Tag Archives: Infant

Floor Time for Babies

Infant Health & Safety, , , , , ,

Your baby’s gross motor development occurs along predictable Cephalo-Caudal principles. As a reminder, this means that your baby develops motor strength and muscle control starting from from the top (Cephalo, Latin for “Head”) toward the bottom (Caudal, Latin for “tail”). This principle of development means that first, your baby works on achieving head and neck control, then upper body strength in the arms, shoulders and upper torso, then lower abdominal strength, and finally, leg strengthening and balance for walking.

For this context, think of the first year of life for a human child as a timeline from birth, essentially laying flat with very little muscle control, to one year, when a baby is now upright, standing and moving independently (cruising, crawling or walking).
The mid-way point, six months, the baby is halfway there. During the sixth month, most babies will be working on sitting upright, and on finding some way to move. Here’s how tummy time plays a critical role in building strength for these skills. Tummy time doesn’t go away, it evolves into “Floor Time”.

Between 2 – 4 months, babies (hopefully!) are working on tummy time, beginning to push up on bent arms and support their head, neck and eventually shoulders and upper body (pushing their chest up off the floor to the nipple level, even) for increasingly longer periods of time. What the 2 month old found frustratingly hard work when placed on his tummy, the 4 month old effortlessly performs: remaining propped up on his bent arms for much longer periods of time.

At five months, he’s ready for a new challenge: rather than resting on his bent forearms during tummy time, he may push straight up on extended arms, getting almost all his chest off the floor down to his belly button. After doing this for a week or two, you’ll begin to see some fancy developments: he’ll start pivoting in a circle and then moving (creeping) backward. Using some combination of pushing off with his arms, typically these earliest movements will take your baby sideways and backwards. These fun efforts mean that your baby will creep backward until he’s halfway under the couch or coffee table. You’ll watch him get stuck many times over, often to your amusement.

To encourage him to pivot (which strengthens his upper body) yet to lower his frustration (Frustration Tolerance – another skill) place a few tempting toys around him in a circle. This way, when his efforts take him away from the object of interest in front of him (because early movements tend to take babies sideways and backwards!) there will be a new and rewarding item that catches his attention.

This activity is called “Floor Time”. Unlike Tummy Time, where you may have needed to use a prop, position your baby carefully, and a receiving blanket was all that was needed, Floor Time requires more space. Your baby needs some space to begin to explore how his body can move, and motivation to investigate his environment. Months before he can crawl and even though he may not yet be able to roll, he’ll still figure out ways to somehow scooch, creep, wiggle or otherwise inch and arch himself a few feet in one direction or another.

A clean area rug or foam matting makes a perfect surface for floor time. Blankets and quilts tend to get bunched up under your baby’s efforts to move. When possible, bare feet is best for sensory input and for traction. Watch those little toes flex and dig into the surface to get leverage to push off with!

By six to eight months, your baby will figure out some version of movement. Though it may not be what you think of as “crawling”, most babies in this age group have some way of getting a few feet away from where you left them. HOW they move matters less than having the motor strength to move, and the cognitive desire to explore. Some babies will use their arms to pivot and creep backward, others will “commando crawl”, using lots of effort with their upper body to drag themselves forward. Some will use an amusing combination of rolling, shimmying or scooting to get around!

Time to Baby Proof!

Changing Table Activities

Infant Health & Safety, New Moms, , , , ,

Changing Table Activities – Soon a favorite part of your baby’s routine!

"Hey, Let's Play!"
“Hey, Let’s Play!”

Changing Table Activities don’t involve diapers – they’re little games to build into your  baby’s daily routine.  During a diaper change, your face is the perfect visual distance from your baby, and she can see your facial expressions more clearly. Take the opportunity to “narrate” your activities and talk throughout during the diapering process. Once your baby is through the early newborn phase and stops crying during most diaper changes, chances are good that she’ll soon decide the changing table is a favorite place to play!

