NBNP150logo whiterectangle  

ShopRite Plaza
264 Main Street
New Paltz, NY 12561
Mon-Sat 10-6
Friday 10-8
Sunday 10-5
(845) 255-0624

Is this a Nursing Strike?

"Hey, so all of the sudden my three month won't eat. He won't take my breast and if he does it's a very short feed. He screams if I even put him in the position. I have milk and it's leaking out- even shooting out now because I'm so full. I tried a bottle with a slow nipple- he took some and then started crying. He has NEVER been like this before. He loves breastfeeding and his weight is great - 20 pounds at 3 months. He is an awesome eater and I'm worried. Should I call the pediatrician? He's arching his back, do you think he has reflux? I'm worried because of the lack of wet diapers. He needs to eat and I feel like I am going to burst!"

While, their might be a few things happening here, the first thing to start with is your baby's refusing to nurse which is called a nursing strike. 

A nursing strike is when a baby suddenly refuses to breastfeed. You might think a baby is weaning themselves but if they are younger than 12-18 months, that is unlikely. In addition, most babies gradually wean off breastfeeding before they stop completely. 

During a nursing strike, sometimes it is obvious why they stopped and more often, it takes detective work to figure out why.  Stay calm. Since his weight is great, you have a cushion of time. He's not going to starve or dehydrate if he doesn't nurse for a half a day or a day.  You, on the other hand will be very uncomfortable, so express milk to prevent engorgement and plugged ducts. You may need to pump several times to bring relief.

When a baby is refusing to breastfeed, you will make faster progress if you accept that there is a very good reason (in his mind, anyway) to NOT breastfeed. Don't fight that and don't force breastfeeding. Take a longer term view stay optimistic and keep trying.

So, if a baby has a very good reason, why do babies go on nursing strikes?

Babies strike for many reasons. What often happens is that something startled or bothered him while he was nursing and he got scared. He's afraid it will happen again. Therefore, if he doesn't nurse, it won't happen and he won't be scared! 

Think back and see if you can remember what might have happened just before he started refusing. Was there a loud noise? Did he bite you? Did you yell?

If you can figure out what it is, talk your baby through the event. Apologize if you did something that scared him. Explain what happened and try to coax him back onto the breast by reassuring him that it won't happen again. That you are his mommy and will protect him.

Maybe he's sick?

If he has an ear infection or a sore throat, nursing may be painful. Sometimes babies gag on a forceful letdown of milk.  Sometimes there's a new smell they don't like, like a new detergent, soap or deodorant. 

If he will not nurse, just keep him skin to skin. Try breastfeeding again when he's sleeping or drowsy. Try taking a bath together and see if that relaxes both of you into breastfeeding. Keep snuggling skin-to-skin, and keep offering without any pressure! Your attitude should be one of coaxing or seducing them back to breastfeeding. Making it their choice, not your will.

New or Old Patterns?

You may find settling into a favorite position helps or you may find just the opposite. Try different and unfamiliar positions to break the pattern.

If it continues more than 12 hours, offer a bottle or cup of breastmilk. If he refuses milk for more than a day, it's probably a good idea to see the doctor to rule out injury or illness.

The Step-by-Step Holiday Guide to Plugs, Blebs and Mastitis

As parties, preparations and push-up bras work their evil magic...

Ho! Ho! Ho! and Go! Go! Go! grinds to a halt.

This is the day you don't feel so good and that throbbing pain in your breast may need medical attention today. Yes, TODAY! The day of all days that you can't afford to waste a single minute, let alone cross the whole day off your calendar and go to bed. Here is a step-by-step guide to moving milk and getting back in the game.

Plugged (clogged) Milk Ducts

Plugged ducts happen when milk stagnates in a section of your breast either from compression or inefficient milk removal. It could be a baby who isn’t latching well, or a few days when you are busy and delay nursing, or it could be from clothing that compresses an area of your breast- like an underwire or too tight bra.

