Lactose Intolerance

Lactose Intolerance and Breast Milk

Does Breast Milk Have Lactose?

All mammalian milks are unique and made specific for their species.  Human milk, too, is completely unique and distinct from all other mammalian milk.  It is the only milk to have more whey than casein (which gives it the “bluish” hue) and it has the highest concentration of lactose of all mammals.   Lactose is not only the principle carbohydrate in breast milk, it is essential for proper brain growth and development.  Having high levels of lactose is critical to grow a baby’s brain!

Can a Baby Have Primary Lactose Intolerance?

Babies produce an abundance of lactase – the enzyme that digests lactose.  Lactase is a brush border intestinal enzyme that begins to be produced at 24 weeks gestation and continues in abundance until 2 ½ – 7 years of age or more.1 While it is quite common to hear of older children and adults who are “lactose intolerant” it is incredibly rare for babies of any race to have primary lactose intolerance.  Primary lactose intolerance is so rare that most medical practitioners and lactation consultants will never see it in their entire lifetime. As we age, the body can begin to have an insufficient amount of lactase (the enzyme that digests lactose) which why it is common to hear of adults and even older children who are lactose intolerant.

What is Secondary Lactase Deficiency?

Secondary lactase deficiency is a symptom caused by another problem entirely.  It is possible for a baby to experience secondary lactase deficiency after using antibiotics, gastrointestinal illness, or mismanagement of infant feeding. 2 This is what is commonly referred to as “lactose intolerance.”

What are the Symptoms of Lactose Intolerance?

  • Fussiness
  • Colic
  • Excessive Gas
  • Bright green/irritating stools3

What Can I do if my Baby is Lactose Intolerant?

Unless your baby has primary lactose intolerance, which is so rare most medical practitioners will never see it during their lifetime, symptoms can be treated and breastfeeding can (and should) continue without any interruption.  Lactose intolerance is not an allergy to breast milk and not a contraindication for breastfeeding. When a baby is experiencing symptoms of lactose intolerance and breastfeeding, breast milk is not the problem and switching to formula is not the solution.

Many babies will experience lactose intolerance when the mother struggles with milk oversupply. Always drinking the lower-in-fat, higher-in-lactose foremilk can lead to a higher-than-normal load of lactose for the baby to digest. Treating the oversupply issues should resolve the lactose intolerance symptoms in baby.

When a baby has had to take a round of antibiotics or experienced any type of gastrointestinal illness, the brush border of the the gastrointestinal tract – which manufactures lactase – can be damaged.  Since lactase is the enzyme which digests lactose, a baby can experience temporary lactose intolerance while the gastrointestinal tract is healing.  Breast milk is the easiest food for a baby’s body to digest and it also has many immunoglobulins and healing properties.  Continuing to breastfeed will bring about the speediest recovery to your baby’s system.


Top 5 Reasons Breastfeeding Fails

Mother Bottle Feeding a BabyWhile breastfeeding initiation rates are on the rise in America (three out of every four women breastfeeding when their baby is born), only 22.3% of moms are exclusively breastfeeding their babies at six months of age. 1  Despite this the World Health Organization and American Academy of Pediatrics recommends exclusive breastfeeding for the first six months, citing significant detrimental health outcomes when babies are not exclusively breastfed.  More and more mothers want to breastfeed their babies.

So why are so many not meeting their breastfeeding goals?  Here is my list of the top 5 reasons breastfeeding fails for some women:

