Managing some breastfeeding challenges

 

Breastfeeding can be challenging whether as a first-time mom or an experienced mom. But remember, the benefits it offers to your newborn and you out-ways the challenges. Many women face different breastfeeding problems while others do not and each breastfeeding journey is quite different from another. In any of the challenges facing, remember you are not alone.

Some of the challenges include;

Low milk production

This is when your breasts do not make enough milk to meet the nutritional needs of your baby and a range of factors may be responsible for this challenge.

What to do

• Make sure your baby is latched on and positioned well.
• Breastfeed often and let your baby decide when to end the feeding.
• Offer both breasts at each feeding and have your baby stay at the first breast if he or she is still sucking and swallowing. Offer the second breast when the baby slows down or stops.
• Avoid giving your baby formula or cereal in addition to your breastmilk in the first few months of life. Your baby may lose interest in breastmilk which can decrease milk supply.

Plugged ducts

They are common in breastfeeding mothers. A plugged milk duct feels like a tender and sore lump in the breast. A plugged duct happens when a milk duct does not drain properly. Pressure then builds up behind the plug, and surrounding tissue gets inflamed. A plugged duct usually occurs only in one breast at a time.

What to do

• Breastfeed on the side with a plugged duct as often as every two hours. This will help loosen the plug and keep your milk moving freely.
• Massage the area, starting behind the sore spot. Move your fingers in a circular motion and massage toward the nipple. 
• Use a warm compress on the sore area.
• Wear a well-fitting, supportive bra that is not too tight, since a tight bra can constrict milk ducts. 
• If you have plugged ducts that keep coming back, get help from a lactation consultant.

Nursing strike:

 A nursing "strike" occurs when a baby suddenly refuses to nurse for no apparent reason. It occurs most often in babies older than 3 months of age.  Do not stop breastfeeding because self-weaning is more gradual than sudden and baby-led weaning rarely occurs during the first year. During a strike, a baby is trying to let you know that something is wrong. A nursing strike usually lasts just a few days but may persist for a week or two. This usually does not mean that the baby is ready to wean (stop breastfeeding totally). Babies react to different things that can lead to a nursing strike. Some babies will continue to breastfeed without a problem. Other babies may just become fussy at the breast. And other babies will refuse the breast entirely. Do not wean during a strike, most babies can be coaxed back to the breast with some patience and determination. 

What to do

·       Keep trying: You might try feeding your baby when he or she is very sleepy. If your baby is frustrated, stop and try again later.

·       Deal with distractions. Try feeding your baby in a quiet room with no distractions.

·       Change positions: Try different breastfeeding positions. If your baby is congested, it might help to suction his or her nose before feedings.

·       Cuddle your baby:  Skin-to-skin contact between you and your baby might renew your baby's interest in breastfeeding. 

·       Address biting issues:  If your baby bites you during breastfeeding, stay calm and slip your finger into your baby's mouth to quickly break the suction.

·       Evaluate changes in your routine: Think about any changes in your routine that might be upsetting your baby. Are you stressed? Are you taking any new medications? Has your diet changed? Are you using a new perfume or fragranced soap? Could you be pregnant? Focus on taking care of yourself.

Mastitis

It is soreness or a lump in the breast that is caused by obstruction, infection and/or allergy. It is most common in the first 2-3 weeks postpartum but can occur at any stage of lactation. As a lactating mother, you should regularly check your breasts for lumps that indicate a blocked duct. If found, ensure the baby feed effectively on that side, adjusting in positioning and attachments, and use hand expression to massage the area starting behind the sore spot to unblock the duct.

Symptoms are similar to the plucked ducts with pain/heat/swelling being more intense and red streaks extending outward from the affected area.

What to do

• Breastfeed on the infected side every two hours or more often. This will keep the milk moving freely and your breast from becoming too full.
• Gently massage the area, starting behind the sore spot. Move your fingers in a circular motion and massage toward the nipple.
• Apply heat to the sore area with a warm, wet cloth.
• Wear a well-fitting, supportive bra that is not too tight, since a tight bra can constrict milk ducts.

Engorgement

Engorgement occurs when the breast gets hard, tight, and painful with full of milk. It can lead to plugged ducts or a breast infection, so it is important to try to prevent it before this happens.

