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Dec 10

I think my baby is suffering from nipple confusion. Can you help?

This is what was suggested in “The Nursing Mother’s Companion”:

“If you have waited longer than a month (to give a bottle) and the baby refuses to take a bottle, be sure to have someone else try. Frequently a baby is more confused and upset by the bottle when her mother tries to persuade her. Trying to force the baby is upsetting for everyone, and rarely successful. Some parents have succeeded by offering the bottle while walking with the baby. Hold the baby facing away from you and bounce her gently as you walk. Some babies dislike the taste of formula; try breastmilk instead. Tasteless silicone nipples may be more readily accepted than rubber types. Recently I’ve been successful in getting babies to take a bottle fitted with the Avent Fast-Flow nipple or the Evenflo HealthFlow nipple. Another technique that has been sucessful for some mothers is to nurse the baby for just a few minutes, then unlatch the baby and slip the bottle into her mouth. If she objects, you can try again after a few minutes more.

The baby who refuses a bottle may do surprisingly well with an ordinary cup, particularly if she is about six months or older.”

Here is my personal experience: ( Min)

Laura (aged 3 1/2 and breastfed for 28 months) was given a bottle too early, so refused the breasts for the first few weeks until she was re-trained to nurse directly from about 5 weeks. In the first few weeks, she was fed bottle fed EBM. My mom was ill at that time, so I spent a lot of time in the hospital with my mom which took me away from her. I nursed her whenever I could and only give her a bottle if I can’t make it back in time for her feed. I was afraid she would regress and not take to the breasts again but she didn’t, so everything was fine until she was about 3 months old. My mom had to be admitted into hospital again and the admission took a long time. I was away from Laura for more than 6 hours. She refused to drink from a bottle and chose to sleep instead after crying her lungs out. Since I was and still am a SAHM, I didn’t pursue trying to get her to use the baby bottle again and just worked around her feeding time and brought her with me whenever I could.

Adam (aged 9 1/2 months and still breastfed) was born with a tongue-tie, so couldn’t nurse directly in the first month. He was cup fed EBM for 4 weeks until he could nurse directly with the help of nipple shields. He drinks a lot and I work part-time, so he has to be fed EBM by my maid while I am away. At about 2 1/2 months, he refused the bottle too and would cry before taking to the bottle again. Initially, he was fed with a fast flowing nipple and he drank a lot because he still wanted to suck after the milk had finished. I was reluctant to give him pacifier but decided to try. He refused the pacifier! With some struggle at each bottle feeding time, he eventually accepted the bottle and now knows that when he wants milk and I am around he will nurse directly. When mama is no where in sight, he accepts the bottle from Dita. He still uses a slow flow nipple which seems to fulfill his sucking needs while giving him nourishment.

Julia, perhaps you can try cup feeding your baby while trying to get her to accept the bottle again. You can either get a feeding cup (especially made for cup feeding infants) from Medela or just use an ordinary cup. Pour small amount into the cup so your caregiver won’t risk spilling your precious EBM.

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Nov 24

Can I breastfeed if my nipple is short or inverted?

There is this invention called “Evert-It” which deals with this problem. I bought it from the Internet due to recommendations in a breastfeeding book that I read. The verdict – yes, it helped in the beginning, but once your baby learns the correct latch-on, you won’t need it anymore. I also found that if you use a breast pump, you can achieve the same result. I use Avent Isis. – Nor Azleena

Manual manipulation
By and large this is not a problem that can’t be overcome. Once the baby is latched on, the nipple is elongated, which is noticeable when the baby comes off the breast after nursing. Pregnancy itself (especially the later stage) can alter the nipple.

However, inverted, flat or short nipples can make good latching on a challenge especially around the 3-4 days post natal when the breast is hard due to the increased blood supply (as the breast changes to making milk rather than colostrums).

Gently pulling the nipple and rolling it between the thumb and fingers during pregnancy has shown to be ineffective but doesn’t do any harm. – Eirian

A few years ago Avent manufactured something called an “ipplette” (about 6 years ago I bought a few in the UK and brought them back here). It worked like a small bicycle pump to pull the nipple out. Consisted of a nipple shield connected to a thin tube connected to a syringe. The research (done by the manufacturer) showed that when used sufficiently (I think a few minutes every day), the muscles lengthwise around the nipple became slightly longer. Don’t know if they still make them.

This little contraption can be made by taking a plastic syringe (probably a 10ml one), cutting off the end where you would put the needle, pulling out the plunger and putting it in the ex needle end and then using the flange end over the nipple and using a gentle pull to elongate the nipple. Don’t know if anyone who has tried this though. Whatever used should be comfortable and not cause any trauma. – Eirian

Ice cube
A wrapped ice cube to make the nipple stand out can always be used just before you try and get the baby latched on if you expect difficulty. – Eirian

This is usually a problem in the early days, once the baby (and mum) has learnt the art of nursing nipple shape and size is not an issue. – Eirian

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Nov 21

I am unsure of the nutrition value in the breast milk after a year. Do I have to supplement with formula milk?

My paediatrician, Dr Cheang, said that after 6 months of age, a baby should be weaned off to solid food and by then, the baby will slowly depend on the solid foods for the nutrients he requires, especially carbohydrates to put on weight and grow.. Mothers should not have any worries about the nutritional value of their breast milk because we have been engineered by nature to produce what our young ones need.

But, if you are worried if your child is not getting enough calcium, iron and Vitamin D (these are the few things lacking in human milk), then see that your child is taking a balanced meal. You can provide yoghurt, milk pudding, cheese and other dairy food. The important thing is, never stop breastfeeding because you thought your milk is not good enough. – Lilian

I’m breastfeeding my child, and now I’m pregnant. Do I stop breastfeeding?

Dr Koe told one of our moms through an email that during pregnancy, the milk is still catered for the older child until a few weeks before delivery of the new baby and your superiorly engineered body will change the milk into colostrum for the baby. As long as you have milk, as long as you want and can nurse and as long as your baby wants milk, your breast milk is still the best of the best! – Lilian

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