  1. Invasive Birth
    Birthing practices are strongly related to breastfeeding initiation and duration.  Natural childbirth does help to get breastfeeding off to a good start.  Stress is strongly linked with delayed milk onset. 2  Cesarean sections and instrumental vaginal births typically delay skin-to-skin initiation and the first breastfeed, both of which have a high impact on breastfeeding duration. 3  Pain medications given to the mother affect the baby causing drowsiness and disorganized suck. 4 Some of these pain medications continue to impact the newborn for up to a month after birth!
  2. Separation of mom and baby after birth
    The single most important thing to getting breastfeeding off to a successful start is skin-to-skin contact (SSC) immediately following birth.  All non-essential items (weighing, bathing, etc.) should be postponed for at least the first two hours following birth. SSC triggers a baby’s innate responses to seek the breast and nurse.  It has many benefits: regulation of mom and baby’s temperatures, stabilizing baby’s heart rate, lowering serum cortisol levels, stabilizing blood sugar, stimulating self-latching and coordinated suckling, increasing mom’s oxytocin levels, regulating adequate milk volume, promoting bonding, and heightening a mother’s confidence.  This time immediately following birth is precious, so postpone everything else and enjoy these sweet moments of cuddling and bonding with your new baby.
  3. Supplementation
    Whether a baby is supplemented with formula, water, herbal tea, glucose water, donor milk, or her milk is “fortified” all of these have an impact on the long-term breastfeeding relationship between mother and baby.  There are many reasons given for this:  mom needing sleep/recovery time, prevention of hypoglycemia or jaundice in baby, or because mom’s milk “hasn’t come in yet.”  (Though none of these reasons are good indications for supplementing breast milk.)  Actual research shows that supplemented babies are significantly less likely to be exclusively breastfed after hospital discharge, breastfeeding duration is shortened 4-fold, and moms remember which brand of formula was used and most will then use that brand because they see it as an endorsement by the medical establishment. 5
  4. Lack of support from friends, family, and/or doctor
    Family, friends, and the medical community strongly influence a mother’s decision to breastfeed.  Research shows that a mother’s impressions of breastfeeding are closely linked with those of her doctor. 6  If you are pregnant or nursing, it is so important to find a supportive environment of others who will help and encourage you when the going gets tough. . . a sleepless night, a fussy baby, pain, a poor latch, cracked nipples, or a myriad of other solvable problems that are so much easier to get through with someone by your side.  Without this support, when you are walking the road alone, the chances of not succeeding are much greater.
  5. Mom isn’t convinced of it
    Maternal determination is a huge factor in overcoming breastfeeding obstacles and helping mothers meet their breastfeeding goals.  Even in cases of emergency c-sections and other unplanned birthing interventions, premature births, multiples, etc. research shows over and over that maternal commitment goes a long way in overcoming strikes against mom or baby in breastfeeding and allowing the breastfeeding relationship to succeed. 7 Conversely, when a mother is not convinced she wants to breastfeed she will likely be much quicker to turn to formula when problems arise.

Breastfeeding and Vaccines

Maternal Vaccines

Are Maternal Vaccines Safe While Breastfeeding?

Mothers often wonder if breastfeeding is compatible with medications, how drugs affect breast milk, and how medications in milk affect a baby.  Vaccines are no different; before getting a vaccine most breastfeeding mothers want to ensure it will not negatively impact their milk or baby.  While many breastfeeding mothers will never be faced with needing a vaccine while breastfeeding, others (due to international travel, endemic illness, etc.) will need one or more.

The CDC states:

“Neither inactivated nor live vaccines administered to a lactating woman affect the safety of breast-feeding for mothers or infants.  Breast-feeding does not adversely affect immunization and is not a contraindication for any vaccine. . . . Although live vaccines multiply within the mother’s body, the majority have not been demonstrated to be excreted in human milk.  Although rubella vaccine virus might be excreted in human milk, the virus usually does not infect the infant.  If infection does occur, it is well-tolerated because the viruses are attenuated.  Inactivated, recombinant, subunit, polysaccharide, conjugate vaccines and toxoids pose no risk for mothers who are breast-feeding or for their infants.” 1

Vaccines WITH Precautions for Breastfeeding

  • Smallpox – contraindicated while breastfeeding

Vaccines Without Breastfeeding Precautions

  • Immune globulins, including Rh immune globulin (RhoGAM)
  • Diphtheria
  • Tetanus
  • Hepatitis A – CDC states that no safety research is available. While it is most likely safe, consider administering the immune globulin instead of the vaccine.
  • Hepatitis B
  • Influenza (inactivated whole virus or subunit)
  • Japanese Encephalitis – No data available regarding its safety during breastfeeding
  • Measles
  • Meningococcal Meningitis
  • Mumps
  • Pneumococcal – No data available regarding its safety during breastfeeding though it is unlikely to cause any concern in breastfed baby.
  • Polio, inactivated
  • Rabies – No data available regarding its safety during breastfeeding though it is commonly given to breastfeeding mothers without observed problems in baby.
  • Rubella
  • Tuberculosis (BCG) – No data available regarding its safety while breastfeeding.
  • Typhoid (Polysaccharide & Live bacterial) – No data available regarding its safety while breastfeeding, although CDC states it should be given in breastfeeding mothers when risk of exposure is high
  • Varicella
  • Yellow fever – Avoid administering to breastfeeding mothers unless travel to endemic areas is unavoidable. 2

What’s the Bottom Line?

While it is always best to not have to take any type of drug, medication, and/or vaccine while breastfeeding, all vaccines are considered safe if necessary with the exception of Smallpox.  There are many well-documented health consequences associated with formula, even for a short duration.  Therefore, when a vaccine is necessary in a breastfeeding mother it should not be a cause of breastfeeding concern or reason for supplementation and/or early weaning.

You may also be interested in reading about infant vaccines and breastfeeding.


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Colic

What is colic?

