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 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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Healthy drinks for kids this summer

By Christina Wright-Yee, registered dietitian at CHOC Children’s

Heading into summer in Southern California means anticipating the above 100-degree temperatures, but we know what we need to do: hydrate, hydrate, hydrate! While registered dietitians and doctors encourage you to drink plenty of fluids throughout the summer, we also want to help you make healthy decisions. Sodas, juices, slushies, iced coffee and sports drinks may be fluids, but they can be full of calories and sugar that can lead to weight gain, heart disease and cavities.

The World Health Organization (WHO) suggests limiting our added sugars to less than 5% of our calorie needs. For kids ages 2-8, this is about three teaspoons per day. For kids older than age 8, it’s no more than six teaspoons per day. New research suggests even 100% fruit juices are similar to the sugars added to the soda and other sweetened beverages, meaning juice is no healthier than soda!

The amount of sugar in your favorite beverage may surprise you! One teaspoon is equivalent to one sugar packet like the ones you might find at a restaurant or café. In the below table, the serving size for all beverages is 12-ounces, even if the average serving size is typically larger.

Sugar content in your favorite drink
Type of beverage Number of packets of sugar
Water 0
Diet sodas or sugar-free drink mix 0
Powerade Zero or Propel 0
“Light” Sodas 0-2
Unsweetened tea 0
G2 Gatorade 2.5
Sports drink (Gatorade/Powerade) 5
Lemonade 6.25
Orange juice 7.5
Snapple iced/sweet tea 8-8.5
Powdered drink mix (with sugar) 9
Cola soda 10.25
Fruit punch 11.5
Root beer 11.5
Grape juice/cranberry juice cocktail 12
Orange soda 13
Starbucks Frappuccino 14
Naked/Odwalla Juices 12-14

Remember to always read the nutrition facts label to find out the actual amount of sugars and added sugars. When choosing a drink for you or your kids this summer, you might see the terms sugar-free, reduced sugar or no added sugars. Here’s what they mean:

  • Sugar free: less than 0.5g sugar per serving
  • Reduced sugar: less than 25% less sugar than the typical brand, but this doesn’t mean it is always the healthiest option. There still might be other beverage options lower in sugar.
  • No added sugars or without added sugars: no sugar added during processing, but the product may have naturally occurring sugars.

What can you do to stay hydrated and healthy this summer while quenching your thirst?

  • Swap out your favorite drink for one lower in sugar
  • Eat nutrient-rich juicy fruits and vegetables that contain more than 90% water, including: watermelon, cantaloupe, honeydew melon, frozen grapes, pineapple, grapefruit, berries, cauliflower, bell peppers, broccoli and tomatoes. Just watch portion sizes!
  • Make your own popsicles using fresh fruits and veggies
  • Add mint and lemon to an ice cube tray and freeze with water, then pop them into water or sparkling water for added refreshment!
  • Add lemon, lime, mint, strawberries, cucumbers or berries to sparkling water or water to boost the flavor.
  • Make homemade lemonade to cut back on the amount of sugar found in store-bought lemonade!
  • Try making a watermelon slushy. Mix two cups watermelon, 1-2 cups of ice, and 1 sprig of fresh mint in a blender and blend until smooth. Add ice to reach desired consistency.

Get important nutrition tips like these sent straight to your inbox

Kids Health, delivered monthly, offers “healthful” information for parents.

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    A registered dietitian at CHOC Children’s Hospital offers creative ideas to parents for healthy snacks for kids this summer.

Healthy snacks for kids this summer

By Janelle Sanchez, registered dietitian at CHOC Children’s

Summer is right around the corner, which brings with it, endless pool days, picnics in the park, and surfing. Staying hydrated is an important part of staying safe this summer. Our bodies are 60% water which maintain the function of various systems including your heart, brain and muscles. Sufficient water intake also helps to regulate your body temperate and even help prevent constipation. It is important to pay attention to not only the water you are drinking, but to be mindful of consuming foods that will also contribute to your water intake. What better way to fight off the heat than by cooling down with some refreshing treats?

Summertime also generally includes a lot of relaxation, celebrations and parties- which often translates into more fun foods than healthy foods, leading to an increased risk for weight gain.

Let’s look at some common summertime treats and try swapping those out with some healthier and more hydrating choices.

Instead of a sugary frozen slushie drink, prep some Cucumber Mint Citrus Infused Water:

  1. Fill pitcher up with water. To make a sizzling drink, use unflavored sparking water.
  2. Add 1 lemon sliced, 1 sliced lime (or as desired), 1/2 cup mint leaves, 1/2 cup sliced cucumber, and stir.
  3. Refrigerate overnight, stir and enjoy!

