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Do I need a lactation consultant?

By Cindy Baker-Fox, registered nurse and international board-certified lactation consultant at CHOC Children’s

In addition to the proven health benefits for mom and baby, breastfeeding can be a wonderful experience that fosters bonding. But in some cases, breastfeeding and breast milk production can be challenging for both mom and baby, and may require assistance from a lactation consultant. The most common concern among moms new to breastfeeding is, “Is my baby getting enough milk?” The process can be difficult or confusing for new moms who are looking for support and education. As a result, some moms may stop breastfeeding earlier than they had hoped. In these cases, it may not be necessary to stop breastfeeding, but rather work with a lactation consultant who can evaluate milk supply, a baby’s breastfeeding skills, and any other factors that may be resulting in breastfeeding issues. They can also provide interventions and follow-up care until the problem, or concern, is resolved.

The difference between lactation consultants and lactation educators

Lactation specialists with the title IBCLC (international board-certified lactation consultants) are clinicians who have received advanced education and training in the fields of lactation, breast anatomy and physiology, infant feeding development, infant oral anatomy, and complex lactation issues and challenges. They have hundreds of hours of experience working with breastfeeding moms and babies. Lactation consultants are usually registered nurses, registered dietitians, feeding therapists, or doctors. Others working in the field of lactation may be trained as lactation educators or lactation counselors. These individuals have more limited training in lactation and breastfeeding than lactation consultants, and they focus mostly on education and support, rather than diagnosis and treatment of complex breastfeeding and lactation issues. A lactation consultant can assess, diagnose and treat many breastfeeding issues. When medications or special therapies are required, the lactation consultant will refer the mom and baby to a specialist who can provide additional care.

Common breastfeeding problems

 The most common breastfeeding problems moms encounter that might require lactation services include:

  • Difficult or painful latching
  • Low milk supply or too much milk supply
  • Infant weight loss (more than 10% loss from birth weight) or inadequate weight gain after two weeks post-birth
  • Fussiness at the breast, breastfeeding refusal, and nursing strikes
  • Breast or nipple pain and/or infections
  • Babies with special feeding needs including premature infants; twins and multiples; infants with medical issues that make latching and sucking difficult; or newborns with hyperbilirubinemia, yellow skin from too much bilirubin in the blood
  • Preparing to go back to work or school
  • Weaning and formula use
  • General breastfeeding education, support and follow-ups

How to find lactation services

Insurance companies, including Medi-Cal and Cal-Optima, are required to provide lactation services and supplies for the mom and baby in the hospital as well as at home. Services may be free or fee-based depending on the lactation provider and the family’s insurance coverage. Many birth hospitals offer free or low-cost breastfeeding clinics and services specifically designed for new moms, newborns and growing infants. Support groups are also common resources provided by birth hospitals. The Special Supplemental Nutrition Program for Women, Infants and Children (WIC), a federal program of the USDA, is another critical resource for many moms, and they too provide in-depth breastfeeding services, including consultations, classes, support groups and nutritional services. La Leche League support groups are also a good resource for education and support. They are available in most communities and provide a vital connection to lactation specialists and other breastfeeding moms in the community.

What to do if you need help breastfeeding:

  • Talk with your baby’s pediatrician who can evaluate if your baby is gaining weight properly and assess his or her mouth to determine if there are any conditions that might be causing sucking or breastfeeding problems. Many pediatric offices have lactation educators in their practice, or they can refer you to a lactation consultant in the community.
  • Contact your insurance company to determine your benefits for lactation services. They may require a referral from your pediatrician.
  • Contact your birth hospital or local community hospital to determine if they offer a breastfeeding hotline, breastfeeding workshops, classes or private consultations.
  • Call the National Women’s Health and Breastfeeding Helpline: 1-800-994-9662. Offered through the U.S. Department of Health and Human Services, this hotline is designed to address breastfeeding women’s questions. The hotline is available Monday through Friday, 9 a.m. to 6 p.m. ET.
  • Call your local WIC office to obtain information about their services and to determine if you qualify for their breastfeeding and nutrition programs.
  • Check with your local public health department, county health office, or any special mother/baby program to which you belong to determine if they offer breastfeeding education and support.
  • Reach out to a family member, friend, neighbor or co-worker who has breastfed. They may be able to provide you with the help and encouragement you need. You might be surprised to hear that they too had breastfeeding issues, and they might be able to share their tips and wisdom with you.

