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New Breast Pump Cleaning Guidelines From CDC

Every tool can carry risk when not used properly. The story about breast pumps and infection risk in the media recently is no exception. Attention all breast feeding & pumping mamas out there (and all the lovely people who support moms who pump milk): The Centers For Disease Control (CDC) has issued new guidelines for properly cleaning your breast pump & parts. The new recommendations come in the wake of a devastating story of a premature baby girl who showed signs of sepsis (bloodstream infection) at age 21 days due to an unusual bacterial infection. She developed spastic cerebral palsy, developmental delays and later passed away. This case is an outlier, for sure, but did prompt learning that the CDC felt the public should know.

After a full investigation, the CDC traced the infection source back to the breast pump and parts. The way the breast pump equipment was cared for may have allowed bacteria to grow. The CDC reported that the girl’s mother typically soaked the collection kit from her personal breast pump in soapy water in a wash basin for ≤5 hours without scrubbing or sanitizing. She then rinsed, air-dried, and stored the kit in a plastic zip-top bag until the next use. It’s possible how she cared for the pump allowed for bacteria to grow and be transferred to the baby. Because the baby was young and born prematurely, the baby was at greater risk for infection that most full-term older infants.

In response to the investigation, we reviewed existing resources for women about how to pump breast milk safely, but found little guidance that was detailed and based on the best available science,” Dr. Anna Bowen, a CDC medical officer, told Parents. “As a result, CDC developed its own guidance.”

New CDC Breast Pump Cleaning Guidelines:

  • Clean your pump parts after every use. Don’t skip a single feeding. I know it’s yet another step in the long process of breastfeeding and pumping, but it’s crucial. Annoying add but the recommendations are based in experts evaluating risks.
  • Wash your hands before touching your pump parts or pumped milk.
  • Key: keep a separate wash basin for the parts, the CDC doesn’t recommend you use the kitchen sink to clean pump supplies as the sink may house germs and bacteria from other food prep.
  • Have a dedicated cleaning brush for your pump and parts. Clean that brush every few days. Don’t re-use the sponge you use to scrub food off your plates and dishes.
  • Use running water and soap to clean breast pump parts that come in contact with breast milk.
  • Then let each piece and part air dry.
  • For extra cleanliness you can boil or steam the parts to sanitize in either a microwavable steamer or use the sanitize cycle in the dishwasher (HOT water). You can use the sanitizing bags that you use in the microwave or you can bring a pot of water to a boil and boil parts in the bubbling water for 5 minutes.

Bottom Line: this news isn’t meant to scare or drive moms away from breastfeeding and pumping. We know the many benefits of breastfeeding for both mom and baby (see below). This is just a reminder to be diligent when cleaning and sanitizing your breast pump. Read more »

Tongue-Tie And Breastfeeding: What To Do For Babies With Tongue-Tie

Image c/o Mayo Clinic

Tongue-tie is a condition in which an unusually short, thick or tight band of tissue (frenulum) tethers the bottom of the tongue’s tip to the floor of the mouth. Often it goes unnoticed and causes no problems in life but rarely it can affect how a child eats and how they sound when they speak, and can sometimes interfere with breastfeeding because baby’s tongue may not have enough range of motion to attach to the breast, suck and swallow effectively. Sometimes tongue-tied babies can’t maintain a latch for long enough to take in a full feeding, and others remain attached to the breast for long periods of time without taking in enough milk. Sometimes babies with tight frenulums make it miserable for mom to feed because of the way they attach and latch. When a newborn has a tight frenulum breastfeeding moms may have nipple pain, mom may hear clicking sound while the baby feeds, or mom may feel it’s inefficient. Sometimes a parent will notice a heart shape to the tip of the tongue as the band of tissue pulls on the tongue where it’s attached.

What to do about tongue-tie can be controversial. Not all pediatricians, Ear, Nose and Throat surgeons, lactation consultants and occupational therapists always agree. However, every baby deserves the chance to be evaluated by both a physician and a board certified lactation consultant if there is concern! Awareness about a newborn’s challenges with breastfeeding increases diagnosis in the newborn period but decisions to clip a tongue-tie come about from a variety of factors. The American Academy of Pediatrics states: “surgery, called frenotomy, should be considered if the tongue-tie appears to restrict tongue movement, such as inability to latch on with breastfeeding. It is a simple, safe, and effective procedure—general anesthesia is not required.” It takes only a few seconds and many pediatricians can perform the clip in their office.