What to do

• Breastfeed often after giving birth and allow to feed for as long as he or she likes.
•  Ensure your baby is appropriately latched on the breast and sucking well
• Breastfeed often on the engorged side to remove the milk, and to prevent the breast from becoming too full.
• Hand express or pump a little milk to soften the breast and nipple before breastfeeding.
• Massage the breast.
• Use cold compresses on your breast in between feedings to help ease the pain.
• Wear a well-fitting, supportive bra that is not too tight.

For more tips on overcoming breastfeeding challenges, consult a breastfeeding consultant or a dietitian.

Formula Feeding

Breast milk is the optimal milk feed for infants because it is nutritionally adequate and reduces the risk of illness in infants. But in a case where breastmilk let-down is delayed, infant formula should be given until breastmilk is produced. While doing so, always ensure to properly and correctly sterilize the feeding tools to prevent bacterial contamination which can cause gastroenteritis.  The feeding must be frequently on-demand until breastmilk is produced. Infant formula is nutritionally adequate but does not provide the same protection against illness as breastmilk. Exclusively breastfed infants have a reduced possibility of being hospitalized for diarrhoea or respiratory tract infections in the first 6 months of life.

The standard formulas are made from skimmed cow’s milk with added fats and nutrients to replicate the nutrients composition of breastmilk. There are different brands of infant formula in the market with each brand having different additions of milk proteins. Always check carefully to make sure you are buying suitable milk for your baby.

For a start, it is recommended that formula with a greater proportion of whey protein be used as this is easier to digest and closer to the protein composition of breast milk. The Whey dominant infant formula is often labelled with a ‘1’ and is promoted for newborn babies. The ratio of proteins in the formula approximates the ratio of whey to casein found in human milk (60:40).

Follow-on formula: Follow-on formulas are only suitable for infants over 6 months as they are higher in protein, iron, and vitamin D than infant formula. The follow-on formula is a Casein dominant infant formula often labelled with a ‘2’ and promoted as suitable for hungrier babies. Although the proportions of the macronutrients (fat, carbohydrate, protein etc) are the same as in the whey-dominant formula, more of the protein present is in the form of casein (20:80). The higher casein content causes large relatively indigestible curds to form in the stomach and is intended to make the baby feel full for longer. When your baby is up to 1 year of age, other kinds of pasteurised milk such as whole cow’s milk, sheep’s or goat’s milk can be given.

PS: There is also a range of specialised infant formulas for infants with certain medical conditions and they should only be used on the advice of a doctor or dietitian.

INTRODUCING COMPLEMENTARY FOODS

Complementary foods should be introduced at the right time, delaying beyond six months of age increases the risk of nutrient and energy deficiencies. As new complementary foods are introduced, infants accept and enjoy the new tastes and textures. At times, they may be fussy when new food is introduced, do not panic as it is very common even as an adult, we tend to refuse foods that are new to our taste buds. When a certain food is rejected, try other alternative, and try to identify if the refusal is due to the texture or the food itself. Try several food mixtures to know which suits your baby the most. Do not forget to introduce each food item singly, and wait for about 2 -3 days to watch out for any allergic reactions. Occasionally, give the previously refused foods to check the level of acceptability. Research has shown that food can be given 5-10 times before it can be adequately accepted by an infant.

Begin with a smooth puree or mashed food for the first few tastes. Foods can be offered from a shallow teaspoon or plastic spoon. Some infants may prefer soft finger foods for a start but do not restrict to finger foods only as that would not provide adequate amounts of nutrients needed.

Foods to offer

You can introduce any food for a start, but it is always encouraged to begin with mashed or pureed low allergic foods like cereals, root vegetables (carrots, potatoes etc) and fruits, often mixed with a little of either breastmilk or infant formula. One of the disadvantages of starting with fruit is that the infant may likely grow a ‘sweet tooth’ afterwards.

Other foods to include are iron-rich foods such as red meat, prawns, fish, eggs, peas, beans, and other suitable meat alternatives as well as iron-fortified breakfast cereals and green vegetables. To increase absorption of iron from plant-based foods,  give food rich in vitamin C at the same meal.

 Hard and crunchy foods should be avoided as infants at this age can bite off lumps but not yet chew them properly, which could lead to choking.

