Nursing Strikes and Starting Solid Foods with Erin Walsh, MA, CCC-SLP, IBCLC, BCS-S

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<v SPEAKER_1>And this might be contributing to why teachers are leaving education.

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<v SPEAKER_4>I think it is really, really critical to not force the baby.

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<v SPEAKER_4>I've heard some scary stories that if your baby gets hungry enough, they'll nurse, but that approach doesn't really establish trust.

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<v SPEAKER_5>Hey there, I'm Katie Ferraro, registered dietitian, college nutrition professor, and mom of seven, specializing in baby-led weaning.

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<v SPEAKER_5>Here on the Baby-Led Weaning with Katie Ferraro podcast, I help you strip out all of the noise and nonsense about feeding, giving you the confidence and knowledge you need to give your baby a safe start to solid foods using baby-led weaning.

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<v SPEAKER_5>What is a nursing strike?

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<v SPEAKER_5>A nursing strike is a temporary period when your baby who's been breastfeeding, well, they suddenly will start to refuse to nurse.

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<v SPEAKER_5>And that change of behavior can be so confusing, it can be so stressful for both the baby and the mom.

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<v SPEAKER_5>But it usually happens for a couple of different reasons, and it's not a signal that your baby is ready to wean.

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<v SPEAKER_5>So what are some reasons why a baby might, quote unquote, strike, okay?

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<v SPEAKER_5>It might be teething or illness, they've got pain in their gums or their ears, and that sucking experience can be uncomfortable.

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<v SPEAKER_5>It might be changes in the routine or the environment, like if you're traveling or there's a new caregiver or distraction, some moms experience reduced supply or flow.

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<v SPEAKER_5>And we're going to talk about that today.

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<v SPEAKER_5>Also, sometimes a mom's reaction, if the mom is reacting strongly and doing the biting or other behavior during nursing, that baby might become hesitant to nurse.

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<v SPEAKER_5>And a nursing strike can last for a few days to over a week, but with a lot of patients, most babies are going to return to breastfeeding.

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<v SPEAKER_5>But I know that interim period, as a mom feels so scary.

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<v SPEAKER_5>And my guest today is here to talk about nursing strikes and changes in breastfeeding when your baby starts solid foods.

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<v SPEAKER_5>Her name is Erin Walsh.

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<v SPEAKER_5>She's a speech language pathologist and she's an Ibclc.

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<v SPEAKER_5>So that means she's internationally board certified lactation consultant.

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<v SPEAKER_5>But as a speech and language pathologist, she has a really interesting job.

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<v SPEAKER_5>So she works at UC San Diego, which is an academic medical center here in San Diego, where I live.

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<v SPEAKER_5>And I know her through other colleagues.

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<v SPEAKER_5>Her expertise is that she works in an ENT clinic.

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<v SPEAKER_5>So she works with three surgeons, six speech pathologists, and she has a very interesting background.

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<v SPEAKER_5>She'd always worked with professional singers and people who had voice problems.

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<v SPEAKER_5>She actually has a piano in her room.

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<v SPEAKER_5>She said that voice problems in musicians, singers, are almost always paired with an airway or a swallowing disorder.

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<v SPEAKER_5>So she actually didn't intend to become an SLP.

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<v SPEAKER_5>She said she went to college for singing and kind of fell into this area.

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<v SPEAKER_5>Now, she's been an SLP for over 20 years.

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<v SPEAKER_5>She's been an Ibclc, so specializing in breastfeeding for over 15 years.

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<v SPEAKER_5>Her expertise is in helping families establish breastfeeding just after birth.

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<v SPEAKER_5>And then if things start to go awry and they need help with continued breastfeeding, that's where Erin comes in.

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<v SPEAKER_5>So she does a lot of work on oral motor function.

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<v SPEAKER_5>She does research in this area.

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<v SPEAKER_5>She's working on a smart pacifier with some engineers, which I think is a very exciting business opportunity that she's exploring.

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<v SPEAKER_5>And Erin did a deep dive on the research about nursing strikes.

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<v SPEAKER_5>And it's pretty interesting that really there's only two published studies about nursing strikes out of Iran.

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<v SPEAKER_5>And there's just not a lot of data about this.

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<v SPEAKER_5>So what Erin's bringing to this interview is her expertise from an anecdotal standpoint.

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<v SPEAKER_5>What do parents tell her about when they're starting solid foods, about the changes that they're experiencing in breastfeeding?

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<v SPEAKER_5>And then how can, she uses the word organize, which I love when therapists use that word a lot.

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<v SPEAKER_5>How do you organize the solid food feeds with the continued breastfeeding?

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<v SPEAKER_5>And of course, as an Ibclc breastfeeding expert, she's really, really gonna help her clients try to stay committed to breastfeeding for beyond the one-year mark.

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<v SPEAKER_5>And she'll talk a little bit about that as well.

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<v SPEAKER_5>So with no further ado, I want to introduce you to Erin Walsh.

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<v SPEAKER_5>She's talking about nursing strikes and changes in breastfeeding when starting solid foods.

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<v SPEAKER_4>More often than not, what constitutes a true nursing strike, I've seen more commonly in babies before they're even eating solids.

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<v SPEAKER_4>But many families come in with questions about how do you organize taking solids with breastfeeding?

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<v SPEAKER_5>Erin, can you tell us a little bit about the research around nursing strikes?

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<v SPEAKER_5>Because as I understand it, there's not a whole lot that has been published about this idea of a nursing strike.

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<v SPEAKER_4>I filmed two studies on PubMed in the last 10 years about nursing strikes, and they were both out of Iran.

