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Sarah Norris – The Baby Detective

Baby Detective Case Files – Temporary Supplementation
May 16, 2017

Baby Detective Case Files – Temporary Supplementation

 

This a series whereby I share a particular parenting challenge or solution to a problem that I think might be of some use or interest to other parents.

It is not meant to be an ’I know best’ or a ‘this is what you should do’…rather it is an exploration of possibilities to show how you might possibly approach one of the many problems encountered as a parent.

 

 

Temporary supplementation during the first few days of baby’s life, before the milk came in.

The Situation

First time mother had a long and difficult birth with substantial blood loss. She had no colostrum after the first day, and no milk for 5 days. The parents wanted to safely feed their baby whilst protecting the breastmilk supply.

I started work with the family on the second day of baby’s life and had reports from the hospital that baby struggled to latch. After each attempted breastfeed she had been given formula in order to maintain healthy blood sugar levels, and to allow baby to be comfortable and content.

On return from the hospital it was obvious that the mother was in severe pain from what later turned out to be a tear in the artery in her neck so there was a balance to be found in taking care of both mother and baby.

The Problem.

After observing a feed it was obvious that baby wanted to latch but very quickly became frustrated when there was no colostrum or milk and refused even to try to latch, just screamed and screamed.

I have come across this many times over the years so we decided to try what I call my ‘Motivation Kit’. This is simply a 1ml syringe and some formula in a little pot (flat based baby bottle caps are great for his) along with a thin cotton swaddle and a pacifier.

 

Muslin square, milk, syringe and pacifier

Motivating Baby

As the mother prepared herself for the feed I ensured baby was awake, but kept her calm, with a pacifier. The aim was to make sure she was in the best possible frame of mind to start the feed.

In a bid to encourage baby to latch I carefully placed a drop of milk from the syringe on to the nipple so that when baby did try she got an instant reward.

I continued dribbling small amounts of formula down the mothers’s nipple or into the corner of baby’s mouth, constantly rewarding her efforts and encouraging her to stay at the breast.

When baby began to get too wriggly we swaddled her firmly with a muslin cloth folded in to a triangle. This made it much easier for the new mother to manoeuvre her and control flailing arms. We also used the pacifier any time she started to get upset from hunger or frustration to prevent escalation.

Caring For Mother

When the mothers pain became too much we stopped the breastfeed and the father or myself topped the baby up with formula, and allowed her to drink until she was peaceful and content. The mother used the breast pump to stimulate the breasts for another 10 minutes (as much as she could bear at that time).

This gentle approach reduced stress to a minimum enabling the baby to satisfy her hunger quickly and calmly, and allowing the parents to relax and enjoy their baby, getting to know her and bond as a family.

We used a bottle called the Munchkin Latch which has a large teat that is soft and supple. This mimics the mouth position and action of the baby at the breast, and also has a very slow flow rate to help prevent baby getting lazy at the breast.

We repeated this every 3 hours during the day and I then did a bottle feed in the middle of the night so that the mother could rest because she was in so much pain..

I know many people say that it is vital for the mother to breastfeed in the night to stimulate her breasts, but in practical experience I have found this to make no difference to the long term feeding outcome. For an exhausted mum, the best possible boost to recovery is sleep, along with good food, so is always beneficial for the milk supply.

We continued in this pattern for four days, tempting and rewarding baby at the breast, then topping up with formula, and she became increasingly adept at latching and staying on for a few minutes longer each day.

Breastmilk Arrives

On day 5 the mother’s milk started to come in and baby began to feed properly from the breast for the first time. We kept the number of minutes feeding low to begin with, again, because of the mother’s pain levels.

We used the syringe technique to help overcome the initial engorgement when the breasts were hard and tight and difficult for a small mouth to cope with. We continued to use the swaddle to calm baby whenever she got frustrated.

Dealing With The Unexpected

During this time the mother had been under medical supervision but on day 6 was readmitted to hospital where she remained for 5 days.

The decision was made to keep baby at home with me overnight so the mother could rest, and I would take her in during the day for feeds.

Throughout this difficult period the baby was fed a mixture of breast and formula, whichever was available at the time without pressurising or stressing the mother, and we continued with 3 hourly feeds which usually included pumping at some point.

The mother’s breastmilk supply continued increasing slowly but steadily, and baby continued getting better at latching and staying at the breast.

When the mother was discharged and blissfully free from pain for the first time in her baby’s life things improved even more.

Happy Endings

As mother became more relaxed and could focus she became very adept at getting baby on the breast and the need for the syringe disappeared almost overnight. By the end of 2 weeks baby was latching easily and the amount of top up needed was naturally decreasing.