Colic seems to be a catch-all term for a baby who cries a lot and the reason is not known.  However, a true “colicky” baby is one who cries at least 3 hours a day, 3 days a week, for at least 3 weeks. 1  A baby with colic should not be mistaken for one who has fussy evenings. Taking care of a baby who cries all the time is very stressful and draining, especially on a breastfeeding mother!

What are the symptoms?

Colic seems to begin when a baby is just a couple weeks old.  A colicky baby usually cries in high-pitched screams, has his knees drawn up as if in pain, and sometimes has a swollen abdomen.  Feeding, holding, carrying, rocking, singing, talking, etc. don’t always stop the crying and it may seem nothing can comfort your baby.  The crying is many times worse late in the day.

What causes colic?

There are several things that commonly cause a baby to be labeled as colicky, though sometimes the cause is not known.

Are there treatment options for colic?

True colic does not have a known cause.  However, since reflux, food allergies, and oversupply are such common causes for colic symptoms, certain measures can be taken to try to help the situation.

  • Hold baby upright and close to you – a sling or wrap are great for this
  • Allow him free access to breastfeed whenever he wants – a sling is perfect for this as well
  • Walk and talk to your baby – don’t leave him laying down crying and don’t sit down with him in your arms crying.  Standing up and moving – even dancing – seem to have a more magical effect!
  • Try holding him tummy down on your forearm
  • Try to take care of his needs before he is so upset and screaming he is harder to calm
  • If you are breastfeeding, keep a detailed food log of everything you eat.  An intolerance or allergy is most likely to be to cow’s milk, though this protein can take several weeks to be completely removed from your milk once you eliminate it from your diet.  If you do eliminate dairy, make sure to eliminate it for at least 3 weeks.  Watch your baby closely and if colic does significantly improve this could be the cause.  After 3 weeks, you can try to reintroduce a small amount of hard cheese to your diet.  If this is tolerated well for a week, attempt soft cheese and/or cultured dairy such as yogurt.  Again, small amounts only!  If this is tolerated, you can then try adding in butter, ice cream, etc.  The last thing to add back in would be milk.

How long will colic last?

Though any length of time of caring for a baby who cries inconsolably is too long, colic usually goes away by the time a baby is four months.  The day in and day out until this point can be stressful, tedious, time consuming, and incredibly difficult but take heart that your tender love and nurturing are better than leaving your baby to be in pain alone.  Breastfeeding is much better than weaning when he is in pain and truly does want his mother’s love and touch.  And, though the days may be long, this period won’t last forever and then breastfeeding and caring for your baby should become much easier!


Here is the tongue after the procedure.

Tongue Tie

What is tongue tie?

The red arrow points to a posterior tongue-tie.

The red arrow points to a posterior tongue-tie.

The frenulum’s job is to anchor the tongue and stabilize its motions.  When this thin membrane, or frenulum, that attaches the tongue to the floor of the mouth is short, it is known as tongue tie (ankyloglossia).  The frenulum can be connected anywhere from the base of the tongue to its very tip.  It may look thin and stretchy or thick and fibrous.

Tongue-tie can be anterior or posterior.  An anterior tongue-tie can typically be easily seen or felt under the tongue – where the frenulum attaches to the tongue on one side and behind the lower gum on the other.  A posterior, or “hidden,” tongue-tie can be more difficult to diagnose if the person does not have experience.  Essentially, a posterior tongue-tie is a band of fibrous tissue on the bottom, underside of the tongue that, when released, will allow the tongue to extend to its full potential.  It is common for babies with posterior tongue ties to also have a lip tie.

These various attachments restrict normal tongue movement keeping the tongue from extending out over the lower gum, reaching the roof of the mouth, etc.  These tongue movements are essential for successful breastfeeding. Tongue tie is more common in boys than girls and it does tend to run in families.

Symptoms

Here is the tongue after the procedure.

Here is the tongue after the procedure.

There are many different symptoms of tongue tie.  You do not need to have all of these, or even a majority, for treatment.  Every case should be evaluated individually.  Some tongue ties that appear severe may not have much impact on breastfeeding; others may look very mild but the mom or baby or both may be struggling with breastfeeding.  Whenever there is a concern, don’t hesitate to seek the advice of a lactation consultant!

