Breastfeeding: A Foundation for Life

By Alana Salcido, registered nurse and lactation consultant at CHOC Children’s

If you were to ask me back in nursing school what kind of nurse I wanted to be, I guarantee I never would have said I wanted to become a lactation consultant. I honestly didn’t even know this was a specialty at that time. Helping other moms succeed with breastfeeding is my way of giving back and my way of changing the world, one couple at a time.

World Breastfeeding Week 2018

Today kicks off World Breastfeeding Week, an annual observance to bring awareness to the importance of human milk and to offer education and encouragement to mothers, health care providers, and the community.

Breast milk is constantly changing

A mother’s milk is constantly changing. Her milk will actually change from feeding to feeding, day to day, month to month as her baby grows. For example, the first milk, known as colostrum, is rich in components that prevent and protect the newborn from common and potentially serious infections. Breastfeeding not only provides exceptional nutrition but it also promotes lifelong health benefits.

Benefits of breastfeeding: preventing disease

Breastfeeding is the most economical solution to the biggest threat against children’s health worldwide: malnutrition and preventable diseases. In developing countries, human milk can mean the difference between life or death in children under five because a mother’s milk provides necessary nourishment for babies.

Breast milk-fed infants have significantly lower rates of illness—even in industrialized countries. The longer a mother breastfeeds, the more infection fighting antibodies are passed to her infant through her milk. Just as the womb protected and nourished the developing child during pregnancy, the body was preparing to protect and nourish her baby after birth by stimulating milk production as early as 12-14 weeks gestation.

Lifelong benefits of breastfeeding

Research has shown that babies who receive breast milk have a lower risk of hypertension, type 1 and type 2 diabetes, allergies, cancer, asthma, intestinal and respiratory infections, and obesity both during childhood and adulthood. Health benefits occur not only for the baby, but for the mother as well. Breastfeeding helps reduce the maternal risks of diseases such as hypertension, type II diabetes, high cholesterol, osteoporosis, breast cancer, and even Alzheimer’s Disease. Research has shown that the health benefits, for both mom and baby, are dose dependent. This means that the longer a woman breastfeeds the greater the health benefits she and her baby receive. Because of this, the WHO (World Health Organization) recommends breast milk in a child’s diet for the first two years of life (with the addition of appropriate complimentary solid foods beginning at 6 months of age).

Lactation consultants can help mothers provide the benefits of breastfeeding

Some mothers who wish to breastfeed their babies face challenges. Statistically, 75 percent of moms in the U.S. start out breastfeeding. By the time babies are six months old, only 44 percent are breastfed.

CHOC Children’s has a team of registered nurses who are international board-certified lactation consultants. We work closely with medical teams to provide support to mothers who need assistance in producing lifesaving breast milk for children. We can also help them achieve their lactation goals which may be different for each mother and could include pumping milk for the first six months, or it might be to exclusively breastfeed until the baby is a year old. We want every child at CHOC to receive optimal nutrition. For the newborn, infant and young child, we support breastfeeding and breast milk use. We firmly believe it when we tell our families that breast milk Is medicine.

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Frozen Breastmilk Safety 101

By Caroline Steele, board-certified lactation consultant, board-certified specialist in pediatric nutrition, and registered dietitian at CHOC Children’s

Caroline Steele, director of clinical nutrition and lactation at CHOC Children’s

CHOC has board-certified lactation consultants as well as certified lactation educators available to assist breastfeeding or pumping moms. Many of our other staff members, including nurses, dietitians and developmental specialists, can also assist families with breastfeeding and pumping, and many have specialty lactation training.

Because nutrition is one of the most important factors in a baby’s health, CHOC Children’s provides lactation services to mothers who wish to breastfeed or pump while their baby is in the hospital.

Here are answers to some of the most common questions we receive on frozen breast milk safety.

Can breastmilk be frozen?

Yes, breastmilk can be frozen and should be frozen if it won’t be used right away (similar to what you would do with other foods).

What is the safest way to freeze breastmilk?

  • For preterm or hospitalized infants, it is generally recognized that milk that will not be used within 48 hours after it is pumped, should be frozen. For healthy babies at home, it is possible to store freshly pumped milk in the refrigerator for 5 days before needing to freeze it.
  • Milk should be frozen in rigid plastic bottles or plastic bags specifically designed for breastmilk storage. Plastic bags are not recommended for hospitalized infants because they are prone to leaking and are more difficult to handle in the hospital setting.
  • Freeze milk in volumes that the baby would normally eat so that once it is thawed, none is wasted.
  • Never add freshly pumped milk to a bottle already containing frozen milk. Newly pumped milk should go into its own container.

