Vitamin D in breastmilk

Yesterday, there were several reports in the news that the American Academy of Pediatrics was increasing the dose of vitamin D supplementation in infants.

There is growing evidence that rickets, the manifestation of severe vitamin D deficiency, can actually occur at higher circulating vitamin D levels as once thought. And there have been a flurry of vitamin D studies that are linking vitamin D deficiencies with many diseases, both chronic and acute.

Yet vitamin D is very different from the other known vitamins. The natural dietary sources are not widespread, and is most commonly found added to foods, such as milk. Our bodies were not designed to depend on dietary sources of vitamin D, it was designed to produce its own through sun exposure to the skin. However in the age of skin cancer, urbanization, and computer games, many people are simply not getting enough sun to produce it. The body's production also varies by skin color and age, so one cannot easily prescribe a certain amount in the sun, and some areas don't receive enough UV radiation in the wintertime to produce anything. Several groups have recommended conducting a vitamin D test to see if one is deficient (young and old alike). Although that is ideal, if your insurance company doesn't cover it, then you could be paying quite a hefty sum for a test.

So increasing the supplementation recommendation is a step in the right direction. Yet, another message some pediatricians have been giving out is a wrong step. And that is that "breastmilk is deficient in vitamin D". Over and over again, I heard reports of that in the news. It is important to note that if a mother has adequate vitamin D status, her milk may not be very rich in vitamin D, but it is rich enough to give to her baby. Whether that is enough for the baby is another story, but it isn't because breastmilk is deficient. It's because breastmilk wasn't designed to be the primary source of vitamin D. The sun was.

Out of the mouths of babes: Getting rid of thrush

Welcome to April's carnival of breastfeeding. This month I am sharing my experience with Thrush. I have always intended to share my story, even before I started blogging. However, I need to point out that the purpose of this post isn't to provide medical advice on how to treat thrush. It is simply my story, and I may have left out some details about thrush that were not relevant to my case, but that may be important to someone else's. Nonetheless, I hope it will provide insight and encouragement to those who read it. So here it is!

Here's my simplistic definition of thrush: it's the white patches in an infant's mouth caused by a yeast infection. However, the infection can also be present on the mother's nipple and the infection can also cause terrible diaper rashes. It is fairly common in infants, and not usually harmful, but it can be hard to get rid of and in some cases it can be quite painful.


The picture above is my daughter with thrush. She was about 10 weeks old. It was taken the weekend before I realized we had it.

All my kids had white tongues. I think for every child, my mother would see that their tongues were white and would mention they might have thrush. Nothing came of it with the first two, but with my third child, I noticed that my nipples would get really hot and itchy. I thought it was the humidity, but then I decided to look at my daughter's mouth. Sure enough, I found some white patches inside her cheeks that couldn't be wiped away. So when I figured it was thrush, I rushed her to the doctor to get rid of that thing! And so my adventure with thrush began...

In our case, it really wasn't that bad. My daughter wasn't having trouble breastfeeding and I wasn't in any pain. But this wasn't an easy time in my life either. My daughter had caught her first cold when she was 3 weeks old. This set off a chain of reactions and needless to say, I was worn out by the little booger :-) Adjusting to a new baby is hard enough as it is, and when a baby that young gets sick, they have a harder time fighting it off. It was really hard to think clearly during that time, especially when you are trying to make the best decision for your baby. So very specific information is important when a parent is stretched so thin.

These were the main questions I had:

• If it is not that big of a deal, then why is treatment necessary?
• If it generally goes away on its own, why is treatment necessary?
• How should I apply the treatment?
• When should I discontinue the treatment?

The biggest hurdle for me was treating her in the first place. Although I will give my kids medicine, I am not one to habitually medicate my kids. I don't even give them vitamin supplements. So I thought, if it wasn't that big of a deal, then do I need to treat it? To add to my confusion, the MedlinePlus Medical Encyclopedia (run by the National Institutes of Health) stated that treating it is "usually NOT necessary" and that it "generally resolves on its own." (I only include the link to it because it currently says "within two weeks." and I do not recall them specifying a time back then, but I could have been wrong. After all, it was a hard time for me.) Given that I was feeling the itching on my nipples and they started to look dry and cracked, I thought it best to go with the first round of nystatin treatment for my daughter. Gentian Violet is another treatment. It is what was used back when I was a baby, but now Nystatin is usually the default treatment. I really don't know why it has fallen out of style. I went with Nystatin by default because I was too worn out to consider any other alternatives.