Symptoms in baby:

  • Shallow latch
  • Clicking
  • Unable to stay on breast; gradual sliding off breast
  • Cannot form suction
  • Falls asleep at breast before feeding
  • Longer breastfeeds
  • Crying/unsettled
  • Slow weight gain/weight loss
  • Irritability or colic
  • Gas or reflux
  • Chews or bites on nipple
  • Sucking blister on top lip
  • Fussy/arches away from breast
  • Breast refusal (if aspiration occurs!)
  • Unable to deal with a fast milk ejection
  • Ineffective milk transfer (not feeding effectively)
  • High palate
  • Spilling milk during feed
  • Coughing, choking, or gulping when feeding
  • Jaw quivering after or between feeds
  • Crying with tongue flat in mouth

Symptoms in Mother:

  • Painful nipples
  • Cracked/bleeding nipples
  • “Lipstick nipple” when baby unlatches
  • White stripe (compression line) at end of nipple
  • Low milk supply
  • Plugged ducts
  • Mastitis
  • Recurring thrush
  • Frustration, disappointment with breastfeeding
  • Untimely weaning

Why is it important for breastfeeding?

The tongue is the most complex muscle in the human body!  It has 8 layers and can move in multiple directions at the same time.  When the tongue is “tied” it cannot move freely and can, therefore, impact breastfeeding:  nipple pain, severe nipple damage, poor latch by baby, and/or inadequate milk being taken in by baby (which can lead to many significant problems such as low milk supply and failure to thrive).

In order to breastfeed effectively a baby must be able to grasp the breast, shape the breast to stabilize it in the mouth, and help create a vacuum that pulls milk out of the breast.  Five key tongue motions are required:

  1. Tongue Extension – Can baby extend his tongue over the lower gum line and maintain it for the duration of a breastfeed?  With tongue tie, tongue extension decreases as the mouth opens wider.
  2. Tongue Elevation – In order to create vacuum to withdraw milk, the front of the tongue needs to lift and touch the breast so that the back of the tongue can drop and a vacuum of negative pressure can be created to draw out milk.  Baby should be able to elevate tongue more than half-way to palate with mouth open wide.
  3. Tongue Grooving – The sides of the tongue need to be able to lift so that it can cup the underside of the breast.
  4. Tongue Lateralization – The tongue tip needs to be able to touch the sides of the mouth.
  5. Wavelike Sucking Motion – Allows the tongue to withdraw milk from the breast and swallow it without choking.

Does tongue tie affect anything in addition to breastfeeding?

Tongue tie can also affect starting solids (choking, gagging, etc.), speech impediments, dental malformations, indigestion, snoring, sleep apnea, and difficulty extending tongue for such things as licking ice cream or kissing.

Treatment

A frenotomy is a simple procedure that gives dramatic improvement to breastfeeding. 1  By clipping the frenulum, the tongue will immediately have more movement range, allowing the breastfeeding issues to be improved if not resolved.  Several randomized, controlled studies have shown division to be highly effective.  The procedure is quick and easy for a skilled technician and all that is needed is sterile scissors. Alternatively, some doctors may use a laser.  Young babies do not need anesthesia for the procedure and many times don’t feel a thing. 2  In fact, it is typically less traumatizing than an immunization!  It is important, however, to find a doctor who is skilled and familiar with both anterior and posterior tongue ties.

If you must wait for a frenotomy, or choose not to have this done, there are other measures that can help optimize a baby’s latch and possibly make the situation more manageable:

1.  Optimum positioning – gravity can help a baby to open as wide as he’s able so laid-back nursing positions tend to work better with tongue-tied babies.

2. Latch alterations – work with a lactation consultant to help baby latch to the best of his ability  One such alteration to try if baby slides to “nipple feeding”…dent breast at or just beyond the margin of the areola with one finger to form a firmed, billowed area of breast for baby to grasp = baby’s chin snuggled into hollow which helps prevent lower lip from sliding toward nipple as baby latches.

3. Finger feeding – Can be helpful when baby doesn’t maintain extended tongue and/or elevates posterior tongue too high.

4. Tongue exercises – Talk with a lactation consultant about exercises that may help in your situation.

5. Nipple Shield – When a baby is otherwise unable to latch AND only after a mother’s milk has come in…select the widest diameter nipple shield possible that still fits in baby’s mouth as a narrow nipple shield can be hard for baby to grasp.

6. Cranio-sacral therapy – the gentle manipulation of the head, neck, and back that can help relax tension and thereby tongue restriction.  This is particularly effective to do alongside tongue tie revision.

When should it be corrected?

If there are breastfeeding issues and your baby is diagnosed with tongue tie, the sooner you have it revised the better.  It is safe to do the procedure on a newborn and, the sooner it is performed, the less relearning the baby has to do at the breast.  Even if the baby is a few months old (or older) when a frenotomy is performed, improvement should immediately be seen.