What are Changing Table Activities?
The few minutes of positive interaction, play and pleasant bonding time that occur before, during or after your baby’s diaper changes. They don’t involve the diapers and wipes, and don’t even require a changing table!

Build several fun little songs and simple play activities into your baby’s routine. Babies love repetition, so by using the same few rhyming games, she’ll soon recognize the activity, becoming more excited and engaged. Together you’ll begin to have special “favorite” songs and games to share.

Don’t think you know any nursery rhymes or baby games? Bet you do!
“Row, Row, Row Your Boat” with rocking movements
Cross baby’s legs one over the other, then flex them up toward her body so the legs are closer to her belly. Sing one verse of the song while slowly rocking your baby gently from side to side. Allow her legs to relax and unfold down, reverse the crossed legs so the other foot is on top now, and bring the legs back up, and sing the song again while gently rocking your baby side to side. This is also helpful for gassy babies (which are most babies!).
Even if not fitting the traditional “Nursery Rhyme” category, in a pinch, you can sing Jingle Bells, Happy Birthday, the Alphabet Song and Row Your Boat. Your baby will be thrilled as you make up little pats or bounces to go along with your song, for example, try gently “clapping” baby’s feet together in rhythm to the song.

Maybe you also remember The Itsy Bitsy Spider, Twinkle Twinkle Little Star, or This Little Piggy Went to Market. These old standards even have easy hand movements built in. Also incorporate any songs or rhymes you remember from your childhood, especially if they are in a different language, and lyrics from favorite bands. Your baby will love them all if you’re singing them.

Because you’ll need to stay in hand’s distance from your baby at all times when on the changing table, use a nearby shelf to store a few playful items to explore with your baby to extend the playtime. A rattle, a board book, a brightly colored puppet or stuffed animal and a baby-safe mirror are some items that you might use to engage your infant. When singing or reading to your baby, use a high-pitched, sing-song tone of voice. Often called “Motherese” or “Parentese”, as annoying as it may be to adults, it’s been shown by research to be significantly better at holding a baby’s interest.

 

Tummy Massage for Gas

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

Tummy massage for gas

Unlike other types of infant massage, this one has very specific hand movements and a very specific purpose. To gently stimulate peristalsis, to encourage motility of intestinal contents (BM and gas),  to provide a “cueing sound”, and finally to offer something for baby to strain against.

Here’s how to do my very specific “Tummy Massage for Gas”

  • Hand-Over-Hand on the Lower Belly: Gently stroke your baby’s tummy from top to bottom using first one hand, then the other, like a paddlewheel. As the belly first tenses, then gradually relaxes, press your hand deeper using a scooping motion.
  • Whoosh! Add your ‘whooshing” sounds during the which soon baby will recognize signals relief or relaxation.
  • Straight Across: Now stroke from YOUR left to YOUR right – straight across, gentle but moderate pressure, just at or below the belly button.
  • Now, Across and Down: Continue the Straight Across stroke, but now ADD the downward stroke, now moving across and down, ending inside the baby’s thigh crease. It’s like a sideways “L” or “7”.
  • Legs Up and Hold’em In Place: Flex baby at the hips and knees toward the tummy, gently press and hold in place, counting slowly to twenty. Repeat the entire sequence two or three times.
    (video coming soon)

Many babies will pass gas during the exercise or have a BM a few minutes later – success and relief for everyone!

Tips for Selecting a Bottle Nipple

bottles, Breastfeeding, , , , ,

Materials and shape

Despite bold marketing statements from manufacturers, no bottle or bottle nipple will work or feel like a mother’s breast.

Bottles are the milk containers. They vary in shape, size, material and features (some are vented, some are wide-necked), but what’s usually most relevant is the bottle nipple, and not the bottle itself. Bottle nipples are commonly available in either silicone or latex. Silicone bottle nipples are clear and firm. Latex bottle nipples are usually tan-colored and are a little bit softer and squishier than silicone. Your baby may have a preference.