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<v SPEAKER_4>The first was published in 2015, and it looked at infants that were attending their routine six-month well child check.

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<v SPEAKER_4>They had 175 infants that were enrolled in the study, and they found that 24 percent of babies at some point exhibited behavior that was consistent with a nursing strike, and realized this is before solids are introduced.

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<v SPEAKER_4>I think that's important to note.

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<v SPEAKER_4>I see many of them that's before solids are introduced, and it was most commonly associated with maternal education and working status, which of course smarted a bit because that's me or was me.

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<v SPEAKER_4>And other factors that they discovered included age-appropriate playfulness.

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<v SPEAKER_4>So it was really normal for a baby around three or four months to have lots of squirrel moments, and every personality is different, but sometimes you had to be in a really dark room to get them to eat.

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<v SPEAKER_4>And then they also talked about nasal obstruction being a cause of a nursing strike.

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<v SPEAKER_4>The other study was published in 2021, and they found 70 infants who came to the doctor because of a nursing strike, and they took demographics on the mom and on the baby, and they found the following factors associated with breast refusal.

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<v SPEAKER_4>50% was just these squirrel moments.

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<v SPEAKER_4>They were just distractible and interested in the world.

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<v SPEAKER_4>48% had vaccinations in the preceding 12 days, so they just didn't feel well.

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<v SPEAKER_4>And then the maternal factors, they came back to the higher levels of education.

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<v SPEAKER_4>So 67% involved parents who had presumably gone back to work.

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<v SPEAKER_4>41% related to acute stress.

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<v SPEAKER_4>And then I was really surprised that only 35% was a drop in milk supply, because that's anecdotally what I've seen a lot of.

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<v SPEAKER_4>But don't quote me on this, but I'd make the case that maybe someone went back to work, it was really stressful, and then their supply went down.

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<v SPEAKER_5>So Erin, when you were looking in the literature at a nursing strike, like I know it's a term that gets thrown around probably very loosely, like many things in the infant feeding world, in social media or in mom's groups, what especially do the researchers look at to constitute a quote unquote nursing strike?

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<v SPEAKER_5>Like what is that consistent behavior that they're gonna say, okay, yes, this is a nursing strike?

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<v SPEAKER_4>Weaning is gradual and not abrupt.

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<v SPEAKER_4>I think that's important to note.

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<v SPEAKER_4>So a nursing strike is a sudden refusal to latch and drink from the parent.

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<v SPEAKER_5>And does it mean like the baby totally goes down to nothing?

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<v SPEAKER_5>I mean, you were mentioning that there's squirrely babies that are, you know, kind of shiny object syndrome, looking around at everything, and maybe not paying attention?

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<v SPEAKER_5>Or is it like a nursing strike is like, oh my gosh, my baby had zero intake for three days?

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<v SPEAKER_5>Or is it just kind of anecdotal?

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<v SPEAKER_4>There's sort of variations of that.

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<v SPEAKER_4>The squirrel moments, I think maybe aren't, I think that's a distracted baby, and not really a baby that's on a nursing strike.

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<v SPEAKER_4>And then there are other babies, and I would say it's very personality dependent.

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<v SPEAKER_4>I mean, the personalities of my two children, now age eight and 13, totally played out from when they were babies, you know, that one of them wanted everything to be just so when it was time to eat.

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<v SPEAKER_4>And they're still like that.

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<v SPEAKER_4>You know, there are some kids when they go to, maybe they have a caregiver, and they start having bottles and a ritual that happens when they're not with their mom in nursing.

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<v SPEAKER_4>And it can really throw things topsy-turvy.

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<v SPEAKER_4>And it can be hard to get that baby to latch again, and others just don't care.

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<v SPEAKER_4>They'll eat whatever you give them, and they're real easy going.

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<v SPEAKER_4>So it's very personality dependent.

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<v SPEAKER_5>Hey, we're gonna take a quick break, but I'll be right back.

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<v SPEAKER_1>Hi, I'm Charles Fournier from the podcast Those Who Can't Teach Anymore.

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<v SPEAKER_1>During my first year of teaching, I learned pretty quick that teaching was not what I saw in dead poet society.

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<v SPEAKER_1>And I wasn't the only one that thought this.

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<v SPEAKER_2>But I also had it in my head, the image of the cool, thoughtful, worldly, literary teacher that you see in dead poet society.

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<v SPEAKER_1>And this image of education might be contributing to why teachers are leaving.

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<v SPEAKER_1>The reality of the classroom is not what is seen on TV, but too many folks don't know this.

00:10:28.836 --> 00:10:31.076

<v SPEAKER_1>Listen to Those Who Can't Teach Anymore.

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<v SPEAKER_1>It's an award-winning, ambi-nominated, teacher-made podcast series that explores why teachers are leaving education and what can be done to stop the exodus.

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<v SPEAKER_1>You can find this podcast in all of the podcast places.

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<v SPEAKER_5>And you mentioned that sometimes with clients, if a baby is getting distracted, or there's a dip in maybe their intake, anytime there's a change in the schedule, it kind of throws everybody for a loop, and you sometimes have to pivot and figure out what works this week, what worked last week doesn't work.

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<v SPEAKER_5>You mentioned, for example, certain babies need to eat in a dark room.

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<v SPEAKER_5>What are some other tips that you have for parents if they have noticed a change in their baby's interest level of breastfeeding without forcing the baby to drink what they're not inclined to?

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<v SPEAKER_5>What can parents do to kind of redirect that baby's attention?

