Ouch! Biting and Breastfeeding

Was I in for a surprise! Sam suddenly began biting me out of nowhere! Breastfeeding was going fine for many months. No biting ever (except one day when he got a tooth). Then about two weeks ago he began to bite me occasionally when nursing, either during latching on, or when he's finished feeding. Then it progressed into much more biting. So much so that I just give up latching him on since he was biting me several times even before nursing. The only mostly-unaffected feeding was the one at 5-6 am. Since he was mostly asleep then, he didn't bite, only at the end (to signal "feeding time over" I guess?).

Anyway, I don't believe he is teething anymore as he's gotten whatever teeth should be in at this point. The two year molars area doesn't look inflamed or anything. He got the other molars already.

Weirdly enough, Sam didn't seem to mind not nursing at all. It bothered me more than it bothered him! He's not a demandy type of kid so he never really asks me to nurse. It's just part of the routine and he's happy to nurse. If I removed him, he was totally cool with that. Also, at the bedtime feeding he isn't very hungry, nor is he at the wake-up feeding. Those were mainly for enjoyment reasons (on both our parts).

Those few nights he went to bed without nursing beforehand, nursed well in the early AM, and then took a few sips in the AM when waking up for real.

Also it didn't help that this all happened during the part of the month where it takes me longer to get a letdown (ovulation time). I know I can stimulate to get a letdown and only then attempt to latch him on, but I didn't even bother.

It didn't look like he really needed the feedings either and frankly, it would be easier to not nurse to sleep. And it was really great to see him enjoying way more solid foods. But honestly it did bother me knowing I'll no longer be able to keep breastfeeding in my arsenal of illness-prevention/fighting.

I thought at the time: Is this just my baby's method of weaning? Or will he "come back"? I'm not making myself crazy to get him back and all that, especially since this is a decent time to wean, but it would be nice if it did.

What did I do? The first few times he bit me, I yelled at him and gave his hand a little pinch. That just scared him off for the next few feedings - he was too frightened to even latch on, poor thing! Bad association. Classical conditioning gone wrong. Then I decided to pretend I was injected with a numbing agent. I did not flinch, I did not smile back at him when he grinned after a chomp well done. I looked as relaxed as I normally look while enjoying ice cream. That must have been what did it. My lack of reaction seemed to make biting a "boring" thing - yay!

I'm glad to report that after a few days of this nonsense, Sam went back to nursing normally (and thus eating less solids).

Nursing at night and milk supply

On a parenting forum, someone wanted to know if she can skip feedings at night (and have her husband give the baby a bottle those times) and still keep her milk supply at a good level. It got me thinking about the ramifications of this breastfeeding "shortcut".

In the beginning, when your baby is a newborn, you start founding your milk supply "factories". Nurse often, on demand, and you are setting up lots of factories in full production mode. Nurse only sometimes, or most of the time (but not each time baby has to eat) and you're leaving out some valuable establishments. In the beginning your milk is just being produced based on your hormones that were set into motion when you experienced labor and delivery.

It's also so important to nurse AT NIGHT especially because your milk-making hormone called prolactin functions at its best during the night. So one nursing session at night can be much more effective in maintaining your supply than a session by day.

Now, at some point your milk supply will regulate. Your hormones that accompanied labor and delivery are phasing out and your milk won't be gushing out like there's no tomorrow. This point varies in women. Some find that their milk regulates at six weeks, while for others (especially those with oversupply issues) tend to find their supply regulating several months later. My supply regulated when Sam was three months old. This can happen overnight, suddenly, or gradually (for me it was rather suddenly).

At that point, your system of supply and demand takes over. Now is when your factory system comes into play. If you have 5 factories in working order versus 15 factories, it'll obviously be way harder to keep up to the demands of your baby. That's why it's so important in the early days to nurse, nurse, nurse. Your baby cannot overdose on nursing.

Some mothers who skip feedings at night will have no problem with nursing later on. But many do. A key difference would be whether the mother is separated from her baby during the day or stays at home with her child. If a mother has to pump because of a separation, it can be a lot more difficult than nursing on demand if she was at home. Say you can't produce enough with the pump, now what? But if you're at home with your baby it's a lot easier since you can nurse several times that day if your baby doesn't fill up with less feedings.

