pumping.
When introducing complementary foods, pay attention to whether the child is ready for regular food. Constipation, diarrhea, abdominal pain, vomiting, pushing out food with the tongue, restless behavior or very deep sleep, skin reactions may indicate that complementary feeding is started too early. In your situation, it is also important to pay attention to the caloric content of food - vegetables, fruits, very thin cereals contain fewer calories than breast milk, therefore, with large portions of such complementary foods, children lose strength and weight.
Weight gain is a reliable indicator that the baby now has enough milk. Therefore, it is important to think about what else he may be missing, what else, besides nutrition, he may be upset about. Evgenia, please tell me how the feeding ends now? You write that the baby sucks for a short time on both breasts and asks for more - what happens if you offer him the breast again?
Evgeniya, if the child’s weight, height and skills correspond to his age, you don’t have to worry about him developing poorly. Please write how the baby gained weight in the first months? What weight were you born with? How much does he weigh now?
Evgeniya, I would like to draw your attention to the fact that the regimen that you describe is normal for most children aged 5 months who are breastfed. Sleeping until 3 am, applying in the second half of the night, quick sucking for 5-7 minutes during the day is the norm. Weight gain is also good. You need to understand why the baby is dissatisfied - perhaps he needs more holding, games according to his age, the opportunity to explore new spaces, more sucking (not food, but sucking at the breast - in babies under 8 months the need for sucking is very high), maybe something else... What do you think about it?
Write! Let everythnig will be alright! If necessary, you can call me after January 12, I will be glad to see you! Happily!
Continuation of correspondence : Tala, good evening! Thank you very much for such a detailed answer, it has already calmed me down a little, I think my attitude is also important in this situation.
There’s just a lot of different information on the Internet, and I wanted to hear the opinion of a specialist (in particular, I read an old article, but it seemed like it was from a breastfeeding consultant that it’s absolutely forbidden to give 2 breasts at one feeding, but I’ve been giving exactly this way).
Regarding supplementary feeding with expressed milk - the fact of the matter is that the baby sucked both breasts so that there was nothing to express in them - literally 15-20 grams. That's why I'm worried. A few days ago I started drinking Lactaphytol tea, and the amount of milk seemed to increase slightly, unless, of course, this is a placebo effect.
Perhaps now you can try pumping after each feeding and supplementing. Or should this always be done in any case (I mean pumping)?
During these holidays, we were visiting my parents, and at the insistence of my mother, we began to give them from bottles, and with a fairly large hole. Perhaps this is also the case. Before this, we fed from a small syringe, to which the grandmothers told us that we were abusing the child.
The same situation with water. I also heard that if the temperature regime and the required humidity in the room are maintained, then there is no need to add additional water, but if the air in the room is dry, warm, and there is no opportunity to walk (it’s very cold here now), then you need to give water to normalize the water balance.. Or is it still impossible to solder in any case?
I also wanted to clarify about complementary feeding - the child really liked the porridge, he directly demands more, but after it he actually sleeps longer than usual (he usually sleeps little with us), other signs seem to be absent (stools became less frequent at all when I began to notice signs of a lack of milk - previously about 5 times a day, now 1 time, there were a couple of times that there was no bowel movement for 24 hours). But I'm still worried whether it's too early. As far as I heard earlier, complementary foods are not introduced at all until 6 months. But, on the other hand, we have already cut 2 teeth at 4.5 months and the second after 2 weeks (I think maybe this still bothers him, because he constantly gnaws on toys and his mouth waters).
I carry the baby in my arms almost constantly; he is completely tame and hardly lies down on his own. True, if mastering a new space is also a baby’s need, then now there really is no such opportunity, since there are 2 cats and a dog here