Different local foods to be given

Staples: grains such as maize, wheat, millet, sorghum, and roots crops such as yam, cassava, and potatoes

Legumes, nuts, and seeds such as beans, Bambara nuts, pigeon peas, soybeans, groundnuts, almonds, cashew nuts, sesame etc

Vitamin A-rich fruits and vegetables such as mango, papaya, dark-green leaves, carrots, yellow sweet potato and pumpkin and other fruits such as banana, pineapple, avocado, etc.

Animal-source foods including flesh foods such as finely minced meat, dried meat powder, chicken, fish, fish powder, liver (1 small size per week) eggs, milk, and milk products

The small amount of oil or butter (not more than half a teaspoon per day) added to vegetables and other foods will provide extra energy.

Foods to limit

Sugar: it should only be added to homemade cooked fruits and puddings (if desired) in small quantities to reduce the tart flavour.

Salt and salty foods: most foods, breastmilk and infant formula naturally contain some sodium needed for infant growth. Exceeding the recommended sodium intake of 400mg (1g salt equivalent) per day may pose a health risk to the developing kidney.

Honey: it should not be given until one year of age to prevent Clostridium botulinum infection.  After 1 year of age, the gut is mature enough to prevent the botulinum bacteria from multiplying.

Liver: if offered, should be limited to one small serving per week because of the high levels of vitamin A.

COMPLEMENTARY FEEDING

 

The complementary feeding period, from 6 to 23 months of age, is one of the most challenging times to meet children’s nutrient demands. While children’s stomachs can only hold a small amount of food, their nutrient needs reach a lifetime peak, leaving them vulnerable to growth faltering.

Based on indicators established by WHO –in Low and Middle-Income Countries (LMICs- Nigeria inclusive), half of all children are not receiving the minimum meal frequency (the minimum number of meals throughout the day needed to meet their nutrient needs); more than two-thirds of children are not receiving the minimum dietary diversity (meals from a minimum number of food groups), and five out of six children are not receiving a minimum acceptable diet (both the minimum meal frequency and minimum dietary.

The World Health Organization (WHO) and UNICEF recommend that infants begin consuming safe and nutritionally adequate solid, semisolid, or soft foods starting at 6 months of age but not earlier than 4 months while continuing to be breastfed until 2 years of age or beyond. The complementary food should be nutrient-rich, without excess energy, saturated and trans fats, free sugars, or salt.

Recommended practices include

• Timely introduction of complementary foods at 6 months of age when the need for energy and nutrients exceeds that provided by breastmilk  

• Appropriate portions sizes, texture  and meal frequency according to age

• Diversity of diet: Should provide sufficient energy, protein, and micronutrients

• Safe: Should be hygienically prepared, stored and fed

• Responsive feeding cue: feed in response to a child’s appetite and satiety signals, and feed with care.

• Encourage self-feeding despite spillage and feed under supervision in a separate plate to develop an individual identity.

When should complementary foods be started?

Complementary foods should be started when the baby can no - longer get enough energy and nutrients from breast milk alone when nerves and muscles in the mouth develop sufficiently to let the baby munch, bite, and chew. This period is between 4 and 6 months of age when their digestive system is mature enough to digest a range of foods. At 4-6 months of age, it becomes easier to feed thick porridges, purees, and mashed foods because children: can control their tongues better start to make up-and-down 'munching' movements start to get teeth like to put things in their mouths are interested in new tastes. 

Signs that a child is developmentally ready

• At least 4 months old

• Start to make up-and-down 'munching' movements

• Interested in new tastes.

• Receives frequent breastfeeds but appears hungry soon after

• Not gaining weight adequately.

Why giving complementary foods too soon is not recommended:

The foods may replace breastmilk which is the most important food for them at that stage. If foods are given, it may become difficult to meet the nutritional needs as they fill the stomach but provide fewer nutrients than breast milk. 

Not developmentally matured to digest foods order than milk

Increases risk of diarrhoea because complementary foods may not be as clean as breast milk.

Starting complementary feeding too late is also dangerous because:

A child does not get the extra food needed to fill the energy and nutrient gaps a child stops growing or grows slowly the risk of malnutrition and micronutrient deficiencies increases. The chances of refusal are very high as they are already accustomed to breastmilk taste.

 

Optimum Nutrients Absorption from Food Duo

Food can be a friend or foe- it greatly depends on how you choose to deal with food, that is, what you eat, how you eat and when you eat. Some food pairing can badly interfere with digestion, causing headaches, drowsiness, bloating and may hamper your weight loss goals. On the other hand, some can be a game-changer in your nutritional status.

