Tuesday, January 29, 2013

Photographs and Memories

I watched video on YouTube recently that asked the question, "How many photographs have been taken?" (The first few minutes are about photos. After that, he goes on to other topics, also interesting, but less pertinent to this article.) The answer was staggering. He reports that there are an estimated 3.5 trillion pictures taken since the invention of the photograph almost 200 years ago. Even more incredible, an estimated 4 billion of those photos were taken in 2012 alone, and 10% of all photos still in existence today were taken last year. And, finally, the statistic that made the biggest impression on me? Approximately 20% of all photos taken today end up on Facebook. Cat memes, anyone?

The reason we take so many more pictures these days than in the past is obvious: digital cameras are easy to use, inexpensive, and we can take as many pictures as we want. In the days of plain old film cameras, we had to ration our picture-taking so as not to waste film or spend money developing poorly focused pictures of a cat's tail or mom's torso. Now? Just point and shoot, point and shoot.

Having relatively high quality cameras on our phones makes picture-taking even more ubiquitous. Though we may not always carry a separate camera with us, most of us always have our cell phone nearby. I know I do. In fact, I don't even have a working camera right now aside from my phone, and without it, I probably wouldn't take many pictures at all. Case in point: Not long after S was born, our digital camera broke. There is a three-month period when S was a baby in which I took no pictures. Then, when we got camera phones, I started taking pictures regularly again. And it's a good thing, too, or I wouldn't have many pictures of baby S, or toddler N, or baby G, or toddler G, or our vacations, or the new cars we bought, or our new house, or the interesting dinner I made, or the pretty brownies with the raspberries on top, or the way G puts his head on the cat, or the first day of school, or... or... well, you get the picture. To put in terms of numbers, the phone I had from February of 2011 until December of 2012 (22 months) had over 1700 pictures on it by the time I retired it in favor of my new phone, with a better camera. That phone, after two months, has 265 pictures on it. Click, click, click.

There's this urge to capture every moment, especially when you have kids. Before kids, we took pictures of our cats, vacations, and the occasional event. Now? Every day is something new. The baby sits up for the first time. The toddler chooses his own crazy outfit. The kindergartner writes his first sentence. Or, sometimes, it's just, "Aren't my kids so amazingly cute?" or "What a sweet smile!" With film cameras, it wasn't always possible to take a picture of every moment that passed, but we could, at least, capture some of the best ones. With camera phones, every moment becomes a "Kodak moment," an opportunity to create a lasting memory for all the world to share.

One Sunday a few weeks ago, we took the kids to the park. It was cold and rainy, but it was also sunny. It was very peculiar weather, and it led to a perfect rainbow arching across the field. My husband captured the most beautiful picture of our two older boys standing together, holding hands, admiring the rainbow.

I'm in awe of the beauty of this picture, the fact that my husband could simply pull out his phone and preserve such a touching moment. How many moments like this were missed in the days before we all had a camera in our pockets?

But when we can snap a picture any time, preserve every moment, do we end up in picture overload? I find sometimes that I scroll right on past friends' vacation albums on Facebook, bored with the idea of looking at yet another several dozen pictures. Of course I'm interested in your African safari or trip to Israel, but I've just looked at three baby albums and 20 pictures of someone else's cats and dogs. I'm out of picture-looking stamina. And when it comes to our own kids, how many memories are lost because we took a picture? How many little events that could have been just ours go out for public consumption and lose that specialness of a precious moment shared just between the two of you?

I was sitting with G on my bed the other night, watching him play with a toy keyboard. He quickly worked out how to turn it on and off, how to make it play a song, and how to bang along on the keys to add to the music. He had this adorable expression on his face, poking at each button with such purpose and smiling with delight when music would play. He found which button made the music stop and pressed it, watching intently as the flashing lights ceased and the music stopped playing, then proudly pressed another button to make the music start again. It was so entertaining to watch him, to see his expression change as he made his discoveries and tested them, the little scientist. My instinct was to grab my phone, sitting on the table beside the bed, and try to capture the look of pride, the sweet smile, the grin of triumph. But then... I didn't. Instead, I just watched him, enjoyed the experience, relaxed. Sometimes the camera can be intrusive, distracting from exactly that which you were trying to photograph, changing the mood, the dynamic.

Now I have only my own memory, complete with how I felt, my impressions of each twinkle of his eye, each quirk of his lips. No photo would completely preserve the entirety of the few minutes he spent exploring that keyboard. No picture could perfectly reproduce the quiet enjoyment of simply watching him as he played. My memories may fade. I may not recall forever those few minutes spent with my toddler son. But for now, it's a private memory, all my own, a time I shared with him and only him. I think there's value in that.

I still take plenty of pictures. I want a record of my kids' childhood. I want picture-perfect reproductions of N's hair when he was 2.5, of S's big brown eyes, of how they've changed as they've grown. 

But I don't need every minute. I don't need every smile, every funny outfit, every new discovery on film (or disk). Sometimes, I just want the image I have in my mind, the pleasure of the retelling, and the integrity of seeing my baby without a lens between us.

Thursday, January 24, 2013

Lockdown at the Elementary School

On Wednesdays, my first-grader gets out of school at 1:05. Yesterday, I showed up at the school around 1:00 and was puzzled to see several police cars, lights flashing, parked around school grounds. I was just in time to overhear an announcement on the loudspeaker, "Students who usually walk home will be permitted to walk home as usual," or something to that effect. "Why wouldn't they be?" I said to myself. Obviously, something was Not Right at the school, but I had no idea what was going on.

