All posts by Nancy Holtzman

Diaper Surprise! 12 Freaky Things to See in Baby’s Diaper during the first year

Breastfeeding, Feeding, Infant Health & Safety, New Moms, solids

Changing your baby’s diaper may feel a bit like unwrapping a surprise gift or delicately defusing a small package bomb. You’re never quite sure what’s inside until its too late, and the contents may shock you, amuse you, or make you run for Dr.Google.

Don’t underestimate the fascination you may have with your baby’s diaper contents. Embrace this stereotypical new parent obsession, though do try to limit detailed diaper discussions to other new parents, and those who feign polite interest without turning white or audibly gagging.

Surprise! Here are 12 freaky things you might find in your baby’s diaper during the first year:

Day 3: Brick dust (uric acid crystals) – a rust or pinkish colored residue staining the front of the diaper. This resolves as baby’s urine becomes more dilute.

Week 2: Gel crystals. These look like oversized grains of sugar stuck to your baby’s genitals. Don’t panic – they’re not coming from your baby! Instead, they’re from the absorbent lining escaping from tiny tears in a disposable diaper.

Week 6: Green spinachy-looking poop. Like the occasional random projectile vomit, these bizarre baby things sometimes happen, possibly on days when baby is nursing more than usual. Unless it’s frequent, frothy, with mucus and blood, don’t worry about occasional green poop in the diaper.

Month 3: Nothing. No poop. Nada. Perhaps several days or even a week may go by with nary a stool. Perfectly normal for breastfed babies, as long as baby is content and pee is plentiful. No need to intervene. What goes in will eventually come out (and usually at the least opportune time and in abundance), so be fully prepared for a poop explosion.

Month 4: Containment Failure or Blow Out. When baby is in a seated position (car seat, bouncer, baby carrier) there’s really only one place for poop to go, and that’s UP. Tell-tale sign of the Blow Out is a yellowish wet spot located at the small of the baby’s back. Usually involves a complete change of clothes, bath optional. For both of you.

Month 5: Mom’s hair (because it’s falling out everywhere). Tip: Time to get a short, sassy hair cut. Hint: Beware the Hair Tourniquet.

Month 6: Slimy mucus in poop when baby has a cold. Swallowed mucus isn’t absorbed by the GI tract and will pass through unchanged into the diaper with poop.

Month 8: Little black threads which look exactly like tiny worms. These are from baby eating fresh bananas (not jarred). They’re just like the little black strings you see in homemade banana bread. Mmm. Banana bread.

Month 9: Gas-mask worthy smells. The strongest odors yet are typically from introducing more protein foods. Whew. Just. Wow.

Month 10: Bits of paper are likely from the tag she was chewing in the store or cardboard from gnawing on the corner of a board book. Paper is one of the four basic food groups of mobile babies. Bonus points if you can still read a letter or word.

Month 11: Easily identifiable bits and pieces of food. Oh, there’s a blueberry! Hey, look, a lima bean! Tip: If you want to know how long it takes for food to make it through your baby’s digestive tract, feed baby some corn. My estimation is you’ll see it again in about 18 hours.

Month 12: Poop that looks (and smells) just like big-people poop. If it’s not too squashed, you can shake it into the toilet instead of sealing it up in the diaper. The more solid food your baby eats, the more their poop will start to look more “familiar”.

Bonus – 18 months: Brightly colored flakes – from that crayon you needed to pry out of your toddler’s mouth. Makes for some pretty poop, though!

Pumping at Work: Uneven Production

bottles, Breastfeeding, Feeding, New Moms, ,

I’m back at work and my baby is 14 weeks old. I have been pumping twice during my workday (9 AM and 1 PM) and I can pump about 10 to 12 ounces a day with these sessions.

My left breast is producing a lot more milk than my right, and might look a little larger. 

After 2 min of stimulation, milk starts to flow from my left breast. I don’t see any milk from right breast until about 5-8 min into pumping, and maybe collect two ounces by the time the session ends between 15 and 20 min. Suggestions? ( I’m using size 27 cups with Medela freestyle).

Congratulations on making the (hard, so hard!) transition back to work, and wow, expressing 10 – 12 ounces in two sessions is great. Good job, you!

Since you mention pumping at 9 AM and 1 PM, you might consider adding a “before leaving work” pumping session after you’re done for the day but before leaving. This might mean that you arrive home with 15 ounces instead of the 10 – 12, if that is important to you. You can pump at work and still breastfeed on arrival home or to childcare.