Combining foods in a balanced and colourful way optimizes nutrient absorption. Diversifying your snacks and meals with colourful fruits and vegetables, protein and healthy fats is a realistic way to achieve it. For instance, taking citrus juice together with green tea increases the absorption of antioxidants in multiple folds. While there is no rule of thumb for combining foods; avoid combining the following foods together

Dairy and animal protein- foods within these food groups should not be paired or consumed at the same time because the calcium inhibits the absorption of iron and vice versa leaving you with little of either as bioavailable.

Milk and tea(coffee, green tea, Lipton etc): the caffeine in some tea products inhibits the absorption of calcium while the casein (milk protein) nullifies most antioxidants benefits in the tea.  

Acidic fruits/juice with starchy foods: having oatmeal with a serving of citrus fruit or a cup of orange juice may seem an ideal meal to break the night’s fast, but the stomach doesn’t really like it. This is because the acidic fruits destroy the enzyme responsible for digesting starches. This could make you start experiencing some tummy troubles earlier enough.

Green leafy vegetables and citrus fruits: green leafy vegetables are rich in non-heme (plant-based) iron, in the absence of vitamin C, the absorption is inhibited. Orange or any other citrus fruit is loaded with this water-soluble vitamin. Consuming your green leafy vegetable with citrus fruit enhances the absorption of iron. Other foods with similar nutrient compositions you could pair include.

Oats and nuts: this duo gives a powerful dose of copper and iron, which aid the formation of haemoglobin-oxygen transporting cells in the body. They are not only rich in micronutrients, but also in protein, and healthy fats and vitamins, which would leave you full for longer hours.

Watermelon and avocado: watermelon and any other red-coloured food are loaded with lycopene-a key nutrient for eye health. This antioxidant is fat-soluble, pairing it with any fat-soluble containing food is the surest way to optimize its absorption.

Sweet potatoes with avocado: sweet potatoes especially the orange flesh contains beta-carotene, a precursor of vitamin A (a fat-soluble vitamin) while avocado is rich in healthy fat. Vitamin A keeps the skin, eye, and immune system in good condition while the healthy fats increase the satiety values and boost vitamin A absorption.

Red apple and dark chocolate: this duo has the potential to improve cardiovascular health. Red apple contains quercetin flavonoid which acts as an anti-inflammatory while catechins is found in dark chocolates is an antioxidant. Quercetin reduces blood clots while antioxidant catechins work against hardened arteries. They reduce the chances of cardiovascular disease.

Meats and carrots: meats are rich in zinc while carrots contain a high quantity of vitamin A- a nutrient needed for cell growth and maintenance of good vision. The absence of zinc limits the bioavailability of vitamin A.

For more food combination suggestions, contact a registered dietitian

Foods that aid Breast milk Production

Breastfeeding is a critical part of motherhood that shouldn’t be taken for granted. Breastmilk is composed from the foods consumed by the breast-feeding mum hence, the need to consume a healthy diet. 

As a new mom or intending mom, you are wondering if there are foods you can consume to support lactation. Consuming specific foods can increase your breastmilk production thereby making it easier for you and your baby. Since breast milk is the sole source of the newborn’s nourishment, it is important to ensure you produce an adequate quantity of it.

If you are worried your baby is not getting enough breastmilk to meet his demands, we got you covered with these list of foods.

Water/fluid: breastmilk contains more than 80% of water. Therefore, staying hydrated is essential to adequate milk production. Drinking up to 3.0l or 9 glasses of water daily will help boost milk supply.

Kunu: kunu is a local beverage made from fermented millet and sorghum, rice, and dried potato. This nutritious beverage contains carbohydrates, protein and fat which are essential for normal body functions

Pap: pap is made from fermented maize, millet or sorghum popularly called akamu, or ogi. It is packed with lots of nutrients and helps in boosting breastmilk production. For better nourishment, add any milk of choice.

Oatmeal: oat is a whole grain rich in dietary fibre with a wide nutritional profile. it is known to increase oxytocin levels in the body. It can be taken as pudding, mixed into a smoothie or consumed together with any soup of choice; it can also be used in making different confectioneries. 

