August is National Breastfeeding Month.

And as much as I hate the word “journey,” allow me to tell you about my breastfeeding journey.

I figure there’s a lot of curiosity out there about a pediatrician’s breastfeeding experience. I mean I sit in my clinic rooms all day counseling about it, right? So surely it was an easy task for me? Surely I would sit in daily joyful motherhood bliss while my babe nursed happily with ease and comfort, right?

Heck. No.

In fact, I disliked a lot about breastfeeding. But I loved some of it, too.

(And guess what? GASP! This pediatrician used some formula, too! What? Did she say the F word?)

Before I gave birth to my first kid, I knew breastfeeding could be challenging for some moms. I didn’t worry or fret about it too much, though, because how hard could it be?

I mean, you just put the baby on the boob, right? I’m a pediatrician! I got this!

Ahahahahahahha.

My first kid refused to latch from day one. I worked with lactation consultants. I struggled with pain. I had his mouth anatomy evaluated (all was fine). I tried shields. I had supply issues. My kid screamed. Every. Nursing. Session. And I cried every nursing session. His reflux was constant and affected positioning, length of feeds, and general happiness.

My postpartum anxiety was vicious. And made everything probably 10 times worse than it already was.

So, I decided to pump. Exclusively.

And it was the hardest damned thing I’ve probably ever done.

It satiated my need for control in a situation where I felt I had no control. But it was hard. And mentally and physically exhausting.

I’d pump in my office many times a day, running late for patients and adding stress to an already stressful day. And while my also-pumping work partner would pull out 10 ounces at a time when she pumped during lunch with me, I’d get a measly 3 or 4.

And every day, I went into the bathroom and cried. What was wrong with me? Why was motherhood feeling so robotic and protocoled and cold? Why did I cry for 45 minutes if I spilled a bottle?

But I knew pumped milk was so beneficial to my baby. So I kept on going. For 6 months. Until my supply tanked because I couldn’t pump enough at work. So we used formula. And guess what? My baby survived. And I survived.

It took such a mental toll on me to not be able to breastfeed my child that when I was pregnant with my second, my husband and my mom both nervously asked me…”you have some cans of formula just in case…right?”

They asked me this out of the kindness of their hearts, and I responded with, “yep! In the closet!” because I too remembered the dark days. And I wanted the experience with my next baby to be different.

And it was different.

Guess who breastfed like a champ? My next kid.

And the breastfeeding experience was great. And flawless. And so easy. And tear-free.

I loved bonding with my child in this special way. I loved feeling like nutrition and protection were transferred to her from my body. I even loved the exhausting 3 am feeds.

So why tell you all this?

To let you know that every mother is different, just as every child is different.
To let you know you aren’t alone if you felt breastfeeding was a struggle you totally weren’t prepared for.
To let you know even the professionals are human, and struggle just as much as you do.
To let you know it is okay to both love and hate breastfeeding.
To let you know I (and any pediatrician) will never judge you for the choices you make in how you feed your child.

Is breastfeeding worth the possible exposure to Covid-19?

Short answer: yes.

Unfortunately, the risk of COVID-19 is everywhere in our lives right now, but the reality is your baby needs another human to survive. So regardless of the way your baby gets their nutrition, having them completely secluded from the world, or attempting to limit their exposure to you, is not only impossible; it's also not a good option for optimal health and growth as well as bonding for your baby.

As always, the way you feed your baby is a personal decision, but it doesn’t change the fact that breastmilk provides protection against many illnesses and is the best source of nutrition for most infants, even and especially during this world health emergency.

What precautions should a well mother take?

• Practice skin to skin, especially immediately after birth during the establishment of breastfeeding.
• Maintain social distancing. In the UK, this time of lockdown and isolation has shown that without the constant stream of visitors, mothers and babies have had better opportunities for uninterrupted bonding, therefor mothers have a better supply, and babies have quicker weight gain.
• Wash your hands before feeding and frequently throughout the day.
• If pumping, limit the people who feed your baby bottles.
• Routinely clean and disinfect surfaces.

But what if you are diagnosed with Covid-19?

In limited studies on breastfeeding women with COVID-19 and other corona virus infections, the virus has not been detected in breast milk; however the bigger risk is likely transmission through respiratory droplets.

With precautions in place, WHO and the CDC both agree that the benefits of breastfeeding are outweighed by the risk.

If you are sick and choose to direct breastfeed:

• Wear a facemask and wash your hands before each feeding.
• Avoid touching your or the baby’s eyes, nose and mouth.
• Continue skin to skin.