Additionally, lots of mothers have oversupply issues so skipping a feeding might make them uncomfortable later on, but wouldn't really harm their supply. Also, just because a lot of people can manage doing something, doesn't mean that this is the norm and the "right" way to approach something. A lot of people don't wear seat belts and don't die in car accidents, just as a dramatic example.

Finger-feeding a baby who can't breastfeed

Sometimes a baby is born with some sort of difficulty which makes it hard for him to nurse properly and or obtain a good latch. Sam was like that. Due to his tongue tie he wasn't able to latch onto my nipples or even suck that well. Only the second day did he attempt a little sucking and by the third day he was able to actually nurse for an entire feeding. So what happened during this time? The hospital staff fed him bottles. I had no choice, really. They did not tell me anything about hand-expressing colostrum (idiots) and they just found it easier to feed him formula, so that was what happened. My sister did give me great advice about that, though. She said to have the nurses use a breastfeeding-friendly method when administering the bottles.

If you read what the internet has to say about that, you'll see all kinds of suggestions from using an SNS (supplemental nursing system), to cup-feeding, spoon-feeding, dropper-feeding, and finger-feeding. The SNS is a really helpful tool (based on what I've read online and heard from mothers who have used them) but I don't have much info since I've never tried it out. Cup-feeding and spoon-feeding sound very messy to me. I know that Sam couldn't easily drink from a cup until he was several months old so no way could I see that working when he was a few days old! Droppers don't sound bad, and I've resorted to using that at times when he was reluctant to eat (I have plastic pipettes).

Which leaves finger-feeding. How does this work? You (or whoever is feeding the baby) wash your hands (important!) and fills a bottle with milk or formula. Then you attach a lactation aid which is really a thin tube that can attach to the baby bottle. Tape the other end of the tube to your finger and let your baby suck your finger as if it's a nipple or pacifier. Release the milk into the tube and your baby is now being fed!

This was a great method to use in our case because Sam was able to build up his sucking muscles while eating, but without the nipple confusion a regular bottle would have caused. I wanted him to learn to suck on skin, not silicone. I actually never did this because the nurses in the hospital were doing it for me, but the technique did work to help Sam suck better, and it got him fed without a bottle!

So if you're in such a situation where your baby can't nurse for whatever reason, don't give up hope. You probably can sort out your breastfeeding issue, whether it's a physical issue like tongue tie, or a milk supply issue. But in the meantime, there is no reason your baby has to be given a bottle. Bottles don't help as well as other breastfeeding-friendly methods do. Plus you can give your baby your own milk most of the time!

Getting a breast pump from your insurance company

I recently got a message through my contact form at the right from Shaffizan, who wrote this post on her blog. She brought up a valid point about obtaining breast pumps from one's insurance company. I'll elaborate on that a bit now.

A good double electric breast pump is an expensive item, no question about it. It's this machine trying to replicate what the human body does, so I guess that's why it isn't cheap. When you have a baby, your expenses rise like a newborn's cry and the last thing you want is yet another important but pricey item to send you over the edge. Just to give you an idea, Amazon has the Medela Pump In Style Advanced Backpack model for $218 and the Ameda Purely Yours for $159. And these are priced at below retail price. If you're like me, you're just not interested in one for that price. Especially when you know they won't last for more than a few years at best.

Enter the new Affordable Care Act which you may or may not approve of. But one thing's for sure, they definitely had breastfeeding mothers in mind (yay!). Under the ACA*:

"Your health insurance plan must cover the cost of a breast pump – and may offer to cover either a rental or a new one for you to keep.

Your plan may have guidelines on whether the covered pump is manual or electric, how long the coverage of a rented pump lasts, and when they’ll provide the pump (before or after you have the baby).

But it’s up to you and your doctor to decide what's right for you."

So the best thing to do is to call your insurance company directly, preferably before you have your baby, and ask them about their breast pump policy. It's probably easier than to go through the ten-inch thick insurance contract book. They will tell you which suppliers they're affiliated with, and you will have to be in touch with them about placing your order. Some insurance companies require you to order the pump within 30 days of giving birth so it's best to find that out early on. It's really that simple.

Now what's if your insurance company won't provide you with the model you really want? Or what's if you want to own a second pump (so you can leave one at work and keep one at home for days off)? Here's a little tip. Since basically everyone's insurance company is providing them with pumps, what's if you don't actually need a pump? They'll still give you one. So these folks now have pumps that are not in use, just collecting dust. Then they sell them on eBay or someplace.

