Choosing and Preparing Formula for your Newborn

DSCN1955You may be wondering… why is a lactation consultant writing about formula? Because in my world of breastfeeding difficulties including chronic low milk supply, mothers often find they need to supplement breastfeeding with another source of nutrition. Sometimes that’s donor milk from another mother, sometimes banked human milk. But most often it is commercially available formula.

All formulas are not created equal. There are pros and cons to various brands. There are milk-based formulas, soy formulas, organic, non-organic and special formulas. But the most important distinction in my mind is liquid vs powder. Why is this so important?

It turns out that powdered infant formula (PIF) is not sterile. The manufacturing process does not allow for elimination of all germs. In addition, preparation of the product in the home can lead to further contamination. The most concerning bacteria found in PIF is called Cronobacter bacteria.

Cronobacter bacteria is an organism that thrives in dry conditions and it’s very prevalent. The bacteria is found in dry herbs and spices, herbal teas, dry milk manufacturing facilities and household vacuum cleaners. It has also been found in waste water. It can thrive on plastics, rubber and silicone bottle nipples. Clearly it is difficult to avoid this little beast.

Becoming sick from Cronobacter is a rare event, but it can be deadly in young infants. Premature babies and infants younger than 2 months are most vulnerable to Cronobacter illness. Cronobacter illness can lead to blood infections or meningitis. According to The Center for Disease Control (CDC) there are about 4-6 reported cases of Cronobacter illness in infants per year, but it may be under-reported. Recently more awareness has led to higher reported numbers. There were 13 known cases in 2011.

Breastfeeding is the best protection against Cronobacter infection. If possible, provide your baby with breast milk—especially for the first 2 months. “Almost no cases of Cronobacter infection have been reported among infants who were being exclusively breastfed.” (Center for Disease Control and Prevention website).

If your baby uses formula, choose formula that is sold as a liquid. Liquid formula is sterile so is less likely to transmit the bacteria. This is especially important for very young or premature babies.

If you choose to use powdered formula, please do so safely with good hygiene in mind.

  • Always wash your hands prior to preparing formula.
  • Use clean tongs to fish the scoop out of the container. Wash the scoop after every use.
  • Clean bottles in hot dishwasher or hot soapy water plus sterilization.
  • Use only clean work surfaces when preparing the bottles.
  • Use hot water to prepare the powdered formula—at least 158 degrees F(70 degrees C) This temperature is necessary to kill the bacteria. Cool to room temperature before feeding to baby by placing closed bottle in ice bath.
  • If you make the formula ahead of time, refrigerate it immediately and use it within 24 hours.

The Center for Disease Control and Prevention: has more information on this topic. The World Health Organization (WHO) has created a PDF in several different languages that includes guidelines regarding formula and breastfeeding.

Twenty Things You Don’t Know about Tongue Tie

Anterior tongue tie

Anterior tongue tie

The medical term for tongue tie is “ankyloglossia” which literally means “anchored tongue.”

Most health care professionals and many lactation consultants do not know how to evaluate for ankyloglossia.

Obvious does not mean severe. “Obvious” simply means the frenulum is attached near the tip of the tongue making it clearly visible.

An anterior tongue tie refers to attachment near the tip of the tongue. Posterior tongue tie refers to attachment at the base of the tongue.

If the frenulum is attached to the back of the tongue (posterior) it can cause even more restriction than if it’s attached to the front of the tongue (anterior)

There is no such thing as a mild tongue tie. Usually if someone says the tongue tie is mild, that means that the person doing the evaluation isn’t sure if it’s causing a restriction.

Tongue ties affect much more than breastfeeding.

Where the frenulum attaches at the floor of the mouth can have as much or more impact than where it attaches to the tongue.

Frenulum attached to lower gum ridge causing trough in tongue.

Frenulum attached to lower gum ridge causing trough in tongue.

Sometimes the frenulum can be attached to the back of the lower gum ridge as well as the floor of the mouth.

The frenulum does not stretch.

No one “grows out of” ankyloglossia.

The procedure to revise the frenulum so the tongue can move properly is called a frenotomy. It’s also commonly referred to as a revision. (It may be called different things in different parts of the world.)

The frenotomy can be done in about 2 seconds by clipping the tissue. If laser is used, it’s a little longer. It is never too late for a frenotomy!

The frenulum is NOT part of the tongue—the tongue will not be clipped during a frenotomy.

The frenulum usually has few nerves and blood vessels.

You can’t tell by looking if baby needs frenotomy.

A frenulum can not “grow back” once it’s clipped. It can, however, heal in such a way that it continues to restrict the movement of the tongue. It is important to keep the wound open during the healing process.

The frenotomy is often just the beginning of the path to full tongue function. Body work and time to learn new skills are often necessary.

There are no documented reports of any complications from a frenotomy.

In some parts of the world, ankyloglossia is commonly remedied with a long fingernail!

See also, “Squeaker: A Story about a Tongue Tie Release.”

Baby Poop: A Story of Getting To Normal

Happy little guy!

Happy little guy!

Lactation consultants are not only interested in what goes into your baby; we’re also interested in what comes out! We like to see very frequent stooling that is yellowish in color with lots of chunky white curds. That is normal breastfed baby poop. If baby is not pooping frequently, or poop is a different color, that is not normal and we want to know why. Continue reading

Yurika’s Story: A Beautiful “Thank You”

This story was sent to me by one of my clients, Yurika. She wants to share it with all of you and hopes that it will help to continue breastfeeding–even when facing challenges.

photo_face0 Mila was born 8lbs 7oz, healthy and passed all the health screening at the hospital before discharging. At our postpartum appointment 3 days after leaving the hospital, her weight loss was brought up as a concern. She seemed to be latching but she was not transferring enough milk and I was experiencing a lot of pain. Her losing more that 10% of her birth weight was addressed at her 7 day postpartum appointment with her pediatrician and we were sent to the breastfeeding center at the hospital that day for further investigation. Continue reading

The Lactation Consultation: What to Expect

This article was written in collaboration with Lyla Wolfenstein, B.S., IBCLC. Lyla is a lactation consultant in Portland, OR.

DSC9909-LA thorough lactation evaluation will probably be different than any other health-related visit you’ve experienced. It is time intensive, multi-dimensional, intuitive, experiential and often includes a bit of detective work. The International Board Certified Lactation Consultant (IBCLC) is the only health care professional that has the expertise and training required to perform such a specialized evaluation.

She (Lyla) is patient with new moms and has an ability to detect problems. She has creative solutions and never gives up on a client.

Continue reading