Breastfeeding help is often just a phone call away. Never hesitate to reach out for help. Working with a lactation specialist may be just the thing you need to help achieve an enjoyable successful breastfeeding experience and reap the benefits associated with breastfeeding.

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How one surgery inspired a career in nursing

By Lisa Turni, surgical unit nurse manager, CHOC Children’s

lisa-turni-rn-choc-childrens
Lisa Turni, surgical unit nurse manager, CHOC Children’s

I’ve been a nurse for 18 years, but the seeds of my career were planted long before I put on my first pair of scrubs. Although I didn’t know it at the time, having surgery as a teenager would ultimately inspire my career path.

Growing up, I was an athlete and especially loved playing basketball. Although I was in good shape, I was always out of breath and would hyperventilate often. I felt insecure because I thought I was giving my best at practice.

When I was 14 years old, my mom took me to the pediatrician who initially assumed I had asthma. But when my doctor lifted my shirt to listen to my breathing, she noticed a depression in my chest. I had always known it was there, but I thought that’s just how my chest looked. He diagnosed me with pectus excavatum, commonly referred to as “sunken chest.” This is when the breastbone, or sternum, and some of the ribs grow abnormally and cause a depression in the middle of the chest. Pectus excavatum is the most common congenital chest wall abnormality in children. Many cases of pectus excavatum are found in the early teenage years because growth spurts during puberty can exacerbate the chest depression.

I was referred to a surgeon, who explained that the depression in my chest was pushing down on my heart and lungs, which make it harder for them to work properly, and harder for me to breathe properly. He told me that I would need surgery to correct the deformity in my chest wall. I hadn’t realized there was anything I could do to fix it. He explained that during surgery, he would make an incision across my chest and reshape my rib cartilage which would keep my breastbone in the correct position.

As my surgery date got closer, I became more aware of the depression in my chest, and the way I thought about and saw myself started to change.

At that age, kids at school can be harsh. Sometimes they would unknowingly ask hurtful questions like, “Oh, why does your chest look like that?”

I started to realize I was different. Not necessarily all of the kids and comments were mean, but I was aware that I stood out. I changed the types of bathing suits and clothing I wore to hide the depression in my chest, a behavior I now know is common among pectus excavatum patients.

A physical abnormality is an emotional thing to shoulder as a child. It can be hard for others to understand how much it can affect a child emotionally. When I became a nurse, I used that understanding to inform the care I provided to my patients.

My surgery went well, and although that occurred in the days before the minimally-invasive Nuss procedure was invented, my surgeon was able to “hide” my scar near my bra line so it wouldn’t show in bathing suits or other clothing. The scar became a badge of honor. It was a sign of my courage.

My hospital stay after surgery is what led me to pursue nursing. I knew from that hospital stay that I wanted to help other kids. Some of my providers during that time got frustrated with me because I couldn’t take a deep breath or cough due to pain. Even though pain management has improved tenfold in the years since, the way my care team acted toward me has made me want to always treat patients better than they did.

After eventually getting my bachelor’s degree in nursing, I came to CHOC Children’s Hospital as a travel nurse. As soon as I stepped foot inside CHOC, I knew it was my forever home because of the people and culture.

I worked my way up to nurse manager of the combined medical/surgical unit. Later, when we created separate medical and surgical units, I chose to stay in the surgical unit. Giving back and taking care of patients undergoing surgery is my way of making a difference. I have a special connection with patients undergoing pectus excavatum surgery.

Even though my surgery was over 20 years ago, I’ve found that many pectus patients have similar journeys. When I share my story with my patients, I let them know they are not alone. When I was younger, I didn’t know anyone else who had this condition or understood what my surgery felt like.

Now, I do my best to connect my pectus excavatum patients with one another for peer-to-peer support. In fact, at CHOC, we’re developing a mentor program where former pectus excavatum patients, along with scoliosis patients, are trained to meet with new patients prior to surgery, and help answer their questions and be part of their support system alongside clinical staff.