It was unclear to me, however, the proper way to apply the medicine. How often should I apply it? I think the bottle said four times a day, but I had read in other places that it should be after every feeding. I take my kids to a family practice. I love having the same doctors as my kids do. They also have a different perspective when it comes to interventions, as they see a wide range of people with a wide range of ailments. So I don't expect them to be experts on thrush, especially when it is a fairly minor condition when compared to other ailments in a lifetime. It just happened that I had to ask the physician assistant I saw that day what I should do to treat my nipples. She looked it up and said that I could apply Monistat. Well, I ended up not using that because there are several different types available, I didn't know which one to get, how to apply it and I really didn't want to call back and ask. The pharmacist said I could apply the Nystatin directly to my nipples. So, after every daytime feeding, I applied Nystatin on myself and squirted the recommended dose inside my baby's cheeks.

The next challenge was figuring out when in fact it was totally gone. It only takes a few yeast cells in the right environment for it to grow back to where it was. So, after a few days of it looking like it was gone, I would stop the treatment. Only to have it reappear several days later.

So, given the MedlinePlus information, I decided to see if it would resolve on its own. I did ask the doctor about it. After making sure it would not hinder the baby's feeding (and it wouldn't because neither one of us were in pain), he allowed me to give it a try.

And, of course, it didn't go away on its own.

So I tried Nystatin again. By this time, my daughter, although maybe just 3-4 months old, was well familiar with the routine and would do all she could to keep from getting that dropper in her mouth. She would even try to spit (razzing style) to keep me from giving her the medicine. So I dreaded giving it to her.

Then finally things changed. After I was almost done with the second round, I decided to call the counseling mother who had helped me with some breastfeeding problems that came about because of my daughter's cold. I wish I had called her first and I have no idea why I took so long to call her. I think we were 6 weeks into this before I did. Not only did she give me the most practical directions, she helped me think through the other treatment options, and asked the lactation consultants in her network about the "resolving on its own" statement (which, by the way, they said that in their experience it is quite unlikely, especially in the warm southern climates).

So this is how I finally got the thrush out of the mouth of my babe:

• After every daytime feeding, I drew the recommended Nystatin dose in the dropper, then put a small amount from it in a spoon.
• Then, I put some on my finger and apply it directly inside her cheek, making sure I applied it in ever nook and cranny. Sometimes I used Qtips, but it was easier with my finger.
• I would also apply some on my nipples. I'd also apply some just before I went to bed.
• [update] Another important thing is to sanitize clothes (especially bra and nursing pads - don't use disposeable pads), toys and other things that go into the baby's mouth.

After the symptoms disappeared, I kept applying it, although I can't remember how long that was. You can always ask your health care provider about that. When all was said and done, my daughter was 5 months old.

So, in all, what could probably have been resolved in 2-3 weeks lasted about 3 months. What a difference it would have made if I had just picked up the phone and called lactation support. If you live in the US and you don't know of any lactation groups around, call the La Leche League's 24-hour Hotline at 1-877-4-LA LECHE. I cannot overstate how much easier it is when you have someone to help you through any lactation challenge you may have.

I also have read claims that unrefined coconut oil has antifungal properties, but the nystatin was cheaper (even after 3 rounds) and more accepted. I already had some refined coconut oil in my pantry for cooking purposes, so at one point I used the oil on myself, as I felt it provided an additional protective barrier, and the nystatin is somewhat sticky.

