There are always challenges in Breastfeeding. Because there are always challenges in parenting. But do we give up?? NO!! (well, sometimes) There are some phases that are typical, though. And I have been kind enough to walk you through them. General rule of thumb for children of any age: When they are going through a growth spurt, they will eat more, sleep less, and be generally disagreeable. Be patient. They don't know what's going on, either. The 4 Month HumpWe commonly see a sharp drop in breastfeeding around 4 months of age. There are quite a few different things that we believe contribute to this, and thought I would take a moment to address some of them.
Hormonal Around this time, many women start going back on hormonal birth control, if they haven't already. The estrogen based hormones in some birth control can interfere with your body's ability to produce milk. For more information on this, and to see which types of BC are better for BF moms, check out this link: http://www.kellymom.com/health/meds/birthcontrol.html Teething / Growth Spurt Around this age, babies also start showing signs and symptoms of teething, as well as going through a fairly large growth spurt. For this reason, their feeding habits, sleeping habits, and behaviors often change. They might want to nurse constantly, cry all the time, spit up more, and have disrupted sleep. They may "act angry" at the breast, making moms think that their milk supply is dropping. If the teething and growth spurt are truly the only things going on right now, then the opposite is true. Baby knows that he/she is growing, and going to need more food, so they will nurse more to create more milk. Babies can increase your milk supply in about 24 hours to what they need it to be for those growth spurts. The same is true for growth spurts at any age. If it is teething, here is a very helpful link on teething symptoms and remedies: http://www.kellymom.com/babyconcerns/teething.html Early Introduction of Solids / Baby getting bottle Introducing solids before 6 months is not recommended by the AAP, as baby's digestional tract is not quite matured enough for anything besides breastmilk. Many doctors are of the old school beliefs that babies need to start rice cereal at 4 months. This is a slightly controversial subject, but according to Nancy Mohrbacher in Breastfeeding Made Simple: "Research found that this practice (introducing solids @ 4 months) is associated with an increased risk of atopic disease and other health problems." And that "in 1997 the AAP Section on Breastfeeding issued is revised policy statement, recommended dealying solids until 6 months of age." (And in case you were wondering, rice cereal is a solid.) She goes on, "In 2001 the WHO published a report by its expert panel, which reviewed over 3,000 studies and concluded that starting solids before 6 months had health drawbacks for both mothers and babies: -Babies are at a greater risk of gastrointestinal infections and diarrhea in both developed and developing contries. -Mothers lose less weight and return to fertility sooner. There was also some evidence that babies who are not exclusively BF for 6 months are at an increased risk for delayed motor development. The WHO expert panel agreed that in most cases exclusive breastfeeding for 6 months results in normal growth and that the benefits of waiting until 6 months to start solid foods outweighed the risks." There is a lot more information out there about the introduction of solids, which will probably end up in another post. But you may ask "What does that have to do with my milk supply?" Well, I'll tell you. It all goes back to those early days of nursing, and the perils of "Negotiated nursings" and "contract feedings". The Womanly Art of Breastfeeding puts it like this: "The underlying reasons are often negotiated nursings ("You'll have to persuade me that you really need to nurse") and contract nursings ("the clock says it isn't time yet") - both recipes for a faltering milk supply or premature weaning. If you want to nurse your baby according to a schedule (if it's 2:00 then we nurse), it's like nursing by contract. If your baby has to convince you, maybe by workig up to full-blown crying, that she really does want to nurse, she's having to negotiate her nursings. It's like she's saying, "If I cry, will you let me?" Neither one is very much fun for either of you....and both are hazardous to breastfeeding. Imagine that you have to have lunch at your workplace cafeteria every day. But when you step up to the counter, you're always quizzed as to why you want to eat and why you want, say, a hamburger instaed of a veggie burger. You put up with it because the food is really good and it's the only place you can eat lunch. But then one day they expand the cafeteria and put in a second counter. At the other counter, you ask for food and you get all you want, with a smile, no questions asked. Which counter will you go to? It's the same for a baby who's always been asked why he wants to nurse. "You can't be hungry yet; it's only been an hour and half," or "You're probably just tired. Let me rock you to sleep," or "Not now. Here's a pacifier." Then one day he starts getting a bottle to hold onto, or a spoonful of solids that he's encouraged to eat, even praised for eating. Now he feels as if he and his mother on the same side. Nursing - and the milk supply that goes with them - start to fade away until it's just easier to give the bottle or offer the crackers than it is to fight about nursing. If you feel you're losing your nursing relationship to negotiations and contracts, it's not too late. Make nursing fun and spontaneous again: nurse in the bathtub, take naps together, offer to nurse for no reason at all, make it silly, play with his toes and hands. It can take some time and patience to conince your baby that the rules are gone, but many mothers have turned a faltering nursing relationship into something they enjoy for many months or years to come. Make yours the lunch counter with the welcoming smile." Hopefully this will help you identify some of the reasons why you may experience some difficulties around 4 or 6 months of age. Know that your milk supply was well established by 6 weeks, and short of baby stopping nursing, or skipping feedings, or taking medication (such as hormonal BC), it won't suddenly "disappear". As long as baby is nursing actively, you will have milk. The baby makes the milk by nursing. Your body, in healthy BF relationships, will continue to make milk as long as baby wants it. Only about 1% of mothers have an actual medical reason for their bodies not manufacturing milk. The rest who have production issues are a result of outside factors. Again, milk supply is another larger question that will warrent it's own post. But hopefully, by the end of this, you will have some ideas about why your 4 month old is acting differently, and you can be confident that they are growing, and just help them work through those difficult spurts. And pat yourself on the back, Mama; you are doing a great job!
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