I loitered by the front gate for a few minutes with my younger sons in the double stroller, trying to eavesdrop on what other parents were saying while we waited for them to open the gates and let us in. Normally, they open the gates a minute or two before the bell rings, and we can scatter off in all directions to go to our kids' classrooms and meet them there. A picture began to form, that there was a lockdown going on that was just being lifted as school was ending. A lockdown? Why?

I was more confused than upset, trying to piece together information from whatever I could overhear. Why hadn't anyone told me what was going on? If there was some danger at the school, shouldn't they have called the parents to let us know what was happening, sent an email, something? Did I need to do anything different or special in light of this development? Why was there a lockdown to begin with? How nervous did I need to be?

Finally, the principal came out through the front gate and told us that they were not going to be opening the gates. Instead, the children who usually came to the front gate on their own would be released one-by-one to their parents. If our child did not normally meet us at the front gate, we were to go to the back gate to pick them up. The back gate is the typical pick-up site where students are escorted to meet their parents if the parent doesn't come to their classroom.

Armed with these instructions, I plodded with my double stroller to the back gate, where my son was already waiting for me. It wasn't unusual, in and of itself, for him to meet me at the back gate - I have to catch him there if I don't make it to the school in time to meet him at his classroom - and he didn't seem agitated or frightened.

"Did you have a lockdown today?" I asked, hoping someone, even if it was my six-year-old, could finally tell me what was going on.

"Yeah. It was the longest lockdown ever!" he said. I would have laughed at the tone if I hadn't been so bewildered and on the verge of worry. "It was like two hours!"

"Two hours?" I said. "Wow."

"Yeah. Well, we were under our desks for like 20 minutes, and then they said we could move around the classroom, but we couldn't go between the buildings," he said.

I wondered if he was exaggerating the time. To him, the lockdown was little more than a boring inconvenience, a disruption to the usual school day, and not something to be worried about.

"And then," he continued, "they made an announcement that you could go back to your classroom if you weren't with your class."

"So some kids got caught in different rooms?" I asked.

"Yeah. You're supposed to go to the nearest classroom if you're outside. But everyone was in our class. It must have been a practice lockdown, not a real one, because they wouldn't have let us move around the classrooms if it was a real one!"

Ah. He didn't know it was a real one. The presence of police, the nervousness of staff and other parents, the change in pick-up rules all spoke to the reality of the situation, but my innocent son was able to retain his innocence still. He thought it was practice.

While waiting for the walk signal on the corner, another mother asked my son if he was scared. "He says it was just practice," I said, making eye contact and emphasizing that so she wouldn't say otherwise. There was no reason to scare him, since everything had apparently worked out fine.

"Oh, just practice. That's good that you're not scared," she said, understanding.

"I don't even know what happened," I said over my kids' heads.

"Oh, you don't know? They got a phone threat!" she said quietly.



When we got home, I had a recorded message from the school, time-stamped 1:15 p.m., on my home phone, explaining that the school had received a phone call around noon from an unidentified caller saying that something spectacular was going to happen in the next five or 10 minutes near the school. No one knew what it meant, so to be safe they went on lockdown and called the police. Nothing happened, apparently, and they didn't have further information, so they lifted the lockdown and sent the kids home at the usual time.

I was bothered by not having any idea what had happened until it was over. Now I'm worried that being so out of the loop means that if something did happen, I wouldn't have a clue! I think I was just unlucky to be near the end of the automated phone call list, so I didn't get the call until after school let out, but this suggests to me that we need a faster way to get the message out. Perhaps classroom phone trees?

When I picked up my son today from school, another parent told me that they finally had the full story. It seems it was a parent who had called to tell the school that a blimp was going to fly overhead, and he thought the kids might like to see it. Unfortunately, he got cut off before he could finish, and his wording caused school officials to think it was a threat.

The mother who told me this gave me her phone number and said that if she ever hears anything, she'll be sure to call me. I thanked her. It's scary to be out of the loop like that. I often wonder why everyone seems to know about things but me, and it's not a position I want to be in anymore.

On the one hand, I'm pleased with the school officials' quick response to a perceived threat, and that the students were responsive and handled the lockdown with aplomb. My son's teacher said the kids were fantastic, followed directions, and knew what to do.

On the other hand, it's pretty terrifying to show up at your child's school and see it surrounded by police cars. Ignorance, in this case, was not bliss.

Monday, January 21, 2013

Car Seat Rule #4: When and How to Forward-Face

This is the fourth in my Car Seat Rules series, in which I focus on one aspect of car seat use in a small, digestible article.

See other Car Seat Rules articles here:
Rule #1, on the Chest Clip
Rule #2, on Rear-Facing
Rule #3, on Newborns

*The advice given in the Car Seat Rules articles is not a substitute for having your seats checked by a car seat professional (CPST) or for reading the manual that came with your car seat.

I spend a lot of time trying to convince you to keep your baby rear-facing as long as possible, but at some point, your child will outgrow the rear-facing specifications of his convertible car seat, or you'll reach a point where you just have to turn him around for some other reason. Many, many car seats on the market now allow children to remain rear-facing up to 40 or 45 pounds. Many children don't reach that weight until four or five years old! Your child has outgrown his rear-facing car seat when: Your child has reached the weight limit for rear-facing (outgrown by weight) OR the top of your child's head is within 1" (one inch) of the top of the car seat (outgrown by height). (Note that "feet touching the back of the vehicle seat" is not one of the criteria.)