If you are sick and choose to express breast milk:

• Express breast milk to establish and maintain milk supply.
• Use a dedicated breast pump.
• Wash hands before touching any pump or bottle parts and before expressing breast milk.
• Follow CDC guidelines for proper cleaning and disinfecting recommendations of pump parts.
• Consider having someone who is well feed the expressed breast milk to the infant, if possible.

Breastfeeding is a key preventative health step, especially during a pandemic.

Talk with your pediatrician about recourses that are available for help during this time. Cook Children’s Virtual Lactation services are available: Virtual Lactation Consultation.

My first question would be, “how do you define ‘all the time’?”

Some people have unrealistic expectations for a breastfeeding baby. By rule, we know that they need to eat 8-12 times per 24 hours to sustain milk supply and growth. These feeds are rarely consistent by the clock’s standards, so throw the “two to three hour” rule out the window.

During those first couple of months, it tends to take 45 minutes to an hour per feed by the time you are able to get the baby stimulated enough to stay awake, fed on side one, burped, fed from the other side, and back down. The bigger the baby gets, the better they are at removing milk and the duration of the feeds will shorten.

Simple math tells us that if a baby is eating every 2 hours for an hour at a time, that is half of your day—and yes, “all the time!” But it's also completely normal.

Cluster feedings, do occur, from time to time as well, as a way for your baby to adjust your milk supply to fit their growing needs. The baby may cluster the night before your milk comes in, and again between one and two weeks when they reach their birth weight and attempt to double your milk supply from the one ounce they were getting to two, per feed.

Expect more clustering during growth spurts, as the baby continues to adjust the supply/ demand, although the older the baby gets, these are often less noticeable.

Try and not let the demands of the baby during these times get you down. It is not an indication that you do not have enough milk, nor does it last very long.

Sometimes I’m asked, “Why is breastfeeding so important to you?”

Honestly, 10 years ago, I was so close to not knowing the answer. I was struggling and ready to quit, before I finally reached out for help.

Eventually I fell in love with breastfeeding and made it my passion to help any mom who asked for help, find her love for it as well.

When I consult with a new mom, I usually start by talking about the milk itself.

Human milk is made specifically for humans. I wouldn’t give a rabbit baby milk from a horse, if I had plentiful rabbit milk.

Though, there are some women who don’t make milk (or enough to suffice), that is not the case for the vast majority.

The carbohydrates, fats and proteins are exactly what our human babies need to thrive. It’s pure, organic, and no risk involved with additives or preservatives or contaminated water.

Breast milk is full of antibodies, and hormones, and probiotics that are invaluable to our children's health.

Our supply is ever-changing and tailored to our children’s needs, through growth or illness, our milk actually reacts before we do as the saliva exchanges between baby and breast.

Here are just a few of the benefits of breastfeeding:

• Breast milk is free.

• It doesn’t know social status or the thickness of your wallet.

• There’s no mixing, measuring, washing or preparing.

• At midnight and 3 a.m., it is warm and ready to serve.

Then there are the facts:

• Our breastfed children are at a lower risk for obesity, diabetes, asthma, diarrhea, ear infections and some childhood cancers.

• The risk of SIDs is also lower in breastfed children.

• For us as the mother, breastfeeding also lowers our chances of osteoporosis, breast and ovarian cancer as well as helps with postpartum depression.

Finally, the physical and emotional connection between you and your baby is powerful.

Eight to 12 times a day, you have the pleasure (although to be honest I know sometimes it feels like you are forced) to sit and bond with your baby for 45 minutes or more at a time in the early days. Talking, singing and eye contact are a positive byproduct of the inability of anyone else being able to help you feed your child.

Skin to skin is the best way to regulate core temperatures, heart rate and blood sugars; and breastfeeding creates a natural and unforced space to do so.

Breastfeeding is natural. I learned that lesson a decade ago and continue to see its benefits with the thousands of moms I’ve helped over the years as a lactation consultant.

Schedule an appointment with our virtual lactation consultant.

For More Information On This Topic

• Virtual Lactation Program at Cook Children's
• 'Am I Making Enough Breast Milk?'
• New Study Shows Breastfeeding Decreases Risks Of SIDS
• What you need to know about breastfeeding and your baby

Whether it’s bottle feeding or breastfeeding, you may have some questions or concerns – things that many other parents have also questioned! If not, or maybe you’re just not sure, speak to your pediatrician about a possible feeding evaluation by a speech-language pathologist (SLP). Build or re-build that bond. There’s lots that can be done to help and it will have lasting effects! Let’s take a look at three of the most common problems moms have and suggestions on what can be done about them.