Among websites, KellyMom and the La Leche League's website were very helpful. For additional experiences with breastfeeding challenges, check these posts from other carnival participants (updated throughout the day):

Jen at Mama's Magic
Half Pint Pixie
Stephanie at Speech Act
Barbara at Mom on the Go
Sinead at Breastfeeding Mums
Tanya at Motherwear Breastfeeding Blog
Donna at Blessed Nest Perch
Lauren at Hobo Mama
Angela at Breastfeeding 1 2 3

It can't be that bad, can it?

Welcome to the Carnival of Breastfeeding. I participated last July, and once again this month's theme is breastfeeding humor. I really don't have much funny or interesting things to say about my own experiences, but here is another one from someone I know:

My friend in Brazil wanted to wean her daughter, but her daughter (probably 18 months at the time) just wasn't ready. One of the things she tried was applying a paste from the boldo leaf, known for its bitter taste, onto the nipples. Soon after her daughter started nursing, she pulled off and said, "ruim", which means bad or yucky in Portuguese. Then she went right back to nursing!

Here are the other participants of the carnival:
Sinead: http://breastfeedingmums.typepad.com/breastfeedingmums_blog/2008/02/carnival-of-bre.html
Stacie: http://twinkies.bastetweb.com/2008/02/24/things-i-fear/
Tanya: http://breastfeeding.blog.motherwear.com/2008/02/the-14th-carniv.html
Amy: http://crunchydomesticgoddess.com/2008/02/25/a-little-breastfeeding-humor/
Angela: http://www.blisstree.com/breastfeeding123/even-more-wacky-search-engine-terms-for-the-humorous-carnival-of-breastfeeding/
Carol: http://happy-sadmama.blogspot.com/2008/02/for-love-of-nursies.html
Andi: http://mamaknowsbreast.com/2008/02/dads_and_breastfeeding.php

The power of one...

Today is the last day of World Breastfeeding Week (WBW). I have made several posts about WBW on my infant feeding history blog, but I wanted to post something here too. If you've read this blog long enough, then you know that I am always coming back to the topic of breastfeeding. The more time passes by, the more it becomes dear to me. This post will be more of a rambling nature, but I do want this to be posted today :-)

My idea for La Leche USA's theme, "The Power of One... _____." is:

The power of one phone call.

How many mothers with breastfeeding problems pick up the phone to call a friend, a lactation consultant, La Leche Leader, even their doctor to talk about it? I haven't checked to see if someone has tried tracking that data, but that's beside the point. My point is that some mothers hesitate to call, or just don't -- whatever the reason. Well, I am glad that La Leche League now has a 24hr hotline (1-877-4-LA LECHE). What a wonderful privilege it is to make a phone call that won't inconvenience anyone -- regardless of what time it is -- for free!

I once read somewhere about someone giving a lactation consultant service gift certificate as a baby gift. I thought that is a wonderful idea so that a mom can have that kind of peace of mind if she needs to call on someone. With my first two children, I didn't need to call anyone. As a matter of fact, I have never even been to a La Leche meeting. But I'm glad I called someone regarding my daughter's breastfeeding, as it helped me manage the situation I was in, which was already quite stressful. As much as I have told friends to call me if they need anything, I know that I don't have many of the answers as I am not trained in that area, but I know I could connect them to who does as well as encourage them. I once asked a mother if they had a friend who was a lactation consultant, would they call them for advice. Her answer as a definite yes. So one day I hope to be a friend like that. Nonetheless, I have considered donating to the LLL hotline as part of a baby gift. Not only will this spread the word about the hotline, but it will be my own small way of making sure it remains.

So, if any of you are inspired to comment, what is one thing that made (or could have made) the difference in your breastfeeding experience?

1-877-4-LA LECHE

1-877-4-LA LECHE is La Leche's new 24hr breastfeeding hotline. Micky on Mocha Milk wrote up some more information about the hotline as well as funding information. Check it out and spread the word.

Another blog?

As if I had enough time on my hands, I have created another blog. The blog will address the history of infant feeding practices and recommendations. I don't think it will be all that active, but I just wanted a place to record my thoughts on the subject.