When it's finally time to turn your car seat around, you'll need to know how to properly install the seat and secure your child in the forward-facing position. Once you've turned your child forward-facing, it is best to continue using a five-point harness until he outgrows the front-facing specifications for his convertible car seat. Many, many car seats on the market allow a child to remain in a five-point harness until 65 pounds. To get an idea of how big that is, my six-year-old isn't 65 pounds yet, and he's quite big for his age. Some go as high as 85 pounds.

Your child has outgrown the forward facing limits of his car seat when: Your child has reached the upper weight limit of his five-point harness (outgrown by weight) OR his shoulders are above the highest shoulder strap slot (outgrown by shoulder height) OR his ears are above the top of the car seat (outgrown by height).

Most of the same rules apply otherwise for front-facing that I've gone over for rear-facing. The main difference is that when adjusting the harness straps, you need to use a slot that is AT or ABOVE your child's shoulders (not below). If you use a slot below your child's shoulders, he will not be properly restrained and even may be able to wiggle out of the straps.

Buckling your child in a five-point harness, front-facing:
  1. Place your child (or have him climb) into the seat. Make sure his bottom is all the way to the back of the seat and that he's sitting up straight.
  2. Pull the harness straps over his shoulders and pull the crotch strap up between his legs.
  3. Fasten the buckles.
  4. Fasten the chest clip.
  5. Tighten the harness. Tug on the shoulder straps to pull out any slack around the hips and then tighten the straps more if needed. Do the "pinch test" to make sure the straps are tight enough: Try to pinch the harness webbing between your thumb and forefinger at the child's collarbone. If you can't maintain a fold in the strap, it is tight enough.
  6. Align the chest clip with the child's nipples or armpits.
Check out this video of my middle son being buckled into his five-point harness.

  Installing your convertible car seat front-facing:
  1. Before placing the seat in the car, check your manual for whether the car seat can be reclined while forward facing. Put the car seat in an upright or allowable recline position before installing.
  2. Have your child sit in the car seat before installing it in your car. Identify the shoulder strap slot that is closest to, but still above your child's shoulders. Re-thread (if necessary) the harness straps. (See your manual for instructions.) Remember that as your child grows, you will need to periodically readjust the harness height. (Some car seats have harnesses that are adjustable "on the fly," meaning you don't have to take the seat out of your car to adjust them. If you have one like this, you can skip this step.)
  3. Locate the belt path that should be used for a front-facing installation. It should be clearly marked on the seat itself. (Usually, there are arrows pointing to the slots with the words "forward-facing belt path" or similar language.) If you're installing using LATCH, feed the latch straps through this path. Make sure they're not twisted. If you're installing with the seat belt of the car, stow the LATCH straps appropriately. (Note that you can install a car seat equally safely using either LATCH or the vehicle seat belt, but NOT BOTH together.)
  4. Place the seat in the car so that the child will be facing the FRONT of the car.
  5. Locate and extend the top tether strap from the back of the seat. Loosen it as much as necessary until you can hook it into the top tether connector on your vehicle seat. This may be located just behind the head rest of the vehicle seat, somewhere on the back of the seat in an SUV or minivan, or sometimes in the ceiling of the car. There should be a tether hook for each rear seat in the vehicle where it is permissible to install a car seat; use the hook associated with the vehicle seat you are using. If there is no top tether hook for the seat you were planning to use, you must install the car seat in a different location. (Note that your front-facing car seat is not properly installed if you do not connect the top tether!)
  6. If using LATCH, snap the LATCH connectors into the LATCH hooks in your vehicle. OR If using the vehicle seat belt, feed the belt through the front-facing belt path. Make sure the belt is not twisted. Buckle the seat belt. Then, loosen the seat belt ALL THE WAY until it locks and then allow it to retract. On an older vehicle, the seat belt may not automatically lock when pulled out all the way. In this case, you'll need to use a seat belt locking clip.
  7. Climb into the seat and lean in with your knee to squish down the vehicle seat. Tighten the LATCH straps as much as you can by hand. (Do not use any aftermarket mechanical tighteners.) OR tug on the seat belt so it will retract as far as possible. Tighten the top tether strap as much as you can.
  8. Standing on the floor of the car or outside the car, grasp the car seat with your stronger hand right at the belt path and attempt to wiggle it. If it shifts more than 1" (one inch) side to side or front to back, the LATCH or seat belt is not tight enough. Lean into the seat again and try to tighten it further.
Other tips:
  • Older children may want to buckle themselves. If they're physically capable, I encourage you to allow them to do so, but always check to make sure the harness is tight enough and that the chest clip is properly positioned.
  • Some children play with the chest clip, try to wiggle out of the straps, etc. This is a discipline issue, and it needs to be handled in the same way you would handle other undesirable behaviors. You can try positive reinforcement (every time you complete a car ride without them messing with the clip or the harness, they get a prize or something), consequences (if you have to stop to fix the straps, they lose a privilege), or some combination. I have also found it very helpful to talk to my kids about the importance of being in the car seat, how it helps keep them safe, and they take pride in knowing how to be properly buckled in. They will even fix their own chest clip if they are buckled incorrectly.
  • Do not dress your child in heavy winter clothing or extra layers when they are in their car seats. Puffy coats will interfere with properly positioning and tightening the harness. It is recommended to remove bulky clothing just prior to buckling the seat, then put the coat or blanket over the child after he is harnessed.
  • Some kids will not be happy about still being in a car seat when some of their friends have "graduated" to a booster. As above, you can talk about the importance of being safe in the car. I'd say that this falls under the "if all your friends jumped off a cliff..." category of parenting. Just because their friends' parents let them sit in a booster doesn't mean you have to allow your child to be less safe in the car.
  • Nothing should go between the car seat and the vehicle seat. Unless your car seat manual specifically states that you may place a towel, blanket, or car seat mat under your car seat, then you should not do so. Anything between the car seat and the vehicle seat may prevent you from properly tightening the LATCH straps or seat belt. If you're not sure, you can contact the manufacturer and ask.
  • If it didn't come in the box with the car seat, you shouldn't use it with the car seat. This includes shoulder strap padding (most car seats come with these anyway, but if yours didn't, don't buy them from somewhere else), head or neck support pillows, toys, etc. Nothing should go between the child and the car seat except the clothing the child is wearing, and nothing should be attached to or interfere with the harness straps.
Your child is ready for a booster seat when...
  1. He has reached the minimum weight AND height limits by state law (minimum is usually 4 years AND 40 pounds) AND
  2. The seat belt fits him properly across his shoulder (not neck), breastbone, and upper thighs (not stomach) AND
  3. He can remain seated upright through the whole car trip and does not lean or slouch (if he is not seated properly, the seat belt will not restrain him properly) AND
  4. You trust that he will not unbuckle his seat belt in the middle of a car ride.
Please remember that an ill-fitting seat belt can do more harm than good. If your child is too small to be using a seat belt (even with a booster seat), in a crash the seat belt can cause internal injuries that would be avoided by using a five-point harness instead.