By the end of week 3 baby was being breastfed for all feeds apart from the one night feed at 3am. This was formula or expressed breastmilk, by parental choice, so that I could do the feed and allow parents to sleep, and they were very happy with the result.

All this was achieved with no cracked or bleeding nipples, and no excessive breastfeeding pain for the mother simply by taking our time, building up gradually, and figuring out a solution that suited this particular family.

Why does my baby cry so much in the evenings ?

Some babies really struggle in the evenings, being restless, difficult to feed, crying, or even having major meltdowns…just when you are at your most tired after caring for them all day.

So you head off to Google or online mum groups and you hear terms like Evening Colic, or The Witching Hour, and that’s what we are going to look at in this blog.

Colic

Firstly, the term colic is not a diagnosis of a particular problem, it is a description of a pattern of behaviour…basically it describes a baby that cries excessively for 3 hours or more, 3 or more times a week.

As you can see, it’s a very loose description, and the excessive crying can be caused by any number of things, including hunger, tiredness, wind, reflux, illness, pain, teething, over handling, over stimulation.

It can also be a mix of several of these and its your job as a parent to try and figure out what is wrong and deal with it.

What is Evening Colic ?

This is much the same.

It describes a baby that cries excessively during the evening (usually from around 5 or 6pm through to 10 or 11pm, or even later if you are really unlucky).

It is more common in younger babies, under 5 months, but can go on much longer if the cause is not discovered.

We still have to play detective and figure out what is going on, but in this case, a major factor is usually overtiredness and/or over stimulation, along with hunger.

A baby has to cope with so many new things once they are born including learning how to latch on to bottles or teats, drink and breathe at the same time, they are feeling discomfort and pain from their own insides that they can’t understand or do anything about.

Their senses are bombarded by light, sound, movement, textures, tastes, smells, and all the interaction from people around them.

Their brains are in overdrive trying to process all this and its overwhelming and exhausting which is one of the reasons babies need so much sleep.

Naps help, but what they really need is some deep sleep so their subconscious can get on with trying to make sense of it all, so by the time evening comes they have just had enough.

They are exhausted and stressed, sometimes too stressed to eat or go to sleep so they get frustrated, and the only way they have to express themselves is by screaming

Tips to Help You Cope

Once you understand what is going on, it makes it easier for us to figure out ways to help them, such as

  • Try to make sure they get lots of sleep through the day (at least 1 hour of good solid sleep before each feed)
  • Make everything calmer in the evenings by turning down lights and music/tv, and getting rid of visitors. Sometimes the best thing is to remove baby to a dark quiet room, and use gentle music or white noise.
  • Handle them gently, rock, sway and walk around, and talk or sing to them soothingly.
  • Don’t make them wait for a feed. It won’t hurt to bring a feed forwards if it avoids baby getting wound up.
  • Make feeding as easy as possible.

**If you are breastfeeding you can try expressing or using formula from a bottle just for this feed.

**If you think your milk supply could be low (very common at this time of day) then try topping baby up with expressed milk or formula to make sure they have a full tummy.

  • Wind thoroughly but use gentle, passive positions and movements.
  • Swaddle baby so they feel secure, and you can even swaddle them to feed and during winding
  • Take turns with your partner if you have one. It is no easy thing dealing with a crying or screaming baby and can easily stress parents so being able to hand them over to someone else whilst you take a break will make a huge difference – don’t both sit there trying to calm baby, take it in turns.
  • Warm deep baths where baby can float and relax can really help. Turn lights down low, make bathroom warm, you can even get in there with baby if you think that will help. Candles are lovely if you can do it safely.
  • Make bottles a bit warmer than usual.
  • If nothing else works then try using a sling if your back is up to it.

Evening colic get better as baby gets older and they become better able to cope with the world, so if its really bad, just do the best you can to help them, and remember that it will end, it’s not forever.

Older babies can also go through temporary patches of evening colic if they are experiencing developmental changes, or if they are teething or starting nursery or during illness, just remember it is an expression of serious ‘end-of-day-itis’ so try and help them as best you can by managing them and removing all the stress factors you can think of.

I hope this has given you some insight into the problem, and some ideas about how to cope with it if you experience evening colic at any time, but if you have any questions or need more help, I’m always happy to help in my free FB group The Baby Buzz where I hang out every day…I love talking about all things baby 🙂

Sarah x

 

 

 

 

The Author

I’m Sarah Norris, a Baby Care Consultant and Parenting Coach.

I have spent over twenty five years, often working 24 hours, 6 days a week, supporting hundreds of families with new or young babies aged from newborn to 12 months old, and often helping with their toddlers and older children.

I help parents discover what parenting style they want to use to care for their baby, and offer advice on different approaches that might suit them and their circumstances best.

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