Post-Procedure

After a frenotomy, it is good to work with your baby to help her learn (or relearn) how to breastfeed properly.  This may include shaping the breast and holding the teat in the baby’s mouth for the duration of the breastfeed for the first few days to two weeks (depending on how much relearning the baby needs).  Be proactive to ensure good positioning and latch so she will learn to use her tongue properly.  It is also a good idea to perform some simple exercises on your baby for the first two weeks to ensure it does not reattach.  Sweep around the inside of her bottom gum by pushing down on the floor of her mouth.  Then lift her tongue by placing your index finger next to the incision and push the tongue up and back so scar tissue does not form.  Do these several times a day for two weeks.

Additional Resources

 


JU29

Urine and Stool Output

Day
Urine Output
Stool Output
1st Day1 or more wet diapers1 or more meconium (black) stools
2nd Day2 or more wet diapers1 or more meconium / transitional stools
3rd Day3 or more wet diapersTransitional stools (brown)
4th - 7th Days6 - 8 wet diapersYellow stools (may be seedy, loose, or runny)
1 - 6 Weeks6 - 8 wet diapers3 - 5 yellow stools
6 Weeks - 6 Months6 - 7 wet diapers3 - 5 stools, may skip days

Adapted from Riordan, J. and Wambach, K. (2010) Breastfeeding and Human Lactation, 4th ed.  Jones and Bartlett Publishers, LLC . 272.


Krista Gray, IBCLC

Krista Gray, IBCLC – Lactation Services

Positioning and attachmentWhether you’re preparing to breastfeed or need support with your current situation, Krista Gray, IBCLC – Lactation Services is here to help.  I am a certified lactation consultant and offer face-to-face and online breastfeeding support (as well as prenatal breastfeeding classes) to assist you in meeting your breastfeeding goals.   I see clients throughout the Upstate of South Carolina and North East Georgia as well as via Skype and FaceTime worldwide.

Lactation Consultations

Initial Consultation – $135 for a 1 – 1 1/2 hour private consultation.  Sometimes you just need that bit of extra support to get breastfeeding off to a good start or to overcome challenges. I can help you reach your personal breastfeeding goals. This visit can take place in your home or my home office.  (Follow-up phone/text/emails for home or office consultations are always free!) Discount for clients who have a prenatal appointment with me.*

Follow Up Consultation – $75 For new concerns and follow up appointments*

Pump Consultation – $60 Heading back to work and want to make sure your pump is working properly? I can help get your pump set up, ensure the flanges are the right size, and share tips and information about maintaining your supply as you return to work.*

Virtual Consultation – $50 I offer virtual breastfeeding consultations worldwide via Skype or FaceTime. (Up to one hour consultation; Payment made via PayPal) 

Telephone/E-mail Consultation – $30 Do you have a specific breastfeeding question? I can discuss this with you on the telephone (up to 30 minute call) or through e-mail.

Monthly Retainer Option – $150 For those who would like me to be available for unlimited calls/texts/emails throughout the month.  There is no limit to how often you can contact me and, if I am not available at the time of a call/email/text I will always respond the same day.

*In home rate applies to homes within 15 miles of 29655 zip code.  Beyond that area, there will be a fuel surcharge and hourly travel fee, which will be quoted at time appointment is made.

*Payment can be made with cash, check, and PayPal.

*Payment is expected at the time services are rendered.  Nursing Nurture does not file insurance on your behalf, but will provide you with an itemized Super Bill for your health insurance provider.

What happens during a consultation? Find out more here.

Download the forms for your breastfeeding consultation.

Learn more about Krista Gray, IBCLC or contact Krista to schedule a lactation consultation. Continue reading »


Nursing while drinking coffee

Caffeine and Breastfeeding

Is it Safe to have Caffeine while Breastfeeding?

Breastfeeding and CaffeineYes, it is generally considered safe to consume caffeine while breastfeeding.  Though all babies are different and some may be more sensitive to the small amounts of caffeine that pass through breast milk, caffeine and breastfeeding are not contraindicated.

How Much Caffeine Passes into Breast Milk?

As a general rule, only about 1% of the maternal dose of any drug a nursing mother takes passes into her milk. But, most drugs are metabolized at a much slower rate in babies than in adults.  Caffeine is no exception.  Approximately 1% – 1.5% of the maternal dose is passed to a baby via breast milk.1 The half-life of caffeine is 97.5 hours in newborns, 14 hours in 3-5 month olds, 2.6 hours in 6+ month olds, and 5 hours in an adult.2  It takes 5 half lives to completely clear a drug from the system.  If you multiply the first-half life times five you will have an idea how long it takes to clear. So while very little caffeine that is ingested by a mother actually transfers to her baby, it can quickly accumulate.  It takes a newborn 487 hours (97.5 x 5) to completely clear caffeine from his system.  Though only a small amount may enter each day, it can quickly build up with such a long half-life. (Further information about drugs and breast milk can be found here.)