Wednesday, January 16, 2013

Sleep: 16 Month Update

I've said it before and I'll say it again: There's something about 16 months. I was able to make major changes in both N's and S's sleep habits when they were 16 months, and now I've changed G's sleep situation at 16 months, and it's gone amazingly smoothly so far.

We finally purchased bunk beds for N and S, which made room for G to have his own bed in their room. My plan was to introduce his bed (S's old bed) as a new nursing and sleeping place and start to eliminate my bed as a place that he would expect to sleep. I had thought this would be a slow process, but I was surprised at how agreeable G was. I'm telling you: 16 months.

Let me give you a little timeline.

Around five or six months of age, I had started introducing a blankie. I always had it on hand when we'd nurse in bed. He'd play with it, fidget with it, stroke it while he nursed, and he started to associate the blankies with nursing and sleep. Indeed, sometimes when he wanted to nurse, he would go get a blankie and bring it to me! This wasn't exactly what I was going for, but it certainly served one very useful purpose. It meant that wherever I wanted to nurse him to sleep, I but needed to have one or two of his blankies (there are several, actually) there so he'd know that's what was expected.

When we got the boys' new beds at the beginning of January, I left S's bed where it was, planning to slowly start having G nap there and working up to always sleeping there. I had to wait until we reasserted our regular routine, with N going to school all day, vacations being over and done with, and random day outings kept to a minimum. This way, I could be sure that we'd be home for G's nap. On Monday, with winter break over, I put a clean sheet on G's new bed and told him he was going to nap on his new bed! I made it sound very exciting. "Look, here's your new bed! Do you want to nurse here? You can nap here in your room now! Wow!" He giggled and saw that his blankies were on the bed and promptly climbed onto the bed and signed that he wanted to nurse. Okie doke.

I nursed him down for his nap, which went much more smoothly than I'd expected. I was worried that being in this new environment would be distracting for him and that he wouldn't buckle down and concentrate on nursing and falling asleep. Fortunately, he'd spent plenty of time in that room with us and was not overly excited about the new scenery. His nap was shorter than usual, a little under an hour, and when he woke up, he came to find me and definitely still seemed tired. Still, I counted it a success. I put him to bed in my bed as usual that night, but for some reason he had trouble falling asleep, and he didn't end up going to bed until 10:00, much later than usual. There were a lot of variables on Monday, so I'm not sure what happened to make bedtime so difficult. I don't think the new bed was related.

Tuesday, I again enforced a nap in his bed. Again, it went fairly smoothly, but he woke after about an hour and was clearly still tired. I ended up nursing him on my bed and letting him sleep for a while there. He was very tired because he'd been up so late the night before, so needing a longer nap was reasonable.

Tuesday night, he wouldn't fall asleep in my bed before I put his brothers to bed, though that's how I normally handle bedtime. He wanted to join us in his brothers' room for books. He then lay down in his bed, gathered his blankies around him, and asked to nurse. I nursed him to sleep in his bed, and he slept there for four hours straight before waking around midnight to nurse. I trudged from my room to his to nurse him in his bed (the reason for putting him straight into a twin!). He woke three times that night to nurse, around midnight, 3:00, and 5:00 (I think), but spent the entire night in his bed and went back to sleep reasonably easily after each nursing session.

Wednesday, he napped well in his bed, wanted to sleep for the night there, and again woke three times, although this time it was around midnight, 4:00, and 5:00. I'm amazed that he's slept in four-hour blocks at all, as that isn't typical (I don't think). I think part of it is not having me nearby - he doesn't feel me shifting next to him, he doesn't smell me there, so he doesn't instantly wake to nurse. Also, since I don't hear every move or snuffle and immediately offer him the breast, he settles himself down more often. When he does wake, he yells for me.