Considerations when selecting a bottle nipple are the shaft length, the base of the shaft (that still fits in baby’s mouth), the material, and the flow rate of the nipple. Slow-flow bottle nipples may be labeled “slow flow”, “newborn”, size 0 or size 1, or by listed by age: 0 to 3 months.

Avoid bottle nipple shapes or latch positions that keep the baby’s mouth tightly pursed or encourage clamping or chomping to control flow. These behaviors don’t translate well when practiced back at the breast! A bottle nipple with a wide base may encourage your baby to keep her mouth open wide, with jaw dropped and lips flanged out like a fish.

Go with the Slow flow: Join the Slow Food Movement

For a breastfeeding baby, almost always, slower bottle feeding is the way to go. It should take about 15 to 30 minutes for a baby to do a “full” feeding from the bottle. The same 3 ounces of milk, offered with a slow flow nipple, will be so much more satisfying to the baby when given over 20 minutes using the slow flow nipple. If he guzzles the same 3 ounces of milk rapidly, in just 5 or 10 minutes, he may not seem relaxed and content at the end, so the caregiver will assume the baby is still hungry, and reach for more milk. In this way, a baby can plow through an alarming volume of milk in a short amount of time.

Slow Flow: Avoid creating a “Flow Rate Preference”

If a baby becomes accustomed to the instantaneous, rapid and easy flow of milk from the bottle, he may become impatient and fuss when needing to work and wait a bit more when at the breast.

Keeping the bottle flow slow and requiring the baby to suck for more than just a few minutes to get their full feeding may help reduce the risk of impatience when back at the breast.

Though people talk about “nipple confusion” – a related and significant issue is this “Flow Rate Preference”. Keep the bottle feeding slow, requiring time and work, in hopes to avoid this flow rate preference with negative consequences back at the breast. Maintaining a strong milk supply is another critical factor: a baby will soon learn to cry and wait for the bottle, if they work hard at the breast for little payoff.

When or why change to a faster flow?

There is no need to move to a faster flow nipple simply because your baby’s age is beyond the ages listed on the package. The flow rate controls the speed in which a baby can drink the bottle, and for breastfeeding babies, slower is almost always better.

It should take about 15 to 30 minutes for a baby to take a “full feeding” from the bottle. A full feeding may be about 2 or 3 ounces at 1-2 months, gradually increasing to about 4 to 6 ounces by six months. Just because a baby usually finishes a bottle doesn’t mean the milk wasn’t enough, or that he should be offered more. Drinking large volumes of milk too quickly may lead to a baby feeling less satisfied, even though the milk volume (meal size) was enough. Babies usually need lots of sucking time to feel content when bottle feeding.

Move to a faster flowing bottle only when an older baby is taking too long to drink a bottle (30+ minutes), or seems frustrated at the slower flow. There is no reason to move simply due to the age suggestions on the nipple package. A 6 month old can still use a 0-3 month bottle nipple. Many babies continue to use the newborn or stage one nipple all through their first year.

If your baby drinks a large amount of milk in a short time (under 10 minutes) and still does not seem satisfied, rather than assuming he needs more milk, consider switching to a slower-flowing nipple and also pacing the feeding by offering more pauses and breaks during bottle-feeding.

Different brands of bottle nipples will work differently, even if they are each labeled “slow flow” or “newborn”. Holding the bottle upside down to see drip rate is not an accurate way to assess flow rate. Most bottles will drip several times and then stop. Try for yourself with the bottle, nipple and water – take a few sucks from several different nipple sizes and brands. You’ll easily be able to assess flow rate differences!

Help, Baby Won’t Take the Bottle!

bottles, Breastfeeding, New Moms, , , , ,

One of the biggest stressors for a new mom preparing to return to employment is the baby who WILL NOT take the bottle.