1. Problem: Baby won’t stay latched during breastfeeding or falls asleep.

The best intervention for saving breastfeeding is the earliest intervention. Getting help from a lactation counselor or consultant before you feel like throwing in the towel will help to alleviate some of the frustration you and baby may be experiencing. Don’t wait - below are some resources you can contact. The WHO’s (World Health Organization) stance is breastfeeding serves a nutritional purpose for children until they’re at least 2 years of age! So keep it up, Mama!

2. Problem: My baby coughs, chokes, and is simply a messy eater.

If a baby is coughing, choking or losing milk from around the bottle when feeding, stop what you’re doing and find a nipple that may flow a little slower. Despite their very new presence in the world, babies are usually very good communicators if we’re really “listening”! They may be telling you that the milk is coming faster than they can swallow it. This might be a really easy fix. However, make sure your feedings are not taking too long and baby is getting enough. If you’re unsure, ask for help.

3. Problem: My baby spits up more than what I feel is normal.

Dr. Smith just wrote a very informative and thorough blog about gastroesophageal reflux and how it impacts feeding. Take a look at what he has to say about it and compare it to what you are seeing in your child. While the majority of cases of reflux resolve on their own around 6 months, as SLPs, we do see infants and children whose eating habits have been severely affected by it. Make sure to make notes about your baby’s behavior and discuss them with your pediatrician!

Learn more from the Tarrant County Breastfeeding Coalition

Those probably won’t be the words that are said, but it might be the message that you hear.

Breastfeeding can be a tricky thing and many different problems can lead to a poor latch or such. One of the most blamed is tongue-ties. We should be careful not to attribute every nursing problem as a tongue tie because it can lead to unnecessary procedures, stress and a lot of time wasted on the wrong things instead of finding the real reason.

A tongue-tie is an attachment of skin and/or muscle below the tongue that restricts the movement of the tongue. Defining what is too tight is often very tricky and often two providers will disagree as to whether a tongue-tie is present.

Tongue-ties can lead to three problems:

1. Difficulty with breastfeeding - Tongue-ties can lead to poor or painful latching.

2. Difficulty with speech - Certain sounds require free movement of the tongue but children often accommodate and are able to speak clearly despite having a tongue-tie.

3. Difficulty with kissing - Another activity that requires free movement of the tongue. Although you might find them being a terrible kisser a benefit as a teen-parent, they might disagree.

When you or your doctors are checking your baby, there are a few signs that might points toward a tongue-tie:

• Obviously short attachment that inserts near the tip of the tongue
• Tongue never passes out past the lower teeth or lips
• Notched appearance of the tongue due to the attachment (like a heart)

If your baby is having breastfeeding problems and there is agreement that it is because of a tongue tie, treatment involves a simple procedure to either clip or laser the attachment. Most ENTs and dentists perform this procedure in the office and the baby goes right back to nursing immediately (often moms report feeling a difference right away).

Making the decision to treat an older child with tongue-tie is usually more difficult. The symptoms and benefit of treatment are not as clear and there are often other means of treatment, such as speech therapy, that can be tried first.

About The Author

Justin Smith is a pediatrician and the Medical Advisor for Digital Health for Cook Children's in Fort Worth, Texas. He has an active community on both Facebook and Twitter as @TheDocSmitty and writes weekly for Cook Children's checkupnewsroom.com. His interest in communications started when he realized that his parents were relying more on the internet for medical information. He believes that strategic use of social media and technology by pediatricians to connect with families can deepen their relationship and provide a new level of convenience for both of their busy lifestyles. Dr. Smith’s innovative pediatric clinic, a pediatric clinic “designed by you,” is set to open in Trophy Club in 2017.

Here are four reasons I don't recommend putting a breastfed newborn on a feeding schedule:

1. They need comfort and bonding. Imagine being thrown into a brand new, anxiety-provoking environment with no skills for calming yourself and no way of escape. Plus, the person who can give you comfort is right there. Sure, you can cuddle them to help, but sometimes they just need to nurse.
2. They are hungry. I can't wait three hours to eat. I'm pretty sure if I could only eat 1-2 ounces of a liquid meal, I'd be starving before three hours came up again as well.
3. Scheduling can hurt your milk supply. Frequent feeds help your milk come in. I've seen too many babies who've been on a rigid schedule come in at 1 week with lower weight gain. Then we are scrambling to get mom's milk supply up so that they can maintain breastfeeding.
4. They will find their own schedule. Implementing a rigid schedule out of the nursery is not necessary. By paying attention, you can discover an ideal schedule for you and your child and help them keep to that without having a rigid schedule.