The stagnant milk curdles into yogurt and then cheese. This solid milk creates a plug - a tiny string cheese, the thickness of angel hair pasta - which causes a back up of milk inside your breast. The painful lump is not the plug. The lump is a reservoir of milk BEHIND the plugged milk duct. If you start massaging on the lump, you are pressing milk into the plug and increasing the pressure without moving any dried milk out.

If you don’t move the plug and get the milk flowing again, you can develop mastitis.

Start self care immediately. It would be a good idea to call in sick to work and/or get help if you have children who rely on you for everything. Continue breastfeeding and pumping as often as possible. To work on getting the plug out, you may want to take a pain reliever, like Motrin, and give it some time to get into your system. You may not. Everyone has different pain tolerances, but working out a plugged duct is painful, even though it also feels good in a certain way.

It’s easier if someone can take care of your baby while you work on this.  If that isn’t possible, try when the baby takes a nap.

  • Breastfeed or pump, so your breast is less full. Either work in a big bowl of warm water or in the bathtub, with the water high enough that you can comfortably lean over and soak your breasts.  Soak them for a few minutes, to let the heat expand the ducts and soften the skin of your nipple.  
  • Grasp the nipple and pull it down away from the breast. Press it between your fingers and roll it, to your pain tolerance. It doesn’t have to be vigorous. All you are trying to do is work some dried milk out and reshape the curdled milk in the duct, so liquid milk can help to wash it out. You may start to see a white dot or a tiny string cheese on the tip of your nipple.
  • Move back about 1/2 inch and repeat, pulling the nipple down and away from your breast. Then, move back another 1/2” pinching and rolling any lumpy areas down, moving milk down to the plug. You may feel stringy lumps like spaghetti, inside your breast while you are massaging. This is dried milk. Massage any sore areas towards the nipple tip. You may use olive or another massage oil to keep friction to a minimum if you are not working in water.
  • When you are working the thickened milk out, it feels painful, or at least uncomfortable, and when the plug releases it feels immediately better. Sometimes you see the breastmilk string cheese in the water. If you don’t, that’s OK. Your baby may remove it while breastfeeding. It won't hurt your baby to swallow it. It’s just breastmilk cheese and still has all the antibodies and nutrients of your milk.

Breastfeeding with a plugged duct

Because a baby’s tongue massages your breast when they breastfeed, try changing up positions when you nurse. Try to line up their nose or chin with the sore spot and breastfeed. Some mothers swear by “dangle nursing.” Get on your hands and knees with the baby beneath you and breastfeed.

Be persistent and stay on top of milk removal. Try to figure out the cause and prevent that from happening. Some women have overabundant milk and their baby can’t remove it fast enough. If their baby oversleeps one night, they develop a plug. Some women are so exhausted they sleep in one position for 5 hours compressing a spot on their breast. Babies go through teething, a distractable phase, or have stuffy noses and leave breasts half-full. And, don't forget the above-mentioned parties and bras.

If you don't work out the plug you may develop a....

Nipple Bleb

A bleb is a milk pimple. It starts when milk sits in the nipple so long that it skins over. The treatment is the same as for plugged ducts. If nursing, massage or gentle exfoliation doesn’t open the skin, you may need to see your doctor to have it lanced. It sounds awful, but it is less painful than a bleb and brings immediate relief. Once the skin is opened, diligent and persistent plugged duct treatment is needed, or it will re-form. Both plugged ducts and blebs can also be a symptom of poor latch and tongue tie.

If you ignore blebs and plugs, you may develop...

Mastitis

Mastitis is an infection inside your breast. It happens when milk stagnates in a section of your breast and you are exhausted. Milk stagnates when there is incomplete removal of milk either from compression or a baby who isn’t latching well. 

Mastitis starts with a plugged duct and a lump in breast which you may or may not notice until it becomes infected. The first sign many women notice is an overnight decrease in milk production on one side. If nursing, pumping and massage don’t move the plug and the milk behind it, a pink or red patch will develop on the skin. Over time the red patch will grow, often into a stripe from nipple to the lump and into the armpit. You will become feverish, often engorged in one breast and feel awful. Mastitis has sudden-onset, flu-like symptoms: fatigue, aches, fever, chills and a sore or throbbing breast.