It's not too hard to find brand new still-in-the-box pumps being sold on eBay by people who got them from their insurance companies. How do you know? They come in the same insurance-given packaging (instead of the retail packaging you find in the store). Often, you can find a good deal on these pump since the sellers don't mind making a quick buck and aren't asking for the full retail price anyway. This is how I bought my second Ameda Purely Yours pump for $45 (brand new, never used).

I personally would not use somebody else's already used pump unless I just use the base and buy my own attachments. Even though most parts could be sterilized depending on the model, there are some areas that can't be sanitized well enough without damaging the equipment. Sometimes this works as another cheap alternative: borrow or buy off somebody's actual pump, but then buy the new pump parts.

You can read more about my pumping experience here.

*The ACA will also cover other breastfeeding-related needs such as lactation support. It also requires larger companies to allow pumping time and a place to pump for mothers who require it.

Printable feeding clock for new moms

When you're discharged from the hospital after delivering your baby, the staff will send you home with a badly photocopied feeding chart with all the hours written out, and you're supposed to circle the corresponding hour each time you feed. This way you can keep track of how many feedings your baby gets over a 24-hour period. That's great for the really early days, maybe a week or so. But afterwards, all you really want to know is when you last fed your baby. It can be hard to remember little details like numbers when you're so busy nursing, sleeping, changing diapers, etc. while your sleep tank is running on empty.

Printable feeding clock

So I created a handy printable clock that lets you keep track of prior feedings when you don't have a pen handy, or can't write (great for Sabbath). You can hang it on your fridge with a magnet and your baby's last feeding time will be prominently displayed in either pink or blue.

INSTRUCTIONS: Download and print the feeding clock or click the thumbnail to the left. Cut out the circle of the clock, along with both handles. You can use pink or blue for a girl or boy, respectively, or you can use both to show the last two feedings. Poke a hole in the center black dot of the clock, and the dots on the hands. Affix the hand/s to the center of the clock using a paper fastener. Alternately you can use a small magnet to hold it in place on the fridge, or affix the hands to the edge of the clock with a paper clip.

To use, simply move the hand to display the correct time when you finish feeding your baby.

Nursing position tricks for unwilling babies

Ever had the experience of your baby repeatedly refusing one side when nursing? Your baby can be doing that for many reasons, among them:

1. random quirk (most common) - babies do all sorts of weird things for no explainable reason
2. during a blocked milk duct - milk isn't coming out fast enough from the affected side so your baby is just not interested in waiting around for snail mail. 
3. after a blocked milk duct - the old, backed up milk from behind the plug is now being released and it doesn't taste that great (it can taste salty because of the high fat content).
4. ear/teething pain - if you suspect this, have your pediatrician examine your baby to rule this out

I came up with a pretty neat hack for this situation. Of course, if the reason is due to some kind of ailment (reason 4), deal with that properly. If you've determined that it's probably due to reasons 1-3, you can proceed to try this simply, yet very effective idea: switch nursing positions.

I normally breastfeed in one position only: cross cradle. Sam lays across a pillow on my lap, and for illustrative purposes, is nursing from the left side. My right arm supports back and my right palm holds his head and neck to face my nipple. My left hand supports my boob from below to give it some lift.

Let's say he refuses to nurse on the right side. I won't reverse the nursing position so he can eat from the right side. Instead I'll keep my hands and everything in the same original places, but I will slide his body over to the right just a bit so his face is now in front of my right breast. If needed I can use my left hand to now lift up my right boob, but usually I don't bother if I want this to be done as smoothly as possible. This can be done so deftly, he will be none the wiser (and he is wise!). Right now he is in more of a football hold, actually.

So a simple switch of positions is often all you need to get your baby to latch onto his/her less-preferred side.