Instead of indulging with an ice cream sandwich, opt for a DIY Fruit and Yogurt Popsicle:  

  1. Blend your favorite fruit  in a food processor or blender on high speed until nearly liquified into a smoothie-like consistency. Try blueberries, raspberries, strawberries or banana.
  2. Pour blended fruit into a large bowl. Add Greek yogurt and lightly mix together. Blend more to get a mixed look, blend less to get a more patterned white and fruit look. For additional sweetness, try adding some agave or honey to the mix.
  3. Pour the thick liquid into popsicle molds. If your popsicle mold has slots for sticks, you can insert them before freezing. If not, freeze for two hours, then insert a wooden popsicle stick in the middle of each mold. Continue to freeze for an additional four to six hours or overnight.
  4. Run popsicle molds under warm water to easily remove.

Recipe adapted from https://sallysbakingaddiction.com/3-ingredient-blueberry-yogurt-swirl-popsicles/

Instead of opting for corn dogs or pizza for a quick meal, try this Avocado Chicken Salad:

  1. Drain and shred canned chicken or tuna in a bowl.
  2. Chop up cilantro, avocado, cucumber, bell peppers, tomato, red onion and add to the protein mix.
  3. Squeeze fresh lemon juice into a bowl, add salt, pepper, and a drizzle of olive oil. Mix together, and pour over salad mixture.
  4. Eat with a spoon and enjoy! Or add inside of a whole wheat pita and enjoy as a wrap!

More ideas for healthy summer snacks for kids:

  • Frozen grapes
  • Frozen bananas dipped in Greek yogurt and chocolate chips or nuts
  • Hydration-loaded fruit and vegetable “fries” including jicama, watermelon and cucumber sticks
  • Chilled spring rolls
  • Cold pasta salad made with zoodles and a light dressing
  • Fruit-filled ice cubes

Get important nutrition tips like these sent straight to your inbox

Kids Health, delivered monthly, offers “healthful” information for parents.

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Tips for traveling with picky eaters

By Sarah Kavlich, registered dietitian at CHOC Children’s

When you’re a parent dealing with a picky eater, childhood and
picky eating can seem synonymous. It’s easy to cater to the pickiness in an
effort to avoid a struggle at mealtimes. However, this can sometimes worsen their
habits. With summer just around the corner and as we move into warmer months
filled with fun, travel and a break from school, parents can use this
opportunity to try some new and interesting foods with their picky eater. Whether
you’re traveling or staying at home, this time of year can offer an opportunity
to experience a new culture through food.

Tips for introducing
new foods to toddlers

Remember that kids are learning
to eat so consider changing your mindset before heading into meals. Remember
that they won’t necessarily eat much of a new food the first time they try it. Repeated
exposure to that new food will help them become more comfortable with the food
over time. Research suggests it can take up to 20 encounters with a food before
someone develops a preference. So, if it is a food you would like to be a
mainstay in your child’s diet, don’t give up right away but also don’t force
it. Maintain structure by letting your child know that everyone in your family
eats the same meals, and there are no separate kids’ meals. This can be a tough
pattern to break but offering a small amount of the new food alongside a few
familiar foods or a favorite dipping sauce during the meal can help.

Tips for traveling
with picky eaters

Exposing your children to new foods while at home, in a lower pressure environment, can help expand their palate before traveling. Start by offering just a small taste test of the new food alongside some familiar foods that your child already feels comfortable eating.

Talk about your upcoming adventure and some of the things your
family might experience there, including testing new food together. Kids learn
by example and often model the behavior of the people they are closest to, so
make sure you have an open mind as well. It’s ok for children to have different
food preferences than their parents.  If
your child shows interest in a new food that you may not enjoy, go ahead and
let them try it without assuming they won’t like it.

On your trip, pack a few of your child’s favorite foods or snacks that travel well like bars, dry cereal or crackers, or pick up some fruits, vegetables, yogurts, or cheese at a local market to help ease them into the new cuisine. Healthy snacks will also help your child from becoming overly hungry between meals. Use words like “exploring” and “adventure” as you offer new foods to promote a more enjoyable atmosphere. Most importantly have fun as you learn together and create lasting memories with your family.

At home before a trip, set the stage by offering some of the foods
you might experience on your upcoming travels, like this healthy recipe:

Rice with Lemongrass and Green
Onion
from
Epicurious.com

(Serves
four)

2
tablespoons vegetable oil

2/3
cup finely chopped onion

1/4
teaspoon turmeric

1
cup long-grain white rice

1
3/4 cups water

2
12-inch-long lemongrass stalks, cut into 2-inch-long pieces

1/2
teaspoon salt

1
large green onion, chopped

Preparation

Heat
1 1/2 tablespoons oil in heavy medium saucepan over medium heat. Add 2/3 cup
onion and turmeric and sauté 5 minutes. Mix in rice. Add water, lemongrass and
1/2 teaspoon salt and bring to simmer. Cover, reduce heat to medium-low and
simmer until rice is tender and liquid is absorbed, about 18 minutes. Remove
from heat; let stand covered 10 minutes. Discard lemongrass.

Heat remaining 1/2 tablespoon oil in heavy large skillet over medium heat. Add green onion and sauté 1 minute. Add rice and stir until heated through. Season to taste with salt.

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Kids Health, delivered monthly, offers “healthful” information for parents.

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