Mastitis can come on suddenly, in a matter of hours. It is a serious condition, that if untreated, can lead to breast abscesses or hospitalization.

There are two components of treatment.

The first is to get the milk flowing and the second is to address the infection. Getting milk moving is addressed in the section above on plugged ducts.

To treat the infection, you are going to have to decide how sick you are and what your treatment options are. It's not easy to decide to go to the emergency room when it's an hour away and you have 2 sick kids and a baby. Or, you've been fighting a yeast infection for months. Or this is your third round of mastitis in the past few months. Or, maybe it's Saturday night and you can go to the Urgent Care doctor in 12 hours.

If you can get the milk moving within an hour or so, you may start to heal with self-care alone. Your first action should be to massage the plug out and use your normal home remedies for sickness. Some people take vitamins, garlic, herbal teas or tinctures, zinc, chicken soup - whatever your favorite healing remedy is - take the time to massage your breast, get the milk flowing and go to bed. Your routine for the next few hours or 1/2 day should be sleep, nurse the baby, hand express/pump and massage the plug out. 

If you have done self-care for 12 hours and you are not getting better, or feel worse, it's time for medical attention.

If you know you are too sick for self-care, call your primary care, midwife or obstetrician, go to urgent care or the emergency room. They will prescribe an breastfeeding-friendly antibiotic which usually clears up the infection in a day or so. They may also take a culture when they examine you. You still need to unplug the duct but it will be easier when the infection is reduced. 

Mastitis is almost always a sign that you are trying to do too many things without enough rest. An exhausted mom will take not time to attend to make sure every latch is perfect, every feed complete. Because she is tired, it seems overwhelming to unplug yet another plugged duct. Mastitis is a call to simplify, to let go of something, so that you can take care of the most important person in your family, YOU.

If you need help resolving your plugged ducts, call or text Donna Bruschi, IBCLC at (845) 750-4402 for an appointment.

What do I register for?

Ask any parent and you will get a confusing list of "must haves" and "must avoids"

This is because we all have personal preferences and guess what? So does your baby!

So how do you buy a gift for someone you've never met? And equipment for a game you've never played?

Here's a place to start:

Essentials. Babies eat, poop and sleep. They need diapers, breastfeeding, a car seat, if you have a car, and a place to sleep.

1. Diapers - cloth or disposable. Even if you plan on using cloth, a pack of disposables eases the learning curve of parenting
2. Wipes - cloth and disposable - babies are wet and messy. Plain water cleans most messes and has no chemicals. Even if you use disposable wipes when you go out, washclothes are bigger and more absorbent than disposable wipes.
3. Breastfeeding support - even if you don't have a horror show beginning, you will have a ton of questions and Lactation
Consultants can answer them to your satisfaction, unlike Google.
4. Domestic help so you can breastfeed. Housekeepers are not just for the rich! There is a special kind of housekeeper called a Postpartum Doula or Baby Nurse who is like your mom, only better. They cook, clean, hold the baby so you can sleep or shower, do laundry and hold you when you cry.
5. Meals so you can take care of your baby. Ever try to cook with only one arm? It's possible. But imagine how much nicer it is to pop a ready to eat meal made with love by your relatives? Buon Appetito!
6. A safe place to put the baby when they aren't in your arms. The American Academy of Pediatrics just updated their Sleep Policy. It's a long read and complicated, but please read it.
7. A car seat. Even if you don't have a car, you might want one for taxis and planes. Have two cars? You will be happier with two car seats.

Anything that makes essentials easier is next on the list.

Nice To Have Items:

For Breastfeeding:

1. 4-6 nursing tanks and bras. You will appreciate expensive ones if you have them, so ask for them.
2. Breast pads. cloth or disposable. You may not need them after a few weeks or you might. Ask for a variety. You will have a preference and you won't know until you use it.
3. Nipple butter or salve. Natural ones made with olive oil and calendula top my list for soothing and healing.
4. Burp Cloths - it's nice to have a dozen. Cloth diapers work well too for catching active letdowns and leaking on the other side.
5. Breastfeeding Pillow - Personally, most women would do better without this until breastfeeding is going well because breast pillows are often too tall or too short. When babies are breastfeeding well, they are convenient and cozy.