I also make sure to be there for my patients’ parents as well. Parents often feel guilty for not noticing how deep the chest depression had gotten – but how could they have known? By the time their kids are becoming teenagers, the period during which pectus excavatum becomes most pronounced, they’re no longer in charge of bathing them and they’re not often seeing them without a shirt. I can comfort them in a unique way because my mom had similar feelings.

They are also understandably worried about their child’s surgery and recovery, and they seem grateful to talk to someone who is so many years post-surgery without any major complications. Parents usually have a lot more questions for someone who has been through it, and I spend as much time with them as they need. Thanks to our new mentor program, it has been amazing to see connections made between our parents and patients, and what a huge support that has been for them.

I’m grateful that I had pectus excavatum because it shaped who I am as a person. When I was younger, I didn’t realize how powerful nursing could be. I’m grateful this has been my journey because it feels right to be able to give back and to help patients and their families.

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How to support someone who is breastfeeding

Laura Mize, registered nurse, international board-certified lactation consultant at CHOC Children’s

Each year, World Breastfeeding Week is celebrated in early August  to raise awareness of the benefits of  breastfeeding. This year’s theme,  “Empower Parents, Enable Breastfeeding” was chosen to be inclusive of all types of parents in today’s world. Breastfeeding is a team effort and involves more than just the baby’s mom.

Here at CHOC, we want to help empower parents and enable breastfeeding by providing support if your child is in the hospital. We understand that having a child in the hospital is stressful, and we know that our pumping and breastfeeding moms may need extra support during this time. Your baby’s bedside nurse and the lactation team will work together to help your family achieve feeding goals.

The mom’s support person is an important part of the team too! Helping mom takes many forms and families come in many different varieties. The mom’s support person may be the baby’s dad or mom’s partner, or it may be a friend or family member. The support person has a unique role that provides needed help to mom and increases the support person’s bond with the baby. The CHOC team provides education and guidance for mom and her support person.

Here are some examples of how the support person can help on a day-to-day basis:

  • Skin-to-Skin with baby is not just for moms! The support person can also do skin-to-skin, as tolerated by baby. Ask your nurse for details.
  • Diaper changes and temperature taking at care time if it is ok with baby’s bedside nurse.
  • Serve as a gatekeeper for family and friends. Everyone wants to know how baby is doing! The support person can provide updates and guide family and friends that want to help.
  • Help mom by keeping track of when it is time to pump or breastfeed.
  • Make sure the pumping/breastfeeding mom is getting proper hydration and nutrition. Ask your bedside nurse about meals available for  pumping and breastfeeding moms.
  • Getting mom and baby into breastfeeding position can feel awkward and challenging at first. The support person can help guide mom and baby. CHOC lactation consultants can teach you what you can to do to help.
  • Wash pump parts so they will be clean and ready for next pump session.
  • Love the baby! Babies can never have too much love.

The support person plays a valuable and important role that benefits both mom and baby. Please ask your bedside nurse what you can do to support mom and baby during their hospitalization.

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What You Need to Know About Pectus Excavatum Surgery: Teen Mentors Explain

Having surgery is not easy, and no one knows that better than someone who has been through it.

CHOC Children’s patients who have undergone surgery for either pectus excavatum or scoliosis  have banded together to form a mentorship program for other patients who will be undergoing the same procedures. Teens and adolescents can connect with a trained mentor who knows what they’re going through and can help them navigate the physical and emotional aspects of surgery and recovery.

While it’s important to seek guidance from your medical team, sometimes as a teenager you just want to hear straight from other teens. We spoke with a few mentors who had the Nuss procedure to correct pectus excavatum (sunken chest), and they offered the following words of advice and encouragement.

What is one thing you wish you would have known before pectus excavatum surgery?

“I wish I would have known to just relax. I know it’s a hectic time; the number one tip from me is just to have a good night’s sleep and prepare. Bring all the essentials and more.”—Matthew H., now 17

Matthew-pectus-excavatum-tips
Matthew H.

