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  • Jul 22, 2021

Breastfeeding (or Chestfeeding) - A Shared Responsibility

In honor of Breastfeeding Awareness Month in August, Dr. Lorky Libaridian, shared this story about how to help families through the challenging first few weeks of feeding.

Two weeks ago, I took a deep breath before knocking on an exam room door. I had heard the baby as I walked down the hallway, a five-day old newborn who had been healthy at birth but was not thriving. As I entered the room, the parents were passing their shrunken and screaming baby back and forth, trying their best to console him and each other. Everyone was in tears.

As a dual board certified Internal Medicine and Pediatric physician, my training prepared me well. I can resuscitate a newborn, treat the many minor injuries and ailments of childhood, keep kids healthy and strong with vaccines, and talk frankly with growing teenagers about both the perils and joys of becoming an adult. What I was not prepared for is the heartache I see almost weekly -- new families who had no idea how hard feeding their baby would be. Thankfully pasteurized human donor milk and formula are here for us -- but the ins and outs of how to help people make milk and how to help babies get it are not included in most medical school curriculums or residencies.

Research tells us between 90-99 percent of all women are physically able to make enough milk for their babies -- yet sometimes it seems every new family I see is struggling with feeding. In fact, 90 percent of first-time mothers who report having met their own feeding goals also report that the first weeks were very difficult. With so many challenges, I'm grateful to have colleagues to whom I can refer families who struggle: Miriam Segura Harrison, MD, IBCLC at Union Square Family Health and Lauryl Ramakrishnan, APRN, IBCLC at Cambridge Pediatrics.

Still, when I'm in the room with a new family and I can see the baby is struggling, the parents are struggling, and everyone (including me!) has missed lunch, I need to know how to move beyond the immediate urge to feed everyone. Thankfully, Dr. Harrison and Lauryl Ramakrishnan shared "lactation first aid" with me, which provided me with tools to respond in the moment. Based on the work of Barbara Wilson-Clay, author of the Breastfeeding Atlas, I referred the family to one of our lactation specialists and shared the following.

Lactation First Aid For Excessive Weight Loss (>90th percentile loss)

  1. Feed the baby - always the most important rule. Talk with your provider about how much to supplement with and when.

  2. Feed the baby with parent's milk first. If it's not enough, formula can also be used to get to the volume needed.

  3. Protect the milk supply - any time a baby gets formula, and any time a baby isn't removing milk from the breast, the feeding parent's milk supply is in danger. This is especially true in the first five weeks.

    Parents should be counseled to pump for 15-20 minutes at a time any time the baby gets a bottle, cup, or syringe feed.

  4. Keep something happening at breast - the breast should be a happy place for both baby and parent. If breastfeeding isn't working or if a family prefers to use formula, continuing skin to skin contact and even bottle feeding skin to skin will support infant growth and development as well as parent milk supply.

    The hormone, Oxytocin, can decrease parent stress levels as well as the baby's. So as long as the baby is getting some volume somehow, skin to skin is the real magic solution to everyone's problems.

For weight loss percentiles, see

"Lactation first aid" helps keep babies -- and milk supplies -- safe until they can be seen by a location specialist (IBCLC). The specialist will help families find out what's happening with feeding and provide support for both babies and parents. If you're a new parent and you or your child is a CHA patient, know that you can ask for lactation help at any time. You can also call CHA Cambridge Pediatrics or CHA Union Square Family Health to make an appointment.

I’m happy to report that the little guy I saw a few weeks ago is back to his birth weight and improving everyday. Providing lactation support improves everyone’s health. It's all a part of bringing Care to the People (including the tiny people)!

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