How is caffeine intake measured and what is too much?

Caffeine is measured in milligrams.  Peak levels of caffeine are found in breast milk between 1-2 hours after consumption.3  As caffeine leaves the maternal blood serum, it also decreases in breast milk.  Consumption of less than 300 mg/day is typically considered to be safe for a breastfeeding baby. 4 However, all babies are different and if you notice symptoms of sleep disturbance, decrease in your baby’s appetite, irritability, and/or hyperactivity it is possible your child is reacting to the caffeine in your breast milk.  Decreasing your caffeine intake, switching to decaffeinated drinks, and waiting for several hours to nurse after caffeine intake are all strategies than can reduce the amount of caffeine your baby is exposed to. Also, preterm or sick infants might be less able to metabolize caffeine and therefore impacted to a greater degree by small amounts of maternal consumption.

How Much Caffeine is in My Favorite Drink?

Caffeine Content of Various Drinks and Foods
CoffeeTea
DrinkServing SizeCaffeine (mg)DrinkServing SizeCaffeine (mg)
Starbucks Filter Coffee, Short8 oz160 mg Starbucks Hot Brewed Tea, ShortAllvaries
Starbucks Filter Coffee, Tall12 oz240 mgStarbucks Chai Tea Latte, Short8 oz50 mg
Starbucks Filter Coffee, Grande16 oz320 mgStarbucks Chai Tea Latte, Tall12 oz75 mg
Starbucks Caffe Latte, Short8 oz75 mgStarbucks Chai Tea Latte, Grande16 oz100 mg
Starbucks Caffe Latte, Tall12 oz150 mg
Starbucks Caffe Mocha, Short8 oz85 mg
Starbucks Caffe Mocha, Tall12 oz95 mg
Starbucks Americano, Short8 oz 75 mg
Starbucks Americano, Tall12 oz150 mg
Starbucks Cappucino, Short8 oz75 mg
Starbucks Cappucino, Tall12 oz75 mg
Starbucks Espresso, Solo75 mg
Starbucks Espresso, Doppio150 mg
Starbucks Macchiato, Solo75 mg
Starbucks Macchiato, Doppio150 mg
Starbucks Caffe Americano, Short8 oz75 mg
Starbucks Caffe Americano, Tall12 oz150 mg
Starbucks Caffe Americano, Grande16 oz225 mg
Starbucks Cappuccino, Short8 oz75 mg
Starbucks Cappuccino, Tall12 oz150 mg
Starbucks Cappuccino, Grande16 oz150 mg
Starbucks Caffe Misto, Short8 oz75 mg
Starbucks Caffe Misto, Tall12 oz115 mg
Starbucks Caffe Misto, Grande16 oz150 mg
Hot Drinks
Starbucks Hot Chocolate, Short8 oz10 mg
Starbucks Hot Chocolate,Tall12 oz15 mg
Starbucks Hot Chocolate,Grande16 oz20 mg
Starbucks Frappuccino, Tall12 oz 70 mg
TeasServing SizeCaffeine (mg)
Starbucks Chai Tea LatteShort (8 oz) / Tall (12 oz)50 mg / 70 mg
Starbucks Green Tea LatteShort (8 oz) / Tall (12 oz)25 mg / 55mg
Soft Drinks
DrinkServing SizeCaffeine (mg)
Coca-Cola12 oz30-35 mg
Coke Zero12 oz35 mg
Diet Coke12 oz38-47 mg
Pepsi12 oz32-39 mg
Diet Pepsi12 oz27-37 mg
Dr. Pepper12 oz36 mg
Mountain Dew12 oz46-55 mg
Barq's Root Beer12 oz18 mg
Energy DrinksServing SizeCaffeine (mg)
Red Bull8 oz76 mg
Full Throttle8 oz70-72 mg
Monster8 oz80 mg

Does Chocolate Contain Caffeine?

Yes, chocolate does contain caffeine but it depends on the type of cocoa beans and the degree of fermentation as to how much caffeine is present.  Typically, chocolate has caffeine levels typical to decaffeinated teas and coffees. 5 Caffeine is not typically listed as an ingredient in chocolate because it is a part of the cocoa itself and not an added ingredient, much the same way as water would not need to be listed as an ingredient in a whole watermelon.

Chocolate also as theobromines which have a similar impact on the body’s nervous system as caffeine. 6   But, as with caffeine, the levels in chocolate are quite low.  One oz of milk chocolate has 6 mg and 1 oz. of dark chocolate has 20 mg. 7 Chocolate does not usually cause problems in breastfeeding babies.