Read more »

Moms, Benefit of Part-time Work, And Breastfeeding

pumpingA new study out confirms something that almost every working mom and dad already suspected — it can be a challenge to maintain breastfeeding goals when you return to work after only a few months with your newborn, especially when asked to return to working full time. The study out this week found that moms who worked about 1/2 time (19 hours or less) were able to continue breastfeeding similarly to those women who didn’t work.

Logical: the more hours a new mom works, the tougher it is for her to continue breast feeding. The amount of time we work may be more influential than the timing of our return to work. In this study, conducted in Australia, women who worked 19 or less hours in a week were much more likely to maintain breast feeding until their baby turned 6 months old, compared to moms who had returned to full-time employment. Additionally, women who work 19 hours or less only faced a 10% chance that they quit breast feeding altogether by the time their baby turned 6 months old. Your level of work place seniority will also affect your ability to continue breast feeding at 6 months, meaning those in managerial-type roles will have more success. Other factors that made it easier? Unsurprising it’s being older, higher education, better physical and mental health and being self-employed.

If we want moms to be successful with the recommended breastfeeding guidelines through infancy we should think on how we prime them for success. And how we support them.

It’s inconvenient but potentially important to acknowledge that it’s simply harder for moms to go back to the workforce, especially those who breastfeed, than it is for dads to newborns. In the first few months of life, the time it takes to nurse a baby is equivalent to a 8-9 hour work day for most women. Most babies will drain a breast in about 12-15 minutes if they are eager and actively feeding but babies often stay on the breast for up to 20 minutes or even 30 minutes at a time. Therefore, if you sit down, feed your baby on the right, feed you baby on the left, burp the baby and then change the inevitable diaper:  poof, one hour.  And, most newborns feed up to 8-10 times daily. 1+1+1+1+1+1+1+1+1. Math is easy when you do it this way.  Breastfeeding alone is a full time job for the first few months. The time spent with a baby nursing diminishes as the months unfold but it can still be a significant number of hours spent every day.

The take home for me here is that we may be more successful, culturally, supporting moms to return to work during the 1st 6 months after a baby is born if we give them options for part-time work. Especially if breastfeeding past 6 months is a goal. Read more »

Buying Breast Milk Online

New research out today confirms that buying breast milk on the Internet via milk-sharing sites may not be safe. Although breast milk purchased from online sites may be free or as cheap as $1-$2 an ounce, it may carry significant risk for babies. Clearly the benefits of breast milk are vast; pediatricians and health experts recommend exclusive breast feeding until 6 months of age. However, simply put, breast milk obtained from unknown (or known) individuals online may carry contamination from medications/drugs excreted in the breast milk,  bacterial, or viral contamination. If a mother isn’t able to provide enough breast milk for her newborn or infant, parents must know that milk from online sellers can be contaminated at the time of collection and/or during transport, dangerous especially for babies born prematurely. If buying human breast milk parents should look for a certified milk bank.

Back in 2010 the FDA spoke out against the practice of buying breast milk online, warning parents of potential risks due to bacteria or viral contamination, exposure to chemicals, medications, and drugs. The research out today confirmed these hesitations: nearly 3/4 of the breast milk obtained by researchers online had bacterial contamination and 20% of the samples tested positive for a virus called CMV.

It should be noted that breast milk bacteria (or virus) counts aren’t deterministic for infection, meaning that just having bacteria in a breast milk sample doesn’t mean a baby will get sick from it. How old a baby is, the amount of bacteria in the sample, and the immune status of an infant all also play a part. However, there are reports of premature babies and babies with immune dysfunction becoming seriously ill from donated unpasteurized breast milk so caution is necessary.

To be very clear the breast milk obtained and studied in the new research was NOT from a milk bank. Human Milk Banking of North America (HMBANA)  breast milk banks screen donors for infections (like HIV) and pasteurize the breast milk to ensure improved safety protection. The trouble for many families unable to make enough breast milk with using these banks can be very costly secondary to the handling, screening, and pasteurization. Milk can be several dollars an ounce! Read more »

Ways To Decrease Risk Of Breast Cancer

When we have children, many of us slip in the self-care department. We may not eat as well, not exercise like we did “pre-baby,” and don’t have time to go and see our own doctors. Simply put, our own care doesn’t come first. Parenthood immediately demotes our status…

All fine in some ways. It’s astonishingly wonderful to care so deeply about our children. That devotion still catches me off guard.

But we have to keep on top of our preventative screening. No reason not to when it may allow us a longer time to parent our children! So that’s where I come to breast cancer screening. As women, breast cancer will affect about 1 in 8 of us during our lifetime, the most common cancer in women after non-melanoma skin cancer. It can be highly curable if detected and treated early. Most women diagnosed with breast cancer are over age 50, but many are younger and some are new moms. There are some risks we need to know and scientific evidence that can help us do a better job caring for ourselves.