“I wish I was more aware of the sudden diet change to ice chips during the first day of post-op care. I remember feeling uncomfortable about my inability to eat food or drink water a few hours after my procedure. If I knew how long I would be on ice chips after my procedure, I feel that I would’ve been able to push through it better than I remember.”—Matthew V., now 22

Matthew-v-pectus-excavatum-tips
Matthew V.

“The one thing I wish I had known before the surgery was how long each day actually was. You never really know how long a day actually is before you go through a surgery. I ended up only bringing my phone and a few books which I ended up rereading during my stay. There was only so much sleep I could get, and I found myself waiting for the next day; sometimes for hours at a time. If I could go back, I probably would have brought more things to occupy my time, not just my phone but also maybe my laptop, some movies and more books. My family and friends ended up being a really big part of my recovery and I can’t thank them enough. Their visits got me through the long days and I found myself up at night waiting for their next visit.”—Brandon, now 20

Brandon-pectus-excavatum-tips
Brandon

What modifications did you make after surgery?

“After surgery, I made sure to wear the most comfortable clothes and to have many pillows, especially since it’s impossible to lay on your side after the procedure.”—Matthew H.

“After surgery, I kept my phone near my bed so I could call one of my family members to help me get up every morning for the first two weeks. I also had to make sure that I was sleeping flat on my back and not turn over in my sleep. However, sleeping flat on my back in post-op helped me prepare for sleeping at home.”—Matthew V.

“We ended up actually propping my bed up a bit and angling it with pieces of wood. This made getting out of bed on my own a bit more manageable. I also developed a method of getting out of bed that I ended up using for almost two months after my surgery; I would bring my legs toward my chest with my hands while on my back and roll forward. This helped me avoid having to use my core to get up. Walking also became a pretty big part of my recovery experience. I would walk with my parents to the end of the neighborhood and back to try and regain some of my strength. I think the worst thing you can do for your recovery is to stay sedentary.”—Brandon

Knowing the recovery that comes with this surgery, would you choose to do it again?

“The month’s worth of pain is definitely worth a lifetime of improved quality of life. The month may seem like an eternity, but trust me, after the whole ordeal is over, you’ll be grateful that you’ve made the right decision.”—Matthew H.

“I would choose to do the surgery again. While it was a painful experience at first, the results you get from the procedure are well worth it.”—Matthew V.

“I would definitely do it again and I encourage anyone else reconsidering the surgery because of pain to do it. I ended up making a full recovery and I feel as if my lungs weren’t as limited after. I felt more comfortable doing sports and going out. The surgery made me feel more confident and comfortable in my own skin and in my opinion that’s worth the pain.”—Brandon

What advice would you give someone before their own surgery and hospital stay?

“If you’re a light sleeper, like me, make sure to bring earplugs or a speaker that can play white noise. There’s a lot of noise and that definitely affected my sleep time. Make sure you can swallow pills. I don’t know if it’s just me, but I couldn’t swallow the biggest pills the nurses gave me, so I had to use the pill crusher and that was not fun for 3 a.m. me. Eat a lot of food and walk around. I know after the surgery you may have a small appetite and not want to walk around. But eating more and walking around really sped up my recovery process. The spirometer really helps too. I left the hospital after four days.”—Matthew H.

“I would tell them that they’re in good hands and that the staff is very responsive and will take very good care of them. I’d also advise them to be patient with the recovery. Once the pain subsides, they’ll begin to feel the results.”–Matthew V.

“I would like to tell others considering the surgery that they aren’t alone. Dozens of us get these types of surgery at CHOC. You are in good hands, if not the best hands possible. Every person in the hospital – staff, nurses, doctors, etc. – is trying to make your stay at the hospital as comfortable as possible. While the surgery may seem like a really big leap of faith, just know that we’re all here for you and you can talk to any one of us, whether that’s staff or a patient. In the end we all want the same thing— for you, the patient, to feel better and recover as quickly as possible. So don’t feel alone, we’ll be here for you whenever you’re ready.”–Brandon

Learn more about having pectus excavatum surgery at CHOC

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What You Need to Know About Spinal Fusion Surgery: Teen Mentors Explain

Having surgery is not easy, and no one knows that better than someone who has been through it.