In my experience, there are two types of “bottle refusal” – Passive Refusers, and Active Refusers. A “Passive Bottle Refuser” will allow the bottle nipple into his mouth but then doesn’t really seem to know what to do with it – he may just chew or play around with it, rather than latch and transfer milk, and eventually will get frustrated, hungry or bored, and begin to fuss. The “Active Bottle Refuser” doesn’t want the bottle nipple in (or sometimes, even near!) his mouth, and will resist or protest attempts to feed him with the bottle: he may cry (or scream), arch, fight or pull away as the bottle nipple approaches or enters the mouth.

The Passive Refuser seems like he doesn’t know what he’s supposed to do with the bottle. The Active Refuser is angry and upset about the whole scenario!

If you have an Active Refuser, the first step is to reduce the stress and negative associations already established around bottle-feeding attempts. Avoid reinforcing negative associations with the bottle/nipple. If your baby is crying and fighting and trying to push the nipple out of his mouth, don’t keep pushing it back into his awareness: take a break or stop for that session. Forcing it on the baby, or making him gag and cry with the nipple in his mouth will not magically result into drinking from the bottle. It just reinforces the negative experience and makes the baby anxious the next time the bottle presented.

Here are a variety of suggestions that can be successful. Some may seem non-traditional, but when the usual suggestions aren’t working, sometimes you need to think out of the box.

Timing: Consider Morning, Not Evening

If the non-nursing partner is offering the bottle, try mornings rather than evenings. In general, everyone’s stress level is lower in the morning, and most babies are happier in the morning and grumpier in the evening. If the bottle isn’t going well, working on it during an already stressful time of day won’t help.

Positioning

Try some non-traditional feeding positions if the usual “sit, cuddle, feed” position isn’t working for you.

Up and Out: Hold baby in a sitting position, facing out against your chest, as you walk around the room, or better yet, walk around outside. Movement and distraction can be very helpful.

Bounce: Sit on a physioball (gym-, yoga-, birth ball) and bounce while offering bottle. Try both a cradled position and a facing out position.

Wear the Baby: Does baby like his carrier? Wear baby in the ERGObaby, Moby Wrap or BabyBjorn, walk around indoors or out, while offering bottle.

The “Disembodied Arm” Technique: Just what it sounds like! Have baby in a car seat or bouncer seat facing something distracting (television?). Sit behind baby, out of sight, with bottle coming around from behind.

Don’t worry that you’ll need to feed your baby using these unusual methods in the long term, we’re taking it step by step. The first step is to encourage baby to allow the bottle nipple into his mouth, latch and transfer milk effectively. Once this is happening reliably, you can work on transitioning that skill to occur in different settings and positions, such as sitting in a rocking chair.

Bottle nipples

Try a few, not dozens: If you’ve had any success with a particular bottle nipple, stick with that one. It’s generally not an issue of trying 20 different bottles/nipples until you find the magic one that baby will accept. It does make sense to try a few but then try working with the one you think baby did the best with.

Nipple flow rate: The flow rate can be another helpful factor. I usually recommend a slow-flow bottle nipple for most breastfed babies, but if you know that your baby gets a lot of milk at the breast in a short amount of time (for example, if you have a heavy milk letdown), then you might want to try the next flow rate up (size 1-2 or 3+ month size). Just make sure to hold her upright and keep the bottle almost horizontal, so she doesn’t feel flooded out with too much milk if she does start sucking.

Latex or Silicone? Bottle nipples are usually available in two different materials. Even with the same shaped bottle nipple, a latex (tan-colored) nipple will feel softer and squishier than a clear, firm silicone nipple. It’s worth trying both latex and silicone to see if your baby has a preference regarding texture and firmness.

Read more on Selecting a Bottle Nipple.

Tease-Remove Technique

Have you seen your baby, sound asleep still attached at the breast, barely flutter-suckling, body relaxed, arms limp? Yet, the moment you try to break the latch and take baby off the breast, he’ll start sucking frantically, like saying “wait – wait – no – don’t take that away, I wasn’t done!” Try eliciting that response with the bottle nipple: when you feel baby tentatively latching on the nipple, gentle traction back as though you’re teasing to take the nipple away. Some babies will respond by sucking harder to draw the nipple back in and keep it there. If this happens, try using some movement and distraction (quick!) and see if baby will continue sucking and get into a suck-swallow-breathe pattern. Remember to always aim the tip of the bottle nipple toward the roof of the baby’s mouth.