It is found at http://infantfeedinghistory.blogspot.com

Super Baby Food

I have always wanted to make my own baby food, but I haven’t done it much. With my first child, it was a challenge enough to have other food before him because I was so disorganized (and breastfeeding is so convenient). So, I ended up buying the stuff from the stores. I was also going to try and make my second child’s food, but one of my husband’s coworker gave us a bunch of baby food because their son rejected it. His wife had started giving him homemade food from a book called Super Baby Food and their baby didn’t want anything to do with that processed stuff. I did a mix of homemade and jarred, but soon he was eating table food with us anyway. Well, now that my third child has been looking at us like a vulture when we are at the table, I decided to get the book from my local library and see what it had to offer.

With the exception of a few precautions, it doesn’t take much know-how to make baked apples, sweet potatoes, and puréed peas. You don’t really need a book for that kind of stuff either. But Super Baby Food is more than a baby cookbook. The subtitle saying that it is “absolutely everything you need to know” is pretty accurate. In addition to recipes, there are plenty of money and time saving tips. Cost consciousness is a plus for me, as this is often a downfall in most cookbooks. For those who prefer a schedule, the author has provided one. Also, there’s a chapter detailing almost every fruit and vegetable you can think of, providing information for from selecting them in the grocery store, to cooking and freezing, as well as at what age it is appropriate to include those foods. The nutrition advice is sound and well explained, and there is an emphasis on whole (i.e. minimally processed) foods. To keep up with the current recommendations, corrections and updates are available through http://www.superbabyfood.com/. You can also browse sample chapters on the site.

By the way, you know how the packaged baby cereal tastes like cardboard? Well, homemade cereal has a much better taste and texture to it. I did buy the boxed stuff. It comes in handy for thickening the cereal when I add too much liquid, and when I haven’t had the chance to make more cereal, but my baby seems to like homemade food better.

In addition, Super Baby Food includes information on cleaning your home with baby-safe materials (I tried cleaning my bathroom with vinegar and baking powder. It worked out really well), as well as a section on birthday parties (I’ve got to try their spaceship cake design).

In summary, Super Baby Food is a resource well worth having.

Super Baby Food (2^nd ed), by Ruth Yaron. ISBN: 0965260313

When to introduce solids

There is no set age when a baby needs to start having solid foods. The usual recommendation is 4-6 months. Most of all, it depends on when the baby is ready. According to The American Dietetics Association, your baby may be ready to begin solid

food if he does all of the following:

• Sits with help or support
• Doubled birth weight and weighs 13+ lbs.
• Is hungry after 8-10 breastfeedings, or 32 oz. of formula, in a day

There is no need to push this with your child. Early introduction of solids can actually increase a babies risk of allergies or malnutrition. There is also a concern that breastfed babies need more iron intake after 6 months of age, but this is not always the case. I still need to review studies related to this, so I am not stating a position about this at this time. I hope to post about this down the road if I have the time to really think about it.

Personally, my goal is to wait until the baby is 6 months old before I introduce any other foods. With my first son I started at 7 months. This was primarily because breastfeeding (a.k.a. nature’s fast food for babies) was so convenient that actually having to prepare something for him required a shift in operation. He appeared to be ready beforehand, but I wasn’t and that was okay. My second child had his first spoon of cereal at exactly 6 months. He had already been watching us at the table and was quite interested in what we had to offer. We couldn’t feed him fast enough! My third is almost 7 months now. She started showing signs of readiness much earlier. I was reluctant to introduce solids earlier to her because I was more concerned about allergies and intolerances with her (topic for another post). Then when she watched us like a vulture during a meal, I figured I’d give it a try. So she got an earlier start at 5 ½ months. Still, I’ve started slow, and really haven’t introduced much over 4 weeks.

There are several precautions needed to take when you introduce foods to your baby, such as having a waiting period for introducing new foods. Some foods should be off limits until after their first birthday. I simply can’t reproduce all that information. Besides, there are other places you can find it. A good resource for infancy and beyond is Super Baby Food by Ruth Yaron (check out their sample chapters online). The American Dietetic Association also has a pdf file available online at: http://www.eatright.org/ada/files/infant_book.pdf.