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<v SPEAKER_4>I think it is really, really critical to not force the baby.

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<v SPEAKER_4>I've heard some scary stories that if your baby gets hungry enough, they'll nurse, but that approach doesn't really establish trust.

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<v SPEAKER_4>And so I would say that persistence and patience, and we all lead really busy lives, and it would be great if they're on our schedule, but they're just not sometimes.

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<v SPEAKER_4>I've had some families just try to cancel plans and just the parent and the baby spend time together where it can really be an on-demand situation and not wedged in between a soccer game and church camp and all these other things that happen in life.

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<v SPEAKER_4>That it's hard for some kids to do that.

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<v SPEAKER_4>Everyone has a different dynamic, and I think that's what I like the most about my job is I get to be really creative and find out who lives at home, what's your schedule like, how can we do this?

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<v SPEAKER_4>For some kids that are really rigidly objecting to latching, what one of the options will be is, babies have many moments of just discontent because that's normal baby behavior.

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<v SPEAKER_4>To latch when they're not hungry, without the demand of feeding can be helpful, and in a back door, so maybe they had a bottle or they drink from a cup, or not an artificial nipple, that might even be more helpful.

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<v SPEAKER_4>Then as their ritual, when they're fussy or as they're drowsy and about to take a nap, or right when they wake up from a nap, just to hold them really close and allow them to latch, but they're not hungry, so they don't get frustrated.

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<v SPEAKER_5>I know we were talking earlier about just the anxiety level of parents, and your job is so interesting, but also I would say, I bet sometimes it's kind of overwhelming for you too, because people don't come to you when everything's going hunky-dory.

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<v SPEAKER_5>They're coming and seeking help because they're struggling with feeding and feeding challenges.

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<v SPEAKER_5>And when, some parents, they're really, really attached to their schedule.

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<v SPEAKER_5>I know I have, I'm a mom of seven, I have a set of quadruplets and a set of twins, and the schedule was everything for us, and I never breastfed them.

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<v SPEAKER_5>I always pumped and then had to have help with bottles and stuff, but I kind of liked it because I'm so type A, and then I could have this schedule, but now I'm working towards my Ibclc as well, and just studying about how important it is to not be on a schedule.

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<v SPEAKER_5>How do you tell moms that, who are so live or die by the schedule, but your baby's not, and you can't, do you have other stuff?

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<v SPEAKER_5>You do have soccer camp and church camp or whatever, if you have other kids going or work.

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<v SPEAKER_5>How do you navigate that?

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<v SPEAKER_5>Because I can imagine that's challenging.

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<v SPEAKER_4>I try to meet everyone where they're at.

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<v SPEAKER_4>If there is someone who is inherently preferring a schedule, I work with it.

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<v SPEAKER_4>If they want to pump, I'll show them how to pump because ultimately, the lifelong benefits of the baby getting human milk and the mother breastfeeding are enormous.

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<v SPEAKER_4>If creating a loosey goosey schedule will ultimately stop them from breastfeeding, I think it's in everybody's best interest.

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<v SPEAKER_4>If you want to pump, then we pump, but maybe do some direct latching, so the microbiome is good.

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<v SPEAKER_4>I try to work with everybody where they're at.

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<v SPEAKER_4>It's not only the daunting thought of providing milk for seven children or four at a time, in your case, or quadruple.

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<v SPEAKER_4>How many do you have?

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<v SPEAKER_5>Well, I have seven total, but I had quads and then I had twins.

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<v SPEAKER_5>You know what?

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<v SPEAKER_5>When I had the quads, I only ever made enough for half of them.

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<v SPEAKER_5>I was always 50-50, like 50% breast milk and I had to supplement 50% formula.

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<v SPEAKER_5>And I thought, well, if I ever have twins, at least I know I make enough.

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<v SPEAKER_5>And then of course, when I had twins, I didn't make enough for the twins.

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<v SPEAKER_5>And I was like, this is so frustrating.

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<v SPEAKER_5>And I know how it all works.

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<v SPEAKER_5>It's just when you're in the thick of it, you're like, I can't believe this is happening to me.

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<v SPEAKER_5>Like, how can I not provide for my baby?

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<v SPEAKER_5>And then, like you said, that stress sometimes causes you to spiral, which in turn negatively impacts your milk supply.

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<v SPEAKER_5>So I can imagine a lot of your job is like, helping to talk parents down and explaining what is typical behavior.

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<v SPEAKER_5>Because if you've never done this before as a mom, and you as a breastfeeding expert and an SLP, you've seen pretty much everything.

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<v SPEAKER_5>So you know, hey, this is cause for concern and this is not like, it's important to have this individual one on one care that I think not every mom has access to.

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<v SPEAKER_4>Yeah, I always try to offer options.

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<v SPEAKER_4>And so it's not always that someone has a really intense schedule where they have other children or they say, I really prefer breastfeeding is just better for my mental health.

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<v SPEAKER_4>But there are certain person, I talked about baby personalities, but we have personalities too.

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<v SPEAKER_4>And, you know, there are some personalities that like things to the baby is fed every three hours and it's each breast for 15 minutes.

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<v SPEAKER_4>And, you know, so I try to offer options and freedom within that, and not tracking all the feeding and all the diapers on the app.

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<v SPEAKER_4>And so it really works.

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<v SPEAKER_4>It's personalized for each person that walks in the door.

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<v SPEAKER_4>And then I give them a plan for about seven days and then we talk about it in the next week.

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<v SPEAKER_4>Like, how did that work?

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<v SPEAKER_4>Was that scary not having a schedule?