After that, we went downhill a bit and started waking more often and not settling as quickly, but he's still spent the whole night in his bed each night so far, so I'm going to stick with it. It's certainly harder to get up and walk down the hall, doze lightly while he nurses, then get back up and trudge back to my room when I'm sure he's done than it was to simply roll over and let him nurse, but there are distinct advantages. First of all, if he's sleeping in longer blocks, that's good for both of us. (Time will tell if this remains the case.) Secondly, I'm able to sleep in much more comfortable positions in my own bed! Sunday night, I ended up spending most of the night in his bed because I kept falling asleep with him. Sleep deprivation + getting over the flu will do that to you.

I'm sure at some point, it will occur to him that he can get out of bed and come to me, and I don't know what will happen when he does. I anticipate a great deal of walking/carrying him back to bed.

Now that he has his own space, at some point I can start trying to teach him to fall asleep without nursing. That will probably be considerably more difficult than this first step has been so far. I'll let you all know when I start that process and how it goes, but I'm very encouraged by how easily he slipped into this new sleep routine.

What is it about 16 months?

Sunday, January 13, 2013

So You Want to Stop Nursing

There will come a time in your baby's life when you no longer want to breastfeed, or he no longer wants to breastfeed, or you come to some kind of mutual agreement that breastfeeding needs to stop. Or, sometimes, it's out of your hands and a medical condition requires you to stop breastfeeding. What do you do?

Well, some of it depends on the age of your baby. Unless there is a medical condition that requires prompt weaning, I personally would not recommend weaning before at least three months of age. I encourage and champion mothers to continue to nurse exclusively until at least six months, as per the AAP, WHO, and other health organizations' recommendations. I also encourage and champion mothers to continue to nurse in tandem with feeding other foods from six months to one year, and I also encourage and champion mothers to continue nursing beyond a year until they are ready to stop.

Alternatives to Total Weaning:

A few points to consider before you decide to wean completely, whatever your reasons:
  • Sometimes cutting back to just a couple of sessions a day can make nursing more enjoyable. If your baby is over a year and eats well, you can introduce whole milk and try to cut back to only nursing once or twice a day. (This is partial weaning, and some tips for doing this will follow.)
  • Just because a doctor prescribes a medication and says you can't nurse while on it doesn't mean that it's true. Doctors don't always know which medications are truly compatible or safe for breastfeeding, and they tend to err on the side of caution. If you need to take a particular medication, first find out if there is a breastfeeding-friendly alternative, or double-check if that medication is truly dangerous to your child or your milk supply. You can check Dr. Hale's Medications and Mothers' Milk or go to the Infant Risk Center's website and look up the medication, or give the Infant Risk Center a call at  (806)-352-2519.
  • While in the thick of it, nursing for six months or a year may seem insurmountable, but it's really a very short time in the scheme of things. It will get easier as you go along, and while you may never enjoy nursing, it should become less of a chore. Stick with it for just a little longer and see how you feel.
  • It's normal to sometimes feel overwhelmed by nursing, especially if you have a baby who nurses frequently. Set yourself small goals, like one more week or one more month or even just one more feeding. Often after a few days, that feeling will pass and you'll again be content to continue nursing. Sometimes life gets complicated and it seems like weaning would be an answer to the complications, but once things lighten up, nursing won't seem like such a burden.
Okay, but you really do want to cut back or stop. How?

First of all, no matter the age of your baby, I recommend taking it in gradual steps (if possible), rather than stopping cold turkey. If you're going from mostly breastmilk to mostly formula, it's going to be very hard on you and your baby to stop very suddenly. You will become very engorged and risk developing plugged ducts and mastitis. Your baby's system will be shocked by the change and he may become physically uncomfortable as well as emotionally upset. After about three days to a week, both of you will feel better, but I do not recommend cold-turkey weaning if it can be avoided, especially with a young baby.

Immediate Weaning of a Young Baby:

If you do have to stop immediately, here are a few ideas to ease the transition.
  • If the baby won't take a bottle from Mom, try to have other people around who can help feed the baby while you wean: Dad, a baby-sitter, grandparent, etc. Sometimes a baby won't take a bottle when Mom is around because the baby wants to nurse.
  • Make sure you still give baby lots of cuddles, hugs, kisses, and love. Sometimes having to wean suddenly, especially if you didn't want to, can make it hard to find ways to connect to the baby, and you want to make sure you maintain your closeness even when you can't offer the breast. 
  • Remember: Even if you can't nurse, you can still co-sleep, do skin-to-skin, wear your baby, and find other ways to support your baby physically and emotionally. 
  • You don't want to bind your breasts because that could cause plugged ducts and mastitis. 
  • Chances are, you will become engorged as soon as you've missed the first feeding or two. You may express a small amount of milk to relieve any immediate discomfort, but removing milk will encourage your body to make more, so be careful.
  • Other ways to help with the engorgement and dry up your milk:
    • Cold compresses will help slow blood flow (and milk production) and ease some of the pain. You may also take a pain reliever.
    • Cold cabbage leaves in your bra. Buy a head of cabbage and keep it in the fridge. Pull off a leaf and break the veins, then put it on your breast inside your bra. When it warms up, put a new one. Repeat as needed.
    • Avoid warm water directly on your breasts, as this will stimulate blood flow.
    • Try to avoid foods that encourage milk production, such as oatmeal and the spice called fenugreek often found in Indian food.
    • Some women find that herbs such as sage and mint reduce their supply.
    • As a last resort, medications such as pseudoephedrine (Sudafed) may reduce milk supply as well.
  • This may be a difficult time for you emotionally. Be sure to continue to care for your baby in other ways. Ask your family and friends to help you watch out for signs of depression.
Milk Donation:

If you as the mother are the one with the medical condition requiring weaning, there are ways to continue to provide breastmilk to your child if you want. There are several mother-to-mother milk donation sites that match up willing donors with mothers in need. These include Eats on Feets, Milkshare, and Human Milk 4 Human Babies. Typically, the agreement is that one or more women will pump for the baby and supply you with their milk, and you will cover the costs of any shipping (if the donor is not local) and for storage bags. This can be a great alternative to formula, or you can feed your baby a combination of donated milk and formula.