CHOC Children’s patients who have undergone surgery for either scoliosis or pectus excavatum have banded together to form a mentorship program for other patients who will be undergoing the same procedures. Teens and adolescents can connect with a trained mentor who knows what they’re going through and help them navigate the physical and emotional aspects of surgery and recovery.

While it’s important to seek guidance from your medical team, sometimes as a teenager you just want to hear straight from other teens. We spoke with a few mentors who had spinal fusion surgery to correct scoliosis, and they offered the following words of advice and encouragement.

What is one thing you wish you would have known before scoliosis surgery?

“I wish I would have known that many people go through the same surgery and that I shouldn’t feel alone. I also wish I would have known that recovery may be hard at times and that you will get through it.”—Tyanna, now 20

tyanna-spinal-fusion-tips
Tyanna

“I wish I would have known how constipated the medicine would make me. I found that my constipation and stomach pain were bugging me more than my back pain, so I stopped taking the pain medicine pretty early. Also, the catheter sounded scary at first, but it was actually the most helpful thing ever since I didn’t have to worry about getting up to use the restroom.”—Jessica, now 19

jessica-spinal-fusion-tips
Jessica

“I wish I would have known that I would experience stomach pain as well as back pain. Knowing that would’ve helped me prepare for the pain rather than get nervous about it when I endured the nausea.”—Taylor, now 14

taylor-spinal-fusion-tips
Taylor

What modifications did you make after surgery?

“I slept with many more pillows around me. Once I got back to school, I brought a pillow to school to use for my back. Going out to restaurants, I would also bring a pillow to support and make my back feel more comfortable. After surgery, I wore mostly baggy clothing, so it was easier to take on and off.”—Tyanna

“I couldn’t carry a backpack, so my school library gave me a set of textbooks for home and a set for school, so I didn’t have to carry heavy books back and forth. I slept with a pillow under my knees when I was sleeping on my back. If I slept on my side, I would put a pillow between my knees and behind one shoulder.”—Jessica

“When I was in the hospital, I had to do physical therapy. The first thing I learned was the barrel roll. This taught me how to get out of bed comfortably and it really helped. I continued to do the roll for a few weeks after my surgery.”—Taylor

Knowing the recovery that comes with this surgery, would you choose to do it again?

“It was a little tough for me during the recovery time, but I know that since I have gone through it once, I would be able to go through it again if I had to. Although having this surgery and recovering was tough on me, it was one of the best decisions I had ever made in my life.”—Tyanna

“Some days were harder than others, but I had so much support from my nurses and family which made me feel so much better. If I had to do this surgery again, I probably would because it wasn’t as bad as I thought it would be and I recovered pretty fast the first time.”—Jessica

“It completely changed my life for the better. Although I don’t have much back flexibility anymore, living my life without the pain and the back braces has just made me such a happier person. Also, I became more confident. Before the surgery, I had a big hump on my back due to my curve and I was very self-conscious about it. Taking that hump away just made me more confident and I loved the way my back looked with my ‘battle scar.’”—Taylor

What advice would you give someone before their own surgery?

“I think that everyone has their own story and experiences with scoliosis, but I would just say, have a great support system and keep yourself surrounded by family and friends to keep you staying positive. Recovery may get hard at times; you just have to keep pushing through it and you will be healed and fully recovered in no time.”—Tyanna

“Wear your hair in French braids the day of surgery so you don’t have to worry about your hair when you’re at the hospital. Dry shampoo will be your best friend! Watch YouTube videos of scoliosis surgery recovery vlogs so you can have an idea of what it’s going to be like. Don’t compare yourself to others and don’t be hard on yourself if it’s taking longer than you thought it would to recover. You will get there in the end; just go at your own pace. It’s natural to feel fear going into surgery, but just go in with confidence and positivity.”—Jessica

“Stay strong. You may want to give up with your physical therapy, but you can’t. The more determined you are, the quicker your recovery will be. I know the pain will be tough. Just know you aren’t alone and there are people there to give you their love and support. You got this!”—Taylor

Learn more about having scoliosis surgery at CHOC

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