What To Do When Baby Won’t Latch

Cindy and Jana

Cindy and Jana are Registered Nurses and International Board Certified Lactation Consultants who have assisted over 20,000 families.  You can download their app NuuNest – Newborn Nurse Answers and Baby Tracking for expert guidance through the first crucial weeks after childbirth or visit their website, Cindy & Jana.  You can also connect with Cindy and Jana on TwitterFacebook and Pinterest.

Noella was just 35 weeks into her pregnancy when her water broke. 12 hours later, her baby boy, Nathan, was born. Nathan was admitted to the neonatal intensive care unit  for antibiotics and monitoring. His first feed was a bottle of formula. Noella pumped faithfully throughout Nathan’s two week hospital stay but had little opportunity to try breastfeeding. When he was discharged from hospital, she began to offer the breast every feed but Nathan was used to bottles. Breastfeeding attempts became increasingly frustrating for both mom and baby. After two more weeks, Noella made the decision to discontinue all feeding attempts at the breast and instead focus her energy on pumping, bottling her expressed milk, and enjoying her newborn.  A month later, we received a phone message from Noella: “You aren’t going to believe it.  Nathan is now breastfeeding! I just decided to try it one day and it worked!”

Why babies may not latch at birth

Noella is not alone in her struggles to establish breastfeeding. Many babies are born prematurely and are not yet strong enough to maintain a latch. There can also be other reasons why babies don’t initiate breastfeeding right from the start:

  • Baby may be recovering from a difficult birth.
  • Baby may have a tongue tie.
  • Baby’s first feeds may have been given by bottle and baby is therefore unsure how to suck at the breast.
  • The shape of mom’s nipples may make it difficult to grasp the breast.
  • Baby may have an anatomical challenge such as a cleft lip or palate or the shape of the mouth or jaw may make latching challenging.

If baby will not latch in the first 24 hours after birth:

  • Keep your baby skin to skin as much as possible.
  • “Practice” breastfeeding: express a drop of milk on your nipple and let baby lick and nuzzle. Try to keep these practice sessions pleasant and free from frustration for both mom and baby.
  • Support baby well during feeding attempts to help baby feel secure. If you are feeding in a cradle or football hold, use pillows to support baby. If you are feeding in a laidback position, baby’s body will be well supported against your body.
  • Begin to use hand expression to stimulate your breasts to begin producing milk. (Learn how to hand express with this video.)
  • Feed any drops of milk obtained back to baby with a spoon. Baby will “sip” the milk from the spoon.

If baby continues to not latch after 24 hours:

  • Continue with “practice sessions”. If either you or the baby becomes frustrated, take a break. Calm your baby by snuggling. Remember, dad can snuggle baby if you need a break!
  • Do some massage and hand expression before attempting at the breast so that the milk is “right there” for baby.
  • In addition to hand expression, begin to use a hospital grade electric pump. We suggest you pump about every 3 hours for 10 minutes per breast (or every time the baby feeds). Please do not be discouraged if you don’t get a single drop! The pumping “tells” your body that baby is here and will need milk. Developing a good supply of milk will be key in coaxing baby to the breast.
  • Consult an International Board Certified Lactation Consultant to have a thorough assessment. The consultant will have suggestions based on the cause of the difficulties.
  • You will, of course, need to feed your baby. Your health care provider may suggest you feed baby by spoon, cup or finger feeding. The first choice is to use your own expressed milk. If, for medical reasons, your health care provider recommends additional supplement, banked human milk is the next choice. If donor milk is not available, infant formula may be used. Feeding your baby will help ensure he has the energy to continue to learn to breastfeed.
  • Some women find using a 20-20-20 principle helpful. “Practice” at the breast for 20 minutes; feed the baby in an alternate way if needed (approximately 20 minutes) and pump/hand express for 20 minutes. (Please note: the times are suggestions only. Please modify according to your baby’s cues. Sometimes babies are quickly frustrated and 20 minutes of trying may be too long.)
  • Sometimes, giving baby a little milk prior to a breastfeeding attempt may be helpful, especially if the baby is quite hungry. Taking the edge off the baby’s hunger may help baby to be more relaxed with the latching attempts.
  • Once baby is taking larger volumes, your health care provider may suggest beginning to use a bottle to feed your baby. This does NOT mean we have given up on breastfeeding! Again, it is important to feed your baby so that he will have energy to learn to feed. When baby is taking larger volumes, some babies will tire before they have been able to complete the feed. If you choose to bottle, use a rounded nipple rather than one with a flattened cross-section. Choose a slow flow nipple. Entice the baby to gape widely when taking the bottle to simulate latching at the breast.
  • A nipple shield may be useful in some instances once milk supply is established. Using a nipple shield before the milk supply is established is not recommended. Please discuss this with your Lactation Consultant.
  • Search out a mother-to-mother support group such a La Leche League.