How long can breastmilk be frozen?

  • If freezing/storing breastmilk in a combination refrigerator/freezer unit, the milk should be stored in the back of the freezer to keep it from being exposed to temperature fluctuations when opening and closing the freezer door. In this type of unit, the milk may be stored 3-6 months.
  • If freezing/storing breastmilk in a deep freezer that can maintain a temperature at or below zero degrees Fahrenheit, it may be stored for 6-12 months.
  • Once frozen milk has been thawed, it must be used within 24 hours or discarded.

I’m giving my baby frozen breastmilk. Are there any risks I should know about?

  • It is best to use the oldest pumped milk first to prevent milk from being frozen too long.
  • Some of the immune enhancing properties of breastmilk are decreased over time when milk is frozen. However, the risk of bacterial contamination of milk that has been kept in the refrigerator too long and not frozen, far outweighs the downside of freezing milk.
  • Sometimes there are slight changes in the taste and smell of milk that has been frozen due to the enzymes naturally present in breastmilk. Those changes are not harmful and don’t matter to most babies.  However, some babies do have a noticeable preference for milk that has not been previously frozen.
Get more helpful tips about lactation and breast milk

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How to Tell If Your Baby is Getting Enough Milk from Breastfeeding

By Michelle Roberts, registered nurse and certified lactation consultant at CHOC Children’s

Every year in August, we celebrate World Breastfeeding Week. This year’s focus is “Sustaining Breastfeeding Together.” As a lactation consultant, the most common question I get from parents of a breastfed infant is, “How do I know my baby is getting enough?” When we bottle feed an infant we can look at the measurements on the bottle to determine the exact amount that a baby gets. When a mom is breastfeeding, she may be concerned because she can’t see the amount taken. A common reason women give up on breastfeeding is feeling they are not producing enough milk.

Here are 5 key indicators a baby is getting enough milk directly from the breast.

  • Breastfeeding 8-10 times minimum per day. Newborn babies should be breastfed a minimum of 10 times per 24 hours. As the baby gets older and is gaining appropriate weight, they may cut back to 8 times per 24 hours. We recommend keeping a breastfeeding log. Start by downloading a template breastfeeding log.
  • Latches well and maintains latch. Babies should latch and remain latched without coming on and off throughout the feeding. It can be difficult to transfer adequate milk if they are not staying on the breast. For the most part, breastfeeding should not be painful. If you are experiencing bleeding or scabbing, the latch is not deep enough and can lead to low weight gain and low milk supply.
  • Audible swallowing. A baby’s suck pattern and frequency of swallowing will change throughout the first three to five days. When a baby is first born, they will be sucking more often than swallowing but as mom’s milk supply increases, the swallowing should increase too. Mom’s milk usually increases between Day Three and Day Five after giving birth.
  • It is important to track a baby’s diapers to make sure they are producing enough diapers based on their age. Your birth hospital or your pediatrician will provide you with a diaper log that will show you how many wet and dirty diapers are expected based on your baby’s age.
  • Weight Gain. All newborn babies lose some weight shortly after birth. Your pediatrician will determine if they lose too much weight. Once mom’s milk supply has increased in volume, the baby should gain an average of 1 oz. per day.

What do you do if you are not sure your baby is getting enough at the breast?

Your pediatrician is always a great person to help you determine whether your baby is doing well. It is also helpful to reach out to women in your life that have breastfed. Call your mom, your sister, a neighbor or a friend for support. It is also beneficial to be aware of your resources within your community. Most birth hospitals have lactation consultants that can work with you on an outpatient basis. A lactation consultant will be able to determine the amount of milk a baby transferred from your breast to your baby’s stomach by using a breastfeeding scale. They can also assist with supplementing at the breast directly.

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World Breastfeeding Week is Aug. 1-7

CHOC Children's Clinical Nutrition and Lacation ServicesBy Joanne DeMarchi, MA, RD, IBCLC, lactation consultant at CHOC Children’s

In recognition of World Breastfeeding Week (WBW), below are some helpful guidelines for working moms who wish to breastfeed.