For Naps and Sleep

1. Rock N Play is #1 for parents. Somehow, the magic RnP keeps babies mostly happy or sleeping when you aren't holding them. It's some kind of miracle.
2. Bassinet that attaches to the parent's bed - These are wonderful for breastfeeding moms and babies. If nobody told you yet, most babies only want to be held by you. It's biological and while some babies don't mind being put down, our brains need the safe feelings and interaction with adults to grow.
3. Crib - While expensive, do not use a secondhand crib unless it has all the original hardware and the sides do not drop.
4. Pack and Play - Many people have this with the changing table/bassinet in the living room and something else in the nursery/bedroom. It's convenient for traveling, too.
5. 2-3 Sheets for the above

Taking care of the Baby

1. Baby clothes - You will have too many newborn and 3 month sizes. Your baby will probably be too big or too little for what ever you stock up on. Be flexible.
2. Blankets- A heavy blanket for the floor or stroller, 3 or 4 swaddle blankets
3. Sleep Sacks/Swaddles These ensure that your baby is warm, but not too warm, while they sleep.
4. Diaper Bag. This can be any tote bag or backpack or can be the real deal.
5. Bathtub or foam mat for sink and a towel
6. Natural Diaper cream and a natural soap/shampoo/bodywash. Skip the Johnson's Baby and Desitin. While natural products are more expensive, you don't need much. Plain warm water is the gentlest, most effective cleaner.

At some point, your family and friends go home & you are left alone to take care of the baby & the house.

For Getting Things Done

1. Enough clothes - There is a balancing point in having too many clothes and scrounging around in the hamper for your baby's or your's "least dirty" dirty shirt.
2. A baby carrier. The average family has 4-6 baby carriers because babies grow and your preferences change. Mobywraps are wonderful stable carriers for the early weeks but can be complicated to learn. Ergobaby, tulababy, Onya and Lillebaby are all great carriers that fit people differently. It's hard to guess while you are pregnant but know that many people are very happy with each of these.
3. Bouncy seat, swing or vibrating seat. This equipment is only useful for a few months - the most painful months. They are worth it.
4. A stroller. While a new baby might not appreciate it, most babies do at some point. A stroller allows you to get out for walks which help you feel better. They are great for combining errands without the in-and-out of the car and they hold a lot of shopping bags, diapers and library books.

These are the essentials! Happy Registering! 

Start Your Registry Here!

What solids do I start my baby on?

purple vegetablesIf you've noticed your 5-6 month old baby watching you eat, asking for food through gesturing and grabbing and sitting up (or almost,) you are probably asking this question!

You're confused by popular feeding theories.

Traditional iron-fortified rice cereal that many grandparents and pediatricians suggest is one. Another is homemade, jarred and squeeze pouches of pureed "Baby Food" and a third popular way is called baby-led weaning.

Baby-led weaning (BLW) is an odd phase in the US.

"Baby-Led" is clear enough but 'weaning' sounds confusing when used in this context because we generally use the term to mean ending breast or bottle feeding.  In Baby-Led Weaning, weaning is used in the original meaning of adding food to a baby's diet. What is means is that babies start by picking up food and feeding themselves. They learn how to eat by trial and error. 

 What NOT to eat is important.

You can feed any food except honey and foods you, the parents, or other family members are allergic to. Raw honey may have botulism spores which is harmless to children and adults but babies have a weaker immune system and are vulnerable to botulism poisoning.

While you are breastfeeding, there is no need for dairy foods in the forms of yogurt, cheese or liquid milk. Cow's milk nutrients are mostly the same only in different proportions. Your milk is the perfect balance of protein, fat and sugar for a human baby or toddler.

Real Babies need Real Food.

In whatever form you decide to start use nutrient dense "real food" - meat, vegetables, fruit & whole grains. A good rule of thumb to follow is to use foods in as close to their natural state as possible. Boxed or canned food is less nutritious and more expensive.