If your baby has a medical condition that requires you to wean from breastmilk but you are not certain you want to dry up your milk, you can continue to pump and save your milk to donate via one of the sites mentioned above, or you may be able to donate to a Human Milk Banking Association of North America milk bank (HMBANA), a nonprofit organization which provides donated breastmilk to preemies and other babies in need. Helping other babies via your breastmilk may help you come to terms with the emotional loss of having to stop nursing your own baby.

Gradual Weaning of a Younger Baby:

If you do not need to wean immediately for a medical reason, weaning can be a much more gradual process.

To gradually wean a very young baby (under three months), you may just have to offer a bottle of formula instead of nursing when your baby shows signs of hunger. Slowly give more bottles and nurse less often until you've found the balance you want. Keep in mind that you may not be able to maintain a partial supply if you wean before three months postpartum. Again, I do not recommend weaning such a young baby from the breast, as those first three months are vitally important to his development, the population of his gut flora, his brain and eye growth, his immune system, and his bond with you. However, if your health or your baby's health depend on your weaning from the breast, then it may not be difficult. Some babies will reject a bottle, and it may be a matter of basically forcing the issue (a baby won't let himself starve) or finding an alternative feeding method until he is ready to take a sippy cup instead. Also, sometimes a baby will prefer one bottle over another, so it may be worth trying a few different brands.

Gradual Weaning of an Infant:

For an infant, the ease of weaning will really depend on whether your baby is willing to take a bottle, and if he tolerates the flavor of formula. As above, it may be as straightforward as replacing a breastmilk feeding with a formula feeding. Remember that until six months of age, the only thing your baby should be eating is breastmilk or formula. If he takes a bottle but doesn't like the flavor of formula, you can try mixing expressed breastmilk with formula and gradually increasing the ratio of formula to breastmilk until he's completely on formula. You may also need to experiment with the temperature of the bottle. Some babies prefer a cold bottle, while others will only take it warm. Some don't have a preference. If he doesn't take a bottle, it may be difficult to introduce one. For a baby over six months, you may try to increase his solids intake or try mixing formula with his cereals or vegetables so he gets the nutrients he needs. You can also try offering formula in a sippy cup or straw cup, as some kids won't mind drinking from a vessel completely different from the breast even if they don't like the bottle. From six months to one year, gradually increasing solids and decreasing feedings from the breast may be all you need to do, and taking several months to completely wean will make it a very gradual and comfortable process.

Remember that until one year of age, breastmilk and/or formula should still make up the majority of your baby's diet, not solid foods. Also, do not introduce whole milk until one year of age.

If your baby relies on nursing to fall asleep or stay asleep, you'll have to take that into account when you decide to wean. You may need to have someone else put the baby to bed for a few nights so that you can break the association of nursing and sleep. I'm not saying it's going to be an easy process, but after three nights to a week, your baby should be used to falling asleep without nursing. It may take a few tries to find what new technique works best, but some ideas to try are rocking, shushing, singing, using a pacifier, putting white noise in the room, swaddling (for younger babies), and patting.

Weaning a Toddler:

For toddlers, weaning may be both more difficult and more simple. Since toddlers can get all the nutrition they need from solid foods and cow's (or other whole) milk, you won't need to worry about introducing a bottle or giving formula. However, toddlers also know how to ask for (demand) what they want, and they've learned to associate nursing with comfort, care, and closeness and may ask for it even when not hungry. However, toddlers also start to understand language, so it can help to talk to them about the weaning process (in an age-appropriate way). You can use phrases like, "No nursing right now. Do you want a snack?" or "You can nurse after ____ (we get home, you eat some peas, we read this book, whatever)," for example.

