WHY WOULD A BREASTFED BABY LOOSE WEIGHT?? Kittie Frantz, RN, CPNP-PC Clinical Instructor in Pediatrics Keck School of Medicine at The University of Southern California 1

DISCLOSURE I own Geddes Productions, LLC – producer of breastfeeding DVDs and a distance learning course called “The Baby’s Perspective” I was breastfed for 9 months I breastfed my three children All of my 7 grandchildren have been breastfed 2

I have received copyright permission to show these photos, films, and drawings only to the live conference audience. Handouts, photos and recordings may not duplicate these images. 3

BREASTFEEDING IS NATURAL IT HAS BEEN GOING ON FOR TENS OF THOUSANDS OF YEARS……RIGHT? 4

S O, IS THE CAUSE OF POOR WEIGHT GAIN … The Mother? The making The Baby? The taking The Opportunity? The Absorption? 5

W HY IS IT ALWAYS “B LAME THE M OTHER ”? “She doesn’t “Have enough milk” “This is her first baby so she is inexperienced” If this were true most of the time, all first borns would never survive 6

U NDERMINING THE M OTHER ’ S CONFIDENCE My bottle baby weighs more than your baby Maybe she just thinks she is not making enough milk AP news 7

I F SHE BREASTFED HER OTHER BABY WITH GOOD WEIGHT GAIN, THEN …. She has a proven breast 8

I AM NOT SAYING THAT IT COULDN ’ T BE THE MOTHER Likely possibility is low She does the making but the other 3 categories involves the baby The lethal gene theory 9

M ATERNAL D IAGNOSIS THAT COULD E FFECT A M ILK S UPPLY Hyper or Hypothyroid Pituitary gland problems Polycystic Ovarian Syndrome Retained Placenta Sheehan’s Syndrome She has lost her pregnancy weight too fast Gastric bypass that inhibits absorption 10

C OULD BE M EDICATIONS SHE TAKES Estrogen containing birth control pill Progesterone birth control shot, patch or pills before 6 weeks postpartum Antihistamines 11

A NATOMICAL D EFICIENCY L ACK OF G LANDULAR T ISSUE Gift from patient 12

S URGERY R EDUCTION MAMMOPLASTY Gift from T Fuller 13

S UGGESTIONS CAN ALSO : “B LAME THE M OTHER ” Let’s build up your milk supply with an electric breast pump © Kittie Frantz 14

S UGGESTIONS THAT ALSO CAN … “B LAME THE M OTHER ” Take some herbal tea or capsules to build up the milk supply Buy special cookies or oatmeal Use gut motility drugs 15

T HIS FEEDS INTO HER FEELINGS OF INADEQUACY LAC+USC Midwives 16

BUT…WHAT IF IT IS NOT HER BODY THAT HAS BETRAYED HER? 17

WHAT IF IT IS THE BABY ? IT TAKES TWO TO TANGO ! 18

THE BABY NEEDS TO SUCKLE WELL 19

HOW CAN WE DETERMINE THAT? © Kittie Frantz 20

THERE ARE THREE PHASES TO THE SUCKLE YOU CAN CHECK © Kittie Frantz 21

THE ANTISIPATORY PHASE © Kittie Frantz 22

THE INNER LIP STIMULUS © Kittie Frantz 23

THE DIGITAL FEEL © Kittie Frantz 24

MAKE SURE BABY IS NOT TONGUE TIED © Kay Hoover Gift from patient 25

WHEN BABY CRIES, IS HIS TONGUE SLEEK AND CURLED? 26

YOU CAN OBSERVE THE BREASTFEED © Kittie Frantz 27

MORE AREOLA ON THE TOP THAN THE BOTTOM? © Kittie Frantz 28

LIPS FLANGED? © Kittie Frantz 29

CHEEKS ROUND? 30

DRAWS IN BREAST SKIN? © Debi Bocar 31

FEEL TONGUE UNDER CHIN? Gift from patient 32

WIDE JAW EXCURSIONS? © 2007 Smillie, Makelin, Frantz licensed from Geddes Productions, LLC Baby-ked Breastfeeding: The Mother-baby Dance 33

SUCKLE/SWALLOWING RATE? © 2007 Smillie, Makelin, Frantz licensed from Geddes Productions, LLC Baby-ked Breastfeeding: The Mother-baby Dance 34

ALL THROUGH EVERY FEEDING? 35

ANY SORE NIPPLES? Gift from patient 36

ANY ENGORGEMENT? © Kittie Frantz 37

THE ELEPHANT IN THE ROOM….. WHY IS HE NOT SUCKLING WELL? Normal for newborns to take time to organize their suckle in the first five days Gryboski Does baby have high or low muscle tone? Is Baby’s central nervous system immature? Is he sick? Sepsis Is he a week late pre-term infant? 38

IF IT IS THE SUCKLE HOW CAN WE FIX THAT? Hand express while baby feeds to increase the flow Listen for swallows Can’t get baby to continue to swallow? Switch breasts 39

I F THAT DOESN ’ T WORK S OMEONE WILL SUGGEST SUPPLEMENTING © Kittie Frantz © Kalman and Frantz 40

B EST TO S UPPLEMENT AT THE B REAST Medela AG © Geddes Productions from Supplemental Nursing System DVD 41

OK….SO MOM IS OK AND BABY IS OK……SO WHAT NEXT? 42

THE O PPORTUNITY ? UNICEF 43

HOW OFTEN DOES HE FEED? Is she just repeating what she was told to do? I would if I was dead tired How many of you could recall how often your baby fed in the first week????? Do a 24 hour recall with her 44

HOW OFTEN SHOULD SHE FEED?? THE AAP SAYS…. 45

IF SHE KEPT A LOG, REVIEW IT 46

HOW LONG SHOULD BABY BE AT THE BREAST? 47

WHAT SHOULD THAT NUMBER BE AT EACH BREAST? THE AAP SAYS… 48

W HAT HE GOT DEPENDS ON HOW WELL HE SUCKLES 49

SO…THERE ARE 3 THINGS NEEDED FOR A GREAT MILK SUPPLY Frequency of the feedings Length of the feedings Quality of the baby’s suckle 50

W HAT CAN INTERFERE WITH BABY ’ S OPPORTUNITY AT THE BREAST ? 51

SWADDLING Gift from patient 52

PACIFIER © Kay Hoover 53

SWINGS AND “PUT THE BABY DOWN” THINGS 54

SCHEDULED FEEDINGS 55

U NDERMINING MOM ’ S CONFIDENCE CAN SLOW THE MILK SUPPLY You mean he isn’t sleeping through the night yet??? So she tries to make that happen 56

SLEEP TRAINING 57

LOS DOS COSAS © Kay Hoover 58

BAD ADVICE © 2009 Geddes Productions, LLC licensed from The Baby’s Perspective 59

DA TAH DA DAH….. HERE COMES LLLI AND WIC!! © H Quimby 60

THIS IS WHAT YOU DO BEST !!! 61

A HH ….. B UT THERE IS ONE MORE THING TO CONSIDER 62

I T COULD BE THE ABSORPTION Infants with undetected cystic fibrosis Infants with myotonic dystrophy Infants with metabolic disorders 63

A NY QUESTIONS ?? 64