1. 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 frantz@usc.edu 1

2. 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

3. 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

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

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

6. 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

7. 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

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

9. 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

10. 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

11. 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

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

13. S URGERY R EDUCTION MAMMOPLASTY Gift from T Fuller 13

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

15. 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

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

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

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

19. THE BABY NEEDS TO SUCKLE WELL 19

20. HOW CAN WE DETERMINE THAT? © Kittie Frantz 20

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

22. THE ANTISIPATORY PHASE © Kittie Frantz 22

23. THE INNER LIP STIMULUS © Kittie Frantz 23

24. THE DIGITAL FEEL © Kittie Frantz 24

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

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

27. YOU CAN OBSERVE THE BREASTFEED © Kittie Frantz 27

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

29. LIPS FLANGED? © Kittie Frantz 29

30. CHEEKS ROUND? 30

31. DRAWS IN BREAST SKIN? © Debi Bocar 31

32. FEEL TONGUE UNDER CHIN? Gift from patient 32

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

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

35. ALL THROUGH EVERY FEEDING? 35

36. ANY SORE NIPPLES? Gift from patient 36

37. ANY ENGORGEMENT? © Kittie Frantz 37

38. 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 36 - 37 week late pre-term infant? 38

39. 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

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

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

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

43. THE O PPORTUNITY ? UNICEF 43

44. 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

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

46. IF SHE KEPT A LOG, REVIEW IT 46

47. HOW LONG SHOULD BABY BE AT THE BREAST? 47

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

49. W HAT HE GOT DEPENDS ON HOW WELL HE SUCKLES 49

50. 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

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

52. SWADDLING Gift from patient 52

53. PACIFIER © Kay Hoover 53

54. SWINGS AND “PUT THE BABY DOWN” THINGS 54

55. SCHEDULED FEEDINGS 55

56. 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

57. SLEEP TRAINING 57

58. LOS DOS COSAS © Kay Hoover 58

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

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

61. THIS IS WHAT YOU DO BEST !!! 61

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

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

64. A NY QUESTIONS ?? 64