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<v SPEAKER_4>Did you feel good about it?

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<v SPEAKER_4>How can I help you?

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<v SPEAKER_4>Because really the ultimate goal is to promote breastfeeding as long as possible.

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<v SPEAKER_4>And even I think it's amazing that you provided as much milk as you did for your children.

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<v SPEAKER_4>It doesn't matter that it wasn't everything that they drank.

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<v SPEAKER_4>Every little bit they got was enormously helpful.

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<v SPEAKER_4>And so I just try to encourage families when they come in that it's not black and white at all.

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<v SPEAKER_4>You can do many, many variations.

00:17:08.705 --> 00:17:13.125

<v SPEAKER_4>There are also some situations where a parent can't produce the milk.

00:17:13.125 --> 00:17:20.625

<v SPEAKER_4>And so it doesn't mean that that person has to pump eight times a day with their only three ounce yield.

00:17:20.625 --> 00:17:25.805

<v SPEAKER_4>It means that, okay, so your baby primarily bottle feeds and then you latch before and after.

00:17:26.425 --> 00:17:30.265

<v SPEAKER_4>And then they see you as a source of comfort and then you latch throughout the day.

00:17:30.265 --> 00:17:34.645

<v SPEAKER_4>And all of that is a health gift for both.

00:17:34.645 --> 00:17:40.705

<v SPEAKER_4>So I just try to meet everybody where they're at and come up with a plan that's sustainable.

00:17:40.705 --> 00:17:43.565

<v SPEAKER_5>So let's talk about when the baby goes to start solid foods.

00:17:43.565 --> 00:17:48.085

<v SPEAKER_5>They're showing all the reliable signs of readiness to eat and they're past that six month mark.

00:17:48.085 --> 00:17:51.165

<v SPEAKER_5>Yeah, the question that I heard you say before, mom say, well, how do I organize that?

00:17:51.165 --> 00:18:04.885

<v SPEAKER_5>Like, what tips do you have for parents who want to continue breastfeeding, who know the importance of breast milk and human milk, even after starting solid foods, what tips do you have and what problems do they typically encounter that you would see in your setting?

00:18:04.885 --> 00:18:08.325

<v SPEAKER_4>The primary source of nutrition still is human milk.

00:18:08.325 --> 00:18:17.385

<v SPEAKER_4>And when they start around six months playing with solid foods, it really takes, as you know, a while to get the hang of it.

00:18:17.385 --> 00:18:18.845

<v SPEAKER_4>And so it's not for nutrition.

00:18:19.485 --> 00:18:21.765

<v SPEAKER_4>It's just to get the mechanics down.

00:18:21.765 --> 00:18:27.605

<v SPEAKER_4>And the amount, this is interesting, the amount of milk that they take is pretty steady.

00:18:27.605 --> 00:18:39.365

<v SPEAKER_4>So after a baby is born, close to a month, after about a month of breastfeeding, they settle in on 25 to 30 ounces in 24 hours.

00:18:39.365 --> 00:18:42.425

<v SPEAKER_4>And that doesn't change for the first year of life.

00:18:42.425 --> 00:18:50.845

<v SPEAKER_4>And for their first six months, when they're not having solids, they will stay on their growth curve if they have 25 to 30 ounces in 24 hours.

00:18:50.845 --> 00:18:53.085

<v SPEAKER_4>Now, it will be organized differently.

00:18:53.085 --> 00:19:03.765

<v SPEAKER_4>So a baby right when they're born will need to nurse pretty often because their tummies are small and they need to keep their blood sugar up and they don't sleep a lot at once, but it changes.

00:19:03.765 --> 00:19:07.445

<v SPEAKER_4>As they get older, they might sleep longer at night.

00:19:07.445 --> 00:19:13.025

<v SPEAKER_4>They might prefer to cluster feed at certain times of the day, but really the amount stays the same.

00:19:13.025 --> 00:19:28.765

<v SPEAKER_4>And once they get the hang of solid foods, around six, seven, eight months, then they do take that nutrition into account for their growth while they continue to drink 25 to 30 ounces a day of breast milk.

00:19:28.765 --> 00:19:33.845

<v SPEAKER_4>And so I always like to assure that the baby is still getting enough breast milk.

00:19:33.845 --> 00:19:48.085

<v SPEAKER_4>I like to say, maybe you start the meal at breast, and then the baby is in the chair and offered food, and then maybe they have some playtime, and then as they're about to go down for a nap, maybe you'd latch them again.

00:19:48.085 --> 00:20:10.445

<v SPEAKER_4>But just to, if possible, with a family schedule, to have ad lib times whenever the baby is frustrated or needs comfort, that latching is very routinely part of that because the volume of milk can add up tremendously over the course of 24 hours and really meet that goal of 25 to 30 ounces.

00:20:10.445 --> 00:20:13.005

<v SPEAKER_4>And it stays that until they're about one.

00:20:13.765 --> 00:20:28.845

<v SPEAKER_4>And then between one and two, it goes down to maybe 20 ounces or so, but it's still a very significant part of their nutrition and immunity and all the other things that I'm sure you're learning in your Ibclc program.

00:20:28.845 --> 00:20:31.405

<v SPEAKER_5>Hey, we're gonna take a quick break, but I'll be right back.

00:20:40.600 --> 00:20:43.400

<v SPEAKER_6>Hey there, I'm Dylan Lewis, one of the hosts of Motley Fool Money.

00:20:43.400 --> 00:20:49.120

<v SPEAKER_6>Each weekday on Motley Fool Money, we talk through the business news you need to know, and the stories moving stocks on Wall Street.

