 I have breastfed for over 52 months. Fifty. Two. Months. Looking back, it flew by. I hardly remember nursing my first baby, and now I'm about to wean my second. In fact, her last day breastfeeding will be tomorrow, the day before I leave for a trip. She will have nursed (nearly) every day for the last 2 years. Breastfeeding is one of the most emotionally-charged topics of motherhood. It is a joyous experience for some, an impossible one for others. Some women love it. Others hate it. Many women who were unable to breastfeed harbor guilt and hard feelings about the whole experience. This is not a post about breastfeeding being better than bottle feeding or why everyone "should" breastfeed. I am a believer in feeding your baby in a way that works best for mom, baby and the whole family. As a mom, I have loved breastfeeding my babies and I feel lucky that I was able to do it, but as a dietitian I am well aware that breastfeeding just doesn't work for everyone, for a variety of reasons. If thinking about breastfeeding hurts your heart, please know that I am sending you a virtual hug and that I am proud of you for figuring out what worked better for you and for baby. Sometimes feeding issues teach us the first of many hard parenting lessons - we are not always in control. I want to share some of my personal thoughts and recommendations about breastfeeding, as my experience - like every mom's - is a bit unique. I hope that in reading this you learn something new, can relate to something you've experienced, or find healing in your own story. Of course, this post could be much, much longer than it is. I am not an IBCLC and I know many of these topics could be greatly expanded upon, so I hope you find the help and support you need if you're struggling.  Get educated. Breastfeeding seems easy - what do you need besides boobs and a baby, right? Most of us haven't grown up surrounded by breastfeeding. Many of us were not breastfed ourselves, so we don't have a tribe of women ready and able to teach us what to do. Both my mom and my mother-in-law breastfed, but this isn't always the case. Some aspects of breastfeeding aren't logical, either. I've had clients who think that feeding a baby less often - when their breasts seem fuller - is the best way to get baby more milk, As you may know, feeding infrequently can hinder your milk supply because baby is removing less milk overall and not telling your body to produce even more. Those first few days after birth are critical in establishing your milk supply and learning what breastfeeding is all about. Read about it before having baby, or better yet - take a class. Many hospitals, birthing centers, and breastfeeding support groups have breastfeeding education classes. If you're local to Phoenix, check out Modern Milk or Babymoon Inn to learn all about breastfeeding before baby arrives. Keep your eyes on the prize. Feeding your baby in the early weeks and months is very overwhelming because it's 'round the clock. I felt like I went from an independent woman to a mom tethered to a baby, literally overnight. My babies never liked bottles, so it was even more overwhelming to be their only food source. Take it one day at a time, mama. Make a goal of 1 week, then 2, then 1 month. If you can get to 6 weeks you've likely gotten over many breastfeeding humps. Believe it or not, once you figure out breastfeeding, it can be much, much easier than pumping or bottle feeding. In fact, one reason why I continued to breastfeed into toddlerhood is because it was easier than weaning (true story). You don't need special equipment or gear when baby is with you. No washing or heating bottles, no cleaning, no worrying about sanitizing equipment. Remember that this is a temporary time in your life. It will be all done before you know it (insert sobbing here). Find an IBCLC, especially one trained in understanding tongue and lip ties. If you have issues breastfeeding, a consult with an IBCLC is the best money you can spend. Seriously. International Board Certified Lactation Consultants are God's gift to new moms, and many are even covered by insurance. WIC employs IBCLCs as well. If something seems wrong, trust your mama gut and get help. I promise you won't regret talking to a pro. I could not have breastfed without the help from Amey Clark, and there are so many wonderful IBCLCs (including Stephanie Nguyen and Lori Isenstadt) who are willing and able to help you navigate this new world of feeding your baby. Both of my babies were severely tongue and lip tied, and it takes a trained practitioner to identify and revise these ties. Make sure your providers know how to revise - or who to refer to for revision. If your provider doesn't "believe" in tongue ties and breastfeeding isn't going well, I strongly consider that you shop around for a second opinion. Above all else, keep seeking help if you're not getting the support you need. There's someone out there who can help you make breastfeeding successful (or at least understand when it's time to switch to another feeding modality). If you use a breastfeeding pillow, bring it on trips. It's so much easier to nurse