Here are 4 reasons goat's milk is dangerous and could even be deadly:

1. It is usually not pasteurized which can lead to all kinds of bad infections (listeria most commonly).
2. It has more protein so baby's kidneys can't handle it well. This along with high sodium level can lead to strokes.
3. It doesn't have enough folate which can lead to anemia.
4. It doesn't have the same electrolytes which can lead to extra acids building up in the baby's body. This causes multiple downstream problems.

Breast is best. Modern formula is really, really good too.

Goat's milk is nothing to kid around with.

Then, I was blessed to have a beautiful son...

….who decided that I needed to be re-taught a few things about children.

And by a few things, I mean everything.

Don’t get me wrong – you don’t have to be a parent to be an excellent doctor. I still dish out the same advice. The books and studies are spot-on and I’m going to give it to you straight. Breastfeeding does provide the best nutrition for babies. But I understand the pain you’re going through to meet that goal. And I understand the frustration of having a child who just won’t latch on. And I understand now why you look at me, with a crazy twitch in your eye, when I tell you to try an extra pumping session a day to build up your supply, mama. I hated that thing, too. Can anyone say “dairy cow”? And guess what – formula isn’t poisonous. I wasn’t physically able to meet my full breastfeeding goals with my kid – there’s no judgement here if you grab that can. And it’s okay if it makes your relationship with your child happier, healthier and more fulfilling.

Our car seat remains rear-facing at 18 months. It’s been proven to be five times safer than forward-facing. I’m sorry for my lecture during your little one’s checkup. And oh yes, I too want to rip my hair out when I can’t reach over far enough to give my kid that 400^th toy to keep them quiet on the trip to grandma’s.

“Crying it out” was a tough one for me. Pre-child, it was so easy to coach parents - encourage them to drop the constant rocking, the running into the nursery at all hours of the night, the fear of allowing their child to cry in order to learn put themselves to sleep. Then I went through it with my son. Let’s just say I give the same advice now (it really does work) …and recommend a glass of wine for every 15 minutes of crying. I probably cried more than my kid did. Motherhood helped me give this advice with a much softer tone. I get it, mom and dad. And I feel your pain (and exhaustion).

Pacifiers – I missed that thing so much. So, so much. Oh man I missed that thing when it had to go. I think I needed one myself when the time came to get rid of it.

As for the well-rounded, healthy meals I recommend offering your child throughout the day – I now understand why there are food shortages in some parts of the world. It’s because all that food is currently on the floor of my kitchen. Where my son threw it. I get it. And I’m here to help you find tricks to make things better. Tried and tested in my own home.

In all seriousness, motherhood has been the most exhausting, challenging, humbling thing I’ve ever experienced. But I can say without a doubt that it’s made me a better doctor for your child. Because helping you get through those everyday challenges is a huge part of what being a pediatrician is all about.

I recently polled some physician mom colleagues to get their take on how motherhood changed them:

• “I am that much more in awe of the composure, patience, faith, resolve my patients' families have, especially considering how chronically sick the kids are that I see, and how too not-infrequently, limited the treatments are. I see my son in every patient. Everything is different. Every heartache is my heartache. Each illness, each story seems to hit home that much harder. I am so so appreciative.”
• “I am much more empathetic and practical in some advice. I think that I am much more emotionally available post having kids and can understand a variety of stresses parents who go through NICU may encounter.”
• “You come to understand that "by the book" is not always what is possible in real life!”
• “I feel like when the kids have a tougher diagnosis - cancer- it hits closer to home and I hold my kids a bit tighter. Likewise, little pearls and tricks that I used help make it more of a village caring mentality for the family which has been lost over the last 30-40 years.”
• “My medical advice is not too different, but I understand the unspoken worry so much better now. So I try to address the emotional stuff first in ways that would not have occurred to me pre-kids. Now I'll directly say things like "you are a good mother even if you need to use formula," or "this lymphadenitis/rectal bleeding/etc is NOT cancer," or "they are not dangerous, but constant viral illnesses all winter TOTALLY SUCK.” I think it has made me a much better pediatrician.”
• “One of my favorite attendings in peds residency told me, as I was a mess after coming back from maternity leave with my first, that a little part of your heart will always be on the outside, dangling like a vulnerable little wisp in the wind that is parenting- and that little wisp makes you so much stronger and so much softer- all for the good....it's so true.”

Happy Mother’s Day, everyone!