Milk for the Discerning Palate

Some babies are very particular about what’s in the bottle. Try using freshly expressed milk, if your baby has been refusing frozen. And, though I’m not usually particular about the temperature of the milk offered (most babies don’t mind lukewarm or even cool milk), if you have a bottle-refusing baby, try making the milk quite warm. For some reason, very warm milk seems to work better for many babies who are reluctant about the bottle. If your baby is over four months old, you could consider trying one ounce of white grape juice and one ounce of water. Some babies will initially refuse milk, but readily take juice from the bottle. Though the recommendation is exclusive breastmilk close to six months, other pediatricians (and certain groups within the AAP) do suggest solid foods (cereals, fruits and vegetables) any time after four months. Again, this is an untraditional approach (and I’m not one to encourage juice intake, especially from a bottle!), but one that may help bridge the ability to bottle feed an older baby.

Recruit a Confident and Experienced Feeder

Have a very experienced bottle-feeder offer the bottle. A professional caregiver who feeds many babies regularly or a friend or fellow new-moms-group attendee who bottle feeds her own baby may have body language, tricks and methods that you or your partner haven’t yet tried. Make sure s/he knows NOT to force the bottle, and that it’s perfectly alright if it doesn’t end up happening that day. You don’t want her to push too hard in her attempts to be successful and save the day! Experiment with sitting right in front of your baby so she can see you, or leaving the room or having the caregiver walk around in another room while offering the bottle.

Don’t Try a Holding out Game

Do not attempt to withhold the breast for an extended period in order to force the baby to take the bottle out of hunger. It is unkind, unnecessary, and usually unsuccessful, especially if baby has not been able to successfully transfer milk from the bottle before. Slow, consistent, unstressed encouragement tends to yield the best longer-term success.

Which brings us to perhaps the most effective and successful technique: Intermittent Bottle By Mom (IBBM)

Intermittent Bottle by Mom

One less-traditional, but highly successful technique I find works well is to have mom work on the bottle feeding since you are the person your baby most associates with feeding, and you are both comfortable and relaxed together. Also, you have the “luxury” (ha!) of time in the morning to work together over several subsequent feeds, whereas your partner is usually trying to work on bottle feeding in the evening during the hardest time of the day, when no one has much energy or patience left.

During an early morning feeding, begin nursing at the breast as usual, and then interrupt the breastfeeding and offer the bottle. If she doesn’t accept the bottle, don’t force it, just put her right back on the breast for another minute or two, and then try once again with the bottle. Go back and forth between the breast and bottle without forcing it at her. Try to have the attitude of “you can get milk here (breast), you can get milk here (bottle), it’s all milk, it’s all good, either is fine!”. Pretend like you don’t mind if she refuses the bottle, just put her back on the breast. If she ends up not taking any of the milk at that early morning feeding, you can leave it on the counter (or refrigerate and rewarm) and try again at the next feeding, 2 hours later before deciding to toss it – that’s why I suggest only using an ounce or two of milk in the bottle, so you won’t be wasting much if she refuses it altogether.

Try this Intermittent Bottle By Mom (IBBM) technique for several feedings during the day, for several days in a row. Remember, never let baby get distressed with this method: If she resists or refuses the bottle, allow her to go right back to the breast. Almost always, moms begin to see success by day 3 or 4, and by 7 – 10 days, baby is often readily taking an ounce or more from the bottle. Success!

How to Nurse Side-Lying

Baby Sleep, Breastfeeding, New Moms, , ,

sidelyingYou can nurse on BOTH SIDES lying down, without needing to roll over yourself and move baby! Here’s how:

You’ll need 3 pillows and a rolled up receiving blanket. (Oh, and a baby).