Share this widely, please.

Yesterday I teamed up with Dr Julie Gralow, the head of breast cancer oncology at the Seattle Cancer Care Alliance (SCCA) and the UW on Twitter for a 1 hour conversation about moms and breast cancer— lifestyle choices, genetic risks, screening, & coping with breast cancer. I learned a ton preparing for the chat and have already tried to think about changes I’ll make in my own life. When I finished the fast-paced hour conversation I sent a note to a friend on Twitter  that I now had to head out for a run, pour out the wine in the house, call my friends to schedule mammography, and ask about a breast MRI. You’ll see why:

Lifestyle Choices May Decrease Breast Cancer Risk

Girls In The News: Beyonce, Bikinis, And Breast Milk Baby

Girls in the news…It just has to get better than this. I’m a bit deflated with the amount of time and energy going into three stories this past week or so.

Last week it was the push-up-padded-bra bikini marketed to young girls (age 8 years) from a big retailer in the US. The company has a bad track record and nonetheless, outrage ensued about early sexual images, contorting body image, and simply pushing girls to “grow up too fast.” This month, I started to hear murmurs about a group of  8 year-old girls in a national dance competition, dressed in bikinis dancing to a Beyonce song with controversial choreography. The dance hit sparked thousands of comments on media Facebook pages and the blogosphere lit up like a sunbeam. And then this week it’s about a breast-feeding baby doll that mechanically sucks on nipples (via a bib worn by the doll’s owner). Concern about young girls being asked to act like grown women, perversion by the doll’s manufacturers, and a too-soon anatomic education about physiologic breast function before kindergarten…

But wait a second. What is this really about? We get so lost when this chatter fills our water-cooler moments we remember all the wrong things: Read more »

Formula, Breast feeding, And Solids

Here’s a response to some of the comments about the post I wrote earlier this week. As I’ve said before, I support parents feeding with breast milk and with formula. Studies like this aren’t designed to alienate parents who feed with formula. Take a listen. Here’s a post I wrote about the juggle/struggle to breastfeed while working. Ultimately, the goal of the Pediatrics study on timing of solids was to illuminate ways to improve obesity prevention. Not divide us or cause us to doubt ourselves.

Breast Feeding vs Formula: Mommy Sleep

Loved a study published today in Pediatrics. Researchers sought to determine if mothers who breastfed slept less than those who formula fed their babies. I hear lots of talk (at birthday parties to office visits) about how formula or rice cereal creates better infant sleepers. So far, science doesn’t back up these claims. But as every new mom (and dad) knows, sleep is the major commodity during your infant’s first 6-12 months. We really want our babies to sleep through the night. Desperately. Six weeks in, crying is at a peak for infants and mothers are utterly exhausted after a pregnancy, a labor/delivery, and a month or so of very fragmented and dwindling sleep. Not only are we at peace when our babies sleep, we often rest, too. Maternal rest is essential for familial functioning, enjoyment of a baby’s infancy, and simple recovery. Sleep is not just about feeling rested or perceiving that you get more (or less) sleep than the other baby’s mothers on the block. It is about wellness, too. The study asserts that, “a growing body of evidence shows that mothers may not, in fact, do fine with less sleep.” Maternal sleep may affect rates of postpartum depression and an infant’s emotional and cognitive outcome. Getting rest is something we actually CRAVE in the first few months of our baby’s lives. Sleep, at some point, has to be a priority.

Researchers in West Virginia wanted to figure out if mothers of formula fed babies got a better night of sleep compared to those who breast fed or partially breast fed. The motivation behind the study was to dispel any perceived disadvantage of breastfeeding. Before you get up in arms about how bad your night sleep was while breast feeding compared to baby Jane next door who was chugging formula, look at what they did. Sometimes understanding how a study was performed helps you interpret how much weight you put into the results. Read more »

The Juggle: Working And Breastfeeding

ShadowA study in Pediatrics highlighting the importance of breastfeeding and the challenges for working moms was published earlier in 2009. Today, it circulated through a business journal and got some more attention.

I read the study today for the first time. Then I re-read it a number of times. I talk about breastfeeding with moms and parents in clinic on a daily basis. I certainly know the challenges of trying to breastfeed through a transition back to work. I also know how hard it is not to be able to do what you set out to do.