When pumping,  see if the 24mm flange might do better on the right breast, even if the 27mm does better on the left. If that is the case, it may stimulate more milk let down and removal over time. Try a dab of olive oil for lubrication and use my suggested pumping techniques (hands-on, massage and compression, repositioning angle of nipple several times, varying vacuum strength and cycling speed accordingly)

It’s normal to find a discrepancy between the two breasts – we are not mirror-image or symmetric people (we have one liver, one spleen, one heart) and each breast functions independently from the other. Between the two breasts, you should be able to make all the milk baby needs and then some, but you may not make an even amount from each.

Some women become aware that one breast makes a lot more milk than the other only once they begin doing a lot of pumping. Other moms can see physical differences in breast size (up to 1 – 2 bra cups sizes) and some moms or babies have a clear preference due to production (with oversupply or very heavy let down, baby may prefer the slower-producing other breast!).

How can you “even things out”?

When nursing your baby, you could try to start her on the right breast – babies are typically most vigorous at the beginning of the feeding session and this “enthusiasm” might help encourage the milk to flow and assist with production. Use lots of breast compression and massage to help things along.

Another perspective: if she is cranky when starting on the “slower” side because she’s used to a fast flow from the bottles and frustrated at having to work hard and wait for the milk when starting on the right side, then instead, you could try starting her on the left breast, and then switch her over to the right to nurse and linger longer. There’s no definitive answer, just try out some of these ideas and see if one helps more than the other.

Keep up the awesome hard work, Mama!

 

 

Help! Baby Won’t Take Bottle! and IBBM Method

bottles, Breastfeeding, Feeding, Infant Health & Safety, New Moms, ,

Hello,
Since you’re here, you’re probably pretty stressed. Sorry about that. I’m here to help with resources and support. I have a pretty good track record on this – which is why you’re here 😉
Hang in there.

Please READ:
Won’t Take a Bottle
Selecting Bottle Nipple
Bottle Feeding the Breastfeed Baby

Please WATCH:
Help, Won’t Take Bottle.

Please TRY IBBM 2x/day for 5 days.

Personalized Support – Home and Phone Consults

Changes in Routine over the Holidays

Baby Sleep, Breastfeeding, Infant Health & Safety, New Moms, , ,

It’s easy for everyday routines to be disrupted over the busy holiday weeks. Travel, visitors, parties, new decorations, and changes in childcare or playgroup routines , plus alterations in meals, nap and bedtime routines may result in both excitement and stress for infants, toddlers and parents.

Some simple steps may help to maintain a sense of security and routine during these busy days:

Keep mealtimes as regular as possible, or offer healthy snacks if a family meal is being held later than your child might like. Most toddlers have a short attention span in the highchair, so bring along some appropriate diversions to keep a child content at the table a little longer, or allow him to play with quiet toys on the floor next to the table if appropriate.

When traveling overnight, bring along some favorite toys, books, music and blankets and try to keep to your regular bedtime routine, even if it’s a little briefer or later than usual. If you usually bathe, read, rock, sing with your little one at bedtime, follow that pattern. Your baby will recognize the familiar rituals, even in a new environment. White noise may help mask unfamiliar city or party sounds.

Unfamiliar faces or crowded rooms at parties may take your child some time to get used to. Sometimes visitors are so eager to see the baby that they want to rush in and envelop the baby in a hug. Explain to visitors and relatives that most young children need some time to acclimate to new places and people (even grandparents, if it’s been awhile since their last visit). Hold your child and let her watch you interact with friends and relatives first. Wait until she seems more relaxed and shows a willingness to explore the environment or be held by someone new.  Using a sling or frontpack is a great way for relatives to see and interact with the baby, while parents are still able to maintain a sense of safety and security.

Keep extra-vigilant at holiday gatherings and parties when there are many adults and children present. It’s often assumed that someone else is watching a child, when in fact the toddler may be unobserved exploring an area that is unsafe or mouthing a potential choke-hazard. Sometimes a well-meaning relative may give a baby or toddler a food or plaything that is unsafe or not age-appropriate. Party foods (including candy, nuts, chips and baby carrots), festive decorations and toys for older children are all tempting and potential hazards for a crawling baby or young toddler.