Mapping my teeth - a teething overview

Sam is teething. He's already sprouted his first two teeth (the bottom ones) at 5 months, but then we had a long break. Finally, at around 10 months we saw some more activity in the teeth arena. Some things that told us he was teething (and not suffering from another ear infection):

• Nursing more. Sucking felt good to his gums. But that's not true for all babies. Some hate the sucking because it hurts them more. YMMV. Even when he wasn't actively swallowing, he still sucked, albeit weakly. Sometimes he'd even protest if I unlatched him (this was going on for half an hour already, what was I to do?!). I found that if I unlatched him and immediately gave him a pacifier, he was happy.
• Biting every bitable and unbitable surface within teeth's reach. He'd waltz over to a cheer and start chomping on its legs, for example.
• Random crying outbursts. Sam doesn't usually burst out in piercing shrieks unless he's experiencing pain. Usually crying starts out at a leisurely 5mph whine, progressing steadily to annoying whimpering, culminating in a speedy full-fledged crying.
• Loss of interest in solids that weren't pureed. What he DID enjoy was frozen foods. Cubed peaches that were stuck in the freezer. I'd let them thaw for a few minutes until they were chunky but icy and he'd enjoy that.
• Pulling at ears. People usually associate that with ear pain, but according to Dr. Sears it's actually a teething sign. Babies that young can't pinpoint the source of ear pain. But teething pain radiates to the ears and that's what they're touching when they pull on them.
• While nursing he'd bang his head like a gavel.
• And one of the most annoying symptoms, which is actually related to nursing, is increased soreness and nipple pain. In the following paragraph I'll tell you why.

Imagine I just attached another set of legs to you, for example a set of crutches. You'd be pretty clumsy at first, knocking into everything in site because you haven't yet figured out your spatial bounds. Same with teething. Sam has to map out his new teeth. He suddenly has new little pincers in weird places where he's never had them before. He doesn't know how far he can go with them yet. So while he's nursing, his latch becomes a bit sharper because there are teeth in the way. After a few days, the soreness and discomfort subside because he's realized how to maneuver his teeth. Makes sense to me when I thought of it like this.

Pump on the fritz

The time has come for my pump to big me a weak goodbye. For the past few days, I could not pump a decent quantity at work. I knew I did not have a supply issue because I had plenty in the mornings and evenings when I nursed Sam. And I had recently replaced the pump parts and they were in fine working order. So what could be the issue? The pump.

On Friday, the pump began to make protesting noises (instead of ch-CH ch-CH ch-CH, it was more like ch-ch-ch-CHAAA ch-ch-ch-CHAAA). I called Ameda parent line and the customer service agent asked me to put the phone to the machine while it's turned on so she can diagnose the sound issue. She immediately told me the pump sounded labored, and that she'd be sending out a replacement by Monday.

I knew the pump might not arrive by Monday when I need to pump so I brought in my backup pump that I keep at home. I already got more than I did on Friday. And today, Tuesday, I got a nice amount! Three cheers for new pumps that work!

If you've got an issue with your pump, call customer service today.

Galactogogues

These are products to take that can help you increase your milk supply. I don't know if I'm a believer in these really because I've only tried fenugreek and it did not help.

Fenugreek is an herbal supplement responsible for lots of things, but nursing moms will often use it to increase milk supply. It's supposed to work well but really did nothing for me in terms of boosting milk. However, it did boost my appetite - hooboy! As I've later read, fenugreek increases appetite and makes you crave carbs, a sure recipe for piling on the extra poundage.

I took it for one whole week, 4 pills every 3 hours, which is about the upper limits of the dose. That week i felt extremely hungry. All the time. I would eat everything in sight. If I controlled myself, I just ended up feeling very weak and lightheaded, a symptom of low blood sugar. It was nuts.

I did try drinking some beer and I think it helped my supply. Too early to tell for sure. But I've been drinking 1 cup of beer for the past 3 nights after putting Sam to bed.

Plugged Milk Ducts 101

A plugged milk duct is pretty much what it sounds like: a blockage forms somewhere in the duct which prevents milk from flowing out towards the nipple. The milk then pools in that area causing lots of discomfort, pain, redness, swelling, hardness and anything else annoying. The only way to relieve it is to free the clogged area. Let's analyze this a bit.

They say that in order to prevent plugged ducts, the breasts must frequently be emptied. That ensures the passageways are free and clear for milk to pass through. Sounds fine. But plugged ducts can also be caused by the very nature of the milk. If milk is fatty it will clog faster. Makes sense, doesn't it? So someone like me is prone to clogged ducts because my milk is pretty fatty sometimes. It's not that I don't empty my breasts enough by feeding often.