I had my go. With my first son, I saw about 9 lactation consultants in the first week. I am not exaggerating. Me with those women hovering over me trying to help while my little man screamed his head off. The beginnings of motherhood. I breast fed, finger fed, pumped breast milk, finger fed, breast fed, then pumped my way into a sleepless oblivion. Read more »

How To Help Your Gassy Baby

Things to give to new parents: smart books. Awesome things to give to new parents: books about how babies eat and poop. What and how babies eat and how they fart and poop (and sleep) are basically all new parents think about. I’m not exaggerating — of course the most emotional part of new parenthood is the love and overwhelm that takes us over. But second to it is what the baby eats and how they poop. Period.

I’m standing on my chair clapping as I tell you that Dr. Bryan Vartabedian recently published a new book: Looking Out for Number Two. A candidly written, humorous, scientifically-backed poo bible. It’s an illuminating look into every parent’s secret obsession – their baby’s poop. I am thankful, both as a mom and pediatrician for his sound advice and expertise. Poop is a big topic in almost every well baby exam and I’ve written about it several times (see below). But I haven’t dedicated a post to something so many parents worry about and search for remedies: gas.

Most babies are naturally gassy, but it can be quite painful (obviously) and lead to lots of screaming and thrashing about. Signs that your baby has gas are: crying, pulling their legs into their bellies, wiggling & hard belly.

Where Does Gas Come From:

There are only 2 sources of gas for your baby: swallowed air and gas made by bacteria in their intestines. You can strategically think of working on both sources when supporting your super farty baby. You will never make all the farts go away (my 9 year-old told me recently that the average person farts upwards of 30 times a day — unsure his source!!) but you may be able to improve the amount your baby makes with a few tweaks.

  • Swallowed air can sometimes come from:
    • A bad breastfeeding latch (for all sorts of reasons — if your baby is a really loud eater or sloppy eater, perhaps check in with your pediatrician or a lactation specialist)
    • Incorrect nipple flow (either too fast or too slow)
    • Bad positioning during feeding (work on switching up how you hold your baby and see if it makes a difference)
    • Shaken/frothy formula (don’t shake the formula in the bottle too much after mixing)
    • Screaming/crying (swallowing air when gasping between freaking out)
    • Lack of burping when a baby love to let that gas go from the top!

Lots os parents reach for OTC meds for their babies gas. Most of time the meds and waters and supplements do NOTHING.  I love what Dr. V says in the book,

The old standby in the battle against gas is simethicone. Simethicone is a compound that’s supposed to work by taking small bubbles and making them into big bubbles that are theoretically easier to pass. As the logic goes, it’s easier to move a consolidated, well-formed fart than a stream of ill-defined foam. However, studies show that it effectively does ZILCH. ~Dr. Vartabedian

Ways To Help Reduce Gas:

Likely nothing new here but just in case…

    • Bicycle kicks: lay baby on their back and move the legs in an up-and-down pedaling motion.
    • Warm bath. Relaxing for your baby and maybe their discomfort.
    • Burp them often during feedings and after feedings and in different positions.
    • If bottle feeding, try adjusting the flow of the nipple you are offering. Too slow and baby might be working too hard to suck and gulp air, too fast and she might be gasping/choking.
    • If breast feeding, check to see if your milk is letting down too quickly, making it hard for baby to keep up with the supply.
    • If baby is drinking formula, try to let the bubbles in the formula settle before you offer it in the bottle. Try swirling the formula and water together with a spoon instead of shaking rapidly.
    • Gentle tummy massage. Yum.
    • Hold your baby on their tummy to apply a little pressure.
    • Consider using a probiotic. “Probiotics are bugs with benefits. Here are four probiotic power strains with a long track record of safety and success: Bifodobacteria, Lactobacillus Reuteri, Lactobacillus GG, Saccharomyces Boulardii.” ~Dr. Vartebedian

With gas, also comes poop questions…so here’s a little bit on that…

Poop 101:

    • Poop can look different each day depending on what your child intakes. Only colors it can’t be? White, red, or black. All those smatterings of brown and green and yellow and orange are good.
    • Baby and toddler poop can be as thick as peanut butter or mushier, like cottage cheese or yogurt. Food comparisons are gross but let’s face it, they are helpful, too.
    • Breast-milk poop usually looks like fancy French mustard: yellow, seedy, or curdy. Formula poop tends to resemble beat-up flan or pudding.
    • After about 6 months of age, more than four poops a day might be “too many,” and less than one a week for a breastfed infant or less than one a day for children over age 2 might be “too few.” If you’re worried, don’t wait – ask your baby’s doctor.
    • Here’s a feature article I wrote for Parents Magazine on poop: The Scoop On Poop: What’s Normal, What’s Not
    • Getting Rid Of Constipation — a how-to help on constipation, an overview of OTC meds, and what to do about it.