 

Baby’s Head Shape: Flat Spots, Torticollis & Plagio

Baby Sleep, Infant Health & Safety, New Moms, , , , , , , , ,

Does your baby have a flat spot on the back of his head? Many babies do. Fortunately, most flat spots, called Positional Plagiocephaly, are mild and need no treatment other than positioning changes and monitoring. Learn how to prevent and treat flattening of your baby’s head, and when to speak with your pediatrician about concerns.

 What is Deformational Plagiocephaly or “Flat Head”?
Also called Positional Plagiocephaly, Deformational Plagio refers to the misshapen or asymmetric shape of the head. The flat spot is usually on the back of the baby’s head, though in some cases, for example, with torticollis, the flat area may be on one side of the skull.

What causes deformational plagiocephaly or “Flat Head”?
The most common cause of deformational plagiocephaly is positional. A newborn’s skull is soft and designed to grow quickly. When babies rest in one position for long periods of time, the skull begins to flatten from the external pressure against it. Since babies can spend a lot of time in the “passive recline position” (car seats, bouncer seats, swings, back-to-sleep position), it’s possible for a flat area to develop. Once a flattening occurs, it’s easier for the head to “resettle” there each time, allowing other parts of the skull to grow but not the flat area.

Shifting your newborn’s sleeping and resting positions is the best prevention for developing a flat spot. During diaper changes and for sleep, try alternating his “head and feet” position, reversing the way you usually lay your baby on his back. When your baby is awake and observed, use more tummy time and side-lying positions. Lots of awake tummy time with encouragement will also help by strengthening the neck, shoulder and arm muscles, which will eventually help your baby shift his own positions. Carrying, holding or “wearing” your baby without pressure on the back of his head will also encourage muscle development and prevents pressure against the flat spot.

Is a Bald Spot or stripe on the back of the head cause for concern?
No. It’s common for babies between 4 – 7 months to “wear away” an area of hair from turning their head side to side when in car seats, bouncer seats or sleeping on the back. This bald patch is normal and if not accompanied by significant skull flattening, is not a cause for worry. Bald patches tend to resolve between 9 to 12 months, as your baby will be sitting, crawling and moving more, spending less time on his back, allowing hair time to fill in again. Many fashionable babies sport a fine mullet.

Torticollis and Flat Head – 
A common cause of deformational plagiocephaly is muscular torticollis. Muscular torticollis (sometimes called “wry neck”) is a tightening of specific neck muscles, which prevent full motion and keep the baby’s head slightly tilted or turned to the side. Because torticollis causes the baby to keep his head at a specific angle, a flat spot may form as the baby’s head rests against the mattress or seat at the same position for repeated periods of time, leading to positional plagiocephaly.

Torticollis is often missed by parents and health care providers, since newborns have short necks and tend to lean or “slump” to one or another side. Make sure your baby is an “equal opportunity slumper” – sometimes leaning to the right side and other times the left, when sleeping, and check that your baby can turn his head equally to both sides. If you’re concerned about your baby’s persistent head-tilt or suspect restricted neck motion, speak to your pediatrician.

Treating Torticollis – for a baby with torticollis, treating the tightened muscles early is important to achieve full head movement as baby grows. Full motion of the head and neck helps with balance as well as the physical appearance of the head shape (and sometimes facial symmetry). Torticollis is best treated early, during your baby’s first several months of life when specific stretching and repositioning techniques are most effective. Your pediatrician may refer you to a pediatric physical therapist to learn specific stretching exercises and positioning tips for your baby’s particular needs.

What about Helmets?
Maybe you’ve seen a baby out in the store or mall wearing what seems like an infant-sized football helmet. This is a therapeutic device called a Cranial Band or Orthotic, worn to help correct a misshaped head.  In more severe Plagio, when flattening or asymmetry is significant and beginning to affect facial appearance (one eye or ear may begin to move out of line with the face), or, in situations where a baby was born very prematurely or has early closure of the skull bones, an Orthotic may be recommended. Made by a specialist, baby helmets are very lightweight, with a hard outer shell and foam lining. Very gentle pressure restricts growth in some areas while allowing the skull to “fill out” and freely grow around the flattened areas, rounding out the head. Helmet therapy typically takes 3 to 6 months with good results.  Babies generally adjust to wearing a helmet quickly – it’s harder on the parents usually due to comments from well-meaning strangers and additional appointments. But remember that mild flattening is common and usually doesn’t require treatment with a helmet.