a young baby with a pillow if that's what you're used to. I brought my Boppy everywhere when we traveled. It's helpful on the plane and is critical at your final destination. Plus, you can wash it when you get home! If you don't respond to a traditional electric pump, try a manual pump or hand expressing. I was a breastfeeding unicorn in that I could never pump much milk but could hand express 5-8 ounces of milk at a time. (I had massive over-supply. Normal pump output when breastfeeding full-time is 0.5-2 oz between both breasts.) It was a little freakish. For some reason, I never did well with an electric pump. I have friends who did much better with manual pumps instead of an electric pump too. Don't get discouraged if pumping isn't working - try other options! Your IBCLC can help you with this. Don't cover - or do. Basically, do what makes you feel comfortable. I always applauded moms who nursed without covers, but I personally didn't feel comfortable doing it with my uber-distracted babies (who whipped their heads around at any slight noise as they nursed). The cover actually kept them focused as they nursed. I did master breastfeeding in the Ergo uncovered, and that was a great option while grocery shopping or traveling. I think the baby's height, mom's torso length, and mom's breast size all influence how well upright nursing in an Ergo or other carrier works, but it's worth a shot. (I even nursed in a carrier while teaching classes at Babymoon and Modern Milk - talk about redefining working mom, right!?)  Don't feel pressured to stop breastfeeding at age 1. (Above is my first baby nursing sometime in her second year of life. Gymnurstics.) Breast milk has an important role for toddlers too - it helps fill their nutritional gaps and can provide extra immune protection as they become more mobile (and more adventurous with what they touch). The World Health Organization actually recommends breastfeeding until at least age 2 - it's not uncommon for women across the world to breastfeed until 3 to 5 years of age. Do what works best for you. My goal with both girls was 2, and with my first I was sad to stop at 28 months - I was 5 months pregnant and didn't want to tandem nurse! My second is only breastfeeding once a day but is pulling back hard as she nurses, which really hurts. That's one reason why she will be done about 2 weeks after her 2nd birthday. Take pictures and videos of your baby breastfeeding. I know this seems silly, and you don't ever need to show these to anyone (although I think they're absolutely beautiful, so show me!), but I think breastfeeding photos are some of my most cherished keepsakes. I treasure the professional ones from Jenn Hydeman, and I also love the ones I took myself in those sweet, quiet moments. Cherish your time with baby. Breastfeeding forced me to sit down, slow down, and focus on my sweet little infant (or toddler). Both girls have had fun routines and quirks around breastfeeding that I will never forget. My eldest loved saying, "Switch sides!" and I adored that my youngest would demand, "Light OFF!" and smile as she got ready for her naptime routine. I loved how breastfeeding seemed to solve all infant problems. I loved hearing my girls exhale a quivering sigh as they settled into their feeding rhythm, or make small coo's as they relaxed and started to fall asleep. I loved the lip shake they made as they stayed latched for comfort, or the sweet gummy smiles they gave me as milk poured out of their toothless mouths. The sound of a breastfeeding baby is magical. It literally makes my uterus hurt. I don't know if I will miss breastfeeding as much as I will miss what it meant - peaceful time with my babies, where there was nothing more important in the world than being with them. I will always be grateful that my breastfeeding experience was a wonderful one (despite tongue/lip ties, clogged ducts, mastitis and thrush). I don't remember the hard parts - I remember the pure magic. Remember that breastfeeding is successful only when it works for both mom and baby. There is much more to feeding and being a good mom than the type of milk baby gets. Give yourself grace to do what works for you and your baby, whatever that may be. I wish you joy and peace on your feeding journey. Never forget that you are an amazing mother, and your baby was perfectly designed to be yours!  * Gagging is good as long as it improves with time!  