Apple sauce, avocado, banana, hamburger, diced chicken, mashed or shredded carrots, chopped mango, french cut green beans, sweet potato and diced pears are all common first foods that can be offered. 

Some people use whole grain oatmeal as a base food and add fruits and vegetables to that. Some people start with all veggies followed by fruits in the hopes that their baby won't develop a preference for sweet foods. While there seems to be some merit to this theory, a broad diet using all the flavors is much more interesting than an all "sweet" diet.

Your baby's diet needs yoga!

Consider that ayurvedic cooking classifies salty, bitter, sour, astringent, sweet and pungent as "the six tastes." Work to use a little bit of each taste in every meal and your baby's senses will be satisfied. Everyone has preferences, including your baby, and introducing a variety of tastes helps to balance strong preference. Ayurveda also recommends a mix of wet and dry, cold and warm, light and heavy foods.

Introduce a variety of textures and tastes. Many babies can start with semi soft, chunky, wet and dry foods. Watch when your baby eats. Puree was developed in a time when formula-fed babies started foods earlier and needed drinkable food. By the middle of the first year, most babies have some teeth and are very interested in chewing and biting. Biting and gumming food strengthens their jaw and flattens their palate, which helps to make enough room for teeth. Different textures keep meals interesting.

When to mix it up?

Feed one food for 3 to 4 days, then add a new food. If there are any allergies you know which food is causing it. Food reactions can take many forms. It might be sleeplessness or irritability. Rashes are common and may look like flushed red cheeks, a bulls-eye around the anus, chapping around the mouth, or a pimply sandpaper rash that covers large areas of skin. Diarrhea, vomiting, and constipation are also common signs of a sesitivity or allergy.

The first month or two, the focus is on offering foods and helping your baby to experiment with new sensations and tastes. While some babies dive right in, others take their time. Continue breastfeeding about the same amount you always have and offer food as an add-on.

Biting the Breast That Feeds You

Nothing prepared Jenn for the searing pain coming from her left breast. She let out a howl and looked down at her son. If that wasn’t bad enough, there was Josh with a big smile on his face. He pulled her nipple out another inch and let it go. He stared at her and tried to nurse again when her hand and a loud “No!” stopped him. His smile turned to a cry and he burst out sobbing.

Jenn felt terrible and confused. It hurt! Why would he bite her? Why was he so proud of hurting her?  Her first impulse was to push him away, then tears came to her eyes and she hugged him in.  A quick look at her nipple showed bright red teeth prints but no blood.

There is not much worse than a baby who bites. The most dedicated nursing mother can give up hope when faced with round two or three of nursing after a hard bite.

Why do babies bite and what can you do to stop them?

Most mothers report that their baby started biting at around 4-6 months of age. A baby usually bites because he wants his mother’s attention and her attention is elsewhere. A baby wants to be in constant connection with his mother because she is his lifeline. When she is away, even if it’s only on a mental vacation, he will try to bring her attention back. Other reasons a baby might be biting is because the milk flow slowed, his teeth hurt or he sees he’s getting an unusual reaction from his mother and he’s curious about it.

The easiest way to avoid being bitten again is to pay attention to your baby while he is nursing. There are clues that a bite is coming. In every feeding, you usually have three stages. The first is active feeding time, when the baby is gulping. That is usually a low risk time for biting. Then comes a transition time where you may feel your baby start to become restless, stop sucking or start squirming. Right after this, there may be a pause followed by the bite.

During the transition time, focus on your baby. If he tries to bite, be prepared to unlatch him with your finger. Alternatively, you can pull him in against your breast so his nose is blocked. When his nose is blocked, his mouth will pop open and he will release your breast. Most mothers have a preference to one way or the other.

At this point you can offer him something else, talk to him about nursing correctly or just end the nursing session and hold him. Try not to overreact by pushing him away or setting him down away from you. This just reinforces the feeling of separation that he was bringing to your attention by biting you.

Some babies bite once and never do it again. Others need a little more coaching. All babies stop because they love breastfeeding and you. They don’t want to hurt you or their ability to nurse.