Carrots: Carrot is a root vegetable rich in fibre, it adds colour and vital nutrients to the diet. Its phytoestrogen content is responsible for its lactogenic effects.

Green leafy vegetables: green leafy veggies are an excellent source of both soluble and insoluble nutrients, dietary fibre and other bioactive compounds that are vital for maternal nutrition and postpartum recovery. It is also an excellent source of phytoestrogen that may enhance milk let-down.

Sesame seeds are rich in protein, fibre and calcium and other vital nutrients needed for maternal nutrition. It is loaded with phytochemicals that promote prolactin secretion and improve milk supply. It can be consumed by adding to your homemade snacks, salads, pasta or processed into milk.

Nuts: nuts like cashew, almonds etc promote breastmilk production as they are rich in phytoestrogen. A handful a day offer vital nutrients such as healthy fats protein and calcium.

 

FOOD PAIRING FOR BETTER HEALTH

 

Do you pair your foods because of aesthetic characteristics, colour or because it is a traditional way of food combination? Have you ever wondered why foods are paired? As foods are paired, it can either enhance or inhibit the absorption of nutrients. By pairing certain foods, you can majorly impact the benefit you get from them: increasing the absorption of important nutrients and boosting the effectiveness of antioxidants.

 VITAMIN C AND PLANT-BASED IRON

 For the non-heme iron (iron from plant sources) to be best absorbed, non-heme iron, you'd need to give it a little boost by pairing it with a source of vitamin C. The vitamin C helps break the iron down into a form that the body can more easily absorb. To get optimal absorption of iron, the two food sources should be paired in a meal. Add a squeeze of orange or any citrus fruits of choice to a green leafy vegetable or consume a citrus fruit immediately after taking a vegetable soup or sauce.

TURMERIC AND BLACK PEPPER

 Turmeric is an age-long flavoring agent that has powerful antioxidant and anti-inflammatory properties. The spice can help relieve symptoms of arthritis and may also benefit kidney health according to some studies. Pairing this age-long spice with black pepper makes the beneficial compounds in turmeric more bioavailable.

 VITAMIN D AND CALCIUM

This combo of vitamin and mineral will helps keep bones healthy. “Vitamin D helps bring in more calcium from the foods consumed. The duo works together because the active vitamin D form causes a cascade of effects that increases the absorption of dietary calcium in the intestines. To get this pairing right, eat foods offering vitamin D, such as catfish, mackerel, salmon, tuna, egg yolks or fortified foods like milk and non-dairy beverages such as soymilk and orange juice with a variety of calcium-providing foods, like leafy greens such as ugu leaves (fluted pumpkin), amaranth leaves etc. and dairy foods.

LYCOPENE AND HEALTHY FATS

In each red gem of a plant-based food, you’ll find lycopene, an incredible disease-fighting antioxidant. Lycopene may help prevent prostate cancer, at early stage. Taking an avocado and gulping it down with a slice of watermelon, cooking your tomatoes as well as serving it with a bit of plant-based oils enhance the body’s absorption of the photochemical.

HEALTHY FAT AND FAT-SOLUBLE VITAMINS

The intestine absorbs the fats-soluble vitamins — vitamin A, vitamin D, vitamin E and vitamin when they’re paired with a fat source. Getting enough of these vitamins and maximally absorbing them is important because deficiencies relate to heightened risk of cancer and type 2 diabetes.  Healthy fats from nuts, seeds, avocado, olive oil or olives help to absorb fat-soluble vitamins from fats-soluble vitamins rich foods such as carrot, sweet potatoes, mango, eggs, liver etc.

COMPLEMENTARY PROTEINS

Proteins contain both essential and non-essential fatty acids. Of all the essential ones needed by the body, only some foods contain all of them. These protein sources, or complete proteins, are often obtained from animal products like meat, poultry, fish, dairy, eggs, and non-animal product such as soy foods. Other protein sources like nuts, legumes, grains, and vegetables are incomplete, meaning they lack one or more of the essential amino acids needed for growth and development. But by pairing incomplete proteins together, one creates a complete protein source.” Examples of these combos include rice and black beans, maize and nuts, whole wheat bread and nuts etc. Pairing these variety of proteins, you’ll get ample amounts of each amino acid.

 

Contact a Dietitian for more interesting food pairing for optimal nutrient absorption.

 

Millicent Onyinyechi (RDN)