Your baby should - and needs to - gag in order to learn how to eat safely.Let's talk about the biggest source of stress for parents when they start Baby-led Weaning (BLW): the gag reflex. Babies who self feed starting at 6 months have to have larger pieces of food (around the size of an adult finger) that they have the ability to pick up, which inherently leads to a fear that baby will choke. Major governing bodies and health associations have always recommended offering finger foods around 6-7 months of age, and a recent study suggested that BLW does not increase risk of choking over spoon feeding as long as choking hazard foods like whole grapes and whole nuts aren't offered. However, it doesn't stop parents from being concerned about safety, since most of us are not comfortable with watching a baby gag. Gagging is not the same as choking. In fact, gagging is good because it means that your baby's body is automatically protecting her airway. You will know baby is gagging and not choking if you can hear sound and if baby is working the food out quickly. Choking does not involve sound (no air = no sound). Most babies gag frequently for 1-2 weeks when starting BLW. Fortunately, as they get more proficient at lateralizing the food to the side of their mouths to chew it before swallowing, gagging greatly reduces. Essentially, as your baby practices and learns that she can not just swallow whole food, she will gag less as and lateralize/chew more. The more gagging and practicing she does, the less she will gag in the long run. Instead of fearing the gag reflex, we want to teach you more about what it is, how it protects your child, and how to help your baby learn to chew safely. Our online course Infant Feeding: the Baby-led Way goes into even more detail about gagging and shows you multiple videos of what it looks like! Coughing and gagging are similar.Did you know that gagging is considered one of two oral protective mechanisms? The other such mechanism is coughing. So, your baby protects her airway by coughing or by gagging. Your baby will cough reflexively after the following things occur:
Gagging is a good thing.We are very comfortable seeing our baby cough, since most of us cough at some point during the day. Gagging, on the other hand, seems much scarier because we assume that it means the baby is choking on food. Remember, gagging is not the same as choking. Furthermore, gagging is simply a protective oral reflex, just like a cough! The purpose of the gag reflex is to protect the baby from ingesting items too large to be handled by the esophagus. Think of it like a gate keeper - NONE SHALL PASS! The gag reflex works by touch-pressure receptors located on the tongue or on the pharyngeal wall. These receptors perceive food that is too large to pass to the esophagus and cause a reverse peristaltic movement in the pharynx. This can also cause a cough. Remember, since it's a reflex, it does it automatically without your baby doing it on purpose. The site for the elicitation of the gag reflex changes with increasing age, but our gag reflex never goes away - it is there to protect you. You may have gagged as an adult when your throat was swabbed for a strep culture or if you took too big a bite of food. In a newborn, the gag reflex at the mid-tongue area. As the baby matures, the site gradually moves back to the pharyngeal wall or the posterior portion of the tongue. As a feeding therapist, if I see a gag reflex that is too easily stimulated, it indicates a hyper-responsive reflex that may interfere with feeding. Conversely, if a gag reflex is not present, the baby may be neurologically depressed and feeding may not be indicated for safety reasons. These children may need to receive nutrition through a feeding tube. That is why encouraging a child to play in their mouth with toys such as a Fluxy is so important - it familiarizes baby with her gag reflex. We want to encourage babies to put their hands in their own mouth. (Yes, it seems gross, but it's actually an important developmental step!) Biting down hard on a toy like the Fluxy or another long, safe teether on the area where the molars will eventually arrive is essential. This allows for great oral awareness, developing jaw grading and strength, and desensitization of the gag reflex in a way that most babies allow (because many don't want us in their mouths)! So, gagging is good, and the more your allow your baby to gag on long teething toys before feeding begins and in the early stages of introducing food, the faster she will understand where her gag reflex is and will learn that food needs to be routed to the back of her gums, not straight down her throat. What's most important is that gagging improves with more exposure to real food. Furthermore, the more you see gagging, the easier it will be on you. Most parents get really nervous by it when they see it at first, but by a few days in it's much more commonplace...and then baby does it less as she gets more skilled. How can you help your baby right now?Let your baby explore her gag reflex as much as possible, and don't be afraid to gently go in baby's mouth (with clean hands, of course!) and feel along the back gum line (where the molars will eventually be). Here's what you can do right now to help your baby with safe eating:
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AuthorsMegan and Judy, co-owners of Feeding Littles, bring you helpful info on food, nutrition, picky eating, and feeding young children. Megan McNamee MPH, RDN is a Registered Dietitian Nutritionist based in Scottsdale, Arizona. Judy Delaware, OTR/L is an Occupational Therapist specializing in feeding therapy with children 3 and under in Boulder, Colorado. Megan and Judy are both moms of two and love helping families develop a healthy appetite for all foods!
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