They sound scary. Especially because online everyone warns you that if you do not treat the plugged duct aggressively (and immediately) then you will most likely get mastitis. I can assure you that I have never gotten mastitis from a plugged duct and I've had at least 50 plugged ducts. They often resolve with some basic care and most are gone within 24 hours or less. I'll walk you through a typical scenario.

It's 3:30 PM, just after my second pumping session at work, and I feel a bit of soreness on the inner edge of my left breast (90% of the time the plug was in that spot since they tend to come and go in the same area). By the time I come home from work I can feel real pain each time I press the area. I also see faint redness. Not like poison ivy red, but more like my boob is blushing.

Now. If I do nothing, Sam will not really enjoy eating from that side since the flow is obstructed and slower. More and more milk will pool up in the affected area. My breast will really hurt by nighttime. Tomorrow it will also be hurty.

However, here's what I do. At 3:31 I head to the bathroom at work and start to really give it to my boob. Using the heel of my hand, I press down from the top of my chest, down the affected side of the boob, and squeeze hard. It's supposed to hurt. Sometimes I'll be lucky and I'll see a white pinprick show up on my nipple right away, but other times it can take even a day to rear itself. That's the plug showing herself. I massage and squeeze (as if I'm hand expressing) and I can literally see a white piece of hardened milk pop out. Sometimes there is more than one milky clump. Often there's a few stringy strands of milk that follow. I keep massaging until nothing comes out anymore. With practice I have learned exactly where on my boob I need to press in order for milk from that specific duct to shoot out.

Some disclaimers:

• Sometimes I have to repeat the process again, so I do that after each nursing session. The area WILL feel sore after the plug is released but that clears away within a day or so. Additionally, milk will flow slowishly from that side, so your baby might not love nursing there. Always start with that side, and then hand express when you're finished nursing.
• The milk from the plugged area might also taste ickyish and salty (it has happened to me plenty of times - the milk also turned a weird shade of yellow). That's why it's common for the baby to stop nursing after a few moments because he's stopping once the milk starts tasting weird - which is when the older milk is coming down the chute.
• It often hurst to breastfeed from the affected side. This is because the area is firm and the baby cannot get a perfect latch - the shallow latch causes sore nipples.
• Sometimes you cannot release the plug via massaging. In such a case I take a hot shower and use a sterilized needle to prod the plug from below, in an outward motion (poking it inward just pushes the plug in further). You shouldn't be bleeding from this. To sterilize a needle, stick it through a flame until the tip turns red, and then rinse under cool water.
• They say to use heat either by showering or a heating pad, but I found none to be as effective as brute force of my hand massaging. The last 30 or so clogs that I had were treated solely with this method, and no heating element. 

If you catch it early, treat it early, and you'll save yourself a lot of discomfort. And having a clogged duct is a pretty good sign - for me, at least - that there's plenty of milk for the baby. In a way, I welcome these since it means I've got lots of milk!

Some like it hot, some like it cold

Sam has a very definitive taste when it comes to bottles. He will never take frozen milk that's been thawed in the fridge. Nor will he take frozen milk that's been rewarmed a second time. [update: since correcting the lipase issue and freezing immediately after expressing, Sam will take a bottle that's been rewarmed twice! So he doesn't have to finish his bottle in one shot anymore.] Now we know it's probably because of my excess lipase issue. He also likes his bottles really warm, even warmer than the temperature of milk when nursing, which is presumably 98.6 degrees or so. I wonder if that somehow masks the metallic/soapy taste caused by the lipase.

So I try to freeze my milk in two categories: full bottles like 4-5 ounces, and toppers of 1-3 ounces. This way, if I even think Sam might not want a full bottle, I try to have him take a smaller bag's worth so we don't waste so much milk. He will not take the leftovers a second time, only on random occasions, but I can't rely on that.

I don't have his bottle-taking habits down to a science because I'm not the one who actually gives him bottles. He wouldn't take one from - the last time we tried was when he was 2 months old, so who knows. Maybe he would drink from a bottle if I administered it. But there's really no need for me to give him one if I could nurse him. Sam only gets bottles at the babysitter, so she's the expert!