00:20:49.120 --> 00:20:55.220

<v SPEAKER_6>On weekends, we dive into the industry shaping tomorrow, and host the experts, authors, and executives that understand them.

00:20:55.220 --> 00:21:00.180

<v SPEAKER_6>Tune in for insights, a long-term perspective on investing, and of course, stock ideas, plenty of them.

00:21:00.180 --> 00:21:02.160

<v SPEAKER_6>To quote a listener, it pays to listen.

00:21:02.160 --> 00:21:04.480

<v SPEAKER_6>Check us out and subscribe wherever you listen to podcasts.

00:21:11.181 --> 00:21:18.881

<v SPEAKER_5>My question for the moms that are exclusively breastfeeding up until the point when they're starting solid foods is, I know that they don't trust their bodies.

00:21:18.881 --> 00:21:21.061

<v SPEAKER_5>They can't see that 25 to 30 ounces.

00:21:21.061 --> 00:21:36.221

<v SPEAKER_5>So they wonder, oh my gosh, well, I noticed my baby is eating less, especially around the eight month mark, when babies really get the hang of picking that food up and bringing it to their mouth, and the moms will freak out, oh my gosh, they're nursing less frequently, the sessions are shorter.

00:21:36.221 --> 00:21:37.621

<v SPEAKER_5>That's weaning in action.

00:21:37.621 --> 00:21:45.001

<v SPEAKER_5>That's your baby gradually learning how to get more nutrition from food and gradually getting a little bit less from milk.

00:21:45.001 --> 00:21:52.881

<v SPEAKER_5>And so if moms hear that 25 to 30 ounce message, if they're breastfeeding, do they sometimes stress out like, well, I can't see it and I don't know if it's there.

00:21:52.881 --> 00:21:57.241

<v SPEAKER_5>How do you tell them like, yes, your baby's doing okay and your body's doing okay?

00:21:57.241 --> 00:22:03.321

<v SPEAKER_4>I think I would hesitate to use the word weaning then because they're not mutually exclusive.

00:22:03.321 --> 00:22:08.281

<v SPEAKER_4>So the supplement of adding solids is maybe the way that I would view that.

00:22:09.701 --> 00:22:17.401

<v SPEAKER_4>Unless your pediatrician says there is a problem with the growth tracking, then they're getting plenty.

00:22:18.101 --> 00:22:25.401

<v SPEAKER_4>If it's reassuring, families can go and weigh their babies and just make sure they're plotting along the lines.

00:22:25.401 --> 00:22:32.921

<v SPEAKER_4>But getting in the weeds of how much they take every feeding or every day can be stressful.

00:22:32.921 --> 00:22:39.581

<v SPEAKER_4>If you are working and you have to pump and you put it in a bottle, then you can see how much it is.

00:22:39.581 --> 00:22:51.601

<v SPEAKER_4>If that helps your mental health to know how much you're giving, then you could pump and you could see it, or you could have a scale and do 24 hours of weighted feeds and know.

00:22:51.601 --> 00:23:02.101

<v SPEAKER_4>But I would say it's much more useful in your long-term relationship with your baby to go to the beach and play, then worry about how much milk there is.

00:23:02.101 --> 00:23:13.921

<v SPEAKER_4>You'll know if they're not gaining and your doctor sees you at certain intervals and they'll start to alert you to, oh, is there an opportunity to give the baby more milk?

00:23:13.921 --> 00:23:19.221

<v SPEAKER_4>What I usually do with families that come in is I say, I want you to walk me through 24 hours.

00:23:19.221 --> 00:23:20.581

<v SPEAKER_4>How do you feed your baby?

00:23:20.581 --> 00:23:21.841

<v SPEAKER_4>Well, what's at rest?

00:23:21.841 --> 00:23:23.821

<v SPEAKER_4>What solids do they take?

00:23:23.821 --> 00:23:30.681

<v SPEAKER_4>We just negotiate because I want them to look back on this time with joy and not stress.

00:23:30.681 --> 00:23:39.481

<v SPEAKER_4>And so if they're comfortable with it, the less you measure and the more it is just sort of a natural interaction between the two, the better.

00:23:39.481 --> 00:23:48.861

<v SPEAKER_5>You mentioned all the apps with the diapers and do you think all the apps are making parents more stressed out or are they helping or is it a matter of both?

00:23:48.861 --> 00:23:50.741

<v SPEAKER_4>I love technology.

00:23:50.741 --> 00:23:52.221

<v SPEAKER_4>I mentioned the smart pacifier.

00:23:52.221 --> 00:23:54.121

<v SPEAKER_4>I mean, that's the direction.

00:23:54.121 --> 00:24:01.081

<v SPEAKER_4>I like going in healthcare because I've been in healthcare for over 20 years and I love technology.

00:24:01.081 --> 00:24:08.061

<v SPEAKER_4>But I think a lot is lost when a family goes home and everything is measured.

00:24:08.061 --> 00:24:16.841

<v SPEAKER_4>And so I try to free them and liberalize the scenario a little bit because your baby talks to you, even though they don't talk to you.

00:24:16.841 --> 00:24:18.361

<v SPEAKER_4>You know, they communicate.

00:24:18.361 --> 00:24:40.161

<v SPEAKER_4>And I love to help families learn what the baby is communicating, what's hunger, what's just a little bit of distress, where they might need to be held, and try to pick up on their cues because that will be invaluable, not just from a nutrition standpoint, but just your relationship with your kids to sort of understand what they're wanting.