Many websites will suggest that, to wean, you eliminate one session per day and offer food or water instead. This is not so simple if you're nursing "on demand" still or do not have a predictable nursing schedule. Here are a few other suggestions I can offer for weaning a toddler. I suggest choosing one of the following techniques and sticking with it for a few days, rather than trying several at once or switching from one to another randomly. As with anything else with a toddler, consistency is key.
  1. Have a designated nursing area in your house. Only nurse there. It could be a special chair, the living room couch, your bed, his bed, etc, but be consistent. "You want to nurse? Okay, let's go to the nursing chair (or Mommy's bed, or whatever)." Sometimes a toddler will be too busy to actually want to go somewhere else and nurse. This can also discourage nursing when out and about (if you want to do that) because the "nursing place" won't be available.
  2. Make a rule about when you nurse that your toddler can understand. Only nurse at night or when the sun is up. Only nurse for sleeping. Only nurse after a meal. Only nurse when we get home from X. Whatever works for your routine.
  3. Rather than cutting back on the number of sessions, cut back on the duration. Start counting, or sing the ABC's or other song, or something that your toddler will understand the "end" of. Say that when you get to the end, or when you get to X number, that he has to stop nursing, and then make him stop. You can start out by not beginning the countdown until he's been nursing for a solid amount of time, and then gradually start the countdown earlier in the sessions once he's used to stopping at the end of it. 
  4. As a last resort, you can try purposely drying up your milk. This may not eliminate the comfort-nursing, at least not at first, but if there's no milk, nursing won't be as satisfying. Again, this would be a last resort. There are herbs (such as sage and mint) that can cause your milk supply to drop, as well as medications that may have a similar effect. This information may be more useful to dry up your milk after you've weaned.
Remember that as you wean, you'll need to replace nursing with something else. Nursing isn't just about food, it's also about comfort, closeness, love, reconnecting, and snuggles. You'll need to make sure he's getting his nutrition from other sources, but you'll also need to meet his emotional needs by allowing lots of cuddles, hugs and kisses, telling him that you love him, and reassurance. 

I want to reiterate that I'm not saying weaning will be easy. Indeed, weaning can be very difficult. Yes, some kids wean themselves. Some begin to prefer the bottle over the breast and simply don't want to nurse anymore. Some mothers find that their milk supply dwindles on its own (such as during pregnancy), which discourages their babies from nursing. Some toddlers are just too busy to stop and nurse. 

If your baby isn't one of those, then weaning will be a challenge. If you decide to say no, you have to stick with it. Your toddler may scream and cry. He may throw a tantrum (he's a toddler, after all). He may hit and kick and claw at you. This depends on your kid, of course, and how he handles being told no (and how attached to nursing he is). You may need to physically separate yourself until he calms down. You will need to find ways to handle the tantrums safely. You can treat nursing and weaning just like anything else you want your child to learn: manners, how to treat friends, sharing, picking up toys, not throwing food on the floor, cooperating during diaper changes. Be consistent and firm.

You may also find that once you have gained some control of the situation, nursing will become more tolerable or even enjoyable. When you're nursing on your terms instead of your toddler's, and you don't feel that your toddler is taking advantage of you, you may find that you don't need or want to wean completely. In this case, you may also want to try the "don't offer/don't refuse" method, whereby you don't ask your toddler if he wants to nurse, but if he asks, you consent. Over time, the child may simply ask less often as he becomes busier and more interested in the world. This is called "child-led weaning," as opposed to "mother-led weaning," and it is a method that works well for some women who are not in a hurry to wean but don't mind cutting back. It also depends on how attached your toddler is to nursing.

If you have weaned or partially weaned your baby or toddler and would like to share how it went for you, please comment with your story. If you have questions for those who have been through the weaning process, please post them in the comments as well. Weaning can be a touchy subject, but at some point, all kids stop nursing, so weaning is relevant and important to discuss.

Read my story about nursing and eventually weaning my middle son, S, here. I haven't started weaning G yet, but I have been known to tell him no or put him off for a bit, either by distracting him or by offering food. He's also used to mostly only nursing in bed, so that has helped keep him from asking to nurse 20 times a day.

Monday, January 7, 2013

The Yes, It's Normal! Guide update in the works!

For my next small project, I plan to update the "Yes, It's Normal!" Guide to Breastfeeding to a 3rd edition. Listed below are the questions addressed in the current version of the Guide. Are there any additional questions you'd like to see added to a new edition? What questions would you like to see answered in more detail? Keep in mind that the Guide is geared toward mothers and babies in the first three months postpartum.

What is the number one piece of advice you would give a new mother about breastfeeding?
How often should my baby be eating?
How do I know if baby is getting enough to eat/drink?
What is a “latch?” How do I know if my baby has a good latch?
Should breastfeeding hurt?
My nipples are bleeding. What do I do?
How much/how often should my baby be eating during the night? When will my baby sleep through the night?
I heard that giving a bottle of formula before bed, or adding rice cereal to the bottle, will help my baby sleep better and longer. Should I try this?
Do I need to give my baby water?
Do I have to switch sides during a feeding? How long should the baby stay on each breast?
What do I do if baby needs to eat while we’re out and about?
Should I give my baby a pacifier?
Should I give my baby a bottle? What do I put in the bottle?
My breasts leak constantly. What can I do about this?
My breasts have never leaked. Is something wrong?
My breasts suddenly don’t feel as full as they used to, and I’ve stopped leaking. What happened? Should I be worried?
I think I have a problem with my milk supply. What can I do to make more milk?
My baby’s bowel movements are loose and frequent. What should his poops look like?
My baby hasn’t had a bowel movement in several days. Help!
My baby is suddenly eating nonstop. What’s going on? Do I have enough milk for him?
My baby has been asleep most of the day, which is unusual. Should I be worried?
My baby is very fussy and nurses frequently for a few hours around the same time every day/night. What’s wrong?
Does what I eat get into the breastmilk? How do I know if something I’m eating is bothering the baby?
Can I drink alcohol while breastfeeding?
I have a sore spot on my breast. What could it be? What is a plugged duct? What do I do about a plugged duct?
What is mastitis? How do I know if I have mastitis? What do I do about mastitis?
What is thrush? How do I treat thrush?
Can I take medications while breastfeeding?

If you've read the Guide, I would really appreciate it if you'd leave me a review at the Amazon site (here) and/or as a comment on "The Guide" page of my blog (here). Also, don't forget to recommend it to friends! 