On Schedules

I have been asked about my position on infant feeding schedules. Here is my (hopefully) short take on it:

I think there needs to be some balance, but I definitely lean toward feeding on demand. Babies grow and change so incredibly fast, that once you get used to a schedule or routine, the baby starts teething, goes through a growth spurt, etc. Still, having a routine or schedule helps you plan your day out so that you aren't simply reacting to everything that's going on. Then, as your child grows older, he or she falls into a more consistent routine.

I keep thinking that my baby will nurse three times at night forever. As much as I wish she'd settle herself back to sleep on her own, my current circumstances don't offer me that luxury. But a year from now, her sleeping patterns will be so different. Ten years from now, she could still be waking up at night, but by then she will be able to deal with it on her own.

Pay attention to your child. It doesn't make sense to hold off a feeding just because you think he shouldn't be hungry. On the other hand, it doesn't make sense to forcefeed a child by nursing him at the drop of a hat (Although nursing is more than feeding. It offers comfort to the baby too. Babies soon learn how to nurse for comfort without stuffing themselves). The same thing goes for the sleep schedule. Although it may be ideal to have him fall asleep without any intervention (such as nursing or rocking), it just isn't always practical. Although it isn't ideal to let a baby cry himself to sleep, sometimes you just can't hold or nurse him anymore.

The common denominator I see in people who are wrestling with these issues is that they do want the best for their child, although they may be afraid of being selfish or manipulated. Be assured, though, that it is often neither.

I have more I could write about this, but it takes a while for me to organize my thoughts and put it into writing. Feel free to leave any comments and we can take it from there.

Why I chose to breastfeed

Well, maybe I didn't choose to. Actually, I never really gave NOT breastfeeding a thought. I have always been in awe at God's design for a woman to sustain life within her womb, nurturing from within. Long before I knew whether I would or could bear a child, years before I met my husband, I looked forward to the day I would be pregnant. The same awe carried through to breastfeeding. Once again, the idea that my body could produce food for such a fragile baby blew my mind. If my body was designed to make it, then surely it was perfect. As I got older, I learned about other benefits, but I also found it to be much more practical. No bottles to boil or carry around (or forget!). No warming up, etc. I was also in a very supportive environment, so I didn't have to worry about the social opposition either (not like I was really concerned about it in the first place). But, in the end, my decision to breastfeed was very simple: regardless of social perceptions, breastfeeding is the way "the Good Lord meant it to be" -- period.

With all three of my children, breastfeeding has come very natural to me. It hasn't been problem free (I have to avoid chocolate among other things), yet I know better to think this is the same experience for everyone. In fact, the third time around has shown me how much I need (and want) to learn about breastfeeding. I realize that most moms who stop breastfeeding wish they had the same ease as I had. But I know many moms who have faced much greater challenges, and have prevailed in breastfeeding their child. Some of these had support, others didn't.

I am writing this to encourage those who want to breastfeed (or continue to breastfeed) to seek support. I am very thankful for the resources that have been made available to me, knowing that they weren't as easily available just a generation ago. There are thousands of people who will bend over backwards to help you do this. You are not alone. If there is one thing I have learned after having three kids (well, I actually learned after having two), is that it is OK to ask for help. I don't need to have all the answers. There are lactation consultants (IBCLC, among others), peer counselors, and simply the average mom (well, the consultants are mostly average moms who have dedicated their lives to this topic) -- all who have been there or are willing to walk through it with you. And, if paying a fee to see a consultant seems steep, then think how quickly you will be spending that amount on formula. There are also several support groups, La Leche League being the most known. There are blogs, there are email groups, forums, you name it.

So what is this post really about? It is about promoting breastfeeding, but I know I couldn't just end my post at the first paragraph because people could say, "Well, I'm glad it worked for you..." It is not my place (or anyone else's) to make that decision for you. However, there are very few reasons why someone cannot breastfeed, but there are many reasons why someone will not breastfeed. So for those who can, I hope this is an encouragement to you.

Feel free to post your thoughts.

UPDATE: Here is a post about when Lactation Consultants aren't supportive, from The Lactivist. My take is, if you have someone who is not helping, then find someone else who will.