WBW is celebrated every year in more than 170 countries. Its purpose is to encourage breastfeeding and improve the health of babies around the world. It also encourages government agencies, professional health organizations and advocates to work together to promote awareness of the many benefits of breastfeeding. This year’s theme, “Breastfeeding and Work – Let’s Make it Work!” revisits the 1993 WBW campaign on the Mother-Friendly Workplace Intitiative. Much has been achieved in 22 years of global action supporting women in combining breastfeeding and work.

The American Academy of Pediatrics (AAP) recommends exclusive breastfeeding after birth and continuing until a baby is at least six months old. Nutritious complementary foods should then be added while a baby continues to be breastfeed for one year or beyond.

According to the Centers for Disease Control and Prevention (CDC) Breastfeeding Report Card – United States 2012, exclusive breastfeeding rates in California are 21.7 percent. Although these rates are improving every year, supporting breastfeeding mothers who return to work is key to increasing these numbers. Breastfeeding mothers are encouraged to use these strategies:

  1. Buy or rent a double electric breast pump before returning to work. Breast pumps are a covered benefit under most insurance plans. Choosing a high-quality electric pump is particularly important for working moms.
  2. Utilize professional support to solve breastfeeding issues. Most birth hospitals offer lactation consultations. WIC and La Leche League support groups are available in most communities. posts helpful evidence-based information for breastfeeding moms.
  3. When moms return to work, they can utilize a pump room at their worksite. The Patient Protection and Affordable Care Act requires employers to provide “reasonable break time and a place” for an employee to express breast milk.
  4. Breastfeeding may lower health care costs, fosters better employee retention rates, and boosts productivity and loyalty to employers.
  5. The USDA provides a variety of breastfeeding resources at

 Learn more about CHOC Children’s Clinical Nutrition and Lactation Services.

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Benefits of Breastfeeding

“Breast milk is the ideal food for babies. It has the vitamins, protein and fat that a baby needs to grow. It’s easy to digest, contains antibodies that help the baby fight off illnesses and lowers the baby’s risk for having asthma, allergies and becoming obese,” says Dr. Bixby, CHOC’s medical director of lactation services. Babies exclusively breastfed for the first six months also tend to have fewer ear infections, respiratory illnesses and diarrhea, Dr. Bixby says. Plus, breastfeeding helps mom and baby bond. The American
Academy of Pediatrics, the American College of Obstetricians and Gynecologists, and the World Health Organization all strongly recommend breastfeeding. And, it’s free!

In the case where a mom can’t produce or sustain her own milk supply, for whatever reason, donor human milk is an excellent alternative to a mother’s breast milk or formula, says Dr. Bixby. “Donor milk isn’t as good as the mother’s own milk but it’s way better than formula, especially for preterm babies or those with gastrointestinal or digestive issues that make it harder for the baby to digest food. Breast milk is designed to help move the gut better. It is a limited resource so at CHOC, we mostly use donor milk for preterm babies under 32 weeks old and also at times for some of our surgical patients.”

CHOC’s Clinical Nutrition and Lactation Services department seeks to be a helpful source of nutrition and lactation information for patients, their families and the community. Individualized, family-centered and culturally sensitive lactation care is part of CHOC’s interdisciplinary approach to healthcare and wellness. CHOC has board-certified lactation consultants on hand to help patients who are breastfeeding or receiving donor breast milk. For information about inpatient lactation services at CHOC, call (714) 509-8455.


  • Percentage of infants in California who were breastfed in 2013: 91.6
  • Percentage of infants nationwide breastfed at 6 months (infants born in 2010) – up from 35% of infants born in 2000: 49%

View the full feature on Babies and Breastfeeding

Dr. Bixby
Dr. Christine Bixby
CHOC Neonatologist


Dr. Bixby is CHOC’s medical director of lactation services. Dr. Bixby completed her fellowship in neonatology at Harbor UCLA Medical Center and also completed her residency and internship training in pediatrics at Harbor UCLA Medical Center. She completed a fellowship in neonatology in a joint program between CHOC and Harbor UCLA Medical Center. Dr. Bixby specializes in caring for premature infants and is involved in research studies focusing on issues related to breast milk, establishing a milk supply and using breast milk for premature babies.

Dr. Bixby’s philosophy of care: “My philosophy of care is to bring in the parents and family as part of the healthcare team and making sure they are educated and  comfortable with the care we are giving their children.”

University of California, Davis, School of Medicine

Neonatal-Perinatal Medicine

More about Dr. Christine Bixby

This article was featured in the Orange County Register on July 7, 2014, and was written by Amy Bentley.