Jack Newman & Edith Kernerman

Jack Newman and Edith Kernerman are both pediatricians and breastfeeding experts who work together out of the Newman Breastfeeding Clinic. Dr. Newman has written numerous books on breastfeeding, including The Ultimate Breastfeeding Book of Answers, and Dr. Jack Newman's Guide to Breastfeeding.

These books and many more can also be found on Dr. Newman's website.

Scenario #1

My 7 month old is a nightmare to feed! I am definitely ready for him to move on to solid foods, but he seems completely uninterested. He is a very active, alert, and persistent child, and if he doesn't want to do something, he will not do it! Should I be making him eat at this age, or can he continue almost exclusively on breastmilk for now?

Jack Newman: There is no reason to rush into feeding the baby. If he’s growing well and generally content, don’t try to feed him. One mistake some mothers make is to follow the advice of everyone and start on cereal. That is a bad idea. Cereal tastes awful, is expensive for what you get and is often constipating.

So, give the baby food off of your plate. With a few exceptions, almost anything is okay to give a 7 month old (exceptions include round slippery things, popcorn, that sort of thing). Just put the food straight from your plate onto his plate and let him eat it, or not eat it. Let him decide. Let him eat with his hands, or not.

Scenario #2

I'm wondering how often I should let my baby feed if he's acting like he's hungry, but really I know that it would just soothe him. He's 5 weeks old and upset most of the time that he's awake. My doctor said to hold him off to a minimum of 2 hours between feeds... but sometimes I wonder if that's possible. I'm strictly breastfeeding, but I've been told by some people that formula may help him sleep longer at night. At the same time I thought I've heard that formula is harder to digest and would it not therefore make his gas worse? Do you have any advice for me?

Jack Newman: First of all, feeding by the clock is not a good idea. The doctor’s advice does not make sense. The notion that a baby is breastfeeding just because he’s on the breast is also a mistake. This is a perfect example of how poorly we teach breastfeeding. If you go to our website, we have videos which will show you how to know if your baby is breastfeeding or not.

Secondly, it is not worth it to put your baby on formula so that he sleeps longer. In fact, formula does not make a baby sleep longer. That’s a myth. A baby who drinks equal amounts of formula and breastmilk will sleep the same period of time, more or less. Again, we teach breastfeeding so poorly that if a baby will take 80 ml from a bottle, he may take much less from the breast, mainly because he is not getting the milk that is available.

Don’t forget, formula is not breastmilk and breastfeeding is much more than breastmilk. This gets better with time; don’t give up on breastfeeding, it’s worth it to keep going.

Note and please try to remember, even in the most difficult times: Colic/gassiness eventually gets better no matter what. Your baby is not allergic to your milk (though he may react to something in your milk that comes from your diet - this can be fixed). There is lots you can do to improve the situation. Stopping breastfeeding not only does not always work, but also starting artificial feeding sometimes makes things even worse. The fact that some babies do improve when they stop breastfeeding does not make stopping a good idea, especially since you and your baby both miss out on the enormous benefits of breastfeeding. Especially since there is lots you can do before contemplating stopping and since colic gets better anyway.

Scenarios # 3 & 4

Question: Our doctor has suggested our baby's colicky behaviour is from underfeeding. I already feel like I breastfeed her 24 hours a day…. Whenever she so much as whimpers I offer her the breast. She is gaining weight, but very slowly (she has been around the 5th percentile since birth). She spits up quite a bit, sometimes even an hour or two after feeding. Could it be she is not gaining more weight because of the spitting up? Could she have reflux?

Question: I am really wondering if breastfeeding is worth it. I know all the benefits, of course, but I have to question it because my son seems to have a reaction to everything I eat. The pediatrician recommended eliminating milk products from my diet but after doing that for 2 weeks, I found no difference. My 7 wk old son gets awful stomach aches, excessive gas and dark green stool when he has a belly ache, which is often.

Edith Kernerman: These are common concerns that many mothers have.

In the first case, the baby seems to always be feeding and yet her weight gain is very slow, so the reason for this is sought outside the feeding. There certainly is not enough information here to make a diagnosis of reflux and, but at the same time, not enough to rule it out. What is often the case in this type of scenario is that baby is not feeding very effectively. I like to say we have a South American-style baby in a North American-lifestyle; baby will be happy only as long as s/he is near the breast. S/he never allows herself to be put down and seems to want to feed all the time - so how can that be the cause of the slow gain?

The answer may just be that this baby is not actually feeding all the time but instead just appears to feed. If a baby is sucking on the breast it doesn't necessarily mean the baby is actually drinking or getting milk. If you were to suck on your finger it doesn't mean you will get anything out. Just because a baby is on the breast doesn't necessarily mean s/he is eating. So, what seems like marathon and/or frequent feedings may actually be marathon or frequent suck sessions. Is this the baby's fault? Of course not. The baby is doing what s/he needs to do - suck. This is a case of the milk not coming to the baby in an efficient way. So, is that the mother's fault? Of course not! The mother may certainly be making all the milk the baby needs, it's just that the baby does not get the milk she is making.

So, how to get that milk into baby? Well, we have a protocol that deals with just that: the Protocol to Manage Breastmilk Intake. This may be found at our website. An abbreviated form of the Protocol is this:

1. Latch the baby well. Ensure an asymmetric latch with baby's chin deep into the breast and baby's nose far away from the breast so the baby's head is in a tipping-back position and his/her nose is way from his/her chest.
2. Ensure baby is actually drinking. Quick rhythmic movements of the chin let us know a baby is sucking. Long drawn out pauses where the chin is at the most dropped-down point and pauses there indicates the mouth has filled with milk.
3. When baby starts to suck again without drinking, use breast compressions to squeeze more milk into baby's mouth.
4. When compressions no longer work at keeping a baby drinking and baby has gone back to just sucking then offer the other side.
5. Repeat above steps.

So what does all of that have to do with spit up? Everything and nothing. Spit up, for the most part, is a laundry issue only. A few spits ups a day are normal. And so may be a few spit ups every feeding. They become an issue if they cause the baby pain during the spitting up and make it so that the baby does not want to eat beyond a little bit to take the edge off the hunger feeling.

In fact, some babies who have reflux (Gastro Esophageal Reflux Disorder - GERD) sometimes do not even spit up very much. They reflux a bit up their throats and it may cause burning so they don't eat. Sometimes they spit up tons. Another reason to make it an issue is if baby chokes on the spit up and turns blue from choking. Babies with GERD tend to be in significant amounts of pain and distress and are not happy when the mother's flow is fast.

Now sometimes you get babies who are at the breast and they are pulling and kicking and screaming and turn very red and seem to have terrible gas. This doesn't usually mean reflux - in fact, this rarely means reflux. This is a baby very frustrated with lack of flow.

So, knowing all of the above, how can we try to rule out reflux or GERD with the little information that we have? We play detective. The mother needs to watch the baby at the breast. If the baby is drinking well and is happy, all is good. If baby starts to fuss and pull we need to know if this is while baby is just sucking (therefore wanting more flow - so use breast compressions or offer the other side) or if baby is drinking while pulling - in which case baby may be saying 'Hey I don't want to eat!' (If so, take the baby off and see if s/he needs a break, stop the compressions, or let baby just suck without drinking and see if that settles him/her down). Does that mean s/he has reflux? No, it means he just doesn't want to eat right then.

By getting a baby to efficiently drink while at the breast, we get more food into the baby while not allowing for too much time for hanging out without drinking.

Therefore happier baby.

Our Sponsors