In our experience, with time and patience, most babies who do not latch initially will eventually go to the breast. While working towards getting baby to the breast, stimulating the milk supply and having lots of skin to skin time are the most important things you can do.


Breastfeeding

Breastfeeding Gave Me Confidence

Krista Elliott HeadshotKim is an American living abroad in China with her husband and 2 very active boys. She enjoys cooking, cross-cultural living, and experiencing life through the eyes of her children.

When I got pregnant with my first son, Nate, I knew I wanted to breastfeed. My mom had breastfed my sister and me and talked often of the benefits. I remember as a child hearing her talk about how she wanted to “give us the best start in life possible” and not really understanding at that time what she meant. Now, after having children of my own, I understand.

Thinking through what it meant to be a mother and how God was entrusting this tiny human to my care, I was determined to breastfeed. I believed it made a lot of practical sense. Breast milk is free, convenient and healthy. I was also looking forward to the extra cuddle time and close knit bonding that breastfeeding provides.

During my pregnancy with Nate, I read lots of books about pregnancy, nursing, and newborn care. I watched other moms nurse, met with a Lactation Consultant and felt like I had a good handle on what to do. I often daydreamed of a perfectly latched baby who smiled lovingly up at me as he enjoyed the nourishing milk, flawlessly suited to his particular needs.

BreastfeedingDay one, the latch hurt.  A lot. I asked the nurse to have the hospital’s Lactation Consultant check in. She was not much help. By the end of the day, my nipples hurt so bad that I dreaded each feeding. Day two, Nate refused to latch and he began to get jaundiced. Day three, we fed him formula through a syringe because he wouldn’t latch and my milk hadn’t come in yet so pumping was fruitless. Nobody offered donor milk as an option.

Thankfully, after my milk came in, we were able to get him to latch again. I went home with him from the hospital totally terrified about nursing. This was a disaster. I was almost ready to give up right then and there. I cried. I sobbed. I prayed. I was destroyed. This was not the story I had pictured in my head. However, my heart was set on doing this. I knew in my soul that breastfeeding was important and that my baby had a right to have access to the nourishment God intended for babies. I desperately wanted my new baby boy to have all the benefits breastfeeding provides.

So I pressed on and contacted the Lactation Consultant I had seen while I was pregnant. She was incredibly helpful. She came to my home, watched me nurse, helped me nurse, and imbued me with confidence. She came as often as I needed her. She brought lanolin for my sore nipples. She worked with me for six weeks and though it got better, nursing was still really painful. The latch looked right. There was no thrush or physical abnormalities. She didn’t find a tongue tie. It simply hurt to nurse. I started to feel crazy and like a giant failure. There was no reason visible for nursing to be this painful.

Nate began to develop some other puzzling symptoms also. He coughed and choked a lot while nursing. He was extremely gassy and fussy after nursing. He had a hard time maintaining his grasp on the nipple and easily slid off or lost suction. Nursing sessions lasted upwards of an hour and so on. The Lactation Consultant recommended I take Nate to the local Dysphasia Clinic. She was out of answers and felt he may benefit from the more specialized kind of care they could provide.

BreastfeedingThe first visit at the Dysphasia Clinic was wonderful. The specialist confirmed that I was not crazy, the latch was perfect, but Nate was not using his mouth and tongue normally. She noticed that his suck/swallow/breathe rhythm was a little disorganized and that he was using a chewing instead of a sucking motion. This was the source of the pain.

Imagine my surprise when she assured me with some special exercises and time, Nate would learn to nurse properly and it would stop hurting!! She assured me that this was all within the range of “normal” for babies and that some just need a little more help to learn the skill of nursing than others. She also felt that his tongue might have been a little tighter than normal, but not enough to warrant surgical correction. She also broke the news to me that my milk supply was most likely low because he was not efficiently removing milk.

Over the following weeks, I was to nurse, then pump, then feed what I pumped to Nate in a special bottle using a special technique. This would empty my breasts more adequately, thus increasing my milk supply and give Nate the opportunity to strengthen his suck and learn the proper suck/swallow/breathe rhythm.

I saw dramatic improvement within the first few visits! Although it was hard work and nursing was still not completely comfortable, we had come a very long way from the first few weeks where I cried before every nursing session in anticipation of the pain. I knew now that I would continue nursing Nate until he was ready to be done. Oddly enough, this struggle gave me a lot of confidence as a mother. I knew that I had what it takes to surmount challenges. I knew I would push through to do what was best for my children despite personal pain or hardships, that I would be able to put my children’s needs above my own.