Letdowns

Letdowns are so weird. Usually the word signifies something negative and disappointing. But not when it comes to BFing. The word letdown brings breastfeeding mothers (and their offspring) much joy. Letdown is an easy laywoman's term for "milk ejection reflex", which is a complex, highly wondrous process that brings your milk to your baby. When the baby sucks your nipple, the nipple and areola become stimulated, which releases oxytocin (the "mothering hormone"). This causes contractions in the milk-making glands, literally squeezing them like a tube of toothpaste. The milk then shoots through the ducts on high-speed and baby enjoys the meal.

Now I never felt letdowns when nursing in the early days. I would feel random letdowns when it was on or around the time Sam would normally eat (say, 2-3 hours since last feeding). It would feel like an 18-wheeler riding over my breasts, and then my nipples would feel somewhat sore for a minute or two. I never felt this while nursing, though.

Only once my milk regulated at 3 months did I begin to feel them! About 30-60 seconds after Sam would actively start to suck, I'd feel that heavy feeling again and his sucking/swallowing pattern became steady and consistent. I'd still feel it randomly between feedings. Those were much more painful than the ones I'd feel while breastfeeding. On fuller days, I'd feel lots of these random ones, and the nursing ones would come really fast, only after a few seconds of sucking.

These days I feel letdowns most of the time, and they're not that obvious either. I usually have to focus on it in order to even notice it! I rarely get the between-feeds letdowns. On lower supply days I can't get more than one letdown per hour or so, even if I try nursing Sam two times in one hour.

I find that when pumping, I need to achieve about 3 letdowns to get 4-5 oz of milk - these days. In the past I'd get that all with one letdown. But when I nurse/pump I can only get one letdown. I don't know, I see lots of sites writing about keeping baby on the breast for longer so you can get more letdowns. I don't have that. While pumping, the initial letdown might yield only 2-3 ounces. So what do I do?

Here's how to achieve a manual letdown muuuuuch faster than using the stimulation mode on the pump. This is also great if you for some reason can't get a letdown and baby really wants to nurse already. Or if you're trying to bring baby back from a nursing strike and you want it to be appealing (i.e. milk already waiting for him at the table):

1. Try to relax. Right. Like pretend you're relaxed. Sit in a relaxing, comfortable position.
2. Start massaging both nipples at the same time - one with each hand. 
3. Try different moves to see which feels better to you: pinching, pulling, twisting, stroking, flicking, etc.  
4. Focus on what the letdown should feel like. Usually within 5 minutes you can get a letdown.
5. Enjoy the flow of milk.

For me, they are completely not psychological, but rather physical. I do not get letdowns by thinking of oceans of flowing milk nor when I look at pictures or videos of Sam (what lots of websites suggest). I can only cause myself to get them from direct stimulation, either from Sam's sucking, or from my hands. 

Fresh frozen and the excess lipase saga

Oxymoron? A scary thing happened to me, I freaked out, I worked to combat it, and it miraculously righted itself with an easy solution: fresh frozen.

Last week Monday Sam refused his normal amount of milk at the babysitter. He usually has a 5 oz bottle at around 11ish and then a 4 oz bottle at around 2-3. That day he had a total of 5 oz. Tuesday he did that again. Same with Wednesday. Each of those days he came home with the remainder of the milk in the bottle. It looked yellowish. I smelled it. I almost barfed. But milk smells, I've heard, so I daringly tasted a drop and BLECHEROO! It really tasted soapy and metallic. No wonder Sam turned it down. He has better taste than that. 

Turns out my milk has excess lipase. There are SO many articles out there that discuss it so I won't go into too much detail. But basically, everyone's BM has lipase, which is an enzyme that breaks down the fat so the baby can digest it. Usually this breaking down of lipase does not happen right away (I think it takes place inside the baby's body), but in some people, they have so much of it that the milk fat becomes broken down much quicker. Some people 4 hours later, some a day later, and some only find their freezer stash of one month old milk is bad. So it's really a unique situation for everyone.

What does one do about that? Some babies are totally cool with the yucky taste and drink the milk anyway. It's perfectly safe. Remember, the milk is just broken down, not spoiled. If baby will not drink it, don't blame him because it truly is yucko. The solution? Heat the milk (aka "scald" it) to 180 degrees and then quickly cool it before storing - this deactivates the enzyme and keeps your milk tasting delicious. That's such a pain, though, if you have to scald at each pumping session because your milk won't last the day in the fridge.