00:24:40.161 --> 00:24:53.661

<v SPEAKER_4>Because your pediatrician will see you at many intervals and give you a heads up if things aren't tracking adequately and they'll send you to someone who, like me, and I'll help you analyze it.

00:24:53.781 --> 00:25:02.781

<v SPEAKER_4>And we can almost always find little ways of getting meals in, whether it's latching or more solids, that will get them on track.

00:25:02.781 --> 00:25:10.101

<v SPEAKER_4>You know, it's very commonly the third or fourth child, and they need to be fed during pickups.

00:25:10.101 --> 00:25:17.481

<v SPEAKER_4>And so when I have the parent write out exactly what they do in 24 hours, they say, oh yeah, I guess I'm not feeding him.

00:25:17.861 --> 00:25:19.281

<v SPEAKER_4>When I'm doing drop-offs.

00:25:19.281 --> 00:25:21.541

<v SPEAKER_4>You know, there's like simple things like that.

00:25:21.541 --> 00:25:28.201

<v SPEAKER_4>And so I prefer to go through it that way, than giving them something else to do, where they have to enter it into an app.

00:25:28.201 --> 00:25:30.601

<v SPEAKER_5>What are some signs that parents should look for?

00:25:30.601 --> 00:25:41.421

<v SPEAKER_5>The cues, the little indicators that their baby is ready to start reducing either the breastfeeding frequency or the durations of the feeds as they get more proficient in eating food?

00:25:41.421 --> 00:25:44.401

<v SPEAKER_5>How will you know that it's time to breastfeed less?

00:25:45.181 --> 00:26:05.001

<v SPEAKER_4>What I will say is just to visualize all of this as complementary feedings because the American Academy of Pediatrics shifted the advisable durability of breastfeeding from one year to two years and thereafter, as desired by mother and child.

00:26:06.781 --> 00:26:10.201

<v SPEAKER_4>I would always have it in the mix.

00:26:10.201 --> 00:26:23.161

<v SPEAKER_4>If you feed your baby a meal, that the typical amounts you've been giving them, three meals a day plus a lot of snacks, and they still seem hungry, that's an opportunity to latch them.

00:26:23.161 --> 00:26:29.641

<v SPEAKER_4>If you're working, and then that is pumped milk that you have in a cup for them.

00:26:29.641 --> 00:26:39.361

<v SPEAKER_4>But I would make sure that they still have quite a bit of milk once they start solids because they get so much nutrition from that, so much immunity.

00:26:39.981 --> 00:26:56.481

<v SPEAKER_4>But it really is a pretty gradual process where as long as it's part of the routine, maybe before you leave for work or before you drop the other kids off in the morning, that you have a devoted time where you're just with the baby and you allow them to nurse.

00:26:56.481 --> 00:27:00.721

<v SPEAKER_4>And the same thing for the evening routine.

00:27:00.721 --> 00:27:11.221

<v SPEAKER_4>Some kids take a lot right when they wake up, and then they have mostly solids during the day, and maybe you pump some milk and they have that, that they're alternating with their solids.

00:27:11.221 --> 00:27:22.821

<v SPEAKER_4>But I think as long as there is an opportunity, right when they wake up before you feed them, that tends to be when babies will get a lot of volume and then maybe right when they're falling asleep.

00:27:22.821 --> 00:27:27.161

<v SPEAKER_5>So the schedule looks differently than it did in the first half of infancy.

00:27:27.721 --> 00:27:32.881

<v SPEAKER_5>They might still be taking the same volume, but it might be spread over a different period of time or different number of nursing sessions.

00:27:32.881 --> 00:27:34.281

<v SPEAKER_5>Is that safe to say?

00:27:34.281 --> 00:27:34.521

<v SPEAKER_4>Yeah.

00:27:34.521 --> 00:27:37.081

<v SPEAKER_4>And it depends on what the family does during the day.

00:27:37.341 --> 00:27:58.101

<v SPEAKER_4>If both parents work and they go to daycare, then what makes sense is to nurse the baby in the morning, and then send the baby with their solids, and then pumped milk for the maybe three meals that they'll have, and some snacks during the day, and then as part of the ritual when they're falling asleep, they may nurse again.

00:27:58.101 --> 00:28:07.761

<v SPEAKER_4>So it just looks a little bit differently, but certainly it's negotiable in whatever situation a family finds themselves in for the schedule.

00:28:07.761 --> 00:28:16.821

<v SPEAKER_5>Do you have tips for moms kind of across the board on maintaining their milk supply as the baby is starting to eat more solids and get more nutrition from food?

00:28:16.821 --> 00:28:24.041

<v SPEAKER_4>As long as they're latching frequently, the supply will be maintained.

00:28:24.041 --> 00:28:28.261

<v SPEAKER_4>And this is, you know, dangerous territory for people that like numbers.

00:28:28.261 --> 00:28:28.961

<v SPEAKER_5>Yeah, you're right.

00:28:28.961 --> 00:28:30.341

<v SPEAKER_5>No, because they'll say, well, what do you mean?

00:28:30.341 --> 00:28:31.061

<v SPEAKER_5>How many times?

00:28:31.061 --> 00:28:33.101

<v SPEAKER_5>Just tell me, make me a schedule so I can follow it.

00:28:33.621 --> 00:28:36.281

<v SPEAKER_4>And if someone wants a schedule, I'll make them a schedule.

00:28:36.281 --> 00:28:41.121

<v SPEAKER_4>But if possible, just making sure that you have that the morning routine.

00:28:41.121 --> 00:28:46.221

<v SPEAKER_4>For example, in some situations, babies will sleep a long time at night.