Thursday, January 3, 2013

So, Which is Easier, Breast-Feeding or Formula-Feeding?

All right! Now that vacations out of the way and I can get back to a more regular blogging schedule, let's talk about that breastfeeding survey! I asked you to fill out a short, 10-question survey about your own exposure to infant feeding and your feelings about which is easier. I was actually fairly surprised by the results, and I think you might be as well.

I received 26 responses, not including my own. If you'd like to respond and haven't yet, I'll leave the survey up for a little while longer. I can revisit it in a few months and see if a greater number of responses alters or reinforces my conclusions.

The first two questions asked whether, in your experience or observation, breastfeeding and formula feeding are "very difficult, difficult, manageable, or easy." The majority of you answered, for both questions, "manageable," which was surprising to me. The second most popular answer for both questions was "easy." Overall, it seems infant feeding in general, be it by breast or bottle, is not considered a great challenge. Many responders felt the need to clarify or justify their responses by adding comments that different variables may affect their feelings, such as whether they work outside the home (making breastfeeding more difficult), or by stating that even if they thought breastfeeding was difficult, it's still worth doing. Two responders who felt formula feeding was difficult commented that it was because of all the bottle-washing.

And what do I think? I think formula feeding is very easy, if you have a baby who tolerates regular formula. I also think breastfeeding is easy, but there is a greater learning curve. I also think breastfeeding is not easy for everyone, for various reasons ranging from a physical problem with creating enough milk, to emotional difficulties, to a baby with physical or medical problems. All-in-all, having done both, I am going to come out and admit that formula feeding is easier in many ways but that I prefer breastfeeding on the whole.

The third question asked if you know how to properly prepare formula. I asked this because I think most people think they know how, but they may not be aware of the official guidelines to prevent bacterial contamination. The majority of you say that you do know how to prepare a bottle of formula properly. Certainly, preparing a bottle is not rocket science, but I was curious to see how confident we all were about our bottle-preparing skills. For the record, I knew the basics (how to measure, how to sterilize/sanitize bottles and nipples, how to warm the bottle). Some health authorities recommend boiling the water prior to use and not allowing it to cool below 70 degrees Celsius before mixing it with the formula powder. It is important to note that powdered formula is not sterile and is not safe for use with very young babies or babies with immune system compromise. Ready-to-use formula is sterile (but also considerably more expensive).

To contrast this, I then asked whether you know what a proper latch should look like when breastfeeding. Most of you say you do know, which is encouraging. The important thing to remember about your baby's latch is that it should feel right. However, if you're looking from the outside, your baby's lips should be flared outwards. The nipple should fall far back in the baby's mouth, so that a good section of the areola is in the baby's mouth as well. Many lactation consultants will advise you to try for an "asymmetrical" latch, meaning that the baby's lower jaw is closer to your chest than his upper jaw. The baby's chin should not be tucked into his chest, and his ear, shoulder, and hips should be in a straight line - his body should not be twisted, and he should not have to turn his head or strain to reach the nipple.

It really got interesting after this. The next four questions asked you specifically about your exposure to formula and breastfeeding aside from your own baby (if you have one). While most of you had often seen babies being fed from bottles, only about a quarter of you had seen babies breastfeeding on a regular basis. Several of you had seen bottles being prepared, and a third of you had prepared bottles for other people's babies. I was not surprised to find that there was far more exposure to bottle feeding than breastfeeding. Certainly the bottle is a pervasive symbol of babies and baby care in the Western world, especially the United States.

Finally, I asked you to decide which is easier, breastfeeding or formula feeding. The majority of you said breastfeeding is easier. Many who said that formula feeding is easier felt the need, again, to modify their responses by adding a comment that they still believe breastfeeding is better, even if formula feeding is easier.

What's interesting to me is that there was a definite reluctance to classify breastfeeding as difficult. I assume most of the respondents are breastfeeding advocates, experienced breastfeeding mothers (or their partners), or favor breastfeeding over formula feeding with their own children. If we say that breastfeeding is not easy, we may increase reluctance in giving it a try, especially among those who are specifically wondering which is really easier. Those who said formula feeding is difficult generally mentioned bottle-washing as a major turn-off. Those who wanted to comment as to what they found difficult about breastfeeding tended to allude to the difficulties associated with pumping and being "tied" to your baby.

I think this reveals a few basic issues in the "breastfeeding versus formula feeding wars." (By the way, the majority of you were not aware of this issue before becoming pregnant with your own baby.) The first is that there is still not enough general exposure to breastfeeding in everyday life. We need to see more breastfeeding in public, on TV, within our own families. Because of the strong formula/bottle-feeding culture in the United States and other Western countries, many children grow up never seeing a baby breastfeeding. Reinforcing this is baby dolls with bottles, the bottle as a symbol of "baby" in baby shower decorations, congratulatory greeting cards, baby birth announcements, and so on.

The second is that there is a perception that in deciding which feeding method to use, it matters which is "easier." I've written a couple of posts on this topic (for example, here and here). Many aspects of child-rearing are neither easy nor fun, while others are incredibly rewarding. What's important is not whether one is "easier" than the other, but which one is more beneficial to mother and child.

So is breastfeeding easier than formula feeding? In all honesty, no. It isn't. But both have their challenges, and the question is whether breastfeeding is overall more beneficial to mother and baby than formula feeding. And to that, I can say unequivocally, YES, it is.