I decided to see how long my milk can "last" before it gets that ewwy taste/smell. I pumped a bit and put it in the fridge. After 4 hours it was fine. After 8 hours it already had a faint metallic taste. 24 hours later it's a strong metallic/soapy taste, plus it smells bad when heated. It didn't smell in the fridge when cold. 

Now this brought back to mind the early days when I went back to work. Sam did not take the bottle willingly at all. He would drink just an ounce or two and then another ounce or two a few hours later. He ate just to tide him over until he got hungry again. Poor boy. He did nurse well once at home and made up for it so I wasn't too worried. He was gaining weight as well. After about 3-4 weeks he would take a complete bottle. Now I think I know why. I'll bet that milk was also lipasey. In addition, Sam doesn't eat warmed up milk that slowly thawed in the fridge. Only milk that went straight from freezer to hot water. 

Later on he either A) got used to the taste and realized this is the situation and you gotta adapt, or B) the lipase was only really bad in the early days, which is common because there is more fat then or something. 

Well, now it seems to be bad again. Also lately I would freeze my milk only once I prepared the bottles for the next day - which was nighttime. Many hours after I'd pumped. So it was in the fridge during most of the day, slowly ickifying itself until the next afternoon when Sam would unwillingly drink just a bit. In the past I'd freeze the milk at work already, right after pumping - I don't know why. I just did that. Turns out that was the key to my solution.

I sent Sam some milk for this Monday that was scalded. He drank it beautifully. It also did not turn yellow, according to the babysitter. And the residue remaining in the bottle by the time he came home did NOT stink. On Tuesday I sent him with fresh frozen milk - milk that was frozen immediately after pumping - and he also drank it all really nicely!

Top: milk unaffected by lipase
Bottom: milk affected by lipase

So for now we are sticking with fresh frozen so I am spared the time-consuming task of scalding it each day. Freezing, I will dutifully point out, does cause some of the milk's important properties to be lost (scalding can also do that, btw), however it is MUCH better to serve this than formula. It's really of no health concern unless the baby only drinks frozen milk - we are talking just two bottles a day here, so no biggie.

Just a reminder: Milk that was affected by lipase activity looks yellower when thawed (but whiter when frozen), looks really fatty when warmed up, you can often see small globules of fat, it smells really bad, and has the taste of metal or soap. It IS safe to eat. The best thing to do if your baby is refusing bottles is to not blame it on the bottle - just taste the milk and you'll know for sure! Also, if you store milk for a freezer stash, defrost a bag every two weeks or so and make sure it tastes/smells fine.

Notice the picture on the left: The milk on top looks like milk should look when frozen. Pale yellow color, of even consistency. The bottom bag contains milk in which lipase already did its thing. You can see separate fatty sections and the milk is overall whiter and thicker looking.

How a tongue-tie is resolved

The proper term is actually "revision". Tongue-ties are revised. On a fine Monday morning when Sam was about five months old, we took him to Dr. Tali Lando of ENT Faculty. She checked his mouth and agreed that he has a posterior tongue-tie, but it's not one of the bad ones she's seen. Still, the good doctor claimed, it pays to just deal with it now while he's a baby and the procedure is no big deal to perform and recover from. Here's how it went.

We laid Sam down on the examining table and held his hands and feet. An assistant held his head down so he faced the doctor. Dr. Lando gave him a quick shot to numb the area (Sam cried for just a few seconds after that) and then snipped the offending frenulum, which took just a few seconds! Then she pressed a gauze on that area to stem the bleeding. When she removed it, the gauze just had a pale peach-colored stain - no bleeding! I was told that I should try to nurse him right away as that would help the area heal quicker. I was only too happy to oblige. Nursing really comforts Sam (and me!).

I nursed him and didn't see any remarkable difference yet. His suction felt like it always did. For the next few days after the procedure, Sam nursed a little less than normal and it did not feel any different than it did before. THEN we noticed a change. A few days later my nipples got sore! Oh boy, did they get sore! Sam also went from nursing for 15 minutes to about 7-10 minutes. By now, at 8 months, he nurses for about 5 minutes. His lips also flange out the proper way, surrounding the nipple in a proper latch. No more lipstick nipples either.

I wondered why I didn't see a change in his feeding right away. Then it occurred to me. He was using brand new muscles that had never yet been within his range. When using them in the beginning, just after the revision, these muscles would tire easily until he exercised them enough to endure an entire feeding.