00:28:46.221 --> 00:28:48.281

<v SPEAKER_4>And if yours doesn't, that's still normal.

00:28:48.281 --> 00:28:51.541

<v SPEAKER_4>But some babies will sleep quite a while at night.

00:28:51.541 --> 00:28:57.961

<v SPEAKER_4>And then the breasts will be very full in the morning and they get a lot of breast milk right when they wake up.

00:28:57.961 --> 00:29:00.901

<v SPEAKER_4>And then, you know, they'd have breakfast an hour later.

00:29:01.401 --> 00:29:04.761

<v SPEAKER_4>And so, that's very well organized.

00:29:04.761 --> 00:29:07.661

<v SPEAKER_4>And then, you might have something similar to the evening.

00:29:07.661 --> 00:29:17.961

<v SPEAKER_4>Maybe if the parent was working and their breasts are pretty full, that you've done the evening routine, and then it's time for the baby to fall asleep, they could also get quite a bit.

00:29:17.961 --> 00:29:24.501

<v SPEAKER_4>Some babies will get the vast majority of what they need just from those bookend nursing sessions.

00:29:24.961 --> 00:29:35.781

<v SPEAKER_4>But I would say throughout the day whenever, if you're with your baby during the day and they're putting their hand to their mouth or seeming a little bit fussy, always latch them.

00:29:35.781 --> 00:29:39.361

<v SPEAKER_4>If they don't want it, they'll let you know, but always offer it.

00:29:39.361 --> 00:29:41.961

<v SPEAKER_5>Let's talk about the if they don't want it, they'll let you know.

00:29:41.961 --> 00:29:46.901

<v SPEAKER_5>Because I think, again, this term nursing strike gets thrown around rather loosey goosey.

00:29:46.901 --> 00:30:02.161

<v SPEAKER_5>If a mom is, oh my gosh, my baby is not latching as frequently or wanting to breastfeed as much at eight months as they were at five months, and they come in and they're stressing out about that, what do you tell them as an SLP who's also specializing in breastfeeding?

00:30:02.161 --> 00:30:06.101

<v SPEAKER_4>If the growth pattern looks good, I would offer reassurance.

00:30:06.101 --> 00:30:07.701

<v SPEAKER_4>That's really typical.

00:30:07.701 --> 00:30:25.101

<v SPEAKER_4>The baby is getting a lot of their nutrition from solids, and if they're concerned that not enough breast milk is taken in within the 24 hours, you can put your express breast milk in their solids, and that's your expertise.

00:30:25.101 --> 00:30:30.981

<v SPEAKER_4>I'm sure you have many, many recipes in that realm, but there are ways that they can get the food if they're too...

00:30:30.981 --> 00:30:39.961

<v SPEAKER_4>Some babies are too distractible during the day to sit and cuddle their mom and nurse, and so that's why I mentioned the morning and evening.

00:30:39.961 --> 00:30:54.501

<v SPEAKER_4>Sometimes that just, that dynamic works better, and it's very focused, and then they still get the milk during the day, but in a different way, in a different setting, so they can be real social and sit with their buddies at the table, and eat and interact.

00:30:54.501 --> 00:30:57.081

<v SPEAKER_5>Hey, we're gonna take a quick break, but I'll be right back.

00:31:05.687 --> 00:31:07.867

<v SPEAKER_5>Erin, I want to hear more about the smart pacifier.

00:31:07.867 --> 00:31:08.867

<v SPEAKER_5>You mentioned it a little bit.

00:31:08.867 --> 00:31:10.947

<v SPEAKER_5>I know you're interested in technology.

00:31:10.947 --> 00:31:12.507

<v SPEAKER_5>Are the other pacifiers stupid?

00:31:12.507 --> 00:31:13.947

<v SPEAKER_5>What makes a smart pacifier?

00:31:13.947 --> 00:31:15.407

<v SPEAKER_5>Tell us all the things.

00:31:15.407 --> 00:31:22.707

<v SPEAKER_4>So for all my other patients that come through, I have fancy tools to figure out what's going on.

00:31:22.707 --> 00:31:28.007

<v SPEAKER_4>So if they're not swallowing, well, I'll put a scope in their nose, and I'll look at their throat while they're swallowing.

00:31:28.007 --> 00:31:31.727

<v SPEAKER_4>Or I'll take an x-ray and figure out why aren't they swallowing.

00:31:31.727 --> 00:31:34.287

<v SPEAKER_4>The mouth is an enigma with the baby.

00:31:35.307 --> 00:31:42.647

<v SPEAKER_4>So many people will see lots of different breastfeeding medicine specialists, and I get lots of different answers.

00:31:42.647 --> 00:31:45.427

<v SPEAKER_4>It's really frustrating for them.

00:31:45.427 --> 00:31:49.487

<v SPEAKER_4>I think it is long overdue that that is not standardized.

00:31:50.907 --> 00:31:54.787

<v SPEAKER_4>We do have a pacifier that we're working on.

00:31:54.787 --> 00:31:58.407

<v SPEAKER_4>We've studied that, of course, the hottest topic is tongue tie.

00:31:58.407 --> 00:32:06.107

<v SPEAKER_4>We're not very good at using our finger, which is not surprising to figure out if a baby is sucking well or not.

00:32:06.107 --> 00:32:09.287

<v SPEAKER_4>And so there's machine learning in this pacifier.

00:32:10.347 --> 00:32:12.067

<v SPEAKER_4>There is a vacuum in it.

00:32:12.067 --> 00:32:15.687

<v SPEAKER_4>It takes all of these different parameters and it puts them together.

