In-Home Infant Feeding & Lactation Support
in Rhode Island

I know what it's like to constantly wonder if you're producing enough milk or if your infant is able to get enough milk at the breast. Clinical indicators of milk transfer rely on objective output metrics. By day 6 of life, the American Academy of Pediatrics expects 6+ wet diapers and 3-4 dirty diapers per 24 hours. The baby should transition from sleepy to relaxed and content post-feed. If you want to know exactly how much your infant is transferring at the breast, we can perform a weighted feed using a professional pediatric scale.

Back-arching, body stiffening, and crying mid-feed can be indicators of physical discomfort, typically tied to gastroesophageal reflux (GER) or an overwhelming flow rate of milk. When milk enters the mouth too quickly, it can overwhelm the baby's airway and they may struggle to coordinate breathing with sucking and swallowing. When stomach acid moves upward it causes a burning sensation; infants instinctively stretch their torsos to escape the pain. You can trial an elevated side-lying position, conduct paced feeding (keeping the bottle horizontal/parallel to the floor), use a slow-flow nipple, and coordinate with your pediatrician to manage underlying inflammation. If you want support implementing positioning changes, trialling different flow rates and learning how to responsively bottle feed, schedule a consult.

While there may be an initial period of desensitization, a latch that causes nipple damage, trauma or extreme pain is worth an evaluation. To get a deeper latch and reduce pain, you can try the "thumbs up technique"; in cross cradle, use your free hand and place your thumb close to your nipple, lift the breast away from the baby's mouth while they are gaping open, then you ensure their lower lip makes contact with the breast tissue under your nipple first and use your thumb to gently push the nipple in towards their palate, ensuring a deep mouthful of tissue. It is much easier to teach this deep latch technique in person, so schedule an evaluation if you still can't get the hang of it. I will also screen for underlying gross motor or structural barriers that prevent your baby from opening wide enough and lifting their tongue.

A clicking sound indicates a broken seal. To feed efficiently, an infant must maintain a continuous latch. When the tongue loses its seal on the nipple, air rushes into the mouth, creating a "click." This can lead to excess air intake, gas, and reflux symptoms and infant discomfort. I assess for improper nipple flow rate or bottle type or anatomical restrictions like a tongue or lip tie that are impacting an efficient latch.

Milk escaping the oral cavity indicates poor labial seal (lip closure) or a flow rate that exceeds the baby's structural ability to coordinate sucking, swallowing, and breathing. The baby is letting the excess milk spill out to protect their airway from being overwhelmed, or they physically can't achieve a proper lip seal on the bottle nipple. Try adjusting the bottle angle to deliver a paced bottle feed. If you're still struggling, we may need to evaluate the nipple base width to ensure the lips can flare naturally, adjust the flow rate of the nipple, or trial cheek support while feeding and infant suck training to build endurance.

At around 2 to 4 months, an infant’s primitive sucking reflex fades, and feeding becomes entirely volitional (voluntary). My advice for people who want to both breastfeed and bottle feed is to offer a bottle of expressed breast milk to their baby after milk is established (around 2 weeks postpartum) but before that 2 month mark. Start by offering 1-2 oz of expressed milk once a week to ensure familiarly and skill maintenance and prevent bottle refusal down the line. To protect the breastfeeding relationship, make sure you and all caregivers are doing paced bottle feeding with a slow flow nipple, and only offering the amount of ounces that mother pumps. My breastfed babies needed to be able to take a bottle while I was at work and I kept them on a flow 1 nipple, never "graduating" to larger nipple sizes to prevent a bottle feeding preference down the line.

First step, we need to secure medical clearance to begin milk trials orally. I am happy to

In the early days shoot for 6-8x