Place one pillow under your head, one pillow between your legs, one pillow (preferably a body pillow) behind your back.

Have your baby on his side, facing you, and use the rolled up receiving blanket behind him to keep him from rolling toward his back once he is latched on and sleepy – you could get sore if he slides down the nipple but keeps nursing.

Nurse on the bottom breast by rolling yourself slightly back onto the pillow behind you. Tuck your baby’s bum either nearer or further away from your tummy to get his head in the right position. (Think of your baby’s body like a “stick” in this position. If you want his head closer to you, move his bum slightly away. If you need his head a little further from you, bring his bum in closer to your tummy).  Nurse! You can use your “top” arm to position your baby and/or your breast. For women with very large/soft breasts, a rolled or folded washcloth under the breast can offer support and bring the breast to a good level for the baby to nurse. Your “bottom” arm is often most comfortable tucked up by your head, (though some people like to have it cradled around the baby). The arm kind of gets in the way.

Now, to nurse on the TOP breast. Shift your hips way back, and roll forward away from the back pillow. You’ll appreciate the pillow between your legs now. Adjust/flex your hips so you are supported rolled forward toward your baby comfortably. Roll your baby slightly more onto his back, using the rolled receiving blanket to keep him at the best angle, halfway between his side and his back. Nurse! Your bottom arm might be most comfortable under your head. Your top arm usually drapes around the baby.

Practice side-lying nursing during the daytime when you’re awake and can see what you’re doing, then you’ll get good at it and can nurse this way at night when the lights are low.

Note: If you’ve just had a c-section, place a folded or rolled towel against your incision area so baby’s feet don’t “kick” a sensitive area.

Note: The American Academy of Pediatrics advises that “Infants may be brought into the bed for feeding or comforting but should be returned to their own crib or bassinet when the parent is ready to return to sleep.”

 

Pump, Store, Feed Care Plan

Breastfeeding, Feeding, New Moms, , , , ,

expressingearlymilkPumping, Storing and Feeding Expressed Milk
(Or, Preparing for Eventual Return to Work  

  • Begin expressing and storing milk once day in the morning immediately or shortly after breastfeeding (week 2-3).
  • May add a 2nd pumping session later in the day (also after breastfeeding) if desired.
  • Double pump (both breasts at the same time) for 12-15 minutes.
  • Adjust vacuum to the maximum level that is still comfortable. Pumping shouldn’t hurt!
  • While pumping, massage and compress the breasts every few minutes
  • Reposition nipple within flange tunnel 2 or 3 times during session
  • Midway into pumping session when milk flow/collection slows down, press the “let-down button” (“speed toggle switch”) for another stimulation-mode (rapid shallow pumping) if your pump has this feature.
  • Introduce the bottle before 5 weeks old. Week 3 or 4 is perfect.
  • Use a SLOW FLOW bottle nipple and paced bottle feeding (upright position, bottle almost horizontal to baby, take pauses for interaction or burping)
  • Begin by offering one ounce by bottle. This can be increased to 2 and gradually 2.5-3 ounces, if a “full” bottle feeding is desired.
  • Continue to offer at least an ounce by bottle every 2-3 days right up until the return to work. AVOID a “bottle feeding vacation” where no bottle is given.
  • Store freshly expressed milk in the back of the refrigerator for about 4 to 7 days.
  • Store milk in milk storage bags in the freezer by lying them flat to freeze overnight, then stacking them up in a container in the back of the freezer.
  • Write the date and volume on the storage bag prior to placing in the freezer.
  • Thaw frozen milk in the refrigerator over 12-24 hours, or place bag directly in a bowl of hot (not boiling) water for a few minutes.
  • If you have additional questions or difficulties pumping or introducing the bottle, contact me for suggestions.
  • My Golden Rule of Breastmilk for Healthy Babies:
    If it LOOKS ok, SMELLS ok and baby will take it (TASTES ok), it’s FINE to use.