00:32:15.687 --> 00:32:18.647

<v SPEAKER_4>The first step in this is we'd like for pediatricians to have this.

00:32:18.647 --> 00:32:21.027

<v SPEAKER_4>So it's like a pass fail, like watch this baby.

00:32:21.027 --> 00:32:22.427

<v SPEAKER_4>They might have trouble.

00:32:22.427 --> 00:32:36.547

<v SPEAKER_4>But then for a more nuanced clinician who just does feeding disorders, we can turn all of the features on and say, well, it was that the second frequency was too high, the vacuum was too high, this was low.

00:32:36.547 --> 00:32:49.307

<v SPEAKER_4>It's still far too subjective to use our finger and say, this baby can suck or they can't suck, or just look in the mouth and say, there's something under the tongue, that's a problem, we should do something about it.

00:32:49.307 --> 00:32:56.607

<v SPEAKER_4>When in many cases, it's not intrusive or obstructive to a very healthy breastfeeding relationship.

00:32:56.607 --> 00:33:07.007

<v SPEAKER_4>So we started this research out of UCSD that my very smart engineering colleagues, wonderful pediatricians that I get to work with at UCSD as well.

00:33:07.007 --> 00:33:12.687

<v SPEAKER_4>But we've studied this and we actually created a business, LatchAbility.

00:33:12.687 --> 00:33:19.767

<v SPEAKER_4>But we'd really like this to be a product that is used in clinics by primary care providers.

00:33:19.767 --> 00:33:24.347

<v SPEAKER_4>So they say, this baby should be watched.

00:33:24.347 --> 00:33:33.187

<v SPEAKER_4>They're at risk of having breastfeeding problems, and then they get sent to a feeding specialist that can really dissect what's going on.

00:33:33.187 --> 00:33:48.027

<v SPEAKER_5>Erin, in closing, what do you recommend to parents who are at peak stress level and they're worried, my baby stopped breastfeeding after we started solid foods and the schedule is all messed up and I'm struggling here to get my baby to eat anything.

00:33:48.027 --> 00:33:51.427

<v SPEAKER_5>How do they know when it's time to see a lactation expert?

00:33:51.427 --> 00:33:54.807

<v SPEAKER_5>How do you find somebody with your background to work with?

00:33:54.807 --> 00:33:58.247

<v SPEAKER_5>Where should they go if they feel like they can't do this on their own?

00:33:58.247 --> 00:34:03.387

<v SPEAKER_4>There are a lot of clinicians and we all have slightly different backgrounds.

00:34:03.387 --> 00:34:06.407

<v SPEAKER_4>So you might want to see where someone's expertise lies.

00:34:06.407 --> 00:34:10.467

<v SPEAKER_4>I don't know that you have to see a hybrid like me to do this.

00:34:10.467 --> 00:34:18.987

<v SPEAKER_4>I think a lactation consultant, even with a different background, this would be very well suited and I would say go sooner than later.

00:34:18.987 --> 00:34:28.167

<v SPEAKER_4>Also there are many breastfeeding support groups around town, online, La Leche League, your friends who have had a baby.

00:34:28.167 --> 00:34:29.547

<v SPEAKER_4>That's invaluable too.

00:34:29.547 --> 00:34:35.807

<v SPEAKER_4>I think that's much more personalized than going in an Instagram wormhole in the middle of the night.

00:34:35.807 --> 00:34:43.187

<v SPEAKER_4>Because as I mentioned before, and what I love about my job is everybody's situation is really different.

00:34:43.187 --> 00:34:49.287

<v SPEAKER_4>To cut and paste to your circumstance is not helpful and more stressful.

00:34:49.287 --> 00:34:55.047

<v SPEAKER_4>Go to someone early and let them map out, show me 24 hours, what do we do in here?

00:34:55.427 --> 00:34:56.847

<v SPEAKER_4>How's the weight tracking?

00:34:56.847 --> 00:35:02.727

<v SPEAKER_4>And then let someone give you options about how it could better suit your family dynamic.

00:35:02.727 --> 00:35:06.147

<v SPEAKER_5>Well, thank you so much for sharing your time and all of this expertise with our audience.

00:35:06.147 --> 00:35:07.627

<v SPEAKER_5>I really appreciate it.

00:35:07.627 --> 00:35:08.327

<v SPEAKER_4>My pleasure.

00:35:08.327 --> 00:35:10.367

<v SPEAKER_4>Thanks for having me.

00:35:10.367 --> 00:35:12.747

<v SPEAKER_5>Well, I hope you enjoyed that interview with Erin Walsh.

00:35:12.747 --> 00:35:20.107

<v SPEAKER_5>She's from UC San Diego, talking to us about some changes in breastfeeding patterns in and around the time when your baby starts solid foods.

00:35:20.107 --> 00:35:24.847

<v SPEAKER_5>I will put all of the references and resources that she talked about on the show notes page for this episode.

00:35:24.887 --> 00:35:26.887

<v SPEAKER_5>Which you can find at blwpodcast.com/472.

00:35:29.427 --> 00:35:31.887

<v SPEAKER_5>A special thank you to our partners at Airwave Media.

00:35:31.887 --> 00:35:36.187

<v SPEAKER_5>If you like podcasts that feature food and science and using your brain, check out some of the podcasts from Airwave.

00:35:36.187 --> 00:35:38.687

<v SPEAKER_5>We're online at blwpodcast.com.

00:35:38.687 --> 00:35:40.407

<v SPEAKER_5>Thanks so much for listening and I'll see you next time.